End-of-Life Preference Lists as an Advance Care Planning Tool for Japanese People.

Advance care planning (ACP) is important to determine the wishes of patients before they lose decision-making capacity. However, Japanese people are often reluctant to have end-of-life discussions. This study aims to develop and categorize an end-of-life preference list in the Japanese context to encourage dialog about ACP for healthcare providers and patients. A questionnaire was developed with end-of-life choices prioritized by a sample of Japanese subjects. Data were collected either in person or by mail. The list of Japanese preferences was compiled and categorized into four domains: medical care, life and care, relationships, and values, with 11-12 items in each domain. The highest-ranking items chosen by >70% of participants were in the relationships and values domains. Subjects with two cohabitants tended to be biased toward the "with others" group, focused on spending time with others, whereas those with older age and higher clinical frailty scale scores tended to be biased toward the "how to live" group.

Selection of acid tolerant bifidobacteria and evidence for a low-pH-inducible acid tolerance response in Bifidobacterium longum.

Acidity is an environmental condition commonly encountered by lactic acid bacteria and bifidobacteria in the gastrointestinal tract and fermented foods. In the present study, 22 strains of Bifidobacterium were screened for acid tolerance in artificial gastric juice (AGJ, pH 3.0) and fermented milk. AGJ tolerance was found to be strain-specific, with a pronounced variation among the strains. Several strains with a high survival rate in AGJ that belonged to Bifid. longum, Bifid. breve and Bifid. adolescentis were selected. Among them, only strain BL1 of Bifid longum was found to possess a high survival rate in fermented milk during refrigerated storage. Strain BL1 exhibited a survival rate of more than 25% in AGJ at pH 3.0 for 2 h and maintained a viable cfu level of more than 10(8) per gram of product in fermented milk (pH 4.6) under refrigerated conditions for 2 weeks. The acid tolerance of strain BL1 was found to depend on the final growth pH (<4.5). Rapid loss of acid tolerance was observed when the cells were shifted from acid to neutral conditions by addition of NaOH. Strain BL1 cells were able to maintain much higher intracellular pH under acid conditions, in comparison with those of AGJ sensitive mutant (BL1-S) or cells that lost acid tolerance following pH shifting from acid to neutral conditions. These results suggested that a cytoplasmic pH homeostasis system may function in the acid tolerance response in this strain.