Antiplatelet drugs for secondary prevention in patients with ischemic stroke or transient ischemic attack: a systematic review and network meta-analysis

Background: Antiplatelet drugs may prevent recurrent ischemic events after ischemic stroke but their relative effectiveness and harms still need to be clarified. Within this network meta-analysis we aimed to summarize the current evidence for using antiplatelet drugs for secondary stroke prevention. Methods: We searched MEDLINE, EMBASE and CENTRAL up to September 2020. Randomized controlled trials (RCTs) assessing antiplatelet drugs for secondary stroke prevention were included. We did pairwise meta-analyses and network meta-analyses using random-effects models. Primary outcomes were all strokes (ischemic or hemorrhagic) and all-cause mortality. Results: The review included 57 RCTs, 50 (n = 165,533 participants) provided data for the meta-analyses. Compared to placebo/no treatment, moderate to high-confidence evidence indicated that cilostazol, clopidogrel, dipyridamole + aspirin, ticagrelor, ticlopidine, and aspirin ≤ 150 mg/day significantly reduced the risk of all strokes (odds ratios, ORs and absolute risk difference, ARD): cilostazol 0.51 (95 % confidence interval, CI, 0.37 to 0.71; 3.6 % fewer), clopidogrel 0.63 (95 % CI, 0.49 to 0.79; 2.7 % fewer), dipyridamole + aspirin 0.65 (95 % CI, 0.55 to 0.78; 2.5 % fewer), ticagrelor 0.68 (95 % CI, 0.50 to 0.93; 2.3 % fewer), ticlopidine 0.74 (95 % CI 0.59 to 0.93; 1.9 % fewer), aspirin ≤ 150 mg/day 0.79 (95 % CI, 0.66 to 0.95; 1.5 % fewer). Aspirin > 150 mg/day and the combinations clopidogrel/aspirin, ticagrelor/aspirin, also decrease all strokes but increase the risk of hemorrhagic events. Only aspirin > 150 mg/day significantly reduced all-cause mortality (OR 0.86, 95 % CI 0.76 to 0.97; ARD 0.9 %, 95 %CI 1.5–0.2 % fewer, moderate confidence). Compared to aspirin ≤ 150 mg/day, clopidogrel significantly reduced the risk of all strokes, cardiovascular events, and intracranial hemorrhage outcomes. Cilostazol also appeared to provide advantages but data are limited to the Asian population. Conclusions: Considering the benefits and harms ratio, cilostazol, clopidogrel, dipyridamole + aspirin, ticagrelor, ticlopidine, and aspirin ≤ 150 mg/day appear to be the best choices as antiplatelet drugs for secondary prevention of patients with ischemic stroke or TIA. Systematic review registration: PROSPERO CRD42020159896

Legume Cover Crop Alleviates the Negative Impact of No-Till on Tomato Productivity in a Mediterranean Organic Cropping System

The ecosystem services a cover crop (CC) provides depend enormously on species choice and tillage system. Here, we evaluated the impact of (a) three winter CCs-rye (Secale cereale L.) and squarrose clover (Trifolium squarrosum L.) monocultures and their mixture, and (b) two tillage systems-roller-crimping of CC residue as dead mulch for no-till (NT) systems and incorporating CC residue into the soil as green manure for conventional tillage (CT) systems-on the performance of organic processing tomato, i.e., plant growth, nutrient accumulation, fruit yield, and weed biomass. The assessments took place over two years in field experiments conducted under Mediterranean conditions. At the termination time, rye and mixture were the most productive and the best weed-suppressive CCs. During tomato growing season, squarrose clover regardless of tillage system stimulated tomato growth, Nitrogen content and uptake, and the yield relative to the other cover crops. Nevertheless, NT generally impaired the tomato nutritional status and increased weed biomass compared to CT despite some potential weed control by cover crops. These two aspects caused a significant drop in tomato yield in all NT systems. The results suggested that, despite the multiple benefits the compared CCs can offer in Mediterranean agroecosystems, legume CCs could be the key to developing feasible organic vegetable no-till systems

Organic farming systems for adaptation to and mitigation of climate change: Effects on soil fertility and resource use efficiency

Organic farming is pointed as one of the most sustainable farming practices in terms of environmental sustainability and climate change mitigation potential. At the core of organic farming practices there are practices aimed at improving soil fertility, increasing soil C content and enhancing system biodiversity. A long-term field experiment (LTE) (MASCOT) was started on 2001 in San Piero a Grado, Pisa (Italy) with the aim to compare two different cropping systems, one managed organically and one conventionally, in terms of agronomical, economic and environmental sustainability. In 2016, the MASCOT was redesigned as a full system trial and the organic system was reshaped according to up to date agroecological standards. Climate change adaptation capacity of the two systems is being assessed through agronomic and economic parameters, whilst greenhouse gas emission mitigation potential is mainly expressed in terms of soil C sequestration

Spectral modelling of the high energy emission of the magnetar 4U 0142+614

We present an empirical spectral modelling of the high energy emission of the anomalous X-ray pulsar 4U 0142+614, based on simultaneous Swift and INTEGRAL observations from X to gamma-ray energies. We adopted models contained in the XSPEC analysis package, as well as models based on recent theoretical studies, and restricted ourselves to those combinations of up to three components which produce a good fit while requiring the lowest number of free parameters. Only three models were found to fit satisfactorily the 0.5-250keV spectrum of 4U 0142+614: i) a ~0.4keV blackbody and two power-laws, ii) a resonant cyclotron scattering model plus a power-law and iii) two log-parabolic functions. We found that only the latter two models do not over-predict the infrared/optical emission observed simultaneously from this AXP, and only the log-parabolic functions can naturally account for the upper limits set by COMPTEL in the gamma-ray range. A possible interpretation of the two log-parabolae in terms of inverse Compton scattering of soft X-ray photons by very energetic particles is discussed

No efficacy of transcranial direct current stimulation on chronic migraine with medication overuse : a double blind, randomised clinical trial

Background: Transcranial direct current stimulation was suggested to provide beneficial effects in chronic migraine, a condition often associated with medication overuse for which no long-term therapy is available. Methods: We conducted a randomised controlled trial to assess long-term efficacy of transcranial direct current stimulation. Adults diagnosed with chronic migraine and medication overuse were assigned to receive in a 1:1:1 ratio anodal, cathodal, or sham transcranial direct current stimulation daily for five consecutive days, along with standardised drug withdrawal protocol. Primary outcome was 50% reduction of days of headache per month at 12 months. Co-secondary outcomes were 50% reduction of days of headache per month at 6 months, reduction of analgesic intake per month, and change in disability and quality of life, catastrophising, depression, state and trait anxiety, dependence attitude and allodynia intensity. Patients were not allowed to take any migraine prophylaxis drug for the entire study period. Results: We randomly allocated 135 patients to anodal (44), cathodal (45), and sham (46) transcranial direct current stimulation. At 6 and 12 months, the percentage of reduction of days of headache and number of analgesics per month ranged between 48.5% and 64.7%, without differences between transcranial direct current stimulation (cathodal, anodal, or the results obtained from the two arms of treatment, anodal plus cathodal) and sham. Catastrophising attitude significantly reduced at 12 months in all groups. There was no difference for the other secondary outcomes. Conclusions: Transcranial direct current stimulation did not influence the short and long-term course of chronic migraine with medication overuse after acute drug withdrawal. Behavioral and educational measures and support for patients' pain management could provide long-term improvement and low relapse rate. Trial registration number NCT04228809

Assessment of a Chain Mower Performance for Weed Control under Tree Rows in an Alley Cropping Farming System

In the area under tree rows of alley cropping systems, coarse plant material as well as pruning material or stones may be present, so the use of a mower equipped with chains as cutting a tool could be advantageous. A mower designed for under-row weed control in orchards, equipped with an automatic tree-skipping mechanism, was modified by replacing blades with chains with the aim of evaluating its performance in an alley cropping system. A first trial was carried out in an open field to preliminarily compare the chain mower with the version equipped with blades in relation to different settings of working speed (1.6 and 2.4 km center dot h(-1)) and rotation speed of the cutting tool (1830 and 2500 rpm). Weed biomass reduction, weed cover reduction, weed height reduction, weed biomass regrowth, and clipping size were assessed. In a second trial, the performance of the mowers with different setting configurations was assessed in an alley cropping system under a more critical environmental condition for mowing, i.e., the presence of dew. Weed biomass reduction, weed cover reduction, weed height reduction, and the mowers' field capacity with different working speed settings were assessed. No major differences emerged between the mowers and the chain mower performance was comparable to that of the standard blade mower. The setting with the high working speed and high rotation speed of the cutting tool turns out to be the best compromise, obtaining a weed biomass reduction of 59.6%, a weed cover reduction of 40.9%, and a higher field capacity compared to the setting with the low working speed, with an increase of 47.9%

The July 2010 outburst of the NLS1 PMN J0948+0022

We report about the multiwavelength campaign on the Narrow-Line Seyfert 1 (NLS1) Galaxy PMN J0948+0022 (z = 0.5846) performed in 2010 July-September and triggered by high activity as measured by Fermi/LAT. The peak luminosity in the 0.1-100 GeV energy band exceeded, for the first time in this type of source, the value of 10^48 erg/s, a level comparable to the most powerful blazars. The comparison of the spectral energy distribution of the NLS1 PMN J0948+0022 with that of a typical blazar - like 3C 273 - shows that the power emitted at gamma rays is extreme.Comment: 2011 Fermi Symposium proceedings - eConf C11050

Adverse effects of immunotherapies for multiple sclerosis: A network meta-analysis

This is the protocol for a review and there is no abstract. The objectives are as follows: To compare adverse effects of immunotherapies for people with multiple sclerosis (MS) or clinically isolated syndrome (CIS), and to rank these treatments according to their relative risks of adverse effects

Cytokine Profile in Striated Muscle Laminopathies: New Promising Biomarkers for Disease Prediction

Laminopathies are a wide and heterogeneous group of rare human diseases caused by mutations of the LMNA gene or related nuclear envelope genes. The variety of clinical phenotypes and the wide spectrum of histopathological changes among patients carrying an identical mutation in the LMNA gene make the prognostic process rather difficult, and classical genetic screens appear to have limited predictive value for disease development. The aim of this study was to evaluate whether a comprehensive profile of circulating cytokines may be a useful tool to differentiate and stratify disease subgroups, support clinical follow-ups and contribute to new therapeutic approaches. Serum levels of 51 pro- and anti-inflammatory molecules, including cytokines, chemokines and growth factors, were quantified by a Luminex multiple immune-assay in 53 patients with muscular laminopathy (Musc-LMNA), 10 with non-muscular laminopathy, 22 with other muscular disorders and in 35 healthy controls. Interleukin-17 (IL-17), granulocyte colony-stimulating factor (G-CSF) and transforming growth factor beta (TGF-β2) levels significantly discriminated Musc-LMNA from controls; interleukin-1β (IL-1β), interleukin-4 (IL-4) and interleukin-8 (IL-8) were differentially expressed in Musc-LMNA patients compared to those with non-muscular laminopathies, whereas IL-17 was significantly higher in Musc-LMNA patients with muscular and cardiac involvement. These findings support the hypothesis of a key role of the immune system in Musc-LMNA and emphasize the potential use of cytokines as biomarkers for these disorders