Trauma care in Scotland: effect of rurality on ambulance travel times and level of destination healthcare facility.

AIM: The aim of this study was to determine the effect of rurality on the level of destination healthcare facility and ambulance response times for trauma patients in Scotland. METHODS: We used a retrospective analysis of pre-hospital data routinely collected by the Scottish Ambulance Service from 2009-2010. Incident locations were categorised by rurality, using the Scottish urban/rural classification. The level of destination healthcare facility was coded as either a teaching hospital, large general hospital, general hospital, or other type of facility. RESULTS: A total of 64,377 incidents met the inclusion criteria. The majority of incidents occurred in urban areas, which mostly resulted in admission to teaching hospitals. Incidents from other areas resulted in admission to a lower-level facility. The majority of incidents originating in very remote small towns and very remote rural areas were treated in a general hospital. Median call-out times and travel times increased with the degree of rurality, although with some exceptions. CONCLUSIONS: Trauma is relatively rare in rural areas, but patients injured in remote locations are doubly disadvantaged by prolonged pre-hospital times and admission to a hospital that may not be adequately equipped to deal with their injuries. These problems may be overcome by the regionalisation of trauma care, and enhanced retrieval capability.

The UK military experience of thoracic injury in the wars in Iraq and Afghanistan.

INTRODUCTION: Thoracic injury during warfare is associated with a high incidence of morbidity and mortality. This study examines the pattern and mortality of thoracic wounding in the counter-insurgency conflicts of Iraq and Afghanistan, and outlines the operative and decision making skills required by the modern military surgeon in the deployed hospital setting to manage these injuries. METHODS: The UK Joint Theatre Trauma Registry was searched between 2003 and 2011 to identify all patients who sustained battle-related thoracic injuries admitted to a UK Field Hospital (Role 3). All UK soldiers, coalition forces and local civilians were included. RESULTS: During the study period 7856 patients were admitted because of trauma, 826 (10.5%) of whom had thoracic injury. Thoracic injury-related mortality was 118/826 (14.3%). There were no differences in gender, age, coalition status and mechanism of injury between survivors and non-survivors. Survivors had a significantly higher GCS, Revised Trauma Score and systolic blood pressure on admission to a Role 3 facility. Multivariable regression analysis identified admission systolic blood pressure less than 90, severe head or abdominal injury and cardiac arrest as independent predictors of mortality. CONCLUSIONS: Blast is the main mechanism of thoracic wounding in the recent conflicts in Iraq and Afghanistan. Thoracic trauma in association with severe head or abdominal injuries are predictors of mortality, rather than thoracic injury alone. Deploying surgeons require training in thoracic surgery in order to be able to manage patients appropriately at Role 3.

Synaptophysin immunoreactivity in the aging rat pituitary gland.

The density of synaptophysin (SN)-immunoreactivity (IR) was examined in pituitary glands of aging male Sprague-Dawley rats. SN-IR was observed as dense dots among endocrine cells of the intermediate lobe, while the neural lobe contained numerous, highly dense immunopositive regions. Some anterior lobe secretory cells contained SN-IR within the cytoplasm, suggestive of the presence of the protein in secretory granules, but no dot-like staining was observed between endocrine cells of that region. A quantitative analysis of the dot-like SN-immunostaining within the intermediate lobe found that tissue from groups of rats aged 13 months, or 15-17 months, contained significantly fewer SN-immunopositive areas than did tissues from 8-month-old animals. Diminished SN immunostaining is suggestive of reduced numbers of synapses in the intermediate lobe, which may lead to alterations in regulation of pituitary hormone secretion from endocrine cells in the older animals.

Alterations in GAP-43-immunoreactive innervation in the aging rat pituitary.

The levels and distribution of the growth-associated protein, GAP-43, were examined in the pituitary glands of young and aging Sprague-Dawley rats, using immunohistochemical techniques on tissue sections and Western blot analyses. GAP-43-immunoreactive innervation was observed in sections in the intermediate and neural lobes of animals aged 8-15 months, while in the oldest rats studied (17 months), stained fibers were observed mainly in the neural, but not the intermediate lobe. Western blots revealed reduced levels of GAP-43 in samples from 15 month old animals, as compared to 12 month old rats, in the neurointermediate lobes. There was no immunoreactivity for GAP-43 in the anterior lobes in the tissue sections or in the blots in any of the glands examined. A diminished level of GAP-43 in pituitary innervation in aged animals suggests a reduced ability for nerve terminals to undergo 'plastic' changes in their relationship to target endocrine cells. Since GAP-43 has also been suggested to modulate neurotransmitter release, a reduction in the protein in aging nerve terminals may diminish availability of transmitters at presynaptic sites.

[Serum levels of vitamin A (retinol), vitamin E (alpha-tocopherol), cholesterol and triglycerides in women with breast cancer. The relationship to some food habits]. / Niveles séricos de vitamina A (retinol), vitamina E (alfa-tocoferol) colesterol y triglicéridos en mujeres con cáncer de mama. Relación con algunos hábitos alimentarios.

The serum levels of vitamin A (retinol), vitamin E (alpha-tocopherol), cholesterol and triglycerides were studied in a group of 40 women who had been diagnosed as having breast cancer, and they were compared to the levels found in a group of 30 healthy women. Our results indicate that the only statistically significant differences found were those involving retinol, with the cancer group showing significantly lower levels (p < 0.05). These parameters have been examined in the context of the frequency of consumption of foods rich in these vitamins and lipids. A higher frequency of consumption of foods rich in the studied vitamins does not appear to cause significant differences in their blood levels. The differences in specific dietary habits have also been analyzed, with both groups showing a high percentage of people who consume skimmed milk and a majority who use olive oil. Nevertheless, the consumption of fruits and vegetables is lower in the cancer group than in the control group.

Regulation of pituitary beta-endorphin secretion in aging rats: in vitro responsiveness to dopamine.

The intermediate lobe of the mammalian pituitary is highly responsive to dopamine inhibition of beta-endorphin secretion. In this study, the ability of aged (12 months) intermediate lobes to respond to dopamine was compared to that of young (6 weeks) tissue, using a short-term in vitro incubation of isolated rat neurointermediate lobes, with measurement of peptide release by radioimmunoassay. Tissue from the aged rats released greater amounts of beta-endorphin peptide than amounts measured from young tissue at all time periods studied. The aged lobes were also found to be significantly more sensitive to dopamine than young glands, as measured by percent change of each group compared to respective baseline release. In comparison, incubation of tissue from young animals in which the intermediate lobe had been acutely denervated by treating rats with injections of the catecholamine neurotoxin, 6-hydroxydopamine, did not differ in responsiveness to dopamine as compared to tissue from control rats. The observations suggest that aging intermediate lobe, while being hypersecretory, is supersensitive to dopamine, perhaps as the result of gradually reduced innervation.