Crosstalk between the sympathetic nervous system, inflammation and coagulation in gestational diabetes; a therapeutic approach in postmenopausal hypertension

The occurrence of gestational diabetes (GDM) during pregnancy is a powerful sign of a risk of later type 2 diabetes (T2D) and cardiovascular diseases (CVDs). The physiological basis for this disease progression is not yet fully understood, but increasing evidence exists on interplay of insulin resistance, subclinical inflammation, and more recently, on unbalance of the autonomic nervous system. Since the delay in development of T2D and CVD after GDM ranges from years to decades, better understanding of the pathophysiology of GDM could give us new tools for primary prevention. The present study was aimed at investigating the role of the sympathetic nervous system (SNS) in GDM and its associations with insulin and a variety of inflammatory cytokines and coagulation and fibrinolysis markers. This thesis covers two separate study lines. Firstly, we investigated 41 women with GDM and 22 healthy pregnant and 14 non-pregnant controls during the night in hospital. Blood samples were drawn at 24:00, 4:00 and 7:00 h to determine the concentrations of plasma glucose, insulin, noradrenaline (NA) and adrenomedullin, markers of subclinical inflammation, coagulation and fibrinolysis variables and platelet function. Overnight holter ECG recording was performed for analysis of heart rate variability (HRV). Secondly, we studied 87 overweight hypertensive women with natural menopause. They were randomised to use a central sympatholytic agent, moxonidine (0.3mg twice daily), the β-blocking agent atenolol (50 mg once daily+blacebo once daily) for 8 weeks. Inflammatory markers and adiponectin were analysed at the beginning and after 8 weeks. Activation of the SNS (increase in NA, decreased HRV) was seen in pregnant vs. non-pregnant women, but no difference existed between GDM and normal pregnancy. However, modulation (internal rhythm) of HRV was attenuated in GDM. Insulin and inflammatory cytokine levels were comparable in all pregnant women but nocturnal variation of concentrations of C-reactive protein, serum amyloid A and insulin were reduced in GDM. Levels of coagulation factor VIII were lower in GDM compared with normal pregnancy, whereas no other differences were seen in coagulation and fibrinolysis markers. No significant associations were seen between NA and the studied parameters. In the study of postmenopausal women, moxonidine treatment was associated with favourable changes in the inflammatory profile, seen as a decrease in TNFα concentrations (increase in atenolol group) and preservation of adiponectin levels (decrease in atenolol group). In conclusion, our results did not support our hypotheses of increased SNS activity in GDM or a marked association between NA and inflammatory and coagulation markers. Reduced biological variation of HRV, insulin and inflammatory cytokines suggests disturbance of autonomic and hormonal regulatory mechanisms in GDM. This is a novel finding. Further understanding of the regulatory mechanisms could allow earlier detection of risk women and the possibility of prevention. In addition, our results support consideration of the SNS as one of the therapeutic targets in the battle against metabolic diseases, including T2D and CVD.

The Innocent Pleasure : A Study on Luther's theology of music

The aim of the study is to examine Luther s theology of music from the standpoint of pleasure. The theological assessment of musical pleasure is related to two further questions: the role of emotions in Christianity and the apprehension of beauty. The medieval discussion of these themes is portrayed in the background chapter. Significant traits were: the suspicion felt towards sensuous gratification in music, music as a mathematical discipline, the medieval theory of emotions informed by Stoic apatheia and Platonic-Aristotelian metriopatheia, the notion of beauty as an attribute of God, medieval aesthetics as the aesthetic of proportion and the aesthetic of light and the emergence of the Aristotelian view of science that is based on experience rather than speculation. The treatment of Luther s theology of music is initiated with the notion of gift. Luther says that music is the excellent (or even the best) gift of God. This has sometimes been understood as a mere music-lover s enthusiasm. Luther is, however, not likely to use the word gift loosely. His theology can be depicted as a theology of gift. The Triune God is categorically giving. The notion of gift also includes reciprocity. When we receive the gifts of God, it evokes praise in us. Praising God is predominantly a musical phenomenon. The particular benefit of music in Luther s thought is that it can move human emotions. This emphasis is connected to the overall affectivity of Luther s theology. In contrast to the medieval discussion, Luther ascribes to saints not just emotions but particularly warm and tender affections. The power of music is related to the auditory and vocal character of the Word. Faith comes through hearing the Word that is at once musical and affective perception. Faith is not a mere opinion but the affective trust of the heart. Music can touch the human heart and persuade with its sweetness, like the good news of the Gospel. Music allows us to perceive Luther s theology as a theology of joy and pleasure. Joy is for Luther a gift of the Holy Spirit that fills the heart and bursts out in voice and gestures. Pleasure appears to be a central aspect to Luther s theology. The problem of the Bondage of the Will is precisely the human inability to feel pleasure in God s will. To be pleased in the visible and tangible creation is not something a Christian should avoid. On the contrary, if one is not pleased with the world that God has created, it is a sign of unbelief and ingratitude. The pleasure of music is aesthetic perception. This in turn necessitates the investigation of Luther s aesthetics. Aesthetic evaluation is not just a part of Luther s thought. Eventually his theology as a whole could be portrayed in aesthetic terms. Luther s extremely positive appreciation of music illutrates his theology as an affective acknowledgement of the goodness of the Creation and faith as an aesthetic contentment.

Therapeutic work with the present moment: A conversation analytical study of guidance into immediacy

Therapeutic work with the client’s present moment experience in existential therapy was studied by means of conversation analysis. Using publicly available video recordings of therapy sessions as data, an existential therapist’s practice of guiding a client into immediacy, or refocusing the talk on a client’s immediate experience, was described and compared with a therapist’s corresponding action in cognitive therapy. The study contributes to the description of interactional practice of existential therapy, and involves the first application of conversation analysis to a comparative study of psychotherapy process. The potential utility of this approach and the clinical and empirical implications of the present findings are discussed.

Therapeutic change in interaction

A process of change within a single case of cognitive-constructivist therapy is analyzed by means of conversation analysis (CA). The focus is on a process of change in the sequences of interaction, which consist of the therapist’s conclusion and the patient’s response to it. In the conclusions, the therapist investigates and challenges the patient’s tendency to transform her feelings of disappointment and anger into self-blame. Over the course of the therapy, the patient’s responses to these conclusions are recast: from the patient first rejecting the conclusion, to then being ambivalent, and finally to agreeing with the therapist. On the basis of this case study, we suggest that an analysis that focuses on sequences of talk that are interactionally similar offers a sensitive method to investigate the manifestation of therapeutic change. It is suggested that this line of research can complement assimilation analysis and other methods of analyzing changes in a client’s talk.

Poetics of the Nameless Middle : Japan and the West in Philosophy and Music of the Twentieth Century

This study investigates the affinities between philosophy, aesthetics, and music of Japan and the West. The research is based on the structuralist notion (specifically, on that found in the narratology of Algirdas Julius Greimas), that the universal grammar functions as an abstract principle, underlying all kinds of discourse. The study thus aims to demonstrate how this grammar is manifested in philosophical, aesthetic, and musical texts and how the semiotic homogeneity of these texts can be explained on this basis. Totality and belongingness are the key philosophical concepts presented herein. As distinct from logocentrism manifested as substantializations of the world of ideas , god or mind, which was characteristic of previous Western paradigms, totality was defined as the coexistence of opposites. Thus Heidegger, Merleau-Ponty, Dōgen, and Nishida often illustrated it by identifying fundamental polarities, such as being and nothing, seer and seen, truth and illusion, etc. Accordingly, totality was schematically presented as an all-encompassing middle of the semiotic square. Similar values can be found in aesthetics and arts. Instead of dialectic syntagms, differentiated unity is considered as paradigmatic and the study demonstrates how this is manifested in traditional Japanese and Heideggerian aesthetics, as well as in the aspects of music of Claude Debussy and Tōru Takemitsu.