口服补液对烧伤休克犬肺组织含水量和血管通透性的影响

Objective To investigate the effect of oral fluid resuscitation on pulmonary vascular per-meability and lung water content in burn dogs during shock stage. Methods Eighteen male Beagle dogs with catheterization of carotid artery and jugular vein for 24 hours were subjected to 50% TBSA full-thickness burn, then they were divided into non-fluid resuscitation(NR), oral fluid resuscitation (OR), intravenous fluid resuscitation (IR) groups, with 6 dogs in each group. Dogs in OR and IR groups were given glucose-electrolyte solution (GES) by gastric tube or intravenous infusion according to Parkland formula within 24 hours after burn, while those in NR group were not given any treatment. Dogs in each group were then given intravenous fluid for further resuscitation after 24 post burn hours(PBH). Deaths were recorded within 72 hours after burn. Mean arterial pressure(MAP) , respiratory rate (RR) , PaO2, extravascular lung water in-dex (ELWI) and pulmonary vascular permeability index (PYPI) were determined before burn and at 30 mins and 4, 8, 24, 48, 72 PBH with the aid of PICCO. Dogs were sacrificed to collect lung tissue for deter-mination of water content at 72 PBH or just before death. Results All dogs died during 9-22 PBH in NR group, 3 dogs died during 25-47 PBH in OR group, and all dogs survived within 72 PBH in IR groups. Com-pared with those before burn, RR (44.0±5.0) times/min, ELWI (10.3±0.6) mL/kg and PVPI (6.6± 0.6) were markedly increased in NR group at 8 PBH, but PaO2 and MAP were obviously decreased (P<0.05). In OR group, RR (33.0±4.0) times/min, ELWI (8.9±0.3) mL/kg and PVPI (5.7±0.4) were significantly lower than those of NR group (P<0.05) , but higher than those of IR group [ RR (26.0± 3.0) times/min, ELWI (8.2±0.3) mL/kg, PVPI (4.2±0.4), P <0.05] at 8 PBH. PaO2 and MAP in OR group were higher than that in NR group (P<0.05). Lung water content showed no statistically signifi-cant difference between OR ang IR groups (P>0.05), which were lower than that in NR group ( P < 0.05). Conclusions Although the protective effect of oral fluid resuscitation with GES on the lung of burn dog at shock stage was inferior to intravenous fluid, it still can decrease pulmonary vascular permeabili-ty, alleviate pulmonary edema, and reduce pulmonary complication compared with no resuscitation with fluids.     

口服补液对烧伤休克犬肺组织含水量和血管通透性的影响

Objective To investigate the effect of oral fluid resuscitation on pulmonary vascular per-meability and lung water content in burn dogs during shock stage. Methods Eighteen male Beagle dogs with catheterization of carotid artery and jugular vein for 24 hours were subjected to 50% TBSA full-thickness burn, then they were divided into non-fluid resuscitation(NR), oral fluid resuscitation (OR), intravenous fluid resuscitation (IR) groups, with 6 dogs in each group. Dogs in OR and IR groups were given glucose-electrolyte solution (GES) by gastric tube or intravenous infusion according to Parkland formula within 24 hours after burn, while those in NR group were not given any treatment. Dogs in each group were then given intravenous fluid for further resuscitation after 24 post burn hours(PBH). Deaths were recorded within 72 hours after burn. Mean arterial pressure(MAP) , respiratory rate (RR) , PaO2, extravascular lung water in-dex (ELWI) and pulmonary vascular permeability index (PYPI) were determined before burn and at 30 mins and 4, 8, 24, 48, 72 PBH with the aid of PICCO. Dogs were sacrificed to collect lung tissue for deter-mination of water content at 72 PBH or just before death. Results All dogs died during 9-22 PBH in NR group, 3 dogs died during 25-47 PBH in OR group, and all dogs survived within 72 PBH in IR groups. Com-pared with those before burn, RR (44.0±5.0) times/min, ELWI (10.3±0.6) mL/kg and PVPI (6.6± 0.6) were markedly increased in NR group at 8 PBH, but PaO2 and MAP were obviously decreased (P<0.05). In OR group, RR (33.0±4.0) times/min, ELWI (8.9±0.3) mL/kg and PVPI (5.7±0.4) were significantly lower than those of NR group (P<0.05) , but higher than those of IR group [ RR (26.0± 3.0) times/min, ELWI (8.2±0.3) mL/kg, PVPI (4.2±0.4), P <0.05] at 8 PBH. PaO2 and MAP in OR group were higher than that in NR group (P<0.05). Lung water content showed no statistically signifi-cant difference between OR ang IR groups (P>0.05), which were lower than that in NR group ( P < 0.05). Conclusions Although the protective effect of oral fluid resuscitation with GES on the lung of burn dog at shock stage was inferior to intravenous fluid, it still can decrease pulmonary vascular permeabili-ty, alleviate pulmonary edema, and reduce pulmonary complication compared with no resuscitation with fluids.     

口服补液对烧伤休克犬肺组织含水量和血管通透性的影响

Objective To investigate the effect of oral fluid resuscitation on pulmonary vascular per-meability and lung water content in burn dogs during shock stage. Methods Eighteen male Beagle dogs with catheterization of carotid artery and jugular vein for 24 hours were subjected to 50% TBSA full-thickness burn, then they were divided into non-fluid resuscitation(NR), oral fluid resuscitation (OR), intravenous fluid resuscitation (IR) groups, with 6 dogs in each group. Dogs in OR and IR groups were given glucose-electrolyte solution (GES) by gastric tube or intravenous infusion according to Parkland formula within 24 hours after burn, while those in NR group were not given any treatment. Dogs in each group were then given intravenous fluid for further resuscitation after 24 post burn hours(PBH). Deaths were recorded within 72 hours after burn. Mean arterial pressure(MAP) , respiratory rate (RR) , PaO2, extravascular lung water in-dex (ELWI) and pulmonary vascular permeability index (PYPI) were determined before burn and at 30 mins and 4, 8, 24, 48, 72 PBH with the aid of PICCO. Dogs were sacrificed to collect lung tissue for deter-mination of water content at 72 PBH or just before death. Results All dogs died during 9-22 PBH in NR group, 3 dogs died during 25-47 PBH in OR group, and all dogs survived within 72 PBH in IR groups. Com-pared with those before burn, RR (44.0±5.0) times/min, ELWI (10.3±0.6) mL/kg and PVPI (6.6± 0.6) were markedly increased in NR group at 8 PBH, but PaO2 and MAP were obviously decreased (P<0.05). In OR group, RR (33.0±4.0) times/min, ELWI (8.9±0.3) mL/kg and PVPI (5.7±0.4) were significantly lower than those of NR group (P<0.05) , but higher than those of IR group [ RR (26.0± 3.0) times/min, ELWI (8.2±0.3) mL/kg, PVPI (4.2±0.4), P <0.05] at 8 PBH. PaO2 and MAP in OR group were higher than that in NR group (P<0.05). Lung water content showed no statistically signifi-cant difference between OR ang IR groups (P>0.05), which were lower than that in NR group ( P < 0.05). Conclusions Although the protective effect of oral fluid resuscitation with GES on the lung of burn dog at shock stage was inferior to intravenous fluid, it still can decrease pulmonary vascular permeabili-ty, alleviate pulmonary edema, and reduce pulmonary complication compared with no resuscitation with fluids.     

口服补液对烧伤休克犬肺组织含水量和血管通透性的影响

Objective To investigate the effect of oral fluid resuscitation on pulmonary vascular per-meability and lung water content in burn dogs during shock stage. Methods Eighteen male Beagle dogs with catheterization of carotid artery and jugular vein for 24 hours were subjected to 50% TBSA full-thickness burn, then they were divided into non-fluid resuscitation(NR), oral fluid resuscitation (OR), intravenous fluid resuscitation (IR) groups, with 6 dogs in each group. Dogs in OR and IR groups were given glucose-electrolyte solution (GES) by gastric tube or intravenous infusion according to Parkland formula within 24 hours after burn, while those in NR group were not given any treatment. Dogs in each group were then given intravenous fluid for further resuscitation after 24 post burn hours(PBH). Deaths were recorded within 72 hours after burn. Mean arterial pressure(MAP) , respiratory rate (RR) , PaO2, extravascular lung water in-dex (ELWI) and pulmonary vascular permeability index (PYPI) were determined before burn and at 30 mins and 4, 8, 24, 48, 72 PBH with the aid of PICCO. Dogs were sacrificed to collect lung tissue for deter-mination of water content at 72 PBH or just before death. Results All dogs died during 9-22 PBH in NR group, 3 dogs died during 25-47 PBH in OR group, and all dogs survived within 72 PBH in IR groups. Com-pared with those before burn, RR (44.0±5.0) times/min, ELWI (10.3±0.6) mL/kg and PVPI (6.6± 0.6) were markedly increased in NR group at 8 PBH, but PaO2 and MAP were obviously decreased (P<0.05). In OR group, RR (33.0±4.0) times/min, ELWI (8.9±0.3) mL/kg and PVPI (5.7±0.4) were significantly lower than those of NR group (P<0.05) , but higher than those of IR group [ RR (26.0± 3.0) times/min, ELWI (8.2±0.3) mL/kg, PVPI (4.2±0.4), P <0.05] at 8 PBH. PaO2 and MAP in OR group were higher than that in NR group (P<0.05). Lung water content showed no statistically signifi-cant difference between OR ang IR groups (P>0.05), which were lower than that in NR group ( P < 0.05). Conclusions Although the protective effect of oral fluid resuscitation with GES on the lung of burn dog at shock stage was inferior to intravenous fluid, it still can decrease pulmonary vascular permeabili-ty, alleviate pulmonary edema, and reduce pulmonary complication compared with no resuscitation with fluids.     

口服补液对烧伤休克犬肺组织含水量和血管通透性的影响

Objective To investigate the effect of oral fluid resuscitation on pulmonary vascular per-meability and lung water content in burn dogs during shock stage. Methods Eighteen male Beagle dogs with catheterization of carotid artery and jugular vein for 24 hours were subjected to 50% TBSA full-thickness burn, then they were divided into non-fluid resuscitation(NR), oral fluid resuscitation (OR), intravenous fluid resuscitation (IR) groups, with 6 dogs in each group. Dogs in OR and IR groups were given glucose-electrolyte solution (GES) by gastric tube or intravenous infusion according to Parkland formula within 24 hours after burn, while those in NR group were not given any treatment. Dogs in each group were then given intravenous fluid for further resuscitation after 24 post burn hours(PBH). Deaths were recorded within 72 hours after burn. Mean arterial pressure(MAP) , respiratory rate (RR) , PaO2, extravascular lung water in-dex (ELWI) and pulmonary vascular permeability index (PYPI) were determined before burn and at 30 mins and 4, 8, 24, 48, 72 PBH with the aid of PICCO. Dogs were sacrificed to collect lung tissue for deter-mination of water content at 72 PBH or just before death. Results All dogs died during 9-22 PBH in NR group, 3 dogs died during 25-47 PBH in OR group, and all dogs survived within 72 PBH in IR groups. Com-pared with those before burn, RR (44.0±5.0) times/min, ELWI (10.3±0.6) mL/kg and PVPI (6.6± 0.6) were markedly increased in NR group at 8 PBH, but PaO2 and MAP were obviously decreased (P<0.05). In OR group, RR (33.0±4.0) times/min, ELWI (8.9±0.3) mL/kg and PVPI (5.7±0.4) were significantly lower than those of NR group (P<0.05) , but higher than those of IR group [ RR (26.0± 3.0) times/min, ELWI (8.2±0.3) mL/kg, PVPI (4.2±0.4), P <0.05] at 8 PBH. PaO2 and MAP in OR group were higher than that in NR group (P<0.05). Lung water content showed no statistically signifi-cant difference between OR ang IR groups (P>0.05), which were lower than that in NR group ( P < 0.05). Conclusions Although the protective effect of oral fluid resuscitation with GES on the lung of burn dog at shock stage was inferior to intravenous fluid, it still can decrease pulmonary vascular permeabili-ty, alleviate pulmonary edema, and reduce pulmonary complication compared with no resuscitation with fluids.     

口服补液对烧伤休克犬肺组织含水量和血管通透性的影响

Objective To investigate the effect of oral fluid resuscitation on pulmonary vascular per-meability and lung water content in burn dogs during shock stage. Methods Eighteen male Beagle dogs with catheterization of carotid artery and jugular vein for 24 hours were subjected to 50% TBSA full-thickness burn, then they were divided into non-fluid resuscitation(NR), oral fluid resuscitation (OR), intravenous fluid resuscitation (IR) groups, with 6 dogs in each group. Dogs in OR and IR groups were given glucose-electrolyte solution (GES) by gastric tube or intravenous infusion according to Parkland formula within 24 hours after burn, while those in NR group were not given any treatment. Dogs in each group were then given intravenous fluid for further resuscitation after 24 post burn hours(PBH). Deaths were recorded within 72 hours after burn. Mean arterial pressure(MAP) , respiratory rate (RR) , PaO2, extravascular lung water in-dex (ELWI) and pulmonary vascular permeability index (PYPI) were determined before burn and at 30 mins and 4, 8, 24, 48, 72 PBH with the aid of PICCO. Dogs were sacrificed to collect lung tissue for deter-mination of water content at 72 PBH or just before death. Results All dogs died during 9-22 PBH in NR group, 3 dogs died during 25-47 PBH in OR group, and all dogs survived within 72 PBH in IR groups. Com-pared with those before burn, RR (44.0±5.0) times/min, ELWI (10.3±0.6) mL/kg and PVPI (6.6± 0.6) were markedly increased in NR group at 8 PBH, but PaO2 and MAP were obviously decreased (P<0.05). In OR group, RR (33.0±4.0) times/min, ELWI (8.9±0.3) mL/kg and PVPI (5.7±0.4) were significantly lower than those of NR group (P<0.05) , but higher than those of IR group [ RR (26.0± 3.0) times/min, ELWI (8.2±0.3) mL/kg, PVPI (4.2±0.4), P <0.05] at 8 PBH. PaO2 and MAP in OR group were higher than that in NR group (P<0.05). Lung water content showed no statistically signifi-cant difference between OR ang IR groups (P>0.05), which were lower than that in NR group ( P < 0.05). Conclusions Although the protective effect of oral fluid resuscitation with GES on the lung of burn dog at shock stage was inferior to intravenous fluid, it still can decrease pulmonary vascular permeabili-ty, alleviate pulmonary edema, and reduce pulmonary complication compared with no resuscitation with fluids.     

口服补液对烧伤休克犬肺组织含水量和血管通透性的影响

Objective To investigate the effect of oral fluid resuscitation on pulmonary vascular per-meability and lung water content in burn dogs during shock stage. Methods Eighteen male Beagle dogs with catheterization of carotid artery and jugular vein for 24 hours were subjected to 50% TBSA full-thickness burn, then they were divided into non-fluid resuscitation(NR), oral fluid resuscitation (OR), intravenous fluid resuscitation (IR) groups, with 6 dogs in each group. Dogs in OR and IR groups were given glucose-electrolyte solution (GES) by gastric tube or intravenous infusion according to Parkland formula within 24 hours after burn, while those in NR group were not given any treatment. Dogs in each group were then given intravenous fluid for further resuscitation after 24 post burn hours(PBH). Deaths were recorded within 72 hours after burn. Mean arterial pressure(MAP) , respiratory rate (RR) , PaO2, extravascular lung water in-dex (ELWI) and pulmonary vascular permeability index (PYPI) were determined before burn and at 30 mins and 4, 8, 24, 48, 72 PBH with the aid of PICCO. Dogs were sacrificed to collect lung tissue for deter-mination of water content at 72 PBH or just before death. Results All dogs died during 9-22 PBH in NR group, 3 dogs died during 25-47 PBH in OR group, and all dogs survived within 72 PBH in IR groups. Com-pared with those before burn, RR (44.0±5.0) times/min, ELWI (10.3±0.6) mL/kg and PVPI (6.6± 0.6) were markedly increased in NR group at 8 PBH, but PaO2 and MAP were obviously decreased (P<0.05). In OR group, RR (33.0±4.0) times/min, ELWI (8.9±0.3) mL/kg and PVPI (5.7±0.4) were significantly lower than those of NR group (P<0.05) , but higher than those of IR group [ RR (26.0± 3.0) times/min, ELWI (8.2±0.3) mL/kg, PVPI (4.2±0.4), P <0.05] at 8 PBH. PaO2 and MAP in OR group were higher than that in NR group (P<0.05). Lung water content showed no statistically signifi-cant difference between OR ang IR groups (P>0.05), which were lower than that in NR group ( P < 0.05). Conclusions Although the protective effect of oral fluid resuscitation with GES on the lung of burn dog at shock stage was inferior to intravenous fluid, it still can decrease pulmonary vascular permeabili-ty, alleviate pulmonary edema, and reduce pulmonary complication compared with no resuscitation with fluids.     

口服补液对烧伤休克犬肺组织含水量和血管通透性的影响

Objective To investigate the effect of oral fluid resuscitation on pulmonary vascular per-meability and lung water content in burn dogs during shock stage. Methods Eighteen male Beagle dogs with catheterization of carotid artery and jugular vein for 24 hours were subjected to 50% TBSA full-thickness burn, then they were divided into non-fluid resuscitation(NR), oral fluid resuscitation (OR), intravenous fluid resuscitation (IR) groups, with 6 dogs in each group. Dogs in OR and IR groups were given glucose-electrolyte solution (GES) by gastric tube or intravenous infusion according to Parkland formula within 24 hours after burn, while those in NR group were not given any treatment. Dogs in each group were then given intravenous fluid for further resuscitation after 24 post burn hours(PBH). Deaths were recorded within 72 hours after burn. Mean arterial pressure(MAP) , respiratory rate (RR) , PaO2, extravascular lung water in-dex (ELWI) and pulmonary vascular permeability index (PYPI) were determined before burn and at 30 mins and 4, 8, 24, 48, 72 PBH with the aid of PICCO. Dogs were sacrificed to collect lung tissue for deter-mination of water content at 72 PBH or just before death. Results All dogs died during 9-22 PBH in NR group, 3 dogs died during 25-47 PBH in OR group, and all dogs survived within 72 PBH in IR groups. Com-pared with those before burn, RR (44.0±5.0) times/min, ELWI (10.3±0.6) mL/kg and PVPI (6.6± 0.6) were markedly increased in NR group at 8 PBH, but PaO2 and MAP were obviously decreased (P<0.05). In OR group, RR (33.0±4.0) times/min, ELWI (8.9±0.3) mL/kg and PVPI (5.7±0.4) were significantly lower than those of NR group (P<0.05) , but higher than those of IR group [ RR (26.0± 3.0) times/min, ELWI (8.2±0.3) mL/kg, PVPI (4.2±0.4), P <0.05] at 8 PBH. PaO2 and MAP in OR group were higher than that in NR group (P<0.05). Lung water content showed no statistically signifi-cant difference between OR ang IR groups (P>0.05), which were lower than that in NR group ( P < 0.05). Conclusions Although the protective effect of oral fluid resuscitation with GES on the lung of burn dog at shock stage was inferior to intravenous fluid, it still can decrease pulmonary vascular permeabili-ty, alleviate pulmonary edema, and reduce pulmonary complication compared with no resuscitation with fluids.     

口服补液对烧伤休克犬肺组织含水量和血管通透性的影响

Objective To investigate the effect of oral fluid resuscitation on pulmonary vascular per-meability and lung water content in burn dogs during shock stage. Methods Eighteen male Beagle dogs with catheterization of carotid artery and jugular vein for 24 hours were subjected to 50% TBSA full-thickness burn, then they were divided into non-fluid resuscitation(NR), oral fluid resuscitation (OR), intravenous fluid resuscitation (IR) groups, with 6 dogs in each group. Dogs in OR and IR groups were given glucose-electrolyte solution (GES) by gastric tube or intravenous infusion according to Parkland formula within 24 hours after burn, while those in NR group were not given any treatment. Dogs in each group were then given intravenous fluid for further resuscitation after 24 post burn hours(PBH). Deaths were recorded within 72 hours after burn. Mean arterial pressure(MAP) , respiratory rate (RR) , PaO2, extravascular lung water in-dex (ELWI) and pulmonary vascular permeability index (PYPI) were determined before burn and at 30 mins and 4, 8, 24, 48, 72 PBH with the aid of PICCO. Dogs were sacrificed to collect lung tissue for deter-mination of water content at 72 PBH or just before death. Results All dogs died during 9-22 PBH in NR group, 3 dogs died during 25-47 PBH in OR group, and all dogs survived within 72 PBH in IR groups. Com-pared with those before burn, RR (44.0±5.0) times/min, ELWI (10.3±0.6) mL/kg and PVPI (6.6± 0.6) were markedly increased in NR group at 8 PBH, but PaO2 and MAP were obviously decreased (P<0.05). In OR group, RR (33.0±4.0) times/min, ELWI (8.9±0.3) mL/kg and PVPI (5.7±0.4) were significantly lower than those of NR group (P<0.05) , but higher than those of IR group [ RR (26.0± 3.0) times/min, ELWI (8.2±0.3) mL/kg, PVPI (4.2±0.4), P <0.05] at 8 PBH. PaO2 and MAP in OR group were higher than that in NR group (P<0.05). Lung water content showed no statistically signifi-cant difference between OR ang IR groups (P>0.05), which were lower than that in NR group ( P < 0.05). Conclusions Although the protective effect of oral fluid resuscitation with GES on the lung of burn dog at shock stage was inferior to intravenous fluid, it still can decrease pulmonary vascular permeabili-ty, alleviate pulmonary edema, and reduce pulmonary complication compared with no resuscitation with fluids.     

重度烧伤患者休克期血浆B型钠尿肽含量变化及意义

Objective To study the plasma content of B-type natriuretic peptide (BNP) in patients with severe burn during shock stage and probe its clinical significance. Methods Forty-two patients aged 18-60 years, with total burn surface area ≥30%TBSA or full-thickness burn area ≥10% TBSA, hospital-ized within 4 hours after burn, were divided into A group (with total burn surface area 30% -50% TBSA or full-thickness burn area 10% -20% TBSA, n = 21 ), and B group (with total burn surface area 50% TB-SA or full-thickness burn area > 20% TBSA, n = 21 ). Twenty patients admitted during the same time for plastic surgery were enrolled as control group. The plasma levels of BNP, creatine kinase (CK), CK-MB, troponin I (Tnl) of all patients were determined on admission. The levels of BNP, Tnl and fluid resuscita-tion volume were examined at 8, 16, 24, 48 post burn hour (PBH) in A and B groups. Analysis of correla-tion between BNP and fluid resuscitation volume was performed. Results On admission: BNP level in A group (68±19 ng/L) and B group (99±38 ng/L) , respectively, was increased as compared with that in control group (17±7 ng/L, P <0.01 ). Tnl level in A group (2.13±0.67 μg/L) and B group (2.98± 0.58μg/L), respectively, was increased as compared with that in control group (0.12 ± 0.03 μg/L, P < 0.01). There was no obvious difference in CK, CK-MB levels among A, B, and control groups ( P > 0.05). BNP levels in A, B groups continuously rose during 8 - 48 PBH, and they were positively correlated with fluid resuscitation volume. TnI level peaked at 24 PBH, and decreased at 48 PBH. Conclusions The plasma level of BNP is sensitive to reflect changes in myocardial ischemia and hypoxia as a rise in level of TnI in shock stage of severe burn, and it was positively correlated with fluid resuscitation volume. BNP can be used to guide fluid resuscitation during shock stage.     

2015年乳腺癌辅助化疗进展

【摘要】〓乳腺癌是危害我国女性健康的头号杀手,尽管近年来辅助化疗的研究进展突飞猛进,但临床中仍有不少问题未能明确,如辅助化疗的合适人群、化疗的开始时间、蒽环及紫杉类的地位和用法、强化维持治疗的作用、疗效及预后的生物标志物等。本文结合乳腺癌辅助化疗在临床上的常见问题和2015年各大乳腺癌会议阐述乳腺癌辅助化疗的最新进展。     

目前国内普通外科临床科研中存在的主要问题

自1978年恢复研究生招生工作以来,同其他临床医学学科一样,普通外科的临床科研工作取得了长足进步,获得了一些有创造性的科研成果,为推动我国普通外科事业的发展作出了较大的贡献。近年,我国普通外科领域的科研论文数量增长较快,但不可否认的是,目前我国普通外科研究领域仍存在     

Controversies in Fistula in Ano

Managing a complex fistula in ano can be a daunting task for most surgeons; largely due to the two major dreaded complications—recurrence & fecal incontinence. It is important to understand the anatomy of the anal sphincters & the aetiopathological process of the disease to provide better patient care. There are quite a few controversies associated with fistula in ano & its management, which compound the difficulty in treating fistula in ano. This article attempts to clear some of those major controversies.     

Disparities in Amputations in Minorities

Background  

As a result of the impact of health disparities on the healthcare system such as their influence on arenas significant to healthcare distribution, including cost, quality, and access, identification and resolution of health disparities is a primary national agenda item. Resolution of disparities in amputation is an area of opportunity that warrants further consideration.