Repetitive peripheral magnetic stimulation (rPMS) is a non-invasive and painless approach that can penetrate deeper structures to improve motor function in people with physical impairment due to stroke. A review of available literature was undertaken to discuss the potential mechanisms of rPMS-based neuromodulation and the application of rPMS in the recovery of motor function (e.g., muscle strength, spasticity, motor control and joint mobility, glenohumeral subluxation) after stroke. Issues of concern about parameters and safety of rPMS were also overviewed. Existing evidence has shown that suprathreshold rPMS can be a potential intervention for motor recovery in patients with stroke because of its neuromodulatory effects. However, the rPMS parameters employed by each research team are highly variable for specific lesions. Thus, more high-quality studies on the optimal rPMS protocols for different impairments are warranted in the future.

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Stroke patients require rehabilitation programs to improve their functioning and quality of life. Proprioceptive neuromuscular facilitation is a widely used rehabilitation technique in clinical facilities. However, previous studies have not completely clarified its effectiveness. This study aimed to evaluate the effectiveness of proprioceptive neuromuscular facilitation in improving balance and mobility in stroke patients through clinical research and literature review. Our findings show that proprioceptive neuromuscular facilitation techniques effectively improve balance and mobility in stroke patients. However, there is little evidence supporting its superiority over the other rehabilitation methods.

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Fibromyalgia (FM) is a common and refractory chronic pain condition with multiple clinical phenotypes. The current diagnosis is based on a syndrome identification which can be subjective and lead to under or over-diagnosis. Therefore, there is a need for objective biomarkers for diagnosis, phenotyping, and prognosis (treatment response and follow-up) in fibromyalgia. Potential biomarkers are measures of cortical excitability indexed by transcranial magnetic stimulation (TMS). However, no systematic analysis of current evidence has been performed to assess the role of TMS metrics as a fibromyalgia biomarker. Therefore, this study aims to evaluate evidence on corticospinal and intracortical motor excitability in fibromyalgia subjects and to assess the prognostic role of TMS metrics as response biomarkers in FM. We conducted systematic searches on PubMed/Medline, Embase, and Cochrane Central databases for observational studies and randomized controlled trials on fibromyalgia subjects that used TMS as an assessment. Three reviewers independently selected and extracted the data. Then, a random-effects model meta-analysis was performed to compare fibromyalgia and healthy controls in observational studies. Also, to compare active versus sham treatments, in randomized controlled trials. Correlations between changes in TMS metrics and clinical improvement were explored. The quality and evidence certainty were assessed following standardized approaches. We included 15 studies (474 FM subjects and 222 controls). The main findings were: (1) fibromyalgia subjects present less intracortical inhibition (mean difference [MD, including] = –0.40, 95% confidence interval [CI] –0.69 to –0.11) and higher resting motor thresholds (MD = 6.90 μV, 95% CI 4.16 to 9.63 μV) when compared to controls; (2) interventions such as exercise, pregabalin, and non-invasive brain stimulation increased intracortical inhibition (MD = 0.19, 95% CI 0.10 to 0.29) and cortical silent period (MD = 14.92 ms, 95% CI 4.86 to 24.98 ms), when compared to placebo or sham stimulation; (3) changes on intracortical excitability are correlated with clinical improvements – higher inhibition moderately correlates with less pain, depression, and pain catastrophizing; lower facilitation moderately correlates with less fatigue. Measures of intracortical inhibition and facilitation indexed by TMS are potential diagnostic and treatment response biomarkers for fibromyalgia subjects. The disruption in the intracortical inhibitory system in fibromyalgia also provides additional evidence that fibromyalgia has some neurophysiological characteristics of neuropathic pain. Treatments inducing an engagement of sensorimotor systems (e.g., exercise, motor imagery, and non-invasive brain stimulation) could restore the cortical inhibitory tonus in FM and induce clinical improvement.

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Stroke is one of the leading causes of death and adult disability globally, representing one of the highest burdens of disease worldwide. Recent advancements of neuromodulation techniques emerge as promising tools for enhancing stroke recovery, such as transcranial electric stimulation and transcranial magnetic stimulation, which can induce short- and long-term changes of synaptic excitability to restore the impaired functions in stroke patients. The review focuses on discussing the neuroplastic mechanisms of those brain stimulation techniques in stroke rehabilitation, also including some new options for neuromodulation which have great potential in stroke rehabilitation, such as optogenetic stimulation and environmental stimulation. In general, these techniques allow the excitation and synchronization of the neural activity after stroke, which could potentially induce long-term potentiation. As a result, the neuroplastic effect can lead to better functional connection in the brain network in assisting stroke recovery. Future directions include the clarification of the pathways of synaptic plasticity in the whole brain network following neuromodulation after stroke, and investigation of the different roles of distinctive cell populations in neural plasticity enhancement. Additional studies are essential for developing standard protocols in neuromodulation based on a better understanding of the molecular and cellular processes for the ultimate optimization of clinical efficacy.

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Improved knowledge of the neuroplastic potential of the brain connectome has facilitated the advancement of neuromodulatory treatments for brain tumor patients especially in the perioperative period. More recently, the idea of inducing neuroplastic changes before surgery as “prehabilitation” has been suggested in low-grade gliomas with favorable data. However, it is uncertain the degree to which this treatment with transcranial magnetic stimulation (TMS) would benefit patients with high-grade gliomas, especially with additional rehabilitation after surgery and targets defined by personalized connectomic data. The current report details a case of a patient with recurrent glioblastoma in the right motor area 2 years after previous total resection. Given the desire for a more aggressive recurrent surgery in a highly functional area, the authors decided to proceed with “prehabilitation” by stimulating the surrounding motor cortices around the lesion to turn down the motor cortex connectivity before the recurrent surgery and then completing “rehabilitation” after the surgery. Structural-functional connectomic analyses were completed using Infinitome software based on an individualized patient brain atlas using machine-learning based parcellations. Repetitive TMS was employed, specifically using continuous and intermittent theta burst stimulation protocols. Prehabilitation consisted of using continuous theta burst stimulation at the estimated surgical entry point parcel and intermittent theta burst stimulation at adjacent parcellations for a total of 10 days with 5 sessions per day per target leading up until the surgery. A gross-total resection was obtained, but the patient woke up with left-sided hemiparesis. Resting-state functional magnetic resonance imaging derived connectivity demonstrated a case of a primarily pure cingulate-motor resection causing hemiplegia with an intact corticospinal tract and supplementary motor area. Functional connectivity outliers in cingulate-motor parcels were identified and compared with connectivity matrices from a healthy control atlas. Anomalies, parcels defined as functioning significantly outside a normal range, were chosen as rehabilitation TMS targets to be similarly treated for a total of 10 days with 5 sessions per day per target approximately two weeks after surgery. By using continuous theta burst stimulation on hyperconnected parcels and intermittent theta burst stimulation on hypoconnected parcels, the patient demonstrated significant motor improvement with only 4+/5 strength in the left arm 1 month after surgery. This report demonstrates for the first time the feasibility of using TMS treatment for glioblastoma surgery near “eloquent” cortices as a means of prehabilitation before surgery and rehabilitation after surgery. This parcel-guided approach for TMS treatment based on the cortical site of entry and individualized connectivity analyses allowed for maximal tumor resection and minimal long-term neurologic deficits.

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Disorders of consciousness (DoC) including the vegetative state, now known as unresponsive wakefulness syndrome, and the minimally conscious state lead to profound disability among affected individuals while placing a major burden on health care facilities, the economy, and society. Efficacious treatment strategies are necessary to alleviate these strains, but standardized, evidence-based protocols for the treatment of DoC are lacking. Progress towards this end remains difficult when considering the current dearth of comprehensive scoping review articles to organize and present the existing literature. The present scoping review seeks to fill this gap while presenting an up-to-date comprehensive compilation of current treatment strategies and their efficacy for vegetative state/unresponsive wakefulness syndrome, and minimally conscious state. To accomplish this, an examination of the existing literature between 2011 and 2021 was conducted using the PubMed database to compile and present current treatment strategies and their efficacy amongst patients in vegetative state/unresponsive wakefulness syndrome and minimally conscious state. Of the 112 articles collected, 32 reported successful treatment, 69 reported some incremental benefits of treatment, and 11 identified no benefit of treatment. Overall, sensory stimulation, transcranial direct current stimulation, transcranial magnetic stimulation, spinal cord stimulation, vagus nerve stimulation, rehabilitation programs, cranioplasty, and pharmacological treatments with zolpidem, amantadine, baclofen, midazolam, and clonazepam dose reduction coupled with neurorehabilitation were associated with successful treatment of DoC. Given the personal, societal, and economic burden associated with DoC, further research is warranted to determine and protocolize evidence-based strategies for effective treatment of those with DoC.

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Stroke is a significant cause of disability in both developing and developed countries. This can cause a severe financial burden on families and society. With the development of robotics and brain-computer interfaces (BCIs), robotic exoskeletons and BCIs have received increasing clinical attention on stroke rehabilitation. Electroencephalography (EEG) is a method of recording brain signals non-invasively, which can be used as a BCI to control exoskeletons. This review focuses on rehabilitation systems of EEG-controlled upper limb exoskeletons, including the newest research progress and clinical evaluation in recent years. From the review, we find EEG-controlled exoskeletons can positively contribute to stroke rehabilitation. However, there are some issues that should be well investigated. More efforts are needed on EEG signal decoding algorithms such as deep learning methods in the clinical context. Practical applications must also bridge the gap between offline experiment and online control. In addition, this review also discusses the impact and significance of shared control, virtual reality/augmented reality, and other ways of human-computer interaction to improve EEG-controlled exoskeletons.

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Increasing attention has recently been focused on reducing abnormal neuroexcitability in patients with Meige’s syndrome using nerve combing surgery. However, nerve injury caused by nerve combing is of critical concern. Animal studies have shown that stem cells can repair cranial nerves; autologous adipose-derived mesenchymal stem cells have been proved to be safe and effective in clinical trials. A total of 38 patients with Meige’s syndrome were enrolled in this prospective nonrandomized controlled study and divided into a non–stem cell group (n = 30) and a stem cell group (n = 8). Patients in the non-stem cell group underwent facial and trigeminal nerve combing only; patients in the stem cell group underwent adipose-derived mesenchymal stem cell implantation after facial and trigeminal nerve combing. A blepharospasm disability index score was used to evaluate effectiveness of the surgery, and a House–Brackmann grade was used to evaluate facial nerve injury. These data were recorded before the operation and at 7 days, 3 months, and 6 months after the operation. The overall improvement percentage of blepharospasm was 93% at 6-month follow-up in the non-stem cell group. A greater number of nerve combing events during the operation led to better outcomes but increased risk of facial paralysis. Patients in the stem cell group had better facial nerve function at the 6-month follow-up (House–Brackmann grade, P = 0.003) and better blepharospasm improvement at 3 and 6 months than those in the non–stem cell group (blepharospasm disability index score, P = 0.003 and P < 0.001, respectively). Cerebrospinal fluid protein analysis showed that levels of several cytokines were significantly increased after adipose-derived mesenchymal stem cell transplantation, including interleukin-6 (P < 0.01) and interferon gamma-induced protein 10 (P < 0.0001) and the growth factors insulin-like growth factor-1 (P < 0.0001), insulin-like growth factor-binding protein-1 (P < 0.0001), growth/differentiation factor-15 (P < 0.001), and angiopoietin-like 4 (P < 0.001). Facial and trigeminal nerve combing combined with adipose-derived mesenchymal stem cell transplantation is a safe and effective remedy to improve recovery from Meige’s syndrome.

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Urinary retention is a serious complication of spinal cord injury. This study examined whether repetitive functional magnetic stimulation (rFMS) applied over the sacral nerve root affected bladder function or mood in patients with urinary retention after spinal cord injury. This single-center, case-control study included 32 patients with detrusor flaccid neurogenic bladder after spinal cord injury, who were randomly assigned to rFMS (n = 11), electroacupuncture pudinal nerve stimulation (EAPNS; n = 11), and control groups (n = 10). All groups received routine bladder function training. The S3 sacral nerve was stimulated at a frequency of 5 Hz, once per day for 4 consecutive weeks in the rFMS group. Electroacupuncture stimulation of the pudendal nerve was performed once daily for 4 weeks in the EAPNS group. The control group received bladder function retraining alone. After the 4-week treatment, there were significant improvements in all three groups (P < 0.05). Primary bladder sensation, maximum bladder volume, maximum bladder pressure, and residual urine were significantly higher in the rFMS group than in the other two groups (P < 0.05). Primary bladder sensation, maximum bladder volume, residual urine, and urinary leukocyte count were significantly different between the EAPNS and control groups (P < 0.05). The rFMS group had significantly lower scores in the self-rated anxiety scale and self-rated depression scale compared with those of the other two groups. The quality of life score significantly increased in all three groups. rFMS is conducive to the recovery of neurogenic function in patients with urinary retention. This study provides a scientific basis for the clinical application and promotion of rFMS.

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Exercise training is often prescribed as an adjunct to medication to improve postural instability in individuals with Parkinson’s disease. As the association between exercise dose and the corresponding effects on postural stability has not been established in this population, we aimed to explore this topic in the present study. This is an exploratory study conducted in the Gait and Balance Laboratory at the Hong Kong Polytechnic University in a period from June 2011 to June 2013. Eligible participants with Parkinson’s disease (n = 51) were randomly assigned to either a balance and gait training group or a strength training group. The 12-week training period included two 4-week phases of physiotherapist-supervised laboratory-based training separated by a 4-week phase of self-supervised home-based training. Blinded testers examined postural stability using the limit of stability test, single-leg-stance test, walking test, and the activities-specific balance confidence scale, at baseline and after each training phase. Baseline evaluations revealed no significant difference between the balance and gait training and strength training groups. In the balance and gait training group, the first 4-week training phase led to significant improvement in most measures of balance and gait performance (P < 0.025), and the 12-week training phase yielded further improvements in gait velocity and activities-specific balance confidence scale score. In the strength training group, the first 4-week training phase led to significant improvement in the endpoint excursion in the limit of stability test and gait velocity, and the 12-week training phase resulted in an improvement in the single-leg-stance time and stride length in the walking test. All improvements occurred during the laboratory-based training sessions. Therefore, in individuals with Parkinson’s disease, a 4-week period of balance and gait training could improve postural stability, whereas longer durations of strength training are required to gain comparable improvements.

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The traditional Chinese herb, Moschus (also called She Xiang in Chinese), is used to accelerate the rehabilitation of Bell’s palsy (BP) through acupoint sticking therapy in China. However, the mechanism of its effect is not clear. In this study, we explored the pharmacological mechanism using bioinformatics analysis. We identified 59 active ingredients in Moschus using the Traditional Chinese Medicine Integrated Database, including 17-beta-estradiol, testosterone, and 2,6-decamethylene pyridine. In total, 837 differently expressed genes were identified in blood of BP patients by RNA sequencing. Finally, 33 proteins were identified with overlapping predictions by the Comparative Toxicogenomics Database and Bioinformatics Analysis Tool for Molecular Mechanism of Traditional Chinese Medicine. Proteins of interest were closely associated with 406 Gene Ontology biological processes and 4 pathways. The hub proteins in the protein–protein interaction network were FOS, JUN, proopiomelanocortin, and G protein-coupled estrogen receptor 1. A pharmacology network was constructed with 15 active components of Moschus, 33 protein targets and four pathways. The docking model of androst-4-ene-3,17-dione and FOS-JUN complexes was predicted and constructed. The results indicated testosterone as an effective component of Moschus that may enhance BP rehabilitation by targeting FUN and the mitogen-activated protein kinase and cyclic adenosine monophosphate signaling pathways, and that docking of androst-4-ene-3,17-dione and FOS-JUN complexes might play a critical role. The findings provide a direction for future research to verify the key targets of Moschus in the treatment of BP and an application prospect in the field of facial nerve rehabilitation.

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According to previous case reports, trigeminal nerve stimulation (TNS) can be successfully used to wake a non-responsive unconscious patient. However, no studies have comprehensively investigated the effect of TNS on patients with disorders of consciousness (DOC). Therefore, the present study aimed to assess the safety and efficacy of TNS in DOC patients recruited at the First Affiliated Hospital of Nanchang University. We used Coma Recovery Scale-Revised (CRS-R) scores to assess patients at baseline and after 1–4 weeks of TNS. The patients were further followed up for 4 weeks after the last stimulation to evaluate the safety of the procedure. The participant group comprised 21 DOC patients with an acquired brain injury who were more than 3 months post-injury. The participants were 44.29 ± 12.55 years old and 5.52 ± 1.83 months post-DOC onset, and included 12 patients who were in a vegetative state or had unresponsive wakefulness syndrome and 9 patients who were in a minimally conscious state. Compared with CRS-R scores at baseline, those at weeks 4 and 8 showed no significant improvements in any of the DOC patients. Nonetheless, CRS-R scores improved throughout the study period in 8 out of the 21 DOC patients. Among those with improved scores, two patients in a minimally conscious state had improved CRS-R scores at week 4, while five had improved scores at 4 weeks later. Only one patient with vegetative state/unresponsive wakefulness syndrome had recovered to a minimally conscious state at week 4. Importantly, no obvious treatment-related adverse events were considered to be related to TNS. Taken together, these data provide early evidence that TNS may be an effective and safe approach for promoting the recovery of consciousness in patients with neurological disorders.

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Apathy is a common sequela to traumatic brain injury affecting multiple aspects of the patient’s rehabilitation, recovery, domestic and social functioning, and quality of life. As a motivational disorder, it is distinct from depression, but shares many similar features. Anatomically, they both involve dysfunction in the ventral and medial prefrontal cortices and the anterior cingulate cortex; however, the dorsal anterior cingulate cortex may be more implicated in regulating motivation, while the subgenual anterior cingulate cortex may be more involved in regulating mood. Current treatment for apathy is limited, especially when standard pharmacotherapies for depression have not been shown to improve apathy. Repetitive transcranial magnetic stimulation is a neuromodulatory therapy effective for refractory depression. The mood modulatory effect was believed related to the anti-correlation between the subgenual anterior cingulate cortex and left dorsolateral prefrontal cortex. Studies have recently shown its safety and successful treatment of apathy in Parkinson’s disease, Alzheimer’s disease, and stroke, although the mechanism has not been fully elucidated. Repetitive transcranial magnetic stimulation has also been successfully applied in persons with traumatic brain injury for depression, dizziness, central pain, visual neglect, cognitive impairments, and disorders of consciousness. In this review, we aimed to summarize the current understanding of apathy and evidence of the clinical application of repetitive transcranial magnetic stimulation to explore the theoretical basis of potential therapeutic benefits of using repetitive transcranial magnetic stimulation for apathy after traumatic brain injury.

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Effective treatments for patients in a persistent vegetative state due to traumatic brain injury (TBI) are currently unavailable. The purpose of this study was to investigate the therapeutic use of sensitive sensory stimulation for patients in persistent vegetative state following TBI. This case report discussed a 36-year-old male patient who experienced TBI 75 days prior to admission. Upon hospital admission, the patient was unconscious, could automatically open his eyes, but could not avoid light, trace motions, or execute commands. He was placed on a nasal feeding diet, exhibited urinary and fecal incontinence and developed postoperative urinary retention and a pulmonary infection. He showed no mobility of the upper and lower extremities with hypomyotonia. Medications for nerve repair, regaining consciousness, preventing seizure, resolving phlegm, and protecting the stomach were administered. The activity of the extremities was improved by exercise therapies and low or medium-frequency electric stimulation, bladder and bowel function was improved by acupuncture and abdominal massage, and consciousness recovery was promoted by acupuncture and hyperbaric oxygen therapy. Five months following admission, the patient regained consciousness with improved bladder and bowel function. Electroencephalogram indicated that brain function had significantly improved. Auditory evoked potentials and somatosensory evoked potentials suggested that sensation conduction pathways had improved significantly. Sensitive sensory stimulation in combination with routine rehabilitation treatment can effectively cause the regain of consciousness in patients with persistent vegetative state following TBI and improve activities of daily living and the function of the sensation conduction pathways..

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Over recent years, the events associated with traumatic brain injury (TBI) have become critical health problems. TBI involves various functional deficits that are caused by neuronal loss and is a common feature in various neuropathologies. Patients with TBI have a very high degree of disability and impairment at both the physical and psychological levels, thus creating a significant burden on the quality of life. Although stem cell therapy has achieved some success in the reconstruction of neural circuits for TBI therapies, there are several limitations that need to be overcome, such as the stem cell transplantation pathways and time to transplantation are challenges for clinical application. Recently, bioactive materials from the tissue engineering field have become promising candidates for TBI therapies. Herein, we briefly summarize and discuss the advantages and disadvantages of TBI-related biomaterials (such as hydrogels, nanofibers, and nanomaterials) for the regeneration of neural tissue and functional recovery at the lesion sites of TBI. Finally, we describe the desirable characteristics of bioactive materials for neural repair in TBI. Because the development of therapeutic strategies with biomaterials is still in its infancy, biomaterials deserve high priority and further development as a treatment for TBI.

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Caffeine is the most commonly used stimulant drug in the world. Increasing evidence has indicated that caffeine may have a neuroprotective effect in delaying the onset or treatment of several neurodegenerative disorders, especially Alzheimer's disease (AD). During the progression of AD, accelerated memory loss and cognitive decline are accompanied by two neuropathological hallmarks, the accumulation of amyloid- and tau proteins. The long incubation nature of AD before definitive diagnosis combined with extended duration of life spent with illness contribute significantly to the public health burden, as patients spend much of their end life in a state of severe disability and heavy dependence. Moreover, current drug treatments only provide marginal benefits, creating an urgent need for developing new therapeutic options. There is supportive evidence from clinical trials that caffeine has neuroprotective properties against dementia and AD, but more research is needed to strengthen and confirm these observations. This mini-review presents a short synopsis of the effect of caffeine/coffee on cognition and Alzheimer's disease by evaluating a substantial basis of clinical trials that are related to this topic.

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Unlike man-made electronic devices such as computers, the nervous system never suffers from “overheating” due to its massive neuro-electrical activities. This paper proposes a new hypothesis that neuronal microtubules (neuro-MTs), which are major structural components of axons and dendrites, are vacuum cylindrical nanotubes that can mediate electrical transmission with a unique form of quasi-superconductivity. It is speculated that hydrolysis of guanosine triphosphate catalyzed by the a-/ß-tubulin subunits would supply cellular energy to relocate electrons to form the conduction electrons inside neuro-MTs. Owing to the consecutive dipole ring structures of neuro-MTs, the moving speed of the conduction electrons inside neuro-MTs is expected to be very slow, and this feature would enable physiological neuro-electrical transmission with super-high energy efficiency. Further, the dipole ring structures of a neuro-MT would help terminate the electron conduction with high efficiency. The proposed neuro-MT-mediated electrical transmission offers a new mechanistic explanation for the saltatory conduction of action potentials along the axons. Lastly, it is speculated that owing to its unique consecutive dipole sheet structures, the myelin sheath which wraps around large axons and some dendrites, may functionally serve as an effective shield for the electromagnetic fields generated by the conduction electrons inside the axonal neuro-MTs.

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Brain functional network (BFN) has become an increasingly important tool to discover informative biomarkers for diagnosing neurodegenerative diseases, such as Alzheimer’s disease and its prodrome stage, namely mild cognitive impairment. Currently, the most popular BFN estimation methods include Pearson’s correlation and sparse representation. Despite their empirical success in some scenarios, such estimated BFNs only capture the low-order relationship (i.e., the direct connectivity strength between brain regions), ignoring the high-order information in the brain (e.g., the global network structure). Therefore, in this study, we proposed a novel method based on the signed random walk (SRW) to estimate high-order BFNs. Not only can SRW measure the global network structure, but it can also naturally deal with negative brain functional connectivity through the structural balance theory. To the best of our knowledge, this study was the first to use SRW in BFN estimation. Furthermore, considering the complex interaction among different brain regions, we developed a parameterized variant of SRW for improving the flexibility of the high-order BFN estimation model. To illustrate the effectiveness of the proposed method, we identified patients with mild cognitive impairment from normal controls based on the estimated high-order BFNs. Our experimental findings showed that the proposed scheme tended to achieve higher classification performance than baseline methods.

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A 74-year-old man with dementia was undergoing rehabilitation following a recent cerebrovascular accident. A nasogastric tube was inserted owing to swallowing dysfunction. However, the patient often dislodged the tube. We decided to apply intermittent feeding via an oro-esophageal tube. One day, he accidentally swallowed the tube into his stomach. The intermittent oro-esophageal tube was successfully removed by gastroscopy. This case herein highlights the need to be aware of dysphagia in patients with dementia when inserting an intermittent oro-esophageal tube.

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Repetitive transcranial magnetic stimulation (rTMS) is an effective treatment for depression. As the left prefrontal cortex activity is linked to depression, rTMS induces blood flow in the left dorsolateral prefrontal cortex. We used rTMS in a middle-aged male patient with depression who had discontinued psychostimulant medication over a 12-month period. He had been consistently taking dextroamphetamine-amphetamine extended release 30 mg once daily prior to the onset of rTMS treatment. The patient achieved depression remission through 39 sessions of high-frequency left dorsolateral prefrontal cortex rTMS treatments. We assessed disease progression using the Quick Inventory of Depressive Symptomatology, and we measured blood pressure before each session of rTMS. After tapering the dextroamphetamine-amphetamine extended release from 30 mg to 10 mg, the patient’s score on the Quick Inventory of Depressive Symptomatology increased slightly to 7 and then dropped to 0. The results indicate that interval rTMS can lower blood pressure and may be an alternative to adjunctive psychostimulants.

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Paroxysmal sympathetic hyperactivity (PSH) is a rare symptom, but is difficult to manage. Here, we report a case of post-trauma PSH in a young male patient. The main reason for the occurrence of PSH in trauma patients may be nonnoxious or noxious stimuli. In this case, the detection of positive sympathetic parameters and heart rate variability after pressure regulation provided strong evidence for the PSH attack, thus enhancing the accuracy and reliability of early diagnosis. Clinicians should be alert to the possibility of PSH caused by rapid decline of ventricular pressure. Moreover, the appropriate regulation of ventricular pressure combined with pharmacologic interventions, rehabilitation and nutritional support may reduce and control this symptom.

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Obsessive-compulsive disorder is a chronic and severe psychiatric disorder with a high prevalence (2–3%) worldwide, of which 30% will be refractory to conventional treatment. Surgical treatment with deep brain stimulation, approved by the U.S. Food and Drug Administration in 2009, seems to be effective in symptomatic control, with response rates exceeding 50% in severely affected patients. However, despite the efficacy indicated in the different studies, surgical treatments for psychiatric disorders are still controversial, and deep brain stimulation for obsessive-compulsive disorder is not yet considered a standard therapy. Since 2009, a wide variety of targets have been suggested for the treatment of obsessive-compulsive disorder; however, to date, there is still no consensus on which target might be optimal for the treatment of obsessive-compulsive disorder. On one hand, authors are trying to find the best target based on each patient and the variability of their symptoms, in an attempt to personalize the treatment. In parallel, there has been a shift in the paradigm of functional neurosurgery from the belief in stimulation focusing on a single target to the modulation of brain circuits or connectomes. With this in mind, it may be possible that many of the targets used in obsessive-compulsive disorder could modulate the same brain network and thus produce an improvement in patients' symptomatology. This study aims to review the evolution of this treatment up to the present time; as well as to make a comparison between these two lines of thought, thus exposing the current state of deep brain stimulation for obsessive-compulsive disorder.

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Peripheral nerve injury and reconstruction would lead to alteration of neural pathways. This is regarded as rewiring peripheral nerves, which could also be a trigger for the corresponding neural rewiring process in the brain. Brain plasticity subsequent to peripheral nerve reconstruction plays an important role in the functional recovery of limbs, which has attracted increasing concerns. The present study aimed to overview recent progress in neuroregeneration-related brain plasticity. Nerve transfer is a special technique of nerve reconstruction that usually leads to substantial peripheral neural rewiring and cortical reorganization. Nerve transfer-related shifting of motor representation was particularly discussed. We also emphasized rehabilitation strategies based on the current peripheral-central rewiring theory. Specific strategies based on neural plasticity were proposed for corresponding recovery stages.

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