Biomedical subjects
J Kleinman
Publications and source records attributed to J Kleinman.
The social course of epilepsy: chronic illness as social experience in interior China.
Findings are reported from a collaborative research project on the experience of epilepsy and treatment among patients and family members in Shanxi and Ningxia Provinces in China. Family, marriage, financial and moral consequences of the social experience of epilepsy support the conceptualization of chronic illness as possessing a social course. Beyond traditional concern with stigma, application of concepts of delegitimation, sociosomatic processes, coping as resistance, contestation in the evaluation of efficacy and compliance, and the cultural ontology of suffering illustrate other ways that social theory is useful in research on chronic illness and disability.
H(+)-ATPases of renal cortical and medullary endosomes are differentially sensitive to Sch-28080 and omeprazole.
Adenosinetriphosphatase (ATPase) activity stimulated by K+ and inhibited by Sch-28080 (SCH), omeprazole (OME), and vanadate has been measured in microsomes from mammalian renal medulla and attributed to a kidney isoform of the H(+)-K(+)-ATPase. To determine whether the H(+)-K(+)-ATPase inhibitors could also inhibit the vacuolar (V)-type H(+)-adenosinetriphosphatase (H(+)-ATPase, i.e., H+ pump) in mammalian intracellular vesicles, we examined their effects on bafilomycin-sensitive acidification in renal cortical vesicles (CEV) and medullary endocytic vesicles (MEV). Rats were injected with fluorescein isothiocyanate-labeled dextran, and labeled endosomes were enriched from kidney tissue homogenates by differential and Percoll density gradient centrifugation. In the CEV, the V-type H+ pump was inhibited 25% by SCH and 30% by OME (100 microM each). Whereas the inhibition by OME was concentration and time dependent, the inhibition by SCH was only concentration dependent. Inhibition by these compounds was similar in the presence of 50 mM K+ (in = out) and in the complete absence of K+, thus ruling out a significant involvement of H(+)-K(+)-ATPase-mediated acidification. Inhibition, however, was not observed with 10 microM SCH and OME. The sensitivity of the V-type H+ pump to 100 microM SCH and OME in CEV was confirmed by the comparable inhibitions of intravesicular acidification observed in acridine orange fluorescence quench studies and by inhibition of Pi liberation in an ATPase assay. We also found that the V-type H+ pump in isolated rat liver endosomes is sensitive to 100 microM SCH and OME to a similar degree. In the MEV, acidification was only weakly affected by 100 microM SCH and OME, thus suggesting that H(+)-ATPases in endosomes from cortical and medullary tubules are different, possibly due to a previously described selective expression of subunit isoforms. Our finding indicates the importance of using low concentrations (< 10 microM) of OME and SCH in studies of H(+)-K(+)-ATPase in nongastric tissues to avoid misinterpretation of the data due to nonspecific inhibition of V-type H(+)-ATPases.
Family-based intervention for schizophrenic patients in China. A randomised controlled trial.
BACKGROUND: We developed and evaluated a comprehensive, ongoing intervention for families of schizophrenic patients appropriate for China's complex family relationships and unique social environment. METHOD: Sixty-three DSM-III-R schizophrenic patients living with family members were enrolled when admitted to hospital and randomly assigned to receive standard care or a family-based intervention that included monthly 45-minute counselling sessions focused on the management of social and occupational problems, medication management, family education, family group meetings, and crisis intervention. RESULTS: At 6, 12, and 18-month follow-ups by blind evaluators, the proportion of subjects rehospitalised was lower, the duration of rehospitalisation was shorter, and the duration of employment was longer in the experimental group than in the control group; these differences were statistically significant at the 12 and 18-month follow-ups and were not explained by differences in drug compliance. Family intervention was associated with significantly lower levels of family burden. CONCLUSIONS: This intervention is less costly than standard treatment, is suitable for urban families of schizophrenic patients in China and feasible given the constraints of the Chinese mental health system.
Search for cytomegalovirus in the postmortem brains of schizophrenic patients using the polymerase chain reaction.
Cytomegalovirus infection has a number of features that suggest a possible association between congenital infection and schizophrenia. Previous studies have investigated anticytomegalovirus antibody titers or attempted directly to identify viral antigens in body fluids or brain tissue from schizophrenic subjects but have been limited by the sensitivity of the available methods. The highly sensitive polymerase chain reaction, a newly developed technique for gene amplification, was used to search for cytomegalovirus in the DNA extracted from postmortem temporal cortex samples of eight schizophrenic subjects, eight nonschizophrenic suicide victims, and eight normal controls. Cytomegalovirus-specific DNA amplification was not detected in any of the samples. The implications of this finding for the viral hypothesis of schizophrenia are discussed.
Search for evidence of herpes simplex virus, type 1, or varicella-zoster virus infection in postmortem brain tissue from schizophrenic patients.
The highly sensitive polymerase chain reaction (PCR) was used to search for herpes simplex virus type 1 (HSV-I) or varicella-zoster virus (VZV) in the DNA extracted from postmortem temporal cortex samples of 8 schizophrenic subjects, 8 nonschizophrenic suicide victims and 8 normal controls. HSV-I or VZV-specific DNA amplification was not detected in any of the samples studied.
Suffering and its professional transformation: toward an ethnography of interpersonal experience.
The authors define experience as an intersubjective medium of microcultural and infrapolitical processes in which something is at stake for participants in local worlds. Experience so defined mediates (and transforms) the relationship between context and person, meaning and psychobiology in health and illness and in healing. Building on this theoretical background, an approach to ethnography is illustrated through an analysis of suffering in Chinese society. The embodied memory of a survivor of serious trauma during the Cultural Revolution provides an example. From there, the authors go on to describe a framework of indigenous Chinese categories for the analysis of experience--mianzi (face), quanxi (connections), renqing (situated emotion), bao (reciprocity). The paper concludes with a discussion of the existential limits of this and other anthropological approaches to the study of experience as moral process.
Tricuspid valve repair. Operative and follow-up evaluation by Doppler color flow mapping.
Severe tricuspid regurgitation may produce significant morbidity and mortality if not corrected, but commonly used methods of intraoperative assessment may be unreliable. Tricuspid regurgitation was evaluated by a new intraoperative technique, Doppler color flow mapping, in 85 patients before and after cardiopulmonary bypass. Regurgitation grade by intraoperative color Doppler mapping correlated well with right ventricular angiography (kappa value = 0.92, p less than 0.01; n = 8) and with preoperative color Doppler studies (kappa = 0.71, p less than 0.05; n = 51). The right atrial V wave correlated poorly with the severity of tricuspid regurgitation intraoperatively, both before (r = 0.30) and after (r = -0.05, p = no significant difference) cardiopulmonary bypass. Advanced (3+ or 4+) tricuspid regurgitation was found in 40% (21) of 52 patients requiring mitral valve repair or replacement. Tricuspid annuloplasty with a prosthetic ring provided a significant (greater than or equal to 2 grade) reduction in regurgitation severity in 94% (17/18; p less than 0.05). Without repair, tricuspid regurgitation decreased to a similar degree after mitral valve operations in 14% (5/36); only one of the five patients had advanced tricuspid regurgitation prepump. Fluid filling of the arrested right ventricle after the surgical procedure did not predict regurgitation severity (false negative rate 50%, 2/4; false positive rate 22%, 2/9). Regurgitation grade remained unchanged after the initial postpump study, up to 60 weeks postoperatively. In conclusion, color Doppler flow mapping provides more accurate intraoperative assessment of tricuspid regurgitation than the right atrial V wave or fluid filling of the right ventricle. This semiquantitative technique aids in the selection of patients appropriate for surgical repair of the tricuspid valve and is useful in judging the adequacy of tricuspid valve repair before chest closure. Advanced (3+ or 4+) tricuspid regurgitation is a common occurrence in patients undergoing mitral valve repair or replacement and rarely responds to conservative (nonoperative) management. Ring annuloplasty provides a highly effective and durable reduction in tricuspid regurgitation.
[Triethylene tetramine in Wilson's disease].
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Benign hamartoma of the lung presenting as massive hemoptysis.
A case is presented of benign pulmonary hamartoma causing episodes of hemoptysis. This is an extremely unusual manner of presentation for such lesions.
Seasonal variation in human central dopamine activity.
This report focuses on two studies of seasonal variation of central dopamine activity in patients with schizophrenia and normal controls. In the two investigations, data were grouped and analyzed by season (i.e., spring-summer vs. fall-winter). The first study concerned blink rate, a putative measure of central dopamine activity; the blink rate for patients with schizophrenia was significantly increased during the spring-summer period. In the second study concentrations of catecholamines and their metabolites were measured in the hypothalamus and nucleus accumbens of normal and schizophrenic subjects. Findings include a reduced concentration of hypothalamus dopamine in normal controls and a reduced concentration of homovanillic acid in the nucleus accumbens of patients with schizophrenia, both during the spring-summer period.
Dopamine and its metabolites in human peripheral nerves: is there a widely distributed system of peripheral dopaminergic nerves?
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Wheat gluten challenge in schizophrenic patients.
Eight chronic schizophrenic patients were maintained on a diet free of gluten, cereal grains, and milk (CM-F diet) and challenged in a double-blind manner with dietary wheat gluten and placebo. While on the CM-F diet, each patient received a daily challenge of 30 g of gluten for 5 weeks and a placebo challenge for 8 weeks. No deterioration in clinical status as measured by the BPRS was noted on gluten challenge. Serum alpha 1 acid glycoprotein measurement demonstrated no evidence of inflammatory response to gluten challenge. The data suggest that sensitivity to dietary gluten is not characteristic of young chronic schizophrenic patients.
Renal volume-pressure and functional relationships in acute allograft rejection.
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The association of lesion-induced reductions in brain monoamines with alterations in striatal carbohydrate metabolism.
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