European Stroke Organisation (ESO) guideline on screening for subclinical atrial fibrillation after stroke or transient ischaemic attack of undetermined origin

We aimed to provide practical recommendations for the screening of subclinical atrial fibrillation (AF) in patients with ischaemic stroke or transient ischaemic attack (TIA) of undetermined origin. These guidelines are based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. Five relevant Population, Intervention, Comparator, Outcome questions were defined by a multidisciplinary module working group (MWG). Longer duration of cardiac rhythm monitoring increases the detection of subclinical AF, but the optimal monitoring length is yet to be defined. We advise longer monitoring to increase the rate of anticoagulation, but whether longer monitoring improves clinical outcomes needs to be addressed. AF detection does not differ from in- or out-patient ECG-monitoring with similar monitoring duration, so we consider it reasonable to initiate in-hospital monitoring as soon as possible and continue with outpatient monitoring for more than 48 h. Although insertable loop recorders (ILR) increase AF detection based on their longer monitoring duration, comparison with non-implantable ECG devices for similar monitoring time is lacking. We suggest the use of implantable devices, if feasible, for AF detection instead of non-implantable devices to increase the detection of subclinical AF. There is weak evidence of a useful role for blood, ECG and brain imaging biomarkers for the identification of patients at high risk of AF. In patients with patent foramen ovale, we found insufficient evidence from RCT, but prolonged cardiac monitoring in patients >55 years is advisable for subclinical AF detection. To conclude, in adult patients with ischaemic stroke or TIA of undetermined origin, we recommend longer duration of cardiac rhythm monitoring of more than 48 h and if feasible with IRL to increase the detection of subclinical AF

Double dynamical regime of confined water

The Van Hove self correlation function of water confined in a silica pore is calculated from Molecular Dynamics trajectories upon supercooling. At long time in the $\alpha$ relaxation region we found that the behaviour of the real space time dependent correlators can be decomposed in a very slow, almost frozen, dynamics due to the bound water close to the substrate and a faster dynamics of the free water which resides far from the confining surface. For free water we confirm the evidences of an approach to a crossover mode coupling transition, previously found in Q space. In the short time region we found that the two dynamical regimes are overimposed and cannot be distinguished. This shows that the interplay between the slower and the faster dynamics emerges in going from early times to the $\alpha$ relaxation region, where a layer analysis of the dynamical properties can be performed.Comment: 6 pages with 9 figures. RevTeX. Accepted for pulbication in J. Phys. Cond. Mat

Fatal Intracranial Hemorrhage Occurring after Oral Anticoagulant Treatment Initiation for Secondary Stroke Prevention in Patients with Atrial Fibrillation

BACKGROUND AND PURPOSE: In this pooled analysis of 7 multicenter cohorts we investigated potential differences in the incidence, characteristics and outcomes between intracranial hemorrhages (ICHs) associated with the use of non-vitamin K oral anticoagulants (NOAC-ICH) or vitamin K antagonists (VKA-ICH) in ischemic stroke (IS) patients after oral anticoagulant treatment initiation for atrial fibrillation (AF). METHODS: We included data from 4.912 eligible AF patients who were admitted in a stroke unit with IS or transient ischemic attack (TIA) and who were treated with either VKAs or NOACs within 3 months post-stroke. Fatal ICH was defined as death occurring during the first 30-days after ICH onset. We additionally performed a meta-analysis of available observational studies reporting 30-day mortality rates from NOAC-ICH or VKA-ICH onset. RESULTS: During 5970 patient-years of follow-up 71 participants had an ICH, of whom 20 were NOAC-ICH and 51 VKA-ICH. Patients in the two groups had comparable baseline characteristics, except for the higher prevalence of kidney disease in VKA-ICH patients. There was a non-significant higher number of fatal ICH in patients with VKA (11 events per 3,385 patient-years) than in those with NOAC (3 events per 2,623 patient-years; HR=0.32,95%CI:0.09-1.14). Three-month functional outcomes were similar (p>0.2) in the two groups. The meta-analysis showed a lower 30-day mortality risk for patients with NOAC-ICH compared to VKA-ICH (RR=0.70,95%CI:0.51-0.95). CONCLUSIONS: NOAC-ICH and VKA-ICH occurring during secondary stroke prevention of AF patients have comparable baseline characteristics and outcomes, except for the risk of fatal ICH within 30 days, which might be greater in VKA-ICH

Early versus late start of direct oral anticoagulants after acute ischaemic stroke linked to atrial fibrillation: an observational study and individual patient data pooled analysis

OBJECTIVE: The optimal timing to start direct oral anticoagulants (DOACs) after an acute ischaemic stroke (AIS) related to atrial fibrillation (AF) remains unclear. We aimed to compare early (≤5 days of AIS) versus late (>5 days of AIS) DOAC-start. METHODS: This is an individual patient data pooled analysis of eight prospective European and Japanese cohort studies. We included patients with AIS related to non-valvular AF where a DOAC was started within 30 days. Primary endpoints were 30-day rates of recurrent AIS and ICH. RESULTS: A total of 2550 patients were included. DOACs were started early in 1362 (53%) patients, late in 1188 (47%). During 212 patient-years, 37 patients had a recurrent AIS (1.5%), 16 (43%) before a DOAC was started; 6 patients (0.2%) had an ICH, all after DOAC-start. In the early DOAC-start group, 23 patients (1.7%) suffered from a recurrent AIS, while 2 patients (0.1%) had an ICH. In the late DOAC-start group, 14 patients (1.2%) suffered from a recurrent AIS; 4 patients (0.3%) suffered from ICH. In the propensity score-adjusted comparison of late versus early DOAC-start groups, there was no statistically significant difference in the hazard of recurrent AIS (aHR=1.2, 95% CI 0.5 to 2.9, p=0.69), ICH (aHR=6.0, 95% CI 0.6 to 56.3, p=0.12) or any stroke. CONCLUSIONS: Our results do not corroborate concerns that an early DOAC-start might excessively increase the risk of ICH. The sevenfold higher risk of recurrent AIS than ICH suggests that an early DOAC-start might be reasonable, supporting enrolment into randomised trials comparing an early versus late DOAC-start

Evidence of coexistence of change of caged dynamics at Tg and the dynamic transition at Td in solvated proteins

Mossbauer spectroscopy and neutron scattering measurements on proteins embedded in solvents including water and aqueous mixtures have emphasized the observation of the distinctive temperature dependence of the atomic mean square displacements, , commonly referred to as the dynamic transition at some temperature Td. At low temperatures, increases slowly, but it assume stronger temperature dependence after crossing Td, which depends on the time/frequency resolution of the spectrometer. Various authors have made connection of the dynamics of solvated proteins including the dynamic transition to that of glass-forming substances. Notwithstanding, no connection is made to the similar change of temperature dependence of obtained by quasielastic neutron scattering when crossing the glass transition temperature Tg, generally observed in inorganic, organic and polymeric glass-formers. Evidences are presented to show that such change of the temperature dependence of from neutron scattering at Tg is present in hydrated or solvated proteins, as well as in the solvents used unsurprisingly since the latter is just another organic glass-formers. The obtained by neutron scattering at not so low temperatures has contributions from the dissipation of molecules while caged by the anharmonic intermolecular potential at times before dissolution of cages by the onset of the Johari-Goldstein beta-relaxation. The universal change of at Tg of glass-formers had been rationalized by sensitivity to change in volume and entropy of the beta-relaxation, which is passed onto the dissipation of the caged molecules and its contribution to . The same rationalization applies to hydrated and solvated proteins for the observed change of at Tg.Comment: 28 pages, 10 figures, 1 Tabl

SLAC T-510 experiment for radio emission from particle showers: Detailed simulation study and interpretation

Over the last several decades, radio detection of air showers has been widely used to detect ultra-high-energy cosmic rays. We developed an experiment under controlled laboratory conditions at SLAC with which we measured the radio-frequency radiation from a charged particle shower produced by bunches of electrons as primaries with known energy. The shower took place in a target made of High Density Polyethylene located in a strong magnetic field. The experiment was designed so that Askaryan and magnetically-induced components of the radio emission could be measured independently. At the same time, we performed a detailed simulation of this experiment to predict the radio signal using two microscopic formalisms, endpoint and ZHS. In this paper, we present the simulation scheme and make a comparison with data characteristics such as linearity with magnetic field and amplitude. The simulations agree with the measurements within uncertainties and present a good description of the data. In particular, reflections within the target that accounted for the largest systematic uncertainties are addressed. The prediction of the amplitude of Askaryan emission agrees with measurements to within 5% for the endpoint formalism and 11% for the ZHS formalism. The amplitudes of magnetically-induced emission agree to within 5% for the endpoint formalism and less than 1% for the ZHS formalism. The agreement of the absolute scale of emission gives confidence in state-of-the-art air shower simulations which are based on the applied formalisms

Second hematopoietic SCT in patients with thalassemia recurrence following rejection of the first graft

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