Objective: To compare the occurrence and prognosis of antibiotic-associated diarrhea (AAD) between patients treated with cefoperazone/sulbactam and piperacillin/tazobactam in the neurosurgery department. Methods: This study retrospectively analyzed patients who received cefoperazone/sulbactam or piperacillin/tazobactam to prevent or treat hospital-acquired infections in the Department of Neurosurgery of The First Medical Center of Chinese PLA General Hospital between October 2019 and October 2020. For patients with AAD, clinical data, antibiotic usage, the incidence of diarrhea, treatment, and prognosis were collected and analyzed. Results: In total, 356 patients were enrolled, and 65 (18.6%) experienced AAD, 38 patients in the cefoperazone/sulbactam group and 27 patients in the piperacillin/tazobactam group. The AAD rate did not differ between the treatment arms. Conversely, the dosage, intensity, and duration of antibiotic therapy differed between the groups, whereas no differences were noted in the time to the appearance of diarrhea and prognosis. According to regression analysis, the incidence of AAD did not differ between the groups (odds ratio [OR] = 0.85, 95% confidence interval [CI] = 0.46–1.48). Conclusion: Cefoperazone/sulbactam or piperacillin/tazobactam can lead to a similar incidence rate of AAD. The combined application of antibiotics and empiric therapy often occurs. The rational use of antibiotics should be improved.

Background: Idiopathic normal pressure hydrocephalus (iNPH) is a potentially reversible neurological disorder of older adults, characterized by the classic triad of gait disturbance, cognitive impairment, and urinary incontinence. Despite its treatable nature, iNPH remains widely underdiagnosed, and the prediction of shunt responsiveness and optimization of therapeutic outcomes remain major clinical challenges. Methods: We conducted a narrative review informed by a structured PubMed search of studies published between January 2017 and June 2026. Forty-eight original clinical studies, including randomized controlled trials (RCTs), prospective and retrospective cohort studies, and cross-sectional studies addressing the pathophysiology, diagnosis, treatment, or prognosis of iNPH, were selected for synthesis; foundational trials and guidelines published before 2017 were cited for context. Results: Emerging, largely correlational evidence links iNPH to impaired glymphatic function, perivascular aquaporin-4 loss, and delayed cerebrospinal fluid (CSF) tracer clearance, although causality remains unproven. Instrumented gait analysis, MRI volumetry, and refined CSF tap test protocols may improve the objectivity of patient evaluation, but most of these tools have been validated only in small single-center cohorts. The first large placebo-controlled RCT (PENS) confirmed gait improvement after shunt surgery, extending earlier evidence from the Japanese SINPHONI and SINPHONI-2 studies, whereas acetazolamide showed no benefit in the DRAIN trial. Adjuvant rehabilitation may enhance gait recovery and reduce fall risk. Multiple clinical, imaging, and neuropsychological predictors of shunt responsiveness have been reported, but no single biomarker achieves sufficient predictive accuracy, and heterogeneity in diagnostic criteria, outcome measures, and follow-up limits comparisons across studies. Conclusion: Shunt surgery is now supported by randomized evidence for gait outcomes, whereas most diagnostic and prognostic biomarkers remain investigational. Priorities include standardized diagnostic pathways, prospective external validation of multimodal prognostic models, incorporation of patient-reported and caregiver outcomes, and equitable access to specialized care.

Background: Low-intensity focused ultrasound (LIFU) is a non-invasive neuromodulation technique that combines millimeter-scale spatial precision with access to cortical and deep targets — including the thalamus, basal ganglia, amygdala, and nucleus accumbens — that otherwise require invasive deep brain stimulation (DBS). Methods: We conducted a narrative critical review of mechanistic, technical, and clinical LIFU literature from PubMed/MEDLINE, Europe PMC, Scopus, Web of Science and ClinicalTrials.gov (final search 30 June 2026), synthesizing in vitro , animal, human neurophysiological, neuroimaging, and early clinical evidence, with attention to the level of evidence, ITRUSST safety and reporting standards, and methodological confounds. Main findings: Proposed biophysical mechanisms include acoustic radiation force, cavitation, and thermomechanical coupling at neuronal membranes, engaging mechanosensitive ion channels and reshaping excitatory–inhibitory (E/I) balance via glutamatergic and GABAergic pathways; the direction of modulation and the physical-to-cellular chain remain incompletely resolved. Theta-burst TUS (tbTUS) induces NMDA-associated LTP-like motor-cortical plasticity lasting 30–60 min. Human studies in movement disorders (Parkinson’s disease, essential tremor), treatment-resistant depression, anxiety, pain, Alzheimer’s disease, and stroke report physiological and early clinical effects. Importantly, the physiological readouts most often reported — motor-evoked potentials, local field potentials, functional connectivity, and neurotransmitter levels — index target engagement and acute neural effects but do not, by themselves, establish meaningful or sustained clinical benefit. Key challenges include parameter heterogeneity, auditory confounds, inconsistent reporting, skull variability, and a paucity of adequately powered randomized controlled trials. Conclusion: LIFU is a promising but still largely investigational technology. ITRUSST consensus safety and reporting guidelines are beginning to standardize the field. Current clinical studies remain small, heterogeneous, and mostly short-term, supporting biological plausibility and target engagement rather than established therapeutic efficacy. This review emphasizes that controlled, adequately powered trials with long-term follow-up are needed before clinical adoption for any indication.

Deep brain stimulation (DBS) and spinal cord stimulation (SCS) have been investigated for over four decades as neuromodulatory treatments for chronic disorders of consciousness (DOC), including the vegetative state/unresponsive wakefulness syndrome (VS/UWS) and the minimally conscious state (MCS), for which no disease-modifying pharmacological therapy exists. This narrative review synthesizes literature published between 2016 and 2026 on the neurobiological rationale, clinical evidence, neurophysiological biomarkers, and safety of DBS and SCS for chronic DOC. The ‘mesocircuit hypothesis’, supported by human intraoperative electrophysiology and nonhuman primate causal manipulation, provides a coherent rationale for central thalamic and centromedian-parafascicular targeting. Across case series, cohort studies, and individual patient data meta-analyses, both DBS and SCS produce clinically meaningful improvement in a minority of patients, consistently more often in MCS (63–74% response) than in VS/UWS (26–30% response), with younger age and shorter injury-to-treatment interval predicting better outcomes. However, the two largest individual patient data meta-analyses of DBS concur that current evidence is insufficient to conclude that stimulation alters the natural history of neurological recovery beyond what would be expected from patient selection and spontaneous recovery, and adverse event rates (8.1% for SCS, 18.2% for DBS) indicate non-trivial surgical risk in this vulnerable population. Neurophysiological and neuroimaging biomarkers derived from EEG, functional near-infrared spectroscopy, functional MRI, and FDG-PET show promise for objective outcome prediction but await prospective validation. We conclude that DBS and SCS remain experimental, mechanistically motivated but not yet definitively proven therapies for chronic DOC, and that adequately powered randomized controlled trials, biomarker-guided patient selection, and dedicated ethical frameworks are needed before either modality can be recommended outside of research settings.