Objective To compare the effect of repeated transcranial magnetic stimulation (rTMS) at different frequencies acting on left dorsolateral prefrontal cortex (LPFC) on arousal for coma patients after brain stem injury.Methods Ninety-nine patients with coma resulted from brain stem injury,admitted to our hospital from February 1,2015 to April 10,2018,were chosen in our study.Among them,30 patients weren't treated with rTMS (control group),33 patients were treated with 10 Hz rTMS (10 Hz rTMS treatment group),and 36 patients were treated with 20 Hz rTMS (20 Hz rTMS treatment group);treatments lasted for 20 d.All patients received routine coma arousal treatment.Glasgow coma scale (GCS) scores,electroencephalogram (EEG) grading,brainstem auditory evoked potential (BAEP) grading and incidence of adverse reactions were compared among the three groups before and after treatment.Results Before treatment,there were no significant differences in GCS total scores,language response scores,motor response scores,eye opening reaction scores,EEG grading and BAEP grading among the three groups (P＞0.05).The total GCS scores,and scores of language response,motor response and open eye response of patients in the 20 Hz rTMS treatment group and 10 Hz rTMS treatment group after treatment were significantly higher than those in the control group (P＜0.05);the total GCS scores and motor response scores of patients in the 20 Hz rTMS treatment group were significantly higher than those in 10 Hz rTMS treatment group after treatment (P＜0.05).After treatment,patients in the control group,10 Hz rTMS treatment group,and 20 Hz rTMS treatment group showed statistically significant differences in EEG grading and BAEP grading (P＜0.05).The incidence of adverse reactions in the 20 Hz rTMS group (19.4％) was statistically higher than that in the 10 Hz rTMS group (3.0％,P＜0.05).Conclusion High-frequency rTMS has an awakening effect on patients with coma resulted from brain stem injury,and the coma awakening effect of 20 Hz rTMS is partially better than that of 10 Hz rTMS,but it has the risk of increasing side effects such as epilepsy and scalp bum.

Objective To analyze the influence of general anesthesia (GA) on bilateral subthalamic nucleus deep brain stimulation (STN-DBS) in treating Parkinson's disease (PD) through microelectrode recording (MER),and discuss the differences between different modes of anesthesia.Methods A retrospective analysis was performed on clinical data of 31 PD patients accepted bilateral STN-DBS in our hospital from June 2015 to June 2017.Nine patients accepted surgery under GA (A group):4 patients were treated with intravenous anesthesia (A1 group),and 5 patients were treated with inhalation anesthesia (A2 group);22 patients accepted surgery under local anesthesia LA group.MER indexes,including STN discharge frequency,STN recorded length,and maximum target error,and short-term (6 months) efficacy were recorded.A linear regression analysis was performed to find possible influence factors on discharge frequency and improving rate of UPDRS scores.Results The discharge frequencies of B group,A1 group and A2 group were 51.42 Hz±6.28 Hz,35.79 Hz±7.02 Hz and 43.18 Hz±5.87 Hz,respectively,with significant differences (F=12.181,P=0.000);as compared with that in the B group,the discharge frequencies of A1 group and A2 group were significantly lower (P＜0.05).The STN recorded lengths of B group,A1 group and A2 group were 5.48 mm±0.33 mm,5.06 mm±0.15 mm and 5.22 mam±0.16 mm,respectively,with significant differences (F=4.115,P=0.027);as compared with that in the B group,the recorded lengths of A1 group and A2 group were significantly shorter (P＜0.05).A1 group had the maximum target error,but no significant differences were noted among the 3 groups (P＞ 0.05).Six months after the surgery,the UPDRS-Ⅲ scores and Schwab-England scores of A group and B group were decreased and daily levodopa equivalent (LEDD) was decreased.As compared with B group,A group had significantly better improvement in Hoehn & Yahr grading (P＜0.05).Disease durations were positively correlated with discharge frequency (r=0.539,P=0.002);age and improving rate of UPDRS scores were negatively correlated (r=-0.572,P=-0.001);preoperative LEDD and improving rate of UPDRS scores were positively correlated (r=0.725,P=-0.000).Conclusions Bilateral STN-DBS performed under GA in PD enjoys good efficacy,which shows no obvious difference as compared with that under LA.Inhalation anesthesia had less influence on electrophysiology than intravenous anesthesia.

Background & Objective: Endovascular treatment is the widely accepted treatment for patients with anterior circulation stroke within 6 hours of onset of stroke. We aimed to evaluate the advantages of endovascular treatment compared to standard medical treatment in treating patients with anterior circulation stroke beyond the 6-hour therapeutic window. Methods: We reviewed the literature concerning endovascular treatment versus medical treatment beyond the 6-hour therapeutic window. Using random-effects meta-analysis, we evaluated the following outcomes: modified Rankin scale in the three-month follow-up [excellent outcome (mRS≤1), functional independence (mRS≤2), moderate outcome(mRS≤3)], recanalization rate at 24 hours, mortality at 90 days or in-hospital, symptomatic intracranial hemorrhage, parenchymal hematoma type 2 and hemorrhagic infarction 1. Results: Four studies including 642 patients were evaluated. Endovascular treatment was associated with higher odds of excellent outcome (OR 2.55; 95% CI 1.48 to 4.41,), functional independence (OR 3.64; 95% CI 2.43 to 5.45), moderate outcome (OR 2.70; 95% CI 1.95-3.74) and recanalization rate at 24 hours (OR 8.81; 95%CI 2.81 to 27.69) compared to MT. No difference in the rates of mortality, symptomatic intracranial hemorrhage, parenchymal hematoma type 2 or hemorrhagic infarction 1 was found between the 2 groups. Studies using strict perfusion imaging inclusion selection showed better moderate outcome in comparison to the studies without perfusion imaging inclusion selection (P <0.012). Conclusion: Our study highlights the superiority of endovascular treatment over standard medical treatment alone for treating patients with anterior circulation stroke beyond 6 hours since stroke onset, although more studies are required for further investigation. Standard of strict selection for eligible patients before endovascular treatment should be based on DAWN or DEFFUSE 3 inclusion criteria.