Hemorrhagic Transformation in Patients With Acute Ischemic Stroke and Atrial Fibrillation: Time to Initiation of Oral Anticoagulant Therapy and Outcomes.

Background In patients with acute ischemic stroke and atrial fibrillation, early anticoagulation prevents ischemic recurrence but with the risk of hemorrhagic transformation ( HT ). The aims of this study were to evaluate in consecutive patients with acute stroke and atrial fibrillation (1) the incidence of early HT, (2) the time to initiation of anticoagulation in patients with HT , (3) the association of HT with ischemic recurrences, and (4) the association of HT with clinical outcome at 90 days. Methods and Results HT was diagnosed by a second brain computed tomographic scan performed 24 to 72 hours after stroke onset. The incidence of ischemic recurrences as well as mortality or disability (modified Rankin Scale scores >2) were evaluated at 90 days. Ischemic recurrences were the composite of ischemic stroke, transient ischemic attack, or systemic embolism. Among the 2183 patients included in the study, 241 (11.0%) had HT . Patients with and without HT initiated anticoagulant therapy after a mean 23.3 and 11.6 days, respectively, from index stroke. At 90 days, 4.6% (95% confidence interval, 2.3-8.0) of the patients with HT had ischemic recurrences compared with 4.9% (95% confidence interval, 4.0-6.0) of those without HT ; 53.1% of patients with  HT were deceased or disabled compared with 35.8% of those without HT . On multivariable analysis, HT was associated with mortality or disability (odds ratio, 1.71; 95% confidence interval, 1.24-2.35). Conclusions In patients with HT , anticoagulation was initiated about 12 days later than patients without HT . This delay was not associated with increased detection of ischemic recurrence. HT was associated with increased mortality or disability

The 4 pi fragment spectrometer FOBOS

The 4 pi fragment spectrometer FOBOS developed for heavy ion research at beam energies of 10 100 AMeV has been commissioned for physical experiments at the Flerov Laboratory of Nuclear Reactions of the Joint Institute for Nuclear Research in Dubna, Based on the logarithmic detector principle, it is able to register charged fragments from protons up to heavy residual nuclei in a large dynamical range. Position sensitive avalanche counters, axial ionization chambers and CsI TI scintillation detectors are arranged in three concentric detector shells. An array of phoswich detectors is used as a more granular forward detector at narrow polar angles. The modular concept of FOBOS allows for different experimental application in the field of exclusive fragment spectroscopy at medium multiplicities. For illustration, the fragment spectroscopy studies concerning the spontaneous fission process and the fragmentation of hot nuclei by means of the FOBOS set up are considere

The COMBAS fragment separator of radioactive nuclei and the FOBOS 4#pi#-detector for charged particles

The projectile-like fragment separator COMBAS is being designed at the Flerov Laboratory of Nuclear Reactions, JINR Dubna, for providing radioactive nuclear beams. COMBAS is a compact achromatic beam line with a high resolving power of 4360. It accepts fragments within 6.4 msr solid angle and with a momentum spread of 10%. The method of isotopic separation is based on a combination of magnetic rigidity and energy loss analysis. The separated radioactive beam is planned to be transported either into a time-projection chamber in the regime gas target - gas detector or to a secondary target positioned in the centre of the FOBOS 4#pi#-array or to another set-up. The FOBOS detector is intended for heavy ion reaction studies in the bombarding energy range of 10-100 AMeV at the cyclotron U-400M of the FLNR. Presently, only primary cyclotron beams are used because COMBAS is not yet complete. FOBOS consists of a gas-detector ball of 30 position-sensitive avalanche counters and 30 axial ionization chambers behind them and an outer scintillator shell of 210 CsI(Tl) counters surrounding the gas detectors. An array of 96 phoswich counters cover the very forward angles. All charged reaction products can be measured in a wide dynamic range and in a geometry convering a substantial part of 4#pi#. First data have been taken concerning fission and emission of intermediate-mass fragments in the reactions "7Li (43 AMeV) on "2"3"2Th and "1"4N (34 AMeV) on "1"9"7Au. (orig.)15 refs.SIGLEAvailable from TIB Hannover: RR 1847(103) / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekBundesministerium fuer Bildung, Wissenschaft, Forschung und Technologie, Bonn (Germany)DEGerman