BACKGROUND: The prevalence of end-stage renal disease (ESRD) has doubled in the past decade, with total costs projected to exceed 16.5 billion dollars by the end of 2002. METHODS: The purpose of this prospective study is to determine all costs related to inpatient and outpatient health care utilization incurred by 76 patients with ESRD in an outpatient hemodialysis setting for 1 year. Costs were derived from a computer-based cost-allocation process that distributed cost components and overhead to designated revenue-producing departments. RESULTS: During the 1-year study period, these patients had 1,459 total inpatient and outpatient hospital visits (mean, 19.2 visits/patient; range, 0 to 84 visits/patient). There were 149 general inpatient hospital admissions. Of 238 total emergency room visits, 89 visits resulted in admission to the hospital (37%). CONCLUSION: Total hospital costs for all patients for the year were 1,831,880 dollars (actual charges, 2,929,147 dollars). As expected, the greatest hospital cost expenditures were attributed to inpatient hospital admissions (1,419,022 dollars; 77.5% of total). Of total hospital costs, inpatient bed costs were the single highest expenditure. The cost for outpatient hemodialysis therapy was 33,784 dollars/patient-year, consisting of facility costs of 17,200 dollars, outpatient pharmacy costs of 14,100 dollars, and outpatient professional costs of 2,500 dollars/patient-year. Average costs for hospital facility and/or professional fees were 42,730 dollars/patient-year, whereas average costs for outpatient dialysis facility and/or professional fees were 33,784 dollars, for an estimated global cost of 76,515 dollars/patient-year. Our cost estimate for care of this unique inner-city population substantially exceeds those reported earlier by others.

• MeSH
• alokace nákladů MeSH
• ambulantní kliniky nemocniční ekonomika   využití   MeSH
• chronické selhání ledvin ekonomika   terapie   MeSH
• dialýza ledvin ekonomika   MeSH
• dospělí MeSH
• financování organizované MeSH
• hospitalizace ekonomika   statistika a číselné údaje   MeSH
• klasifikační systém DRG MeSH
• komorbidita MeSH
• lidé středního věku MeSH
• lidé MeSH
• městské obyvatelstvo MeSH
• náklady na léky MeSH
• náklady na zdravotní péči MeSH
• nemocnice - náklady MeSH
• poplatky a výdaje MeSH
• prospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• urgentní služby nemocnice ekonomika   využití   MeSH
• vysokoškolská lékařská centra ekonomika   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Geografické názvy
• Jižní Karolína MeSH

BACKGROUND: Low CD4 recovery among HIV-positive individuals who achieve virologic suppression is common but has not been studied among individuals initiating treatment at CD4 counts of >500 cells/mm. SETTING: United States, Africa, Asia, Europe and Israel, Australia, Latin America. METHODS: Among participants randomized to immediate antiretroviral therapy (ART) in the Strategic Timing of AntiRetroviral Therapy trial, low CD4 recovery was defined as a CD4 increase of <50 cells/mm from baseline after 8 months despite viral load of ≤200 copies/mL. Risk factors for low recovery were investigated with logistic regression. RESULTS: Low CD4 recovery was observed in 39.7% of participants. Male sex [odds ratio (OR), 1.53; P = 0.007], lower screening CD4 cell counts (OR, 1.09 per 100 fewer cells/mm; P = 0.004), higher baseline CD8 cell counts (OR, 1.05 per 100 more cells/mm; P < 0.001), and lower HIV RNA levels (OR, 1.93 per log10 decrease; P < 0.001) were associated with low CD4 recovery. D-dimer had a quadratic association with low CD4 recovery, with lowest odds occurring at 0.32 μg/mL. At lower HIV RNA levels, the odds of low CD4 recovery were elevated across the levels of screening CD4 count; but at higher HIV RNA levels, the odds of low CD4 recovery were higher among those with lower vs. higher screening CD4. CONCLUSIONS: Low CD4 recovery is frequent among participants starting ART at high CD4 counts. Risk factors include male sex, lower screening CD4 cell counts, higher CD8 cell counts, and lower HIV RNA levels. More follow-up is required to determine the impact of low CD4 recovery on clinical outcomes.

• MeSH
• CD4-pozitivní T-lymfocyty účinky léků   MeSH
• dospělí MeSH
• HIV infekce farmakoterapie   MeSH
• látky proti HIV terapeutické užití   MeSH
• lidé MeSH
• logistické modely MeSH
• neúspěšná terapie MeSH
• počet CD4 lymfocytů * statistika a číselné údaje   MeSH
• rizikové faktory MeSH
• sexuální faktory MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH
• Research Support, N.I.H., Extramural MeSH

• MeSH
• erytrocyty MeSH
• hematokrit MeSH
• hypoxie patofyziologie   MeSH
• krysa rodu rattus MeSH
• osmotická fragilita MeSH
• počet erytrocytů MeSH
• počet leukocytů MeSH
• Check Tag
• krysa rodu rattus MeSH

• Klíčová slova
• lékařství ženské, Evropa, trendy,

• NLK Obory
• gynekologie a porodnictví
• gynekologie a porodnictví

The majority of incidentally discovered adrenal tumors are later characterized as non-producing adrenocortical adenomas (NPA). We asked whether laboratory abnormalities in parameters that reflect glucocorticoid action can be found in patients with NPA despite their nature of being clinically unapparent. Since glucocorticoids are potent immunosuppressants we studied blood counts and differential blood counts along with corticotropin and dehydroepiandrostenedione sulfate (DHEAS) blood concentrations, as well as cortisol values before and after an overnight 1 mg dexamethasone suppression test. We compared the results of normal individuals, of patients with adrenal adenomas and normal hormone profiles and with subclinical autonomous glucocorticoid hypersecretion, as well as overt cortisol excess. We found that almost all indices of the blood counts were significantly different between the patients groups. In particular, patients with adrenal non-producing adenomas already showed signs of glucocorticoid excess, including relative lymphocytopenia, lowered DHEAS, and ACTH concentrations than control individuals. We also found that the extent of lymphocytopenia correlated with the concentrations of DHEAS and ACTH, and DHEAS correlated well with ACTH. We conclude that the basal ACTH and DHEAS values along with the differential blood counts give good information on the extent of glucocorticoid excess and that silent adrenal adenomas seem to oversecrete glucocorticoids at concentrations that already alter these parameters.

• MeSH
• adenom krev   metabolismus   MeSH
• adrenokortikotropní hormon krev   MeSH
• dehydroepiandrosteronsulfát krev   MeSH
• dospělí MeSH
• glukokortikoidy metabolismus   MeSH
• krevní obraz MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory nadledvin krev   metabolismus   MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVE: AIDS-related mortality has changed dramatically with the onset of highly active antiretroviral therapy (HAART), which has even allowed compensated HIV-infected patients to withdraw from secondary therapy directed against opportunistic pathogens. However, in recently autopsied HIV-infected patients, we observed that associations with a broad spectrum of pathogens remain, although detailed analyses are lacking. Therefore, we focused on the possible frequency and spectrum shifts in pathogens associated with autopsied HIV-infected patients. DESIGN: We hypothesized that the pathogens frequency and spectrum changes found in HIV-infected patients examined postmortem did not recapitulate the changes found previously in HIV-infected patients examined antemortem in both the pre- and post-HAART eras. Because this is the first comprehensive study originating from Central and Eastern Europe, we also compared our data with those obtained in the West and Southwest Europe, USA and Latin America. METHODS: We performed autopsies on 124 HIV-infected patients who died from AIDS or other co-morbidities in the Czech Republic between 1985 and 2014. The pathological findings were retrieved from the full postmortem examinations and autopsy records. RESULTS: We collected a total of 502 host-pathogen records covering 82 pathogen species, a spectrum that did not change according to patients' therapy or since the onset of the epidemics, which can probably be explained by the fact that even recently deceased patients were usually decompensated (in 95% of the cases, the last available CD4+ cell count was falling below 200 cells*μl-1) regardless of the treatment they received. The newly identified pathogen taxa in HIV-infected patients included Acinetobacter calcoaceticus, Aerococcus viridans and Escherichia hermannii. We observed a very limited overlap in both the spectra and frequencies of the pathogen species found postmortem in HIV-infected patients in Europe, the USA and Latin America. CONCLUSIONS: The shifts documented previously in compensated HIV-infected patients examined antemortem in the post-HAART era are not recapitulated in mostly decompensated HIV-infected patients examined postmortem.

• MeSH
• charakteristiky bydlení MeSH
• dospělí MeSH
• druhová specificita MeSH
• HIV infekce farmakoterapie   imunologie   MeSH
• lidé MeSH
• oportunní infekce doprovázející AIDS imunologie   MeSH
• pitva MeSH
• počet CD4 lymfocytů MeSH
• posmrtné změny * MeSH
• vysoce aktivní antiretrovirová terapie * MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

BACKGROUND: Radiotherapy combined with immunotherapy shows increasing efficacy in treating metastatic malignancies; however, positive outcomes may be negatively impacted by lymphocytopenia. Previous studies suggest thymosin α1 (Tα1) may mitigate radiation-induced lymphocytopenia. This study retrospectively evaluated the effects of a Tα1 loading dose on peripheral blood lymphocyte counts and assessed the safety and efficacy of radiotherapy combined with of PD-1 inhibitors in patients with advanced or refractory cancers. METHODS: A total of 48 patients received a 7-day loading dose of Tα1 (1.6 or 3.2 mg, once daily) followed by hypofractionated radiotherapy and PD-1 inhibitors. Peripheral blood T cells, B cells, and natural killer cells were quantified by flow cytometry before and after Tα1 treatment. The primary endpoint was the change from baseline in lymphocyte subset counts. Secondary endpoints included adverse events, objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), and overall survival (OS). RESULTS: The median follow-up was 13.7 months. Tα1 treatment for 7 days significantly increased the median counts of peripheral blood total T cells (422.5/μL to 614.0 /μL, P<0.001), CD4+ T cells (244.5/μL to 284.5/μL, P<0.001), and CD8+ T cells (159.0/μL to 222.5/μL, P<0.001). Among the 36 patients with evaluable data, the ORR was 19.4% and DCR was 69.4%. The median PFS and OS were 5.1 months and 9.6 months, respectively. Two patients (4.2%) experienced grade ≥3 treatment-related adverse events. CONCLUSION: A 7-day loading dose of Tα1 elevated lymphocyte counts in advanced cancer patients and was accompanied by satisfactory safety and efficacy profiles. It should be noted that the median follow-up of 13.7 months may be insufficient to fully assess long-term survival outcomes and the potential for late-onset toxicities. As this was an exploratory analysis across multiple tumor types, these findings warrant validation in larger, randomized studies with more homogenous cohorts.

• Publikační typ
• časopisecké články MeSH

OBJECTIVE: The aim of this study was to evaluate changes in the relative counts of different leukocyte subsets in peripheral and umbilical cord blood in pregnancies complicated by preterm prelabor rupture of membranes (PPROM) with respect to the presence of intraamniotic inflammation (IAI) and fetal inflammatory response syndrome (FIRS). METHODS: Fifty-two women with singleton pregnancies complicated by PPROM were included in this study. From samples of peripheral and umbilical cord blood, relative counts of these leukocyte subpopulations were determined using multicolor flow cytometry: granulocytes, monocytes, lymphocytes, T cells and their subpopulations, B cells and their subpopulations, and NK cells and their subpopulations. IAI was defined as increased concentrations of interleukin 6 in the amniotic fluid. Amniotic fluid samples were obtained by transabdominal amniocentesis. RESULTS: Women with IAI had higher relative counts of monocytes (p = 0.04) in peripheral blood. There was an increased relative number of granulocytes (p = 0.003) and a decreased number of lymphocytes (p = 0.0048), helper CD4+ T cells (p = 0.019), NK cells (p = 0.0001) within leukocytes, NK cells within lymphocytes (p = 0.003) and CD16+ NK cells within NK cells (p = 0.005) in umbilical cord blood samples of women with FIRS. However, after adjusting the results for gestational age at sampling, all differences disappeared. CONCLUSIONS: The presence of IAI or FIRS is not accompanied by significant changes in the relative counts of immune cells in peripheral blood or umbilical cord blood in pregnancies complicated by PPROM.

• MeSH
• chorioamnionitida imunologie   krev   MeSH
• dospělí MeSH
• fetální krev * imunologie   cytologie   MeSH
• interleukin-6 krev   metabolismus   MeSH
• leukocyty imunologie   MeSH
• lidé MeSH
• plodová voda imunologie   metabolismus   MeSH
• počet leukocytů MeSH
• předčasný odtok plodové vody * imunologie   krev   MeSH
• průtoková cytometrie MeSH
• syndrom systémové zánětlivé reakce imunologie   krev   MeSH
• těhotenství MeSH
• zánět imunologie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• podpora zdraví MeSH
• zdraví žen MeSH
• zdravotnické služby pro ženy MeSH
• Publikační typ
• kongresy MeSH

• MeSH
• celiakie * imunologie   patologie   MeSH
• enterocyty ultrastruktura   MeSH
• imunohistochemie metody   MeSH
• lidé MeSH
• lymfocyty imunologie   MeSH
• počet lymfocytů metody   přístrojové vybavení   MeSH
• senzitivita a specificita MeSH
• střevní sliznice imunologie   patologie   MeSH
• Check Tag
• lidé MeSH