Association of a Transitional Heart Failure Management Program With Readmission and End-of-Life Care in Rural Japan.

Background: Evidence on transitional care for heart failure (HF) in Japan is limited. Methods and Results: We implemented a transitional HF management program in rural Japan in 2019. This involved collaboration with general practitioners or nursing care facilities and included symptom monitoring by medical/nursing staff using a handbook; standardized discharge care planning and information sharing on self-care and advance care planning using a collaborative sheet; and sharing expertise on HF management via manuals. We compared the outcomes within 1 year of discharge among patients hospitalized with HF in the 2 years before program implementation (2017-2018; historical control, n=198), in the first 2 years after program implementation (2019-2020; Intervention Phase 1, n=205), and in the second 2 years, following program revision and regional dissemination (2021-2022; Intervention Phase 2, n=195). HF readmission rates gradually decreased over Phases 1 and 2 (P<0.05). This association was consistent regardless of physician expertise, follow-up institution, or the use of nursing care services (P>0.1 for interaction). Mortality rates remained unchanged, but significantly more patients received end-of-life care at home in Phase 2 than before (P<0.05). Conclusions: The implementation of a transitional care program was associated with decreased HF readmissions and increased end-of-life care at home for HF patients in rural Japan.

Effect of halotolerant starter microorganisms on chemical characteristics of fermented chum salmon (Oncorhynchus keta) sauce.

Chum salmon sauce mash was inoculated with barley koji (barley steamed and molded with Aspergillus oryzae ) and halotolerant microorganisms (HTMs), Zygosaccharomyces rouxii , Candida versatilis , and Tetragenococcus halophilus , in nine different combinations under non-aseptic conditions similar to the industrial fish sauce production and fermented at 35 +/- 2.5 degrees C for 84 days. The changes in the chemical components, color, and sensory properties during fermentation were investigated. Free amino acid content was increased, and the browning of fish sauce was enhanced by the usage of barley koji during fermentation. The halotolerant yeast (HTY) produced ethanol and repressed the browning by consumption of reducing sugar. Inoculated Z. rouxii in the fish sauce mash produced 2-phenylethanol (2-PE) and 4-hydoxy-2(or 5)-ethyl-5(or 2)-methyl-3(2H)-furanone (HEMF), and C. versatilis in the fish sauce mash produced 4-ethylguaiacol (4-EG), known as characteristic flavor compounds in soy sauce, adding soy-sauce-like flavor to the fish sauce. Thus, inoculation of HTMs and barley koji was effective for conferring the soy-sauce-like flavor and increasing free amino acid and ethanol contents in fish sauce product.

Microbiota during fermentation of chum salmon (Oncorhynchus keta) sauce mash inoculated with halotolerant microbial starters: analyses using the plate count method and PCR-denaturing gradient gel electrophoresis (DGGE).

Nine different combinations of mugi koji (barley steamed and molded with Aspergillus oryzae) and halotolerant microorganisms (HTMs), Zygosaccharomyces rouxii, Candida versatilis, and Tetragenococcus halophilus, were inoculated into chum salmon sauce mash under a non-aseptic condition used in industrial fish sauce production and fermented at 35 +/- 2.5 degrees C for 84 days to elucidate the microbial dynamics (i.e., microbial count and microbiota) during fermentation. The viable count of halotolerant yeast (HTY) in fermented chum salmon sauce (FCSS) mash showed various time courses dependent on the combination of the starter microorganisms. Halotolerant lactic acid bacteria (HTL) were detected morphologically and physiologically only from FCSS mash inoculated with T. halophilus alone or with T. halophilus and C. versatilis during the first 28 days of fermentation. Only four fungal species, Z. rouxii, C. versatilis, Pichia guilliermondii, and A. oryzae, were detected throughout the fermentation by PCR-denaturing gradient gel electrophoresis (PCR-DGGE). In FCSS mash, dominant HTMs, especially eumycetes, were nonexistent. However, under the non-aseptic conditions, undesirable wild yeast such as P. guilliermondii grew fortuitously. Therefore, HTY inoculation into FCSS mash at the beginning of fermentation is effective in preventing the growth of wild yeast and the resultant unfavorable flavor.

Development of microsatellite markers for Japanese scallop (Mizuhopecten yessoensis) and their application to a population genetic study.

The Japanese scallop (Mizuhopecten yessoensis) is one of the main fishery products in Japan, but with the expansion of culture operations of the Japanese scallop, various problems have been encountered including high mortality, poor growth, poor seed production, and so on. Moreover, there is concern that many years of cultivation may have affected the genetic structure of the scallop population. To approach these problems and concerns, we developed microsatellite markers as a molecular tool for population genetic studies. By using 4 microsatellite markers as well as a mitochondrial marker, we investigated the genetic structure of samples from the islands of Hokkaido (14 populations) and Honshu (Tohoku, 3 populations) in Japan, and south Primorye (4 populations) in Russia. All the populations sampled had high genetic diversity (average expected heterozygosity, 0.7011 to 0.7622; haplotype diversity, 0.6090 to 0.8848), and almost all showed a tendency of homozygote excess, which was significant in 2 populations. Hierarchical analysis of molecular variance tests based on the microsatellite and mitochondrial markers indicated that the 3 geographic regions were genetically divergent from one another, with little evidence of divergence within regions. Homogeneity in allele frequency distributions between natural and cultured scallops and allele frequency stability over a period of 2 decades indicated that the culturing operations have probably not had a substantial effect on the genetic structure of the populations.

Genetic structure of Japanese scallop population in Hokkaido, analyzed by mitochondrial haplotype distribution.

To examine the genetic structure of Japanese scallop populations (Mizuhopecten yessoensis) in Hokkaido prefecture, Japan, and compare it with those in the Aomori prefecture, we applied a method for lineage analysis based on sequence variation in a mitochondrial DNA segment (NcR2). After showing that there was a low probability of doubly uniparental inheritance of mitochondrial DNA in the scallop, we sequenced the NcR2 regions of 914 individuals from 15 populations (13 in Hokkaido and 2 in Aomori). In total, 103 different haplotypes were detected. Results of homogeneity tests for pairwise populations and the fixation indices indicated that significant heterogeneity (P < 0.0005) and structuring (pairwise fixation index F(ST) = 0.1606-0.4444, P = 0.0000; fixation index among groups F(CT) = 0.1549, P = 0.0078) could be inferred between the Hokkaido and Aomori groups, but not among populations within the groups. Moreover, heterogeneity of the haplotype distribution between populations of the 1980s and 1990s or 2000s at the 4 culturing areas was not observed (P > 0.05), and the haplotype diversity between them was not significant (P = 0.05), suggesting that the culture operations had not imparted a significant effect on the genetic structure during these periods.

Alpha-glucosidase inhibitory activity of a 70% methanol extract from ezoishige (Pelvetia babingtonii de Toni) and its effect on the elevation of blood glucose level in rats.

The 70% methanol extract from ezoishige (Pelvetia babingtonii de Toni) inhibited the rat-intestinal alpha-glucosidase, sucrase and maltase activities, with IC50 values of 2.24 and 2.84 mg/ml. Sucrose was orally administered with or without the extract to rats at 1000 mg/kg. The postprandial elevation in the blood glucose level at 15 and 30 min after the administration of sucrose with the extract was significantly suppressed when compared with the control. These results suggest that the extract from ezoishige has potent alpha-glucosidase inhibitors and would be effective for suppressing postprandial hyperglycemia.