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  <Article>
    <Journal>
      <PublisherName>jmedicalcasereports</PublisherName>
      <JournalTitle>Frontiers in Medical Case Reports</JournalTitle>
      <PISSN>I</PISSN>
      <EISSN>S</EISSN>
      <Volume-Issue>Volume 7; Issue 5</Volume-Issue>
      <PartNumber/>
      <IssueTopic>Multidisciplinary</IssueTopic>
      <IssueLanguage>English</IssueLanguage>
      <Season>(Sep-Oct, 2026)</Season>
      <SpecialIssue>N</SpecialIssue>
      <SupplementaryIssue>N</SupplementaryIssue>
      <IssueOA>Y</IssueOA>
      <PubDate>
        <Year>-0001</Year>
        <Month>11</Month>
        <Day>30</Day>
      </PubDate>
      <ArticleType>Medical Case Reports</ArticleType>
      <ArticleTitle>ExoTMS__ampersandsignreg; in a Patient with Endometrial Cancer and Major Depressive Disorder: A Case Report</ArticleTitle>
      <SubTitle/>
      <ArticleLanguage>English</ArticleLanguage>
      <ArticleOA>Y</ArticleOA>
      <FirstPage>1</FirstPage>
      <LastPage>8</LastPage>
      <AuthorList>
        <Author>
          <FirstName>Sanjay</FirstName>
          <LastName>Thunga</LastName>
          <AuthorLanguage>English</AuthorLanguage>
          <Affiliation/>
          <CorrespondingAuthor>N</CorrespondingAuthor>
          <ORCID/>
          <FirstName>Shaurya</FirstName>
          <LastName>Mahajan</LastName>
          <AuthorLanguage>English</AuthorLanguage>
          <Affiliation/>
          <CorrespondingAuthor>Y</CorrespondingAuthor>
          <ORCID/>
          <FirstName>Arya</FirstName>
          <LastName>Bhakta</LastName>
          <AuthorLanguage>English</AuthorLanguage>
          <Affiliation/>
          <CorrespondingAuthor>Y</CorrespondingAuthor>
          <ORCID/>
          <FirstName>Laalasa</FirstName>
          <LastName>Vinnakota</LastName>
          <AuthorLanguage>English</AuthorLanguage>
          <Affiliation/>
          <CorrespondingAuthor>Y</CorrespondingAuthor>
          <ORCID/>
          <FirstName>Mia</FirstName>
          <LastName>Arnautalic</LastName>
          <AuthorLanguage>English</AuthorLanguage>
          <Affiliation/>
          <CorrespondingAuthor>Y</CorrespondingAuthor>
          <ORCID/>
          <FirstName>Yatharth</FirstName>
          <LastName>Mahajan</LastName>
          <AuthorLanguage>English</AuthorLanguage>
          <Affiliation/>
          <CorrespondingAuthor>Y</CorrespondingAuthor>
          <ORCID/>
          <FirstName>Netra</FirstName>
          <LastName>Ramanathan</LastName>
          <AuthorLanguage>English</AuthorLanguage>
          <Affiliation/>
          <CorrespondingAuthor>Y</CorrespondingAuthor>
          <ORCID/>
          <FirstName>Vipul</FirstName>
          <LastName>Reddy</LastName>
          <AuthorLanguage>English</AuthorLanguage>
          <Affiliation/>
          <CorrespondingAuthor>Y</CorrespondingAuthor>
          <ORCID/>
          <FirstName>Charles</FirstName>
          <LastName>Vigilia</LastName>
          <AuthorLanguage>English</AuthorLanguage>
          <Affiliation/>
          <CorrespondingAuthor>Y</CorrespondingAuthor>
          <ORCID/>
          <FirstName>Keerthy</FirstName>
          <LastName>Sunder</LastName>
          <AuthorLanguage>English</AuthorLanguage>
          <Affiliation/>
          <CorrespondingAuthor>Y</CorrespondingAuthor>
          <ORCID/>
        </Author>
      </AuthorList>
      <DOI/>
      <Abstract>Major depressive disorder (MDD) frequently co-occurs with complicated grief and psychological distress related to cancer survivorship, and a substantial proportion of patients do not achieve remission with conventional treatment. This case report describes a 59-year-old woman with MDD, complicated grief following a significant personal loss, and a history of endometrial cancer in remission, who underwent 10 sessions of ExoTMS, a novel repetitive transcranial magnetic stimulation (rTMS) platform, targeting the left dorsolateral prefrontal cortex. Outcomes were assessed using the Perceived Stress Scale (PSS-10), Brain Fog Scale, Insomnia Severity Index (ISI), and Warwick-Edinburgh Mental Well-being Scale (WEMWBS). Following treatment, the patient demonstrated an 18.8% reduction in perceived stress, an 18.6% reduction in brain fog, a 73.7% reduction in insomnia severity (shifting from moderate clinical insomnia to no clinically significant insomnia), and a 14.9% improvement in mental well-being. Treatment was well tolerated, with no adverse effects reported across all sessions. These findings provide preliminary, hypothesis-generating observations and support further investigation of ExoTMS in larger, controlled studies.</Abstract>
      <AbstractLanguage>English</AbstractLanguage>
      <Keywords>ExoTMS,Repetitive Transcranial Magnetic Stimulation (rTMS),Major Depressive Disorder (MDD),Complicated Grief,Endometrial Cancer Survivorship,Insomnia</Keywords>
      <URLs>
        <Abstract>https://jmedicalcasereports.org/ubijournal-v1copy/journals/abstract.php?article_id=16387&amp;title=ExoTMS__ampersandsignreg; in a Patient with Endometrial Cancer and Major Depressive Disorder: A Case Report</Abstract>
      </URLs>
      <References>
        <ReferencesarticleTitle>References</ReferencesarticleTitle>
        <ReferencesfirstPage>16</ReferencesfirstPage>
        <ReferenceslastPage>19</ReferenceslastPage>
        <References>Aoyama M, Sakaguchi Y, Morita T, Ogawa A, Fujisawa D, Kizawa Y, Tsuneto S, Shima Y, Miyashita M. Factors associated with possible complicated grief and major depressive disorders. Psychooncology 2018; 27: 915-921.&#13;
&#13;
Chapman DP, Whitfield CL, Felitti VJ, Dube SR, Edwards VJ, Anda RF. Adverse childhood experiences and the risk of depressive disorders in adulthood. J Affect Disord 2004; 82: 217-225.&#13;
&#13;
Dees M. Enhancing the mental well-being of postmenopausal women using ExoTMSand;reg;. Mental Wellness 2026; 4.&#13;
&#13;
Eisma MC. Prolonged grief disorder in ICD-11 and DSM-5-TR: Challenges and controversies. Aust N Z J Psychiatry 2023; 57: 944-951.&#13;
&#13;
Maheswaran H, Weich S, Powell J, Stewart-Brown S. Evaluating the responsiveness of the Warwick Edinburgh Mental Well-Being Scale (WEMWBS): group and individual level analysis. Health Qual Life Outcomes 2012; 10: 156.&#13;
&#13;
Nanos G, Silva M, Patel C. Effects of ExoTMS stimulation on sleep quality: a sham-controlled study. Sleep Science and Practice 2026; 10: 25.&#13;
&#13;
Noda Y, Silverstein WK, Barr MS, Vila-Rodriguez F, Downar J, Rajji TK, Fitzgerald PB, Mulsant BH, Vigod SN, Daskalakis ZJ, Blumberger DM. Neurobiological mechanisms of repetitive transcranial magnetic stimulation of the dorsolateral prefrontal cortex in depression: a systematic review. Psychol Med 2015; 45: 3411-3432.&#13;
&#13;
Otte C, Gold SM, Penninx BW, Pariante CM, Etkin A, Fava M, Mohr DC, Schatzberg AF. Major depressive disorder. Nat Rev Dis Primers 2016; 2: 16065.&#13;
&#13;
Pand;aacute;nek D, Gerla V, Dees M, Halaas Y, McCoy JD, Cady L, Nanda R, Eberwein R, Johnston H 3rd, Tvrdik N, Nanos G, Patel C, Silva M. Innovations in repetitive transcranial magnetic stimulation: a review of clinical evidence and patient-reported outcomes for ExoTMS. Front Psychiatry 2026; 17: 1850212.&#13;
&#13;
Saelens J, Gramser A, Watzal V, Zarate CA Jr, Lanzenberger R, Kraus C. Relative effectiveness of antidepressant treatments in treatment-resistant depression: a systematic review and network meta-analysis of randomized controlled trials. Neuropsychopharmacology 2025; 50: 913-919.&#13;
&#13;
Sanjida S, Obermair A, Gebski V, Armfield N, Janda M. Long-term quality of life outcomes of women treated for early-stage endometrial cancer. Int J Gynecol Cancer 2021; 31: 530-536.&#13;
&#13;
Szuhany KL, Malgaroli M, Miron CD, Simon NM. Prolonged Grief Disorder: Course, Diagnosis, Assessment, and Treatment. Focus (Am Psychiatr Publ) 2021; 19: 161-172.&#13;
&#13;
Yang M, Morin CM, Schaefer K, Wallenstein GV. Interpreting score differences in the Insomnia Severity Index: using health-related outcomes to define the minimally important difference. Curr Med Res Opin 2009; 25: 2487-2494.</References>
      </References>
    </Journal>
  </Article>
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