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We analysed the deep archival Chandra observations of the high-temperature galaxy cluster Abell 2319 to investigate the prominent cold front in its core. The main sharp arc of the front shows wiggles, or variations of the radius of the density jump along the arc. At the southern end of the arc is a feature that resembles a Kelvin–Helmholtz (KH) eddy, beyond which the sharp front dissolves. These features suggest that KH instabilities develop at the front. Under this assumption, we can place an upper limit on the ICM viscosity that is several times below the isotropic Spitzer value. Other features include a split of the cold front at its northern edge, which may be another KH eddy. There is a small pocket of hot, less-dense gas inside the cold front, which may indicate a 'hole' in the front's magnetic insulation layer that lets the heat from the outer gas to penetrate inside the front. Finally, a large concave brightness feature south-west of the cluster core can be caused by the gas-dynamic instabilities. We speculate that it can also be an inner boundary of a giant AGN bubble, similar to that in Ophiuchus. If the latter interpretation is supported by better radio data, this could be a remnant of another extremely powerful AGN outburst. [ABSTRACT FROM AUTHOR]

Exotic atom experiments place transition-edge sensor (TES) microcalorimeter arrays in a high-energy charged particle-rich environment. When a high-energy charged particle passes through the silicon substrate of a TES array, a large amount of energy is deposited and small pulses are generated across multiple pixels in the TES array due to thermal crosstalk. We have developed analysis techniques to assess and reduce the effects of charged particle events on exotic atom X-ray measurements. Using this technique, the high-energy and low-energy components of the X-ray peaks due to pileup are eliminated, improving the energy resolution from 6.6 to 5.7 eV at 6.9 keV. [ABSTRACT FROM AUTHOR]

A novel triggering function developed for 240-pixel Transition-Edge Sensors is demonstrated under the high rate of particle background. The function is integrated into the standard data acquisition system in the NIST TES framework. It enables any type of combination of trigger pattern when a pixel is triggered, which is called "group trigger." As a practical implementation, the primary trigger is distributed to the four physically nearest pixels. The group trigger function was utilized throughout the entire one-month J-PARC experiment for the measurement of the Kaonic-atom X-rays. This trigger allowed us to confirm that the increased background and degraded energy resolution we observed when operating the TES array in the presence of an ion beam are the result of thermal crosstalk from charged particles. We show that the maximum of the average of the signals among the neighboring four pixels is useful for event selection. We use cuts based on this parameter to improve the peak-to-background level in a measured x-ray energy spectrum by a factor of ∼ 2, while keeping 95% of measured events. This flexible group triggering technique allows us to improve the signal to noise on the very faint Kaonic Helium x-ray lines we are measuring, better understand our experiment environment, and we believe this technique may prove useful in other ground and space-based TES applications. [ABSTRACT FROM AUTHOR]

A useful function, called group trigger, is implemented in a data acquisition system of a 240-pixel X-ray transition-edge sensor array to store simultaneous waveforms from any desired set of pixels. It works as a diagnostic tool which can record both primary pulses and associated crosstalk events with enough freedom to optimize the data output. Under a high rate of charged particle background, such as in an accelerator, investigating signals from any combination of trigger patterns for a particular event is of high importance. We utilized this function throughout an entire experiment at J-PARC, measuring kaonic atom X-rays in 2018. This was the first time a group trigger was applied to exotic-atom spectroscopy. In this experiment, the primary trigger was distributed to the four physical nearest neighbor pixels for practical purposes. The function clarified the effect of thermal and electrical cross talk from X-rays and charged particles, resulting in a better understanding of the behavior of the TES array in such a high-background environment. [ABSTRACT FROM AUTHOR]

We integrated a TES X-ray spectrometer with a charged kaon beam line at J-PARC to perform X-ray spectroscopy of kaonic helium atoms. Limited beam intensity and a broad beam spot size made it crucial to increase the detector acceptance angle as much as possible, requiring significant development. To this end, our TES system shared the same vacuum with a cryogenic system of the liquid helium experimental target. We also specially developed a target cell for liquid helium and a thinned aperture array on top of the TES detector. Additionally, thermal and magnetic shields and infrared filters were optimized in terms of a larger acceptance angle and energy resolution of the detector. The scientific campaign was performed in June, 2018, where the whole system was stably operated for almost one month. [ABSTRACT FROM AUTHOR]

We propose an anomaly detection technique for high-resolution X-ray spectroscopy. The method is based on the neural network architecture variational auto-encoder, and requires only normal samples for training. We implement the network using python taking account of the effect of Poisson statistics carefully, and demonstrate the concept with simulated high-resolution X-ray spectral data sets of one-temperature, two-temperature, and non-equilibrium plasma. Our proposed technique would assist scientists in finding important information that would otherwise be missed due to the unmanageable amount of data taken with future X-ray observatories. [ABSTRACT FROM AUTHOR]

X-ray substructures in clusters of galaxies provide indirect clues about the microphysical properties of the intracluster medium (ICM), which are still not very well known. In order to investigate X-ray substructures in detail, we studied archival ∼1 Msec Chandra data of the core of the Perseus cluster, focusing on the substructures associated with the sloshing cold front. In the east half of the cold front, we found a Kelvin–Helmholtz instability (KHI) layer candidate. The measured width-to-azimuthal extension ratio and the thermodynamic properties are all consistent with it being a KHI layer currently developing along the sloshing cold front. We found a thermal pressure deficit of the order of 10−2 keV cm−3 at the KHI layer. Assuming that turbulent pressure fully supports the pressure deficit, we estimated the turbulent strength at several hundred km s−1, which translates into the turbulent heating rate of Q turb ∼ 10−26 erg cm−3 s−1. This value agrees within an order of magnitude with the previous estimation derived from the surface brightness fluctuations, and can balance the radiative cooling at this radius. In the west half of the cold front, we found feather-like structures which are similar to the structures observed in recent numerical simulations of the gas sloshing of magnetized plasma. Their thermodynamic properties are consistent with one of the feathers being a projected gas depletion layer induced by the amplified magnetic field whose strength is |$B\sim 30\,\mathrm{\mu G}$|⁠. [ABSTRACT FROM AUTHOR]

High-resolution spectroscopy of the core of the Perseus Cluster of galaxies, using the Hitomi satellite above 2 keV and the XMM–Newton Reflection Grating Spectrometer at lower energies, provides reliable constraints on the abundances of O, Ne, Mg, Si, S, Ar, Ca, Cr, Mn, Fe, and Ni. Accounting for all known systematic uncertainties, the Ar/Fe, Ca/Fe, and Ni/Fe ratios are determined with a remarkable precision of less than 10 per cent, while the constraints on Si/Fe, S/Fe, and Cr/Fe are at the 15 per cent level, and Mn/Fe is measured with a 20 per cent uncertainty. The average biases in determining the chemical composition using archival CCD spectra from XMM–Newton and Suzaku typically range from 15 to 40 per cent. A simple model in which the enrichment pattern in the Perseus Cluster core and the protosolar nebula are identical gives a surprisingly good description of the high-resolution X-ray spectroscopy results, with χ2 = 10.7 for 10 degrees of freedom. However, this pattern is challenging to reproduce with linear combinations of existing supernova nucleosynthesis calculations, particularly given the precise measurements of intermediate α-elements enabled by Hitomi. We discuss in detail the degeneracies between various supernova progenitor models and explosion mechanisms, and the remaining uncertainties in these theoretical models. We suggest that including neutrino physics in the core-collapse supernova yield calculations may improve the agreement with the observed pattern of α-elements in the Perseus Cluster core. Our results provide a complementary benchmark for testing future nucleosynthesis calculations required to understand the origin of chemical elements. [ABSTRACT FROM AUTHOR]

We present data preprocessing based on an artificial neural network to estimate the parameters of the X-ray emission spectra of a single-temperature thermal plasma. The method finds appropriate parameters close to the global optimum. The neural network is designed to learn the parameters of the thermal plasma (temperature, abundance, normalization and redshift) of the input spectra. After training using 9000 simulated X-ray spectra, the network has grown to predict all the unknown parameters with uncertainties of about a fewper cent. The performance dependence on the network structure has been studied. We applied the neural network to an actual high-resolution spectrum obtained with Hitomi. The predicted plasma parameters agree with the known best-fitting parameters of the Perseus cluster within uncertainties of ≲10 per cent. The result shows that neural networks trained by simulated data might possibly be used to extract a feature built in the data. This would reduce human-intensive preprocessing costs before detailed spectral analysis, and would help us make the best use of the large quantities of spectral data that will be available in the coming decades. [ABSTRACT FROM AUTHOR]

The microphysical properties, such as effective viscosity and conductivity, of the weakly magnetized intergalactic plasma are not yet well known. We investigate the constraints that can be placed by an azimuthally resolved study of the cold front in Abell 3667 using ~500 ks archival Chandra data. We find that the radius of the interface fluctuates with position angle and the morphology of the interface is strikingly similar to recent numerical simulations of inviscid gas-stripping. We find multiple edges in the surface brightness profiles across the cold front as well as azimuthal variations, which are consistent with the presence of Kelvin-Helmholtz instabilities (KHIs) developing along the cold front. They indicate that the characteristic length-scale of KHI rolls is around 20-80 kpc. This is the first observational indication of developing KHIs along a merger cold front in a galaxy cluster. Based on the KHI scenario, we estimated the upper limit of the intracluster medium effective viscosity. The estimated value of μ ≲ 200 g cm-1 s-1 is at most 5 per cent of the isotropic Spitzer-like viscosity. The observed apparent mixing towards the outer edges away from the tip of the front provides an additional evidence for suppressed viscosity. [ABSTRACT FROM AUTHOR]

We are developing a new technique to apply transition-edge sensors (TESs) to X-ray spectroscopy of exotic atoms, especially of kaonic atoms. To demonstrate the feasibility of this pioneering project, performance of a TES-based X-ray detector was evaluated in pion- and kaon-beam environments at particle accelerators. We successfully observed X-rays from pionic-carbon atoms with a resolution as good as 7 eV FWHM at 6 keV. Also at a kaon beamline, we confirmed that the TES spectrometer will be able to achieve our resolution goal, 6 eV, in our first scientific campaign to measure X-rays from kaonic-helium atoms. [ABSTRACT FROM AUTHOR]

We present the results of a very deep (500 ks) Chandra observation, along with tailored numerical simulations, of the nearest, best resolved cluster cold front in the sky, which lies 90 kpc (19 arcmin) to the north-west ofM87. The northern part of the front appears the sharpest, with a width smaller than 2.5 kpc (1.5 Coulomb mean free paths; at 99 per cent confidence). Everywhere along the front, the temperature discontinuity is narrower than 4-8 kpc and the metallicity gradient is narrower than 6 kpc, indicating that diffusion, conduction and mixing are suppressed across the interface. Such transport processes can be naturally suppressed by magnetic fields aligned with the cold front. Interestingly, comparison to magnetohydrodynamic simulations indicates that in order to maintain the observed sharp density and temperature discontinuities, conduction must also be suppressed along the magnetic field lines. However, the northwestern part of the cold front is observed to have a non-zero width. While other explanations are possible, the broadening is consistent with the presence of Kelvin-Helmholtz instabilities (KHI) on length-scales of a few kpc. Based on comparison with simulations, the presence of KHI would imply that the effective viscosity of the intracluster medium is suppressed by more than an order of magnitude with respect to the isotropic Spitzer-like temperature dependent viscosity. Underneath the cold front, we observe quasi-linear features that are ~10 per cent brighter than the surrounding gas and are separated by ~15 kpc from each other in projection. Comparison to tailored numerical simulations suggests that the observed phenomena may be due to the amplification of magnetic fields by gas sloshing in wide layers below the cold front, where the magnetic pressure reaches ~5-10 per cent of the thermal pressure, reducing the gas density between the bright features. [ABSTRACT FROM AUTHOR]

We present the results of deep Chandra, XMM-Newton and Suzaku observations of the nearby galaxy cluster Abell 85, which is currently undergoing at least two mergers, and in addition shows evidence for gas sloshing which extends out to r ≈ 600 kpc. One of the two infalling subclusters, to the south of the main cluster centre, has a dense, X-ray bright cool core and a tail extending to the south-east. The northern edge of this tail is strikingly smooth and sharp (narrower than the Coulomb mean free path of the ambient gas) over a length of 200 kpc, while towards the south-west the boundary of the tail is blurred and bent, indicating a difference in the plasma transport properties between these two edges. The thermodynamic structure of the tail strongly supports an overall north-westward motion. We propose, that a sloshing-induced tangential, ambient, coherent gas flow is bending the tail eastwards. The brightest galaxy of this subcluster is at the leading edge of the dense core, and is trailed by the tail of stripped gas, suggesting that the cool core of the subcluster has been almost completely destroyed by the time it reached its current radius of r ≈ 500 kpc. The surface-brightness excess, likely associated with gas stripped from the infalling southern subcluster, extends towards the south-east out to at least r500 of the main cluster, indicating that the stripping of infalling subclusters may seed gas inhomogeneities. The second merging subcluster appears to be a diffuse non-cool-core system. Its merger is likely supersonic with a Mach number of ≈1.4. [ABSTRACT FROM AUTHOR]

Abstract: The photoluminescence (PL) spectra of the type II ZnSe–ZnTe superlattices with dual-subband structures have two emission peaks. The PL peak at the higher energy side appears by the excitation even with the light, with the middle energy between the PL peaks. The emission energy of the up-converted light shows dependence similar to the case of direct excitation (high-energy excitation) on the excitation intensity. The emission energy increases with increase in the excitation intensity. The up-converted and the direct excited emissions are due to the same state in the superlattice. [Copyright &y& Elsevier]

In this study, we successfully applied a transition-edge sensor (TES) spectrometer as a detector for microbeam X-ray measurements from a synchrotron X-ray light source in the hard X-ray region to determine uranium (U) distribution at the micro-scale and its chemical species in biotite obtained from a U mine. It is difficult to separate the fluorescent X-ray of the U Lα 1 line at 13.615 keV from that of the Rb Kα line at 13.395 keV in the X-ray fluorescence spectrum with an energy resolution of approximately 220 eV using a conventional silicon drift detector (SDD). Meanwhile, the fluorescent X-rays of U Lα 1 and Rb Kα were fully separated by a TES with 50 eV energy resolution at an energy of around 13 keV. The successful peak separation by the TES led to an accurate mapping analysis of trace U in micro-X-ray fluorescence measurements and a decrease in the signal-to-background ratio in micro-X-ray absorption near edge structure spectroscopy. Thus, it could be a powerful tool for studying the U distribution and speciation in various environmental samples.

We herein report a 49-year-old woman who developed "happy heart syndrome" while watching a family theater performance. She was followed up with cardiac magnetic resonance imaging (CMR). The time course of the CMR findings was similar to that previously reported for Takotsubo cardiomyopathy (TTC), including the form of "broken heart syndrome." CMR findings for "happy heart syndrome" have not been sufficiently investigated. However, the CMR findings in this case suggest that "happy heart syndrome" and other conventional TTC including "broken heart syndrome" are clinically a single disease, at least from an imaging aspect.

Introduction: "Secondary exposure to anticancer drugs" refers to exposure to anticancer drugs after chemotherapy via the patient's urine and other excretions. The necessity of countermeasures against secondary exposure to anticancer drugs has been recently highlighted. Although anticancer drugs are also excreted through sweat, few studies have reported exposure to drug residues via this route. We investigated the amount of cyclophosphamide (CPA) excreted in the sweat of patients receiving CHOP therapy (cyclophosphamide, doxorubicin, vincristine, and prednisone)., Methods: The study population included eight patients with malignant lymphoma who received CHOP therapy between May and December 2021. The amount of CPA in their underwear (namely, cotton short-sleeved shirts) worn from the start of the CHOP therapy until 24 h after the end of CPA administration was measured, using liquid chromatography-mass spectrometry (LC-MS/MS)., Results: CPA was detected in the underwear of all the patients, with levels ranging between 7.38 and 160.77 ng/cm 2 . No subjective changes were observed in the sweating status of any patients during the study period., Conclusions: These results suggested that patients' sweat, as well as urine, is a potential route for exposure to anticancer drugs. Whether visibly contaminated or not, the clothing and linen worn directly by patients should be handled as a source of sweat-mediated exposure to anticancer drugs both in medical facilities and at home., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

To test bound-state quantum electrodynamics (BSQED) in the strong-field regime, we have performed high precision x-ray spectroscopy of the 5g-4f and 5f- 4d transitions (BSQED contribution of 2.4 and 5.2 eV, respectively) of muonic neon atoms in the low-pressure gas phase without bound electrons. Muonic atoms have been recently proposed as an alternative to few-electron high-Z ions for BSQED tests by focusing on circular Rydberg states where nuclear contributions are negligibly small. We determined the 5g_{9/2}- 4f_{7/2} transition energy to be 6297.08±0.04(stat)±0.13(syst)  eV using superconducting transition-edge sensor microcalorimeters (5.2-5.5 eV FWHM resolution), which agrees well with the most advanced BSQED theoretical prediction of 6297.26 eV.

Accurate determination of cerium (Ce) valence state is important for interpreting the Ce anomaly in geological archives for (paleo)redox reconstruction. However, the routine application of Ce L 3 -edge X-ray absorption near-edge structure (XANES) spectroscopy for detecting trace Ce in geological samples can often be restricted by coexisting titanium (Ti) due to the proximity of their fluorescence emission lines. Therefore, the signal-to-noise ratio of Ce L 3 -edge XANES spectra may not be sufficiently high for high-quality spectroscopic analysis. This study introduces a semi-quantitative approach appropriate for Ti-rich, Ce-dilute geological materials by synchrotron-based X-ray measurement at the Ce L 2 -edge. First, the results confirm that Ce L 2 -edge XANES spectra are able to avoid overlapping Ti K β emissions and provide more reliable information on the Ce valence state in Ti-rich materials relative to L 3 -edge XANES. Moreover, the application of transition-edge sensor (TES) could reach the higher sensitivity with better energy resolution than conventional silicon drift detector (SDD) to detect fluorescence X-ray (Ce L β1 ). The investigation on bauxites developed from the Columbia River Basalts shows that combining Ce L 2 -edge XANES and TES allows for resolving weak Ce fluorescence lines at the L 2 -edge from Ti-rich, Ce-dilute samples (Ti/Ce mass ratio up to ∼6000, tens of ppm Ce). The outcome emphasizes the practical possibility of investigating Ce redox state in Ti-rich geological samples., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

We have measured the 3d→2p transition x rays of kaonic ^{3}He and ^{4}He atoms using superconducting transition-edge-sensor microcalorimeters with an energy resolution better than 6 eV (FWHM). We determined the energies to be 6224.5±0.4(stat)±0.2(syst)  eV and 6463.7±0.3(stat)±0.1(syst)  eV, and widths to be 2.5±1.0(stat)±0.4(syst)  eV and 1.0±0.6(stat)±0.3(stat)  eV, for kaonic ^{3}He and ^{4}He, respectively. These values are nearly 10 times more precise than in previous measurements. Our results exclude the large strong-interaction shifts and widths that are suggested by a coupled-channel approach and agree with calculations based on optical-potential models.

We observed electronic K x rays emitted from muonic iron atoms using superconducting transition-edge sensor microcalorimeters. The energy resolution of 5.2 eV in FWHM allowed us to observe the asymmetric broad profile of the electronic characteristic Kα and Kβ x rays together with the hypersatellite K^{h}α x rays around 6 keV. This signature reflects the time-dependent screening of the nuclear charge by the negative muon and the L-shell electrons, accompanied by electron side feeding. Assisted by a simulation, these data clearly reveal the electronic K- and L-shell hole production and their temporal evolution on the 10-20 fs scale during the muon cascade process.

We have succeeded in operating a transition-edge sensor (TES) spectrometer and evaluating its performance at the SPring-8 synchrotron x-ray light source. The TES spectrometer consists of a 240 pixel National Institute of Standards and Technology (NIST) TES system, and 220 pixels are operated simultaneously with an energy resolution of 4 eV at 6 keV at a rate of ∼1 c/s pixel -1 . The tolerance for high count rates is evaluated in terms of energy resolution and live time fraction, leading to an empirical compromise of ∼2 × 10 3 c/s (all pixels) with an energy resolution of 5 eV at 6 keV. By utilizing the TES's wideband spectroscopic capability, simultaneous multi-element analysis is demonstrated for a standard sample. We conducted x-ray absorption near-edge structure (XANES) analysis in fluorescence mode using the TES spectrometer. The excellent energy resolution of the TES enabled us to detect weak fluorescence lines from dilute samples and trace elements that have previously been difficult to resolve due to the nearly overlapping emission lines of other dominant elements. The neighboring lines of As Kα and Pb Lα2 of the standard sample were clearly resolved, and the XANES of Pb Lα2 was obtained. Moreover, the x-ray spectrum from the small amount of Fe in aerosols was distinguished from the spectrum of a blank target, which helps us to understand the targets and the environment. These results are the first important step for the application of high resolution TES-based spectroscopy at hard x-ray synchrotron facilities.

Aim: To assess factors associated with home deaths in non-cancer elderly patients receiving home medical care by general practitioners., Methods: A retrospective observational study was carried out in a primary care clinic in Tokyo. Patients who received home medical care and died between January 2010 and September 2017 were included in the analysis. Data from 119 non-cancer patients aged ≥65 years were collected between September and December 2017 using medical records. Patient characteristics, comorbidities, cognitive impairment, duration of home medical care, number of household members, patient's relationship with their primary caregiver, use of home care nursing services, and patient and family preference on place of death were obtained as independent variables. The main outcome was the place of death., Results: Among the analyzed patients, 59.7% had impaired cognition and 47.1% expressed a preference for place of death. Patient-family congruence on the preferred place of death was 57.1% (kappa coefficient 0.39). Multivariate analysis showed that family preference for home death (adjusted odds ratio [aOR] 137.0, 95% CI 13.0-1443.8), cognitive impairment (aOR 4.26, 95% CI 1.12-16.2), death by non-infectious diseases (aOR 13.7, 95% CI 2.50-74.7) and living with more than two family members (aOR 4.79, 95%CI 1.38-16.7) were significantly associated with home deaths., Conclusions: Family preference, rather than patient preference, was a facilitating factor for home death among non-cancer older patients receiving home medical care. As many patients receiving home medical care have impaired cognition, early end-of-life discussions with patients and decision-making support for caregivers should be promoted to realize their preferences on place of death. Geriatr Gerontol Int 2019; 19: 1231-1235., (© 2019 Japan Geriatrics Society.)

Aim: We aimed to evaluate whether potentially inappropriate medications (PIMs) increase the risk for adverse clinical outcomes including falls, emergency department (ED) visits and unplanned hospitalizations in older Japanese patients with chronic diseases, comparing the difference between patients with and without polypharmacy., Methods: A prospective observational cohort study was carried out in a Japanese outpatient primary care clinic. Baseline data was collected from January to March 2016. A total of 740 patients aged ≥65 years with chronic diseases were enrolled and were followed up at 1 year; falls, ED visits and unplanned hospitalizations were recorded. A questionnaire and review of the patients' medical records were used to collect information regarding sociodemographic status, comorbidities and medication prescriptions. PIMs were defined using the Screening Tool of Older Person's Prescriptions criteria version 2. Using logistic regression analysis, the incidence of falls, and ED visits and hospitalizations were compared between patients with and without PIMs, stratifying by number of prescriptions: those with five or more prescriptions and those with fewer than five prescriptions., Results: PIMs were identified in 32.3% of enrolled patients. After stratification by number of prescriptions, PIMs were significantly associated with falls in the group with polypharmacy (OR 2.03, 95% CI 1.11-3.69). This association was not seen in the group without polypharmacy. PIMs were not associated with ED visits or hospitalizations at the 1-year follow up upon multivariate analysis., Conclusions: The combination of PIMs and polypharmacy might increase the risk of falls, therefore clinicians need to pay attention to both PIMs and polypharmacy. Geriatr Gerontol Int 2018; 18: 1064-1070., (© 2018 Japan Geriatrics Society.)

To search for giant X-ray pulses correlated with the giant radio pulses (GRPs) from the Crab pulsar, we performed a simultaneous observation of the Crab pulsar with the X-ray satellite Hitomi in the 2 - 300 keV band and the Kashima NICT radio observatory in the 1.4 - 1.7 GHz band with a net exposure of about 2 ks on 25 March 2016, just before the loss of the Hitomi mission. The timing performance of the Hitomi instruments was confirmed to meet the timing requirement and about 1,000 and 100 GRPs were simultaneously observed at the main and inter-pulse phases, respectively, and we found no apparent correlation between the giant radio pulses and the X-ray emission in either the main or inter-pulse phases. All variations are within the 2 sigma fluctuations of the X-ray fluxes at the pulse peaks, and the 3 sigma upper limits of variations of main- or inter-pulse GRPs are 22% or 80% of the peak flux in a 0.20 phase width, respectively, in the 2 - 300 keV band. The values become 25% or 110% for main or inter-pulse GRPs, respectively, when the phase width is restricted into the 0.03 phase. Among the upper limits from the Hitomi satellite, those in the 4.5-10 keV and the 70-300 keV are obtained for the first time, and those in other bands are consistent with previous reports. Numerically, the upper limits of main- and inter-pulse GRPs in the 0.20 phase width are about (2.4 and 9.3) ×10 -11 erg cm -2 , respectively. No significant variability in pulse profiles implies that the GRPs originated from a local place within the magnetosphere and the number of photon-emitting particles temporally increases. However, the results do not statistically rule out variations correlated with the GRPs, because the possible X-ray enhancement may appear due to a > 0.02% brightening of the pulse-peak flux under such conditions.

Background: The use of dietary supplements and over-the-counter (OTC) drugs is increasing, and there is adequate concern about potential harmful effects. However, there are limited reports on the concurrent use of nonprescription medications with prescription medications in elderly patients. Therefore, this study was conducted to describe the use of dietary supplements and OTC drugs, and to identify predictors for their use in elderly patients using medications prescribed for chronic diseases., Methods: This was a cross-sectional study that enrolled 729 patients aged ≥65 years with chronic diseases, between January and March 2016. Data regarding socio-demographic status, medical condition, number of prescriptions, use of nonprescription medications, and psychological status were collected using a self-administered questionnaire and by review of medical records. Data regarding use of dietary supplements and OTC drugs were analyzed using descriptive statistics. Logistic regression analysis was applied to investigate factors associated with the use of dietary supplements and OTC drugs., Results: The regular use of nonprescription drugs was reported by 32.5% of patients. Vitamins were the most commonly used dietary supplements in elderly patients. Female sex, higher educational qualifications, and good economic status were identified as predictors for the use of nonprescription medications. Concurrent use of nonprescription medications with more than 5 prescription medications was detected in 12.2% of participants. The disclosure rate of the use of nonprescription medications by patients to the physician was 30.3%., Conclusion: The use of dietary supplements and OTC drugs was common in elderly patients with chronic diseases, and its use is associated with sex, education, and economic status. General practitioners (GPs) need to recognize the potential use of nonprescription medications, considering that polypharmacy was common and disclosure rate was low in this study.

Aim: The use of potentially inappropriate medications (PIMs) for older patients is a major public health problem. However, there is little information regarding PIMs in Japanese primary care settings, and the association between psychological problems and PIMs is unknown. The present study was carried out to explore the prevalence of PIMs among older patients in a primary care setting in Tokyo, and to assess the association between PIMs and depression and anxiety., Methods: A cross-sectional study in a Japanese outpatient clinic providing primary care was carried out. Data were collected from January 2016 to March 2016. A total of 740 patients aged ≥65 years with chronic diseases were enrolled. Information regarding sociodemographic status, comorbidities, and prescription and psychological status was collected using a questionnaire that patients were required to complete, and by reviewing the patients' medical records., Results: The Screening Tool of Older Person's Prescriptions criteria version 2 revealed PIM prescription for 32.3% of patients. Benzodiazepines, hypnotic Z-drugs and proton pump inhibitors accounted for a majority of PIMs. After adjusting for age, sex, comorbidities, estimated glomerular filtration rate and the number of medications, anxiety was identified as a predictor for PIMs., Conclusions: PIMs among older patients are common in Japanese primary care settings, and prescription of benzodiazepines or hypnotic Z-drugs and proton pump inhibitors was frequent as PIMs. PIMs might be associated with anxiety; therefore, their association should be focused on and addressed to reduce PIMs. Geriatr Gerontol Int 2017; 17: 2520-2526., (© 2017 Japan Geriatrics Society.)

We report on an 84-year-old woman with anteroseptal acute myocardial infarction. Emergency coronary angiography revealed the occlusion of proximal left anterior descending artery without collateral circulation, and percutaneous coronary intervention was performed. Two drug eluting stents were implanted, and the procedure was concluded with thrombolysis in myocardial infarction grade 3 without complications. Postoperatively, no murmur was audible on auscultation and no shunt flow was observed on transthoracic echocardiography (TTE), and normal blood pressure was maintained. On day 2, however, the patient's vital signs deteriorated to a state of shock and systolic murmur appeared at the apical region. TTE showed a left-to-right shunt in the apical septal region, and ventricular septal perforation was diagnosed. Although emergency surgery was considered, the patient's vital signs improved the following day. The disappearance of the cardiac murmur and the shunt was confirmed. The clinical course was uneventful thereafter, and the patient was discharged., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

We report a 55-year-old man who experienced proximal muscle weakness accompanied by the atrial flutter (AFL) with 1:1 conduction. Detailed examination revealed elevated antimitochondrial antibodies (AMA) and creatine kinase (CK). AFL was converted to sinus rhythm by cardioversion. He was diagnosed as AMA-positive myositis-associated AFL and was treated by prednisolone. Although his muscle weakness and CK level improved, AFL with 1:1 conduction reappeared. Therefore, radiofrequency catheter ablation (RFCA) was needed to treat the AFL, resulting in maintenance of sinus rhythm. This case report describes cardiac involvement in a patient with AMA-positive myositis., (2017 BMJ Publishing Group Ltd.)