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In this study, we assess the homogeneity of aerosol optical depth (AOD) between two sun photometer networks, the Global Atmosphere Watch-Precision Filter Radiometer (GAW-PFR) and the European SKYNET radiometers network (ESR), at the common wavelengths of their main instruments (500 and 870 nm). The main focus of this work is to evaluate the effect of the improved Langley plot calibration method (ILP) used by SKYNET and to investigate the factors affecting its performance. We used data from three intercomparison campaigns that took place during 2017–2021. Each campaign was organized at two locations (mountainous rural – Davos, Switzerland; urban – Rome, Italy). Our analysis shows that differences in AOD due to post-processing and instrument differences are minor. The main factor leading to AOD differences is the calibration method. We found a systematic underestimation of AOD in ESR compared to in GAW-PFR due to underestimation of the calibration constant calculated with the ILP method compared to the calibration transfers using the PFR as a reference. The calibration and AOD differences are smaller in Davos, where the traceability criteria are satisfied at 870 nm and where the median differences are below 0.01 at 500 nm. In Rome, the AOD median differences at 500 nm were in the 0.015–0.034 range. We conducted a sensitivity study, which shows that part of the difference can potentially be explained by errors in the assumed surface albedo and instrument solid-view angle provided as inputs to the ILP code (based on Skyrad pack 4.2). Our findings suggest that the ILP method is mainly sensitive to the measured sky radiance. The underestimation in calibration is probably caused by an error in the retrieved scattering AOD (sc-AOD) through the sky radiance inversion. Using an alternative retrieval method (Skyrad MRI pack version 2) to derive sc-AOD and to recalibrate the instruments with the ILP method, we found no significant differences between the retrieved sc-AOD and no systematic increase in the ILP-derived calibration constant when using the MRI pack for sc-AOD inversion instead of the Skyrad 4.2. The potential error may be a result of the model assumptions used for the sky radiance simulations. In conclusion, the on-site calibration of sun photometers has several advantages, including the fact that instrument shipments and data gaps can be avoided. However, it has also the disadvantages of a larger uncertainty and significant systematic differences compared to the traditional Langley calibration performed under low- and constant-AOD conditions at high-altitude sites. The larger uncertainty of the ILP method can be attributed to the required modelling and input parameters.

To retrieve columnar intensive aerosol properties from sun–sky photometers, both irradiance and radiance calibration factors are needed. For the irradiance the solar calibration constant, V0, which denotes the instrument counts for a direct normal solar flux extrapolated to the top of the atmosphere, must be determined. The solid view angle, SVA, is a measure of the field of view of the instrument, and it is important for obtaining the radiance from sky diffuse irradiance measurements. Each of the three sun-photometer networks considered in the present study (SKYNET, AERONET, WMO GAW) adopts different protocols of calibration, and we evaluate the performance of the on-site calibration procedures, applicable to every kind of sun–sky photometer but tested in this analysis only on SKYNET Prede POM01 instruments, during intercomparison campaigns and laboratory calibrations held in the framework of the Metrology for Aerosol Optical Properties (MAPP) European Metrology Programme for Innovation and Research (EMPIR) project. The on-site calibration, performed as frequently as possible (ideally monthly) to monitor changes in the device conditions, allows operators to track and evaluate the calibration status on a continuous basis, considerably reducing the data gaps incurred by the periodic shipments for performing centralized calibrations. The performance of the on-site calibration procedures for V0 was very good at sites with low turbidity, showing agreement with a reference calibration between 0.5 % and 1.5 % depending on wavelengths. In the urban area, the agreement decreases between 1.7 % and 2.5 %. For the SVA the difference varied from a minimum of 0.03 % to a maximum of 3.46 %.

The Prede POM sky radiometer is a filter radiometer deployed worldwide in the SKYNET international network. A new method, called Skyrad pack MRI version 2 (MRI v2), is presented here to retrieve aerosol properties (size distribution, real and imaginary parts of the refractive index, single-scattering albedo, asymmetry factor, lidar ratio, and linear depolarization ratio), water vapor, and ozone column concentrations from the sky radiometer measurements. MRI v2 overcomes two limitations of previous methods (Skyrad pack versions 4.2 and 5, MRI version 1). One is the use of all the wavelengths of 315, 340, 380, 400, 500, 675, 870, 940, 1020, 1627, and 2200 nm if available from the sky radiometers, for example, in POM-02 models. The previous methods cannot use the wavelengths of 315, 940, 1627, and 2200 nm. This enables us to provide improved estimates of the aerosol optical properties, covering almost all the wavelengths of solar radiation. The other is the use of measurements in the principal plane geometry in addition to the solar almucantar plane geometry that is used in the previous versions. Measurements in the principal plane are regularly performed; however, they are currently not exploited despite being useful in the case of small solar zenith angles when the scattering angle distribution for almucantars becomes too small to yield useful information. Moreover, in the inversion algorithm, MRI v2 optimizes the smoothness constraints of the spectral dependencies of the refractive index and size distribution, and it changes the contribution of the diffuse radiances to the cost function according to the aerosol optical depth. This overcomes issues with the estimation of the size distribution and single-scattering albedo in the Skyrad pack version 4.2. The scattering model used here allows for non-spherical particles, improving results for mineral dust and permitting evaluation of the depolarization ratio. An assessment of the retrieval uncertainties using synthetic measurements shows that the best performance is obtained when the aerosol optical depth is larger than 0.2 at 500 nm. Improvements over the Skyrad pack versions 4.2 and 5 are obtained for the retrieved size distribution, imaginary part of the refractive index, single-scattering albedo, and lidar ratio at Tsukuba, Japan, while yielding comparable retrievals of the aerosol optical depth, real part of the refractive index, and asymmetry factor. A radiative closure study using surface solar irradiances from the Baseline Surface Radiation Network and the parameters retrieved from MRI v2 showed consistency, with a positive bias of the simulated global irradiance of about +1 %. Furthermore, the MRI v2 retrievals of the refractive index, single-scattering albedo, asymmetry factor, and size distribution have been found to be in agreement with integrated profiles of aircraft in situ measurements of two Saharan dust events at the Cape Verde archipelago during the Sunphotometer Airborne Validation Experiment in Dust (SAVEX-D) 2015 field campaign.

This paper is an overview of the progress in sky radiometer technology and the development of the network called SKYNET. It is found that the technology has produced useful on-site calibration methods, retrieval algorithms, and data analyses from sky radiometer observations of aerosol, cloud, water vapor, and ozone. A formula was proposed for estimating the accuracy of the sky radiometer calibration constant F0 using the improved Langley (IL) method, which was found to be a good approximation to observed monthly mean uncertainty in F0, around 0.5 % to 2.4 % at the Tokyo and Rome sites and smaller values of around 0.3 % to 0.5 % at the mountain sites at Mt. Saraswati and Davos. A new cross IL (XIL) method was also developed to correct an underestimation by the IL method in cases with large aerosol retrieval errors. The root-mean-square difference (RMSD) in aerosol optical thickness (AOT) comparisons with other networks took values of less than 0.02 for λ≥500 nm and a larger value of about 0.03 for shorter wavelengths in city areas and smaller values of less than 0.01 in mountain comparisons. Accuracies of single-scattering albedo (SSA) and size distribution retrievals are affected by the propagation of errors in measurement, calibrations for direct solar and diffuse sky radiation, ground albedo, cloud screening, and the version of the analysis software called the Skyrad pack. SSA values from SKYNET were up to 0.07 larger than those from AERONET, and the major error sources were identified as an underestimation of solid viewing angle (SVA) and cloud contamination. Correction of these known error factors reduced the SSA difference to less than 0.03. Retrievals of other atmospheric constituents by the sky radiometer were also reviewed. Retrieval accuracies were found to be about 0.2 cm for precipitable water vapor amount and 13 DU (Dobson Unit) for column ozone amount. Retrieved cloud optical properties still showed large deviations from validation data, suggesting a need to study the causes of the differences. It is important that these recent studies on improvements presented in the present paper are introduced into the existing operational systems and future systems of the International SKYNET Data Center.

The Prede sky radiometer measures direct solar irradiance and the angular distribution of diffuse radiances at the ultraviolet, visible, and near-infrared wavelengths. These data are utilized for the remote sensing of aerosols, water vapor, ozone, and clouds, but the calibration constant, which is the sensor output current of the extraterrestrial solar irradiance at the mean distance between Earth and the Sun, is needed. The aerosol channels, which are the weak gas absorption wavelengths of 340, 380, 400, 500, 675, 870, and 1020 nm, can be calibrated by an on-site self-calibration method, the Improved Langley method. This on-site self-calibration method is useful for the continuous long-term observation of aerosol properties. However, the continuous long-term observation of precipitable water vapor (PWV) by the sky radiometer remains challenging because calibrating the water vapor absorption channel of 940 nm generally relies on the standard Langley (SL) method at limited observation sites (e.g., the Mauna Loa Observatory) and the transfer of the calibration constant by a side-by-side comparison with the reference sky radiometer calibrated by the SL method. In this study, we developed the SKYMAP algorithm, a new on-site method of self-calibrating the water vapor channel of the sky radiometer using diffuse radiances normalized by direct solar irradiance (normalized radiances). Because the sky radiometer measures direct solar irradiance and diffuse radiance using the same sensor, the normalization cancels the calibration constant included in the measurements. The SKYMAP algorithm consists of three steps. First, aerosol optical and microphysical properties are retrieved using direct solar irradiances and normalized radiances at aerosol channels. The aerosol optical properties at the water vapor channel are interpolated from those at aerosol channels. Second, PWV is retrieved using the angular distribution of the normalized radiances at the water vapor channel. Third, the calibration constant at the water vapor channel is estimated from the transmittance of PWV and aerosol optical properties. Intensive sensitivity tests of the SKYMAP algorithm using simulated data of the sky radiometer showed that the calibration constant is retrieved reasonably well for PWV cm, which indicates that the SKYMAP algorithm can calibrate the water vapor channel on-site in dry conditions. Next, the SKYMAP algorithm was applied to actual measurements under the clear-sky and low-PWV ( cm) conditions at two sites, Tsukuba and Chiba, Japan, and the annual mean calibration constants at the two sites were determined. The SKYMAP-derived calibration constants were 10.1 % and 3.2 % lower, respectively, than those determined by a side-by-side comparison with the reference sky radiometer. After determining the calibration constant, we obtained PWV from the direct solar irradiances in both the dry and wet seasons. The retrieved PWV values corresponded well to those derived from a global-navigation-satellite-system–global-positioning-system receiver, a microwave radiometer, and an AERONET (Aerosol Robotic Network) sun–sky radiometer at both sites. The correlation coefficients were greater than 0.96. We calculated the bias errors and the root mean square errors by comparing PWV between the DSRAD (direct solar irradiance) algorithm and other instruments. The magnitude of the bias error and the root mean square error were and  cm for PWV cm, respectively. However, our method tended to underestimate PWV in the wet conditions, and the magnitude of the bias error and the root mean square error became large, and  cm for PWV>3 cm, respectively. This problem was mainly due to the overestimation of the aerosol optical thickness before the retrieval of PWV. These results show that the SKYMAP algorithm enables us to observe PWV over the long term, based on its unique on-site self-calibration method.

Hypoxic training enhances endurance sports tolerance. However, individual responses vary due to physiological differences. This study investigated the relationship between genetic factors and exercise tolerance in hypoxic conditions. This randomized crossover study included 22 male university students (age 20.8±1.3 years, peak oxygen uptake 54.5±6.5 mL/min/kg). Incremental load tests were conducted to assess the symptomatic limit on separate days under normoxic and hypoxic conditions (oxygen concentration 15.4±0.8%) using an ergometer. The initial test environment was randomized. The peak oxygen uptake and blood lactate were monitored every minute, and Δ peak oxygen uptake (peak oxygen uptake under hypoxia - peak oxygen uptake under normoxia) was calculated. Sixteen genotypes linked to exercise tolerance (such as angiotensin-converting enzyme [ACE]) were examined. Peak oxygen uptake significantly decreased under hypoxia (p<0.01). Δ peak oxygen uptake varied among individuals (minimum: 0.7 and maximum: - 18.9). Among analyzed genetic polymorphisms, ACE-II genotypes showed significantly greater Δ peak oxygen uptake than ACE-ID/ACE-DD genotypes (p=0.02). ACE-II genotypes exhibited lower blood lactate elevation at peak exercise in normoxic (p=0.01) and hypoxic (p=0.03) conditions. Participants with the ACE-II genotype had lower lactate concentrations and greater reductions in peak oxygen uptake under hypoxic conditions. Optimizing hypoxic training requires individualized programs incorporating genetic analysis., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Background: The cause of chronic thromboembolic pulmonary hypertension (CTEPH) remains largely unknown. Recently, clonal hematopoiesis (CH) has been reported to be associated with cardiovascular and thromboembolic diseases. Here, we investigated the prevalence and clinical impact of CH in patients with CTEPH., Methods and Results: Whole-exome sequencing and deep-panel sequencing were performed in 214 patients with CTEPH. Clinical data before and after treatment were compared between patients with and without CH. RNA sequencing and serum analysis were performed to explore the pathogenesis that CH contributes to CTEPH. Among the enrolled patients, 20.1%, notably 44.4% who were 80 to 89 years old, had variants in CH-associated genes. In regard to clinical impact, B-type natriuretic peptide levels and home oxygen therapy rate were significantly higher, and 6-minute walk distance was significantly shorter after treatment in patients with CH than in those without CH. Moreover, novel clot reformation in the pulmonary artery despite the use of anticoagulants and additional angioplasty events after treatment completion were more frequent in patients with CH. RNA sequencing analysis revealed that blood coagulation and neutrophil extracellular trap formation pathways were enriched in patients with CH. Additionally, serum citrullinated histone H3 levels were higher in patients with CH than those without CH. These results were consistent in the subgroup of patients who did not have the history of hematological disorders., Conclusions: The findings in this study raise the possibility that CH will induce a more prothrombotic state through neutrophil activation and neutrophil extracellular trap formation, contributing to pathogenesis and poor treatment response in patients with CTEPH.

Obesity hypoventilation syndrome (OHS) is caused by complex interactions between multiple pathological processes, including diminished respiratory drive and sleep-related breathing alterations, leading to structural and functional respiratory impairment and ultimately, pulmonary hypertension (PH). Because PH is closely associated with OHS, thoroughly evaluating its etiology is essential, and individualized treatments must be considered. We describe two patients with OHS exhibiting severe PH with pulmonary vascular resistance exceeding 5 Wood units; both were classified as Group 1 PH, i.e., pulmonary arterial hypertension (PAH). Initially admitted to our hospital complaining of dyspnea, both patients commenced PAH therapies in addition to positive airway pressure therapy and diuretics, improving their hemodynamic status, dyspnea, and exercise capacity, and finally enabling their discharge. These findings suggest that PAH can coexist with OHS, and PAH therapies, introduced with careful consideration, may provide substantial benefits for select patients., (© 2024 American Academy of Sleep Medicine.)

Competing Interests: This research was supported by the Japan Agency for Medical Research and Development (AMED) under Grant Number JP23ek0109535. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Genetic backgrounds of patients with pulmonary arterial hypertension (PAH) were not fully investigated. A variant of c.14429G > A (p.Arg4810Lys) in the ring finger protein 213 gene (RNF213) was recently identified as a risk allele for poor treatment response and poor clinical prognosis in patients with PAH. However, the molecular mechanisms of the RNF213 p.Arg4810Lys variant in development of PAH are unknown. We investigated the underlying molecular mechanisms of RNF213-associated vasculopathy using an in vivo mouse model. RNF213 +/p.Arg4828Lys mice, harboring the heterozygous RNF213 p.Arg4828Lys variant corresponding to the p.Arg4810Lys variant in humans, were created using the CRISPR-Cas9 system to recapitulate the genetic status of PAH patients. RNF213 +/p.Arg4828Lys mice had a significant elevation of the right ventricular systolic pressure, hypertrophy of the right ventricle, and increased thickness of the pulmonary arterial medial wall compared with wild-type mice after 3 months of exposure to a hypoxic environment. C-X-C motif chemokine ligand 12 (CXCL12), a C-X-C chemokine receptor type 4 (CXCR4) ligand, was significantly elevated in the lungs of RNF213 +/p.Arg4828Lys mice, and PAH was ameliorated by the administration of a CXCR4 antagonist. CXCL12-CXCR4 is an angiogenic chemokine axis, and immunohistochemistry demonstrated an increase in CXCR4 in vimentin-positive spindle-shaped cells in adventitia and interstitial lesions in RNF213 +/p.Arg4828Lys mice and lung specimens from severe PAH patients with the RNF213 p.Arg4810Lys variant. We confirmed a cause-and-effect relationship between the RNF213 p.Arg4810Lys variant and PAH via the CXCL12-CXCR4 pathway. The findings in this study suggest that targeting this pathway might be a novel therapeutic strategy for RNF213-associated vasculopathy., (© 2024. The Author(s).)

Definitive diagnosis of familial hypercholesterolemia (FH) is paramount for the risk management of patients and their relatives. The present study aimed to investigate the frequency of gene variants contributing to low-density lipoprotein cholesterol (LDL-C) metabolism and their clinical relevance in patients with early-onset coronary artery disease (EOCAD). Among 63 consecutive patients with EOCAD (men <55 years or women <65 years) who underwent percutaneous coronary intervention (PCI) from 2013 to 2019 at Keio University Hospital, 52 consented to participate in this retrospective study. Targeted sequencing of LDLR , PCSK9 , APOB , and LDLRAP1 was performed. Of the 52 patients enrolled (42 men; mean age: 50 ± 6 years), one ( LDLR , c.1221&#95;1222delCGinsT) harbored a pathogenic mutation, and one ( APOB , c.10591A>G) harbored variants of uncertain significance. Both the patients harboring the variants were male, showing no history of diabetes mellitus or chronic kidney disease, no family history of EOCAD, and no physical findings of FH (i.e., tendon xanthomas or Achilles tendon thickening). Patients harboring the LDLR variant had three-vessel disease, were on a statin prescription at baseline, and had stable LDL-C levels; however, the case showed a poor response to the intensification of medication after PCI. Approximately 3.8% of patients with EOCAD harbored variants of gene related to LDL-C metabolism; there were no notable indicators in the patients' background or clinical course to diagnose FH. Given the difficulty in diagnosing FH based on clinical manifestations and family history, genetic testing could enable the identification of hidden risk factors and provide early warnings to their relatives., Competing Interests: F.K. has a financial relationship with a research grant from Recordati S.p.A., (Copyright © 2023 Hiroshi Miyama et al.)

Failure of the right ventricle plays a critical role in any type of heart failure. However, the mechanism remains unclear, and there is no specific therapy. Here, we show that the right ventricle predominantly expresses alternative complement pathway-related genes, including Cfd and C3aR1. Complement 3 (C3)-knockout attenuates right ventricular dysfunction and fibrosis in a mouse model of right ventricular failure. C3a is produced from C3 by the C3 convertase complex, which includes the essential component complement factor D (Cfd). Cfd-knockout mice also show attenuation of right ventricular failure. Moreover, the plasma concentration of CFD correlates with the severity of right ventricular failure in patients with chronic right ventricular failure. A C3a receptor (C3aR) antagonist dramatically improves right ventricular dysfunction in mice. In summary, we demonstrate the crucial role of the C3-Cfd-C3aR axis in right ventricular failure and highlight potential therapeutic targets for right ventricular failure., (© 2022. The Author(s).)

Competing Interests: Conflict of interest: The authors have no conflicts of interest to declare.

This study examined whether disaster resilience affects the recovery of mental health states and mitigates psychosocial anxiety 10 years later the Fukushima Daiichi nuclear power plant accident. The survey was conducted in Fukushima's evacuation-directed and non-evacuation-directed areas in January 2020. The 695 participants responded to a questionnaire including items on radiation-related anxiety regarding the Fukushima Daiichi accident, an action-oriented approach as a resilience factor, psychological distress, and demographic information. The structural equation modeling showed that the action-oriented approach also eased radiation-related anxiety by mediating with improving mental health states. Moreover, a multi-group model analysis was conducted for evacuation-directed and non-directed areas. In the evacuation-directed area, we found stronger associations among resilience, mental health states, and radiation-related anxiety, and a direct effect of resilience factors on radiation risk anxiety. These findings emphasize the importance of resilience in post-disaster contexts, at least for a decade, where mental health deteriorates and various psychosocial issues become more complex., 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 © 2022 Kobayashi, Maeda, Nakayama, Takebayashi, Sato, Setou, Momoi, Horikoshi, Yasumura and Ohto.)

The ring finger protein 213 gene (RNF213) encodes a 590 kDa protein that is thought to be involved in angiogenesis. This gene was first recognized as a vasculopathy-susceptibility locus through genome-wide association studies undertaken in a Japanese population, demonstrating that heterozygotes for RNF213 p.Arg4810Lys (c.14429G>A, rs112735431) had a greatly increased risk of moyamoya disease. The association of RNF213 p.Arg4810Lys as a susceptibility variant of moyamoya disease was reproduced in Korean and Chinese individuals and, later, in Caucasians. Variants of the RNF213 gene have been linked to a number of vascular diseases such as moyamoya disease, intracranial major artery stenosis, pulmonary arterial hypertension, and peripheral pulmonary artery stenosis, and have also been associated with co-occurrent diseases and vascular disease in different organs. Based on the findings that we have reported to date, our paper proposes a new concept of “RNF213-associated vascular disease” to unify these conditions with the aim of capturing patients with multiple diseases but with a common genetic background. This concept will be highly desirable for clarifying all of the diseases in the RNF213-associated vascular disease category by means of global epidemiological investigations because of the possibility of such diseases appearing asymptomatically in some patients.

Fatty acids (FAs) have structural and functional diversity. FAs in the heart are closely associated with cardiac function, and their qualitative or quantitative abnormalities lead to the onset and progression of cardiac disease. FAs are important as an energy substrate for the heart, but when in excess, they exhibit cardio-lipotoxicity that causes cardiac dysfunction or heart failure with preserved ejection fraction. FAs also play a role as part of phospholipids that compose cell membranes, and the changes in mitochondrial phospholipid cardiolipin and the FA composition of plasma membrane phospholipids affect cardiomyocyte survival. In addition, FA metabolites exert a wide variety of bioactivities in the heart as lipid mediators. Recent advances in measurement using mass spectrometry have identified trace amounts of n-3 polyunsaturated fatty acids (PUFAs)-derived bioactive metabolites associated with heart disease. n-3 PUFAs have a variety of cardioprotective effects and have been shown in clinical trials to be effective in cardiovascular diseases, including heart failure. This review outlines the contributions of FAs to cardiac function and pathogenesis of heart diseases from the perspective of three major roles and proposes therapeutic applications and new medical perspectives of FAs represented by n-3 PUFAs.

The Fukushima Daiichi Nuclear Power Station accident in 2011 produced over 100000 evacuees. In order to deal with an increased need of mental health care, brief, transdiagnostic Telephonic Interventions (TI) have been provided for those at risk of different mental health problems identified based on results of the Mental Health and Lifestyle Survey (MHLS). This study aimed to examine usefulness of TI with focusing on evacuees' subjective estimation assessed in individual follow-up interviews. The sample comprised 484 persons who had been evacuated from 13 municipalities in Fukushima Prefecture to 8 safer regions in and out of Fukushima. We conducted semi-structured interviews for participants receiving TI (intervention group) and those not receiving TI despite being identified as high risk (non-intervention group). The intervention group was older, had a higher proportion of self-reported mental illness, and higher unemployment compared with the non-intervention group. The satisfaction proportion of those who underwent TI was as high as 74.6%. Satisfaction was significantly associated with advance knowledge of TI availability (OR = 3.00, 95% CI: 1.59-5.64), and advice on health-related practices (OR = 2.15, 95% CI: 1.12-4.13). Thus, TI is considered to be feasible and useful for public health management practices in major disasters.

The effective therapy for pulmonary arterial hypertension (PAH) with inadequate clinical response is scarce except for lung transplantation when prostacyclin infusion is ineffective. The purpose of this study is to investigate the efficacy and safety of selexipag in addition to the infusion of prostacyclin. Nine patients [median 38 (36-49) years of age; 78% female] with PAH whose clinical response was inadequate despite the use of prostacyclin infusion analogs, were evaluated. Addition of selexipag significantly improved hemodynamics and no serious adverse events were observed. Selexipag with prostacyclin infusion analogs can be an effective therapeutic strategy for the PAH patients with inadequate clinical response., Competing Interests: There are no sources of support in the form of grants, gifts, equipment, and/or drugs. There are no conflicts of interest associated with this study., (© 2022 The Authors.)

A Mental Health and Lifestyle Survey (MHLS) has been conducted yearly as part of the Fukushima Health Management Survey since 2012, in order to monitor different health issues related to long-term evacuation of affected people after the 2011 Fukushima disaster. This survey is a mail-based one of nearly 210,000 affected people living in the evacuation zone at the time of the disaster. Another purpose of the MHLS is to provide efficient interventions by telephone based on the results of the survey. Significant findings contributing to understanding of non-radiological health effects caused by long-term evacuation were obtained from the MHLS, directly connecting to telephone-based interventions for over 3,000 respondents per year. In this article, the mental health outcomes of the MHLS, including depressive symptoms and posttraumatic responses, are reviewed, and the usefulness of telephone-based interventions is discussed. The evidence showed that, despite improvement of core mental health outcomes, the prevalence of respondents at high risk of some psychiatric problems remained high compared to that among the general population in Japan. In particular, several mental health consequences of respondents staying outside of Fukushima Prefecture were higher than those staying inside Fukushima. Along with further efforts to increase the response rate, we need to continue and modify the MHLS to meet the requirements of the affected people and communities.