Prognostic value of metastatic pattern in colorectal cancer: a multicenter retrospective analysis in a real-life cohort.

BACKGROUND: Metastatic patterns have been linked with prognosis in colorectal cancer. We aim to determine the distribution of metastases, their dynamics during disease and their prognostic impact for specific clinical treatment scenarios (resection of metastasis and/or systemic treatment, best supportive care). MATERIAL AND METHODS: 978 patients diagnosed with metastatic colorectal adenocarcinoma treated at three oncological centers from 2006 to 2018 were included. Overall survival was assessed depending on tumor load, distribution of metastases and treatment of the patients. RESULTS: Most patients had single site metastasis (n = 684; 69.9%): 398 patients had liver (n = 398; 40.7%) and 103 patients had lung only metastasis (10.6%). The number of organs involved in metastases at diagnosis was highly prognostic (HR 0.77; CI 0.65, 0.90), whereas the additional gain of metastases during progression of the disease was not. The majority of patients (62.9-74.2%) with initial lung, liver or both metastases retained their initial metastatic status. In the overall population, lung only metastases were associated with the most favorable outcome (HR 0.64; CI 0.50, 0.81). This was also observed in patients receiving best supportive care (HR 0.45; CI 0.27, 0.75). Resection of lung only metastases resulted in longer median survival (102.2 months). A relevant survival difference in patients treated by systemic therapy alone was not observed. Lung only metastasis was associated with rectal cancer (p < .001) and RAS-mutation (p = .01); both, lung and liver metastasis were associated with time from diagnosis to first metastasis (p < .001). CONCLUSION: The number of organs involved in metastasis at diagnosis but not the total cumulative number of involved organs is of prognostic relevance in colorectal adenocarcinoma. This prognostic relevant initial metastasis distribution remains unchanged in the majority of patients during the disease. However, the prognostic impact of the metastatic pattern is potentially altered by treatment modality.

Real-World Treatment Patterns, Outcomes, Resource Utilization and Costs in Treatment-Resistant Major Depressive Disorder: PATTERN, a Retrospective Cohort Study in Belgium.

OBJECTIVE: Treatment-resistant depression (TRD), a subgroup of major depressive disorder (MDD) that does not adequately respond to treatment, has a substantial impact on the quality of life of patients and is associated with higher medical and mental health care costs. This study aimed to report real-world treatment patterns, outcomes, resource utilization, and costs in the management of TRD by psychiatrists in Belgium. METHODS: We conducted a retrospective, non-interventional cohort study of patients ≥ 18 years, with diagnosed MDD who are treatment-resistant, defined as not responding to two different antidepressant treatments in the current moderate to severe major depressive episode (MDE). Data obtained from medical records of patients included patient health state (MDE, response, remission, and recovery) and resource use (number of consultations and emergency room visits, non-drug and drug interventions, and hospitalizations). RESULTS: One hundred and twenty-five patients were enrolled in nine sites, with an average observation period of 34 months. During the MDE, 89.7% of patients were treated with selective serotonin reuptake inhibitors, 63.2% with serotonin-norepinephrine reuptake inhibitors, and 60.8% with anti-psychotics. Twenty-four percent of patients did not respond to any treatment; 76% responded, of whom 61% experienced a relapse; 28% of patients reached recovery, of whom 31.4% experienced recurrence. The average yearly direct cost of a TRD patient is €9012, mainly driven by hospitalization in the MDE. The observed absenteeism relates to a high indirect cost, representing 70% of the total MDE cost. CONCLUSION: TRD is associated with a high unmet need and economic burden for patients and society, with highest costs in the MDE health state driven by absenteeism.

Phase transformations in Pt/Fe bilayers during post annealing probed by resistometry.

X-ray diffraction (XRD), secondary neutral mass spectrometry (SNMS) depth profiling, and electrical resistivity measurements were used to follow the phase transformations in Pt/Fe bi-layered thin films during annealing. Initially, the electrical resistivity increases linearly with temperature up to 150 °C due to the contribution of phonon scattering of the metallic Pt and Fe bilayer. Further increase of the annealing temperature leads to a steeper linear increase, which is associated with the initial formation of the chemically disordered A1-phase followed by the formation of the chemically ordered L10-FePt phase, as confirmed by XRD and SNMS studies. Finally, at about 620 °C the single L10-FePt phase has formed throughout the film. Moreover, the electrical resistivity contains also the magnetic contribution to the total resistivity. In this case, the loss in magnetic order is indicated by a change in temperature dependence of the resistivity at about 310 °C, representing the Curie temperature of the initially formed A1-FePt alloy, while the finally formed L10-FePt alloy reveals a higher magnetic transition temperature of about 410 °C. In this study, it has been demonstrated that resistometry in combination with structural and chemical analysis provides valuable information on diffusion processes, structural phase formations and its stability range, as well as on the magnetic transition temperature.

[Pathological laughter. A case study]. / Pathologische lach.

SUMMARY: A 22-year-old man sometimes engaged in inappropriate laughter. The affective lability fitted in with the diagnosis of mental retardation and of a personality disorder Not Otherwise Specified. In this brief review of the literature we discuss the neuroanatomy, psychodynamics and phenomenology of pathological laughter. Up till now there have been only a few restricted and fragmentary studies of pathological laughter in psychiatry. Pathological laughter is often a result of organic mental disorders.

Comparative microstructural study of the diffusion zone between NiCr alloy and different dental ceramics.

Our knowledge on the bonding mechanisms between the metal and ceramic parts of dental systems is very limited. This work tested the hypothesis that the details of the interface processes can be described in the framework of a chemical diffusion model. The development of interfacial phases was investigated by cross-sectional analytical transmission electron microscopy between a NiCr (Wiron 99) alloy and three different dental ceramics (Carat, Vita VMK 95, and Vision). All systems were investigated at normal firing conditions (suggested by the manufacturer) and at increased firing times as well. The conclusions are based on the results that the formation of a nanocrystalline Cr(2)O(3) layer and amorphous silicon oxide inclusions were detected in the early stage of the firing process in all investigated systems, and that, in the case of Carat and Vision ceramics, formation of complex NiCr and NiCrTi oxides was also observed at longer annealing times.

[Interface between Ni-Cr alloy and ceramic studied by scanning electron microscopy]. / Ni-Cr ötvözet és kerámia határfelület pásztázó elektronmikroszkópos (PEM) vizsgálata.

In this investigation we observed the interface between Wiron 99 (Bego) dental Ni-Cr alloy and Vision (Wohlwend AG) ceramic opaquer with SEM. In the system there are intermediate phases coming from a solid phase rection which play an essential role in the metal-ceramic bond. The analytical methods showed that in this phases the content of Ni and Cr charge not monotonously from alloy to ceramic which shows strong chemical effects (the selective affinity of Cr and Ni). The concentration of Cr after the alloy surface increases in a 1-1.5 microns layer, where its concentration is higher than at the alloy, while the concentration of Ni decrease in this layer. Than at the ceramic side of the reaction zone the concentration of Ni increases in a 1-1.5 microns wide layer where its concentration is near upon that one in the alloy.

Interface sharpening instead of broadening by diffusion in ideal binary alloys.

We demonstrate, using computer simulations based on deterministic kinetic equations and Monte Carlo technique, that during intermixing in an ideal AB system with an initially wide A/B interface-if the diffusion coefficient D strongly depends on concentration-the interface can become sharp on nanoscale. The sharp interface shifts proportionally with time (in contrast to the square root law). Furthermore, it is also shown that at the beginning of the intermixing in a finite bilayer or in multilayers, the diminution of the concentration gradient takes place by filling up one of the initially pure layers (layer B if D is large there) and by the shift of the sharpening interface.

Structure of magnetic noise in dynamic fracture.

We present an experimental study of magnetic emission spectra recorded during impact fracture of steel. Novel features of dynamic fracture are revealed, i.e., the distribution of the voltage signals of the spectra; furthermore, the areas and energies of voltage peaks exhibit a power law behavior. The value of the exponents of the distributions proved to be characteristic for the failure mode: ductile failure gives rise to exponents significantly higher than brittle failure. The results imply that magnetic crackling noise accompanying impact fracture has a scale invariant structure which reveals new aspects of the dynamics of the fracture process.

Measurement of periapical pressure created by occlusal loading.

AIM: To develop an in vitro model in which the pressure in the periapical tissues can be measured during loading. METHODOLOGY: Extracted human maxillary central incisors were embedded in resin blocks that had physical characteristics similar to those of bone and periodontal ligament. Each tooth was loaded with 20, 40, 50, 60, 75, 85, 100, 200, 300 and 450 N vertical forces from the incisal edge of the crown on three consecutive occasions. A minute resistor embedded in the periapical space was used to detect apical pressure changes during occlusal loading. The ratio of apical pressure changes (DeltaP) to the loading force changes (DeltaF) was calculated. RESULTS: The periapical pressure detected was in direct proportion to the loading force. The mean value of DeltaP/DeltaF was 5.994 kPa N-1 (SD = 2.04). CONCLUSIONS: Direct proportionality was found between the coronal loading and the apical hydrostatic pressure. The DeltaP/DeltaF ratio determined in this study makes it easier to estimate the apical hydrostatic pressure values during occlusal loading of single-rooted teeth. In this study, the apical pressure generated under occlusal loading was the same magnitude as that estimated with the finite element method.