Katie Lin - Academia.edu (original) (raw)

Papers by Katie Lin

Research paper thumbnail of Kinematics of Chinese Toad Bufo Gargarizans

中国科学:技术科学(英文版), 2010

Abstract A three-dimensional motion force tester for animal was used to measure the reaction forc... more Abstract A three-dimensional motion force tester for animal was used to measure the reaction forces of the feet of a Chinese toad (B. gargarizans) against a horizontal solid surface on which it crawled. The motion behavior of the Chinese toad was recorded by a ...

Research paper thumbnail of CCDC 1006082: Experimental Crystal Structure Determination

An entry from the Cambridge Structural Database, the world's repository for small molecule cr... more An entry from the Cambridge Structural Database, the world's repository for small molecule crystal structures. The entry contains experimental data from a crystal diffraction study. The deposited dataset for this entry is freely available from the CCDC and typically includes 3D coordinates, cell parameters, space group, experimental conditions and quality measures.

Research paper thumbnail of CCDC 1006081: Experimental Crystal Structure Determination

An entry from the Cambridge Structural Database, the world's repository for small molecule cr... more An entry from the Cambridge Structural Database, the world's repository for small molecule crystal structures. The entry contains experimental data from a crystal diffraction study. The deposited dataset for this entry is freely available from the CCDC and typically includes 3D coordinates, cell parameters, space group, experimental conditions and quality measures.

Research paper thumbnail of CCDC 1006080: Experimental Crystal Structure Determination

An entry from the Cambridge Structural Database, the world's repository for small molecule cr... more An entry from the Cambridge Structural Database, the world's repository for small molecule crystal structures. The entry contains experimental data from a crystal diffraction study. The deposited dataset for this entry is freely available from the CCDC and typically includes 3D coordinates, cell parameters, space group, experimental conditions and quality measures.

Research paper thumbnail of Can the Canadian Syncope Risk Score (CSRS) help to risk stratify emergency department patients presenting with syncope without an evident serious cause?

Canadian Journal of Emergency Medicine, 2020

Research paper thumbnail of Evaluation of the Effects on Human Performance Characteristics and Peak Head Accelerations With the Use of Various Intra-Oral Appliances

Various studies have investigated the relationship between the mandibular position and its affect... more Various studies have investigated the relationship between the mandibular position and its affect on human performance characteristics. To maintain the jaw in an optimal position Mandibular Orthopedic Repositioning Appliances (MORA) have been produced. A protective mouthguard is an appliance worn in the mouth which helps prevent injuries to the teeth, lips, cheeks, tongue, and jaw as a result of impact. More recently, it has been hypothesized that mouthguards reduce the risk of concussion by attenuating the impact to the jaw rather than transferring the force to the brain. Currently, there are no standards for testing protective mouthguards. Such a test would prove useful to determine maximum acceleration levels of the head. The aim of this study is to (1) quantify the effectiveness of repositioning the jaw on strength and aerobic potential as well as (2) to determine if a protective mouthguard can give the same affects of a MORA device. In addition, (3) a test protocol will be esta...

Research paper thumbnail of Nitrification in biological rapid sand filters treating drinking water: monitoring governing factors

Research paper thumbnail of Increased insight in microbial processes in rapid sandfilters in drinking water treatment (DW BIOFILTERS)

The aim of this research project is to improve our knowledge on biological rapid sand filters as ... more The aim of this research project is to improve our knowledge on biological rapid sand filters as they are present in thousands groundwater based water works. This includes molecular investigations of the microorganisms responsible for the individual processes (e.g. nitrification); and detailed monitoring and experiments in the filters and laboratory to provide insight in the process mechanisms, kinetics and effect of environmental factors. Management of the filters (e.g. backwashing, flow rate, carrier type) will be investigated at pilot and full scale, supported by mathematical models. The sustainability and climate friendliness are evaluated by life cycle assessment (LCA). Molecular methods based on qPCR are being developed and implemented to quantify bacteria in different functional groups, such as those responsible for nitrification. This allows for development of diagnostic tools to detect if essential or core members are present or absent in a malfunctioning filter. It is mean...

Research paper thumbnail of Los requisitos establecidos por la sentencia C 1052 de 2001 a las acciones ciudadanas de inconstitucionalidad en Colombia: ¿pasadas dos décadas han disminuido las sentencias inhibitorias de la Corte Constitucional?

El presente escrito pretende ocuparse del control abstracto de constitucionalidad realizado por l... more El presente escrito pretende ocuparse del control abstracto de constitucionalidad realizado por la Corte Constitucional colombiana y abordar especialmente el caso de las sentencias inhibitorias de dicho tribunal. En el ano 2.001 el Tribunal Constitucional Colombiano expidio la sentencia C-1052, en la cual se establecieron cargas argumentativas en cabeza del accionante y cuyo proposito segun la misma Corte, fue evitar las sentencias inhibitorias. Hoy pasados 19 anos, se quiere responder las siguientes preguntas ?se alcanzo el fin perseguido por dicha sentencia? y ?puede la Corte Constitucional limitar el acceso ciudadano a una de las figuras mas importantes del constitucionalismo colombiano? Responder estas preguntas justifican la elaboracion del presente articulo. La metodologia usada es dogmatica jurisprudencial con estudio de datos y se pudo demostrar que el fin perseguido por la Corte Constitucional al expedir la citada sentencia no se cumplio, pues desde entonces las sentencias ...

Research paper thumbnail of 터널설계의 New Paradigm을 지향합니다. (주)하경엔지니어링 터널지반부 / 기술연구소

Research paper thumbnail of Ethnicity and health literacy: a survey on hypertension knowledge among Canadian ethnic populations

OBJECTIVES With an increase and diversity in ethnic populations in Westernized countries, underst... more OBJECTIVES With an increase and diversity in ethnic populations in Westernized countries, understanding the differences in levels of knowledge surrounding hypertension is important in planning appropriate prevention strategies. The purpose of our study was to assess levels of hypertension knowledge in Chinese, Indian and White populations in a large metropolitan Canadian city. DESIGN A telephone survey was conducted in English, Chinese (Cantonese and Mandarin) and Indian languages (Hindi, Punjabi and Urdu). Hypertension knowledge was assessed through a 10-item validated instrument; respondents received 1 point for each correct answer. Logistic regression was used to test differences in hypertension knowledge among these three populations. RESULTS Survey response rates were 68.7% (301) for Chinese, 61.3% (248) for Indian and 69.7% (254) for White populations. The average hypertension knowledge score for Chinese respondents was 7.23 out of 10, 7.11 for Indian respondents and 7.28 for ...

Research paper thumbnail of Interprofessional doula project

Research paper thumbnail of Outcomes After Recurrent Intentional Methanol Exposures Not Treated With Alcohol Dehydrogenase Inhibitors Or Hemodialysis

BACKGROUND Relying on a treatment threshold for methanol poisoning of 20 mg/dL (6.2 mmol/L) as a ... more BACKGROUND Relying on a treatment threshold for methanol poisoning of 20 mg/dL (6.2 mmol/L) as a stand-alone criterion may lead to unnecessary and invasive treatment because it is likely too conservative, especially for patients with repeated, intentional methanol exposures. OBJECTIVE We investigated how often patients with recurrent intentional methanol exposures above this threshold developed biochemical or overt clinical toxicity despite not being treated with either an alcohol dehydrogenase inhibitor (ADHi) or hemodialysis. METHODS We identified patients with ≥3 methanol-related emergency visits from 2002 to 2015 and selected every visit in which neither ADHi nor hemodialysis were administered despite serum methanol >20 mg/dL but neither metabolic acidosis nor end organ toxicity at presentation. The primary outcome was the incidence of visual deterioration or death. RESULTS Four patients accounted for the 17 visits that met inclusion criteria. All exposures were intentional s...

Research paper thumbnail of Content Analysis of Stroke Teleconsultation Recordings in the Moravian-Silesian Region, Czech Republic

Frontiers in Neurology, 2021

Background: Direct teleconsultations between emergency medical services (EMS) crews and hospital-... more Background: Direct teleconsultations between emergency medical services (EMS) crews and hospital-based stroke neurologists are mandated in the Czech Republic as triage and prenotification tool in acute stroke patients. The main aim of this study was to analyze the efficacy as well as quality of such teleconsultations in daily clinical practice.Methods: This is a descriptive analysis of teleconsultations between EMS paramedic crews and hospital-based neurologists in a geographically defined region of the Czech Republic (Moravian-Silesian region) between October 2018 to December 2018. All teleconsultations were analyzed for length and content. Content analysis included the following information: date, age, sex, prehospital neurological deficit(s), known/unknown time of symptom onset, anticoagulation status, vital signs, premorbid disability, and patient ID/insurance company number.Results: Within the study period, paramedics conducted 522 calls across 6 stroke centers. Of these, 334 (...

Research paper thumbnail of Meta-analysis of interventions to reduce door to needle times in acute ischaemic stroke patients

BMJ Open Quality, 2020

BackgroundDoor-to-needle time (DTN) has an important impact on thrombolysis and reperfusion outco... more BackgroundDoor-to-needle time (DTN) has an important impact on thrombolysis and reperfusion outcomes in the treatment of acute ischaemic stroke. This systematic review is a critical synthesis of studies evaluating DTN reduction strategies.MethodOvid MEDLINE, PubMed, Cochrane Database of Systematic Reviews, CINAHL, ProQuest dissertations and LILACS were used as bibliographic databases for primary literature. CIHI, Health Quality Council of Alberta, Health Quality Ontario and websites of heart and stroke associations in Canada, USA, UK, Australia and New Zealand were used as sources of grey literature. Searched reports were screened by title and abstract, and full texts were located for review. Articles quality was evaluated using National Institute of Health’s Study Quality Assessment tools. Methods for improving DTN were categorised under 13 DTN reduction strategies, primarily adapted from the Target: Stroke Phase II recommendations, and including two additional categories: Strategi...

Research paper thumbnail of Integration of pan-cancer transcriptomics with RPPA proteomics reveals mechanisms of epithelial-mesenchymal transition

PLOS Computational Biology, 2018

Research paper thumbnail of A summary of the Canadian Stroke Best Practice Recommendations, Sixth Edition (2018): Updates relevant to prehospital and emergency medicine providers

Research paper thumbnail of SGEM Hot Off the Press: Computer provider order entry (CPOE) and emergency department flow

Research paper thumbnail of Review: In acute ischemic stroke, adding endovascular therapy to t-PA improves functional independence at 90 days

Annals of internal medicine, Jan 20, 2015

Question In acute ischemic stroke (AIS), does adding endovascular therapy (EVT) to IV tissue-type... more Question In acute ischemic stroke (AIS), does adding endovascular therapy (EVT) to IV tissue-type plasminogen activator (t-PA) improve clinical outcomes? Review scope Included studies compared EVT (intraarterial thrombolytic administration and/or thrombectomy) plus IV t-PA (in eligible patients) with IV t-PA alone or standard therapy (in patients ineligible for IV t-PA) for treating AIS, and had follow-up 12 weeks. Trials using urokinase for IV thrombolysis in >50% of patients were excluded. Primary outcome was functional independence (modified Rankin Scale [mRS] score 0 to 2) at 90 days. Other outcomes were all-cause mortality and symptomatic intracerebral hemorrhage (ICH). Review methods MEDLINE, EMBASE/Excerpta Medica, Cochrane CENTRAL, EBSCO, CINAHL, and Web of Science (1995 to May 2015); clinical trial databases; and reference lists were searched for English-language, peer-reviewed, published, randomized, controlled trials (RCTs). 10 RCTs met the inclusion criteria; {2 were available in abstract form only}*, and 8 (n =2423, median age 62 to 71 y, 53% men, mean follow-up 3 mo, mean time from stroke onset to randomization 223 to 231 min) were published in full and included in the meta-analysis. Only data from the 8 published RCTs are discussed here. Patients in all RCTs had large-vessel, anterior-circulation ischemic stroke. 5 RCTs (all published in 2015) used stent retrievers for EVT in 86% to 100% of patients; 4 used unspecified IV t-PA in the control group, 3 IV alteplase, and 1 IV alteplase or urokinase. All 8 RCTs blinded outcome assessors and had adequate completeness of outcome data; none had adequate allocation concealment or blinded patients and researchers. 1 of 3 RCTs published in 2013 was stopped early for futility, and 4 of 5 RCTs published in 2015 were stopped early for efficacy or external evidence of benefit. Main results EVT plus IV t-PA improved functional independence at 90 days compared with IV t-PA alone; groups did not differ for all-cause mortality or symptomatic ICH (Table). Conclusion In acute ischemic stroke, adding endovascular therapy to IV tissue-type plasminogen activator improves functional independence at 90 days. EVT plus IV t-PA vs IV t-PA alone (or standard therapy in patients ineligible for t-PA) in acute ischemic stroke Outcomes Number of trials (n) Weighted event rates RBI/RRR/RRI (95% CI) NNT (CI) EVT+t-PA IV t-PA alone Functional independence at 90 d 8 (2419) 45% 32% RBI 40% (12 to 70) 8 (5 to 28) All-cause mortality 8 (2419) 16% 17% RRR 9.3% (12 to 28) NS Symptomatic ICH 8 (2423) 5.1% 4.8% RRI 6.6% (26 to 52) NS EVT = endovascular therapy; ICH = intracerebral hemorrhage; NS = not significant; t-PA = tissue-type plasminogen activator; other abbreviations defined in Glossary. RBI, RRR, RRI, NNT, and CI calculated from odds ratios and control event rates in article using a random-effects model. Modified Rankin Scale score 0 to 2. Commentary IV t-PA is the standard of care for early-presentation AIS, but benefits are balanced against important risks for harm. The advent of mechanical methods of EVT, with relevant trials summarized in the review by Sardar and colleagues, promises to transform the landscape of AIS management. Early studies published in 2013 suggested that EVT added neither benefit nor harm compared with IV t-PA in the treatment of AIS. The development of newer mechanical thrombectomy devices (especially retrievable stent devices) with superior reperfusion success rates compared with older technology (1), advanced neuroimaging, and streamlined time-to-treatment targets led to more encouraging results in trials published in 2015 (MR CLEAN, EXTEND-IA, ESCAPE, SWIFT PRIME, and REVASCAT). These results challenged the 2013 data and showed clear benefit and similar safety with EVT compared with conventional therapy. The systematic review and meta-analysis by Sardar and colleagues provides a timely synthesis of the evidence to date, with an emphasis on pragmatic outcomes (functional neurologic outcome by mRS score, mortality, and ICH rates). Clinically, it is important to note that the trials included in the meta-analysis focused primarily on patients with large-vessel, anterior-circulation ischemic strokes. The ESCAPE and EXTEND-IA trials suggest additional benefit when advanced imaging techniques are available to identify patients with favorable collateral blood supply and salvageable ischemic penumbra (2,3). Data are insufficient to extrapolate EVT benefit to patients with posterior circulation or distal territory strokes. None of the trials showed increased risk for major complications (including ICH) with EVT compared with conventional therapy. This suggests that EVT is effective and safe as an adjunct to conventional therapy in appropriately selected patients.

Research paper thumbnail of Analyses of Greek Research Reactor with mixed HEU-LEU Be reflected core

Research paper thumbnail of Kinematics of Chinese Toad Bufo Gargarizans

中国科学:技术科学(英文版), 2010

Abstract A three-dimensional motion force tester for animal was used to measure the reaction forc... more Abstract A three-dimensional motion force tester for animal was used to measure the reaction forces of the feet of a Chinese toad (B. gargarizans) against a horizontal solid surface on which it crawled. The motion behavior of the Chinese toad was recorded by a ...

Research paper thumbnail of CCDC 1006082: Experimental Crystal Structure Determination

An entry from the Cambridge Structural Database, the world's repository for small molecule cr... more An entry from the Cambridge Structural Database, the world's repository for small molecule crystal structures. The entry contains experimental data from a crystal diffraction study. The deposited dataset for this entry is freely available from the CCDC and typically includes 3D coordinates, cell parameters, space group, experimental conditions and quality measures.

Research paper thumbnail of CCDC 1006081: Experimental Crystal Structure Determination

An entry from the Cambridge Structural Database, the world's repository for small molecule cr... more An entry from the Cambridge Structural Database, the world's repository for small molecule crystal structures. The entry contains experimental data from a crystal diffraction study. The deposited dataset for this entry is freely available from the CCDC and typically includes 3D coordinates, cell parameters, space group, experimental conditions and quality measures.

Research paper thumbnail of CCDC 1006080: Experimental Crystal Structure Determination

An entry from the Cambridge Structural Database, the world's repository for small molecule cr... more An entry from the Cambridge Structural Database, the world's repository for small molecule crystal structures. The entry contains experimental data from a crystal diffraction study. The deposited dataset for this entry is freely available from the CCDC and typically includes 3D coordinates, cell parameters, space group, experimental conditions and quality measures.

Research paper thumbnail of Can the Canadian Syncope Risk Score (CSRS) help to risk stratify emergency department patients presenting with syncope without an evident serious cause?

Canadian Journal of Emergency Medicine, 2020

Research paper thumbnail of Evaluation of the Effects on Human Performance Characteristics and Peak Head Accelerations With the Use of Various Intra-Oral Appliances

Various studies have investigated the relationship between the mandibular position and its affect... more Various studies have investigated the relationship between the mandibular position and its affect on human performance characteristics. To maintain the jaw in an optimal position Mandibular Orthopedic Repositioning Appliances (MORA) have been produced. A protective mouthguard is an appliance worn in the mouth which helps prevent injuries to the teeth, lips, cheeks, tongue, and jaw as a result of impact. More recently, it has been hypothesized that mouthguards reduce the risk of concussion by attenuating the impact to the jaw rather than transferring the force to the brain. Currently, there are no standards for testing protective mouthguards. Such a test would prove useful to determine maximum acceleration levels of the head. The aim of this study is to (1) quantify the effectiveness of repositioning the jaw on strength and aerobic potential as well as (2) to determine if a protective mouthguard can give the same affects of a MORA device. In addition, (3) a test protocol will be esta...

Research paper thumbnail of Nitrification in biological rapid sand filters treating drinking water: monitoring governing factors

Research paper thumbnail of Increased insight in microbial processes in rapid sandfilters in drinking water treatment (DW BIOFILTERS)

The aim of this research project is to improve our knowledge on biological rapid sand filters as ... more The aim of this research project is to improve our knowledge on biological rapid sand filters as they are present in thousands groundwater based water works. This includes molecular investigations of the microorganisms responsible for the individual processes (e.g. nitrification); and detailed monitoring and experiments in the filters and laboratory to provide insight in the process mechanisms, kinetics and effect of environmental factors. Management of the filters (e.g. backwashing, flow rate, carrier type) will be investigated at pilot and full scale, supported by mathematical models. The sustainability and climate friendliness are evaluated by life cycle assessment (LCA). Molecular methods based on qPCR are being developed and implemented to quantify bacteria in different functional groups, such as those responsible for nitrification. This allows for development of diagnostic tools to detect if essential or core members are present or absent in a malfunctioning filter. It is mean...

Research paper thumbnail of Los requisitos establecidos por la sentencia C 1052 de 2001 a las acciones ciudadanas de inconstitucionalidad en Colombia: ¿pasadas dos décadas han disminuido las sentencias inhibitorias de la Corte Constitucional?

El presente escrito pretende ocuparse del control abstracto de constitucionalidad realizado por l... more El presente escrito pretende ocuparse del control abstracto de constitucionalidad realizado por la Corte Constitucional colombiana y abordar especialmente el caso de las sentencias inhibitorias de dicho tribunal. En el ano 2.001 el Tribunal Constitucional Colombiano expidio la sentencia C-1052, en la cual se establecieron cargas argumentativas en cabeza del accionante y cuyo proposito segun la misma Corte, fue evitar las sentencias inhibitorias. Hoy pasados 19 anos, se quiere responder las siguientes preguntas ?se alcanzo el fin perseguido por dicha sentencia? y ?puede la Corte Constitucional limitar el acceso ciudadano a una de las figuras mas importantes del constitucionalismo colombiano? Responder estas preguntas justifican la elaboracion del presente articulo. La metodologia usada es dogmatica jurisprudencial con estudio de datos y se pudo demostrar que el fin perseguido por la Corte Constitucional al expedir la citada sentencia no se cumplio, pues desde entonces las sentencias ...

Research paper thumbnail of 터널설계의 New Paradigm을 지향합니다. (주)하경엔지니어링 터널지반부 / 기술연구소

Research paper thumbnail of Ethnicity and health literacy: a survey on hypertension knowledge among Canadian ethnic populations

OBJECTIVES With an increase and diversity in ethnic populations in Westernized countries, underst... more OBJECTIVES With an increase and diversity in ethnic populations in Westernized countries, understanding the differences in levels of knowledge surrounding hypertension is important in planning appropriate prevention strategies. The purpose of our study was to assess levels of hypertension knowledge in Chinese, Indian and White populations in a large metropolitan Canadian city. DESIGN A telephone survey was conducted in English, Chinese (Cantonese and Mandarin) and Indian languages (Hindi, Punjabi and Urdu). Hypertension knowledge was assessed through a 10-item validated instrument; respondents received 1 point for each correct answer. Logistic regression was used to test differences in hypertension knowledge among these three populations. RESULTS Survey response rates were 68.7% (301) for Chinese, 61.3% (248) for Indian and 69.7% (254) for White populations. The average hypertension knowledge score for Chinese respondents was 7.23 out of 10, 7.11 for Indian respondents and 7.28 for ...

Research paper thumbnail of Interprofessional doula project

Research paper thumbnail of Outcomes After Recurrent Intentional Methanol Exposures Not Treated With Alcohol Dehydrogenase Inhibitors Or Hemodialysis

BACKGROUND Relying on a treatment threshold for methanol poisoning of 20 mg/dL (6.2 mmol/L) as a ... more BACKGROUND Relying on a treatment threshold for methanol poisoning of 20 mg/dL (6.2 mmol/L) as a stand-alone criterion may lead to unnecessary and invasive treatment because it is likely too conservative, especially for patients with repeated, intentional methanol exposures. OBJECTIVE We investigated how often patients with recurrent intentional methanol exposures above this threshold developed biochemical or overt clinical toxicity despite not being treated with either an alcohol dehydrogenase inhibitor (ADHi) or hemodialysis. METHODS We identified patients with ≥3 methanol-related emergency visits from 2002 to 2015 and selected every visit in which neither ADHi nor hemodialysis were administered despite serum methanol >20 mg/dL but neither metabolic acidosis nor end organ toxicity at presentation. The primary outcome was the incidence of visual deterioration or death. RESULTS Four patients accounted for the 17 visits that met inclusion criteria. All exposures were intentional s...

Research paper thumbnail of Content Analysis of Stroke Teleconsultation Recordings in the Moravian-Silesian Region, Czech Republic

Frontiers in Neurology, 2021

Background: Direct teleconsultations between emergency medical services (EMS) crews and hospital-... more Background: Direct teleconsultations between emergency medical services (EMS) crews and hospital-based stroke neurologists are mandated in the Czech Republic as triage and prenotification tool in acute stroke patients. The main aim of this study was to analyze the efficacy as well as quality of such teleconsultations in daily clinical practice.Methods: This is a descriptive analysis of teleconsultations between EMS paramedic crews and hospital-based neurologists in a geographically defined region of the Czech Republic (Moravian-Silesian region) between October 2018 to December 2018. All teleconsultations were analyzed for length and content. Content analysis included the following information: date, age, sex, prehospital neurological deficit(s), known/unknown time of symptom onset, anticoagulation status, vital signs, premorbid disability, and patient ID/insurance company number.Results: Within the study period, paramedics conducted 522 calls across 6 stroke centers. Of these, 334 (...

Research paper thumbnail of Meta-analysis of interventions to reduce door to needle times in acute ischaemic stroke patients

BMJ Open Quality, 2020

BackgroundDoor-to-needle time (DTN) has an important impact on thrombolysis and reperfusion outco... more BackgroundDoor-to-needle time (DTN) has an important impact on thrombolysis and reperfusion outcomes in the treatment of acute ischaemic stroke. This systematic review is a critical synthesis of studies evaluating DTN reduction strategies.MethodOvid MEDLINE, PubMed, Cochrane Database of Systematic Reviews, CINAHL, ProQuest dissertations and LILACS were used as bibliographic databases for primary literature. CIHI, Health Quality Council of Alberta, Health Quality Ontario and websites of heart and stroke associations in Canada, USA, UK, Australia and New Zealand were used as sources of grey literature. Searched reports were screened by title and abstract, and full texts were located for review. Articles quality was evaluated using National Institute of Health’s Study Quality Assessment tools. Methods for improving DTN were categorised under 13 DTN reduction strategies, primarily adapted from the Target: Stroke Phase II recommendations, and including two additional categories: Strategi...

Research paper thumbnail of Integration of pan-cancer transcriptomics with RPPA proteomics reveals mechanisms of epithelial-mesenchymal transition

PLOS Computational Biology, 2018

Research paper thumbnail of A summary of the Canadian Stroke Best Practice Recommendations, Sixth Edition (2018): Updates relevant to prehospital and emergency medicine providers

Research paper thumbnail of SGEM Hot Off the Press: Computer provider order entry (CPOE) and emergency department flow

Research paper thumbnail of Review: In acute ischemic stroke, adding endovascular therapy to t-PA improves functional independence at 90 days

Annals of internal medicine, Jan 20, 2015

Question In acute ischemic stroke (AIS), does adding endovascular therapy (EVT) to IV tissue-type... more Question In acute ischemic stroke (AIS), does adding endovascular therapy (EVT) to IV tissue-type plasminogen activator (t-PA) improve clinical outcomes? Review scope Included studies compared EVT (intraarterial thrombolytic administration and/or thrombectomy) plus IV t-PA (in eligible patients) with IV t-PA alone or standard therapy (in patients ineligible for IV t-PA) for treating AIS, and had follow-up 12 weeks. Trials using urokinase for IV thrombolysis in >50% of patients were excluded. Primary outcome was functional independence (modified Rankin Scale [mRS] score 0 to 2) at 90 days. Other outcomes were all-cause mortality and symptomatic intracerebral hemorrhage (ICH). Review methods MEDLINE, EMBASE/Excerpta Medica, Cochrane CENTRAL, EBSCO, CINAHL, and Web of Science (1995 to May 2015); clinical trial databases; and reference lists were searched for English-language, peer-reviewed, published, randomized, controlled trials (RCTs). 10 RCTs met the inclusion criteria; {2 were available in abstract form only}*, and 8 (n =2423, median age 62 to 71 y, 53% men, mean follow-up 3 mo, mean time from stroke onset to randomization 223 to 231 min) were published in full and included in the meta-analysis. Only data from the 8 published RCTs are discussed here. Patients in all RCTs had large-vessel, anterior-circulation ischemic stroke. 5 RCTs (all published in 2015) used stent retrievers for EVT in 86% to 100% of patients; 4 used unspecified IV t-PA in the control group, 3 IV alteplase, and 1 IV alteplase or urokinase. All 8 RCTs blinded outcome assessors and had adequate completeness of outcome data; none had adequate allocation concealment or blinded patients and researchers. 1 of 3 RCTs published in 2013 was stopped early for futility, and 4 of 5 RCTs published in 2015 were stopped early for efficacy or external evidence of benefit. Main results EVT plus IV t-PA improved functional independence at 90 days compared with IV t-PA alone; groups did not differ for all-cause mortality or symptomatic ICH (Table). Conclusion In acute ischemic stroke, adding endovascular therapy to IV tissue-type plasminogen activator improves functional independence at 90 days. EVT plus IV t-PA vs IV t-PA alone (or standard therapy in patients ineligible for t-PA) in acute ischemic stroke Outcomes Number of trials (n) Weighted event rates RBI/RRR/RRI (95% CI) NNT (CI) EVT+t-PA IV t-PA alone Functional independence at 90 d 8 (2419) 45% 32% RBI 40% (12 to 70) 8 (5 to 28) All-cause mortality 8 (2419) 16% 17% RRR 9.3% (12 to 28) NS Symptomatic ICH 8 (2423) 5.1% 4.8% RRI 6.6% (26 to 52) NS EVT = endovascular therapy; ICH = intracerebral hemorrhage; NS = not significant; t-PA = tissue-type plasminogen activator; other abbreviations defined in Glossary. RBI, RRR, RRI, NNT, and CI calculated from odds ratios and control event rates in article using a random-effects model. Modified Rankin Scale score 0 to 2. Commentary IV t-PA is the standard of care for early-presentation AIS, but benefits are balanced against important risks for harm. The advent of mechanical methods of EVT, with relevant trials summarized in the review by Sardar and colleagues, promises to transform the landscape of AIS management. Early studies published in 2013 suggested that EVT added neither benefit nor harm compared with IV t-PA in the treatment of AIS. The development of newer mechanical thrombectomy devices (especially retrievable stent devices) with superior reperfusion success rates compared with older technology (1), advanced neuroimaging, and streamlined time-to-treatment targets led to more encouraging results in trials published in 2015 (MR CLEAN, EXTEND-IA, ESCAPE, SWIFT PRIME, and REVASCAT). These results challenged the 2013 data and showed clear benefit and similar safety with EVT compared with conventional therapy. The systematic review and meta-analysis by Sardar and colleagues provides a timely synthesis of the evidence to date, with an emphasis on pragmatic outcomes (functional neurologic outcome by mRS score, mortality, and ICH rates). Clinically, it is important to note that the trials included in the meta-analysis focused primarily on patients with large-vessel, anterior-circulation ischemic strokes. The ESCAPE and EXTEND-IA trials suggest additional benefit when advanced imaging techniques are available to identify patients with favorable collateral blood supply and salvageable ischemic penumbra (2,3). Data are insufficient to extrapolate EVT benefit to patients with posterior circulation or distal territory strokes. None of the trials showed increased risk for major complications (including ICH) with EVT compared with conventional therapy. This suggests that EVT is effective and safe as an adjunct to conventional therapy in appropriately selected patients.

Research paper thumbnail of Analyses of Greek Research Reactor with mixed HEU-LEU Be reflected core