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The science operations of the spacecraft and remote sensing instruments for the Martian Moon eXploration (MMX) mission are discussed by the mission operation working team. In this paper, we describe the Phobos observations during the first 1.5 years of the spacecraft’s stay around Mars, and the Deimos observations before leaving the Martian system. In the Phobos observation, the spacecraft will be placed in low-altitude quasi-satellite orbits on the equatorial plane of Phobos and will make high-resolution topographic and spectroscopic observations of the Phobos surface from five different altitudes orbits. The spacecraft will also attempt to observe polar regions of Phobos from a three-dimensional quasi-satellite orbit moving out of the equatorial plane of Phobos. From these observations, we will constrain the origin of Phobos and Deimos and select places for landing site candidates for sample collection. For the Deimos observations, the spacecraft will be injected into two resonant orbits and will perform many flybys to observe the surface of Deimos over as large an area as possible. Graphical Abstract

PURPOSE Cardiac implantable electronic devices (CIEDs) offer diagnostic information such as device-measured physical activity (PA). Peak oxygen consumption (VO2) measured by cardiopulmonary exercise testing (CPET) is the most objective variable showing exercise capacity. The purpose of this study was to investigate the relationship between these 2 variables. METHODS We retrospectively studied consecutive patients with CIEDs undergoing CPET between April 1, 2018, and January 31, 2021. These patients were divided into 2 groups: patients with peak VO2 ≤ 14 ml/kg/min (low peak VO2 group) and those showing peak VO2 > 14 ml/kg/min (high peak VO2 group). The peak device-measured PA was compared between the 2 groups. The relationship between the peak device-measured PA and peak VO2 was also investigated. RESULTS There were 50 and 51 patients in the low and high peak VO2 groups, respectively. The peak device-measured PA, which was expressed in units of hours/day, was significantly lower in the low peak VO2 group than in the high peak VO2 group (3.06, interquartile range [2.43-4.00] vs. 5.50, interquartile range [4.04-6.70] p 3.87 h/day could predict high peak VO2 (80.4%, sensitivity; 72.0%, specificity). In multivariate linear regression analysis, peak device-measured PA was an independent predictor of peak VO2 (regression coefficient, 0.61; 95% confidence interval, 0.33-0.89; p

PURPOSE Ionoacoustics is one of the promising approaches to verify the beam range in proton therapy. However, the weakness of the wave signal remains a main hindrance to its application in clinics. Here we studied the potential use of a fixed-field alternating gradient accelerator (FFA), one of the accelerator candidates for future proton therapy. For such end, magnitude of the pressure wave and range accuracy achieved by the short-pulsed beam of FFA were assessed, using both simulation and experimental procedure. METHODS A 100 MeV proton beam from the FFA was applied on a water phantom, through the acrylic wall. The beam range measured by the Bragg peak (BP)-ionization chamber (BPC) was 77.6 mm, while the maximum dose at BP was estimated to be 0.35 Gy/pulse. A hydrophone was placed 20 mm downstream of the BP, and signals were amplified and stored by a digital oscilloscope, averaged, and low-pass filtered. Time-of-flight (TOF) and two relative TOF values were analyzed in order to determine the beam range. Furthermore, an acoustic wave transport simulation was conducted to estimate the amplitude of the pressure waves. RESULTS The range calculated when using two relative TOF was 78.16 ± 0.01 and 78.14 ± 0.01 mm, respectively, both values being coherent with the range measured by the BPC (the difference was 0.5-0.6 mm). In contrast, utilizing the direct TOF resulted in a range error of 1.8 mm. Fivefold and 50-fold averaging were required to suppress the range variation to below 1 mm for TOF and relative TOF measures, respectively. The simulation suggested the magnitude of pressure wave at the detector exceeded 7 Pascal. CONCLUSION A submillimeter range accuracy was attained with a pulsed beam of about 21 ns from an FFA, at a clinical energy using relative TOF. To precisely quantify the range with a single TOF measurement, subsequent improvement in the measuring system is required.

Objectives Early detection of pancreatic cancer is notoriously difficult. A novel cancer diagnostic method using the ability of nematodes to detect odor of urine samples has been developed (N-NOSE). This method has a high sensitivity and specificity for various cancers; however, it has not yet been verified in pancreatic cancer. We examined the usefulness of this method to aid early diagnosis of pancreatic cancer in a cancer center. Methods We collected urine samples and clinical data from patients hospitalized in our division, between July 2017 and February 2019. We excluded patients with a known current or past history of other cancers. We investigated the relationship between the results of N-NOSE and the presence of pancreatic cancer. Results There were 95 noncancer cases and 104 pancreatic cancer cases. The sensitivity and specificity of N-NOSE for pancreatic cancer were 84.6% (88/104) and 60% (57/95), respectively. N-NOSE was able to detect stages 0 to I pancreatic cancer and had a higher correlation with early-stage pancreatic cancer than advanced stage. Conclusions N-NOSE has sufficient sensitivity and specificity for use in clinical practice, and it holds great potential as a diagnostic aid for pancreatic cancer, especially for early-stage pancreatic cancer.

A 70-year-old dextral woman was admitted to a hospital with agraphia for kanji (Japanese morphograms). She had a history of severe constipation, nightmares, and visual hallucinations. Neurological examinations revealed no obvious Parkinson's disease symptoms. She showed poor skills in writing the kanji for looking at picture objects, [e.g., writing the Japanese word “inu” (which means dog) when she saw a drawing of a dog] or dictated words. A reduced striatal uptake of [123I]-2β-carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl) nortropane (FP-CIT) on single-photon-emission computed tomography and reduced meta-iodobenzylguanidine (MIBG) cardiac uptake on myocardial scintigraphy were detected. The accumulation of amyloid beta in the bilateral cerebral cortices was observed on amyloid-positron emission tomography. We herein report a case of Lewy body dementia with pure agraphia for kanji with underlying Alzheimer's disease pathology.

Breast cancer is the most common malignancy in women and has a risk of late recurrence. We report a case of metastasis to the stomach and colon 23 years after surgery, with characteristic findings. A 74-year-old woman underwent breast cancer resection at the age of 51. At the time, no additional therapy was performed despite the histological diagnosis of invasive lobular carcinoma with lymph node metastasis. Upper gastrointestinal endoscopy, which was performed as a follow-up for her chronic gastritis, revealed multiple erosions. Histology revealed diffuse proliferation of signet ring cell-like atypical cells, that were positive for cytokeratin CAM5.2 and estrogen receptor. These findings suggested metastasis from the invasive lobular breast carcinoma. Positron-emission tomography revealed sternal and vertebral metastases. Colonoscopy also performed to screen for intestinal metastasis revealed several lesions that resembled hyperplastic polyps. Although these lesions were not strongly suspected of metastasis, histology surprisingly revealed the same findings as the gastric metastasis. This case involved gastric and colorectal superficial metastases that were synchronously detected 23 years after primary treatment. We report that early-stage colorectal metastasis may resemble hyperplastic polyps, and biopsy should always be considered in patients with a history of breast cancer, regardless of years elapsed since treatment.

Background Despite advances in chemotherapy, curing multiple liver metastases is quite rare. Even when response is obtained, regrowth of the tumors is almost inevitable. We aimed to evaluate the efficacy and adverse events of helical tomotherapy for chemo‐refractory multiple liver metastases. Methods Forty‐five patients with chemo‐refractory multiple (3‐10) liver metastases after standard systemic chemotherapy entered the single‐institutional prospective study. Liver metastases were the major disease; however, 31 also had uncontrolled primary lesions and/or other metastases. The prescribed dose was 55 Gy in 25 fractions. The median planning target volume (PTV) and normal liver volume (NLV) of first treatment were 128 cm3 and 1175 cm3, respectively. The median of V15Gy, V30Gy, and mean dose to NLV were 45%, 23%, and 19.4 Gy, respectively. Results Forty‐two patients (93%) completed the planned treatment. Median survival time (MST) for all patients was 8 months, and the 1‐year survival rate was 29%. The median local control (LC) period was 5 months and the 6‐month control rate of irradiated tumors was 33%. A ≥30% decrease in tumor markers was observed in 31%. The most common grade 3 toxicity was lymphocytopenia (40%), followed by fatigue (6%). Radiation‐induced liver disease (RILD) was not observed. Pancreatic cancer as the primary tumor, distant metastases outside the liver, low pretreatment neutrophil‐to‐lymphocyte ratio (NLR), and low pretreatment monocyte‐to‐lymphocyte ratio (MLR) were associated with poorer prognoses. Conclusions Helical tomotherapy for chemo‐refractory multiple liver metastases is a feasible and potentially effective treatment. Incorporating tomotherapy into the first‐line treatment in combination with systemic chemotherapy should be considered. Trial registration number CROG 12005., Despite the remarkable advances of systemic chemotherapy for multiple liver metastases, the efficacy is still limited and cure of the multiple lesions is difficult. Helical tomotherapy for chemo‐refractory multiple liver metastases was suggested to be a feasible and potentially effective treatment with acceptable adverse events.

Obstructive sleep apnea (OSA) is associated with the occurrence of various kinds of bradyarrhythmia and tachyarrhythmia. The activation of the autonomic nerve system is an important causative factor of the pathogenesis of the arrhythmia in OSA patients. Previous studies have shown that the R-R interval is an effective parameter for evaluating autonomic nerve activities. However, whether or not OSA can induce variations in the R-R interval and whether or not continuous positive airway pressure (CPAP) therapy can improve these variations in OSA patients are unclear. The present study explored whether or not CPAP therapy could improve the regularity of the R-R interval.

To identify prognostic factors for TAFRO syndrome, a rare inflammatory disorder of unknown etiology characterized by thrombocytopenia, anasarca, fever, reticulin myelofibrosis, renal dysfunction, and organomegaly. Data of patients with TAFRO syndrome were extracted from a Japanese patient registry. Patients were divided into groups according to the clinical and laboratory parameters at initial presentation. Cut-off values for the laboratory parameters were determined using receiver operating characteristic curve analysis and by clinical relevance. Patient survival was analyzed by the Kaplan–Meier method. Univariable analysis was performed using log-rank tests. Multivariable analyses were performed with the logistic regression model and the Cox-proportional hazards model. We extracted the data of 83 patients with TAFRO syndrome from the registry. Univariable analysis identified several potential prognostic factors. Of these factors, age ≥ 60 years and D-dimer ≥ 18 μg/dL remained significant predictors of poor overall survival in the multivariable Cox-proportional hazards model. Based on these results, we developed a simple prognostic scoring system for TAFRO syndrome (TS-PSS). Patients in our cohort were stratified into low, intermediate, and high-risk groups by the TS-PSS. This system should be verified with independent patient cohorts in future studies. Supplementary Information The online version contains supplementary material available at 10.1007/s12185-021-03159-x.

The dual spacecraft mission BepiColombo is the first joint mission between the European Space Agency (ESA) and the Japanese Aerospace Exploration Agency (JAXA) to explore the planet Mercury. BepiColombo was launched from Kourou (French Guiana) on October 20th, 2018, in its packed configuration including two spacecraft, a transfer module, and a sunshield. BepiColombo cruise trajectory is a long journey into the inner heliosphere, and it includes one flyby of the Earth (in April 2020), two of Venus (in October 2020 and August 2021), and six of Mercury (starting from 2021), before orbit insertion in December 2025. A big part of the mission instruments will be fully operational during the mission cruise phase, allowing unprecedented investigation of the different environments that will encounter during the 7-years long cruise. The present paper reviews all the planetary flybys and some interesting cruise configurations. Additional scientific research that will emerge in the coming years is also discussed, including the instruments that can contribute. Open Access funding provided by Istituto Nazionale di Astrofisica within the CRUI-CARE Agreement. Peerreview

Oxidative stress owing to an imbalance between reactive oxygen species and antioxidants, such as coenzyme Q10 (CoQ10), is a major contributor to male infertility. We investigated the effects of the reduced form of CoQ10 (ubiquinol) supplementation on semen quality in dogs with poor semen quality. Three dogs received 100 mg of ubiquinol orally once daily for 12 weeks. Semen quality, serum testosterone, and seminal plasma superoxide dismutase (SOD) activity were examined at 2-week intervals from 2 weeks before ubiquinol supplementation to 4 weeks after the treatment. Ubiquinol improved sperm motility, reduced morphologically abnormal sperm, and increased seminal plasma SOD activity; however, it had no effect on testosterone level, semen volume, and sperm number. Ubiquinol supplementation could be used as a non-endocrine therapy for infertile dogs.

An in-situ cosmic-dust instrument called the Mercury Dust Monitor (MDM) had been developed as a part of the science payload for the Mio (Mercury Magnetospheric Orbiter, MMO) stage of the joint European Space Agency (ESA)–JAXA Mercury-exploration mission. The BepiColombo spacecraft was successfully launched by an Ariane 5 rocket on October 20, 2018, and commissioning tests of the science payload were successfully completed in near-earth orbit before injection into a long journey to Mercury. MDM has a sensor consisting of four plates of piezoelectric lead zirconate titanate (PZT), which converts the mechanical stress (or strain) induced by dust-particle impacts into electrical signals. After the commencement of scientific operations, MDM will measure the impact momentum at which dust particles in orbit around the Sun collide with the sensor and record the arrival direction. This paper provides basic information concerning the MDM instrument and its predicted scientific operation as a future reference for scientific articles concerning the MDM’s observational data.

In contrast to conventional X-ray therapy, proton beam therapy (PBT) can confine radiation doses to tumours because of the presence of the Bragg peak. However, the precision of the treatment is currently limited by the uncertainty in the beam range. Recently, a unique range verification methodology has been proposed based on simulation studies that exploit spherical ionoacoustic waves with resonant frequency (SPIREs). SPIREs are emitted from spherical gold markers in tumours initially introduced for accurate patient positioning when the proton beam is injected. These waves have a remarkable property: their amplitude is linearly correlated with the residual beam range at the marker position. Here, we present proof-of-principle experiments using short-pulsed proton beams at the clinical dose to demonstrate the feasibility of using SPIREs for beam-range verification with submillimetre accuracy. These results should substantially contribute to reducing the range uncertainty in future PBT applications.

Chronic kidney disease is a prognostic factor for cardiovascular disease. Worsening renal function (WRF), specifically, is an important predictor of mortality in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention (PCI). We evaluate the prognostic impact of mid-term WRF after PCI on future cardiovascular events. We examined the renal function data of 1086 patients in the first year after PCI using the SHINANO 5-year registry. Patients were divided into two groups, mid-term WRF and non-mid-term WRF, and primary outcomes were major adverse cardiovascular events (MACE) and death. Mid-term WRF was defined as an increase in creatinine (≥ 0.3 mg/dL) in the first year after PCI. Mid-term WRF was found in 101 patients (9.3%), and compared to non-mid-term WRF, it significantly increased the incidence of MACE (p p p = 0.001). Furthermore, mid-term WRF patients had higher incidence of future heart failure (p p = 0.01). Patients with both mid-term WRF and chronic kidney disease had increased MACE compared to patients with either condition alone (p p p

Cardiac implantable electronic devices (CIEDs) offer heart failure (HF) diagnostic information, including intrathoracic impedance (ITI) or physical activity (PA). However, few studies have evaluated the utility of these parameters measured by CIEDs with CorVue algorithm. The purpose of this study was to investigate the relationship between ITI alerts triggered by the CorVue algorithm and HF development. We also examined the association between device-measured PA and ITI alerts associated with HF development. We retrospectively studied consecutive patients with CIEDs equipped with CorVue algorithm, which were implanted between June 1, 2011 and August 31, 2019. These patients were divided into two groups: patients with decreased ITI followed by the ITI alerts (ITI alert group) and those without the alerts (non-ITI alert group). There were 35 and 14 patients in the ITI and non-ITI alert groups, respectively. A total of 96 ITI alerts were observed. ITI alerts associated with HF development were observed in 21% (20/96); whereas, ITI alerts not associated with HF development were observed in 79% (76/96). Accurate device-measured PA was confirmed in 76 ITI alerts, which consisted of 30 alerts with lower PA and 46 alerts without lower PA. ITI alerts associated with HF development were observed in 30% (9/30) of the alerts with lower PA, whereas observed only in 6.5% (3/46) of the alerts without lower PA. In conclusion, the CorVue ITI alerts indicated a high false-positive rate. However, device-measured PA may be useful to determine whether ITI alerts are associated with HF development or not, which was attributed to the high negative predictive value.

International audience; Mercury has a unique and complex space environment with its weak global magnetic field, intense solar wind, tenuous exosphere, and magnetospheric plasma particles. This complex system makes Mercury an excellent science target to understand effects of the solar wind to planetary environments. In addition, investigating Mercury’s dynamic magnetosphere also plays a key role to understand extreme exoplanetary environment and its habitability conditions against strong stellar winds. BepiColombo, a joint mission to Mercury by the European Space Agency and Japan Aerospace Exploration Agency, will address remaining open questions using two spacecraft, Mio and the Mercury Planetary Orbiter. Mio is a spin-stabilized spacecraft designed to investigate Mercury’s space environment, with a powerful suite of plasma instruments, a spectral imager for the exosphere, and a dust monitor. Because of strong constraints on operations during its orbiting phase around Mercury, sophisticated observation and downlink plans are required in order to maximize science outputs. This paper gives an overview of the Mio spacecraft and its mission, operations plan, and data handling and archiving.

Background: We have developed a Wilms’ tumor 1 (WT1)-targeting dendritic cell (DC)-based cancer vaccine combined with standard chemotherapy for patients with advanced pancreatic ductal adenocarcinoma (PDA). Methods: We evaluated predictive markers of overall survival (OS) in PDA patients treated with multiple major histocompatibility complex class I/II-restricted, WT1 peptide-pulsed DC vaccinations (DC/WT1-I/II) in combination with chemotherapy. Throughout the entire period of immunochemotherapy, the plasma levels of soluble factors derived from granulocytes of 7 eligible PDA patients were examined. Moreover, systemic inflammatory response markers (neutrophil-to-lymphocyte ratio [NLR], monocyte-to-lymphocyte ratio [MLR], and granulocyte-to-lymphocyte ratio [GLR]) were assessed. In addition, cytoplasmic WT1 expression in PDA cells was examined. Results: Compared to the 4 non-super-responders (OS Conclusions: Prolonged low levels of a granulocyte-related systemic inflammatory response after the early period of therapy and low cytoplasmic WT1 expression in PDA cells may be markers predictive of OS in PDA patients receiving WT1-targeting immunochemotherapy.

In this study, we aimed to elucidate the utility of transrectal ultrasonography (TRUS) and blood lactate concentration (bLac) measurement to diagnose cows with severe uterine torsion. We investigated the association of TRUS and bLac measurement with macroscopic findings on laparotomy for severe uterine torsion in nine cows. We found that an increased ultrasonographic cross-sectional thickness (15-25 mm) and multiple hypoechogenic areas corresponded to macroscopic vascular compromise in the uterus on laparotomy. In addition, bLac was elevated (≥5.0 mmol/l) in cows showing uterine necrosis on laparotomy. A combined diagnostic approach with TRUS and bLac measurement enables assessment of the uterine vascular status and has utility for selecting the treatment option (including laparotomy) and predicting the outcomes.

Duchenne muscular dystrophy (DMD) is caused by mutations in DMD, which codes for dystrophin. Because the progressive and irreversible degeneration of muscle occurs from childhood, earlier therapy is required to prevent dystrophic progression. Exon skipping by antisense oligonucleotides called phosphorodiamidate morpholino oligomers (PMOs), which restores the DMD reading frame and dystrophin expression, is a promising candidate for use in neonatal patients, yet the potential remains unclear. Here, we investigate the systemic efficacy and safety of early exon skipping in dystrophic dog neonates. Intravenous treatment of canine X-linked muscular dystrophy in Japan dogs with a 4-PMO cocktail resulted in ∼3%-27% in-frame exon 6-9 skipping and dystrophin restoration across skeletal muscles up to 14% of healthy levels. Histopathology was ameliorated with the reduction of fibrosis and/or necrosis area and centrally nucleated fibers, significantly in the diaphragm. Treatment induced cardiac multi-exon skipping, though dystrophin rescue was not detected. Functionally, treatment led to significant improvement in the standing test. Toxicity was not observed from blood tests. This is the first study to demonstrate successful multi-exon skipping treatment and significant functional improvement in dystrophic dogs. Early treatment was most beneficial for respiratory muscles, with implications for addressing pulmonary malfunction in patients.

International audience; BepiColombo Mio, also known as the Mercury Magnetospheric Orbiter (MMO), is intended to conduct the first detailed study of the magnetic field and environment of the innermost planet, Mercury, alongside the Mercury Planetary Orbiter (MPO). This orbiter has five payload groups; the MaGnetic Field Investigation (MGF), the Mercury Plasma Particle Experiment (MPPE), the Plasma Wave Investigation (PWI), the Mercury Sodium Atmosphere Spectral Imager (MSASI), and the Mercury Dust Monitor (MDM). These payloads operate through the Mission Data Processor (MDP) that acts as an integrated system for Hermean environmental studies by the in situ observation of charged and energetic neutral particles, magnetic and electric fields, plasma waves, dust, and the remote sensing of radio waves and exospheric emissions. The MDP produces three kinds of coordinated data sets: Survey (L) mode for continuous monitoring, Nominal (M) mode for standard analyses of several hours in length (or more), and Burst (H) mode for analysis based on 4-20-min-interval datasets with the highest cadence. To utilize the limited telemetry bandwidth, nominal- and burst-mode data sets are partially downlinked after selections of data based on L- or L/M-mode data, respectively. Burst-mode data can be taken at preset timings, or by onboard automatic triggering. The MDP functions are implemented and tested on the ground as well as cruising spacecraft; they are responsible for conducting full scientific operations aboard spacecraft.

Background and aims In recent years, the short single-balloon enteroscope (SBE) has been used during endoscopic retrograde cholangiopancreatography (ERCP) for patients with surgically altered anatomy and has been reported to be useful. However, difficulties remain, and the procedures and devices need improvements. We assessed the usefulness and superiority of a new short SBE equipped with passive bending and high-force transmission by comparisons with outcomes using the conventional short SBE. Methods This study evaluated short SBE-assisted ERCP-related procedures for Roux-en-Y gastrectomy between September 2011 and October 2017. Outcomes including the procedural success rate, which was the primary outcome, were assessed to compare the conventional short SBE (SIF-Y0004 [prototype]) and the new short SBE (SIF-H290S). Results Of 74 procedures performed in 61 patients, 51 procedures in 39 patients involved the SIF-Y0004, and 23 procedures in 22 patients involved the SIF-H290S. The procedural success rates were 70.6 % for SIF-Y0004, and 95.7 % for SIF-H290S, representing better results for the new short SBE (P = 0.02). The new short SBE also had a superior diagnostic success rate (P = 0.047) and median time to reach the blind end (P Conclusions Roux-en-Y gastrectomy patients treated with the new short SBE had better outcomes than those treated with conventional short SBE. More cases need to be studied; however, the new short SBE has the potential to improve ERCP outcomes in patients with surgically altered anatomy.

Objectives While bile duct brush cytology during endoscopic retrograde cholangiopancreatography (ERCP) is a well-established procedure for detecting malignant biliary stricture, its sensitivity is reportedly low. We aimed to determine the pre-ERCP factors affecting brush cytology sensitivity. Methods We retrospectively analyzed 185 patients who underwent brush cytology during the first ERCP for undiagnosed biliary stricture at our institution between January 2014 and December 2016. We analyzed the relationship of age, sex, final diagnosis, stricture location, tumor size, stricture length, total bilirubin level, white blood cell count, and C-reactive protein level with brush cytology sensitivity. Results The following conditions were established as final diagnoses: benign disease, 19 cases (10.3%); intrahepatic cholangiocarcinoma, 10 cases (5.4%); hilar cholangiocarcinoma, 38 cases (20.5%); extrahepatic cholangiocarcinoma, 44 cases (23.8%); pancreatic cancer, 55 cases (29.7%); other malignant tumors, 19 cases (10.3%). The sensitivity and specificity of brush cytology were 60.8% and 94.7%, respectively. The stricture length, total bilirubin level, and white blood cell count in true-positive cases were significantly higher than those in false-negative cases. Furthermore, a stratified analysis of the bilirubin levels demonstrated that sensitivity was highest in patients with moderate jaundice (80% for a total bilirubin level of 10-20 mg/dL), but significantly lower in patients with severe jaundice (total bilirubin level ≥20 mg/dL). Conclusion While the sensitivity of brush cytology increases with bilirubin levels of up to 20 mg/dL, severe jaundice has a negative effect on sensitivity, warranting additional pathological examinations according to the pre-ERCP bilirubin level.

In order to determine whether Martian dust belts (ring or torus) actually exist and, if so, to determine the characteristics of the dust, we propose a Circum-Martian Dust Monitor (CMDM) to be deployed on the Martian Moons Exploration (MMX) project, in which JAXA plans to launch the spacecraft in 2024, investigate Phobos and Deimos, and return samples back to Earth. The CMDM is a newly developed instrument that is an impact dust detector. It weighs only 650 g and has a sensor aperture area of ∼ 1 m2, according to the conceptual design study. Detectable velocities (v) range from 0.5 km/s to more than 70 km/s, which will cover all possible dust particles: circummartian (low v), interplanetary (mid v), and interstellar (high v) particles. The measurable mass ranges from 1.3 × 10−9 g to 7.8 × 10−7 g at v = 0.5 km/s. Since the MMX spacecraft will take a quasi-circular, prograde orbit around Mars, the CMDM will be able to investigate particles from Phobos and Deimos with relative velocities lower than 1 km/s. Therefore, the CMDM will be able to determine whether or not a confined dust ring exists along Phobos' orbit and whether an extended dust torus exists along Deimos' orbit. It may also be able to clarify whether or not any such ring or torus are self-sustained.

Lymphadenopathy may be difficult to diagnose using imaging results alone. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) may help to diagnose and determine the appropriate management of lymphadenopathy. EUS-FNA has been used as a safe and less invasive method for obtaining pathologic specimens from extraluminal lesions using endoscopic ultrasound. The present study evaluated the usefulness of EUS-FNA for lymphadenopathy. Between July 2013 and December 2016, 72 patients undergoing EUS-FNA for lymphadenopathy that could not be diagnosed solely using imaging were included. The present study evaluated the sensitivity, specificity, positive and negative predictive value, overall accuracy, helpfulness in determining the management of lymphadenopathy and EUS-FNA-associated complications. Of the 72 included patients, 8 were diagnosed with benign (inflammatory or reactive) lymphadenopathy. The diagnostic sensitivity, specificity, positive and negative predictive value, and overall accuracy were 95.3, 100, 100, 72.7 and 95.8%, respectively. While EUS-FNA of metastatic nodes identified the origin in the majority of cases, the procedure resulted in a different histopathological diagnosis from the previous image-based diagnosis in 9 patients. Consequently, 2 patients with testicular cancer were administered bleomycin, etoposide, and cisplatin. An individual with GIST was administered imatinib, and a patient with prostate cancer was administered degarelix (antihormon drug). A total of 5 other patients received palliative medicine due to the change in diagnosis. EUS-FNA also helped determine the appropriate cancer management plan in other patients; specifically, based on the cytology of the metastatic lymph node, EUS-FNA helped determine the cancer stage, and to identify recurrence or the primary cancer from which tissue could not be collected. No EUS-FNA-associated symptoms were reported. To conclude, the present study suggested that EUS-FNA of suspected metastatic lymph nodes appears safe and useful for cancer staging and diagnosing recurrence. It may also useful for diagnosing patients whose collection of samples from the original cancer appeared impractical. EUS-FNA for lymphadenopathy that may not be diagnosed with imaging alone may assist in diagnosis and help to determine the appropriate management strategy.

The response of a radiation detector fabricated from piezoelectric lead zirconate titanate (PZT) was studied. The response signal due to a single 400 MeV/n xenon (Xe) ion was assumed to have a simple form that was composed of two variables, the amplitude and time constant. These variables were estimated by comparing two output waveforms obtained from a computer simulation and an experiment on Xe beam irradiation. Their values appeared to be dependent on the beam intensity.

A 42‐year‐old man with schizophrenia was referred to our hospital after 2 weeks of worsening fatigue. His hemoglobin level was 2.8 g/dL owing to folic acid deficiency stemming from alcohol abuse and consumption of unbalanced meals. We induced behavioral changes in the patient by motivational interviewing. We had direct methodical conversations with medical staff involved with the patient as well as his family, and established new social support for him as well as public assistance. These have resulted in the patient maintaining a favorable lifestyle ever since.

Sleep-disordered breathing (SDB) is one of the most common complications among heart failure (HF) patients. Changes of respiratory patterns during the various stages in patients with HF have not been fully investigated. In this case, the algorism using thoracic impedance sensor and minute ventilation (sleep apnea monitoring [SAM] algorithm) with implanted pacemaker (REPLY 200 SR or DR, Sorin CRM SAS, Clamart, France) was used to monitor respiration. Impedance data from the implanted pacemaker can be converted into respiratory data, which can be used to calculate the respiratory disturbance index (RDI) per unit of time. Using this algorithm, we observed a sudden appearance of abnormal breathing at the onset of HF, followed by gradual improvement of respiratory patterns during the recovery stage. The results from respiratory monitoring using the SAM algorithm were strongly correlated with those from the positive airway pressure device. This case report could imply that proper utilization of this sensor could facilitate the early detection and therapeutic control of HF. Keywords: Heart failure, Pacemaker, Respiratory monitoring

Resting end-tidal CO2 levels obtained from capnography are associated with the severity of heart failure (HF). It has not been fully investigated whether other respiratory parameters acquired from detailed capnography waveform analyses could evaluate the recovery process in HF patients. In this case, the analysis of nasal capnography waveforms (diurnal five minutes recording) was performed to monitor and analyze end-tidal CO2 (ETCO2) values, inspiratory/expiratory ratio and respiratory intervals. We observed that these three parameters increased concurrently with decreasing plasma BNP levels during the recovery stage of HF. The kurtosis of frequency distributions of capnography waveforms became larger as HF improved. Proper utilization of these analyses could evaluate HF severity during the recovery process in patients with HF.

Background The purpose of this study is to investigate if a laryngeal mask could improve respiratory condition during radiofrequency catheter ablation (RFCA). Methods Twenty-four consecutive patients who underwent RFCA for atrial fibrillation were divided into two groups (Facemask group; n = 10, Laryngeal mask group; n = 14). All patients were completely sedated under intravenous anesthesia and fitted with artificial respirators during the RFCA. The capnography waveforms and their differential coefficients were analyzed to evaluate the changes of end-tidal CO2 (ETCO2) values, respiratory intervals, expiratory durations, and inspiratory durations. Results During the RFCA, ETCO2 values of the laryngeal mask group were higher than those of the facemask group (36.0 vs. 29.2 mmHg, p = 0.005). The respiratory interval was significantly longer in the laryngeal mask group than those in the facemask group (4.28 s vs.5.25 s, p 2 was significantly higher when using a laryngeal mask than when using a facemask. The inspiratory-expiratory ratio of the laryngeal mask group was significantly larger than that of the facemask group (1.59 vs. 1.27, p 2 value is the most influential parameter on the fluoroscopic duration during the RFCA procedure (β = − 0.477, p = 0.029). Conclusions The use of a laryngeal mask could stabilize respiration during intravenous anesthesia, which could improve the efficiency of RFCA.

This study aimed to elucidate the influential parameter, acquired from the analyses of nasal capnography waveforms, for the elevated plasma brain natriuretic peptide (BNP) levels in patients (n = 34) with heart failure (HF). The capnography waveforms were analyzed to evaluate changes in end-tidal CO2 (ETCO2) values and expiratory and inspiratory durations. The relationship between these parameters, estimated from capnography analyses and plasma BNP, was then evaluated. Mean ETCO2 values and BNP levels showed a strong negative correlation (R2 = 0.6355, p < 0.0001) in HF patients with chronic kidney disease (CKD) (R2 = 0.6355, p < 0.0001). The ETCO2 value was the most influential parameter that indicated elevated BNP levels in HF patients with CKD (β = − 0.577; p = 0.031). The mean ETCO2 level could be a potentially influential parameter reflecting elevated BNP levels in HF patients, especially in HF patients with CKD. Respiratory parameters, acquired from detailed nasal capnography analyses, might be reasonable for evaluating the severity of HF.

Previous studies suggested that sleep-disordered breathing was associated with cardiovascular diseases such as heart failure (HF). Recently, algorithms of cardiac implantable electronic devices (CIEDs) have been developed to detect advanced sleep apnea (SA); the Apnea Scan (AP Scan) being an example. The purpose of this study was to investigate the association between respiratory disturbance index (RDI) measured using the AP Scan algorithm and HF development. We retrospectively studied consecutive patients with CIEDs equipped with the AP Scan algorithm which were implanted between December 1, 2011 and March 31, 2019. These patients were divided into 2 groups according to the trends of RDI: patients with a continually high RDI > 30 (severe SA group) and those without a continually high RDI (non-severe SA group). There were 16 and 46 patients in the severe and non-severe SA groups, respectively. Increased left ventricular end-diastolic and end-systolic dimensions were observed in the severe SA group. Regarding cardiovascular events, HF was observed in 8 patients (50.0%) in the severe SA group and 1 patient (2.2%) in the non-severe SA group; thus, there was a significantly higher proportion of patients with HF in the severe SA group. In conclusion, continually high RDI was associated with HF development in patients with CIEDs equipped with the AP Scan algorithm. Therefore, an elevated RDI may be a risk factor for the development of HF in patients with CIEDs.

The JAXA/ISAS spacecraft DESTINY$^+$ will be launched to the active asteroid (3200) Phaethon in 2022. Among the proposed core payload is the DESTINY+ Dust Analyzer (DDA) which is an upgrade of the Cosmic Dust Analyzer flown on the Cassini spacecraft to Saturn (Srama et al. 2011). We use two up-to-date computer models, the ESA Interplanetary Meteoroid Engineering Model (IMEM, Dikarev et al. 2005), and the interstellar dust module of the Interplanetary Meteoroid environment for EXploration model (IMEX; Sterken2013 et al., Strub et al. 2019) to study the detection conditions and fluences of interplanetary and interstellar dust with DDA. Our results show that a statistically significant number of interplanetary and interstellar dust particles will be detectable with DDA during the 4-years interplanetary cruise of DESTINY+. The particle impact direction and speed can be used to descriminate between interstellar and interplanetary particles and likely also to distinguish between cometary and asteroidal particles., Comment: 40 pages, 18 Figures, accepted for Planetary and Space Science

Based on lessons learnt with the BepiColombo Laser Altimeter (BELA) [1], electronics design improvements have been implemented for the Ganymede Laser Altimeter (GALA), to be launched on ESA's JUICE spacecraft in 2022 [2]. Improvements include multi-point grounding and separation of “aggressor” printed circuit boards (PCBs) for the high-voltage Q-switch electronics and the pulsed high-power current source of the diode-laser pumped Nd:YAG laser from “victim” PCBs for the sensitive Si avalanche photodiode detector (APD) operating at a noise floor of about 300 fA/sqrt(Hz) in a bandwidth of 100 MHz. Most importantly, the detector amplifier has increased phase margin to avoid feedback of undamped filter resonances, and its output is digitized as differential signal very close to the APD.

The variation of the electromechanical coupling factor of lead zirconate titanate (PZT) was studied using a piezoelectric PZT disk exposed to a 400 MeV/n xenon beam. The resonant and antiresonant frequencies were measured in pairs by an impedance analyzer in situ manner. A systematic behavior of the pairs resulted in a decrease of the coupling factor. It was found that the coupling factor linearly decreased with increasing integrated beam energy incident on the PZT disk while its surface temperature was equilibrium at room temperature. We discuss a possible PZT-based radiation detector for practical use in a high-radiation field.

In order to determine blood lactate concentrations (bLac) and their validity as a diagnostic marker in bovine uterine torsion, blood samples were taken from 54 Holstein cows with uterine torsion before the correction of torsion. bLac in a group of cows with and without uterine necrosis were 15.0 and 3.0 mmol/l, respectively (P5.0 and >6.5 mmol/l, respectively. These findings suggest that in dairy cows with uterine torsion, an increase in bLac is a diagnostic predictor of uterine necrosis as well as poor prognosis in dams.

Background: We evaluated the 1-year outcomes of percutaneous coronary intervention (PCI) for elderly patients (aged ≥ 80 years) in the second-generation drug-eluting stent (DES) era. Methods and Results: Between August 2012 and July 2013, 1923 consecutive patients (mean age, 71 ± 11 years; ≥80 years, 23%; men, 77%) who underwent 2250 elective/urgent PCI procedures were enrolled in the Shinshu Prospective Multicenter Analysis for Elderly Patients with Coronary Artery Disease Undergoing Percutaneous Coronary Intervention registry. The primary end point was major adverse cardiovascular events (MACEs; cardiovascular death, myocardial infarction, and stroke) at 1 year. The 1-year incidence of MACEs, cardiac death, and stroke was significantly higher in elderly patients than in nonelderly patients (12.4% vs 5.3%, P < .0001; 7.8% vs 2.2%, P < .0001; and 2.8% vs 1.3%, P = .033, respectively). However, no significant difference in elective PCI procedures was detected. In elderly patients, the incidence of cardiac death and target lesion revascularization was significantly lower for DES than for non-DES (2.7% vs 10.5%, P = .0001 and 4.1% vs 8.6%, P = .029, respectively). Conclusion: Although elderly patients had a significantly poorer prognosis than younger patients, the adverse events rate was comparable in those patients who underwent elective PCI in the second-generation DES era.

The J-SICT DC Vaccine Study Group provides dendritic cell (DC) vaccines for compassionate use under unified cell production and patient treatment regimens. We previously reported beneficial effects of DC vaccines on the overall survival of 62 patients with advanced non-small cell lung cancer (NSCLC) in a single-center analysis. Here, we extended analysis to 260 patients with NSCLC who were treated at six centers. Of the 337 patients who met the inclusion criteria, we analyzed 260 patients who received ≥5 peptide-pulsed DC vaccinations once every 2 weeks. The mean survival time (MST) from diagnosis was 33.0 months (95 % confidence interval [CI]: 27.9–39.2), and that from time of first vaccination was 13.8 months (95 % CI 11.4–16.8). An erythema reaction at the injection site that was ≥30 mm in diameter was correlated most strongly with overall survival from the first vaccine (≥30 vs.

Little is known about the mid-term outcomes of patients with atrial fibrillation (AF) who undergo coronary stenting in the second-generation drug-eluting stent (DES) era. We evaluated the 1-year outcomes of AF patients undergoing percutaneous coronary intervention (PCI) with second-generation DES. This retrospective cohort analysis used integrated data from the SHINANO registry, a prospective observational multicenter cohort study, which enrolled 1923 consecutive patients undergoing PCI for any coronary artery disease. We retrospectively recruited 917 of these patients (mean age, 71.3 ± 10.0 years; male, 77 %) who received PCI with 2nd generation DES. The primary endpoint was net adverse clinical events (NACE: cardiac death, stroke, MI, stent thrombosis, and major bleeding) at 1 year. The secondary endpoints were major adverse cardiovascular events (MACE: cardiac death, stroke, and MI), stroke, MI, and major bleeding at 1 year. One-year follow-up was completed in 871 (94.9 %) patients, of whom 85 had AF. The incidence of NACE (15.4 vs. 7.3 %, P = 0.008), MACE (10.6 vs. 5.4 %, P = 0.047), and major bleeding (6.0 vs. 2.3 %, P = 0.049) were all significantly higher in AF compared to non-AF patients. On multivariate analysis, AF was an independent predictor of NACE (HR 2.32, 95 % CI 1.24-4.34, P = 0.008). In the second-generation DES era, patients with AF undergoing PCI still have a poorer prognosis, with more thrombotic and bleeding events, than those without AF. More attention should be paid to the thrombotic and bleeding risk in AF patients undergoing PCI.

The differential diagnosis of gastrointestinal subepithelial lesions (SELs) such as gastrointestinal stromal tumors from other benign tumors is important. In the present study, adequate sample rates of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) with a 22G Franseen needle for SELs were evaluated. The present study included 57 consecutive lesions (61 sessions) of EUS-FNA using a 22G needle to evaluate SELs between July 2013 and October 2017. Adequate sample rates were compared retrospectively between a 22G conventional needle group (C group) and a 22G Franseen needle group (F group). The overall adequate sample rate was 80.3%. The adequate sample rates in the C and F groups were 75.0% (33/44) and 94.1% (16/17), respectively (P=0.15). For lesions ≥20 mm, the adequate sample rates were 82.8% (24/29) in the C group and 91.7% (11/12) in the F group, 8.9% higher in the F group. However, for lesions

Diabetes is known to be one of the risks of arteriosclerosis. However, the therapeutic goal of HbA1c in diabetic elderly is still unclear, in particular, in secondary prevention after percutaneous coronary intervention (PCI). Between August 2012 and July 2013, a total of 1665 consecutive patients

OBJECTIVE To histologically evaluate and compare features of myofibers within the elongated soft palate (ESP) of brachycephalic and mesocephalic dogs with those in the soft palate of healthy dogs and to assess whether denervation or muscular dystrophy is associated with soft palate elongation. SAMPLE Soft palate specimens from 24 dogs with ESPs (obtained during surgical intervention) and from 14 healthy Beagles (control group). PROCEDURES All the soft palate specimens underwent histologic examination to assess myofiber atrophy, hypertrophy, hyalinization, and regeneration. The degrees of atrophy and hypertrophy were quantified on the basis of the coefficient of variation and the number of myofibers with hyalinization and regeneration. The specimens also underwent immunohistochemical analysis with anti-neurofilament or anti-dystrophin antibody to confirm the distribution of peripheral nerve branches innervating the palatine myofibers and myofiber dystrophin expression, respectively. RESULTS Myofiber atrophy, hypertrophy, hyalinization, and regeneration were identified in almost all the ESP specimens. Degrees of atrophy and hypertrophy were significantly greater in the ESP specimens, compared with the control specimens. There were fewer palatine peripheral nerve branches in the ESP specimens than in the control specimens. Almost all the myofibers in the ESP and control specimens were dystrophin positive. CONCLUSIONS AND CLINICAL RELEVANCE These results suggested that palatine myopathy in dogs may be caused, at least in part, by denervation of the palatine muscles and not by Duchenne- or Becker-type muscular dystrophy. These soft palate changes may contribute to upper airway collapse and the progression of brachycephalic airway obstructive syndrome.

The Synergy Between PCI With TAXUS and Cardiac Surgery (SYNTAX) score is effective in predicting clinical outcome after percutaneous coronary intervention (PCI). However, its prediction ability is low because it reflects only the coronary characterization. We assessed the predictive value of combining the ankle-brachial index (ABI) and SYNTAX score to predict clinical outcomes after PCI. The ABI-SYNTAX score was calculated for 1,197 patients recruited from the Shinshu Prospective Multi-center Analysis for Elderly Patients with Coronary Artery Disease Undergoing Percutaneous Coronary Intervention (SHINANO) registry, a prospective, observational, multicenter cohort study in Japan. The primary end points were major adverse cardiovascular and cerebrovascular events (MACE; all-cause death, myocardial infarction, and stroke) in the first year after PCI. The ABI-SYNTAX score was calculated by categorizing and summing up the ABI and SYNTAX scores. ABI ≤ 0.49 was defined as 4, 0.5 to 0.69 as 3, 0.7 to 0.89 as 2, 0.9 to 1.09 as 1, and 1.1 to 1.5 as 0; an SYNTAX score ≤ 22 was defined as 0, 23 to 32 as 1, and ≥ 33 as 2. Patients were divided into low (0), moderate (1 to 2), and high (3 to 6) groups. The MACE rate was significantly higher in the high ABI-SYNTAX score group than in the lower 2 groups (low: 4.6% vs moderate: 7.0% vs high: 13.9%, p = 0.002). Multivariate regression analysis found that ABI-SYNTAX score independently predicted MACE (hazards ratio 1.25, 95% confidence interval 1.02 to 1.52, p = 0.029). The respective C-statistic for the ABI-SYNTAX and SYNTAX score for 1-year MACE was 0.60 and 0.55, respectively. In conclusion, combining the ABI and SYNTAX scores improved the prediction of 1-year adverse ischemic events compared with the SYNTAX score alone.

Objective Little is known about the relationship between body composition indicators, including body mass index (BMI), fat mass index (FMI) and lean BMI (LBMI), and adverse outcomes after percutaneous coronary intervention (PCI) in Asian populations. The aim of this study was to clarify this relationship. Methods The SHINANO registry is a prospective, observational, multicenter cohort registry that enrolled 1923 consecutive patients with coronary heart disease (CHD) from August 2012 to July 2013; 66 patients were excluded because of missing data. We evaluated 1857 patients with CHD who underwent PCI (aged 70±11 years; 23% women; BMI 23.8±3.5 kg/m2; LBMI 18.3±1.8 kg/m2; FMI 5.4±2.2 kg/m2). Patients were divided into three groups, based on BMI, LBMI and FMI tertiles, to assess the prognostic value of the three indicators. The primary endpoint was major adverse cardiac events (MACE), including all cause death, non-fatal myocardial infarction and ischaemic stroke at 1 year. Results Over a 1 year follow-up period (1776 patients, 95.6%), the cumulative MACE incidence was 8.7% (161 cases). Using Kaplan–Meier analysis, the MACE incidence was significantly higher in patients with lower BMI values (13.4–22.2 kg/m2) (p=0.002) and lower LBMI values (11.6–17.6 kg/m2) (p

Background/aim Wilms' tumor 1 (WT1) is a tumor-associated antigen highly expressed in cancer. We examined the safety of WT1-peptide pulsed dendritic cell (WT1-DC) vaccine in combination with chemotherapy in patients with surgically resected pancreatic cancer. Patients and methods Eight patients with resectable pancreatic cancer undergoing surgery either combined with S-1 or S-1 plus gemcitabine therapy were enrolled. Immunohistochemical analysis of WT1 was performed in 34 cases of pancreatic cancer. Results No serious side-effects were observed, except grade I fever in five and grade I reactions at the injection site in all patients. WT1-specific cytotoxic T-lymphocytes were detected in seven patients, and WT1 and human leukocyte antigen class I antigens were positive in all 34 cases. Conclusion Our study clarified the safety and potential acquisition of immunity after vaccination targeting WT1. Further efficacy of WT1-DC vaccine to improve prognosis would be determined by a prospective clinical trial for resectable pancreatic cancer.

The aging population phenomenon has garnered much attention in recent years, with far reaching implications for the economy, industry and capital markets. This paper focuses on how the aging population affects healthcare REITs in Japan and Singapore by way of a detailed comparative study. Healthcare REITs focus their investments in various medical facilities such as hospitals, medical centers, nursing homes and retirement facilities. Their success is connected to the evolution of the healthcare system and REITs structure. This study focuses on the business model for healthcare REITs, acquisition and distribution implications as well as the stock return performance over time.

Covered self-expandable metallic stents (CSEMS) may provide palliative drainage for unresectable distal malignant biliary strictures. Laser-cut CSEMS allows easy positioning due to its characteristic of minimal stent shortening. Endoscopic stent removal is sometimes recommended for recurrent biliary obstruction (RBO). However, there are no previous reports of endoscopic removal of laser-cut CSEMS. The current study presents data from 6 patients who were placed a laser-cut CSEMS for unresectable distal malignant biliary strictures, and later endoscopic stent removal was attempted for RBO at the present institute. The duration of stent placement, the procedural success rate, the procedural duration, and accidental complications were evaluated. The mean duration of stent placement was 156±37.9 days (range, 117-205). The procedural success rate was 100%. The mean procedural duration was 11.8±7.5 min (range, 5-24). No complications were reported. Laser-cut CSEMS were safely removed from all patients. The present case report is the first to demonstrate that Endoscopic stent removal of laser-cut CSEMS was safely performed.

We herein report a case of Addison's disease caused by tuberculosis characterized by atypical hyperpigmentation, noted as exacerbation of the pigmentation of freckles and the occurrence of new freckles, that was diagnosed in the presence of active pulmonary tuberculosis. The clinical condition of the patient was markedly ameliorated by the administration of hydrocortisone and anti-tuberculosis agents. When exacerbation of the pigmentation of the freckles and/or the occurrence of new freckles are noted, Addison's disease should be considered as part of the differential diagnosis. In addition, the presence of active tuberculosis needs to be assumed whenever we treat patients with Addison's disease caused by tuberculosis, despite its rarity.

Background: CHADS2 or CHA2DS2-VASc score is used for prediction of stroke in patients with atrial fibrillation (AF). Recently, CHADS2 score is reported to have prognostic value in acute coronary syndrome without AF. However, clinical validation of CHA2DS2-VASc score for prognostic stratification in coronary heart disease (CHD) without AF remains uncertain. In this study, we evaluate whether CHA2DS2-VASc score could predict clinical outcome in CHD without known AF. Methods: SHINANO registry was a prospective, observational, multicenter cohort study, enrolling 1923 consecutive patients with CHD from August 2012 to July 2013. Two hundred nine patients were excluded because of known AF. We calculated CHA2DS2-VASc score in the remaining 1714 patients (mean age 70 ± 11 years, 23% female) without known AF. To assess the clinical validation of CHA2DS2-VASc score, we divided patients into 3 groups according to the tertiles (score 0–2, 3–4, and ≥5). The primary endpoint was MACE including death, nonfatal myocardial infarction, and ischemic stroke at 1 year. Results: One-year follow-up was completed in 1632 patients (95.2%). Cumulative incidence of MACE was 139 cases. In Kaplan–Meier analysis, incidence of MACE was significantly higher in patients with CHA2DS2-VASc score ≥5 compared to 3–4 and 0–2 (14.6% vs. 6.8% vs. 5.3%, p