Disorders Of Cerebral Circulation Research Articles

Natural products for the treatment of neurodegenerative diseases

BackgroundNeurodegenerative diseases are among the most common diseases in older adults worldwide. Alzheimer's disease (AD) and Parkinson's disease (PD) are two of the most common neurodegenerative diseases, and are accompanied by cerebral cortical atrophy, neuronal loss, protein accumulation, and excessive accumulation of metal ions. Natural products exhibit outstanding performance in improving cerebral circulatory disorders, promoting cerebral haematoma absorption, repairing damaged nerve tissue, and improving damaged nerve function. In recent years, studies have shown that neuroinflammatory mechanisms and signalling pathways closely related to the occurrence and development of neurological diseases include microglial activation, nuclear factor-κB (NF-κB) pathway, mitogen activated protein kinases (MAPK) pathway, reactive oxygen pathway, nucleotide binding oligomerisation domain-like receptor protein3 (NLRP3) inflammasomes, toll-like receptor4 (TLR4) pathway, nuclear factor erythroid 2-related factor 2 (Nrf2)/hemeoxygenase-1 (HO-1) pathway, phosphoinositide 3-kinase (PI3K)/protein kinase B (Akt) pathway, and intestinal flora. Therefore, this study considered the mechanism of neurological diseases as the starting point to review the mechanism of action of natural products in the prevention and treatment of AD and PD in recent years to provide a theoretical basis for clinical prevention and treatment. AimNatural products are a promising source of novel lead structures that have long been used to treat various nervous system diseases. MethodologyThis review collected literature on neurological diseases and natural products from 2012 to 2022, which were mainly searched through databases such as ScienceDirect, Springer, PubMed, SciFinder, China National Knowledge Infrastructure (CNKI), Wanfang, Google Scholar, and Baidu Academic. The following keywords were searched: neurological disorders, natural products, signalling pathway, mechanism of action. ResultsThis review summarises the pathogenesis of degenerative neurological diseases, recent findings on natural products used in neurodegenerative diseases, and the molecular mechanisms underlying these effects.

Acute myocardial infarction and brain infarction morbidity as a quality indicator of the chronic non-communicable diseases overcoming in Turkmenistan

Improving the provision of medical care to patients with chronic non-communicable diseases should be based on objective indicators of the effectiveness of preventive measures and medical examinations. Such an indicator can be the incidence of acute myocardial infarction and cerebral infarction. Objective: to characterize the trends in the dynamics of the incidence of myocardial infarction and acute disorders of cerebral circulation in Turkmenistan. Materials and methods. A retrospective descriptive epidemiological study was performed. The dynamics, spatial and temporal characteristics of the incidence of myocardial infarction (ICD-10 code I21–I23), cerebral infarction (ICD-10 code I63) in the period 2016– 2020 in Turkmenistan as a whole and by administrative-territorial units were studied. Results. During the study period, Turkmenistan has seen a decrease in the overall incidence of acute myocardial infarction from 10.9 per 100 thousand in 2016 to 7.8 per 100 thousand in 2020. Currently, the highest level of total incidence of myocardial infarction is registered in Ashgabat and the Balkan Velayat (9.0 per 100 thousand people), the smallest is in the Mary Velayat (6.9 per 100 thousand people). There is also a decrease in the overall incidence of acute disorders of cerebral circulation. In the whole country from 2016 to 2020, the indicator decreased from 5.6 to 4.7 per 100 thousand population. At the level of individual administrative-territorial units, significant fluctuations in indicators were observed during the study period, and in the city of Ashgabat, an increase in the overall incidence of brain infarction. Conclusion. The decrease in the overall incidence of acute cerebral circulatory disorders and acute myocardial infarction indicates the high quality of the work of the national health system in the aspect of prevention of chronic NCDs. In some administrative-territorial units of Turkmenistan, the peculiarities of the dynamics of morbidity were revealed, requiring special organizational approaches.

Stroke lesion segmentation model based on convolutional fusion and an improved attention mechanism

Ischemic stroke is an acute cerebral blood circulation disorder caused by cerebral artery stenosis or occlusion with high rates of fatality and disability. Magnetic resonance imaging has shown high efficiency in the rapid diagnosis of ischemic stroke. However, the segmentation of stroke lesions is challenging because of their small size and blurred boundaries with normal tissues. Manually segmenting the lesions is subjective, laborious, and time-consuming. Therefore, we propose a segmentation model for stroke lesions that is based on the fusion of convolution and an improved attention mechanism. First, to extract richer context information, we propose a convolutional fusion encoding module that realizes the fusion of two-dimensional convolution and three-dimensional convolution on the contraction path in the encoding end, and enhance features using the convolutional block attention mechanism module. Then, we propose an improved residual-attention gate hybrid decoding module for integrating features with different resolutions focusing on the target region, thus improving the segmentation detail of the edges of small lesions. Lastly, we use a stroke lesion dataset to evaluate its performance in the experiment. The results demonstrate that, compared with the existing models such as TransUNet, SAN-Net, and W-Net, the Dice similarity coefficient of the proposed model exhibits better (0.6193) performance.

Retrospective analysis of cases of transient global amnesia admitted to the hospital

Introduction. Transient global amnesia (TGA) is a clinical syndrome, the main clinical manifestation of which is sudden development of anterograde and retrograde amnesia, lasting not more than 24 hours, without other general cerebral or focal neurological symptoms.The aim of the work was to reveal the peculiarities of clinical manifestations and data of additional methods of examination of patients with TGA syndrome referred to the primary vascular department with suspected acute cerebral circulation disorder (ACCD).Materials and methods. The study included 16 patients with transient global amnesia diagnosed according to the diagnostic criteria of Hodges and Warlow (1990). All patients underwent a detailed neurological and general medical examination. Electrocardiography, multispiral computer tomography of the head, echocardiography, ultrasound duplex scanning of the main arteries of the head and neck, laboratory examination (lipid spectrum) were performed. The Brief Mental Status Rating Scale was used to assess cognitive impairment.Results. The majority of patients had elevated blood pressure (BP). The leading trigger factor of transient global amnesia was stress. The duration of amnesia ranged from 1.5 to 5 hours. There was a significant impairment of short-term memory. On the first and second days of hospitalization, 50% of patients had normal cognitive functions on a brief mental status assessment scale, but by the 5th−7th day only 12.5 % of patients had abnormalities. Ultrasound markers of atherosclerosis in the form of intima-media complex thickening and dyslipidemia were found in 6 patients. Signs of left ventricular hypertrophy were found in the majority of patients. Discussion TGA is a relatively rare condition and an understudied syndrome. Due to its suddenness of clinical manifestation, TGA requires differential diagnostics with acute cerebral circulatory disorders, epilepsy, acute hypertensive encephalopathy and psychogenic amnesia.Conclusion. The clinical features of TGA identified in the patients were a history of arterial hypertension, elevated BP during an episode of TGA. The leading provoking factor was stress. TGA episode occurred predominantly in the first half of the day. The majority of patients had complaints of headache on admission. Cognitive disorders detected in patients on the first and second days of the disease quickly regressed to normal. Left ventricular hypertrophy was detected in most patients.

Cerebroprotective effect of sitagliptin and aminoguanidine combination in disorders of cerebral circulation

The aim of the study was to evaluate a cerebroprotective activity of the sitagliptin and aminoguanidine combination in rats with an acute and chronic cerebral circulation insufficiency, as well as with a traumatic brain injury.Materials and methods. The study was carried out on male Wistar rats in 3 stages using, respectively, a model of a chronic pathology: a chronic cerebral circulation insufficiency (CCCI), as well as 2 models of the acute brain injury (BI): an acute cerebral circulation insufficiency (ACCI), and a traumatic brain injury (TBI). А CCCI was modeled by a bilateral stenosis of the common carotid arteries (by 50%), a model of a hemorrhagic stroke caused by an intracerebral injection of the autologous blood was used as a stroke, a TBI was modeled by a mechanical damage to the brain tissue. To assess the pathology course severity, the following tests were used: Adhesion test, Open field, Morris water maze test, as well as Garcia and Combs&D’Alecy scales. In the animals with an acute damage to the brain at the end of the experiment, the severity of edema of the affected hemisphere was also determined. The treatment was with sitagliptin (10 mg/kg), aminoguanidine (25 mg/kg), or a combination thereof. The obtained data were subjected to the statistical processing.Results. In the course of the study, it was found out that the administration of a sitagliptin and aminoguanidine combination, unlike each of the components, had a cerebroprotective effect in the animals with a chronic or acute damage to the brain, reducing the severity of psychoneurological (cognitive and sensory-motor) disorders, as well as the brain edema.Conclusion. Aminoguanidine, as an iNOS blocker, enhances the action of sitagliptin, preventing the brain edema development and reducing the neurological deficit severity (the severity of cognitive and sensory-motor impairments) in the animals with an acute and chronic cerebral circulation insufficiency.

Improving multidisciplinary hospital care for acute cerebral circulation disorders in Kazakhstan

BackgroundAccording to the World Stroke Organization, there was a significant increase in stroke cases, stroke deaths, and the DALY rate in low- and middle-income countries in 2022. The number of stroke cases rose by 70.0%, stroke deaths reached 86.0%, and the DALY rate reached 89.0%. Among cerebrovascular diseases, ischemic stroke accounts for 62.0% of all strokes, with more than 7.6 million cases reported annually.Kazakhstan, with a population of 19,832,737, is the largest country in Central Asia in terms of territory. In Kazakhstan, the incidence of cerebrovascular disease has risen from 258.4 cases per 100,000 population in 2015 to 433.7 cases per 100,000 population in 2020. Official statistics indicate that the average inpatient mortality rate from stroke in the country is 16.2%, and the average time for patients to be delivered to the hospital after an ambulance call is 40 min (83.2%).Our study findings reveal that in the regions of Kazakhstan, the main contributors to the high morbidity and mortality rates in stroke are a shortage of doctors, inadequate primary healthcare, insufficient follow-up and treatment, and delayed hospitalization. Consequently, this study has helped fill knowledge gaps regarding the epidemiological situation in these regions and underscores the need for training doctors in managing high-risk patients, establishing multidisciplinary home visit teams, and establishing “Stroke Schools” to enhance public awareness of early stroke signs and the fundamentals of a healthy lifestyle. Future research endeavors should consider these study results as valuable contributions towards addressing the existing problems. AimTo study the prevalence and mortality of acute cerebral circulation impairment in the population within multidisciplinary hospitals in the cities of Nur-Sultan and Almaty, Republic of Kazakhstan, for the period of 2018–2020.This retrospective study was conducted in two stages. In the first stage, an analysis of morbidity, prevalence, and mortality was conducted for the population of Nur-Sultan and Almaty cities, as well as for the overall population of Kazakhstan. This analysis was based on data from the “Electronic Register of Discharged Patients” (IS ERDB) and the annual collection “Health of the Population of the Republic of Kazakhstan and the Activities of Health Organizations in 2015–2020". In the second stage, we examined the care provided to patients with acute impaired cerebral circulation in a multidisciplinary hospital in these two cities. The analysis was based on data regarding the sex and age composition of treated patients in hospitals across the Republic of Kazakhstan, categorized according to the ICD-10 code “Acute Impaired Cerebral Circulation” (I60–I64). We investigated the methods of patients' delivery to medical organizations, types of hospitalization, and outcomes of treated patients. The sample of patients was selected using data from the “Electronic Register of Dispensary Patients” of the Ministry of Health of the Republic of Kazakhstan, along with the statistical collection “Health of the Population of the Republic of Kazakhstan and the Activities of Healthcare Organizations”. Between January 1, 2018, and December 31, 2020, a total of 5965 patients were diagnosed with a cerebrovascular event and admitted to a general hospital in Nur-Sultan city, while 13,498 patients were diagnosed and admitted in Almaty city.

Dosiahnennia kardiolohii u vyvchenni kryteriiv diahnostyky ta predyktoriv prohnozuvannia uskladnen systemy krovoobihu pid chas ishemichnoi khvoroby sertsia u poiednanni z arterialnoiu hipertenziieiu (ohliad literatury; rezultaty vlasnykh doslidzhen)

Introduction. It is generally accepted, that activation of renin-angiotensin-aldosterone system is the first step in the development of hypertension, subsequently leading to the formation of atherosclerotic lesions in blood vessels of heart, brain, kidneys, aorta, and further alteration of peripheral vessels. Some time after the onset of hypertension, left ventricle hypertension develops, inducing various forms of coronary heart disease, strokes, etc. Currently the above circumstances turned to be a global problem of cardiology and medicine. However, data on diagnostic criteria and the evaluation of these combined diseases prognostic predictors are far from complete. The aim of the study. To reflect achievements of modern cardiology in the investigation of criteria predicting complications in the blood circulatory system. Materials and methods. A review of 51 articles is supplemented with author`s own results. Results. It is estimated that arterial hypertension induce hypertrophy of the left ventricle with further cardiac remodeling, which contributes to myocardial infarction, strokes, and cardiac arrhythmias. In patients with coronary heart disease combined with hypertension, structural reorganization of myocardium is supplemented with remodeling of cardiac conducting system resulting with ventricular extrasystoles, atrial fibrillation, etc. Predictors of acute left ventricular failure and chronic heart failure have been published in the literature. Due to our observations, coronary heart disease in patients with hypertension correlates with disturbances in central hemodynamics, decreased contractile function of the left ventricle, changes in blood supply of different pulmonary zones, significant disturbances in tissue metabolism, these pathological signs leading to the development of chronic heart failure, arrhythmias and heart blockage, disorders of cerebral blood circulation. Conclusion. The obtained results make it possible the identification of diagnostic criteria and predictors of various circulatory complications in patients with the diagnosed coronary heart disease combined with hypertension. However, more observations are needed to get new insight into the pathogenic mechanisms of complications development, further specification of their predictors and creating more effective methods of their prevention. Keywords: prediction of malignant arrhythmias, atrial fibrillation, left ventricular hypertrophy.

ACUTE DISORDERS OF CEREBRAL CIRCULATION AGAINST THE BACKGROUND OF POST-COVID SYNDROME (REVIEW ARTICLE)

This article analyzed and discussed the topic of acute disorders of cerebral blood circulation against the background of post-covid syndrome.

Metabolic marker of acute cerebral circulation disorder in postmortal diagnosis

Metabolic marker of acute cerebral circulation disorder in postmortal diagnosis

LIPID PEROXIDATION AND ANTIOXIDANT PROTECTION SYSTEM IN RATS UNDER CONDITIONS OF ISCHEMIC STROKE ON THE BACKGROUND OF ANXIETY-DEPRESSIVE DISORDERS

Background. Acute disorders of cerebral blood circulation are one of the most important medical and social problems, due to their high share in the structure of morbidity and mortality of the population, significant indicators of temporary loss of working capacity and primary disability. At the same time, the World Health Organization estimates that by 2021, 615 million people (about 10% of the world's population) will have symptoms of depressive or anxiety disorders. Therefore, the study of the pathogenetic links of comorbidity of anxiety-depressive disorders against the background of ischemic stroke is relevant.
 Aim: to study changes in antioxidant protection and lipid peroxidation under conditions of experimental ischemic stroke comorbid with anxiety-depressive disorders.
 Materials and methods. Experimental studies were conducted on 30 non-linear laboratory rats, which were divided into 3 groups: 1 group – intact control, 2 group – animals of the group with simulated ischemic stroke; Group 3 – rats with simulated ischemic stroke and anxiety-depressive disorders. Reproduction of ischemic stroke in rats was carried out using the model of endovascular occlusion of the middle cerebral artery (focal ischemia) according to E. Z. Longa. A model of reserpine-induced depression in rats was chosen for an in-depth study of the pathophysiological links of anxiety-depressive disorders.
 To assess the state of lipid peroxidation and the antioxidant defense system, the level of malondialdehyde, catalase, superoxide dismutase, and reduced glutathione in brain tissue homogenate and circulating blood was studied.
 Results. A sharp depletion of the body's protective reactions was established in rats with both ischemic stroke and under conditions of comorbid pathology, which was confirmed by a probable decrease in the level of catalase, superoxide dismutase and an increased level of malondialdehyde. In particular, the level of catalase and superoxide dismutase decreased in the brain tissue homogenate of rats with comorbid pathology; the level of malondialdehyde increased. At the circulating level, there was a 40-fold increase in the level of catalase (p<0.05) compared to intact animals, which indicated a compensatory reaction of the body to the activation of free-radical oxidation, since this enzyme neutralizes hydrogen peroxide.
 Conclusions. The obtained data indicate a more severe course of ischemic stroke against the background of anxiety-depressive disorders and the involvement of both pro- and anti-inflammatory cytokines in the development mechanism, as well as a violation of the balance between the processes of lipid peroxidation and antioxidant protection.

ANXIETY-DEPRESSIVE SPECTRUM DISORDERS IN PATIENTS WITH CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION IN THE LONG TERM AFTER SURGERY

HighlightsThe article presents the analysis of anxiety and depressive disorders in patients who were followed as outpatients after surgery for chronic thromboembolic pulmonary hypertension in the long term, taking into account the study during the COVID–19 pandemic.The prevalence of clinically pronounced anxiety disorders in the group was 10.9%, depression - 18.6%, a combination of anxiety-depressive disorders was noted in 10.3% of cases.Multifactorial analysis revealed that the development of severe anxiety disorders in patients with chronic thromboembolic pulmonary hypertension in the long term is associated with a complicated postoperative course. Independent risk factors for clinically pronounced depressive disorders in these patients were older age, a history of cerebral circulation disorders, as well as pronounced post-COVID-19 functional disorders. Aim. To study the frequency and severity of anxiety-depressive disorders in patients with chronic thromboembolic pulmonary hypertension (CTEPH) in the long term after pulmonary thromboendarterectomy and to identify factors affecting their development.Methods. 156 patients with CTEPH were examined in the long term after surgery using the generalized anxiety disorder (GAD) questionnaire GAD-7 and the Beck`s Depression Inventory. In patients who suffered COVID-19, a “Post-COVID-19 Functional Status scale” (PCFS) was used to measure functional status over time after COVID-19. Logistic regression analysis was used to identify predictors of clinically pronounced GAD and depression in the long-term period after surgery.Results. In patients with CTEPH, clinically significant GAD and depression in the long term after surgery were observed in 10.9 and 18.6% of cases, respectively. A combination of anxiety and depressive disorders was noted in 10.3% of patients. The development of GAD was associated with cardiopulmonary insufficiency in the early postoperative period (ОR 3,1; CI 1,2–13,8; p = 0,009). Clinically pronounced depression was associated with older age (ОR 1,3; CI 1,04–2,0; p = 0,02), chronic cerebral circulatory insufficiency (ОR 7,6; CI 1,8–17,5; p = 0,02) and pronounced post-COVID-19 functional neurological disorders according to the PCFS scale (ОR 6,7; CI 1,9–14,5; p = 0,007). The combination of clinically expressed anxiety and depression was correlated with older age (ОR 1,1; CI 1,02–1,3; p = 0,04).Conclusion. The prevalence of clinically pronounced GAD in the group was 10.9%, depression was 18.6%, and a combination of anxiety and depressive disorders was noted in 10.3% of patients. The development of clinically significant GAD is associated with a complicated course of cardiac surgery. Independent risk factors for clinically significant depression were older age, a history of cerebral circulatory disorders and pronounced post-COVID-19 functional neurological disorders.

#6332 INFLUENCE OF NUTRITIONAL STATUS ON THE INCREASE IN CARDIOVASCULAR RISK AND THE RISK OF KIDNEY DAMAGE IN COMORBIDITY OF HYPERTENSION AND COPD

Abstract Background and Aims It is widely known that obesity is a modulated additional factor in increasing cardiovascular risk in patients with hypertension. Since the number of patients with comorbidity of arterial hypertension and COPD is increasing, the question of the relationship between nutritional status and cardiovascular risk remains relevant. Purpose of the study: to determine the role of nutritional status indicators in the formation of cardiovascular risk in patients with comorbidity of hypertension and COPD. Method 101 patients were included in a cross-sectional study: 32 patients with comorbidity of hypertension and COPD (Gr I), 43 patients with hypertension (Gr II), and 26 patients with chronic obstructive pulmonary disease (Gr III). Exclusion criteria: informed consent of the patient to processing of personal data, Hypertension stage II, 1-3 degree, COPD A - C clinical groups(stable phase), age≥40 years. Exclusion criteria: age≥80 years, myocardial infarction and cerebral circulatory disorders, kidney diseases (polycystosis, developmental abnormalities, glomerulonephritis, pyelonephritis), diabetes mellitus, cancer, GFR < 30 ml/min. Patients underwent general clinical examination, determined nutritional status by anthropometric study and bioimpedancemetry, assessed the renal function by laboratory examination of blood. Methods of parametric and nonparametric statistics were used. Results A high cardiovascular risk in Gr I was in 22 (68,8%) patients, in Gr II - in 27 (62,9%) patients and in Gr III - in 10 (38,5%) patients. GFR in Gr I was 67,5 (57,0;77,0) ml/min, in Gr II -70.6 (57.0; 83.0) ml/min, and in Gr III - 82.5 (70.0;89.0) ml/min (p = 0.02). BMI in Gr I was 30.2 (26.5;35.0) kg/m2, in GrII - 29.7 (26.3;33.9) kg/m2, in GrIII - 26.8 (24.6;29.6) kg/m2. Percentage of adipose tissue in Gr I was 35.1 (30.0;41.7), in Gr II-38.2 (32.4;42.1) and in Gr III - 27.7 (21.0;34.1) (p = 0.01). The total muscle tissue in Gr I was 28,6 (24,6;30,6)%, in Gr II - 28,5 (25,0;31,2)%, in Gr III - 32,1 (27,8;35,3)%(p = 0.1), visceral fat in Gr I was 11,0 (8,0;14,0)%, in Gr II- 11,0 (9,0;15,0) %, in Gr III- 9,0 (6,0;13,0) %(p = 0.1); sarcopenia index in Gr I was 77,8(61,6;86,2), in Gr II- 77,8(66,1;101,8), in Gr III- 90,6(86,0;98,6)(p = 0,1). In Gr I, correlations were found: negative between GFR and high cardiovascular risk (R = -0.6), positive - between sarcopenia index, visceral fat and high cardiovascular risk (R = 0.5; 0.6), negative - between the amount of muscle tissue and high cardiovascular risk in patients (R = -0.5) (p<0,05). Conclusion In patients with a comorbidity of hypertension and COPD, along with an increase in the amount of adipose tissue and visceral fat, the amount of muscle tissue decreases, which leads to sarcopenic obesity. Sarcopenic obesity is associated with high cardiovascular risk and worsening of renal function, which also leads to an increased risk of cardiovascular complications.

Cognitive impairment in the acute period of cardioembolic stroke

Background. Acute disorders of cerebral circulation are one of the most urgent problems of modern clinical neurology. Its significance is due to both the high frequency of occurrence and a large number of unsatisfactory outcomes, as well as the significant impact on the quality of life. Cognitive disorders are one of the main syndromes that manifest in post-stroke period and are associated with the rehabilitation potential, as well as opportunities for social and household adaptation. Our objective was to study the profile of cognitive impairment in a continuous sample of patients with cardioembolic stroke in the acute period of stroke, as well as to determine the correlations between their occurrence and the factors determining the course of the disease. Design and methods. The study involved 46 patients of both sexes in the acute stage of ischemic stroke (average age was 69 ± 11 years). The selection of patients was carried out in accordance with the diagnostic criteria of the International Association of Vascular Behavioral and Cognitive Disorders VASCOG. The results of the Hachinski scale were also considered. All patients underwent interview for history, complaints, as well as the assessment of the neurological status. Risk factors for stroke were evaluated. We also assessed the results of computer and magnetic resonance imaging, standard “stroke” scales and performed a neuropsychological examination aimed at a comprehensive study of cognitive functions. All studies were conducted at the end of 10-14 days from the development of focal neurological symptoms. Results. Cognitive disorders in patients with cardioembolic ischemic stroke turned out to be quite heterogeneous. Their severity in the majority of our patients was considered as mild cognitive impairment. Changes at dementia level were much less common and were characteristic of patients with extensive lesions or in the case of disorders in the field of cognitively significant “strategic” foci. Neurodynamic disorders predominated in the profile of disorders of higher cortical functions. Memory impairment was expressed slightly and was of a secondary nature. With the aggravation of cognitive disorders, mnestic disorders progressed. In addition, regulatory disorders began to be detected. The most significant correlations were found between the results of neurocognitive tests on the one hand and the assessment on the Bartel scales, the assessment of changes in white matter, as well as the volume of the necrosis focus, the presence of heart failure and dyscirculatory encephalopathy in the anamnesis. Conclusions. Cognitive impairment is a significant component of the clinical picture of cardioembolic stroke. Their severity is largely determined by the volume and topical localization of the ischemic focus, as well as the presence and severity of previous chronic cerebrovascular pathology. This determines the need to develop methods to assess the state of cognitive functions before the development of stroke.

NEUROIMAGING CHARACTERISTICS OF ENCEPHALOPATHY IN CHRONIC KIDNEY DISEASE

According to WHO, vascular diseases of the brain in the developed countries of the world account for 15% of the total mortality. At the same time, acute and chronic encephalopathies occupy a special place in the structure of vascular diseases. In recent years, special attention has been paid to encephalopathies developing as a result of renal pathology, since kidney diseases, namely chronic kidney disease (CKD) is a huge socio-economic problem that leads to cerebral complications, with a significant deterioration in the quality of life, a sharp loss of working capacity, and a high percentage of mortality. In the diagnosis of various encephalopathies and other disorders of cerebral circulation, an invaluable role is played by MRI, MSCT, brain angiography with their wide diagnostic capabilities.

Cognitive function restoration in rats with chronic brain ischemia using Semax and hopantenic acid comprehensive administration

The relevance and importance of treating patients with ischemic brain lesions are indisputable. Chronic ischemic processes in the brain occur much more frequently than acute cerebral circulation disorders, leading to prolonged disability and being the main contributors to a significant number of strokes. Cognitive dysfunctions prevail in the dynamics of the post-ischemic period and are often the primary determinants of the severity of residual organic and subsequent functional impairments of the brain. The aim of the study is to investigate the effectiveness of separate and combined administration of Semax and hopantenic acid in the pharmacological correction of cognitive disorders in rats with experimental chronic brain ischemia. It has been established that rats with chronic brain ischemia exhibit cognitive impairments from the 1st day, manifested in worsened learning processes, short-term and long-term memory functioning in the context of conditioned active avoidance and conditioned feeding reflexes. It has been shown that separate and combined application of Semax and hopantenic acid contributes to the restoration of the learning process and improvement of mnestic functions in rats with chronic brain ischemia. The most pronounced nootropic effect in rats with chronic brain ischemia was registered under the conditions of combined administration of Semax and hopantenic acid, starting from the 3rd day of the study. Subsequently, in terms of anti-ischemic efficacy, the effect of Semax follows, which was realized starting from the 3rd day of the study. The least pronounced neuroprotective effect belongs to hopantenic acid, starting from the 7th day of the study. The author considers the obtained data as experimental groundwork for the feasibility of clinically testing the nootropic effects of the combined administration of Semax and hopantenic acid in cases of chronic brain ischemia. The comprehensive pharmacological correction of cognitive disorders in chronic brain ischemia is pathogenetically justified and aimed at activating sanogenetic mechanisms.

New possibilities of multimodal correction of disorders of central nervous system functions in elderly persons

NEW POSSIBILITIES OF MULTIMODAL CORRECTION OF DISORDERS OF CENTRAL NERVOUS SYSTEM FUNCTIONS IN ELDERLY PERSONS Victor V. Kuznetsov, Serhiy H. Burchynskyi, Kostiantyn O. Apykhtin D. F. Chebotarev Institute of Gerontology of the National Academy of Medical Sciences of Ukraine, 67 Vyshgorodska Str., Kyiv 04114, Ukraine Introduction. The increase in the share of elderly and senile people in the population adds urgency to the problems of various forms of cognitive dysfunction and closely related psycho-emotional disorders and disorders of cerebral circulation. Real success in solving these problems is possible only with the application of therapeutic effects at the earliest possible stage of the disease, as well as with the possibility of implementing a pharmacological prophylactic approach. At the root of the weakening of cognitive functions is a violation of the neurotransmitter balance in the brain. An effective way to prevent it is the use of nootropics. Nootropics affect the biosynthetic energy, neurotransmitter processes in the brain, the blood supply to the brain by exerting a protective effect on the vascular wall, inhibiting the thrombus formation reaction, normalizing blood viscosity, etc. The drug MemoProve is a unique combination of neurotropic peptone polypeptides (N-PEP-12), which is able to reproduce the effects of natural neurotrophic factors in the central nervous system (NGF), as well as improve cholinergic neuromediation by activating the main enzyme of acetylcholine biosynthesis – choline acetyltransferase. The aim is comprehensive analysis of the effect of a course of MemoProve on the psycho-emotional state, the structure of the state of bioelectrical activity of the brain, and the state of cerebral blood circulation in the elderly. Materials and Methods. A comprehensive clinical and instrumental examination of 20 elderly patients (average age 68.2 ± 3.2 years) with initial manifestations of dyscirculatory atherosclerotic encephalopathy was conducted. Before conducting an analysis of the effect of course (1 month) use of MemoProve on the functional state of the brain in elderly patients, an EEG study was conducted before and 24 hours after taking 2 tablets of the drug in order to determine the sensitivity of the brain to MemoProve. Results and conclusions. Three variants of the EEG reaction to MemoProve were identified. Common to these options is an increase in the total power of electrogenesis of the brain (by 15-25 %), an increase in the frequency of the -rhythm – the main, basic rhythm of the EEG. The type of influence of MemoProve on the power of slow rhythms (delta, theta) has features depending on the EEG variant. In elderly patients, MemoProve caused an increase in the linear systolic blood flow velocity in the two middle cerebral arteries, the vertebral arteries and the main artery. The results of a comprehensive analysis of the effect of course therapy of MemoProve indicate its positive effect on the functional state of the brain (in terms of emotional and cognitive indicators, bioelectrical activity of the brain, the state of cerebral hemodynamics) in elderly people and give grounds for recommending MemoProve for use in the system of geriatric pharmacological correction of emotional and cognitive processes. Keywords: cognitive dysfunction, neurotransmitter balance, nootropics, peptone polypeptides, MemoProve, EEG.

Cerebral Sinus Vein Thrombosis and Gender: A Not Entirely Casual Relationship.

Cerebral sinus venous thrombosis (CSVT) is a relatively rare acute disorder of cerebral circulation, but it can potentially be associated with serious sequelae and a poor prognosis. The neurological manifestations associated with it are often not adequately taken into consideration given the extreme variability and nuances of its clinical presentation and given the need for radiological methods suitable for this type of diagnosis. CSVT is usually more common in women, but so far there are little data available in the literature on sex-specific characteristics regarding this pathology. CSVT is the result of multiple conditions and is therefore to be considered a multifactorial disease where at least one risk factor is present in over 80% of cases. From the literature, we learn that congenital or acquired prothrombotic states are to be considered extremely associated with the occurrence of an acute episode of CSVT and its recurrences. It is, therefore, necessary to fully know the origins and natural history of CSVT, in order to implement the diagnostic and therapeutic pathways of these neurological manifestations. In this report, we summarize the main causes of CSVT considering the possible influence of gender, bearing in mind that most of the causes listed above are pathological conditions closely linked to the female sex.

Involvement immune response in the pathogenesis of ischemic stroke

Acute disorders of cerebral circulation are one of the leading problems of modern clinical medicine, due to their significant spread in the human population and the extremely negative impact exerted on the patient’s body. Currently available data allow us to talk about the multi-vector nature of the pathogenesis of ischemic brain damage. Within the framework of the cascade of developing pathochemical and pathophysiological processes, an essential role in the formation of ischemic stroke belongs to the inflammatory reaction occurring through the immune system’s response to cerebral tissue ischemia. One of the places of its implementation is the vessel wall located in the ischemic zone, where monocytes and neutrophils are attracted with the help of cell adhesion proteins. Complement activation plays a significant role, carried out mainly due to the C3 component or during the initialization of the mannose pathway. Activation of microglia and astrocytes plays a huge role directly in the focus of ischemia. It should be noted that in the process of activation, both microglia and astrocytes are able to acquire a pro-inflammatory or anti-inflammatory phenotype. The prevalence of the pro-inflammatory variant contributes to prolonged damage to brain tissue, while the predominance of the anti-inflammatory phenotype has a protective effect. An important role is played by a violation of the function of the blood-brain barrier, which provides an additional influx of leukocytes to the site of ischemia. In addition, individual subpopulations of T-lymphocytes penetrating through the damaged barrier also play a significant role in the organization and dynamics of the immuno-inflammatory response. The action of Th1 and Th2 cells, gamma-delta T lymphocytes, natural killer cells, as well as regulatory T lymphocytes has been most studied. The role of B-lymphocytes in the formation of a stroke focus is considered.

Surgical treatment of severe deformity of the internal carotid arteries

Objective. To evaluate the outcomes of internal carotid artery (ICA) redressment with transposition into the «new orifice» with a severe pathological elongation of the internal carotid artery. Materials and methods. In 2021, 42 operations were performed in 38 patients having severe deformations of the ICA required the transposition of ICA orifice by 2 or more diameters from the old orifice are presented. Four patients underwent reconstructions on both sides. All patients were symptomatic, with chronic cerebrovascular insufficiency grade 2–4 (according to the classification of A. V. Pokrovsky, 1978). 29 women (76.3 %), 9 men (23.7 %) were enrolled in the study. The average age was 69.1±7.7 years. 18 patients (47.4 %) were found to have a combination of hemodynamically significant pathological deformities with atherosclerotic lesions of the carotid arteries. All patients underwent ultrasound duplex scanning and computed tomography with contrasting brachiocephalic arteries in the preoperative period. Results. Most deformations are represented by S- and Z-shaped (73,8 %) оr ICA loops (21,4 %). The maximum level of transposition was required for loop deformations (25.6 mm±6.17) and was comparable for S- and Z-shaped deformations (17.8 mm±6.3; 17.5 mm±8.0). In the postoperative period, there were no signs of cerebral circulation disorders in this group of patients. In 84 % of cases, 32 patients showed clinical improvement with partial or complete regression of cerebral neurological symptoms. In 1 case (2.4 %), there was a hematoma of a postoperative wound that did not require specific surgical or medical treatment. During postoperative duplex control in the postoperative period, turbulent flows, stenosis and deformity in the area of the new orifice were not observed. Conclusion. The results confirm the data reported by other authors about the safety of the surgical method. ICA reconstruction with orifice transposition may be an alternative method of surgical treatment with minimal risk of complications. To achieve the best result, during the creation of a new orifice of the ICA, it is necessary to preserve as much as possible the original anatomy of the bulb of the ICA and the bifurcation of the common carotid artery. For a more detailed assessment of the results, further study is planned on a large clinical material.

The influence of orthostatic test (or verticalization) on the blood flow through the internal jugular and vertebral veins

Highlights. In the absence of venous pathology during verticalization, there is an increase in venous outflow both through the vertebral veins and through the internal jugular veins. In the absence of venous pathology, the internal jugular veins are the dominant route of venous outflow in clinostasis and orthostasis.Aim. To study the dynamics of venous outflow along the internal jugular veins (IJV) and vertebral veins (VV) during the transition from horizontal to vertical position.Methods. The study included 10 healthy women aged 24±2.91 years. Inclusion criteria were as follows: 1) optimal structure of the venous system, in which both of patient`s IJV are approximately symmetrical in cross-sectional area (CSA) and the intensity of the collapse, CSA of IJV exceeds CSA of the common carotid artery by 2–2.5 times, noticeable efficiency of valves during the Valsalva maneuver; 2) venous pressure (VD) in the brachial vein is 18–20 mm Hg. The exclusion criteria were: 1) a history of any disorders of cerebral circulation, symptoms of venous encephalopathy, vertebrobasilar insufficiency, compression of the neurovascular bundle when exiting the chest, arterial hypertension, any cervical spine pathology, hypertrophy and rigidity of the cervical and nodding muscles, 2) arterial pathology of brachiocephalic/intracranial arteries (stenosis, tortuosity, anomalies of the structure), 3) any cardiac pathology, 4) endocrine diseases. The study involved the method of triplex ultrasound with measurements of the cross-sectional areas of IJV, the diameters of VV, time-averaged mean velocity for volumetric blood flow (TAV) in clinostasis and orthostasis. Changes in volumetric venous outflow during verticalization of patients were evaluated as well.Results. In orthostasis, the mean CSA of IJV decreased from 0.862±0.043 cm2 to 0.19±0.024 cm2 , the mean TAV increased from 6.950±2.373 cm/s to 66,000±6.875 cm/s, the average volumetric blood flow increased from 5.952±2.006 mL/s to 12.425±1.559 mL/s. The mean TAV for VV during verticalization increased from 6,800±2.067 cm/s to 16,000±2.271 cm/s, and the average volumetric blood flow from 0.167±0.051 ml/s to 0.402±0.098 mL/s.Conclusion. In all cases, the volumetric blood flow along IJV dominated the volumetric blood flow along VV in clinostasis and orthostasis. In the absence of venous pathology, the dominant pathway of venous outflow in clinostasis and orthostasis are IJV.