Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Flooding tolerance of four floodplain meadow species depends on age

Numerous restoration campaigns focused on re-establishing species-rich floodplain meadows of Central Europe, whose species composition is essentially controlled by regular flooding. Climate change predictions expect strong alterations on the discharge regime of Europe's large rivers with little-known consequences on floodplain meadow plants. In this study, we aim to determine the effects of flooding on seedlings of different ages of four typical flood meadow species. To this end, we flooded seedlings of two familial pairs of flood meadow species of wetter and dryer microhabitats for 2 weeks each, starting 2, 4, 6, and 8 weeks after seedling germination, respectively. We show that a 2-week-flooding treatment had a negative effect on performance of seedlings younger than 6 weeks. Summer floods with high floodwater temperatures may have especially detrimental effects on seedlings, which is corroborated by previous findings. As expected, the plants from wet floodplain meadow microhabitats coped better with the flooding treatment than those from dryer microhabitats. In conclusion, our results suggest that restoration measures may perform more successfully if seedlings of restored species are older than the critical age of about 6 weeks before a spring flooding begins. Seasonal flow patterns may influence vegetation dynamics of floodplain meadows and should, therefore, be taken into account when timing future restoration campaigns

Differences in the survival of four floodplain meadow species among five age groups.

<p>Differences in the survival of four floodplain meadow species among five age groups.</p

Time schedule and air temperatures for the flooding experiment of four floodplain meadow species.

<p>(A) Time schedule of age groups: four age groups with a 2-week flooding treatment starting 2, 4, 6, and 8 weeks after germination (age2, age4, age6, age8) and one unflooded control group (noFl) with regular growth through 12 weeks. (B) Temperature trend during time of the experiment (solid line: daily mean temperature, dashed line: daily minimum temperature, dotted line: daily maximum temperature). Temperature data from HLNUG (Hessian Agency for Nature Conservation, Environment and Geology, <a href="http://www.hlnug.de" target="_blank">http://www.hlnug.de</a>), weather station Linden (distance from experimental site: 700 m).</p

Performance of four floodplain meadow plant species after a 2-week flooding period.

<p>Performance of four floodplain meadow plant species after a 2-week flooding period.</p

Effects of a 2-week flooding treatment on survival of four floodplain meadow plant species.

<p>Cumulative survival of <i>Veronica maritima</i> L., <i>Veronica teucrium</i> L., <i>Sanguisorba officinalis</i> L., and <i>Sanguisorba minor</i> Scop. after a 2-week flooding treatment, starting 2, 4, 6, and 8 weeks, respectively, after germination (age2-age8), and a control group with no flooding (noFl). age2, dot-dashed line & plus; age4, dotted line & filled triangle point up; age6, two-dashed line & circle; age8, long-dashed line & triangle point down; noFl, solid line & cross.</p

Performance of four floodplain meadow plant species after a 2-week flooding period.

<p>Mean (± 95% confidence interval) logarithmic response ratio of plant height (A), leaf number (B) and biomass (C), and mean (± 95% confidence interval) specific leaf area (SLA, D) for each species-seedling age group combination: <i>Veronica maritima</i> L., <i>Veronica teucrium</i> L., <i>Sanguisorba officinalis</i> L., and <i>Sanguisorba minor</i> Scop.; flooding started 2, 4, 6, and 8 weeks after germination (age2-age8), and control group with no flooding (noFl). Effects of flooding treatments on survived plants were considered significant (i.e. different from the controls) when 95% CI did not overlap with zero. Missing bars represent groups with a mortality of 100%.</p

Global, regional, and national burden of traumatic brain injury and spinal cord injury, 1990-2016 : a systematic analysis for the Global Burden of Disease Study 2016

Background Traumatic brain injury (TBI) and spinal cord injury (SCI) are increasingly recognised as global health priorities in view of the preventability of most injuries and the complex and expensive medical care they necessitate. We aimed to measure the incidence, prevalence, and years of life lived with disability (YLDs) for TBI and SCI from all causes of injury in every country, to describe how these measures have changed between 1990 and 2016, and to estimate the proportion of TBI and SCI cases caused by different types of injury. Methods We used results from the Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2016 to measure the global, regional, and national burden of TBI and SCI by age and sex. We measured the incidence and prevalence of all causes of injury requiring medical care in inpatient and outpatient records, literature studies, and survey data. By use of clinical record data, we estimated the proportion of each cause of injury that required medical care that would result in TBI or SCI being considered as the nature of injury. We used literature studies to establish standardised mortality ratios and applied differential equations to convert incidence to prevalence of long-term disability. Finally, we applied GBD disability weights to calculate YLDs. We used a Bayesian meta-regression tool for epidemiological modelling, used cause-specific mortality rates for non-fatal estimation, and adjusted our results for disability experienced with comorbid conditions. We also analysed results on the basis of the Socio-demographic Index, a compound measure of income per capita, education, and fertility. Findings In 2016, there were 27.08 million (95% uncertainty interval [UI] 24.30-30.30 million) new cases of TBI and 0.93 million (0.78-1.16 million) new cases of SCI, with age-standardised incidence rates of 369 (331-412) per 100 000 population for TBI and 13 (11-16) per 100 000 for SCI. In 2016, the number of prevalent cases of TBI was 55.50 million (53.40-57.62 million) and of SCI was 27.04 million (24 .98-30 .15 million). From 1990 to 2016, the age-standardised prevalence of TBI increased by 8.4% (95% UI 7.7 to 9.2), whereas that of SCI did not change significantly (-0.2% [-2.1 to 2.7]). Age-standardised incidence rates increased by 3.6% (1.8 to 5.5) for TBI, but did not change significantly for SCI (-3.6% [-7.4 to 4.0]). TBI caused 8.1 million (95% UI 6. 0-10. 4 million) YLDs and SCI caused 9.5 million (6.7-12.4 million) YLDs in 2016, corresponding to age-standardised rates of 111 (82-141) per 100 000 for TBI and 130 (90-170) per 100 000 for SCI. Falls and road injuries were the leading causes of new cases of TBI and SCI in most regions. Interpretation TBI and SCI constitute a considerable portion of the global injury burden and are caused primarily by falls and road injuries. The increase in incidence of TBI over time might continue in view of increases in population density, population ageing, and increasing use of motor vehicles, motorcycles, and bicycles. The number of individuals living with SCI is expected to increase in view of population growth, which is concerning because of the specialised care that people with SCI can require. Our study was limited by data sparsity in some regions, and it will be important to invest greater resources in collection of data for TBI and SCI to improve the accuracy of future assessments. Copyright (C) 2018 The Author(s). Published by Elsevier Ltd.Peer reviewe