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PubMedDate not supplied

New avenues in 3-D computerised (stereopathological) imaging of breast cancer (review).

Multimodal methods of three-dimensional (3-D) imaging of breast cancer are described. These involve scanning confocal microscopy, using 50 MHz acoustic or near-infrared images, four-view (tetrahedral) radiography and x-ray projection microscopy. Computerised volume data from these techniques can be used to produce three-dimensional images of tissue ranging from 500 microns to approximately 4 mm in thickness. Preliminary findings indicate that stereoscopic images or 3-D computerised reconstructions are capable of advancing the understanding of the structure of ductal carcinoma in situ, lesions simulating microinvasive breast carcinoma, surgical clearance of high-grade calcifying ductal carcinoma in situ, and the 3-D growth patterns of invasive forms of breast carcinoma. In the future computerised image fusion techniques seem likely to be able to take advantage of multimodal imaging of breast cancers, thus correcting primary imaging artefacts, improving robustness, and combining complementary information. In addition, the use of computerised tetrahedral radiography may change the intraoperative assessment of breast cancers, which mostly depend at present upon subsequent laboratory procedures that take days to perform.

Breast Neoplasms↗
PubMed1992

The value of somatosensory evoked potential testing for upper lumbar radiculopathy. A correlation of electrophysiologic and anatomic data.

Patients with lumbar pain syndromes can present with a complex variety of complaints. Most clinicians focus on the lower lumbar nerve roots, but upper lumbar radicular syndromes can provide an especially difficult diagnostic challenge to the spine specialist requiring a multimodal approach to sort out diagnostic complexities. The purpose of this study was to analyze the correlation of somatosensory evoked potential findings with documented spinal pathology demonstrated on morphologic studies, thereby determining whether somatosensory evoked potential testing has a place in spinal diagnosis. The results of this study demonstrated the correlation of somatosensory evoked potential findings with anatomic abnormalities noted on computed tomographic and magnetic resonance imaging scans and discograms. Somatosensory evoked potential testing is recommended not as an isolated test, but as part of an electrophysiologic battery that would also include conventional electromyography.

Electromyography↗
PubMed2006

Direct quantitative in vivo comparison of calcified atherosclerotic plaque on vascular MRI and CT by multimodality image registration.

PURPOSE: To investigate direct volumetric in vivo correspondence of calcified atherosclerotic plaque lesions in MRI and CT images of the thoracic aorta by multimodality image registration and fusion. MATERIALS AND METHODS: Twelve CT (11 noncontrast and one contrast) and MRI (TruFISP, contrast T1-weighted volumetric interpolated breath-hold examination (VIBE)) data sets were co-registered by approximate segmentation of the aorta and subsequent automatic co-registration by maximization of mutual information (MI). We quantitatively assessed 22 co-registered calcified plaque lesions on CT and MRI. RESULTS: The three-dimensional registration consistency and accuracy were 1.74 +/- 1.3 mm, and 2.42 +/- 1.65 mm, respectively. The ratio of CT/MRI calcified plaque volume decreased asymptotically with MRI volume, and correlated with average CT lesion density (r = 0.72) for small lesions (<25 mm(3)). The average calcified plaque volume, circumferential extent, and maximal radial width by MRI were significantly smaller compared to CT (35%, 68%, and 53%, respectively; P < 0.05). CONCLUSION: Software co-registration allowed precise, direct, and voxel-based comparison of calcified atherosclerotic plaque lesions imaged by MRI and CT. In comparison with co-registered MRI, overestimation of calcified plaque in aortic CT due to "blooming" correlates with the average lesion density for small plaques, and is greater for small plaques.

Aged↗
PubMed2003

Treatment of pancreatic cancer: challenge of the facts.

Adenocarcinoma of the pancreas is associated with the worst survival of any form of gastrointestinal malignancy. In spite of the progress in surgical treatment, resulting in increasing resection rates and a decrease in treatment-related morbidity and mortality, the true figures of cure are even today below 3%. The dissemination of pancreatic cancer behind the local tissue compartments restricts the short-term (< 3 years) and long-term outcome for patients who have undergone resection. By histological evaluation, less than 15% of the patients undergoing R(0) resection have a pN(0) status, more than 60% suffer from lymph angiosis carcinomatosa, and more than 50% suffer extrapancreatic nerve plexus infiltration. Hematoxylin and eosin-negative lymph nodes were found to be cancer positive when reverse transcriptase polymerase chain reaction (RT- PCR) or immunostaining was applied to the HE-negative lymph nodes. Cancer of the uncinate process has a very poor prognosis because there are no early symptoms; vessel wall involvement occurs early and frequently; a high association of liver metastasis exists as well. Surgery offers a low success rate, but it provides the only chance of cure. Ductal pancreatic cancer is diagnosed in more than 95% of the cases in an advanced stage; potentially curative resection can be performed only in about 10%-15% of these patients. Major contributions of surgery to improved treatment results are the reduction of surgical morbidity--e.g., early postoperative local and systemic complications--and a decrease of hospital mortality below 3%-5%. In most recently published prospective trials, R(0) resection has been reported to result in an increase in short-term survival beyond that recorded for patients with residual tumor. However, R(0) resection fails to improve long-term survival. In many published R(0) series, standard tissue resection of pancreatic head cancer with the Kausch-Whipple procedure failed to include remote cancer cell-positive tissues in the operative specimen; e.g., N(2)-lymph nodes, nerve plexus, and perivascular extrapancreatic and retropancreatic tissues were not excised. Cancer recurrence after so-called R(0) resection with curative intent is frequently the consequence of cancer left behind. Thus, long-term survival (> 5 years) is observed in a very small group of patients, contradicting the published 5-year actuarial survival rates of 20%-45% for resected patients. The assessment of clinical benefit from surgical or medical cancer treatment should therefore be based on several end points, not only on actuarial survival. Publication of actuarial survival figures must include the number of observed (actual) survivals, the definition of the subset of patients followed after resection, and the total number of patients in the study group; anything less is misleading. In reporting pancreatic cancer treatment trial results after oncological resections, more convincing primary end points to evaluate treatment efficacy are median survival (in months), actual survival at 1-5 years, and progression-free survival (in months). In series with multimodality treatment, clinical benefit response as well as quality of life measurements using the EORTC Quality of Life index C30 (QLQ-C30) are of importance in evaluating survival data. Adjuvant treatment improves survival after oncological resection; however, the short-term and long-term benefit after adjuvant chemotherapy in R(0) as well as in R(1)-(2) resected patients has not yet been underscored by data from controlled clinical trials. The survival benefit (median survival time) of adjuvant chemotherapy or radiochemotherapy has been demonstrated to be 6-10 months. Therefore, after oncological resection of pancreatic cancer each patient should be offered adjuvant treatment. A neoadjuvant treatment protocol for pancreatic cancer, however, has not been established.

Humans↗
PubMed2004

[Influence of pain perception, morbidity and mood on functional impairment in elderly chronic pain patients].

The purpose of the study was to address the impact of pain perception, morbidity and mood on functional impairment in elderly chronic pain patients. Multimorbid pain patients beyond the age of 65 in two geriatric hospitals (n = 84), a pain clinic (n = 60) and three general practices (n = 117) provided information about pain perception, comorbidity, additional symptoms and mood by means of the "Structured Pain Interview for Geriatric Patients", the "Cumulative Illness Rating Scale" and a list of symptoms. Data analysis relied on stepwise multiple regression with variables of pain perception entered in the first step, of morbidity entered in the second step and of mood entered in the third step. Although patients believe that pain is the main reason for their functional impairment (71.3%), the data do not support this assumption. Increasing morbidity and bad mood have more impact to reduced functional performance than the pain perception. Our results support the recommendation that a multimodal program should be offered to even multimorbid and older people with chronic pain in order to achieve a maximum of functional rehabilitation.

Activities of Daily Living↗
PubMed2006

New trends in the treatment of undifferentiated carcinomas of the thyroid.

INTRODUCTION: Malignant tumours of the thyroid are generally classified as either well-differentiated thyroid carcinoma, which is composed of papillary and follicular carcinoma, or undifferentiated/anaplastic thyroid carcinoma (ATC). ATC is not only the most lethal disease in the field of endocrine surgery but also one of the most aggressive tumours characterized by an almost invariable fatal outcome, which only very rarely exceeds a 1-year course. DISCUSSION: The impact of surgical resection in association with external beam radiation on ATC outcome has been extensively investigated also in studies based on multicentric database, and there is a general agreement on the significance of a complete resection of the tumour. It has been difficult up to now to collect data regarding chemotherapy adjuvant treatment. In spite of the lack of an extensive review about the results of this kind of treatment by itself or as part of a multimodal approach, it seems that among the several chemotherapy agents experienced, none proved to influence significantly ATC prognosis. Neither doxorubicin (the most commonly used) nor other drugs, such as cisplatin, bleomycin, fluorouracil or cyclophosphamide, showed any real efficacy in controlling the disease. CONCLUSION: The most recent development in this field seems to be represented by the possibility offered by PPARg agonists; even more promising might be the use of adenovirus-mediated p53 tumour suppressor gene therapy or BMP-7. All these new therapies need further confirmation coming from ongoing clinical trials such as those involving the use of vascular and growth factor-targeted agents.

Antibiotics, Antineoplastic↗
PubMed1982

Therapy and outcome in 51 children with mesoblastic nephroma: a report of the National Wilms' Tumor Study.

Mesoblastic nephroma is a distinctive pathologic renal tumor with unique clinical, therapeutic, and prognostic patterns. This report reviews 51 patients (2.8% of 1905 patients submitted to NWTS with renal tumors) with this diagnosis from the NWTS contrasting this disease entity with Wilms' tumor. There were 33 males and 18 females, predominantly term babies born after uncomplicated pregnancies. The mean age at tumor excision was 3.44 +/- 0.6 mo (one child 9 yr). A palpable mass was the predominant presentation in 48 patients and in addition hematuria (9), hypertension (2), vomiting (3), and jaundice (1) were noteworthy. Diagnostic studies included IVP (49 positive, 2 negative) and ultrasound (15 positive, 1 negative). Adequate operative excision was achieved in 43 of 51 patients while 8 children had local extension and 10 had tumor spillage. Operation alone (23), predominantly since 1978, surgery plus chemotherapy (24), prior to 1978, and surgery, chemotherapy, and radiation therapy (4), prior to 1976, were the modes of therapy. The follow-up ranges from 4 mo to 11.5 yr. Survival was excellent; 50 patients survive (98%), only 1 dying of sepsis. These data suggest that mesoblastic nephroma contrasts with Wilms' tumor in that it occurs in a younger age group, has a benign biologic behavior, and a more favorable outcome. Aggressive multimodal treatment though utilized in the early years of the study is not essential to achieve this outcome.

Age Factors↗
PubMedDate not supplied

Outcome predictors in anorectic patients after 6 months of multimodal treatment.

BACKGROUND: Anorexia nervosa is a severe disorder that often responds poorly to treatment. At this time, little is known about pretreatment predictors of response. METHODS: A sample of 42 restrictor type anorectics was tested at the assessment phase and after 180 days retested using the Temperament and Character Inventory and Eating Disorder Inventory 2 along with other clinical evaluation instruments. After 180 days of treatment with multimodal 'network' therapy, the patients were divided into two groups. The first group included patients who showed relevant clinical improvement; the second group included patients considered 'not yet responding'. Data collected from the not-yet-responding group were compared by the t test with the other group's data to evaluate prognostic indexes. RESULTS: Diagnosis of personality disorder, which afflicted about 50% of patients, seemed not to be a relevant prognostic factor. However, a lower novelty seeking was characteristic of the nonresponder group. Higher levels of asceticism and maturity fears also characterized the nonresponder group. CONCLUSION: Present data suggest some elements that could be useful to focus pharmacotherapy, psychotherapy and family counseling on the current psychopathology of each patient.

Adolescent↗
PubMed2005

Radiofrequency for the treatment of liver tumours.

Resection should still be considered the gold standard for many liver tumours. There is, however, growing interest in the use of radiofrequency (RFA) for the treatment of liver tumours. By RFA, tumour tissue can be destructed selectively without significant damage to vascular structures in the remaining liver. The technique is safe and feasible for many types of liver tumours. RFA appears to be beneficial in the treatment of hepatocellular carcinoma. In the Netherlands, single-centre reports suggest that RFA may be used successfully to control hepatocellular carcinoma in those patients awaiting liver transplantation. RFA is being increasingly used for colorectal liver metastases as an adjunct to surgical resection in case of unresectable lesions. However, to date, there are still no data showing that such an approach is beneficial. For this reason, in the Netherlands, RFA for unresectable colorectal liver metastases is mainly used within a clinical trial. Within the multimodality treatment of neuroendocrine metastases, RFA may deserve a place for either intention to cure (rare) or debulking with the aim of reduction of symptoms or prolongation of life.

Carcinoma, Hepatocellular↗
PubMed2001

Cardiomyocyte apoptotic cell death in arterial hypertension: mechanisms and potential management.

Hypertensive heart disease is a progressive condition in which the compensatory left ventricular hypertrophy that maintains cardiac output leads to myocardial remodeling, characterized by fibrosis, insufficient vascularization, and alterations in cardiomyocytes, including contractile disturbances, changes in gene expression, and decrease in the number of cells. Structural abnormalities in the myocardial wall accelerate the development of diastolic and systolic dysfunction, resulting in heart failure. Many observations point to the apoptotic cell death of cardiomyocytes as a relevant factor in the transition from compensatory hypertrophy to pump failure in experimental and human hypertension. Potential inducers of cardiomyocyte apoptosis in overloaded hearts include extrinsic factors, such as mechanical forces, neurohormonal activation, oxidative stress, hypoxia, and cytokines. Some lines of evidence indicate that angiotensin II and the overstretching of cardiomyocytes are originally involved in the triggering of apoptosis in hypertension, whereas other factors are being investigated. Furthermore, intracellular changes, such as downregulation of survival proteins or activation of death proteins, seem to play an important role. The assumption that the apoptosis of cardiomyocytes worsens hypertensive heart disease prognosis brings forth new approaches to avoid or slow the transition to pump failure. In this respect, experimental data indicate that currently used antihypertensive drugs interfere with cardiomyocyte apoptosis. Moreover, the knowledge of intracellular apoptotic processes in cardiomyocytes provides novel therapeutic strategies to be added to the multimodal approach in the prevention of heart failure.

Angiotensin II↗
PubMed1999

[Assessment of cognitive suitability to drive after brain injury].

There is an increasing interest in methods for assessing fitness to hold a driver's licence among patients with traumatic brain injury, cerebrovascular accidents and other central nervous system diseases which present cognitive impairments. This article describes a multimodal approach including medical, neuropsychological and open-road evaluations. We also present a study of 135 patients with cognitive deficits, 29 females and 106 males, mean age 48. Data from neuropsychological assessments are compared to scores on the Mini Mental State Examination and to results from the open-road tests. We recommend that patients with Mini Mental State scores > 20 are referred for further neuropsychological assessments, while patients with scores < 20 are usually unfit for driving. We regard the Mini Mental State Examination as unsuited for patients with aphasia. Our recommendation is that patients who present a complicated picture are referred to regional interdisciplinary centres.

Adolescent↗
PubMedDate not supplied

[Intermittent normobaric hypoxia in rehabilitation of young seamen with respiratory diseases].

The article presents the results of multimodality rehabilitation of 120 young seamen suffering from respiratory diseases. It is shown that intermittent normobaric hypoxia as a component of rehabilitation treatment prevents maladaptation, corrects compromised immunity. The data of 6-month follow-up reports reduction in morbidity and temporary disability.

Adaptation, Physiological↗
PubMed2005

Modulation of the semantic system by word imageability.

A prevailing neurobiological theory of semantic memory proposes that part of our knowledge about concrete, highly imageable concepts is stored in the form of sensory-motor representations. While this theory predicts differential activation of the semantic system by concrete and abstract words, previous functional imaging studies employing this contrast have provided relatively little supporting evidence. We acquired event-related functional magnetic resonance imaging (fMRI) data while participants performed a semantic similarity judgment task on a large number of concrete and abstract noun triads. Task difficulty was manipulated by varying the degree to which the words in the triad were similar in meaning. Concrete nouns, relative to abstract nouns, produced greater activation in a bilateral network of multimodal and heteromodal association areas, including ventral and medial temporal, posterior-inferior parietal, dorsal prefrontal, and posterior cingulate cortex. In contrast, abstract nouns produced greater activation almost exclusively in the left hemisphere in superior temporal and inferior frontal cortex. Increasing task difficulty modulated activation mainly in attention, working memory, and response monitoring systems, with almost no effect on areas that were modulated by imageability. These data provide critical support for the hypothesis that concrete, imageable concepts activate perceptually based representations not available to abstract concepts. In contrast, processing abstract concepts makes greater demands on left perisylvian phonological and lexical retrieval systems. The findings are compatible with dual coding theory and less consistent with single-code models of conceptual representation. The lack of overlap between imageability and task difficulty effects suggests that once the neural representation of a concept is activated, further maintenance and manipulation of that information in working memory does not further increase neural activation in the conceptual store.

Adolescent↗
PubMed2025

Predicting the First Onset of Suicidal Thoughts and Behaviors in Adolescents Using Multimodal Risk Factors: A 4-Year Longitudinal Study.

OBJECTIVE: Suicide is one of the leading causes of death among youth worldwide, yet existing studies that aimed to predict the first onset of suicidal thoughts and behaviors (STB) included a limited number of data modalities and/or focused on adult populations. This study aimed to prospectively predict first-onset STB across 4-year follow-ups in adolescents using an existing STB history classification model that was previously applied to baseline data and a new machine learning model with 195 biopsychosocial features. METHOD: Participants were 7,503 unrelated adolescents (54.5% female, ages 9-11 years at baseline) from the multisite, longitudinal Adolescent Brain Cognitive Development (ABCD) Study. An existing baseline STB history classification model was applied to predict longitudinal first-onset STB in adolescents compared with healthy controls and clinical controls (individuals with a mental health disorder but no STB). A new elastic net logistic regression model with 195 features was trained on data from 14 sites (n = 5,220), and the resulting top 15 features were validated at 7 independent sites (n = 2,283). RESULTS: The previously developed model to classify STB lifetime history also prospectively predicted first-onset STB in adolescents with an area under the curve (AUC) [95% CI] of 0.73 [0.70, 0.75], p < .001, compared with healthy controls and AUC [95% CI] of 0.63 [0.60, 0.66], p < .001, compared with clinical controls. The newly trained model with top 15 features performed similarly with AUC [95% CI] of 0.73 [0.71, 0.76], p < .001, and AUC [95% CI] of 0.64 [0.60, 0.66], p < .001, for the same comparison groups. The most consistent predictors across models included female sex, sleep disturbances, and maladaptive home and school environments. CONCLUSION: The models predicted first-onset STB in adolescents with moderate accuracy. This study also confirmed the roles of well-established psychological risk factors for STB and identified several novel neurocognitive and brain imaging risk factors. Future studies should validate these models in large-scale diverse samples before clinical translation. PLAIN LANGUAGE SUMMARY: This study followed over 7,500 adolescents for 4 years and tested 2 machine learning models using psychological, social, and brain data to identify those at risk of experiencing suicidal thoughts or behaviors. Both models predicted first-time suicidal thoughts or behaviors with moderate accuracy. Key risk factors that were identified included being female, experiencing sleep problems, and negative home and school environments. DIVERSITY & INCLUSION STATEMENT: We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. Diverse cell lines and/or genomic datasets were not available. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. We actively worked to promote sex and gender balance in our author group. One or more of the authors of this paper received support from a program designed to increase minority representation in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.

Adolescent↗
PubMed2005

Multimodality treatment of esophageal cancer.

Stage specific management of non-small cell lung cancer is widely accepted. The use of pretreatment disease stage to guide therapy for esophageal cancer is an intellectually appealing concept. To date, there isa relative lack of data upon which one may base stage specific treatment decisions for esophageal carcinoma. This is because thorough pretreatment TNM staging is not universally practiced. As a result, stage-specific treatment varies widely. Based upon the available data, surgery alone may be appropriate for resectable, node-negative disease. In the case of clearly un-resectable disease, definitive chemoradiation is indicated.The value of neoadjuvant or adjuvant treatment modalities in the case of clearly resectable node-negative disease (TlN0 or T2N0) is questionable;however, in the presence of lymph node involvement (N1), or in the case of a marginally resectable primary tumor (T3 or T4), neoadjuvant chemoradiation is probably indicated. Although the achievement ofa complete pathologic response following chemoradiation may obviate surgical resection, even microscopic residual cancer can result in local recurrence. To date, there is no reliable method of ascertaining a complete pathologic response before surgical resection. Therefore, when feasible, the addition of surgical resection following chemoradiation is warranted. Future treatment trials for esophageal cancer should include rigorous pretreatment staging protocols to elucidate stage-specific results of therapy.

Combined Modality Therapy↗
PubMed1994

Similarity of fluorescence lifetime distributions for single tryptophan proteins in the random coil state.

The picosecond time-resolved fluorescence decay data of nine single-tryptophan (trp) proteins and two multi-trp proteins in their native and denatured states were analyzed by the maximum entropy method (MEM). In the denatured state (6 M guanidine hydrochloride) a majority of the single-trp proteins show bimodal (at 25 degrees C) and trimodal (at 85 degrees C) distributions with similar patterns and similar values for average lifetimes. In the native state of the proteins the lifetime distributions were bimodal or trimodal. These results (multimodal distributions) are contradictory to the unimodal Lorentzian distribution of lifetimes reported for some proteins in the native and denatured states. MEM analysis gives a unimodal distribution of lifetimes only when the signal-to-noise ratio is poor in the time-resolved fluorescence decay data. The unimodal distribution model is therefore not realistic for proteins in the native and denatured states. The fluorescence decay components of the bi- or trimodal distribution are associated with the rotamer structures of the indole moiety when the protein is in the random coil state.

Amino Acid Sequence↗
PubMedDate not supplied

Adjuvant therapy for patients with colorectal cancer.

There are now excellent data that patients with stage III colon cancer or stage II and III rectal cancer live longer if they receive, respectively, systemic or regional and systemic therapy after surgery. In addition, disease-free survival, particularly freedom from the symptoms of regional recurrence, in the high risk rectal cancer patient population has been markedly improved by application of multimodality treatment approaches. Newer prospective protocol testing variations in administration of systemic therapy, addition of 5-fluorouracil modulation techniques that proved effective in advanced disease settings, and the combination of therapy attempting to decrease single treatment toxicities while maintaining an antitumor effect have been built on the initial dramatic successes of the past 20 years. This paper concisely summarizes the data that should allow a marked decrease in mortality and morbidity if applied uniformly to patients who remain at high risk for recurrence after surgery for their colon or rectal adenocarcinomas.

Adenocarcinoma↗
PubMed1999

Precise localization of dysfunctional areas in vertebro-basilar infarction by FDG- and O-15-H2O-PET using standardized image analysis and image registration to 3-D MR.

The advantages of standardized multimodal image analysis are demonstrated in a case of symptomatic tremor after basilar thrombosis. Functionally and structurally lesioned areas were mapped in Talairach space using 3-D MRI, cerebral FDG-PET and O-15-H2O-PET. Structural lesions were found in the left midbrain, thalamus, putamen and cerebellar areas. Voxel-based statistics in comparison to a normal data base revealed hypometabolism in the left thalamus, left red nucleus, left cerebellar hemisphere including dentate nucleus and in the left inferior olivary nucleus. The O-15-H2O-PET investigation revealed metabolic uncoupling along the rubroolivocerebellar loop. Given the delicate anatomy of the structures involved, image registration and standardized image analysis techniques are essential for a synoptic multimodality analysis of morphological and functional pathology and should generally be used for cerebral PET investigations.

Adult↗