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        Long-Term Follow-up of Enhanced Holter- Electrocardiography Monitoring in Acute Ischemic Stroke

        Rolf Wachter,Mark Weber-Krüger,Gerhard F. Hamann,Pawel Kermer,Jan Liman,Meinhard Mende,Joachim Seegers,Katrin Wasser,Sonja Gröschel,Timo Uphaus,Holger Poppert,Martin Köhrmann,Markus Zabel,Ulrich Laufs 대한뇌졸중학회 2022 Journal of stroke Vol.24 No.1

        Background and Purpose Prolonged electrocardiography (ECG)-monitoring in stroke patients improves the detection of paroxysmal atrial fibrillation (pAF). However, most randomized studies only had short follow-up. We aimed to provide 3-year follow-up data for AF detection and stroke recurrence risk. Methods We randomized 402 patients aged ≥60 years with acute ischemic strokes without AF to either enhanced and prolonged monitoring (EPM; 3×10-day Holter-ECG-monitoring) or standard-of-care (≥24 hours ECG-monitoring). The endpoint of the current analysis was AF within 36 months analyzed by intention to treat. Long-term follow-up was performed for 36 months. Results Two hundred and seventy-four patients (80%) participated in the extended follow-up(median duration of follow-up was 36 months [interquartile range, 12 to 36]). During the first 6 months, more AF was documented in the EPM arm compared to the control arm (13.5% vs. 5.1%; 95% confidence interval, 2.9% to 14.4%; P=0.004). During months 6 to 36, AF was less detected in the EPM intervention arm than in the control arm (2.0% vs. 7.3%; 95% confidence interval, 0.7% to 9.9%; P=0.028). Overall, the detection rate of AF within 36 months was numerically higher within the EPM group (15.0% vs. 11.1%, P=0.30). Numerically less patients in the EPM arm had recurrent ischemic strokes (5.5% vs. 9.1%, P=0.18), transient ischemic attacks (3.0% vs. 4.5%, P=0.44) or died (4.5% vs. 6.6%, P=0.37). Conclusions Enhanced and prolonged ECG monitoring increased AF detection during the first six months, but there was significantly more clinical AF during months 6 to 36 observed in the usual-care arm. This suggests that EPM leads to an earlier detection of clinically relevant AF.

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        Dorsal Track Control (DTC): A Modified Surgical Technique for Atraumatic Handling of the Distal Esophagus in Esophagojejunostomy

        Jan Schulte am Esch,Nadja Lehwald-Tywuschik,Fabian Steinfurth,Feride Kröpil,Andreas Krieg,Hülya Sarikaya,Wolfram Trudo Knoefel,Martin Krüger,Tahar Benhidjeb,Morris Beshay 대한위암학회 2019 Journal of gastric cancer Vol.19 No.4

        Surgical therapy for adenocarcinoma of the esophagogastric junction II requires distal esophagectomy, in which a transhiatal management of the lower esophagus is critical. The ‘dorsal track control’ (DTC) maneuver presented here facilitates the atraumatic handling of the distal esophagus, in preparation for a circular-stapled esophagojejunostomy. It is based on a ventral semicircular incision in the distal esophagus, with an intact dorsal wall for traction control of the esophagus. The maneuver facilitates the proper placement of the purse-string suture, up to its tying (around the anvil), thus minimizing the manipulation of the remaining esophagus. Furthermore, the dorsally-exposed inner wall surface of the ventrally-opened esophagus serves as a guiding chute that eases anvil insertion into the esophageal lumen. We performed this novel technique in 21 cases, enabling a safe anastomosis up to 10 cm proximal to the Z-line. No anastomotic insufficiency was observed. The DTC technique improves high transhiatal esophagojejunostomy.

      • Influence of molecular architecture on the entanglement network: topological analysis of linear, long- and short-chain branched polyethylene melts <i>via</i> Monte Carlo simulations

        Jeong, Seung Heum,Kim, Jun Mo,Yoon, Jeongha,Tzoumanekas, Christos,Krö,ger, Martin,Baig, Chunggi The Royal Society of Chemistry 2016 SOFT MATTER Vol.12 No.16

        <P>We present detailed results on the effect of chain branching on the topological properties of entangled polymer melts via an advanced connectivity-altering Monte Carlo (MC) algorithm. Eleven representative model linear, short-chain branched (SCB), and long-chain branched (LCB) polyethylene (PE) melts were employed, based on the total chain length and/or the longest linear chain dimension. Directly analyzing the entanglement [or the primitive path (PP)] network of the system via the Z-code, we quantified several important topological measures: (a) the PP contour length L-pp, (b) the number of entanglements Z(es) per chain, (c) the end-to-end length of an entanglement strand d(es), (d) the number of carbon atoms per entanglement strand N-es, and (e) the probability distribution for each of these quantities. The results show that the SCB polymer melts have significantly more compact overall chain conformations compared to the linear polymers, exhibiting, relative to the corresponding linear analogues, (a) similar to 20% smaller values of < L-pp > (the statistical average of L-pp), (b) similar to 30% smaller values of < Z(es)>, (c) similar to 20% larger values of < d(es)>, and (d) similar to 50% larger values of < N-es >. In contrast, despite the intrinsically smaller overall chain dimensions than those of the linear analogues, the LCB (H-shaped and A(3)AA(3) multiarm) PE melts exhibit relatively (a) 7-8% larger values of < L-pp >, (b) 6-11% larger values of < Z(es)> for the H-shaped melt and similar to 2% smaller values of < Z(es)> for the A(3)AA(3) multiarm, (c) 2-5% smaller values of < d(es)>, and (d) 7-11% smaller values of < N-es >. Several interesting features were also found in the results of the probability distribution functions P for each topological measure.</P>

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