Prevalence and severity of depression in patients with the consequences of ischemic strokes and in patients with chronic brain ischemia

The aim of our study was to investigate the prevalence and severity of depression in patients with the consequences of ischemic strokes and in patients with chronic brain ischemia. Material and Methods. We examined 100 patients with consequences of ischemic strokes and 17 patients with chronic cerebral ischemia. The Hamilton Depression Rating Scale was used to assess the presence and degree of depression. Conclusions. Slightly less than half of the patients with chronic cerebral ischemia (47.1%) had no depression, 42.1% had mild depression, and only 11.8% of the patients had moderate and severe depression. A different situation was observed in the group of patients with the consequences of ischemic strokes. Among them, only 22.0% of patients had no depression, 44.0% had mild depression, and 34.0% of patients had moderate, severe, and extremely severe depression (p < 0.05).

CORRELATION ANALYSIS BETWEEN LABORATORY IMMUNE AND METABOLIC PARAMETERS IN CHRONIC BRAIN ISCHEMIA STAGES I AND II ALONG WITH HYPERTENSION AFTER TREATMENT

Determination of interrelationships between impairments of laboratory parameters of immune and metabolic status in patients with chronic cerebral ischemia of I-II stages was carried out. The study included 104 patients, of which 76 were female and 28 males, with CCI on the background of II degree hypertension, of which 52 patients were with stage I and 52 with stage II at the age of 50 ± 5 years. Also, clinical and laboratory parameters were studied in 22 healthy donors of the same age. Evaluation of clinical and laboratory data was carried out at the beginning of treatment and 2 weeks after its end. The sorption capacity of erythrocytes and the sorption capacity of the glycocalyx (SEG), the activity of lipid peroxidation processes, the state of the antioxidant system were determined in blood plasma and erythrocytes, the level of stable metabolites of nitric oxide (SMNO), neopterin, C-reactive protein, cytokines (TNFα, IL- 1β, IL-8, IFNγ, IL-18, G-CSF, IL-4, IL-10), immunoglobulins (IgM, IgG, IgA), complement system components (C3, C4, C5, C5А), the phagocytic and oxygen-dependent activity of polymorphonuclear blood leukocytes. Comparative assessment of the results of correlation, factorial and cluster analyzes for assessing the parameters of the immune and metabolic status in patients with stage I CCI revealed the most significant laboratory parameters necessary for determination in the clinic for objective assessment of the severity of immune and metabolic disorders: TNFα, IL-8, IL-10, SMNO and NEG. In patients with CCI stage II, to objectively assess the severity of immune and metabolic disorders, TNFα, IL-8, IL-17, IL-10, the phagocytic number of neutrophils and SEG are recommended.

PERSONALIZED PHARMACOLOGICAL CORRECTION OF IMMUNE SYSTEMS, METABOLIC AND NEUROPSYCHIC PARAMETERS IN CHRONIC BRAIN ISCHEMIA OF STAGE I AND II ON THE BACKGROUND OF HYPERTENSION DISEASE

The study aimed to develop a personalized pharmacological correction of immune, metabolic and neuropsychiatric disorders in chronic cerebral ischemia (CCI) stages I and II. The study included 104 patients, of which 76 were female and 28 were male, with CCI on the background of grade II hypertension, of which 52 patients were with stage I and 52 with stage II at the age of 50±5 years. Clinical and laboratory parameters were studied in 22 healthy donors of the same age who formed a control group. Patients with CCI were randomized according to gender, age, treatment method, concomitant pathology, and duration of the disease. Evaluation of clinical and laboratory data was carried out at the beginning of treatment and 2 weeks after its end. The sorption capacity of erythrocytes and the sorption capacity of the glycocalyx (SEG), the activity of lipid peroxidation processes, the state of the antioxidant system were determined in blood plasma and erythrocytes, the level of stable metabolites of nitric oxide (SMNO), neopterin, C-reactive protein, cytokines (TNFα, IL-1β, IL-8, IFNγ, IL-18, G-CSF, IL-4, IL-10), immunoglobulins (IgM, IgG, IgA), complement system components (C3, C4, C5, C5A), phagocytic and oxygen-dependent activity of polymorphonuclear blood leukocytes. It has been established that for patients with CCI I with high concentrations of IL-8, IL-10, SMNO and a low SEG index, the intake of Cereton and Actovegin or Ceraxon and Mexicor will be insufficient for effective correction of immunometabolic disorders, which requires additional administration of an immunomodulator. Patients with CCI II, who have a higher plasma level of TNFα, IL-10 and low SEG values, need to prescribe Ceraxon, Mexicor and Glutoxim or Ceraxon, Mexicor and Polyoxidonium in order to obtain the maximum clinical and laboratory positive effect.

A Descriptive Study of Histopathological of Chronic Brain Ischemia of Rat Tissue

Worldwide, cerebrovascular accidents (stroke) are the second leading cause of death and the third leading cause of disability. However, not many the histopathological study of progression in chronic stroke has been published so far. This study gives the detail explanation of mechanism of recovery and might give the idea of new timeline when to set up the treatment to regenerate restoration of damaged cells. Fourteen male Wistar rats (15–20 weeks, weighing 250-400 g) were used in this study. Prior to 7 days of adaptation to the laboratory environment, rats were divided into four groups. Sham group (n=2), rats that sacrificied 4th week (n=2), 8th week (n=5), 12th week(n=5). 90 minutes temporary MCAO procedures were performed using the Indonesian modified technique. CD31 and Doublecortin markers were used to evaluate angiogenesis and neurogenesis. The results showed that ventricle size of ipsilateral brain was not so affected as in week 12th compared to 8th week. Gliosis as a response to damage to the central nervous system was more dense in week 12th as oppose to week 4th. Regarding angiogenesis and neurogenesis, there is significant improvement of angiogenesis and neurogenesis within weeks, however 4th week post MCAO shows prominent recovery. We summarized that rat’s brain shows spontanenous improvement in chronic phase of stroke ischemia and angiogenesis and neurogenesis still happends until week 12th.

New opportunities in the treatment of patients with chronic brain ischemia

The study was aimed to evaluate the clinical efficacy of Hericium erinaceus extract (Cebrofit) in combination with vinpocetine compared to vinpocetine monotherapy in patients with chronic cerebral ischemia. Two groups of patients were identified — the basic and control, which included 160 patients with stage I and II dyscirculatory encephalopathy aged 30 to 80 years. All subjects underwent basic therapy, during which for 3 months patients of the basic group took Cebrofit 1 capsule 150 mg twice a day and vinpocetine (Vicebrol) 1 tablet 5 mg three times a day, and patients of the control group used only vinpocetine according to the scheme described above. Based on a comprehensive study, it was found that the use of Cebrofit in combination with vinpocetine compared to vinpocetine monotherapy resulted in accelerated regression of subjective and objective manifestations of chronic brain ischemia with an advantage in patients with stage I dyscirculatory encephalopathy. In patients with stage I dyscirculatory encephalopathy, the use of Cebrofit in combination with vinpocetine produced a pronounced neuroprotective effect, which manifested in a significant improvement in general condition, a decrease in the severity of neurological symptoms, a decrease in the manifestations of asthenia and anxiety after 28 days of therapy, and a significant increase in cognitive performance after 7 days of therapy, while maintaining this positive trend until the end of the course of treatment. In patients with stage II dyscirculatory encephalopathy under the influence of Cebrofit in combination with vinpocetine, positive differences in the form of a decrease in the severity of clinical and neurological symptoms, manifestations of asthenia, anxiety, and depression, as well as improvement in cognitive functions were recorded after 84 days of treatment, which allows recommending the use of these schemes in clinical practice.

Features of responding to stress of elderly patients with chronic brain ischemia

The aim of the study. To study the peculiarities of responding to stress, the stress resistance and adaptation of older men and women with chronic brain ischemia, as well as the stressboard effect of Mexidol.Material and methods. 124 patients aged 60–74 years old are surveyed: 72 men and 52 women (average age, respectively, 65.3 ± 0.4 and 64.7 ± 0.7 years) with Chronic Brain Ischemia I–II stage against the background of arterial hypertension and its combinations with atherosclerosis of cerebral vessels. The level of psychosocial stress was determined on the Holmes-Ray scale. Features of the response of patients to stress was studied using the methodology Scale of Psychological Stress PSM-25 and S. Rogenzweig. Stress resistance was investigated using S. Kuhlen's stress resistance self-resistant test and Villianson. The level of anxiety was determined using a scale of Ch.D. Spilberger and Yu.L. Khanin, depressed – backup questionnaire. The type of adaptation reactions was studied in the leukocyte blood formula on the percentage ratio of lymphocytes and segmented neutrophils, taking into account the representation of other formed elements.Results. The level of stress in older women with Chronic Brain Ischemia was higher than in men. The predominance of the intrinsic orientation of the reaction to stress and resolving the type of response to men, and the extrapunitive or self-defense type among women, which may indicate the largerness of the latter. The level of stress resistance was lower in women than in men, which correlated with higher indicators of situational anxiety. Adverse adaptation reactions were more often registered in women than in men. The course of treatment with Mexidol of elderly patients with chemical leads to a decrease in the severity of subjective and objective symptoms, alarming disorders, increases the stress resistance and adaptive capabilities of the body, which is confrmed by an increase in the number of persons with favorable adaptation reactions. The high effciency and safety of sequential therapy with Mexidol (injections, then the tableted form of Mexidol Forte 250) is shown.

Neuroprotective action of Cortexin, Cerebrolysin and Actovegin in acute or chronic brain ischemia in rats

This study was the first to compare the neuroprotective activity of Cerebrolysin®, Actovegin® and Cortexin® in rodent models of acute and chronic brain ischemia. The neuroprotective action was evaluated in animals with acute (middle cerebral artery occlusion) or chronic (common carotid artery stenosis) brain ischemia models in male rats. Cortexin® (1 or 3 mg/kg/day), Cerebrolysin® (538 or 1614 mg/kg/day) and Actovegin® (200 mg/kg/day) were administered for 10 days. To assess the neurological and motor impairments, open field test, adhesive removal test, rotarod performance test and Morris water maze test were performed. Brain damage was assessed macro- and microscopically, and antioxidant system activity was measured in brain homogenates. In separate experiments in vitro binding of Cortexin® to a wide panel of receptors was assessed, and blood-brain barrier permeability of Cortexin® was assessed in mice in vivo. Cortexin® or Cerebrolysin® and, to a lesser extent, Actovegin® improved the recovery of neurological functions, reduced the severity of sensorimotor and cognitive impairments in rats. Cortexin® reduced the size of necrosis of brain tissue in acute ischemia, improved functioning of the antioxidant system and prevented the development of severe neurodegenerative changes in chronic ischemia model. Radioactively labeled Cortexin® crossed the blood-brain barrier in mice in vivo with concentrations equal to 6–8% of concentrations found in whole blood. During in vitro binding assay Cortexin® (10 μg/ml) demonstrated high or moderate binding to AMPA-receptors (80.1%), kainate receptors (73.5%), mGluR1 (49.0%), GABAA1 (44.0%) and mGluR5 (39.7%), which means that effects observed in vivo could be related on the glutamatergic and GABAergic actions of Cortexin®. Thus, Cortexin, 1 or 3 mg/kg, or Cerebrolysin®, 538 or 1614 mg/kg, were effective in models acute and chronic brain ischemia in rats. Cortexin® contains compounds acting on AMPA, kainate, mGluR1, GABAA1 and mGluR5 receptors in vitro, and readily crosses the blood-brain barrier in mice.

CEREBROVASCULAR DISORDERS: TYPICAL AND UNUSUAL CLINICAL PROBLEMS

There is a big number of patients with chronic brain ischemia both among in-patients and out-patients seen by neurologists. This is a typical clinical situation. Retino-cochleo-cerebral vasculopathy (also called Susac syndrome) is a rare autoimmune disorder affecting brain vessels, the 8th cranial nerve and retina. Chronic brain ischemia usually manifests as cognitive decline, affective (emotional) disorders and focal neurological signs. We studied a “portrait” of patients with chronic brain ischemia, admitted to the hospital As in-patient of rehabilitation unit. Here we present the typical case using as an example cerebral ischemic conditions and unusual ones describing retino-cochleo-cerebral vasculopathy as one of the conditions from the group of primary angiitis of central nervous system in adults. All the case were observed by us in neurological and neurorehabilitation wards. It is a pilot project with 43 patients as the total number of patients included into this study. Their mean age was 62.8 years. The mean duration of in-patient observation was 14 days at the hospital. In this paper we discuss the clinical characteristics of our cohort of patients. The least affected here was the short-term memory for numbers. The most affected domain included emotions, anxiety, and depression. We followed this situation in most of our cases. The unusual clinical case of Susac syndrome in a male patient of 59 years is described. The diagnosis was confirmed using modern instrumental tests such as magnetic-resonance tomography and fluorescent angiography of eye retina.