Objective To evaluate the systematic reviews of repetitive transcranial magnetic stimulation (rTMS) for insomnia, to provide supporting evidence for clinical practice. Methods PubMed, Embase, Web of Science, Cochrane Library, Elsevier Science Direct, China National Knowledge Infrastructure, SinoMed, Wanfang and Chongqing VIP were searched from databases establishment to May 30, 2022, to find systematic reviews on the treatment of insomnia with rTMS as the main method. The methodological quality, reporting quality and evidence quality of outcome indicators were evaluated by AMSTAR 2, PRISMA 2020 and GRADE. Results A total of 4 systematic reviews published between 2018 and 2021 were included. Further analysis showed that one of the systematic reviews had a low AMSTAR 2 quality rating and the remaining systematic reviews were very low. The average PRISMA 2020 score of these 4 systematic reviews was (20.75±3.27) points, of which 3 systematic reviews had some defects in their reports, and the other one had relatively complete reports. The GRADE evidence quality assessment showed that there were 40 outcome indicators in the included literature, of which 3 outcome indicators (sleep quality, the percentage of S2 sleep in total sleep time, and S3 sleep in percentage of total sleep time) were rated as moderate, 17 were rated as low and 20 were rated as very low. Conclusions The treatment of insomnia by rTMS has achieved certain effects in clinical practice, but the systematic review of rTMS as the main intervention measure for insomnia needs to further improve the quality and standardize related research. The clinical application of rTMS for insomnia should be treated as appropriate.
【Abstract】ObjectiveTo study Toll like receptor 4 (TLR4) expression on peripheral blood monocytes (PBMCs) during the early stage of human acute pancreatitis. MethodsThirty consecutive patients with acute pancreatitis admitted within 24 h of onset of abdominal pain were enrolled in this study. Another 20 healthy volunteers were included as control. Blood samples were collected by venipuncture on the day of admission and 3， 7 d after admission and PBMCs were isolated. TLR4 and CD14 expressions on PBMCs were detected by flow cytometry. Serum tumor necrosis factor alpha (TNF-α) and interleukin 6 (IL-6) were measured simultaneously. Correlations between these parameters were analyzed. ResultsTLR4 expression increased on the day of admission and then continued to decline for several days. On third day, TLR4 expression was almost normal compared with the normal control. The alteration of serum TNF-α was consistent with that of TLR4. ConclusionDuring the early stage of human acute pancreatitis, mononuclear-macrophages may be ignited through TLR4 (a door keeper of innate immune system), which lead to TNF-α production.