[Meaningful 'romming' (routine outcome monitoring): seeking a balance between userfriendliness and clinical relevance]. / Zinvol 'rommen': zoeken naar een evenwicht tussen gebruiksvriendelijkheid en klinische relevantie.

BACKGROUND: In the course of the last few years several ROM systems have been developed in which the measurements and feedback are restricted to the therapy outcome in terms of symptom reduction. In these ROM systems the emphasis is on the user-friendliness and on the ease with which the measurements can be implemented in clinical practice. However, research shows that many therapists and clients consider that the measurement of symptom reduction is too simplistic. AIM: To develop a ROM system that is therapeutically more relevant. METHOD: We describe the development and implementation of the Leuven Systematic Case study Protocol. RESULTS: In this multidimensional and multimodal monitoring system the emphasis is on the therapeutic relevance of 'romming:' not simply in terms of symptom reduction, but also in terms of processes of change and growth-orientated processes. In addition, the monitoring system takes into account the unique characteristics of client and therapist and the synergy existing between them. CONCLUSION: Not only do therapists have to learn to deal with the practical aspects of 'romming', they also need to be trained and supported so that they can deal adequately with a more explicit evaluation and feedback 'culture'.

Measurement of longitudinal changes in body composition during weight loss and maintenance in overweight and obese subjects using air-displacement plethysmography in comparison with the deuterium dilution technique.

BACKGROUND: Air-displacement plethysmography (ADP) may be a valid and practical technique to assess body composition in a clinical setting. OBJECTIVE: This study aimed to assess longitudinal changes in body composition using ADP and to compare it with the deuterium dilution technique. DESIGN: The study was a 6-months dietary intervention, consisting of four phases. The first month, subjects were fed in energy balance (phase I). This was followed by 1 month with an energy intake of 33% of energy requirements (phase II), followed by 2 months at 67% of energy requirements (phase III) and 2 months of ad libitum intake (phase IV). Body composition was assessed using ADP (Bod Pod) and deuterium dilution at baseline and at the end of each phase. The baseline analysis included 111 subjects (88 female). Sixty-one subjects (50 female) completed all measurements and were included in the longitudinal analysis. RESULTS: At baseline, the fat mass (FM) as assessed with the Bod Pod was on average 2.3 ± 4.2 kg (mean ± 2 s.d.) higher than that assessed with deuterium dilution. The difference in FM between techniques increased significantly with increasing FM (R(2)=0.23; P<0.001). Both techniques showed significant changes in FM over time P<0.001). On average, FM as assessed with the Bod Pod was 2.0 kg higher than with deuterium dilution (P<0.001). During phase II, there was a significant interaction between time and method, meaning that the Bod Pod showed a larger decrease in FM than deuterium dilution. CONCLUSIONS: The Bod Pod was able to detect all changes in the body composition, but consistently measured a higher FM than deuterium dilution.

PEGylated lipids impede the lateral diffusion of adsorbed proteins at the surface of (magneto)liposomes.

Protein binding to nanoparticles is a crucial issue in biomedicine, as it triggers their clearance from the bloodstream after intravenous injection. Many techniques are available for measuring strong protein binding interactions, but weak dynamic interactions are more difficult to assess. To tackle the latter problem, in the present work, cytochrome c was chosen as a representative model of a water-soluble protein and the adsorbing particulates were either small unilamellar phospholipid vesicles or 14 nm diameter solid superparamagnetic iron oxide cores onto which a phospholipid bilayer was strongly chemisorbed (so-called magnetoliposomes). Incorporation of cytochrome c oxidase into the phospholipid bilayer allowed the association of cytochrome c with the surface of the particles to be measured with high sensitivity by VIS-spectrophotometry. The impact of enzyme density as well as some of the physical features of the PEG corona (degree of PEGylation and PEG chain length) adjacent to the surface of the lipid structures on the overall kinetics was also investigated.

Evaluation of peri-tumoral vessels surrounding colorectal liver metastases after intravenous injection of extruded magnetoliposomes in rats: correlation with 3T MRI and histopathology.

BACKGROUND: Magnetoliposomes have pronounced signal-enhancing effect on T1-weighted (T1w) images of the liver using qualitative analysis which may be benefical for demonstrating peritumoral vasculature. PURPOSE: To correlate peri-tumoral vasculature (ring-enhancement) surrounding colorectal liver metastases after injection of magnetoliposomes using T1-weighted (T1w) imaging with histopathology in a rat model. MATERIAL AND METHODS: All experiments were approved by the responsible Animal Care Committee. Three rats injected with CC531 coloncarcinoma cells in the portal vein were imaged at 3T using a small diameter four channel coil. The presence of liver metastases, signal intensity changes within intrahepatic vessels, peri-tumoral vasculature (ring-enhancement) surrounding liver metastases on T1w imaging and histopathology, and the histopathological distribution of iron particles were evaluated. SS SE-EPI and T1w GE sequences were used. Images were evaluated qualitatively and MRI findings were correlated with histopathology. RESULTS: Fifteen liver metastases were present which were all detected at MRI (mean diameter 2.4 mm (SD 0.8 mm, range 1.5-4.7 mm)). Ring-enhancement surrounding liver metastases at contrast-enhanced T1w GE sequences was present in all liver metastases. Correlation with histopathology showed the corresponding presence of dilated sinusoids filled with iron particles surrounding the liver metastases. CONCLUSION: Blood-pooling of iron oxide particles within magnetoliposomes was demonstrated with increased and hyperintensity of vessels after injection of magnetoliposomes. Qualitatively, ring-enhancement surrounding the liver metastases was seen on T1w imaging and corresponded histopathologically with the presence of iron particles (magnetoliposomes) within the dilated sinusoids surrounding the liver metastases.

No long-term weight maintenance effects of gelatin in a supra-sustained protein diet.

In the short-term, gelatin showed stronger hunger suppression and less energy intake compared with other proteins. This study investigated if a supra-sustained gelatin-milk protein (GMP) diet improves weight maintenance (WM) compared with a sustained milk protein (SMP) diet and supra-sustained milk protein (SSMP) diet during a 4-months WM period after 8-week weight loss (WL) in sixty-five healthy subjects (28.6+/-3.4kg/m(2); 44+/-10years). Absolute protein intake was kept constant (sustained) throughout per subject. Diets were: protein(P)/fat(F)/carbohydrate(C): 15/40/45% of energy (En%) (SMP) and 30/25/45 En% (SSMP or GMP) for weeks 9-16. Diets on weeks 17-24: P/F/C: 30/35/35 En% (SMP) and 60/5/35 En% (SSMP or GMP). From weeks 8 to 16, and weeks 16 to 24, changes in BMI were similar between the GMP (-0.4+/-0.6 and 0.3+/-0.7kg/m(2) respectively), and the SMP (-0.7+/-0.9 and 0.1+/-0.7kg/m(2) respectively) and SSMP (-0.6+/-0.6 and 0.3+/-0.6kg/m(2) respectively) diets. Sparing of fat free mass (FFM): increases/decreases in FFM%/fat-mass% from weeks 8 to 16 were similar between the GMP and both control diets, and maintained from weeks 16 to 24. In conclusion, all 3 diets resulted in a successful WM period, while a GMP diet does not improve body weight maintenance and related variables after weight loss compared with a SMP and SSMP diet.

Dietary protein, weight loss, and weight maintenance.

The role of dietary protein in weight loss and weight maintenance encompasses influences on crucial targets for body weight regulation, namely satiety, thermogenesis, energy efficiency, and body composition. Protein-induced satiety may be mainly due to oxidation of amino acids fed in excess, especially in diets with "incomplete" proteins. Protein-induced energy expenditure may be due to protein and urea synthesis and to gluconeogenesis; "complete" proteins having all essential amino acids show larger increases in energy expenditure than do lower-quality proteins. With respect to adverse effects, no protein-induced effects are observed on net bone balance or on calcium balance in young adults and elderly persons. Dietary protein even increases bone mineral mass and reduces incidence of osteoporotic fracture. During weight loss, nitrogen intake positively affects calcium balance and consequent preservation of bone mineral content. Sulphur-containing amino acids cause a blood pressure-raising effect by loss of nephron mass. Subjects with obesity, metabolic syndrome, and type 2 diabetes are particularly susceptible groups. This review provides an overview of how sustaining absolute protein intake affects metabolic targets for weight loss and weight maintenance during negative energy balance, i.e., sustaining satiety and energy expenditure and sparing fat-free mass, resulting in energy inefficiency. However, the long-term relationship between net protein synthesis and sparing fat-free mass remains to be elucidated.

Insulin acutely upregulates protein expression of the fatty acid transporter CD36 in human skeletal muscle in vivo.

Enhanced fatty acid uptake may lead to the accumulation of lipid intermediates. This is related to insulin resistance and type 2 diabetes mellitus. Rodent studies suggest that fatty acid transporters are acutely regulated by insulin. We investigated differences in fatty acid transporter content before and at the end of a hyperinsulinemic euglycemic clamp in skeletal muscle (m. vastus lateralis) of obese, glucose-intolerant men (IGT) and obese normal glucose tolerant controls (NGT). The fatty acid transporter FAT/CD36 protein content increased 1.5-fold (P < 0.05) after 3-hrs of insulin stimulation with no difference between IGT and control subjects. No change was seen in cytosolic fatty acid binding protein (FABPc) protein content. The increase in FAT/CD36 protein content was positively related to insulin resistance as measured during the clamp (r = 0.56, P < 0.05). An increase in FAT/CD36 protein content in skeletal muscle may result in a higher fractional extraction of fatty acids (larger relative uptake) after a meal, enhancing triglyceride accumulation in the muscle. We conclude that also in obese humans the FAT/CD36 protein content in skeletal muscle is dynamically regulated by insulin in vivo on the short term.

Protein-induced satiety: effects and mechanisms of different proteins.

Relatively high protein diets, i.e. diets that maintain the absolute number of grams of protein ingested as compared to before dieting, are a popular strategy for weight loss and weight maintenance. Research into multiple mechanisms regulating body weight has focused on the effects of different quantities and types of dietary protein. Satiety and energy expenditure are important in protein-enhanced weight loss and weight maintenance. Protein-induced satiety has been shown acutely, with single meals, with contents of 25% to 81% of energy from protein in general or from specific proteins, while subsequent energy intake reduction was significant. Protein-induced satiety has been shown with high protein ad libitum diets, lasting from 1 to 6 days, up to 6 months. Also significantly greater weight loss has been observed in comparison with control. Mechanisms explaining protein-induced satiety are nutrient-specific, and consist mainly of synchronization with elevated amino acid concentrations. Different proteins cause different nutrient related responses of (an)orexigenic hormones. Protein-induced satiety coincides with a relatively high GLP-1 release, stimulated by the carbohydrate content of the diet, PYY release, while ghrelin does not seem to be especially affected, and little information is available on CCK. Protein-induced satiety is related to protein-induced energy expenditure. Finally, protein-induced satiety appears to be of vital importance for weight loss and weight maintenance. With respect to possible adverse events, chronic ingestion of large amounts of sulphur-containing amino acids may have an indirect effect on blood pressure by induction of renal subtle structural damage, ultimately leading to loss of nephron mass, and a secondary increase in blood pressure. The established synergy between obesity and low nephron number on induction of high blood pressure and further decline of renal function identifies subjects with obesity, metabolic syndrome and diabetes mellitus II as particularly susceptible groups.

Partitioning of propranolol in the phospholipid bilayer coat of anionic magnetoliposomes.

This work deals with the partitioning of the cationic amphiphilic drug, propranolol, in the coating of so-called magnetoliposomes (MLs), which consist of nanometre-sized, magnetizable iron oxide cores covered with a phospholipid bilayer. MLs of two types were used: either the ML coat consisted entirely of anionic dimyristoylphosphatidylglycerol, or it was mixed with zwitterionic dimyristoylphosphatidylcholine in a 5/95 molar ratio. To separate sorbed from non-sorbed propranolol, high-gradient magnetophoresis was used. The sorption profiles clearly show that electrostatic interactions play a key role in the sorption process as drug incorporation in the ML coat was favoured by increasing the anionic character of the ML envelope and by reducing the salt concentration of the medium. Also, upon drug binding some phospholipid molecules were expelled from the ML coat. The observations may be of relevance in the biomedical field, i.e. in the development of ML-based, intracellular theranostics.

Specific heating power of fatty acid and phospholipid stabilized magnetic fluids in an alternating magnetic field.

Magnetic fluids (MFs) with a similar narrow size distribution of the iron oxide core were stabilized with lauric acid (MF 1), oleate (MF 2) or, after dialysis in the presence of liposomes, with phospholipid molecules (MF 3 and MF 4, respectively). The hydrodynamic sizes of the MF 1 and MF 3 were half those found for MF 2 and MF 4. The MFs were exposed to inductive heating in an alternating magnetic field at a frequency of 200 kHz and a maximum magnetic field strength of 3.8 kA m(-1). Specific absorption rates (SAR) of 294 ± 42 (MF 1), 214 ± 16 (MF 2), 297 ± 13 (MF 3) and 213  ± 6 W g(-1) Fe (MF 4) were obtained. The data for MF 2 and MF 4 were identical to those found for the commercially available ferucarbotran. The biomedical relevance of the phospholipid-coated MFs is briefly discussed.

Long-term effects of consumption of a novel fat emulsion in relation to body-weight management.

OBJECTIVE: To assess weight maintenance after weight loss by consumption of yoghurt with a novel fat emulsion (Olibra) including effects on body composition, resting energy expenditure (REE), fat oxidation, hunger feelings and satiety hormones. DESIGN: A randomized, placebo-controlled, double-blind, parallel design. A 6-week weight loss period (2.1 MJ/day) was followed by 18 weeks weight maintenance with test (Olibra) or placebo yoghurt. SUBJECTS: Fifty overweight women (age: 18-58 years, body mass index (BMI) 25-32 kg/m2). MEASUREMENTS: In weeks 1, 7 and 25, a satiety test with questionnaires and blood samples for analysis of satiety hormones. In weeks 2, 8 and 26, REE, body weight and body composition. RESULTS: During weight maintenance after significant body weight reduction, there was no significant increase in body weight in the test group (1.1+/-3.4 kg); the placebo group did gain weight (3.0+/-3.1 kg, P<0.001). Compared to the placebo group, the test group was less hungry 4 h after yoghurt consumption in week 25 (P<0.05) and showed increased glucagon like peptide-1 values 180 min after yoghurt consumption (week 25 vs week 1, P<0.05). Measured REE as a function of fat-free mass (FFM) was significantly higher than predicted REE (P<0.05) in week 26 for the test group, but not for the placebo group. Fat mass (FM) was significantly more decreased in the test group (6.5+/-4.1 kg) compared to the placebo group (4.1+/-3.6 kg) (week 26 vs week 2, P<0.05). CONCLUSION: Consumption of Olibra yoghurt improved weight maintenance compared to placebo, which can be explained by the relatively higher REE as a function of FFM, relatively higher decrease in FM and the relatively lower increase in hunger.

Parenting and psychosocial development of IVF children: a follow-up study.

BACKGROUND: This report details a follow-up study of the parent-child relationship and the child's psychosocial development after IVF. The pilot study compared 31 IVF families and 31 families with a naturally conceived child when the children were aged 2 years. Twenty-seven IVF and 23 control families participated again when the children were aged 8-9 years. METHODS: Fathers and mothers completed questionnaires assessing parenting variables and the child's behaviour. For most children, behavioural ratings were also obtained from the child's teacher. RESULTS: No significant differences were found between IVF and control parents' reports of child behaviour, parenting behaviour, parenting stress and most of the parenting goals. The parenting goal adjustment was significantly more important for IVF than for control fathers; religion was more important for IVF than for naturally conceiving mothers. Teacher ratings of the child's behaviour did not differ significantly between the IVF and control groups. All couples but one had talked to other persons about the IVF conception; 75% of the IVF parents had not yet informed their children. IVF parents who had informed their child observed more (internalizing and for fathers also overall) problem behaviours in their child, compared with IVF parents who had not yet disclosed the IVF conception. CONCLUSIONS: Parenting and the children's psychosocial development do not differ significantly between IVF families and control families.