罗格列酮对前驱糖尿病或非糖尿病代谢综合症血浆脂联素水平和动脉僵硬度的影响

目的噻唑烷二酮类对糖尿病患者动脉粥样硬化替代标记物如脂联素和动脉僵硬度有较好的作用。这些有益的作用是否会在非糖尿病患者(如前驱糖尿病或非糖尿病代谢综合症)出现还不明确。目前的研究是评价非糖尿病患者胰岛素致敏剂罗格列酮对循环脂肪细胞因子水平和肱踝脉搏波传递速度的作用。方法99例前驱糖尿病或非糖尿病患者随机分配到罗格列酮组和对照组(分别为50和49例)。罗格列酮组每日4mg罗格列酮,持续12周。所有患者均口服葡萄糖75 g,检测口服葡萄糖耐量试验前后肱踝脉搏波传递速度、脂联素、抵抗素和高敏C反应蛋白水平。结果相对于对照…     

Professional non‐neutrality: criticising the third party in psychotherapy

Using audio‐recorded data from cognitive‐constructivist psychotherapy, the article shows a particular institutional context in which successful professional action does not adhere to the pattern of affective neutrality which Parsons saw as an inherent component of medicine and psychotherapy. In our data, the professional’s non‐neutrality functions as a tool for achieving institutional goals. The analysis focuses on the psychotherapist’s actions that convey a critical stance towards a third party with whom the patient has experienced problems. The data analysis revealed two practices of this kind of critique: (1) the therapist can confirm the critique that the patient has expressed or (2) return to the critique from which the patient has focused away. These actions are shown to build grounds for the therapist’s further actions that challenge the patient’s dysfunctional beliefs. The article suggests that in the case of psychotherapy, actions that as such might be seen as apparent lapses from the neutral professional role can in their specific context perform the task of the institution at hand.     

Use of nasal provocation test in the diagnostics of occupational rhinitis

OBJECTIVES: The purpose of the study was to evaluate the usefulness and clinical value of the nasal provocation test (NPT) with various allergens and non-IgE-mediated irritants in the diagnostics assessing occupational rhinitis. METHODS: A large number nasal provocation data from patients with suspected occupational rhinitis was evaluated retrospectively. The results of nasal provocation tests with different agents, as well as the correlation of nasal scoring to weighed mucus secretion, were analyzed. RESULTS: Altogether 507 NPTs were done in three years in 165 persons. In total, 39% of the allergen provocations (125/318) were positive. The most common positive reactions were against flours, animal epithelia, storage mites and various plants. Wood dusts, mainly through non-IgE-mediated reactions, gave 50% positive results. Positive NPTs to moulds were observed mainly in sensitized patients. Altogether, 10% of the control provocations were positive. The weighting of mucus secretion added sensitivity of NPT. CONCLUSIONS: The NPT is an essential standard tool in the diagnostics of allergic occupational rhinitis; however it needs to be evaluated in the context of the medical and work history and knowledge of sensitization. Although expensive and laborious, NPT is safe and easy for the patient. We still need reliable diagnostic tools for non-allergic work-related rhinitis.