the role of cetuximab in converting initially unresectable colorectal cancer liver metastases for resection

Abstract In patients with metastatic colorectal cancer (mCRC) predominantly confined to the liver, whether a patient undergoes potentially curative resection of the liver lesions is a well-established principal determinant of long-term survival. There are a number of different agents, both chemotherapeutic and targeted biologic agents, which can aid in shrinking liver tumors, which would have otherwise been unresectable, allowing for potentially curative resection. The aim of this review article is to summarize the available evidence regarding optimal therapeutic strategies for converting initially unresectable metastases for potentially curative resection; we do not discuss patients who present with initially resectable disease. We have taken the approach to review trials that included R0 resection rates as one of the principal study endpoints and specifically enrolled patients with liver-limited disease. Primary tumor location has recently emerged as a putative prognostic and predictive factor in patients with mCRC; however, presently, there is a lack of resectability outcomes differentiating tumor location–defined subgroups, and several ongoing trials and retrospective analyses are anticipated to guide insights in the future. In conclusion, in patients with RAS wild-type mCRC, the data support preferential use of the anti-epidermal growth factor receptor monoclonal antibody cetuximab when combined with standard-of-care infusional doublet chemotherapy regimens (FOLFOX or FOLFIRI) for the conversion of initially unresectable metastases for potentially curative resection. Furthermore, we discuss data involving intensified chemotherapy regimens (i.e., 3-drug backbones such as FOLFOXIRI with or without a targeted biologic agent) to promote the conversion of initially unresectable metastases for potentially curative resection

Spin-Boson Hamiltonian and Optical Absorption of Molecular Dimers

An analysis of the eigenstates of a symmetry-broken spin-boson Hamiltonian is performed by computing Bloch and Husimi projections. The eigenstate analysis is combined with the calculation of absorption bands of asymmetric dimer configurations constituted by monomers with nonidentical excitation energies and optical transition matrix elements. Absorption bands with regular and irregular fine structures are obtained and related to the transition from the coexistence to a mixing of adiabatic branches in the spectrum. It is shown that correlations between spin states allow for an interpolation between absorption bands for different optical asymmetries.Comment: 15 pages, revTeX, 8 figures, accepted for publication in Phys. Rev.

Brands in international and multi‐platform expansion strategies: economic and management issues

Powerful media branding has historically facilitated successful international expansion on the part of magazine and other content forms including film and TV formats. Multi-platform expansion is now increasingly central to the strategies of media companies and, as this chapter argues, effective use of branding in order to engage audiences effectively and to secure a prominent presence across digital platforms forms a core part of this. Drawing on original research into the experience of UK media companies, this chapter highlights some of the key economic, management and socio-cultural issues raised by the ever-increasing role of brands and branding in the strategies of international and multi-platform expansion that are increasingly common- place across media

484pretrospective ras analysis of the epic trial cetuximab plus irinotecan vs irinotecan in patients pts with second line metastatic colorectal cancer mcrc

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Class Attendance and Students’ Evaluations of Teaching: Do No-Shows Bias Course Ratings and Rankings?

Background: Many university departments use students’ evaluations of teaching (SET) to compare and rank courses. However, absenteeism from class is often nonrandom and, therefore, SET for different courses might not be comparable. Objective: The present study aims to answer two questions. Are SET positively biased due to absenteeism? Do procedures, which adjust for absenteeism, change course rankings? Research Design: The author discusses the problem from a missing data perspective and present empirical results from regression models to determine which factors are simultaneously associated with students’ class attendance and course ratings. In order to determine the extent of these biases, the author then corrects average ratings for students’ absenteeism and inspect changes in course rankings resulting from this adjustment. Subjects: The author analyzes SET data on the individual level. One or more course ratings are available for each student. Measures: Individual course ratings and absenteeism served as the key outcomes. Results: Absenteeism decreases with rising teaching quality. Furthermore, both factors are systematically related to student and course attributes. Weighting students’ ratings by actual absenteeism leads to mostly small changes in ranks, which follow a power law. Only a few, average courses are disproportionally influenced by the adjustment. Weighting by predicted absenteeism leads to very small changes in ranks. Again, average courses are more strongly affected than courses of very high or low in quality. Conclusions: No-shows bias course ratings and rankings. SET are more appropriate to identify high- and low-quality courses than to determine the exact ranks of average courses

Resistance and resilience of social–ecological systems to recurrent typhoon disturbance on a subtropical island: Taiwan

Tropical cyclones (TCs) have major effects on ecological and social systems. However, studies integrating the effects of TCs on both social and ecological systems are rare, especially in the northwest Pacific, where the frequency of TCs (locally named typhoons) is the highest in the world. We synthesized studies of effects of recurrent typhoons on social and ecological systems in Taiwan over the last several decades. Many responses to TCs are comparable between social and ecological systems. High forest ecosystem resistance, evident from tree mortality below 2% even following multiple strong typhoons, is comparable with resistance of social systems, including the only 4% destruction of river embankments following a typhoon that brought nearly 3000 mm rainfall in three days. High resilience as reflected by quick returns of leaf area index, mostly in one year, and streamwater chemistry, one to several weeks to pre‐typhoon levels of ecosystems, are comparable to quick repair of the power grid within one to several days and returns of vegetable price within several weeks to pre‐typhoon levels of the social systems. Landslides associated with intense typhoons have buried mountain villages and transported large quantities of woody debris to the coast, affecting the coastal plains and reefs, illustrating a ridge‐to‐reef link between ecological and societal systems. Metrics of both social and ecological function showed large fluctuations in response to typhoons but quickly returned to pre‐disturbance levels, except when multiple intense typhoons occurred within a single season. Our synthesis illustrates that the social–ecological systems in Taiwan are highly dynamic and responsive to frequent typhoon disturbance, with extraordinarily high resistance and resilience. For ecosystems, the efficient responsiveness results from the selective force of TCs on ecosystem structure and processes. For social systems, it is the result of the effects of TCs on planning and decision making by individuals (e.g., farmers), management sectors, and ultimately the government. In regions with frequent TCs, the social–ecological systems are inevitably highly dynamic and rapid responses are fundamental to system resistance and resilience which in turn is key to maintaining structure and function of the social–ecological systems

Limiter lock systems at TEXTOR: flexible tools for plasma-wall investigation

Limiter lock systems on the top and the bottom of the TEXTOR vessel are essential elements for experimental investigations of plasma-wall interaction in a tokamak. The lock systems are designed as user facilities that allow the insertion of wall elements (limiter) and tools for diagnostic (electrical probes, gas injection) without breaking the TEXTOR vacuum. The specially designed holder on top of the central carrier and a powerful vacuum pump system permit the exchange of components within similar to1 h. Up to ten electrical signals, four thermocouples, and a gas supply can be connected at the holder interface. Between discharges, the inserted component can be positioned radially and turned with respect to the toroidal magnetic field. Additionally, the central carrier is electrically isolated to apply bias voltages and currents up to 1 kV and 1 kA, respectively.An important feature of the lock system is the good access for optical spectroscopic observation of the inserted components in the vicinity of the edge plasma. The whole spectrum from ultraviolet to infrared is covered by spectrometers and filters combined with cameras. Toroidally and poloidally resolved measurements are obtained front the view on top of the probes while the tangential poloidal view delivers radially and toroidally resolved information.A programmable logic controller (Simatic S5) that is operated inside the TEXTOR bunker and from remote locations outside the concrete wall drives all possible features of the lock system

A compact laboratory transmission X-ray microscope for the water window

In the water window (2.2-4.4 nm) the attenuation of radiation in water is significantly smaller than in organic material. Therefore, intact biological specimen (e.g. cells) can be investigated in their natural environment. In order to make this technique accessible to users in a laboratory environment a Full-Field Laboratory Transmission X-ray Microscope (L-TXM) has been developed. The L-TXM is operated with a nitrogen laser plasma source employing an InnoSlab high power laser system for plasma generation. For microscopy the Ly α emission of highly ionized nitrogen at 2.48 nm is used. A laser plasma brightness of 5 × 1011 photons/(s × sr × μm2 in line at 2.48 nm) at a laser power of 70 W is demonstrated. In combination with a state-of-the-art Cr/V multilayer condenser mirror the sample is illuminated with 106 photons/(μm2 × s). Using objective zone plates 35-40 nm lines can be resolved with exposure times < 60 s. The exposure time can be further reduced to 20 s by the use of new multilayer condenser optics and operating the laser at its full power of 130 W. These exposure times enable cryo tomography in a laboratory environment

Transition from the Couette-Taylor system to the plane Couette system

We discuss the flow between concentric rotating cylinders in the limit of large radii where the system approaches plane Couette flow. We discuss how in this limit the linear instability that leads to the formation of Taylor vortices is lost and how the character of the transition approaches that of planar shear flows. In particular, a parameter regime is identified where fractal distributions of life times and spatiotemporal intermittency occur. Experiments in this regime should allow to study the characteristics of shear flow turbulence in a closed flow geometry.Comment: 5 pages, 5 figure