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Carphology
Carphology
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https://doi.org/10.1136/pn-2023-004081

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    Flushed? Away

    Three cheers for neuroscience, as other ‘non brain’ disorders need to rely upon our boffins to address their major unmet needs. Step forward fezolinetant, described breathlessly as ‘game-changing’ ‘transformative’ and as a ‘completely blockbuster drug’ in the press - not by the journalists, but by quoted experts. For a mere £5160 per annum, the CNS active drug blocks a protein called neurokinin-3 that plays a unique role in regulating body temperature in menopausal women. The drug appears remarkably well tolerated, and reduced hot flushes by 60% (compared with 45% with placebo).

    BMJ 2023;383:p2969

    Stroke City FC

    Tony Pulis, the former Stoke football manger is said to have coined the phrase, ‘but can they do it on a wet Wednesday night in Stoke?’ This is a dour dismissing of seemingly ‘luxury players’ (read talented, but can they roll their sleeves up and compete when the game is not glamorous). This must have been the motivation behind the TENSION study. It is known that endovascular thrombectomy in acute ischaemic stroke due to large vessel occlusion is safe and improves functional outcome. But patient inclusion for pivotal studies relied on ‘luxury’ imaging modalities such as MRI or volumetry of the infarct core using perfusion CT: can you still benefit from thrombectomy with an unenhanced CT (on a wet Wednesday night in Stoke)? The answer was an unequivocal yes, even established large infarcts benefited – so much so that the trial ended after the first pre-planned interim analysis. Better outcome favoured intervention OR 2·58 (95% CI 1·60–4·15); p=0·0001) as did mortality (HR 0·67 (95% CI 0·46–0·98); p=0·038).

    Lancet 2023;402 (10414):1753–1763.

    Mab? Mib? Llarregub

    Each month treats us to a new monoclonal for dementia and November brought gantenerumab. If you’ve met a patient with Alzheimer’s who has asked you – “please can I have a subcutaneous, fully human, anti-Aβ IgG1 monoclonal antibody jab please, because I want to reduce my amyloid plaque burden on PET imaging?” you may be working in a different clinic from me. Do we have the right outcome measures for these studies? Researchers used the Clinical Dementia Rating scale–sum of boxes for cognition, and this did not differ significantly from controls in either of the Graduate I or II studies that were combined in this analysis. Was 116 weeks long enough to see a benefit? 25% of those in the treatment arm saw amyloid-related imaging abnormalities, most of which were asymptomatic.

    N Engl J Med 2023; 389:1862–1876

    The eyes have it

    The squeamish among you should look away now. Surgeons in New York reported in November 2023 the world’s first complete eye transplant. Lauding this breakthrough and major endeavour (it was a twenty-one hour procedure) the article informs us that Mr James had previously received a partial face transplant in May. The team confirmed that there is blood flowing to the retina, but there were no guarantees that he would have vision from this new eye. Nonetheless the recipient declared this life changing as he expressed his gratitude to the donor and their family. Are we one step closer to surgery to restore vision?

    BBCwww.bbc.co.uk/news/world-us-canada-67375145

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    Footnotes

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Commissioned; internally peer reviewed.

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