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PubMed1995

Intraoral defect coverage with muscle flaps.

PURPOSE: This study investigated whether wound healing after the use of purely muscular flaps for intraoral defect coverage is negatively influenced by insipient muscular atrophy and the absence of a covering layer. MATERIALS AND METHODS: In an experimental study, microsurgical transplantation of muscle flaps from the anterior abdominal wall was carried out in 18 Lewis rats. A nerve anastomosis for motor reinnervation was not performed. Atrophy of the muscle flaps was determined by measuring the reduction of their size and weight after 3, 8, and 20 weeks. In the clinical part of the study, free muscle transplants from different donor regions (vastus lateralis, pectoralis major, internal oblique, and temporalis muscles) were used for defect coverage in various areas of the oral cavity. To study epithelization, punch biopsy specimens from the muscle surface were taken at periods of 2 to 4 weeks up to 6 months for histologic evaluation. Final evaluation of reconstruction results with special regard to speech, tongue mobility, mouth opening, chewing, and swallowing took place after 6 months. RESULTS: In the experimental study, average weight loss of the muscle flaps was 67% after 20 weeks, and the remaining surface area was 71%. The number of myocytes was only about 30% compared with control muscles, and parts of the flap appeared as a thin fibrous membrane. Clinically, this atrophy led to restricted mobility in such areas as the floor of the mouth, the buccal plane, and the tongue. Muscle flaps covering solid structures such as bones or reconstruction plates adapted well to the transplant bed, and the atrophy of the muscle led to no constriction of the surrounding tissue. Atrophy also did not have a negative effect when muscle flaps were placed in the region of the pharyngeal wall. Epithelization started from the edges after 2 weeks and was concluded after 8 weeks in all transplants if no additional radiation was performed. The muscle tissue was sufficiently resistant so that infection, fistulization, and necrosis did not occur. CONCLUSIONS: Muscle flaps undergo considerable atrophy with a cicatricial transformation and reduction of flexibility. Despite these disadvantages they can be used in the hard palate, the alveolar crest, and in the pharyngeal wall without causing functional restriction. Because of constriction of the surrounding tissues, mobile areas such as the buccal plane, the floor of the mouth, and the tongue are not suitable as sites for muscle transplants.

Abdominal Muscles↗
PubMed1992

The impact of changing BCG coverage on tuberculosis incidence in Swedish-born children between 1969 and 1989.

In April 1975, the mass vaccination of newborns against tuberculosis was replaced by selective vaccination of groups at risk. BCG coverage fell from more than 95% before 1974 to 1.8% between 1975 and 1982 and thereafter reached an average of 13.7% up to 1989. The cumulative incidence of tuberculosis before 5 years of age was estimated among children born in Sweden during periods of high, low and moderate increasing BCG coverage. The incidence figures per 100,000 children was 0.8, 3.9 and 2.9, respectively, for children born to Swedish parents and 2.6, 39.4 and 13.2, respectively, for those born to foreign parents. The observed incidence of tuberculosis among non-BCG vaccinated children born to Swedish parents was within the expected limits given by a prognostic model based on the natural change of the risk of infection. The effectiveness of the selective BCG vaccination programme, which was intensified after 1981 for the second generation of immigrants, was estimated to 0.82 (95% confidence interval 0.38, 0.95) assuming that there was no change of the risk of infection for children born to foreign parents over the period studied. From April 1975 to December 1989, tuberculosis was notified in 85 children born in Sweden during the same period, 7 of them were BCG vaccinated and 78 non-vaccinated, 45 were symptomatic, 3 of them with disseminated tuberculosis.

Adolescent↗
PubMed2006

A targeted proteomic approach for the analysis of rat liver mitochondrial outer membrane proteins with extensive sequence coverage.

Membrane proteins play an important role in cellular function. However, their analysis by mass spectrometry often is hindered by their hydrophobicity and/or low abundance. In this article, we present a method for the mass spectrometric analysis of membrane proteins based on the isolation of the resident membranes, isolation of the proteins by gel electrophoresis, and electroelution followed by enzymatic digestion by both trypsin and proteinase K. With this method, we have achieved 82-99% sequence coverage for the membrane proteins carnitine palmitoyltransferase-I (CPT-I), long-chain acyl-CoA synthetase (LCAS), and voltage-dependent anion channel (VDAC), isolated from rat liver mitochondrial outer membranes, including the transmembrane domains of these integral membrane proteins. This high sequence coverage allowed the identification of the isoforms of the proteins under study. This methodology provides a targeted approach for examining membrane proteins in detail.

Amino Acid Sequence↗
PubMed2004

Content analysis of prime-time television coverage of physical activity, 1970-2001.

BACKGROUND: The purpose of this study was to examine how major nightly television networks reported on the health benefits of physical activity. METHODS: A retrospective content analysis of physical activity coverage on four major nightly television networks from 1970 to 2001 was performed. The Vanderbilt Television News Archives were searched for keywords "physical activity," "physical fitness," and "exercise." RESULTS: During the 31-year time period, 111 non-overlapping reports aired on all networks combined. The link between physical activity and health was reported in 53 (47.7%) articles, with general health (n =16, 14.4%) and heart disease (n =12, 12.6%) cited most frequently. Just three broadcasts related to the Surgeon's General Report on Physical Activity and Health were aired following its publication in 1996. CONCLUSIONS: Although the protective health benefits of physical activity are well established, physical activity received a modest amount of television coverage from 1970 through 2001.

Analysis of Variance↗
PubMed2007

[Evaluation of vaccine coverage in children from 2 to 4 years old in South-Eastern France].

BACKGROUND: Few studies have evaluated vaccination coverage in early childhood in South-Eastern France and spatial and social factors associated to it. POPULATION AND METHODS: We carried out a study in children aged 3.5-4.5 years and attending 112 nursery schools randomly selected in South-Eastern France. Data were collected in 2002-2003 during a mandatory health assessment by physicians and nurses of the services of maternal and infant protection, who completed a new questionnaire developed to standardise these examinations in the whole region. RESULTS: Among the 2959 selected children, 2460 (83.1%) could be included in the study; out of them, 96.4% had been vaccinated against diphtheria and tetanus, 95.0% against poliomyelitis, 92.8% against pertussis, 89.3% against haemophilus influenzae type b and 96.5% against tuberculosis. Vaccination rates at the age of 18 months including the first booster were less important than vaccination rates for children aged 3.5-4.5 years. Only 24.3% of the children had been vaccinated against hepatitis B and 86.4% against measles-mumps-rubella. Vaccination rates at the age of 2, were significantly higher on the basis of the health certificates of the 24th month (CS24) than on the basis of our study. Vaccination rates were highest in urban areas and those with educational priority. CONCLUSION: Vaccination rates at the age of 3.5-4.5 years are satisfying but rates for the first booster should be improved. Vaccination rates against hepatitis B were low when those against MMR do not reach the WHO recommended level of 95.0%. Our results suggest that the analysis of data from the CS24 overestimates the real vaccination coverage at this age in South-Eastern France.

Child, Preschool↗
PubMed2004

Weight adjustment in calculating surface ligand coverage or density for chromatographic bonded phases.

A method based on successive approximation is proposed for the calculation of surface coverage or ligand density of chemically bonded stationary phases from elemental analysis data. The approach could be used to calculate surface coverage in many stationary phase preparations, including end-capping and stepwise couplings. Key in this procedure is the use of successive approximation to simplify the adjustment of weight changes in stationary phase preparation. The method does not involve complicated mathematic equations.

Chromatography↗
PubMed2006

Influence of the degree of coverage of C18-bonded stationary phases on the mass transfer mechanism and its kinetics.

The influence of the degree of coverage of a silica surface with bonded C18 alkyl chains on the mass transfer mechanism in RPLC was investigated. Five packing materials were used, prepared with the same batch of silica particles (5 microm diameter, 90 A average pore size): one column was packed with the silica derivatized by trimethylchlorosilane (TMS) (C1, 3.92 micromol/m2), and the other four with the silica first derivatized with octadecyl-dimethyl-chlorosilane (C18, 0.42, 1.01, 2.03, and 3.15 micromol/m2), and then endcapped with TMS. A solution of methanol and water (25/75, v/v) was used as the mobile phase. The experimental HETP curves were acquired for each column by measuring the first moment and the second central moment of phenol and correcting them for the influence of the temperature increase due to the heat generated by the friction of the stream against the bed. The different kinetic parameters of the mass transfer in these packed chromatographic columns were identified (longitudinal diffusion, eddy diffusion, film mass transfer, and transparticle mass transfer) and quantified by fitting the experimental data to a new general HETP equation recently derived [F. Gritti, G. Guiochon, Anal. Chem., in press (AC-060203R).]. The agreement was excellent and allowed the comparison of the kinetic parameters among the six columns used. The highest column efficiency measured at conventional or fast flow rates (>0.5 ml/min) is obtained for the most retentive column, which has a surface coverage of 2.03 micromol/m2. The smallest HETP measured is as low as 10 microm, only twice the average particle diameter dp, due to the large contribution of surface diffusion (90%) to the particle effective diffusivity. However, no significant difference was observed between the efficiencies of the columns packed with C1 and C18 derivatized silica.

Chromatography, High Pressure Liquid↗
PubMed2004

Is universal coverage a solution for disparities in health care? Findings from three low-income provinces of Thailand.

The policy on universal coverage (UC) of health care has been adopted and implemented incrementally by the government of Thailand since April 2001 with the aim of providing the access to care for the uninsured population. The success of UC, however, depends on how effective its design and implementation arrangements are in reaching population and affecting households' health seeking behavior and abilities to take up benefits of UC. The results from the household survey of 1834 respondents conducted in three low-income provinces (Tak, Sakol Nakorn, Narathiwat) show that the Gold card with exemption scheme was pro-poor while other insurance schemes tended to favor the rich with 2.6% of respondents reported having more than one type of health insurance coverage and 8.9% without health insurance. The insurance status had statistically significant association with health care use, and knowledge on family planning method and sexually transmitted diseases. Additionally, consumer preferences and socioeconomics factors are a key to disparities in health care utilization.

Adolescent↗
PubMed2005

Early unreamed intramedullary nailing without a safety interval and simultaneous flap coverage following external fixation in type IIIB open tibial fractures: a report of four successful cases.

The conversion method from external fixation (EF) to intramedullary nailing (IMN) for open tibia fractures, especially to Gustilo type IIIB open tibia fractures, have potentially high risk of infections. We document a report of a more progressive approach in four consecutive cases of type IIIB open tibial fractures successfully managed with early unreamed IMN without a safety interval and simultaneous flap coverage following EF. The mean patients age at the time of injury was 43.8 years (range 23-64 years), and three patients were male. The timing from EF to IMN without safety interval combined with well-vascularised flap (free latissimus dorsi flaps in two patients and pedicled soleus flaps in two patients) ranged 48 to 72 hours. Average time to union was 14 months (range 9-21 months). There was one nonunion patient whose fracture healing was gained by reamed IMN without bone grafting. However, there were no infections. The functions in all patients were satisfactory. This early unreamed IMN without a safety interval and with simultaneous flap coverage following EF is a useful and effective option for treating type IIIB open tibial fractures.

Accidents, Traffic↗
PubMed2006

Versatility of the sural fasciocutaneous flap in coverage defects of the lower limb.

We present in this work, our experience with the sural fasciocutaneous flap to treat coverage defects following a lower limb posttraumatic lesion. This paper is a review of these flaps carried out in different centres between 2000 and 2005. The series consists of 14 patients, 12 men and 2 women with an average age of 38 years (23-54) and with a medium follow-up time of 2 years (12-48 months). In all of the cases, aetiology was a lower limb injury or its complications, most frequently a distal tibial fracture (eight patients), followed by sequelae from Achilles tendon reconstruction (two patients), fracture of the calcaneus (two patients) and osteomyelitis of the distal tibia secondary to an open fracture (two patients). Associated risk factors in the patients for performing the flap were diabetes (one case) and cigarette smoking (four cases). The technique is based on the use of a reverse-flow island sural flap with the superficial sural artery dependent on perforators of the peroneal arterial system. The anatomical structures which constitute the pedicle are the superficial and deep fascia, the sural nerve, short saphenous vein, superficial sural artery together with an islet of subcutaneous cellular tissue and skin. The flap was viable in 13 of 14 patients. Only one flap failed in, a diabetic patient. No patient showed signs of infection. Slight venous congestion of the flap occurred in two cases. No further surgical intervention of the donor site was required. In two cases partial necrosis of the skin edges occurred which resolved satisfactorily with conservative treatment. The sural fasciocutaneous flap is useful for the treatment of complex injuries of the lower limbs and their complications. Its technical advantages are: easy dissection with preservation of more important vascular structures in the limb, complete coverage of the soft tissue defect in just one operation without the need of microsurgical anastomosis. All this results in a well vascularised cutaneous islet and thus a reliable flap.

Adult↗
PubMed2004

U.S. healthcare: the intertwined caduceus of physicians, coverage, quality, and cost.

As cardiologists, we should increase our efforts to improve coverage, quality, and cost, both by caring for individual patients and by improving our systems. How? Coverage: by promoting a coordinated approach, beginning with state demonstrations of new safety net and individual and private insurance approaches. Quality: by adopting evidence-based practice and adapting practice guidelines for payment, beginning with non-payment for class III; by setting standards of practice below which we may not fall and paying for quality and service above this level; by involving patients as partners in their care and providing them with incentives. Cost: by challenging routine practices (why return in one year?); by beginning to address the widening gap between what is possible and what is affordable, taking part in broader discussions on what is worth the cost, supporting tort reform, and proposing alternatives; by improving our systems to reduce medical errors and addressing future physician shortages by working in teams with primary care physicians and nurses. Let's work with our patients to improve their health. Together we can make real progress.

Delivery of Health Care↗
PubMed2004

Effect of middle school entry requirements on hepatitis B vaccination coverage.

We examined hepatitis B immunization coverage in states with and without middle school entry vaccination requirements. Hepatitis B vaccination was initiated and completed more frequently in states with middle school mandates, although near-universal coverage was not obtained. Nonetheless, establishment of mandates in states without them could significantly reduce hepatitis B transmission.

Adolescent↗
PubMed2006

Extracellular polymeric bacterial coverages as minimal area surfaces.

Surfaces formed by extracellular polymeric substances enclosing individual and some small communities of Acidithiobacillus ferrooxidans on plates of hydrophobic silicon and hydrophilic mica are analyzed by means of atomic force microscopy imaging. Accurate nanoscale descriptions of such coverage surfaces are obtained. The good agreement with the predictions of a rather simple but realistic theoretical model allows us to conclude that they correspond, indeed, to minimal area (constant mean curvature) surfaces enclosing a given volume associated with the encased bacteria. This is, to the best of our knowledge, the first shape characterization of the coverage formed by these biomolecules, with potential applications to the study of biofilms.

Aluminum Silicates↗
PubMedDate not supplied

Radial forearm free flap for coverage of postoperative lateral heel wounds after open reduction and internal fixation of the calcaneus.

For intraarticular calcaneus fractures, open reduction and internal fixation has become commonplace for the reduction of morbidity of postinjury arthritis. Despite adequate surgical results, there are often associated postoperative wound complications. The purpose of this study was to describe a unique application of the radial forearm free flap for coverage of lateral postoperative heel defects seen after calcaneal fixation. Seven lateral heel wounds after open reduction of calcaneal fractures in 6 patients were covered with radial forearm free flaps. The technique used involved passage of the pedicle of the laterally placed flap anteriorly to the Achilles tendon so that it can be anastomosed to the posterior tibial artery. Flap application was 100% successful, with good functional and cosmetic results in all patients. The radial forearm free flap provides a quick, reliable, and easily harvested source of coverage for lateral heel wounds seen after open reduction and internal fixation of the calcaneus. Tunneling of the flap pedicle anterior to the Achilles tendon is simple and provides the additional advantages of access to reliable vessels, reduced scarring, and avoidance of further wound problems often seen with incisions used to access the anterior tibial artery.

Adult↗
PubMed2006

Is conventional wisdom wrong? Coverage for substance abuse treatment under Medicaid managed care.

Conventional wisdom suggests that coverage for substance abuse treatment under Medicaid is generally poor, and that access to care may be reduced when control over behavioral health services is given to private health plans, such as those under Medicaid managed care. To examine this premise, this study reports on a cross-sectional comparative survey of state Medicaid managed care programs conducted in the year 2000. Although not all states provided substance abuse benefits under their Medicaid programs, our findings suggest that a majority of states used managed care arrangements to provide substance abuse treatment, with most providing an array of covered services. Most Medicaid behavioral health plans were fully capitated. The number of comprehensive health plans providing substance abuse services was slightly higher than the number of behavioral health carveouts. About half of the waiver programs that covered substance abuse treatment covered methadone maintenance, but waiver programs employing comprehensive health plans were more likely to provide coverage for methadone maintenance.

Health Services Accessibility↗
PubMed2004

Early results with use of gracilis muscle flap coverage of infected groin wounds after vascular surgery.

INTRODUCTION: Management of a nonhealing femoral wound after vascular surgery can pose a challenging problem, particularly when there is prosthetic material involved. We prefer to use pedicled gracilis muscle flaps (PGMFs) to cover problematic groin wounds when more conventional management is not possible. METHODS: We describe the technique for using PGMFs to provide groin coverage, report a summary of our short-term and long-term results, and describe why we prefer this reconstructive technique. RESULTS: Twenty PGMFs were placed in 18 patients to treat nonhealing and infected groin wounds. Exposed prosthetic vascular reconstructions were covered with the PGMF in 14 wounds, and in situ autogenous vascular reconstructions were covered in four. Seven wound infections were polymicrobial, 10 had a single gram-positive organism, and one had a single gram-negative organism. Pseudomonas cultured out in four wounds, and Candida in one wound. Two patients had a virulent combination of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococcus. Complete healing was initially achieved in all wounds, and no patient died within 30 days of surgery. Two PGMFs failed, at 2 weeks and 2 months, respectively, one from tension on the flap pedicle and one from acute inflow occlusion. Underlying prosthetic reconstruction was salvaged in 12 of 14 wounds; the remaining wounds with autogenous reconstructions or exposed femoral vessels all closed successfully. At a mean follow-up of 40 +/- 10 months there were no recurrent groin infections. Seven patients died, at 2.5, 3, 8, 12, 14, 22, and 28 months, respectively. CONCLUSION: PGMF transposition is an effective option to cover infected or exposed femoral vessels or salvage prosthetic graft material in the groin. In appropriately selected patients, when complete graft removal and extra-anatomic bypass is not an acceptable option, gracilis muscle flap coverage is a viable alternative. The technique is relatively simple, and morbidity from PGMF harvest is minimal.

Adult↗
PubMed2007

Coverage of the left subclavian artery during thoracic endovascular aortic repair.

BACKGROUND: Thoracic aortic stent grafts require proximal and distal landing zones of adequate length to effectively exclude thoracic aortic lesions. The origins of the left subclavian artery and other aortic arch branch vessels often impose limitations on the proximal landing zone, thereby disallowing endovascular repair of more proximal thoracic lesions. METHODS: Between October 2000 and November 2005, 112 patients received stent grafts to treat lesions involving the thoracic aorta. The proximal aspect of the stent graft partially or totally occluded the origin of at least one great vessel in 28 patients (25%). The proximal attachment site was in zone 0 in one patient (3.6%), zone 1 in three patients (10.7%), and zone 2 in 24 patients (85.7%). Patients with proximal implantation in zones 0 or 1 underwent debranching procedures of the supra-aortic vessels before stent graft repair. In one patient who underwent zone 1 deployment, the left subclavian artery was revascularized before stent graft deployment. Among patients who underwent zone 2 deployment with partial or complete occlusion of the left subclavian artery, none underwent prior revascularization. Patients were assessed postoperatively and at follow-up for development of neurologic symptoms as well as symptoms of left upper extremity claudication or ischemia. RESULTS: Mean follow-up was 7.3 months. Among the 24 patients with zone 2 implantation, 10 (42%) had partial left subclavian artery coverage at the time of their primary procedure. A total of 19 patients experienced complete cessation of antegrade flow through the origin of the left subclavian artery without revascularization at the time of the initial endograft repair as a result of a secondary procedure or as a consequence of left subclavian artery thrombosis. Left upper extremity symptoms developed in three (15.8%) patients that did not warrant intervention, and rest pain developed in one (5.3%), which was treated with the deployment of a left subclavian artery stent. Two primary (type IA and type III) endoleaks (7.1%) and one secondary endoleak (type IA) (3.6%) were observed in patients who underwent zone 2 deployment. Three cerebrovascular accidents were observed. Thoracic aortic lesions were successfully excluded in all patients who underwent supra-aortic debranching procedures. CONCLUSION: Intentional coverage of the origin of the left subclavian artery to obtain an adequate proximal landing zone during endovascular repair of thoracic aortic lesions is well tolerated and may be managed expectantly, with some exceptions.

Adolescent↗
PubMed2005

On the influence of soft tissue coverage in the determination of bone kinematics using skin markers.

Accurate measurement of underlying bone positions is important for the understanding of normal movement and function, as well as for addressing clinical musculoskeletal or post-injury problems. Non-invasive measurement techniques are limited by the analysis technique and movement of peripheral soft tissues that can introduce significant measurement errors in reproducing the kinematics of the underlying bones when using external skin markers. Reflective markers, skeletally mounted to the right hind limb of three Merino-mix sheep were measured simultaneously with markers attached to the skin of each segment, during repetitions of gait trials. The movement of the skin markers relative to the underlying bone positions was then assessed using the Point Cluster Technique (PCT), raw averaging and the Optimal Common Shape Technique (OCST), a new approach presented in this manuscript. Errors in the position of the proximal joint centre, predicted from the corresponding skin markers, were shown to be phasic and strongly associated with the amount soft tissue coverage, averaging 8.5 mm for the femur, 2.8 for the tibia and 2.0 for the metatarsus. Although the results show a better prediction of bone kinematics associated with the Optimal Common Shape Technique, these errors were large for all three assessment techniques and much greater than the differences between the various techniques. Whilst individual markers moved up to 4 mm from the optimal marker set configuration, average peak errors of up to 16, 5 and 3 mm (hip, knee and tibio-metatarsal joints respectively) were observed, suggesting that a large amount of kinematic noise is produced from the synchronous shifting of marker sets, potentially as a result of underlying muscle firing and the inertial effects of heel impact. Current techniques are therefore limited in their ability to determine the kinematics of underlying bones based on skin markers, particularly in segments with more pronounced soft tissue coverage.

Animals↗