Giant multiple caloric effects in charge transition ferrimagnet

磁場と圧力でマルチに冷却可能な酸化物新材料 --フェリ磁性電荷転移酸化物におけるマルチ熱量効果の実証--. 京都大学プレスリリース. 2021-06-22.Caloric effects of solids can provide us with innovative refrigeration systems more efficient and environment-friendly than the widely-used conventional vapor-compression cooling systems. Exploring novel caloric materials is challenging but critically important in developing future technologies. Here we discovered that the quadruple perovskite structure ferrimagnet BiCu₃Cr₄O₁₂ shows large multiple caloric effects at the first-order charge transition occurring around 190 K. Large latent heat and the corresponding isothermal entropy change, 28.2 J K⁻¹ kg⁻¹, can be utilized by applying both magnetic fields (a magnetocaloric effect) and pressure (a barocaloric effect). Adiabatic temperature changes reach 3.9 K for the 50 kOe magnetic field and 4.8 K for the 4.9 kbar pressure, and thus highly efficient thermal controls are achieved in multiple ways

Outcomes of robot-assisted partial nephrectomy in the treatment of renal cell carcinoma at Kawasaki Medical School Hospital

　Robot-assisted partial nephrectomy (RAPN) was introduced in our hospital for treating small renal cell carcinoma in May 2018; we examined treatment outcomes in 24 patients (25 kidneys) who had undergone this procedure till 2019. The median observation period was 11 months (range, 1-17 months). The patients’ age range was 43-77 years (median, 68 years). Fourteen men and 10 women underwent the procedure. Their BMI was 17.9-39.7 (median, 24.1) kg/m2 . In one patient, RAPN was performed twice at different times for treating bilateral renal cancer. The right kidney was affected in 12 cases and the left kidney in 13 cases. The clinical cancer stage was T1a in 20 cases and T1b in 5 cases. Tumor sizes were 0.9-6.2 cm (median, 2.5 cm), and RENAL nephrometry scores were 4-10 (median, 7). The transperitoneal approach was used in 22 cases, and the retroperitoneal approach in 3. The operating durations were 147-358 min (median, 225 min), console durations were 59-394 min (median, 152 min), and renal ischemia durations were 8-54 min (median, 21 min). Blood loss was 10-700 ml (median 10 ml), and none of the patients underwent blood transfusion. The histopathological analysis of the resected tumors revealed clear cell renal cell carcinoma in 20 cases, chromophobe renal cell carcinoma in 2 cases, and papillary renal cell carcinoma, angiomyolipoma, and leiomyoma in 1 case each. All margins were negative. The postoperative hospital stay lengths were 5-14 days (median, 9 days). The postoperative deterioration in renal function was mild, and there were no severe complications. In the early stages after its introduction, RAPN was safely performed and allowed for the preservation of renal function. We plan to continue studying more cases going forward

Treatment outcomes of laparoscopic radical prostatectomy at Kawasaki Medical School Hospital

　Laparoscopic radical prostatectomy (LRP) was carried out in 196 patients with prostate cancer between December 2009 and November 2017 at Kawasaki Medical School Hospital, and the therapeutic outcomes were assessed. An extraperitoneal approach was used in all cases except 1 and the median follow-up period was 55 months (range, 10-117 months). The median patient age was 69 years (range, 56-79 years), median body mass index was 23.3 kg/m2 (range, 15.2-33.2 kg/m2 ), and median prostate-specific antigen (PSA) level at diagnosis was 7.4 ng/mL (range, 2.2-42.0 ng/mL). Clinical stages of T1c, T2a, T2b, T2c, T3a, and T3b accounted for 63, 43, 31, 57, 1, and 1 case, respectively, while Gleason scores at biopsy of ≥ 6, 7, and ≥ 8 accounted for 26, 138, and 32 cases, respectively. The median prostate volume was 22.0 mL (range, 7.3-65.6 mL), median operating time was 266 minutes (range, 142-540 minutes), and median blood loss (including in urine) was 650 mL (range, 10-5,800 mL). During the initial induction period, 94 patients received autologous blood transfusion and 7 received allogeneic blood transfusion. Nerve-sparing prostatectomy was performed in 17 cases (bilateral in 3, unilateral in 14). Capsular invasion was observed in 57 cases (29.1%) and positive resection margins were observed in 51 cases (26.4%). The median indwelling catheter duration was 6 days (range, 4-26 days) and the median hospital stay after surgery was 11 days (range, 8-34 days). The main complications were intraoperative rectal injury in 7 cases (3.6%), postoperative inguinal hernia in 28 (14.3%), and urethral stenosis in 8 (4.1%). The rate of urinary incontinence at ≥ 1 year after surgery was 32.7% and the rate of PSA recurrence was 15.8%. The overall survival rate was 95.6% at 5 years and 94.7% at 10 years. In conclusion, the oncological outcomes were similar to that reported by previous reports, but postoperative stress urinary incontinence and complications were slightly worse. In the future, further improvement of the surgical technique was desired

形態学的に骨髄腫細胞との鑑別に苦慮した plasmacytoid な形態を示した膀胱癌の多発骨転移の１例

　尿路上皮癌には，腫瘍細胞が形質細胞に酷似した形態を呈することがある．今回，形態学的に骨髄腫細胞との鑑別に苦慮したplasmacytoid な形態を示した膀胱癌の骨髄転移の一例を経験したので報告する．　症例は80歳代男性で，20XX 年10月に蛋白尿と腎機能障害が出現し，精査にて多発性骨髄腫（IgG-λ），ISS Ⅱ期と診断され，BD 療法（bortezomib+dexamethasone）を開始した．効果は良好で，３コース施行後にはVGPR（very good partial response）に到達した．20XX ＋１年２月間歇的に認めていた血尿の精査を行い，細胞診や膀胱鏡検査から膀胱癌の併発を確認した．骨髄腫治療は中断し，膀胱癌治療を優先した．PET/CT 検査ではリンパ節やその他臓器への転移は認めず，６月に膀胱全摘術が施行された．術後は経過良好であったため，全身状態の回復を待ち，骨髄腫治療を再開する予定であった．しかし，９月末頃から腰痛が出現し，10月には腰痛の増強を認めたため再度PET/CT 検査を施行したところ，多発する骨髄病変を認めた．骨髄腫の増悪を疑い骨髄検査を施行した．骨髄穿刺塗沫標本では，形質細胞様の異形細胞を多数認め，骨髄腫の増悪を推測させる所見であった．しかし同時に施行された骨髄腫関連検査では，IgG やその他の免疫グロブリンは正常であり，蛋白分画や免疫固定法でもM 蛋白は検出されなかった．骨髄生検の病理組織学的検査の結果，形質細胞様の異形細胞は尿路上皮系の腫瘍細胞であり，膀胱癌の骨転移と診断された．PET/CT 検査での多発骨髄病変は，多発性骨髄腫の増悪ではなく，膀胱癌の多発骨転移であった．　膀胱全摘後の再発は，遠隔転移が20～50% と遠隔転移が多く，遠隔転移部位として骨，リンパ節，肺，肝の順に多いと報告されている．そのため，骨髄塗抹標本検鏡の際，遭遇する可能性があり，骨髄腫細胞と見誤らないためには，免疫染色を含めた組織学的な検討，血清・尿の蛋白解析が必須と考えられた．　Urothelial cancer cells may appear similar to plasma cells. We present a case of plasmacytoid bladder cancer with bone marrow metastasis and difficult morphological differentiation from myeloma. A male in his 80s presented with proteinuria and renal dysfunction in October 20XX. Detailed examination led to a diagnosis of International Staging System Stage II multiple myeloma (IgG-λ), and BD (bortezomib + dexamethasone) therapy was started. Three courses of treatment resulted in a very good partial response. Intermittent hematuria was observed in February 20XX+1, and cytodiagnosis and cystoscopy confirmed bladder cancer. Myeloma treatment was discontinued, and treatment of bladder cancer was prioritized. There was no metastasis to lymph nodes or other organs on positron emission tomography-computed tomography (PET/CT) and cystectomy was performed in June. The postoperative course was good, and myeloma treatment was to resume once the patient had improved. However, in late September, he developed lower back pain that intensified in October. Repeat PET/ CT confirmed multiple bone marrow lesions. Exacerbation of myeloma was suspected. Bone marrow aspiration confirmed multiple plasma cell-like atypical cells, indicating exacerbation of myeloma. However, other myeloma-related tests performed at the same time, including IgG and immunoglobulins, were normal, and M protein was not detected on protein fractionation or immunofixation. Histopathological examination of a bone marrow biopsy showed that plasma cell-like atypical cells were urothelial tumor cells, and bone metastasis from bladder cancer was diagnosed. Multiple bone marrow lesions found on PET/CT were not an exacerbation of multiple myeloma but instead were multiple bone metastases from bladder cancer.　Recurrence following cystectomy has a high prevalence of distant metastasis (20 to 50%), and distant metastasis sites include bones, lymph nodes, lungs, and liver in the order of prevalence. Therefore, bone marrow aspiration and histological examination with immunostaining, in addition to serum and urine protein analysis are essential to prevent confusion with myeloma cells

Ferromagnetic amorphous oxides in the EuO-TiO[2] system studied by the Faraday effect in the visible region and the x-ray magnetic circular dichroism at the Eu M[4,5] and L[2,3] edges

Amorphous Eu[2]TiO[4] and EuTiO[3] have been studied by a combination of the Faraday effect in the visible region and polarization-dependent x-ray absorption spectroscopy at the Eu M[4, 5] and L[2, 3]edges to examine the role of Eu 4f-5d exchange interactions on the ferromagnetic behavior. The bulk-sensitive x-ray absorption spectra (XAS) for Eu L[2, 3] edges show that most of the europium ions are present as the divalent state in the amorphous Eu[2]TiO[4] and EuTiO[3]. The Eu M[4, 5] edge x-ray magnetic circular dichroism (XMCD) signals, measured for the amorphous Eu[2]TiO[4], dramatically increase upon cooling through the Curie temperature (16 K) determined by a superconducting quantum interference device (SQUID) magnetometer. Sum-rule analysis of the XMCD at Eu M4, 5edges measured at 10 K yields a 4f spin magnetic moment of 6.6μB per Eu[2+] ion. These results confirm that the ferromagnetic properties exclusively arise from 4f spins of Eu[2+]. In addition, for both the amorphous Eu[2]TiO[4] and EuTiO[3], the temperature and magnetic-field dependence of Eu L[2, 3]edge XMCD signals can be scaled with the corresponding magnetization measured by SQUID, indicating that the 5d magnetic polarization of Eu[2+] is involved in the process to cause the ferromagnetic interaction between Eu[2+] ions. We further discuss the origin of ferromagnetism in the amorphous system on the basis of the energy diagram of Eu 4f and 5d levels deduced from the Faraday effect in the visible region. From the wavelength dependence of Faraday rotation angles of the amorphous EuO-TiO[2] system in comparison with those of the divalent Eu chalcogenides as reported previously, it is found that the magnitude of crystal-field splitting of Eu 5d levels in the former is on the same order as that in the latter, which explains an enhanced ferromagnetic exchange interaction between Eu 4f and 5d states

Single-Session Impact of High-Power Laser with Moses Technology for Lower Pole Stones in Retrograde Intrarenal Surgery: Retrospective Study

Background: This study aimed to evaluate the efficacy of a high-power holmium laser with Moses technology (MT) for the treatment of lower pole stones during retrograde intrarenal surgery (RIRS). Methods: Herein, 305 patients with lower pole stones who underwent RIRS using a high-power holmium laser with MT were retrospectively classified into the stone-free (SF) and non-SF groups. We measured the stone burden, stone volume, stone hardness, pre- or post-operative stent placement, infundibulopelvic angle (IPA), infundibular width (IW), infundibular length (IL), and calyceal pelvic height in terms of pelvicalyceal anatomy using retrograde pyelograms and evaluated the predictive factors of postoperative SF. Results: A total of 173 (56.7%) and 229 (75.1%) patients achieved a SF status on postoperative day one and at one month, respectively. Operation time in the SF group was shorter than that in the non-SF group (51.0 vs. 74.5 min). There were no significant differences in postoperative complications between the SF and non-SF groups. Significantly predictive risk factors in postoperative SF included total stone volume (odds ratio (OR), 1.056; 95% CI, 1.015–1.099; p = 0.007), IPA (OR, 0.970; 95% CI, 0.956–0.993; p = 0.009), and IW (OR, 0.295; 95% CI, 0.121–0.718; p = 0.007). The cut-off values of stone volume, IPA, and IW were 515.2 mm3, 46.8°, and 7.75 mm, respectively. Conclusions: A high-power holmium laser with MT in lower pole stones is a valuable option for positive outcomes and patient’s safety. Larger stone volume, acute IPA, and narrow IW were negative predictors related to postoperative SF status

Treatment outcomes of laparoscopic radical prostatectomy at Kawasaki Medical School Hospital

Regular Articlejournal articl