[A Case of Consciousness Disturbance Due to Hyperammonemia Associated with Urinary Tract Infections].

We describe the case of a patient with hyperammonemia owing to urinary tract infections. The patient, a 66-year-old-woman, was previously diagnosed with bilateral hydronephrosis. She was admitted to the emergency room with macrohematuria and bilateral lumbar pain, which persisted for 2 days. She was hospitalized with the diagnosis of pyelonephritis. Despite antibiotic treatment, she developed sudden disturbance in consciousness on the 2nd day of illness. To improve the hyperammonemia and metabolic acidosis, we initiated continuous hemodiafiltration (CHDF) and urinary drainage by bilateral nephrostomy, after which her consciousness improved, and she was discharged on day 19. For patients with urinary tract infections and who are unaware of disturbance in consciousness, it is important to consider that obstructive urinary tract infections can cause hyperammonemia.

Nearly diffraction-limited hard X-ray line focusing with hybrid adaptive X-ray mirror based on mechanical and piezo-driven deformation.

We have developed the new hybrid adaptive X-ray mirror based on mechanical and piezo-driven deformation to realize precise shape controllability on a long-length mirror. The mechanical bender approximately provides the required ellipse, while the piezoelectric actuators attached to the mirror correct very small residual errors to satisfy the diffraction-limited condition. The mechanical bender significantly reduces the role of the piezoelectric actuator, resulting in the suppression of accuracy degradation due to the drift and/or junction effect of the piezoelectric actuators. In addition, line focusing was demonstrated with two different numerical apertures at SPring-8, and the obtained beam sizes were 127 and 253 nm (FWHM), which agree well with the diffraction-limited sizes.

Generation of apodized X-ray illumination and its application to scanning and diffraction microscopy.

X-ray science has greatly benefited from the progress in X-ray optics. Advances in the design and the manufacturing techniques of X-ray optics are key to the success of various microscopic and spectroscopic techniques practiced today. Here the generation of apodized X-ray illumination using a two-stage deformable Kirkpatrick-Baez mirror system is presented. Such apodized illumination is marked by the suppression of the side-lobe intensities of the focused beam. Thus generated apodized illumination was employed to improve the image quality in scanning X-ray fluorescence microscopy. Imaging of a non-isolated object by coherent X-ray diffractive imaging with apodized illumination in a non-scanning mode is also presented.

Optimal deformation procedure for hybrid adaptive x-ray mirror based on mechanical and piezo-driven bending system.

A hybrid deformable x-ray mirror consisting of a mechanical bender and a bimorph deformable mirror has been developed to realize adaptive optical systems, such as zoom condenser optics, for synchrotron-radiation-based x-ray microscopy. In the developed system, both bending mechanisms comprehensively contribute to the formation of the target mirror shape and can narrow the role of piezoelectric actuators, thereby enabling a more stable operation. In this study, the behavior of the bimorph mirror under the clamped condition was investigated, and the sharing of the deformation amount for each bending mechanism was optimized to minimize the amplitude of the voltage distribution of the bimorph mirror.

Development of a glue-free bimorph mirror for use in vacuum chambers.

PZT (lead zirconate titanate)-glued bimorph deformable mirrors are widely used in hard X-ray regimes; however, they have not yet been used in soft X-ray regimes because they are less compatible for usage under high vacuum. In this study, we developed a glue-free bimorph deformable mirror, in which silver nano-particles were employed to bond PZT actuators to mirror substrates. Under an appropriate bonding condition, the bonding layer was confirmed to be uniform and the mirror's bending characteristics were demonstrated to be sufficiently stable; its gas emission rate was also shown to be acceptable. Piezo responses before and after additional heating at 200 °C showed the thermal stability of its bonding and bending properties.

[CASE REPORT: COMPLETE RESECTION OF RETROPERITONEAL CYSTIC LYMPHANGIOMA AND SURROUNDING ORGANS].

A 65-year-old man was admitted to our institution with vomiting and right flank pain. Computed tomography (CT) imaging showed a 21-cm retroperitoneal multilocular cystic tumor which had been identified four years previously. It had increased from 17 to 21 cm. The initial diagnosis was cystic lymphangioma because it was a clear cystic tumor without a boundary or a solid component in the first CT, but later CT revealed an unclear boundary with surrounding organs suggesting malignancy. We decided to resect the tumor because it was symptomatic and might be malignant. The tumor was then resected along with surrounding organs because invasion was suspected. Pathological findings indicated a diagnosis of cystic lymphangioma with chronic inflammation and confirmed complete resection of the tumor. The patient has remained free of recurrence at one year after surgery. This experience indicates that cystic lymphangioma should be completely resected to prevent recurrence.

Repeated spontaneous migration of ureteral stent in hemiplegia patient during ureteral stone treatment.

A 48-year-old man with a history of cerebral infarction presented with gross hematuria. The patient's limping accompanies twisting trunk on his walking. The diagnosis was right upper ureteral stone. Prior to Extracorporeal shockwave lithotripsy (ESWL) ureteral stent was inserted. After the second ESWL ureteral stent was displaced upwardly without patient's unknown. Retrograde intrarenal surgery (RIRS) was performed for both removal of ureteral stent and fragmentation of residual stone. Spontaneously, post RIRS ureteral stent was migrated upwardly to the same position. Ureteral stent migration is uncommon. Twisting walk may cause the position of ureteral stent upwardly.

Nearly diffraction-limited X-ray focusing with variable-numerical-aperture focusing optical system based on four deformable mirrors.

Unlike the electrostatic and electromagnetic lenses used in electron microscopy, most X-ray focusing optical systems have fixed optical parameters with constant numerical apertures (NAs). This lack of adaptability has significantly limited application targets. In the research described herein, we developed a variable-NA X-ray focusing system based on four deformable mirrors, two sets of Kirkpatrick-Baez-type focusing mirrors, in order to control the focusing size while keeping the position of the focus unchanged. We applied a mirror deformation procedure using optical/X-ray metrology for offline/online adjustments. We performed a focusing test at a SPring-8 beamline and confirmed that the beam size varied from 108 nm to 560 nm (165 nm to 1434 nm) in the horizontal (vertical) direction by controlling the NA while maintaining diffraction-limited conditions.

Hard X-ray nanofocusing using adaptive focusing optics based on piezoelectric deformable mirrors.

An adaptive Kirkpatrick-Baez mirror focusing optics based on piezoelectric deformable mirrors was constructed at SPring-8 and its focusing performance characteristics were demonstrated. By adjusting the voltages applied to the deformable mirrors, the shape errors (compared to a target elliptical shape) were finely corrected on the basis of the mirror shape determined using the pencil-beam method, which is a type of at-wavelength figure metrology in the X-ray region. The mirror shapes were controlled with a peak-to-valley height accuracy of 2.5 nm. A focused beam with an intensity profile having a full width at half maximum of 110 × 65 nm (V × H) was achieved at an X-ray energy of 10 keV.

Experimental and simulation study of undesirable short-period deformation in piezoelectric deformable x-ray mirrors.

To construct adaptive x-ray focusing optics whose optical parameters can be varied while performing wavefront correction, ultraprecise piezoelectric deformable mirrors have been developed. We computationally and experimentally investigated undesirable short-period deformation caused by piezoelectric actuators adhered to the substrate during mirror deformation. Based on the results of finite element method analysis, shape measurements, and the observation of x-ray reflection images, a guideline is developed for designing deformable mirrors that do not have short-period deformation errors.

Single-nanometer focusing of hard x-rays by Kirkpatrick-Baez mirrors.

We have constructed an extremely precise optical system for hard-x-ray nanofocusing in a synchrotron radiation beamline. Precision multilayer mirrors were fabricated, tested, and employed as Kirkpatrick-Baez mirrors with a novel phase error compensator. In the phase compensator, an at-wavelength wavefront error sensing method based on x-ray interferometry and an in situ phase compensator mirror, which adaptively deforms with nanometer precision, were developed to satisfy the Rayleigh criterion to achieve diffraction-limited focusing in a single-nanometer range. The performance of the optics was tested at BL29XUL of SPring-8 and was confirmed to realize a spot size of approximately 7 nm.