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Context. Low-energy (<300 keV) protons entering the field of view of XMM-Newton can scatter with the X-ray mirror surface and reach the focal plane. They are observed in the form of a sudden increase in the background level, the so-called soft proton flares, affecting up to 40% of the mission observing time. Soft protons can hardly be disentangled from true X-ray events and cannot be rejected on board. Aims. All future high throughput grazing incidence X-ray telescopes operating outside the radiation belts are potentially affected by soft proton-induced contamination that must be foreseen and limited since the design phase. In-flight XMM-Newton's observations of soft protons represent a unique laboratory to validate and improve our understanding of their interaction with the mirror, optical filters, and X-ray instruments. At the same time, such models would link the observed background flares to the primary proton population encountered by the telescope, converting XMM-Newton into a monitor for soft protons. Methods. We built a Geant4 simulation of XMM-Newton, including a verified mass model of the X-ray mirror, the focal plane assembly, and the EPIC MOS and pn-CCDs. Analytical computations and, when available, laboratory measurements collected from literature were used to verify the correct modelling of the proton scattering and transmission to the detection plane. Similarly to the instrument X-ray response, we encoded the energy redistribution and proton transmission efficiency into a redistribution matrix file (RMF), mapping the probability that a proton from 2 to 300 keV is detected in a certain detector channel, and an auxiliary response file (ARF), storing the grasp towards protons. Both files were formatted according to the standard NASA calibration database and any compliant X-ray data analysis tool can be used to simulate or analyse soft proton-induced background spectra. An overall systematic uncertainty of 30% was assumed on the basis of the estimated accuracy of the mirror geometry and transmission models. Results. For the validation, three averaged soft proton spectra, one for each filter configuration, were extracted from a collection of 13 years of MOS observations of the focused non X-ray background and analysed with Xspec. A similar power-law distribution is found for the three filter configurations, plus black-body-like emission below tens of keV used as a correction factor, based on the dedicated spectral analysis of 55 in-flight proton flares presented in Paper II. The best-fit model is in agreement with the power-law distribution predicted from independent measurements for the XMM-Newton orbit, spent mostly in the magnetosheath and nearby regions. For the first time we are able to link detected soft proton flares with the proton radiation environment in the Earth's magnetosphere, while proving the validity of the simulation chain in predicting the background of future missions. Benefiting from this work and contributions from the Athena instrument consortia, we also present the response files for the Athena mission and updated estimates for its focused charged background. [ABSTRACT FROM AUTHOR]

Context. Low-energy (< 300 keV) protons entering the field of view of the XMM-Newton telescope scatter with the X-ray mirror surface and might reach the X-ray detectors on the focal plane. They manifest in the form of a sudden increase in the rates, usually referred to as soft proton flares. By knowing the conversion factor between the soft proton energy and the deposited charge on the detector, it is possible to derive the incoming flux and to study the environment of the Earth magnetosphere at different distances, given the wide and elliptical XMM-Newton orbit. Thanks to detailed Geant4 simulations, we were able to build specific soft proton response matrices for MOS and PN. Aims. In this second paper, we present the results of testing these matrices with real data for the first time, while also exploring the seasonal and solar activity effect on the proton environment. The selected spectra are relative to 55 simultaneous MOS and PN observations with flares raised in four different temporal windows: December-January and July-August of 2001-2002 (solar maximum) and 2019-2020 (solar minimum). Methods. We selected and extracted the flare mean spectra and count rates in the 2–11.5 keV energy range for the four epochs. After investigating the rate variations among the MOS1, MOS2, and PN instruments, we fit the X-ray spectra using XSPEC and the proton response matrices. The best-fitting parameters derived for the three instruments were compared in order to obtain the systematic errors. Results. There is no seasonal or solar activity effect on the soft proton mean count rates, but we find large discrepancies in the instrument cross-correlations across the 20 years of satellite operations. In 2001-2002, after a few years of operation, the MOS1 and MOS2 rates are similar, and about 20% with regard to the PN ones. After 20 years, PN does not present any variation in its response, while MOS1 suffers a reduction of ∼30%, in addition to the 30% loss due to the damage of two CCDs, and MOS2 is affected by an even worse degradation (70%). The main result of the spectral analysis is that the physical model representative of the proton spectra at the input of the telescope is a power law. However, a second and phenomenological component is necessary to take into account imprecision in the generation of the matrices at softer (< 5 keV) energies. This component contributes for 21% for the MOS and 5% for the PN to the total flux in the 2–5 keV energy range. Conclusions. This study, which is the first application of the soft proton response matrices to real data, shows coherent results between detectors and allows us to estimate systematic uncertainties in the measured spectra of 3% between the two MOS detectors and of 24% between MOS and PN, together with a systematic in the input flux of about a factor of two. They are all likely due to uncertainties in the proton transmission models, with the presence of additional passive material in front of the front-illuminated MOS, and element deposition on its electrode structure across the mission life. Dedicated studies and laboratory measurements are required for improving the accuracy of the proton response files. [ABSTRACT FROM AUTHOR]

Although mitral annular calcification is a common degenerative condition of the fibrous mitral annulus, tricuspid annular calcification, especially isolated, is rare. We report the case of a 73-year-old male, with a history of hypertension and severe kyphoscoliosis, referred to the emergency department for progressive dyspnea and leg swelling. Echocardiography revealed a dilated right heart with a homogeneous, hyperechoic, crescent shaped mass along the tricuspid annulus. Computed tomography confirmed the calcific nature of the lesion. Right heart catheterization revealed mild pre-capillary pulmonary hypertension and a mild spirometrically-defined restrictive ventilatory defect. Kyphoscoliosis has recently been associated with alterations in cardiac deformation and with an increased risk of restrictive lung disease. In our patient, we hypothesized that both these anomalies could have led to premature tricuspid annular degeneration resulting in a giant tricuspid calcification.

Renal denervation (RDN) is a safe and effective strategy for the treatment of difficult to treat hypertension. The blood pressure (BP)-lowering efficacy of RDN is comparable to those of many single antihypertensive medications and it allows to consider the RDN as a valuable option for the treatment of difficult to treat hypertension together with lifestyle modifications and medical therapy. A multidisciplinary team is of pivotal importance from the selection of the patient candidate for the procedure to the post-procedural management. Further studies are needed to investigate the effect of RDN on clinical outcomes and to better identify the predictors of BP response to RDN in order to recognize the patients who are more likely to benefit from the procedure.

The elderly represent an increasing proportion of patients presenting with acute coronary syndrome (ACS). Various data have shown that the benefits of percutaneous coronary revascularization are maintained in elderly patients presenting with ACS. Conversely, the management of antiplatelet therapy remains challenging and controversial, because older patients are usually at a high risk of both ischemia and bleeding. Moreover, the recommended ischemic and bleeding risk scores in patients with ACS were developed from studies with a low representation of older patients. New antiplatelet strategies have been developed, but their evidence in elderly patients is limited because they are usually underrepresented in randomized clinical trials due to their clinical complexity. The aim of this review is to summarize the different factors associated with increased ischemic and/or bleeding risk and the scientific evidence about the different antiplatelet strategies in elderly patients presenting with ACS and undergoing percutaneous coronary revascularization.