AimsChronic heart failure (CHF) patients are frequently rehospitalized within 6 months after an episode of fluid retention. Rehospitalizations are preventable, but this requires an extensive organization of the healthcare system. In this study, we tested whether intensive follow-up of patients through a telemonitoring-facilitated collaboration between general practitioners (GPs) and a heart failure clinic could reduce mortality and rehospitalization rate. Methods and resultsOne hunderd and sixty CHF patients [mean age 76 + 10 years, 104 males, mean left ventricular ejection fraction (LVEF) 35 + 15%] were block randomized by sealed envelopes and assigned to 6 months of intense follow-up facilitated by telemonitoring (TM) or usual care (UC). The TM group measured body weight, blood pressure, and heart rate on a daily basis with electronic devices that transferred the data automatically to an online database. Email alerts were sent to the GP and heart failure clinic to intervene when pre-defined limits were exceeded. All-cause mortality was significantly lower in the TM group as compared with the UC group (5% vs. 17.5%, P ¼ 0.01). The total number of follow-up days lost to hospitalization, dialysis, or death was significantly lower in the TM group as compared with the UC group (13 vs. 30 days, P ¼ 0.02). The number of hospitalizations for heart failure per patient showed a trend (0.24 vs. 0.42 hospitalizations/patient, P ¼ 0.06) in favour of TM. ConclusionTelemonitoring-facilitated collaboration between GPs and a heart failure clinic reduces mortality and number of days lost to hospitalization, death, or dialysis in CHF patients. These findings need confirmation in a large trial.

ABSTRACT.Purpose: Elevated intra-ocular pressure (IOP) has been identified as a major risk factor for glaucoma. Additionally, extensive literature depicts a vascular dysfunction to exist in these patients. However, a large ocular blood floworiented trial to integrate these findings in the clinical setting is lacking. This study would likely help to identify which of these vascular data can be used as a clinical tool for screening and disease stratification. Method: Prospective, cross-sectional, case-control hospital-based study.Patients with primary open-angle glaucoma (POAG), normal-tension glaucoma (NTG), ocular hypertension (OHT), glaucoma suspects and healthy volunteers were recruited. In addition to a comprehensive ophthalmological examination, a vascular-oriented questionnaire was completed and ocular blood flow assessment (colour Doppler imaging of retrobulbar vessels, retinal oximetry, dynamic contour tonometry, optical coherent tomography enhanced-depth imaging of the choroid) were performed. Statistical analysis was based on multiple imputation to account for missingness. Results: A total of 614 subjects (291 males) were recruited between March and December 2013 (POAG: 214, NTG: 192; OHT: 27; glaucoma suspect: 41; healthy controls: 140). Glaucoma groups (NTG and POAG) were age and gender matched with the control group (p > 0.05). Glaucoma groups were paired in terms of functional and structural parameters (p > 0.08). Mean ocular perfusion pressure was higher in the glaucoma groups than in controls (p < 0.001). Glaucoma groups had lower retrobulbar velocities, higher retinal venous saturation and choroidal thickness asymmetries when compared to the healthy group, in line with the current literature. Conclusions: The Leuven Eye Study stands as one of the largest clinical trials on ocular blood flow in glaucoma. The creation of this vast database may help integrate the vascular aspects of glaucoma into the clinical practice of glaucoma.

Retinal Vein Occlusion (RVO) is a blinding disease caused by one or more occluded retinal veins. Current treatment methods only focus on symptom mitigation rather than targeting a solution for the root cause of the disorder. Retinal vein cannulation is an experimental eye surgical procedure which could potentially cure RVO. Its goal is to dissolve the occlusion by injecting an anticoagulant directly into the blocked vein. Given the scale and the fragility of retinal veins on one end and surgeons' limited positioning precision on the other, performing this procedure manually is considered to be too risky. The authors have been developing robotic devices and instruments to assist surgeons in performing this therapy in a safe and successful manner. This work reports on the clinical translation of the technology, resulting in the world-first in-human robot-assisted retinal vein cannulation. Four RVO patients have been treated with the technology in the context of a phase I clinical trial. The results show that it is technically feasible to safely inject an anticoagulant into a [Formula: see text]-thick retinal vein of an RVO patient for a period of 10 min with the aid of the presented robotic technology and instrumentation.

Careful patient selection improves ocriplasmin efficacy. Transient optic disk morphology changes such as decreased cup/disk area ratio may occur in patients without VMT resolution.

PurposeTo evaluate the feasibility of robot assisted retinal vein cannulation for retinal vein occlusion.MethodsProspective experimental study performed in in vivo porcine eyes. A standard three port pars plana vitrectomy was followed by laser induced branch retinal vein occlusion. Consequently, a retinal vein cannulation with the help of a surgical robot and a micro‐needle was performed. Complete success was defined as a stable intravenous position of the needle tip confirmed by blood washout for at least 3 min. Secondary outcomes were the occurrence of intraoperative complications and technical failures.ResultsCannulation was successful in 15 out of 18 eyes with a complete success rate (duration of infusion of more than 3 min) of 73.3% after exclusion of 2 eyes from analysis due to failure in establishing a blood clot. There were no technical failures regarding the robotic device. The intravessel injections of ocriplasmin in 2 out of 2 eyes led to a clot dissolution. In a subset of 5 eyes, a second cannulation attempt at the border of the optic disc resulted in a stable intravessel position and infusion during 361.8 (±138.5) seconds.ConclusionsRobot assisted retinal vein cannulation with prolonged infusion time is technically feasible. Human experiments are required to analyze the clinical benefit of this new therapy.

Intraocular pressure (IOP) measurement is the cornerstone of the management of glaucoma patients. The gold standard for assessing IOP is Goldmann applanation tonometry (GAT). Recently, the dynamic contour tonometer (DCT) has become available. While both devices provide reliable IOP measurements, the results are not interchangeable. DCT has the advantage of measuring an additional parameter: ocular pulse amplitude (OPA). OPA is defined as the difference between systolic and diastolic IOP and represents the pulsatile wave front produced by the varying amount of blood in the eye during the cardiac cycle. It has been shown to vary with ocular structural parameters, such as axial length, corneal thickness, and ocular rigidity, as well as with systemic variables like heart rate, blood pressure, and left ventricular ejection fraction. Although the existence of some of these associations is still controversial, the clinical relevance of OPA has been consistently suggested, especially in glaucoma. Further research on this intriguing parameter could not only provide insight into glaucoma pathophysiology but also help integrate this variable into clinical practice.

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Internal combustion engines (ICE) are combined with electric motors and batteries in both hybrid electric vehicles (HEV) and plug-in hybrid electric vehicles (PHEV) to improve efficiency and achieve a limited all electric range. This paper determines the electrical power required for charging a fleet of PHEVs in Belgium. A stochastic model based on the driving behavior of Western European drivers, determines the availability of the PHEVs for grid charging.Three scenarios are defined to generate charging profiles based on the driving profiles. The first two scenarios, defined as uncoordinated charging, are based on a continuation of the current tariff schemes available to residential users, i.e. a single electricity tariff or a double electricity tariff including a day and night tariff. In the third scenario, coordinated charging is proposed. When coordinated charging is applied, the time of charging is shifted to a more appropriate moment of the night where total electrical load is minimal. The charging energy when coordinated charging is applied for each PHEV is defined to be equal to that of the single tariff scenario.The extra load caused by charging PHEVs is added to the residential and industrial electricity consumption of Belgium in 2008. Based on this data, a year load duration diagram can be determined to quantify demand for both power and energy in base load, variable load and peak load. Uncoordinated charging for residential users will cause difficulties for the electricity production system because peak load will rise substantially while base load stays the same. Coordinated charging is essential to minimize the impact on the electricity production system and could be implemented using smart meter technology.