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    Xenon-Enhanced Dual-Energy CT Imaging in Combined Pulmonary Fibrosis and Emphysema

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    Little has been reported on the feasibility of xenon-enhanced dual-energy computed tomography (Xe-DECT) in the visual and quantitative analysis of combined pulmonary fibrosis and emphysema (CPFE).We compared CPFE with idiopathic pulmonary fibrosis (IPF) and chronic obstructive pulmonary disease (COPD), as well as correlation with parameters of pulmonary function tests (PFTs).Studied in 3 groups were 25 patients with CPFE, 25 with IPF without emphysema (IPF alone), 30 with COPD. Xe-DECT of the patients’ entire thorax was taken from apex to base after a patient’s single deep inspiration of 35% stable nonradioactive xenon. The differences in several parameters of PFTs and percentage of areas enhanced by xenon between 3 groups were compared and analyzed retrospectively., (R = 0.528, P < 0.0001) and a negative correlation with %RV (R = -0.594, P < 0.0001) and RV/TLC (R = -0.579, P < 0.0001). The percentage of areas enhanced by xenon in patients with CPFE showed significantly a negative correlation with RV/TLC (R = -0.529, P = 0.007). Xenon enhancement of CPFE indicated 3 different patterns such as upper predominant, diffuse, and multifocal defect. The percentage of areas enhanced by xenon in upper predominant defect pattern was significantly higher than that in diffuse defect and multifocal defect pattern among these 3 different patterns in CPFE.The percentage of areas enhanced by xenon demonstrated strong correlations with obstructive ventilation impairment. Therefore, we conclude that Xe-DECT may be useful for distinguishing emphysema lesion from fibrotic lesion in CPFE

    The effect of meal frequency in a reduced-energy regimen on the gastrointestinal and appetite hormones in patients with type 2 diabetes: A randomised crossover study

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    Appetite and gastrointestinal hormones (GIHs) participate in energy homeostasis, feeding behavior and regulation of body weight. We demonstrated previously the superior effect of a hypocaloric diet regimen with lower meal frequency (B2) on body weight, hepatic fat content, insulin sensitivity and feelings of hunger compared to the same diet divided into six smaller meals a day (A6). Studies with isoenergetic diet regimens indicate that lower meal frequency should also have an effect on fasting and postprandial responses of GIHs. The aim of this secondary analysis was to explore the effect of two hypocaloric diet regimens on fasting levels of appetite and GIHs and on their postprandial responses after a standard meal. It was hypothesized that lower meal frequency in a reduced-energy regimen leading to greater body weight reduction and reduced hunger would be associated with decreased plasma concentrations of GIHs: gastric inhibitory peptide (GIP), glucagon-like peptide-1(GLP-1), peptide YY(PYY), pancreatic polypeptide (PP) and leptin and increased plasma concentration of ghrelin. The postprandial response of satiety hormones (GLP-1, PYY and PP) and postprandial suppression of ghrelin will be improved.In a randomized crossover study, 54 patients suffering from type 2 diabetes (T2D) underwent both regimens. The concentrations of GLP-1, GIP, PP, PYY, amylin, leptin and ghrelin were determined using multiplex immunoanalyses.<0.043) and the postprandial reduction of ghrelin correlated positively with its fasting level (r = 0.9, p<0.001). The postprandial responses of GIHs and appetite hormones were similar after both diet regimens.Both hypocaloric diet regimens reduced fasting leptin and GIP and postprandial response of GIP comparably. The postprandial responses of GIHs and appetite hormones were similar after both diet regimens. Eating only breakfast and lunch increased fasting plasma ghrelin more than the same caloric restriction split into six meals. The changes in fasting ghrelin correlated negatively with the decrease in body weight. These results suggest that for type 2 diabetic patients on a hypocaloric diet, eating larger breakfast and lunch may be more efficient than six smaller meals during the day

    What Do Patients Think about the Cause of Their Mental Disorder? A Qualitative and Quantitative Analysis of Causal Beliefs of Mental Disorder in Inpatients in Psychosomatic Rehabilitation

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    Patients’ causal beliefs about their mental disorders are important for treatment because they affect illness-related behaviours. However, there are few studies exploring patients’ causal beliefs about their mental disorder.(a) To qualitatively explore patients’ causal beliefs of their mental disorder, (b) to explore frequencies of patients stating causal beliefs, and (c) to investigate differences of causal beliefs according to patients’ primary diagnoses.Inpatients in psychosomatic rehabilitation were asked an open-ended question about their three most important causal beliefs about their mental illness. Answers were obtained from 678 patients, with primary diagnoses of depression (N = 341), adjustment disorder (N = 75), reaction to severe stress (N = 57) and anxiety disorders (N = 40). Two researchers developed a category system inductively and categorised the reported causal beliefs. Qualitative analysis has been supplemented by logistic regression analyses.The causal beliefs were organized into twelve content-related categories. Causal beliefs referring to “problems at work” (47%) and “problems in social environment” (46%) were most frequently mentioned by patients with mental disorders. 35% of patients indicate causal beliefs related to “self/internal states”. Patients with depression and patients with anxiety disorders stated similar causal beliefs, whereas patients with reactions to severe stress and adjustment disorders stated different causal beliefs in comparison to patients with depression.There was no opportunity for further exploration, because we analysed written documents.These results add a detailed insight to mentally ill patients’ causal beliefs to illness perception literature. Additionally, evidence about differences in frequencies of causal beliefs between different illness groups complement previous findings. For future research it is important to clarify the relation between patients’ causal beliefs and the chosen treatment

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