These findings increase awareness regarding the vulnerability of residents internationally. Addressing the mental health of residents is a pressing issue, and training programs need to actively address the psychological well-being of residents.

The results of this study show high rates of depression, burnout, and suicidal ideation among medical students from the Middle East region. Increased rates of substance use were detected as well as a more tolerant attitude toward substance use in general, specifically cannabis. It is crucial that medical educators and policymakers keep tackling the complex multifactorial mental health issues affecting medical students and design effective solutions and support systems.

The psychiatric effects of anabolic-androgenic steroids (ie, testosterone and its derivatives) have been less well studied than their physical effects but are reported to include depression, mania, psychosis, and aggression. Dependence can also occur, with withdrawal involving psychiatric and physical symptoms. Adverse effects of steroid abuse should be managed by discontinuing the drugs-by tapering if necessary-and by treating the symptoms.

Idiopathic REM sleep behavior disorder (iRBD) is now considered a prodromal stage of an α‑synucleinopathy‐related to neurodegenerative disease such as Parkinson's diseases. Emerging evidence has shown that post‐translational modification or glycosylation are implicated in dynamic disease mechanisms and the onset of many pathological conditions. We hypothesized that the characterization of the glycosylation pattern of patients with RBD would be of great value to understand the pathophysiology and underlying mechanisms and represent potentially useful biomarkers for disease‐associated molecular changes. To test this hypothesis, we assessed the serum glycome of patients with RBD and compared to that of healthy controls. NanoRPLC–MS was used to generate quantitative N‐glycan profiles while high‐temperature PGC‐LC–MS platform was employed to generate quantitative isomeric N‐glycan profiles. By analyzing permethylated glycans derived from human blood sera on C18‐LC–MS/MS, we identified 59 N‐glycan structures in healthy (control) cohort, 56 N‐glycans in RBD cohort. Sixteen N‐glycans structures were found to be significantly altered in the RBD cohort (p < 0.05). N‐glycans with the composition of HexNAc4Hex5Fuc1, HexNAc5Hex5, and HexNAc4Hex5Fuc1NeuAc1 presented the most substantial difference between controls and RBD patients (p < 0.01). HexNAc4Hex5Fuc1NeuAc1 showed a relatively high abundance (3.1 ± 0.7% in the control cohort versus 4 ± 3% in the idiopathic RBD cohort). These N‐glycans can be potential diagnostic biomarker candidates and provide a window into underlying neurodegenerative processes in patients with idiopathic RBD. In addition, 7 N‐glycan isomers were significantly different between controls and RBD patients (p < 0.05). HexNAc4Hex5Fuc1NeuAc1 (4511‐2) and HexNAc4Hex5Fuc1 NeuAc2 (4512‐2) showed the most substantial difference between the control and idiopathic RBD cohorts (p < 0.001). Levels of both these two isomeric structures were higher in the idiopathic RBD cohort. Further larger studies are required to assess the reproducibility of these findings and to elucidate the role played by the changes in glycan structures in the pathogenetic mechanisms of RBD. This information will be instrumental in developing molecular therapeutic targets to promote neuroprotection and prevention of neurodegeneration.

ObjectiveTo perform a rigorous in-depth proteomics analysis to identify circulating biomarker signatures for idiopathic REM sleep behavior disorder (RBD), capable of providing new insights into the underlying pathogenic mechanisms and putative α-synuclein-related neurodegenerative processes.MethodsSerum samples from patients with idiopathic RBD (n = 9) and healthy controls (n = 10) were subjected to a thorough liquid chromatography–mass spectrometry (MS)/MS proteomics analysis using ultimate 3,000 nanoLC interfaced to an ESI-orbitrap velos. Data were analyzed with a systems biology approach to identify altered pathways in RBD.ResultsWe identified 259 proteins, 11 of which displayed significantly altered expression level in patients with RBD as compared to controls. Significant reduction in serum levels of dopamine β-hydroxylase (DBH) and vitamin D binding protein (GC) were consistent with alterations in the norepinephrinergic (NErgic) and dopaminergic systems, respectively. Additional altered protein profiles indicated that immunity, inflammation, complement, and coagulation also play a role in RBD pathophysiology.ConclusionsOur results shed light on the protein signature profile, molecular pathways, and mechanisms involved in the pathogenesis of RBD and its clinical manifestation. This knowledge opens a new avenue towards more accurate and timely diagnosis and characterization of RBD, which might ultimately translate into new therapeutic strategies with disease-modifying effects. Further evaluation of the identified markers is required to confirm their diagnostic value and potential to guide clinical decision-making.