Intermittent chemotherapy plus either intermittent or continuous cetuximab for first-line treatment of patients with KRAS wild-type advanced colorectal cancer (COIN-B): a randomised phase 2 trial

Background: Advanced colorectal cancer is treated with a combination of cytotoxic drugs and targeted treatments. However, how best to minimise the time spent taking cytotoxic drugs and whether molecular selection can refine this further is unknown. The primary aim of this study was to establish how cetuximab might be safely and effectively added to intermittent chemotherapy.

Methods: COIN-B was an open-label, multicentre, randomised, exploratory phase 2 trial done at 30 hospitals in the UK and one in Cyprus. We enrolled patients with advanced colorectal cancer who had received no previous chemotherapy for metastases. Randomisation was done centrally (by telephone) by the Medical Research Council Clinical Trials Unit using minimisation with a random element. Treatment allocation was not masked. Patients were assigned (1:1) to intermittent chemotherapy plus intermittent cetuximab or to intermittent chemotherapy plus continuous cetuximab. Chemotherapy was FOLFOX (folinic acid and oxaliplatin followed by bolus and infused fluorouracil). Patients in both groups received FOLFOX and weekly cetuximab for 12 weeks, then either had a planned interruption (those taking intermittent cetuximab) or planned maintenance by continuing on weekly cetuximab (continuous cetuximab). On RECIST progression, FOLFOX plus cetuximab or FOLFOX was recommenced for 12 weeks followed by further interruption or maintenance cetuximab, respectively. The primary outcome was failure-free survival at 10 months. The primary analysis population consisted of patients who completed 12 weeks of treatment without progression, death, or leaving the trial. We tested BRAF and NRAS status retrospectively. The trial was registered, ISRCTN38375681.

Findings: We registered 401 patients, 226 of whom were enrolled. Results for 169 with KRAS wild-type are reported here, 78 (46%) assigned to intermittent cetuximab and 91 (54%) to continuous cetuximab. 64 patients assigned to intermittent cetuximab and 66 of those assigned to continuous cetuximab were included in the primary analysis. 10-month failure-free survival was 50% (lower bound of 95% CI 39) in the intermittent group versus 52% (lower bound of 95% CI 41) in the continuous group; median failure-free survival was 12·2 months (95% CI 8·8–15·6) and 14·3 months (10·7–20·4), respectively. The most common grade 3–4 adverse events were skin rash (21 [27%] of 77 patients vs 20 [22%] of 92 patients), neutropenia (22 [29%] vs 30 [33%]), diarrhoea (14 [18%] vs 23 [25%]), and lethargy (20 [26%] vs 19 [21%]).

Interpretation: Cetuximab was safely incorporated in two first-line intermittent chemotherapy strategies. Maintenance of biological monotherapy, with less cytotoxic chemotherapy within the first 6 months, in molecularly selected patients is promising and should be validated in phase 3 trials.

Investigation of the solid-liquid phase transition of carbon at 150 GPa with spectrally resolved X-ray scattering

We have resolved the solid-liquid phase transition of carbon at pressures around 150GPa. High-pressure samples of different temperatures were created by laser-driven shock compression of graphite and varying the initial density from 1.30g/cm³ to 2.25g/cm³. In this way, temperatures from 5700K to 14,500K could be achieved for relatively constant pressure according to hydrodynamic simulations. From measuring the elastic X-ray scattering intensity of vanadium K-alpha radiation at 4.95keVat a scattering angle of 126°, which is very sensitive to the solid-liquid transition, we can determine whether the sample had transitioned to the fluid phase. We find that samples of initial density 1.3g/cm³ and 1.85g/cm³ are liquid in the compressed states, whereas samples close to the ideal graphite crystal density of 2.25g/cm³ remain solid, probably in a diamond-like state.

Pilot tone reference-less phase conjugator for phase modulated retrodirective antenna applications

This letter presents a simple tracking phased locked loop (PLL) that can be used to track phase-modulated signals and provide a phase-conjugated signal for retrodirective retransmission. The configuration allows the retrodirective antenna to directly track phase-modulated signals with no requirement for a separate continuous wave (CW) pilot tone. The ability to directly track phase-modulated signals is carried out using a 4× multiplier on the tracking PLL reference signal. Practical phase conjugation results are presented for a five-element retrodirective array simultaneously sending and receiving phase-modulated (QPSK) signals. Signals with levels as low as -122 dBm can be phase-conjugated and retransmitted with 30 dBm EIRP.

Micromechanical analysis of cohesive granular materials using the discrete element method with an adhesive elasto-plastic contact model

An adhesive elasto-plastic contact model for the discrete element method with three dimensional non-spherical particles is proposed and investigated to achieve quantitative prediction of cohesive powder flowability. Simulations have been performed for uniaxial consolidation followed by unconfined compression to failure using this model. The model has been shown to be capable of predicting the experimental flow function (unconfined compressive strength vs. the prior consolidation stress) for a limestone powder which has been selected as a reference solid in the Europe wide PARDEM research network. Contact plasticity in the model is shown to affect the flowability significantly and is thus essential for producing satisfactory computations of the behaviour of a cohesive granular material. The model predicts a linear relationship between a normalized unconfined compressive strength and the product of coordination number and solid fraction. This linear relationship is in line with the Rumpf model for the tensile strength of particulate agglomerate. Even when the contact adhesion is forced to remain constant, the increasing unconfined strength arising from stress consolidation is still predicted, which has its origin in the contact plasticity leading to microstructural evolution of the coordination number. The filled porosity is predicted to increase as the contact adhesion increases. Under confined compression, the porosity reduces more gradually for the load-dependent adhesion compared to constant adhesion. It was found that the contribution of adhesive force to the limiting friction has a significant effect on the bulk unconfined strength. The results provide new insights and propose a micromechanical based measure for characterising the strength and flowability of cohesive granular materials. 

Extent and mechanism of phase separation during the extrusion of calcium phosphate pastes

The aim of this study was to increase understanding of the mechanism and dominant drivers influencing phase separation during ram extrusion of calcium phosphate (CaP) paste for orthopaedic applications. The liquid content of extrudate was determined, and the flow of liquid and powder phases within the syringe barrel during extrusion were observed, subject to various extrusion parameters. Increasing the initial liquid-to-powder mass ratio, LPR, (0.4-0.45), plunger rate (5-20 mm/min), and tapering the barrel exit (45°-90°) significantly reduced the extent of phase separation. Phase separation values ranged from (6.22 ± 0.69 to 18.94 ± 0.69 %). However altering needle geometry had no significant effect on phase separation. From powder tracing and liquid content determination, static zones of powder and a non-uniform liquid distribution was observed within the barrel. Measurements of extrudate and paste LPR within the barrel indicated that extrudate LPR remained constant during extrusion, while LPR of paste within the barrel decreased steadily. These observations indicate the mechanism of phase separation was located within the syringe barrel. Therefore phase separation can be attributed to either; (1) the liquid being forced downstream by an increase in pore pressure as a result of powder consolidation due to the pressure exerted by the plunger or (2) the liquid being drawn from paste within the barrel, due to suction, driven by dilation of the solids matrix at the barrel exit. Differentiating between these two mechanisms is difficult; however results obtained suggest that suction is the dominant phase separation mechanism occurring during extrusion of CaP paste.

Optimizing the embedded heaters position in the pultrusion process using finite element analysis

This study is based on a previous experimental work in which embedded cylindrical heaters were applied to a pultrusion machine die, and resultant energetic performance compared with that achieved with the former heating system based on planar resistances. The previous work allowed to conclude that the use of embedded resistances enhances significantly the energetic performance of pultrusion process, leading to 57% decrease of energy consumption. However, the aforementioned study was developed with basis on an existing pultrusion die, which only allowed a single relative position for the heaters. In the present work, new relative positions for the heaters were investigated in order to optimize heat distribution process and energy consumption. Finite Elements Analysis was applied as an efficient tool to identify the best relative position of the heaters into the die, taking into account the usual parameters involved in the process and the control system already tested in the previous study. The analysis was firstly developed with basis on eight cylindrical heaters located in four different location plans. In a second phase, in order to refine the results, a new approach was adopted using sixteen heaters with the same total power. Final results allow to conclude that the correct positioning of the heaters can contribute to about 10% of energy consumption reduction, decreasing the production costs and leading to a better eco-efficiency of pultrusion process.

Processos de avaliação dos pavimentos rodoviários: Caso de estudo: reforço do pavimento em dois trechos do sublanço Enxara/Torres Vedras Sul

Relatório de Estágio Curricular para obtenção do grau de Mestre em Engenharia Civil na Área de Especialização de Vias de Comunicação e Transportes

Signification de l’expérience de la phase palliative du cancer, pour des personnes atteintes et leurs familles des Baléares, alors que le pronostic leur est connu

Le cancer est considéré comme l’une des principales causes de morbidité et de mortalité et, en Espagne, représente à lui seul 25% du taux de mortalité globale. Lorsqu’une personne et sa famille font l’expérience de traverser la phase avancée du cancer, celles-ci vivent un grand choc émotionnel où les souffrances physique, psychique et spirituelle peuvent être présentes. L’information donnée par les professionnels de la santé aux membres de la famille, incluant la personne atteinte, en ce qui concerne le diagnostic et le pronostic du cancer est maintenant plus fréquente dans le contexte méditerranéen. Il n'est pas clair, toutefois, comment cette nouvelle approche est vécue par les familles. C’est pourquoi, le but de cette recherche qualitative de type phénoménologique est d’explorer la signification de l’expérience de familles dont l’un des membres est atteint d’un cancer terminal, alors que tous connaissent le pronostic de la maladie. Les résultats obtenus reposent sur l’analyse en profondeur d’entrevues réalisées auprès de quatre couples. L’analyse des données, à l’aide de la méthode phénoménologique de Giorgi (1997), fait émerger deux thèmes centraux caractérisant la signification de cette expérience de la phase palliative de cancer, alors que l’information sur le mauvais pronostic est connue tant par la personne atteinte que sa famille. Le premier thème central est celui de vivre intensément la perte de la vie rêvée et comporte le vécu suite au choc du pronostic fatal, le fait de vivre constamment des sentiments et des émotions liés à différentes pertes telles que la tristesse, la frustration, l’inquiétude et l’incertitude, et l’espoir de ne pas souffrir. Le deuxième thème central qui ressort est le développement de stratégies par les couples participants afin de rendre leur vie plus supportable. Ces stratégies sont les suivantes : accueillir l’information et le soutien professionnel, retrouver une certaine normalité dans la vie quotidienne, profiter de la vie, recevoir l’aide de la famille et des amis, maintenir une communication cognitive et instrumentale ouverte, se protéger au niveau émotionnel et envisager l’avenir sans la personne aimée. Tous ces éléments, dans le contexte individuel de vie de chaque famille transforment chacun de ces vécus en une expérience unique qui doit être comprise et respectée comme telle par tous les professionnels de la santé impliqués. Les connaissances développées par cette recherche permettront aux infirmières de mieux comprendre l’expérience de la phase palliative du cancer pour des couples dont le diagnostic et le pronostic fatal sont connus par tous, ceci afin d’améliorer leur qualité des soins. Afin de poursuivre le développement du savoir infirmier, il est recommandé de poursuivre des études afin d’explorer plus en profondeur la communication au sein des couples.

La structure de Jordan des matrices de transfert des modèles de boucles et la relation avec les hamiltoniens XXZ

Les modèles sur réseau comme ceux de la percolation, d’Ising et de Potts servent à décrire les transitions de phase en deux dimensions. La recherche de leur solution analytique passe par le calcul de la fonction de partition et la diagonalisation de matrices de transfert. Au point critique, ces modèles statistiques bidimensionnels sont invariants sous les transformations conformes et la construction de théories des champs conformes rationnelles, limites continues des modèles statistiques, permet un calcul de la fonction de partition au point critique. Plusieurs chercheurs pensent cependant que le paradigme des théories des champs conformes rationnelles peut être élargi pour inclure les modèles statistiques avec des matrices de transfert non diagonalisables. Ces modèles seraient alors décrits, dans la limite d’échelle, par des théories des champs logarithmiques et les représentations de l’algèbre de Virasoro intervenant dans la description des observables physiques seraient indécomposables. La matrice de transfert de boucles D_N(λ, u), un élément de l’algèbre de Temperley- Lieb, se manifeste dans les théories physiques à l’aide des représentations de connectivités ρ (link modules). L’espace vectoriel sur lequel agit cette représentation se décompose en secteurs étiquetés par un paramètre physique, le nombre d de défauts. L’action de cette représentation ne peut que diminuer ce nombre ou le laisser constant. La thèse est consacrée à l’identification de la structure de Jordan de D_N(λ, u) dans ces représentations. Le paramètre β = 2 cos λ = −(q + 1/q) fixe la théorie : β = 1 pour la percolation et √2 pour le modèle d’Ising, par exemple. Sur la géométrie du ruban, nous montrons que D_N(λ, u) possède les mêmes blocs de Jordan que F_N, son plus haut coefficient de Fourier. Nous étudions la non diagonalisabilité de F_N à l’aide des divergences de certaines composantes de ses vecteurs propres, qui apparaissent aux valeurs critiques de λ. Nous prouvons dans ρ(D_N(λ, u)) l’existence de cellules de Jordan intersectorielles, de rang 2 et couplant des secteurs d, d′ lorsque certaines contraintes sur λ, d, d′ et N sont satisfaites. Pour le modèle de polymères denses critique (β = 0) sur le ruban, les valeurs propres de ρ(D_N(λ, u)) étaient connues, mais les dégénérescences conjecturées. En construisant un isomorphisme entre les modules de connectivités et un sous-espace des modules de spins du modèle XXZ en q = i, nous prouvons cette conjecture. Nous montrons aussi que la restriction de l’hamiltonien de boucles à un secteur donné est diagonalisable et trouvons la forme de Jordan exacte de l’hamiltonien XX, non triviale pour N pair seulement. Enfin nous étudions la structure de Jordan de la matrice de transfert T_N(λ, ν) pour des conditions aux frontières périodiques. La matrice T_N(λ, ν) a des blocs de Jordan intrasectoriels et intersectoriels lorsque λ = πa/b, et a, b ∈ Z×. L’approche par F_N admet une généralisation qui permet de diagnostiquer des cellules intersectorielles dont le rang excède 2 dans certains cas et peut croître indéfiniment avec N. Pour les blocs de Jordan intrasectoriels, nous montrons que les représentations de connectivités sur le cylindre et celles du modèle XXZ sont isomorphes sauf pour certaines valeurs précises de q et du paramètre de torsion v. En utilisant le comportement de la transformation i_N^d dans un voisinage des valeurs critiques (q_c, v_c), nous construisons explicitement des vecteurs généralisés de Jordan de rang 2 et discutons l’existence de blocs de Jordan intrasectoriels de plus haut rang.

Ultrasonic Study Of The Elastic Properties And Phase Transitions In Selected Mixed Sulphate Crystals

The thesis investigated the elastic properties and phase transitions in selected mixed sulphate crystals – Lithium Hydrazinium Sulphate [LiN2H2SO4], Lithium Ammonium Sulphate [LiNH4SO4] and Lithium Potassium Sulphate [LiKSO4] – using ultrasonic technique. The pulse echo overlap technique has been used for measuring ultrasonic velocity and its dependence on temperature along different directions with waves of longitudinal and transverse polarizations. Two major numerical techniques and the corresponding computer programs developed as part of present work are presented in this thesis. All the 9 elastic constants of LHS are determined accurately from ultrasonic measurements and applying misorientation correction refines the constants. Ultrasonic measurements are performed in LAS to determine the elastic constants and to study the low temperature phase transitions. Temperature variation studies of elastic constant of LAS are performed for 6 different modes of propagation for heating and cooling at low temperatures. All the 5 independent elastic constants of LPS is determined using ultrasonic measurements. It is concluded that LPS crystal does not undergo a phase transition near this temperature. A comparison of the three crystals studied shows that LPS has maximum number of phase transitions and LHS has the least number. It is interesting to note that LPS has the simplest formula unit among the three. There is considerable scope for the future work on these crystals and others belonging to the sulphate family.

Phase transitions in lithium ammonium sulfate below room temperature: An ultrasonic study

A detailed ultrasonic study of the elastic properties of lithium ammonium sulfate ~LiNH4SO4! or LAS has been carried out below room temperature. The elastic constants of LAS at room temperature are reported. The discrepancy present in earlier elastic constant data associated with the different choice of axes for this orthorhombic system are clarified. The results of the temperature variation study down to 220 K confirm the ferroelastic phase transition at 285 K and establish a thermal hysteresis of about 2.5 K between the cooling and heating cycles. Results of the investigation on the suspected weak phase transition at 256 K suggest that this transition occurs at 242 K on cooling and at 256 K on heating, thus having a thermal hysteresis of about 14 K. However, since the observed elastic anomaly for this transition is very small, the nature of this transition still remains unclear

Elastic constant measurements of super ionic LiKSO4:Na single crystals

Elastic properties of sodium doped Lithium potassium sulphate, LiK0.9Na0.1SO4, crystal has been studied by ultrasonic Pulse Echo Overlap [PEO] technique and are reported for the first time. The controversy regarding the type of crystal found while growth is performed at 35 °C with equimolar fraction of Li2SO4H2O, K2SO4 and Na2SO4 has been resolved by studying the elastic properties. The importance of this crystal is that it exhibits pyroelectric, ferroelectric and electro optic properties. It is simultaneously ferroelastic and superionic. The elastic properties of LiK0.9Na0.1SO4 crystal are well studied by measuring ultrasonic velocity in the crystal in certain specified crystallographic directions and evaluating the elastic stiffness constants, compliance constants and Poisson’s ratios. The anisotropy in the elastic properties of the crystal are well explained by the pictorial representation of the surface plots of phase velocity, slowness and linear compressibility in a-b and a-c planes.

High‐temperature phase transitions in pure and deuterated ammonium dihydrogen phosphate: Conductivity and dielectric measurements

Results of axiswise measurements of the electrical conductivity (dc and ac) and dielectric constant of NH4H2PO4 confirm the occurrence of the recently suggested high‐temperature phase transition in this crystal (at 133 °C). The corresponding transition in ND4D2PO4 observed here for the first time takes place at 141.5 °C. The mechanism involved in these transitions and those associated with the electrical conduction and dielectric anomalies are explained on the basis of the motional effects of the ammonium ions in these crystals. Conductivity values for deuterated crystals give direct evidence for the predominance of protonic conduction throughout the entire range of temperatures studied (30–260 °C).

Electrical properties and phase transitions in ethylenediammonium dinitrate

dc and ac electrical conductivities, dielectric constant and dielectric loss factor in single crystals of ethylenediammonium dinitrate (EDN) have been measured axiswise as a function of temperature. All the above properties exhibit anomalous variations at 404 K thereby confirming the occurence of a phase transition in EDN at this temperature. Electrical conductivity parameters have been evaluated and possible conduction mechanisms are discussed. The role of protons in electrical trasport phenomenon is established by chemical analysis.

Phase effects on synchronization by dynamical relaying in delay-coupled systems

Synchronization in an array of mutually coupled systems with a finite time delay in coupling is studied using the Josephson junction as a model system. The sum of the transverse Lyapunov exponents is evaluated as a function of the parameters by linearizing the equation about the synchronization manifold. The dependence of synchronization on damping parameter, coupling constant, and time delay is studied numerically. The change in the dynamics of the system due to time delay and phase difference between the applied fields is studied. The case where a small frequency detuning between the applied fields is also discussed.