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Biomedical subjects

M B King

Publications and source records attributed to M B King.

At least 37 records · Page 2Linked to original sources
PubMed1995

Dynamic balance in older persons: effects of reduced visual and proprioceptive input.

BACKGROUND: Understanding the motor and sensory contributions to balance function in older persons is important in order to design effective interventions to prevent falls and loss of mobility. We tested the contributions of visual and proprioceptive input, muscle strength, and age to balance performance in 110 subjects free of clinical evidence of neurologic disease (mean age 80 years). METHODS: The EquiTest Sensory Organization Test was used to present sequential conditions that altered sensory input in a 2 (tactile/proprioceptive input) x 3 (visual input) design. Center of force and shear force data were recorded from the platform; the primary outcomes were loss of balance (LOB) and anterior-posterior center of force (COF) displacement as a proportion of foot length (COFD). RESULTS: Subjects had 3.5 +/- 2.7 LOB during testing. Reduction of vision input increased the odds ratio of a LOB 5.7 fold (3.9, 8.4, 95% CI) in unstable surface conditions, but adaptation with repeated trials was substantial. The adjusted odds ratio of a LOB was 0.65 and 0.45 in the second and third trials, respectively, compared to the first. Muscle strength and age were independent predictors of LOB. Gait velocity, single stance balance, and reported difficulty with ambulation, mobility, and instrumental activities of daily living were also associated with LOB. CONCLUSIONS: Performance on clinical tests of strength, balance, and gait was associated with performance on a challenging balance test which reduced sensory input and effectiveness of motor responses. Adaptation to challenging balance conditions was substantial in this group of older subjects, but was diminished in the oldest subjects.

Activities of Daily Living↗
PubMed1994

Functional base of support decreases with age.

BACKGROUND: Poor balance in older persons increases the risk of injurious falls during daily activities. Functional base of support (FBOS), the anterior-posterior proportion of foot length used in maximal sustained forward and backward leaning, tests controlled center of mass movement, a component of balance required in daily activities. The purpose of this study was to examine the relationship between FBOS and age and establish the reliability of this measure. METHODS: Subjects were 113 community-dwelling men and women, ages 20 to 91. FBOS, measured on a force platform, is the difference between mean center of pressure location during sustained forward and backward leaning, divided by foot length. Forward lean (FL), backward lean (BL), and average sway distance during normal standing (STAND SWAY) and while leaning (FBOS SWAY) were also measured. RESULTS: Mean FBOS was .60 +/- .07 in subjects under age 60, and .42 +/- .12 in subjects 60 and older. FBOS remained constant in younger subjects; beyond age 60, FBOS declined about 16% per decade and was more variable. FL and BL also declined with age, remaining 66% and 34% of FBOS, respectively. STAND SWAY and FBOS SWAY were significantly correlated with each other, but not with FBOS. CONCLUSIONS: FBOS is a reliable measure and is decreased on average in older persons. This decrease is not related to increased sway while standing or leaning. FBOS is a simple force platform test that has potential as a measure of change in this dimension of balance and as a predictor of falls risk in older persons.

Adult↗
PubMed1994

Long-term benzodiazepine users--a mixed bag.

In this article it is argued that long-term benzodiazepine (BZD) users can be classified into four broad groups, namely medical, daytime, night-time and polydrug users. Although the groups are not exhaustive or mutually exclusive, such a classification may go some way to clarify our understanding of the complex psychological and sociological phenomena involved in long-term consumption of BZDs.

Anti-Anxiety Agents↗
PubMed1994

The proteinase-antiproteinase balance in alpha-1-proteinase inhibitor-deficient lung transplant recipients.

We examined the proteinase-antiproteinase balance in the bronchoalveolar lavage (BAL) fluid from alpha-1-proteinase inhibitor (alpha 1PI)-deficient lung transplant recipients to determine whether they would derive benefit from intravenous augmentation therapy with alpha 1PI. BAL fluid from 11 alpha 1PI-deficient lung transplant recipients and eight control subjects was assayed for free neutrophil elastase activity, immunoreactive alpha 1PI, and elastase inhibitory capacity. Samples were obtained during intervals of health and respiratory illness. BAL fluid from healthy alpha 1PI-deficient lung transplant recipients had minimal or unmeasurable free elastase activity, which was not different from that of control subjects. alpha 1PI concentrations in BAL fluid from alpha 1PI-deficient lung transplant recipients were reduced when compared with those of control subjects. Despite this observation, all but one alpha 1PI-deficient patient had the ability to inhibit exogenous elastase. During respiratory illness, however, three of seven alpha 1PI-deficient lung transplant recipients had measurable free elastase activity, which was inhibited ex vivo by addition of alpha 1PI. We conclude that alpha 1PI-deficient lung transplant recipients demonstrate free elastase activity in BAL fluid during severe lower respiratory tract inflammation, which is not present during health. Intravenous supplementation of alpha 1PI-deficient lung transplant recipients with exogenous alpha 1PI during respiratory tract inflammation may be indicated to inhibit elastase-mediated injury to the transplanted lung.

Adult↗
PubMed1994

Unusual forms of pulmonary embolism.

The first word of the title, unusual, captures the theme of this article. The entities discussed here: fat embolism, tumor embolism, venous air embolism, and amniotic fluid embolism, as well as other unusual embolic events are uncommon disorders that occur in specific circumscribed clinical settings. We have attempted to provide a cognitive jolt to remind the reader to consider these unusual events in appropriate differential diagnoses. No laboratory test, physical finding, or patient complaint will yield a timely diagnosis. Yet, these entities can be acutely life threatening; swift recognition is imperative. Timely and effective therapy rests on the clinical certainty that a test is not likely to establish. It is, perhaps, the greatest demand placed upon the agile clinical mind--to think of it!

Adrenal Cortex Hormones↗
PubMed1993

The urethral syndrome: a controlled evaluation.

It has long been considered that psychological factors play an important rôle in women with urinary tract symptoms. Where no significant infection can be demonstrated, psychological factors have been claimed as paramount to the extent that the 'irritable urethral syndrome' has been postulated as a parallel to the irritable bowel. This paper reports on a controlled study of psychological and menstrual problems in women presenting in family practice with urinary symptoms. Women were assessed by structured interview. Two groups of women took part: (A) 54 women with urinary symptoms, 15 of whom later proved to have significant bacterial infection on culture. (B) 21 women attending for contraceptive advice also agreed to participate in a comparison group. Women presenting with urinary tract symptoms had higher mean scores on psychological and menstrual measures than comparison women, regardless of the presence of demonstrable infection. Thus, psychological and menstrual symptoms appear to determine whether a woman who experiences urinary tract symptoms attends her doctor, regardless of whether significant infection is present. No evidence was found, for the existence of an irritable urethral syndrome, in which psychological factors are postulated as the predominant cause.

Adolescent↗
PubMed1993

Psychiatrists' religious attitudes in relation to their clinical practice: a survey of 231 psychiatrists.

A total of 231 psychiatrists working in several London teaching hospitals were surveyed about their private religious attitudes and how these affected their reported clinical practice. Although only 27% reported a religious affiliation and 23% a belief in God, 92% felt that psychiatrists should concern themselves with the religious concerns of their patients. Although the psychiatrists who were religious were more likely to make referrals to religious leaders or to disclose their own beliefs to patients, contrary to reports from the United States there was no evidence that psychiatrists' private religious beliefs had an important influence on their clinical practice.

Adult↗
PubMed1993

Reproduction of the obliterative bronchiolitis lesion after heterotopic transplantation of mouse airways.

Obliterative bronchiolitis, characterized histopathologically by airway inflammation and occlusion of small airways by vascularized fibrous tissue, constitutes an important threat to the long-term survival of lung and heart-lung transplant recipients. The pathogenesis of obliterative bronchiolitis is poorly understood, and successful preventative or treatment strategies are not available. We sought to develop a preclinical model system of obliterative bronchiolitis by transplanting murine airway grafts, consisting of tracheas and main bronchi, into the subcutaneous tissue of allogeneically mismatched recipient animals. By 10 days after transplantation, allografts demonstrated subepithelial and/or peritracheal inflammation, epithelial necrosis, and early fibroproliferation. Grafts harvested 21 days after transplantation demonstrated fibroproliferation in the airway wall or lumen in nine of 10 allografts versus 0 of 10 isografts (P = 0.0001). In addition, abnormal epithelium (ie, nonciliated cuboidal, squamous, or absent) was seen in all allografts, while nine of nine isografts demonstrated normal respiratory epithelium (P = 0.0003). Although differences exist between this model and the chronic rejection process in human lung transplant recipients, these findings reproduce the characteristic features of obliterative bronchiolitis and demonstrate that this lesion can result from allograft rejection. This model will be useful for studying the pathogenesis, prevention, and treatment of obliterative bronchiolitis after lung transplantation.

Animals↗
PubMed1992

Controlled evaluation of management of schizophrenia in one general practice: a pilot study.

The study reports on a controlled evaluation of services offered to patients with a diagnosis of schizophrenia in comparison to diabetic patients and matched attenders with no chronic illness. Data were collected from one inner city London group practice, by a retrospective analysis of patients' notes over a period of 6 years. Although patients with schizophrenia attended significantly more often than other patients, clinical assessments in the surgery were rarely undertaken. Communications with hospital consultant services were rare for both chronic groups of patients but in the case of those with schizophrenia the doctor received on average only one letter every 2 years. The findings support other recommendations for a more structured approach to the care of schizophrenia in general practice with regular attention to mental state assessment and monitoring of drug treatment.

Communication↗
PubMed1992

Emotional distress in doctors: sources, effects and help sought.

All doctors in a London Teaching Hospital were sent a self-administered, anonymous questionnaire, to study past episodes of emotional distress. We inquired about frequency of past and current emotional distress, sources of distress, effects on work and home life, type of help sought and perceived outcome of that help. Of 320 doctors, 210 (66%) responded. One hundred and forty-one (68%) reported previous episodes of moderate or severe emotional distress. Logistic regression revealed that distress was significantly more common in younger doctors and in women. Many respondents reported work problems as causing their distress and work was frequently adversely affected by episodes of distress. Professional help was rarely sought; non-professional help was from family and friends. Current emotional distress was related to a history of past distress, especially among the most junior doctors. We conclude that past emotional distress is reported by most doctors, with work pressures an important contributing factor. Doctors do not appear to use available sources of professional help. Our findings confirm that doctors have difficulty disclosing psychological problems. Specific programmes aimed at prevention and management of distress in doctors need to be initiated and evaluated.

Adult↗
PubMed1992

Is there still a role for benzodiazepines in general practice?

Opinion on benzodiazepines has moved from optimism after their entry onto the market to disillusionment over their potential for dependence. Legal proceedings against manufacturers of benzodiazepines, health authorities and doctors will be taking place this year. Nonetheless, just over 18 million prescriptions for benzodiazepines were issued in 1990, most of which came from general practice. Is there any role left for this group of drugs? This review addresses the issues of dependence on an withdrawal from benzodiazepines and weighs up the evidence for their present vilification.

Benzodiazepines↗
PubMed1991

Relationship of oxidant-mediated cytotoxicity to phospholipid metabolism in endothelial cells.

Exposure to oxidants permeabilizes cell membranes and liberates unesterified fatty acids (UFA) in a variety of cell types, including endothelial cells. Products of phospholipase activity, particularly UFA and lysophosphatides, possess potent detergent-like properties, and we postulated that oxidant injury might be mediated by the accumulation of these toxic phospholipase products. Several radiolabels were incorporated into defined positions in the phospholipids of cultured, confluent bovine pulmonary endothelial cells (BPAEC). The release of radiolabeled fatty acids and the accumulation of cell-associated phospholipase products were measured and compared to a standard cytotoxicity assay (51Cr release) in response to an oxidant stress, in this case 0.1 to 10 mM hydrogen peroxide (H2O2). H2O2 caused time- and dose-dependent 51Cr release as well as liberation of saturated ([14C]stearic acid) and unsaturated ([3H]arachidonic acid) fatty acids and the accumulation of phospholipase A2 and C products. The ability of BPAEC to incorporate UFA into complex phospholipids was shown to be severely impaired in the presence of H2O2. Further studies showed that H2O2 caused depletion of BPAEC adenosine triphosphate (ATP) content to undetectable levels, and that the depletion of cellular ATP by iodoacetic acid induced substantial release of [3H]arachidonic acid but not [14C]stearic acid from BPAEC. This finding suggests that release of UFA in response to an oxidant stress may be due in part to a defect in ATP-dependent reacylation pathways and need not reflect any increase in phospholipase activities. Also unsaturated fatty acids were found to be toxic to BPAEC upon adding them to supernatants of cultured monolayers.

Adenosine Triphosphate↗
PubMed1990

Male rape.

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Affective Symptoms↗