Ticagrelor vs Clopidogrel in CYP2C19 loss-of-function carriers with Stroke or TIA

BACKGROUNDComparisons between ticagrelor- aspirin and clopidogrel-aspirin in CYP2C19 loss-of-function carriers have not been well studied for secondary stroke prevention.METHODSWe conducted a randomized, double-blind, placebo-controlled trial of 6,412 patients with a minor ischemic stroke or TIA who carried CYP2C19 LOF alleles determined by point-of-care testing. Patients were randomly assigned within 24 hours after symptom onset, in a 1:1 ratio to receive ticagrelor (180 mg loading dose on day 1 followed by 90 mg twice daily for days 2 through 90) or clopidogrel (300 mg loading dose on day 1 followed by 75 mg per day for days 2 through 90), plus aspirin (75-300 mg loading dose followed by 75 mg daily for 21 days). The primary efficacy outcome was stroke and the primary safety outcome was severe or moderate bleeding, both within 90 days. RESULTSStroke occurred within 90 days in 191 (6.0%) versus 243 (7.6%), respectively (hazard ratio, 0.77; 95% confidence interval, 0.64 to 0.94; P=0.008). Moderate or severe bleeding occurred in 9 patients (0.3%) in the ticagrelor-aspirin group and in 11 patients (0.3%) in the clopidogrel-aspirin group; any bleeding event occurred in 170 patients (5.3%) vs 80 (2.5%), respectively. CONCLUSIONSAmong Chinese patients with minor ischemic stroke or TIA within 24 hours after symptoms onset who were carriers of CYP2C19 loss-of-function alleles, ticagrelor- aspirin was modestly better than clopidogrel-aspirin for reducing the risk of stroke but was associated with more total bleeding events at 90 days. (CHANCE-2 ClinicalTrials.gov number, NCT04078737.

Characteristics of flowering and pollination of Leucospermum cordifolium

[ Objective ] This study aims to understand the flowering and fruiting characteristics of Leuco- spermum cordifolium and the reasons of low fruiting rate in order to promote seed production , hybrid breeding , flowering period regulation , and new variety cultivation. [ Methods ] This report used L . cordi- folium as materials to study flowering phenology , floral characteristics , pollen vitality , stigma acceptabili- ty , hybridization index , and pollination and fruiting characteristics. [ Results ] ( 1 ) The flowering period of L . cordifolium was in late winter , or early spring to summer. ( 2 ) The most suitable in vitro germination medium for measuring pollen vitality contained 30 g / L sucrose+150 mg / L boric acid+50 mg / L calcium chloride. ( 3 ) The receptivity of the stigma was gradually increased from 1 day to 7 day of flowering , and was strongest from 5 day to 7 day. The results of hybridization index indicated that L . cordifolium was partially self-compatible or cross compatible , requiring pollinators. ( 4 ) Field observation showed that fruiting rate was low in its natural state , but it could spontaneously complete pollination and there was no phenomenon of apomixis. ( 5 ) The artificial pollination experiment found that L . cordifolium had the highest setting rate of 17.14% , while self-pollination had the lowest setting rate of 4.94%. [ Conclusion ] The disparity in maturation times of the pistil and stamen is the primary factor contributing to the dimin- ished setting rate of L . cordifolium . The presence of callose on the pistil and ovary , as well as the enlarge- ment of the pollen tube tip , are also important reasons for the low setting rate

Hematocrit Predicts Poor Prognosis in Patients with Acute Ischemic Stroke or Transient Ischemic Attack

This study aims to investigate the association between HCT (Hematocrit) levels and adverse outcomes in patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA); 14,832 participants from the China National Stroke Registry-III with AIS or TIA were analyzed. Participants were categorized into quartiles based on baseline HCT levels. The primary outcome was poor functional outcomes (modified Rankin Scale ≥ 3) during three months, with secondary outcomes including all-cause death, stroke recurrence, and combined vascular events. Logistic regression or Cox regression models were used to assess the relationship between HCT and clinical outcomes. Compared to the third quartile, patients in the lowest quartile group showed increased risk of poor functional outcome (adjusted OR: 1.35, 95% CI: 1.15–1.58, p p = 0.028), as did those in the highest quartile (adjusted HR: 2.02, 95% CI: 1.26–3.25, p = 0.004). Sensitivity analysis shows that the association of HCT with all-cause death weakened, while the association with poor functional outcome was strengthened after excluding patients with recurrent stroke. Our results indicated that HCT level could be used as a short-term predictor for poor functional outcomes and all-cause death in patients with AIS or TIA