OBJECTIVE -This study examined the risk of reamputation, stratified by original level of amputation, in a population of diabetic patients. We also illustrated reamputation rates by ipsilateral and contralateral limbs.RESEARCH DESIGN AND METHODS -The study population included 277 diabetic patients with a first lower-extremity amputation performed between 1993 and 1997 at University Hospital in San Antonio, Texas. Reamputation episodes for the ipsilateral and contralateral limbs were recorded through 2003. Using a cumulative incidence curve analysis, we compared the reamputation rate by limb. Cumulative rates of reamputation were calculated for each limb at each amputation level at 1, 3, and 5 years.RESULTS -Cumulative rates of reamputation per person were 26.7% at 1 year, 48.3% at 3 years, and 60.7% at 5 years. Ipsilateral reamputation per amputation level at the 1-, 3-, and 5-year points were toe: 22.8, 39.6, and 52.3%; ray: 28.7, 41.2, and 50%; midfoot: 18.8, 33.3, and 42.9%; and major: 4.7, 11.8, and 13.3%. For contralateral reamputation, the rates at 1, 3, and 5 years were toe: 3.5, 18.8, and 29.5%; ray: 9.3, 21.6, and 29.2%; midfoot: 9.4, 18.5, and 33.3%; and major: 11.6, 44.1, and 53.3%.CONCLUSIONS -This study showed that a patient is at greatest risk for further same-limb amputation in the 6 months after the initial amputation. Although risk to the contralateral limb rises steadily, it never meets the level of that of the ipsilateral limb. This finding will help clinicians focus preventive efforts and medical resources during individualized at-risk periods for diabetic patients undergoing first-time amputations. Diabetes Care 29:566 -570, 2006F oot ulcers and lower-extremity amputations (LEAs) are disabling complications of diabetes that can lead to significant increases in mortality and morbidity (1,2), most notably recurrent amputation at increasingly higher levels. It has been shown that a history of ulceration increases the risk of amputation (3,4), as do prior amputations (4). Several studies have reported reamputation rates (5-15). However, the results of these studies are too general to apply to individual patients; some studies combined reamputation episodes of both ipsilateral and contralateral limbs (5-7) and others addressed reamputation of only one extremity (8 -10). Reamputations at specific levels have been studied (11-15), but how the rates differ by level of amputation is still unknown. In addition, many of these studies included reamputations for patients with existing amputations. The true reamputation rate of first-time amputations has not been reported before this study.In this retrospective cohort study, we aimed to 1) illustrate the difference between the reamputation risk for ipsilateral and contralateral limbs and 2) stratify the risk of reamputation by the original level of amputation. With these findings, we hope to help clinicians estimate individualized risk for patients based on the level of first-time amputation.RESEARCH DESIGN AND METHODS -In this retrospective cohort study,...

Increased expression of sLe(x) could be involved in establishment of colorectal cancer metastasis. It appears that examining sLe(x) expression may serve as a potent marker of the recurrence in patients with colorectal cancer.

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The actually direct Suzuki−Miyaura coupling with "protected" R−B(dan) (dan = naphthalene-1,8-diaminato) was demonstrated to smoothly occur without in situ deprotection of the B(dan) moiety. The use of t-BuOK (Ba(OH) 2 in some cases) as a base under anhydrous conditions is the key to the successful cross-coupling, where R−B(dan) is readily converted into a transmetalation-active borate-form, regardless of the well-accepted diminished boron-Lewis acidity.

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Background-The prognostic relevance of plasma volume reduction (PVR) in acute heart failure patients remains unclear because of the confounding hemodynamic effect of left ventricular ejection fraction impairment on kidney function. Methods and Results-Subjects enrolled in the West Tokyo Heart Failure Registry were examined. The PV at admission and discharge was estimated from the subjects' body weight and its deviation from the ideal body weight. Patients in the top tertile of estimated PVR were classified as PVR+. Of the 381 patients with acute heart failure, 181 (47.5%) had heart failure with preserved ejection fraction (HFpEF). Estimated PVR was associated with worsening renal function in the HFpEF (odds ratio, 3.28; 95% confidence interval, 1.55-6.96; P=0.002) but not in the heart failure with reduced ejection fraction cohort (odds ratio, 1.22; 95% confidence interval, 0.61-2.42; P=0.57). This association in the HFpEF cohort remained significant after adjusting for a history of hypertension and diabetes mellitus and the estimated glomerular filtration rate (odds ratio, 3.34; 95% confidence interval, 1.52-7.33; P=0.003). The use of intravenous diuretics was a significant predictor of PVR in the HFpEF and heart failure with reduced ejection fraction groups. Conclusions-The effect of estimated PVR differs by HF type, and the estimated PVR during hospitalization is a predictor of worsening renal function in patients with HFpEF but not in heart failure with reduced ejection fraction. Clinical Trial Registration