Physical outcome measures for conductive and mixed hearing loss treatment: A systematic review.

BACKGROUND: The number of potential options for rehabilitation of patients with conductive or mixed hearing loss is continually expanding. To be able to inform patients and other stakeholders, there is a need to identify and develop patient-centred outcomes for treatment of hearing loss. OBJECTIVE OF REVIEW: To identify outcome measures in the physical core area used when reporting the outcome after treatment of conductive and mixed hearing loss in adult patients. TYPE OF REVIEW: Systematic review. SEARCH STRATEGY: Systematic review of the literature related to reported physical outcome measures after treatment of mixed or conductive hearing loss without restrictions regarding type of intervention, treatment or device. EVALUATION METHOD: Any measure reporting the physical outcome after treatment or intervention of mixed or conductive hearing loss was sought and categorised. The physical outcome measures that had been extracted were then grouped into domains. RESULTS: The literature search resulted in the identification of 1434 studies, of which 153 were selected for inclusion in the review. The majority (57%) of papers reported results from middle ear surgery, with the remainder reporting results from either bone conduction hearing devices or middle ear implants. Outcomes related to complications were categorised into 17 domains, whereas outcomes related to treatment success was categorised into 22 domains. CONCLUSIONS: The importance of these domains to patients and other stakeholders needs to be further explored in order to establish which of these domains are most relevant to interventions for conductive or mixed hearing loss. This will allow us to then assess which outcome measures are most suitable for inclusion in the core set.

Influence of habitat discontinuity, geographical distance, and oceanography on fine-scale population genetic structure of copper rockfish (Sebastes caurinus).

The copper rockfish is a benthic, nonmigratory, temperate rocky reef marine species with pelagic larvae and juveniles. A previous range-wide study of the population-genetic structure of copper rockfish revealed a pattern consistent with isolation-by-distance. This could arise from an intrinsically limited dispersal capability in the species or from regularly-spaced extrinsic barriers that restrict gene flow (offshore jets that advect larvae offshore and/or habitat patchiness). Tissue samples were collected along the West Coast of the contiguous USA between Neah Bay, WA and San Diego, CA, with dense sampling along Oregon. At the whole-coast scale (approximately 2200 km), significant population subdivision (F(ST) = 0.0042), and a significant correlation between genetic and geographical distance were observed based on 11 microsatellite DNA loci. Population divergence was also significant among Oregon collections (approximately 450 km, F(ST) = 0.001). Hierarchical amova identified a weak but significant 130-km habitat break as a possible barrier to gene flow within Oregon, across which we estimated that dispersal (N(e)m) is half that of the coast-wide average. However, individual-based Bayesian analyses failed to identify more than a single population along the Oregon coast. In addition, no correlation between pairwise population genetic and geographical distances was detected at this scale. The offshore jet at Cape Blanco was not a significant barrier to gene flow in this species. These findings are consistent with low larval dispersal distances calculated in previous studies on this species, support a mesoscale dispersal model, and highlight the importance of continuity of habitat and adult population size in maintaining gene flow.

Phenotypically based taxonomy using API 50CH of lactobacilli from Nigerian ogi, and the occurrence of starch fermenting strains.

One-hundred and twenty isolates of lactic acid bacteria isolated from ogi and three traditional cereal-based alcoholic beverages from Nigeria, together with 18 reference strains from Swedish sour doughs, and 50 type-and reference strains of mainly Lactobacillus, were phenotypically classified on their fermentation ability of 49 carbohydrates, including soluble starch. Data were examined by Jaccard Coefficient (SJ), Simple Matching Coefficient (SSM), and unweighted pair group algorithm with arithmetic averages (UPGMA). Seven major clusters were defined at the 82% SJ-similarity level (corresponds to the SSM-level of 91%). Three were identified as Lactobacillus plantarum or L. plantarum-like (together 41% of the ogi isolates). The others were obligately heterofermentative; Cluster 7 was identified as L. confusus (11% of the ogi isolates). Three minor clusters were identified as L. murinus, L. agilis or L. gallinarium, and Leuconostoc mesenteroides subsp. mesenteroides, respectively. The phenotype of the L. plantarum isolates varied within wide limits. Seventeen isolates possessed starch fermenting capacity. Nine of these were identified as L. plantarum or L. plantarum-like (isolated from ogi); one was identified as Leuconostoc mesenteroides subsp. mesenteroides, and the rest were unidentified non-clustering strains.

Survival of Lactobacillus plantarum DSM 9843 (299v), and effect on the short-chain fatty acid content of faeces after ingestion of a rose-hip drink with fermented oats.

In a controlled and randomised double-blind study, 26 healthy adult volunteers consumed, for 21 d, 400 ml of a rose-hip drink containing oats (0.7 g/100ml) fermented with Lactobacillus plantarum DSM 9843 (RHL; containing 5 x 10(7) cfu ml(-1)), and 22 volunteers in a second group the same amount of a pure rose-hip drink (RH). Significant increases in the total faecal concentration of carboxylic acids (P < 0.05 after 1 week and P < 0.01 after 3 weeks of intake), acetic acid (P < 0.01 after 3 weeks of intake) and propionic acid (P < 0.01 after 3 weeks of intake and P < 0.05 eight days after intake ceased) were recorded in the RHL group, indicating increased fermentation in the colon. In both groups a significant increase was obtained in the concentration of faecal lactic acid (P < 0.001 after 1 and 3 weeks of intake). No changes were seen in the concentration of faecal butyrate. The numbers of faecal bifidobacteria and lactobacilli increased significantly in both groups after 3 weeks of intake. Sulphite-reducing clostridia rapidly decreased in the group receiving the product with Lb. plantarum DSM 9843 after 1 week of intake, and then also in the pure rose-hip group after 3 weeks of intake. No changes were seen in the numbers of total anaerobes, gram-negative anaerobes or total aerobes during administration. Lb. plantarum DSM 9843 was recovered in faeces from all volunteers in the RHL group. Median amounts were 7.0 (5.0-8.8) log10 cfu g(-1) after one week of intake, and 6.7 (5.0-8.9) log10 cfu g(-1) after 3 weeks, respectively. The strain was still recovered from faeces of five volunteers 8 d after administration ceased (> 4.8 log10 cfu g(-1)). During the period of intake the volunteers in the RHL group experienced a significant increase in stool volume, a significant decrease in flatulence and slightly softer stools. Volunteers in the RH group experienced a slight but significant decrease in stool volume.

Persistence of Lactobacillus plantarum DSM 9843 on human tonsillar surface after oral administration in fermented oatmeal gruel. A pilot study.

The occurrence of Lactobacillus plantarum DSM 9843 on tonsillar scrapings was studied after single-dose administration. Six healthy volunteers gargled 100 ml of fermented oatmeal gruel containing 2 x 10(11) colony forming units (cfu) of Lb. plantarum DSM 9843 for 2 min and then swallowed it. Two healthy volunteers drank 50 ml fermented oatmeal gruel (containing 1 x 10(11) cfu of Lb. plantarum DSM 9843) mixed with 50 ml fruit juice, and in another experiment, 5 ml fermented oatmeal gruel (containing 1 x 10(10) cfu of Lb. plantarum DSM 9843) mixed with 95 ml fruit juice. Lb. plantarum DSM 9843 were found in tonsillar scrapings 4-8 h after intake of 2 x 10(11) cfu, for 5-8 h after intake of 1 x 10(11) cfu, and finally up to 4 h after intake of 1 x 10(10) cfu. On electron microscopy micrographs, short rod-shaped bacteria were visible 1 h after intake of the fermented oatmeal gruel, but not 2 h after intake. The results suggest that Lb. plantarum DSM 9843 possess an ability to adhere to tonsillar cells.

Randomly amplified polymorphic DNA (RAPD) for rapid typing of Lactobacillus plantarum strains.

Randomly amplified polymorphic DNA (RAPD) has been used for rapid typing of Lactobacillus plantarum strains. RAPD was used with either purified chromosomal DNA serving as template in the polymerase chain reaction, or with crude cell extracts, and using a 9-mer primer with 80% G+C content. Amplified DNA was visualized by ethidium bromide staining after separation on agarose gels. Patterns from 20 Lact. plantarum strains and two Lact. pentosus strains were analysed using the Pearson products moment correlation coefficient (r) and the unweighted pair group method with arithmetic averages (UPGMA). With some exceptions, the two sources of template DNA gave the same clusters and subclusters of strains at the similarity level of 50%. About 50% of the strains could be individually separated from all the other tested strains. The buffer brand, the amount of primer and crude cell extract used in the PCR-step were crucial for the final pattern.

Administration of different Lactobacillus strains in fermented oatmeal soup: in vivo colonization of human intestinal mucosa and effect on the indigenous flora.

In vivo colonization by different Lactobacillus strains on human intestinal mucosa of healthy volunteers was studied together with the effect of Lactobacillus administration on different groups of indigenous bacteria. A total of 19 test strains were administered in fermented oatmeal soup containing 5 x 10(6) CFU of each strain per ml by using a dose of 100 ml of soup per day for 10 days. Biopsies were taken from both the upper jejunum and the rectum 1 day before administration was started and 1 and 11 days after administration was terminated. The administration significantly increased the Lactobacillus counts on the jejunum mucosa, and high levels remained 11 days after administration was terminated. The levels of streptococci increased by 10- to 100-fold in two persons, and the levels of sulfite-reducing clostridia in the jejunum decreased by 10- to 100-fold in three of the volunteers 1 day after administration was terminated. In recta, the anaerobic bacterium counts and the gram-negative anaerobic bacterium counts decreased significantly by the end of administration. Furthermore, a decrease in the number of members of the Enterobacteriaceae by 1,000-fold was observed on the rectal mucosa of two persons. Randomly picked Lactobacillus isolates were identified phenotypically by API 50CH tests and genotypically by the plasmid profiles of strains and by restriction endonuclease analysis of chromosomal DNAs.(ABSTRACT TRUNCATED AT 250 WORDS)

Alteration of intestinal microflora is associated with reduction in abdominal bloating and pain in patients with irritable bowel syndrome.

OBJECTIVE: The influence of the gastrointestinal (GI) microflora in patients with irritable bowel syndrome (IBS) has not been clearly elucidated. This study was undertaken to see if patients with IBS have an imbalance in their normal colonic flora, as some bacterial taxa are more prone to gas production than others. We also wanted to study whether the flora could be altered by exogenous supplementation. In a previous study we have characterized the mucosa-associated lactobacilli in healthy individuals and found some strains with good colonizing ability. Upon colonization, they seemed to reduce gas formation. METHODS: The study comprised 60 patients with IBS and a normal colonoscopy or barium enema. Patients fulfilling the Rome criteria, without a history of malabsorption, and with normal blood tests underwent a sigmoidoscopy with biopsy. They were randomized into two groups, one receiving 400 ml per day of a rose-hip drink containing 5 x 10(7) cfu/ml of Lactobacillus plantarum (DSM 9843) and 0.009 g/ml oat flour, and the other group receiving a plain rose-hip drink, comparable in color, texture, and taste. The administration lasted for 4 wk. The patients recorded their own GI function, starting 2 wk before the study and continuing throughout the study period. Twelve months after the end of the study all patients were asked to complete the same questionnaire regarding their symptomatology as at the start of the study. RESULTS: All patients tolerated the products well. The patients receiving Lb. plantarum had these bacteria on rectal biopsies. There were no major changes of Enterobacteriaceae in either group, before or after the study, but the Enterococci increased in the placebo group and remained unchanged in the test group. Flatulence was rapidly and significantly reduced in the test group compared with the placebo group (number of days with abundant gas production, test group 6.5 before, 3.1 after vs 7.4 before and 5.6 after for the placebo group). Abdominal pain was reduced in both groups. At the 12-month follow-up, patients in the test group maintained a better overall GI function than control patients. There was no difference between the groups regarding bloating. Fifty-nine percent of the test group patients had a continuous intake of fermented products, whereas the corresponding figure for the control patients was 73%. CONCLUSIONS: The results of the study indicate that the administration of Lb. plantarum with known probiotic properties decreased pain and flatulence in patients with IBS. The fiber content of the test solution was minimal and it is unlikely that the fiber content could have had any effect. This type of probiotic therapy warrants further studies in IBS patients.

Numerical taxonomy of Lactobacillus spp. associated with healthy and diseased mucosa of the human intestines.

Two-hundred and fifty Lactobacillus strains isolated from healthy and diseased mucosa of human intestines of 75 individuals and 49 reference strains were phenotypically classified using 49 unit characters. Data were processed by the Jaccard (SJ) and Simple Matching (SSM) coefficients, and unweighted pair group algorithm with arithmetic averages. Seventeen major clusters were defined at the 76% SJ-similarity level which approximately correspond to the SSM-level of 91%. Seven clusters could be identified: Lactobacillus plantarum (isolates recovered from 5% of the patients), Lact. casei subsp. rhamnosus (17% of the patients), Lact. casei subsp. pseudoplantarum (5% of the patients), Leuconostoc mesenteroides subsp. mesenteroides (3% of the patients), Lact. buchneri (4% of patients), Lact. reuteri (4% of the patients) and Lact. salivarius subsp. salivarius (9% of the patients). Unassigned clusters 1 and 3 both contained homofermentative Lactobacillus strains. Cluster 1 included the type strains of Lact. crispatus, Lact. acidophilus, Lact. jensenii and Lact. gasseri, and cluster 3, the type strains of Lact. delbrueckii subsp. lactis, Lact. agilis and Lact. casei subsp. tolerans. Clusters 1 and 3 were found in 15% and 25% of the patients, respectively. Unassigned clusters 2, 6, 7, 8 and 10 contained homofermentative Lactobacillus strains but no reference strains. Clusters 11, 12, 15 and 17 were made up of heterofermentative Lactobacillus strains but no reference strains. Phenotypical characteristics of the clusters are given. No obvious trends in species (cluster) composition between different intestinal locations could be noted. Most clusters contained isolates from both diseased and healthy mucosa. Exceptions were cluster 15 and cluster 17 which only included isolates from healthy mucosa, and cluster 11 which only included isolates from diseased mucosa. Cluster 15 was isolated in 12% of the patients, and cluster 11 in 8%.

Impairment of bacterial flora in human ulcerative colitis and experimental colitis in the rat.

Changes in the colonic mucosa-associated microflora were determined both in patients with active and inactive ulcerative colitis and in rats with acetic acid-induced colitis. In patients with active ulcerative colitis, significant decreases in the number of anaerobic bacteria (Brain Heart Infusion medium), anaerobic gram-negatives and Lactobacillus were found, whereas no changes were seen in the number of aerobic bacteria and Enterobacteriaceae. In patients with inactive ulcerative colitis, no significant differences in colonic mucosa-associated microflora could be demonstrated. Similar changes were seen in rats with acetic acid-induced colitis. Thus, 4 days after acetic acid administration, at which time the colitis was well developed as evaluated by morphological appearance and myeloperoxidase activity, reduction in the number of anaerobic bacteria and Lactobacillus was seen. The first day after acetic acid administration, when the colitis had not developed, or after 14 days, when the colitis had been overcome, no alterations were seen in the mucosa-associated microflora as compared with control rats. We conclude that a reduction in the number of anaerobic bacteria and Lactobacillus is a common feature in active colitis regardless of the origin of colitis.

The effect of exogenous administration of Lactobacillus reuteri R2LC and oat fiber on acetic acid-induced colitis in the rat.

The potential beneficial effect of exogenous administration of Lactobacillus on acetic acid-induced colitis was evaluated in the rat. Colitis was induced by instillation of 4% acetic acid for 15 sec in an exteriorized colonic segment. This produced uniform colitis with a threefold increase in myeloperoxidase (MPO) activity of the colonic tissue (an index of neutrophil infiltration) and a sixfold increase in plasma exudation into the lumen of the colon (mucosal permeability) as evaluated 4 days after acetic acid administration. Intracolonic administration of L. reuteri R2LC immediately after acetic acid administration, at a dose of 5 ml of 7 x 10(7) colony-forming units (CFU)/ml in two forms: either as pure bacterial suspension or as fermented oatmeal soup, prevented the development of colitis. Thus, the morphologic score, MPO activity, and mucosal permeability were almost normalized by Lactobacillus treatment. Initiating the treatment 24 h after acetic acid administration or using lower doses of 1 ml for 3 consecutive days resulted in a smaller protective effect. We conclude that exogenous administration of L. reuteri R2LC prevents the development of acetic acid-induced colitis in the rat.

Effect of fermented oatmeal soup on the cholesterol level and the Lactobacillus colonization of rat intestinal mucosa.

Rats were fed with freeze-dried oatmeal soup fermented by six different Lactobacillus strains from rat and man; the formula is intended for enteral feeding. The serum cholesterol levels after 10 d were lower for rats eating oatmeal as compared to a commercial product, Biosorb Sond. Colonizing ability of the administered strains were evaluated in vivo. Only Lactobacillus reuteri R21c were able to, effectively, colonizing the mucosa; it represented about 30% of the Lactobacillus population 24 d after termination of the administration. L. reuteri R21c was easily recognized by the ability to produce a yellow pigment on agar plates. The identity was confirmed by carbohydrate fermentations (API 50CH), plasmid pattern and endonuclease restriction analysis of the chromosomal DNA.

Systematics of the Lactobacillus population on rat intestinal mucosa with special reference to Lactobacillus reuteri.

The systematics of the Lactobacillus population of the intestines of 88 different rats was studied; 80 rats had been fed on fermented oat-meal soup (Molin et al. 1992). One-hundred-twenty-two Lactobacillus strains from the intestinal mucosa were phenotypically classified together with twenty-eight reference strains of Lactobacillus and Leuconostoc, using 49 unit characters. Data were examined using Jaccard coefficient, and unweighted pair group algorithm with arithmetic averages. Two major and eleven minor clusters were defined at the 76% SJ-similarity level: Cluster 1 included thirty isolates which could not be identified further, but had resemblance to the type strains of L. jensenii, L. gasseri, L. crispatus, and to some extent to L. acidophilus. Cluster 12 including fifty-four intestinal isolates was identified as L. reuteri; and so was cluster 13 (five isolates). Isolates of the major clusters were found in all parts of the intestines. The genomic homogeneity of the L. reuteri isolates was scrutinized by endonuclease restriction analysis of the chromosomal DNA, and the isolates could be divided into six genomic strains.

A mannose-specific adherence mechanism in Lactobacillus plantarum conferring binding to the human colonic cell line HT-29.

Two Lactobacillus plantarum strains of human intestinal origin, strains 299 (= DSM 6595) and 299v (= DSM 9843), have proved to be efficient colonizers of the human intestine under experimental conditions. These strains and 17 other L. plantarum strains were tested for the ability to adhere to cells of the human colonic cell line HT-29.L.plantarum 299 and 299v and nine other L. plantarum strains, including all six strains that belong to the same genetic subgroup as L. plantarum 299 and 299v, adhered to HT-29 cells in a manner that could be inhibited by methyl-alpha-D-mannoside. The ability to adhere to HT-29 cells correlated with an ability to agglutinate cells of Saccharomyces cerevisiae and erythrocytes in a mannose-sensitive manner and with adherence to D-mannose-coated agarose beads. L. plantarum 299 and 299v adhered to freshly isolated human colonic and ileal enterocytes, but the binding was not significantly inhibited by methyl-alpha-D-mannoside. Periodate treatment of HT-29 cells abolished mannose-sensitive adherence, confirming that the cell-bound receptor was of carbohydrate nature. Proteinase K treatment of the bacteria also abolished adherence, indicating that the binding involved protein structures on the bacterial cell surface. Thus, a mannose-specific adhesin has been identified in L. plantarum; this adhesin could be involved in the ability to colonize the intestine.