Circulating adiponectin concentrations in patients with congestive heart failure

OBJECTIVES: To determine concentrations of adiponectin and its predictive value on outcome in a cohort of patients with congestive heart failure (CHF). METHODS: Serum and clinical data were obtained for outpatients with clinically controlled CHF (n  =  175). Serum concentrations of adiponectin, C reactive protein, N‐terminal pro‐brain natriuretic peptide (NT‐proBNP), interleukin (IL) ‐1β, IL‐6, IL‐8, IL‐10, IL‐12, tumour necrosis factor α and CD‐40 ligand were determined. The association of adiponectin with the clinical severity of CHF was sought as well as the predictive value of this adipokine on mortality, CHF hospitalisations or the occurrence of each of these end points. RESULTS: Concentrations of adiponectin were significantly increased in patients with CHF. Patients with higher New York Heart Association class had significantly higher serum concentrations of adiponectin. Adiponectin serum concentrations were lower in patients with diabetes and CHF as well as in patients with ischaemic cardiomyopathy. Serum adiponectin concentration was positively associated with age and NT‐proBNP but was negatively correlated with C reactive protein concentrations. Serum adiponectin above the 75th centile was found to be an independent predictor of total mortality, CHF hospitalisations or a composite of these end points over a two‐year prospective follow up. CONCLUSION: Adiponectin is increased in CHF patients and predicts mortality and morbidity

Controlled release of vancomycin from thin sol-gel films on implant surfaces successfully controls osteomyelitis

Peri-prosthetic infection remains a serious complication of joint replacement surgery. Herein, we demonstrate that a vancomycin-containing sol-gelfilm on Ti alloy rods can successfully treat bacterial infections in an animal model. The vancomycin-containing sol-gel films exhibited predictable release kinetics, while significantly inhibiting S. aureus adhesion. When evaluated in a rat osteomyelitis model, microbiological analysis indicated that the vancomycin-containing sol-gel film caused a profound decrease in S. aureus number. Radiologically, while the control side showed extensive bone degradation, including abscesses and an extensive periosteal reaction, rods coated with the vancomycin-containing sol-gel film resulted in minimal signs of infection. mCT analysis confirmed the radiological results, while demonstrating that the vancomycin-containing sol-gel film significantly protected dense bone from resorption and minimized remodeling. These results clearly demonstrate that this novel thin sol-gel technology can be used for the targeted delivery of antibiotics for the treatment of periprosthetic as well as other bone infections. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc

Using Multisensory Haptic Integration to Improve Monitoring in the Intensive Care Unit

Introduction: Alarm fatigue and medical alarm mismanagement reduces the quality of patient care and creates stressful work environments for clinicians. Here, the feasibility of a novel “prealarm” system that utilizes multisensory integration of auditory and haptic stimuli is examined as a possible solution. Methods: Three vital signs (heart rate, blood pressure, and blood oxygenation) were represented by three musically distinct sounds that were combined into soundscapes and progressed through five pre-alarm zones (very low to very high). Three haptic conditions were tested with the auditory stimulus to determine the best combination of auditory and haptic stimulation. Qualitative data was collected through surveys and the NASA TLX index Results: Alterations in frequency and timbre were most effective at transmitting information regarding changing vital sign zones with comparatively higher accuracy and quicker reaction time (RT), p \u3c .01. The addition of haptic stimuli to the auditory soundscape caused no significant decline in study participant accuracy or RT. However, two weeks after training, participants performed the tasks significantly faster ( p \u3c .001) and felt the alarm monitoring task was significantly less cognitively demanding ( p \u3c .01), compared to the unisensory condition. Participants also felt more confident in identifying changing vital signs with the addition of haptic stimuli. Discussion: The current study demonstrates that multisensory signals do not diminish the perception of transmitted information and suggest efficient training benefits over unimodal signals. Multisensory training may be beneficial over time compared to unisensory training due to a stronger consolidation effect. The potential integration of haptic input with existing auditory alarm systems and training is supported

Thigh-length compression stockings and DVT after stroke

Controversy exists as to whether neoadjuvant chemotherapy improves survival in patients with invasive bladder cancer, despite randomised controlled trials of more than 3000 patients. We undertook a systematic review and meta-analysis to assess the effect of such treatment on survival in patients with this disease