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Background In patients with acute ischemic stroke, little is known regarding the frequency of abnormal ECG findings other than atrial fibrillation and their association with cardiovascular outcomes. We aim to analyze the frequency and type of abnormal ECG findings, subsequent changes in medical treatment, and their association with cardiovascular outcomes in patients with acute ischemic stroke. Methods and Results In the investigator‐initiated multicenter MonDAFIS (impact of standardized monitoring for detection of atrial fibrillation in ischemic stroke) study, 3465 patients with acute ischemic stroke or transient ischemic attack and without known atrial fibrillation were randomized 1:1 to receive Holter‐ECG for up to 7 days in‐hospital with systematic evaluation in a core cardiology laboratory (intervention group) or standard diagnostic care (control group). Outcomes included predefined abnormal ECG findings (eg, pauses, atrial fibrillation, brady‐/tachycardias), medical management in the intervention group, and combined vascular end point (recurrent stroke, myocardial infarction, major bleeds, or all‐cause death) and mortality at 24 months in both randomization groups. Predefined abnormal ECG findings were detected in 326 of 1693 (19.3%) patients in the intervention group. Twenty of these 326 patients (6.1%) received a pacemaker, and 62 of 326 (19.0%) patients had newly initiated or discontinued β‐blocker medication. Discontinuation of β‐blockers was associated with a higher death rate in the control group than in the intervention group during 24 months after enrollment (adjusted hazard ratio, 11.0 [95% CI, 2.4–50.4]; P =0.025 for interaction). Conclusions Systematic in‐hospital Holter ECG reveals abnormal findings in 1 of 5 patients with acute stroke, and mortality was lower at 24 months in patients with systematic ECG recording in the hospital. Further studies are needed to determine the potential impact of medical management of abnormal ECG findings. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02204267.

Dieser Fallbericht zeigt die Behandlung einer Patientin, die im 3. Schwangerschaftstrimenon eine Karpaltunnelsymptomatik entwickelt hat und mit blutigem Schröpfen erfolgreich behandelt werden konnte.

Die Akupunktur ist ein Therapieverfahren der Chinesischen Medizin, das inzwischen auch in der westlichen Welt haufig eingesetzt wird. In den letzten beiden Jahrzehnten wurde die Akupunktur intensiv wissenschaftlich untersucht. Darstellung von Wirksamkeit, Therapiesicherheit und gesundheitsokonomischer Relevanz der Akupunktur bei chronischen Schmerzerkrankungen und Allergien. Im Rahmen einer Ubersichtsarbeit (narratives Review) wurde die relevante Literatur ausgesucht, vorgestellt und interpretiert. Akupunktur hat sich bei vielen chronischen Schmerzerkrankungen unter Routinebedingungen als wirksam erwiesen, so z. B. bei Kniegelenksschmerzen aufgrund von Arthrose, bei Migrane, Spannungskopfschmerz, chronischen Schmerzen der Lenden- und Halswirbelsaule, Schulterschmerzen, Dysmenorrhoe und Fibromyalgie. Auserdem zeigt sich bei den meisten Schmerzerkrankungen eine spezifische Wirksamkeit. Auch bei Patienten mit allergischen Erkrankungen ist Akupunktur wirksam. Akupunktur hat sich in den grosen klinischen Studien als relativ sicheres Therapieverfahren erwiesen, allerdings kommen in seltenen Fallen auch schwere Komplikationen vor (z. B. Pneumothorax-Falle, Hepatitis-Infektionen). In der Regel ist Akupunktur mit zusatzlichen Therapiekosten verbunden, gilt allerdings bei Schmerzerkrankungen als kosteneffektive Therapiestrategie. Diskussion: Als nichtpharmakologisches Verfahren kommt Akupunktur eine wachsende Bedeutung bei der Behandlung von chronischen Schmerzerkrankungen und Allergien zu. Sie wird daher zunehmend in aktuelle Therapieleitlinien aufgenommen. In weiteren Studien sollten die Wirksamkeit der Akupunktur bei weiteren Indikationen und die Wirkmechanismen der Akupunktur untersucht werden.

Hintergrund Die Akupunktur ist ein Therapieverfahren der Traditionellen Chinesischen Medizin, das inzwischen auch in der westlichen Welt häufig eingesetzt wird. In den letzten beiden Jahrzehnten wurde es intensiv wissenschaftlich untersucht. Ziel der Arbeit Darstellung von Wirksamkeit, Therapiesicherheit und gesundheitsökonomischer Relevanz der Akupunktur bei chronischen Schmerzerkrankungen und Allergien. Material und Methoden Im Rahmen einer Übersichtsarbeit (narratives Review) wird die relevante Literatur ausgesucht, vorgestellt und interpretiert. Ergebnisse Akupunktur hat sich bei vielen chronischen Schmerzerkrankungen unter Routinebedingungen als wirksam erwiesen, so z. B. bei Kniegelenksschmerzen aufgrund von Arthrose, bei Migräne, Spannungskopfschmerz, chronischen Schmerzen der Lenden- und Halswirbelsäule, Schulterschmerzen, Dysmenorrhö und Fibromyalgie. Außerdem zeigt sich bei den meisten Schmerzerkrankungen eine spezifische Wirksamkeit. Auch bei Patienten mit allergischen Erkrankungen ist Akupunktur wirksam. Akupunktur hat sich in den großen klinischen Studien als relativ sicheres Therapieverfahren erwiesen, allerdings kommen in seltenen Fällen auch schwere Komplikationen vor (z. B. Pneumothoraxfälle, Hepatitisinfektionen). In der Regel ist Akupunktur mit zusätzlichen Therapiekosten verbunden, gilt allerdings bei Schmerzerkrankungen als kosteneffektive Therapiestrategie. Diskussion Als nichtpharmakologischem Verfahren kommt Akupunktur eine wachsende Bedeutung bei der Behandlung von chronischen Schmerzerkrankungen und Allergien zu. Sie wird daher zunehmend in aktuelle Therapieleitlinien aufgenommen. In weiteren Studien sollte ihre Wirksamkeit bei weiteren Indikationen bestimmt werden. Die Wirkmechanismen sollten untersucht werden., Background: Acupuncture is a traditional Chinese medicine therapy method that is also frequently used in the western world. It has been the subject of intensive scientific research over the past two decades. Aim of the work: To describe the efficacy, therapy safety, and health economic relevance of acupuncture for chronic pain disorders and allergic diseases. Material and methods: In the context of a review (narrative review) the relevant literature was selected, presented, and interpreted. Results: Acupuncture is effective in chronic pain disorders such as chronic knee joint pain in osteoarthritis, migraine, tension headache, chronic lumbar spine pain, chronic cervical spine pain, shoulder pain, dysmenorrhea, and fibromyalgia under routine conditions. In addition, specific efficacy is shown in most chronic pain indications. Acupuncture is also effective in patients with allergic diseases. In large clinical studies, acupuncture has proven to be a relatively safe therapy, but severe complications (e.g. pneumothorax cases, hepatitis B) also occur in rare instances. Acupuncture is usually associated with higher therapy costs, but is considered a cost-effective treatment strategy for pain disorders. Discussion: As a nonpharmacological procedure, acupuncture is becoming increasingly important in pain and allergy therapy and is therefore increasingly included in current guidelines. In further studies, the efficacy of acupuncture should be determined in other indications and the mechanisms of action of this therapy method should be investigated.

Background: Impaired kidney function increases the risk of vascular events in stroke patients, when assessed by single measurements of serum creatinine and estimated glomerular filtration rate (eGFR). Whether repeated measurements improve risk prediction in acute stroke patients is unknown. Methods: The investigator-initiated, prospective, multicenter Systematic Monitoring for Detection of Atrial Fibrillation in Patients with Acute Ischemic Stroke study randomized 3,465 acute ischemic stroke patients without known AF to usual diagnostic procedures for detecting AF or an additive Holter-ECG. eGFR was estimated by the CKD-Epi formula. Dynamics of eGFR during hospitalization was categorized as “stable ≥60ml/min”, “rising” (by at least 15% from any baseline value), “falling” (by at least 15% and baseline eGFR≥60ml/min) and “stable Results: The dynamics of eGFR were available in 1,623 patients. In 1,001 (61.7%) eGFR was “stable≥60ml/min”, in 231 (6.7%) “rising”, in 74 (4.6%) “falling”, and in 317 (19.5%) “stable Conclusions: Hospitalized ischemic stroke patients with a falling eGFR (of at least 15%, baseline ≥60ml/min) are at similar risk for recurrent vascular events or death and at higher risk for death as stroke patients with constantly reduced kidney function. Repeated estimates of eGFR may therefore improve risk prediction.

Aims We aimed to analyze prevalence and predictors of NOAC off-label under-dosing in AF patients before and after the index stroke. Methods The post hoc analysis included 1080 patients of the investigator-initiated, multicenter prospective Berlin Atrial Fibrillation Registry, designed to analyze medical stroke prevention in AF patients after acute ischemic stroke. Results At stroke onset, an off-label daily dose was prescribed in 61 (25.5%) of 239 NOAC patients with known AF and CHA2DS2-VASc score ≥ 1, of which 52 (21.8%) patients were under-dosed. Under-dosing was associated with age ≥ 80 years in patients on rivaroxaban [OR 2.90, 95% CI 1.05–7.9, P = 0.04; n = 29] or apixaban [OR 3.24, 95% CI 1.04–10.1, P = 0.04; n = 22]. At hospital discharge after the index stroke, NOAC off-label dose on admission was continued in 30 (49.2%) of 61 patients. Overall, 79 (13.7%) of 708 patients prescribed a NOAC at hospital discharge received an off-label dose, of whom 75 (10.6%) patients were under-dosed. Rivaroxaban under-dosing at discharge was associated with age ≥ 80 years [OR 3.49, 95% CI 1.24–9.84, P = 0.02; n = 19]; apixaban under-dosing with body weight ≤ 60 kg [OR 0.06, 95% CI 0.01–0.47, P n = 56], CHA2DS2-VASc score [OR per point 1.47, 95% CI 1.08–2.00, P = 0.01], and HAS-BLED score [OR per point 1.91, 95% CI 1.28–2.84, P Conclusion At stroke onset, off-label dosing was present in one out of four, and under-dosing in one out of five NOAC patients. Under-dosing of rivaroxaban or apixaban was related to old age. In-hospital treatment after stroke reduced off-label NOAC dosing, but one out of ten NOAC patients was under-dosed at discharge. Clinical trial registration NCT02306824.

Background: Diabetic polyneuropathy (DPN) is a common complication of diabetes, which presents with a loss of sensorimotor function or pain. This study assessed the effectiveness and safety of acupuncture as a treatment for DPN-related complaints. Methods: In this randomized controlled trial, patients with type II diabetes and symptoms of neuropathy in the lower limbs were included. A total of 12 acupuncture treatments were administered over 8 weeks. The waitlist control group received the same acupuncture treatment starting at week 16 (after baseline). Results: A total of 62 patients were randomized (acupuncture group n = 31; control group n = 31). The primary outcome was overall complaints, and it was reduced with a significant difference of 24.7 on a VAS (CI 95% 14.8;34.7, p < 0.001) between both groups in favor of acupuncture. Reductions were recorded for the secondary outcomes VAS pain, neuropathic pain symptom inventory (NPSI), emotional dimensions of pain, SF-12, and diabetic peripheral neuropathic pain impact (DPNPI) after the intervention and at the follow-ups in the acupuncture group. Adverse reactions were minor and transient. Conclusions: Acupuncture leads to a significant and lasting reduction in DPN-related complaints when compared to routine care and is well tolerated, with minor side effects.

Aims The Berlin Atrial Fibrillation Registry was designed to analyse oral anticoagulation (OAC) prescription in patients with atrial fibrillation (AF) and acute ischaemic stroke. Methods and results This investigator-initiated prospective multicentre registry enrolled patients at all 16 stroke units located in Berlin, Germany. The ongoing telephone follow-up is conducted centrally and will cover 5 years per patient. Within 2014 and 2016, 1080 patients gave written informed consent and 1048 patients were available for analysis. Median age was 77 years [interquartile range (IQR) 72–83], 503 (48%) patients were female, and 254 (24%) had a transient ischaemic attack (TIA). Overall, 470 (62%) out of 757 patients with known AF and a (pre-stroke) CHA2DS2-VASc ≥ 1 were anticoagulated at the time of stroke. At hospital discharge, 847 (81.3%) of 1042 patients were anticoagulated. Thereof 710 (68.1%) received a non-vitamin K-dependent oral anticoagulant (NOAC) and 137 (13.1%) a vitamin K antagonist (VKA). Pre-stroke intake of a NOAC [odds ratio (OR) 15.6 (95% confidence interval, 95% CI 1.97–122)] or VKA [OR 0.04 (95% CI 0.02–0.09)], an index TIA [OR 0.56 (95% CI 0.34–0.94)] rather than stroke, heart failure [OR 0.49 (95% CI 0.26–0.93)], and endovascular thrombectomy at hospital admission [OR 12.9 (95% CI 1.59–104)] were associated with NOAC prescription at discharge. Patients’ age or AF type had no impact on OAC or NOAC use, respectively. Conclusion About 60% of all registry patients with known AF received OAC at the time of stroke or TIA. At hospital discharge, more than 80% of AF patients were anticoagulated and about 80% of those were prescribed a NOAC.

Subarachnoid haemorrhage (SAH) is usually associated with severe headache, whereas the options of pharmacological analgesia are restricted. Acupuncture is a promising method in treatment of headaches associated with meningeal sensitivity or irritation, such as migraine or post-dural puncture headache. We report on 3 patients, who suffered severe headache due to aneurysmal SAH, and received acupuncture when pharmacological measures were exhausted. After acupuncture treatment all patients reported at least 50% pain reduction and could stop or reduce analgesics without side effects. Acupuncture may be an effective pain treatment method in patients suffering from headache due to SAH. Randomized trials using acupuncture as an add-on to standard analgesic therapy would help evaluate the role of acupuncture for this purpose.

Background: Acupuncture is used to treat patients with diabetic peripheral neuropathy; however, the evidence is unclear. We present the design and methodology of the ACUDPN (ACUpuncture in Diabetic Peripheral Neuropathy) trial, which investigates the effectiveness of acupuncture for the treatment of diabetic peripheral neuropathy (DPN) symptoms. The aim of this study is to investigate whether acupuncture is effective for the treatment of DPN symptoms.Methods: This study is a two-armed, randomized, controlled, parallel group, open-label, confirmatory, multicenter trial (8-week intervention period plus 16 weeks of follow-up). Physicians in outpatient units in Germany who specialize in acupuncture treatment will treat 110 diabetes type II patients with clinical symptoms of peripheral neuropathy in the feet and legs with signs of neuropathy according to nerve conduction testing. The patients will be randomized in a 1:1 ratio to one of the following two groups: (a) semi-standardized acupuncture plus routine care or (b) routine care alone. Acupuncture will consist of 12 treatments per patient over 8 weeks. The primary outcome will be the overall DPN-related complaints in the extremities after 8 weeks as measured by the Visual Analog Scale (VAS). Further outcome measures will include DPN-related pain, the Neuropathic Pain Symptom Inventory (NPSI), Diabetic Peripheral Neuropathic Pain Impact (DPNPI) scores and nerve conduction parameters of the sural nerve at weeks 8, 16 and 24.Discussion: The results of this trial will be available in 2021 and will help clarify whether acupuncture can be considered effective for the treatment of DPN with regard to the subdimensions of the neuropathic clinical picture.Trial registration: ClinicalTrials.gov: NCT03755960. Registered on November 19, 2018, https://clinicaltrials.gov/ct2/show/study/NCT03755960.

Summary Background Systematic electrocardiogram (ECG) monitoring improves detection of covert atrial fibrillation in stroke survivors but the effect on secondary prevention is unknown. We aimed to assess the effect of systematic ECG monitoring of patients in hospital on the rate of oral anticoagulant use after 12 months. Methods In this investigator-initiated, randomised, open-label, parallel-group multicentre study with masked endpoint adjudication, we recruited patients aged at least 18 years with acute ischaemic stroke or transient ischaemic attack without known atrial fibrillation in 38 certified stroke units in Germany. Patients were randomly assigned (1:1) to usual diagnostic procedures for atrial fibrillation detection (control group) or additional Holter-ECG recording for up to 7 days in hospital (intervention group). Patients were stratified by centre using a random permuted block design. The primary outcome was the proportion of patients on oral anticoagulants at 12 months after the index event in the intention-to-treat population. Secondary outcomes included the number of patients with newly diagnosed atrial fibrillation in hospital and the composite of recurrent stroke, major bleeding, myocardial infarction, or death after 6 months, 12 months, and 24 months. This trial was registered with ClinicalTrials.gov , NCT02204267 , and is completed and closed for participants. Findings Between Dec 9, 2014, and Sept 11, 2017, 3465 patients were randomly assigned, 1735 (50·1%) to the intervention group and 1730 (49·9%) to the control group. Oral anticoagulation status was available in 2920 (84·3%) patients at 12 months (1484 [50·8%] in the intervention group and 1436 [49·2%] in the control group). For the primary outcome, at 12 months, 203 (13·7%) of 1484 patients in the intervention group versus 169 (11·8%) of 1436 in the control group were on oral anticoagulants (odds ratio [OR] 1·2 [95% CI 0·9–1·5]; p=0·13). Atrial fibrillation was newly detected in patients in hospital in 97 (5·8%) of 1714 in the intervention group versus 68 (4·0%) of 1717 in the control group (hazard ratio [HR] 1·4 [95% CI 1·0–2·0]; p=0·024). The composite of cardiovascular outcomes and death did not differ between patients randomly assigned to the intervention group versus the control group at 24 months (232 [13·5%] of 1714 vs 249 [14·5%] of 1717; HR 0·9 [0·8–1·1]; p=0·43). Skin reactions due to study ECG electrodes were reported in 56 (3·3%) patients in the intervention group. All-cause death occured in 73 (4·3%) patients in the intervention group and in 103 (6·0%) patients in the control group (OR 0·7 [0·5–0·9]). Interpretation Systematic core centrally reviewed ECG monitoring is feasible and increases the detection rate of atrial fibrillation in unselected patients hospitalised with acute ischaemic stroke or transient ischaemic attack, if added to usual diagnostic care in certified German stroke units. However, we found no effect of systematic ECG monitoring on the rate of oral anticoagulant use after 12 months and further efforts are needed to improve secondary stroke prevention. Funding Bayer Vital. Translation For the German translation of the abstract see Supplementary Materials section.

Background: Preoperative anxiety causes a profound psychological and physiological reactions, that may lead to a worse postoperative recovery, higher intensity of acute and persistent postsurgical pain and impaired quality of life in the postoperative period. Previous randomized controlled trials (RCTs) suggest that auricular acupuncture (AA) is safe and effective in treatment of preoperative anxiety; a systematic evidence on this topic is missing. Therefore, this protocol was developed following the PRISMA guidelines to adequately evaluate the existing literature regarding the value of AA for the reduction of anxiety in patients in a preoperative setting, compared to other forms of acupuncture or pharmacological or no control interventions and measured with questionnaires regarding anxiety and fear. Methods and analysis: The following databases will be searched: MEDLINE (PubMed), EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), ISI Web of Science, Scopus Database and Google search. RCTs will be included if an abstract is available in English. Data collection and analysis will be conducted by 2 reviewers independently. Quality and risk assessment of included studies will be done using the Cochrane 5.1.0 handbook criteria and meta-analysis of effectiveness and symptom scores will be conducted using the statistical software RevMan V.5.3.Ethics and dissemination: This systematic review will evaluate the efficacy and safety of AA for preoperative anxiety. Since all data used in this systematic review and meta-analysis have been published, this review does not require ethical approval. The results may be published in a peer-reviewed journal or be presented in relevant conferences.Registration number: PROSPERO ID CRD42020184795

Acupuncture is a traditional Chinese medicine therapy method that is also frequently used in the western world. It has been the subject of intensive scientific research over the past two decades.To describe the efficacy, therapy safety, and health economic relevance of acupuncture for chronic pain disorders and allergic diseases.In the context of a review (narrative review) the relevant literature was selected, presented, and interpreted.Acupuncture is effective in chronic pain disorders such as chronic knee joint pain in osteoarthritis, migraine, tension headache, chronic lumbar spine pain, chronic cervical spine pain, shoulder pain, dysmenorrhea, and fibromyalgia under routine conditions. In addition, specific efficacy is shown in most chronic pain indications. Acupuncture is also effective in patients with allergic diseases. In large clinical studies, acupuncture has proven to be a relatively safe therapy, but severe complications (e.g. pneumothorax cases, hepatitis B) also occur in rare instances. Acupuncture is usually associated with higher therapy costs, but is considered a cost-effective treatment strategy for pain disorders.As a nonpharmacological procedure, acupuncture is becoming increasingly important in pain and allergy therapy and is therefore increasingly included in current guidelines. In further studies, the efficacy of acupuncture should be determined in other indications and the mechanisms of action of this therapy method should be investigated.

Study objective Previous randomized controlled trials (RCTs) suggest that auricular stimulation (AS) is safe and effective in treatment of preoperative anxiety; however, a systematic evaluation is lacking. The aim was to summarize the evidence on efficacy and safety of AS for preoperative anxiety, as well as for other outcomes. Design We conducted a systematic review of RCTs including patients from all available populations. The search was done through MEDLINE (PubMed), EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), ISI Web of Science and Scopus Database from inception to June 2020. Study selection and data extraction were performed in by 2 independent reviewers with ability to resolve disagreements by a third author. Meta-analyses as well as the risk of bias and evidence quality assessments were performed according to the Cochrane 6.2, 2021 handbook recommendations. Interventions We compared AS with pharmacological and non-pharmacological interventions for different outcomes. Measurements We assessed the repercussion of the evaluated interventions over anxiety scores and their safety, physiological parameters, perioperative medications requirement and intensity of postoperative pain. Main results We have included 15 studies with 1603 patients. AS has presented reduced anxiety scores as compared to the sham control (Standardized Mean Difference (SMD) -0.72, 95% confidence interval (CI) -1.09 to −0.36, p Conclusions AS may be useful in treatment of preoperative anxiety. Due to heterogenous certainty in effect estimates, further research is needed to clarify the actual efficacy of AS for preoperative anxiety.

ZusammenfassungSowohl Vorhofflimmern als auch eine Demenz weisen eine hohe Prävalenz in der älteren Bevölkerung auf und werden in einem relevanten Ausmaß durch vergleichbare kardiovaskuläre Risikofaktoren bedingt. Vorhofflimmern ist bekanntermaßen ein unabhängiger Risikofaktor für den ischämischen Schlaganfall und zudem ein Risikofaktor für die Entwicklung einer Demenz, wie bevölkerungsbasierte Untersuchungen und systematische Übersichtsarbeiten belegen. Unabhängig von durch Vorhofflimmern bedingten zerebralen Ischämien scheint eine durch Vorhofflimmern induzierte chronische zerebrale Hypoperfusion und eine systemische Entzündungsreaktion der Entwicklung kognitiver Defizite Vorschub zu leisten. Obwohl bei bekanntem Vorhofflimmern bisher weder eine rhythmuserhaltende Therapie noch eine Gerinnungshemmung im Sinne einer medikamentösen Schlaganfallprävention nachweislich förderlich für die Prävention einer Demenz ist, stellt eine individualisierte und leitliniengerechte Therapie des Vorhofflimmerns sicher einen vielversprechenden Ansatz klinischer Studien dar. Die kognitive Funktion von Patienten mit Vorhofflimmern sollte zudem in der klinischen Praxis Beachtung finden.

Atrial fibrillation (AF) and dementia are both frequent diseases with substantial socioeconomic impact. While AF has been associated with cognitive dysfunction and dementia, we currently lack an exact understanding of the complex association between AF and cognitive decline. Based on an extended literature search we summarize key publications focusing on AF-related cognitive decline and dementia. Moreover, ongoing trials and potential therapeutic implications are discussed. While further prospective studies using a standardized definition of AF and cognitive decline are urgently needed, growing evidence supports the hypothesis that AF is an independent risk factor for cognitive decline and dementia in general and for Alzheimer's disease in particular. In addition to AF-related ischaemic stroke, white matter damage and systemic inflammation are candidate pathomechanisms and therefore a potential target for prevention of cognitive decline. Whether individualized best-medical therapy of AF holds the promise of preventing cognitive decline should be tested in randomized trials.

Background: Preoperative anxiety causes profound psychological and physiological reactions that may lead to a worse postoperative recovery, higher intensity of acute and persistent postsurgical pain and impaired quality of life in the postoperative period. Previous randomized controlled trials (RCTs) suggest that auricular acupuncture (AA) is safe and effective in the treatment of preoperative anxiety; however there is a lack of systematic evidence on this topic. Therefore, this protocol was developed following the PRISMA guidelines to adequately evaluate the existing literature regarding the value of AA for the reduction in anxiety in patients in a preoperative setting, compared to other forms of acupuncture, pharmacological, or no control interventions and measured with questionnaires regarding anxiety and fear. Methods: The following databases will be searched: MEDLINE (PubMed), EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), ISI Web of Science, and Scopus Database. RCTs will be included if an abstract is available in English. Data collection and analysis will be conducted by two reviewers independently. Quality and risk assessment of included studies will be done using the Cochrane 5.1.0 handbook criteria and meta-analysis of effectiveness and symptom scores will be conducted using the statistical software RevMan V.5.3. Conclusions: This systematic review will evaluate the efficacy and safety of AA for preoperative anxiety. Since all data used in this systematic review and meta-analysis have been published, this review does not require ethical approval. The results may be published in a peer-reviewed journal or be presented in relevant conferences. Registration number: PROSPERO ID CRD42020.

Aims Therapeutic oral anticoagulation on hospital admission reduces morbidity and mortality after acute ischaemic stroke in patients with atrial fibrillation (AF). The underlying mechanism is not fully understood. In order to assess the impact of INR-level on admission on stroke volume, lesion pattern and the frequency of intracranial arterial occlusion, we analysed serial MRI measurements in AF patients suffering acute ischaemic stroke. Methods and results This subgroup analysis of the prospective '1000Plus' study included patients with acute ischaemic stroke and known AF or a first episode of AF in hospital. All patients underwent serial brain magnetic resonance imaging. Stroke patients were categorized as follows: Group1, phenprocoumon intake, international normalized ratio (INR) ≥1.7 on admission, no thrombolysis; Group2, INR

Wall-anchoring components lead to higher port stability and can have a time-sparing effect on laparoscopic procedures., Objective: Safe and reliable access systems are crucial in laparoscopy, and trocar dislodgement is still a common and frustrating problem. Wall emphysema can occur besides the risky prolongation of the surgical procedure. Wall-anchoring components provide a better hold of the device. This comparative analysis assesses the frequency of dislodgement and a time-sparing effect on the intervention of 3 different trocar systems, including an innovation in the field of access-providing systems. Methods: Patients who underwent laparoscopy for various gynecological indications were included and randomized consecutively into 3 groups according to the access system used in the intervention: (A) trocar fitted with a spiral thread on the sleeve, (B) trocar with plain sleeve, (C) trocar as in B together with a fixator. This novelty is installed on the trocar before insertion and then sutured to the abdominal wall. Intervention time, frequency of trocar corrections, and the time loss through correction were registered. Standard statistical analyses were performed. Results: The cohort comprised 131 patients; 51 patients were consecutively randomized into group A, 38 into group B, and 42 into group C. Mean intervention time was different, shortest in C and highest in B. Frequency of interruption of the intervention due to adjustment of the device and time loss through adjustment was lowest in group C (fixator + plain sleeve) and highest in group B (plain-sleeve) (0.47 vs 0.29, P

Neutrophils in cerebrospinal fluid (CSF) samples are commonly considered a pathological feature; however, there is little information on the frequency and significance of these cells in CSF samples without pleocytosis. Therefore, the frequency and possible clinical significance of neutrophils in CSF was investigated. In a retrospective study comprising 1556 consecutive CSF samples, cytologies and patient records were reviewed. Five hundred thirty-eight CSF samples without pleocytosis were identified. Neutrophils were detected in 35.5% of these samples. The presence of neutrophils was associated with sepsis (P < 0.01), recent epileptic seizure (P < 0.0001), and blood contamination (P < 0.01). Amongst patients without CSF pleocytosis, CNS infections were not more frequent if neutrophils were present. Neutrophils are frequently observed in CSF with normal leukocyte counts. As sepsis but not CNS infection occurred more frequently in these patients, we conclude that in the absence of CSF pleocytosis, neutrophils are not indicative of CNS infections.

To perform hysterectomy in uterus myomatosus, there are several surgical techniques. For a uterine weight of >1000g, after a caesarean section and in nullipara per vaginam, the most common surgical technique for hysterectomy in patients is hysterectomy per laparotomiam. A new endoscopical technique developed to treat such patients and to avoid laparotomy is described in this case report: the laparoscopic combined hysterectomy (LACH) using the change-over technique. Adhesiolysis, preparation of the ureters and the bladder and morcellation of the uterus of 2480g were performed minimally-invasive in two steps, from one side of the patient with a change-over of the OP-team to the other side of the patient. The cervix was removed per vaginam.