A recent study showed that the standard narrow focal zone (FZ) demonstrates similar safety and superior treatment efficacy when compared to the extended FZ during extracorporeal shockwave lithotripsy (SWL) for renal stones. This study’s findings were published in Journal of Endourology.

In this prospective randomized study, 276 patients diagnosed with renal stones were assigned to receive SWL using either standard or extended FZ. The treatment was administered using a Modulith SLX-F2 lithotripter, delivering a maximum of 3000 shocks at a frequency of 1.5 Hz. The primary outcome of the study assessed the success of the treatment 12 weeks after a single SWL session, which was determined by the absence of a stone or stone fragment smaller than 4 mm on computed tomography. Secondary outcomes included the incidence of the stone-free rate (SFR), perinephric hematoma, and changes in the levels of acute renal injury markers in the urine.

Similar baseline parameters were observed in both groups. The standard FZ group achieved a significantly higher treatment success rate (74.3%) than the extended FZ group (59.3%). Additionally, standard FZ exhibited a significantly better SFR (Grade-A, 36.8% vs. 23.0%,) and lower post-treatment pain levels. Both groups had comparable rates of perinephric hematoma formation, changes in urinary acute renal injury markers, and unplanned hospital admissions.

The above results demonstrated that the standard narrow FZ shows comparable safety and improved treatment efficacy in comparison to the extended FZ in extracorporeal SWL for renal stones.

According to a recent study, erenumab (140 mg) demonstrated long-lasting effectiveness over a period of 3 years in individuals with episodic migraine (EM) who had 2-4 unsuccessful attempts at preventive treatment. This study’s findings were published in the journal, Neurology.

Following the 12-week double-blind treatment phase (DBTP) of the LIBERTY study, 240/246 (97.6%) participants entered the Open-Label Extension Phase (OLEP) and received a monthly dosage of 140 mg of erenumab for a period of 3 years. The main outcomes of this study included determining the percentage of participants who achieved a reduction of 50% or more in monthly migraine days (MMDs), analyzing the mean change in MMDs from the baseline, and assessing the tolerability and safety of the treatment.

At week 168, a total of 79 out of 151 participants (52.3%) in the overall population, who had valid data points, achieved a reduction of at least 50% in MMDs and were considered responders. In the continuous erenumab group, 35 out of 117 participants (29.9%) were ≥50% responders at week 12 of the double-blind treatment period, and 26 out of 35 (74.3%) remained responders in at least half of the visits during the open-label extension period. Among the 82 out of 117 participants (70.1%) in the continuous erenumab group who did not achieve responder status at week 12, 17 out of 82 (20.7%) converted to ≥50% responders in at least half of the open-label extension phase visits. In the placebo-erenumab group, out of the 103 out of 120 participants (85.8%) who did not achieve responder status at week 12, 42 out of 103 (40.8%) converted to ≥50% responders in at least half of the open-label extension phase visits after switching to erenumab treatment. The mean (SD) change in MMD from baseline over 3 years showed a sustained improvement of -4.4 [3.9] days at week 168. The safety and tolerability profile remained consistent with previous studies.

The above study demonstrated that in individuals with episodic migraine (EM) who had previously encountered 2-4 unsuccessful preventive treatment attempts experienced long-lasting efficacy with erenumab (140 mg) over a period of 3 years.

A recent study found that in patients experiencing acute mild to moderate ischemic stroke, the combination of clopidogrel and aspirin proved more effective in reducing early neurologic deterioration at 7 days compared to aspirin alone while maintaining a similar safety profile. These results suggest that dual antiplatelet therapy could be a more advantageous treatment option for patients with acute mild to moderate stroke. This study’s results were published in the JAMA Neurology journal.

In this multicenter, randomized, open-label, clinical trial, a total of 3000 patients with acute mild to moderate stroke within 48 hours of symptom onset were included. The patients were randomly assigned to two groups: one group received a combination of clopidogrel and aspirin (n = 1541), while the other group received aspirin alone (n = 1459). The primary endpoint of the trial was early neurologic deterioration at 7 days, which was defined as an increase of 2 or more points in the National Institutes of Health Stroke Scale (NIHSS) score, excluding cases of cerebral hemorrhage, compared to the baseline. Safety end points included bleeding events.

The modified intention-to-treat analysis included a total of 2915 patients. Within the dual antiplatelet therapy group, 72 out of 1502 patients (4.8%) experienced early neurologic deterioration, compared to 95 out of 1413 patients (6.7%) in the aspirin alone group (the risk difference was -1.9%). Additionally, there were no significant differences in bleeding events observed between the two groups.

Thus, it can be concluded that in individuals with acute mild to moderate ischemic stroke, the use of both clopidogrel and aspirin was found to be superior in decreasing early neurologic deterioration at 7 days when compared to aspirin alone, exhibiting a similar safety profile.

According to a recent study, endovascular therapy (EVT) yielded positive results in global analyses of cognitive benefit and across five separate cognitive tests. These findings provide new evidence regarding the influence of EVT on cognition and provide further support for the overall advantages of EVT treatment. This study’s results were published in the Neurology journal.

The ESCAPE randomized trial data were analyzed, which involved 315 patients. Among them, 165 were assigned to EVT and 150 to the control group. Cognitive evaluations were performed 90 days post-stroke using the Sunnybrook Neglect Assessment Procedure (SNAP), Montreal Cognitive Assessment (MoCA), Boston Naming Test (BNT), Trail-making test A (Trails A), and Trail-making test B (Trails B). Logistic regression was used to investigate the connection between EVT and favorable cognitive outcomes on the 5 tests separately, while adjusting for demographic and clinical variables. Generalized estimating equations and ordinal regression were used to determine the likelihood of positive outcomes with EVT on overall cognitive function, incorporating all 5 tests. To examine the connection between final infarct volume (FIV) and cognitive outcome, FIV was incorporated into the models.

There was a greater likelihood of achieving a positive outcome with EVT for MoCA (adjusted odds ratio [aOR] 2.32), BNT (aOR 2.33), SNAP (aOR 3.85), trails A (aOR 3.50), and trails B (aOR 2.56). EVT also showed higher odds of favorable outcome in terms of global binary (aOR 2.57) and ordinal analyses (aOR 2.83) of cognitive function. After incorporating FIV into the models, both EVT and FIV were found to be significantly associated with cognitive outcome. Additionally, there was a significant correlation between global cognitive performance and mRS at day 90 (r = -0.78, p < 0.001), with the most substantial reductions in favorable cognitive outcome observed between mRS scores 4 and 5, as well as between mRS scores 2 and 3.

Thus, it can be concluded that EVT produced favorable outcomes in global analyses of cognitive benefit and in five distinct cognitive assessments.