Circadian aspects of mortality in hospitalized patients: A retrospective observation from a large cohort.

AIM: This study aimed to describe the circadian characteristics of hospitalized mortality in order to provide nursing guidance for preventing in-hospital mortality. DESIGN: A retrospective analysis on inpatient information was implemented. METHODS: Harmonic Analysis of Time Series was applied to quantify the periodic structure of the frequency of the occurrence of death. RESULTS: A total of 3300 cases were included in the present study (male, 63.4% and median age 73 years), including 1540 (46.7%) ICU patients. Incidence of overall hospitalized death exhibited a circadian pattern, presenting peaks from 07:00 to 12:00 and 15:00 to 20:00 P.M., with 21.5% and 13.1% increase above the average at those peak points, respectively. Similarly, the incidence of sudden cardiac death (SCD) showed peaks between 06:00-12:00 and 15:00-20:00, with a 34.7% and 28.0% increase above the average at peak time, respectively. The distribution of death incidence revealed no statistical difference between SCD and non-SCD (p = 0.525).

Comorbidity among inpatients with dementia: a preliminary cross-sectional study in West China.

OBJECTIVE: To investigate comorbidities among hospitalized patients with dementia. METHOD: Data were extracted from the discharge records in our hospital. Comorbidities based on ICD-10 were selected from the Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Index (ECI). The distributions of these comorbidities were described in dementia inpatients and age- and sex-matched nondementia controls, as well as in inpatients with Alzheimer's disease and vascular dementia. A logistic regression model was applied to identify dementia-specific morbid conditions. RESULTS: A total of 3355 patients with dementia were included, with a majority of 1503 (44.8%) having Alzheimer's disease, 395 (11.8%) with vascular dementia, and 441 (13.1%) with mixed dementia. The mean number of comorbidities was 3.8 in dementia patients (vs. 2.9 in controls). The most prevalent comorbidities in inpatients with dementia compared with those without dementia were cerebral vascular disease (73.0% vs. 35.9%), hypertension (62.8% vs. 56.2%), and peripheral vascular disease (53.7% vs. 31.2%). Comorbidities associated with dementia included epilepsy (OR 4.8, 95% CI 3.5-6.8), cerebral vascular disease (OR 4.1, 95% CI 3.7-4.5), depression (OR 4.0, 95% CI 3.2-5.0), uncomplicated diabetes (OR 1.5, 95% CI 1.4-1.7), peripheral vascular disease (OR 1.8, 95% CI 1.6-2.0), rheumatoid arthritis collagen vascular disease (OR 1.7, 95% CI 1.3-2.3), and anemia (OR 1.2, 95% CI 1.04-1.3). Some comorbidities suggested a protective effect against dementia. They were hypertension (OR 0.8, 95% CI 0.7-0.9), COPD (OR 0.6, 95% CI 0.5-0.6), and solid tumor without metastasis (OR 0.4, 95% CI 0.3-0.4). Vascular dementia has more cardiovascular and cerebrovascular comorbidities than Alzheimer's disease. CONCLUSION: Patients with dementia coexisted with more comorbidities than those without dementia. Comorbidities (esp. cardio-cerebral vascular risks) in patients with vascular dementia were more than those in patients with AD. Specifically, vascular and circulatory diseases, epilepsy, diabetes and depression increased the risk of dementia.

The effect of intravenous infusion on the rapid recovery of elderly patients treated with painless colonoscopy and the value of ultrasonic measurement of the inferior vena cava diameter in guiding intravenous infusion.

BACKGROUND: Elderly patients with painless colonoscopy often complain listlessness, fatigue when they left postanesthesia care unit (PACU). These patients also commonly occur hypotension during anesthesia. However, intravenous infusion and blood volume assessment are seldom performed in elderly patients. Therefore, we aimed to observe the effect of intravenous infusion and to explore the value of inferior vena cava diameter (IVCD) measurement by ultrasound in rapid recovery. METHODS: Randomized, controlled, clinical trials, elderly patients (aged ≥60 years) with painless colonoscopy were randomly divided into two groups: intravenous infusion versus no intravenous infusion was administered procedure. The primary outcome observed was the time required for complete recovery from anesthesia. Secondary outcomes included willingness to accept follow-up colonoscopy, discomfort symptoms, changes in the inferior vena cava (IVC)-related parameters. Hypotension was defined as a ≥20% decrease in systolic blood pressure (SBP) from baseline. The patients in the two groups were divided into non-hypotensive and hypotensive subgroups, respectively. Receiver operating characteristic (ROC) curves were used to determine the efficacy of the IVC-related parameters for predicting hypotension and the optimal threshold. RESULTS: A total of 65 patients were enrolled, including 34 patients in the infusion group and 31 patients in the conventional group. Administration of intravenous infusion reduced the time required for complete recovery and increased the willingness to accept follow-up colonoscopy and reduced discomfort symptoms. The IVC-related parameters were changed before and after bowel preparation and after reaching infusion loading dose. The ROC curve was used to predict hypotension during anesthesia. The maximum value of inferior vena cava diameter (IVCDmax) was the best predictive efficacy in the both groups [area under the ROC curve (AUC) =0.839, AUC =0.877, respectively]. CONCLUSIONS: Intravenous infusion promotes the rapid recovery of elderly patients with painless colonoscopy. Measurement of the IVCDmax can help to guide intravenous infusion.

Clinical profile of aetiological and risk factors of young adults with ischemic stroke in West China.

OBJECTIVE: Our study aimed to present the clinical characteristics of aetiological and risk factors of ischemic stroke (IS) in young adults in order to provide reference to the early prevention and management. PATIENTS AND METHODS: Data of young IS patients aged 18-50 years who were admitted to our tertiary stroke center were retrospectively reviewed. Demographic and clinical characteristics, and risk factors/aetiologies were assessed. Differences of clinical characteristics between the young (18-34 years) and old (35-50 years) age groups were investigated. RESULTS: 343 consecutive inpatients were recruited (mean age 43.8 years). 40 patients (11.7 %) were in the young age group. The prevalence of smoking, diabetes and hypertension accounted for 49.0 %, 24.8 % and 36.2 % respectively, with higher rates in old age group (all p < 0.05). Hyperlipidemia and drinking took up 34.4 % and 45.2 %, with no statistical difference between age groups. 56 patients (16.3 %) were in the "large-artery atherosclerosis" category, and higher percentage of patients was in the old age group (17.8 % vs 5.0 %, p < 0.05). 9.9 % of the patients were classified as the "cardioembolism'' category, and higher percentage of patients was in the young age group (20.0 % vs 8.6 %, p < 0.05). 46 patients (13.4 %) were diagnosed as small vessel occlusion, with similar prevalence in the young and old age group. 15 patients (4.6 %) had other determined causes and 192 patients (56.0 %) were due to undetermined cause. CONCLUSION: the traditional vascular risk factors are frequent and increases with age in young stroke. Further investigation on the 'rare' risk factor and etiology would beneficial.

Safety, tolerability, and pharmacokinetics of adamgammadex sodium, a novel agent to reverse the action of rocuronium and vecuronium, in healthy volunteers.

Neuromuscular blockers (NMBs) selectively block neuromuscular transmission at the N2-nicotinic receptor on motor neurons to paralyze skeletal muscles, and are mainly used to facilitate tracheal intubation and surgical procedures. Rapid reversal is necessary in clinical practice to avoid profound block and reduce recovery time. Adamgammadex sodium is a modified γ-cyclodextrin derivative consisting of a lipophilic core and a hydrophilic outer end that forms an inactive tight inclusion complex with free molecules of rocuronium and vecuronium. In preclinical study, adamgammadex produced a concentration-dependent reversion effect of neuromuscular blockade induced by rocuronium in beagle dogs. Furthermore, adamgammadex had a less potential side effects than sugammadex and other clinical used neuromuscular block antagonists. In this study, the objective was to assess the safety, tolerability, and pharmacokinetics of single intravenous injection of adamgammadex in healthy volunteers. Approved by the China Food and Drug Administration, 52 healthy volunteers (half male and half female) were enrolled in this single-center, randomized, double-blind placebo-controlled study. No serious adverse effects were happened in this study. The overall frequency of adverse effects in adamgammadex was similar for that in placebo, and there was no specific adverse effect in adamgammadex. All of the volunteers bearing the adverse effects were recovered to normal without any treatment or intervention. In pharmacokinetic study, the value of half-time, Tmax, and clearance were not changed significantly, and the Cmax and AUC0-∞ increased with a similar ratio of the escalating doses. For dose proportionality analysis of adamgammadex, the estimate of slope was close to 1, and it was not significantly different from 1 after doses (AUC0-∞, 0.9965 [90%CI, 0.9468, 1.046]; Cmax, 0.9462 [90%CI, 0.8800, 1.012]). Therefore, adamgammadex exposure in plasma increased in a dose- proportional manner. The urinary route is a significant excretory pathway for adamgammadex, and it is mostly completed at 8 h. All the results in this study showed that adamgammadex may be a novel safe neuromuscular blockade reversal agent .

Mortality-specific comorbidity among inpatients with ischemic stroke in West China.

OBJECTIVE: This study aimed to investigate the current condition of mortality-specific comorbidity among hospitalized patients with ischemic stroke. METHODS: Five-year data of inpatients with ischemic stroke (IS) were extracted from the hospital medical database. A retrospective review of eighteen mortality-specific comorbidities in extensively validated Charlson Comorbidity Index (CCI) was carried out for each patient. In addition, the distribution of the CCI-based prognostic score was calculated. RESULTS: A total of 10 331 (male 57.6%) cases with IS were recruited in the present study. The most prevalent mortality-specific comorbidities from high to low were as follows: peripheral vascular disease (35.1%), diabetes uncomplicated (25.2%),mild liver disease (18.3%), chronic pulmonary disease (14.7%), congestive heart failure (10.8%), atrial fibrillation or flutter (10.3%), diabetes complicated (9.1%), moderate or severe renal disease (7.5%), and dementia (7.1%). High prevalence of comorbidities in the elderly was also noted (31.1% patients with score ≥3). Spearman correlation analysis with a rho of 0.25 (P < 0.001) showed a mild correlation between the age- and the CCI-based prognostic score. CONCLUSION: High prevalence of peripheral vascular disease, diabetes, liver disease, chronic pulmonary disease, congestive heart failure, atrial fibrillation, or flutter as major contributors to mortality was presented in in-hospital patients with IS in our area. One-third of old patients with IS expose high mortality risk with the CCI score ≥3. Early prevention and management of the potential comorbidities are necessary to reduce the mortality.

Risk assessment of in-hospital mortality of patients with epilepsy: A large cohort study.

PURPOSE: This study aimed to explore the mortality risks of hospitalized patients with epilepsy (PWE). METHODS: Our data source was extracted from discharge abstracts in a hospital medical database. Various clinical variables, including demographical characteristics, natural features of epilepsy, and comprehensive set of comorbidities, were screened to investigate the risk. Comorbidities were defined using a validated ICD-10-based classification. The distributions of comorbid conditions and demographics were presented. In-hospital mortality rates of groups with epilepsy and without epilepsy were compared. Logistic regression was applied to explore the important predictors of in-hospital mortality. RESULTS: A cohort of 11,422 PWE (male: 58.5%, mean age: 40.2 years) was recruited for the study. The most common comorbidities were cerebrovascular disease, hypertension, and peripheral vascular disease, which accounted for 23.5%, 18.8%, and 8.0% of the study cohort, respectively. In-hospital mortality rates were 2.9% and 1.1% in the epilepsy and nonepilepsy cohort, respectively. Male patients exhibited an increased risk of death (odds ratio (OR) = 1.2; 95% confidence interval (CI) = 1.0-1.6). Patients aged over 65 years were more likely to die than those below 18 years (OR = 18.2; 95% CI = 8.8-31.0). Patients with comorbidities, including central nervous system (CNS) infections, renal disease, traumatic brain and head injuries, anoxic brain injury, metastatic cancer, pulmonary circulation disorders, encephalopathy, solid tumor without metastasis, cardiac arrhythmias, and diabetes without complication, had a higher risk of in-hospital death than patients without comorbidities (OR = 6.1, 5.2, 5.1, 4.4, 3.7, 2.5, 2.4, 2.0, 1.5, 1.4, respectively; 95% CI = 4.1-9.1, 3.8-7.0, 2.8-9.5, 2.4-8.3, 2.2-6.3, 1.5-4.3, 1.4-4.2, 1.1-3.7, 1.1-2.1, 1.0-1.9, respectively). CONCLUSION: The in-hospital mortality of PWE increased remarkably with age, and this parameter was predominant in male patients. Central nervous system infection, renal disease, traumatic brain and head injuries, anoxic brain injury, metastatic cancer, pulmonary circulation disorders, encephalopathy, solid tumor without metastasis, cardiac arrhythmias, and diabetes without complication were the most important comorbidities associated with in-hospital death.