成人缺血性脑卒中后神经修复结局的非侵入性、非药物/生物技术干预措施——系统评价、综合文献综述。

Non-invasive, non-pharmacological/bio-technological interventions towards neurorestoration upshot after ischemic stroke, in adults-systematic, synthetic, literature review.

机构信息

Physical and Rehabilitation Medicine Department, Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila", 020022 Bucharest, Romania.

Neuromuscular Rehabilitation Clinic Division, Teaching Emergency Hospital "Bagdasar-Arseni", 041915 Bucharest, Romania.

出版信息

Front Biosci (Landmark Ed). 2021 Nov 30;26(11):1204-1239. doi: 10.52586/5020.

Abstract

Considering its marked life-threatening and (not seldom: severe and/or permanent) disabling, potential, plus the overall medico-psycho-socio-economic tough burden it represents for the affected persons, their families and the community, the cerebrovascular accident (CVA)-including with the, by far more frequent, ischemic type-is subject to considerable scientific research efforts that aim (if possible) at eliminating the stroke induced lesions, and consist, as well, in ambitious-but still poorly transferable into medical practice-goals such as brain neuroregeneration and/or repair, within related corollary/upshot of neurorestoration. We have conducted, in this respect, a systematic and synthetic literature review, following the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)" concept. Accordingly, we have interrogated five internationally renowned medical data bases: Elsevier, NCBI/PubMed, NCBI/PMC, PEDro, and ISI Web of Knowledge/Science (the last one to check whether the initially identified articles are published in ISI indexed journals), based on a large (details in the body text) number of most appropriate, to our knowledge, key word combinations/"syntaxes"-used contextually-and subsequently fulfilling the related, on five steps, filtering/selection methodology. We have thereby selected 114 fully eligible (of which contributive: 83-see further) papers; at the same time, additionally, we have enhanced our documentation-basically, but not exclusively, for the introductive part of this work (see further)-with bibliographic resources, overall connected to our subject, identified in the literature within a non-standardized search. It appears that the opportunity window for morph-functional recovery after stroke is larger than previously thought, actually being considered that brain neurorestoration/repair could occur, and therefore be expected, in later stages than in earlier ones, although, in this context, the number of cases possibly benefitting (for instance after physical and/or cognitive rehabilitation-including with magnetic or direct current transcranial stimulation) is quite small and with more or less conflicting, related outcomes, in the literature. Moreover, applying especially high intense, solicitating, rehabilitation interventions, in early stages post (including ischemic) stroke could even worsen the functional evolution. Accordingly, for clarifications and validation of more unitary points of view, continuing and boosting research efforts in this complex, interdisciplinary domain, is necessary. Until finding (if ever) effective modalities to cure the lesions of the central nervous system (CNS)-including post ischemic stroke-it is reasonable and recommendable-based on rigorous methodologies-the avail of combined ways: physiatric, pharmacologic, possibly also bio-technologic. On a different note, but however connected to our subject: periodic related systematic, synthetic literature reviews reappraisals are warranted and welcome.

摘要

考虑到其具有明显的危及生命和(不少情况下:严重和/或永久性)致残的潜在风险,以及它给患者、其家庭和社区带来的整体医疗-心理-社会经济负担,脑血管意外(CVA)——包括更为常见的缺血性类型——受到了相当多的科学研究关注,这些研究旨在(如果可能的话)消除中风引起的损伤,并实现雄心勃勃的目标,如脑神经再生和/或修复,这是神经修复的相关结果。在这方面,我们按照“系统评价和荟萃分析的首选报告项目(PRISMA)”的概念进行了系统和综合的文献回顾。为此,我们在五个国际知名的医学数据库中进行了检索:Elsevier、NCBI/PubMed、NCBI/PMC、PEDro 和 ISI Web of Knowledge/Science(最后一个用于检查最初确定的文章是否发表在 ISI 索引期刊上),基于大量(详细信息在正文文本中)我们认为最合适的、与我们的知识相关的关键词组合/“语法”——上下文使用——并随后满足相关的、分五步的筛选/选择方法。我们因此选择了 114 篇完全符合条件的(其中有贡献的:83 篇——见下文)论文;同时,我们还通过文献中的参考文献资源扩展了我们的文献资料,这些文献资源基本上但不限于本工作的引言部分(见下文),与我们的主题相关,在非标准化搜索中确定。似乎中风后形态功能恢复的机会窗口比以前想象的要大,实际上,脑神经修复/修复有可能发生,并且因此可以预期,在早期阶段比在晚期阶段,尽管在这种情况下,可能受益的病例数量(例如,在身体和/或认知康复后——包括磁刺激或直流电经颅刺激)相当小,并且文献中相关结果存在或多或少的冲突。此外,在(包括缺血性)中风后早期阶段应用特别高强度、高要求的康复干预措施甚至可能会使功能演变恶化。因此,有必要继续加强这一复杂的跨学科领域的研究工作,以澄清和验证更统一的观点。直到找到(如果有的话)治愈中枢神经系统(CNS)损伤的有效方法——包括中风后——基于严格的方法,使用联合方法是合理和推荐的:物理治疗、药物治疗,可能还有生物技术。另一方面,但与我们的主题相关:定期进行相关的系统、综合文献综述重新评估是必要的,也是受欢迎的。

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