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Biomedical subjects

A Moulton

Publications and source records attributed to A Moulton.

At least 19 recordsLinked to original sources
PubMed2006

Law and public health at CDC.

Public health law is an emerging field in U.S. public health practice. The 20th century proved the indispensability of law to public health, as demonstrated by the contribution of law to each of the century's 10 great public health achievements. Former CDC Director Dr. William Foege has suggested that law, along with epidemiology, is an essential tool in public health practice. Public health laws are any laws that have important consequences for the health of defined populations. They derive from federal and state constitutions; statutes, and other legislative enactments; agency rules and regulations; judicial rulings and case law; and policies of public bodies. Government agencies that apply public health laws include agencies officially designated as "public health agencies," as well as health-care, environmental protection, education, and law enforcement agencies, among others.

Centers for Disease Control and Prevention, U.S.↗
PubMed2006

Patterns of extra-spinal left-right skeletal asymmetries in adolescent girls with lower spine scoliosis: relative lengthening of the ilium on the curve concavity & of right lower limb segments.

Extra-spinal skeletal length asymmetry have been reported for the upper limbs and periapical ribs of patients with thoracic adolescent idiopathic scoliosis. This paper reports (1) a third pattern with relative lengthening of the ilium on the concavity of lower spine scolioses, and (2) a fourth pattern of relative lengthening of the right total leg and right tibia unrelated statistically to the severity or side of lower spinal scolioses. The findings pose the question: are these anomalous extra-spinal left-right skeletal length asymmetries unconnected with the pathogenesis of AIS. Or, are they indicative of what may also be happening to some vertebral physes as an initiating pathogenic mechanism for the scoliosis?

Adolescent↗
PubMed2006

Left-right upper arm length asymmetry associated with apical vertebral rotation in subjects with thoracic scoliosis: anomaly of bilateral symmetry affecting vertebral, costal and upper arm physes?

Left-right skeletal length asymmetries in upper limbs related to curve side and severity have been detected with adolescent idiopathic scoliosis (AIS). This paper reports upper arm length asymmetry in thoracic scoliosis related significantly to apical vertebral rotation in school screening referrals. The reason(s) for the association of upper arm length asymmetry with apical vertebral rotation is unknown and three factors are considered: (1) neuromuscular mechanisms from primary or secondary causes, (2) relative concave neurocentral synchondrosis overgrowth, and (3) relative concave periapical rib length overgrowth, A putative anomaly of growth plates (physes) of ribs, neurocentral synchondroses and upper arms, would account for the findings. A solution to this dilemma may emerge from the results of surgery should concave periapical rib resections become evaluated further for right thoracic AIS in girls.

Adolescent↗
PubMed2006

Etiologic theories of idiopathic scoliosis: neurodevelopmental concept of maturational delay of the CNS body schema ("body-in-the-brain").

Several workers consider that the etiology of adolescent idiopathic scoliosis (AIS) involves undetected neuromuscular dysfunction. During normal development the central nervous system (CNS) has to adapt to the rapidly growing skeleton of adolescence, and in AIS to developing spinal asymmetry from whatever cause. Examination of evidence from (1) anomalous extra-spinal left-right skeletal length asymmetries, (2) growth velocity and curve progression, and (3) the CNS body schema, parietal lobe and temporoparietal junction, led us to propose a new etiologic concept namely of delay in maturation of the CNS body schema during adolescence. In particular, the development of an early AIS deformity at a time of rapid spinal growth the association of CNS maturational delay results in the CNS attempting to balance a lateral spinal deformity in a moving upright trunk that is larger than the information on personal space (self) already established in the brain by that time of development. It is postulated that the CNS maturational delay allows scoliosis curve progression to occur - unless the delay is temporary when curve progression would cease. The putative maturational delay in the CNS body schema may arise (1) from impaired sensory input: (2) primarily in the brain; and/or (3) from impaired motor output. Oxidative stress with lipid peroxidation in the nervous system may be involved in some patients. The concept brings together many findings relating AIS to the nervous and musculo-skeletal systems and suggests brain morphometric studies in subjects with progressive AIS.

Aging↗
PubMed2006

Patterns of extra-spinal left-right skeletal asymmetries and proximo-distal disproportion in adolescent girls with lower spine scoliosis: ilio-femoral length asymmetry & bilateral tibial/foot length disproportion.

Anomalous extra-spinal left-right skeletal length asymmetries have been detected in girls with adolescent idiopathic (AIS) in four sites (1) upper limbs, (2) periapical ribs, (3) ilium, and (4) right leg and right tibia. This paper on adolescent girls with lower spine scoliosis reports (1) a fifth pattern of left-right ilio-femoral length asymmetry associated with sacral alar height asymmetry, and (2) bilateral anomalous lengthening of the tibia relative to the foot. The findings are consistent with the hypothesis that at the time of diagnosis of AIS in girls there are anomalies of skeletal proportions associated with a predisposition to curve progression; these proportions are in three dimensions--left-right, cephalo-caudal in the trunk (proximo-distal in the lower limbs), and front-back in the trunk. The origin of these anomalies is unknown but possible causes, and of the associated AIS, are genetic and environmental factors acting in embryonic life not expressed phenotypically until years after birth.

Adolescent↗
PubMed2006

Etiologic theories of idiopathic scoliosis: the breaking of bilateral symmetry in relation to left-right asymmetry of internal organs, right thoracic adolescent idiopathic scoliosis (AIS) and vertebrate evolution.

In the search to understand the etiology and pathogenesis of adolescent idiopathic scoliosis (AIS) some workers have focused on mechanisms initiated in embryonic life including a disturbance of bilateral (left-right or mirror-image) symmetry highly conserved in vertebrates. The normal external bilateral symmetry of vertebrates results from a default process involving mesodermal somites. The normal internal asymmetry of the heart, major blood vessels, lungs and gut with its glands is also highly conserved among vertebrates. It results from the breaking of the initial bilateral symmetry by a binary asymmetry switch mechanism producing asymmetric gene expression around the embryonic node and/or in the lateral plate mesoderm. In the mouse this switch occurs during gastrulation by cilia driving a leftward flow of fluid and morphogen(s) at the embryonic node (nodal flow) that favors precursors of the heart, great vessels and viscera on the left. Based on the non-random laterality of thoracic AIS curves, the hypothesis is suggested that an anomaly of the binary asymmetry switch explains the excess of right/left thoracic AIS. Some support for this hypothesis is the prevalence of right and left scoliosis curve laterality associated with situs inversus. There is recent evidence that vertebrates within their bilateralised shell retain an archaic left-right asymmetric visceral body organization evident in thoracic and abdominal organs.

Adolescent↗
PubMed2006

Etiologic theories of idiopathic scoliosis: enantiomorph disorder concept of bilateral symmetry, physeally-created growth conflicts and possible prevention.

The detection of anomalous extra-spinal left-right skeletal length asymmetries in the upper limbs, periapical ribs, ilia and lower limbs of subjects with adolescent idiopathic scoliosis (AIS) raises questions about skeletal bilateral symmetry of vertebrates in health and disorder, its origin and control. The vertebrate body plan externally has mirror-image bilateral symmetries that are highly conserved culminating in the adult form. The normal human body can be viewed as containing paired skeletal structures in the axial and appendicular skeleton as 1) separate left and right paired forms (eg long limb bones, ribs, ilia), and 2) united in paired forms (eg vertebrae, sternum, skull, mandible). Each of these separate and united pairs are mirror-image forms--enantiomorphs. Left-right asymmetries of growth plates (physes) may cause (1) in long bones length asymmetries, (2) within one or more vertebral physes putative growth conflict with distortion as deformity, and (3) between ribs and vertebrae putative growth conflict that triggers thoracic AIS suggesting preventive surgery on spine and ribs. There is evidence of a possible role for environmental factors in AIS development. Genes and the environment (nature/nurture) may interact pre- and/or post-natally to explain both the deformity of AIS and its association with widespread anomalous skeletal length asymmetries. If substantiated there may ultimately be a place for the prevention of AIS in some subjects.

Humans↗
PubMed2002

The early detection of adolescent idiopathic scoliosis in three positions using the scoliometer and real-time ultrasound: should the prone position also be used?

The standing forward bending position is in general use for the early detection of adolescent idiopathic scoliosis. It also reveals humps caused by leg-length inequality and for this reason some workers have advocated using the sitting forward bending position. Most recently the prone position has been evaluated and even recommended. The introduction of B-mode and subsequently real-time ultrasound to measure rib rotation and spinal rotation has involved using the prone position. The numerical description of back humps in scientific studies requires measurements at several levels on the back from T1-S1. This paper utilizes 30 subjects referred by school screening for scoliosis from whom 10-level Scoliometer Angle of Trunk Inclinations (ATIs) were obtained twice in each of three positions--standing forward bending, sitting forward bending and prone. The ATIs were converted to 18 levels and (1) analysed for reproducibility, (2) compared in the three positions, and (3) compared with real-time ultrasound data of rib rotation obtained in the prone position. Several statistical methods are used. The reproducibility is best in the sitting and prone positions. While the prone position produces lower ATI readings, R squared values are significantly higher and Residual Mean Square (RMS) values significantly lower than those for each of the standing and sitting forward bending positions. Though the prone position has clear advantages, it is not advocated in clinical practice for various reasons. More research is needed. The evidence supports the view that the sitting forward bending position has advantages for the early detection of adolescent idiopathic scoliosis.

Adolescent↗
PubMed2002

Back shape assessment in each of three positions in preoperative patients with adolescent idiopathic scoliosis: evaluation of a 10-level Scoliometer method interpolated to 18-levels.

A Scoliometer was used by one observer (RKP) to assess the reproducibility of angle of trunk inclinations (ATIs) in 13 preoperative patients with AIS (thoracic 7, thoracolumbar 6, mean Cobb angle 50 degrees, right 9, age 15.4 years, girls 10). Three positions were used namely standing forward-bending, (FB) sitting FB and prone. Readings of ATI on the back were obtained at each of 10 levels (T1-S1). The subject was repositioned after walking around the room and a second set of readings obtained (repeats). All readings were converted by a computer program to 18 levels and plotted. The readings from 18 levels were analysed by level, as well as summated and averaged both without and with correction for the side of the curve. Conclusions. Back surface asymmetry measured with a Scoliometer in these preoperative patients with AIS is less in the prone position than in each of the forward bending positions. The standing FB position has the best reproducibility which supports the practice of using this position to measure Scoliometer ATIs in preoperative patients with AIS.

Adolescent↗
PubMed2002

Spine-rib rotation differences at the apex in preoperative patients with adolescent idiopathic scoliosis: evaluation of a three-level ultrasound method.

This paper evaluates a new real-time ultrasound method to assess the difference between axial spinal (laminal) rotation and rib rotation at the apex of the scoliosis curve. An Aloka SSD 500 portable ultrasound machine with a veterinary long (172mm) 3.5 MHz linear array transducer was used to assess the reproducibility of the method in 13 preoperative patients with AIS. With the subject in a prone position and her head supported, readings of laminal and rib rotation were made directly on the back at 18 and 12 levels respectively The subject was repositioned after walking around the room and a second set of spinal and rib rotations obtained (repeats). All the readings were made by one observer (ASK). After plotting on graphs three levels of maximal difference between spine rotation and rib rotation about the apex were chosen visually by one observer (RGB) for which the mean apical spine-minus-rib rotation difference (SRRD) was calculated for each repeat. Findings for apical SRRDs. The mean apical SRRDs for the two repeats are 7.1 degrees and 6.9 degrees (range 2-18 degrees) with coefficients of variation of 49% and 62% respectively. Reproducibility. Graphic representation of spinal and rib rotation by 12 levels shows a fairly good agreement between repeats for most subjects. Spinal rotation is always greater than rib rotation. A paired t-test for the mean apical SRRD of the repeats shows no significant difference. Linear regression analysis of the mean apical SRRD repeats correlate significantly (r=0.70, P=0.008) with a residual mean square of 6.9 degrees (rms = 2.6 degrees). The technical error of the measurement (TEM) is 2.3 degrees and coefficient of reliability (R) 0.66. Conclusions. Real-time ultrasound can assess the difference between spinal and rib rotation about the apex of the scoliosis curve without the altered position detectably affecting the findings. The error (2-3 degrees) is high relative the mean apical SRRD (6-7 degrees). The apical SRRD findings have relevance to the pathogenesis of AIS.

Adolescent↗
PubMed2002

Preliminary study of a new real-time ultrasound method for measuring spinal and rib rotation in preoperative patients with adolescent idiopathic scoliosis.

A portable ultrasound machine with a linear array transducer was used by one observer (ASK) to evaluate the reproducibility for each of spinal (laminal) rotation and rib rotation in 13 preoperative patients with AIS (thoracic 7, thoracolumbar 6, mean Cobb angle 50 degrees, right 9, left 4, age 15.4 years, girls 10). With the subject in a prone position and her head supported, readings of spinal (laminal) and rib rotations were made directly on the back at 18 and 12 levels respectively. The subject was repositioned after walking around the room and a second set of spinal and rib rotations obtained (repeats). Conclusious. Repositioning the patient significantly alters some single level readings of lam inal rotation and rib rotation. Although the mean average spinal rotation and rib rotation each have acceptable reproducibility, repositioning the patient significantly alters the findings. In the appraisal of surgery by ultrasound the positional change reported here for (I) single level laminal rotation and rib rotation, and (2) mean average rotation imposes caution on the interpretation of the findings. The method enables the axial spine-nh rotation differences to be evaluated which is the subject of a separate paper.

Adolescent↗
PubMed2002

Anterior universal spine system for adolescent idiopathic scoliosis: a follow-up study using scoliometer, real-time ultrasound and radiographs.

Nine patients with AIS treated surgically with anterior USS instrumentation were examined by several methods pre-operatively and at each of 8 weeks, 1 year and 2 years after surgery (mean age 14.6 years, girls 7, boys 2, thoracolumbar 7, lumbar 1, thoracic 1, left 7, right 2). The methods used were (1) Scoliometer to measure angle of trunk inclinations (ATIs) in the standing forward bending position at each of 10 levels and converted to 18 levels by a computer program, (2) real-time ultrasound in the prone position of laminal rotations at each of 1 8 levels from TI-SI, and (3) anteroposterior radiographs in the standing erect position measured for each of Cobb angle, segmental vertebral rotation (Perdriolle) and segmental vertebral translation from the Ti-Si line (horizontal translation of each vertebral centroid from the T1-S1 line). The findings were plotted graphically and segmentally for each of Scoliometer ATJs, ultrasound laminal rotations, and radiographic vertebral rotations and translations. Findings. Graphical representation of the data shows that the improvement brought about by surgery is most clearly and consistently evident for segmental vertebral translation. The statistical analysis shows that the radiological parameters (Cobb angle, apical vertebral rotation and apical vertebral translation) and ultrasound spinal (laminal) rotation do not change detectably in follow-up. The Scoliometer ATI findings show an increase from 4 degrees (at 8 weeks) to 7 degrees (at 2 years) which is statistically significant. The evidence from this small sample of patients is consistent with the view that the compared with posterior USS, anterior USS surgery for AIS results in (1) similar initial rib hump correction, and (2) less rib hump reassertion during follow-up. More data are needed to evaluate these views.

Adolescent↗
PubMed2001

Snapping iliotibial band. Report of ten cases and review of the literature.

UNLABELLED: The authors performed a retrospective study on 10 young patients (11 hips) presenting with a tight iliotibial band resistant to nonsurgical treatment. The main symptoms were pain and snapping of the hip during running and strenuous brisk walking. Diagnosis was made by the exclusion of other pathology and the elicitation of the snap. Surgical treatment was performed in all these patients to aid physiotherapy. The main principle of management however remains stretching exercises. When surgery is required, the aim is to elongate the iliotibial band. In our series, we used Z-plasty of the band followed by repair of the fascia as described by Stainsby. Our postoperative rehabilitation was different from Stainsby's, however. We allowed early progressive full weight bearing in contrast to the two weeks bed rest adopted by Stainsby. Stretching exercises were started two weeks after surgery; this was active in the first four weeks. The results were good at a mean follow-up period of 12 months (range: 8 to 24 months). Scar sensitivity was a problem in three of these patients; this responded only partially to a desensitization program. CONCLUSION: A reasonable result can be obtained following Z-plasty of a tight and symptomatic iliotibal band. Surgery is required only occasionally and there are associated complications, which must be discussed with the patients, these being recurrence of symptoms and wound problems.

Adult↗
PubMed2000

Sand pits and bucket handles: A case of bilateral traumatic bucket-handle tears of the medial menisci.

Bucket-handle tears of the medial menisci are a common injury in young adult athletes. The incidence of acute bilateral tears occurring simultaneously is anecdotally very small and its occurrence has not been reported. We present the case of an 18-year-old man who sustained bilateral bucket-handle tears of the medial menisci while long jumping. We propose that the mechanism of injury may be analogous to that in footballers. This case report raises awareness of the occurrence of bilateral bucket-handle tears.

Adolescent↗
PubMed1999

Two-surgeon approach to thoracic outlet syndrome: long-term outcome.

An orthopaedic surgeon and a vascular surgeon jointly conducted 30 operations for thoracic outlet syndrome in 27 patients, having done the preoperative assessments in conjunction with a neurologist. Anterior scalenectomy was performed by the supraclavicular route except in one case where the infraclavicular route was used. The further surgical procedure was tailored to the abnormalities identified--i.e. resection of cervical rib or band, or medial scalenectomy. The first rib was spared. At median follow-up of 37 months (range 3-228) results were judged excellent or good on 26/30 sides (87%); on the three occasions when scalenectomy alone was performed, the results were only fair or poor. There were no major complications and no patient required reoperation. The long-term outcome in this series suggests that, with multidisciplinary assessment and two-surgeon operative treatment, good results can be obtained by the supraclavicular route without resection of the first rib.

Adolescent↗
PubMed1998

Development of databases and registries. International issues.

This paper describes the U.S. Public Health Service (PHS) efforts to develop a National Xenotransplantation Registry (NXR). The function of the registry is discussed, paying particular attention to data collection and harmonization issues. The need for standardization and coordination on an international scale is presented and the benefits of such efforts are discussed. Finally, a recommendation for an international effort aimed at harmonization is made.

Animals↗
PubMed1994

Recombinant adeno-associated virus-mediated gene transfer into hematopoietic progenitor cells.

Recombinant adeno-associated viruses (rAAV) containing only the inverted terminal repeats (ITR) from the wild-type virus are capable of stable integration into the host cell genome, and expression of inserted genes in cultured cells. We have now defined the ability of rAAV to introduce genes into primary hematopoietic progenitors. A vector was constructed containing the coding sequences for beta-galactosidase (beta-gal), including a nuclear localization signal, under the control of a strong viral promotor. Infectious vector particles were prepared by cotransfection of the vector plasmid with a second plasmid that contained the coding sequences for AAV proteins into adenovirus-infected human embryonic kidney cells. These vector preparations transferred and expressed the beta-gal gene in human K562 erythroleukemia and Detroit 6 cells. Positive immunoselection yielded a population of enriched CD34+ cells that were transduced with the rAAV beta-gal vector. Nuclear localized enzyme expression was documented in 60% to 70% of infected cells. Progenitor-derived colonies that developed after 2 weeks in clonogenic cultures were shown to have viral-associated DNA at an estimated copy number of 1 to 2 per cell using a semiquantitative polymerase chain reaction (PCR) method. Integration of AAV into hematopoietic progenitors was documented using wild-type virus, as its genome may integrate at a preferred site on chromosome 19. Our data suggest that rAAV will transfer and express genes in primitive hematopoietic progenitors with high frequency, and support the development of this vector system for therapeutic gene transfer.

Adenoviruses, Human↗