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The long-term outcome of asymptomatic patients with severe AS was dismal when managed conservatively in this real-world analysis and might be substantially improved by an initial AVR strategy. (Contemporary Outcomes After Surgery and Medical Treatment in Patients With Severe Aortic Stenosis Registry; UMIN000012140).

In tests, Chromobacterium violaceum ATCC 12472 produced several N-acyl-L-homoserine lactones (AHLs). Of these, N-(3-hydroxydecanoyl)-L-homoserine lactone was dominant, and controlled violacein production by quorum sensing. Strain VIR07, an AHL-deficient mutant, did not produce violacein. Violacein production in VIR07 was induced by adding long-chain AHLs (C10-C16), but was inhibited by adding short-chain AHLs (C4-C8). Strain VIR07 showed the response of violacein production when AHLs diffused from a variety of AHL-producing bacteria on agar plates, and thus might be a useful biosensor for recognizing exogenous AHLs.

Quorum sensing is a regulatory system for controlling gene expression in response to increasing cell density. N-Acylhomoserine lactone (AHL) is produced by gram-negative bacteria, which use it as a quorum-sensing signal molecule. Serratia marcescens is a gram-negative opportunistic pathogen which is responsible for an increasing number of serious nosocomial infections. S. marcescens AS-1 produces N-hexanoyl homoserine lactone (C 6 -HSL) and N-(3-oxohexanoyl) homoserine lactone and regulates prodigiosin production, swarming motility, and biofilm formation by AHL-mediated quorum sensing. We synthesized a series of N-acyl cyclopentylamides with acyl chain lengths ranging from 4 to 12 and estimated their inhibitory effects on prodigiosin production in AS-1. One of these molecules, N-nonanoyl-cyclopentylamide (C 9 -CPA), had a strong inhibitory effect on prodigiosin production. C 9 -CPA also inhibited the swarming motility and biofilm formation of AS-1. A competition assay revealed that C 9 -CPA was able to inhibit quorum sensing at four times the concentration of exogenous C 6 -HSL and was more effective than the previously reported halogenated furanone. Our results demonstrated that C 9 -CPA was an effective quorum-sensing inhibitor for S. marcescens AS-1.

AimsOver the last decade, major developments in medicine have led to significant changes in the clinical management of heart failure patients. This study was designed to evaluate the recent trends in clinical characteristics, management, and short‐term and long‐term prognosis of patients with acute decompensated heart failure (ADHF) in Japan.Methods and resultsThe Kyoto Congestive Heart Failure study is a prospective, observational, multicentre cohort study, enrolling consecutive ADHF patients from 19 participating hospitals in Japan from November 2014 to March 2016. A total of 4000 patients will be enrolled into the study and patients' anthropometric, socio‐economic, and clinical data from hospital admission to discharge will be collected. In addition, in a pre‐determined subgroup of patients (n=1500), a longitudinal follow‐up for 2 years is scheduled.ConclusionsThe Kyoto Congestive Heart Failure study will provide valuable information regarding patients with ADHF in the real‐world clinical practice of Japan and will be indispensable for future clinical and policy decision‐making with respect to heart failure.

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Key Points Question Is use of mineralocorticoid receptor antagonist at discharge associated with better outcomes in patients hospitalized for acute decompensated heart failure? Findings In this cohort study of 2068 propensity score–matched Japanese patients hospitalized for acute decompensated heart failure, mineralocorticoid receptor antagonist administered at discharge was statistically significantly associated with a lower risk for the primary composite outcome of mortality or heart failure readmission, although no difference in all-cause death was observed. Meaning Use of mineralocorticoid receptor antagonist at discharge from acute decompensated heart failure hospitalization may be associated with heart failure hospitalization but not with lower mortality.

the high controlling nutritional status (conUt) score that represents poor nutritional status has been acknowledged to have prognostic implications in chronic heart failure. We aimed to investigate its role in acute decompensated heart failure (ADHf). Using the data from an multicenter registry that enrolled 4056 consecutive patients hospitalized for ADHF in Japan between 2014 and 2016, we analyzed 2466 patients in whom data on the components of the conUt score at hospital presentation were available. The decrease of lymphocyte count and total cholesterol was assigned with 0, 1, 2, and 3 points and the decrease of albumin was assigned with 0, 2, 4, and 6 points according to the severity. We defined low CONUT score as 0-4 (N = 1568) and high CONUT score as 5-9 (N = 898). The patients in the high CONUT score group were older and more likely to have a smaller body mass index than those in the low conUt score group. the high conUt score group was associated with higher rate of death and infection during the index hospitalization compared to the low CONUT score group (9.0% versus 4.4%, and 21.9% versus 12.7%, respectively). After adjusting for confounders, the excess risk of high relative to low CONUT score for mortality and infection was significant (OR: 1.61, 95%CI: 1.05-2.44, and OR: 1.66, 95%CI: 1.30-2.12, respectively). The effect was incremental according to the score. High CONUT score was associated with higher risk for in-hospital mortality and infection in an incremental manner in patients hospitalized for ADHf. Despite recent advances in chronic heart failure (HF) therapy, there remain unmet needs to reduce the high mortality rate and to assess the mortality risk in patients hospitalized for acute decompensated HF (ADHF) 1 .