brain

Susceptibility-weighted imaging (SWI), an advanced MRI technique, has a high sensitivity in detecting microvascular changes, hemorrhages, and calcifications, thereby improving the diagnosis and management of various neurological pathologies. This study evaluated the frequency of abnormal findings in SWI sequence in patients with brain pathologies referred to Loghman Hakim Hospital.

This cross-sectional study was conducted on patients with various brain pathologies who underwent brain MRI with SWI sequence at Loghman Hakim Hospital from October 2021 to October 2022. The frequency of different brain pathologies in the SWI sequence was assessed.

A total of 157 brain pathologies were evaluated. In 129 cases (82.2%), the most probable lesion diagnosis was only found in the SWI sequence. Thrombosis in veins was found in all cerebral venous thrombosis (CVT) patients in SWI and other sequences. Hemorrhage in venous infarct was observed in 20% of CVT cases. In patients with vascular malformations, the diagnosis of cavernoma was made in 9 patients (81.8%) and capillary telangiectasia in 2 patients (18.2%).

The findings of this study demonstrated the significant role of SWI in evaluating various brain pathologies, especially in cases where routine MRI sequences are not diagnostic. Therefore, we recommend using SWI in routine brain MRI.

Cerebral stroke, known as one of the most common causes of mortality and morbidity worldwide. The frequency of stroke is rising by ageing the population and placed a significant concern for public health. However, modifying risk factors contributing to stroke may decrease the burden of the disease. This study aimed to examine the association of life stressors and personality types with stroke.

The participants were a convenient clinical sample of 100 patients with ischemic stroke and 100 individuals without stroke. The Paykel life event questionnaire and Friedman and Rosenman personality type questionnaire were used to evaluate life stressor and personality characteristics, respectively.

Among the different types of stressor subgroups, mean prevalence score of total life stressors, psycho-social stressors, frustration-despair stressors and mental-physical stressors were significantly higher in patients (p=0.001, p<0.001, p=0.001, and p<0.001 respectively). The prevalence of type A personality in stroke patients and control groups were 52 and 45 %, respectively (p = 0.322). Severity scores of stressors were often higher in cerebral infarction patients with type A personality.

There is an association between higher psychological stressors and stroke, and people with type A personality in both groups experienced more stress than type B. It suggests that cerebral infarction patients with type A personality have a higher level of stress in response to life events which could be considered as a modifiable factor.

Rotenone is commonly used for Parkinson's disease (PD) experimental models based on selective neurodegeneration of midbrain dopaminergic neurons and motor dysfunctions. Meanwhile, rotenone is a toxic compound that causes high mortality, requiring a more significant number of experimental animals. Differences between male and female species in response to rotenone toxicity were reported, stating higher sensitivity in males than in females. In spite of the suggested various doses of rotenone, it is essential to regulate its dosage, especially when male and female species are involved in the experiments. The present study aimed to determine the optimal dose and duration of chronic rotenone injections in rats to achieve a relatively lower mortality rate.

Male and female albino rats were treated with moderate (2 mg/kg/day) and low (0.3-0.5 mg/kg/day) rotenone at different regimens. The brain (substantia nigra, striatum) and spinal cord were analyzed for neurodegeneration using H&E staining. The body weight and mortality of rats were monitored on a daily basis.

Comparative studies indicated that low doses of systemic rotenone injections were less toxic to females than to male rats. Female rats were more sensitive to chronic rotenone exposures, indicated by aggressive and anxious behavior. Nonetheless, the lower mortality rate in female than that in male rats suggested distinct physiological mechanisms to play a role in reduced rotenone toxicity in female rats.

These observations should be considered when male and female rats are involved in PD modeling. The diverse responses to neurotoxin are essential to provide a valid platform for further treatment schemes and clinical outcomes.

Parkinson's disease (PD) is a chronic, progressive neurological disorder characterized by the degeneration of dopaminergic neurons in the substantia nigra, a region of the brain responsible for motor control. Following Alzheimer's disease, Parkinson's is the second most prevalent neurodegenerative disorder. Despite the availability of various pharmacological treatments, these medications often exhibit side effects and may have varying efficacy and duration of action. To address the limitations of conventional therapies, this review aims to identify the most promising medicinal plants traditionally employed in the management of Parkinson's disease.

This review employed a comprehensive search strategy to identify relevant literature on the use of medicinal plants for Parkinson's disease. Authoritative scientific databases, including Web of Science, PubMed, Scopus, and Google Scholar, were systematically searched using the following keywords: 'medicinal plants,' 'traditional medicine,' 'Parkinson's,' and 'neurology.' Irrelevant articles were excluded from the review process.

Traditional Iranian medicine incorporates a diverse array of medicinal plants for the management of Parkinson's disease. Notable examples include Nigella sativa (black cumin), Boswellia serrata (frankincense), Thymus vulgaris (thyme), Hypericum perforatum (St. John's wort), Zingiber officinale (ginger), Heracleum persicum (Persian hogweed), Curcuma longa (turmeric), Cinnamomum verum (cinnamon), Olea europaea (olive), Camellia sinensis (tea), Prunus domestica (plum), Ficus carica (fig), Echium amoenum (Iranian borage), Prunus dulcis (almond), Lavandula angustifolia (lavender), and various Scutellaria species.

While medicinal plants may offer potential benefits as adjunctive therapies for Parkinson's disease, further research is warranted to establish their efficacy and safety. Current studies on these plants are limited in scope, and additional evidence is required to draw definitive conclusions regarding their role in the management of Parkinson's.

Context: 

Infertility is a significant global concern that causes stress in families, necessitating broader studies on infertility management due to its increasing prevalence.

Evidence Acquisition:

 Obesity is a notable risk factor for infertility or dysfunction in the reproductive system. Persian medicine (PM), as one of the complementary and integrative medical systems, highlights the connection between abdominal organs and the brain.

This study utilized the works of Avicenna, Razi, and Ahvazi to explore personalized indicators of clinical reasoning in various infertility conditions. The PM practitioners emphasized two primary considerations in the clinical reasoning of infertility: The brain and abdominal fascia, where pathological changes in one could directly affect the other, potentially contributing to infertility. A key element in this connection is Maraqq, a membranous structure (part of the fascia) in the abdomen, analogous to the parietal peritoneum in modern terminology. Maraqq plays a role in digestion, breathing, and fertility. Disturbances in the brain and Maraqq may have adverse effects on fertility.

Treatment strategies in PM appear to leverage the brain-abdominal fascia connection (Maraqq or peritoneum) to address infertility.

Stress during pregnancy significantly impacts offspring early physiological programming. Herbal remedies are frequently used by pregnant women to enhance their wellbeing. Moringa oleifera Leaf Extract (MoLE) is believed to have both anti-stress and antioxidant properties which can act as a Selective Estrogen Receptor Modulator (SERM) that regulate activities of estrogen, and can have different effects on different tissues. Goal of this study is to compile information on molecular docking analysis of phytochemicals found in MoLE targeting Estrogen Receptor-alpha (ER-α) and assess effects of MoLE administration on dam's and fetal brain tissues and placenta, during gestational stress.

Phytochemical study of MoLE was determined using Gas Chromatography-Mass Spectrometry. Molecular docking technique was employed to predict aspects of interaction and binding affinities energy of bioactive phytocompounds in protein site of ER-α using autodock tools. 30 apparently healthy pregnant Albino-Wistar rats were randomly placed into 6 groups of 5 rats per group and exposed to Chronic Unpredictable Stress (CUS) protocol for two weeks, as follows: Group I (water and normal rat chow ad libitum), Group II (CUS protocol only), Group III (5 mg/kg body weight/day of MoLE), Group IV (10 mg/kg body weight/day of MoLE), Group V (CUS protocol +5 mg/kg body weight/day of MoLE), Group VI (CUS protocol +10 mg/kg body weight/ day of MoLE).

This study found that 1-Propanol, 3,3'-oxy bis- and 1, 2, 3-Trimethyldiazir-idine are most potent ligands for ER-α among all 41 compounds. Photomicrograph examination of tissues from stressed rats showed mild to severe alterations in histology. Consumption of MoLE during chronic stress showed mild to moderate protective effects.

These findings suggest that 1-Propanol, 3,3'-oxy bis- and 1, 2, 3-Trimethyldiaziridine can be further investigated for development of novel therapeutics.

 Ischemic stroke (IS) is still a major cause of neurological disability. This study aimed to ascertain potential markers closely related to IS diagnosis and treatment and then we examined the neuroprotective effect of N-acetylcysteine (NAC) in a transient cerebral ischemia.

 Male Wistar rats were randomly divided into three groups (n=6), including sham, IR (ischemia-reperfusion), IR+NAC (150 mg/kg, ip; intraperitoneally, 1 hour prior to ischemia and 5 min before reperfusion). The infarct volume was evaluated by 2,3,5-triphenyl tetrazolium chloride staining. H&E and Nissle staining were performed to evaluate cerebral ischemia-reperfusion injury. miR-374a-5p gene expression, MAPK6, NLRP3, smad6, TNF-α, and IL-1β protein levels were determined by Real-time PCR, Western blot, and Elisa in the cerebral cortex exposed to IR.

 Herein, we found that IR increased infarct volume and pathological damage to the cerebral cortex after global cerebral artery occlusion/reperfusion. In addition, miR-374a-5p gene expression decreased, while MAPK6, NLRP3, and smad6 protein expressions increased in the IR group. TNF-α and IL-1β protein levels increased in the ischemic cortex. Treatment with NAC significantly attenuated infarct size, inflammation and reversed aforementioned molecule levels.

 Taken together, these results suggested that ischemic insult can increase infarct size, neuronal damage, and inflammation may in part by modulating miR-374a-5p, MAPK6, NLRP3, and smad6 pathway in the brain cortex after cerebral IR insult and providing new clues to molecular mechanisms and treatment targets in IS. It can be alleviated by NAC as a potential therapy for someone afflicted with ischemia.

There is paucity of information about the impact of different neuroactivation paradigms on brain temperature changes in functional magnetic resonance spectroscopy (fMRS) studies. Magnetic resonance spectroscopy (MRS) thermometry was used to estimate the pattern of brain temperature changes with single and continuous neuroactivation paradigms.
Single-voxel MRS data was acquired from the visual cortex of four healthy volunteers using the standard spin-echo Point-RESolved Spectroscopy (PRESS) localization sequence synchronized to single and continuous visual stimulation paradigms at 3.0 tesla (T). Blood oxygenation level-dependent (BOLD) effects were estimated from changes in spectral peak height, linewidth, and area. Brain temperature was calculated by substituting the frequency offset of the water peak relative to the N-acetyl aspartate (NAA), creatine (Cr), and choline (Cho) peaks into previously deduced calibration equations for each reference peak. BOLD and temperature changes from baseline were compared by paired t-test at a significance level of p < 0.05.
In the single activation paradigm, Cho (p = 0.01) peak height, and NAA (p = 0.01) and Cr (p = 0.02) peak areas showed significant changes without significant brain temperature changes relative to all three peaks (p > 0.05). In the continuous activation paradigm, Cr (p = 0.04) peak width showed significant change, with significant brain temperature changes relative to all three reference peaks (p < 0.05).
Brain temperature significantly reduced with continuous visual activation but not with single visual activation paradigms.

Since brain temperature fluctuations are related to cognitive disorders, regulating brain temperature has become a key focus in cognitive studies. This study examined the effect of frontopolar cortical cooling on working memory using a cortical thermal stimulation device (CTSD).  This phase II, randomized, controlled trial included twenty participants randomly divided into two groups to receive 30 minutes of frontopolar cortical cooling across four sessions. The control group received sham cooling, while the intervention group received real cooling. Spatial working memory tests were recorded from both groups before and after the first and after the fourth sessions. The cortical thermal stimulation device used for cooling operates through the flow of water and alcohol in a closed loop. After four sessions of frontopolar cortical cooling, a significant improvement in working memory was observed. The analysis of working memory results, based on an ANCOVA test, showed an improvement in the Spatial Working Memory (SWM) test in the intervention group compared to the control group (p < 0.05). Considering the positive effect of frontopolar cortical cooling on working memory capacity, the results suggest that using an appropriate tool for cooling the cerebral cortex could become a practical approach in cognitive rehabilitation.

Considering Titanium Dioxide Nanoparticles' (TiO2NPs) widespread use in industries such as food and cosmetics industries with increasing daily demand. The aim of the current study was to evaluate the TiO2NPs' teratogenic effects on the chick's brain tissue.

Ninety fertilized eggs on the third day of incubation were equally divided into 5 groups of control, and intraovarian injection of TiO2NPs concentrations at 12.5, 25, 50, and 100 μg/ml. The chicks' survival rate and weight measurements were evaluated after 21 days. The cerebrum and cerebellum samples were analyzed after staining with Hematoxylin-Eosin, and Luxol Fast Blue-Cresyl Echt Violet.

Macroscopic and histomorphometric analyses revealed no significant differences between the groups. No statistically significant differences were observed in the weights of the brains of chicks. In group one the survival rate was 85.71%, group two 71.42%, group three 64.28% and group four 50%. Four cases of omphalocele and non-absorption of the yolk sac were observed in the group treated at 100 μg/ml. There were no statistically significant differences regarding the perivascular space of the cerebrum, neurons with Nissl bodies, the length of the cortex and medulla of the cerebellum, and the number of Purkinje cells, formation of myelin and pathological lesion.

The finding of the current study demonstrates that the effects of TiO2NPs tend to be dose-dependent, posing a considerable danger in terms of embryonic tissue development. Further research endeavors could follow to explore more extensively, especially in the context of humans and the environment.

This article presents the results of a study on the toxic effects of a copper oxide nanocomposite compound on the body of white rats over short- and long-term experiments.

The copper oxide nanocomposite compound was orally administered daily to the rats at 500µg/kg for 10 days. The examination of the effects was carried out immediately after the completion of the exposure to the nanocomposite and four months post exposure.Biochemical and hematological parameters in the blood, and the morphology of the brain cells in the sensorimotor cortex, and in liver and kidney cells were also investigated.

The experimental findings indicated that the nanocomposite compound caused alterations in the biochemical and hematological parameters in the rats’ blood. It also affected the morphology of the rats’ brain sensorimotor cortex, without causing pronounced changes in the structure of the rats’ liver and kidneys. We also found that the copper oxide nanocomposite had a primary genotoxic effect on blood cells. In the long-term, the toxic effect of the
nanocomposite compound declined.

The copper oxide nanocomposite at 500μg/kg had adverse effects on the normal metabolism of the rats and was toxic to their liver and kidney cells. The cytotoxic effects of this compound were observed in the arabinogalactan matrix of the liver and kidney cells. The histological alterations were significant, which warrants further investigations when researchers plan to use this compound in animals or humans as a drug because of its antibacterial properties.

Polycystic ovary syndrome (PCOS) is the most frequent endocrine disorder in women of reproductive age, which may affect various organs, including the brain and liver.

This study aimed to investigate the potential ameliorating effects of black seed (Nigella sativa) hydroethanolic extract on the liver and brain tissues in a rat model of polycystic ovary.

In this experimental study, eighteen female rats were divided into three groups: Control (PCO rats on day 0 after induction of PCO), vehicle (PCO rats receiving saline via gavage for 28 days), and black seed extract (BSE) (PCO rats receiving BSE via gavage for 28 days). Polycystic ovary was induced by a single intraperitoneal injection of 2 mg/kg estradiol valerate. Liver tissue was evaluated for the average number of damaged hepatocytes (segmented nucleus and cytoplasm shrinkage), number of Kupffer cells, and number of lipid droplets, while brain tissue was assessed for vacuolization, apoptosis, and cell shrinkage.

In the BSE group, liver weight significantly decreased, while brain weight increased compared to the vehicle and control groups. Moreover, there was a significant decrease in the number of damaged hepatocytes and Kupffer cells in the BSE group compared to the vehicle group in the liver tissue. In the brain tissue, there was a significant reduction in the number of vacuolations in the BSE group compared to the vehicle group.

Black seed extract demonstrated potential ameliorating effects on the adverse impacts of PCO in the liver (reducing damaged hepatocytes and Kupffer cells) and brain (reducing vacuolations). Further histologic and molecular analyses are needed to investigate the protective effects of BSE thoroughly.

During university life, students often face significant changes in relationships and academic pressures. Given the stressors faced by nursing students and the importance of their academic success, the study aimed to assess the impact of Super Brain Yoga on nursing students’ concentration, memory, and academic progress. This quasi-experimental study was conducted on 59 nursing students at Near East University in Cyprus from February to June 2023. The intervention group (N=29) performed Super Brain Yoga three times a week for two months, while the control group (N=30) continued the usual routines. Data were collected using the demographic questionnaire, Wechsler’s memory test, Concentration test, and the semester grade point average. Data analysis was performed using independent and paired t-test, chi-square, and ANCOVA using SPSS software version 26, with a significance level of P˂0.05. The study revealed a significant difference in total memory scores (P<0.001) and its subscales including personal and public information (P<0.001), orientation (P<0.001), mental control (P<0.001), logical memory (P=0.002), repeating numbers (P<0.001), visual memory (P<0.001), and learning associations (P=0.003) between the experimental and control groups after the intervention. Findings revealed a significant difference between the two groups in the reaction time (P=0.003) and the error of the reverse counting (P=0.021) following the intervention. After the intervention, based on ANCOVA test with adjusting the baseline values, there was no statistically significant difference in the semester mean of Grade Point Average between the two groups (95% confidence interval, P=0.657) Super Brain Yoga is a non-invasive intervention that can improve memory, concentration, and cognitive abilities in nursing students.

Radiation therapy is associated with a risk of long-term adverse effects. Ginger extract has several components that have many biological activities and vitamin c has also been recognized for protection against radiation-induced cell damage. The present study is designed to investigate the possible ameliorating effect of ginger extract and vitamin C on radiation-induced oxidative body damage.  Ginger extract and vitamin C were daily given to rats during 14 days before starting irradiation.

Rats were exposed to gamma radiation (6 Gray).

the result revealed that the levels of lipid peroxidation measured in brain tissues such as malondialdehyde (MDA), acetylcholinesterase (AChE) were significantly increased, while reduced the activities of superoxide dismutase (SOD), catalase (CAT) and glutathione (GSH) content, dopamine (DA) and serotonin (ST) levels were significantly decreased in the brain homogenate of irradiated rats. Gamma-irradiation (6 Gy) resulted in a significant elevation in inflammatory markers of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), interleukin-12 (IL-12) and C-reactive protein (CRP) compared to the control group. The rats that were administrated combined treatment with ginger extract and vitamin C showed significantly less severe damage and remarkable improvement in all of the last mentioned parameters when compared to irradiated rats.

According to the results obtained it could be concluded that a combined treatment with ginger extract by its antioxidant constituents, and vitamin C might be a useful candidate against radiation-induced oxidative stress, enzyme activities in the brain and metabolic disorders without any toxicity.

One of the brain anomalies that typically affects the elderly is Alzheimer’s disease (AD) and its frequency has greatly grown during the previous few decades. AD is affected by many genetics and environmental circumstances. Environmental factors and the quantity of air pollutants are two of the most significant elements influencing the prevalence of AD.

In this study, information from articles on the effects of air and environmental pollutants on AD was utilized. Additionally, the role of machine learning in predicting diseases was examined.

Several studies, approached from various perspectives, have delved into the factors influencing the onset of AD. The development of machine learning techniques has made it possible to record information about the environmental conditions and people’s habitats to make possible the occurrence of dementia-related abnormalities. According to the reviewed studies, certain biological pollutants can significantly increase the likelihood of developing AD. Also, it indicated the use of this technique has been based on biological information recorded for various diseases. The results showed that unhealthy environmental conditions increase the odds ratio of AD several times. Therefore, using this information provides the possibility to prevent the occurrence of AD.

In general, reliable information on the living conditions of the elderly, together with other information about AD, allows for the accurate forecast needed to avert the loss of social and personal capital. The future contribution of this knowledge is something we can envision.

This study used the GEANT4 Monte Carlo toolkit for radiation transport simulations in brain carbon therapy, incorporating a human phantom model to accurately assess dose delivery to targeted and non-targeted organs. Weight factors were employed to generate a Spread Out Bragg Peak (SOBP). The study used the ORNL-MIRD phantom to simulate carbon therapy for brain tumors, finding that the optimal energy range for carbon ions was 2420-2560 MeV to effectively cover the tumor. To achieve a homogeneous radiation dose, a Spread Out ragg Peak (SOBP) was generated using multiple Bragg peaks with specific intensity factors. Beam parameters were also evaluated per ICRU guidelines. This study estimated the flux and dose distributions of secondary particles—protons, electrons, neutrons, alpha particles, and photons—in the brain tumor and surrounding tissues. We calculated the cumulative dose from both carbon ions and secondary particles, finding an absorbed dose ratio of 0.003 in healthy brain tissue compared to the tumor, with values of 4.8 × 10-4 for the skull and 2.6 × 10-5 for the thyroid. Notably, neutrons and photons can significantly increase energy transfer to distant organs, raising secondary cancer risk. The findings presented in this article demonstrated that the involvement of secondary particles in the dose received by both the brain and other organs remains minimal, as the highest absorbed dose was predominantly localized within the tumor.

Parkinson's disease dementia (PDD) and Dementia with Lewy bodies (DLB) are two syndromes categorized under synucleinopathy, sharing comparable symptoms. The identification of biomarkers would offer an accurate approach for improved diagnosis, treatment, and monitoring of treatment efficacy for these distinct forms of dementia.

This study utilized spectral analysis and nonlinear dynamic analysis to compare electroencephalogram (EEG) characteristics between PDD and DLB patients. EEG data was collected from 30 PDD patients, 36 DLB patients, and 36 healthy subjects at rest. Following a conditioning phase to minimize noise and eliminate artifacts, we derived spectral and complexity features using Welch's method and sample entropy. Analysis of variance with repeated measures was performed to compare spectral features and nonlinear dynamics of brain activity between the groups.

Post hoc comparison showed that in the control group, the power of delta and theta bands was lower and the power of alpha and beta bands was higher than in patients with PDD and DLB. (P < 0.05). In the theta and alpha bands, the PDD group showed greater power than the DLB group (P < 0.05). Furthermore, there was a significant main effect of diagnosis (F = 4.67, P = 0.007), and also the diagnosis by region interaction for complexity values (F = 4.58, P = 0.009). Post hoc analysis showed that the EEG complexity of the control group was significantly higher than that of the PDD and DLB groups in the frontal, central, temporal and parietal regions (P < 0.05). Moreover, the EEG complexity of the PDD group was significantly higher than that of the DLB group in the central, temporal and parietal regions (P < 0.05).

Although both PDD and DLB had almost similar patterns compared to the control group, they showed differences in the EEG power spectrum and its nonlinear dynamics. Our findings indicated marked diffuse slowing and lower cortical complexity or activity in DLB patients compared to PDD in all regions, especially in the central, temporal and parietal areas.

Understanding neural mechanisms underlying cognitive workload is crucial for advancing our knowledge of human cognition and mental processes. In this study, we utilized electroencephalography (EEG) analysis to investigate brain activity associated with varying mental cognitive workloads from a psychological perspective.

We employed a publicly accessible EEG dataset consisting of a cohort of 36 healthy volunteers (75% female), aged 18 to 26 years, while the participants were at rest or engaged in an arithmetic task to explore mental cognitive workload. After preprocessing to reduce noise and various artifacts and to obtain a clean signal for every subject, functional connectivity and complexity features were calculated from EEGs through the coherence and permutation entropy algorithms, respectively. Then, repeated measures analysis of variance (ANOVA) was conducted to assess the differences in complexity and connectivity measures across various brain regions between the rest and task states.

Brain sites showed significant within-subject effects, and the interaction between states and channels was significant for connectivity values (F = 3.68, P = 0.034). Post hoc comparisons indicated that FP1-F7, FP1-F8 and FP1-Fz connectivity were significantly lower during the task state compared to the rest state (P < 0.05). Moreover, F4-P3, F4-P4, FP1-O1, FP2-O2, F3-O1, F4-O1, F8-O1, C4-O1, F3-O2, F4-O2, F7-O2, F8-O2, Fz-O1, Fz-O2, Cz-O1 and Fz-P4 connectivity were significantly higher during the arithmetic task state (P < 0.05). Furthermore, brain sites showed significant within-subject effects and the interaction between states and channels was significant for entropy values (F = 3.50, P = 0.041). Post hoc comparisons indicated that the permutation entropy was significantly higher in the FP1, T3, T4, P4 and Pz channels during the arithmetic task compared to the rest state (P < 0.05).

During arithmetic tasks, the increased connectivity in the frontoparietal and frontooccipital networks and heightened complexity in the prefrontal, temporal and parietal lobes reflect the collaborative engagement of brain areas specialized in numerical processing, attention, working memory, cognitive control, and visual-spatial cognition. These changes in connectivity and complexity facilitate the integration of multiple cognitive processes essential for effective arithmetic problem-solving.