Effects of long-term intake of lactotripeptides on cardiovascular risk factors in hypertensive subjects.

BACKGROUND/OBJECTIVES: Lactobacillus helveticus LBK-16H-fermented milk products containing tripeptides isoleucine-proline-proline and valine-proline-proline lower blood pressure in hypertensive subjects using office and home blood pressure registration. The present study was aimed to evaluate the effects of two doses of these lactotripeptides on 24-h ambulatory blood pressure and lipidomics profiles in mildly hypertensive subjects. SUBJECTS/METHODS: In a randomized, double-blind, placebo-controlled parallel group study, 89 mildly hypertensive subjects ingested, after a 1-month run-in period, a fermented milk drink with 5 mg per day of lactotripeptides during 3 months, and a milk drink with 50 mg per day of lactotripeptides for the following 3 months, or a placebo milk drink without lactotripeptides. Ambulatory blood pressure (24 h) was recorded at baseline and at the end of the intervention periods. Lipidomics profiles were characterized before and after the 6-month intervention. RESULTS: After the second intervention period (50 mg per day of lactotripeptides), systolic and diastolic 24-h blood pressures decreased significantly in the peptide, but not in the placebo group. However, the treatment effects -2.6 mm Hg (95% confidence interval (CI): -5.7 to 0.4) in systolic and -1.3 mm Hg (95% CI: -3.4 to 0.8) in diastolic blood pressure did not reach statistic significance. Ingestion of 5 mg per day of lactotripeptides for 3 months did not lower blood pressure. The peptide group was dominated by decrease in multiple phospholipids (PL). CONCLUSIONS: Ingestion of fermented milk with daily dose of 50 mg of lactotripeptides appears to lower elevated blood pressure slightly from the baseline, but not significantly compared with the placebo group and to induce significant decreases in multiple PL.

Long-term intervention with Lactobacillus helveticus fermented milk reduces augmentation index in hypertensive subjects.

BACKGROUND: The milk casein-derived biologically active tripeptides, isoleucyl-prolyl-proline (Ile-Pro-Pro) and valyl-prolyl-proline (Val-Pro-Pro), have documented antihypertensive effect probably related to reduced angiotensin formation. It has been suggested that these tripeptides may reduce arterial stiffness and improve endothelial function. Our aim was to evaluate whether the milk-based drink containing Ile-Pro-Pro and Val-Pro-Pro influence arterial stiffness, measured as augmentation index (AIx), and endothelial function in man. METHODS: In a double-blind parallel group intervention study, 89 hypertensive subjects received daily peptide milk containing a low dose of tripeptides (5 mg/day) for 12 weeks and a high dose (50 mg/day) for the following 12 weeks, or a placebo milk drink to titrate the dose-response effect. Arterial stiffness was assessed by pulse wave analysis at the beginning and end of each intervention period. Endothelial function was tested by examining pulse wave reflection response to sublingual nitroglycerin and salbutamol inhalation. Blood pressure was measured by using office and 24-h ambulatory blood pressure measurement. RESULTS: At the end of the second intervention period, AIx decreased significantly in the peptide group compared with the placebo group (peptide group -1.53% (95% confidence interval (CI) -2.95 to -0.12), placebo group 1.20% (95% CI 0.09-2.32), P=0.013). No change in endothelial function index was observed (peptide group 0.02 (95% CI -0.06 to 0.08), placebo group 0.04 (95% CI -0.04 to 0.12), P=0.85). There were no statistically significant differences between the effects of the peptide and placebo treatment on office and 24-h ambulatory blood pressure. CONCLUSIONS: Long-term treatment with Lactobacillus helveticus-fermented milk containing bioactive peptides reduces arterial stiffness expressed as AIx in hypertensive subjects.

Lupin protein attenuates the development of hypertension and normalises the vascular function of NaCl-loaded Goto-Kakizaki rats.

The beneficial cardiovascular effects of soy protein have been studied intensively in recent years. Another protein-rich legume is lupin, which has been shown to have similar effects to those of soy in lowering serum cholesterol levels. In this study we compared the effects of lupin and soy protein on hypertension and vascular functions in spontaneously diabetic Goto-Kakizaki (GK) rat, which develop hypertension when fed a high-salt diet. The rats were fed with a 6% NaCl diet containing either lupin or soy protein isolate (20% weight/weight) for two weeks. In the end of the study the SBP was 18.6 mmHg lower (p<0.001) in the lupin group, and 12.0 mmHg lower (p<0.01) in the soy group than in the control group. Lupin and soy treatments normalised the decreased vasocontraction observed in the NaCl-fed control group, but only lupin treatment improved the impaired endothelium-dependent vasorelaxation. The attenuation of hypertension is likely to be mediated by the corrected vascular dysfunction, whose precise mechanism and the possible clinical relevance remains to be studied further.

Effects of low-fat hard cheese enriched with plant stanol esters on serum lipids and apolipoprotein B in mildly hypercholesterolaemic subjects.

OBJECTIVE: To investigate the cholesterol-lowering effects of a low-fat cheese enriched with plant stanol esters in mildly hypercholesterolaemic subjects, as part of their normal diet. DESIGN: A randomized double-blind parallel-group study. SETTING: Valio Ltd, Helsinki. SUBJECTS: Sixty-seven mildly hypercholesterolaemic volunteers (24 men, 43 women) participated in the study, which all of them completed. INTERVENTIONS: The subjects were randomly assigned to the plant stanol ester group or the control group. During the 5-week intervention, the subjects in the stanol group consumed a cheese enriched with 2 g of plant stanols per day, and the subjects in the control group, a control cheese with no plant stanols. RESULTS: In the stanol ester group, as compared to the control group, both serum total and low-density lipoprotein (LDL) cholesterol decreased significantly, that is, by 5.8% (-0.32 mmol/l, 95% CI -0.50 to -0.15 mmol/l, P < 0.001) and 10.3% (-0.36 mmol/l, 95% CI -0.53 to -0.18 mmol/l, P < 0.001), respectively. There were no significant changes in high-density lipoprotein cholesterol (HDL), triglycerides or apolipoprotein B concentrations between the groups. CONCLUSION: Cheese enriched with 2 g of plant stanol in the form of fatty acid esters decreases serum total and LDL cholesterol significantly.

Effect of ingesting sour milk fermented using Lactobacillus helveticus bacteria producing tripeptides on blood pressure in subjects with mild hypertension.

Angiotensin-converting enzyme (ACE) is important in the regulation of blood pressure (BP). Two tripeptides that inhibit ACE, isoleucyl-prolyl-proline (Ile-Pro-Pro) and valyl-prolyl-proline (Val-Pro-Pro), have been isolated from certain sour milks. The aim of the study reported was to evaluate the effect on BP in subjects with mild hypertension of a new sour milk containing tripeptides. The initial number of subjects was 60 (36 men, 24 women). Among the criteria for inclusion in the study were systolic BP (SBP) between 140 and 180 mmHg and/or diastolic BP (DPB) between 90 and 110 mmHg, without antihypertensive drug therapy. There were two study periods with a washout period between. All subjects were given 1.5 dl per day of a placebo (regular sour milk) or of the active product, a milk that had been fermented with Lactobacillus helveticus bacteria and contained 2.4-2.7 mg of Ile-Pro-Pro and 2.4-2.7 mg of Val-Pro-Pro per 1.5 dl. In the first phase, SBP fell 16 mmHg from baseline in the active group, 2 mmHg more than in the placebo group (P=0.0668) and no difference in DBP (P=0.92). There was a statistically significant downward trend both in SBP and DBP (P=0.0001). During the second phase, SBP fell 11 mmHg in the active group (P=0.008). The reduction in SBP was significantly larger in active than placebo group (P=0.012). In the crossover analysis combining both phases, SBP fell on average 2.6+/-15.9 mmHg more on the active product compared with the placebo product, but this difference was not statistically significant (P=0.3111). The difference in DBP, 1.0+/-8.3 mmHg between the two test products was not significant either (P=0.4431). In conclusion, the ingestion of sour milk fermented by L. helveticus bacteria and that containing ACE inhibitory tripeptides seems to lower BP modestly.

Evaluation of methods for MR imaging of human right ventricular heart volumes and mass.

PURPOSE: To assess the utility of two different imaging directions in the evaluation of human right ventricular (RV) heart volumes and mass with MR imaging; to compare breath-hold vs. non-breath-hold imaging in volume analysis; and to compare turbo inversion recovery imaging (TIR) with gradient echo imaging in RV mass measurement. MATERIAL AND METHODS: We examined 12 healthy volunteers (age 27-59 years). Breath-hold gradient echo MR imaging was performed in two imaging planes: 1) perpendicular to the RV inflow tract (RVIT view), and 2) in the transaxial view (TA view). The imaging was repeated in the TA view while the subjects were breathing freely. To analyze RV mass using TIR images, the RV was again imaged at end-diastole using the two views. The RV end-diastolic cavity (RVEDV) and muscle volume as well as end-systolic cavity volume (RVESV) were determined with the method of discs. All measurements were done blindly twice to assess repeatability of image analysis. To assess reproducibility of the measurements, 6 of the subjects were imaged twice at an interval of 5-9 weeks. RESULTS: RVEDV averaged 133.2 ml, RVESV 61.5 ml and the RVmass 46.2 g in the RVIT view and 119.9 ml, 56.9 ml and 38.3 g in the TA view, respectively. The volumes obtained with breath-holding were slightly but not significantly smaller than the volumes obtained during normal breathing. There were no marked differences in the RV muscle mass obtained with gradient echo imaging compared to TIR imaging in either views. Repeatability of volume analysis was better in TA than RVIT view: the mean differences were 0.7 +/- 4.0 ml and - 5.4 +/- 14.0 ml in end-diastole and 1.6 +/- 3.1 ml and - 1.5 +/- 13.9 ml in end-systole, respectively. Repeatability of mass analysis was good in both TIR and cine images in the RVIT view but slightly better in TIR images: - 0.5 +/ -2.4 g compared to 0.8 +/- 2.9 g in cine images. Reproducibility of imaging was good, mean differences for RVEDV and RVESV were -1.0 +/- 4.8 ml and -0.8 +/- 2.8 ml, respectively. Mean difference for RVmass was -0.9 +/- 2.6 g. CONCLUSION: The present study suggests that gradient echo MR imaging is well applicable to RV volume and mass measurements. The best imaging plane for volumetric analysis seems to be the TA plane and there was no significant difference between breath-hold and conventional imaging. To assess RV mass, we recommend RVIT view; the TIR sequence quickly produced images of better quality compared to gradient echo images but no significant difference between masses was found and repeatability of analysis was equally good with both methods.

Hearing impaired children in developing countries.

The majority of hearing impaired children live in the developing countries. Limited resources are available for screening, prevention, diagnosis and intervention. These problems were the topic for discussion in a special session in the Congress.

Progression of sensorineural hearing impairment in aided and unaided ears.

The possibility of "adult onset auditory deprivation" has been proposed as a condition of extensive deterioration of speech discrimination in unaided ears. Pure tone thresholds and speech discrimination were studied in a follow-up examination on 500 patients using hearing aids unilaterally. The follow-up time ranged from 5 to 24 years. In average the same amount of deterioration was obtained in both ears. Deterioration in pure tone thresholds increased after the age of 80 years and speech discrimination after 65 years respectively. The results obtained gave no support to the concept of adult onset auditory deprivation in unaided ears.

MR gradient echo volumetric analysis of human cardiac casts: focus on the right ventricle.

PURPOSE: Our goal was to assess the utility of different imaging directions in volumetric studies of the heart with MRI, in particular to identify the optimal imaging plane for studies of the right ventricle. METHOD: We examined 12 sets of human four-chamber cadaveric cardiac casts. Gradient echo MRI was performed in four imaging planes: (a) perpendicular to the right ventricular inflow tract; (b) perpendicular to the right ventricular outflow tract; (c) in the left ventricular short axis view; and (d) in the axial view. The volumes of the right ventricle and other cardiac cavities were determined with the method of discs. The true cast volumes were measured with the water displacement technique. The agreement between true and measured volumes and the repeatability of image analysis were determined using the Bland-Altman method. RESULTS: There were no statistically significant differences between the measured and true right ventricular volumes irrespective of the imaging plane. The axial plane gave the smallest mean absolute difference from the true right ventricular volume (3.2 +/-2.2 ml) and also the best repeatability of volume analysis (0.2+/-1.6 ml). However, the other imaging planes performed nearly as well, and the differences across the planes were not statistically significant (p > 0.05). Also, in studies of the left ventricle and left and right atrium, the axial view appeared to give the best results, but differences across the imaging planes remained small. CONCLUSION: The present studies of human cardiac casts suggest that gradient echo MRI is well applicable to right ventricular volume measurements. Imaging the right ventricle in axial planes covering the entire heart gives good agreement with true right ventricular volumes and excellent analysis reproducibility. However, other imaging directions perform nearly as well, and thus selection of the imaging plane may not be of major importance to the accuracy of cardiac volume measurements with MR.

Behavioural observation audiometry in testing young hearing-impaired children.

The aim was to examine the accuracy of unconditioned behavioural observation audiometry (BOA) in predicting hearing acuity in children and the validity of test results at various frequencies. The study was designed to longitudinally compare each child's best BOA response level (at the age >12 months) with the conclusive pure-tone threshold of the better ear. The subjects were 119 children derived from a material of 353 children fitted with a hearing aid at Helsinki University Central Hospital. BOA was carried out on 119 children, 19 of whom did not respond to frequency-specific stimuli. The predictive power of BOA depended on the severity of hearing loss. At the hearing level of 30-39 dB, BOA registered 10-15 dB poorer levels than the pure-tone audiometry. The pure-tone averages (0.5, 1, 2 kHz) of 50-69 dB agreed best with the BOA responses. In severe impairments (more than 70 dB HL), the BOA registered too good hearing. Correlation of the results from the two modes to measure hearing level was highly significant (r = 0.71, p = 0.000), and the pure-tone hearing level agreed with that of BOA at the frequencies 0.5 to 4 kHz. Our results show that BOA averages < or =30 dB rarely indicate hearing loss demanding fitting of a hearing aid.

Hearing disability assessment in evaluating hearing aid benefit.

The aim was to study the applicability of an eight-item questionnaire in evaluating the benefit derived from hearing-aid use. Since 1977, 3402 hard-of-hearing patients have been fitted with a hearing aid for the first time and followed up for 3 months in the Helsinki University Central Hospital. The questionnaire included eight situation-specific items in hearing: speech face-to-face, speech in a small and large group, loud speech, in telephone and radio/TV, doorbell, telephone signal. The scoring ranged from 0 to 16. After a 3 months' use of amplification, the questionnaire was completed again. The median (interquartile range) and arithmetic mean (standard deviation) of the prefitting scores were 5.0 (4.0-6.0) and 5.3 (2.33). The postfitting scores were 1.0 (0.0-2.0) and 1.1 (1.17), respectively. The difference was highly significant. An eight-item questionnaire in the evaluation of hearing problems provided a reliable numerical score of disability. Follow-up is important to secure satisfactory results in rehabilitation, especially in old age.

Oral glycerol and intravenous dexamethasone in preventing neurologic and audiologic sequelae of childhood bacterial meningitis. The Finnish Study Group.

To assess the value of adjunctive intravenous dexamethasone (DXM) and oral glycerol (GLY) for the treatment of bacteriologically proved bacterial meningitis, 122 infants and children with bacterial meningitis were randomly assigned to receive DXM intravenously (n = 32), GLY orally (n = 30), DXM plus GLY (n = 34) or neither (n = 26) of these drugs. All patients were treated with the same antimicrobial agent, ceftriaxone. The patients were followed neurologically for as long as 6 months. A thorough hearing evaluation was performed routinely 2 months or more after discharge from hospital. Overall 4 (7%) of the GLY-treated patients, compared with 11 (19%) of those not given GLY, developed audiologic or neurologic sequelae (P = 0.052), the relative risk of sequelae being 2.94 (95% confidence interval, 0.99 to 8.72). The patients who had received GLY showed less severe or profound bilateral hearing impairment than those not given GLY (0 vs. 7%, P = 0.049), and none of them had other neurologic abnormalities 3 or 6 months after discharge, compared with 5 (9%) of those not treated with GLY (P = 0.024). The DXM recipients showed only a tendency to less severe hearing impairment than those not given DXM. In conclusion oral GLY prevented neurologic sequelae in infants and children with bacterial meningitis more effectively than intravenous DXM.

Interference of immunoglobulin G (IgG) antibodies in IgA antibody determinations of Chlamydia pneumoniae by microimmunofluorescence test.

In the microimmunofluorescence test for measuring immunoglobulin A (IgA) antibodies against Chlamydia pneumoniae, removal of interfering IgG antibodies made IgA antibody reactivity patterns in 952 serum samples easier to interpret, prozone effects disappeared, and titers increased, especially in the sera with high IgG titers. IgA rheumatoid factors did not interfere in the assay.

Cochlear implants, vibrators and hearing aids in the rehabilitation of postlingual deafness.

Three groups of postlingually deaf adults were formed by non-random selection. The subjects with some residual hearing were fitted with a powerful hearing aid (HA group, n = 10). The others received either a single-channel vibrotactile aid (V group, n = 8) or a single-channel intracochlear implant (CI group, n = 10). Training containing individual counselling and rehearsal in small groups was arranged. During the follow-up (CI group 2.0 yrs, V group 1.8 yrs, HA group 2.6 yrs), the subject's achievement was assessed by a repetition of audiological testing and written questionnaires. Whereas the HA group obtained the highest scores in the audiological tests, the CI group found the implant most beneficial in everyday life. No significant improvement in the test scores was observed during the follow-up. The extent of personal training, after an initial training period and motivation of the user, did not affect the test scores or the subjective evaluation.

Audiological results using single-channel intracochlear implant, vibrotactile aid or acoustic hearing aids.

Users of a single-channel intracochlear implant (CI, n = 10) (3M/House), a single-channel vibrotactile aid (V, n = 8) (Minivib 3/Special Instrument Ab) and acoustic hearing aids (HA, n = 9) were tested. The comparison was made after training and a minimum of 11 months' use of the devices. All subjects were considered profoundly deaf, but the HA group had some residual hearing. The HA group achieved the best mean test scores in all the tests given. The difference between the CI group and V group increased, in favour to the CI users, as the auditory task was changed from the level of simple signal analysis to the level of linguistic interpretation.

Correlations between meatocisternography and audiological tests in suspected eight nerve tumors.

92 cases of suspected eight nerve tumors are analysed. Correlations between the findings in audiological and vestibular tests, patient histories and findings in conventional x-ray examinations and on the other hand those obtained in meatocisternography with air contrast in computerized tomography are drawn in order to see whether specific features of audiological tests can predict the meatocisternographic finding. The cases with positive findings are verified at surgery.