RESUMEN
Laparoscopes can suffer from fogging and contamination difficulties, resulting in a reduced field of view during surgery. A series of diamond-like carbon films, doped with SiO, were produced by pulsed laser deposition for evaluation as biocompatible, antifogging coatings. DLC films doped with SiO demonstrated hydrophilic properties with water contact angles under 40°. Samples subjected to plasma cleaning had improved contact angle results, with values under 5°. Doping the DLC films with SiO led to an average 40% decrease in modulus and 60% decrease in hardness. Hardness of the doped films, 12.0 - 13.2 GPa, was greater than that of the uncoated fused silica substrate, 9.2 GPa. The biocompatibility was assessed through CellTiter-Glo assays, with the films demonstrating statistically similar levels of cell viability when compared to the control media. The absence of ATP released by blood platelets in contact with the DLC coatings suggests in vivo hemocompatibility. The SiO doped films displayed improved transparency levels in comparison to undoped films, achieving up to an average of 80% transmission over the visible spectrum and an attenuation coefficient of 1.1 × 104 cm-1 at the 450 nm wavelength. The SiO doped DLC films show promise as a method of fog prevention for laparoscopes.
RESUMEN
Peritoneal loose bodies (PLBs) have been sparingly documented within the surgical and radiologic literature, with 38 cases reported to date. A 67-year-old male presented to urology for the management of an asymmetric prostatic nodule. Imaging incidentally identified a well-circumscribed mass of low T2 signal intensity with a small fatty core in the left lower quadrant close to the sigmoid colon; malignancy was in the differential. The mass grew slightly over the next year. A diagnostic laparoscopy retrieved a free floating 4 × 4 cm benign mass from the pelvis, identified as necrotic fat with areas of dystrophic calcifications. PLBs are often a diagnostic dilemma without surgical intervention. Here we present a diagnostic algorithm based on a comprehensive literature review and our case to help better identify unknown abdominal and pelvic fatty masses and to avoid surgery strictly for diagnosis, especially for patients that are not ideal surgical candidates. Using this algorithm, the mass in the patient presented here could have been accurately characterized without invasive diagnostic measures.
RESUMEN
The pollen extracellular matrix contains proteins mediating species specificity and components needed for efficient pollination. We identified all proteins >10 kilodaltons in the Arabidopsis pollen coating and showed that most of the corresponding genes reside in two genomic clusters. One cluster encodes six lipases, whereas the other contains six lipid-binding oleosin genes, including GRP17, a gene that promotes efficient pollination. Individual oleosins exhibit extensive divergence between ecotypes, but the entire cluster remains intact. Analysis of the syntenic region in Brassica oleracea revealed even greater divergence, but a similar clustering of the genes. Such allelic flexibility may promote speciation in plants.
Asunto(s)
Proteínas de Arabidopsis , Arabidopsis/genética , Lipasa/química , Familia de Multigenes , Proteínas de Plantas/química , Polen/química , Proteoma , Alelos , Secuencias de Aminoácidos , Secuencia de Aminoácidos , Arabidopsis/química , Brassica/química , Brassica/genética , Etiquetas de Secuencia Expresada , Genes de Plantas , Variación Genética , Genoma de Planta , Lipasa/genética , Datos de Secuencia Molecular , Fosfotransferasas/química , Fosfotransferasas/genética , Proteínas de Plantas/genética , Estructura Terciaria de Proteína , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Alineación de SecuenciaRESUMEN
We describe the properties of a special class of RNA associated with chromatin. We discuss why this RNA should be considered a distinct class of RNA and not an artifactual degradation product of either transfer or ribosomal RNA.
Asunto(s)
Cromosomas/análisis , ARN/análisis , Acrilamidas , Adenosina Monofosfato/análisis , Animales , Secuencia de Bases , Cesio , Cromatina/análisis , Cromatografía DEAE-Celulosa , Cromatografía en Gel , ADN/análisis , Electroforesis , Técnicas In Vitro , Hibridación de Ácido Nucleico , ARN/aislamiento & purificación , ARN Ribosómico/análisis , ARN de Transferencia/análisis , Ratas , Dodecil Sulfato de SodioRESUMEN
Prenatal exposure to alcohol causes a wide range of deficits known as fetal alcohol spectrum disorders (FASDs). Many factors determine vulnerability to developmental alcohol exposure including timing and pattern of exposure, nutrition and genetics. Here, we characterized how a prevalent single nucleotide polymorphism in the human brain-derived neurotrophic factor (BDNF) gene (val66met) modulates FASDs severity. This polymorphism disrupts BDNF's intracellular trafficking and activity-dependent secretion, and has been linked to increased incidence of neuropsychiatric disorders such as depression and anxiety. We hypothesized that developmental ethanol (EtOH) exposure more severely affects mice carrying this polymorphism. We used transgenic mice homozygous for either valine (BDNFval/val ) or methionine (BDNFmet/met ) in residue 68, equivalent to residue 66 in humans. To model EtOH exposure during the second and third trimesters of human pregnancy, we exposed mice to EtOH in vapor chambers during gestational days 12 to 19 and postnatal days 2 to 9. We found that EtOH exposure reduces cell layer volume in the dentate gyrus and the CA1 hippocampal regions of BDNFmet/met but not BDNFval/val mice during the juvenile period (postnatal day 15). During adulthood, EtOH exposure reduced anxiety-like behavior and disrupted trace fear conditioning in BDNFmet/met mice, with most effects observed in males. EtOH exposure reduced adult neurogenesis only in the ventral hippocampus of BDNFval/val male mice. These studies show that the BDNF val66met polymorphism modulates, in a complex manner, the effects of developmental EtOH exposure, and identify a novel genetic risk factor that may regulate FASDs severity in humans.
Asunto(s)
Ansiedad/genética , Factor Neurotrófico Derivado del Encéfalo/genética , Depresores del Sistema Nervioso Central/toxicidad , Etanol/toxicidad , Hipocampo/efectos de los fármacos , Mutación Missense , Efectos Tardíos de la Exposición Prenatal/genética , Animales , Condicionamiento Clásico , Miedo , Femenino , Hipocampo/crecimiento & desarrollo , Masculino , Ratones , Polimorfismo de Nucleótido Simple , EmbarazoRESUMEN
In this chapter, we review the effects of global null mutant and overexpressing transgenic mouse lines on voluntary self-administration of alcohol. We examine approximately 200 publications pertaining to the effects of 155 mouse genes on alcohol consumption in different drinking models. The targeted genes vary in function and include neurotransmitter, ion channel, neuroimmune, and neuropeptide signaling systems. The alcohol self-administration models include operant conditioning, two- and four-bottle choice continuous and intermittent access, drinking in the dark limited access, chronic intermittent ethanol, and scheduled high alcohol consumption tests. Comparisons of different drinking models using the same mutant mice are potentially the most informative, and we will highlight those examples. More mutants have been tested for continuous two-bottle choice consumption than any other test; of the 137 mouse genes examined using this model, 97 (72%) altered drinking in at least one sex. Overall, the effects of genetic manipulations on alcohol drinking often depend on the sex of the mice, alcohol concentration and time of access, genetic background, as well as the drinking test.
Asunto(s)
Consumo de Bebidas Alcohólicas/genética , Alcoholismo/genética , Modelos Animales de Enfermedad , Etanol/administración & dosificación , Animales , Conducta de Elección/efectos de los fármacos , Conducta de Elección/fisiología , Condicionamiento Operante/efectos de los fármacos , Condicionamiento Operante/fisiología , Ratones , Ratones Transgénicos , Autoadministración , Caracteres SexualesRESUMEN
Exposure to ethanol during fetal development produces long-lasting neurobehavioral deficits caused by functional alterations in neuronal circuits across multiple brain regions. Therapeutic interventions currently used to treat these deficits are only partially efficacious, which is a consequence of limited understanding of the mechanism of action of ethanol. Here, we describe a novel effect of ethanol in the developing brain. Specifically, we show that exposure of rats to ethanol in vapor chambers during the equivalent to the third trimester of human pregnancy causes brain micro-hemorrhages. This effect was observed both at low and high doses of ethanol vapor exposure, and was not specific to this exposure paradigm as it was also observed when ethanol was administered via intra-esophageal gavage. The vast majority of the micro-hemorrhages were located in the cerebral cortex but were also observed in the hypothalamus, midbrain, olfactory tubercle, and striatum. The auditory, cingulate, insular, motor, orbital, retrosplenial, somatosensory, and visual cortices were primarily affected. Immunohistochemical experiments showed that the micro-hemorrhages caused neuronal loss, as well as reactive astrogliosis and microglial activation. Analysis with the Catwalk test revealed subtle deficits in motor function during adolescence/young adulthood. In conclusion, our study provides additional evidence linking developmental ethanol exposure with alterations in the fetal cerebral vasculature. Given that this effect was observed at moderate levels of ethanol exposure, our findings lend additional support to the recommendation that women abstain from consuming alcoholic beverages during pregnancy.
Asunto(s)
Encéfalo/patología , Depresores del Sistema Nervioso Central/toxicidad , Etanol/toxicidad , Trastornos del Espectro Alcohólico Fetal/patología , Hemorragias Intracraneales/etiología , Hemorragias Intracraneales/patología , Animales , Astrocitos/efectos de los fármacos , Astrocitos/patología , Fenómenos Biomecánicos , Encéfalo/efectos de los fármacos , Encéfalo/crecimiento & desarrollo , Modelos Animales de Enfermedad , Femenino , Trastornos del Espectro Alcohólico Fetal/fisiopatología , Gliosis/etiología , Gliosis/patología , Gliosis/fisiopatología , Hemorragias Intracraneales/fisiopatología , Masculino , Microglía/efectos de los fármacos , Microglía/patología , Actividad Motora/efectos de los fármacos , Neuronas/efectos de los fármacos , Neuronas/patología , Embarazo , Ratas Sprague-DawleyRESUMEN
Moderate resolution thermal denaturation profiles are presented for the purified DNAs from Escherichia coli, cow, mouse, rat and chicken. All show multiple thermal transitions indicative of large blocks of DNA with very similar base composition. The eucaryotes all have much more of this kind of DNA than does E. coli. The satellite DNAs of cow and mouse are clearly visible and it is likely that the other transitions represent additional families of repeated DNA.
Asunto(s)
ADN , Desnaturalización de Ácido Nucleico , Animales , Bovinos , Centrifugación por Gradiente de Densidad , Pollos , ADN Bacteriano , ADN Satélite , Escherichia coli , Cinética , Ratones , Peso Molecular , Ratas , Especificidad de la Especie , TemperaturaRESUMEN
The cloning and sequencing of the Brucella abortus groES and groEL genes are reported. The genes are adjacent on the Brucella chromosome, and presumably comprise a functional operon. Putative promoter and terminator sequences are also identified. The groES gene exhibits 60%, and the groEl gene 69%, sequence identity with the corresponding Escherichia coli genes.
Asunto(s)
Proteínas Bacterianas/genética , Brucella abortus/genética , Proteínas de Choque Térmico/genética , Operón/genética , Secuencia de Aminoácidos , Proteínas Bacterianas/química , Secuencia de Bases , Chaperonina 10 , Chaperonina 60 , Clonación Molecular , Proteínas de Choque Térmico/química , Datos de Secuencia Molecular , Regiones Promotoras Genéticas , Homología de Secuencia de Ácido Nucleico , Regiones Terminadoras GenéticasRESUMEN
Brucella abortus arginase and ornithine cyclodeaminase genes have been cloned and sequenced. These gene sequences are located in the same operon and occur in the same order as the homologous genes in Agrobacterium tumefaciens Ti C58 plasmid. The nucleotide sequences of the two genes have 72% and 65% identity to the respective Ti plasmid genes. Both genes are present in a single copy, and expression of arginase is regulated in response to arginine.
Asunto(s)
Amoníaco-Liasas/genética , Arginasa/genética , Brucella abortus/genética , Agrobacterium tumefaciens/genética , Secuencia de Aminoácidos , Secuencia de Bases , Brucella abortus/enzimología , Datos de Secuencia Molecular , PlásmidosRESUMEN
Heterokaryons of Verticillium dahliae, forced between complementary auxotrophs, were stable at 21 degrees and resembled the wild type morphologically. In such heterokaryons the hyphal cells were predominantly uninucleate, and no nuclear migration from cell to cell was observed. Heterokaryosis was apparently confined to binucleate, interhyphal, anastomosed cells that arose 1-2 mm behind the colony front. Such anastomosed cells thereby fed and maintained large homokaryotic areas including the colony edge. This stable mosaic colony is in sharp contrast to the heterokaryon of Neurospora.-Heterokaryons of V. dahliae cannot continue growth at 30 degrees because the high temperature prevents hyphal anastomosis. Heterozygous diploids sector out from heterokaryons after 8-12 days at 30 degrees . Interhyphal anastomosed cells are apparently the site of karyogamy.
RESUMEN
Inheritance of mitochondrial DNA (mtDNA) in Holstein cattle was characterized by pedigree analysis of nucleotide sequence variation. mtDNA was purified from leukocytes of 174 individuals representing 35 independent maternal lineages, and analyzed for nucleotide sequence variation by characterization of restriction fragment length polymorphism and direct sequence determination. These data revealed 11 maternal lineages in which leukocytes from some individuals seemingly were homoplasmic for the reference mtDNA sequence at nucleotide 364, whereas those from other individuals were homoplasmic for a sequence variant at this position. Both alternative alleles were detected in all branches of these 11 lineages, suggesting that mutation at nucleotide 364 and fixation of the variant sequence occurred frequently in independent events. Thirteen instances were detected of mother-daughter pairs in which leukocytes of each of the two animals seemingly were homoplasmic for a different allele at nucleotide 364, demonstrating the bovine mitochondrial genome can be replaced completely by a nucleotide sequence variant within a single generation. The two alternative sequences seemingly arose de novo at similar frequency, ruling out replicative advantage or other selective bias as the explanation for rapid fixation of mutations at nucleotide 364. Another instance of intralineage sequence variation was detected at nucleotide 5602. This variation was detected in only one of the lineages examined, and evidently arose within three generations.
Asunto(s)
Bovinos/genética , ADN Mitocondrial/genética , Mutación/genética , Polimorfismo de Longitud del Fragmento de Restricción , Alelos , Animales , Secuencia de Bases , Femenino , Variación Genética/genética , Datos de Secuencia Molecular , LinajeRESUMEN
The chemical elicitor acibenzolar-S-methyl (ASM; Actigard 50 WG), which induces systemic acquired resistance (SAR), was investigated to determine the effect on bacterial wilt of tomato caused by Ralstonia solanacearum on moderately resistant cultivars under greenhouse and field conditions. In greenhouse experiments, ASM was applied as foliar spray and/or soil drench (3 µg/ml) before and as foliar spray (30 µg/ml) after transplanting. The chemical elicitor was ineffective in reducing bacterial wilt incidence on susceptible tomato cultivars Equinox and FL 47 when plants were inoculated with R. solanacearum. However, greenhouse studies indicated that ASM significantly enhanced resistance in cultivars with moderate resistance to bacterial wilt such as Neptune and BHN 466. It appeared that ASM-mediated resistance was partially due to prevention of internal spread of R. solanacearum toward upper stem tissues of tomato plants. The effect of ASM on moderately resistant cultivars was consistent in field experiments conducted in 2002 and 2003 in Quincy, FL, where bacterial wilt incidence was significantly reduced in ASM-treated BHN 466 (in 2002), FL 7514 (in 2003), and Neptune (both years) plants. ASM-treated BHN 466 and FL 7514 produced significantly higher tomato yield than the untreated controls. This is the first report of ASM-mediated control of bacterial wilt under field conditions, which suggests that use of this treatment for moderately resistant genotypes may be effective for control of bacterial wilt of tomato.
RESUMEN
A Brucella abortus protein with a molecular weight of 50 kDa has been shown to bind bovine immunoglobulin G from healthy, brucellosis-free animals. The Brucella immunoglobulin G binding molecule appears to be a protein, since it is susceptible to proteolysis. The protein is presumed to be located on the cell surface, since intact cells precipitate bovine immunoglobulin G. Examination of other species of Brucella shows that all Brucella species and strains tested express the protein. B. abortus cells also bound immunoglobulin G from other animal species. These included cat, chicken, dog, guinea pig, horse, human, mouse, rat, sheep, swine, and turkey but not immunoglobulin G from goat or rabbit.
Asunto(s)
Antígenos de Diferenciación/metabolismo , Proteínas Bacterianas/metabolismo , Brucella abortus/inmunología , Inmunoglobulina G/metabolismo , Receptores Fc/metabolismo , Animales , Western Blotting , Brucella/inmunología , Humanos , Técnicas In Vitro , Unión Proteica , Receptores de IgG , Especificidad de la EspecieRESUMEN
OBJECTIVE: To determine the prevalence of gestational diabetes mellitus in Zuni Indian women and the subsequent rate of diabetes among Zuni women with GDM. RESEARCH DESIGN AND METHODS: A retrospective analysis of 809 deliveries over a 4-yr period among Zuni Indian women was conducted to determine the prevalence of GDM and diabetes antedating pregnancy. A prospective case-control study of 47 full-blooded Zuni Indian women with GDM and 47 control subjects was performed to determine the progression to clinical diabetes in women with a first-time diagnosis of GDM. Cases with GDM delivered during a defined 8-yr period. The control group of Zuni women delivered during the same time period but had plasma glucose values < 7.8 mM on the 1-h glucose screening test. Cases with GDM and control subjects were matched for age, body mass index, gravidity, and length of follow-up. All women were re-evaluated for diabetes up to 9 yr after the index pregnancy. RESULTS: Between 1987-1990, 116 cases of GDM and 8 cases of pre-existing diabetes were identified, giving a prevalence of maternal diabetes in pregnancy of 15.3%. At the time of follow-up, 14 of 47 (30%) women with GDM had developed diabetes after a mean of 4.8 yr compared with only 3 of 47 (6%) from the control group with an average of 5.5 yr follow-up. CONCLUSIONS: GDM is prevalent among Zuni Indians and is associated with an increased risk of diabetes. Glucose tolerance after GDM may deteriorate at a greater rate in Native Americans than in other populations.
Asunto(s)
Diabetes Mellitus/epidemiología , Diabetes Gestacional/epidemiología , Indígenas Norteamericanos , Embarazo en Diabéticas/epidemiología , Adulto , Glucemia/análisis , Estudios de Casos y Controles , Femenino , Estudios de Seguimiento , Prueba de Tolerancia a la Glucosa , Humanos , New Mexico/epidemiología , Embarazo , Prevalencia , Estudios Prospectivos , Estudios RetrospectivosRESUMEN
In this report, we propose new International Classification of Diseases (ICD) codes that could be incorporated into computer-based patient records or administrative data to monitor and improve diabetes care. Neither the ICD, 9th Revision, nor its imminent replacement, the ICD, 10th Revision, has specific codes for foot examinations and funduscopic examinations in the asymptomatic person, high-risk diabetic foot status, or clinically significant macular edema. Adoption of official codes for these procedures and conditions implemented in conjunction with computerized databases could be used for surveillance, program planning, and quality of care assessment. Computerized medical records could use the codes to monitor care and issue reminders to patients and providers. Payors could offer reimbursement incentives to encourage compliance with standard recommendations. These codes for care procedures could be linked to outcomes, such as amputations and blindness, to improve our understanding of the etiology of blindness and the relationship between process and outcome. The uniform adoption of these codes would facilitate comparison between health care systems, geographic regions, and nations. The diabetes community should encourage the National Center for Health Statistics to adopt new codes that could be used to monitor diabetes preventive care practices.
Asunto(s)
Atención a la Salud/normas , Pie Diabético/prevención & control , Pie Diabético/terapia , Retinopatía Diabética/prevención & control , Retinopatía Diabética/terapia , Sistemas de Registros Médicos Computarizados/normas , Guías de Práctica Clínica como Asunto , Adulto , Amputación Quirúrgica , Ceguera , Bases de Datos Factuales , Pie Diabético/epidemiología , Retinopatía Diabética/epidemiología , Angiografía con Fluoresceína/normas , Humanos , Degeneración Macular/diagnóstico , Examen Físico/normas , Factores de Riesgo , Resultado del Tratamiento , Estados Unidos , Agencias Voluntarias de SaludRESUMEN
OBJECTIVE: To determine the rates and demographic determinants of work disability, hours worked per week, work-loss days, and wages in individuals with diabetes. RESEARCH DESIGN AND METHODS: A probit regression analysis was performed on a cross-sectional population-based survey of U.S. noninstitutionalized civilian population (National Medical Expenditures Survey--2, 1987). The sample was restricted to individuals aged > or = 25 years. A total of 1,502 individuals reported having diabetes, and 20,405 did not. Information on workforce participation and income were collected quarterly. Work disability was defined as a self-report of having been unable to work because of illness or disability for > or = 2 quarters in 1987. RESULTS: Work disability was reported by 25.6% of individuals with diabetes, compared with 7.8% of those without diabetes. Work disability rates were higher for older people, females, and African-Americans, and lower for Hispanics and for individuals with greater non-wage income. Individuals with diabetes engaged in the workforce had more work-loss days than did nondiabetic individuals, but had similar hourly wages. Predicted mean earnings were significantly lower for individuals with diabetes at all ages, resulting in $4.7 million loss in earnings in 1987 due to work disability. CONCLUSIONS: Work disability is significantly higher for individuals with diabetes than for those without diabetes at all ages, and results in a significant decrease in earnings. A disproportionate burden of work disability is borne by older individuals and women with diabetes. Better information on the determinants of work disability in individuals with diabetes is needed.
Asunto(s)
Diabetes Mellitus/rehabilitación , Evaluación de la Discapacidad , Empleo/estadística & datos numéricos , Absentismo , Adulto , Negro o Afroamericano/estadística & datos numéricos , Factores de Edad , Estudios Transversales , Demografía , Personas con Discapacidad/estadística & datos numéricos , Femenino , Hispánicos o Latinos/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Análisis de Regresión , Factores Sexuales , Estados Unidos , Población Blanca/estadística & datos numéricosRESUMEN
OBJECTIVE: To describe geographic variation in rates of lower-limb major amputation in Medicare patients with and without diabetes. RESEARCH DESIGN AND METHODS: This cross-sectional population-based study used national fee-for-service Medicare claims from 1996 through 1997. The unit of analysis was 306 hospital referral regions (HRRs) representing health care markets for their respective tertiary medical centers. Numerators were calculated using nontraumatic major amputations and the diabetes code (250.x) for individuals with diabetes. Denominators for individuals with diabetes were created by multiplying the regional prevalence of diabetes (as determined using a 5% sample of Medicare Part B data identifying at least two visits with a diabetes code for 1995-1996) by the regional Medicare population. Denominators for individuals without diabetes were the remaining Medicare beneficiaries. Rates of major amputations were adjusted for age, sex, and race. RESULTS: Rates of major amputations per year were 3.83 per 1,000 (95% CI 3.60-4.06) individuals with diabetes compared with 0.38 per 1,000 (95% C1 0.35-0.41) individuals without diabetes. Marked geographic variation was observed for individuals with and without diabetes; however, patterns were distinct between the two populations. Rates were high in the Southern and Atlantic states for individuals without diabetes. In contrast, rates for individuals with diabetes were widely varied. Variation across HRRs for individuals with diabetes was 8.6-fold compared with 6.7-fold in individuals without diabetes for major amputations. CONCLUSIONS: Diabetes-related amputation rates exhibit high regional variation, even after age, sex, and race adjustment. Future work should be directed to exploring sources of this variation.
Asunto(s)
Amputación Quirúrgica/estadística & datos numéricos , Pie Diabético/epidemiología , Pie Diabético/cirugía , Pierna , Medicare/estadística & datos numéricos , Distribución por Edad , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Geografía , Humanos , Masculino , Prevalencia , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVE: To quantify the contribution of various risk factors to the risk of amputation in diabetic patients and to develop a foot risk scoring system based on clinical data. RESEARCH DESIGN AND METHODS: A population case-control study was undertaken. Eligible subjects were 1) 25-85 years of age, 2) diabetic, 3) 50% or more Pima or Tohono O'odham Indian, 4) lived in the Gila River Indian Community, and 5) had had at least one National Institutes of Health research examination. Case patients had had an incident lower extremity amputation between 1983 and 1992; control subjects had no amputation by 1992. Medical records were reviewed to determine risk conditions and health status before the pivotal event that led to the amputation. RESULTS: Sixty-one people with amputations were identified and compared with 183 control subjects. Men were more likely to suffer amputation than women (odds ratio [OR] 6.5, 95% CI 2.6-15), and people with diabetic eye, renal, or cardiovascular disease were more likely to undergo amputation than those without (OR 4.6, 95% CI 1.7-12). The risk of amputation was almost equally associated with these foot risk factors: peripheral neuropathy, peripheral vascular disease, bony deformities, and a history of foot ulcers. After controlling for demographic differences and diabetes severity, the ORs for amputation with one foot risk factor was 2.1 (95% CI 1.4-3.3), with two risk factors, 4.5 (95% CI 2.9-6.9), and with three or four risk factors, 9.7 (95% CI 6.3-14.8). CONCLUSIONS: Male Sex, end-organ complications of eye, heart, and kidney, and poor glucose control were associated with a higher amputation rate. Peripheral neuropathy, peripheral vascular disease, deformity, and a prior ulcer were similarly equally associated with an increased risk of lower extremity amputation.