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At least 343 records · Page 19Linked to original sources
PubMed2003

Multimodal image fusion in ultrasound-based neuronavigation: improving overview and interpretation by integrating preoperative MRI with intraoperative 3D ultrasound.

OBJECTIVE: We have investigated alternative ways to integrate intraoperative 3D ultrasound images and preoperative MR images in the same 3D scene for visualizing brain shift and improving overview and interpretation in ultrasound-based neuronavigation. MATERIALS AND METHODS: A Multi-Modal Volume Visualizer (MMVV) was developed that can read data exported from the SonoWand neuronavigation system and reconstruct the spatial relationship between the volumes available at any given time during an operation, thus enabling the exploration of new ways to fuse pre- and intraoperative data for planning, guidance and therapy control. In addition, the mismatch between MRI volumes registered to the patient and intraoperative ultrasound acquired from the dura was qualified. RESULTS: The results show that image fusion of intraoperative ultrasound images in combination with preoperative MRI will make perception of available information easier by providing updated (real-time) image information and an extended overview of the operating field during surgery. This approach will assess the degree of anatomical changes during surgery and give the surgeon an understanding of how identical structures are imaged using the different imaging modalities. The present study showed that in 50% of the cases there were indications of brain shift even before the surgical procedure had started. CONCLUSIONS: We believe that image fusion between intraoperative 3D ultrasound and preoperative MRI might improve the quality of the surgical procedure and hence also improve the patient outcome.

Brain↗
PubMed1997

Integration of functional and anatomical brain images.

This article concerns the integration of functional and anatomical volumetric brain images. Integration consists of two steps: matching or registration, where the images are brought into spatial agreement, and fusion or simultaneous display where the registered multimodal image information is presented in an integrated fashion. Approaches to register multiple images are divided into extrinsic methods based on artificial markers, and intrinsic matching methods based solely on the patient related image data. The various methods are compared by a number of characteristics, which leads to a clear preference for one class of intrinsic methods, viz. voxel-based matching. Furthermore, two- and three-dimensional techniques to display multimodality image information are outlined.

Brain↗
PubMed1998

Efficacy of multimodality therapy in advanced renal cell carcinoma.

OBJECTIVES: The integration of systemic biologic response modifier (BRM) therapy and surgery to treat metastatic renal cell carcinoma (RCC) is an evolving approach. The purpose of this study was to evaluate the efficacy of this form of multimodality therapy in patients with metastatic RCC. METHODS: Between 1988 and 1996, 14 patients at our institution underwent initial BRM therapy followed by surgical resection of primary and metastatic RCC lesions. Patient records were reviewed to determine the response to BRM therapy, progression-free survival rate, and overall survival rate. The mean follow-up for the entire group was 43.5 months. RESULTS: After BRM therapy, 9 patients manifested an objective response and 5 patients had stable disease. All patients were then rendered disease-free by surgical excision of residual or recurrent metastatic lesions and the primary tumor. The cancer-specific survival rate at 3 years was 81.5%. Currently, 7 patients are alive and disease-free (mean follow-up 41.4 months), 3 patients are alive with recurrent disease (mean survival 48.3 months), 3 patients died of metastatic disease (mean survival 27.9 months), and 1 patient died of an unrelated cause 54.4 months after therapy. CONCLUSIONS: The results of this study suggest that adjunctive surgery after BRM therapy can extend the survival of selected patients with metastatic RCC. Aggressive surgical resection of stable or responding lesions after BRM therapy should be considered in the management of these patients.

Adult↗
PubMed2002

Object activation in semantic memory from visual multimodal feature input.

The human brain's representation of objects has been proposed to exist as a network of coactivated neural regions present in multiple cognitive systems. However, it is not known if there is a region specific to the process of activating an integrated object representation in semantic memory from multimodal feature stimuli (e.g., picture-word). A previous study using word-word feature pairs as stimulus input showed that the left thalamus is integrally involved in object activation (Kraut, Kremen, Segal, et al., this issue). In the present study, participants were presented picture-word pairs that are features of objects, with the task being to decide if together they "activated" an object not explicitly presented (e.g., picture of a candle and the word "icing" activate the internal representation of a "cake"). For picture-word pairs that combine to elicit an object, signal change was detected in the ventral temporo-occipital regions, pre-SMA, left primary somatomotor cortex, both caudate nuclei, and the dorsal thalami bilaterally. These findings suggest that the left thalamus is engaged for either picture or word stimuli, but the right thalamus appears to be involved when picture stimuli are also presented with words in semantic object activation tasks. The somatomotor signal changes are likely secondary to activation of the semantic object representations from multimodal visual stimuli.

Adult↗
PubMed2003

Display of fused images: methods, interpretation, and diagnostic improvements.

The use of integrated visualization for medical images aims at assisting clinicians in the difficult task of mentally translating and integrating medical image data from multiple sources into a three-dimensional (3D) representation of the patient. This interpretation of the enormous amount and complexity of contemporary, multiparameter, and multimodal image data demands efficient methods for integrated presentation. This article reviews methods for fused display with the main focus on integration of functional with anatomical images. First, an overview of integrated two-dimensional (2D) and 3D medical image display techniques is presented, and topics related to the interpretation of the integrated images are discussed. Then we address the key issue for clinical acceptance, ie, whether these novel visualization techniques lead to diagnostic improvements. Methods for fused display appear to be powerful tools to assist the clinician in the retrieval of relevant information from multivariate medical image data. Evaluation of the different methods for fused display indicates that the diagnostic process improves, notably as concerns the anatomical localization (typically of functional processes), the registration procedure, enhancement of signal, and efficiency of information presentation (which increases speed of interpretation and comprehension). Consequently, fused display improves communication with referring specialists, increases confidence in the observations, and facilitates the intra- and intersubject comparison of a large part of the data from the different sources, thereby simplifying the extraction of additional, valuable information. In most diagnostic tasks the clinician is served best by providing several (interactive and flexible) 2D and 3D methods for fused display for a thorough assessment of the wealth of image information from multiple sources.

Anatomy, Cross-Sectional↗
PubMed2002

Multimodal assessment of pain in the esophagus: a new experimental model.

A new multimodal pain assessment model was developed integrating electrical, mechanical, cold, and warmth stimuli into the same device. The device, with a bag and electrodes for electrical stimulation, was positioned in the lower part of the esophagus in 11 healthy subjects. Mechanical stimuli were delivered with an impedance planimetric system. Thermal stimuli were performed by circulating water of different temperatures (5-50 degrees C) inside the bag. All subjects reported both nonpainful and painful local and referred sensations to all stimuli. Temporal summation to repeated electrical stimuli could be studied. For all stimuli, there was a relationship between stimulus intensity and pain intensity. The referred pain area increased with increasing intensity of the electrical and mechanical stimuli. There were several differences between the sensations evoked by the four stimulus modalities, indicating activation of different visceral nerve pathways. This model offers the possibility for controlled multimodal stimuli activating the superficial and deeper layers of the human gut and should be used in basic, clinical, and pharmacological pain studies.

Adult↗
PubMed2006

Monitoring analgesia.

Analgesia (pain relief) amnesia (loss of memory) and immobilisation are the three major components of anaesthesia. The perception of pain, and therefore, the need for analgesia, is individual, and the monitoring of analgesia is indirect and, in essence, of the moment. Under general anaesthesia, analgesia is continually influenced by external stimuli and the administration of analgesic drugs, and cannot be really separated from anaesthesia: the interaction between analgesia and anaesthesia is inescapable. Autonomic reactions, such as tachycardia, hypertension, sweating and lacrimation, although non-specific, are always regarded as signs of nociception or inadequate analgesia. Autonomic monitoring techniques, such as the analysis of heart rate variability, laser Doppler flowmetry, phlethysmographically derived indices and the pupillary light reflex, may help to quantitate reactions of the autonomic nervous system. For the past few years, automated electroencephalographic analysis has been of great interest in monitoring anaesthesia and could be useful in adapting the peroperative administration of opioids. A range of information collected from the electroencephalogram, haemodynamic readings and pulse plethysmography might be necessary for monitoring the level of nociception during anaesthesia. Information theory, multimodal monitoring, and signal processing and integration are the basis of future monitoring.

Analgesia↗
PubMed2002

Sensory inputs stimulate progenitor cell proliferation in an adult insect brain.

Although most brain neurons are produced during embryonic and early postnatal development, recent studies clearly demonstrated in a wide range of species from invertebrates to humans that new neurons are added to specific brain structures throughout adult life. Hormones, neurotransmitters, and growth factors as well as environmental conditions modulate this neurogenesis. In this study, we address the role of sensory inputs in the regulation of adult neural progenitor cell proliferation in an insect model. In some insect species, adult neurogenesis occurs in the mushroom bodies, the main sensory integrative centers of the brain, receiving multimodal information and often considered as the analog of the vertebrate hippocampus. We recently showed that rearing adult crickets in enriched sensory and social conditions enhanced neuroblast proliferation in the mushroom bodies. Here, by manipulating hormonal levels and affecting olfactory and/or visual inputs, we show that environmental regulation of neurogenesis is in direct response to olfactory and visual stimuli rather than being mediated via hormonal control. Experiments of unilateral sensory deprivation reveal that neuroblast proliferation can be inhibited in one brain hemisphere only. These results, obtained in a relatively simple brain, emphasize the role of sensory inputs on stem cell division.

Animals↗
PubMed2000

Nutrient tasting and signaling mechanisms in the gut. IV. There is more to taste than meets the tongue.

The tongue is the principal organ that provides sensory information about the quality and quantity of chemicals in food. Other information about the temperature and texture of food is also transduced on the tongue, via extragemmal receptors that form branches of the trigeminal, glossopharyngeal, and vagal nerves. These systems, together with information from the gastrointestinal (GI) system, interact to determine whether or not food is palatable. In this themes article, emphasis is placed on the integrative aspects of gustatory processing by showing the convergence of gustatory information with somatosensory, nociceptive, and visceral information (from the GI system) on the tongue and in the brain. Our thesis is that gustation should be thought of as an integral part of a distributed, interacting multimodal system in which information from other systems, including the GI system, can modulate the taste of food.

Animals↗
PubMed2000

Continuous monitoring of regional cerebral blood flow: experimental and clinical validation of a novel thermal diffusion microprobe.

OBJECT: Current clinical neuromonitoring techniques lack adequate surveillance of cerebral perfusion. In this article, a novel thermal diffusion (TD) microprobe is evaluated for the continuous and quantitative assessment of intraparenchymal regional cerebral blood flow (rCBF). METHODS: To characterize the temporal resolution of this new technique, rCBF measured using the TD microprobe (TD-rCBF) was compared with rCBF levels measured by laser Doppler (LD) flowmetry during standardized variations of CBF in a sheep model. For validation of absolute values, the microprobe was implanted subcortically (20 mm below the level of dura) into 16 brain-injured patients, and TD-rCBF was compared with simultaneous rCBF measurements obtained using stable xenon-enhanced computerized tomography scanning (sXe-rCBF). The two techniques were compared using linear regression analysis as well as the Bland and Altman method. Stable TD-rCBF measurements could be obtained throughout all 3- to 5-hour sheep experiments. During hypercapnia, TD-rCBF increased from 49.3+/-15.8 ml/100 g/min (mean +/- standard deviation) to 119.6+/-47.3 ml/100 g/ min, whereas hypocapnia produced a decline in TD-rCBF from 51.2+/-12.8 ml/100 g/min to 39.3+/-5.6 m/100 g/min. Variations in mean arterial blood pressure revealed an intact autoregulation with pressure limits of approximately 65 mm Hg and approximately 170 mm Hg. After cardiac arrest TD-rCBF declined rapidly to 0 ml/100 g/min. The dynamics of changes in TD-rCBF corresponded well to the dynamics of the LD readings. A comparison of TD-rCBF and sXe-rCBF revealed a good correlation (r = 0.89; p < 0.0001) and a mean difference of 1.1+/-5.2 ml/100 g/min between the two techniques. CONCLUSIONS: The novel TD microprobe provides a sensitive, continuous, and real-time assessment of intraparenchymal rCBF in absolute flow values that are in good agreement with sXe-rCBF measurements. This study provides the basis for the integration of TD-rCBF into multimodal monitoring of patients who are at risk for secondary brain injury.

Adolescent↗
PubMed2002

Effect of postoperative epidural analgesia on surgical outcome.

Pain relief allowing sufficient mobilization after major surgical procedures can only be achieved by continuous epidural analgesia with local anesthetics, which also reduces the stress response to surgery. However, the role of postoperative epidural analgesia on postoperative morbidity is controversial. We therefore update the effects of postoperative analgesia on surgical outcome. After major abdominal surgery, postoperative epidural analgesia with local anesthetics significantly reduces postoperative ileus and pulmonary complications while effects on cardiac morbidity are debatable. Continuous epidural analgesia significantly lowers the risk of thromboembolic complications after lower body procedures, while no effect is seen after major abdominal surgery. Unfortunately, many studies have inadequate study design, with use of lumbar epidural analgesia for abdominal procedures, or the epidural regimen does not contain a sufficient amount of local anesthetics. Future evaluation of the effects of epidural analgesia on postoperative outcome also requires integration of epidural analgesia within a multimodal rehabilitation programme.

Analgesia, Epidural↗
PubMed2026

Livestock Multi-Omics Integration: A Systematic Framework From Statistical Association to Causal Interpretation.

Livestock multi-omics integration is key to unraveling complex trait regulation, yet systematic, livestock-specific strategies remain scarce. This review traces the progression from single-omics accumulation to multi-dimensional integration, highlighting how large-scale genomic, epigenomic, and transcriptomic projects lay the foundation for functional dissection. We identify core impediments: extreme species diversity, marked data heterogeneity, limited sample sizes, and a pervasive reduction of multi-omics data to simplistic differential screens, resulting in low translational efficiency. We critically appraise four common pitfalls-overinterpreting correlation as causation, relegating proteomics to corroborating transcriptomics, incomplete microbiome-host integration lacking environmental context, and systematic neglect of metabolic fluxomics-and show how exposomics and fluxomics add necessary causal and dynamic dimensions. To address these, we propose a livestock-adapted three-tier analytical framework: (1) statistical association of cross-omics covariation patterns; (2) machine learning-driven feature mining and integrative modeling; and (3) causal interpretation encompassing Mendelian randomization, prior-knowledge-guided network inference, and physical causal evidence via fluxomics and metabolic control analysis. We further discuss how multimodal sequencing (single-cell, spatial, temporal) and generative AI can fundamentally mitigate heterogeneity and strengthen causal evidence. Finally, we outline future priorities in database standardization, livestock-specific benchmarking, and translational pipelines, charting a path from correlation-centric reporting to mechanistic causality and precision breeding.

Animals↗
PubMed2006

Multiple parameter vector bending and high-temperature sensors based on asymmetric multimode fiber Bragg gratings inscribed by an infrared femtosecond laser.

We present a multiple parameter integrated fiber sensor that can detect vector bending and ambient temperature simultaneously with a single asymmetric multimode fiber Bragg grating. Multimode Bragg gratings were fabricated in an all-silica core fiber by an infrared femtosecond laser, which showed multiple transmission dips in the transmission spectrum. Bending and ambient temperature fluctuations affect the shapes of multiple transmission dips in different ways. In bending, different dips have different sensitivities. On the other hand, temperature fluctuations tended to influence the dips uniformly across different dips. By analyzing the changing spectrum of dips, one can distinguish the changes induced by bending or temperature fluctuations. Furthermore, the high thermal stability of Bragg gratings inscribed by an infrared femtosecond laser can make this double parameter fiber sensor work in very harsh, high-temperature environments.

Journal Article↗
PubMed1989

Gastric cancer.

The overall cure rate for gastric cancer has changed relatively little in the United States over the past 30 years, largely because patients continue to present for treatment in advanced stages. The paucity of symptoms in early gastric cancer, the low incidence in the general United States population, and the lack of cost-effective screening methods suggest that improvements in early detection are unlikely. Hope for improved survival in late stage cases lies mostly in a better understanding of the pathophysiology and patterns of spread, in evolving techniques for more accurate perioperative staging, and in the gradually improving results of multimodality therapy for local-regional and systemic disease. A proposal is made for a new staging system integrating newer approaches to staging and for controlled trials of multimodality therapy in patients unlikely to be cured by surgery alone.

Algorithms↗
PubMed1994

[Eclectic, synthetic and integrative psychotherapy].

Eclectic psychotherapy selects convenient techniques from various approaches. Synthetic psychotherapy combines various approaches both technically and theoretically. Integrative psychotherapy aims at putting diverse theoretical systems together under a system, which would be superordinated or metatheoretical. Following partial integrative hypotheses are stressed: 1. common factors are responsible for the effect of all important pure-form therapies, 2. different factors in diverse therapies have the same final effect, 3. different factors influence specifically certain symptoms, certain problems and certain patients. Following contemporary eclectic-integrative systems are seen as most influential: Lazarus's multimodal therapy. Beutler's systematic eclectic psychotherapy, Hart's functional eclectic therapy, Prochaska's transtheoretical approach, Garfield's eclectic approach, Driscoll's pragmatic therapy and Knobloch's integrated psychotherapy. Satisfactory integration still remains a goal to be achieved. Differentiation is viewed as an important part of the integration. It should offer to each patient specifically what he needs according to his symptoms, problems and personality.

Humans↗
PubMed1984

The incidence of metastases after multimodal therapy for cancer of the head and neck.

Combined therapeutic regimens integrating chemotherapy, radiation therapy, and surgery are reported to be effective in treating advanced squamous cell carcinomas of the head and neck. The current study evaluates 58 consecutive patients with advanced (T4, N3) head and neck cancers. Forty patients (multimodal group) were treated with 2 courses of chemotherapy (cisplatin 2 mg/kg; methotrexate 280-560 mg/m2 with leucovorin rescue; bleomycin 30 mu X 3) followed by radiation therapy and surgery. Eighteen patients (combined group) were treated with preoperative radiation therapy followed by surgery. In the multimodal group there were 27 (67.5%) partial responses and nine (22.5%) complete responses, for an overall response rate of 90%. Response rates by site of primary lesion were: oral cavity, 11 of 11; oropharynx, 13 of 17; hypopharynx, 5 of 5; and larynx 7 of 7. Distant metastases (skin, lung, bone, central nervous system [CNS]) appeared in 16 patients (40%) (P less than 0.05 versus combined) at a median time of 8.5 months after diagnosis, 15 in patients having a partial (11) or complete (4) response. Thirteen patients (33%) developed distant metastases within 1 year of diagnosis (P less than 0.05 versus combined). In 11 of these patients, the primary lesion and neck disease were resectable. Two thoracotomies were performed for solitary pulmonary metastases; one was resected for cure. Fifteen patients (38%) underwent curative resection; 11 (73%) were alive at 1 year, and ten (67%) were free of disease. Overall survival was 20 of 40 (50%) at 1 year. In the combined group, there were 14 partial responses (78%) and no complete responses. Early distant metastases appeared in two patients (12.5%), at 2 and 6 months after diagnosis. Seven patients (38%) underwent curative resection; six of seven (86%) were alive at 1 year, four of seven (57%) were disease-free. Six of 16 patients at risk (37.5%) survived 1 year. After combined therapy, six of ten patients (60%) with responses to therapy survived 1 year versus 12 of 20 responders (57%) without distant metastases in the multimodal group. It is concluded that multimodal therapy for advanced head and neck cancer results in a higher response rate than with conventional combined therapy. The incidence of early and postoperative distant metastases was increased after the multimodal regimen. At 1 year there were no differences in survival between the combined and multimodal groups for responders without early metastases. Further observation is needed to determine the net long-term effects of this regimen. A prospective randomized comparison of combined and multimodal therapy for advanced lesions is indicated.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1992

Geometry driven multimodality matching of brain images.

Clinical diagnosis, as well as therapy planning and evaluation, are increasingly supported by multimodal images. There are many instances desiring integration of the information obtained by various imaging devices. This paper describes a new approach to match images of different modalities. Differential operators are used in combination with Gaussian blurring to extract geometric features from the images that correspond to similar structures. The resulting 'feature' images may be used with existing matching techniques that minimize the distance between the features in the images to be matched. Our first application of this new approach concerns matching of MRI and CT brain images. The so-called L upsilon upsilon operator produces a ridge-like feature image from which in CT and MRI the center curve of the cranium is easily extracted. First results of this operator's performance in matching tasks are shown. Another promising operator is the 'umbilicity' operator, which is presented in combination with SPECT images.

Brain↗