Chief complaints associated with mortality involving civilian transport after Wen-chuan earthquake.

OBJECTIVES: Previous studies have reported that civilian transport is a mortality risk factor in low-resource communities. Few studies have analyzed the chief complaints associated with mortality involving civilian transport after an earthquake.Therefore, the present study was conducted to determine whether mortality resulting from medical professional transport differs from that involving civilian transport, and if so, the chief complaints associated with mortality involving civilian transport after the Wen-chuan earthquake. METHODS: A hospital-based case-control study was conducted. Cases included all victims transported by civilians to West China Hospital from the disaster area (n=473). Controls included all victims transported by medical professionals to West China Hospital (n=1452). We further analyze six potential chief complaints of death to clarify the specific contributing chief complaints associated with mortality involving civilian transport. RESULTS: Civilian transport is associated with significantly greater mortality compared with medical professional transport (Pearson's χ-test: P<0.05). Patients with altered mental status had the greatest risk of death [odds ratio (OR)=4.552, 95% confidence interval (CI)=2.165-9.572], followed by patients with trunk injury (OR=2.517, 95% CI=1.251-5.066), and finally patients with shortness of breath (OR=2.345, 95% CI=1.040-5.288). CONCLUSION: Altered mental status, trunk injury, and shortness of breath were the significant chief complaints associated with mortality involving civilian transport to the hospital after the Wen-chuan earthquake. Our data suggest that patients with any of these complaints should be transported by medical professionals, not civilians, to the nearest hospital for treatment.

Effects of Scalp Acupuncture on Serum NSE and S-100β Concentrations and Postoperative Cogni- tive Function of Elderly Patients Undergoing Hip Replacement / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To explore the effect of Scalp acupuncture on serum neuron specific enolase (NSE) and S-100β concentrations, and incidence rates of postoperative delirium (POD) and postoperative cognitive function (POCD) of elderly patients undergoing hip replacement.</p><p><b>METHODS</b>Eighty-four patients undergoing scheduled hip replacement under combined spinal-epidural anesthesia (CSEA) were assigned to the control group (group C) and the scalp acupuncture group (group S) according to random digit table, 42 cases in each group. In group S, scalp acupuncture was additionally performed according to International Standardized Scheme for Scalp Acupuncture. Scalp acupuncture was performed during the operation from the MS1 middle line of forehead [1 cun before Shenting (GV24), including Shenting (GV24)] and MS5 middle line of vertex [from Baihui (DU20) to Qianding (DU21), including Baihui (DU20) and Qianding (DU21)]. The operation time and post-operative length of stay were observed. The midazolam dosage, hemorrhage amount, fluid transfusion amount, urine amount, use rates of ephedrine and atropine during the operation were also observed and compared between the two groups. The occurrence rate of POD and POCD at post-operative day 3 (T₁), week 1 (T₂), month 3 (T₃), and month 6 (T₄) were measured. Eighteen patients were randomly selected to collect blood from internal jugular vein before anesthesia t₀), immediately after ending the surgery (t₁), 6 h after operation (t₂), 24 h after operation (t₃), and 48 h after operation (t₄), respectively. Serum levels of NSE and S-100β were correspondingly measured.</p><p><b>RESULTS</b>There was no statistical difference in the operation time, midazolam dosage used during the operation, hemorrhage amount, fluid transfusion amount, urine amount, use rates of ephedrine and atropine (P > 0.05). Compared with group C, the post-operative length of stay was shortened in group S (P < 0.05). The incidence rate of POD and that of POCD at each time point were lower in group S (P < 0.05). The expression level of NSE decreased at t₂, t3, and t₄, and the expression level of S100β also decreased at t₁, t₂, t₃, and t₄(P < 0.05). There was no statistical difference in expression levels of NSE or S100β between the two groups at other time points (P > 0.05).</p><p><b>CONCLUSION</b>Scalp acupuncture could attenuate central nervous system lesion and improve POCD of elderly patients undergoing hip replacement.</p>