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ABSTRACT Background Objectives Methods Results Conclusion Intra‐oesophageal acid stimulation increases masseter muscle activity. However, the infusion speeds used in previous studies are significantly slow, with minimal acid volume (30 mL over 30 min). Additionally, it is unclear how masseter muscle activity, symptoms of discomfort, stress levels and saliva quantity change over time.The time course of masseter muscle activity, heartburn and discomfort symptoms, salivary cortisol concentration to assess stress, autonomic nervous system (ANS) activity and saliva quantity under the influence of intra‐oesophageal acid infusion were evaluated at a faster injection rate and larger volume than in previous studies.Ten healthy adults underwent polygraphic monitoring, consisting of electromyography of the masseter muscle and electrocardiography during intra‐oesophageal acid infusion (10 mL/min, 10 min). Symptoms of heartburn and discomfort were assessed using the visual analogue scale (VAS), and saliva quantity was measured. Friedman's test was used for multiple comparisons.Masseter muscle activity, VAS scores for heartburn and discomfort, as well as saliva quantity during the 10‐min acid infusion, increased significantly compared with that before acid infusion (p < 0.001, 0.001, 0.019 and 0.047, respectively) and decreased 10 and 20 min after acid infusion (p = 0.004, 0.004 and 0.007, respectively). No significant changes were observed in the salivary cortisol concentration or ANS activity.Intra‐oesophageal acid infusion stimulated symptoms of heartburn and discomfort and increased masseter muscle activity and saliva production, which may not be related to psychological stress. [ABSTRACT FROM AUTHOR]

Uncovering neutrinoless double beta decay (0ν2β) is crucial for confirming neutrinos' Majorana characteristics. The decay rate of 0νββ is theoretically uncertain, influenced by nuclear matrix elements that vary across nuclides. To reduce this uncertainty, precise measurement of the half-life of neutrino-emitting double beta decay (2ν2β) in different nuclides is essential. We have launched the PIKACHU (Pure Inorganic scintillator experiment in KAmioka for CHallenging Underground sciences) project to fabricate high-purity Ce-doped Gd3Ga3Al2O12 (GAGG) single crystals and use them to study the double beta decay of 160Gd. Predictions from two theoretical models on nuclear matrix element calculations for 2ν2β in 160Gd show a significant discrepancy in estimated half-lives, differing by approximately an order of magnitude. If the lower half-life estimation holds true, detecting 2ν2β in 160Gd could be achievable with a sensitivity enhancement slightly more than an order of magnitude compared to prior investigations using Ce-doped Gd2SiO5 (GSO) crystal. We have successfully developed GAGG crystals with purity levels surpassing previous standards through refined purification and selection of raw materials. Our experiments with these crystals indicate the feasibility of reaching sensitivities exceeding those of earlier studies. This paper discusses the ongoing development and scintillator performance evaluation of high-purity GAGG crystals, along with the anticipated future prospects of the PIKACHU experiment. [ABSTRACT FROM AUTHOR]

Background: Masseter muscle activity during wakefulness may be associated with temporomandibular disorder (TMD)‐related symptoms, psychosocial status and pain‐related disability; however, this relationship is unclear. Objectives: This study aimed to determine the relationship between masseter muscle electromyography (EMG) burst/duration during wakefulness and TMD‐related symptoms, psychosocial status and pain‐related disability. Methods: Sixty participants were assessed masseter muscle activity during wakefulness using a data‐logger‐type ultraminiature EMG system and TMD‐related symptoms, psychosocial status and pain‐related disability through Axis I and II of the diagnostic criteria for TMD (DC/TMD). EMG bursts lasting longer than 0.25 s but less than 2.0 s and those lasting longer than 2.0 s were classified as phasic and tonic bursts, respectively. Results: Participants with palpation‐related pain in the temporalis and masseter muscles, as assessed through the DC/TMD examination form in Axis I, had more bursts (number/h) (p =.035 and p =.009, respectively) and longer duration (time/h) (p =.013 and p =.004, respectively) of tonic bursts of the masseter muscle during wakefulness. Participants with palpation‐related pain in the masseter muscles had higher oral behaviour scores during wakefulness using Axis II (p =.001), which affected the number and duration of tonic bursts of the masseter muscle activity during wakefulness (p =.011 and p =.007, respectively). Conclusion: As tonic bursts mainly reflect clenching, individuals with pain in the masseter muscles by palpation may have a high frequency and longer duration of clenching, as well as a high frequency of oral behaviours during wakefulness. [ABSTRACT FROM AUTHOR]

Simple Summary: Previous studies have shown that women with endometriosis have an increased risk of ovarian cancer. However, it is unclear whether endometriosis is associated with a risk of developing endometrial cancer. Therefore, this study was designed to retrospectively assess the clinicopathological relationship between endometrial cancer and endometriosis using the medical records of patients with endometrial cancer who underwent surgery at our institution. Endometriosis is known to be associated with an increased risk of endometrioid and clear cell ovarian cancer. However, the association between endometriosis and endometrial cancer is controversial. Therefore, we retrospectively analyzed the medical records of women with endometrial cancer who had undergone surgery at our institution to evaluate the clinicopathological relationship between endometrial cancer and endometriosis. The study included 720 women pathologically diagnosed with endometrial cancer at our hospital between 2000 and 2020. The participants were allocated to two groups of patients with endometrial cancer: patients with endometriosis (n = 101) and patients without endometriosis (n = 619). Endometrial cancer patients with endometriosis were significantly younger (median age 54.0 vs. 58.0; p = 0.002). In addition, endometrial cancer patients with endometriosis had fewer pregnancies and deliveries (median pregnancy 1.58 vs. 1.99; p = 0.019, median delivery 1.25 vs. 1.56; p = 0.012). The percentage of patients classified as stage IA was significantly higher in those with endometrial cancer with endometriosis (68.3% vs. 56.4%; p = 0.029). In the analysis of synchronous ovarian cancer, the percentage of dual primary cancer was higher in patients with endometriosis (14.9% vs. 1.6%; p < 0.001). The association of young-onset early-stage endometrial cancer with endometriosis is an important finding that cannot be ignored clinically. [ABSTRACT FROM AUTHOR]

Although the Pipelle endometrial biopsy is widely performed as a practical and minimally invasive test for endometrial disease(s), its effectiveness in ovarian cancer has not been explored. The aim of the present study was to evaluate the results of Pipelle endometrial biopsy for ovarian, fallopian tube, and peritoneal cancers. A pre-treatment Pipelle-endometrial biopsy was performed in 90 patients with ovarian, fallopian tube, or peritoneal cancers between January 2014 and November 2021. We retrospectively analysed the association between the results of Pipelle endometrial biopsy and clinicopathological data. Moreover, we evaluated their impact on the following treatment in advanced cases initially treated with chemotherapy. The sensitivity and false-negative rates for Pipelle endometrial biopsy were 25/90 (27.8%) and 65/90 (72.2%) in all patients, respectively, and 23/56 (41.0%) and 33/56 (58.9%) in cases with advanced disease (stages III and IV), respectively. Pipelle-positive endometrial biopsy-positive (Pipelle-positive) was not observed in 29 patients with clinical stage I disease, and Pipelle-positive patients exhibited significantly more high-grade serous carcinomas, and positive peritoneal, endometrial, and cervical cytologies than Pipelle-endometrial biopsy-negative cases. Surgical pathology was confirmed in 23 Pipelle-positive patients, and 17/23 (74.0%) had the same diagnosis as that for Pipelle endometrial biopsy. Conversely, 6/23 (26.0%) patients exhibited a minor diagnostic discrepancy between Pipelle endometrial biopsy and surgical pathology. Nineteen of the 38 (50.0%) patients initially treated with chemotherapy were identified as Pipelle-positive, contributing to a prompt histological diagnosis and pre-treatment tumour sampling. Companion diagnostic tests were performed using Pipelle endometrial biopsy samples from 4 inoperable patients. Although the positive rate of Pipelle endometrial biopsy in ovarian, fallopian tube, and peritoneal cancers is low, Pipelle endometrial biopsy may enable prompt histological diagnosis and initiation of chemotherapy while collecting tumour tissue for genetic testing in some cases with advanced disease. The effectiveness of pre-treatment Pipelle endometrial biopsy for ovarian, fallopian tube, and peritoneal cancers remains unclear. This study demonstrated that Pipelle endometrial biopsy may enable prompt histological diagnosis and initiation of chemotherapy while collecting tumour tissue for genetic testing in some cases with advanced disease. This was a single-centre, retrospective study; as such, the effectiveness of Pipelle endometrial biopsy should be evaluated in larger prospective studies, including comparisons with other tumour sampling methods. [ABSTRACT FROM AUTHOR]

The Academic Research Consortium for High Bleeding Risk (ARC-HBR) defined high bleeding risk (HBR) in patients undergoing percutaneous coronary intervention. We have reported a simplified HBR (S-HBR), excluding six items with prevalences under 1% from ARC-HBR. The Japanese Circulation Society developed an HBR specific to Japanese (J-HBR), adding three items to ARC-HBR in consideration of ethnicity. Data comparing each HBR are scarce. Patients treated with second-generation drug-eluting stents between January 2010 and December 2013 were enrolled, in whom all items of ARC-HBR, and the incidences of major bleeding and ischemic events were examined. Also, the diagnostic values of ARC-HBR, S-HBR, and J-HBR at 1 and 7 years post procedure were compared by using receiver-operating characteristic curves. The study sample consisted of 3430 patients. Mean follow-up period was 2299 ± 904 days. The incidence of major bleeding at 1 and 7 years in each definition was as follows: ARC-HBC, 3.3% and 10.6%; S-HBR, 3.3% and 10.7%; and J-HBR, 2.9% and 10.0%. The diagnostic value of J-HBR for major bleeding at 1 year was lower than that of ARC-HBR (C statistics 0.64 vs. 0.68, p < 0.001). Other diagnostic values of S-HBR and J-HBR were comparable to those of ARC-HBR. S-HBR was as useful as ARC-HBR in predicting both short- and long-term HBR, and J-HBR is useful for predicting long-term HBR. [Display omitted] • Simplified high bleeding risk (S-HBR) consists of 11 factors which had prevalence greater than 1%. • S-HBR had similar diagnostic value of bleeding and ischemic events with Academic Research Consortium for High Bleeding Risk (ARC-HBR). • Japan HBR was able to predict larger number of at-risk patients than ARC-HBR. [ABSTRACT FROM AUTHOR]

Mechanical circulatory support (MCS) is essential to maintain the hemodynamics in selected patients with cardiogenic shock (CS). However, little is known about predictors and clinical impact of device-related complications on clinical outcomes in patients with MCS. We retrospectively reviewed consecutive 477 patients who received veno-arterial extracorporeal membrane oxygenation (VA-ECMO), Impella (Abiomed, Danvers, MA, USA), and intra-aortic balloon pump (IABP) from January 2012 to May 2020. After excluding patients with only VA-ECMO and patients with MCS for procedural support, 403 patients were included in this study. Predictors and clinical outcomes of device-related complications were analyzed. Furthermore, complication rates were compared between Impella and IABP groups in patients with and without VA-ECMO. Hemolysis, major bleeding defined by Bleeding Academic Research Consortium type 3 or 5 bleeding, thromboembolic events, and ischemic stroke were observed in 42 (10.4%), 150 (37.2%), 52 (12.9%), and 30 patients (7.4%), respectively. Patients with major bleeding had a higher in-hospital mortality than those without major bleeding (31.2% vs. 56.0%, p<0.001), whereas hemolysis (47.6% vs. 52.4%, p=0.32), thromboembolic events (38.5% vs. 40.7%, p=0.76), and ischemic stroke (48.5% vs. 39.7%, p=0.33) did not increase the in-hospital mortality. In multivariate analysis, both Impella and VA-ECMO were independent predictors of major bleeding and thromboembolic events. However, in-hospital mortality was similar between the Impella and IABP groups irrespective of the VA-ECMO insertion. Among several important complications in CS patients with MCS, major bleeding events most strongly affected the mortality. Implanted MCS type was associated with the device-related complications. [Display omitted] [ABSTRACT FROM AUTHOR]

In this case, we successfully repositioned the transcatheter heart valve (THV) by pulling it with a snare inserted via the right brachial artery. Attempting to pull the THV via the femoral approach was not successful, due to the vector of the pulling force not being coaxial. Changing the direction of the force by switching to an approach from the right brachial artery successfully prevented perivalvular leakage. While there are previous case reports of repositioning an implanted transcatheter valve in a native valve using a gooseneck snare, to our knowledge, this is the first case of successfully repositioning an implanted transcatheter valve in a valve-in-valve procedure using the precise assessment that can be achieved with intra-procedural transesophageal echocardiography. Perivalvular leakage (PVL) is a major problem after transcatheter aortic valve replacement. In this case, we experienced PVL after implantation of self-expandable transcatheter heart valve (THV) inside the previously inserted Mosaic bioprosthetic valve. Depth of the implanted valve was too low into left ventricle accessed with transesophageal echocardiogram. It is barely known whether THV in surgical implanted aortic valve could be repositioned using snare maneuver, but we successfully pulled the valve via brachial artery and PVL was controlled. [ABSTRACT FROM AUTHOR]

Investigates the impact of racket grip position on hand segments to racket head velocity in a tennis forehand. Styles of holding tennis rackets; Use of direct linear transformation approach; Analysis of the ball speed and trajectory optimization.

Background: EUV lithography is making substantial progress in optimizing (i) tool, (ii) mask blanks, and (iii) resist materials to support the next generation EUV imaging performance. EUV masks use a variety of absorbers and capping layers fabricated on mirroring multi-layer (ML) stacks. Aim: The highly conformal e-beam resist-patterning process needs to understand the absorbed intensity distribution spread from the electron scattering in the resist/substrate stack, as well as the consecutive radiation-chemical effects induced by the electron energy spread together with the dissolution behavior of the resist. Approach: We present the results of resist response to 50-keV electron multi-beam exposure based on statistical numerical simulation on different EUV absorbers and reflecting ML stacks directly compared with the numerical lithographic parameters extracted from the experimental resist screening. The experiments were performed with the IMS Nanofabrication Multi-Beam Mask Writer (MBMW) ALPHA tool in a positive Chemically Amplified Resist provided by FUJIFILM, coated on experimental EUV masks with different stack compositions prepared by HOYA. Results: All input parameters for MBMW corrections were precisely specified to the corresponding absorbed energy distribution signature of the specific EUV stack. Experiments confirmed the necessity to match the model calibration values to each small change in the mask stack composition. Conclusions: The method was successfully implemented into leading-edge mask writing and resist/substrate/tool testing for achieving the sub-7-nm node at different EUV-mask stacks. [ABSTRACT FROM AUTHOR]

Although ovarian clear cell carcinoma (CCC) is associated with high incidence of thromboembolism, the clinicopathological and biological significance of hypercoagulable status in CCC remains unclear. We retrospectively analyzed pretreatment D-dimer levels, thromboembolic status, and clinical outcome of 125 CCCs in the discovery set and 143 CCCs in two other independent validation sets. Next, we performed RNA sequencing of 93 CCCs and compared coagulation-related gene profiles with 2492 pan-cancer data. We investigated differences in molecular characteristics of CCC subclasses based on coagulation status. In the discovery dataset, D-dimer elevation above the normal range was significantly associated with shorter progression-free and overall survival, irrespective to thromboembolic status. Multivariate analysis identified D-dimer elevation and clinical stage as an independent prognostic factors. We confirmed the prognostic significance of D-dimer elevation in the validation sets. Tissue factor and IL6, which are considered key elements of cancer-induced hypercoagulation, were highly expressed in CCC than in other cancers regardless of D-dimer level. Higher activity of various oncogenic pathways was observed in CCC with compared to without D-dimer elevation. Moreover, hierarchical cluster analysis divided 57 CCCs with D-dimer elevation into immunologically hot and cold tumor subtypes. Hot tumors were characterized by enrichment of T-cell inflamed phenotype, inflammation, the epithelial-mesenchymal transition, and high serum levels of CRP, and cold tumors by enrichment of cell cycle and MYC pathways. CCC represents hypercoagulable disease and elevate D-dimer is a prognostic factor for decreased survival in CCC. D-dimer high CCC has distinct molecular characteristics into the inflammatory-driven pathway (hot tumor) and the immune-suppressive pathway (cold tumor). Treatment implication of our proposed molecular classification merits further investigation. • D-dimer elevation is a prognostic factor for ovarian clear cell carcinoma, irrespective to thromboembolic status. • mRNA expression of Tissue factor and IL6 was significantly higher in CCC than other cancers. • D-dimer high CCC was divided into two subtypes: immunologically hot- and cold-tumors. [ABSTRACT FROM AUTHOR]

Background: As drug-metabolizing enzyme activities are affected by a variety of factors, such as drug-drug interactions, a method to evaluate drug-metabolizing enzyme activities in real time is needed. In this study, we developed a novel SPECT imaging probe for evaluation of hepatic CYP2D activity. Methods: Iodine-123- and 125-labeled 4-iodobenzylmequitazine ( 123/125 I-BMQ) was synthesized with high labeling and purity. CYP isozymes involved in the metabolism of 125 I-BMQ in mouse liver microsomes were evaluated, and the utility of 123/125 I-was assessed from biological distribution and SPECT imaging evaluation in normal and CYP2D-inhibited mice. Results: In vitro metabolite analysis using mouse liver microsomes showed that 125 I-BMQ is specifically metabolized by CYP2D. Biological distribution and SPECT imaging of 123/125 I-BMQ in normal mice showed that injection 123/125 I-BMQ accumulated early in the liver and was excreted into the gallbladder and intestines. In CYP2D-inhibited mice, accumulation in the liver was increased, but accumulation in the gallbladder and intestines, the excretory organ, was delayed. Since only metabolites of 125 I-BMQ are detected in bile, visualization and measuring of the accumulation of metabolites over time in the intestine, where bile is excreted, could predict the amount of metabolites produced in the body and evaluate CYP2D activity, which would be useful in determining the dosage of various drugs metabolized by CYP2D. Conclusion: 123/125 I-BMQ is useful as a SPECT imaging probe for comprehensive and direct assessment of hepatic CYP2D activity in a minimally invasive and simple approach., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Mizutani, Kobayashi, Nishi, Fujita, Takahashi, Muranaka, Sato, Kitamura, Suzuki, Nishii, Shikano, Magata, Ishida, Kunishima, Fukuchi and Kawai.)

Background: The Academic Research Consortium for High Bleeding Risk (ARC-HBR) defined a consensus clinical criterion for patients at HBR undergoing percutaneous coronary intervention (PCI). This study aimed to validate and compare the ARC-HBR criteria and the contemporary risk score for long-term bleeding outcomes using a cohort of patients undergoing PCI., Methods and results: This study analyzed 3,410 patients who underwent PCI between 2010 and 2013. The endpoint was defined as incidence of The Bleeding Academic Research Consortium 3 or 5 bleeding events. In addition to ARC-HBR, this study validated the predictability of the Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy (PRECISE-DAPT) score, Patterns of non-adherence to Anti-platelet Regimens In Stented patients (PARIS) bleeding score, and Coronary Revascularization Demonstrating Outcome Study in Kyoto (CREDO-Kyoto) bleeding scores for bleeding events. There was a trend toward an increase in bleeding events, as the risk score increased for all bleeding risk scores used in this study. The ARC-HBR criteria had higher diagnostic sensitivity for bleeding events than other bleeding risk scores., Conclusions: Patients with a higher number of risk factors in each of the four bleeding risk scores had a higher risk of long-term bleeding events. In comparison to other contemporary risk scores, the ARC-HBR criteria were more sensitive in the identification of patients with bleeding events in the long-term.

Background: Gastrointestinal bleeding (GIB) and intracranial bleeding (ICB) are frequently observed as major bleeding events after percutaneous coronary intervention (PCI); however, there are few reports on these predictors and their association with the Academic Research Consortium for High Bleeding Risk (ARC-HBR)., Methods and results: The study included 3,453 patients who underwent PCI with second-generation drug-eluting stents between 2010 and 2013. Mean follow up was 2,663±596 days. The cumulative incidences of GIB and ICB were significantly higher in the HBR group than in the non-HBR group (6.3% vs. 1.9%, P<0.001, 5.5% vs. 2.3%, P<0.001). Older age, oral anticoagulant (OAC), and severe chronic kidney disease were independent predictors of GIB (hazard ratios [HR], 1.64; 95% confidence intervals [CI], 1.11-2.41; P=0.012; HR, 1.94; 95% CI, 1.23-3.05; P=0.004; HR, 1.80; 95% CI, 1.02-3.19, P=0.043 respectively), and low body weight, OAC, and left main coronary artery stenting were independent predictors of ICB by multivariate logistic regression analysis (HR, 1.83; 95% CI, 1.20-2.80; P=0.005; HR, 2.04; 95% CI, 1.31-3.19; P=0.002; HR, 1.79; 95% CI, 1.18-2.70; P=0.006 respectively)., Conclusions: ARC-HBR was consistently associated with GIB and ICB within a 7-year period. GIB and ICB had three predictors each. Of these, only OAC administration was common, and the other two were different.

Background: The association between renal morphological findings and changes in renal function in patients undergoing transcatheter aortic valve implantation (TAVI) is unexplored., Aims: We aimed to investigate the association between renal morphological findings and changes in renal function in patients undergoing TAVI., Methods: Among 283 consecutive patients undergoing TAVI between 2018 and 2021, the study sample included 224 patients. Renal morphological measurements were performed by preoperative multidetector computed tomography. Estimated glomerular filtration rate (eGFR) improvement and deterioration were defined as positive or negative changes in an eGFR of ≥10% one month after TAVI. The renal cortex thickness index was defined as the ratio of total renal cortex thickness to body surface area., Results: The incidences of eGFR improvement and deterioration were 33.9% and 24.1%, respectively. The renal cortex thickness index had a significant correlation with changes in eGFR (r=0.34, p<0.01). The index of the area under the curve of renal cortex thickness for eGFR improvement and deterioration were 0.73 and 0.68, respectively. The cut-off values were 5.82 mm/m 2 for eGFR improvement (odds ratio [OR]: 0.10; 95% confidence interval: 0.05-0.20; p<0.01) and 4.89 mm/m 2 for eGFR deterioration (OR: 9.07; 95% confidence interval: 4.55-18.6; p<0.01)., Conclusions: The renal cortex thickness index was associated with changes in renal function in patients who underwent TAVI. Its measurements might be useful for predicting the renal function change in patients undergoing TAVI.

Cholesterol crystal embolism (CCE) is a rare but serious complication of percutaneous coronary intervention (PCI). However, its incidence, risk factors, and prognosis in the contemporary era are not well known. We included 23,184 patients who underwent PCI in our institution between January 2000 and December 2019 in this study. The diagnosis of CCE was made histologically or by the combination of cutaneous signs and specific blood test results. In patients with CCE, we evaluated the incidence, risk factors, and prognosis. A total of 88 patients (0.38%) were diagnosed with CCE. The incidence of CCE seemed to decline through the investigated 20 years. Positive predictors of CCE were age ≥70 years (68% vs 59%, p = 0.012), aortic aneurysm (23% vs 7.2% p <0.001), and a femoral approach (71% vs 45%, p <0.001), whereas a negative predictor of CCE was the use of an inner sheath (63% vs 77%, p <0.001). The rate of 1-year mortality and the requirement for chronic hemodialysis within 1 year after PCI in patients with CCE were 10% and 11%, respectively. The use of an inner sheath and a nonfemoral approach was associated with a lower incidence of CCE. In conclusion, because the prognosis of patients with CCE is still poor, preprocedural identification of high-risk patients and selection of low-risk procedures could be important for preventing CCE., Competing Interests: Disclosures The authors have no conflicts of interest to declare., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

BACKGROUND Vulvar extramammary Paget disease (EMPD) with abnormal cervical cytology is extremely rare. We encountered a case of secondary EMPD derived from urothelial carcinoma diagnosed after cytological examination for cervical cancer screening. We diagnosed the case promptly owing to suspicion based on the patient's medical history and vulvar appearance. We report the case and present a review of published cases of EMPD with abnormal cervical cytology. CASE REPORT A 77-year-old Japanese woman visited a hospital because cervical cancer screening raised the suspicion of adenocarcinoma. Findings of the cytological examinations of the cervix, endometrium, and urethral meatus corresponded to those of other malignant neoplasms of the Bethesda system. The patient had undergone total urethral cystectomy for urothelial carcinoma 5 years earlier. In our hospital, we found erythema extending from the urethral meatus to the vulva and performed a vulvar biopsy based on the suspicion of recurrence of the urothelial carcinoma. We diagnosed secondary EMPD derived from the urothelial carcinoma based on the findings of Paget cells in the epithelium and immunohistochemistry. CONCLUSIONS A review of all the reported cases of EMPD with abnormal cervical cytology shows that the frequency of primary lesions is high in primary EMPD and secondary EMPD derived from urothelial carcinoma. These cases demonstrated the difficulty of suspecting EMPD based on cervical cytology alone. It should be considered that the cells derived from vulvar EMPD can be observed in cervical cytology, particularly in patients with a history of primary EMPD or urothelial carcinoma and with vulvar symptoms.

Background: The validity of the Academic Research Consortium for High Bleeding Risk (ARC-HBR) definitions of early (<1 year), late (1-4 years), and very late (>4 years) bleeding events is unknown., Methods and results: This study was performed on patients (n=3,453) implanted with second-generation drug-eluting stents (DES) between 2010 and 2013. Data on all criteria of the ARC-HBR definition were collected retrospectively. The primary endpoint was Bleeding Academic Research Consortium Type 3 or 5 bleeding events; the ischemic endpoint was a composite of cardiac death, myocardial infarction, and ischemic stroke. The mean follow-up period was 7.5 years. Compared with non-high bleeding risk (HBR) patients, HBR patients (n=1,840; 53.3%) had an increased risk of the primary endpoint (early events, 3.6% vs. 0.5% [P<0.0001]; late events, 5.3% vs. 2.5% [P<0.0001]; very late events, 5.5% vs. 2.1% [P<0.0001]) and of ischemic events during follow-up. The discrimination ability of the ARC-HBR definition for late and very late bleeding events was comparable to that of early bleeding events (C statistics 0.679, 0.621, and 0.620, respectively) with high negative predictive value (96.6%, 95.1%, and 93.1%, respectively). Multivariate analysis revealed the different effects of individual criteria on bleeding events in each follow-up period., Conclusions: The ARC-HBR definition consistently identified patients at risk of long-term bleeding and ischemic events after second-generation DES implantation.

Background: Venous thromboembolism (VTE) has a long-term risk of recurrence, which can be prevented by anticoagulation therapy.Methods and Results:The COMMAND VTE Registry is a multicenter registry enrolling 3,027 consecutive patients with acute symptomatic VTE between January 2010 and August 2014. The entire cohort was divided into the transient risk (n=855, 28%), unprovoked (n=1,477, 49%), and cancer groups (n=695, 23%). The rate of anticoagulation discontinuation was highest in the cancer group (transient risk: 37.3% vs. unprovoked: 21.4% vs. cancer: 43.5% at 1 year, P<0.001). The cumulative 5-year incidences of recurrent VTE, major bleeding and all-cause death were highest in the cancer group (recurrent VTE: 7.9% vs. 9.3% vs. 17.7%, P<0.001; major bleeding: 9.0% vs. 9.4% vs. 26.6%, P<0.001; and all-cause death: 17.4% vs. 15.3% vs. 73.1%, P<0.001). After discontinuation of anticoagulation therapy, the cumulative 3-year incidence of recurrent VTE was lowest in the transient risk group (transient risk: 6.1% vs. unprovoked: 15.3% vs. cancer: 13.2%, P=0.001). The cumulative 3-year incidence of recurrent VTE beyond 1 year was lower in patients on anticoagulation than in patients off anticoagulation at 1 year in the unprovoked group (on: 3.7% vs. off: 12.2%, P<0.001), but not in the transient risk and cancer groups (respectively, 1.6% vs. 2.5%, P=0.30; 5.6% vs. 8.6%, P=0.44)., Conclusions: The duration of anticoagulation therapy varied widely in discordance with current guideline recommendations. Optimal duration of anticoagulation therapy should be defined according to the risk of recurrent VTE and bleeding as well as death.

To improve the power conversion efficiency of solar cells, it is important to understand the underlying relaxation mechanisms of photogenerated charge carriers in organic semiconductors. In this work, we studied the charge carrier dynamics of diketopyrrolopyrrole-linked tetrabenzoporphyrin thin films where the diketopyrrolopyrrole unit has two n-butyl groups, abbreviated as C4-DPP-BP. We used time-resolved terahertz (THz) spectroscopy to track charge carrier dynamics with excitations at 800 and 400 nm. Compared with tetrabenzoporphyrin (BP), the extension of π-electron delocalization to the diketopyrrolopyrrole peripherals leads to an increase in absorption in the near-infrared region. Following the excitation at 800 nm, we found that the transient THz signals in C4-DPP-BP thin films decay with time constants of 0.5 and 9.1 ps, with small residual components. With excitation at 400 nm, we found that the transient THz signals decay with time constants of 0.4 and 7.5 ps. On the basis of the similarity of the decay profiles of the transient THz signals obtained with excitations at 400 and 800 nm, we considered that the decaying components are due to charge carrier recombination and/or trapping at defect sites, which do not depend on the excess energy of the photoexcitation. In contrast to BP, even without an electron acceptor, we observed the finite offset of the transient THz signals at 100 ps, demonstrating the existence of long-lived charge carriers. We also measured the photoconductivity spectra of C4-DPP-BP thin films with the excitation at both 800 and 400 nm. It was found that the spectra can be fitted by the Drude-Smith model. From these results, it was determined that the charge carriers are localized right after photoexcitation. At 0.4 ps, the product of the quantum yield of charge generation and mobility of charge carriers at 400 nm is approximately twice that obtained at 800 nm. We discuss the implications of the excess excitation energy in organic semiconductor-based devices.