Repetitive transcranial magnetic stimulation (rTMS) is a commonly-used treatment for major depressive disorder (MDD). However, our understanding of the mechanism by which TMS exerts its antidepressant effect is minimal. Furthermore, we lack brain signals that can be used to predict and track clinical outcome. Such signals would allow for treatment stratification and optimization. Here, we performed a randomized, sham-controlled clinical trial and measured electrophysiological, neuroimaging, and clinical changes before and after rTMS. Patients (N = 36) were randomized to receive either active or sham rTMS to the left dorsolateral prefrontal cortex (dlPFC) for 20 consecutive weekdays. To capture the rTMS-driven changes in connectivity and causal excitability, resting fMRI and TMS/EEG were performed before and after the treatment. Baseline causal connectivity differences between depressed patients and healthy controls were also evaluated with concurrent TMS/fMRI. We found that active, but not sham rTMS elicited (1) an increase in dlPFC global connectivity, (2) induction of negative dlPFC-amygdala connectivity, and (3) local and distributed changes in TMS/EEG potentials. Global connectivity changes predicted clinical outcome, while both global connectivity and TMS/EEG changes tracked clinical outcome. In patients but not healthy participants, we observed a perturbed inhibitory effect of the dlPFC on the amygdala. Taken together, rTMS induced lasting connectivity and excitability changes from the site of stimulation, such that after active treatment, the dlPFC appeared better able to engage in top-down control of the amygdala. These measures of network functioning both predicted and tracked clinical outcome, potentially opening the door to treatment optimization.

Transmission electron microscopy (TEM) observations of graphite tubules (buckytubes) and their derivatives have revealed not only the previously reported buckytube geometries but also additional shapes of the buckytube derivatives. Detailed cross-sectional TEM images reveal the cylindrical cross section of buckytubes and the growth pattern of buckytubes as well as their derivatives. These observations of frozen growth stages of buckytubes and derivatives suggest a helical growth mechanism analogous to that of crystal growth via screw dislocations. The helicacy of buckytubes is analyzed by electron diffraction whereas the anisotropy of electronic structure is revealed by momentum transfer resolved electron energy loss spectrometry. Based on the TEM observations, it is proposed that buckytubes act as precursors to closed-shell fullerene (buckyball) formation and the possible steps in buckyball formation are outlined. In arc evaporation experiments in which residue rods (containing various amounts of buckytubes) were used as the starting anode for fullerene production, the amount of buckytubes in the rod was correlated with fullerene yield.

No abstract