Search

Clinical trials addressing large core acute ischemic stroke (AIS) are ongoing across multiple international groups. Future development of clinical guidelines depends on meta-analyses of these trials calling for a degree of homogeneity of elements across the studies. This common data element study aims to provide an overview of key features of pertinent large core infarct trials.PubMed and ClinicalTrials.gov databases were screened for published and ongoing clinical trials assessing mechanical thrombectomy in patients with AIS with large core infarct. Nested Knowledge AutoLit living review platform was utilized to categorize primary and secondary outcomes as well as inclusion and exclusion criteria for patient selection in the trials.The most reported data element was ASPECTS score but with varied definitions of what constitutes large core. Non-utility-weighted modified Rankin score (mRS) was reported in 6/7 studies as the primary outcome, while the utility-weighted mRS was the outcome of interest in the TESLA trial, all of them at the 3 months mark, with only LASTE looking for mRS shift at the 6 months mark. Secondary outcomes had more variations. Mortality is reported separately only in 4/7 trials, all at the 3‑month mark. Additionally, the TENSION trial reported the frequency of serious adverse events, including mortality, at the 1‑week and 12-month mark.Overall, in large core trials there is a large degree of heterogeneity in the collected data elements. Differences in definition and timepoints render reaching a unified standard difficult, which hinders high quality meta-analyses and cohesive evidence-driven synthesis.

Background Coronavirus disease 2019 (COVID-19) continues to pose a significant threat to public health worldwide. The purpose of this study was to review current evidence obtained from randomized clinical trials on the efficacy of antivirals for COVID-19 treatment. Methods A systematic literature search was performed using PubMed to identify randomized controlled trials published up to September 4, 2021 that examined the efficacy of antivirals for COVID-19 treatment. Studies that were not randomized controlled trials or that did not include treatment of COVID-19 with approved antivirals were excluded. Risk of bias was assessed using the Scottish Intercollegiate Guidelines Network (SIGN) method. Due to study heterogeneity, inferential statistics were not performed and data were expressed as descriptive statistics. Results Of the 2,284 articles retrieved, 31 (12,440 patients) articles were included. Overall, antivirals were more effective when administered early in the disease course. No antiviral treatment demonstrated efficacy at reducing COVID-19 mortality. Sofosbuvir/daclatasvir results suggested clinical improvement, although statistical power was low. Remdesivir exhibited efficacy in reducing time to recovery, but results were inconsistent across trials. Conclusions Although select antivirals have exhibited efficacy to improve clinical outcomes in COVID-19 patients, none demonstrated efficacy in reducing mortality. Larger RCTs are needed to conclusively establish efficacy.

We report a novel case of a radiation-induced cavernous malformation developing in a vestibular schwannoma previously treated with stereotactic radiosurgery. Eleven years after treatment, the patient presented with a large predominantly cystic lesion in the cerebellopontine angle. We performed surgery, and a solid vascular lesion was identified within the schwannoma, which was determined to be a cavernous malformation after histopathological analysis. We review the literature of radiation-induced cavernous lesions, illustrating that while rare, these lesions do pose concern as a long-term complication of brain radiation therapy. We also discuss the possibility that radiation-induced cavernous malformation-like lesions are pathologically distinct from cavernous malformations.

We report a case of a 50-year-old woman whose 0.5 mm middle cerebral artery (MCA) aneurysm was treated with gauze wrapping at an outside facility. She returned 9 months later with seizures and an inflammatory process in the region of the prior aneurysm. Surgical re-exploration at that time was aborted. Two years later, she presented with a gauzoma associated with local inflammatory response and severe narrowing of the MCA. A common carotid artery to MCA bypass was performed, followed by surgical removal of the gauze and inflammatory material. Over a 3-month period, she recovered with significant improvement in her preoperative neurological deficits.

Beyond explicit reviewer commentary, editors may rely on other metrics when evaluating manuscripts under consideration for publication. One potential, indirect measure of merit may be the ease or difficulty in identifying reviewers willing to review a given paper. We sought to determine whether reviewer decisions to agree or decline to review a manuscript are associated with manuscript acceptance. Original Research submissions to “Radiology” from 1/1/2008 to 12/31/2011 were studied. Using Student’s t tests, we studied the association between the ratio number-of-reviewers-declining:number-of-reviewers-agreeing to review manuscripts (“decline:agree ratio”) and editor decision to accept or reject the manuscript. A subgroup analysis of papers in which all four invited reviewers agreed to review the paper (“universal agree-to-review group”) was performed. Pearson’s correlation was used to study decline:agree ratio and accepted manuscript citation rate. Original Research manuscript acceptance rate at Radiology was 14.5% (780/5375). Decline:agree ratio was similar between accepted and rejected manuscripts (0.87 ± 0.84 versus 0.90 ± 0.86 respectively, P = 0.35). “Universal agree-to-review” papers were accepted at similar rates to other papers (15.7% [22/140] versus 14.5% [758/5235] respectively, P = 0.69). Higher decline:agree ratios corresponded to lower manuscript citation rates (r = 0.09, P = 0.048). Our study, based on the lack of correlation between agreement to review rate and acceptance rate to Radiology and the direct correlation between agreement to review rate and manuscript citation rate, suggests that reviewers may have a preference for manuscripts with greater potential scientific relevance, but that reviewer motivation to agree to review does not include the expectation of manuscript acceptance.