ObjectiveTo systematically evaluate the effect of repeated transcranial magnetic stimulation (rTMS) in treating epilepsy.MethodsThe randomized controlled trials (RCTs) of rTMS for epilepsy and related diseases were collected from PubMed, EMbase, Cochrane Library, CBM, CNKI, VIP, and Wanfang databases by computer. The retrieval time was from establishment to June 2019. Two researchers independently screened the literature, extracted the data and evaluated the deviation risks of the included studies. RevMan5.3 software was used for Meta analysis.ResultsA total of 21 RCTs were included, including 1 587 patients. The results showed that rTMS assisted antiepileptics drugs (AEDs) could improve the effective rate of epilepsy treatment [RR=1.28, 95% CI (1.19, 1.37)], significantly reduced HAMA, HAMD and NFDS scores in the treatment of patients with epilepsy combined with anxiety and depression [MD=−3.94, 95% CI (−4.25, −3.63)], and improve DQ and GMFM-88 scores in children with cerebral palsy combined with epilepsy [MD=7.95, 95% CI (7.00, 8.90)]. In addition, using rTMS will not cause additional adverse reaction [peto OR=0.52, 95% CI (0.31, 0.84)].ConclusionsThe current evidence showed that rTMS combined AEDs can improve the efficient of AEDs therapy. When treat anxiety depression comorbidity, it can significantly reduce the anxiety depression score. In addition in children with cerebral palsy merger, it can improve muscle strength and development. And rTMS will not cause additional adverse reactions. Limited by the quantity and quality of the selected studies, the conclusions need to be verified by more high-quality studies.
【摘要】 目的 探讨在基层医院建立脑卒中单元模式的临床意义。 方法 将2006年1-3月和2007年同期共381例脑卒中患者分为脑卒中单元组和普通病房组。脑卒中单元组按照脑卒中单元模式进行治疗，普通病房组按照传统方法治疗，分别于治疗前、治疗后7、15、30 d时，对比分析两组患者神经功能缺损及疗效。 结果 脑卒中单元组和普通病房组治疗后，随时间两组的神经功能缺损评分（NIHSS）均逐渐降低，两组在治疗后15、30 d时差异有统计学意义（P=0.007），脑卒中单元组家属满意度明显高于普通病房组（P=0.002）。 结论 在基层医院脑卒中单元模式对脑卒中患者的治疗效果明显优于传统治疗。【Abstract】 Objective To investigate the clinical significance of setting up stroke unit model in basic hospital. Methods Three hundreds and eighty-one stroke patients were randomly divided into stroke unit group (n=186) and general ward group (n=189). The stroke unit group patients were treated with the stroke unit model designed by ourselves, while the control group patients were treated with traditional method, The clinical efficacy was compared before treatment, seven days, 15 days and 30 days after treatment. Results Improvement in neurological score was significantly better among patients treated in the SU than in the GW. NIHSS scores gradually reduce in the both groups after treatment, which were significantly lower than those in the control group on 15 days and 30 days after treatment(P=0.007,0.004). The satisfactory of relatives in the stroke unit group was better than that in the general ward group(P=0.002). Conclusion The efficacy of treatment with stroke unit model was better than that of treatment with traditional method in the stroke patients.
ObjectiveTo study the relation between daily activity that can make right atrium pressure rise (such as abdominal belt, sighs, weight lifting) and patent foramen ovale (PFO). MethodsA total of 122 cases of positive patients by the routine transcranial Doppler (TCD) foaming test between 2014 and 2015 were collected. Forty-one patients underwent TCD foaming test in the case of abdominal belt, 41 in the case of sighs, and 40 in the case of weight lifting. We recorded the right to left shunting of the above three cases, and compared them with the normal TCD foam test. ResultsThere was a significant difference in the positive rate between the sigh group and abdominal belt group, and between the sigh group and weight lifting group (χ2=10.5, 7.40; P<0.01). The positive rate in the abdominal belt group was not significantly different from that of the weight lifting group (χ2=0.314, P>0.05). In the sigh group, the sigh shunting volume was significantly higher than that when the patients were at rest. The shunting volume was the biggest when the patients had Valsalva movement, followed by sighing and resting. ConclusionThe daily activity that can make right atrium pressure rise (such as abdominal belt, sighs, weight lifting) can increase the shunting flow from the right to the left. The highest positive rate occurs when patients sigh. This study can provide a certain theoretical basis for the pathogenesis of patent foramen ovale and cryptogenic stroke.
ObjectiveTo analyze the pathogenic bacteria distribution, structure and characteristics of drug resistance in patients with acute stroke complicated with pulmonary infection, in order to provide reference for the prevention of hospital infection and rational use of antimicrobial agents. MethodsA total of 864 clinical specimens of acute stroke complicated with pulmonary infection were chosen for study between January 2012 and December 2014. Separation and cultivation were done in accordance with the operation procedures regulated by the Ministry of Health. Drug sensitivity examination was done by Kirby-Bauer (k-b). Super-extensive spectrum β lactamase (ESBL) and methicillin resistant staphylococcus aureus (MRSA) were detected to analyze the bacterial species and resistance transition. ResultsA total of 864 samples were cultivated, in which G-bacteria accounted for 61.2%. The main pathogenic bacteria was Klebsiella pneumoniae bacteria, Escherichia coli, Pseudomonas aeruginosa, Acinetobacter baumanmii and Staphylococcus aureus. Imipenem had high antimicrobial activity to G-bacilli, especially to Escherichia coli and Klebsiella pneumoniae bacteria. Linezolid, vancomycin and teicoplanin had high antibacterial activity to staphylococcus aureus. Vancomycin resistant Staphylococcus aureus was not found. Ciprofloxacin had high antibacterial activity to Pseudomonas aeruginosa, while imipenem had low antibacterial activity to Pseudomonas aeruginosa. Amikacin had high antibacterial activity to acinetobacter. ConclusionG-bacilli are predominant in acute stroke complicated with pulmonary infection. ESBLs and MRSA detection rate is high, and we should pay attention to the rational use of antibiotics to reduce drug resistance.
Objective To know more about the correlation between patent foramen ovale (PFO) and ischemic stroke among young and middle-aged people through analysis on various risk factors of ischemic stroke. Methods Eighty-three patients with cerebral infarction from 15 to 55 years old diagnosed for the first time in the Department of Neurology of Xianyang Hospital between January 2016 and January 2017 were selected as the study subjects. They were divided into two groups, PFO group (n=42) and non-PFO group (n=41). Seventy-eight heathy people from the Physical Examination Department of the same hospital were selected as controls. All patients and heathy subjects underwent transcranial Doppler (TCD) foaming experiments, and the occurrence and shunt volume of PFO were observed. General information and cerebrovascular disease risk factors of the patients were investigated. Results The age of subjects in PFO and non-PFO groups was not significantly different (P>0.05). Among the risk factors, there was no significant difference between the PFO and non-PFO groups in drinking history (P>0.05). The incidences of other ischemic stroke risk factors (hypertension, diabetes, smoking, hyperlipidemia, hyperhomocysteinemia, and carotid arteriosclerosis) in the PFO group were significantly lower than those in the non-PFO group (P<0.05). The rank sum test results showed that large and medium shunt rates of the cerebral infarction group were significantly higher than those of the control group (P<0.05). Conclusions PFO may be one of the cause of ischemic stroke in young and middle-aged people. Pathogenesis of ischemic stroke is likely to have a relationship with the severity of the shunt from right to left.