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PubMedDate not supplied

Effect of short-duration hyperventilation during endotracheal suctioning on intracranial pressure in severe head-injured adults.

A repeated measures randomized within-group design was used to determine the effectiveness of controlled short-duration hyperventilation (HV) in blunting the increase of intracranial pressure (ICP) during endotracheal suctioning (ETS). A multimodal continuous real-time computerized data acquisition procedure was used to compare the effects of two HV ETS protocols on ICP, arterial pressure, cerebral perfusion pressure (CPP), heart rate, and arterial oxygen saturation in severe head-injured adult patients. The results indicated that short-duration HV for 1 minute, which decreases the PaCO2, reduced ETS-induced elevations in ICP while maintaining CPP. However, it is not clear whether short-duration HV is neuroprotective, particularly in ischemic regions of the brain. Therefore, before a change in practice is implemented on the use of short-duration HV as a prophylactic treatment against ETS-induced elevations in ICP, additional questions on cerebral oxygen delivery and uptake need to be answered.

Adolescent↗
PubMed2006

Continuous muscle tissue oxygenation in critically injured patients: a prospective observational study.

BACKGROUND: Despite normalization of vital signs, critically injured patients may remain in a state of occult underresuscitation that sets the stage for sepsis, organ failure, and death. A continuous, sensitive, and accurate measure of resuscitation after injury remains elusive. METHODS: In this pilot study, we evaluated the ability of two continuous measures of peripheral tissue oxygenation in their ability to detect hypoperfusion: the Licox polarographic tissue oxygen monitor (PmO2) and the InSpectra near-infrared spectrometer (StO2). We hypothesized that deltoid muscle tissue oxygenation measurements could detect patients in "occult shock" who are at increased risk for post-injury complications. The study was designed to (1) define values for PmO2 and StO2 in patients who by all standard measures appeared to be clinically resuscitated; (2) evaluate the relationship between PmO2, StO2 and other physiologic variables including mean arterial pressure (MAP), lactate and base deficit (BD); and (3) examine the relationship between early low tissue oxygen values and the subsequent development of infections and organ dysfunction. Licox probes were inserted into the deltoid muscle of critically injured patients after initial surgical and radiologic interventions, and transcutaneous StO2 monitors were applied over the same muscle bed. PmO2, StO2, and standard physiologic data were collected continuously using a multimodal bioinformatics system. RESULTS: Twenty-eight critically injured patients were enrolled in this study at admission to the intensive care unit (ICU). For patients who appeared to be well resuscitated (defined as MAP > or = 70 mm Hg, heart rate [HR] < or = 110 bpm, BD > or = -2, and partial pressure of arterial oxygen (PaO2) = 80 and 150 mm Hg), the mean PmO2 was 34 +/- 11 mm Hg and StO2 was 63 +/- 27%. There was a strong relationship between PmO2 and BD (p < 0.001) but no significant relationship between StO2 and BD. The relationship between PmO2 and StO2 was weak but statistically significant. Early low values of both PmO2 and StO2 identified patients at risk for infectious complications or multiple organ failure (MOF). In patients who were well resuscitated by standard continuous parameters (HR and MAP), low PmO2 during the first 24 hours after admission (PmO2 < or = 25 for at least 2 hours) was strongly associated with the development of infectious complications (Odds Ratio = 16.5, 95% CI 1.49 to 183, p = 0.02). CONCLUSIONS: PmO2 is a responsive, reliable and continuous monitor of changes in base deficit. Initial low values for either PmO2 or StO2 were associated with post-injury complications. PmO2 monitoring may be useful in identifying patients in the state of occult underresuscitation who remain at risk for developing infection and MOF.

Adolescent↗
PubMed1976

Characteristics of drug abuse patients at a Veterans Administration Hospital.

A total of 308 patients were treated at the Wood VAC Drug Treatment Center during its first 2 years of operation (November 1, 1971-October 318 1973). They completed confidential questionnaires upon admission. Personal information and data concerning drug usage were obtained. Significant findings include the following: 1. A wide variety of opiate and nonopiate drugs were available in the military. 2. Although most patients had experienced illicit drugs prior to service, over 60% tried heroin for the first time while in the military; 83% of these men were subsequently treated for opiate dependence. 3. High rates of unemployment, marital instability, and convictions for illegal activities were revealed. A significant proportion of first convictions occurred prior to major drug usage. Data suggest that a flexible and multimodal approach to drug abuse therapy may have the best potential for success. Problems in evaluating and coordinating drug treatment programs are discussed briefly.

Adult↗
PubMed2001

Neoadjuvant strategies for pancreatic cancer.

Recent prospective and retrospective data suggest that the use of multimodality therapy combining pancreaticoduodenectomy with postoperative adjuvant chemotherapy (fluorouracil) and external-beam radiation therapy maximizes local tumor control and improves the length of survival in pancreatic cancer patients, compared with surgery alone. Since postoperative chemoradiation is often delayed in these patients due to the morbidity and prolonged recovery time associated with surgery, investigators are assessing the efficacy of administering chemoradiation before pancreaticoduodenectomy in patients with potentially resectable pancreatic adenocarcinoma. When given prior to surgery, chemoradiation is not delayed and patients found to have disease progression after chemoradiation are not subjected to an unnecessary laparotomy.

Adenocarcinoma↗
PubMed2007

Towards natural stimulation in fMRI--issues of data analysis.

In search for suitable tools to study brain activation in natural environments, where the stimuli are multimodal, poorly predictable and irregularly varying, we collected functional magnetic resonance imaging data from 6 subjects during a continuous 8-min stimulus sequence that comprised auditory (speech or tone pips), visual (video clips dominated by faces, hands, or buildings), and tactile finger stimuli in blocks of 6-33 s. Results obtained by independent component analysis (ICA) and general-linear-model-based analysis (GLM) were compared. ICA separated in the superior temporal gyrus one independent component (IC) that reacted to all auditory stimuli and in the superior temporal sulcus another IC responding only to speech. Several distinct and rather symmetric vision-sensitive ICs were found in the posterior brain. An IC in the V5/MT region reacted to videos depicting faces or hands, whereas ICs in the V1/V2 region reacted to all video clips, including buildings. The corresponding GLM-derived activations in the auditory and early visual cortices comprised sub-areas of the ICA-revealed activations. ICA separated a prominent IC in the primary somatosensory cortex whereas the GLM-based analysis failed to show any touch-related activation. "Intrinsic" components, unrelated to the stimuli but spatially consistent across subjects, were discerned as well. The individual time courses were highly consistent in sensory projection cortices and more variable elsewhere. The ability to differentiate functionally meaningful composites of activated brain areas and to straightforwardly reveal their temporal dynamics renders ICA a sensitive tool to study brain responses to complex natural stimuli.

Acoustic Stimulation↗
PubMed2003

Dependence of bending losses on cladding thickness in plastic optical fibers.

Our main goal is to provide a comprehensive explanation of the existing differences in bending losses arising from having step-index multimode plastic optical fibers with different cladding thickness and under different types of conditions, namely, the variable bend radius R, the number of fiber turns, or the fiber diameter. For this purpose, both experimental and numerical result of bending losses are presented for different cladding thicknesses and conditions. For the measurements, two cladding thicknesses have been considered: one finite and another infinite. A fiber in air has a finite cladding thickness, and rays are reflected at the cladding-air interface, whereas a fiber covered by oil is equivalent to having an infinite cladding, since the very similar refractive index of oil prevents reflections from occurring at the cladding-oil interface. For the sake of comparison, numerical simulations based on ray tracing have been performed for finite-cladding step-index multimode waveguides. The numerical results reinforce the experimental data, and both the experimental measurements and the computational simulations turn out to be very useful to explain the behavior of refracting and tunneling rays along bent multimode waveguides and along finite-cladding fibers.

Journal Article↗
PubMed1992

Multimodality evoked potentials in severe athetoid cerebral palsy: correlation with clinical features and all-night polygraphical data.

We examined the correlation between the clinical and electrophysiological features, short latency somatosensory evoked potentials (SSEPs), auditory brainstem responses (ABRs), electrically elicited blink reflexes (BRs) and all-night polysomnographical examination (PSG) data in eight patients with severe athetoid cerebral palsy (ACP). Absence ABRs were observed in cases who had suffered from severe neonatal hyperbilirubinemia (posticteric ACP), and in most of them gaze abnormalities and a significant reduction in rapid eye movements during REM sleep, as observed on PSG, coexisted. Prolongation of the interpeak latency, N13-N20, of SSEPs existed concurrently with disturbed late components of BRs in two cases of posticteric ACP. The phasic contractions of the submental muscle during sleep were impaired in most of the patients. Multimodality evoked potentials together with PSGs seem to be useful for assessing brainstem dysfunctions in ACP and might also be of use for elucidating the pathogenesis of the episodic sudden death in ACP.

Adolescent↗
PubMed1998

Bifrontal measurements of brain tissue-PO2 in comatose patients.

The purpose of this study was to compare brain tissue-PO2 (PtiO2) in lesioned vs. non-lesioned brain tissue. PtiO2 was monitored bifrontally with a "Clark"-type microcatheter in patients following severe head injury (n = 6) and subarachnoid hemorrhage (SAH) (n = 1) from day 2 to day 12 posttrauma/post SAH. Mean arterial blood pressure, intracranial pressure (ICP), cerebral perfusion pressure and end-tidal CO2 were monitored. Data were stored and analyzed by a multimodal cerebral monitoring system. The CT of five patients was classified as "diffuse injury" and of one patients as "evacuated mass lesion". The patient with SAH (Hunt and Hess IV) had a concomitant intracerebral hematoma which was removed. In all cases, one catheter was placed close to the lesion, while the other was situated in an area with no visible pathology. For analysis, bifrontal PtiO2 data were taken from both on-line monitoring and O2 reactivity tests (FiO2 1.0 for 10 min). Two different patterns were identified: periods of concordance (22% of recordings) and periods in which PtiO2 was lower in lesioned cerebral white matter (78%) but always running parallel. In the latter case, O2-reactivity response was markedly reduced on the lesioned side. Our findings demonstrate a decreased PtiO2 and a reduced O2 reactivity in contused or infarcted brain tissue. Future studies have to clarify which PtiO2 is more important to be used as a guide for therapy.

Brain Concussion↗
PubMedDate not supplied

Assessment of toxicity in cooperative oncology clinical trials: the long and short of it.

Cancer therapy is associated with inherent adverse effects and the need for complete, consistent and accurate reporting of toxicity is paramount in multicenter cooperative oncology clinical trials. Accurate toxicity information is essential to weigh the costs and benefits associated with new treatment regimens. A major issue faced by investigators and clinical trial coordinators today is the lack of clear directions regarding what method should be used in toxicity assessment in cooperative oncology clinical trials. Research personnel are faced with two options: (1) to be proactive and use a "directed" method of toxicity assessment or (2) to simply follow the data trail and report selected toxicity based only on routine documentation in the chart. The differences between these two approaches may be immense depending on one's perspective. The purpose of this article is to review how the current methods of toxicity assessment evolved and discuss issues and concerns in toxicity assessment in a challenging healthcare environment where clinical trials continue to increase in complexity and workload through the use of novel and multimodality therapies. The potential implications for toxicity data management practices, data quality, patient care management and resource utilization are discussed.

Antineoplastic Agents↗
PubMed2006

Method for multimodal analysis of independent source differences in schizophrenia: combining gray matter structural and auditory oddball functional data.

The acquisition of both structural MRI (sMRI) and functional MRI (fMRI) data for a given study is a very common practice. However, these data are typically examined in separate analyses, rather than in a combined model. We propose a novel methodology to perform independent component analysis across image modalities, specifically, gray matter images and fMRI activation images as well as a joint histogram visualization technique. Joint independent component analysis (jICA) is used to decompose a matrix with a given row consisting of an fMRI activation image resulting from auditory oddball target stimuli and an sMRI gray matter segmentation image, collected from the same individual. We analyzed data collected on a group of schizophrenia patients and healthy controls using the jICA approach. Spatially independent joint-components are estimated and resulting components were further analyzed only if they showed a significant difference between patients and controls. The main finding was that group differences in bilateral parietal and frontal as well as posterior temporal regions in gray matter were associated with bilateral temporal regions activated by the auditory oddball target stimuli. A finding of less patient gray matter and less hemodynamic activity for target detection in these bilateral anterior temporal lobe regions was consistent with previous work. An unexpected corollary to this finding was that, in the regions showing the largest group differences, gray matter concentrations were larger in patients vs. controls, suggesting that more gray matter may be related to less functional connectivity in the auditory oddball fMRI task.

Acoustic Stimulation↗
PubMedDate not supplied

Attention deficit/hyperactivity disorder: characteristics, interventions and models.

An epidemiological study of Attention Deficit/Hyperactivity Disorder (ADHD) suggests that the prevalence may be two to three times higher than the figure of 3-5% often cited. In addition, the data suggest that both underdiagnosis and overdiagnosis occur frequently. Rodent animal models of ADHD, like the Spontaneously Hypertensive Rat (SHR) and other rat models such as those with chemical and radiation-induced brain lesions and cerebellar stunting, and the Coloboma mouse model exhibit clear similarities with several aspects of the human disorder and should prove useful in studying specific traits. Operant behavioral tasks that model learning, short-term memory and simple discriminations are sensitive to ADHD and methylphenidate has been shown to normalize ADHD performance in a short-term memory task. Recent findings challenge not only the current postulate that response inhibition is a unique deficit in ADHD, but also the concepts of ADHD and its treatment, which presume intact perceptual abilities. Time perception deficits may account, in part, for the excessive variability in motor response times on speeded reaction time tasks, motor control problems and motor clumsiness associated with ADHD. The Multimodality Treatment Study of ADHD (MTA) provided data suggesting that pharmacological interventions that included systematic and frequent follow-up with parents and teachers, with or without psychosocial interventions, are superior to psychosocial interventions or standard community care alone. Additionally, the MTA was one of the first studies to demonstrate benefits of multimodal and pharmacological interventions lasting longer than 1 year. Imaging studies have demonstrated differences in brain areas in children with ADHD: anterior corpus callosum, right anterior white matter, and cerebellar volumes are all decreased in children with ADHD and there is less brain asymmetry in ADHD subjects. Additionally, functional imaging studies, coupled with pharmacological manipulations, suggest decreased blood flow and energy utilization in prefrontal cortex and striatum and the dysregulation of catecholamine systems in persons with ADHD.

Animals↗
PubMed2006

Prospective evaluation of quality of life in patients with localized oesophageal cancer treated by multimodality therapy or surgery alone.

BACKGROUND: Health-related quality of life (HRQL) outcomes are important in assessing new approaches to the treatment of cancer. Neoadjuvant therapy is being used increasingly before surgery in patients with localized oesophageal cancer. This prospective non-randomized study evaluated HRQL in patients treated by preoperative chemotherapy and radiation therapy followed by surgery (multimodal therapy) or by surgery alone. METHODS: Data from European Organization for Research and Treatment of Cancer quality of life questionnaires QLQ-30 and QLQ-OES24 were collected prospectively. Questionnaires were completed at diagnosis, after chemoradiotherapy where applicable, and at 3, 6 and 12 months after surgery. RESULTS: The study included 202 consecutive patients with oesophageal cancer considered suitable for curative (R0) resection at the time of staging. Eighty-seven patients received chemotherapy combined with external-beam radiotherapy before surgery. At baseline, 75 (86 percent) of 87 patients in the multimodal group completed questionnaires, compared with 72 (62.6 percent) of 115 in the surgery-alone group. There were no significant differences in baseline global HRQL scores between groups. Preoperative chemoradiotherapy significantly reduced physical (P=0.004) and role (P=0.007) functioning before surgery, despite a significant (P=0.043) improvement in the dysphagia score. Oesophageal resection had a negative impact on global, functional and symptom HRQL scores at 3 months in both groups. Most variables had recovered by 6 months in the two groups, but at 12 months physical and role functioning remained impaired in the surgery-alone group, and social functioning and financial worries in the multimodal group. CONCLUSION: Although the multimodal regimen had a negative impact on HRQL before surgery, postoperative quality of life in patients who had multimodal therapy was similar to that in those who had surgery alone.

Adult↗
PubMed1995

[Role of radiotherapy in the combined treatment of invasive cancer of the vulva].

The authors review the literature on the different combinations of radiotherapy with chemotherapy and surgery with the aim of giving a state of art on the role of combined multimodality treatment of invasive vulvar carcinoma. From the data of the recent literature it appears that radiation integrated with surgery and chemotherapy can play an important role in reducing the risk of postoperative locoregional failure in patients with advanced primary or nodal disease and avoiding exenteration in patients with disease involving the anus or proximal urethra. This integrated multimodality therapy is a promising approach in the treatment of invasive vulvar carcinoma but further exploration in a larger number of patients is needed before giving consolidated data applicable in routine oncological clinical practice.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2003

Wireless and PDA: a novel strategy to access DICOM-compliant medical data on mobile devices.

The medical procedures at the patient bedside are out of the scope of current HIS/RIS systems, which means that patient record and image data access during the medical visit or the execution, recording and confirmation of the medicine prescriptions, still do not enjoy computerized support. As a consequence, the necessary inclusion of new data to the patient record, still needs to be carried out through notations on paper and later typed, causes delays on the availability of this information (Mobile computing in a hospital: the Ward-In-Hand project. SAC 2000-ACM Symposium on Applied Computing, Março, 2000, Villa Olmo, Como, Italy). This paper presents a software technology where the medical and nursing staff will be equipped with a handheld computer connected by radio to a central server that provides access to the electronic patient records and that will actively inform about tasks pending distribution. The server acts as a database for multimodal electronic patient record information, storing patient data from computerized tomography (CT), ultrasonography (US), magnetic resonance (MRI) images and also medical findings, observations and prescriptions coded as DICOM Structured Reports (Digital Image and Communications in Medicine). The prototype described in this article implements a medical images and structured reports server that makes the search and recovery of data stored in the DICOM standard possible.

Brazil↗
PubMed2006

Initial therapy with radical prostatectomy for high risk localized prostate cancer.

PURPOSE: This study provides a perspective on initial treatment in select patients with high risk, localized prostate cancer. MATERIALS AND METHODS: A select literature review was done with commentary on the philosophy of initial surgery followed by adjuvant or salvage therapies. RESULTS: Early detection and associated stage migration identify a cadre of men with unfavorable but apparently localized prostate cancer who historically would not have been viewed as appropriate candidates for radical prostatectomy. Decreased morbidity from radical prostatectomy and data demonstrating improved outcomes in some patients treated with multimodal therapy protocols provide a rationale for including radical prostatectomy as part of an aggressive treatment plan to achieve optimal local elimination of cancer. Data suggest that radical prostatectomy and adjuvant or possibly even salvage radiation therapy may provide the best elimination of large local cancers. Whether such an approach provides results that are better than or even as good as those of the common standard of radiation therapy plus androgen deprivation therapy remains to be seen and, if so, at what cost to the patient in terms of adverse effects. However, it is likely that optimal elimination of local disease is needed to achieve the maximum benefit from adjuvant systemic endocrine, chemotherapy or targeted treatments. In other words optimal local therapy may be necessary but not sufficient. CONCLUSIONS: Initial radical prostatectomy may have a role for treating high risk localized prostate cancer.

Humans↗
PubMed2001

Adult psychosocial outcome of prepubertal major depressive disorder.

OBJECTIVE: To compare adult psychosocial functioning (PSF) of subjects with prepubertal major depressive disorder (PMDD) to a normal comparison (NC) group. METHOD: PSF of subjects with PMDD (n = 72) and of NC subjects (n = 28) was compared after prospective follow-up to adulthood. These 100 subjects were 90.9% of the baseline 110 subjects who participated in the "Nortriptyline in Childhood Depression: Follow-up Study." Research nurses who were blind to group status conducted telephone interviews using the Longitudinal Interval Follow-up Evaluation (LIFE) to obtain PSF data. RESULTS: At follow-up, the PMDD group was 20.7+/-2.0 and the NC subjects were 20.9+/-2.2 years old. The PMDD subjects were 10.3+/-1.5 years old at baseline. Time between baseline and follow-up was 9.9+/-1.5 years. In the PMDD group, subjects with MDD, bipolar disorder, or substance use disorders during the previous 5 years had significantly worse PSF than NC subjects. These PSF impairments included significantly worse relationships with parents, siblings, and friends; significantly worse functioning in household, school, and work settings; and worse overall quality of life and global social adjustment. CONCLUSIONS: Although combined treatments for PMDD have little scientific basis, multimodality regimens seem prudent until definitive treatment data become available.

Adaptation, Psychological↗
PubMed2004

The origin of protein sidechain order parameter distributions.

Previous work by Wand et al. (Nature 2001, 411, 501-504) showed that the NMR order parameters characterizing the amplitude of motion of protein side chains seemed to form a multimodal distribution. At the time, no detailed explanation of this at the molecular level was offered, yet three "classes" of motion were inferred. We have analyzed a larger published data set and found that, although the distribution is multimodal, the evidence for three classes is weak. More significantly, we have been able to provide a simple physical explanation for the distributions based on the results of molecular dynamics simulations. This result will aid in the interpretation of data from NMR dynamics experiments.

Amino Acids↗
PubMed2002

Changing patterns of failure of head and neck cancer.

BACKGROUND: With the increased use of neoadjuvant therapy for advanced stage squamous cell carcinoma of the head and neck, we have observed an apparent change in the pattern of failure from predominantly locoregional sites to distant metastases. We reviewed the patterns of failure in cancers of the oral cavity, oropharynx, and larynx at our institution during the last decade. OBJECTIVE: To determine whether there has been a significant change in the patterns of recurrence from the historical locoregional failure to distant sites, and whether this change is associated with the increased use of multimodality therapy. METHODS: We reviewed cancer registry data on patients with squamous cell carcinoma of the head and neck diagnosed between January 1, 1988, and December 31, 1999. Sites included the oral cavity and oropharynx (including the tongue, floor of mouth, retromolar trigone, gingiva, tonsil, and lip) and larynx. RESULTS: Among 432 patients with squamous cell carcinoma of the head and neck, 280 (65%) had oral cavity and oropharyngeal cancers, and 152 (35%) had laryngeal cancers. Overall, 19% developed locoregional recurrence, and 8% developed distant failure. Although locoregional failure for oral cavity and oropharyngeal squamous cell carcinoma decreased from 26% to 16% from 1988-1993 to 1994-1999, distant failure increased significantly from 3% to 8%. During these periods, multimodality therapy was used in 62% of oral cavity and oropharyngeal cancers, and this rate remained essentially unchanged. For laryngeal cancer, locoregional and distant failure remained stable at 18% and 9%, respectively. In these laryngeal cancers, the use of multimodality therapy decreased from 60% to 46%, but this difference was not statistically significant (P =.43). CONCLUSIONS: Although locoregional control in oral cavity and oropharyngeal cancers has improved significantly with the use of multimodality therapy, the incidence of distant failure has doubled. In laryngeal squamous cell carcinoma, the patterns of failure have not changed significantly.

Adolescent↗