Category: 8. Health

A new study led by Ryan Hankins, MD, urologist at MedStar Georgetown University Hospital, suggests that rectal spacers used during prostate cancer radiation therapy may help reduce the long-term prevalence of erectile dysfunction (ED). While rectal spacers are commonly used to protect the rectum from radiation exposure, this research offers the first large-scale real-world evidence that their benefits may extend to preserving sexual function in patients with prostate cancer.¹

Rectal spacers have already been shown in clinical trials to reduce rectal toxicity during prostate radiotherapy (RT), improving overall treatment tolerance. However, until now, their impact on erectile function had not been explored using national real-world data. The new study evaluates the association between rectal spacer use and ED diagnoses among prostate cancer patients receiving RT, using a robust dataset spanning thousands of US counties.

The analysis drew on Medicare 5% and 100% standard analytic files, covering adult patients treated with intensity-modulated radiation therapy, brachytherapy, stereotactic body radiation therapy, or proton therapy between 2015 and 2022. Researchers focused on the proportion of patients diagnosed with ED in the years following treatment, comparing it with the proportion of patients in each county who had received rectal spacers during RT 1 to 5 years prior.

The study included 247,250 patients with prostate cancer across 3132 US counties. On average, 1.3% of patients treated with RT were diagnosed with ED annually. Notably, rectal spacer use rose significantly during the study period, from just 2.9% in 2015 to 18.9% by 2022. Researchers used zero-inflated Poisson regression models to assess the association, controlling for various demographic and socioeconomic factors at both the patient and population levels.

After adjusting for these variables, the results showed that counties with higher rectal spacer usage saw significantly lower rates of ED diagnoses 4 to 5 years later. Specifically, a 10-percentage point increase in rectal spacer utilization was associated with a 7.7% reduction in ED diagnosis after four years (P <.001) and an 8.4% reduction after five years (P =.006), suggesting a delayed but meaningful protective effect.

“We do believe that the use of rectal spacers may actually decrease the incidence of being diagnosed with erectile dysfunction after treatment with radiation therapy,” explained Hankins in an interview with Targeted Oncology^TM.

Future research will aim to better understand the biological mechanisms behind this time lag and explore the impact of rectal spacers in long-term, patient-level clinical trials.

In the interview, Hankins further discussed these findings supporting the long-term benefit of rectal spacing in preserving sexual function in patients with prostate cancer who are undergoing prostate RT.

Targeted Oncology^TM: Can you discuss the rationale behind investigating the association between rectal spacer use during prostate radiotherapy and subsequent diagnosis of erectile dysfunction using this large dataset?

Hankins: We use rectal spacers to help prevent [adverse events] from radiation therapy for prostate cancer. The spacers [were] developed to help with rectal toxicity, primarily to prevent rectal toxicity from radiation therapy. We are seeing now that there may be other benefits

There have been some studies to show that there are benefits to bladder symptoms, but now we’re seeing that there may be benefits to erectile dysfunction diagnoses in patients treated for prostate cancer that have received rectal spacers, which is very interesting.

Your study utilized county-level data. What were the key considerations that led you to choose this approach rather than individualized patient-level analysis?
These are large datasets that are readily available. So, this is based on diagnoses that are reported—or really government-reported diagnosis codes. And so, we can dive into large datasets to see if we can find associations with improvement in these side effects. And that’s really why we used this information.

The study really was able to include 247,000 men, nearly a quarter of a million prostate cancer patients, that were treated with radiation therapy across over 3,000 US counties.

Were you surprised by the 4- to 5-year delay in ED reduction? What did you expect going into this?

We were very surprised when we saw this. With prostate cancer treatment using radiation therapy, we know that there can be a delay, sometimes, in treatment [adverse events]. But it was very surprising to see that there may be a delay in even benefit with regard to these treatment-related [adverse events].

How clinically significant is the 7% to 8% reduction in erectile dysfunction prevalence with increased spacer use?

There are various rates of erectile dysfunction after radiation therapy in the published literature, and it ranges somewhere between 20% and 37% or so. So, when you see somewhere around a 7% to 8% reduction in the incidence of the diagnosis of erectile dysfunction after the treatment of prostate cancer, I think that really is somewhat significant, or a very interesting thing that we should continue to look into.

What other findings were significant or important to note?

I think the most interesting issue is that of why there is such a delay that we see in the decreased incidence of the diagnosis of erectile dysfunction. It is important to note that using this diagnosis and county-level data, there is a possible association here. It does not necessarily mean that there’s causation or causative factors. We need to look into this a bit further. And I think personalized further research into this topic is warranted.

Which controlled factors most influenced your findings?

It is hard to know using this type of dataset what factors influenced these findings. But we know that this is a comparative study of patients that received rectal spacers in comparison to patients that don’t receive rectal spacers. We really cannot make a definitive comment on what findings led to this. However, we do believe that the use of rectal spacers may actually decrease the incidence of being diagnosed with erectile dysfunction after treatment with radiation therapy.

What is the main message for oncologists from this study?

I think we have great evidence now, and evolving evidence, that shows multiple benefits for the use of rectal spacers in patients that have prostate cancer and are planning or considering radiation therapy as a definitive treatment. I think it just adds to the body of literature that shows we do recommend patients receive a rectal spacer. It’s a minimally invasive procedure that’s done in the office under local anesthesia, and it can have significant benefits for patients.

We think that it’s an important thing patients should consider having done. I think that radiation oncologists and urologists should be versed in doing it and understanding the benefits.

And we saw that during this, just looking at this data, there was an increase in the utilization of spacers from between 3% 5 years prior, up to 20.9% by 2022. So, there’s an increase in the utilization year over year, and I think that will just continue to occur as physicians become more versed in placing rectal spacers and the benefits that it has.

What are the next steps for research?

Really looking into this, and ideally into long-term, prospective, comparative trials, that’s going to be the most important thing. This is a study looking at diagnosis codes and with available Medicare 5% and 100% standard analytic file datasets. However, more intense research and long-term studies on patients receiving treatment is really going to be warranted and needed to know and really parse out the details here.

REFERENCE:

Hankins RA, Sato R, Mehta P, Bhattacharyya S, Ezekwekwu E, Collins S. Real-world U.S. county-level analysis of erectile dysfunction diagnosis following radiation therapy for localized prostate cancer: The impact of rectal spacer utilization. J Urol. 2025;213(5S):e1327. doi:10.1097/01.JU.0001110184.48142.9e.03

A new study from the USC Caruso Department of Otolaryngology – Head and Neck Surgery, part of Keck Medicine of USC, published today in JAMA Otolaryngology – Head & Neck Surgery, is the first to link hearing aids and cochlear implants, surgically implanted devices that help those with profound hearing loss perceive sound, to improved social lives among adults with hearing loss.

“We found that adults with hearing loss who used hearing aids or cochlear implants were more socially engaged and felt less isolated compared to those who didn’t use them,” said Janet Choi, MD, MPH, an otolaryngologist with Keck Medicine and lead researcher of the study. “This suggests that hearing devices may help prevent the social disconnection and broader health consequences that can follow untreated hearing loss.”

Hearing loss affects an estimated 40 million American adults, yet many go untreated. When left unaddressed, hearing loss can make communication difficult, leading people to withdraw from conversations and social activities, according to Choi.

Previous research has shown that over time, social withdrawal can reduce mental stimulation and increase the risk of loneliness, anxiety, depression, cognitive decline and dementia. It has also linked chronic social isolation to biological and neurological changes, including increased brain inflammation and alterations in brain structure.

“Understanding the link between hearing loss, hearing device use and social isolation is crucial,” said Choi. “Until this study, it has been unclear whether hearing devices could help reverse the isolation.”

Choi and her fellow researchers conducted a comprehensive, systematic review and meta-analysis of 65 previously published studies, encompassing over five thousand participants, on how hearing aids and cochlear implants affect three key measures: social quality of life, perceived social handicap, which refers to the limitations and frustrations hearing loss can create in social situations, and loneliness.

The researchers found that adults using hearing devices feel more socially connected and less limited in social situations. They are better able to engage in group conversations and feel more at ease in noisy or challenging listening environments. Participants also reported feeling less socially handicapped by their hearing loss, with fewer barriers and frustrations during interactions and an improved ability to stay engaged without feeling excluded. This increased confidence can help users connect more easily with family, friends and colleagues, leading to stronger feelings of belonging and reduced social anxiety. The study also suggested hearing devices may reduce loneliness, although further research is needed in this area, according to Choi.

Those with cochlear implants reported the most improvement in their social quality of life. This is likely because cochlear implants offer greater hearing restoration than hearing aids, especially for individuals with more severe hearing loss. As a result, they may experience more noticeable improvements in social engagement once their hearing is restored.

While it was outside the scope of the study to measure how better social lives relate to improved cognitive outcomes, Choi believes there may be a connection, as previous research has found managing hearing loss may be key to reducing the risk of cognitive decline and dementia. “While our study didn’t directly measure cognitive outcomes, the improvements we saw in communication and social engagement suggest that by restoring clearer communication, hearing devices may help preserve cognitive health by keeping the brain more actively involved and people more connected,” Choi said.

This research follows a January 2024 study by Choi showing that adults with hearing loss who use hearing aids have an almost 25% lower risk of mortality, suggesting that treating hearing loss can improve lifespan as well as social quality of life.

“These new findings add to a growing body of research showing that hearing health is deeply connected to overall well-being,” said Choi. “We hope this encourages more people to seek treatment and helps clinicians start conversations with patients about how hearing devices can improve their quality of life.”

In an interview, Aaron T. Gerds, MD, hematologist-oncologist at Cleveland Clinic and assistant professor in the Department of Medicine, School of Medicine, at Case Western Reserve University, discusses the unmet needs in the treatment of essential thrombocythemia (ET), as well as novel methods for approaching disease treatment.

ET has very few commercially available treatments today. There is only 1 FDA-approved drug for ET: anagrelide (Agrylin). However, anagrelide is often inadequate, with some prospective trials even suggesting that hydroxyurea is superior, according to Gerds. Providers will also use interferons off-label.

This year’s European Hematology Association (EHA) conference featured a significant abstract on ropeginterferon for ET, marking a big year for ET research. ET is usually a less-studied disease because it is less common than other hematologic malignancies, and patients often have very good survival rates, sometimes approaching that of the normal population.

However, Gerds emphasizes that this doesn’t mean ET is without risk. The disease can progress to acute leukemia, also known as blast-phase myeloproliferative neoplasm (MPN), or to myelofibrosis, which involves an enlarging spleen, increased symptom burden, and cytopenias. ET itself can cause many symptoms for patients, especially those with higher platelet counts. These include constitutional symptoms like headaches, fevers, night sweats, and weight loss. Patients can also have an increased risk of bleeding events due to acquired von Willebrand syndrome. Therefore, effective therapies are lacking, and the consequences of this disease need to be addressed.

To Gerds, what providers and patients really need are therapies that routinely change the course of the disease. While the average survival for an ET patient is good, it’s not perfect, and there are high-risk patients. Developing new therapies that can truly modify the disease, either eliminating it or at least lengthening the runway for these patients, would be incredibly important.

As konwledge about MPNs grows, research is focusing less on morphologic features—like too many red cells in polycythemia vera (PV), too many platelets in ET, or scar tissue in the bone marrow in myelofibrosis. Instead, researchers are thinking more about the driver mutation. Patients with MPNs typically have 1 of 3 driver mutations: JAK2, calreticulin (CALR), or MPL. Clinically, these three entities behave differently.

CALR-mutant protein is external to the cell. When the protein mutates, it gets stuck on the thrombopoietin receptor, Gerds explains. As the receptor is built and pushed to the cell surface, the mutated protein remains, activating the pathway. Because it’s external, it’s amenable to different forms of attack, such as monoclonal antibodies, bispecific antibodies, cellular therapy, CAR T-cells, or even vaccine therapy.

This discovery has led to a clear pivot towards these types of treatments for this subset of MPN patients. A straightforward approach is to develop a monoclonal antibody that targets this external protein, similar to how there are monoclonal antibodies for almost everything else, like rituximab (Rituxan) in hematology. Monoclonal antibodies can disrupt JAK-STAT signaling, effectively starving these cells of the signal they need to divide, grow, and survive. It may also recruit immune cells, leading to some cell death via the immune system.

Simon Bowler, 50, from the U.K., was known as an active, healthy man with no underlying conditions. He often enjoyed a beer with friends without any problems. But in October 2023, a single beer left him feeling faint and unsteady, People reported.

Shortly after, a lump appeared on his neck. Doctors initially thought it was just a benign cyst. But as other alarming symptoms emerged, including blurred vision at night and abnormal hair growth on his head, Simon became worried.

Further tests, including an ultrasound and biopsy, revealed the truth: the lump was melanoma, the most dangerous type of skin cancer.

In February 2024, Simon underwent surgery to remove the tumor and began a year-long immunotherapy course to stop the cancer from returning. However, later that year, it had spread to his brain. His blurred vision and nighttime concentration problems returned, requiring radiation and more immunotherapy.

Simon is currently pausing treatment due to complications while his medical team decides the next steps, People reported.

Statistics show only half of patients with melanoma that has spread to the brain survive beyond five years.

Despite his illness, Simon is determined to make a difference. In May 2025, he launched a GoFundMe campaign, raising nearly £7,000 (US$9,545) to start a tennis accessories business. He plans to donate part of the profits to charities including Macmillan, the NHS and mental health support funds.

“I’ve been stripped of a lot of my identity, but I haven’t lost my will to keep going… I just want to get back to helping people, mentoring young players, and showing them what resilience looks like,” he said, the Daily Mail reported.

Melanoma is caused by damage from UV and UVB rays from sunlight or tanning beds. Cases are rising among younger people. Doctors warn that melanoma can appear anywhere on the body, including the scalp, under fingernails, palms, soles, even inside the mouth.

Experts recommend using high-SPF sunscreen, applying it 30 minutes before going outside, avoiding harsh midday sun and keeping children well protected.

Why Fecal Transplants Sometimes Fail: Function, Not Just Colonization, May Hold the Key

A recent Clemson University study reveals that fecal microbiota transplantation (FMT) may fail not due to poor colonization, but because transplanted microbes often don’t function properly in the recipient’s gut. Led by Anna Seekatz, PhD, and PhD candidate Sophie Millard, the research showed that even when human microbes successfully colonized mouse guts, they didn’t produce the necessary metabolites to fight C difficile infection. The study underscores that compatibility between donor microbes and the host’s gut environment—including immune responses, nutrient availability, and existing microbiota—is critical. This highlights the need for personalized, function-focused microbiome therapies rather than one-size-fits-all approaches.

Moderna’s mRNA-1010 Shows Efficacy in Phase 3 Seasonal Flu Vaccine Trial

Moderna’s mRNA-1010 seasonal flu vaccine candidate has shown promising results in a phase 3 trial, demonstrating 26.6% higher relative efficacy compared to a standard-dose flu vaccine in adults aged 50 and older. The study, which included over 40,000 participants across 11 countries, showed strong protection against multiple influenza strains, including A/H1N1, A/H3N2, and B/Victoria. Participants aged 65+ saw a 27.4% increase in efficacy. The vaccine was well tolerated, with mostly mild side effects and no major safety concerns. These findings highlight the potential of mRNA technology to improve flu vaccination, especially for older adults, and support ongoing efforts toward regulatory approval.

West Nile Virus Dominated Arboviral Cases in 2023, as CDC Reports First US Infection With Lineage 3 Strain

In 2023, West Nile virus (WNV) accounted for 95% of the 2,770 reported arboviral cases in the US, resulting in over 2,000 hospitalizations and 208 deaths, according to a CDC report. Notably, the first US human case of WNV lineage 3—a strain previously found only in European mosquitoes—was identified, raising concerns about surveillance gaps. The patient was coinfected with both lineage 1 and 3, highlighting the need for improved diagnostic tools and expanded surveillance. The CDC also reported increased cases of Powassan virus and La Crosse virus, underscoring the growing diversity of arboviral threats. Experts emphasize the importance of mosquito control, clinician awareness, donor screening, and enhanced testing to better detect and respond to emerging arboviral diseases.

New Advances in Chronic Hepatitis B: Non-Invasive Fibrosis Algorithm and Immunoadsorption Therapy

Two recent studies published in BMC Gastroenterology highlight major advances in chronic hepatitis B (CHB) care. The first validates a non-invasive fibrosis staging algorithm using five routine lab variables—platelet count, ALT, AST, GGT, and age—to accurately identify both advanced fibrosis and minimal liver damage without the need for biopsy, making it especially valuable in primary care and low-resource settings. The second study introduces a novel immunoadsorption therapy using anti-HBsAg antibody-coated beads, which significantly reduced HBsAg and HBV DNA levels in a preclinical rabbit model. This approach shows potential as an adjunct to current therapies aiming for a functional cure, though human trials are still needed.

FDA Food Recalls Announced in June 2025 Due to Potential Contamination Risks

In June 2025, the FDA announced multiple nationwide food recalls due to potential contamination with harmful bacteria, including Salmonella, Listeria monocytogenes, Clostridium botulinum, and Bacillus cereus. Major recalls included millions of eggs from August Egg Company and cucumbers from several suppliers due to Salmonella risk, as well as shrimp, enoki mushrooms, and cheese curds potentially contaminated with Listeria. Additional recalls involved salted smoked herring contaminated with C botulinum and children’s cough syrup tainted with B cereus. While no related illnesses were reported, the incidents underscore the ongoing need for robust food safety surveillance and consumer awareness to prevent foodborne illnesses.

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In the United States, there are 1 million people living with Parkinson’s and 7 million with Alzheimer’s. As the American population continues to age, the number of neurodegenerative disease cases is projected to increase with no current cures in the market.

The Isakson Center for Neurological Disease Research at the University of Georgia uses an interdisciplinary research approach to better understand and treat Parkinson’s and Alzheimer’s diseases. The researchers at the Isakson Center come from diverse academic backgrounds such as neuroscience, toxicology, pharmacy and veterinary medicine. 

As animals are prone to the same neurodegenerative diseases as humans, the UGA College of Veterinary Medicine, one of the highest-ranked veterinary schools in the nation, works together with the Isakson Center to find treatments for humans and animals alike.

Mice and rats make up 95% of the animals used in scientific research as they share genetic similarities to humans and are easy to manage. Rodent models have gained criticism in scientific research as rodents often live in more controlled conditions with less environmental pressures than humans, leading to differing disease expression.

Through its collaboration with the veterinary school, those at the Isakson Center occasionally use animals other than rodents such as canines and primates. These animals have more complex brain structures than rodents and have lifestyles similar to humans as they tend to be more sedentary and are prone to mental health problems such as anxiety and depression. 

“A mouse is not a replica of a human, you see,” said Johnny Isakson Distinguished Professor Arthi Kanthasamy. “So we go to higher-order models, like dogs.”

While scientists at the Isakson Center will run tests on animals when conducting their research, they attempt to minimize the use of animals by turning to methods such as in-vitro models or computer simulations when at all possible. When animals are used in research, the Isakson Center must adhere to the various university and national guidelines and policies with regard to their treatment of animals.

“We do not take lightly the decision to use animals in some of our research,” said Julie McPeake, senior director of communications and marketing at the College of Veterinary Medicine.

A recent example of the progress the Isakson Center has made using canine models to further understand neurological disorders has been through their research on Cushing’s Disease, a syndrome leading to the overproduction of cortisol. In diseases such as Cushing’s Disease, canines are more likely to exhibit noticeable symptoms than humans, making canine research invaluable for further understanding diseases in humans and canines alike.

The shared goal of the scientists at the Isakson Center is to deepen their understanding of diseases in animals and humans in order to find solutions to mitigate their symptoms and search for potential cures.

“A lot of the diseases that occur in humans occur in animals and vice versa,” said College of Veterinary Medicine Dean Lisa Nolan in a statement. “So, solutions that we find in one can inform the care of the other.”

Neva Drane is a third-year journalism and anthropology student at the University of Georgia.

 

Chances are you don’t realize the impact anxiety can have on guys. Studies continuously show that women are twice as likely as men to be diagnosed with an anxiety disorder–but that doesn’t mean you’re immune.

Researchers can’t explain the causes of this disparity, but believe guys may feel pressured to exhibit anxious feelings in ways that seem more masculine.

“I think the biggest thing is men are socialized not to show anxiety,” said Carmen McLean, PhD, a researcher and clinical associate professor at Stanford University’s Department of Psychiatry. “Socializing to show agency and self-efficiency dissuades from showing anxiety.”

This is one reason anxiety is often accompanied by substance abuse and other “internalizing disorders, ” said McLean. Sometimes these signs can be subtle, meaning it’s especially important to recognize symptoms of anxiety disorders specific to males.

Some clues—nervousness, dread over impending danger and rapid breathing—are common across gender lines, but these five manifestations of anxiety disproportionately impact men:

Anxious Men Fear Dating

Men with social anxiety disorder are more likely to fear dating and are more commonly single, separated or divorced, according to an analysis of survey information from Columbia University.

“Men are supposed to take the lead in dating,” explained Stefan G. Hofmann, PhD and psychology professor at Boston University who researches anxiety. “The male is the one who is expected to take the first step. That puts them in a performance situation.”

Even in the age of apps, men are typically the pursuer. On OkCupid, males are three times more likely to send a first message in an opposite-sex exchange. This means constantly offering yourself up for evaluation and rejection–an anxiety-inducing prospect.

“It’s a challenge for people who don’t like to play that game,”said Hofman.

Plus, some agonize over being chronically single–with reason–David Ezell, clinical director of Darien Wellness, a psychology clinic in Connecticut, told Men’s Health.

“Men really benefit from marriage,” Ezell said. “They’re less likely to be sick. They’re less likely to be hospitalized. They’re hospitalized for shorter stays if they are hospitalized.”

Also, marriage is a status symbol, a sign of “maturation,” said Ezell.

With so much at risk, dating and bachelorhood are significant sources of stress in men with anxiety.

Anxious Men May Abuse Alcohol and Drugs

Men drink and use drugs to relieve anxiety more often than women, according to the same Columbia University study. Research has consistently shown a link between substance abuse and mental health disorders, particularly in men.

“They are looking for medication,” said Ezell. He explains a glass of booze pairs well with the “I-can-fix-it-myself” attitude associated with masculinity because it doesn’t require medical assistance and may seem like a socially acceptable way to ease stress.

“Alcohol is a very effective drug,” said Hofmann. “It’s why it’s so popular.”

Think about college students who “pre-game” by drinking at a dorm or with a small group of friends before going to larger parties. They may not realize it, but this helps manage the anxiety of socializing.

Guys who forego professional treatment may instead turn to drugs or heavy drinking to cope with anxiety–and this may be a doorway to addiction.

Anxious Men May Seem Angry

In some men, anxiety may manifest as rage or anger. “It’s much more acceptable,” said McLean. While women may find support from friends or mental health professionals, guys often let their feelings build up until they hit a breaking point–and then the flood gates open.

“Because emotions don’t get expressed [by men], because anxiety isn’t expressed in a healthy way, there are busts of anger as a result,” said Ezell. “I think anger is considered decisive.”

If typical signs of anxiety, like nervousness or fear, are discouraged in men, anger is their only acceptable emotional response.

Anxious Men Have Strained Relationships

In another study of survey data from Columbia University, men were more likely than women to experience relationship strain from worrying.

This could be because women are more likely to have a circle of close friends, whereas men tend to have few confidants who can provide support through emotional distress.

“Men tend to rely on romantic partners for stress,” said Hofman. This can be a burden, he explained.

Sociologist Eli J. Finkel further detailed the risk of putting all that psychological dependence on one person in his book, The All-Or-Nothing Marriage. Finkel argued that modern relationships are tense because people seek comfort, growth, purpose, and a host of other needs from romantic partnerships. Prior generations sought comfort in an entire network of family and friends.

“Marriage for a long time served a set and relatively limited array of different functions for us,” Finkel told the NPR podcast Hidden Brain. “And over time we’ve piled more and more of these emotional and psychological functions.”

Anxious men might burn out their few outlets (or only outlet) for social support quickly.

Anxious Men Obsesses Over Status

Ezell’s practice is located in Darien, Connecticut, a bedroom community for hedge fund managers and Wall Street executives. With a median family income of $208,125, it’s frequently named one of the wealthiest municipalities in the United States.

Despite their success, Ezell has clients who are riddled with anxiety over what they haven’t accomplished. “My clients make a lot of money,” said Ezell. “They are still not happy and want to know why.”

Guys are often anxious about getting ahead of peers, he said. If a friend winters in Aspen, his client wants to winter in the Alps. There is a particular pressure in status attainment—and status advancement—that fuels anxiety disorders for many.

“We are very grateful by getting things,” Ezell said, “but we get acclimated to that status very quickly. If I am eating well; I want to be eating better.”

People often feel stressed. Many don’t have time to go outside and relax. Cities keep growing, and virtual access to natural spaces feels more common while real ones feel far away.

In Japan, people use forest bathing to reduce stress. They call it Shinrin Yoku. It simply means spending quiet time in a forest. No phones, no distractions – just nature.

Researchers wanted to test something different. Can forest bathing work through a screen? Can people feel calmer by using virtual reality instead of going outside? They set up a study to find out.

Building a virtual forest

The researchers wanted to create a very realistic virtual forest experience. To do this, they filmed a 360° VR video in Sonnenberg nature reserve. This forest is the largest Douglas fir forest in Europe.

The team didn’t stop at just recording the scenery. They also captured all the natural sounds, like the wind blowing through the trees and birds singing.

On top of that, the researchers added the scent of Douglas fir essential oils to match what someone would actually smell in the forest. Participants in the study had different experiences based on the setup.

Some people got the full experience. They saw the forest video through VR headsets. At the same time, they heard the forest sounds and smelled the fir scent. This gave them a complete, rich, multisensory experience.

Other participants only experienced one sense at a time. Some only watched the forest video without sound or scent. Others only listened to the forest sounds, while some only smelled the scent without visuals or audio.

When the researchers tested hearing or scent alone, they kept the visuals simple and plain. They wanted to avoid flashy images or colors that could distract people. The goal was to focus only on one sense at a time for clear results.

Virtual forest improved mood

The researchers didn’t just let people jump into the virtual forest. First, they showed participants stressful images to raise their stress levels.

Once people felt stressed, they put on VR headsets. They then experienced one of four versions of the forest. Some got the full version. Others experienced just one sense.

People who used sight, sound, and scent together felt the biggest mood boost. They also felt more connected to nature.

The single-sense versions helped too but not as much. Some participants even showed slight improvements in working memory. This type of memory helps with short-term thinking and tasks.

Still, the researchers said more studies are needed. They explained that the results may not apply to everyone.

Study lead author Leonie Ascone is a researcher in the Neuronal Plasticity working group at the University Medical Center Hamburg-Eppendorf (UKE).

“We can already say that digital nature experiences can absolutely produce an emotional effect – even if they don’t replace actual nature,” noted Ascone.

VR nature in busy everyday places

Virtual nature won’t replace real forests, but it may help in other spaces. Simone Kühn, who led the research, is director of the Center for Environmental Neuroscience at the Max Planck Institute for Human Development

Kühn believes VR nature could help people in stressful environments. “Especially in places with limited access to nature – such as clinics, waiting areas or urban interiors – multisensory VR applications or targeted nature staging could support mental well-being.”

“The images, sounds and scents of nature offer previously underestimated potential for improving mood and mental performance in everyday situations.”

The research suggests that nature videos can even reduce pain in some cases. Now, Kühn sees more possibilities. Virtual nature could help people in hospitals, offices, and city spaces. It might make everyday life feel less tense.

Nature still works, even virtually

This study gives one simple message – nature affects people in a positive way. Even when nature appears on a screen, it still changes how people feel. The researchers saw clear improvements in mood and connection to nature, even though participants never left the room.

But it’s important to be realistic. Virtual forest bathing is not a perfect solution. It cannot fully replace being outdoors. Real forests offer more than just sights, sounds, and smells. There is fresh air, physical movement, and other factors that VR cannot copy.

Still, virtual forest bathing can help people who cannot easily go outside. People in hospitals, city apartments, or busy workplaces often have no access to real forests. For them, even a short virtual nature experience may reduce stress and lift their mood.

The study is published in the Journal of Environmental Psychology.

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DNA viruses in the detected samples

By assembling and analyzing the metagenomic sequencing data, this study only discovered two virus contig sequences, tig000081 and tig000315, which possessed the characteristics of Caulimoviridae viruses. Therefore, the two novel Caulimoviridae viruses, tig000081 (7,546 nt) and tig000315 (7,585 nt) are tentatively named “Lancifolium Caulimovirus A” (LCaA) and “Lancifolium Caulimovirus B” (LCaB), respectively.

To validate the accuracy of the two reference contig sequences, overlapping fragments from LCaA and LCaB were cloned, sequenced, and assembled to obtain full-length genomic sequences. Final genome lengths were determined as 7,542 nt for LCaA and 7,582 nt for LCaB, with complete sequences deposited in the China National GeneBank Database (CNGB) under accession number sub064865. The open reading frame (ORF) prediction using ORF Finder (https://www.ncbi.nlm.nih.gov/orffinder/) and conserved domain analysis via InterPro (https://www.ebi.ac.uk/interpro/) revealed distinct genomic architectures of the two viruses. For LCaA, it had four ORFs: ORF1 was 963 nt and encoded a viral movement protein (MP) (aa 23–277), which was necessary for initial cell-to-cell movement during the early stages of viral infection and predicted to be responsible for the intercellular transport of viral genomes in plant cells [29]. ORF2 was 2,571 nt and encoded an 856-amino acid protein containing one Caulimovir coat domain (amino acids 427–522), homologous to coat proteins in Cauliflower mosaic virus. ORF3 was 1,656 nt and encoded a viral replication and maturation polyprotein (amino acids 104–527). This polyprotein contained one RT POL domain (139–318) and one RNase HI RT Ty3 domain (412–535). The retroviral reverse transcriptase (prototypical RT) had three enzymatic activities: RNA-dependent DNA polymerase, ribonuclease H, and DNA-dependent DNA polymerase. These activities involve copying the plus-strand RNA genome to produce minus-strand DNA, removing the RNA template, and synthesizing plus-strand DNA using minus-strand DNA as a template [30]. ORF4 was 1,233 nt and encoded a hypothetical protein (amino acids 64–393) with an uncharacterized function. (Fig. 1A). Former research had reported that the CaMV genome always encodes six proteins, a cell-to-cell movement protein, two aphid transmission factors: a polyprotein precursor of proteinase, a precursor of the capsid proteins, the reverse transcriptase and ribonuclease H, and an inclusion body protein/translation transactivator [5, 31]. Our newly detected LCa virus processed most of the key proteins of the CaMV, and ORF2 containing one Caulimovir coat domain. Based on the description of the above-mentioned LCa virus characteristics, we believe that this virus belongs to the Cauliflower Mosaic Virus.

LCaB contained three ORFs. ORF1 encoded a viral movement protein (amino acids 47–145), which, like LCaA, was predicted to be a Caulimoviridae movement protein. ORF2 encoded a protein containing one caulimovir coat domain (amino acids 371–467), one retropepsin-like domain (amino acids 750–841), and one RT POL domain (amino acids 982–1,161). ORF3 encoded a protein with a cytoplasmic domain (amino acids 1–30), a transmembrane region (amino acids 31–50), a noncytoplasmic domain (amino acids 54–94), and another transmembrane region (amino acids 95–113) (Fig. 1B).

The genetic evolutionary relationship of the genus Caulimovirus

According to the International Committee on Taxonomy of Viruses (ICTV; https://ictv.global/), the genus Caulimovirus currently comprises 18 recognized species, including Cauliflower mosaic virus (CaMV) and eight other taxonomically validated members (Fig. 2). All the known genus Caulimovirus virus sequences were alignment with Mega 11 [32], and using maximum likelihood statistical method with 100 bootstrap replications to test the phylogeny. Then, the obtained tree file was up-loaded to the iTOL(https://itol.embl.de/) to beautify the graphics. Systematic phylogenetic analysis classified all reported Caulimovirus species into four well-supported monophyletic groups (Fig. 2). These species share a common evolutionary origin but subsequently diverged into four distinct lineages during key evolutionary transitions. Besides, the obtained phylogenetic tree showed that LCaA and LCaB share the closest evolutionary affinity, forming a distinct clade with Plant associated caulimovirus (PAC), Strawberry vein banding virus (SVBV), Pelargonium vein alating virus (PVA), and Malva yellow mosaic virus (MYMAV) (Fig. 2). That means within this branch, the genetic variation shared among species (the similarity of homologous gene sequences) is significantly higher than that between them and the species in other branches on the evolutionary tree. This indicates that they separated from each other for a shorter period during the evolutionary process and accumulated fewer genetic differences.

Marker-based identification of LCa DNA viruses

The tiger lily plants suspected to be infected with the virus were selected, and their phynotypes were shown in Fig. 3A and B. Based on Sanger sequencing and assembly of virus fragments in the pooled samples, we observed natural genetic variations in the LCaA and LCaB viruses. We finally obtained seven LCaA virus isolates and six LCaB isolates, and their genome sequences were deposited in the China National GeneBank (CNGB; accession number sub064865) and National Center for Biotechnology Information (NCBI), which is also shown in Sub Table 2. The genome sequence similarities among LCaA virus isolates ranged from 99.59 to 99.73%, while those among LCaB isolates ranged from 98.51 to 98.91%. To identify these newly discovered LCa viruses, their genome sequences were aligned using Clustal Omega (https://www.ebi.ac.uk/Tools/msa/clustalo/). Based on conserved sequences shared by LCaA and LCaB, four marker primers (listed in Table 1) were specifically designed to detect LCa viruses. Following PCR amplification, Marker 1 produced amplicons of 519 bp (LCaA) and 513 bp (LCaB), whereas Marker 2 yielded 269 bp amplicons for both variants (Fig. 3D). Furthermore, using LCaA-specific conserved sequences, Marker 3 produced a 342 bp amplicon for LCaA. Combined detection using Markers 1, 2, and 3 enabled specific identification of LCaA viruses (Fig. 3D). Marker 4 generated a 203 bp amplicon using this approach. Using Markers 1, 2, and 4, LCaB viruses were reliably identified (Fig. 3D). Furthermore, the bulbs’ DNA of the marked samples in Shuanghe town were amplified using the four primer pairs. The results showed that the Shuanghe-1(SH-1) was infected with both LCaA and LCaB, the Shuanghe-2(SH-2) was infected with LCaA, the Shuanghe-3 (SH-3) was infected with LCaB, the Shuanghe-4(SH-4) not infected with LCa virus (Fig. 3E). The above experiments demonstrated that the four primer pairs enable efficient and specific identification of LCa viruses.

At the same time, another forty tiger lily plants were randomly collected at each sample collecting point. Their DNA was extracted using the methods mentioned before. Furthermore, the extracted DNA was used as templates for PCR. Marker 1 and Marker 2 were used as the primers to detect the LCa virus in those randomly collected samples. The following identification experiments were performed as mentioned before. The results showed that the LCa virus incidence of the tiger lily in Shuanghe, Sancha, Caoba Xia, Zhengdian, and Dongshan was 10%, 1%, 2%, 2%, and 2%, respectively (Sub Fig. 1).

Viral abundance analysis of all detected viruses

We analyzed the DNA and RNA virus abundance based on the viral metagenomic and metatranscriptomic analysis. Only one Caulimoviridae family virus was detected using viral metagenomic sequencing data, and the above experiments demonstrated that this family Caulimoviridae virus is a newly found LCa virus. The viral abundance analysis using viral metatranscriptomic sequencing data, and the virus contigs information were provided in Sub Table 2. The viral abundance statistic data are shown in Sub Table 3. The result showed that order Sobelivirales account for 8%, Iris potyvirus A species account for 5%, Shallot yellow stripe virus species account for 4%, genus Potexvirus account for 8%, Lily symptomless virus species account for 7%, Cucumber mosaic virus species account for 3%, order Reovirales account for 0.1%, Lenarviricota phylum account for 0.005%, family Caulimoviridae account for 0.001%. Other viruses were unclassified, and nearly 64% unclassified viruses belong to the order Martellivirales. 2% of unclassified virus belong to the genus Carlavirus, and 2% belong to the order Tymovirales (Fig. 4).