In all-ceramic restorations involving a zirconia framework, surface treatment of the zirconia surface is required to enhance bonding strength with the veneering ceramics and thus prevent chipping. The purpose of the present study was to investigate the influence of surface roughness and heat treatment of the zirconia and use of liner porcelain on bond strength between veneering ceramics and a zirconia framework. Debonding/crack-initiation strength (b) was determined according to ISO 9693. No significant difference was observed among conditions, except with use of a liner under heat treatment, which yielded a b of 26.0±2.9-28.9±1.7 MPa. Electron probe microanalysis revealed that components of the veneering ceramics remained on the zirconia surface after debonding, suggesting that fractures occur in the veneering ceramics and that improving the strength of the veneering ceramics themselves might increase bond strength.
Introduction
A case of multiple liver metastases of clear cell RCC with a significant response to sunitinib as the fifth line after nivolumab is reported.
Case presentation
The patient was a 65‐year‐old man who underwent open nephrectomy for RCC. After the nephrectomy, he had recurrences several times, and metastasectomy had been performed for each recurrence. At 13 years after the nephrectomy, multiple liver, and lung metastases appeared. The treatment was switched to axitinib, followed by cabozantinib, then nivolumab. The best response was PR, SD, and PD for these three drugs, and treatment duration was 14, 3, and 3 months, respectively. As the fifth line, sunitinib was administered, with significant shrinkage of the multiple liver metastases, and PR has been maintained for 34 months.
Conclusion
Sunitinib after an IO‐drug showed a significant effect in spite of only slight efficacy with other VEGFR‐TKIs, which may have occurred through the alteration of the immunological microenvironment.
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