The effectiveness of virtual reality for rehabilitation of Parkinson disease: an overview of systematic reviews with meta-analyses.

BACKGROUND: An increasing number of systematic reviews (SRs) and meta-analyses (MAs) of clinical trials have begun to investigate the effects of virtual reality (VR) in patients with Parkinson disease (PD). The aim of this overview was to systematically summarize the current best evidence for the effectiveness of VR therapy for the rehabilitation of people with PD. METHODS: We searched SR-MAs based on randomized controlled trials (RCTs) for relevant literature in PubMed, Embase, and Cochrane library databases for systematic reviews from inception to December 5, 2020, and updated to January 26, 2022. The methodological quality of included SR-MAs was evaluated with the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2), and the certainty of evidence for outcomes with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). We created an evidence map using a bubble plot format to represent the evidence base in 5 dimensions: effect size of VR therapy versus active intervention (AT), clinical outcome area, number of trials, statistical significance, and certainty of evidence. RESULTS: From a total of 585 reports, 12 reviews were identified, of which only one was rated moderate quality, three were rated low quality, and eight were rated critically low quality by AMSTAR 2. Compared with AT, VR therapy induced increased benefits on stride/step length, balance, and neuropsychiatric symptoms. Compared with passive intervention (PT), VR therapy had greater effects on gait speed, stride/step length, balance, activities of daily living, and postural control in people with PD. Certainty of evidence varied from very low to moderate. CONCLUSIONS: We found the methodological quality of the reviews was poor, and certainty of the most evidence within them was low to very low. We were therefore unable to conclude with any confidence that, in people with PD, VR therapy is harmful or beneficial for gait, balance, motor function, quality of life, activities of daily living, cognitive function, neuropsychiatric symptoms, and postural control. In the future, rigorous-designed, high-quality RCTs with larger sample sizes are needed to further verify the effectiveness of VR therapy in the treatment of PD.

MicroRNA-342-5p protects against myocardial ischemia-reperfusion injury by targeting the GPRC5A pathway.

Myocardial ischemia/reperfusion (MI/R) injury usually occurs in patients with cardiovascular disease. However, myocardial reperfusion insult often induces apoptosis. It is assumed that that microRNAs (miRNAs) are involved in the pathological and physiological processes associated with myocardial ischemia/reperfusion (MI/R). In the present study, we found decreased expression of miR-342-5p in hypoxia/reoxygenation (H/R) cardiomyocyte model (H9C2 cells) and MI/R mouse model. Alternatively, overexpression of miR-342-5p was found to ameliorate myocardial cell damage in both in vivo and in vitro. In addition, G protein-coupled receptor, family C, group 5, member A (GPRC5A) was identified as a direct target of miR-342-5p. The up-regulation of GPRC5A functioned to inhibit the previously observed protective effect of miR-342-5p in the H9C2 H/R model. Our results revealed that miR-342-5p may be a potential target for MI/R injury prevention and therapy of MI/R injury.