The distribution structure of medical and care resources based on regional characteristics throughout Japan in 2020.

BACKGROUND: Given Japan's rapidly aging population, the Ministry of Health, Labour and Welfare's policy of reducing hospital beds and replacing medical care with nursing care requires the establishment of a coordinated system of medical and care services tailored to regional characteristics. To gain useful knowledge for the development of such a system, this study aimed to identify differences in the structure of the relationship between medical and care resources due to differences in regional characteristics. METHODS: Initially, regional characteristics were used to group all 334 secondary medical areas (SMA) in Japan by principal component analysis. Subsequently, the related structure of the distribution of medical and care resources for each group were compared. For these　comparisons, first, the related structure of the distribution of medical and care resources nationwide was modeled using structural equation modeling. Secondly, multigroup analysis was conducted to investigate differences among the models across groups. RESULTS: The nationwide SMAs were grouped largely based on urbanicity and middle-density regionality. The groups with high urbanicity and high middle-density regionality consisted of SMAs with a high and medium population density. By contrast, the low middle-density regionality group consisted of SMAs containing large cities with a high population density and depopulated areas with a low population density. The model of the related structure of the distribution of medical and care resources differed among these groups. In the non-urbanicity and middle-density regionality groups, nursing care abundance tended to increase acute care abundance. In addition, in all groups, nursing care abundance tended to increase long-term hospitalization care abundance and clinic care abundance (with beds). CONCLUSIONS: The key finding of this study was that the government's objective of reducing hospital beds may not be achieved solely by expanding nursing homes. This is because many of the models did not show a tendency that higher nursing care abundance reduces the values of the factors which increase more hospital beds. This finding was particularly relevant in middle-density regionality groups. This finding suggests that the location of nursing homes should be monitored because of concerns about the oversupply of nursing homes and sprawl in those areas.

Comparative expression of hexose transporters (SGLT1, GLUT1, GLUT2 and GLUT5) throughout the mouse gastrointestinal tract.

Hexose transporters play a pivotal role in the absorption of food-derived monosaccharides in the gastrointestinal tract. Although a basic knowledge of the hexose transporters has already been gained, their detailed distribution and comparative intensities of expression throughout the gastrointestinal tract have not been fully elucidated. In this study, we quantitatively evaluated the expression of SGLT1, GLUT1, GLUT2, and GLUT5 by in situ hybridization and real-time PCR techniques using a total of 28 segments from the gastrointestinal tract of 9-week-old mice. GLUT2 and GLUT5 mRNA expressions were detected predominantly from the proximal to middle parts of the small intestine, showing identical expression profiles, while SGLT1 mRNA was expressed not only in the small intestine but also in the large intestine. Notably, GLUT1 mRNA was expressed at a considerable level in both the stomach and large intestine but was negligible in the small intestine. Immunohistochemistry demonstrated the polarized localization of hexose transporters in the large intestine: SGLT1 on the luminal surface and GLUT1 on the basal side of epithelial cells. The present study provided more elaborate information concerning the localization of hexose transporters in the small intestine. Furthermore, this study revealed the significant expression of glucose transporters in the large intestine, suggesting the existence of the physiological uptake of glucose in that location in mice.

Diverse immune responses to orally administered heat-killed cell preparation of Enterococcus faecalis strain EC-12 in murine immune tissues.

Diverse immune responses to an orally administered heat-killed cell preparation of Enterococcus faecalis strain EC-12 (EC-12) among jejunal-Peyer's patches (PPs), ileal-PPs, mesenteric lymph nodes (MLNs), and spleen were compared by real-time PCR in mice. Intriguingly, distinct responses to EC-12 were observed in the various tissues. This study indicates a site-specific response to orally administered bacteria, particularly in jejunal- and ileal-PPs.

The cellular expression of SMCT2 and its comparison with other transporters for monocarboxylates in the mouse digestive tract.

SMCT1 (slc5a8) is a sodium-coupled monocarboxylate transporter expressed in the brush border of enterocytes. It regulates the uptake of short-chain fatty acids (SCFAs) produced by bacterial fermentation in the large intestine. Another subtype, SMCT2 (slc5a12), is expressed abundantly in the small intestine, but its precise expression profile remains unknown. The present study using in situ hybridization method, immunohistochemistry, and quantitative PCR analysis examined the distribution and cellular localization of SMCT2 in the digestive tract of mice and compared the expression pattern with those of other transporters for monocarboxylates. While an abundant expression of SMCT2 was found in the jejunum, this was negligible in the duodenum, terminal ileum, and large intestine. In contrast, SMCT1 had predominant expression sites in the large bowel and terminal ileum. Subcellularly, SMCT2 was localized in the brush border of enterocytes in the intestinal villi-as is the case for SMCT1, suggesting its involvement in the uptake of food-derived monocarboxylates such as lactate and acetate. MCT (slc16) is a basolateral type transporter of the gut epithelium and conveys monocarboxylates in an H+-dependent manner. Since among the main subtypes of MCT family only MCT1 was expressed significantly in the small intestine, it is able to function as a counterpart to SMCT2 in this location.