Objective This study aimed to investigate the effect of sequential bilateral low‐frequency repetitive transcranial magnetic stimulation (rTMS) over dorsolateral prefrontal cortex (DLPFC) on patients with primary insomnia (PI). Methods A total of 32 eligible right‐handed participants diagnosed by PI according to International classification of sleep disorders (ICD‐3) were recruited into this study. Participants received 10 daily sessions of sequential bilateral 1 Hz rTMS over DLPFC. Before and after the whole procedure of rTMS, patients were assessed by Pittsburgh Sleep Quality Index (PSQI) for the severity of sleep disturbance. Meanwhile, serum concentration of brain‐derived neurotrophic factor (BDNF) and gamma‐aminobutyric acid (GABA) in patients was measured by ELISA and UPLC, respectively. Moreover, the amplitude of MEPs reflecting the right cortical excitability was examined. Finally, Pearson correlation analysis was performed to evaluate the correlation among the change of these variables. Results After rTMS treatment, the PSQI score was markedly decreased as compared to pre‐rTMS; the concentrations of serum BDNF and GABA were significantly higher; the amplitude of MEPs was markedly reduced. Pearson correlation analysis revealed that the change of PSQI score was negatively associated with the alteration of serum BDNF level and serum GABA level, and positively associated with the change of MEPs amplitude; the change of MEPs amplitude was negatively associated with fold change in the serum BDNF level and the serum GABA level; the increase in serum GABA level was positively associated with the serum BDNF level. Conclusions A sequential bilateral low‐frequency rTMS over DLPFC significantly improves primary insomnia probably by increasing the level of BDNF and GABA in the brain and reducing cortical excitability.

Backgroundhypertension is one of the major preventable risk factors for numerous diseases. The role of vitamin E in blood pressure (BP) has been controversial. We aimed to investigate the relationship between gamma-tocopherol serum concentration (GTSC) and BPMethodsData from 15,687 US adults from the National Health and Nutrition Examination Survey (NHANES) were analyzed. The correlations of GTSC with systolic BP (SBP), diastolic BP (DBP), and prevalence of hypertension were investigated by multivariate logistic regression models, generalized summation models, and fitted smoothing curves. Subgroup analyses were performed to investigate possible effect modifiers between them.ResultsWith each natural log increase in GTSC, SBP, and DBP increased by 1.28 mmHg (β 1.28, 95% CI 0.71–1.84) and 1.15 mmHg (β 1.15, 95% CI 0.72–1.57), respectively, both P for trend < 0.001; the prevalence of hypertension increased by 12% (OR 1.12, 95% CI 1.03–1.22), P for trend 0.008. In subgroup analysis, in drinkers, with each natural log increase in GTSC, SBP, and DBP increased by 1.77 mmHg (β 1.77,95% CI 1.13–2.41) and 1.37 mmHg (β 1.37,95% CI 0.9–1.85), respectively, whereas they were not correlated in non-drinkers.ConclusionGTSC was linearly and positively associated with SBP, DBP, and the prevalence of hypertension, and alcohol consumption may modify the relationship of GTSC with SBP and DBP.