Background/Objective: Neurostimulants may improve or accelerate cognitive and functional recovery after intracerebral hemorrhage (ICH), ischemic stroke (IS), or subarachnoid hemorrhage (SAH), but few studies have described their safety and effectiveness in the intensive care unit (ICU). The objective of this study was to describe amantadine and modafinil administration practices during acute stroke care starting in the ICU and to evaluate safety and effectiveness. Methods: Consecutive adult ICU patients treated with amantadine and/or modafinil following acute non-traumatic IS, ICH, or SAH were evaluated. Neurostimulant administration data were extracted from the electronic medication administration record, including medication (amantadine, modafinil, or both), starting dose, time from stroke to initiation, and whether the neurostimulant was continued at hospital discharge. Patients were considered responders if they met two of three criteria within 9 days of neurostimulant initiation: increase in Glasgow coma scale (GCS) score ≥ 3 points from pre-treatment baseline, improved wakefulness or participation documented in caregiver notes, or clinical improvement documented in physical or occupational therapy notes. Potential confounders of the effectiveness assessment and adverse drug effects were also recorded. Results: A total of 87 patients were evaluable during the 3.7-year study period, including 41 (47%) with ICH, 29 (33%) with IS, and 17 (20%) with SAH. The initial neurostimulant administered was amantadine in 71 (82%) patients, modafinil in 13 (15%), or both in 3 (3%) patients. Neurostimulants were initiated a median of 7 (4.25, 12.75) days poststroke (range 1-27 days) for somnolence (77%), not following commands (32%), lack of eye opening (28%), or low GCS (17%). The most common starting dose was 100 mg twice daily for both amantadine (86%) and modafinil (54%). Of the 79 patients included in the effectiveness evaluation, 42 (53%) were considered responders, including 34/62 (55%) receiving amantadine monotherapy and 8/24 (33%) receiving both amantadine and modafinil at the time they met the definition of a responder. No patient receiving modafinil monotherapy was considered a responder. The median time from initiation to response was 3 (2, 5) days. Responders were more frequently discharged home or to

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Background Patients resuscitated from cardiac arrest ( CA ) have highly variable neurological, circulatory, and systemic ischemia‐reperfusion injuries. After the initial hypoxic‐ischemic insult, a cascade of immune and inflammatory responses develops and is often fatal. The role of the immune response in pathophysiological characteristics and recovery is not well understood. We studied immune cell activity and its association with outcomes in a cohort of CA survivors. Methods and Results After informed consent, we collected blood samples at intervals over a week after resuscitation from CA . We examined the expression of CD 39 and CD 73 (alias 5′‐nucleotidase), production of tumor necrosis factor‐α, generation of reactive oxygen species, and secretion of vascular endothelial growth factor by circulating myeloid and lymphoid cells, in comparison to cells obtained from control subjects before coronary artery bypass grafting surgery. The number of circulating total and CD 73‐expressing lymphocytes correlated with survival after CA . Incubation of immune cells, obtained from post‐ CA subjects, with AMP , a substrate for CD 73, resulted in inhibition of tumor necrosis factor‐α production and generation of reactive oxygen species. This effect was blocked by adenosine 5′‐(α, β‐methylene) diphosphate, a specific inhibitor of CD 73 and ZM 241385, an A2 adenosine receptor antagonist. We also found that AMP ‐dependent activation of CD 73 induces production of vascular endothelial growth factor. Conclusions CD 73‐expressing lymphocytes mediate cellular protection from inflammation after CA through inhibition of proinflammatory activation of myeloid cells and promotion of vascular endothelial growth factor secretion. The contribution of CD 73 lymphocytes in the regulation of acute inflammation and tissue injury after CA warrants further study.

OBJECTIVES:To determine the cost of Dupuytren=s contracture in the Czech Republic. METHODS: Survey among general surgery specialists and orthopedic surgeons (panel of total 9 surgeons) conducted. The assessment itself was done using a classical Delphi panel method, combined with data from medical charts and/or hospital information systems. Besides the surgeons, also rehabilitation specialists (to cover costs for rehabilitation) and internal medicine specialists (to cover complications) were included into the panel. RESULTS: If indirect costs (productivity loss) are included, they represent the major part of all costs (76 %). In case of direct cost inclusion, rehabilitation stands for more than 50% of costs, followed by surgery costs (almost 30 %). Mean direct costs (1 operation field) are estimated at about 12,000 CZK with a variation of 9 200 to 14,400 CZK. If indirect costs (productivity loss) are included, total costs increase dramatically, arriving at mean costs of almost 50 thousand CZK (21,800 to 90,200 CZK). CONCLUSIONS: Cost of Dupuyt-ren=s contracture range from 21,800 to 90 200 CZK if indirect cost included. Indirect cost represent 76% of all costs. OBJECTIVES:To evaluate utilization of resources and direct medical costs of postmenopausal osteoporosis treatment in patients without fractures. METHODS: A medical chart review was performed to examine the medical resources used to treat osteoporosis during the year preceding the start of the study. Data were collected between July 2010 and April 2011 by local investigators from 5 centers in Slovenia (99 patients), 5 in Serbia (105), 10 in Slovakia (100) and 3 in Bulgaria (106). Data of patients above 50 years of age, diagnosed with osteoporosis without fractures and treated for osteoporosis was included in the study. Based on these data, costs of osteoporosis treatment from the public payer and patient's perspective in all countries except Bulgaria were estimated. Costs of ambulatory and outpatient visits, examinations and drugs were calculated. RESULTS: Patients with osteoporosis were monitored more frequently in Slovenia and Slovakia (on average 2.00 and 1.87 ambulatory visits per year, respectively). In Serbia and Bulgaria, ambulatory visits were less frequent (0.79 and 0.67 visits per year, respectively). Percentages of patients treated with bisphosphonates were 99%, 98%, 78% and 61% in Slovakia, Bulgaria, Slovenia and Serbia, respectively, while 83%, 85%, 81% and 57% was treated with calcium and vitamin D supplements, respectively. Average 1-year cost of osteoporosis treatment was highest in Slovakia and Slovenia, accounting for 491 € (CI95%: 444; 634) and 384 € (CI95%: 345; 435), respectively, while in Serbia these costs were 190 € (CI95%: 164; 231). CONCLUSIONS: The highest standard of treatment and monitoring osteoporosis was observed in Slovenia. On the other side treatment of osteoporotic patients generated the highest costs in Slovakia, however some of these costs could be related to comorbidities.

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