Tenecteplase vs. alteplase for treatment of acute ischemic stroke: A systematic review and meta-analysis of randomized trials

Background and objectivesSeveral randomized controlled trials (RCTs) have compared tenecteplase to alteplase for treatment of acute ischemic stroke (AIS). Yet, there is no meta-analysis that includes the latest published RCTs of 2022. We sought to compare the safety and efficacy of tenecteplase vs. alteplase for the treatment of AIS through a meta-analysis of all published RCTs.MethodsA systematic literature review of the English language literature was conducted using PubMed, Web of Science, Scopus, and Embase. We included RCTs that focused on patients with AIS treated with tenecteplase and alteplase. Multiple reviewers screened through potential studies to identify the final papers included in our analysis. Following PRISMA guidelines, multiple authors extracted data to ensure accuracy. Data were pooled using a random-effects model.ResultsNine trials, with 3,706 patients, compared outcomes of patients treated with tenecteplase and alteplase for AIS. Both treatments resulted in comparable rates of modified Rankin Scale (mRS) 0–1 at 90 days (RR = 1.03; 95% CI = 0.97–1.10; P-value = 0.359) and mRS 0–2 at 90 days (RR = 1.03; 95% CI = 0.87–1.22; P-value = 0.749). There was no heterogeneity among included studies regarding mRS 0–1 rates (I2 = 26%; P-value = 0.211); however, there was significant heterogeneity in mRS 0–2 rates (I2 = 71%; P-value = 0.002). Similarly, rates of mortality (RR = 0.97; 95% CI = 0.81–1.16; P-value = 0.746) and symptomatic intracranial hemorrhage (sICH) rates (RR = 1.10; 95% CI = 0.75–1.61; P-value = 0.622) were comparable in both treatment groups. There was no significant heterogeneity among included studies in either mortality (I2 = 30%; P-value = 0.181) or sICH (I2 = 0%; P-value = 0.734) rates. Further analysis comparing dosing of tenecteplase (0.1, 0.25, 0.32, and 0.4 mg/kg) yielded no significant differences for any of the endpoints (mRS 0–1, mRS 0–2, sICH, and mortality) compared to alteplase.DiscussionBased on available evidence from completed RCTs, tenecteplase has proven similar safety and efficacy to alteplase for treatment of AIS

Determining crystal structures through crowdsourcing and coursework

We show here that computer game players can build high-quality crystal structures. Introduction of a new feature into the computer game Foldit allows players to build and real-space refine structures into electron density maps. To assess the usefulness of this feature, we held a crystallographic model-building competition between trained crystallographers, undergraduate students, Foldit players and automatic model-building algorithms. After removal of disordered residues, a team of Foldit players achieved the most accurate structure. Analysing the target protein of the competition, YPL067C, uncovered a new family of histidine triad proteins apparently involved in the prevention of amyloid toxicity. From this study, we conclude that crystallographers can utilize crowdsourcing to interpret electron density information and to produce structure solutions of the highest quality

Surgical Feedback Evaluation Tool for Resident Physicians

Currently, residents of surgical specialties lack effective and efficient feedback assessment tools to improve surgical performance after surgical cases. Our aim is to increase the rate of attending surgeon assessments of resident surgical performance to at least 75% of cases for the Podiatric Surgery and General Surgery residency programs at Henry Ford Wyandotte Hospital using the Surgical Performance Evaluation Tool (SPET), with at least 70% perceived positive impact in the post-implementation survey within a 1-month PDSA cycle. Residents and attendings completed separate pre-implementation online surveys to identify the baseline rate and quality of resident surgical performance feedback and what perceived positive impact this feedback may have. The SPET was then utilized in paper format for a 1-month long PDSA cycle. Surgical performance feedback evaluations were handed to attending surgeons by residents, filled out immediately postoperatively and handed directly back to the resident. The residents then compiled this data into collecting bins in their respective call rooms for future analysis. Post-implementation online surveys were then administered to residents and attendings. The quality of evaluation categories and subcategories will be explored and modified as needed with each new PDSA cycle to ensure a high perceived positive impact from both residents and attendings through the results of the pre- and post-implementation surveys. With respect to our attending physicians’ surveys, we found those currently giving feedback pre-implementation of SPET to be at 71.43% and post-implementation to be at 77.78%. Our data also supports an increase in residents implementing feedback with 33.89% pre-implementation and 44.44% post-implementation. When it came to how likely attending surgeons are to fill out evaluations, we saw an increase from pre-implementation percentages at 45.83% to postimplementation at 66.67%. With respect to our resident surveys, we found the percentage of residents receiving feedback to be 33.33% prior to implementing the SPET, and 50% post-implementation. The percentage of surgical casesreceiving feedback on was 29.17% pre-implementation, 38.89% postimplementation. Post-surgical feedback was received promptly 73.04% of the time pre-implementation and 82.11% post-implementation. In regard to evaluations being of high quality, thoroughness and accuracy, our findings showed 40.63% pre-implementation, 50% post-implementation. For perceived positive impact on performance and professional development, our data showed 39.58% pre-implementation, 58.33% post-implementation. Lastly, the percentage of residents reviewing their feedback evaluations: 93.75% pre-implementation and 100% post-implementation. The implementation of the SPET demonstrated an increase in the amount, quality, and review of feedback being given tosurgical residents. Most importantly, the largest improvements were in the likelihood for attendings to provide feedback and feedback having a positive impact on performance. Although quicker and more efficient than current models, voluntary compliance for implementing a new assessment tool is difficult to maintain. Based on these findings, we conclude that if compliance can be further improved via incentivized responses, that our goal of 70% of perceived positive impact can be achieved.https://scholarlycommons.henryford.com/merf2019qi/1016/thumbnail.jp

sj-docx-1-ine-10.1177_15910199231206100 - Supplemental material for Impact of smoking on outcomes following endovascular therapy for acute ischemic stroke: A systematic review and meta-analysis

Supplemental material, sj-docx-1-ine-10.1177_15910199231206100 for Impact of smoking on outcomes following endovascular therapy for acute ischemic stroke: A systematic review and meta-analysis by Hassan Kobeissi, Sherief Ghozy, Bilal Turfe, Melika Amoukhteh, Ramanathan Kadirvel, Waleed Brinjikji, Alejandro A. Rabinstein, and David F. Kallmes in Interventional Neuroradiology</p