International Neuromodulation Society

Acute postoperative pain remains prevalent among patients undergoing gastrointestinal tumor surgery. The study was conducted to evaluate the efficacy of transcutaneous auricular vagus nerve stimulation (taVNS) in alleviating postoperative pain in this population. This patient- and assessor-blinded randomized controlled trial was conducted at the Second Affiliated Hospital of Zhejiang University School of Medicine. Eligible participants who underwent elective laparoscopic gastrointestinal tumor surgery were randomly assigned to the taVNS or control stimulation group. Both groups received the stimulation on the day before surgery and the day after surgery. The primary outcome was the change in visual analogue scale (VAS) scores at 24h postoperatively. The median reduction in VAS scores was 12.0 in the taVNS group, compared with 5.0 in the control stimulation group (median [interquartile range, IQR] 12.0 [10.0-13.3] mm vs 5.0 [2.0-8.0] mm; P < 0.001). Additionally, the taVNS group showed lower cumulative morphine milligram equivalents (MME) at 48h (median [IQR] 0 [0-5] mg vs 5 [0-10] mg; P=0.004) and 72h (median [IQR] 0 [0-5] mg vs 5 [0-10] mg; P=0.002), and shorter time to first flatus (median [IQR] 45 [40-60]h vs 75 [60-85]h; P < 0.001). The incidence of complications, length of hospital stay, and quality of recovery-15 (QoR-15) scores are similar between groups. TaVNS statistically alleviated postoperative pain in patients undergoing gastrointestinal tumor surgery, decreased analgesic requirements, and promoted gastrointestinal function recovery. NCT06763913.

Craving is a core symptom and treatment target in tobacco use disorder. However, self-reported craving ratings often show weak or inconsistent associations with clinical outcomes, possibly because they overlook automatic motivational processes central to cue-reactivity. Response time to craving-item ratings has been proposed as an implicit marker of such processes, but its sensitivity to intervention and clinical relevance remain untested. In this exploratory secondary analysis of a randomized trial, tobacco-dependent adults completed an image-based cue-reactivity paradigm immediately before and after a single 1 Hz repetitive transcranial magnetic stimulation (rTMS) session targeting either the left frontopolar cortex (lFPC; n=12) or the vertex (Cz; n=11). We examined whether response time, modeled both as a mean-level measure and as a function of self-reported craving, was modulated by stimulation site and whether these indices were associated with smoking outcomes at baseline and one-week follow-up. Mean response time showed a significant Group × Time × Stimulus effect (χ²(1) = 8.64, p = 0.003): lFPC stimulation attenuated the typical post-exposure speeding observed in the vertex group, selectively for smoking cues. Models incorporating self-reported craving yielded convergent smoking-specific effects (Wald χ²(1) = 4.47, p = 0.034), but the curvature patterns were inconsistent and statistically fragile, limiting interpretability. Exploratory clinical analyses did not reveal reliable associations with smoking-related outcomes, although repeated nominal associations with tonic craving under smoking cues suggested a possible relationship. These findings provide initial evidence that response time may capture implicit components of cue-reactivity and function as a modulable behavioral endpoint sensitive to lFPC neuromodulation.

BackgroundEarly and accurate identification of mild cognitive impairment (MCI) is crucial for timely intervention and preventing further cognitive decline. Functional near-infrared spectroscopy (fNIRS) is a non-invasive, portable tool for clinical screening, but its diagnostic accuracy is often constrained by single-paradigm approaches and small sample sizes. To address this limitation, this study aimed to develop and validate an efficient early MCI screening model by integrating large-sample fNIRS data from resting-state and 1-back task paradigms using ensemble machine learning, thereby enhancing the accuracy and reliability of early MCI diagnosis.MethodsA total of 462 right-handed participants (185 MCI patients and 277 healthy controls, aged 58 -87 years) were included in the final analysis after screening, with MCI diagnosis jointly determined by two experienced neurologists based on Petersen’s criteria. fNIRS signals were collected during resting-state and 1-back task sessions; after preprocessing in MATLAB, features were extracted from oxygenated hemoglobin (HbO) signals of both paradigms.ResultsFeature selection was performed via a gradient boosting classifier based on feature importance scores, resulting in 108 selected features. Five classifiers were trained and evaluated using 10-fold cross-validation. The integrated dataset combining resting-state and 1-back task features outperformed the single-paradigm datasets: the Neural Network model on this integrated dataset achieved an accuracy of 86.49%, sensitivity of 94.74%, specificity of 77.78%, and Area Under the Curve (AUC) of 93.49%. In contrast, the Nearest Neighbor model on the resting-state dataset and the Decision Tree model on the 1-back task dataset yielded accuracies of 70.27% and 75.68%, respectively. Group classification using MoCA scores achieved an accuracy of 86.55%, which was comparable to single-paradigm machine learning models but inferior to the integrated model.DiscussionThis study demonstrates the value of a large-sample, data-driven approach and multi-paradigm feature integration in fNIRS-based MCI screening, providing an efficient diagnostic model for clinical application.Clinical trial registrationhttps://www.chictr.org.cn/showprojEN.html?proj=192047.

Electroconvulsive therapy (ECT) shows potential in treating obsessive-compulsive disorder (OCD), especially in treatment-resistant cases. However, its efficacy, associated factors, and particularly the role of baseline thyroid-stimulating hormone (TSH), remain underexplored. This study examines ECT's therapeutic efficacy in OCD patients and assesses baseline TSH levels' predictive utility to identify biomarkers influencing treatment outcomes. Fifty-nine OCD patients who received ECT at Shandong Daizhuang Hospital (January 2010 to August 2024) were enrolled. Demographic and clinical data were collected; patients were stratified into responders/nonresponders via the Clinical Global Impressions-Improvement scale. Multivariate logistic regression and receiver operating characteristic (ROC) curve analysis were used to evaluate associations between baseline TSH, other factors, and ECT outcomes. Forty-one patients (69.49%) responded to ECT. Responders and nonresponders had no significant demographic differences. Fluoxetine use (χ2=4.274, P=0.039) and baseline TSH (T=2.997, P=0.004) correlated with outcomes, but only baseline TSH (OR=0.574, P=0.040) was significant in multivariate analysis. ROC showed baseline TSH's AUC=0.685 (95% CI: 0.525-0.845, P=0.021), with 90.2% sensitivity, 50.0% specificity, and 0.402 Youden index. ECT is effective for OCD in this cohort. Fluoxetine use and baseline TSH correlated with outcomes; lower baseline TSH linked to higher response rates, suggesting it may predict ECT outcomes.

La esquizencefalia es una malformación congénita del desarrollo cortical que se caracteriza por una hendidura cerebral revestida por sustancia gris heterotópica, que comunica la superficie pial con el sistema ventricular. El diagnóstico suele realizarse en etapas tempranas de la vida y su presentación en adultos mayores es poco frecuente, lo que representa un desafío diagnóstico, especialmente cuando los síntomas neurológicos son inespecíficos. El objetivo de este artículo es presentar un caso clínico de esquizencefalia tipo abierta del lóbulo frontal derecho, diagnosticada en un paciente adulto mayor (72 años) que consultó por un episodio convulsivo tónico-clónico generalizado de reciente aparición, hallazgo que motivó la realización de una resonancia magnética cerebral. El estudio mostró la hendidura cortical característica y permitió establecer un diagnóstico no invasivo, destacando su utilidad en convulsiones de inicio tardío. Este reporte subraya la importancia de considerar esta malformación dentro del diagnóstico diferencial de epilepsia en adultos mayores.

This community service activity has an impact on improving the implementation of Yanbu'a method learning assistance in improving the ability to apply tajwid to students at TPQ Haniful Ulum. Rahayu Village. TPQ Haniful Ulum is a Quranic education institution serving students from early childhood to adolescence, yet it still faces challenges in achieving correct Tajweed Reading standards. The approach used in this study is participatory action research (PAR). The results show that the Yanbu’a learning method is mentored gradually and systematically through Reading habituation, repetition, and direct teacher correction. The students’ response and enthusiasm towards this method is very positive, reflected in increased participation and eagerness to learn. The teachers also demonstrate active involvement in the mentoring process. There has been a significant improvement in students’ tajweed skills, particularly in letter articulation, the length of recitation (mad), and Reading rules. The factors supporting the success of this mentoring include the availability of Yanbu’a books, teacher commitment, and a conducive learning environment. Meanwhile, the inhibiting factors include limited time, a limited number of teachers, and variations in students’ ability levels in applying Tajweed. In conclusion, mentoring the Yanbu’a learning method, delivered consistently and intensively, can enhance students’ skills in applying tajweed at TPQ Haniful Ulum. To maintain and improve the results achieved, it is necessary to strengthen teacher capacity and increase supporting facilities.

Sleep disturbances are both prodromes and potential risk factors for Parkinson’s disease (PD), yet associations between long-term sleep patterns and PD remain unclear. We analyzed data from two online cohorts—PPMI-Online (n = 15,905) and Fox Insight (n = 1929)—to examine associations between self-reported sleep duration trajectories across life stages and PD risk and age at onset (AAO). Latent class growth analysis identified distinct trajectories, linear and logistic regression examined their associations with PD risk and AAO, adjusting for demographics, lifestyle, and comorbidities. In PPMI-Online, sleep duration was generally stable in early adulthood with divergence in midlife. Compared to stable sleepers (7–8 h/day), individuals with midlife reductions (6–7 to ≤5–6 h/day: OR = 1.90; 7–8 to ≤6–7 h/day: OR = 1.64) and persistent short sleep (≤6 h/day: OR = 1.41) had higher PD risk, independent of comorbidities. Similar patterns were observed in probable prodromal PD. Persistent short sleep and sleep decline were also linked to earlier AAO (up to –4.23 years) across cohorts. These findings suggest that midlife sleep reduction may signal early PD, while chronic short sleep may represent a modifiable risk factor, highlighting the need for prospective studies to explore early detection and prevention potential.

Introduction: Addictions pose a major global health and socioeconomic challenge. Treatment strategies include pharmacological interventions, deep brain stimulation, and ablative procedures. Stereotactic radiosurgery (SRS) has emerged as a noninvasive, precise option for addiction management. nderstanding the anatomy and connectivity of the nucleus accumbens (NAc) is key to refining radiosurgical targets and improving outcomes.Method: Diffusion tensor imaging from 3T and 1.5T MRI scanners was obtained in five healthy subjects using T1 and T2 sequences. Images were fused with autosegmentation of the NAc, ventral tegmental area (VTA), amygdala, hippocampus, hypothalamus, and periventricular gray (PVG). The insula, medial/lateral orbitofrontal cortex, and dorsolateral prefrontal cortex were manually drawn. Connectivity to the NAc was visually assessed with fractional anisotropy thresholds (20–10). The five densest fiber tracts guided target selection, aligned to the anterior–posterior commissure, and transferred to Gamma Plan for radiosurgical planning.Results: The strongest connections were between the medial orbitofrontal cortex (mOFC), hypothalamus, VTA, PVG, and amygdala with the NAc. The mOFC–NAc and hippocampus–NAc tracts were the most and least robust, respectively. Derived stereotactic coordinates supported connectome-based targeting, proposing a 90 Gy dose to the NAc shell and aligning the 20 Gy isodose for neuromodulation. The right and left NAc received &gt; 20 Gy in 75.2% and 55.6% of their volumes, while the optic apparatus received ≤ 5.4 Gy (Dmax).Discussion: The NAc, within the ventral striatum, integrates limbic, cognitive, and motor inputs regulating reward and motivation. Its shell and core subregions differ functionally, with the shell showing dense dopaminergic input from the VTA and high sensitivity to reinforcement stimuli. Chronic substance exposure induces neuroplastic changes underlying compulsive behaviors, making the NAc shell a rational neurosurgical target. DBS, radiofrequency ablation, and SRS have yielded variable but promising results in refractory opioid and alcohol dependence. Advances in diffusion imaging now enable precise mapping of NAc connectivity and subregion-specific targeting. High-dose (up to 90 Gy) LINAC-based radiosurgery has shown safety and potential for radiomodulation, highlighting the therapeutic promise of anatomically informed, connectivity-guided interventions.Conclusions: Addiction remains a pervasive disorder with high relapse rates despite medical and behavioral therapies. Radiosurgery, a time-tested and safe functional technique, may offer a new treatment alternative. Connectivity-based SRS using commercial planning software allows visualization and autosegmentation of key NAc connections, supporting patient-specific, circuit-informed targeting in addiction neuromodulation.