Performance of Transcatheter Direct Annuloplasty in Patients With Atrial and Nonatrial Functional Tricuspid Regurgitation.

BACKGROUND: A novel echocardiography-based definition of atrial functional tricuspid regurgitation (A-FTR) has shown superior outcomes in patients undergoing conservative treatment or tricuspid valve transcatheter edge-to-edge repair. Its prognostic significance for transcatheter tricuspid valve annuloplasty (TTVA) outcomes is unknown. OBJECTIVES: This study sought to investigate prognostic, clinical, and technical implications of A-FTR phenotype in patients undergoing TTVA. METHODS: This multicenter study investigated clinical and echocardiographic outcomes up to 1 year in 165 consecutive patients who underwent TTVA for A-FTR (characterized by the absence of tricuspid valve tenting, midventricular right ventricular [RV] dilatation, and impaired left ventricular ejection fraction) and nonatrial functional tricuspid regurgitation (NA-FTR). RESULTS: A total of 62 A-FTR and 103 NA-FTR patients were identified, with the latter exhibiting more pronounced RV remodeling. Compared to baseline, the tricuspid regurgitation (TR) grade at discharge was significantly reduced (P < 0.001 for both subtypes), and TR ≤II was achieved more frequently in A-FTR (85.2% vs 60.8%; P = 0.001). Baseline TR grade and A-FTR phenotype were independently associated with TR ≤II at discharge and 30 days. In multivariate analyses, A-FTR phenotype was a strong predictor (OR: 5.8; 95% CI: 2.1-16.1; P < 0.001) of TR ≤II at 30 days. At 1 year, functional class had significantly improved compared to baseline (both P < 0.001). One-year mortality was lower in A-FTR (6.5% vs 23.8%; P = 0.011) without significant differences in heart failure hospitalizations (13.3% vs 22.7%; P = 0.188). CONCLUSIONS: Direct TTVA effectively reduces TR in both A-FTR, which is a strong and independent predictor of achieving TR ≤II, and NA-FTR. Even though NA-FTR showed more RV remodeling at baseline, both phenotypes experienced similar symptomatic improvement, emphasizing the benefit of TTVA even in advanced disease stages. Additionally, phenotyping was of prognostic relevance in patients undergoing TTVA.

Artificial intelligence-analyzed computed tomography in patients undergoing transcatheter tricuspid valve repair.

BACKGROUND: Baseline right ventricular (RV) function derived from 3-dimensional analyses has been demonstrated to be predictive in patients undergoing transcatheter tricuspid valve repair (TTVR). The complex nature of these cumbersome analyses makes patient selection based on established imaging methods challenging. Artificial intelligence (AI)-driven computed tomography (CT) segmentation of the RV might serve as a fast and predictive tool for evaluating patients prior to TTVR. METHODS: Patients suffering from severe tricuspid regurgitation underwent full cycle cardiac CT. AI-driven analyses were compared to conventional CT analyses. Outcome measures were correlated with survival free of rehospitalization for heart-failure or death after TTVR as the primary endpoint. RESULTS: Automated AI-based image CT-analysis from 100 patients (mean age 77 ± 8 years, 63% female) showed excellent correlation for chamber quantification compared to conventional, core-lab evaluated CT analysis (R 0.963-0.966; p < 0.001). At 1 year (mean follow-up 229 ± 134 days) the primary endpoint occurred significantly more frequently in patients with reduced RV ejection fraction (EF) <50% (36.6% vs. 13.7%; HR 2.864, CI 1.212-6.763; p = 0.016). Furthermore, patients with dysfunctional RVs defined as end-diastolic RV volume > 210 ml and RV EF <50% demonstrated worse outcome than patients with functional RVs (43.7% vs. 12.2%; HR 3.753, CI 1.621-8.693; p = 0.002). CONCLUSIONS: Derived RVEF and dysfunctional RV were predictors for death and hospitalization after TTVR. AI-facilitated CT analysis serves as an inter- and intra-observer independent and time-effective tool which may thus aid in optimizing patient selection prior to TTVR in clinical routine and in trials.

Mortality after cardiac resynchronization therapy or right ventricular pacing in transcatheter aortic valve replacement recipients.

BACKGROUND: Permanent pacemaker implantation (PMI) is associated with increased morbidity after transcatheter aortic valve replacement (TAVR). Cardiac resynchronization-therapy (CRT) is recommended for patients if left ventricular ejection fraction (LVEF) is ≤ 40% and ventricular pacing is expected in favor to sole right ventricular (RV) pacing. Meanwhile, LVEF may recover after TAVR in patients with aortic valve disease and the benefit of CRT is unknown. OBJECTIVE: To analyze the impact of CRT implantation as compared to RV pacing after TAVR. METHODS AND RESULTS: Between 2012 and 2022, 4385 patients (53.1% female, mean age 81 ± 6 years) without prior PMI undergoing TAVR were retrospectively identified in our institutional registry. After stratification of patients in LVEF ≤ 40%, 41-49% and ≥ 50%, Kaplan-Meier analysis revealed significantly different survival rates in each subgroup at 5 years (37.0% vs. 43.5% vs. 55.1%; P ≤ 0.021). At multivariate regression, LVEF and new PMI after TAVR were not relevant for survival. A total of 105 patients with LVEF ≤ 40% received PMI after TAVR (86 patients with RV pacing and 19 with CRT). At 5 years, all-cause mortality was significantly lower in patients with CRT-device as compared to patients without CRT-device (Kaplan Meier estimate of 21.1% vs. 48.8%; HR 0.48, CI 0.204 - 1.128; log rank p = 0.045). In multivariate analysis CRT remained a significant factor for 5-year survival in these patients (HR 0.3, CI 0.095-0.951, p = 0.041). CONCLUSION: In patients undergoing TAVR, PMI did not influence 5-year survival. In patients with LVEF ≤ 40%, CRT-device implantation was associated with improved survival compared to non-CRT-device implantation.

[Conservative treatment of valvular heart disease in adults]. / Konservative Therapie von Herzklappenvitien im Erwachsenenalter.

Currently, there is no specific medication approved for the treatment of valvular heart disease per se. Except for secondary mitral valve insufficiency and tricuspid valve insufficiency in pulmonary hypertension, drug therapy for higher-grade valvular heart disease is limited to diuretic therapy for symptom control. Conservative therapy for comorbidities and potential heart failure can be beneficial regardless of the specific valve lesion. In cases of aortic valve stenosis or insufficiency, controlling arterial hypertension is important. Patients with mitral valve stenosis benefit from rhythm and rate control. Diuretics can help reduce regurgitant volume in patients with primary mitral valve insufficiency and tricuspid valve insufficiency. In addition to drug therapy, maintaining functional capacity is crucial for the outcome of patients. Therefore, it is recommended to engage in active physical activity whenever possible, despite the presence of valvular heart disease.

Pulmonary Vascular Resistance to Predict Right Heart Failure in Patients Undergoing Left Ventricular Assist Device Implantation.

Right heart failure (RHF) is associated with poor outcomes, especially in patients undergoing left ventricular assist device (LVAD) implantation. The aim of this study was to identify predictors of RHF after LVAD implantation. Of 129 consecutive patients (mean age 56 ± 11 years, 89% male) undergoing LVAD implantation, 34 developed RHF. Compared to patients without RHF, those with RHF required longer invasive mechanical ventilation and had longer intensive care unit and hospital stays (p < 0.01). One-year all-cause mortality was significantly higher in patients with versus without RHF after LVAD implantation (29.4% vs. 1.2%; hazard ratio 35.4; 95% confidence interval 4.5-277; p < 0.001). Mortality was highest in patients with delayed RHF after initial LVAD-only implantation (66.7%). Patients who did versus did not develop RHF had significantly higher baseline pulmonary vascular resistance (PVR; 404 ± 375 vs. 234 ± 162 dyn/s/cm5; p = 0.01). PVR > 250 dyn/s/cm5 was a significant predictor of survival in patients with RHF after LVAD implantation. These data confirm the negative impact of RHF on morbidity and mortality after LVAD implantation. Preoperative PVR > 250 dyn/s/cm5 determined using invasive right heart catheterization was an independent predictor of developing RHF after LVAD implantation, and of subsequent mortality, and could be used for risk stratification in the setting for deciding between single or biventricular support strategy.

A Comparative Study of 1-Year Postprocedural Outcomes in Transcatheter Mitral Valve Repair in Advanced Primary Mitral Regurgitation: PASCAL vs. MitraClip.

Both the MitraClip and PASCAL systems offer transcatheter edge-to-edge repair (TEER) solutions for mitral regurgitation. Evidence indicates a lower technical success rate for TEER in complex degenerative mitral regurgitation (DMR) cases. We conducted a retrospective analysis of patients who underwent transcatheter edge-to-edge therapy for primary mitral regurgitation with advanced anatomy, defined as mitral regurgitation effective regurgitant orifice area (MR-EROA) ≥0.40 cm2 or large flail gap (≥5 mm) or width (≥7 mm) or Barlow's disease, that completed follow-up after 1 year. Our criteria were met by 27 patients treated with PASCAL and 18 with MitraClip. All patients exhibited a significant, equivalent short-term reduction in MR-EROA, mitral regurgitation vena contracta diameter (MR-VCD), regurgitant volume, and clinical status. At 1 year follow-up, reductions in MR-VCD, regurgitant volume, and MR-EROA remained significant for both groups without significant differences between groups. MR-Grade ≤ 1+ was achieved in 18 (66.7%) and 10 (55.6%) patients, respectively. At follow-up, no difference in hospitalization for cardiac decompensation was observed. Overall death was similar in both groups. Our study suggests that both the PASCAL and MitraClip systems significantly reduce mitral regurgitation even in advanced degenerative diseases. Within our limited data, we found no evidence of inferior performance of the PASCAL system.

Applying the TRILUMINATE Eligibility Criteria to Real-World Patients Receiving Tricuspid Valve Transcatheter Edge-to-Edge Repair.

BACKGROUND: According to the TRILUMINATE (Clinical Trial to Evaluate Cardiovascular Outcomes in Patients Treated With the Tricuspid Valve Repair System) trial, transcatheter tricuspid edge-to-edge repair (T-TEER) improves quality of life beyond medical treatment, while no effects on heart failure hospitalization (HFH) and survival were observed at 1 year. However, the generalizability of the TRILUMINATE trial to real-world conditions remains a subject of discussion. OBJECTIVES: The aim of this study was to apply the clinical TRILUMINATE inclusion and exclusion criteria to a real-world T-TEER patient group and evaluate symptomatic and survival outcome in TRILUMINATE-eligible and TRILUMINATE-ineligible patients. METHODS: Clinical TRILUMINATE inclusion and exclusion criteria were applied to a cohort of patients who underwent T-TEER at 5 European centers from 2016 to 2022. Study patients were compared regarding baseline characteristics, survival, HFH, and symptomatic outcomes as measured by NYHA functional class, a quality-of-life questionnaire and 6-minute walk distance. RESULTS: Of 962 patients, 54.8% were classified as TRILUMINATE eligible, presenting with superior left ventricular function and fewer comorbidities compared with the ineligible population. Tricuspid regurgitation reduction, improvement in NYHA functional class, quality of life, and exercise capacity were comparable in both groups. However, the 1-year survival and HFH rates significantly differed (tricuspid regurgitation ≤2+ at discharge, 82% vs 85%; survival, 85% vs 75%; HFH, 14% vs 22% for eligible vs ineligible patients). CONCLUSIONS: The observed differences in survival and HFH outcomes suggest a limited generalizability of TRILUMINATE to real-world conditions and indicate the need for additional studies evaluating the outcomes after T-TEER in less selected patient populations.

Eyeball translations affect saccadic eye movements beyond brainstem control.

Vision requires that we rotate our eyes frequently to look at informative structures in the scene. Eye movements are planned by the brain but their execution depends on the mechanical properties of the oculomotor plant, that is, the arrangement of eyeball position, muscle insertions, and pulley locations. Therefore, the biomechanics of rotations is sensitive to eyeball translation because it changes muscle levers. Eyeball translations are little researched as they are difficult to measure with conventional techniques. Here, we investigated the effects of eyeball translation on the coordination of eyeball rotation by high-speed MRI recordings of saccadic eye movements during blinks, which are known to produce strong translations. We found that saccades during blinks massively overshoot their targets and that these overshoots occur in a transient fashion such that the gaze is back on target at the time the blink ends. These dynamic overshoots were tightly coupled to the eyeball translation, both in time and in size. Saccades made without blinks were also accompanied by small amounts of transient eyeball retraction, the size of which scaled with saccade amplitude. These findings demonstrate a complex combination of rotation and translation of the eye. The mechanical consequences of eyeball translation on oculomotor control should be considered along with the neural implementation in the brainstem to understand the generation of eye movements and their disorders.NEW & NOTEWORTHY We found that saccades during blinks can massively overshoot their target when the eyeball is retracted. Our data imply that the overshoots are not part of the saccade plan prepared in the brainstem, but instead a consequence of the altered biomechanics resulting from concurrent eyeball translation and rotation. To our best knowledge, this is the first direct observation of dynamic properties of the oculomotor plant altering the execution of rotational eye movements.

Timing and kinematics of horizontal within-blink saccades measured by EOG.

Eyeblinks are the brief closures of the lid. They are accompanied by a cocontraction of the eye muscles that temporarily pulls the whole eyeball back into its socket. When blinks occur together with execution of saccadic gaze shifts, they interfere with the saccadic premotor circuit, causing these within-blink saccades to be slower than normal and also time-locked to blinks. To analyze the trajectory of within-blink saccades, subtraction of the entangled blink-related eye movement is required. Here we propose a combination of principal component analysis (PCA) and a regression model to subtract the blink-related component of the eye movement based on the respective blink metrics. We used electrooculography (EOG) to measure eye and lid movements of 12 participants who performed saccades with and without blinks. We found that within-blink saccades are slower than without-blink saccades and are tightly coupled in time to blink onset. Surprisingly, in some participants we observed large dynamic overshoots of up to 15° for saccades of only 5° amplitude. The finding of dynamic overshoots was independently confirmed by dynamic MRI for two of the participants and challenges the current view that within-blink saccades are programmed as slow, but straight, saccades. We hypothesize that the dynamic overshoots could be attributed to inhibition of omnipause neurons during blinks, the simultaneous cocontraction of extraocular muscles, or a combination of both.NEW & NOTEWORTHY This study observed that people make large dynamic overshoots when making a saccadic eye movement within a blink but their eyes are back on target by the time the eyelids are open. We used electrooculography (EOG) to measure eye movements even when the lid is down and introduced a novel procedure to subtract blink-related EOG components. These findings challenge the current view that within-blink saccades are programmed as slow but straight saccades.

Real-Time MRI Reveals Unique Insight into the Full Kinematics of Eye Movements.

Our eyes are constantly in motion and the various kinds of eye movements are closely linked to many aspects of human cognitive processing. Measuring all possible eye movements unobtrusively is not achievable with current methods. Video-based eye-trackers only measure rotational but not translational motion of the eye, require a calibration process relying on the participant's self-report of accurate fixation, and do not work if vision of the eyeball is blocked. Scleral search coils attach physical weight on the eyeball and also do not measure translation. Here, we describe a novel and fully automated method to use real-time magnetic resonance imaging (MRI) for eye tracking. We achieved a temporal resolution sufficient to measure eye rotations and translations as short as those that occur within a blink and behind a closed eyelid. To demonstrate this method, we measured the full extent of the blink-related eye movement for two individuals, suggesting that the eye approaches a holding position during lid closure and can move by as much as 35° in rotation and 2 mm in translation. We also investigated the coordination of gaze shifts with blinks. We found that the gaze shift is tightly coupled in time to the translational blink movement and that blinks can induce significant temporal shifts of the gaze trajectory between left and right eye. Our MR-based Eye Tracking (MREyeTrack) method allows measurement of eye movements in terms of both translation and rotation and enables new opportunities for studying ocular motility and its disorders.

Phase-field-crystal description of active crystallites: Elastic and inelastic collisions.

The active Phase-Field-Crystal (aPFC) model combines elements of the Toner-Tu theory for self-propelled particles and the classical Phase-Field-Crystal (PFC) model that describes the transition between liquid and crystalline phases. In the liquid-crystal coexistence region of the PFC model, crystalline clusters exist in the form of localized states that coexist with a homogeneous background. At sufficiently strong activity (related to self-propulsion strength), they start to travel. We employ numerical path continuation and direct time simulations to first investigate the existence regions of different types of localized states in one spatial dimension. The results are summarized in morphological phase diagrams in the parameter plane spanned by activity and mean density. Then we focus on the interaction of traveling localized states, studying their collision behavior. As a result, we distinguish "elastic" and "inelastic" collisions. In the former, localized states recover their properties after a collision, while in the latter, they may completely or partially annihilate, forming resting bound states or various traveling states.

The evolution of treatment over 80 years at the outpatient department of the Viennese school of dentistry.

OBJECTIVES: The delivery of oral health services, diagnostics and treatment underwent significant changes in the 20th century thanks to achievements by pioneers in dentistry. The Golden Age of Dentistry in Vienna, Austria, was marked by renowned dentists like Bernhard Gottlieb in the 1930s. Data records from the outpatient department of this period have been found and served as a source from which to draw comparisons between those days and the present. To date, data supporting an overall perception of advances in dentistry during the last century in tooth preservation and patients' demands have been lacking. The aim of this study was to evaluate changes in treatments and patient characteristics between the interwar period and the present and to assess how treatments for dental emergencies developed. METHODS: Patients' records were extracted from books handwritten from January to May 1933 and compared with electronically generated data from the same period in 2013. In total, patient data from 10 111 individuals (3878 in 1933 and 6233 in 2013) were analysed. Comparisons were undertaken for gender, age, place of residence, diagnosis and therapy. RESULTS: Various statistically significant demographic and treatment differences were found between 1933 and 2013. Patients' mean ages in 2013 and 1933 were 42 and 31 years, respectively. In 2013, there were significantly more women than in 1933 (3378 vs 1936), with 54% women in 2013 and 50% women in 1933. In 2013, there were significantly fewer tooth extractions as dental emergency treatment than in 1933 (2% vs 34%). CONCLUSIONS: Treatment in the outpatient department is much more conservative in the 21st century. The characteristics of patients visiting the outpatient department have changed over the generations, and treatment needs should be evaluated accordingly.

AICAR inhibits NFκB DNA binding independently of AMPK to attenuate LPS-triggered inflammatory responses in human macrophages.

5-aminoimidazole-4-carboxamide-1-ß-D-ribofuranoside (AICAR) is an established pharmacological activator of AMP-activated protein kinase (AMPK). Both, AICAR and AMPK were reported to attenuate inflammation. However, AICAR is known for many AMPK-independent effects, although the mechanisms remain incompletely understood. Here we report a potent suppression of lipopolysaccharide (LPS)-induced inflammatory gene expression by AICAR in primary human macrophages, which occurred independently of its conversion to AMPK-activating 5-aminoimidazole-4-carboxamide-1-ß-D-ribofuranosyl monophosphate. Although AICAR did not interfere with activation of cytosolic signalling cascades and nuclear translocation of nuclear factor - κB (NFκB) by LPS, it prevented the recruitment of NFκB and RNA polymerase II to target gene promoters. AICAR also inhibited signal transducer and activator of transcription 3 (STAT3)-dependent induction of interleukin (IL) IL-6 and IL-10 targets, while leaving STAT6 and HIF1α-dependent gene expression in IL-4 and dimethyloxalylgylcine-treated macrophages intact. This points to a transcription factor-specific mode of action. Attenuated gene expression correlated with impaired NFκB and STAT3, but not HIF-binding in electrophoretic mobility shift assays in vitro. Conclusively, AICAR interferes with DNA binding of NFκB and STAT3 to modulate inflammatory responses.

The additional value of the lateral chest radiograph for the detection of small pulmonary nodules-a ROC analysis.

OBJECTIVE: For the past 30 years, many authors have described different advantages of the use of the additional lateral chest radiograph. However, some radiologic departments gave up performing the lateral view recently. A potential reason for this might be a lack of evidence for any diagnostic benefit of the additional lateral view of the thorax in recent studies. The objective of this study was to evaluate the diagnostic benefit of the additional lateral view for the detection of small pulmonary nodules compared with CT examinations as a gold standard. METHOD: The patient population consisted of 45 patients with SPN and 45 patients without SPN. Four radiologists with varying experience in the assessment of thoracic imaging first examined the sole posteroanterior (PA) projection. After a few days, they were instructed to examine the PA and the additional lateral view. A receiver-operating characteristic analysis was accomplished to compare the documented results. RESULTS: The mean Az value of the sole PA view was 0.75 and 0.77 by the combination of PA and additional lateral view. So, there was no significant difference between the detectable Az values (Δ = 0.02; p = 0.384). With a cut-off value of >3, the additional view even reduced the sensitivity by averaging to 5.6%. The decrease of sensitivity by using the additional view was most detectable within the group of more experienced radiologists. CONCLUSION: The additional lateral view of the chest provides no diagnostic benefit in the detection of small pulmonary nodules in comparison with the sole PA projection. Nevertheless, the results of the present study must not be understood as a general evaluation of the benefits of the lateral radiograph per se, because we did not examine other relevant issues (i.e. cardiac failure, lung parenchyma diseases or abnormalities in hilar anatomy). Advances in knowledge: Our study demonstrates a lack of evidence for any diagnostic benefit of the additional lateral view of the thorax in detecting SPN.

CT differentiation of enlarged mediastinal lymph node due to anthracosis from metastatic lymphadenopathy: a comparative study proven by endobronchial US-guided transbronchial needle aspiration.

PURPOSE: Anthracosis often results in mediastinal nodal enlargement. The aim of this comparative study was to evaluate if it is possible to differentiate endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) proven anthracotic lymph nodes from malignant lymph node enlargement by means of multislice computed tomography (MSCT). METHODS: We compared the MSCT findings of 89 enlarged lymph nodes due to anthracosis with 54 malignant lymph nodes (non-small cell lung cancer 75.9%, small cell lung cancer 18.5%, and non-Hodgkin lymphoma 5.6%). The lymph nodes were assessed for density (calcification, fat, and necrosis), shape (oval, round), contrast enhancement, and contour (sharp, ill-defined). RESULTS: Malignant lymph nodes showed significantly greater axis diameters (P < 0.001). Both anthracotic and malignant nodes were most often oval (86.5% of all malignant nodes vs. 81.5% of all anthracotic nodes, P = 0.420) and showed confluence in a remarkable percentage (28.1% vs. 42.6%, P = 0.075). Anthracotic nodes showed calcifications more often (18% vs. 0%, P < 0.001). Malignant lymph nodes showed a significantly greater short and long axis diameter (P < 0.001), and they had a higher frequency of ill-defined contours (27.8% vs. 2.2%, P < 0.001) and contrast enhancement (27.8% vs. 5.6%, P < 0.001). Nodal necrosis, which appeared in one third of the malignant nodes, was not observed in anthracosis (35.2% vs. 0%, P < 0.001). Confluence of enlarged lymph nodes was seen in malignant lymph nodes (42.6%), as well as in lymph node enlargement due to anthracosis (28.1%, P = 0.075). CONCLUSION: Our results show that there are significant differences in MSCT findings of malignant enlarged lymph nodes and benign lymph node enlargement due to anthracosis.

Standard versus inverted digital luminescence radiography in detecting pulmonary nodules: a ROC analysis.

OBJECTIVE: Observer performance tests were conducted to compare the effect of presenting digital luminescence radiography (DLR) monitor images in positive mode ("bones black") or negative mode ("bones white") in the detectability of subtle lung nodules. METHODS: Five radiologists independently reviewed digital radiographs of 55 patients with either (a) a single, small (6-12 mm), non- calcified peripheral nodule confirmed by chest CT (n=47) or (b) normal finding (n=8) confirmed by chest CT, respectively. Mean size of pulmonary nodules was 8.3mm (range 6-12 mm, median 7 mm). Radiographs were displayed either in standard mode (bones white) or inverse intensity (bones black). A total of 550 observations resulted. For the evaluation ROC analysis was performed using a specialized computer algorithm. RESULTS: The standard presentation mode showed a sensitivity of 61.7% and a specificity of 72.5%, the inverse presentation mode a sensitivity of 68.1% and a specificity of 75.0%. ROC- analysis showed that the difference between the standard mode (Az- value 0.694) and the inverse mode (Az- value 0.810) was significant in favour of the inverse presentation mode (p=0.001). This finding was especially observed in more experienced radiologist (Az- values 0.716 vs. 0.909, P<0.001). CONCLUSION: Our study demonstrates a significant advantage of the inverse mode in the detection of small pulmonary nodules compared with the commonly used negative mode when interpreted by more experienced radiologists. ADVANCE IN KNOWLEDGE: Inverse intensity images ("bones black") may have some advantages in the detection of small pulmonary nodules in experienced readers when presented on a stand-alone display.

Percutaneous image-guided implantation of totally implantable venous access ports in the forearm or the chest? A patients' point of view.

PURPOSE: This study aimed to compare patients' satisfaction and impact on daily life after implantation of totally implantable venous access ports (TIVAP) in the forearm and the chest. METHODS: In this prospective study, 50 patients (mean age, 55.8 ± 15.4 years) received three questionnaires on days 1, 30, and 90 after implantation in the forearm (n = 25) or the chest (n = 25). Knowledge concerning device function, comfort perception, and impact of TIVAP on daily activities were evaluated. Ratings were dichotomized depending on whether statements were agreed with or contradicted. Fisher's exact test was used to determine differences between the forearm port (FP) and chest port (CP) groups. RESULTS: There was no significant difference between the two groups with regard to unpleasant feelings (p = 0.09) and discomfort while puncturing (p = 0.06). Main fears in both groups were dysfunction and infection. The possibility of high-pressure injections via the TIVAP was rated important in both groups. More CP patients feared dislocation of their TIVAP during sleep (p < 0.05). CP patients experienced more negative perceptions while driving a car and wearing brassieres (p < 0.05) than FP patients. All patients would recommend their device. CONCLUSIONS: During certain activities, the FP device seems to be favorable, since it causes less discomfort than the CP.

Arsenic removal via ZVI in a hybrid spouted vessel/fixed bed filter system.

The description and operation of a novel, hybrid spouted vessel/fixed bed filter system for the removal of arsenic from water are presented. The system utilizes zero-valent iron (ZVI) particles circulating in a spouted vessel that continuously generates active colloidal iron corrosion products via the "self-polishing" action between ZVI source particles rolling in the moving bed that forms on the conical bottom of the spouted vessel. This action also serves as a "surface renewal" mechanism for the particles that provides for maximum utilization of the ZVI material. (Results of batch experiments conducted to examine this mechanism are also presented.) The colloidal material produced in this fashion is continuously captured and concentrated in a fixed bed filter located within the spouted vessel reservoir wherein arsenic complexation occurs. It is demonstrated that this system is very effective for arsenic removal in the microgram per liter arsenic concentration (i.e., drinking water treatment) range, reducing 100 µg/L of arsenic to below detectable levels (≪10 µg/L) in less than an hour.A mechanistic analysis of arsenic behavior in the system is presented, identifying the principal components of the population of active colloidal material for arsenic removal that explains the experimental observations and working principles of the system. It is concluded that the apparent kinetic behavior of arsenic in systems where colloidal (i.e., micro/nano) iron corrosion products are dominant can be complex and may not be explained by simple first or zeroth order kinetics.

Identification of risk factors for catheter-related thrombosis in patients with totally implantable venous access ports in the forearm.

PURPOSE: To identify risk factors for the development of catheter-related thrombosis (CRT) in patients with totally implantable venous access ports (TIVAP) in the forearm, and to analyze the effect of prophylaxis and treatment. METHODS: We retrospectively identified 200 patients (94 men, 106 women, mean age 57.7 +/-14 y) with TIVAP implantation in the forearm between 3/2010 and 11/2010. Type, number of punctures and sonographically defined diameter of the accessed vein were analyzed. Chemotherapy administered prior to the implantation procedure and history of thrombo-embolic events were assessed. Thrombo-embolic prophylaxis (TEP) following port implantation and treatment as well as course of CRT were analyzed. RESULTS: Twenty-one patients (10.5%) were diagnosed with CRT. Accessed vessels and mean diameter were basilic (n=150, 3.7 mm), brachial (n=39, 3.5 mm) and cephalic (n=11, 3.5 mm) vein. Neither type nor vessel diameter had effect on CRT development (P>.05). Implantation in the left forearm resulted in a significantly higher rate of CRT (P=.04). Ninety-five patients (47.5%) received chemotherapy and 30 patients (15.0%) had a history of thrombosis prior to implantation; both had no effect on development of CRT. Low molecular weight heparin (LMWH) was prescribed in 94/200 patients (47.0%) and had no effect on development of CRT (P>.05). Therapeutic anticoagulation with LMWH resulted in clinical improvement in 12/21 patients (57.4%). CONCLUSIONS: TIVAPs of the forearm may be associated with a certain rate of early and late CRT. The simplest vein to puncture should be selected for vascular access. Thrombo-embolic prophylaxis appears to be rather ineffective for prevention of CRT.