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PubMed1996

National Cancer Data Base report on esophageal carcinoma.

BACKGROUND: The prognosis for patients with esophageal carcinoma is poor, with less than fifty percent surviving 1 year after diagnosis. Although diagnostic and staging methods have improved, a large proportion of patients present with advanced disease. Research is being conducted to determine what multimodality treatment regimens provide the best local control and survival. METHODS: Using the National Cancer Data Base's most current accrual of oncologic data for cases diagnosed in 1988 and 1993, patterns of care and outcome were analyzed for esophageal carcinoma. RESULTS: A substantial increase was demonstrated between 1988 and 1993 in the proportion of esophageal adenocarcinomas and patients presenting with Stage IV disease. The therapeutic regimen most frequently employed in 1993 was combined radiation therapy and chemotherapy, which rose 8.2% from 2.2% in 1988. CONCLUSIONS: The dramatic rise across the years of this study in the occurrence of esophageal adenocarcinomas indicates a need for developing strategies to evaluate Barrett's preneoplastic mucosal changes more precisely. The increasing use of combined chemotherapy and radiation therapy reflects the results of randomized trials that have demonstrated improved response and outcome for this combined regimen compared with radiation therapy alone. There was no substantial increase in the use of surgical resection with chemotherapy and radiation therapy throughout these years.

Adenocarcinoma↗
PubMedDate not supplied

Informatics in radiology (infoRAD): navigating the fifth dimension: innovative interface for multidimensional multimodality image navigation.

The display and interpretation of images obtained by combining three-dimensional data acquired with two different modalities (eg, positron emission tomography and computed tomography) in the same subject require complex software tools that allow the user to adjust the image parameters. With the current fast imaging systems, it is possible to acquire dynamic images of the beating heart, which add a fourth dimension of visual information-the temporal dimension. Moreover, images acquired at different points during the transit of a contrast agent or during different functional phases add a fifth dimension-functional data. To facilitate real-time image navigation in the resultant large multidimensional image data sets, the authors developed a Digital Imaging and Communications in Medicine-compliant software program. The open-source software, called OsiriX, allows the user to navigate through multidimensional image series while adjusting the blending of images from different modalities, image contrast and intensity, and the rate of cine display of dynamic images. The software is available for free download at http://homepage.mac.com/rossetantoine/osirix.

Humans↗
PubMed2006

Maximized combined modality treatment of an unselected population of oral and oropharyngeal cancer patients. Final results of a pilot study compared with a treatment-dependent prognosis index.

BACKGROUND: In an attempt to raise the survival of an unselected and representative population of oral and oropharyngeal squamous cell cancer patients, a pilot study of an integrated four-modality treatment was conceived. Final endpoints were compliance, loco-regional control, survival (after complete 5-year follow-up), and a concept of trial assessment using the treatment-dependent prognostic index TPI. PATIENTS: Eighty-seven consecutive patients with histologically proven untreated stages I-IV disease presented in the period between 1997 and 1999 of whom 14 had to be considered uncurable and 73 were fit to be treated with the intention of achieving a cure. METHODS: All patients received one cycle of neoadjuvant intraarterial chemotherapy with 150 mg/m(2) cisplatin (systemically neutralized with sodium thiosulphate), and, if possible, by consecutive treatment applying both surgery of the primary tumour and the neck lymphatics, as well as by adjuvant radiation over 5 weeks (51.3 Gy) plus concurrent chemotherapy (weekly systemic docetaxel 25 mg/m(2)). RESULTS: Ninety per cent of all cases and 96% of the patients treated with curative intention received more than one modality due to study design. Patient non-compliance in the group treated with curative intention has been 18/73 (=25%), and protocol compliance has been 32/73 (=44%). The locoregional control rate for all cases was 71% (62/87 patients) and for the patients treated with curative intention 83.5% (61/73 patients). Thirteen/fourteen non-curable patients died after a mean period of 4 months. After a median observation time of 5 years, the final absolute survival of the unselected population was 53%, and of the patients treated with curative intention 62% (especially, 70% and 50% for patients with operable stages III and IV, respectively). CONCLUSION: The multimodality regimen as presented proved feasible and showed high objective and relative survival rates in comparison with known data from tumour registries of unselected populations. Intra-arterial chemotherapy should be considered a valuable addition to treatment. The potential of survival benefit from this multimodality regimen in comparison with the prognosis index TPI should be investigated in further studies.

Adult↗
PubMed2005

Predictive camera tracking for bronchoscope simulation with CONDensation.

This paper exploits the use of temporal information to minimize the ambiguity of camera motion tracking in bronchoscope simulation. The condensation algorithm (Sequential Monte Carlo) has been used to propagate the probability distribution of the state space. For motion prediction, a second-order auto-regressive model has been used to characterize camera motion in a bounded lumen as encountered in bronchoscope examination. The method caters for multimodal probability distributions, and experimental results from both phantom and patient data demonstrate a significant improvement in tracking accuracy especially in cases where there is airway deformation and image artefacts.

Algorithms↗
PubMed2003

[Surgery for oesophageal cancer: current controversies].

Any attempt to define the present role of surgery in the treatment of oesophageal cancer should integrate the dramatic changes that occurred within this disease over the last 2 decades: major shift in the histologic type of tumours, improved staging methods, spectacular reduction of operative risks, standardization of oncologic principles focusing on the completeness of resection, and development of multimodality therapeutic strategies. Surgery has still a pivotal role. Esophagectomy should be performed by trained surgeons in high-volume institutions. Radical surgery with en-bloc resection and 2 fields lymphadenectomy, should be encouraged in low-risk patients with subcarinal tumors. Although multimodality treatment strategy is commonly applied for locally advanced disease, few data support its superiority over surgical resection alone, followed by adjuvant therapy when appropriate. One may thus hypothesize that the risk/benefit ratio of such strategies is probably optimal in case of early stage tumors, and future studies may further clarify this issue. Conversely, locally advanced tumors, particularly those located in the upper mediastinum and the neck, may be managed alternatively without surgery. However, surgery remains an important tool to ensure optimal palliation of dysphagia, to achieve local control, and finally to improve quality of life. In that way, video-assisted techniques and/or trans hiatal approaches aiming to minimize the surgical insult may have a place in the treatment of patients who have substantially responded to induction therapy. Tumors located close to the pharyngo-oesophageal junction are best managed with chemotherapy and radiotherapy. Finally, salvage surgery may be considered in highly selected patients in case of non-response or local relapse without distant metastases.

Combined Modality Therapy↗
PubMed2001

Spatial coding of visual and somatic sensory information in body-centred coordinates.

Because sensory systems use different spatial coordinate frames, cross-modal sensory integration and sensory-motor coordinate transformations must occur to build integrated spatial representations. Multimodal neurons using non-retinal body-centred reference frames are found in the posterior parietal and frontal cortices of monkeys. We used functional magnetic resonance imaging to reveal regions of the human brain using body-centred coordinates to code the spatial position of both visual and somatic sensory stimuli. Participants determined whether a visible vertical bar (visual modality) or a location touched by the right index finger (somatic sensory modality) lay to the left or to the right of their body mid-sagittal plane. This task was compared to a spatial control task having the same stimuli and motor responses and comparable difficulty, but not requiring body-centred coding of stimulus position. In both sensory modalities, the body-centred coding task activated a bilateral fronto-parietal network, though more extensively in the right hemisphere, to include posterior parietal regions around the intraparietal sulcus and frontal regions around the precentral and superior frontal sulci, the inferior frontal gyrus and the superior frontal gyrus on the medial wall. The occipito-temporal junction and other extrastriate regions exhibited bilateral activation enhancement related to body-centred coding when driven by visual stimuli. We conclude that posterior parietal and frontal regions of humans, as in monkeys, appear to provide multimodal integrated spatial representations in body-centred coordinates, and these data furnish the first indication of such processing networks in the human brain.

Adult↗
PubMed2001

What works in severe head injury?

Traumatic brain injury has an important socioeconomic impact in industrialized countries. However, well-conducted clinical trials are rare. Case-control studies have shown that prevention works. Pathophysiological understanding is becoming more complete as data on chemokines, local brain tissue oxygen tension and hypothermia accumulate. Multimodality monitoring will certainly assume greater importance in the future. Research with targeted therapeutic strategies indicates that secondary ischaemic insults can be prevented. Specific subgroups of patients with traumatic brain injury who will benefit from the use of hypothermia and barbiturates have been identified. Enteral feeding is the preferred nutritional strategy, and the follow-up period should be extended beyond the traditional 1 year.

Journal Article↗
PubMed2004

Interactive virtual endoscopy in coronary arteries based on multimodality fusion.

A novel approach for platform-independent virtual endoscopy in human coronary arteries is presented in this paper. It incorporates previously developed and validated methodology for multimodality fusion of two X-ray angiographic images with pullback data from intravascular ultrasound (IVUS). These modalities pose inherently different challenges than those present in many tomographic modalities that provide parallel slices. The fusion process results in a three- or four-dimensional (3-D/4-D) model of a coronary artery, specifically of its lumen/plaque and media/adventitia surfaces. The model is used for comprehensive quantitative hemodynamic, morphologic, and functional analyses. The resulting quantitative indexes are then used to supplement the model. Platform-independent visualization is achieved through the use of the ISO/IEC-standardized Virtual Reality Modeling Language (VRML). The visualization includes an endoscopic fly-through animation that enables the user to interactively select vessel location and fly-through speed, as well as to display image pixel data or quantification results in 3-D. The presented VRML virtual-endoscopy system is used in research studies of coronary atherosclerosis development, quantitative assessment of coronary morphology and function, and vascular interventions.

Algorithms↗
PubMed2003

Screening for ovarian cancer.

Ovarian cancer frequently presents late, when chances for long-term survival are poor. The increased survival advantage for patients diagnosed with early-stage ovarian cancer suggests that screening to detect early-stage disease might have an impact on disease mortality. Attempts are being made to develop effective screening procedures for early ovarian cancer in symptom-free women, using a variety of serum tumor markers, proteomic patterns, and ovarian morphological and vascular features. Two distinct screening strategies have emerged, one utilizing transvaginal scanning as the primary test, and the other involving measurement of the serum tumor marker CA125 as the primary test with transvaginal ultrasonography as the secondary test (multimodal screening). Large randomized trials are now underway to provide definitive data on the impact of screening on mortality and address morbidity, health economics and psychosocial issues.

Clinical Trials as Topic↗
PubMed1993

[Primary cerebral lymphoma. Current status of diagnosis and therapy].

Primary cerebral lymphomas are rare tumors. In the last years the frequency of these space occupying lesions is increasing. Diagnosis by image-generating methods is often difficult. Stereotactic biopsy is a reliable diagnostic tool. Explorative craniotomy with tumor resection should be avoided if possible. An effective multimodal therapeutic regimen is the combination of radiotherapy and chemotherapy. Epidemiologic data, diagnostic methods and therapeutic proceedings are presented and discussed on a series of 7 patients with primary cerebral lymphomas treated in our department.

Aged↗
PubMed2001

Regional anaesthesia in vascular surgery: a multidisciplinary approach to accelerate recovery and postoperative discharge.

A multimodal, rehabilitative, fast discharge approach to abdominal aortic surgery is analyzed. The approach was developed in two phases during the years 1997-2000: in the first phase (1997) patients had thoracic epidural anesthesia plus TIVA and analgesia. They had improvement of the classical surrogate outcomes and analgesia: pain relief, nasogastric tube withdrawal, mobilization, ileus, hospital length of stay were significantly (p< 0,01) improved when compared to a historical, standard management group (1996: general anesthesia or lumbar epidural anesthesia plus general anesthesia with gas). In the second phase we started a more aggressive perioperative approach based on thoracic epidural anesthesia plus general anesthesia with gas and spontaneous breathing and postoperative epidural analgesia, left subcostal minilaparotomy incisions, aggressive postoperative nursing and pain relief on the ward. Preliminary results on 44 patients show no mortality, low postoperative morbility (cardiac complications 2,2%, peripheral embolization 2,2%, no pulmonary complications), no ICU stay and fast hospital discharge (median: 3,5 days, range: 2-8 days) without complications. We conclude that preliminary data support the safety and the need for further improvement of a multimodal, aggressive rehabilitative approach in abdominal vascular surgery.

Anesthesia Recovery Period↗
PubMed1990

Genetic studies of variation in Rayleigh and photometric matches in normal trichromats.

The inheritance of Rayleigh match midpoints and photometric matches (551-667 nm) was studied in observers with normal color vision. An analysis was performed to evaluate whether the measured interobserver variations in these two traits were consistent with single gene allelic variation, polygenic variation, or environmental factors. A bipartite 2 deg field and a computerized tracking method were used to obtain Rayleigh matches; a new photometric technique, termed heterochromatic modulation photometry (HMP), was used to obtain photometric matches. Data were collected from 72 nonrelated males to determine distribution characteristics for the normal population. The distributions were analyzed for evidence of multimodality and the results indicated that the distributions for Rayleigh match midpoints and HMP matches obtained in this study were unimodal and symmetrical. Data from 52 observers from 5 families were used to study the transmission of the two traits in pedigrees. Statistical analysis of the pedigree data suggested that the major source of variations for Rayleigh match midpoints and for HMP matches were each due to allelic variation at single gene loci; that is, each may be determined by a single gene. Results were inconclusive as to whether variation in the two traits could be determined by the same gene.

Adolescent↗
PubMed2006

Biological parametric mapping: A statistical toolbox for multimodality brain image analysis.

In recent years, multiple brain MR imaging modalities have emerged; however, analysis methodologies have mainly remained modality-specific. In addition, when comparing across imaging modalities, most researchers have been forced to rely on simple region-of-interest type analyses, which do not allow the voxel-by-voxel comparisons necessary to answer more sophisticated neuroscience questions. To overcome these limitations, we developed a toolbox for multimodal image analysis called biological parametric mapping (BPM), based on a voxel-wise use of the general linear model. The BPM toolbox incorporates information obtained from other modalities as regressors in a voxel-wise analysis, thereby permitting investigation of more sophisticated hypotheses. The BPM toolbox has been developed in Matlab with a user-friendly interface for performing analyses, including voxel-wise multimodal correlation, ANCOVA, and multiple regression. It has a high degree of integration with the SPM (statistical parametric mapping) software relying on it for visualization and statistical inference. Furthermore, statistical inference for a correlation field, rather than a widely used T-field, has been implemented in the correlation analysis for more accurate results. An example with in vivo data is presented, demonstrating the potential of the BPM methodology as a tool for multimodal image analysis.

Brain↗
PubMed2001

Linear inverse source estimate of combined EEG and MEG data related to voluntary movements.

A method for the modeling of human movement-related cortical activity from combined electroencephalography (EEG) and magnetoencephalography (MEG) data is proposed. This method includes a subject's multi-compartment head model (scalp, skull, dura mater, cortex) constructed from magnetic resonance images, multi-dipole source model, and a regularized linear inverse source estimate based on boundary element mathematics. Linear inverse source estimates of cortical activity were regularized by taking into account the covariance of background EG and MEG sensor noise. EEG (121 sensors) and MEG (43 sensors) data were recorded in separate sessions whereas normal subjects executed voluntary right one-digit movements. Linear inverse source solution of EEG, MEG, and EEG-MEG data were quantitatively evaluated by using three performance indexes. The first two indexes (Dipole Localization Error [DLE] and Spatial Dispersion [SDis]) were used to compute the localization power for the source solutions obtained. Such indexes were based on the information provided by the column of the resolution matrix (i.e., impulse response). Ideal DLE values tend to zero (the source current was correctly retrieved by the procedure). In contrast, high DLE values suggest severe mislocalization in the source reconstruction. A high value of SDis at a source space point mean that such a source will be retrieved by a large area with the linear inverse source estimation. The remaining performance index assessed the quality of the source solution based on the information provided by the rows of the resolution matrix R, i.e., resolution kernels. The i-th resolution kernels of the matrix R describe how the estimation of the i-th source is distorted by the concomitant activity of all other sources. A statistically significant lower dipole localization error was observed and lower spatial dispersion in source solutions produced by combined EEG-MEG data than from EEG and MEG data considered separately (P < 0.05). These effects were not due to an increased number of sensors in the combined EEG-MEG solutions. They result from the independence of source information conveyed by the multimodal measurements. From a physiological point of view, the linear inverse source solution of EEG-MEG data suggested a contralaterally preponderant bilateral activation of primary sensorimotor cortex from the preparation to the execution of the movement. This activation was associated with that of the supplementary motor area. The activation of bilateral primary sensorimotor cortical areas was greater during the processing of afferent information related to the ongoing movement than in the preparation for the motor act. In conclusion, the linear inverse source estimate of combined MEG and EEG data improves the estimate of movement-related cortical activity.

Dura Mater↗
PubMed2002

Long-term outcome of neoadjuvant therapy for locally advanced breast carcinoma: effective clinical downstaging allows breast preservation and predicts outstanding local control and survival.

OBJECTIVE: To review the long-term follow-up data from the authors' institutional experience of 62 patients with locally advanced breast cancer (LABC) treated with a uniform multimodality regimen. The authors determined the rate of breast preservation, the disease-free and overall survival, and the factors associated with locoregional and distant recurrent disease. SUMMARY BACKGROUND DATA: It remains a challenge to achieve local and distant control of LABC. Over the last decade, preoperative or neoadjuvant chemotherapy has emerged as the standard of care for these patients. Successful tumor downstaging has been associated with increased rates of breast-conserving therapy (BCT), but the overall effect on long-term survival remains to be seen. METHODS: This study examines a cohort of 62 patients with LABC treated at the authors' institution from 1992 to 1998. The uniform treatment regimen consisted of neoadjuvant doxorubicin (Adriamycin), followed by operation (BCT if sufficient clinical downstaging), followed by non-cross-resistant cyclophosphamide/methotrexate/5-fluorouracil, followed by radiation therapy. Treatment was both dose-intensive and time-intensive, with a total treatment time of 32 to 35 weeks. RESULTS: In this patient population, the median age was 44 years, with approximately two thirds white patients and one third African American. Eighty-two percent of patients were clinical stage III at presentation, 13 patients had T4d inflammatory cancers, and 3 patients were stage IV at diagnosis. Eighty-four percent of patients demonstrated a significant clinical response to doxorubicin. Twenty-eight patients had sufficient clinical downstaging to attempt BCT, and 22 (45%) of 49 noninflammatory patients underwent successful BCT. Pathologic complete response was seen in 15% of patients. Median follow-up for the cohort was 70 months. The local recurrence rate was 14%, including two ipsilateral breast tumor recurrences (10%) in the BCT patients. Seven (12%) patients developed a new primary cancer in the contralateral breast. Distant metastases occurred in 18 (31%) patients, and the 5-year overall survival rate for the cohort was 76%. Furthermore, in the patients who underwent an attempt at BCT, the survival rate was 96% at 5 years. CONCLUSIONS: Dose-intensive and time-intensive multimodality neoadjuvant therapy was successfully administered to a mixed racial group over shortened times. Patients who had sufficient clinical downstaging to allow BCT have the best long-term outcome. Patients who required mastectomy are at a higher risk of relapse, as well as the development of new contralateral cancers, yet have 5-year survival rates of over 50%.

Adult↗
PubMed2006

Multimodality noninvasive imaging demonstrates in vivo cardiac regeneration after mesenchymal stem cell therapy.

OBJECTIVES: The purpose of this study was to test the hypothesis, with noninvasive multimodality imaging, that allogeneic mesenchymal stem cells (MSCs) produce and/or stimulate active cardiac regeneration in vivo after myocardial infarction (MI). BACKGROUND: Although intramyocardial injection of allogeneic MSCs improves global cardiac function after MI, the mechanism(s) underlying this phenomenon are incompletely understood. METHODS: We employed magnetic resonance imaging (MRI) and multi-detector computed tomography (MDCT) imaging in MSC-treated pigs (n = 10) and control subjects (n = 12) serially for a 2-month period after anterior MI. A sub-endocardial rim of tissue, demonstrated with MDCT, was assessed for regional contraction with MRI tagging. Rim thickness was also measured on gross pathological specimens, to confirm the findings of the MDCT imaging, and the size of cardiomyocytes was measured in the sub-endocardial rim and the non-infarct zone. RESULTS: Multi-detector computed tomography demonstrated increasing thickness of sub-endocardial viable myocardium in the infarct zone in MSC-treated animals (1.0 +/- 0.2 mm to 2.0 +/- 0.3 mm, 1 and 8 weeks after MI, respectively, p = 0.028, n = 4) and a corresponding reduction in infarct scar (5.1 +/- 0.5 mm to 3.6 +/- 0.2 mm, p = 0.044). No changes occurred in control subjects (n = 4). Tagging MRI demonstrated time-dependent recovery of active contractility paralleling new tissue appearance. This rim was composed of morphologically normal cardiomyocytes, which were smaller in MSC-treated versus control subjects (11.6 +/- 0.2 mum vs. 12.6 +/- 0.2 mum, p < 0.05). CONCLUSIONS: With serially obtained MRI and MDCT, we demonstrate in vivo reappearance of myocardial tissue in the MI zone accompanied by time-dependent restoration of contractile function. These data are consistent with a regenerative process, highlight the value of noninvasive multimodality imaging to assess the structural and functional basis for myocardial regenerative strategies, and have potential clinical applications.

Animals↗
PubMed2025

Target and biomarker exploration portal for drug discovery.

MOTIVATION: The discovery of novel drug targets and precision biomarkers remains a major challenge in drug development, with traditional differential expression analysis often overlooking key regulatory proteins. Here, we present a novel, web-based bioinformatics tool, the Target and Biomarker Exploration Portal (TBEP), designed to accelerate the drug discovery process by integrating large-scale biomedical data with network analysis techniques. RESULTS: TBEP harnesses machine-learning approaches to mine and combine multimodal datasets, including human genetics, functional genomics, and protein-protein interaction networks, to decode causal disease mechanisms and uncover novel therapeutic targets and precision biomarkers for specific phenotypes. A unique feature of the tool is its ability to process large-scale data in real-time, facilitated by an efficient cloud-based architecture. Additionally, the tool incorporates an integrated large language model (LLM), which assists researchers in exploring and interpreting complex biological relationships within the generated networks and multi-omics data using natural language (English). By offering an intuitive, interactive interface, the LLM enhances the exploration of biological insights, making it easier for scientists to derive actionable conclusions. This powerful integration of network analysis, multi-omics data, and LLM provides a robust framework for accelerating the identification of novel drug targets. AVAILABILITY AND IMPLEMENTATION: The tool is publicly available at https://tbep.missouri.edu. The source code, documentation and installation instructions are available at GitHub repository: https://github.com/mizzoudbl/tbep.

Drug Discovery↗