Transcatheter treatment of severe tricuspid regurgitation using the edge-to-edge repair technique.

AIMS: The aim of this study was to investigate the procedural feasibility and short-term durability of the transcatheter tricuspid valve edge-to-edge repair technique in highly symptomatic patients with severe tricuspid regurgitation (TR). METHODS AND RESULTS: Eighteen consecutive patients suffering from severe right-sided heart failure (NYHA Class III-IV), primarily due to moderate to severe tricuspid regurgitation, were included in the study. Applying a modified steering technique for the clip delivery system, six patients were treated for isolated severe TR, while 12 patients were treated for moderate to severe TR and concomitant severe mitral regurgitation. The primary objectives were procedural success, defined as reduction of at least one TR grade, and 30-day echocardiographic and clinical outcomes. A total of 41 clips (2.3±0.7 per patient) were placed into the tricuspid valve of high surgical risk patients (EuroSCORE II: 10±8%). Procedural success was achieved in all patients; no MACCE occurred in hospital. The presence of a TR grade ≥3 was reduced from 94% (17 patients) before the procedure to 33% (six patients) at 30-day follow-up (p<0.001). Sixteen patients (89%) reported an improvement in NYHA functional class at 30 days. CONCLUSIONS: Applying a modified steering technique, the edge-to-edge repair technique can be successfully used for the treatment of TR. At 30-day follow-up, the short-term durability of TR reduction appeared promising and the majority of patients improved clinically. Further studies with larger patient populations and longer follow-up have to define the role of this novel treatment option for patients with right-sided heart failure and severe TR.

[Concentration enhancement for retaining daily living competence in dementia]. / Konzentrationssteigerung zum Erhalt der Alltagskompetenz bei Demenz.

BACKGROUND: Dementia is characterized by reduced memory and concentration abilities leading to a decrease in activities of daily living. Various studies have shown that various forms of physical exercise have a positive therapeutic effect at an early stage of dementia. OBJECTIVE: In the present study the effects of an exercise-based Brain-Gym concept on the concentration and routine daily competences were evaluated in dementia patients. MATERIAL AND METHODS: During a 4-month intervention period specially trained nursing staff and healthcare students put this exercise program into practice. Using an intervention and control group design, the concentration abilities of the dementia patients were tested on a monthly base. Additionally, the routine daily competence of the patients was evaluated by the nursing staff. RESULTS: Even though no significant differences could be detected, the intervention group achieved higher scores in concentration abilities than the control group on all four testing dates. Furthermore, the routine daily competence was improved in the intervention group throughout the intervention period. CONCLUSION: This concept can be used for dementia patients. Due to the low requirements concerning coordination and condition Brain-Gym is suitable for the target group and can easily be implemented by caregivers; however, significant evidence of positive impacts on concentration and everyday life competence could not yet be found in this study.

Evaluation of six night vision enhancement systems: qualitative and quantitative support for intelligent image processing.

OBJECTIVE: An evaluation study was conducted to answer the question of which system properties of night vision enhancement systems (NVESs) provide a benefit for drivers without increasing their workload. BACKGROUND: Different infrared sensor, image processing, and display technologies can be integrated into an NVES to support nighttime driving. Because each of these components has its specific strengths and weaknesses, careful testing is required to determine their best combination. METHOD: Six prototypical systems were assessed in two steps. First, a heuristic evaluation with experts from ergonomics, perception, and traffic psychology was conducted. It produced a broad overview of possible effects of system properties on driving. Based on these results, an experimental field study with 15 experienced drivers was performed. Criteria used to evaluate the development potential of the six prototypes were the usability dimensions of effectiveness, efficiency, and user satisfaction (International Organization for Standardization, 1998). RESULTS: Results showed that the intelligibility of information, the easiness with which obstacles could be located in the environment, and the position of the display presenting the output of the system were of crucial importance for the usability of the NVES and its acceptance. CONCLUSION: All relevant requirements are met best by NVESs that are positioned at an unobtrusive location and are equipped with functions for the automatic identification of objects and for event-based warnings. APPLICATION: These design recommendations and the presented approach to evaluate the systems can be directly incorporated into the development process of future NVESs.