The Influence of Cu-Additions on the Microstructure, Mechanical and Magnetic Properties of MnAl-C Alloys

Alloys of the form (Mn54Al44C2)100-xCux (with x = 0, 1, 2, 4 and 6) were produced by induction melting. After homogenisation and quenching, most of the alloys consist entirely of the retained ε-phase, except for x = 6, in which the κ-phase was additionally present. After subsequent annealing, the alloys with x ≤ 2 consist entirely of a Cu-doped, ferromagnetic τ-phase, whereas the alloys with x > 2 additionally contain the κ-phase. The polarisation of the alloys at an applied field of 14 T decreases with increasing Cu-content, which is attributed i) to the dilution of the magnetic moment of the τ-phase unit cell by the Cu atoms, which do not carry a magnetic moment, and ii) at higher Cu-contents, to the formation of the κ-phase, which has a much lower polarisation than the τ-phase and therefore dilutes the net polarisation of the alloys. The Curie temperature was not affected by the Cu-additions. The stress needed to die-upset the alloys with x ≤ 2 was similar to that of the undoped alloy, whereas it was much lower for x = 4 and 6, due to the presence of intergranular layers of the κ-phase. The extrinsic magnetic properties of alloys with x ≤ 2 were improved by die-upsetting, whereas decomposition of the τ-phase during processing had a deleterious effect on the magnetic properties for higher Cu-additions

The cardiac diagnostic work-up in stroke patients—A subanalysis of the Find-AFRANDOMISED trial

Background The cardiac diagnostic workup of stroke patients, especially the value of echocardiography and enhanced and prolonged Holter-ECG monitoring, is still a matter of debate. We aimed to analyse the impact of pathologies detected by echocardiography and ECG monitoring on therapeutic decisions and prognosis. Methods Find-AF(RANDOMISED) was a prospective multicenter study which randomised 398 acute ischemic stroke patients >= 60 years to enhanced and prolonged Holter-ECG monitoring or usual stroke unit care. This substudy compared therapeutic consequences of echocardiography and routine Holter-ECG or enhanced and prolonged Holter-ECG monitoring, respectively, and prognosis of patients with or without pathologic findings in echocardiography or Holter-ECG monitoring. Results 50.3% received enhanced and prolonged Holter-ECG monitoring and 49.7% routine ECG monitoring. 82.9% underwent transthoracic echocardiography (TTE), 38.9% transesophageal echocardiography (TEE) and 25.6% both procedures. 14/89 TEE pathologies and 1/90 TTE pathology led to a change in therapy, resulting in a number needed to change decision (NNCD) of 12 and 330 (p < 0.001), respectively. In comparison, enhanced and prolonged Holter-ECG monitoring found atrial fibrillation (AF) in 27 of 200 patients, and routine ECG monitoring in twelve of 198 patients, leading to therapeutic changes in all patients (NNCD 8 and 17, respectively, p < 0.001). Conclusions Most changes in therapeutic decisions were triggered by enhanced and prolonged Holter-ECG monitoring, which should therefore play a more prominent role in future guidelines. Echocardiography identifies a patient group at high cardiovascular risk, but rarely result in therapeutic changes. Whether this patient group requires further cardiovascular workup remains unknown. This should be further investigated by interdisciplinary neurocardiologic teams and in appropriate future trials

Holter-electrocardiogram-monitoring in patients with acute ischaemic stroke (Find-AF RANDOMISED ): an open-label randomised controlled trial

Background Atrial fibrillation is a major risk factor for recurrent ischaemic stroke, but often remains undiagnosed in patients who have had an acute ischaemic stroke. Enhanced and prolonged Holter-electrocardiogram-monitoring might increase detection of atrial fibrillation. We therefore investigated whether enhanced and prolonged rhythm monitoring was better for detection of atrial fibrillation than standard care procedures in patients with acute ischaemic stroke. Methods Find-AF(RANDOMISED) is an open-label randomised study done at four centres in Germany. We recruited patients with acute ischaemic stroke (symptoms for 7 days or less) aged 60 years or older presenting with sinus rhythm and without history of atrial fibrillation. Patients were included irrespective of the suspected cause of stroke, unless they had a severe ipsilateral carotid or intracranial artery stenosis, which were the exclusion criteria. We used a computer-generated allocation sequence to randomly assign patients in a 1: 1 ratio with permuted block sizes of 2, 4, 6, and 8, stratified by centre, to enhanced and prolonged monitoring (ie, 10-day Holter-electrocardiogram [ECG]-monitoring at baseline, and at 3 months and 6 months of follow-up) or standard care procedures (ie, at least 24 h of rhythm monitoring). Participants and study physicians were not masked to group assignment, but the expert committees that adjudicated endpoints were. The primary endpoint was the occurrence of atrial fibrillation or atrial flutter (30 sec or longer) within 6 months after randomisation and before stroke recurrence. Because Holter ECG is a widely used procedure and not known to harm patients, we chose not to assess safety in detail. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01855035. Findings Between May 8, 2013, and Aug 31, 2014, we recruited 398 patients. 200 patients were randomly assigned to the enhanced and prolonged monitoring group and 198 to the standard care group. After 6 months, we detected atrial fibrillation in 14% of 200 patients in the enhanced and prolonged monitoring group (27 patients) versus 5% in the control group (nine of 198 patients, absolute difference 9.0%; 95% CI 3.4-14.5, p=0.002; number needed to screen 11). Interpretation Enhanced and prolonged monitoring initiated early in patients with acute ischaemic stroke aged 60 years or older was better than standard care for the detection of atrial fibrillation. These findings support the consideration of all patients aged 60 years or older with stroke for prolonged monitoring if the detection of atrial fibrillation would result in a change in medical management (eg, initiation of anticoagulation)