Scoping review of therapeutic approaches among individuals with secondary exercise addiction

Secondary exercise addiction shows high comorbidity with eating and body image disorders. Despite its substantial impact on physical and mental health and daily functioning, evidence on effective therapeutic interventions remains limited. The aim of this scoping review was to identify and describe therapeutic interventions applied to adult individuals with secondary exercise addiction. This review followed the PRISMA Sc-R guidelines and covered the years 2002–2024. Ultimately, five studies were included (four randomized controlled trials and one quasi-experimental study). Three studies applied psychotherapeutic interventions based on cognitive-behavioral models (Cognitive Behavioral Therapy, Lifestyle, Exercise, Attitudes, and Relationships Program, Physical Exercise and Dietary Therapy), while two integrated physical or nutritional components. A secondary analysis published in 2024 based on the LEAP trial dataset was identified but not treated as an independent study to avoid duplication. EBSCOhost, Web of Science, PubMed, and Google Scholar were searched from January to May 2025 using terms related to exercise addiction, exercise abuse, psychotherapy, intervention, and treatment. English-language studies were eligible if they described an intervention with at least one treated group with pre- and post-test measures; the participants of the study were adult patients suffering from eating disorders and exercise addiction (the therapy programs involved one inpatient and four outpatient treatments) and therapeutic intervention was carried out with outcomes based on exercise addiction level data. Four out of five included studies reported improvements in variables related to compulsivity, although these did not always imply a reduction in the amount of exercise, indicating that qualitative changes may be more relevant. Longer interventions showed more consistent effects, but even brief treatments generated positive changes in non-clinical populations. The examination of the research revealed a gap in studies addressing interventions for those with secondary exercise addiction, especially highlighting the need for randomized controlled trials (RCTs) with proper randomization methods.

Real-world effectiveness of medication-assisted treatment and psychotherapy for opioid use disorder: a national multi–health care organization analysis

BackgroundHarm reduction strategies for opioid use disorder (OUD) emphasize pragmatic, evidence-based approaches that reduce overdose risk, relapse, and other adverse outcomes without requiring abstinence. Medication for opioid use disorder (MOUD) and structured psychotherapy represent core harm-reduction modalities, yet their real-world comparative effectiveness, alone and in combination, remains underexplored at scale.MethodsA retrospective cohort study was conducted using the TriNetX Research Network, comprising de-identified electronic health records from 112 U.S. health systems. 18,047 adults aged 18–45 were identified with a diagnosis of opioid dependence (ICD-10 F11.20) between 2016 and 2025. Subjects were assigned to eight mutually exclusive treatment cohorts: no treatment (Cohort 1); buprenorphine alone (Cohort 2); methadone alone (Cohort 3); psychotherapy alone (30 minutes (Cohort 4), 45 minutes (Cohort 5), or 60 minutes (Cohort 6)); buprenorphine + psychotherapy (Cohort 7); and methadone + psychotherapy (Cohort 8), with combination treatments defined within a ±30-day window. Cox proportional hazards models estimated adjusted hazard ratios (aHRs) for remission (F11.21, F11.11) within 12 months.ResultsBuprenorphine (aHR = 2.33; 95% CI: 1.85–2.94), methadone (aHR = 2.50; 95% CI: 2.05–3.04), and psychotherapy (30 min: aHR = 2.18; 45 min: aHR = 2.38) were each independently associated with significantly higher remission compared to no treatment. The combination of buprenorphine + psychotherapy yielded the strongest effect (aHR = 5.26; 95% CI: 2.68–10.32). Anxiety diagnoses and gabapentinoid prescriptions were positively associated with remission; benzodiazepine co-prescription was negatively associated.ConclusionsIn this first national-scale, multi–health-care-organization analysis, both pharmacologic and psychosocial harm-reduction interventions were independently associated with improved OUD remission, with additive benefit when integrated. These findings underscore the value of embedding comprehensive, multimodal harm-reduction services within routine care and support policies promoting equitable access to both MOUD and behavioral health supports across diverse health systems.

A prospective cohort study on the incidence and influencing factors of subsyndromal delirium in ICU patients

BackgroundThis study aims to develop and validate a machine learning-based risk prediction model for subsyndromal delirium (SSD) in ICU patients, while identifying key risk factors.MethodThis study was a prospective study, selecting patients who were hospitalized in the ICU from October 2024 to May 2025. We compared seven machine learning algorithms: Random Forest (RF), Decision Tree (DT), K-Nearest Neighbor (KNN), Logistic Regression (LR), Elastic Network (EN), Extreme Gradient Enhancement (XGB), and Support Vector Machine (SVM).ResultIn our study, the prevalence rate of SSD was 37.158%. The comparative analysis shows that XGB is the best predictive model (AUC = 0.84). Feature importance analysis identified four significant predictive factors: Use of vasoactive drugs (0.412), Monthly household income (0.306), Undergone surgery (0.191) and Number of Medications (0.036).ConclusionThe prediction model based on XGB has a good effect in identifying the risk of SSD in ICU patients. These findings enable clinicians to stratify high-risk groups and implement timely and targeted intervention measures, effectively reducing the risk of adverse consequences. Future multicenter studies should validate these results in larger cohorts.

Human Ventral Tegmental Local Field Potentials in Treatment-Resistant Depression and Obsessive-Compulsive Disorder

The ventral tegmental area (VTA) is a key node within the limbic circuitry. Through dense dopaminergic, glutamatergic, and GABAergic projections, the VTA forms reciprocal loops with prefrontal and limbic cortices that are consistently implicated in major depressive disorder (MDD) and obsessive–compulsive disorder (OCD) (1,2). Decades of animal research have established the VTA as a central hub for motivational drive and reward prediction error signaling (3,4). Despite its presumed critical role in mental disorders, direct electrophysiological recordings from the human VTA have so far remained absent.

Retron-Powered Approach Enables Genome Editing Across Diverse Bacterial Species

For decades, the ability to precisely rewrite bacterial genomes has been largely confined to a single workhorse organism: Escherichia coli. That limitation has slowed efforts to study pathogens, engineer sustainable biomanufacturing strains, and probe how microbes influence human health. While genome editing tools have transformed eukaryotic biology, most high‑efficiency bacterial editors simply haven’t worked outside E. coli.

A new study from the Gladstone Institutes aims to change that. In a large, nine‑lab collaboration, researchers have translated a retron‑based DNA editing system from E. coli into 14 additional bacterial species spanning three major phyla. The work, published in Nature Biotechnology and titled Genome editing of phylogenetically distinct bacteria using cross-species retron-mediated recombineering,” demonstrates that retrons, bacterial immune elements that continuously produce short DNA strands, can be engineered into portable genome editing modules the authors call recombitrons. “Recombitrons—a genome editing tool created by pairing modified, donor-producing bacterial retrons with single-stranded binding and annealing proteins—have increased the efficiency of recombineering to install flexible, precise edits in the prokaryotic chromosome,” the authors wrote.

Retrons normally function as part of a viral defense system, generating DNA fragments that help bacteria detect and respond to infection. Seth Shipman, PhD, a Gladstone Investigator and senior author of the study, has spent years repurposing this machinery. “We’ve been easily editing E. coli genomes using retrons for years now, which has substantially increased the pace of our fundamental biology and our molecular technology development,” he said. “But we kept hearing from the broader field, asking when there would be a version of this technology that could be put to work in other bacterial species that matter for the environment, industrial processes, or human health.”

Shipman’s lab previously showed that retrons can act as cellular DNA-making factories, generating the donor strands needed for genome editing. In bacteria, the resulting editing tool built by pairing modified retrons with single‑stranded DNA–binding and annealing proteins is known as a recombitron. Until now, however, functional recombitrons existed only in E. coli.

To test whether the architecture could travel, the team designed a panel of 10 retron-based editing systems and partnered with other labs specializing in diverse bacterial species. “We designed all the molecular parts at Gladstone, then sent them to the collaborators, where they ran the experiment in their labs,” said first author Alejandro González‑Delgado, PhD. Samples were then returned to Gladstone for centralized analysis.

The results show broad functionality. The recombitrons worked in all 15 species tested, including clinically relevant pathogens such as Klebsiella pneumoniae and Pseudomonas aeruginosa, as well as fast‑growing biotechnology strains like Vibrio natriegens and Pseudomonas putida. Editing efficiencies varied widely—from fractions of a percent to more than 90%—but the team demonstrated that modifying retron structure or other system components could boost performance in lower‑efficiency hosts.

“Each retron worked differently in different bacteria,” González‑Delgado noted. “This reinforces why it’s important to have lots of different retrons, so scientists can choose the ones best suited to their favorite bacterial species.”

The study provides a roadmap for expanding genome editing into species that have historically been difficult to engineer. Researchers studying microbial pathogenesis, gut ecology, or industrial bioproduction can now match retron systems to their organism of interest.

“My lab builds molecular technology, and we want these technologies to be used as broadly as possible to uncover new biology and intervene in disease,” Shipman said. “We hope it will continue to spread from here.”

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Prepregnancy Lifestyle Risk Factors in Women Seeking Digital Fertility Services: Cross-Sectional Descriptive Study

<strong>Background:</strong> Approximately 1 in 3 pregnancies in the United States are complicated by one or more adverse pregnancy outcomes. This high prevalence contributes to the elevated rates of maternal and infant mortality in the United States. Modifiable prepregnancy or preconception lifestyle factors have been associated with adverse pregnancy outcomes in observational studies, which underscores the importance of preconception care. <strong>Objective:</strong> This cross-sectional descriptive study aimed to (1) estimate the prevalence of preconception lifestyle risk factors among women seeking services from a digital fertility platform, (2) characterize the study population and present relevant reference data, and (3) examine the distribution of prepregnancy lifestyle scores across demographic and clinical subgroups. <strong>Methods:</strong> The digital health company, Doveras Fertility, has built a prepregnancy digital health platform for individuals and couples seeking to optimize their fertility potential. Targeting users prior to initiation of pregnancy, the platform facilitates the assessment of baseline lifestyle risk factors. This paper reports on 396 adult women who sought the platform’s services in a 1-month period between May and June 2024 by completing a digital fertility questionnaire. Self-reported data were analyzed for 6 healthy prepregnancy lifestyle factors known to be associated with maternal health outcomes in prior observational studies, and each participant was given a composite score between 0 to 6 to represent the number of these healthy behaviors reported. The 6 healthy prepregnancy lifestyle factors include a BMI of 18.5 to 24.9 kg/m<sup>2</sup>, not currently smoking, ≥150 min/week of moderate to vigorous physical activity, healthy eating, no daily alcohol intake, and use of a prenatal multivitamin. <strong>Results:</strong> The study population was racially and ethnically diverse, with a mean age of 32.9 (SD 6.3) years. Most (235/396, 59%) participants received a composite score of 3 factors or fewer, and less than 5% (19/396) scored 6 out of 6. For context, this cohort had higher proportions of participants with unhealthy BMI and dietary patterns than those in the reference data. Regarding fertility, 46% (182/396) met the clinical definition of infertility (≥1 year trying to conceive), with the prevalence of infertility ranging from 16% (3/19) among those with the highest lifestyle scores to 59% (17/29) among those with the lowest. <strong>Conclusions:</strong> Most women seeking services from this digital fertility platform exhibited multiple lifestyle factors that have been previously associated with adverse pregnancy outcomes in observational studies. These results suggest that nearly all survey participants have potential risk factors for adverse maternal outcomes and therefore the potential to adopt at least one improvement in their lifestyle behavior. A digital platform may offer an accessible mechanism for identifying and characterizing preconception risk factors; however, future longitudinal studies are needed to evaluate whether platform-based interventions can effectively support behavior change and improve maternal health outcomes.