In-situ tumor vaccination by percutaneous ablative therapy and its synergy with immunotherapeutics: An update on combination therapy.

Percutaneous tumor ablation is now a widely accepted minimally invasive local treatment option offered by interventional radiology and applied to various organs and tumor histology types. It utilizes extreme temperatures to achieve irreversible cellular injury, where ablated tumor interacts with surrounding tissue and host via tissue remodeling and inflammation, clinically manifesting as post-ablation syndrome. During this process, in-situ tumor vaccination occurs, in which tumor neoantigens are released from ablated tissue and can prime one's immune system which would favorably affect both local and remote site disease control. Although successful in priming the immune system, this rarely turns into clinical benefits for local and systemic tumor control due to intrinsic negative immune modulation of the tumor microenvironment. A combination of ablation and immunotherapy has been employed to overcome these and has shown promising preliminary results of synergistic effect without significantly increased risk profiles. The aim of this article is to review the evidence on post-ablation immune response and its synergy with systemic immunotherapies.

High rates of subglottic stenosis seen in African-American children admitted with severe croup to hospitals in the United States between 2003 and 2013.

BACKGROUND: To assess whether differences exist in the epidemiology and the treatment of croup with respect to gender, race, income and geographical location. METHODS: Retrospective weighted analysis of patients under 19 admitted with a diagnosis of croup with a subcohort of patients requiring intubation or diagnostic bronchoscopy from the National Inpatient Sample and Kids' Inpatient Database from 2003 to 2013. ICD-9 codes and demographics were analyzed; cross tabulations and linear regression modeling were performed. RESULTS: Between 2003 and 2013, 202,188 pediatric patients were admitted with a diagnosis of croup, equivalent to 1-per-100 pediatric admissions. Males were more likely to be admitted for croup than females [OR 2.13 (2.08-2.17)]. Incidence of croup is highest in Caucasians and lowest in Asian and African-American patients. African-American children are more likely to undergo diagnostic bronchoscopy or require intubation [OR 1.23 (1.08-1.401)] than other races. A higher rate of subglottic stenosis was seen in African-American children who required bronchoscopy than expected (39.1% vs 26.7%). After controlling for subglottic stenosis, African-American patients were no longer more likely to undergo diagnostic bronchoscopy or require intubation than other races [OR 1.129 (0.959-1.33)]. CONCLUSION: African-American children admitted with a diagnosis of croup appear to have an increased rate of intubation or bronchoscopy. This may be related to the high incidence of subglottic stenosis in this population. After controlling for subglottic stenosis, no difference in intervention rates was seen.

Improving Ultrasound Detection of Uterine Adenomyosis Through Computational Texture Analysis.

The purpose of our study was to determine if a textural analysis metric can be implemented to improve diagnosis of adenomyosis by ultrasound.We retrospectively identified 38 patients with a magnetic resonance imaging (MRI) diagnosis of uterine adenomyosis that also had a pelvic ultrasound within 6 months. We also identified 50 normal pelvic ultrasound examinations confirmed by a normal pelvic MRI within 6 months as a control group. A region of interest (ROI) was subsequently placed on the study population ultrasound image corresponding to the area of adenomyosis on MRI. An ROI was placed in the area of the junctional zone in the normal controls. The abnormal and normal ROIs were then compared against trained normal and abnormal distributions to determine the success rate, sensitivity, specificity, and negative and positive predictive values of our computer metric. The ultrasound reports performed before MRI were also reviewed to determine the radiologist correct/incorrect interpretation rate for comparison with our textural analysis metric.Using a training population of 50 normal ultrasound examinations (confirmed with a normal MRI) and 38 abnormal ultrasound examinations (MRI confirmed adenomyosis), we had an overall 75% (66/88 accurately diagnosed) success rate with a sensitivity, specificity, and negative and positive predictive values of 70%, 79%, 73%, and 76%, respectively (P < .0001). The sensitivity and false-negative rate of the initial ultrasound interpretation were 26% (10/38) and 74% (28/38), respectively.

Quantitative analysis of ultrasound images for computer-aided diagnosis.

We propose an adaptable framework for analyzing ultrasound (US) images quantitatively to provide computer-aided diagnosis using machine learning. Our preliminary clinical targets are hepatic steatosis, adenomyosis, and craniosynostosis. For steatosis and adenomyosis, we collected US studies from 288 and 88 patients, respectively, as well as their biopsy or magnetic resonanceconfirmed diagnosis. Radiologists identified a region of interest (ROI) on each image. We filtered the US images for various texture responses and use the pixel intensity distribution within each ROI as feature parameterizations. Our craniosynostosis dataset consisted of 22 CT-confirmed cases and 22 age-matched controls. One physician manually measured the vectors from the center of the skull to the outer cortex at every 10 deg for each image and we used the principal directions as shape features for parameterization. These parameters and the known diagnosis were used to train classifiers. Testing with cross-validation, we obtained 72.74% accuracy and 0.71 area under receiver operating characteristics curve for steatosis ([Formula: see text]), 77.27% and 0.77 for adenomyosis ([Formula: see text]), and 88.63% and 0.89 for craniosynostosis ([Formula: see text]). Our framework is able to detect a variety of diseases with high accuracy. We hope to include it as a routinely available support system in the clinic.