Impact of Polypharmacy and Risk Factors for Exacerbation of Lower Urinary Tract Symptoms in Patients with Urological Conditions: A Retrospective Study in a Japanese Municipal Hospital.

Polypharmacy exacerbates lower urinary tract symptoms (LUTS). Japan exhibits a higher prevalence of concomitant medication use in drug therapy than other countries. Previous age- and sex-specific reports exist; however, none include patients of all ages. Therefore, this retrospective study determined the impact of polypharmacy and its associated risk factors on LUTS exacerbation in outpatients with urological conditions. We included patients receiving medication who visited the Department of Urology at the Gifu Municipal Hospital (Gifu, Japan) between January, 2018 and December, 2018. The association between LUTS and polypharmacy and the risk factors for LUTS exacerbation were investigated. Patients were categorized into two groups according to their polypharmacy status. We performed propensity score matching and compared the International Prostate Symptom Score (IPSS) between the groups using the unpaired t-test. Multiple logistic regression analysis was performed to examine the risk factors, including "polypharmacy" and "taking multiple anticholinergic medications" for LUTS exacerbation. When comparing the IPSS between the groups, the polypharmacy group was found to have significantly higher scores than the non-polypharmacy group in six items, including "total score" and "storage score." Multiple logistic regression analysis results showed high significance in three items, including "polypharmacy" (odds ratio (OR) = 1.67, 95% confidence interval (CI): 1.03-2.71) and "taking multiple anticholinergic medications" (OR = 8.68, 95% CI: 1.05-71.7). In conclusion, this study revealed that "polypharmacy" and "taking multiple anticholinergic medications" were risk factors for LUTS. Particularly, "polypharmacy" is associated with storage symptom exacerbation. Therefore, eliminating "polypharmacy" and "taking multiple anticholinergic medications" is expected to improve LUTS.

Visualization of Alternating Triangular Domains of Charge Density Waves in 2H-NbSe_{2} by Scanning Tunneling Microscopy.

The charge density wave (CDW) state of 2H-NbSe_{2} features commensurate domains separated by domain boundaries accompanied by phase slips known as discommensurations. We have unambiguously visualized the structure of CDW domains using a displacement-field measurement algorithm on a scanning tunneling microscopy image. Each CDW domain is delimited by three vertices and three edges of discommensurations and is designated by a triplet of integers whose sum identifies the types of commensurate structure. The observed structure is consistent with the alternating triangular tiling pattern predicted by a phenomenological Landau theory. The domain shape is affected by crystal defects and also by topological defects in the CDW phase factor. Our results provide a foundation for a complete understanding of the CDW state and its relation to the superconducting state.

Squeezed Abrikosov-Josephson Vortex in Atomic-Layer Pb Superconductors Formed on Vicinal Si(111) Substrates.

Unlike bulk counterparts, two-dimensional (2D) superconductors are sensitive to disorder. Here, we investigated superconductivity of Pb atomic layers formed on vicinal substrates to reveal how surface steps with an interval shorter than the coherence length ξ affect it. Electrical transport showed reduced critical temperature and enhanced critical magnetic field. Scanning tunneling microscopy exhibited vortices elongated along the steps, that is, Abrikosov-Josephson vortices squeezed normal to the steps due to the reduced ξ. These results demonstrate that steps work as disorder and vicinal substrates provide a unique platform to manipulate the degree of disorder on 2D superconductors.

Effect of Dipeptidyl Peptidase-4 Inhibitors vs. Metformin on Major Cardiovascular Events Using Spontaneous Reporting System and Real-World Database Study.

BACKGROUND: Metformin had been recommended as the first-line treatment for type 2 diabetes since 2006 because of its low cost, high efficacy, and potential to reduce cardiovascular events, and thus death. However, dipeptidyl peptidase-4 (DPP-4) inhibitors are the most commonly prescribed first-line agents for patients with type 2 diabetes in Japan. Therefore, it is necessary to clarify the effect of DPP-4 inhibitors on preventing cardiovascular events, taking into consideration the actual prescription of antidiabetic drugs in Japan. METHODS: This study examined the effect of DPP-4 inhibitors on preventing cardiovascular events. The Japanese Adverse Drug Event Report (JADER) database, a spontaneous reporting system in Japan, and the Japanese Medical Data Center (JMDC) Claims Database, a Japanese health insurance claims and medical checkup database, were used for the analysis. Metformin was used as the DPP-4 inhibitor comparator. Major cardiovascular events were set as the primary endpoint. RESULTS: In the analysis using the JADER database, a signal of major cardiovascular events was detected with DPP-4 inhibitors (IC: 0.22, 95% confidence interval: 0.03-0.40) but not with metformin. In the analysis using the JMDC Claims Database, the hazard ratio of major cardiovascular events for DPP-4 inhibitors versus metformin was 1.01 (95% CI: 0.84-1.20). CONCLUSIONS: A comprehensive analysis using two different databases in Japan, the JADER and the JMDC Claims Database, showed that DPP-4 inhibitors, which are widely used in Japan, have a non-inferior risk of cardiovascular events compared to metformin, which is used as the first-line drug in the United States and Europe.

Proteome analysis of high affinity mouse saliva proteins to hydroxyapatite.

Caries sensitivity varies between the two strains of inbred mice, BALB/cA has high sensitivity and C3H/HeN has low sensitivity. One potential reason seems to be a difference in pellicle-forming saliva protein composition. Here, we performed a proteomic analysis in order to identify differences of hydroxyapatite (HAP) adsorbed saliva proteins between these two mouse strains. HAP column chromatography revealed twice the quantity of high-affinity saliva proteins in C3H/HeN compared to BALB/cA. One- and two-dimensional electrophoresis showed 2 bands/spots with deviating migration. They were identified as murine carbonic anhydrase VI (CAVI) by peptide mass fingerprinting and confirmed with western blotting using a specific polyclonal antibody. Total RNA from the salivary glands of both mouse strains, PCR amplification of cDNA with a CAVI specific primer, and sequence analysis revealed one different base in codon 96, resulting in one different amino acid. Glyco-chains of CAVI deviate in one N-glycan, confirmed by mass analysis. CAVI activity was estimated from distinct circular dichroism spectra of the molecules and found higher in C3H/HeN mice. In summary, the CAVI composition of BALB/cA and C3H/HeN differs in one amino acid and a glyco-chain modification. Further, saliva from caries resistant C3H/HeN mice displayed higher CAVI activity and also overall hydroxyapatite adsorption, suggesting a relationship with caries susceptibility.

Verification of the "Upward Variation in the Reporting Odds Ratio Scores" to Detect the Signals of Drug-Drug Interactions.

The reporting odds ratio (ROR) is easy to calculate, and there have been several examples of its use because of its potential to speed up the detection of drug-drug interaction signals by using the "upward variation of ROR score". However, since the validity of the detection method is unknown, this study followed previous studies to investigate the detection trend. The statistics models (the Ω shrinkage measure and the "upward variation of ROR score") were compared using the verification dataset created from the Japanese Adverse Drug Event Report database (JADER). The drugs registered as "suspect drugs" in the verification dataset were considered as the drugs to be investigated, and the target adverse event in this study was Stevens-Johnson syndrome (SJS), as in previous studies. Of 3924 pairs that reported SJS, the number of positive signals detected by the Ω shrinkage measure and the "upward variation of ROR score" (Model 1, the Susuta Model, and Model 2) was 712, 2112, 1758, and 637, respectively. Furthermore, 1239 positive signals were detected when the Haldane-Anscombe 1/2 correction was applied to Model 2, the statistical model that showed the most conservative detection trend. This result indicated the instability of the positive signal detected in Model 2. The ROR scores based on the frequency-based statistics are easily inflated; thus, the use of the "upward variation of ROR scores" to search for drug-drug interaction signals increases the likelihood of false-positive signal detection. Consequently, the active use of the "upward variation of ROR scores" is not recommended, despite the existence of the Ω shrinkage measure, which shows a conservative detection trend.

Atomic-layer Rashba-type superconductor protected by dynamic spin-momentum locking.

Spin-momentum locking is essential to the spin-split Fermi surfaces of inversion-symmetry broken materials, which are caused by either Rashba-type or Zeeman-type spin-orbit coupling (SOC). While the effect of Zeeman-type SOC on superconductivity has experimentally been shown recently, that of Rashba-type SOC remains elusive. Here we report on convincing evidence for the critical role of the spin-momentum locking on crystalline atomic-layer superconductors on surfaces, for which the presence of the Rashba-type SOC is demonstrated. In-situ electron transport measurements reveal that in-plane upper critical magnetic field is anomalously enhanced, reaching approximately three times the Pauli limit at T = 0. Our quantitative analysis clarifies that dynamic spin-momentum locking, a mechanism where spin is forced to flip at every elastic electron scattering, suppresses the Cooper pair-breaking parameter by orders of magnitude and thereby protects superconductivity. The present result provides a new insight into how superconductivity can survive the detrimental effects of strong magnetic fields and exchange interactions.

Orbital Angular Momentum Induced Spin Polarization of 2D Metallic Bands.

The electrons in 2D systems with broken inversion symmetry are spin-polarized due to spin-orbit coupling and provide perfect targets for observing exotic spin-related fundamental phenomena. We observe a Fermi surface with a novel spin texture in the 2D metallic system formed by indium double layers on Si(111) and find that the primary origin of the spin-polarized electronic states of this system is the orbital angular momentum and not the so-called Rashba effect. The present results deepen the understanding of the physics arising from spin-orbit coupling in atomic-layered materials with consequences for spintronic devices and the physics of the superconducting state.

Allantoin and hydantoin as new protein aggregation suppressors.

Allantoin is widely used in pharmaceutical and cosmetic products, and is composed of a hydantoin ring and a ureido group. Recent reports showed that allantoin suppresses thermal aggregation of hen egg white lysozyme (LYZ). However, structural insight into the properties of allantoin on protein aggregation and whether allantoin controls the aggregation of other proteins under different stress conditions remain unclear. Here we studied the structural properties of allantoin in terms of its effects on protein aggregation by comparing allantoin with urea and hydantoin. Furthermore, we analyzed the effects of allantoin and its derivatives on the aggregation of LYZ, carbonic anhydrase from bovine erythrocytes (BCA), albumin from chicken egg white (OVA), and immunoglobulin G (IgG) by various stresses in comparison with arginine. These four proteins are widely different in charged state and molecular size. Allantoin suppressed the aggregation and inactivation of LYZ comparing to arginine without affecting the melting temperature of proteins, and was responsible for the slightly improved formation of soluble oligomers and insoluble aggregates of IgG with thermal and acidic stresses. In contrast, hydantoin increased the solubility of aromatic amino acids more effectively than arginine and allantoin. The structural properties underlying the observed effects of allantoin as an aggregation suppressor include hydrophobic interactions between hydantoin moiety and aromatic ring on the surface of proteins, which is reflected on the difference between allantoin and arginine. These results show that the backbone of hydantoin ring may be a new category of additives for development of small aggregation suppressors.

Trimethylamine N-oxide (TMAO) is a counteracting solute of benzyl alcohol for multi-dose formulation of immunoglobulin.

Multi-dose formulation of biopharmaceuticals contains an antimicrobial preservative, which may facilitate aggregation of the proteins due to their hydrophobic protein binding. Here, we have investigated the effects of co-solvents on heat-induced protein aggregation in the presence of an antimicrobial preservative. Human immunoglobulin G (IgG) and benzyl alcohol were chosen because of their wide usage as a pharmaceutical protein and a preservative. Trimethylamine N-oxide (TMAO) was found to be the most effective additive in suppressing benzyl alcohol-induced IgG aggregation among the additives tested. Interestingly, TMAO was less effective in increasing the thermal-unfolding temperature of IgG than trehalose, indicating that the observed suppression of IgG aggregation by TMAO in the presence of benzyl alcohol is not simply due to its stabilization effect of the protein structure. The solubility of benzyl alcohol increased with increasing concentrations of TMAO, suggesting that the hydrophobic interaction of TMAO with benzyl alcohol is responsible for the observed aggregation suppression. Thus, TMAO may be a potential aggregation suppressor in multi-dose formulation of biopharmaceuticals.

Thermal aggregation of human immunoglobulin G in arginine solutions: Contrasting effects of stabilizers and destabilizers.

Arginine is widely used as aggregation suppressor of proteins in biotechnology and pharmaceutics. However, why the effect of arginine depends on the types of proteins and stresses, including monoclonal antibodies, is still unclear. Here we investigated the precise processes of the thermal aggregation of human immunoglobulin G (IgG) in the presence of additives. As expected, arginine was the best additive to suppress the formation of insoluble aggregates during heat treatment, though it was unable to preserve the monomer content. A systematic analysis of the additives showed that sugars and kosmotropic ion inhibit the formation of soluble oligomers. These behaviors indicate that the thermal aggregation of IgG occurs by (i) the formation of soluble oligomers, which is triggered by the unfolding process that can be stabilized by typical osmolytes, and (ii) the formation of insoluble aggregates through weak cluster-cluster interactions, which can be suppressed by arginine. Understanding the detailed mechanism of arginine will provide useful information for the rational formulation design of antibodies.

Controlled Modification of Superconductivity in Epitaxial Atomic Layer-Organic Molecule Heterostructures.

Self-assembled organic molecules can potentially be an excellent source of charge and spin for two-dimensional (2D) atomic-layer superconductors. Here we investigate 2D heterostructures based on In atomic layers epitaxially grown on Si and highly ordered metal-phthalocyanine (MPc, M = Mn, Cu) through a variety of techniques: scanning tunneling microscopy, electron transport measurements, angle-resolved photoemission spectroscopy, X-ray magnetic circular dichroism, and ab initio calculations. We demonstrate that the superconducting transition temperature (Tc) of the heterostructures can be modified in a controllable manner. Particularly, the substitution of the coordinated metal atoms from Mn to Cu is found to reverse the Tc shift from negative to positive directions. This distinctive behavior is attributed to a competition of charge and spin effects, the latter of which is governed by the directionality of the relevant d-orbitals. The present study shows the effectiveness of molecule-induced surface doping and the significance of microscopic understanding of the molecular states in these 2D heterostructures.

Effect of counter ions of arginine as an additive for the solubilization of protein and aromatic compounds.

Arginine is widely used in biotechnological application, but mostly with chloride counter ion. Here, we examined the effects of various anions on solubilization of aromatic compounds and reduced lysozyme and on refolding of the lysozyme. All arginine salts tested increased the solubility of propyl gallate with acetate much more effectively than chloride. The effects of arginine salts were compared with those of sodium or guanidine salts, indicating that the ability of anions to modulate the propyl gallate solubility is independent of the cation. Comparison of transfer free energy of propyl gallate between sodium and arginine salts indicates that the interaction of propyl gallate is more favorable with arginine than sodium. On the contrary, the solubility of aromatic amino acids is only slightly modulated by anions, implying that there is specific interaction between acetic acid and propyl gallate. Unlike their effects on the solubility of small aromatic compounds, the solubility of reduced lysozyme was much higher in arginine chloride than in arginine acetate or sulfate. Consistent with high solubility, refolding of reduced lysozyme was most effective in arginine chloride. These results suggest potential broader applications of arginine modulated by different anions.

Charge state of arginine as an additive on heat-induced protein aggregation.

Arginine (Arg) is one of the most versatile solvent additives, such as suppressing protein aggregation, increasing solubility of small aromatic compounds and peptides, and preventing protein binding on solid surfaces. In this study, we investigated the role of the charged state of α-amino group of Arg for the prevention of protein aggregation. As expected, Arg effectively suppressed thermal aggregation of hen egg-white lysozyme at neutral pH, whereas the suppression effect diminished at and above pH 9.0, which corresponds to the pK of Arg's α-amino group. The pH dependence of Arg as an aggregation suppressor was confirmed by additional experiments with neutral proteins, bovine hemoglobin and bovine γ-globulin. Interestingly, N-acetylated arginine, which lacks the α-amino group, showed a weaker suppressive effect on protein aggregation than Arg, even at neutral pH. These results indicate that both positively charged α-amino group and guanidinium group play important roles in suppressing heat-induced protein aggregation by Arg. The elucidated limitation of Arg at alkaline pH provides new insight in the application as well as the mechanism of Arg as a solvent additive.

Current-Driven Supramolecular Motor with In Situ Surface Chiral Directionality Switching.

Surface-supported molecular motors are nanomechanical devices of particular interest in terms of future nanoscale applications. However, the molecular motors realized so far consist of covalently bonded groups that cannot be reconfigured without undergoing a chemical reaction. Here we demonstrate that a platinum-porphyrin-based supramolecularly assembled dimer supported on a Au(111) surface can be rotated with high directionality using the tunneling current of a scanning tunneling microscope (STM). Rotational direction of this molecular motor is determined solely by the surface chirality of the dimer, and most importantly, the chirality can be inverted in situ through a process involving an intradimer rearrangement. Our result opens the way for the construction of complex molecular machines on a surface to mimic at a smaller scale versatile biological supramolecular motors.

Imaging Josephson vortices on the surface superconductor Si(111)-(√7×√3)-In using a scanning tunneling microscope.

We have studied the superconducting Si(111)-(√7×√3)-In surface using a ³He-based low-temperature scanning tunneling microscope. Zero-bias conductance images taken over a large surface area reveal that vortices are trapped at atomic steps after magnetic fields are applied. The crossover behavior from Pearl to Josephson vortices is clearly identified from their elongated shapes along the steps and significant recovery of superconductivity within the cores. Our numerical calculations combined with experiments clarify that these characteristic features are determined by the relative strength of the interterrace Josephson coupling at the atomic step.

Dependence of ethanol effects on protein charges.

Ethanol is used as a conventional disinfectant solution. It is highly effective against enveloped viruses due to its effects on virus membranes. It also confers inactivation of non-enveloped viruses, which can be ascribed to conformational changes or changes in association state of the viral proteins induced by ethanol. We have examined here the effects of pH and hence the charged state of proteins on the ethanol-induced conformational changes and self-association of model proteins, i.e., bovine serum albumin (BSA) and ribonuclease A (RNase A). Both proteins showed qualitatively different aggregation behavior and structure changes by ethanol at pH 4.0 and 7.0, at which BSA has opposite charges and RNase A has different degree of net positive charges.

Robust protection from backscattering in the topological insulator Bi1.5Sb0.5Te1.7Se1.3.

Electron scattering in the topological surface state (TSS) of the topological insulator Bi1.5Sb0.5Te1.7Se1.3 was studied using quasiparticle interference observed by scanning tunneling microscopy. It was found that not only the 180° backscattering but also a wide range of backscattering angles of 100°-180° are effectively prohibited in the TSS. This conclusion was obtained by comparing the observed scattering vectors with the diameters of the constant-energy contours of the TSS, which were measured for both occupied and unoccupied states using time- and angle-resolved photoemission spectroscopy. The robust protection from backscattering in the TSS is good news for applications, but it poses a challenge to the theoretical understanding of the transport in the TSS.

Synergistic solubilization of porcine myosin in physiological salt solution by arginine.

Myosin is an important protein resource for food industries and has a bipolar filamentous structure that is composed of subfilaments that occur in vivo. It has been shown that a high ionic strength is required to prevent myosin from forming filamentous structures and to solubilize the protein in aqueous solution. In the presence of 100-200 mM NaCl, 50 mM arginine was more effective than other additives tested, including NaCl, in myosin solubilization. Before reaching equilibrium solubility, the myosin solution was initially supersaturated upon the dilution of a stock myosin solution in 1 M NaCl into the test solvents. Arginine slowed the process of equilibration and stabilized the supersaturated solution more effectively than other additives. No structural changes in myosin caused by arginine were observed, which indicated that arginine enhanced the solubility of myosin in a physiological salt solution without affecting the structure.