An assessment of pelvic binder placement at a UK major trauma centre.

Introduction Pelvic binders are used to reduce the haemorrhage associated with pelvic ring injuries. Application at the level of the greater trochanters is required. We assessed the frequency of their use in patients with pelvic ring injuries and their positioning in patients presenting to a single major trauma centre. Methods A retrospective review of our trauma database was performed to randomly select 1000 patients for study from April 2012 to December 2016. Patients with a pelvic binder or a pelvic ring injury defined by the Young and Burgess classification were included. Computed tomography was used to identify and measure pelvic binder placement. Results 140 patients were identified: 110/140 had a binder placed. Of the total, 54 (49.1%) patients had satisfactory placement and 56 (50.9%) had unsatisfactory placement; 30/67 (44.8%) patients with a pelvic ring injury had no binder applied, of whom 6 (20%) had an unstable injury; 9/67 patients died. Discussion This is the first study assessing pelvic binder placement in patients at a UK major trauma centre. Unsatisfactory positioning of the pelvic binder is a common problem and it was not used in a large proportion of patients with pelvic ring injuries. This demonstrates that there is a need for continuing education for teams dealing with major trauma.

Human metabolism of mammalian lignan precursors in raw and processed flaxseed.

BACKGROUND: The mammalian lignans enterolactone and enterodiol are produced in the colon by the action of bacteria on the plant precursor secoisolariciresinol diglycoside, which is found in high concentrations in flaxseed. OBJECTIVE: Two experiments were conducted to determine 1) whether there is a dose response in urinary lignan excretion with increasing flaxseed intake, 2) whether flaxseed processing affects lignan excretion, 3) peak plasma lignan concentrations, and 4) plasma lignan concentrations after chronic supplementation. DESIGN: Nine healthy young women supplemented their diets with 5, 15, or 25 g raw or 25 g processed (muffin or bread) flaxseed for 7 d during the follicular phase of their menstrual cycles. Twenty-four-hour urine samples were collected at baseline and on the final day of supplementation. As an adjunct to the 25-g-flaxseed arm, subjects consumed the supplement for an additional day and blood and urine samples were collected at specific intervals. All blood and urine samples were analyzed for enterolactone and enterodiol by gas chromatography-mass spectroscopy. RESULTS: A dose-dependent urinary lignan response to raw flaxseed was observed (r = 0.72, P < 0.001). The processing of flaxseed as a muffin or bread did not affect the quantity of lignan excretion. Plasma lignan concentrations were greater (P < or = 0.05) than baseline by 9 h after flaxseed ingestion (29.35+/-3.69 and 51.75+/-7.49 nmol/L, respectively). The total plasma area under the curve was higher on the eighth than on the first day (1840.15+/-343.02 and 1027.15+/-95.71 nmol x h/L, respectively). CONCLUSION: Mammalian lignan production from flaxseed precursors is dependent on time and dose but not on processing.

Lignans in homemade and commercial products containing flaxseed.

Epidemiologic, in vitro, and in vivo studies support the hypothesis that mammalian lignans have cancer protective effects. Flaxseed is the richest source of plant precursors to mammalian lignans. However, there are limited data on the lignans from processed foods containing flaxseed, despite increasing flaxseed use. Thus the objective of this study was to quantify the lignans in flaxseed-containing processed foods and their relationship to the percent flaxseed in the food. Twenty-five foods including raw flaxseed, homemade products containing flaxseed, and commercial breads and breakfast cereals with and without flaxseed were subjected to an in vitro fermentation designed to simulate the colonic environment necessary for the conversion of plant precursors to mammalian lignans. The lignan production from cereals containing flaxseed was significantly greater than that from their component grains (p < or = 0.01), and the lignan production from breads containing > 4% flaxseed was significantly greater than that from breads containing < 4% flaxseed (p < or = 0.05). Lignan production was significantly related to percent flaxseed in homemade products (r = 0.95, p < or = 0.01) and breakfast cereals (r = 0.997, p < or = 0.0001). Although a significant relationship was also observed in commercial breads (r = 0.58, p < or = 0.05), the correlation was lower because of the variability in different flaxseed varieties and the lignan contribution from other grains and oilseeds in these products. In conclusion, the addition of flaxseed to processed foods increased the production of mammalian lignans significantly. The amount of lignan production was linearly dependent on the percent flaxseed but was also influenced by other grains and the variety of flaxseed.