[Performance evaluation of integrated cytoprotective therapy of different duration in patients with cerebral infarction].

The paper reviews the preliminary results of a multicenter randomized clinical research. The aim of the study was to determine the optimal duration of different types of energy-correction therapy. 99 case report forms of patients with cerebral infarction were reviewed with their prior envelope randomization into three groups. Patients in the first group (experimental group), consisting of 32 patients, as part of combined therapy received ascorbic acid (5% solution twice a day in a recommended dosage of 20 ml/day for 20 days); the second group (37 patients) received 10 ml of cytoflavin intravenously by drop infusion twice a day for 10 days; the third group received cytoflavin for 20 days (from day 1 to day 10 - 20 ml a day, from day 11 to day 20 - 10 ml a day). The average NIH scale score on admission was 14.9 ± 2.6. Prescription of cytoflavin came with average 1.7 - 1.8 time regression (p < 0.05) of the volumes of cerebral ischemia in the of cases of the 10- and 20-day courses of treatment, while there were no significant morphologic changes in the ascorbic acid group. These results correlated with the best dynamics and outcomes of the neurological and performance status of patients receiving cytoflavin. Despite the lack of significant general differences in the clinical and morphological data of the second and third groups, the patients with underlying grave medical condition in the 20-day cytoflavin group (with NIH score of 14-20 points on admission) tended to have improved neurologic status parameters in comparison with the experimental group and the 10-day cytoflavin group. These results attest to the advantages of personalized antioxidant energy-correction therapy.

[Modern methods of energy homeostasis correction in elderly patients].

In the multicenter randomized clinical-instrumental prospective study 185 patients aged 55-75 years (mean age 68 years) with 94 men and 91 women with cerebral infarction were included. All the patients were hospitalized in the period from 6 to 24 hours from the time of the debut of clinical symptoms, 42,2% of patients scored 14 and above on NIH scale on admission. Patients were randomized into 3 groups: 1st group consisted of 64 patients treated as an antioxidant by 5% solution of ascorbic acid 2 times a day the recommended dose (20 ml/day) for 20 days; 2nd group consisted of 72 patients who received energy monitor Cytoflavin in a daily dose of 20 ml (10.0 ml/drip 2 times a day for 10 days); 3rd group consisted of 49 patients with Cytoflavin therapy extended to 20 days, moreover from 11th to 20th day the dose was 10 ml/day. Cytoflavin treatment was more efficient than ascorbic acid, which can be explained by different pharmacologic mechanisms. Treatment with Cytoflavin for 10 days resulted in a significant decrease of ischemia zone volume by 25% in average, treatment with Cytoflavin for 20 days--by 29%, which manifested in better outcomes in neurologic and functional status. Ascorbic acid demonstrated no effect on morphologic parameters. Patients having at the time of admission 18-20 points according to the NIH and treated with Cytoflavin for 20 days demonstrated significant trend towards improvement of the parameters of the neurological status.

[The complex energy correction of chronic brain ischemia].

Considerable disturbance of all quality of life domains that worsens social adaptation and daily living and results in an asthenic-neurotic syndrome, along with neurologic and mnestic-intellectual disturbances, was revealed in patients with chronic brain ischemia (stages I, II, III). Based on the results of the double blind placebo-controlled trial, the high clinical efficacy of cytoflavin in patients with chronic brain ischemia has been shown. The treatment with cytoflavin decreases the severity of subjective symptoms and complaints thus increasing the working ability of patients, improves balance and gait, decreases the severity of asthenic and neurotic syndromes, improves cognitive and memory functions (information storage, reasoning and attention), positively effects on quality of sleep and all aspects of quality of life, in particular, on physical activity, self-rating of health and viability as well as social activity, mental health and emotional lability.

[Course of free radical processes and prognosis of ischemic and hemorrhagic stroke].

A study of free radical processes (FRP) markers in 381 patients with ischemic and hemorrhagic stroke revealed the importance of oxidant stress that was most severe in patients with large volumes of stroke. Intensification of FRP consists in the reduction or inversion of oxygen FRP activity and increase in lipid free radical FRP that last till the patient discharge from a hospital. FRP indicators are early prognostic markers of stroke course and outcome. An inverse correlation between the level of anti peroxide plasma activity (APA) and the dynamics of the increase in stroke lesion from 1 to 20 days, and direct correlation between malondialdehyde (MDA) titer and the risk of hemorrhagic transformation and growth of the lesion from 5 to 20 days of disease were revealed. The results indicate that inclusion of antoixidant therapy should be conducted as early as possible after stroke using high doses of drugs in severe cases. The high efficacy of antioxidant cytoflavin in a daily dose of 20 ml in patients with stroke of different character and severity was shown. The positive effect of cytoflavin on FRP markers was accompanied by the improvement of clinical and morphological presentations and stroke outcome.

[Current conceptions of neurocytoprotective therapy].

The review is devoted to pharmacological effects and clinical effectiveness of one of the "oldest" neurocytoprotective drugs cerebrolysin. Experimental data that have revealed molecular mechanisms of the drug action as well as the results of clinical trials demonstrating the efficacy of cerebrolysin in the treatment of acute and chronic brain ischemia, Alzheimer's disease, moderate and mild cognitive disorders are described in details. It has been concluded that the efficacy o this drug has been supported by fundamental research, using animal models and cell cultures, and multiple clinical trials in patients with different pathologies.

[Effect of early correction of energy and free-radical homeostasis on the clinical-morphological presentation of cerebral infarction].

A randomized comparative prospective 35-day clinical-instrumental trial of 30 patients with an ischemic hemispheric stroke hospitalized on the first day of disease was carried out. In addition to basic therapy, 16 patients of the main group were treated with the antioxidant power-normalizing drug cytoflavin used in dosage 20 ml/day intravenous in drops from the 1st to 10th day and 2 tablets twice a day from the 11th to 35th day. Fourteen patients of the comparison group received basic therapy only. Patient's state was assessed at 0-24 h and 5, 11, 21, 35 days of stroke. Assessment of neurological status (the Glasgow Coma Scale, the NIH stroke scale, a short version of MMSE), brain MRI (brain lesion volume), a study of antioxidant stress markers, assessment of functional outcome (the Barthel index and the modified Rankin scale) were conducted. The early active correction of power and free radical homeostasis by cytoflavin improved the dynamics of brain morphological changes and free-radical changes that was correlated with the activation of consciousness and reduction of neurologic deficit that resulted in the decrease of disability.

[Efficacy of cytoflavin in the treatment of chronic cerebral ischemia].

The author presents results of multicentre randomized studies of therapeutic efficiency of cytoflavin tablets in patients with chronic cerebral ischemia including asthenovegetative syndrome. Cytoflavin was shown to reduce clinical manifestations of asthenia, anxiety, depression, cognitive and emotional disorders and simultaneously improve quality of life. The efficiency of cytoflavin is confirmed by improved physical and psychic state of the patients, their enhanced social activity.

[Efficacy of cytoflavin in patients in the acute ischemic stroke].

We present the results of a multicenter study on efficacy of cytoflavin in the treatment of patients with acute ischemic stroke. Seventy patients (41 of the main group and 29 of the control group) were enrolled in the study. All patients received basic therapy aimed at improving systemic hemodynamics, rheological blood properties and at the prevention of stroke complications. Patients of the main group were treated with cytoflavin as follows: days 1-10 - 20 ml (in 400 ml of the 0,9% NaCl solution) twice a day intravenously in drops; days 11-35 - 850 mg twice a day. We assessed the dynamics of restoration of lost functions (NIHSS, the Rankin scale, the Barthel index) and volumes of ischemic lesion (MRI T1-, T2-, diffusion-weighted images). Results of the study on patients of the control group were supplemented with literature data about 306 patients studied using clinical scales and 40 patients studied with MRI. We revealed a trend towards an effect of cytoflavin on the preservation of brain matter in the acute phase of stroke. Cytoflavin reduced the neurological deficit and improved activities of daily living in patients that may be explained by the less brain damage.

[Status of cerebral capillary circulation during ischemia with barbiturate protection]. / Sostoianie kapilliarnogo krovoobrashcheniia mozga pri ishemii v usloviiakh barbituratnoi zashchity.

Experiments on 78 albino rats with ligated common carotid arteries were carried out to study the effect of a barbiturate agent (barbamil) administered in a dose of 150 mg/kg of animal body weight on cerebral capillary circulation at different terms of ischemia (1, 3 hours, 1, 3, 7, 14 days). The findings obtained during follow-up point to a beneficial effect of the barbiturate on the structures of the capillary wall (endotheliocytes, pericytes, basal membrane). Furthermore, the drug appears to maintain the capillary lumen and the normal level of capillary permeability, which contributes to the improvement of microcirculation in ischemia. The paper also describes some ultrastructural mechanisms of the decrease and stabilization of the cerebral capillary blood flow under the barbiturate impact due to endothelial synapses blockade, inhibition of vasoconstrictive mechanisms and stabilization of the membrane structures of the capillary network.