Safety profile of vonoprazan compared with proton pump inhibitors: insight from a pharmacovigilance study.

Proton pump inhibitors (PPIs) are used to treat acid-related disorders such as peptic ulcer and gastroesophageal reflux disease. Recently, vonoprazan, a novel potassium-competitive acid blocker (P-CAB), has been introduced as more effective treatment option. The purpose of this study was to clarify the adverse events associated with vonoprazan compared to PPIs using a spontaneous reporting system database. We performed a retrospective pharmacovigilance disproportionality analysis using the Japanese Adverse Drug Event Report (JADER) database. Adverse event reports submitted to the Pharmaceuticals and Medical Devices Agency between 2004 and 2017 were analyzed, and the reporting odds ratio (ROR) and 95% confidence interval (CI) for each adverse event were calculated. The database comprised 11,433 reports associated with PPIs, and 636 reports with vonoprazan. Hepatic and skin disorders were commonly detected in both PPIs and vonoprazan. There was a significant association of interstitial lung disease with PPIs as a class (ROR: 1.61, 95%CI: 1.47-1.77), but not with vonoprazan. Vonoprazan was strongly associated with haemorrhagic enterocolitis (ROR, 86.5; 95%CI, 59.7125). Among the PPIs, the signal score of microscopic colitis was noteworthy in the case of lansoprazole (ROR, 405; 95%CI, 348-472). It is suggested that there is a diversity in the strength of the association between PPIs and vonoprazan with adverse events. Our results may provide useful information for the treatment of acid-related disorders, but further research with more data is needed to finally clarify this.

Endpoint stiffness magnitude increases linearly with a stronger power grasp.

Humans can increase the endpoint stiffness of their arm to reduce self-generated movement variability and to reject unpredictable perturbations from the environment, like during handheld drilling, thereby increasing movement precision. Existing methods to estimate changes in the endpoint stiffness use robotic interfaces to apply position or force perturbations to measure the arm's dynamic response. We propose an alternative method of measuring changes in the power grasp force to estimate adaptations in the magnitude of the arm's endpoint stiffness. To validate our method, we examined how the strength of the power grasp, when holding onto a robotic manipulandum, affected the arm's endpoint stiffness in three different locations of the workspace. The endpoint stiffness magnitude increased linearly with the grasp force, and this linear relationship did not depend on the arm's posture or position in the workspace. The endpoint stiffness may have increased as a combination of greater grasp stiffness and greater arm stiffness, since larger co-contraction was observed in the elbow and shoulder with a stronger grasp. Changes in the grasp force could serve as a metric in assessing how humans adapt their endpoint stiffness magnitude.

Increase in Grasp Force Reflects a Desire to Improve Movement Precision.

Grasping is an action engraved in the human genome, enabling newborn infants to hang from a monkey-bar immediately after birth. The grasp force provides rich information about the brain's control of arm movements. In this study, we tested the hypothesis that the grasp force increases to improve the hand's movement precision during reaching. In two reaching experiments, subjects increased grasp force to suppress movement imprecision that arose from both self-generated motor noise and from an unpredictable environment. Furthermore, the grasp force did not increase constantly, but increased specifically along the movement where the hand's deviation was greatest. The increased grasp was premeditated and was not a reaction to environmental forces, suggesting that the central nervous system has a predictive, state-dependent model of movement precision during reaching. The grasp force provides a high temporal resolution and calibration-less estimate of movement precision adaptation.

Individualistic weight perception from motion on a slope.

Perception of an object's weight is linked to its form and motion. Studies have shown the relationship between weight perception and motion in horizontal and vertical environments to be universally identical across subjects during passive observation. Here we show a contradicting finding in that not all humans share the same motion-weight pairing. A virtual environment where participants control the steepness of a slope was used to investigate the relationship between sliding motion and weight perception. Our findings showed that distinct, albeit subjective, motion-weight relationships in perception could be identified for slope environments. These individualistic perceptions were found when changes in environmental parameters governing motion were introduced, specifically inclination and surface texture. Differences in environmental parameters, combined with individual factors such as experience, affected participants' weight perception. This phenomenon may offer evidence of the central nervous system's ability to choose and combine internal models based on information from the sensory system. The results also point toward the possibility of controlling human perception by presenting strong sensory cues to manipulate the mechanisms managing internal models.

Emerging applications of single-cell diagnostics.

The performance of DNA sequencers (next generation sequencing) is rapidly enhanced these days, being used for genetic diagnostics. Although many phenomena could be elucidated with such massive genome data, it is still a big challenge to obtain comprehensive understanding of diseases and the relevant biology at the cellular level. In general terms, the data obtained to date are averages of ensembles of cells, but it is not certain whether the same features are the same inside an individual cell. Accordingly, important information may be masked by the averaging process. As the technologies for analyzing bio-molecular components in single cells are being developed, single cell analysis seems promising to address the current limitations due to averaging problems. Although the technologies for single cell analysis are still at the infant stage, the single cell approach has the potential to improve the accuracy of diagnosis based on knowledge of intra- and inter-cellular networks. In this review several technologies and applications (especially medical applications) of genome and transcriptome analysis or single cells are described.

Therapeutic effect of suicide gene-transferred mesenchymal stem cells in a rat model of glioma.

We evaluated a new therapeutic strategy for malignant glioma, which combines intratumoral inoculation of mesenchymal stem cells (MSCs) expressing cytosine deaminase gene with 5-fluorocytosine (5-FC) administration. For in vitro and in vivo experiments, MSCs were transfected with adenovirus carrying either enhanced green fluorescent protein gene (AdexCAEGFP) or cytosine deaminase gene (AdexCACD), to establish MSC-expressing EGFP (MSC-EGFP) or CD (MSC-CD). Co-culture of 9L glioma cells with MSC-CD in a medium containing 5-FC resulted in a remarkable reduction in 9L cell viability. The migratory ability of MSC-EGFP toward 9L cells was demonstrated by double-chamber assay. For the in vivo study, rats harboring 9L brain tumors were inoculated with MSC-EGFP or MSC-CD. Immunohistochemistry of rat brain tumors inoculated with MSC-EGFP showed intratumoral distribution of MSC-EGFP. Survival analysis of rats bearing 9L gliomas treated with intratumoral MSC-CD and intraperitoneal 5-FC resulted in significant prolongation of survival compared with control animals. In conclusion, molecular therapy combining suicide gene therapy and MSCs as a targeting vehicle represents a potential new therapeutic approach for malignant glioma, both with respect to the antitumor potential of this system and its neuroprotective effect on normal brain tissue.

Development of capillary array DNA sequencers for genome analysis.

Massive analysis of biological molecules is being successfully applied to elucidate various biological phenomena using techniques of molecular science. This new era was initiated by the Human Genome Project, which was supported by the development of various automated tools including DNA sequencers and DNA chips. A small project led by Akiyoshi Wada in Japan triggered the development of automated DNA analysis instruments. As one of the members of the project, the author has been engaged in developing DNA analyzers including capillary array DNA sequencers. Here, the principles and development of the main technologies related to capillary array DNA sequencers, which contributed to the completion of the Human Genome Project, are reviewed.

Localized distributions of quasi-two-dimensional electronic states near defects artificially created at graphite surfaces in magnetic fields.

We measured the local density of states of a quasi two-dimensional electron system (2DES) near defects, artificially created by Ar-ion sputtering, on surfaces of highly oriented pyrolytic graphite (HOPG) with scanning tunneling spectroscopy (STS) in high magnetic fields. At valley energies of the Landau level spectrum, we found two typical localized distributions of the 2DES depending on the defects. These are new types of distributions which are not observed in the previous STS work at the HOPG surface near a point defect [Y. Niimi, Phys. Rev. Lett. 97, 236804 (2006).10.1103/PhysRevLett.97.236804]. With increasing energy, we observed gradual transformation from the localized distributions to the extended ones as expected for the integer quantum Hall state. We show that the defect potential depth is responsible for the two localized distributions from comparison with theoretical calculations.

Construction of a versatile ultralow temperature scanning tunneling microscope.

We constructed a dilution-refrigerator (DR)-based ultralow temperature scanning tunneling microscope (ULT-STM) which works at temperatures down to 30 mK, in magnetic fields up to 6 T and in ultrahigh vacuum (UHV). Besides these extreme operation conditions, this STM has several unique features not available in other DR-based ULT-STMs. One can load STM tips as well as samples with clean surfaces prepared in an UHV environment to a STM head keeping low temperature and UHV conditions. After then, the system can be cooled back to near the base temperature within 3 h. Due to these capabilities, it has a variety of applications not only for cleavable materials but also for almost all conducting materials. The present ULT-STM has also an exceptionally high stability in the presence of magnetic field and even during field sweep. We describe details of its design, performance, and applications for low temperature physics.

Real-space imaging of alternate localization and extension of quasi-two-dimensional electronic States at graphite surfaces in magnetic fields.

We measured the local density of states (LDOS) of a quasi-two-dimensional (2D) electron system near point defects on a surface of highly oriented pyrolytic graphite with scanning tunneling microscopy and spectroscopy. Differential tunnel conductance images taken at very low temperatures and in high magnetic fields show a clear contrast between localized and extended spatial distributions of the LDOS at the valley and peak energies of the Landau level spectrum, respectively. The localized electronic state has a single circular distribution around the defects with a radius comparable to the magnetic length. The localized LDOS is in good agreement with a spatial distribution of a calculated wave function for a single electron in 2D in a Coulomb potential in magnetic fields.

STS observations of Landau levels at graphite surfaces.

Scanning tunneling spectroscopy (STS) measurements were made on surfaces of two different kinds of graphite samples, Kish graphite and highly oriented pyrolytic graphite (HOPG), at very low temperatures and in high magnetic fields. We observed a series of peaks in the tunnel spectra associated with Landau quantization of the quasi-two-dimensional electrons and holes. A comparison with the calculated local density of states at the surface layers allows us to identify Kish graphite as bulk graphite and HOPG as graphite with a finite thickness of 40 layers. This explains the qualitative difference between the two graphites reported in the recent transport measurements which suggested the quantum-Hall effect in HOPG. This work demonstrates how powerful the combined approach between the high quality STS measurement and the first-principles calculation is in material science.

Learning arm's posture control using reinforcement learning and feedback-error-learning.

In this paper, we propose a learning model using the Actor-Critic method and the feedback-error-learning scheme. The Actor-Critic method, which is one of the major frameworks in reinforcement learning, has attracted attention as a computational learning model in the basal ganglia. Meanwhile, the feedback-error-learning is learning architecture proposed as a computationally coherent model of cerebellar motor learning. This learning architecture's purpose is to acquire a feed-forward controller by using a feedback controller's output as an error signal. In past researches, a predetermined constant gain feedback controller was used for the feedback-error-learning. We use the Actor-Critic method for obtaining a feedback controller in the feedback-error-earning. By applying the proposed learning model to an arm's posture control, we show that high-performance feedback and feed-forward controller can be acquired from only by using a scalar value of reward.

Amicrobial pustular dermatosis in two patients with immunological abnormalities.

We report two patients with severe amicrobial pustular dermatosis with immunological abnormalities: a 63-year-old woman with a 30-year-history of discoid lupus erythematosus and sicca syndrome, and a 35-year-old woman with high levels of gamma-globulinemia and positive antinuclear antibodies. Both patients presented with crusty and eroded erythematous plaques studded with aseptic pustules on the back, face, and scalp. Histological examination showed acanthosis, neutrophilic exocytosis to the epidermis, and neutrophilic and lymphocytic infiltration with nuclear dust in the dermis. These patients were diagnosed as having "amicrobial pustulosis associated with autoimmune diseases". The eruptions improved with combination treatment of oral prednisolone with cyclosporin A or diaminodiphenylsulphone. Although the pathogenesis remains unclear, amicrobial pustular dermatosis might be one of the cutaneous complications in autoimmune diseases.

Re-biopsy in a patient with IgA nephropathy showing success of treatment with cyclosporin A and angiotensin-II receptor blocker.

We report a patient with IgA nephropathy (IgAN) showing reduction of proteinuria and histological improvement of renal injury with cyclosporin A (CsA) and angiotensin-II receptor blocker (ARB) therapy. The amount of urinary protein was reduced from 4.4 to 1.8 g/24 h after 2 months of CsA (150 mg/day) therapy, and further, to 0.4 g/24 h after 1 month of the combination therapy with ARB (candesartan, 4 mg/day). A renal re-biopsy, after treatment with CsA for 3 months and ARB for 1 month, demonstrated a reduction of IgA deposits, disappearance of crescents, re-separation of foot process fusion and decrease of interstitial cellular infiltration. After CsA therapy for 20 months and ARB for 18 months, the patient currently remains stable without deterioration of serum creatinine (1.7 mg/dl) and urinary protein excretion (0.5 g/day). These findings seem to indicate that combination therapy with CsA and ARB is effective for achieving histological improvement and protecting against deteriorated renal function, in addition to reducing proteinuria, in IgAN.

Miniaturized pyrosequencer for DNA analysis with capillaries to deliver deoxynucleotides.

As the human genome project proceeds, various types of DNA analysis tools are required for life sciences and medical sciences including DNA diagnostics. For example, a small DNA sequencer for sequencing a short DNA is required for bed-side DNA testing as well as DNA analysis in a small laboratory. Here, a new handy DNA sequencing system (pyrosequencer) based on the detection of inorganic pyrophosphate (PPi) released by polymerase incorporation is demonstrated. The system uses the bioluminescence detection system. The key point for the miniaturized DNA sequencer is to make a deoxynucleotide triphosphate (dNTP) delivery system small and inexpensive. It has been realized by using narrow capillaries to connect a reaction chamber and four dNTP reservoirs. Each dNTP is introduced into the reaction chamber by applying a pressure to the reservoir. Compared with other microdispensers, it is much cheaper and easier. By optimizing the conditions, an excellent sequencing ability is achieved while it is a simple and inexpensive system. In most cases, more than 40 bases can be successfully sequenced. A homopolymeric region, which can not be easily sequenced by a conventional gel-based DNA sequencer, is readily sequenced with this system. The new system is successfully applied to sequence a GC rich region or a region close to a priming region where misreading frequently occurs. A rapid analysis for a short DNA was easily achieved with this small instrument.

Quantitative detection of single nucleotide polymorphisms for a pooled sample by a bioluminometric assay coupled with modified primer extension reactions (BAMPER).

A new method for SNP analysis based on the detection of pyrophosphate (PPi) is demonstrated, which is capable of detecting small allele frequency differences between two DNA pools for genetic association studies other than SNP typing. The method is based on specific primer extension reactions coupled with PPi detection. As the specificity of the primer-directed extension is not enough for quantitative SNP analysis, artificial mismatched bases are introduced into the 3'-terminal regions of the specific primers as a way of improving the switching characteristics of the primer extension reactions. The best position in the primer for such artificial mismatched bases is the third position from the primer 3'-terminus. Contamination with endogenous PPi, which produces a large background signal level in SNP analysis, was removed using PPase to degrade the PPi during the sample preparation process. It is possible to accurately and quantitatively analyze SNPs using a set of primers that correspond to the wild-type and mutant DNA segments. The termini of these primers are at the mutation positions. Various types of SNPs were successfully analyzed. It was possible to very accurately determine SNPs with frequencies as low 0.02. It is very reproducible and the allele frequency difference can be determined. It is accurate enough to detect meaningful genetic differences among pooled DNA samples. The method is sensitive enough to detect 14 amol ssM13 DNA. The proposed method seems very promising in terms of realizing a cost-effective, large-scale human genetic testing system.

Multiplex polymerase chain reaction (PCR) with color-tagged module-shuffling primers for comparing gene expression levels in various cells.

A method based on the multiplex polymerase chain reaction (PCR) and gel electrophoresis for the comparative analysis of gene expression levels was developed. Using the method many cDNA fragments from different sources can be compared simultaneously. Competitive PCR amplification of expressed genes from different sources was performed by using 'module-shuffling primers' (MPSs). The MPSs (labeled with different fluorophores) consist of sequence modules of 3 or 4 nt. The modules are arranged in different orders in each primer; therefore, the base sequences of the primers are different but their melting temperatures are identical. The genes expressed in different sources are ligated with tags complementary with the MPSs. Tag-ligated fragments are mixed in one tube and amplified at the same amplification efficiency by the MPSs. Amplified fragments are detected separately by multiple-color gel electrophoresis. This method can detect different amounts of each expressed gene, up to a difference in amounts of 30%, and its detection limit is 0.1 amol per assay.

DNA hybridization using "bead-array": probe-attached beads arrayed in a capillary in a predetermined order.

We present a DNA analysis device called "Bead-Array", in which DNA-probe-attached beads (100 microns) are arrayed in a capillary in a predetermined order. We developed this device to overcome the problems of using DNA microarray technology, including high cost and a lengthy analysis time. Bead-arrays can easily be mass-produced even for many different probe combinations, and the small reaction volume and the use of sample flows enables faster hybridization. To demonstrate this, we examined DNA hybridization experiments using 18-mer DNA probes and targets and compared them to ones with beads in tubes. The results show that hybridization in bead-arrays progresses more than 100 times faster and reach the plateau in less than three min. These features suggest that the bead-array particularly meets the need for high-speed and disposable devices, for example diagnosis devices.