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Multimodal treatment using surgery, radiotherapy, and chemotherapy in a patient with a perivascular epithelioid cell tumor of the uterus.

Perivascular epithelioid tumor (PEComa), a recently defined tumor, is a very rare disease affecting various organs, most often the uterus. This tumor displays a variety of histologic and clinical features and at this point is regarded as a tumor with uncertain malignant potential. A 9-year-old girl with abdominal pain and vaginal spotting was diagnosed with PEComa of the uterus with metastasis. She received chemotherapy comprising vincristine, ifosfamide, and doxorubicin, as well as radiotherapy after surgery. After this multimodal treatment, there was no evidence of recurrence or further metastasis. She remains disease-free 1.5 years after her initial diagnosis. PEComa of the uterus displaying malignant characteristics may have a more favorable response to more aggressive therapy.

Antineoplastic Combined Chemotherapy Protocols↗

Multimodal monitoring in the neurological intensive care unit.

BACKGROUND: Neurocritical care is a specialty that focuses on the critical care management of patients with catastrophic neurologic diseases. Brain ischemia and hypoxia are often central causes of brain damage in these patients. Until recently, the only methods widely accepted for monitoring in the neurological intensive care unit have been intracranial pressure and cerebral perfusion pressure monitoring. Recent developments in technology have resulted in several new monitoring techniques that can provide the neurointensivist with information, at the cellular level, that can help guide management. REVIEW SUMMARY: The brain requires a continuous blood-borne supply of oxygen and glucose for normal metabolism. Ischemia occurs when supply is insufficient to meet the metabolic demand. Cerebral blood flow can now be directly monitored using laser Doppler or thermal diffusion techniques. Transcranial cerebral oximetry can estimate regional cerebral oxygen saturation, although the reliability is questionable. Jugular bulb oximetry can provide a global assessment of oxygen delivery, and consumption and brain tissue oxygen tension monitoring can provide a focal measurement of cerebral oxygenation. Intracerebral microdialysis can provide information about glucose metabolism and the overall health of the neuron. CONCLUSIONS: New monitoring techniques can provide the neurointensivist with crucial information about brain physiology and metabolism. Combining these techniques ("multimodal monitoring") can produce a more accurate overall picture. This approach, along with new computer systems for integrating data at the bedside, may change the way patients with brain injury are monitored and treated in the future.

Brain↗

Multimodality diagnostic imaging of diffuse esophageal leiomyomatosis.

A case of diffuse esophageal leiomyomatosis is presented, with emphasis on the imaging findings across multiple contemporary diagnostic modalities. This entity represents a rare presentation of uncommon benign smooth muscle tumors of the esophagus. The characteristic clinical, histologic, and multimodality imaging findings may distinguish this benign tumor from its malignant counterpart leiomyosarcoma and from achalasia.

Adult↗

Skeletal scintigraphy in the multimodality assessment of young children with acute skeletal symptoms.

The authors review the scintigraphic manifestations of acute osteomyelitis, septic arthritis, transient synovitis, Legg-Calvé-Perthes disease, fractures of toddlers, and some systemic conditions that cause skeletal symptoms during childhood. They offer suggestions regarding incorporation of skeletal scintigraphy into a multimodality approach for assessing children with skeletal symptoms.

Arthritis, Infectious↗

Curative potential of multimodality therapy for locally recurrent rectal cancer.

OBJECTIVE: To assess the results of multimodality therapy for patients with recurrent rectal cancer and to analyze factors predictive of curative resection and prognostic for overall survival. SUMMARY BACKGROUND DATA: Locally recurrent rectal cancer is a difficult clinical problem, and radical treatment options with curative intent are not generally accepted. METHODS: A total of 394 patients underwent surgical exploration for recurrent rectal cancer. Ninety were found to have unresectable local or extrapelvic disease and 304 underwent resection of the recurrence. The latter patients were prospectively followed to determine long-term survival and factors influencing survival. RESULTS: Overall 5-year survival was 25%. Curative, negative resection margins were obtained in 45% of patients; in these patients a 5-year survival of 37% was achieved, compared to 16% (P <.001) in patients with either microscopic or gross residual disease. In a logistic regression analysis, initial surgery with end-colostomy and symptomatic pain (both univariate) and increasing number of sites of the recurrent tumor fixation in the pelvis (multivariate) were associated with palliative surgery. Overall survival was significantly decreased for symptomatic pain (P <.001) and more than one fixation (P =.029). Survival following extended resection of adjacent organs was not different from limited resection (28% vs. 21%, P =.11). Patient demographics and factors related to the initial rectal cancer did not affect outcome. Perioperative mortality was only 0.3%, but significant morbidity occurred in 26% of patients, with pelvic abscess being the most common complication. CONCLUSIONS: This study demonstrates that many patients with locally recurrent rectal cancer can be resected with negative margins. Long-term survival can be achieved, especially for patients with no symptoms and minimal fixation of the recurrence in the pelvis, provided no gross residual disease remains.

Adult↗

Iterative, multimodal, and scalable single-cell profiling for discovery and characterization of signaling regulators.

Cell signaling plays a critical role in regulating cellular state, yet uncovering regulators of signaling pathways and understanding their molecular consequences remains challenging. Here, we present an iterative experimental and computational framework to identify and characterize regulators of signaling proteins, using the mTOR marker phosphorylated RPS6 (pRPS6) as a case study. We present a customized workflow that uses the 10x Flex assay to jointly profile intracellular protein levels, transcriptomes, and CRISPR perturbations in single cells. We use this to generate a "glossary" dataset of paired protein-RNA measurements across targeted perturbations, which we leverage to train a predictive model of pRPS6 levels based solely on transcriptomic data. Applying this model to a genome-wide Perturb-seq dataset enables in silico screening for pRPS6 and nominates novel regulators of mTOR signaling. Experimental validation confirms these predictions and reveals mechanistic diversity among hits, including changes in signaling output driven by anabolic activity, cellular proliferation and multiple stress pathways. Our work demonstrates how integrated experimental and computational approaches provide a scalable framework for multimodal phenotyping and discovery.

Journal Article↗

Bayesian inference of lineage trees by joint analysis of single-cell multimodal lineage-tracing data with BiLinT.

The advent of single-cell lineage-tracing technologies has enabled the simultaneous profiling of gene expression and lineage barcodes. However, accurate, high-resolution reconstruction of cell lineage trees remains challenging because most existing approaches treat these modalities separately and therefore fail to fully exploit their complementary information. Here we present BiLinT, a Bayesian framework that jointly models multimodal single-cell lineage-tracing data for lineage tree reconstruction. BiLinT integrates barcode evolution (a continuous-time Markov chain) with gene expression dynamics (an Ornstein-Uhlenbeck process) within a unified probabilistic model. Across synthetic and real data sets, BiLinT provides accurate lineage-tree reconstruction and reveals differentiation-associated clonal structure and developmental fate biases.

Journal Article↗

Multimodal imaging and computer assisted diagnosis for functional tumour characterisation.

Radiological modalities, especially CT, mainly provide morphological and structural information with high spatial resolution covering large volumes. Novel developments, which are predominantly MR-based, also deliver 'functional' information, which can be used for individual characterisation of tumour biology. Both aspects and modalities, additionally complemented by ultrasound, have to be combined in the radiological workflow of cancer patients including volumetric visualisation, information extraction from multimodal imaging, quantitative surrogates, intelligent interpretation assistance and image-guided procedures. Based on volumetric visualisation and the generation of 3D+t maps, CAD tools have to address registration of different image series from different modalities, and extraction of quantitative surrogates. The latter will then serve tumour characterisation, therapeutic decision-making, image-guided procedures and efficacy evaluation.

Diagnosis, Computer-Assisted↗

Symmetry breaking and dynamical independence in a multimode laser

Multimode lasers display various behaviors caused by the asymmetry between the modes belonging to orthogonal polarizations. We discuss dynamical independence, clustering, and grouping in a solid state laser with intracavity second harmonic generation, and show that these effects result from unstable cycles lying within their invariant planes. These invariant planes are dynamically independent. The sequential or random itinerancy of limit unstable cycles lying within the invariant planes explains most of the effects caused by asymmetry.

Journal Article↗

Comparison of the bifurcation scenarios predicted by the single-mode and multimode semiconductor laser rate equations

We present a detailed comparison of the bifurcation scenarios predicted by single-mode and multimode semiconductor laser rate equation models under large amplitude injection current modulation. The influence of the gain model on the predicted dynamics is investigated. Calculations of the dependence of the time averaged longitudinal mode intensities on modulation frequency are compared with experiments performed on an Al(x)Ga(1-x)As Fabry-Perot semiconductor laser.

Journal Article↗

Dynamics and control of a multimode laser: Reduction of space-dependent rate equations to a low-dimensional system.

We suggest a quantitatively correct procedure for reducing the spatial degrees of freedom of the space-dependent rate equations of a multimode laser that describe the dynamics of the population inversion of the active medium and the mode intensities of the standing waves in the laser cavity. The key idea of that reduction is to take advantage of the small value of the parameter that defines the ratio between the population inversion decay rate and the cavity decay rate. We generalize the reduction procedure for the case of an intracavity frequency doubled laser. Frequency conversion performed by an optically nonlinear crystal placed inside the laser cavity may cause a pronounced instability in the laser performance, leading to chaotic oscillations of the output intensity. Based on the reduced equations, we analyze the dynamical properties of the system as well as the problem of stabilizing the steady state. The numerical analysis is performed considering the specific system of a Nd:YAG (neodymium-doped yttrium aluminum garnet) laser with an intracavity KTP (potassium titanyl phosphate) crystal.

Journal Article↗

Speckle statistics in a chaotic multimode fiber.

Wave chaos is devoted to the study of wave motion when the geometrical limit of rays is chaotic. Imprints of ray chaos may be found either in spectral and spatial properties of modes or in spatio-temporal evolution of wave packets. In this paper, we present a thorough experimental and theoretical analysis of field statistics for light propagating in a multimode fiber with a noncircular cross section. This optical fiber serves as a powerful tool to image waves in a system where light rays exhibit a chaotic dynamics. We show that, in the speckle regime, the experimentally measured statistical properties of intensity patterns are well accounted for by a "random Gaussian" hypothesis. A comparison is also made in the case of regular ray motion by using a circular optical fiber. Possible extensions and applications of the tools and concepts of wave chaos are mentioned in modern communication technology.

Journal Article↗

Noise-induced multimode behavior in excitable systems.

Based on experiments with electronic circuits, we show how a system of coupled excitable units can possess several noise-induced oscillatory modes. We characterize the multimode organization in terms of the coherence resonance effect. Multiple gain of regularity is found to be related to different frequency entrainments and to the appearance of additional time scales.

Journal Article↗

Detecting scaling in the period dynamics of multimodal signals: application to Parkinsonian tremor.

Patients with Parkinson's disease exhibit tremor, involuntary movement of the limbs. The frequency spectrum of tremor typically has broad peaks at "harmonic" frequencies, much like that seen in other physical processes. In general, this type of harmonic structure in the frequency domain may be due to two possible mechanisms: a nonlinear oscillation or a superposition of (multiple) independent modes of oscillation. A broad peak spectrum generally indicates that a signal is semiperiodic with a fluctuating period. These fluctuations may posses intrinsic order that can be quantified using scaling analysis. We propose a method to extract the correlation (scaling) properties in the period dynamics of multimodal oscillations, in order to distinguish between a nonlinear oscillation and a superposition of individual modes of oscillation. The method is based on our finding that the information content of the temporal correlations in a fluctuating period of a single oscillator is contained in a finite frequency band in the power spectrum, allowing for decomposition of modes by bandpass filtering. Our simulations for a nonlinear oscillation show that harmonic modes possess the same scaling properties. In contrast, when the method is applied to tremor records from patients with Parkinson's disease, the first two modes of oscillations yield different scaling patterns, suggesting that these modes may not be simple harmonics, as might be initially assumed.

Humans↗

Multimodal map and complex basin of attraction of a simple hopper.

In this paper, we study the global dynamics of a simple passive mechanical model for hopping. The hopper is a two-mass, single-spring system constrained to move in the vertical direction (under gravity) above a rigid ground. The hopper model and its basic dynamics including the existence of incessant hopping motions have been reported elsewhere. Here, we extend the study to investigate the global dynamics of the hopper. The global map of the hopper is multimodal. We construct an approximate analytic map near the fixed points of the map and show that the fixed points exhibit one-way stability. We also show that the map is invariant under the inversion of the mass ratio of the hopper. Next, we construct the global basin of attraction of these fixed points and show that their structure is highly complex and retains form at finer scales. This structure of the basin of attraction contains regions where the fate of an arbitrary initial condition becomes unpredictable.

Journal Article↗

Statistical analysis of multimode weakly nonlinear Rayleigh-Taylor instability in the presence of surface tension.

A weakly nonlinear model is proposed for the Rayleigh-Taylor instability in the presence of surface tension. The dynamics of a multimode perturbation of the interface between two incompressible, inviscid, irrotational, and immiscible fluids is analyzed. The quadratic and cubic nonlinear effects are taken into account. They include the nonlinear corrections to the exponential growths of the fundamental modulations. The role of the initial modulation spectrum is discussed. A saturation criterion in terms of the product of a local rms and a particular wave number is exhibited. It gives theoretical foundations for numerical conjectures and allows one to analyze the effects of fundamental parameters of the problem such as the dimension or the Atwood number.

Journal Article↗

Dynamics of multimode diode lasers with strong, frequency-selective optical feedback.

The dynamical behavior of a class of multimode semiconductor diode lasers with emission wavelength around 980 nm is investigated both experimentally and numerically in the presence of strong, frequency-selective optical feedback provided by a fiber Bragg grating. The focus is set on the switching between broad- and narrow-band optical spectra, on chaotic transitions, and on the loss of frequency locking between laser and grating. Laser and feedback parameters are chosen in the typical ranges pertaining to wavelength stabilization in erbium-doped fiber amplifiers for telecommunication applications. An improved set of rate equations, which allows for arbitrary feedback levels and includes experimentally measured gain and linewidth enhancement factor, is studied analytically and numerically.

Journal Article↗

Formation of an information network in a self-pulsating multimode laser.

We investigated self-induced pulsations in a globally-coupled microchip multimode solid-state laser operating on a Lambda transition. A variety of dynamic states, featuring locking of pulsation frequencies, multidimensional quasiperiodic, and chaotic pulsations, induced by nonlinear modal interactions were observed depending on the number of oscillating modes. The underlying modal interplay was characterized in terms of the dynamic statistical quantity of information circulations. Mode grouping and information sender-receiver-mediator relationships established among mode groups, i.e., "information networks," were identified. Observed dynamic states were reproduced by numerical simulation of a model equation and each dynamic state was shown to create its own information network.

Journal Article↗