Chronic Cerebral Ischemia Research Articles

MAIN ECHOCARDIOGRAPHIC PARAMETERS IN PATIENTS WITH CHRONIC CEREBRAL ISCHEMIA DEPENDING ON THE PRESENCE OF CONCOMITANT CHRONIC OBSTRUCTIVE PULMONARY DISEASE

This study examines the main echocardiographic parameters in patients with chronic cerebral ischemia (CCI) and analyzes how these parameters are influenced by the presence of concomitant chronic obstructive pulmonary disease (COPD). CCI, associated with reduced cerebral blood flow, can be exacerbated by COPD, which negatively affects cardiovascular and respiratory functions. The study evaluates key echocardiographic markers such as left ventricular ejection fraction, right ventricular function, and pulmonary artery pressure. The findings indicate that patients with both CCI and COPD exhibit more significant cardiac dysfunction, suggesting that COPD may worsen cardiovascular complications in CCI patients.

LABORATORY PARAMETERS IN PATIENTS WITH CHRONIC CEREBRAL ISCHEMIA DEPENDING ON THE PRESENCE OF CONCOMITANT CHRONIC OBSTRUCTIVE PULMONARY DISEASE

This study investigates the laboratory parameters in patients with chronic cerebral ischemia (CCI) in relation to the presence of concomitant chronic obstructive pulmonary disease (COPD). CCI is characterized by a progressive reduction in cerebral blood flow, while COPD can exacerbate hypoxia, potentially worsening brain ischemia. The research evaluates blood biomarkers, including inflammatory markers and oxygenation indices, to determine the impact of COPD on CCI patients. Results suggest that patients with both CCI and COPD present with more severe inflammatory responses and lower oxygenation levels, which may influence the progression of cerebral ischemia and overall prognosis.

ROLE OF THE EMOTIONAL-MOTIVATIONAL COMPONENT IN THE DYNAMICS OF CNS FUNCTIONAL CAPACITY IN SECONDARY SCHOOL STUDENTS

The main clinical syndromes of chronic cerebral ischemia (CCI) are impaired gait and balance disorders, High morbidity level among school children, which has been recorded over the past decade in our country, necessitates a review of the contributing causes, mechanisms and factors. Objective. The purpose of the study is to assess CNS functional capacity in secondary school students taking into account anxiety and the motivational component. Materials and Methods. The study enrolled 424 secondary school students aged 10–17, living in Astrakhan. Simple and complex visual-motor reaction test was carried out. To study personality traits, anxiety and motivation levels of the participants, the authors used Junior Eysenck Personality Questionnaire (JEPQ), School Anxiety Test (Phillips Test), and Spielberg-Andreeva motivation questionnaire. Results. A significant decrease in the level of CNS functional capacity was noted when compared with the age norm. CNS functional level increases with age, while its values in the examined 12–13 and 14–15 year-old participants are below the average age ones. A decrease in the motivation level was revealed among the trial subjects. A positive attitude towards learning and effective motivation was revealed in 53.6 % of secondary school students aged 10–11; 38,6 % aged 12–13; 30,3 % aged 14–15 and 30 % aged 16–17. A high level of general anxiety was revealed in 40.9 % of secondary school students aged 10–11; 63.6 % aged 12–13; 12.8 % aged 14–15 and 6 % aged 16–17. Conclusion. The parameters of CNS functional capacity in most cases are characterized by below average values. The anxiety level significantly decreases with age, which indicates an adequate influence of learning environment on students. The highest anxiety level was revealed in the trial subjects aged 12–13. Motivation for learning decreases with age, which is probably due to psychological and motivational age-related changes in adolescence.

Нейровизуализационный подход для выявления биомаркеров рабочей памяти у больных с хронической ишемией мозга

Verbal working memory (VWM) is a fundamental function responsible for temporary storage and short-term handling of verbal information. The study was aimed to determine the working memory biomarker associated with imaging of the source of infra-slow electrical activity in patients with chronic cerebral ischemia (CCI). A total of 50 patients with CCI took part in the study: 16 males and 34 females aged 50–85 years. VWM was evaluated by the Luria test. The subjects were divided into two groups matched by age with the VWM below and above the average level for the studied sample. The infra-slow, below 0.1 Hz, electrical activity, otherwise known as the DC potentials (DCPs) of the brain, was recorded with five monopolar leads: frontal, central, occipital, right and left temporal. The resting state fMRI was used to analyze brain regions with the activated BOLD (blood-oxygen-level-dependent) signal that were associated with the brain regions responsible for VWM and the DCP generation sources recorded with the non-polarizable electrodes. The differences in BOLD signal activation and infra-slow activity amplitude were found in two VWM groups. These resting-state neural networks, VWM and the neural network responsible for DCP generation, overlapped in frontal regions. There were significant differences in DCP recorded with the frontal lead in two VWM groups (р = 0.00004). In patients with CCI, infra-slow activity, recorded with the frontal lead that is generated by the neural network fragment representing an intersection of the VWM network and the part of the brain responsible for DCP generation in the frontal region, is a VWM biomarker.

ASSESSMENT OF THE STATUS OF COGNITIVE FUNCTIONS AND AUTOREGULATION OF CEREBRAL BLOOD CIRCULATION IN PATIENTS WITH CEREBROVASCULAR PATHOLOGY AGAINST THE CONSEQUENCES OF COVID-19

Aim. The aim of the study. Study of the state of cognitive functions (CF) and cerebral autoregulation (CA) in patients with cerebrovascular pathology (CVP), which was formed against the background of the consequences of COVID-19. Materials and methods. 108 patients (49 men and 59 women) who suffered from COVID-19 were examined, including those with chronic cerebral ischemia (CCI) in compensated (I group n=24) and subcompensated (II group n=38) stages, and 46 patients (III group) who suffered an ischemic stroke (II) in the post-epidemic period. CF research was conducted using the Mini-Mental State Examination (MMSE) scale, the Frontal Assessment Batter (FAB) test battery, a 10-word memorization test. (KrO2) load, vasomotor reactivity index (IVMR), functional nitroglycerin test (KrFNT). The obtained results were statistically calculated using the parametric ANOVA test and the non-parametric Kruscall-Wallis test. Results. According to the MMSE scale, the average score is in the range of mild cognitive disorders (CD) (25.5±0.6 points – I group), as well as mild dementia (23.6±0.2 and 20.9±0.4 points in groups II and III, respectively), in group III these values border on moderate dementia. In the FAB test, moderate CD with impaired praxis and spatial activity (group I), severe CD with impaired praxis and physical function (group II) and dementia (group III) were noted. A decrease in KrCO2 indicators was observed in patients of all groups, KrO2 values in group I did not change significantly, in groups II and III they were significantly reduced. IVMR values were slightly reduced in group I (62.9±7.5, CG – 71.5±6.9), sharply decreased in groups II and III (group II – 51.2±4.6, p<0 .05; III group – 42.1±3.9, p<0.05). Also, in groups II and III, significantly pronounced hyporeactivity to FNT was noted. Conclusions. Moderate CD of praxis and spatial activity was noted in patients with compensated CCI, severe CD with impaired control over activity and praxis was observed in the subcompensated CCI group, signs of vascular dementia were noted in patients with II consequences. The most significant decrease in IVMR indicators as an integral indicator of the state of CA is observed in patients with II, also a significant decrease of this index is noted in the subcompensated group of CCI, which confirms the high probability of the development of II in this group of patients.

Pattern of cognitive changes and content of cerebral neurotrophic factor in patients with chronic cerebral ischemia

Objective. To study the pattern of cognitive changes and the content of cerebral neurotrophic factor (BDNF) in the blood serum of patients with chronic cerebral ischemia (CICI).Materials and methods. We examined 128 people who were divided into two groups: the main group – 82 patients (38 men and 44 women) aged 60–74 years with CICI, the control group – 46 people comparable to the patients of the main group by gender and age, but without clinical manifestations of CICM. Cognitive functions were assessed using the Mini-Mental Status Scale (MSMS) and the Battery of Tests for the Assessment of Frontal Dysfunction (FMS). Attention (Schulte test), speech fluency (speech fluency subtest BTLD, verbal association test), memory (memory subtest KSHOPS; 5 words test) and visuospatial functions (clock drawing test) were studied. The content of BDNF in the blood serum of patients was determined by the enzyme immunoassay method.Results. The pattern of cognitive impairment in CIGM was characterized by changes in the domains of executive brain functions and complex attention. The content of BDNF in the blood serum of patients with CICI was significantly lower than that of the control group; in men is lower compared to female patients. Significant correlations were revealed between the severity of cognitive disorders and the level of BDNF in the blood serum.

Mesenchymal Stem Cell-Loaded Hydrogel Improves Surgical Treatment for Chronic Cerebral Ischemia.

Chronic cerebral ischemia (CCI) results in a prolonged insufficient blood supply to the brain tissue, leading to impaired neuronal function and subsequent impairment of cognitive and motor abilities. Our previous research showed that in mice with bilateral carotid artery stenosis, the collateral neovascularization post Encephalo-myo-synangiosis (EMS) treatment could be facilitated by bone marrow mesenchymal stem cells (MSCs) transplantation. Considering the advantages of biomaterials, we synthesized and modified a gelatin hydrogel for MSCs encapsulation. We then applied this hydrogel on the brain surface during EMS operation in rats with CCI, and evaluated its impact on cognitive performance and collateral circulation. Consequently, MSCs encapsulated in hydrogel significantly augment the therapeutic effects of EMS, potentially by promoting neovascularization, facilitating neuronal differentiation, and suppressing neuroinflammation. Furthermore, taking advantage of multi-RNA-sequencing and in silico analysis, we revealed that MSCs loaded in hydrogel regulate PDCD4 and CASP2 through the overexpression of miR-183-5p and miR-96-5p, thereby downregulating the expression of apoptosis-related proteins and inhibiting early apoptosis. In conclusion, a gelatin hydrogel to enhance the functionality of MSCs has been developed, and its combination with EMS treatment can improve the therapeutic effect in rats with CCI, suggesting its potential clinical benefit.

Features of dissomnia and cognitive impairments in chronic cerebral ischemia due to diabetes mellitus type 2

Introduction. Currently, diabetes mellitus occupies a leading position in terms of prevalence, disability, mortality and it is a medical and social problem. Microvascular and macrovascular diabetic complications negatively affect the quality and duration of sleep with detrimental effects on metabolism and weight regulation. The cognitive sphere is more impaired in type 2 diabetes mellitus in the form of a decrease in the speed of reaction to external stimuli and the ability to concentrate for a long time, so thinking becomes slower, and clinically significant cognitive impairments leads to work and social maladaptation and a decrease in adequate glycemic control. Aim of the study: to study the nature of diagnosed cognitive impairments and variants of dissomnias in chronic cerebral ischemia and to evaluate the features of identified dissomnias in the development of early dementia in type 2 diabetes mellitus. Object and methods. During the period from 2017 to 2023, 207 patients with chronic cerebral ischemia and neurological deficits of varying severity were examined. All patients underwent a comprehensive clinical and neurological examination using specialized scales to study the cognitive sphere and sleep level, laboratory and instrumental methods of examination. The study applied non-inclusion, inclusion and exclusion criteria and selected 147 patients with chronic cerebral ischemia and type 2 diabetes mellitus. The data has been processed statistically. Results. Cognitive impairments (95,1 ± 2,4%) and dyssomnia (88,9 ± 3,5%) develop in patients with type 2 diabetes mellitus with chronic cerebral ischemia, and their combination is significant (p < 0,05) prevailed (82,7 ± 4,2%) with dysmetabolic signs. At the same time, moderate (43,2 ± 5,5%) and severe (34,6 ± 5,3%) cognitive disorders with moderate dyssomnia (63,0 ± 5,4%) and increased sleepiness (64,2 ± 5,3%) with episodes of obstructive sleep apnea (16,0 ± 4,1%) and narcolepsy (6,2 ± 2,7%) compared with patients without type 2 diabetes mellitus (p < 0,05). Conclusions. The presence of type 2 diabetes mellitus increased the risk of developing dyssomnia and cognitive disorders, and the identification of dyssomnia led to an increased chance of a deterioration in the intellectual-mnestic level to the degree of moderate and severe impairments. Neuropsychological testing in combination with dyssomnia questionnaires and quantitative assessment of the severity of cognitive dysfunction is absolutely necessary.

PSYCHOPATHOLOGY OF EMOTIONAL SPHERE IN PATIENTS WITH CHRONIC CEREBRAL ISCHEMIA AND OBSTRUCTIVE SLEEP APNEA

Obstructive sleep apnea (OSA) is the most common sleep disorder globally. OSA affects 2–6 % of the adult population and 15–26 % of those aged over 70. The main daytime OSA symptoms are daytime sleepiness, decreased mood and concentration. Patients with chronic cerebral ischemia (CCI) often have the same complaints. Although such symptoms characterize emotional and affective disorders, the patients are usually treated by neurologists. The purpose of the study is to identify the characteristics of emotional and affective disorders in patients with chronic cerebral ischemia and obstructive sleep apnea. Materials and Methods. The study involved 45 patients aged 50–78 with CCI, type 1–2. Patients were examined for OSA and underwent cardiorespiratory monitoring. The psychoemotional status of individuals with CCI and OSA was assessed according to HADS, SHAPS, and ESS. Statistical analysis of cardiorespiratory monitoring parameters determined the critical level of average night saturation, at which depressive symptoms are detected. Results. It was found that patients with severe OSA had more severe depressive symptoms and anhedonia, but lower anxiety levels compared with CCI patients without severe OSA. The authors determined critical levels of mean night saturation for development of depression (SpO2avrg<89 %) and clinically significant depression (SpO2avg<87 %). Conclusion. Depression is proved to be the most common emotional disorder in patients with CCI and concomitant OSA. The authors determined critical levels of average night saturation for depressive disorders in patients with CCI type 1–2.

Acupoint catgut embedding attenuates oxidative stress and cognitive impairment in chronic cerebral ischemia by inhibiting the Ang II/AT1R/NOX axis.

Chronic cerebral ischemia (CCI) is a common neurological disorder, characterized by progressive cognitive impairment. Acupoint catgut embedding (ACE) represents a modern acupuncture form that has shown neuroprotective effects; nevertheless, its effects on CCI and the mechanisms remain largely unknown. Here, we aimed to explore the therapeutic action of ACE in CCI-induced cognitive impairment and its mechanisms. The cognitive function of CCI rats was determined using Morris water maze test, and histopathological changes in the brain were assessed through hematoxylin-eosin (HE) staining. To further explore the molecular mechanisms, the expression levels of oxidative stress markers and the Ang II/AT1R/NOX axis-associated molecules in the hippocampus were evaluated using enzyme-linked immunosorbent assay (ELISA), western blotting, and immunohistochemistry. Here, we observed that ACE treatment alleviated cognitive dysfunction and histopathological injury in CCI rats. Intriguingly, candesartan (an AT1R blocker) enhanced the beneficial effects of ACE on ameliorating cognitive impairment in CCI rats. Mechanistically, ACE treatment blocked the Ang II/AT1R/NOX pathway and subsequently suppressed oxidative stress, thus mitigating cognitive impairment in CCI. Our findings first reveal that ACE treatment could suppress cognitive impairment in CCI, which might be partly due to the suppression of Ang II/AT1R/NOX axis.

IMPAIRED GAIT AND BALANCE DISORDERS AS RISK MARKERS FOR FALLS IN CHRONIC CEREBRAL ISCHEMIA

The main clinical syndromes of chronic cerebral ischemia (CCI) are impaired gait and balance disorders, which increase risks for falls. The objective of the study is to analyze correlation between impaired gait and postural instability to determine risk markers for falls in CCI patients. Materials and Methods. We examined 104 CCI patients (15 men and 89 women, median age 70 (63; 76) years). The patients did not have significant functional limitations in daily life (modified Rankin scale, 0–2 points). Thirteen patients (13 %) had a history of acute cerebrovascular accidents, thirty-seven patients (36 %) had a history of falls. Moderate cognitive impairment was detected in 53 patients (51 %). Impaired gait and balance disorders were assessed according to Tinetti test, Berg balance scale, and stabilometric platform. Statistica 13.0, SPSS 22 was used for statistical data processing. Results. According to the Tinetti test, impaired gait was detected in 101 patients (97 %), balance disorders were found in 32 patients (31 %). According to the Berg balance scale, most patients had a low risk for falls. Stabilometry showed a decrease in the limits of stability, mainly forward. Discriminant analysis revealed that significant predictors of falls in CCI patients are the “forward” limit of stability (<59 points), female gender, age (>67 y.o.), depression (>9 points, HADS), sway index (eyes closed) in the clinical test for sensory integration and balance (>0.855), balance score for the Tinetti test (<15 points), and a history of acute cerebrovascular accident. Conclusion. Stabilometry along with clinical assessment can improve the effectiveness of determining the risk group for falls in CCI patients.

Elucidating the mechanisms of Buyang Huanwu Decoction in treating chronic cerebral ischemia: A combined approach using network pharmacology, molecular docking, and in vivo validation

ObjectiveThis study aimed to explore the potential mechanisms of Buyang Huanwu Decoction (BHD) in regulating the AKT/TP53 pathway and reducing inflammatory responses for the treatment of chronic cerebral ischemia (CCI) using UHPLC-QE-MS combined with network pharmacology, molecular docking techniques, and animal experiment validation. MethodsTargets of seven herbal components in BHD, such as Astragalus membranaceus, Paeoniae Rubra Radix, and Ligusticum chuanxiong, were identified through TCMSP and HERB databases. CCI-related targets were obtained from DisGeNET and Genecards, with an intersection analysis conducted to determine shared targets between the disease and the herbal components. Functional enrichment analysis of these intersecting targets was performed. Networks of gene ontology and pathway associations with these targets were constructed and visualized. A pharmacological network involving intersecting genes and active components was delineated. A protein-protein interaction network was established for these intersecting targets and visualized using Cytoscape 3.9.1. The top five genes from the PPI network and their corresponding active components underwent molecular docking. Finally, the 2-vessel occlusion (2-VO) induced CCI rat model was treated with BHD, and the network pharmacology findings were validated using Western blot, RT-PCR, behavioral tests, laser speckle imaging, ELISA, HE staining, Nissl staining, LFB staining, and immunohistochemistry and immunofluorescence. ResultsAfter filtration and deduplication, 150 intersecting genes were obtained, with the top five active components by Degree value identified as Quercetin, Beta-Sitosterol, Oleic Acid, Kaempferol, and Succinic Acid. KEGG pathway enrichment analysis linked key target genes significantly with Lipid and atherosclerosis, AGE-RAGE signaling pathway, IL-17 signaling pathway, and TNF signaling pathway. The PPI network highlighted ALB, IL-6, AKT1, TP53, and IL-1β as key protein targets. Molecular docking results showed the strongest binding affinity between ALB and Beta-Sitosterol. Behavioral tests using the Morris water maze indicated that both medium and high doses of BHD could enhance spatial memory in 2-VO model rats, with high-dose BHD being more effective. Laser speckle results showed that BHD at medium and high doses could facilitate CBF recovery in CCI rats, demonstrating a dose-response relationship. HE staining indicated that all doses of BHD could reduce neuronal damage in the cortex and hippocampal CA1 region to varying extents, with the highest dose being the most efficacious. Nissl staining showed that nimodipine and medium and high doses of BHD could alleviate Nissl body damage. LFB staining indicated that nimodipine and medium and high doses of BHD could reduce the pathological damage to fiber bundles and myelin sheaths in the internal capsule and corpus callosum of CCI rats. ELISA results showed that nimodipine and BHD at medium and high doses could decrease the levels of TNF-α, IL-6, IL-17, and IL-1β in the serum of CCI rats (p < 0.05). Immunohistochemistry and immunofluorescence demonstrated that BHD could activate the AKT signaling pathway and inhibit TP53 in treating CCI. Western blot and RT-PCR results indicated that nimodipine and all doses of BHD could upregulate Akt1 expression and downregulate Alb, Tp53, Il-1β, and Il-6 expression in the hippocampus of CCI rats to varying degrees (p < 0.05). ConclusionBHD exerts therapeutic effects in the treatment of CCI by regulating targets, such as AKT1, ALB, TP53, IL-1β, and IL-6, and reducing inflammatory responses.

Emotional intelligence and specificity of brain cortical activity in coronary heart disease

Testing the components of emotional intelligence (EI) in patients with coronary heart disease (CHD) showed that they are more likely to react to emotionally significant situations than to express their emotions. The most pronounced influence on the frequency-spatial organization of brain activity, mainly in the θ1-, α2- and β1-ranges, is induced by such EI components as the expression of positive emotions, the use of emotions in decision-making and empathy. An increase in self-assessment of positive expression is associated with an increase in the power of the β1-rhythm in the parieto-occipital cortex with the dominance of the left hemisphere and an increase in the θ1 not only in these areas, but also in the posterofrontal cortical sites. The increase in empathy is accompanied by a decrease in the power of the β1-rhythm, mainly in the temporal cortex of the left hemisphere. Gender differences were found in the association of self-assessment of negative expression and the power of θ- and β-oscillations with greater involvement of the left frontal areas in women. The identified features of the relationship between EI and EEG parameters may be a consequence of the reorganization of cortical activity in patients with coronary heart disease, which develops as a result of chronic cerebral ischemia.

Impact of comorbidity on surgical management of breast cancer in elderly patients.

e12596 Background: More than half of breast cancers are diagnosed above the age of 60 years, a quarter of which diagnosed with invasive breast cancer among those over 75 years of age. Treatment of breast cancer (BC) at this age remains a complex problem. Elderly patients often have various comorbidities that impose increased risks of complications with antitumor treatment. This leads to both excessive and insufficient treatment of BC. In patients over 75 years of age, an individual approach to treatment is recommended, taking into account their general health and life expectancy, the risk of death from breast cancer compared to other causes, as well as the advantages and disadvantages of treatment methods. Objective: To evaluate the influence of comorbidity on the risks of complications (early and delay) after surgical treatment in elderly and senile patients (pts). Methods: A retrospective analysis of the results of breast cancer treatment in 292 pts over 75 years of age, who underwent surgical treatment at the first stage in SBIH Moscow Clinical Scientific and Practical Center named after A.S. Loginov of DHM from 2016 to 2019. The initial stages of breast cancer (I and IIA) were diagnosed in 257 (88.0%) pts, 35 pts (12.0%) has IIB and IIIA clinical stages. Radical mastectomy was performed in 171 (58.6%) cases, breast-conserving surgery was performed in the remaining 121 (41.4%). Forty-six (15.8%) patients had diabetes mellitus, 121 (41.4%) had cardiovascular disease, 36 (12.3%) had heart rhythm disorders, 38 (13.0%) had chronic cerebral ischemia, and the risk of grade 3 and 4 cardiovascular complications was found in 251 (86.0%) cases. Results: In the early postoperative period severe complications occurred in 1 (1.7%) patient (acute coronary syndrome) leading to death. No local recurrences were detected. The overall 3-year survival rate was 86.3% and the recurrence-free survival rate was 89.7%. In 10 (3.4%) cases, death was due to progression of RRMS, 30 (10.3%) patients died from other causes (acute cardiovascular failure, stroke, COVID-19). Conclusions: Comorbid conditions in elderly patients after surgery did not affect the development of complications in the early postoperative period. Preliminary preoperative preparation of elderly patients (correction and selection of drug therapy for concomitant chronic diseases) reduces the risk of early postoperative complications.

Construction and Application of Cerebral Functional Region-Based Cerebral Blood Flow Atlas Using Magnetic Resonance Imaging-Arterial Spin Labeling.

Cerebral conditions often require precise diagnosis and monitoring, necessitating advanced imaging techniques. Current modalities may not adequately detect early signs of reversible tissue damage, underlining the need for innovative diagnostic tools that can quantify changes in cerebral blood flow (CBF) with high specificity and sensitivity.This study integrates three-dimensional arterial spin labeling (3D-ASL) with structural MRI to develop comprehensive CBF atlases that cover all main functional regions of the brain. This innovative magnetic resonance imaging- arterial spin labeling (MRI-ASL) methodology provides a rapid and noninvasive means of quantifying region-specific CBF, offering a detailed view of CBF levels across different functional regions.The comparison between chronic cerebral ischemia (CCI) patients and healthy subjects revealed significantly diminished CBF across the cerebral functional regions in the constructed CBF atlases for the former. This approach not only allows for the efficient identification of CCI by analyzing concurrent decreases in CBF across critical areas relative to healthy distributions but also enables the tracking of treatment responses and rehabilitation progress through longitudinal CBF atlases.The CBF atlas developed using the MRI-ASL technique represents a novel advancement in the field of cerebral diagnostics and patient care. By comparing regional CBF levels against normative standards, this method enhances diagnostic capabilities, enabling clinicians to provide personalized care to patients with cerebral conditions.

Pharmaco- and ozone therapy in outpatient medical rehabilitation programs for patients with chronic cerebral ischemia

Abstract. Purpose of the study. To evaluate the effectiveness of medical rehabilitation of patients with stage 1 chronic cerebral ischemia using ozone therapy in an outpatient setting. Material and methods. A randomized, prospective, single-center, open-label, controlled study was conducted on 80 patients with stage 1 chronic cerebral ischemia, who were divided into 2 groups by means of simple randomization: in the study group (SG/41 patients), the patients received rehabilitation in accordance with the federal clinical guidelines and intravenous ozone therapy; in the control group (CG/39 patients), the patients underwent only standardized treatment. The effectiveness of rehabilitation measures was monitored using validated rating scales, electroencephalography, and quality of life assessment. Results. The implementation of the medical rehabilitation program for patients with stage 1 chronic cerebral ischemia in an outpatient setting provides a significant reduction in pain (p &lt; 0.01), correction of psycho-emotional and cognitive disorders (p &lt; 0.01), normalization of lipid metabolism (p &lt; 0.01), and improvement in quality of life (p &lt; 0.01). The efficacy of the developed outpatient medical rehabilitation program for patients with stage 1 chronic cerebral ischemia was 85.4 %, and that of the standardized program — 77.0 %. Conclusion. Integrated pharmacotherapy and ozone therapy provide a significant increase in the effectiveness of medical rehabilitation of patients with chronic cerebral ischemia at the outpatient stage.

Consolidation and Reconsolidation of Auditory-Verbal Memory in Parkinson’s Disease

The paper describes the processes of consolidation and reconsolidation of auditory-verbal memory in patients diagnosed with Parkinson’s disease (G20, ICD-10) in comparison with cerebrovascular pathologies of a chronic and acute nature. The research objective was to identify the specifics of consolidation and reconsolidation of auditory-verbal memory in patients of this nosological group. The methods involved an experiment in F. Bartlett’s schema reconstruction, as well as methods of descriptive and comparative statistics. The experiment involved 104 people (67.5 ± 4.5, 21% male), including 30 patients with Parkinson’s disease (G20) (67.8 ± 4.8, 24% male), 34 patients diagnosed with sequelae of cerebral infarction (I69.3) (67.4 ± 4.4, 20% male), and 40 patients with other specified lesions of cerebral vessels on a model of chronic cerebral ischemia (CICI) (I67.8 67.6 ± 4.4, 24% male). All codes were indicated in accordance with ICD-10. The research revealed reliably significant features of consolidation and reconsolidation of auditoryverbal memory in Parkinson’s disease. The greatest number of differences belonged to the comparative analysis with the patients with chronic cerebral ischemia. This nosology was characterized by a greater number of distortion errors but few additions and sequence violations. In Parkinson’s disease, information underwent transformations already at the storing stage, which led to impairment of short-term and long-term memory. Distortion errors were more numerous than consistency errors, which casts doubt on the kinetic factor as the key one.

Exploring the neuroprotection of the combination of astragaloside A, chlorogenic acid and scutellarin in treating chronic cerebral ischemia via network analysis and experimental validation

Chronic cerebral ischemia (CCI) primarily causes cognitive dysfunction and other neurological impairments, yet there remains a lack of ideal therapeutic medications. The preparation combination of Astragalus membranaceus (Fisch.) Bunge and Erigeron breviscapus (Vant.) Hand.-Mazz have been utilized to ameliorate neurological dysfunction following cerebral ischemia, but material basis of its synergy remains unclear. The principal active ingredients and their optimal proportions in this combination have been identified through the oxygen and glucose deprivation (OGD) cell model, including astragaloside A, chlorogenic acid and scutellarin (ACS), and its efficacy in enhancing the survival of OGD PC12 cells surpasses that of the combination preparation. Nevertheless, mechanism of ACS against CCI remains elusive. In this study, 63 potential targets of ACS against CCI injury were obtained by network pharmacology, among which AKT1, CASP3 and TNF are the core targets. Subsequent analysis utilizing KEGG and GO suggested that PI3K/AKT pathway may play a crucial role for ACS in ameliorating CCI injury. Then, a right unilateral common carotid artery occlusion (rUCCAO) mouse model and an OGD PC12 cell model were established to replicate the pathological processes of CCI in vivo and in vitro. These models were utilized to explore the anti-CCI effects of ACS and its regulatory mechanisms, particularly focusing on PI3K/AKT pathway. The results showed that ACS facilitated the restoration of cerebral blood flow in CCI mice, enhanced the function of the central cholinergic nervous system, protected against ischemic nerve cell and mitochondrial damage, and improved cognitive function and other neurological impairments. Additionally, ACS upregulated the expression of p-PI3K, p-AKT, p-GSK3β and Bcl-2, and diminished the expression of Cyto-c, cleaved Caspase-3 and Bax significantly. However, the PI3K inhibitor (LY294002) partially reversed the downregulation of Bax, Cyto-c and cleaved Caspase-3 expression as well as the upregulation of p-AKT/AKT, p-GSK3β/GSK3β, and Bcl-2/Bax ratios. These findings suggest that ACS against neuronal damage in cerebral ischemia may be closely related to the activation of PI3K/AKT pathway. These results declared first time ACS may become an ideal candidate drug against CCI due to its neuroprotective effects, which are mediated by the activated PI3K/AKT pathway mitigates mitochondrial damage and prevents cell apoptosis.

Chronic insomnia and ways to overcome it

Relevance. Chronic insomnia is one of the most common forms of nighttime sleep disorders. It leads to a decrease in human performance, the development of social maladjustment, and even changes in the personal sphere. Chronic insomnia can become a trigger for decompensation of somatic, neurological and mental diseases, which determines the need to find ways to overcome it. Objective. To determine the efficacy and safety of the dietary supplement Alpha-Melatonin Relax in the treatment of chronic insomnia in patients with chronic cerebral ischemia. Materials and methods. The study involved 30 patients (18 women and 12 men) with chronic cerebral ischemia of stage I and II, the average age of which was 46.12 ± 4.98 years. The course of treatment consisted of 30 days of taking Alpha-Melatonin Relax, 1–2 tablets 30–60 minutes before bedtime. Clinical and neurological symptoms were assessed and tested using the Pittsburgh Sleep Quality Index (PSQI) questionnaire, Epworth Daytime Sleepiness Scale, and the Hospital Anxiety and Depression Scale (HADS) in dynamics. Results and their discussion. The study results showed that 30-day administration of Alpha-Melatonin Relax provided a significant p≤0.05 improvement in the subjective assessment of the quality of night sleep, a decrease in the time to fall asleep, an increase in sleep duration, a decrease in the severity of emotional disorders and daytime dysfunction. Clinical and neurological follow-up of patients during the treatment course revealed a significant reduction in the severity of chronic insomnia, asthenia, and anxiety-depressive symptoms, which allows us to recommend the use of the dietary supplement Alpha-Melatonin Relax in clinical practice. Conclusions. Based on the data of a clinical-neurological and psychodiagnostic study, the statistically significant effectiveness of the dietary supplement AlphaMelatonin Relax in correcting the symptoms of chronic insomnia in patients with the initial stages of chronic brain ischemia has been proven.

Cpeb4-mediated Dclk2 promotes neuronal pyroptosis induced by chronic cerebral ischemia through phosphorylation of Ehf

Chronic cerebral ischemia (CCI) is a clinical syndrome characterised by brain dysfunction due to decreased chronic cerebral perfusion. CCI initiates several inflammatory pathways, including pyroptosis. RNA-binding proteins (RBPs) play important roles in CCI. This study aimed to explore whether the interaction between RBP-Cpeb4 and Dclk2 affected Ehf phosphorylation to regulate neuronal pyroptosis. HT22 cells and mice were used to construct oxygen glucose deprivation (OGD)/CCI models. We found that Cpeb4 and Dclk2 were upregulated in OGD-treated HT22 cells and CCI-induced hippocampal CA1 tissues. Cpeb4 upregulated Dclk2 expression by increasing Dclk2 mRNA stability. Knockdown of Cpeb4 or Dclk2 inhibited neuronal pyroptosis in OGD-treated HT22 cells and CCI-induced hippocampal CA1 tissues. By binding to the promoter regions of Caspase1 and Caspase3, the transcription factor Ehf reduced their promoter activities and inhibited the transcription. Dclk2 phosphorylated Ehf and changed its nucleoplasmic distribution, resulting in the exit of p-Ehf from the nucleus and decreased Ehf levels. It promoted the expression of Caspase1 and Caspase3 and stimulated neuronal pyroptosis of HT22 cells induced by OGD. Cpeb4/Dclk2/Ehf pathway plays an important role in the regulation of cerebral ischemia-induced neuronal pyroptosis.