Recovery Period Of Ischemic Stroke Research Articles

Remote Monitoring of Cardiovascular Risks of Medical Rehabilitation of Ischemic Stroke Patients Using Information and Telecommunication Systems

Due to the high incidence of cerebral stroke, the relevance of the problem of medical rehabilitation for this category of patients is beyond doubt. The increase in disability rates due to movement disorders among stroke survivors (3.2 per 100,000 population) necessitates the introduction of innovative rehabilitation technologies. Patients with cerebral stroke have a high risk of cardiocerebral complications, which should not limit the possibilities of medical rehabilitation. Therefore, the control of possible MR-risks is an important organizational aspect and can be implemented through the introduction of information and communication (ICT) and telemedicine technologies. Conducting dynamic telemetric ECG monitoring during of medical rehabilitation allows to prevent the development of possible cardiovascular risks and personalize the medical rehabilitation program. Aim. To study the effectiveness of remote tele-ECG monitoring based on information and communication technologies for assessing the cardiovascular risks of medical rehabilitation in patients with ischemic stroke. Material and methods. The study included 83 patients with ischemic stroke, mean age 55 [51; 57]), women – 44.6%, men – 55.4%; 42 patients in the early and 41 patients in the late recovery periods of ischemic stroke. All patients underwent a complex of multimodal rehabilitation techniques to restore hand dysfunction and statolocomotor disorders, carried out sequentially during one visit. For the purpose of dynamic control of probable cardiovascular risks, objectification of the state of the cardiovascular system, correction of the intensity and duration of rehabilitation loads, a portable information and communication technologies-based telecardiac complex was used for ECG registration. The ECG parameters were assessed in real time, as well as the stored data on the CardioOblako service. Results and discussion. The spectrum of ECG changes in patients in the early and late recovery periods of ischemic stroke was revealed. The dependence of ECG indexes and their dynamics on the duration of ischemic stroke and its subtype was determined. Asymptomatic changes in the form of heart rhythm disorders (14,4% – supraventricular rhythm disorders, 9,6% – ventricular extrasystoles of the 1st class), as well as repolarization processes (9,6% of cases) were registered during the course of rehabilitation measures. When discussing the results obtained, the probable neurogenic character of cardiac rhythm and conduction disturbances as a consequence of central neurogenic cardiovascular regulation, which is stabilized by central nervous system neuroplasticity over time, is emphasized. At the same time, the literature indicates that these processes can be regulated by therapeutic and rehabilitative measures. In our study, correction of the intensity and duration of rehabilitation loads normalized the changes of ECG indices registered in the process of medical rehabilitation. Conclusion. We determined the need for a comprehensive cardiovascular risk assessment program for patients with IS with the participation of a therapist/cardiologist using dynamic telemetric ECG monitoring during of medical rehabilitation for the timely detection and prevention of cardiovascular complications of medical rehabilitation, personalization of the medical rehabilitation program.

The Use of Enhanced External Counterpulsation in Complex Medical Rehabilitation of Stable Coronary Heart Disease in Patients Permanently Residing in Humid Subtropics

Aim. To study the dynamics of overall tolerance in patients in the early recovery period of ischemic stroke (IS) with mild and moderately severe paresis, to evaluate the effect of aerobic training in this group of patients on exercise tolerance during inpatient treatment as of Compulsory Medical Insurance (CMI). Material and methods. The first group of 30 patients were examined (17 women, 13 men, the average age – 60,6±6,45 years old) during the 4-6 week of IS. Total points of the FIM scale were 118±5,2 /121,8±4,5. The second group- control group consisted of 30 patients with chronic cerebral ischemia (CCI). The following were mainly dominated among the vascular risk factors in both groups of patients: atherosclerosis of brachiocephalic artery of various degrees of severity poorly controlled arterial hypertension, smoking, dyslipidemia. Physical exercise tolerance was assessed by cardiopulmonary testing on a bicycle ergometer using the Quark CPET spiroergometer system from COSMED (Italy). The peak oxygen consumption (VO2 peak), the maximum load performed in metabolic units (MET), the percentage of the proper maximum oxygen consumption (% pred VО2 peak) with constant ECG monitoring, blood pressure during the exercise test were evaluated. Patients with stroke received aerobic training during rehabilitation treatment – 10-12 sessions according to the target indicators. Results and discussion. The minimum required values of VO2 peak to provide an active daily life equals on average 15 -18 ml/min *kg of oxygen. Analysis of the results of our study showed a decrease in the VO2 peak in group 1 of stroke patients to 13.22 ± 3.32 ml/min * kg. The VO2 peak at stroke is only 54.96% ± 12.82 of the proper average values of VO2 and corresponds to 3.73 ± 0.92 MET. The results of the study confirm a very low level of exercise tolerance in the stroke group, which is significantly lower than in the CCI group (VO2 peak is 19.43 ± 4.77 ml/min * kg, which is 83.96 ± 12.93% of the proper average values and corresponds to 5.74 ± 1 .65 MET). The results of the study confirm a very low level of exercise tolerance in the stroke group, which is significantly lower than in the CCI group (VO2 peak is 19.43 ± 4.77 ml/min * kg, which is 83.96 ± 12.93% of the proper average values and corresponds to 5.74 ± 1.65 MET). Cardiopulmonary testing showed the absence of reliable dynamics of VO2 peak (p=0.29) and MET (p= 0.4) at the end of the rehabilitation course. A significant increase in VO2 peak was observed only in some patients who reached a load intensity level of 70% or more of the peak heart rate during training. Later a control study was conducted among 16 patients of the stoke group after 6 months. Cardiopulmonary testing showed the absence of reliable dynamics of the studied parameters in the absence of cardio training ambulatory. Our study of the patients’ with stroke condition in dynamics showed that there was no possibility of spontaneous (without aerobic exercise) restoration of exercise tolerance. Conclusion. In the early recovery period of IS, patients have a persistent long-term decrease of overall tolerance. Aerobic exercises have shown safety and good tolerance in IS rehabilitation programs. Aerobic exercises should be long-term, begin in a hospital and continue during ambulatory treatment. The intensity of training is a key parameter in the adjustment of Aerobic exercises for the patients with IS.

New Assessment of Overall Tolerance in the Rehabilitation of Patients in the Early Recovery Period of Ischemic Stroke

Enhanced external counterpulsation (EECP) has taken a worthy place among other methods in the complex treatment and rehabilitation of patients with cardiovascular pathology. Its use in outpatient and sanatorium-clinical practice significantly expands the prospect of treatment and improvement of prognosis in a wide range of patients with multifocal atherosclerosis. Aim. To study the effect of the EECP method in the complex medical rehabilitation of stable forms of coronary heart disease (CHD) in patients permanently residing in the resort city of Sochi. Material and methods. The study included 60 patients with CHD (FC II – 23, FC III – 29, FC IV – 8) living in the resort city of Sochi. Patients were randomized into intervention and control groups, in which there were no significant differences between clinical and anthropometric parameters. All of them received basic drug therapy, a complex of climatotherapeutic non-drug effects and attended the Coronary Club, a public health school for patients with СHD. Additional outpatient courses of EECP were conducted in the form of 35 one-hour sessions daily, 5 days a week, a full course for 7 weeks for each patient of the intervention group on basis. Initially and after the end of the rehabilitation course, the patients of both groups underwent electrocardiography (ECG), bifunctional daily ECG and blood pressure monitoring, Doppler echocardiography, ultrasound duplex scanning of brachycephalic vessels and lower limb vessels, exercise test on cycle ergometer, six-minute walking test, as well as physical activity level determination using IPAQ questionnaire and psychodiagnostic testing. Results and discussion. When comparing the data, patients in the intervention group showed a significant reduction in angina attacks and nitroglycerine use, stabilization of central haemodynamic parameters, increased exercise tolerance and improved subjective “quality of life” indicators. Conclusion. The data obtained confirm the experience accumulated in the world medical practice of the effective clinical impact of the EECP method in the treatment of patients with chronic coronary syndromes in outpatient treatment, including in conditions of humid subtropical climate. Therefore, its inclusion in the programs of complex sanatorium-resort rehabilitation of patients with stable forms of CHD is justified and promising.

Valproic Acid Inhibits Glial Scar Formation after Ischemic Stroke

Introduction: Cerebral ischemia induces reactive proliferation of astrocytes (astrogliosis) and glial scar formation. As a physical and biochemical barrier, the glial scar not only hinders spontaneous axonal regeneration and neuronal repair but also deteriorates the neuroinflammation in the recovery phase of ischemic stroke. Objectives: Previous studies have shown the neuroprotective effects of the valproic acid (2-n-propylpentanoic acid, VPA) against ischemic stroke, but its effects on the ischemia-induced formation of astrogliosis and glial scar are still unknown. As targeting astrogliosis has become a therapeutic strategy for ischemic stroke, this study was designed to determine whether VPA can inhibit the ischemic stroke-induced glial scar formation and to explore its molecular mechanisms. Methods: Glial scar formation was induced by an ischemia-reperfusion (I/R) model in vivo and an oxygen and glucose deprivation (OGD)-reoxygenation (OGD/Re) model in vitro. Animals were treated with an intraperitoneal injection of VPA (250 mg/kg/day) for 28 days, and the ischemic stroke-related behaviors were assessed. Results: Four weeks of VPA treatment could markedly reduce the brain atrophy volume and improve the behavioral deficits in rats’ I/R injury model. The results showed that VPA administrated upon reperfusion or 1 day post-reperfusion could also decrease the expression of the glial scar makers such as glial fibrillary acidic protein, neurocan, and phosphacan in the peri-infarct region after I/R. Consistent with the in vivo data, VPA treatment showed a protective effect against OGD/Re-induced astrocytic cell death in the in vitro model and also decreased the expression of GFAP, neurocan, and phosphacan. Further studies revealed that VPA significantly upregulated the expression of acetylated histone 3, acetylated histone 4, and heat-shock protein 70.1B in the OGD/Re-induced glial scar formation model. Conclusion: VPA produces neuroprotective effects and inhibits the glial scar formation during the recovery period of ischemic stroke via inhibition of histone deacetylase and induction of Hsp70.1B.

Cognitive impairment restoration in patients suffered with stroke during the post-COVID period

Frequency of vascular complications, including strokes, in patients suffered from COVID-19 infection is known to be increased up to 8 times, especially compared with influenza. The purpose: to investigate the fundamental mechanisms of brain ischemia in the patients with mnestic dysfunctions who previously underwent COVID-19 through pharmacocorrection via Phenibut (g-amino-b-phenylbutyric acid hydrochloride) and magnetic therapy in the early recovery period of ischemic stroke. The authors describe the possibilities of cognitive rehabilitation for people who have had ischemic stroke in the post-COVID period. Considering that the presence of mnestic dysfunctions has a negative impact on the process of rehabilitation of cerebral accidents, the fundamental mechanisms of brain ischemia in patients with mnestic dysfunctions in the early recovery period in patients who have undergone COVID-19 have been studied through pharmacocorrection via Phenibut (g-amino-b-phenylbutyric acid hydrochloride) and magnetic therapy. 46 patients aged 40 to 60 years were examined. A comparative study of three randomized clinical groups of patients with separate and complex use of Phenibut and magnetic stimulation. The effectiveness of the proposed therapy in restoring executive functions was established on the basis of indicators of the MMSE scale, the test for the study of frontal dysfunction – FAB, regression of depressive symptoms and is characterized by a decrease in the score on the GDS scale. The authors conclude that mnestic disorders are a functional "target" in cerebral ischemia in the post-COVID period, which requires close attention in relation to pharmacocorrection methods and comprehensive rehabilitation and further research, including the elucidate the pathogenetic mechanisms of cerebral ischemia.

Ішемічний інсульт при метаболічному синдромі та цукровому діабеті: клініко-морфометричні особливості, лікування

У статті висвітлюються питання ведення пацієнтів із метаболічним синдромом та ішемічним інсультом. Наведені результати дослідження клініко-морфометричних особливостей головного мозку у хворих з ішемічним інсультом при метаболічному синдромі та цукровому діабеті 2-го типу і впливу альфа-ліпоєвої кислоти на перебіг відновного періоду ішемічного інсульту.

Глиатилин в лечении постинсультных больных

В статье представлены данные исследования влияния препарата Глиатилин на выраженность неврологического дефицита, показатели повседневной жизненной активности и состояние когнитивных функций у больных в восстановительном периоде ишемического инсульта (ИИ). Установлено, что у пациентов в восстановительном периоде ИИ применение Глиатилина в дозе 1000 мг в/м 1 раз в сутки (длительность применения 14 дней), а затем по 400 мг 2 раза в сутки (длительность применения 2 месяца) позволяет уменьшить степень выраженности субъективной и объективной неврологической симптоматики. У пациентов отмечается улучшение нарушенных когнитивных функций, в том числе происходит восстановление концентрации внимания и памяти, улучшение умственной и физической работоспособности, эмоционального состояния больных, что повышает эффективность реабилитационных мероприятий.

Медотилін у лікуванні постінсультних когнітивних порушень

Стаття присвячена питанням лікування пацієнтів, які перенесли інсульт. Робиться акцент на корекції когнітивних порушень. Наведено дані дослідження впливу генеричного препарату Медотилін (холіну альфосцерат) на стан когнітивних функцій, показники повсякденної життєвої активності у хворих у відновному періоді ішемічного інсульту.

A panel of serum biomarkers, including damage, apoptosis and neurotrophic markers, for the assessment of prognosis of the course of ischemic stroke

Identification of the relationship between clinical and neuroimaging data and the content of serum biomarkers (damage marker - neuron-specific enolase (NSE), apoptosis - p53 protein and neuroplasticity - brain-derived neurotrophic factor (BDNF)) in acute, early and late recovery periods of ischemic stroke. Eighty patients in the acute, early and late recovery periods of ischemic stroke, aged from 49 to 75 years, were examined. The comparison group included 20 patients with chronic cerebral ischemia, comparable to the study group. A clinical assessment was carried out on the following scales: The National Institutes of Health Stroke Scale (NIHSS), the European Stroke Scale (ESS), the modified Rankin scale, the Bartel Index and SS-QOL. In the acute, early and late recovery periods of ischemic stroke, the dynamics of biomarker levels (NSE, p53 protein, BDNF) in blood serum and brain MRI in T1, T2, FLAIR, DWI modes were quantified. In patients with a favorable course in the acute period of stroke, low values of the NSE level and a trend towards increased levels of serum BDNF by the 10th day of the disease were noted. For the first time, it was found that high NSE and stable BDNF levels or a tendency to their decrease were observed in the acute period in patients with an unfavorable course of ischemic stroke. In the early recovery period of ischemic stroke, a strong correlation was established between the degree of independence and disability of patients, and the levels of serum NSE and BDNF. A significant inverse correlation was proved between the severity of neurological deficit, assessed on the ESS, in the late recovery period of ischemic stroke (12 months) and the level of BDNF in blood serum (r=-0.464). The selected complex of biochemical methods allowed us to assess the severity of damage, the activity of apoptotic and compensatory neurotrophic capabilities of brain tissue in ischemic stroke, as well as their relationship with clinical and neuroimaging data. We have shown the prognostic significance of the selected markers, which will allow, with an integrated approach, more accurate prediction of the further course and outcome of stroke.

PRACTICAL ASPECTS AND RESULTS OF COGNITIVE THERAPY IN THE EARLY RECOVERY PERIOD OF ISCHEMIC STROKE.

The aim: To determine the impact of cognitive training on the degree of cognitive functions recovery and quality of life in the early recovery period of ischemic stroke. Materials and methods: 108 patients with cerebral infarction were examined outpatiently, follow-up from 1 to 3 months from the onset of the disease. Basic assessment methods: screening index of cognitive disorders according to the Montreal Cognitive Assessment Scale (MoCA), SF-36 questionnaire. Results and Conclusions: Comprehensive rehabilitation measures for the early recovery period of ischemic stroke achieve improvement of the cognitive sphere: a significant increase in the average score on the Montreal scale of cognitive functions assessment (MoCA scale) in both observation groups.

Impact of the physical rehabilitation onset time in early recovery period of ischemic stroke (second stage of medical rehabilitation) on the level of daily activity and independence

Ischemic stroke (IS) is the leading cause of neurological inpatient care, readmission, and long-term disability. Until now, there is no single point of view on when the second stage of medical rehabilitation after an IS should be started and the amount of the rehabilitation activities.Objective: to compare the effectiveness of the course of motor rehabilitation during the first 30–90 days and 91–180 days after IS.Patients and methods. The patients were divided into two groups: group 1 included 44 patients in whom ≤3 months passed from IS onset, and group 2–39 patients in whom >3 but <6 months have passed since the IS onset. All patients included in the study received physiotherapy exercises, simulator exercises, robotic mechanotherapy, physiotherapy, massage, speech therapy, cognitive training, and secondary IS prevention.Results and discussion. In both groups patients got a positive treatment result: a significant increase in muscle strength, gait stability, quality, and speed. The number of patients who achieved independence (≤2 points on the Rankin scale) before the start of the rehabilitation course among patients of group 1 was 9.4%, after the end of the course – 40.6%. More initially independent patients were included in the group 2 – 28.6%; after a course of rehabilitation, the proportion of independent patients increased to 35.7%.Conclusion. Rehabilitation courses are effective in patients who have had IS, both in the first three months and in the period from the 4th to the 6th month. It is advisable to conduct the second stage of medical rehabilitation earlier after a stroke.

Сomplex rehabilitation of walking function in central paresis of the lower limb using neuroprosthetic technology

Disability after a stroke is most often associated with decreased patient activity due to walking disorder. In case of severe paresis, the function of the limb in the early stages of recovery is advisable to support with the help of partial prosthetics, using methods that provide functional stimulation. The complex treatment of central paresis includes botulinum therapy, which is due to the high incidence of spasticity.
 Aim: of the study: evaluation of the efficacy of functional electrical stimulation in a complex of multimodal effects in restoring movement in stroke patients with lower limb paresis.
 Materials and methods: Stimulation and neuroprosthetic methods (Bioness L300) were used as the main therapeutic program of rehabilitation treatment for patients with motor disorders of the lower limb after an ischemic stroke (n = 70). The median period of stroke was 21 [11; 47] days, median age 54 [42; 65] years. Scales and questionnaires were used to assess the loss of strength and volume of movement disorders, spasticity, walking speed and self-care (Medical Research Council Weakness Scale (1981, MRC), Barthel Index (1965), Modified Ashworth Scale (MAS), 10-meter test).
 Results: The effectiveness of personalized therapy with the use of a neuroprothesis (Bioness L300) in patients in the acute and early recovery period of ischemic stroke was shown. The additional use of botulinum toxin made it possible to eliminate the inhibitory effect of spasticity, which expanded the possibility of using intensive methods of physical rehabilitation. There was an increase in daily activity, walking speed, and the level of self-care of patients in 90 % of cases.
 Conclusion: The use of a complex of stimulating personalized techniques in the acute period of a stroke is justified and safe. The functional electrical stimulation helps to overcome power paresis, increases the overall level of physical activity of patients after a stroke, motivation for recovery and improves the quality of life. (1 figure, 2 tables, bibliography: 9 refs)

Структурно-морфометрические и клинико-энцефалографические особенности эпилепсии у больных в позднем восстановительном периоде ишемического инсульта (обзор литературы)

Актуальность. В последние годы во всех странах отмечается существенный рост заболеваемости эпилепсией у лиц старших возрастных групп. Одним из наиболее частых факторов риска развития эпилептических припадков являются цереброваскулярные заболевания. Считается, что 10–30 % впервые диагностированных эпилептических припадков у пациентов старше 60 лет возникают после инсульта, что в дальнейшем значительно усложняет клиническую картину заболевания и служит причиной ухудшения качества жизни больных, замедляет восстановление потерянных вследствие инсульта функций, усиливает когнитивные и мнестические расстройства, увеличивает риск внезапной смерти, что, в свою очередь, требует пересмотра проводимой терапии с учетом фармакологического взаимодействия препаратов. Кроме того, достоверно установлено, что эпилептический приступ, который дебютировал в возрасте старше 60 лет, значительно увеличивает риск первичного и повторного инсульта. Несмотря на длительный период изучения данной проблемы, диагностика постинсультной эпилепсии (ПИЭ) затруднена до настоящего времени в связи с отсутствием единой позиции относительно понимания патогенеза, разной дефиницией диагноза, необъективной интерпретацией межприступной (интериктальной) электроэнцефалографии. Цель: провести анализ литературных данных относительно структурно-морфометрических и клинико-энцефалографических особенностей эпилепсии у больных в разные периоды ишемического инсульта. Проанализировать вероятность риска дебюта ПИЭ. Материалы и методы. Про-анализированы имеющиеся публикации, касающиеся вопросов ПИЭ, с помощью поиска, проведенного по таким базам данных, как Кокрановская база систематических обзоров (CDSR), центральный реестр контролируемых исследований Кокрана (CENTRAL), база данных SCOPUS и MEDLINE. Были отобраны соответствующие рандомизированные контролируемые исследования, однако из-за нехватки обзорных исследований и метаанализа в работу включены, в частности, наблюдательные и эпидемиологические исследования. Результаты. В большинстве проанализированных исследований авторы показали большую вариабельность частоты развития ПИЭ. Высокая вариабельность объясняется особенностями течения инсульта в разных популяциях, разной дефиницией диагноза ПИЭ, различным дизайном проведенных исследований. Однако в большинстве исследований было установлено, что риск развития ПИЭ удваивается от первого до пятого года после перенесенного инсульта и составляет около 4,2–5 %. Выводы. Таким образом, изучение нейрофункциональных и структурно-морфометрических изменений у больных эпилепсией в позднем восстановительном периоде ишемического инсульта является важной проблемой клинической неврологии, многие аспекты которой имеют в настоящее время неоднозначные, нередко противоречивые толкования. Поэтому изучение данной взаимосвязи позволит лучше понять патогенез ПИЭ, расширит возможности ее терапии и диагностики.

Comparative Characterization of Candidate Molecular Markers in Ischemic and Hemorrhagic Stroke

According to epidemiological studies, the leading cause of morbidity, disability and mortality are cerebrovascular diseases, in particular ischemic and hemorrhagic strokes. In recent years considerable attention has been given to the study of molecular markers of ischemic and hemorrhagic strokes. These studies are relevant because brain-specific protein biomarkers of neurons and glial cells can provide valuable and timely diagnostic information necessary for clinical decision-making.The aim of the study was to reveal the differences in the serum level of molecular markers in acute, subacute and early recovery periods of ischemic and hemorrhagic strokes.Material and methods. The study included 59 patients. Twenty patients were diagnosed with hemorrhagic stroke and 39 had ischemic stroke. The control group included 20 volunteers. Serum levels of molecular CNS markers were determined in acute, subacute, and early recovery stages of stroke. The serum levels of CNS molecular markers of patients with ischemic and hemorrhagic stroke was measured quantitatively by enzyme immunoassay. Statistical analysis was performed by nonparametric Mann-Whitney method.Results. The level of brain-derived neurotrophic factor (BDNF) in the control volunteers was 574.5 [455.5; 615] pg/ml. Significant differences were found for acute and subacute periods of hemorrhagic stroke: it was 674 [560; 749] pg/ml (P=0.003) and 664 [616; 762] pg/ml (P=0.0001).The level of neuron-specific enolase was significantly increased in all periods of the study: it was 4.15 [3.53; 4.8] ng/ml in the control group, 5.4 [4.4; 6.4] ng/ml in acute period of ischemic stroke (P<0.001), 5.4 [4.4; 6.4] ng/ml in early recovery period of ischemic stroke (P=0.001), 5.1 [4.6; 6.4] ng/ml in acute period of hemorrhagic stroke (P=0.014), 664 [616; 762] ng/ml in subacute period of hemorrhagic stroke (P=0.003).In the control group, the serum S-100 protein level was 4.5 [3.8; 5.4] ng/ml. In the acute and early recovery periods of ischemic stroke, S-100 protein level has significantly fallen down to 4.1 [3.4; 4.6] ng/ml (P<0.031) and 3.9 [3.4; 6] ng/ml (P=0.014), respectively. Glial-cell derived neurotrophic factor level was 1.98 [1.64; 2.1] ng/ml in the controls and increased up to 2.4 [2.2; 5] ng/ml (P=0.002) in the acute period and 2.4 [2.3; 2.6] ng/ml (P<0.001) in the subacute period of hemorrhagic stroke.The vascular endothelial growth factor receptor-1 (VEGFR-1) was significantly lower in the subacute period of hemorrhagic stroke: 485 [211; 945] pg/ml in the subacute period vs 903.5 [626; 1115] pg/ml in the controls (P=0.001).Conclusion. We found differences in the serum level of molecular markers in patients with ischemic and hemorrhagic strokes. In the acute period, early recovery period of ischemic stroke, and subacute period of hemorrhagic stroke, there was an increase in the serum level of neuron-specific enolase. The level of brain-derived neurotrophic factor increased significantly in the acute and subacute periods of hemorrhagic stroke. In the acute and early recovery periods of ischemic stroke, the level of S-100 protein decreased. The level of glial cell-derived neurotrophic factor increased in the acute and subacute periods of hemorrhagic stroke. In the subacute period of hemorrhagic stroke, the level of endothelial growth factor receptor-1 significantly decreased. Moreover, there was significant difference between values of this parameter in the subacute period of hemorrhagic stroke and in the early recovery period of ischemic stroke.

Research on in vivo metabolites of Longxue Tongluo Capsules by liquid chromatography coupled with hybrid ion trap/time-of-flight mass spectrometry

Longxue Tongluo Capsules(LTC) has good efficacy against blood stasis syndrome during the recovery period of ischemic stroke. Its main active ingredient is the phenolic extract of Chinese dragon's blood. In our previous study, the primary mass fragmentation pathways of phenolic derivatives from LTC were clarified. Herein, the metabolites in rat plasma were characterized following the oral administration of loureirin A and loureirin C using liquid chromatography coupled with hybrid ion trap/time-of-flight mass spectro-metry(LC-IT-TOF-MS), with 18 and 55 metabolites identified, respectively. On this basis, with the help of the obtained accurate molecular weight, characteristic fragment ions, reference comparison, combined with LTC database and natural products database self-created in our group, 18 prototypes and 106 metabolites were tentatively identified in rat plasma after oral gavage of LTC at a dose of 500 mg·kg~(-1). Glucuronidation, sulfonation, and methylation were major biotransformation pathways of LTC. This study preliminarily clarified the LTC constituents absorbed into blood and laid the foundation for clarifying the effective substances of LTC.

Assessment of Neuron-Specific Enolase and Brain-Derived Neurotrophic Factor Levels at Rehabilitation Stages in the Early and Late Recovery Periods of Ischemic Stroke

Assessment of Neuron-Specific Enolase and Brain-Derived Neurotrophic Factor Levels at Rehabilitation Stages in the Early and Late Recovery Periods of Ischemic Stroke

Dynamics of recovery of cognitive deficit in patients in the early recovery period of ischemic stroke

Study of the effectiveness of the use of the drug Ampasse in the process of complex rehabilitation in patients in the early recovery period of ischemic stroke at the second (stationary) stage. The study included 60 patients, 28 women and 32 men, aged 43 to 76 years (mean - 58.4±9.1 years), in the recovery period after suffering a stroke in the period from 1 to 12 months (on average - 4.7±3.5 months). All patients received complex rehabilitation, patients of the 1st group received additional intravenous injections of the drug Ampasse 25 mg (5.0 ml), 15 injections. Patients of the 2nd group (n 0) did not receive Ampasse. To assess cognitive functions, the following tests were used: the Montreal Cognitive Assessment Scale (MoCA), Stroop's test, subtest 9 of the Wechsler test, Koos cubes (CC), the severity of anxiety and depression was assessed, and motor recovery was assessed by the hand motor activity test (ARAT). The assessment was carried out before the start of treatment and on the 21st day. There was a statistically significant increase in the score on the MoCA scale, in patients of the 1st group by an average of 2 points, in the 2nd group there was no significant dynamics, a statistically significant difference was found in the proportion of patients who had an increase in the MoCA index after the course of treatment in the 1st group. compared with the 2nd (χ2 - 22.528, p<0.001). Decreased the level of rigidity according to the Stroop test in patients of the 1st group compared with the 2nd (χ2 - 8.297, p=0.004). The number of patients who showed positive dynamics in the Koos cubes test in the 1st group was statistically significantly higher (χ2- 4.344, p=0.038). A statistically significant decrease in the level of depression was revealed in patients of the 1st group. The number of patients with improved motor function of the hand was greater in the 1st group of MG (χ2 - 4.286, p<0.039). In patients in complex therapy receiving intravenous administration of the drug Ampasse at a dose of 25 mg (5.0 ml) 15 administrations, a statistically significant improvement in cognitive functions was revealed according to MoCA tests, Stroop test, Koos Cubes, when compared with the comparison group. The use of Ampasse increased the effectiveness of cognitive and motor rehabilitation in patients with post-stroke disorders.

Neurorehabilitation in the Early Recovery Period of Ischemic Stroke. Pharmacology Support

Aim: The aim of the study was to evaluate the clinical outcome in the use of neuroprotective agents in the acute period of ischemic stroke. Material and Methods: The study was performed on the basis of the stroke of the Center for Reconstructive and Rehabilitation Medicine (University Clinic) of the Odessa National Medical University. A retrospective analysis of clinical outcomes of 115 patients with acute stroke was conducted. Results: An average NIHSS score at discharge was 4.1±0.1 points when treated with no refinery, then it reached 3.6±0.1 points when using peptidergic drugs, and 3.4±0.1 when using D-fdf. 3.1±0.1 points. When using D-FDF, the MMSE score was 3.5±0.1 points, whereas when using cholinergic agents, this index did not exceed 26.9±1.5 points, and when using peptidergic agents - 26.8±1.4 points. Conclusion: The use of neuroprotective agents positively affects the effectiveness of neuro-rehabilitation in patients with acute stroke. The best results in three months after the hospitalization were obtained for peptidergic agents and D-fructose-1,6-diphosphate.

Cellex in the therapy of patients with complex and central apnea in the early recovery period of ischemic stroke

A variety of structural and functional post-stroke disturbances demands an integrated clinical/diagnostic approach. Persistent hypoxemia due to disturbance of a saturation of blood oxygen in sleep can decrease the effectiveness of neurorehabilitation. In some cases of sleep apnea, the efficiency of continuous positive airway pressure therapy is insufficient and it should be combined with course neuroprotective therapy. Modern approaches to neuroprotective and neuroreparative therapy are considered as the independent direction for treatment of the central sleep apnea syndromes in patients with stroke consequences that is obviously important aspect of secondary prevention of a stroke.

Therapy of moderate cognitive impairment in the early recovery period of ischemic stroke

To assess the efficacy and safety of prospecta in the treatment of moderate cognitive impairment in the early recovery period of ischemic stroke. The study included 275 patients (mean age 64.0±8.1 years) with a history of single ischemic stroke from 3 to 6 months, with moderate cognitive impairment, and moderate activity in everyday life, who were randomized in two groups. During the screening phase, the severity of cognitive impairment was assessed with the Mini-Mental State Examination and Montreal Cognitive Assessment scales; the level of activity in everyday life was evaluated with the Barthel Scale; and quality of life was assessed with the Stroke Specific Quality of Life Scale. Patients took 2 tablets of prospecta or placebo 2 times a day for 24 weeks. The follow-up period was 4 weeks. The primary endpoint of the study was the proportion of patients with improvement in cognitive function (+1 or more on the MoCA test) after 24 weeks of treatment. The occurrence and type of adverse events (AEs), their severity, relationship to the drug, outcome, changes in vital signs, and the proportion of patients with clinically significant abnormality in laboratory tests were analyzed to assess the safety. A clinically significant improvement in cognitive function was obtained in 91.9% of patients in the prospecta group vs 82.,1% in the placebo group, (p=0.02). There were 57 AEs in 37 (27.4%) Prospecta group patients and 53 AEs in 39 (27.9%) Placebo group participants (p=1.00). No AEs were certainly associated with taking the medication. No clinically significant changes in vital signs or abnormal laboratory results were detected during the study. Prospecta is an effective and safe treatment option for patients with moderate cognitive impairment in the early recovery period of ischemic stroke.