Targeting Abnormal Tau Phosphorylation for Alzheimer's Therapeutics

Alzheimer's disease (AD) is a widespread neurodegenerative disorder characterized by progressive memory and cognitive decline, posing a formidable public health challenge. This review explores the intricate interplay between two pivotal players in AD pathogenesis: β-amyloid (Aβ) and tau protein. While the amyloid cascade theory has long dominated AD research, recent developments have ignited debates about its centrality. Aβ plaques and tau NFTs are hallmark pathologies in AD. Aducanumab and lecanemab, monoclonal antibodies targeting Aβ, have been approved, albeit amidst controversy, raising questions about the therapeutic efficacy of Aβ-focused interventions. On the other hand, tau, specifically its hyperphosphorylation, disrupts microtubule stability and contributes to neuronal dysfunction. Various post-translational modifications of tau drive its aggregation into NFTs. Emerging treatments targeting tau, such as GSK-3β and CDK5 inhibitors, have shown promise in preclinical and clinical studies. Restoring the equilibrium between protein kinases and phosphatases, notably protein phosphatase-2A (PP2A), is a promising avenue for AD therapy, as tau is primarily regulated by its phosphorylation state. Activation of tau-specific phosphatases offers potential for mitigating tau pathology. The evolving landscape of AD drug development emphasizes tau-centric therapies and reevaluation of the amyloid cascade hypothesis. Additionally, exploring the role of neuroinflammation and its interaction with tau pathology present promising research directions.

Navigating the dementia landscape: Biomarkers and emerging therapies

The field of dementia research has witnessed significant developments in our understanding of neurodegenerative disorders, with a particular focus on Alzheimer's disease (AD) and Frontotemporal Dementia (FTD). Dementia, a collection of symptoms arising from the degeneration of brain cells, presents a significant healthcare challenge, especially as its prevalence escalates with age. This abstract delves into the complexities of these disorders, the role of biomarkers in their diagnosis and monitoring, as well as emerging neurophysiological insights. In the context of AD, anti-amyloid therapy has gained prominence, aiming to reduce the accumulation of amyloid-beta (Aβ) plaques in the brain, a hallmark of the disease. Notably, Leqembi recently received full FDA approval, marking a significant breakthrough in AD treatment. Additionally, ongoing phase 3 clinical trials are investigating novel therapies, including Masitinib and NE3107, focusing on cognitive and functional improvements in AD patients. In the realm of FTD, research has unveiled distinct neuropathological features, including the involvement of proteins like TDP-43 and progranulin, providing valuable insights into the diagnosis and management of this heterogeneous condition. Biomarkers, including neurofilaments and various tau fragments, have shown promise in enhancing diagnostic accuracy. Neurophysiological techniques, such as transcranial magnetic stimulation (TMS), have contributed to our understanding of AD and FTD. TMS has uncovered unique neurophysiological signatures, highlighting impaired plasticity, hyperexcitability, and altered connectivity in AD, while FTD displays differences in neurotransmitter systems, particularly GABAergic and glutamatergic circuits. Lastly, ongoing clinical trials in anti-amyloid therapy for AD, such as Simufilam, Solanezumab, Gantenerumab, and Remternetug, offer hope for individuals affected by this devastating disease, with the potential to alter the course of cognitive decline. These advancements collectively illuminate the evolving landscape of dementia research and the pursuit of effective treatments for these challenging conditions.

Mechanistic Intimate Insights into the Role of Hydrogen Sulfide in Alzheimer's Disease: A Recent Systematic Review

In the rapidly evolving field of Alzheimer's Disease (AD) research, the intricate role of Hydrogen Sulfide (H2S) has garnered critical attention for its diverse involvement in both pathological substrates and prospective therapeutic paradigms. While conventional pathophysiological models of AD have primarily emphasized the significance of amyloid-beta (Aβ) deposition and tau protein hyperphosphorylation, this targeted systematic review meticulously aggregates and rigorously appraises seminal contributions from the past year elucidating the complex mechanisms of H2S in AD pathogenesis. Current scholarly literature accentuates H2S's dual role, delineating its regulatory functions in critical cellular processes-such as neurotransmission, inflammation, and oxidative stress homeostasis-while concurrently highlighting its disruptive impact on quintessential AD biomarkers. Moreover, this review illuminates the nuanced mechanistic intimate interactions of H2S in cerebrovascular and cardiovascular pathology associated with AD, thereby exploring avant-garde therapeutic modalities, including sulfurous mineral water inhalations and mud therapy. By emphasizing the potential for therapeutic modulation of H2S via both donors and inhibitors, this review accentuates the imperative for future research endeavors to deepen our understanding, thereby potentially advancing novel diagnostic and therapeutic strategies in AD.

Hydrogen Sulfide: An Emerging Regulator of Oxidative Stress and Cellular Homeostasis-A Comprehensive One-Year Review

Hydrogen sulfide (H2S), traditionally recognized as a toxic gas, has emerged as a critical regulator in many biological processes, including oxidative stress and cellular homeostasis. This review presents an exhaustive overview of the current understanding of H2S and its multifaceted role in mammalian cellular functioning and oxidative stress management. We delve into the biological sources and function of H2S, mechanisms underlying oxidative stress and cellular homeostasis, and the intricate relationships between these processes. We explore evidence from recent experimental and clinical studies, unraveling the intricate biochemical and molecular mechanisms dictating H2S's roles in modulating oxidative stress responses and maintaining cellular homeostasis. The clinical implications and therapeutic potential of H2S in conditions characterized by oxidative stress dysregulation and disrupted homeostasis are discussed, highlighting the emerging significance of H2S in health and disease. Finally, this review underscores current challenges, controversies, and future directions in the field, emphasizing the need for further research to harness H2S's potential as a therapeutic agent for diseases associated with oxidative stress and homeostatic imbalance. Through this review, we aim to emphasize H2S's pivotal role in cellular function, encouraging further exploration into this burgeoning area of research.

External use of radon and sulfide mineral waters in the treat-ment of experimental arthrosis

Abstract: The article presents the results of studies of the effect of radon and sulfide min-eral waters (MW) on Wistar rats with experimental arthrosis. materials and methods. Rats were randomized into 4 groups. Group 1 consisted of intact rats (control group). In the remaining three groups, a model of knee arthrosis was reproduced using dexamethasone injections. Group 2 consisted of rats with untreated pathology. Group 3 consisted of rats using radon MW procedures, and group 4 consisted of rats using sulfide MW. Results. Morphological studies have determined that using radon and sulfide MW has a curative effect on the structural and functional organization of the joint and cartilage - the manifes-tations of inflammation in the knee joints are significantly reduced, dystrophic manifesta-tions disappear, and reparative processes in cartilage improve. There are signs of an im-provement in the state of metabolic processes in the body of rats: the balance in the lipid peroxidation and antioxidant systems is restored, and the indicators of the processes of energy supply of transmembrane transport (according to the activity of magnesium-dependent Na+/K+-ATP-ase and Ca2+-ATP-ase) and protein exchange.Conclusion. Based on the data obtained, it was concluded that both applied MWs have a unidirectional, but somewhat different in strength, curative effect on the course of experimental arthrosis, which is due to different mechanisms of the biological action of radon and hydrogen sul-fide. Keywords: experimental arthrosis; morphological and metabolic indicators; radon; hydrogen sulfide; mineral water.

Topical Reappraisal of Molecular Pharmacological Approaches to Endothelial Dysfunction in Diabetes Mellitus Angiopathy

Diabetes mellitus (DM) is a frequent medical problem, affecting more than 4% of the population in most countries. In the context of diabetes, the vascular endothelium can play a crucial pathophysiological role. If a healthy endothelium—which is a dynamic endocrine organ with autocrine and paracrine activity—regulates vascular tone and permeability and assures a proper balance between coagulation and fibrinolysis, and vasodilation and vasoconstriction, then, in contrast, a dysfunctional endothelium has received increasing attention as a potential contributor to the pathogenesis of vascular disease in diabetes. Hyperglycemia is indicated to be the major causative factor in the development of endothelial dysfunction. Furthermore, many shreds of evidence suggest that the progression of insulin resistance in type 2 diabetes is parallel to the advancement of endothelial dysfunction in atherosclerosis. To present the state-of-the-art data regarding endothelial dysfunction in diabetic micro- and macroangiopathy, we constructed this literature review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We interrogated five medical databases: Elsevier, PubMed, PMC, PEDro, and ISI Web of Science.

Recent Advances in Molecular Research on Hydrogen Sulfide (H2S) Role in Diabetes Mellitus (DM)-A Systematic Review

Abundant experimental data suggest that hydrogen sulfide (H₂S) is related to the pathophysiology of Diabetes Mellitus (DM). Multiple molecular mechanisms, including receptors, membrane ion channels, signalingmolecules, enzymes, and transcription factors, are known to be responsible for the H₂S biological actions; however, H₂S is not fully documented as a gaseous signaling molecule interfering with DM and vascular-linked pathology. In recent decades, multiple approaches regarding therapeutic exploitation of H₂S have been identified, either based on H₂S exogenous apport or on its modulated endogenous biosynthesis. This paper aims to synthesize and systematize, as comprehensively as possible, the recent literature-related data regarding the therapeutic/rehabilitative role of H₂S in DM. This review was conducted following the “Preferred reporting items for systematic reviews and meta-analyses” (PRISMA) methodology, interrogating five international medically renowned databases by specific keyword combinations/“syntaxes” used contextually, over the last five years (2017–2021). The respective search/filtered and selection methodology we applied has identified, in the first step, 212 articles. After deploying the next specific quest steps, 51 unique published papers qualified for minute analysis resulted. To these bibliographic resources obtained through the PRISMA methodology, in order to have the best available information coverage, we added 86 papers that were freely found by a direct internet search. Finally, we selected for a connected meta-analysis eight relevant reports that included 1237 human subjects elicited from clinical trial registration platforms. Numerous H₂S releasing/stimulating compounds have been produced, some being used in experimental models. However, very few of them were further advanced in clinical studies, indicating that the development of H₂S as a therapeutic agent is still at the beginning.

Case report and related comments in a relatively young male patient with right hemiplegia after left thalamo- mesencephalic hemorrhage and a consequent Parinaud syndrome – interdisci-plinary therapeutic – rehabilitative approach

Thalamo- mesencephalic hemorrhage is a devasting event, with a increased morbidity and mor-tality rate. Parinaud’s syndrome, also known as the dorsal midbrain syndrome, is characterized by a supranuclear vertical gaze disturbing, resulting from an insult to the mesencephalic tectum. Matherial and Method. We report the case of a 45-year-old man with personal antecedents of ar-terial hypertension, obesity and type 2 Diabetus mellitus, who was first admitted in the Neuro-logy Clinic Division of the Teaching Emergency Hospital Bucharest with a sudden onset of com-plete right hemiplegia, mixed aphasia and right central– type facial palsy on 17.04.2021, being diagnosed – following complex paraclinic investigations -with a left thalamo- mesencephalic hemorrhage. Results and discusssion. The patient followed a neuro- muscular rehabilitation program in our Neuro- Rehabilitation Clinic Division with favorable outcomes, the case repre-senting a real challenge regarding the complexity of the factors involved. Conclusions. The cli-nical outcomes and the quality of life of patients suffering from thalamo- mesencephalic hemor-rhage depend both on the prompt diagnosis and the efficient treatment, followed by an appro-priate rehabilitation program. Keywords: neuro-rehabilitation, thalamo-mesencephalic hemorrhage, Parinaud syndrome

Clinical particularities regarding rehabilitation treatment of a young patient with right pontine ischemic stroke, resulting in dysarthria and left side brachial and crural hemiparesis, and quite recent COVID-19 history

Introduction. Cerebrovascular attacks are one of the leading causes of mortality and morbidity in the world. The most severe are considered to be pontine strokes, because of the high risk of vital functions impairment. The clinical presentation of a pontine stroke can vary from the clas-sical crossed syndrome (ipsilateral cranial nerve palsy and contralateral motor and/or sensory impairment) to pure motor hemiplegia or pure sensory stroke, which are less common.1 Materials and methods. This presentation describes the case of a 39-year-old patient with a re-cent history of untreated SARS-COV 2 infection that was followed in the next month by a sudden onset of facial paralysis, dysarthria and a progressive left hemiplegia. The patient’s functional status was assessed in our Neuromuscular Clinical Division and he underwent a rehabilitation program consisting of physical, occupational and speech therapies. Multidisciplinary efforts were made in order to find the underlying cause of the pontine ischemic stroke. Results. The patient had a personal history of cardiovascular disease risk factors (essential hy-pertension and hyperlipidaemia), without other pathological brain imagining outcomes and normal bleeding tests. The suspicion of an interatrial communication was raised. The patient managed to rapidly maintain the standing posture and to practice walking with unilateral sup-port. At discharge, the facial paralysis and dysarthria were almost completely remitted. The left brachial extremity also showed signs of improvement, as the patient was able to perform flexion and extension movements of the fingers, wrist and forearm. Conclusion. To conclude, the patient’s evolution was favourable, although the certain cause of the underlying stroke has not been clarified. The neurological complications of COVID-19 in-clude ischemic strokes, and cases were reported in young adults too2,3. If this were the case, pre-vention of further cerebrovascular attacks and their complications is necessary1. Caution in terms of medium/long-term prophylactic anticoagulant therapy and careful control of associated cardiovascular disease risk factors has been proposed and discussed in the multidisciplinary team: rehabilitation physician, neurologist, cardiologist. Keywords: cerebrovascular attacks, COVID-19, cardiovascular disease risk factors, ischemic strokes, reha-bilitation

Study on the impact of the therapeutic swimming on elderly women diagnosed with osteoporosis

Introduction The adult woman has a complex of endocrine metabolic changes that can influence and cause various disorders in the body regarding the decrease of functional and regulatory ca-pacities. The involuntary changes in a woman's aging highlight both the appearance and the functionality. In this sense, we intend to conduct a study on morphological changes, parameters that represent risk factors in the development of osteoporosis. Studies by Kanis (1) and Munshi (2) show that maintaining adequate bone mass as well as ensuring adequate muscle tone can prevent osteoporosis, and a pronounced incidence of the onset and development of chronic de-generative pathologies can promote fractures. Material and method. In connection with the elu-cidation of this aspect, we will use the Frax estimation method, which is based on the introduc-tion of values obtained from medical evaluations. Regarding the study, we propose to the sub-jects a therapeutic swimming program to avoid the occurrence of osteoporotic fractures. Results and discussions. Regarding the field of factors favoring the estimation of a fracture in the items regarding cortisone treatments, alcohol consumption, digestive problems, minor traumas, the investigated subjects answered with No 100%.In order to obtain objective results, the study will continue for a period of 1 year, the intermediate tests will be performed after 4 months from the beginning of the work program and at the same time the program will undergo changes, de-pending on the results obtained from the evaluations. Conclusions. The implementation of this water exercise program will lead to adaptive changes in the direction of limiting the unevolu-tionary processes of senescence. Keywords: elderly women; osteoporosis; estimate; physical activity, therapeutic swimming

Rehabilitation of severe neurological complications post SARS-CoV-2 infection

Medical rehabilitation is a multi-professional / interdisciplinary process aimed at enhancing and restoring functional ability (activity and participation) and quality of life to people with im-pairments or disabilities. Rehabilitation is applied throughout the continuum of care. COVID-19 patients may develop a myriad of acute medical problems (linked to the virus per se, or as con-sequences of the invasive procedures), which can cause acute, post-acute and long-term conse-quences requiring rehabilitation. Information about short and long-term sequelae of COVID-19 indicate an increasing need for rehabilitation. The paper is focused on two main aspects: rehabil-itation of the severe neurological disabilities that occurred during the acute phase and continu-ing in the chronic phase (i.e., different neurological sensory-motor and cognitive deficits sec-ondary to stroke, encephalitis, seizures, encephalopathies). The other main issue is generated by the disruption of regular rehabilitation in people with neurological disabilities and chronic dis-eases (people living with sequels after stroke, Parkinson's disease, multiple sclerosis) due to quarantine, social isolation, movement restriction, and other healthcare systems ’disruptions. Methods Internet literature search (Lit Covid and PubMed) using the following keywords (Covid-19, Coronavirus, neurological complications, rehabilitation). During 2020-2021 were published 88 papers (in 2020 = 54, and in 2021= 54), with 21 reviewes (2020 = 15; 2021 = 8), and 2 systematic reviews, refearing neuroreabilitation in Covid-19 subacutre and long-term cas-es. Discussion REH-COVER Cochrane Rehabilitation WHO initiative (“Rapid Living Systematic Reviews Second Edition, called 2020”), contains the main cornerstones for a tailored rehabilita-tion programme, the best (current) available rehabilitation evidence on recovery interventions, for the patients living with sequelae of COVID-19. Conclusions More than two years since the outbreak of the COVID-19 pandemic, it is obvious that rehabilitation services play a crucial role in post-COVID recovery trajectories. A further achievement of research and evidence focussed on the clinical management, comprehensive treatments, and efficacy need to be targeted on short and long-term (neuro)-rehabilitation service models of care, for COVID-19 survivors. Keywords: Covid-19, rehabilitation, neurological disabilities, SARS-CoV-2

Study on the effects of the use of therapeutic ultrasound in the treatment of osteoarticular diseases

Introduction. The use of therapeutic ultrasounds is a method that proved its efficiency in articu-lar and periarticular pathology, in the subacute and chronic stages. The biological effects of the ultrasound use are determined by their interaction with the cellular structures whereas the re-sults depend on the used parameters. The purpose of the survey is to evaluate / identify the ef-fects of using ultrasounds in the treatment of musculoskeletal conditions (lumbar discopathy), knee osteoarthritis). Material and method. The survey was conducted on an outpatient basis in a period of 7 months and it is of the longitudinal type. It included 151 patients diagnosed with low back pain and knee osteoarthritis. The evaluated parameters were: pain, functional skills, articu-lar rigidity and the quality of life. Results. The effects of the use of ultrasounds is found in the decrease of pain, the stiffness of the joints and the contracture of the muscles, as shown by the re-sults of several surveys. Our survey proves that the use of ultrasounds decreases pain and in-creases the functional skills, it influences the physical function more obviously in patients with knee osteoarthritis, which is an aspect found in others surveys. Discussion. The use of a complex ultrasound treatment (in the pulsed way to avoid thermal effects) and kinesiotherapy enabled in our research the decrease of the pain and of the rigidity in the joints, the increase of the function-al skills and the quality of life, whereas these obtained results are in accordance with those of others surveys. Conclusions. The use of the therapeutic ultrasounds can have the following ef-fects: the decrease of the pain and of the joint rigidity, the improvement of the physical capacity for daily activities and the improvement of the quality of life. The use of low intensity ultra-sounds can determine biological effects with actions for a short period or for an average one. Keywords: therapeutic ultrasound, treatment, osteoarticular diseases, quality of life

Clinical and rehabilitative considerations in a complex case of spastic tetraplegia, mixed aphasia, secondary encephalopathy – post severe traumatic brain injury with hemorrhagic and is-chemic lesions – with favorable late evolution and post-symptomatic status after SARS-COV-2 infection

The traumatic brain injury remains a current research topic considering the severity and the in-creased incidence of this pathology. Both physical and neuro-psychological sequelae require a complex rehabilitation program. Material and methods. We describe the evolution of a 20-year-old case, victim of a severe traumatic brain injury due to physical aggression, with spastic te-traplegia, extended ischemia in the left cerebral hemisphere, mixed aphasia, post-traumatic en-cephalopathy, left eyelid ptosis, right paresis of nerve III, post remitted status of left subdural hematoma, post remitted status of right fronto-parietal subarachnoid hemorrhage, severe joint stiffness (right elbow and fist, bilateral hips and knees), cachexia and SARS-COV-2 infection. In our clinic the patient followed medical, complex kinetotherapeutic treatments and was functio-nally assessed using the following scales: modified Ashworth, Penn Spasm Frequency Scale ( Penn), Life Quality Assessment ( QOL ), Montreal Cognitive Assessment ( MoCA ), FAC Interna-tional Scale, Glasgow Outcome Scale-Extended (GOS-E), modified Rankin scale (mRS ). Results. During the hospitalization, the patient presented a favorable late evolution with a great impro-vement of motor and neurological deficit, aphasia in remision, improvement of eyelid ptosis and joint stiffness, fact also confirmed by the increasing scores from the evaluated scales. Con-clusions. Consequently in traumatic brain injury the proper medication, personalized rehabilita-tion program, ergotherapy, speech therapy, a great deal of involvement and documentation of current information is required to improve the patient's quality of life. Keywords: traumatic brain injury, neuro-rehabilitation program, spastic tetraplegia

Estimating the effectiveness of the multi-/interdisciplinary therapeutic program in elderly patients with incomplete myeloradicualar injuries after cervical spinal cord injury

Nowadays elderly persons may be frequent victims of traumatic cervical spinal cord injury (CSCI). A selected group of 28 (7 women (25%) and 21 (75%) men) elderly tetraplegic patients with traumatic CSCI, were admitted to the THEBA Neuromuscular Rehabilitation Clinic with incomplete (AIS-B, -C, -D) myeloradicular injuries. The female patients had an average age of 71.42 years, 5 of them coming from rural areas and 2 from urban areas. The male patients had an average age of 69.11 years, 10 of them living in rural areas, and 11 in urban areas. The spine lesi-on location was at the C2 vertebral level (in 3 women and 4 men), C3 (in a woman and 4 men), C4 (in a woman and 6 men), C5 (in 1 woman and 5 men); C6 (in a woman); C7 (for 2 men). The patients' neurological levels of injuries were: C2 (in 3 women and 4 men), C3 (in one woman and 4 men), C4 (in one woman and 6 men), C5 (in one woman and 5 men), C6 (in one woman) and C7 (in 2 men). The AIS / Frankel degree at admission, was: complete lesion (AIS-A), in 1 women patient, incomplete lesion AIS-B (in 2 male patients), AIS-C (for 2 women and 10 men), AIS-D (for 4 women and 9 men). The average muscle strength at admission was 62.71 (SD 23.32) for women patients and 59.44 (SD 26.89) for male patients; and at discharge these averages were 70.5 (SD 21.23) for women and 69.22 (SD 27.06) for men. In the study group there were 19 opera-ted patients (3 women and 16 men); in which the anterior osteosynthesis was performed (for 3 women patients and 10 male patients) and respectively the posterior vertebral approach (in 6 male patients). The neurological evolution was favorable, so that at discharge were only patients with incomplete lesions AIS-C (1 women and 11 men), AIS-D (6 women and 10 men). The follo-wing comorbidities were associated: obesity (in 2 men), arterial hypertension (in 7 women and 11 men), diabetes (in 2 women and 4 men), traumatic brain injury (in 7 men), chronic alcoholism (in 2 men), pneumonia (in one woman and 6 men), neoplastic diseases (in 2 men), osteoporosis (in one woman and one man), anemia (in one woman and one man), glaucoma (in one woman), depression (in one woman), Lyme disease (in one woman), ischemic heart disease (in 3 women and 1 man), gastric ulcer in one man and ankylosing spondylitis (in 2 men). Complications of the immobilization syndrome were enterocolitis (in 2 men), bronchopneumonia (in 6 male pati-ents), urinary tract infections (in 6 women patients and in 12 male patients) and bedsores (in one male patient). Effectiveness of the final therapeutic approach was assessed (in percentage) by evaluating the progress of the muscle strength (quantified and compared at discharge vs. admis-sion) reported to the number of days of treatment. Statistics was performed for small groups (Anova and Pearson) to establish the effectiveness of the rehabilitation program, evaluating the level of correlation between the scores quantified with the aforementioned the scales. An inver-sely proportional relationship was found between spasticity and kinetic therapy efficacy (F 0.000, Pearson -0.09), between the PENN scale scores and kinetic therapy efficacy (F 0.000, Pear-son -0.24) and a directly proportional relationship between the scores assessing quality of life, FIM and the efficacy of kinetic therapy (F 0.02, Person 0.42). These results underline the impor-tance of a multi-interdisciplinary team approach in the management of the tetraplegic patients after CSCI during the subacute post-lesional/ post-operative stage.

The importance of a multidisciplinary approach to improve the life quality for patients with Parkinson's disease

Parkinson's disease is defined as a complex degenerative neurological disease with progressive evolution, which is part of motor system of the brain disorders, being the second degenerative disease as a frequency after Alzheimer's disease. It is characterized by tremor when muscles are at rest (rest tremor), increased muscle tone (stiffness), slow voluntary movements and difficulty maintaining balance (postural instability). Occupational therapy helps Parkinson's patients im-prove their ability to perform daily tasks. The intervention consists in assisting patients in deve-loping a self-care routine, taking into account the limitations of functional mobility, encoura-ging patients to maintain maximum function of daily activities for as long as possible, learning adaptive techniques to reduce tremor. Materials and methods. The devices used for this purpose are commercially available but they are quite expensive, which is why we wanted to make devi-ces made of material as cheap and affordable as possible. Some of the devices can be successfully made of material that every person has in their home. We also took into account the variant of making them without the need to use complicated tools and devices that are not available to pa-tients. Starting from these premises, we thought and made in our occupational therapy laborato-ry various devices designed to offer patients a variety of techniques and exercises and also a fle-xible work environment. On a pallet plate we fixed a series of elements such as zippers, snap button, hook-and-eye closure, systems that patients use on a regular basis. We also manufactu-red a device designed to help patients with household chores such as dish washing. The device is provided at one end with a washing sponge, its handle being a detergent tank. The size and sha-pe have been adapted to the needs of patients with Parkinson's disease. Results and discussions. In order to obtain the devices, cheap materials were used at the disposal of every person eager to make them. It started with simple objects that any patient uses for personal hygiene and more. The technique of making the devices was a very simple one, from the very beginning the steps that must be followed in order to make them were clearly established. Conclusions. Using the devices made during the physiotherapy sessions, significant improvements of the life quality for patients with Parkinson's disease were observed. Keywords: Parkinson, Occupational therapy, Devices, ADL

Considerations about Hypoxic Changes in Neuraxis Tissue Injuries and Recovery

Hypoxia represents the temporary or longer-term decrease or deprivation of oxygen in organs, tissues, and cells after oxygen supply drops or its excessive consumption. Hypoxia can be (para)-physiological-adaptive-or pathological. Thereby, the mechanisms of hypoxia have many implications, such as in adaptive processes of normal cells, but to the survival of neoplastic ones, too. Ischemia differs from hypoxia as it means a transient or permanent interruption or reduction of the blood supply in a given region or tissue and consequently a poor provision with oxygen and energetic substratum-inflammation and oxidative stress damages generating factors. Considering the implications of hypoxia on nerve tissue cells that go through different ischemic processes, in this paper, we will detail the molecular mechanisms by which such structures feel and adapt to hypoxia. We will present the hypoxic mechanisms and changes in the CNS. Also, we aimed to evaluate acute, subacute, and chronic central nervous hypoxic-ischemic changes, hoping to understand better and systematize some neuro-muscular recovery methods necessary to regain individual independence. To establish the link between CNS hypoxia, ischemic-lesional mechanisms, and neuro-motor and related recovery, we performed a systematic literature review following the" Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA") filtering method by interrogating five international medical renown databases, using, contextually, specific keywords combinations/"syntaxes", with supplementation of the afferent documentation through an amount of freely discovered, also contributive, bibliographic resources. As a result, 45 papers were eligible according to the PRISMA-inspired selection approach, thus covering information on both: intimate/molecular path-physiological specific mechanisms and, respectively, consequent clinical conditions. Such a systematic process is meant to help us construct an article structure skeleton giving a primary objective input about the assembly of the literature background to be approached, summarised, and synthesized. The afferent contextual search (by keywords combination/syntaxes) we have fulfilled considerably reduced the number of obtained articles. We consider this systematic literature review is warranted as hypoxia's mechanisms have opened new perspectives for understanding ischemic changes in the CNS neuraxis tissue/cells, starting at the intracellular level and continuing with experimental research to recover the consequent clinical-functional deficits better.

Cellular and Molecular Targets for Non-Invasive, Non-Pharmacological Therapeutic/Rehabilitative Interventions in Acute Ischemic Stroke

BACKGROUND

Cerebral circulation delivers the blood flow to the brain through a dedicated network of sanguine vessels. A healthy human brain can regulate cerebral blood flow (CBF) according to any physiological or pathological challenges. The brain is protected by its self-regulatory mechanisms, which are dependent on neuronal and support cellular populations, including endothelial ones, as well as metabolic, and even myogenic factors.

OBJECTIVES

Accumulating data suggest that "non-pharmacological" approaches might provide new opportunities for stroke therapy, such as electro-/acupuncture, hyperbaric oxygen therapy, hypothermia/cooling, photobiomodulation, therapeutic gases, transcranial direct current stimulations, or transcranial magnetic stimulations. We reviewed the recent data on the mechanisms and clinical implications of these non-pharmaceutical treatments.

METHODS

To present the state-of-the-art for currently available non-invasive, non-pharmacological-related interventions in acute ischemic stroke, we accomplished this synthetic and systematic literature review based on the Preferred Reporting Items for Systematic Principles Reviews and Meta-Analyses (PRISMA).

RESULTS

The initial number of obtained articles was 313. After fulfilling the five steps in the filtering/selection methodology, 54 fully eligible papers were selected for synthetic review. We enhanced our documentation with other bibliographic resources connected to our subject, identified in the literature within a non-standardized search, to fill the knowledge gaps. Fifteen clinical trials were also identified.

DISCUSSION

Non-invasive, non-pharmacological therapeutic/rehabilitative interventions for acute ischemic stroke are mainly holistic therapies. Therefore, most of them are not yet routinely used in clinical practice, despite some possible beneficial effects, which have yet to be supplementarily proven in more related studies. Moreover, few of the identified clinical trials are already completed and most do not have final results.

CONCLUSIONS

This review synthesizes the current findings on acute ischemic stroke therapeutic/rehabilitative interventions, described as non-invasive and non-pharmacological.

Benefits of crenotherapy in digestive tract pathology (Review)

Balneotherapy, a branch of physical and rehabilitation medicine using the natural factors of balneal resorts for therapeutical purposes to modulate the symptoms of numerous diseases, represents a non-pharmaceutical therapeutic alternative, easily accepted by patients and used both preventively and curatively. Crenotherapy, a branch of balneotherapy, is the method in which mineral waters are used as a therapeutic internal cure by ingestion. This procedure is performed in spa resorts (where these natural resources exist), and the ingestion of mineral water takes place at the source (spring), in the quantities recommended by the medical rehabilitation physician, according to specific regimens for the condition to be treated. Depending on their physical and chemical composition, the therapeutic mineral waters fall into several categories, having clear indications for certain pathologies. Hypotonic, isotonic, or slightly hypertonic mineral waters are recommended in diseases of the digestive tract and hepatobiliary conditions. Over time, studies have been conducted to determine the effect of these types of treatments, highlighting the complex influence of crenotherapy on the gastrointestinal tract, with favorable results, therefore the use of mineral water intake in various pathologies being recommended. The current review focuses on the existing literature data and refers to the main progress made in understanding the benefit, indications, and crenotherapy procedures in the management of gastrointestinal disorders.