The edition · Top Clinical Updates
A neuroprotectant that worked, and 24 prescribing cascades worth knowing by name
A Chinese phase 3 trial reports a 13-point absolute gain in full recovery after ischaemic stroke, a Lancet trial settles a long-argued question about liposuction for lipoedema, and a two-million-patient cohort names the drug sequences that most often start a cascade.
The edition in brief
The cross-specialty desk today leads with LAIS, a phase 3 trial at 32 Chinese hospitals in which 997 adults with acute ischaemic stroke and a baseline NIHSS of 7 to 20 received intravenous loberamisal or placebo for ten days within 48 hours of onset. Full functional recovery at 90 days, defined as a modified Rankin Scale score of 0 to 1, occurred in 69.7% versus 56.3% — a risk difference of 13.3 percentage points. Neuroprotection has an almost unbroken record of failure in stroke, so replication outside China matters before practice moves. A BMJ network meta-analysis of 124 trials in 18,429 adults aged 40 and over finds brisk walking or jogging and combined aerobic-resistance training the most consistent exercise modalities for bone mineral density, with clinically meaningful gains at around 600 METs-minutes per week, and a dose-response curve that flattens or reverses beyond that. A German multicentre trial in 410 women with lipoedema reports that 68% achieved at least a two-point fall in leg pain after liposuction versus 8% on conservative therapy, at the cost of serious adverse events in 8% versus 3%. The AIROPLANE cluster crossover trial found no difference in the primary outcome between starting resuscitation at 30% and 21% oxygen in infants born at 32 to 35 weeks. The edition closes on 24 prescribing cascades prioritised from an Ontario cohort of 2.3 million older adults.
A neuroprotectant finally beat placebo in acute ischaemic stroke
Watch for replication outside China; do not change stroke practice on a single-country trial, however large the effect looks.
For bone density, the exercise that works is brisk walking — at about 600 METs-minutes a week
Tell patients over 40 to aim for two to three hours of brisk walking a week, with resistance work added for the spine.
Liposuction relieved lipoedema pain where conservative therapy did not
Liposuction relieves lipoedema pain far better than conservative care, with a serious adverse event rate of about 8% to weigh against it.
Starting at 30% or 21% oxygen made no difference to the primary outcome in late-preterm resuscitation
No reason to change the starting oxygen fraction for infants born at 32 to 35 weeks — the escalation signals are secondary and unblinded.
Ask when the new symptom started, not just what it is
When a new symptom appears in an older adult, read the medication list by start date before reaching for a new prescription.
Twenty-four prescribing cascades, ranked by how often they actually happen
When you are about to write the second drug in one of these pairs, ask whether the first should be reduced or stopped instead.
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