Low iCa is associated with prehospital hypotension regardless of age, ISS, or sampling time and is a better predictor of mortality than base deficit. Since acidosis reduces calcium binding to serum protein and actually increases iCa, the association between base deficit and iCa in this study requires further investigation.

Human and bovine milk inhibited the metabolic activity of Escherichia coli, as shown by luminescence monitoring of constructs expressing the luxCDABE genes. Inhibition was dependent on both xanthine oxidase (XO) activity and on the presence of nitrite, implying that XO-generated nitric oxide functions as an antibacterial agent.Though the abundance of xanthine oxidase (XO) in milk has been recognized for more than a century (19), its physiological function has remained a matter of speculation. Isolated studies, however, have considered an antimicrobial role for XO; in these, purified XO was shown to inhibit bacterial growth in the presence of a reducing substrate, which presumed the generation of hydrogen peroxide (13,18,25).Recently, the ability of XO to catalyze reactions that generate nitric oxide (NO˙) from inorganic nitrite was reported (11,20). NO˙is formed only under anaerobic conditions; when oxygen is present, superoxide is also produced, which reacts with XO-generated NO˙to form peroxynitrite (12), a powerful bactericidal agent (6). These observations prompted us to investigate the antibacterial activities of milk, particularly under defined oxygen tensions and with reference to the involvement of nitrite. We used Escherichia coli cells transformed with a plasmid, pLITE27, which carries the luxCDABE operon from Photorhabdus luminescens controlled by the constitutive promoter. Microorganisms expressing the lux operon are able to emit light due to the activity of bacterial luciferase on reduced flavin mononucleotide and a long-chain aldehyde that produces flavin mononucleotide, acid, and blue-green light. Since reduced flavin mononucleotide production depends upon functional electron transport, only metabolically active cells can produce light (4). Therefore, lux operon-dependent bioluminescence is an extremely sensitive, nondestructive, real-time reporter of cell metabolism that has been successfully used to monitor antimicrobial effects (23). This technology confers many advantages over conventional plating techniques and has allowed us to demonstrate, for the first time, bacteriostatic activity for both bovine and human milk that is dependent on XO, low oxygen tensions, and nitrite.E. coli isolate 16906 was transformed with the luxCDABE operon (23). Cells were grown overnight at 37°C on nutrient agar plates with 50 g of ampicillin per ml, subcultured into minimal salts medium (8), and grown at 37°C with aeration for 3 h. Aliquots were mixed with an equal volume of 40% glycerol and frozen at Ϫ80°C. Before each assay, aliquots were pelleted by centrifugation and resuspended in fresh minimal salts medium at 37°C without glucose or a nitrogen source. Suspension of the cells in the nutrient-deprived medium caused the cells to cease active growth and enter stationary phase, where metabolic activity is at a steady low level. Measured light output was stable, as monitored by a specifically adapted luminometer. This instrument (LKB 1250) was modified so that the reaction cuvette could be continuously supplied w...

Hypothesis: We hypothesized that patients with diabetes mellitus (DM) have worse outcomes following trauma compared with patients without a history of DM. Design: Retrospective data analysis of the Pennsylvania Trauma Systems Foundation database that compiles data from 27 accredited trauma centers in Pennsylvania. Setting: We used the Pennsylvania Trauma Systems Foundation database of 295 561 patients to compare outcomes in patients with DM vs those in patients who did not have DM. Patients: A total of 12 489 patients with DM from January 1984 to December 2002 were matched by sex, age, and Injury Severity Score with 12 489 patients who did not have DM. Main Outcome Measures: Differences in the length of hospital stay, intensive care unit stay, ventilatory assistance days, complications, and mortality rates. Results: Patients with DM spent more days in the intensive care unit and receiving ventilator support. They were more likely to have a complication (23.0% in the DM group vs 14.0% in the non-DM group [odds ratio, 1.80; 95% confidence interval, 1.69-1.92]). No difference in mortality rates or length of hospital stay was noted. Conclusion: Patients with DM exposed to trauma have greater hospital morbidity resulting from longer intensive care unit stay, increased ventilator support, and more complications.