Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “multimodality”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 973 records · Page 54Linked to original sources
PubMed1991

Multimodal therapy for stones in pelvic kidneys.

Stones located in pelvic kidneys can be successfully treated by extracorporeal lithotripsy, either alone or in combination with endourology and open surgery. A multimodal approach was used in 16 patients with pelvic kidney stone disease and a 87.5% stone-free rate was achieved. The proper positioning of the patient on the lithotripter apparatus and the correct integration of the different therapeutic procedures were the real clues for obtaining a remarkable success rate with a minimally invasive approach.

Adult↗
PubMed1993

Multimodality therapy for advanced clear cell sarcoma of the kidney in a young adult.

We report a clear cell sarcoma of the kidney (CCSK) in a young adult with multiple liver and bone metastases who was treated with surgery, chemotherapy and radiation. Combination chemotherapy consisting of vinblastine, actinomycin D, cyclophosphamide, pepleomycin, cisplatin (modified VAB-6 regimen) and arterial infusion of mitomycin C and doxorubicin into the hepatic artery resulted in the complete disappearance of the liver metastasis. Although systemic and localized combination chemotherapies were very effective against the liver metastasis, the clinical course was that of high-grade malignancy, resulting in death with brain metastasis 32 months after tumor resection. Differing from typical Wilms tumor in children, the treatment of CCSK has been a subject of controversy, particularly in the advanced and adult type. Nevertheless, we consider that the multimodal treatment has an important role in the stabilization of metastatic lesions even at an advanced stage in the adult type of CCSK.

Adolescent↗
PubMed1980

Stress management: a multimodal approach.

This newly developed stress-management program evolved from study of the three major trends in stress research: psychological, physiological and sociological. Primarily geared to managers in an industrial setting, this program helps the individuals to reduce physiological tension via autohypnosis and alter stress-producing behaviors through a number of cognitive restructuring techniques. A variety of philosophical issues are raised that relate to 'type A' behavior focusing on 'the hurry syndrome', aggression and a general balance in 'life tasks'. In addition, there is an educational component and participants are acquainted with their 'health probabilities' in terms of life style, weight, smoking and other factors. This multimodal program follows participants over a 2-year period to reinforce psycho-behavioral changes.

Cognition↗
PubMed1986

Multimodal treatment (extracorporeal shock wave lithotripsy and endourology) of complicated renal stone disease.

From October 1983, (installation of the extracorporeal shock wave lithotripsy unit) to August 1985, 207 patients presented at the Katharinenhospital Stuttgart with complicated renal stone disease (70 borderline stones, 77 partial and 60 complete staghorn calculi). 197 patients were treated with the new technology for urinary stone therapy, i.e. extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCN), and ureterorenoscopy. The combination of PCN and ESWL proved to be the optimal therapeutic approach in the majority of cases (44%), particularly for partial and complete staghorns, whereas PCN or ESWL monotherapy are indicated for borderline stones (51% ESWL, 26% PCN, 20% combination, 3% surgery) and selected cases of staghorn calculi only. Based on this treatment policy (minimal invasiveness and morbidity), 75 patients with partial staghorn (21% ESWL, 28 PCN, 44% combination, 7% surgery) and 52 cases of complete staghorn stone (2% ESWL, 13% PCN, 74% combination, 11% surgery) have been treated successfully. The rate of major complications was low (2.5% septicemia, 2% major renal hemorrhage, 0.5% mortality). With this new concept of multimodal therapy (ESWL and endourology), even cases of malignant stone formation ('stone cancer') may be treatable, since these methods can be applied repeatedly without damaging the renal parenchyma.

Adolescent↗
PubMed1996

Assessment of flow events at the ductus venosus-inferior vena cava junction and at the foramen ovale in fetal sheep by use of multimodal ultrasound.

BACKGROUND: Previous techniques for the study of the fetal circulation did not permit assessment of phasic events associated with the cardiac cycle. We used multimodal ultrasound techniques to examine flow events that occur in the major veins and across the foramen ovale in the circulation of the fetal lamb. METHODS AND RESULTS: We studied eight fetal lambs instrumented with catheters in the superior and inferior venae cavae and a peripheral umbilical vein and performed ultrasound studies that included M-mode and two-dimensional imaging, pulsed and Doppler color flow ultrasound, and contrast echocardiography to evaluate flow in the ductus venosus, in both venae cavae, and through the foramen ovale. Two blood streams of different flow velocities were identified within the cephalic portion of the inferior vena cava. The stream that originated from the narrowed ductus venosus had a higher velocity than that from the caudal inferior vena cava (mean velocity, 57 +/- 13 versus 16 +/- 3 cm/s; P < .0002). Facilitated by the eustachian valve and the septum primum, the ductus venosus stream preferentially passed through the foramen ovale to the left atrium. This flow occurred during most of the cardiac cycle, except for 19.6 +/- 2.3% of the cycle when the foramen ovale was closed during atrial contraction. Superior vena cava flow passed almost exclusively into the right atrium and tricuspid valve; a small amount that was refluxed from the right atrium into the inferior vena cava subsequently passed through the foramen into the left atrium. CONCLUSIONS: Visualization of fetal circulatory streaming at the venous sites by ultrasound techniques aids in understanding the function of the fetal circulation and may be helpful in detecting the human fetus that is hemodynamically compromised.

Animals↗
PubMed2005

Detection of vascular adhesion molecule-1 expression using a novel multimodal nanoparticle.

Endothelial vascular adhesion molecule-1 (VCAM-1) is a critical component of the leukocyte-endothelial adhesion cascade, and its strict temporal and spatial regulation make it an ideal target for imaging and therapy. The goal of this study was to develop novel VCAM-1-targeted imaging agents detectable by MRI and fluorescence imaging using phage display-derived peptide sequences and multimodal nanoparticles (NPs). We hypothesized that VCAM-1-mediated cell internalization of phage display-selected peptides could be harnessed as an amplification strategy to chaperone and trap imaging agents inside VCAM-1-expressing cells, thus improving target-to-background ratios. To accomplish our goal, iterative phage display was performed on murine endothelium under physiological flow conditions to identify a family of VCAM-1-mediated cell-internalizing peptides. One specific sequence, containing the VHSPNKK motif that has homology to the alpha-chain of very late antigen (a known ligand for VCAM-1), was shown to bind VCAM-1 and block leukocyte-endothelial interactions. Compared with VCAM-1 monoclonal antibody, the peptide showed 12-fold higher target-to-background ratios. A VHSPNKK-modified magnetofluorescent NP (VNP) showed high affinity for endothelial cells expressing VCAM-1 but surprisingly low affinity for macrophages. In contrast, a control NP without VCAM-1-targeting sequences showed no affinity for endothelial cells. In vivo, VNP successfully identified VCAM-1-expressing endothelial cells in a murine tumor necrosis factor-alpha-induced inflammatory model and colocalized with VCAM-1-expressing cells in atherosclerotic lesions present in cholesterol-fed apolipoprotein E apoE-/- mice. These results indicate that: (1) small peptide sequences can significantly alter targeting of NPs, (2) the used amplification strategy of internalization results in high target-to-background ratios, and (3) this technology is useful for in vivo imaging of endothelial markers.

Animals↗
PubMed2002

MOSAIC: Multimodal Stroke Assessment Using Computed Tomography: novel diagnostic approach for the prediction of infarction size and clinical outcome.

BACKGROUND AND PURPOSE: With new CT technologies, including CT angiography (CTA), perfusion CT (PCT), and multidetector row technique, this method has regained interest for use in acute stroke assessment. We have developed a score system based on Multimodal Stroke Assessment Using CT (MOSAIC), which was evaluated in this prospective study. METHODS: Forty-four acute stroke patients (mean age, 63.8 years) were enrolled within a mean of 3.0+/-1.9 hours after symptom onset. The MOSAIC score (0 to 8 points) was generated by results of the 3 sequential CT investigations: (1) presence and amount of early signs of infarction on noncontrast CT (NCCT; 0 to 2 points), (2) stenosis (>50%) or occlusion of the distal internal carotid or middle cerebral artery on CTA (0 to 2 points), and (3) presence and amount of reduced cerebral blood flow on 2 adjacent PCT slices (0 to 4 points). The predictive value of the MOSAIC score was compared with each single CT component with respect to the final size of infarction and the clinical outcome 3 months after stroke by use of the modified Rankin Scale (mRS) and the Barthel Index (BI). RESULTS: Among the CT components, PCT showed the best correlation to infarction size (r=0.75) and clinical outcome (r=0.60 to 0.62) compared with NCCT (r=0.43 to 0.58) and CTA (r=0.47 to 0.71). The MOSAIC score showed consistently higher correlation factors (r=0.67 to 0.78) and higher predictive values (0.73 to 1.0) than all single CT components with respect to outcome measures. A MOSAIC score <4 predicted independence with 89% to 96% likelihood (mRS </=2, BI >/=90); a MOSAIC score <5 predicted fair outcome with 96% to 100% likelihood (mRS </=3, BI >/=60). CONCLUSIONS: The MOSAIC score based on multidetector row CT technology is superior to NCCT, CTA, and PCT in predicting infarction size and clinical outcome in hyperacute stroke.

Acute Disease↗
PubMed2005

Safety and efficacy of intravenous tissue plasminogen activator stroke treatment in the 3- to 6-hour window using multimodal transcranial Doppler/MRI selection protocol.

BACKGROUND: Growing data point toward intravenous tissue plasminogen activator (tPA) benefit after 3 hours in selected stroke patients. We aim to study safety and efficacy of tPA treatment in the 3- to 6-hour window using multimodal transcranial Doppler (TCD)/MRI selection criteria. METHODS: We studied patients with acute middle cerebral artery (MCA) occlusion. Patients within 0 to 3 hours from symptom onset (A) were treated according to standard computed tomography criteria. Treatment within 3 to 6 hours (B) was decided according to TCD/MRI protocol. Continuous TCD assessed clot location and recanalization. National Institutes of Health Stroke Scale (NIHSS) at 24 hours assessed neurological improvement/worsening and modified Rankin score <3 functional independence at third month. RESULTS: Of 135 patients, 56 were in the 3- to 6-hour window. Only 13 (23%) patients within 3 to 6 hours did not meet MRI inclusion criteria. Finally, 122 patients were treated with tPA: A, 79 (65%); B, 43 (35%). Median time to treatment was: A, 136 minutes (range 60 to 180); B, 223 (185 to 360). There were no differences in demographic parameters, baseline NIHSS (A, 17; B, 17; P=0.89), and occlusion location (proximal MCA A, 65.8%; B, 74.4%; P=0.28). Recanalization rates at 2 hours were similar (A, 49.3%; B, 55.2%; P=0.33), as were hemorrhagic transformation rates (asymptomatic: A, 18.7%, B, 26.6%, P=0.43; symptomatic: A, 3.75%, B, 2.38%, P=0.66). Improvement at discharge was similar in both groups (NIHSS dropped 6.3 points [A] versus 6.1 [B]; P=0.86). However, the number of patients who benefited from treatment was slightly higher in the 3- to 6-hour group (A, 58.2%; B, 76.2%; P=0.05), whereas the same rate of patients worsened (A, 11.4%; B, 7.1%; P=0.46). At 3 months, the rate of independent patients was: A, 42% versus B, 38% (P=0.74). CONCLUSIONS: tPA treatment can be safely and effectively extended to the 3- to 6-hour window using TCD/MRI selection criteria. Not using these criteria in the 3- to 6-hour window avoids potentially effective treatment in a high rate of patients.

Acute Disease↗
PubMed2005

Use of multimodal MRI and novel endovascular therapies in a patient ineligible for intravenous tissue plasminogen activator.

BACKGROUND AND PURPOSE: Options are limited for individuals who present to the ED within 3 hours of ischemic stroke onset, but who are deemed ineligible for intravenous thrombolysis. Multimodal MRI has been shown to be of great help in identifying stroke patients with large areas of at risk "penumbral tissue", who may gain from the use of novel endovascular therapies. We report a patient who twice benefited from this management approach, in the setting of hemorrhagic risk following successive ischemic strokes. CASE DESCRIPTION: The patient is a 78 year old male who experienced acute ischemic stroke on 2 separate occasions 5 months apart, and for whom perceived contraindications to appropriate thrombolytic therapy administration led to the successful use of different endovascular therapies at each encounter. Furthermore, following mechanical clot retrieval during the second encounter, the high intensity signal area noted on the baseline diffusion weighted imaging (DWI) in the posterior circulation territory, was almost completely resolved on the day 7 post-procedure MRI. CONCLUSIONS: To our knowledge, this is the first reported case of reversal of a DWI abnormality in the posterior circulation territory.

Aged↗
PubMed2006

Toward a multimodal neuroprotective treatment of stroke.

BACKGROUND AND PURPOSE: Stroke remains a common medical problem with importance attributable to the demographic changes in industrialized societies. SUMMARY OF REVIEW: After years of setbacks, acute stroke therapy has finally emerged, including thrombolysis with tissue plasminogen activator (t-PA). However, t-PA treatment is limited by a narrow time window and side effects, so that only 3% of all stroke patients receive thrombolysis. Unimodal targeting of key events in stroke pathophysiology was not effective in providing long-term benefits, leading to negative results in previous clinical neuroprotective stroke trials. A successful future stroke therapy should approach multiple pathophysiological mechanisms besides revascularization at once, including reduction of t-PA-related side effects, prevention of cell death, stimulation of neuroregeneration, and plasticity. CONCLUSIONS: Strategies targeting these processes include multiple combination therapies as well as treatment with multimodal drugs that interact with these mechanisms. Here, we review such combination approaches, and outline how this concept could be developed into future stroke treatment.

Animals↗
PubMedDate not supplied

Evaluation of brain dysfunction in hypertensive putaminal hemorrhage with multimodality evoked potentials.

Changes in multimodality evoked potentials (MEP's), consisting of somatosensory evoked potentials (SEP's), visual evoked potentials (VEP's), and auditory evoked brainstem responses (AEBR's), were studied in 36 patients with hypertensive putaminal hemorrhage to ascertain the relation among areas and distribution of brain dysfunction, the size of hemorrhage on computerized tomographic scan, and the clinical outcome. Among MEP's, SEP's were most significantly involved in all patients. Abnormalities in VEP's and AEBR's remained mild or moderate when the hemorrhage did not extend to the diencephalon. If SEP's were normal or mildly abnormal, they improved early the ictus. These patients did well clinically. If SEP's were absent, the patients had poor outcome even when the hemorrhage was small and located outside the internal capsule. In contrast, deterioration or persistence of MEP's indicated secondary insult to the brain and poor patient outcome. Early and serial MEP studies are useful in evaluating primary and secondary brain dysfunction and in predicting patient outcome in hypertensive putaminal hemorrhage.

Adult↗
PubMed2005

Maximizing ventricular function with multimodal cell-based gene therapy.

BACKGROUND: Angiogenesis is enhanced after transplantation of vascular endothelial growth factor (VEGF)-expressing cells into a myocardial scar. Insulin-like growth factor I (IGF-I) may induce hypertrophy and inhibit apoptosis. We evaluated the effect of cell-based IGF-I and VEGF multigene therapy on left ventricular (LV) function, cell survival, and apoptosis after bone marrow cell (BMC) transplantation. METHODS AND RESULTS: Female Lewis rats underwent left anterior descending ligation 3 weeks before transplantation with male donor BMC, BMC transfected with VEGF (BMC+VEGF), IGF-I (BMC+IGF-I), VEGF and IGF-I (BMC+VEGF+IGF-I), or medium without cells (control) (n=4 per group x 5 groups x 4 time points). Three days and 1, 2, and 4 weeks after transplantation, VEGF and IGF-I expression was quantitated by real-time polymerase chain reaction, cell survival by polymerase chain reaction for sry2, apoptosis by TUNEL staining, LV function by echocardiography and myosin heavy chain, and light chain and troponin I by Western blot. One week after transplantation, IGF-I expression in the scar and border zone was greatest in BMC+IGF-I and BMC+VEGF+IGF-I rats (P<0.05). VEGF expression in the scar and border zone was greatest in BMC+VEGF and BMC+VEGF+IGF-I hearts (P<0.05). Transplanted cell survival was lowest in BMC, intermediate in BMC+VEGF and BMC+IGF-I, and greatest in BMC+VEGF+IGF-I (P<0.05). Apoptotic indices were significantly reduced in BMC+VEGF+IGF-I, BMC+VEGF, and BMC+IGF-I (P<0.05). Two and 4 weeks after transplantation, LV ejection fraction was lowest in control, intermediate in BMC, BMC+VEGF, and BMC+IGF-I, and greatest in BMC+VEGF+IGF-I (P<0.05). CONCLUSIONS: Transplantation of VEGF- and IGF-I-expressing BMC reduced apoptosis, maximized transplanted cell survival, and enhanced LV function. Multimodal cell-based gene therapy may maximize the benefits of cell transplantation.

Animals↗
PubMed2002

A species conserving genetic algorithm for multimodal function optimization.

This paper introduces a new technique called species conservation for evolving parallel subpopulations. The technique is based on the concept of dividing the population into several species according to their similarity. Each of these species is built around a dominating individual called the species seed. Species seeds found in the current generation are saved (conserved) by moving them into the next generation. Our technique has proved to be very effective in finding multiple solutions of multimodal optimization problems. We demonstrate this by applying it to a set of test problems, including some problems known to be deceptive to genetic algorithms.

Algorithms↗
PubMed2001

Multimodality neuroimaging: research and clinical applications.

This manuscript reviews the current stance and the pertinent problems of transcranial magnetic stimulation (TMS) and functional magnetic resonance imaging (fMRI) as brain mapping methodologies. The missing structure-function relation limits the use of TMS, whereas the uncertainty about the functional significance of activated cortical regions might render interpretation of fMRI studies difficult. Advances in image processing, however, allowed for 3- dimensional real-time visual guidance of TMS and integration with fMRI data. We describe the method used to coregister TMS and fMRI and present examples where a multimodality neuroimaging approach might add to our understanding of normal and pathological brain function.

Brain Mapping↗
PubMed2003

AMIDE: a free software tool for multimodality medical image analysis.

Amide's a Medical Image Data Examiner (AMIDE) has been developed as a user-friendly, open-source software tool for displaying and analyzing multimodality volumetric medical images. Central to the package's abilities to simultaneously display multiple data sets (e.g., PET, CT, MRI) and regions of interest is the on-demand data reslicing implemented within the program. Data sets can be freely shifted, rotated, viewed, and analyzed with the program automatically handling interpolation as needed from the original data. Validation has been performed by comparing the output of AMIDE with that of several existing software packages. AMIDE runs on UNIX, Macintosh OS X, and Microsoft Windows platforms, and it is freely available with source code under the terms of the GNU General Public License.

Costs and Cost Analysis↗
PubMed2005

Cost-effectiveness of ADHD treatments: findings from the multimodal treatment study of children with ADHD.

OBJECTIVE: Attention deficit hyperactivity disorder (ADHD) is a costly public health problem. To the authors' knowledge, this is the first study on the cost-effectiveness of the major forms of ADHD treatments used in NIMH's Multimodal Treatment Study of Children With ADHD (MTA Study). METHOD: Five hundred seventy-nine children with ADHD, combined type, ages 7 to 9.9, were assigned to 14 months of medication management, behavioral treatment, both combined, or community care. Services were tallied throughout the study, including medication, health care visits, behavioral treatments, and rental costs. Provider specialty, total time, and number of visits with providers were used to calculate costs, adjusted to FY 2000 dollars with the consumer price index. RESULTS: Treatment costs varied fourfold, with medication management being the least expensive, followed by behavioral treatment, and then combined treatment. Lower costs of medication treatment were found in the community care group, reflecting the less intensive (and less effective) nature of community-delivered treatment. Medical management was more effective but more costly than community care and more cost-effective than combination treatment and behavioral treatment alone. Under some conditions, combination treatment (medical management and psychotherapy) were somewhat more cost-effective, as demonstrated by lower costs per additional child "normalized" among children with multiple comorbid disorders. CONCLUSIONS: Medical management treatment, although not as effective as combined medical management and behavioral treatment, is likely to be more cost-effective in routine treatment for children with ADHD, particularly those without comorbid disorders. For some children with comorbid disorders, it may be cost-effective to provide combination treatment.

Attention Deficit Disorder with Hyperactivity↗
PubMed1984

Agoraphobia: a multimodal treatment approach.

A female patient with agoraphobia is presented to demonstrate the need for maximal flexibility in designing a treatment program for the agoraphobic patient. This patient required a multimodal approach utilizing pharmacotherapy, marital psychotherapy, and individual psychotherapy, alone and in combination. The paper looks specifically at nodal decision points in treatment at which reassessment was necessary and changes in psychotherapeutic intervention were made. The importance and implications of involving the patient's significant other in treatment are explored with respect to the outcomes such involvement may have on the treatment. A review of the literature on treatments for agoraphobia highlights the conclusion reached, that the agoraphobic patient presents with a biopsychosocial problem which frequently requires the clinician to combine several treatment modalities.

Adult↗
PubMed1984

Multimodal treatment of a child with schizophrenia.

A case is presented of a five-year-old boy with schizophrenia who received both art and play therapy within a multimodal therapeutic program. The course of the two therapies is presented followed by a discussion of the similarities and differences of the techniques, but also noting the complementary and synergistic results.

Anger↗