Some studies have confirmed the neuroprotective effect of remote ischemic conditioning against stroke. Although numerous animal researches have shown that the neuroprotective effect of remote ischemic conditioning may...Some studies have confirmed the neuroprotective effect of remote ischemic conditioning against stroke. Although numerous animal researches have shown that the neuroprotective effect of remote ischemic conditioning may be related to neuroinflammation, cellular immunity, apoptosis, and autophagy, the exact underlying molecular mechanisms are unclear. This review summarizes the current status of different types of remote ischemic conditioning methods in animal and clinical studies and analyzes their commonalities and differences in neuroprotective mechanisms and signaling pathways. Remote ischemic conditioning has emerged as a potential therapeutic approach for improving stroke-induced brain injury owing to its simplicity, non-invasiveness, safety, and patient tolerability. Different forms of remote ischemic conditioning exhibit distinct intervention patterns, timing, and application range. Mechanistically, remote ischemic conditioning can exert neuroprotective effects by activating the Notch1/phosphatidylinositol 3-kinase/Akt signaling pathway, improving cerebral perfusion, suppressing neuroinflammation, inhibiting cell apoptosis, activating autophagy, and promoting neural regeneration. While remote ischemic conditioning has shown potential in improving stroke outcomes, its full clinical translation has not yet been achieved.展开更多
Sleep disturbances are common in patients with stroke,and sleep quality has a critical role in the onset and outcome of stroke.Poor sleep exacerbates neurological injury,impedes nerve regeneration,and elicits serious ...Sleep disturbances are common in patients with stroke,and sleep quality has a critical role in the onset and outcome of stroke.Poor sleep exacerbates neurological injury,impedes nerve regeneration,and elicits serious complications.Thus,exploring a therapy suitable for patients with stroke and sleep disturbances is imperative.As a multi-targeted nonpharmacological intervention,remote ischemic conditioning can reduce the ischemic size of the brain,improve the functional outcome of stroke,and increase sleep duration.Preclinical/clinical evidence showed that this method can inhibit the inflammatory response,mediate the signal transductions of adenosine,activate the efferents of the vagal nerve,and reset the circadian clocks,all of which are involved in sleep regulation.In particular,cytokines tumor necrosis factorα(TNFα)and adenosine are sleep factors,and electrical vagal nerve stimulation can improve insomnia.On the basis of the common mechanisms of remote ischemic conditioning and sleep regulation,a causal relationship was proposed between remote ischemic conditioning and post-stroke sleep quality.展开更多
Background: Stroke has been considered the major cause of chronic disability in the world and ranks among the leading causes of death. Despite the fact that new vascular events often happen and risk factors are the sa...Background: Stroke has been considered the major cause of chronic disability in the world and ranks among the leading causes of death. Despite the fact that new vascular events often happen and risk factors are the same that Cardiovascular Diseases, secondary prevention through non-pharmacological measures, are not part of the routine physical rehabilitation after stroke. Objective: The aim is to answer the following clinical question: Should aerobic fitness be part of the physical rehabilitation of individuals post-stroke? Methodological Design: The methodology used in the study was an integrative literature review. Inclusion Criteria: Articles in English are published in secondary databases: systematic reviews with or without meta-analysis, which address the question PICO: patient (post-stroke), intervention (aerobic exercise), comparison (with or without aerobic conditioning) the outcome (volume of oxygen consumed peak (VO<sub>2peak</sub>), quality of life (QoL), morbidity and mortality). Outcomes: VO<sub>2peak</sub>, QoL, complications and mortality. Analysis of Studies: The methodological quality of included studies is assessed using the tools: PRISMA and R-AMSTAR. Results: There was “good” evidence for the inclusion of aerobic exercise on physical rehabilitation of post-stroke individuals to improve their physical capacity (VO<sub>2peak</sub>), facilitating the completion of activities of daily living and gait. There was weak evidence on the association of aerobic fitness with positive results on QoL in stroke victims and insufficient results to evaluate the effect of aerobic fitness on the risk of stroke recurrence and mortality. Conclusion: The aerobic conditioning should be included in the rehabilitation of stroke victims.展开更多
Despite obvious progress in the treatment of acute forms of ischemic stroke, the risk of this condition remains unacceptably high. Brain infarction in the middle cerebral artery basin occurs in patients with atheroscl...Despite obvious progress in the treatment of acute forms of ischemic stroke, the risk of this condition remains unacceptably high. Brain infarction in the middle cerebral artery basin occurs in patients with atherosclerosis. The onset of the brain infarction is facilitated by the cessation of circulation (embolism) in conditions of insufficient collateral circulation. The extent of the infarct zone is determined by neuronal death and impaired microcirculation. The development of new methods for effective targeted restorative stroke therapy is crucial for restorative treatment and reducing the risk of mortality after stroke. Remote ischemic conditioning (RIC) is an approach to limiting reperfusion injury in the ischemic region of the brain after focal ischemia. One of the most commonly used <i>in vivo</i> models in stroke studies is the filament model of Middle Cerebral Artery Occlusion (MCAO) in rats. In our experiment, it was performed for 30 min (J. Koizumi) with subsequent 48-hour reperfusion. Within the first 24 hours after the start of reperfusion several short episodes of ischemia in low limbs were induced. After 48 hours of reperfusion the brains were harvested and stained with TTC. Then we evaluated the effect of RIC within 24 hours <i>ex vivo</i> in rats’ brains, as well as syndecan-1 plasma concentration. Infarct area was assessed by means of Image-Pro program with statistical analysis. Infarct volumes in the model group (31.97% ± 2.5%) were significantly higher compared to the values in the RIC group 48 hours after ischemia-reperfusion (13.6% ± 1.3%) (*P < 0.05). A significant reduction in the area of infarction after RIC is likely due to the effect on the regulation of collateral blood flow in the ischemia area. On the second day after ischemia-reperfusion, tissue swelling was reduced in the RIC group compared to the model group. Analysis of the average concentration of Syndecan-1 revealed the difference between model and RIC groups. Syndecan-1, endothelial glycocalyx protein, might be the regulat展开更多
Ischemic stroke is a major neurological disease with limited effective therapeutic options except for thrombolysis and thrombectomy. Remote ischemic conditioning (RIC) is an approach that promises an alternative to th...Ischemic stroke is a major neurological disease with limited effective therapeutic options except for thrombolysis and thrombectomy. Remote ischemic conditioning (RIC) is an approach that promises an alternative to the current treatment portfolio. As an easy-handled, non-invasive regimen, it takes advantage of transient ischemia (currently often made through inflation and deflation of limb blood pressure cuff) to enhance the tolerance of vital organs to ischemia. RIC can be executed before, during and after the onset of stroke. The mechanisms of action of RIC employed at different stroke stages are similar and may involve humoral, neurological and inflammatory pathways. As new mechanisms underlying RIC-induced neuroprotection continue to be revealed, we review in this article some of the latest development in this field, including:① RIC and RIC-induced fundamental change, hypoxia, as well as the role of hypoxia inducible factors against stroke;② Potential role of RIC-induced extracellular vesicles in neuroprotection;③ RIC-induced metabolic changes in tissue protection;④ Potential effect of RIC on red blood cells (RBC) oxygen delivery;and ⑤ RIC and its anti-inflammatory potential.展开更多
基金supported partly by the National Natural Science Foundation of China,No.82071332the Chongqing Natural Science Foundation Joint Fund for Innovation and Development,No.CSTB2023NSCQ-LZX0041 (both to ZG)。
文摘Some studies have confirmed the neuroprotective effect of remote ischemic conditioning against stroke. Although numerous animal researches have shown that the neuroprotective effect of remote ischemic conditioning may be related to neuroinflammation, cellular immunity, apoptosis, and autophagy, the exact underlying molecular mechanisms are unclear. This review summarizes the current status of different types of remote ischemic conditioning methods in animal and clinical studies and analyzes their commonalities and differences in neuroprotective mechanisms and signaling pathways. Remote ischemic conditioning has emerged as a potential therapeutic approach for improving stroke-induced brain injury owing to its simplicity, non-invasiveness, safety, and patient tolerability. Different forms of remote ischemic conditioning exhibit distinct intervention patterns, timing, and application range. Mechanistically, remote ischemic conditioning can exert neuroprotective effects by activating the Notch1/phosphatidylinositol 3-kinase/Akt signaling pathway, improving cerebral perfusion, suppressing neuroinflammation, inhibiting cell apoptosis, activating autophagy, and promoting neural regeneration. While remote ischemic conditioning has shown potential in improving stroke outcomes, its full clinical translation has not yet been achieved.
基金supported by the National Key R&D Program of China(No.2017YFC1308401)the Talent Introduction Project of the Beijing Bureau of Foreign Expert(No.BJ2018001).
文摘Sleep disturbances are common in patients with stroke,and sleep quality has a critical role in the onset and outcome of stroke.Poor sleep exacerbates neurological injury,impedes nerve regeneration,and elicits serious complications.Thus,exploring a therapy suitable for patients with stroke and sleep disturbances is imperative.As a multi-targeted nonpharmacological intervention,remote ischemic conditioning can reduce the ischemic size of the brain,improve the functional outcome of stroke,and increase sleep duration.Preclinical/clinical evidence showed that this method can inhibit the inflammatory response,mediate the signal transductions of adenosine,activate the efferents of the vagal nerve,and reset the circadian clocks,all of which are involved in sleep regulation.In particular,cytokines tumor necrosis factorα(TNFα)and adenosine are sleep factors,and electrical vagal nerve stimulation can improve insomnia.On the basis of the common mechanisms of remote ischemic conditioning and sleep regulation,a causal relationship was proposed between remote ischemic conditioning and post-stroke sleep quality.
文摘Background: Stroke has been considered the major cause of chronic disability in the world and ranks among the leading causes of death. Despite the fact that new vascular events often happen and risk factors are the same that Cardiovascular Diseases, secondary prevention through non-pharmacological measures, are not part of the routine physical rehabilitation after stroke. Objective: The aim is to answer the following clinical question: Should aerobic fitness be part of the physical rehabilitation of individuals post-stroke? Methodological Design: The methodology used in the study was an integrative literature review. Inclusion Criteria: Articles in English are published in secondary databases: systematic reviews with or without meta-analysis, which address the question PICO: patient (post-stroke), intervention (aerobic exercise), comparison (with or without aerobic conditioning) the outcome (volume of oxygen consumed peak (VO<sub>2peak</sub>), quality of life (QoL), morbidity and mortality). Outcomes: VO<sub>2peak</sub>, QoL, complications and mortality. Analysis of Studies: The methodological quality of included studies is assessed using the tools: PRISMA and R-AMSTAR. Results: There was “good” evidence for the inclusion of aerobic exercise on physical rehabilitation of post-stroke individuals to improve their physical capacity (VO<sub>2peak</sub>), facilitating the completion of activities of daily living and gait. There was weak evidence on the association of aerobic fitness with positive results on QoL in stroke victims and insufficient results to evaluate the effect of aerobic fitness on the risk of stroke recurrence and mortality. Conclusion: The aerobic conditioning should be included in the rehabilitation of stroke victims.
文摘Despite obvious progress in the treatment of acute forms of ischemic stroke, the risk of this condition remains unacceptably high. Brain infarction in the middle cerebral artery basin occurs in patients with atherosclerosis. The onset of the brain infarction is facilitated by the cessation of circulation (embolism) in conditions of insufficient collateral circulation. The extent of the infarct zone is determined by neuronal death and impaired microcirculation. The development of new methods for effective targeted restorative stroke therapy is crucial for restorative treatment and reducing the risk of mortality after stroke. Remote ischemic conditioning (RIC) is an approach to limiting reperfusion injury in the ischemic region of the brain after focal ischemia. One of the most commonly used <i>in vivo</i> models in stroke studies is the filament model of Middle Cerebral Artery Occlusion (MCAO) in rats. In our experiment, it was performed for 30 min (J. Koizumi) with subsequent 48-hour reperfusion. Within the first 24 hours after the start of reperfusion several short episodes of ischemia in low limbs were induced. After 48 hours of reperfusion the brains were harvested and stained with TTC. Then we evaluated the effect of RIC within 24 hours <i>ex vivo</i> in rats’ brains, as well as syndecan-1 plasma concentration. Infarct area was assessed by means of Image-Pro program with statistical analysis. Infarct volumes in the model group (31.97% ± 2.5%) were significantly higher compared to the values in the RIC group 48 hours after ischemia-reperfusion (13.6% ± 1.3%) (*P < 0.05). A significant reduction in the area of infarction after RIC is likely due to the effect on the regulation of collateral blood flow in the ischemia area. On the second day after ischemia-reperfusion, tissue swelling was reduced in the RIC group compared to the model group. Analysis of the average concentration of Syndecan-1 revealed the difference between model and RIC groups. Syndecan-1, endothelial glycocalyx protein, might be the regulat
文摘Ischemic stroke is a major neurological disease with limited effective therapeutic options except for thrombolysis and thrombectomy. Remote ischemic conditioning (RIC) is an approach that promises an alternative to the current treatment portfolio. As an easy-handled, non-invasive regimen, it takes advantage of transient ischemia (currently often made through inflation and deflation of limb blood pressure cuff) to enhance the tolerance of vital organs to ischemia. RIC can be executed before, during and after the onset of stroke. The mechanisms of action of RIC employed at different stroke stages are similar and may involve humoral, neurological and inflammatory pathways. As new mechanisms underlying RIC-induced neuroprotection continue to be revealed, we review in this article some of the latest development in this field, including:① RIC and RIC-induced fundamental change, hypoxia, as well as the role of hypoxia inducible factors against stroke;② Potential role of RIC-induced extracellular vesicles in neuroprotection;③ RIC-induced metabolic changes in tissue protection;④ Potential effect of RIC on red blood cells (RBC) oxygen delivery;and ⑤ RIC and its anti-inflammatory potential.
