Preoperative clinical factors predict postoperative functional outcomes after major lower limb amputation: An analysis of 553 consecutive patients

BackgroundDespite being a major determinant of functional independence, ambulation after major limb amputation has not been well studied. The purpose, therefore, of this study was to investigate the relationship between a variety of preoperative clinical characteristics and postoperative functional outcomes in order to formulate treatment recommendations for patients requiring major lower limb amputation.MethodsFrom January 1998 through December 2003, 627 major limb amputations (37.6% below knee amputations, 4.3% through knee amputations, 34.5% above knee amputations, and 23.6% bilateral amputations) were performed on 553 patients. Their mean age was 63.7 years; 55% were men, 70.2% had diabetes mellitus, and 91.5% had peripheral vascular disease. A retrospective review was performed correlating various preoperative presenting factors such as age at presentation, race, medical comorbidities, preoperative ambulatory status, and preoperative independent living status, with postoperative functional endpoints of prosthetic usage, survival, maintenance of ambulation, and maintenance of independent living status. Kaplan-Meier survival curves were constructed and compared by using the log-rank test. Odds ratios (OR) and hazard ratios (HR) with 95% confidence intervals were constructed by using multiple logistic regressions and Cox proportional hazards models.ResultsStatistically significant preoperative factors independently associated with not wearing a prosthesis in order of greatest to least risk were nonambulatory before amputation (OR, 9.5), above knee amputation (OR, 4.4), age >60 years (OR, 2.7), homebound but ambulatory status (OR, 3.0), presence of dementia (OR, 2.4), end-stage renal disease (OR, 2.3), and coronary artery disease (OR, 2.0). Statistically significant preoperative factors independently associated with death in decreasing order of influence included age ≥70 years (HR, 3.1), age 60 to 69 (HR, 2.5), and the presence of coronary artery disease (HR, 1.5). Statistically significant preoperative factors independently associated with failure of ambulation in decreasing order of influence included age ≥70 years (HR, 2.3), age 60 to 69 (HR, 1.6), bilateral amputation (HR, 1.8), and end-stage renal disease (HR, 1.4). Statistically significant preoperative factors independently associated with failure to maintain independent living status in decreasing order of influence included age ≥70 years (HR, 4.0), age 60 to 69 (HR, 2.7), level of amputation (HR, 1.8), homebound ambulatory status (HR, 1.6), and the presence of dementia (HR, 1.6).ConclusionsPatients with limited preoperative ambulatory ability, age ≥70, dementia, end-stage renal disease, and advanced coronary artery disease perform poorly and should probably be grouped with bedridden patients, who traditionally have been best served with a palliative above knee amputation. Conversely, younger healthy patients with below knee amputations achieved functional outcomes similar to what might be expected after successful lower extremity revascularization. Amputation in these instances should probably not be considered a failure of therapy but another treatment option capable of extending functionality and independent living

Effects of local Joule heating on the reduction of contact resistance between carbon nanotubes and metal electrodes

We report here a practical application of known local Joule heating processes to reduce the contact resistance between carbon nanotubes and metallic electrical contacts. The results presented in this study were obtained from a series of systematic Joule heating experiments on 289 single-walled carbon nanotubes (SWCNTs) and 107 multiwalled carbon nanotubes (MWCNTs). Our experimental results demonstrate that the Joule heating process decreases the contact resistances of SWCNTs and MWCNTs to 70.4% and 77.9% of their initial resistances, respectively. The I-V characteristics of metallic nanotubes become more linear and eventually become independent of the gate voltages (Vgs). For semiconducting nanotubes, the contact resistance has a similar decreasing tendency but the dependency of source-drain current (Ids) on Vgs does not change with the Joule heating process. This suggests that the reduction of the contact resistance and the decrease of the transport potential barrier are largely attributed to the thermal-energy-induced desorption of adsorbates such as water and oxygen molecules from the nanotube surface and the interface region, as well as thermal-energy-enhanced bonding between the nanotubes and electrode surfaces. In comparison to several other methods including rapid thermal annealing, e-beam lithography patterning of the top metal layer, and focused ion beam induced metal deposition of the top layer, the Joule heating process not only effectively reduces the contact resistance but also simultaneously measures the resistance and monitors the change in the transport potential barrier at the interface region