New interdisciplinary cognitive-behavioural-nutritional approach to obesity treatment: a 5-year follow-up study.

OBJECTIVE: The aim of this prospective case-control study was to assess the long-term effectiveness of interdisciplinary cognitive-behavioural-nutritional therapy, combined with daily physical exercise and relaxation sessions, on weight and psychosocial issues during a 6-week in-hospital stay. SETTING: Five years (60 +/- 1 months) later, the patients were readmitted for a one-day medical evaluation including a physical examination and laboratory work-up, and the completion of a detailed questionnaire focusing on dietary and psychosocial factors that may affect weight loss/regain. SUBJECTS: The follow-up population consisted of 55 morbidly obese subjects aged 49.5 +/- 2 years (45 females and 10 males; BMI: 40 +/- 0.7 kg/m2). During their initial 6-week in-hospital stay, they lost an average of 7.6 +/- 0.4 kg. RESULTS: Five years later, 25.5% of the patients had lost a further 11.9 +/- 1.8 kg, 20% maintained their initial weight loss (0.6 +/- 0.4 kg), and 54.5% regained weight (10.4 +/- 1 kg). The weight changes significant correlated with the degree of psychosocial difficulties (p < 0.001), eating behaviour problems (p < 0.001), dietary fat intake (p < 0.005) and total energy intake (p < 0.05). Fasting plasma insulin and blood glucose concentrations were significantly higher in the patients who regained weight after five years, and significantly lower in those who had lost more weight. CONCLUSION: As a whole, these results show the efficacy of an interdisciplinary approach to the long-term treatment of morbidly obese patients. It is likely that an outpatient psychological follow-up would have improved this therapeutic success.

The influence exerted by a restricted phospholipid microenvironment on the expression of tissue factor activity at the cell plasma membrane surface.

Phosphatidylserine (PhtdSer) is an anionic aminophospholipid necessary for the development of optimal tissue factor (TF) activity at the cell surface. This study investigates the implication of a restricted lipid environment with respect to PhtdSer availability on TF expression and activity. K562 cells, showing a reduced ability to externalize PhtdSer, were transfected with human TF cDNA. PhtdSer exposure and TF activity were examined in transfected cells and compared to monocytic THP-1 cells expressing constitutive and inducible TF or megakaryocytic HEL cells showing a high PhtdSer externalization potency. TF expression was evidenced by flow cytometry and its activity measured using functional assays. PhtdSer exposure was monitored by enzymatic prothrombinase assay. One clone (DC9) expressed a stable amount of TF antigen without global modification of its membrane status. Despite a noticeable TF expression level, clone DC9 presented only a weak TF activity even after ionophore stimulation. The apparent Km, relative to factor X (FX) activation by TF-factor VIIa (FVIIa) complex, was 335 nM versus 70 nM for THP-1 cells. The velocity of the reaction was found 3-fold slower in DC9 than THP-1 cells. Ionophore treatment resulting in slightly enhanced amounts of available PhtdSer abolished this difference. The DC9 clone appears suitable for further investigations on the biology of TF expressed at the surface of cells where the contribution of PhtdSer is significantly attenuated. Such cells should enable further assessment of the role of TF as a receptor coupled to intracellular signaling pathways and its fate during apoptotic cell death.

[Wound healing and hyperbaric oxygen. Experimental study of the angiogenesis phase in the rat]. / La cicatrisation sous oxygénothérapie hyperbare. Etude expérimentale de sa phase angiogénique chez le rat.

Hyperbaric oxygen therapy (HBO) is widely reported as highly favourable to wound healing. The experimental models generally used to investigate its effects are difficult to set up and reliable quantification of the results obtained is rarely achieved. The underlying pathophysiological mechanisms occurring during HBO remain poorly understood and its mode of application for clinical practice is difficult to standardise. Our study was carried out to assess the contributions of oxygen and hyperbaric pressure on the initial steps of wound healing. It was based on qualitative and quantitative analysis of the development of the angiogenic process in a granulation tissue bud, using animals implanted with fibrin chambers, an in vivo model initially described by Dvorak in guinea pigs. In our study, rats were further submitted to HBO (OHB group) or hyperbaric air (Air-HB group) treatments. The control group (Control group) consisted of rats maintained in the treatment tank under normal atmospheric conditions. Nine specific parameters were determined and analysed during the course of the angiogenic process by classical histological techniques. The vascular density and the height of the bud were particularly examined at day 7, 14 and 21 following chamber implantation. At D7 the neovessel density and bud height were significantly higher in OHB group than in Air-HB or Control groups, thus confirming the beneficial effects of this treatment on the initial steps of wound healing. Nevertheless, the results reported herein also suggest a possible inhibitory effect of hyperbaric therapy alone on this very early process, although the pathophysiological significance of this effect on wound healing remains to be determined.