Objective: To study the effect of a new fermented milk product containing GABA (FMG) on the blood pressure (BP) of patients with mild hypertension. Design: A randomized, placebo-controlled, single-blind trial. Setting: The study was carried out at the outpatient clinic of the Cardiovascular Disease Center, Tokyo Metropolitan Police Hospital, Japan. Subjects: The study population comprised 39 mildly hypertensive patients (16 women and 23 men) aged 28 -81 y (mean, 54.2 y). Interventions: The study consisted of a 12-week period of daily intake of FMG or placebo (weeks 1 -12) followed by 2 weeks of no intake (weeks 13 and 14). We measured the peripheral BP and heart rate of seated patients at weeks 0, 2, 4, 8, 12 and 14. Routine blood study and urinalysis were performed before and after the intake. Results: There was a significant decrease of BP within 2 or 4 weeks, and it remained decreased throughout the 12-week intake period. For the FMG recipients, the mean decrease after 12 weeks was 17.4 AE 4.3 mmHg in the systolic BP (SBP) and 7.2 AE 5.7 mmHg in the diastolic BP (DBP). Both of these values differed statistically from baseline levels (P < 0.01), and the SBP of the FMG group differed from the placebo group (P < 0.05). Heart rate, body weight, hematological and blood chemistry variables, and urinalysis results (glucosuria and proteinuria) did not vary both groups throughout the study. Conclusion: FMG may contribute to lowering BP in mildly hypertensive people.

BackgroundFrailty is a characteristic of older patients with heart failure, who undergo functional decline during hospitalization. At present, continuous intravenous infusion of diuretics is widely used for the treatment of hospitalized patients with heart failure. In this prospective, randomized, open-label controlled trial, we tested whether an early switch from continuous intravenous infusion therapy to oral treatment with diuretics prevents functional decline in patients hospitalized for heart failure.MethodsA total of 59 patients hospitalized for heart failure were randomized to either continuous intravenous infusion (n = 30) or oral medication (n = 29) within 48 h of admission. The primary outcome was the Barthel index, a universally utilized scale to assess the functional status of patients in their activities of daily living, assessed at 10 days. Secondary outcomes included the number of daily steps counted using pedometers and average hospital costs.ResultsBarthel index scores were significantly higher in the oral medication group than in the intravenous group (78.1 ± 20.8 vs. 59.6 ± 34.2, P = 0.029). The number of daily steps was significantly higher in the oral treatment group relative to the intravenous group (P < 0.001), and the average hospital costs were similar between the randomized groups. Multivariate analysis revealed that oral medication was a significant independent predictor of Barthel index score at day 10, and the number of daily steps was significantly associated with the patient’s functional outcome.ConclusionsThis trial showed that, in patients hospitalized for heart failure, oral medication increased functional independence during hospitalization compared with sustained continuous intravenous infusion, most likely because the release from the infusion line enabled the patients to be more mobile. Notably, these beneficial effects were achieved without increasing hospital costs.

SummaryA 69-year-old woman without any past disease history was hospitalized for heart failure. After hospitalization, she showed myocardial infarction, atrioventricular dissociation, and cardiac dysfunction, and finally she passed away despite intensive care. Autopsy revealed that the cardiac abnormalities were due to bacterial myocarditis possibly resulting from urinary tract infection by E. coli. Although bacterial myocarditis is rare in developed countries, we should consider its possibility when patients show various cardiac abnormalities with bacterial infection.(Int Heart J 2018; 59: 229-232) Key words: Heart failure, Myocardial infarction, Atrioventricular dissociation M yocarditis induces various cardiac abnormalities including systolic dysfunction and arrhythmia. The most common cause of myocarditis in developed countries is the infection of viruses such as coxsackievirus, adenovirus, enterovirus, parvovirus B-19, parainfluenza viruses and human herpesvirus-6. 1,2) Although bacterial myocarditis was has been very rare in developed countries, 3) the number of patients with bacterial myocarditis has recently been increasing because of an increase in immunocompromised hosts. In most cases, bacterial myocarditis is suspected based on clinical test results, but few cases have been diagnosed while alive. We here present a patient who suddenly developed myocardial infarction, atrioventricular dissociation, and heart failure without any past disease history. Morbid anatomy revealed that the diagnosis was bacterial myocarditis. Here we describe the various clinical and pathological findings of this case and with some also discussions about bacterial myocarditis in general. Case ReportA 69-year-old woman visited our hospital because of death of her brother's death. While she was plunged in grief, she suddenly felt dyspnea. Approximately 2 weeks before, she had visited a local doctor because of wheezing and insomnia. Pleural effusion had been found by chest X-ray examination, and a diuretic had been prescribed. In our hospital, she had slight tachycardia (106/minute) but other physical findings, including blood pressure (118/64 mmHg) and body temperature (35.5 ), were normal (35.5 ). X-ray examination revealed bilateral pleural effusion and pulmonary congestion, and the electrocardiogram showed a negative T wave in I, aVL, and V3-6 leads. Routine blood examination revealed the elevation of C-reactive protein levels (4.8 mg 8 mg/dL) and white blood cell counts (13.9 × 10 3 /μL). Ultrasound echocardiography showed dilatation of the left ventricle (left ventricular dimension diastolic/systolic 60/51 mm), systolic dysfunction (ejection fraction 31%), mild aortic regurgitation, and moderate mitral regurgitation. The wall motion was diffusely reduced, and in particular, the wall motions of the inferior apex wall and the anterolateral wall were severely impaired. We diagnosed her as acute decompensated heart failure with unknown etiology and administered furosemide, carperitide and dobutamine. Since she had no fever a...

BackgroundFulminant type 1 diabetes is a non-autoimmune disorder characterized by sudden onset. This complication is rarely associated with myocarditis, suggesting an involvement of viral infection. We report a patient with myocarditis who was admitted for fulminant type 1 diabetes and diagnosed using a combination of non-invasive techniques.Case presentationWe describe the case of a 25-year-old Japanese man with fulminant type 1 diabetes complicated by myocarditis. The patient was admitted with flu-like symptoms and diabetic ketoacidosis, followed by chest pain the next day. Myocardial damage was suspected based on ST-segment elevation on electrocardiogram and elevation of cardiac enzymes. However, coronary angiography revealed no abnormality in the coronary arteries. We diagnosed myocarditis by a combination of echocardiography, cardiovascular magnetic resonance imaging (CMR), as well as Thallium-201 and Iodine-123 beta-methyl iodophenyl pentadecanoic acid (Tl-201 BMIPP and I-123 BMIPP) and myocardial imaging. More importantly, CMR revealed diffuse enhancement in the subepicardium of the left ventricle with late gadolinium enhancement, consistent with myocardial edema. The patient was successfully treated, received a two-week education program on diabetes and discharged without complication.ConclusionsThe rapid onset and flu-like symptoms strongly suggest the involvement of viral infection in the pathogenesis of fulminant type 1 diabetes and myocarditis. While cardiac muscle biopsy is routinely performed, this case demonstrates that a combination of non-invasive techniques, especially CMR, may successfully diagnose myocarditis in patients with fulminant type 1 diabetes.

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