IMPORTANCEWhether intravenous thrombolysis is needed in combination with mechanical thrombectomy in patients with acute large vessel occlusion stroke is unclear.OBJECTIVE To examine whether mechanical thrombectomy alone is noninferior to combined intravenous thrombolysis plus mechanical thrombectomy for favorable poststroke outcome. Investigator-initiated, multicenter, randomized, open-label, noninferiority clinical trial in 204 patients with acute ischemic stroke due to large vessel occlusion enrolled at 23 hospital networks in DESIGN, SETTING, AND PARTICIPANTS

The data support the notion that HIF-1α plays a role in brain edema formation and BBB disruption via a molecular pathway cascade involving AQP-4 and MMP-9. Pharmacological blockade of this pathway in patients with TBI may provide a novel therapeutic strategy.

Instrumentation of the spine is safe and has an important role in stabilization of the infected spine. Despite the presence of active infection, we believe that instrumentation after radical debridement will not increase the risk of recurrent infection. In fact, greater benefit can be achieved through spinal stabilization, which can even promote accelerated healing.

INTRODUCTION: While surgical resection has been shown to improve short-term local disease control, it remains debated whether surgical resection is associated with improved overall survival in patients with malignant primary osseous spinal neoplasms. We reviewed survival data from a US cancer registry spanning 30 years to determine if surgical resection was independently associated with overall survival.METHODS: The SEER registry was queried to identify cases of histologically confirmed primary spinal chordoma, chondrosarcoma, osteosarcoma, or Ewing's sarcoma of the mobile spine and pelvis via ICD-O-2 coding. Patients with systemic metastasis were excluded. Age, sex, race, tumor location, and primary treatments were identified. Extent of local tumor invasion was classified as confined within periosteum vs extension beyond periosteum to surrounding tissues. The association of surgical resection with overall survival was assessed via Cox proportional-hazards regression analysis adjusting for age, radiotherapy, and tumor invasiveness.RESULTS: Eight-hundred, twenty-seven patients were identified with non-metastatic primary osseous spinal neoplasms (215 chordoma, 282 chondrosarcoma, 158 osteosarcoma, 172 Ewing's sarcoma). Overall median survival was histology specific (chordoma: 96 months, Ewing's sarcoma: 90 months, chondrosarcoma: 88 months, osteosarcoma: 18 months). Adjusting for age, radiation therapy, and extent of local tumor invasion in patients with isolated (non-metastatic) spine tumors, surgical resection was independently associated with significantly improved survival for chordoma (Hazard Ratio [95% confidence interval (CI); 0.617 (0.25-0.98)], chondrosarcoma (HR [95%CI]; 0.153 [0.07-0.36]), osteosarcoma (HR [95%CI]; 0.382 [0.21-0.69]), and Ewing's sarcoma (HR [95%CI]; 0.494 [0.26-0.96]).CONCLUSION: In our analysis of a 30-year US population based cancer registry (SEER), patients undergoing surgical resection of primary spinal chordoma, chondrosarcoma, Ewing's sarcoma, or osteosarcoma demonstrated prolonged overall survival independent of patient age, extent of local invasion, or location. Surgical resection may play a role in prolonging survival in the multi-modality treatment of patients with these malignant primary osseous spinal neoplasms.