Shubham Jha

© 2017 The Author. Published by S. Karger AG, Basel.Small cell carcinoma of the vagina is rare, so rare in fact that the total number reported in English-language journals is less than 30. Due to this extremely low incidence, no specific treatment guidelines have been established, and most of what is clinically known is derived from a handful of single case reports. However, as befitting its highly aggressive histologic features, which are reminiscent of small cell lung cancer, first-line treatment is modeled after SCLC. Herein is reported the case of a 51-year-old African-American patient with metastatic biopsy-proven small cell carcinoma of the vagina that progressed through multiple therapies: first-line cisplatin and etoposide and radiotherapy, followed by the tumor macrophage-stimulating agent RRx-001 in a clinical trial called QUADRUPLE THREAT, which per protocol preceded a mandated rechallenge with cisplatin and etoposide. RECIST v.1.1 tumor progression on both RRx-001 and cisplatin/etoposide was accompanied by central necrosis in several of the enlarged lymph nodes and hepatic metastases, which may have been evidence of pseudoprogression, accounting for her ongoing longer-than-expected survival, since the necrotic tissue may have primed the activity of the PD-1 inhibitor. The lack of response to RRx-001 is hypothesized to have correlated with sparse tumor macrophage infiltration, seen on pre- and post-treatment biopsies, since the mechanism of action of RRx-001 relates to stimulation of tumor-associated macrophages.

Ethical morality is one of the significant issues in self-driving cars. The paper provides a newer approach to solve the ethical decision problems in self-driving cars until there is no concrete ethical decision to all problems. This paper gives a two-way approach to solve a problem, with first being the mapping of problem to the solution already known or which has a fixed set of solutions and action priorities defined to a problem previously. Now, if no solution is found or mapping is unsuccessful, then the second stage activates, where the solution from Deep Q-learning model is calculated. It estimates the best Q value and returns that solution or action which maximizes the reward at that instance. The reward function is designed with decreasing priorities and acts accordingly, where the users can change or define their priorities if needed. The case study and results show that the solution that is present in the paper will lead to solving ethical morality problems in self-driving cars up to a great extent.