Prognostic significance of tumor-infiltrating lymphocytes in ductal carcinoma in situ of the breast

Tumor-infiltrating lymphocytes (TILs) provide prognostic value in invasive breast cancer and guidelines for their assessment have been published. This study aims to evaluate: (a) methods of TILs assessment, and (b) their prognostic significance in breast ductal carcinoma in situ (DCIS). Hematoxylin and eosin sections from two clinically annotated DCIS cohorts; a training set (n = 150 pure DCIS) and a validation set (n = 666 comprising 534 pure DCIS and 132 cases wherein DCIS and invasive breast carcinoma were co-existent) were assessed. Seven different scoring methods were applied to the training set to identify the most optimal reproducible method associated with strongest prognostic value. Among different methods, TILs touching ducts' basement membrane or away from it by one lymphocyte cell thickness provided the strongest significant association with outcome and highest concordance rate [inter-cluster correlation coefficient = 0.95]. Assessment of periductal TILs at increasing distances from DCIS (0.2 , 0.5 , and 1 mm) as well as percent of stromal TILs were practically challenging and showed lower concordance rates than touching TILs. TILs hotspots and lymphoid follicles did not show prognostic significance. Within the pure DCIS validation set, dense TILs were associated with younger age, symptomatic presentation, larger size, higher nuclear grade, comedo necrosis and estrogen receptor negativity as well as shorter recurrence-free interval (p = 0.002). In multivariate survival analysis, dense TILs were independent predictor of shorter recurrence-free interval (p = 0.002) in patients treated with breast conservation. DCIS associated with invasive carcinoma showed denser TILs than pure DCIS (p = 9.0 × 10-13). Dense TILs is an independent prognostic variable in DCIS. Touching TILs provides a reproducible method for their assessment that can potentially be used to guide management

Els camins del present, viatges pel passat i el futur

La temàtica sobre la qual el Dr. Riera i Tuèbols ha escrit al llarg de la seva trajectòria professional és àmplia i diversa i, per tant, múltiples poden ser les refl exions al voltant del pensament i la seva obra. Aquest volum n’és una mostra. Cal assenyalar que aquesta diversitat temàtica no és aleatòria, sinó el resultat d’una concepció holística de la cultura que li ha permès eliminar les fronteres entre aspectes aparentment allunyats com l’origen de l’Univers, la il·lustració, la fi losofi a de la natura, la bioètica o la Segona Guerra Mundial..

Improving health outcomes: innovation, coverage, quality and adherence.

The Israeli health system has made considerable progress in reducing deaths amenable to medical care but has more to do. This commentary describes how progress in this area results from innovation, coverage, quality, and adherence to treatment. It describes what is being done in Israel and beyond to address each of these factors but concentrates on the often poorly recognised problem of adherence to treatment, describing the growing evidence that it is often sub-optimal and reviewing evidence on what can be done to improve it

Source separation employing beamforming and SRP-PHAT localization in three-speaker room environments

This paper presents a new blind speech separation algorithm using beamforming technique that is capable of extracting each individual speech signal from a mixture of three speech sources in a room. The speech separation algorithm utilizes the steered response power phase transform for obtaining a localization estimate for each individual speech source in the frequency domain. Based on those estimates each desired speech signal is extracted from the speech mixture using an optimal beamforming technique. To solve the permutation problem, a permutation alignment algorithm based on the mutual output correlation is employed to group the output signals into the correct sources from each frequency bin. Evaluations using real speech recordings in a room environment show that the proposed blind speech separation algorithm offers high interference suppression level whilst maintaining low distortion level for each desired signal