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PubMed2006

All-fiber multimode-interference-based refractometer sensor: proposal and design.

A novel all-fiber refractometer sensor is proposed, which is based on multimode interference in the multimode fiber core section sandwiched between two single-mode fibers. A wide-angle beam propagation method in the cylindrical coordinate is employed as the modeling tool for simulation and design of the proposed refractometer sensor. The design for a refractometer is presented that shows that the refractometer would have an estimated resolution of 5.4 x 10(-5) for refractive indices from 1.33 to 1.45 and of 3.3 x 10(-5) for refractive indices from 1.38 to 1.45 through the choice of an appropriate length of the multimode fiber core section.

Journal Article↗
PubMed1999

Multimodality therapy of esophageal cancer.

Multimodality therapy of esophageal cancer has been evaluated in several clinical trials, with positive results in terms of improved survival compared with single-modality therapy. A case report is presented describing the use of paclitaxel in a multimodality regimen for a patient with a bulky esophageal tumor. In addition, results are described of a clinical trial in which patients received a paclitaxel-based regimen as part of multimodality therapy for esophageal cancer.

Adult↗
PubMed2000

Long-term survival after multimodality treatment for resectable pancreatic cancer.

BACKGROUND: The prognosis of pancreatic adenocarcinoma after radical pancreatectomy is poor, especially in advanced-stage disease. STUDY AIM: To determine the survival rates and evaluate the effectiveness of multimodality treatment for advanced pancreatic cancer. METHODS: From November 1983 to January 1993, 30 patients with pancreatic adenocarcinoma including 9 with carcinoma of the body and tail were treated by a multimodal approach consisting of extended pancreatectomy, intraoperative radiotherapy (IORT), and hepatic artery or portal vein infusion of mitomycin C (MMC) followed by systemic bolus injection. All surviving patients were followed for more than 8 yr and survival rates were calculated by the Kaplan-Meier method. RESULTS: There were no operative or hospital deaths. Eight patients survived for more than 5 yr, 3 of whom survived more than 10 yr. The 5-yr survival rate for 27 patients excluding 3 with metastasis to the liver, peritoneum, or lung was 31%, with a median survival of 31.1 mo. Among them, the 1-, 3-, and 5-yr survival rates for 19 patients with regional nodal metastasis were 95, 50, and 28%, respectively, with a median survival of 36.0 mo. CONCLUSION: The multimodality treatment combined with IORT and MMC chemotherapy appeared to have a benefit for prognosis of advanced pancreatic adenocarcinoma.

Adenocarcinoma↗
PubMed2003

Multimodal distribution versus logarithmic transformation of thyroid volumes in adolescents: detection of subgroup with subclinical thyroid disorders and its impact on the assessment of the upper limit of normal thyroid volumes.

Our objective was to evaluate whether there is a multimodal distribution of thyroid volume (ThV) in iodine-replete adolescents and to examine the relation between excessive ThV and the presence of thyroid hypoechogenicity (HE), serum thyroperoxidase antibodies (anti-TPO) and TSH levels >4.5 mU/l. ThV was measured by ultrasound in adolescents aged 13 yr (N = 1083) and 17 yr (N = 1089) from 22 schools in 6 districts of eastern Slovakia and expressed as ml and ml/m2 body surface area. For each age group the multimodal distribution of ThV values was tested by computing their frequency at intervals of 0.5 m/m2 and plotting the cumulative frequency on a probability scale in which each segment with normal distribution should give a straight line. In all examined subjects the HE was evaluated by ultrasound; in 924 (42.5%) of those anti-TPO was estimated by radioimmunoassay and TSH by immuno-electrochemiluminiscent assay. The medians of urinary iodine found in 55-164 spot urine samples from each of 6 districts (total number = 1003) were 126-142 microg/l, indicating an iodine-replete status. There was a trimodal distribution of ThV in each group, 80-85% in the lowest, 10-15% in the middle, and 5-7% in the upper segments. In the 10th ThV decile of the 17-yr group the frequency of HE (33/109 = 30.3%), anti-TPO (13/62 = 21.0%) and TSH (6/62 = 9.7%) was significantly higher than that in the 1st-9th decile (71/980 = 7.2%, P<0.001; 23/482 = 4.8%, P<0.001 and 5/482 = 1.0%, P<0.001, resp.). Similar differences were found in the 13-yr group (21/109 = 19.2% vs. 58/974 = 5.9%, P<0.001 for HE, 5/60 = 8.3% vs. 3/320 = 0.9%, P<0.001 for anti-TPO and 2/64 = 3.1% vs. 4/317 = 1.3% (not significant) for TSH >4.5 mU/l. Thus in the 10% of subjects with the highest ThV, the frequency of HE and anti-TPO was 4-5 times higher than in the remaining 90%. Our data indicate that an epidemiological evaluation of a large population of adolescents can detect a group with early signs of thyroid dysfunction (e.g. excessive ThV, increased frequency of HE, anti-TPO and TSH >4.5% mU/l), although such dysfunction may not be clinically apparent. This contrasts with numerous earlier reports which used a logarithmic transformation of the data in similar ThV sets, thus making the data appear homogeneous (unimodal) and with a normal distribution and obscuring the true multimodal distribution. This further prevents recognition of subjects with evidence of disordered thyroid status which thus become falsely included into a normal range.

Adolescent↗
PubMed2004

Multimodal classical conditioning of fear: contributions of direct, observational, and verbal experiences to current fears.

The authors propose that a multimodal classical conditioning model be considered when clinicians or clinical researchers study the etiology of fears and anxieties learned by human beings. They argue that fears can be built through the combined effects of direct, observed, and verbally presented classical conditioning trials. Multimodal classical conditioning is offered as an alternative to the three pathways to fear argument prominent in the human fear literature. In contrast to the three pathways position, the authors present theoretical arguments for why "learning by observation" and "learning through the receipt of verbal information" should be considered classical conditioning through observational and verbal modes. The paper includes a demonstration of how data, commonly collected in research on the three pathways to fear, would be studied differently using a multimodal classical conditioning perspective. Finally, the authors discuss implications for assessment, treatment, and prevention of learned fears in humans.

Adolescent↗
PubMed2003

Slot: a research platform for investigating multimodal communication.

In this article, we present the spatial logistics task (SLOT) platform for investigating multimodal communication between 2 human participants Presented are the SLOT communication task and the software and hardware that has been developed to run SLOT experiments and record the participants' multimodal behavior. SLOT offers a high level of flexibility in varying the context of the communication and is particularly useful in studies of the relationship between pen gestures and speech. We illustrate the use of the SLOT platform by discussing the results of some early experiments. The first is an experiment on negotiation with a one-way mirror between the participants, and the second is an exploratory study of automatic recognition of spontaneous pen gestures. The results of these studies demonstrate the usefulness of the SLOT platform for conducting multimodal communication research in both human- human and human-computer interactions.

Communication↗
PubMedDate not supplied

The effect of music and multimodal stimulation on responses of premature infants in neonatal intensive care.

To assess the benefits of lullaby singing and multimodal stimulation on premature infants in neonatal intensive care, 40 infants in a Level III Newborn Intermediate Care Unit were divided into control (n = 20) and experimental (n = 20) groups by pair matching on the basis of gender, birthweight, gestational age at birth and severity of medical complications. Participants met these project criteria: (a) corrected gestational age > 32 weeks; (b) age since birth > 10 days; and (c) weight > 1700 g. All participants had been referred for developmental stimulation by the medical staff. Experimental infants received reciprocal, multimodal (ATVV) stimulation paired with line singing of Brahms' Lullaby. Stimulation was provided for 15-30 minutes, one or two times per week from referral to discharge. Dependent variables were (a) days to discharge, (b) weight gain/day, and (c) experimental infants' tolerance for stimulation. Results showed that music and multimodal stimulation significantly benefited females' days to discharge and increased weight gain/day for both males and females. Both male and female infants' tolerance for stimulation showed marked and steady increase across the stimulation intervals with females' tolerance increasing more rapidly than males.

Body Weight↗
PubMed1999

Organization of olfactory and multimodal afferent neurons supplying the calyx and pedunculus of the cockroach mushroom bodies.

The mushroom bodies of neopteran insects are considered to be higher olfactory centers because their calyces receive abundant collaterals of projection neurons from the antennal lobes. However, intracellular recordings of mushroom body efferent neurons demonstrate that they respond to multimodal stimuli, implying that the mushroom bodies receive a variety of sensory cues. The present account describes new features of the organization of afferent neurons supplying the calyces of the cockroach Periplaneta americana. Afferent terminals segment the calyces into discrete zones, I, II, III, and IIIA, which receive afferents from 1) two discrete populations of sexually isomorphic olfactory glomeruli, 2) two types of male-specific olfactory glomeruli, 3) the optic lobes, and 4) multimodal interneurons that originate in protocerebral neuropils. In addition, intracellular recordings and dye fills show that at least four morphologically distinct GABAergic elements link many regions of the protocerebrum to the calyces. A new type of touch-sensitive centrifugal neuron has been identified terminating in the pedunculus. The dendrites of this afferent reside in satellite neuropil, beneath the mushroom body's medial lobe, which is supplied by collaterals from medial lobe efferent neurons and by terminals from the central complex. The role of this centrifugal cell in odorant sampling is considered. Golgi impregnation identifies other afferents in proximal regions of the calyx (zone IIIA) that also originate from satellite neuropils, suggesting major reafference from the medial lobes channeled through this region. The relevance of multimodal supply to the calyx in odorant discrimination is discussed as are comparisons between mushroom body organization in this phylogenetically basal neopteran and other taxa.

Animals↗
PubMed2000

[Utilization of multimodal therapy concepts in stomach carcinoma in Germany].

INTRODUCTION: In view of disappointing results after surgery alone multimodal therapeutic regimes are used to improve long-term prognosis in locally advanced gastric carcinomas. In presence of many reports about encouraging results ("down staging", improved R0-resection rates) but simultaneously missing evidence of efficiency of neoadjuvant therapies in respect to long-term survival (large randomized multicenter trials do not exist until today) and the herewith related uncertainties, we started an inquiry among many surgical units with the intention to evaluate the clinical practice of multimodal treatment for gastric cancer patients in Germany today. METHODS: In a questionnaire (3/99) we asked among 97 surgical units (41 university hospitals, 56 big community hospitals) in Germany for the management of gastric cancer patients with special interest to practice and state of adjuvant and neoadjuvant therapeutic strategies. Further we analyzed all resected gastric cancer patients (1986-1995) without neoadjuvant treatment in advanced stage of disease (pT3/4NxMx; stage III/IV (UICC'92) in respect to R0-resection rate and long-term prognosis (Kaplan-Meier). RESULTS: Overall feedback amounted to 78% (76/97) and was higher in university hospitals (90%) than in big community hospitals (70%). Today, neoadjuvant therapies are of more interest than adjuvant therapeutic regimes. But also neoadjuvant therapy is only used in 32% as a rule (in 16% with, in 16% without study conditions). 25% of all surgical units do not employ any neoadjuvant therapy in locally advanced gastric cancer until today. In all other surgical units neoadjuvant treatment is performed more individually and sporadically (43%) only in some patients. Neoadjuvant therapies are practiced by haematooncologists in 50%, gastroenterologists in 32% and surgeons in 27%. The predominant neoadjuvant therapeutic strategy is chemotherapy alone (84%). Many surgical units in Germany are interested to participate in a multicenter trial with more interest in neoadjuvant than adjuvant therapy. 185 of 309 resected gastric cancer patients (60%) were classified as stage IIIa, stage IIIb or stage IV patients. R0-resection rate of these advanced gastric cancer patients amounted to 37%; only 24% of them survived 5 years or more. CONCLUSIONS: Considering the missing evidence that multimodal therapies are able to prolong long-term survival in advanced gastric cancer patients, its use without study conditions is questionable. Conclusions, taken from data of clinical trials regarding carcinomas of the esophagus and esophagealgastric junction, are inconsistent in respect to long-term prognosis and results are not transferable to gastric carcinomas. A prospective randomized multicenter trial in advanced gastric cancer patients is of great importance. Following our data, in Germany a high readiness to participate in the forthcoming EORTC-study is present.

Chemotherapy, Adjuvant↗
PubMed2001

Multimodality therapy for patients with clinical Stage I and II malignant mixed Müllerian tumors of the uterus.

BACKGROUND: The role of adjuvant therapy in the management of patients with malignant mixed Müllerian tumors (MMMT) of the uterus has not been defined. The outcome of planned multimodality therapy for patients with apparent early stage disease was assessed. METHODS: A pilot study was performed on 38 patients with clinical Stage I or II MMMTs of the uterus who were offered treatment according to a standard protocol. The protocol consisted of removal of the uterus, fallopian tubes, and ovaries and surgical staging followed by tailored radiation therapy and chemotherapy, consisting of cisplatin and epirubicin. RESULTS: The overall survival was 74% (28 of 38 patients), with a mean duration of follow-up for survivors of 55 months (range, 17-121 months). The mean time to death from disease was 26 months (range, 7-87 months). The survival rate for those patients who completed treatment according to the multimodality protocol was 95% (20 of 21 patients), with a disease free survival rate of 90% (19 of 21 patients). The overall survival of patients who did not receive the recommended treatment protocol for various reasons was 47% (8 of 17 patients). An analysis of survival curves demonstrated that there was a significant survival advantage for those patients who completed the treatment according to the multimodality protocol (P = 0.01). CONCLUSIONS: In this pilot study, patients with clinical Stage I or II MMMTs who underwent surgical staging and aggressive adjuvant radiation and chemotherapy had an excellent survival rate. The results justify a randomized prospective study of this approach.

Adult↗
PubMed2001

[Rapid recovery after colonic resection. Multimodal rehabilitation by means of Kehlet's method practiced in Vasteras].

UNLABELLED: By using a multimodal rehabilitation program professor Kehlet has shown accelerated recovery after colonic surgery with hospital stay of only two days, irrespective of open or laparoscopic technique. These results have not been confirmed in other studies. The aim of this study was to replace our traditional approach with Kehlet's multimodal regimen and try to reproduce his reported data. METHODS: 22 patients (median age 67 years) underwent right- or leftsided colectomies, 15 open (7 with midline incisions) and 7 laparoscopically. Continuous thoracic epidural, immediate mobilization and oral nutrition were used. Discharge was planned three days after surgery. On the first postoperative day all had oral intake and on the third day patients were mobilized for a median of 9.7 hours and all had resumed defecation. Pain and fatigue scores (VAS) were low. The median post-operative hospital stay was 3.5 (range 3-8) days. Two patients returned with complications. No cardiopulmonary or infectious complications were seen. The multimodal rehabilitation programme resulted in a quick recovery and a hospital stay of three days in most patients after colonic surgery.

Adult↗
PubMedDate not supplied

[Combined multimodal treatment for liver and lung metastasis from colorectal cancer: a new therapeutic option?].

The authors analyse which therapeutic strategy to adopt on the basis of prognostic factors and staging of hepatic and pulmonary metastases from colorectal cancer. They underline the effectiveness of combined multimodal therapy in the treatment of very advanced metastatic stages. 218 patients with metastases from colorectal cancer (12 pulmonary and 206 hepatic metastases) were treated from January 1980 to October 2000. Among these patients, 159 underwent surgery (4 pulmonary and 155 hepatic resections), 16 were reoperated on for metastatic relapse, 14 with multiple metastases underwent locoregional therapy and 29, deemed unresectable initially, were treated with neoadjuvant chemo- and radiotherapy. In the operated patient group the 5-year actuarial survival rate was 22% with an operative mortality of 3.8% and a morbidity of 17.5%. The 16 patients reoperated on for metastatic relapse had a 5-year actuarial survival of 21% with an operative mortality of 6.2% and a morbidity of 15.8%. The 14 patients treated with locoregional therapy had a median survival of 6 months whereas the 29 patients treated in two different periods with combined multimodal treatment had a response rate of 59.2%. Five patients had a complete response and 4 are currently disease-free. Surgical resection is at present the best known treatment for metastatic disease. In very advanced, as yet undisseminated stages, in which there is no surgical indication for metastases a neoadjuvant treatment is proposed if the primary tumour has already been completely resected. The aim of this therapeutic strategy, called combined multimodal therapy, is to obtain the disease regression with the aid of systemic chemo- and radiotherapy and to offer a chance of re-staging the disease.

Aged↗
PubMed2001

Multimodality MR imaging depiction of hemodynamic changes and cerebral ischemia in subarachnoid hemorrhage.

BACKGROUND AND PURPOSE: Subarachnoid hemorrhage (SAH) is a common and serious neurologic emergent condition. We tested the hypothesis that multimodality MR imaging depicts changes in cerebral blood flow SAH, before any surgical or endovascular intervention, and that the frequency of these changes increases with time after ictus. METHODS: We prospectively examined 37 patients with suspected SAH and three with symptoms of acute stroke but who subsequently had SAH. Routine CT and multimodality MR imaging were performed within 18 h of presentation. Standard MR imaging, diffusion-weighted MR imaging, time-of-flight MR angiography, and dynamic first-pass gadolinium-enhanced MR perfusion imaging were performed. Images were reviewed for abnormalities in cerebral blood flow, ischemia, and infarction. Nine patients did not have SAH at CT and CSF investigations. Of 31 patients with proved SAH, 13 were examined during the acute stage (within 4 d of ictus) and 18, during the subacute stage (4-14 d after ictus). RESULTS: MR imaging showed alteration in cerebral blood flow parameters in 16 of 31 patients before surgery or endovascular treatment. The frequency of blood flow changes and associated complications increased with worsening clinical grade and increasing time after ictus. CONCLUSION: Multimodality MR imaging provides information not available from CT in patients with SAH. MR imaging shows oligemic and ischemic areas in SAH before surgery or endovascular treatment. MR imaging is a simple noninvasive method of assessing cerebral blood flow and its complications in SAH. It can be performed in a clinical environment.

Adult↗
PubMed2001

[Organizational prerequisites for multimodality therapy concepts].

The increasing use of multimodal therapies confronts clinics with the need to create new organisational structures. The high degree of specialisation necessitates that the separate disciplines seek ways of working closer together. This is particularly the case when staging results have to be evaluated and a multimodal therapy course chosen or when quality management issues and the coordination of different steps of a treatment are being considered. By establishing disease-oriented organisational structures and by institutionalizing interdisciplinary cooperation, e.g. in daily tumor board meetings and in fixed disease management teams, the organisational prerequisites for implementing multimodal therapies are created.

Combined Modality Therapy↗
PubMed2003

Models of surgical procedures for multimodal image-guided neurosurgery.

Improvement of image guided surgery systems requires a better anticipation of the surgical procedure. This anticipation may be provided by a better understanding of surgical procedures and/or the use of information models related to neurosurgical procedures. We are introducing a generic model of surgical procedures in the context of multimodal image-guided craniotomies. The basic principle of the model is to break down the surgical procedure into a sequence of steps defining the surgical script. Each step is defined by an action; the model assigns to each surgical step a list of image entities extracted from multimodal preoperative images (anatomical and/or functional images) which are relevant to the performance of that particular step. The model has been built in two phases: creation and consolidation. Besides, a planning software prototype based on the generic model has been built. The resulting generic model is described by an UML class diagram and textual description. Some initial benefits of this approach can already be outlined: improvement of multimodal information management, enhancement of the preparation and the guidance of the surgical act.

Humans↗
PubMedDate not supplied

Colorectal cancer metastases: surgical indications and multimodal approach.

BACKGROUND/AIMS: The therapeutic plan to follow in patients affected by hepatic and pulmonary metastases from colorectal cancer is based on prognostic factors and staging. METHODOLOGY: Our experience from January 1980 to January 2002 underlines the effectiveness of combined multimodal therapy in the treatment of advanced metastatic stages. A total of 224 patients with metastases from colorectal cancer have been treated. Among these patients 160 underwent surgery (4 pulmonary and 156 hepatic resections), 17 have been reoperated for metastatic relapse, 14 with multiple metastases underwent locoregional therapy, while 33, deemed not resectable initially, have been treated with neoadjuvant chemo- and radio-therapy. RESULTS: For the operated patient group the 5-year actuarial survival was 22% with an operative morbidity of 17.5% and mortality of 3.8%. The 17 patients reoperated for metastatic relapse had a 5-year actuarial survival of 21% with an operative morbidity of 11.6% and mortality of 5.8%. The 14 patients treated with locoregional therapy had a median survival of 6 months whereas the 33 patients treated with combined multimodal treatment in two different periods had a response rate of 57.57%. Five patients had a complete response and 4 are presently alive: 3 are disease free and 1 with disease. 1 died of pulmonary primitive neoplasm 24 months later. CONCLUSIONS: Surgical resection is presently the best known treatment for metastatic disease. In advanced, but not yet disseminated, stages in which there is no indication to surgery on metastases (II-III stages according to Gennari's classification), a neoadjuvant treatment is proposed, if the primary tumor has already been completely resected. This therapeutic strategy, called combined multimodal therapy, has the aim to obtain the disease regression and to offer the chance of disease re-staging.

Actuarial Analysis↗
PubMed2006

Effects of a multimodal exercise program for people with ankylosing spondylitis.

BACKGROUND AND PURPOSE: Few randomized controlled studies have examined the effects of exercise in patients with ankylosing spondylitis (AS). This study investigated the effects of a 12-week, multimodal exercise program in patients with AS. SUBJECTS: A convenience sample of 30 patients with AS (18 male, 12 female), with a mean age of 34.9 years (SD=6.28), participated in the study. Twenty-six subjects were classified as having stage I AS and 4 subjects were classified as having stage II AS according to the modified New York Criteria. METHODS: This study was a randomized controlled trial. Subjects were assigned to either a group that received an exercise program or to a control group. The exercise program consisted of 50 minutes of multimodal exercise, including aerobic, stretching, and pulmonary exercises, 3 times a week for 3 months. Subjects in both groups received medical treatment for AS, but the exercise group received the exercise program in addition to the medical treatment. All subjects received a physical examination at baseline and at 12 weeks. The examinations were conducted under the supervision of a physician who specialized in physical medicine and rehabilitation and included the assessment of spinal mobility using 2 methods: clinical measurements (chin-to-chest distance, Modified Schober Flexion Test, occiput-to-wall distance, finger-to-floor distance, and chest expansion) and inclinometer measurements (gross hip flexion, gross lumbar flexion, and gross thoracic flexion). In addition, vital capacity was measured by a physiologist, and physical work capacity was evaluated by a doctorally prepared exercise instructor. RESULTS: The measurements of the exercise group for chest expansion, chin-to-chest distance, Modified Schober Flexion Test, and occiput-to-wall distance were significantly better than those of the control group after the 3-month exercise period. The spinal movements of the exercise group improved significantly at the end of exercise program, but those of the control group showed no significant change. In addition, the results showed that the posttraining value of gross thoracic flexion of the exercise group was significantly higher than that of the control group. Physical work capacity and vital capacity values improved in the exercise group but decreased in the control group. DISCUSSION AND CONCLUSION: In this study, a multimodal exercise program including aerobic, stretching, and pulmonary exercises provided in conjunction with routine medical management yielded greater improvements in spinal mobility, work capacity, and chest expansion.

Adult↗
PubMed1991

Multimodal radiography: a new imaging technique and system for oral diagnosis.

The multimodal radiography system is based on the combined use of narrow-beam radiography and spiral tomography in one set of equipment. The essentials of a system are a multifunction unit, preprogrammed imaging procedures for various dentomaxillofacial objects and a co-ordinate system for object location. Four years of clinical experience have shown that multimodal radiography is effective for depicting dentomaxillofacial structures for diagnostic purposes. The detailed narrow beam imaging mode of multimodal radiography has also been compared with intraoral radiography as regards their abilities to reveal periodontal and periapical lesions. Preliminary results indicate that detailed narrow beam radiography is more accurate than intraoral radiography in the diagnosis of periodontal and periapical pathology.

Equipment Design↗