Growth Hormone Promotes Motor Function after Experimental Stroke and Enhances Recovery-Promoting Mechanisms within the Peri-Infarct Area

I see nothing here that suggests that a protocol was written and distributed to all stroke hospitals in the world.  So because we have no great stroke association with a database of all research and  protocols and the means to distribute stroke research to all stroke medical professionals and every one of the 10 million yearly stroke survivors, this will fall by the wayside. 

 

Growth Hormone Promotes Motor Function after Experimental Stroke and Enhances Recovery-Promoting Mechanisms within the Peri-Infarct Area

Sonia Sanchez-Bezanilla 1,2 , N. David Åberg 3,4, Patricia Crock 2,5, Frederick R. Walker 1,2,6,7, Michael Nilsson 1,2,6,7,8, Jörgen Isgaard 1,3,4,*,† and Lin Kooi Ong 1,2,6,9,*,† 1 School of Biomedical Sciences and Pharmacy and the Priority Research Centre for Stroke and Brain Injury, the University of Newcastle, University Dr, Callaghan, NSW 2308, Australia; sonia.sanchezbezanilla@uon.edu.au (S.S.-B.); rohan.walker@newcastle.edu.au (F.R.W.); michael.nilsson@newcastle.edu.au (M.N.) 2 Brain and Mental Health, Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305, Australia; patricia.crock@newcastle.edu.au 3 Department of Internal Medicine, University of Gothenburg, 405 30 Gothenburg, Sweden; david.aberg@medic.gu.se 4 Department of Internal Medicine, Region Västra Götaland, Sahlgrenska University Hospital, Blå stråket 5, 413 45 Gothenburg, Sweden 5 Department of Paediatric Endocrinology and Diabetes, John Hunter Children’s Hospital, Kookaburra Cct, New Lambton Heights, NSW 2305, Australia 6 NHMRC Centre of Research Excellence Stroke Rehabilitation and Brain Recovery, 245 Burgundy Street, Heidelberg, VIC 3084, Australia 7 Centre for Rehab Innovations, Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305, Australia 8 LKC School of Medicine, Nanyang Technological University, 50 Nanyang Ave, Singapore 639798, Singapore 9 School of Pharmacy, Monash University Malaysia, Bandar Sunway, Subang Jaya 47500, Selangor, Malaysia * Correspondence: jorgen.isgaard@medic.gu.se (J.I.); ong.linkooi@monash.edu (L.K.O.) † These authors contributed equally to this work.
Received: 20 December 2019; Accepted: 15 January 2020; Published: 17 January 2020

Abstract: Motor impairment is the most common and widely recognised clinical outcome after stroke. Current clinical practice in stroke rehabilitation focuses mainly on physical therapy, with no pharmacological intervention approved to facilitate functional recovery. Several studies have documented positive effects of growth hormone (GH) on cognitive function after stroke, but surprisingly, the effects on motor function remain unclear. In this study, photothrombotic occlusion targeting the motor and sensory cortex was induced in adult male mice. Two days post-stroke, mice were administered with recombinant human GH or saline, continuing for 28 days, followed by evaluation of motor function. Three days after initiation of the treatment, bromodeoxyuridine was administered for subsequent assessment of cell proliferation. Known neurorestorative processes within the periinfarct area were evaluated by histological and biochemical analyses at 30 days post-stroke. This study demonstrated that GH treatment improves motor function after stroke by 50%–60%, as assessed using the cylinder and grid walk tests. Furthermore, the observed functional improvements occurred in parallel with a reduction in brain tissue loss, as well as increased cell proliferation, neurogenesis, increased synaptic plasticity and angiogenesis within the periinfarct area. These findings provide new evidence about the potential therapeutic effects of GH in stroke recovery

Reduced vitamin D levels are associated with stroke-associated pneumonia in patients with acute ischemic stroke

I see nothing here that suggests that a protocol was written and distributed to all stroke hospitals in the world.  So because we have no great stroke association with a database of all research and  protocols and the means to distribute stroke research to all stroke medical professionals and every one of the 10 million yearly stroke survivors, this will fall by the wayside. 

Reduced vitamin D levels are associated with stroke-associated pneumonia in patients with acute ischemic stroke

Clinical Interventions in Aging — Huang GQ, Cheng HR, Wu YM, et al. | January 02, 2020

By performing this study with 863 consecutive acute ischemic stroke patients, researchers examined the potential link between serum vitamin D levels and stroke-associated pneumonia (SAP). They defined in-hospital SAP as a complication that happened following a stroke, during hospitalization, that was verified radiographically. Within 24 hrs of admission, measurements of serum vitamin D levels were obtained, and patients were classified as vitamin D sufficient (> 50 nmol/L), insufficient (25–50 nmol/L), and deficient. They detected significantly lower vitamin D levels in patients with SAP vs those without SAP. Patients with vitamin D deficiency vs those with vitamin D insufficiency or sufficiency exhibited a significantly higher incidence of SAP. An independent link of vitamin D deficiency and insufficiency with SAP was revealed following adjustment for confounders. A linear relation to the risk of SAP was demonstrated by vitamin D levels in multiple-adjusted spline regression. Overall, decreased vitamin D was identified as a potential risk factor of in-hospital SAP, which can assist clinicians to recognize high-risk SAP patients.

Read the full article on Clinical Interventions in Aging

For Stroke Victims, Brain Magnetic Stimulation Leads to Improved Walking Speed

This won't do a damn bit of good for you or new stroke survivors. No protocols will be written and distributed worldwide. This will fall by the wayside because we have fucking failures of stroke associations doing nothing useful for stroke survivors and don't care they are doing nothing. Like creating a database of stroke research and protocols.  That way we could demand our stroke medical professionals implement current protocols instead of hoping that your doctor will read research and create a protocol from that research. Stroke survivors are screwed until they run stroke associations.

For Stroke Victims, Brain Magnetic Stimulation Leads to Improved Walking Speed

A technique of magnetic stimulation of the brain can increase walking speed in patients who are undergoing rehabilitation after a stroke, reports a research update in the American Journal of Physical Medicine & Rehabilitation, the official journal of the Association of Academic Physiatrists. The journal is published by Wolters Kluwer.

Noninvasive repetitive transcranial magnetic stimulation (rTMS) - especially high-frequency stimulation on the same side of the brain where the stroke occurred - leads to improved walking speed, according to the review and meta-analysis by Chengqi He, MD, of Sichuan University, People's Republic of China, and Shasha Li, PhD, of Massachusetts General Hospital and Harvard Medical School and colleagues. But at least so far, the evidence doesn't show improvement in balance and other key outcomes in stroke patients undergoing rTMS.

Magnetic Stimulation of the Brain after Stroke - Promising Results, More Research Needed

The researchers performed a systematic review of the research literature to identify studies of the effects of rTMS on walking and balance function after stroke. In this technique, patients undergo repeated sessions of magnetic stimulation of the brain, with the goal of stimulating a targeted area of the brain. The technique is painless and noninvasive; stimulation is delivered through the skull (transcranial) using magnetic coils.

The review identified nine studies of rTMS, five of which were randomized controlled trials. The studies, including patients with ischemic stroke (caused by a blood clot) or hemorrhagic stroke (caused by bleeding within the brain), were published between 2012 and 2017. Seven studies used high-frequency rTMS and two used low-frequency rTMS. The studies were rated as high quality, but varied in terms of time since stroke, type of magnetic coil used, and brain area targeted.

Six studies, including 139 patients, provided complete data on walking speed. Analysis of pooled data from these studies showed significant improvement in walking speed in patients who received rTMS. The increase in walking speed was greater in studies stimulating the brain on the same side were the stroke occurred (ipsilesional). Based on just one study, there was no significant effect of rTMS targeting the opposite side of the brain (contralesional).

Three studies, including 77 patients, provided complete information on tests of balance function. Analysis of those studies found no significant improvement in balance with rTMS. Additional analyses showed no significant improvement in motor function or brain responsiveness (cortical excitability) with rTMS.

Each year, an estimated 700,000 patients experience a stroke, and about 30 percent of these cannot walk independently at six months after their stroke. Restoration of independent walking ability is a top priority for rehabilitation after a stroke; current rehabilitation approaches are of limited value in restoring walking function.

In recent years, rTMS has come to attention as a potentially useful approach to promoting recovery of limb function. By pooling the results of recent studies, the researchers sought to more precisely evaluate the effects of rTMS on recovery of walking ability and balance function after a stroke.

The findings suggest a significant effect of high-frequency rTMS on walking speed, especially with ipsilateral stimulation. But the limited research evidence to date does not show changes in balance, motor function, or cortical excitability after rTMS. "Future studies with larger sample sizes and an adequate follow-up period are required to further investigate the effects of rTMS on lower limb function and its relationship with changes in cortical excitability with the help of functional neuroimaging techniques," Drs. He and Li and colleagues conclude.