Nonmedical correction of lipid metabolism disorders in patients with chronic cerebral ischemia

The authors evaluated the effectiveness of the isolated use of iodine-bromine baths and ozone therapy, as well as their complex application in the correction of lipid metabolism disorders in chronic cerebral ischemia. Statistical analysis of biochemical parameters after the treatment made it possible to come to the conclusion about the sufficient effectiveness and feasibility of using the proposed methods.

Meta-analytical evaluation of the clinical efficacy of a complex metabolic neuroprotector in patients with chronic cerebral ischemia

The aim of the study is to evaluate the clinical efficacy, safety, and impact of the complex metabolic neuroprotector on the patients’ quality of life (CMN) Cytoflavin in tablets, as well as in the course of stepwise pharmacotherapy of patients with chronic cerebral ischemia (CCI) of various etiologies, followed by meta-analysis, on the basis of a systematic review of published clinical studies.Material and methods. A selection of randomized controlled trials was carried out over the past 15 years, in which CMN Cytoflavin was used in the tablet dosage form or in a stepwise course of therapy in at least 25 patients diagnosed with chronic cerebral ischemia with a total course of therapy of at least 25 days. The assessment of CMP clinical efficacy and the analysis of formalized indicators of clinical efficacy (relative risk, odds ratio, frequency of outcomes, values of absolute and relative benefits, etc.) was carried out.Results and conclusion. 403 publications for 2000–2017 describing the use of CMN Cytoflavin were analyzed. 16 studies were selected for the systematic review, the meta-analysis included 6 randomized clinical trials and one non-randomized study of the use of CMN in patients with CCI. The data of the systematic review and meta-analysis showed a sufficient efficacy of complex metabolic neuroprotector use in patients with chronic cerebral ischemia. However, the meta-analysis revealed significant heterogeneity between the studies. The drug has a beneficial effect on the quality of life of patients, increases the likelihood of a positive outcome in relation to the relief of asthenic and vestibular-atactic syndromes, in relation to complaints of increased fatigue, headache, dizziness, noise in the head, impaired coordination. It improves cognitive functions, exhibits sufficiently high tolerance and safety.

Potential Protective Effect of Dl-3-n-Butylphthalide on Chronic Cerebral Ischemia Brain Injury

: Chronic cerebral ischemia is one of the common ischemic cerebrovascular diseases. Chronic cerebral ischemia can lead to brain dysfunction, and its pathophysiological mechanism involves inflammation, blood-brain barrier destruction, oxidative stress, and other factors. Due to it being difficult to detect, it is easily overlooked, and it is often only observed following onset of cognitive dysfunction. At present, there are few drugs for this treatment. DL-3-N-BUTYLPHTHALIDE (NBP), a compound extracted from celery seed, may play an important role in protecting against brain damage caused by chronic cerebral ischemia. Therefore, we pay more attention to the prevention and treatment of NBP on chronic cerebral ischemia.

Interrelation of cognitive functions and neural networks with blood flow velocity through the internal jugular vein in patients with chronic cerebral ischemia

Understanding age-related and functional changes in cerebral venous circulation is critical for the development of new preventive, diagnostic and therapeutic approaches to maintaining brain health in the elderly. Chronic cerebral ischemia is one of the widespread socially significant vascular diseases caused by a decrease in the level of blood circulation. To assess the role of venous outflow through the internal jugular veins in cognitive decline and neural networks in patients with chronic cerebral ischemia, 30 men and 40 women (average age 66.5 years), cognitive functions and organization of neural networks were studied at high and low levels of cerebral venous blood flow through the internal jugular veins. To assess the venous outflow, the systolic blood flow rate was measured by the internal jugular veins. A higher rate of venous outflow through internal jugular veins is associated with a more successful performance of the Luria test for verbal memory. A higher or lower blood flow rate affects the formation of neural networks of the brain. At a higher blood flow rate, the predominant areas of the resting neural networks (the passive mode network of the brain and the salient network) are localized in the frontal regions, at a low blood flow rate, the predominant neural network (frontal-parietal) is located in the left hemisphere. The state of faster and slower venous outflow forms neural networks using different neural formations that affect verbal memory. Reorganization of neural networks in this case, apparently, is the central mechanism responsible for cognitive decline in chronic cerebral ischemia (2 figs, 1 table, bibliography: 10 refs)

Repeated intravenous infusion of mesenchymal stem cells for enhanced functional recovery in a rat model of chronic cerebral ischemia

OBJECTIVE Stroke is a major cause of long-term disability, and there are few effective treatments that improve function in patients during the chronic phase of stroke. Previous research has shown that single systemic infusion of mesenchymal stem cells (MSCs) improves motor function in acute and chronic cerebral ischemia models in rats. A possible mechanism that could explain such an event includes the enhanced neural connections between cerebral hemispheres that contribute to therapeutic effects. In the present study, repeated infusions (3 times at weekly intervals) of MSCs were administered in a rat model of chronic stroke to determine if multiple dosing facilitated plasticity in neural connections. METHODS The authors induced middle cerebral artery occlusion (MCAO) in rats and, 8 weeks thereafter, used them as a chronic stroke model. The rats with MCAO were randomized and intravenously infused with vehicle only (vehicle group); with MSCs at week 8 (single administration: MSC-1 group); or with MSCs at weeks 8, 9, and 10 (3 times, repeated administration: MSC-3 group) via femoral veins. Ischemic lesion volume and behavioral performance were examined. Fifteen weeks after induction of MCAO, the thickness of the corpus callosum (CC) was determined using Nissl staining. Immunohistochemical analysis of the CC was performed using anti-neurofilament antibody. Interhemispheric connections through the CC were assessed ex vivo by diffusion tensor imaging. RESULTS Motor recovery was better in the MSC-3 group than in the MSC-1 group. In each group, there was no change in the ischemic volume before and after infusion. However, both thickness and optical density of neurofilament staining in the CC were greater in the MSC-3 group, followed by the MSC-1 group, and then the vehicle group. The increased thickness and optical density of neurofilament in the CC correlated with motor function at 15 weeks following induction of MCAO. Preserved neural tracts that ran through interhemispheric connections via the CC were also more extensive in the MSC-3 group, followed by the MSC-1 group and then the vehicle group, as observed ex vivo using diffusion tensor imaging. CONCLUSIONS These results indicate that repeated systemic administration of MSCs over 3 weeks resulted in greater functional improvement as compared to single administration and/or vehicle infusion. In addition, administration of MSCs is associated with promotion of interhemispheric connectivity through the CC in the chronic phase of cerebral infarction.

Immunopathogenesis and immunotherapeutic approaches of neurodegenerative and cerebrovascular diseases with cognitive impairment. The current state of the problem and prospects

Cognitive impairments (CI) are a serious problem in modern society, because they significantly reduce patients’ quality of life and tend to progress. Age-related diseases such as neurodegenerative — first of all Alzheimer’s disease (AD) and cerebrovascular disorders are key causes leading to CI. At present, approaches to treating these diseases have limited effectiveness in restoring cognitive functions, and do not change disease course, although they can slow cognitive decline.Understanding the immunopathogenesis of neurodegenerative and cerebrovascular diseases defines new targets and approaches to their treatment. In addition, suppression of neuroinflammation is advisable in the cases of early nonclarified cognitive decline, when information from routine medical, laboratory and instrumental examination of patients is insufficient to identify the causes of CI.This article summarizes current understanding of the immunopathogenesis of AD and chronic cerebral ischemia. The mechanism of neuroinflammation is presented as a cascade of sequential events that are closed in a self-perpetuating inflammatory response in the end. So called damage-associated molecular patterns, specific receptors that can bind them (pattern recognition receptors), intracellular signal transduction in microglia, cytokines and adhesion molecules are considered as potential points of application of immunomodulatory therapy. The review provides information on the current level of development of immunotherapy of AD, chronic cerebral ischemia and offers the prospect of its application.

Resistive index of internal carotid artery and brain networks in patients with chronic cerebral ischemia

Quantitative assessment of cerebral hemodynamics is important for patients with chronic cerebral ischemia (CCI), as it helps to reveal the pathogenesis of the disease and set the course for effective prevention and treatment. The study was aimed to assess the correlation of the left carotid artery (ICA) resistive index (RI) with cognitive functions and brain network organization based on fMRI data in patients with CCI (51 males and 105 females). The listed above indicators were studied in patients with the left ICA RI values below and above the average (0.54 ± 0.013). The lower, normal physiological ICA resistance levels corresponded to the more successful realization of verbal cognitive functions. In the first group, RI was within normal range (RI = 0.42 ± 0.007), and in the second group RI exceeded normal levels (RI = 0.61 ± 0.01). Variation of the right ICA RI did not correlate with the characteristics of verbal cognitive functions. FMRI data analysis was used to assess the differences in connectivity between various brain regions in the groups with low and high RI. The normal physiological and elevated RI values of the left ICA correlated with differences in the organization of brain networks: normal physiological RI values corresponded to a better organization of hemispheric connections in the basal ganglia and brainstem, and high RI values corresponded to a better organization of connections between the frontal regions and the cerebellum as well as occipital areas of the cerebral cortex. The left ICA RI can be considered as a biomarker of cognitive decline and brain networks reorganization in patients with CCI.