Efficacy of repetitive transcranial magnetic stimulation for post-stroke depression: a systematic review and meta-analysis of randomized clinical trials.

We aimed to conduct a meta-analysis to evaluate the efficacy of repetitive transcranial magnetic stimulation (rTMS) in patients with post-stroke depression (PSD). Six relevant electronic databases (PubMed, CENTRAL, Embase, Web of Science, CINAHL, and PsycINFO) were searched. Randomized controlled trials (RCTs) that compared rTMS with control condition for PSD were included. The mean change in depression symptom scores was defined as the primary efficacy outcome. Secondary outcomes included the remission rate of depression, stroke recovery, and cognitive function recovery. In total, 7 RCTs with 351 participants were included. At post-treatment, rTMS was significantly more effective than the control condition, with a standardized mean difference (SMD) of -1.15 (95%CI: -1.62 to -0.69; P<0.001, I2=71%) and remission with an odds ratio (OR) of 3.46 (95%CI: 1.68 to 7.12; P<0.001; I2=11%). As for stroke recovery, rTMS was also better than the control condition (SMD=-0.67, 95%CI: -1.02 to -0.32; P<0.001). However, no significant difference was found for cognitive function recovery between the two groups (SMD=4.07, 95%CI: -1.41 to 9.55; P=0.15). To explore the potential moderators for the primary outcome, a series of subgroup and sensitivity analyses were performed. The results implied that rTMS may be more effective in Asian samples than in North American samples (P=0.03). In conclusion, from the current evidence in this study, rTMS could be an effective treatment for patients with PSD. Further clinical studies with larger sample sizes and clearer subgroup definitions are needed to confirm these outcomes.

Efficacy of repetitive transcranial magnetic stimulation for post-stroke depression: a systematic review and meta-analysis of randomized clinical trials

We aimed to conduct a meta-analysis to evaluate the efficacy of repetitive transcranial magnetic stimulation (rTMS) in patients with post-stroke depression (PSD). Six relevant electronic databases (PubMed, CENTRAL, Embase, Web of Science, CINAHL, and PsycINFO) were searched. Randomized controlled trials (RCTs) that compared rTMS with control condition for PSD were included. The mean change in depression symptom scores was defined as the primary efficacy outcome. Secondary outcomes included the remission rate of depression, stroke recovery, and cognitive function recovery. In total, 7 RCTs with 351 participants were included. At post-treatment, rTMS was significantly more effective than the control condition, with a standardized mean difference (SMD) of -1.15 (95%CI: -1.62 to -0.69; P<0.001, I2=71%) and remission with an odds ratio (OR) of 3.46 (95%CI: 1.68 to 7.12; P<0.001; I2=11%). As for stroke recovery, rTMS was also better than the control condition (SMD=-0.67, 95%CI: -1.02 to -0.32; P<0.001). However, no significant difference was found for cognitive function recovery between the two groups (SMD=4.07, 95%CI: -1.41 to 9.55; P=0.15). To explore the potential moderators for the primary outcome, a series of subgroup and sensitivity analyses were performed. The results implied that rTMS may be more effective in Asian samples than in North American samples (P=0.03). In conclusion, from the current evidence in this study, rTMS could be an effective treatment for patients with PSD. Further clinical studies with larger sample sizes and clearer subgroup definitions are needed to confirm these outcomes.

[Clinical observation on the anthracyclines-induced cardiotoxicity in patients with early-stage breast cancer].

Objective: To evaluate the anthracyclines-induced cardiotoxicity in patients with early-stage breast cancer. Methods: This retrospective study analyzed data of 64 patients (aged from 36 to 59 years old) with early-stage breast cancer after surgery. Patients were divided into ACT group (n=21), FAC group (n=19) and EC group (n=24). The NCI CTC 4.0 scores was used to evaluate the side effects at the time of 2 weeks, 4 weeks and 6 weeks after chemotherapy. Meanwhile, the level of cTnT, the incidence of abnormal electrocardiogram (ECG) and left ventricular ejection fraction (LVEF) were used to evaluate the anthracyclines-induced cardiotoxicity, the follow-up observation points were as follows: at the acute cardiotoxicity (time A), subacute cardiotoxicity (time B), 24 months after chemotherapy (time C), 36 months after chemotherapy (time D), 48 months after chemotherapy (time E), 60 months after chemotherapy (time F). The 3-years and 5-years overall survival and progress free disease survival among three groups were compared. Results: The ages, clinical stage, the size of tumor, axillary lymph node positivity and Eastern Cooperative Oncology Group Scores were similar among three groups (P>0.05); the incidence of side effects level 4 was 0. The levels of cTnT in the three groups were significantly lower than those at the baseline and time points C, D, E and F (all P<0.05), and the levels of cTnT were significantly higher in EC group than in FAC and ACT group at the time points B, C, D, E and F (P<0.05); however, the incidence of abnormal ECG and LVEF was similar among the 3 groups (P>0.05). The 5-year overall survival was 95.2% (20/21) ,100% (19/19) and 95.8% (23/24) in ACT group, FAC group and EC group, respectively; 5-year progress free disease survival was 95.2% (20/21) ,94.7% (18/19) and 91.7% (22/24) in ACT group, FAC group and EC group, respectively (P>0.05) . Conclusions: Patients with early-stage breast cancer after surgery could tolerate the anthracyclines-induced cardiotoxicity. Three chemotherapy schemes of ACT, FAC and EC, especially the EC protocol, could affect the myocardial damage. However, outcome is comparable among patients treated with above chemotherapy schemes in this patient cohort.

[Outcome determinants in cardiac arrest patients secondary to acute myocardial infarction receiving extra-corporeal membrane oxygenation combined with percutaneous coronary intervention therapy].

Objective: To investigate the clinical efficacy and outcome determinants in cardiac arrest patients secondary to acute myocardial infarction treated with extracorporeal membrane oxygenation (ECMO) and percutaneous coronary intervention (PCI). Methods: The clinical data of 27 patients hospitalized from January 2014 to March 2017 in 3 hospitals were retrospectively analyzed. The clinical data of the surviving group (12 cases) and the death group (15 cases) were compared and the outcome determinants were explored. Results: Twenty seven patients were successfully treated with coronary angiography and emergency PCI under ECMO assistance, and the successful procedure rate was 100%. The survival rate was 44.4% (12/27). There was no significant difference in gender, age, body weight, myocardial infarct location, past disease history and smoking status between the two groups (all P>0.05). Traditional cardiopulmonary resuscitation time was significantly longer, the CCU hospitalization time was significantly shorter, the number of diseased vessels was significantly higher, and the prevalence of distribution of blood vessels in left main stem was significantly higher and mean artery pressure at 24 and 48 hours post ECMO was significantly lower in the death group than in survival group (all P<0.05). Multiple logistic regression analysis showed that left anterior descending artery lesion, higher number of lesion vessels, longer traditional cardiopulmonary resuscitation time, longer time interval between cardiac arrest and ECMO placement were related increased risk of death post ECMO and emergency PCI in this patient cohort(OR=1.316, 95%CI 1.217-5.792, P=0.002; OR=1.238, 95%CI 1.107-4.961, P=0.000; OR=1.712, 95%CI 1.136-3.973, P=0.001; OR=1.629, 95%CI 1.132-4.521, P=0.000, respectively), while higher mean artery pressure at 48 hours post ECMO was related with reduced risk of death post ECMO and emergency PCI in this patient cohort(OR=0.672, 95%CI 0.326-0.693, P=0.001). Conclusions: ECMO combined with emergency PCI can improve the success rate of traditional cardiopulmonary resuscitation in patients with cardiac arrest secondary to acute myocardial infarction. Left anterior descending artery lesion, number of lesion vessels, traditional cardiopulmonary resuscitation time, time interval between cardiac arrest and ECMO placement and mean artery pressure at 48 hours post ECMO are outcome determinants post ECMO and emergency PCI in this patient cohort.

Correlation of serum PCSK9 in CHD patients with the severity of coronary arterial lesions.

OBJECTIVE: The present study aims to investigate the correlation between serum level of proprotein convertase subtilisin/kexin type 9 (PCSK9) and the severity of coronary arterial lesion in patients with coronary heart disease (CHD). PATIENTS AND METHODS: Between August 2010 and January 2015, 126 CHD patients and 70 patients with coronary arterial stenosis < 50% (controls) were included in the present study. Serum PCSK9 level was determined using ELISA. Demographic characteristics, relevant clinical data and biochemical data were collected from all patients, and their relationship with PCSK9 was analyzed to evaluate the correlation of PCSK9 expression with the severity of coronary artery disease (CAD). RESULTS: Concentrations of total cholesterol (TC) and fasting blood sugar (FBS) were significantly higher in CHD patients than in controls (p < 0.05). No significant differences were observed in gender, age, body mass index (BMI), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), family history, smoking history and history of hypertension between groups (p > 0.05). Serum PCSK9 levels in the CHD group were significantly higher than those in the control group [(96.4 ± 33.2) ng/mL vs. (81.8 ± 27.6) ng/mL, p < 0.05]. Compared with those of patients with single-vessel or double-vessel disease, PCSK9 levels were significantly elevated in patients with multi-vessel disease (p < 0.05). The Gensini score of the CHD group was significantly lower than that of the control group (11.4 ± 10.5 vs. 37.3 ± 10.3, p < 0.05). The Gensini score of patients with multi-vessel disease was significantly higher compared with patients of single-vessel  or double-vessel disease (p < 0.05). Correlation analysis revealed that PCSK9 was positively correlated with many clinical parameters, including age, BMI, TC, TG, systolic blood pressure, FBS, Gensini score and LDL-C (p < 0.05). However, PCSK9 was not correlated with either gender ratio or diastolic blood pressure (p > 0.05). CONCLUSIONS: Serum PCSK9 level is significantly elevated in CHD patients and its variation is correlated with the severity of CAD.