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PubMed1989

Functional and psychosocial effects of multimodality limb-sparing therapy in patients with soft tissue sarcomas.

We have documented functional and psychosocial changes in patients with extremity soft tissue sarcomas who have undergone multimodality limb-sparing treatments. In 88 patients, parameters related to economic status, sexual activity, pain, limb function, and global quality of life (QOL) were recorded prior to surgery and every 6 months postoperatively. Changes from the preoperative assessment for every parameter were analyzed in each patient. Six months after surgery, there was a decrease in employment status, sexual activity, and in limb function in a significant number of patients. At 12 months, these decreases were still evident. Despite these changes, global QOL measured by a standardized test showed at least some improvement in a significant proportion of patients at 12 months. These findings highlight the difficulty in defining QOL. It could not be ascertained if radiation therapy and/or chemotherapy were causative factors in specific changes because of the small numbers of patients in each subgroup. However, among 60 patients with high-grade sarcomas, significant wound problems developed in 10 of 33 who received postoperative radiation therapy in combination with adjuvant doxorubicin and cyclophosphamide chemotherapy compared with one of 27 patients who received adjuvant chemotherapy alone (P = .016). Also, among high-grade sarcoma patients with 12-month follow-up, six of 19 patients who received radiation therapy and chemotherapy developed joint contractures compared with zero of 15 patients who received chemotherapy alone (P less than .04). The combination of postoperative radiation therapy and chemotherapy appeared to be associated with significantly more tissue-related injury in patients with high-grade sarcomas compared with chemotherapy alone.

Adolescent↗
PubMed1992

Multimodality treatment of stage IIIA non-small-cell lung carcinoma: a critical review of the literature and strategies for future research.

PURPOSE AND DESIGN: Stage IIIA non-small-cell lung carcinoma (NSCLC) is composed of regionally advanced yet potentially resectable disease. Many trials have evaluated a variety of therapeutic strategies. Most have been single-arm phase II trials, although a number of comparative phase III trials have also been performed. This review critically evaluates the existing literature on the treatment of stage IIIA NSCLC, particularly the various multimodality approaches that have been used. RESULTS: A review of the existing literature does not establish the optimal treatment of stage IIIA NSCLC. Although radiation therapy alone remains the most commonly administered therapy for apparently unresectable disease, the status of radiation as a "standard" therapy can be seriously challenged based on existing data. Similarly, although a number of studies have established that surgical resection is clearly feasible in selected patients with stage IIIA disease, the efficacy of surgery also remains to be definitively established. Many studies have explored neoadjuvant chemotherapy, either in conjunction with radiation or surgery, with results that are best described as conflicting and controversial. CONCLUSIONS: Without question, randomized phase III trials are required at this time to define what is to be considered optimal treatment. An attempt is made to define the most important questions that should be addressed in future phase III trials. Additionally, a number of study designs are suggested to best answer the therapeutic questions posed.

Carcinoma, Non-Small-Cell Lung↗
PubMed2001

Multimodal treatment of malignant sacrococcygeal germ cell tumors: a prospective analysis of 66 patients of the German cooperative protocols MAKEI 83/86 and 89.

PURPOSE: To evaluate a multimodal approach including surgery and cisplatinum chemotherapy for treatment of children with malignant sacrococcygeal germ cell tumors (GCT) and to compare adjuvant and neoadjuvant strategies in advanced tumors. PATIENTS AND METHODS: Between 1983 and 1995, 71 patients with malignant sacrococcygeal GCT were prospectively enrolled onto the German protocols for nontesticular GCT Maligne Keimzelltumoren 83/86 and 89. Five patients who received no chemotherapy (n = 2) or nonplatinum chemotherapy (n = 2) or who did not undergo tumor resection (n = 1) were excluded from this analysis. Among the 66 patients analyzed were 14 boys and 52 girls. The median age was 17.4 months (range, 7 months to 119 months). Median follow-up was 79 months (range, 4 months to 145 months). RESULTS: Fifty-two patients presented with locally advanced stage T2 tumors, and 30 patients had distant metastases at diagnosis. Patients received a median of eight cycles (range, four to nine cycles) of cisplatinum-based chemotherapy. Thirty-five patients underwent tumor resection at diagnosis and received adjuvant cisplatinum-based chemotherapy (group A). Thirty-one patients received up-front chemotherapy followed by delayed tumor resection (group B). Group B included more metastatic tumors than group A (group B, 19 of 31 patients; group A, 11 of 35 patients, P =.01). Preoperative chemotherapy facilitated complete tumor resections (group B, 20 of 31 patients; group A, five of 35 patients, P <.001) and avoided second-look surgery. Metastases at diagnosis and completeness of the first attempt of tumor resection were significant prognostic predictors; however, metastases were not predictive for patients treated with up-front chemotherapy. At 5 years follow-up, event-free survival was 0.76 +/- 0.05 (50 of 66 patients), and overall survival was 0.81 +/- 0.05 (54 of 66 patients). Four patients died as a result of therapy-related complications, and eight patients died of their tumors. Patients with locally advanced and metastatic tumors (T2b M1) fared better with neoadjuvant treatment [overall survival: 0.83 +/- 0.09 (16 of 19 patients) versus 0.45 +/- 0.15 (five of 11 patients), P =.01]. CONCLUSION: Even locally advanced and metastatic sacrococcygeal GCT can be successfully treated with up-front cisplatinum-based chemotherapy followed by delayed but complete tumor resection.

Actuarial Analysis↗
PubMed2004

Multimodal inhibition of return effects in adults with and without Down syndrome.

Data from a previous study (Welsh & Elliott, 2001) has been reanalyzed to explore inhibition of return (IOR) effects in adults with and without Down syndrome (DS). Participants were required to react and move with either the left or right hand as quickly as possible to 1 of 2 target locations based on either a visual or a verbal cue. Although persons with DS demonstrated a different pattern of information processing capabilities, they demonstrated the same magnitude of IOR across all conditions of presentation as their peers without DS. This pattern of results provides further support for the multimodal and response-based nature of IOR. Moreover, the results indicate that the inhibitory processes that underlie IOR in the average population seem to be functional in persons with DS.

Acoustic Stimulation↗
PubMed2005

Peer-assessed outcomes in the multimodal treatment study of children with attention deficit hyperactivity disorder.

Peer-assessed outcomes were examined at the end of treatment (14 months after study entry) for 285 children (226 boys, 59 girls) with attention deficit hyperactivity disorder (ADHD) who were rated by their classmates (2,232 classmates total) using peer sociometric procedures. All children with ADHD were participants in the Multimodal Treatment Study of Children with ADHD (MTA). Treatment groups were compared using the orthogonal treatment contrasts that accounted for the largest amount of variance in prior MTA outcome analyses: Medication Management + Combined Treatment versus Behavior Therapy + Community Care; Medication Management versus Combined Treatment; Behavior Therapy versus Community Care. There was little evidence of superiority of any of the treatments for the peer-assessed outcomes studied, although the limited evidence that emerged favored treatments involving medication management. Post hoc analyses were used to examine whether any of the four treatment groups yielded normalized peer relationships relative to randomly selected-classmates. Results indicated that children from all groups remained significantly impaired in their peer relationships.

Attention Deficit Disorder with Hyperactivity↗
PubMed2003

Multimodal particle size distributions emitted from HFA-134a solution pressurized metered-dose inhalers.

The purpose of this research was to investigate the measurement and in vitro delivery implications of multimodal distributions, occurring near or in the respirable range, emitted from pressurized metered-dose inhalers (pMDIs). Particle size distributions of solution pMDIs containing hydrofluoroalkane-134a (HFA-134a) and ethanol were evaluated using 2 complementary particle-sizing methods: laser diffraction (LD) and cascade impaction (CI). Solution pMDIs were formulated from mixtures of HFA-134a (50%-97.5% wt/wt) and ethanol. A range of propellant concentrations was selected for a range of vapor pressures. The fluorescent probe, Rhodamine B, was included for chemical analysis. The complementary nature of LD and CI allowed identification of 2 dominant particle size modes at 1 and 10 micro m or greater. Increasing propellant concentrations resulted in increases in the proportion of the size distributions at the 1- micro m mode and also reduced the particle size of the larger droplet population. Despite significant spatial differences and time scales of measurement between the particle-sizing techniques, the fine particle fractions obtained from LD and CI were practically identical. This was consistent with LD experiments, which showed that particle sizes did not decrease with increasing measurement distance, and may be explained by the absence of significant evaporation/disintegration of larger droplets. The fine particle fractions (FPFs) emitted from HFA-134a/ethanol solution pMDI can be predicted on the basis of formulation parameters and is independent of measurement technique. These results highlight the importance of presenting particle size distribution data from complementary particle size techniques.

Aerosols↗
PubMed1996

A longitudinal study of multimodal evoked potentials in patients following radiotherapy for nasopharyngeal carcinoma.

Radiation rhombencephalopathy and radiation myelopathy may occur in patients months or years after radiotherapy for malignancy of the head and neck. We obtained multimodal evoked potentials longitudinally in 26 patients with proven nasopharyngeal carcinoma. Recordings were made before radiotherapy and at 1 week, 3 months, 9 months, 15 months, and 24 months after radiotherapy. All absolute latencies of evoked response before and after radiation were within normal limits. However, the I-III interpeak latencies of brainstem auditory evoked potentials and the onset latencies of motor evoked potentials in the whole group of patients at 15 months after radiation were significantly longer than those before radiotherapy, whereas the latencies at 24 months were not significantly different. The N20 latencies of somatosensory evoked potentials after radiotherapy were significantly prolonged at 3 months of follow-up; the prolongation then became normal. They indicate that a subclinical reversible radiation-induced dysfunction may occur in the auditory, sensory, and motor systems.

Adult↗
PubMed2004

A multimodal approach to managing the symptoms of multiple sclerosis.

Multiple sclerosis (MS) is a disease of the CNS with a challenging clinical course characterized by heterogeneous symptoms related to inflammation and demyelination. Disease-modifying agents (DMAs) are used to treat the related neuronal degradation. Certain symptoms occur regularly, although with variable frequency, regardless of treatment with DMAs. Because there is no cure for MS at this time, symptom management is critically important to quality of life. Symptoms commonly seen are spasticity, fatigue, sexual dysfunction, bladder dysfunction, pain, and cognitive dysfunction. Other symptoms include depression, bowel dysfunction, paroxysmal symptoms, and weakness. The symptom management model that provides optimal results for patients with MS is a multimodal approach using effective communication, patient education, physical modalities and activities, occupational and other therapies, and pharmacologic interventions. Individualizing treatment for each patient involves gaining control of symptoms as early as possible to prevent cycles of symptoms from developing.

Cognition Disorders↗
PubMed1994

Combined and three-dimensional rendered multimodal data for planning cranial base surgery: a prospective evaluation.

Magnetic resonance (MR), X-ray computed tomography (CT), and angiographic images best depict soft tissue, bone, and blood vessels respectively. No one on its own is sufficient in the preoperative assessment of cranial base lesions. We have developed and evaluated a computational technique for the three-dimensional (3D) combination and display of multimodality images for planning cranial base surgery. This evaluation was prospective and performed in such a way that the results could be quantified. Eight patients (three acoustic neuromas, four subfrontal and suprasellar meningiomas, and one petrous apex meningioma) underwent MR, CT, and MR angiographic investigations. These images were registered with anatomical landmarks rather than an external frame. Two techniques were used to display the resulting combined images: multiple slices in which bone from CT was overlaid on soft tissue from registered MR and pseudo-3D-rendered movie sequences showing bone from CT, lesions and optic nerves from MR, and blood vessels from MR angiography. The advantages of the combined displays compared with those of conventional methods of viewing were assessed prospectively by the operating surgeon and by an independent surgeon, and the results were compared with operative findings. The preoperative assessment showed a significant improvement (P < 0.05, sign test) in the depiction of both individual structures (lesion and bone from overlaid slices and lesion and vasculature from 3D-rendered displays) and structural relationships (tumor-bone relationships from overlaid slices and of tumor-vasculature relationships from 3D-rendered displays). The operative findings indicated that a more accurate interpretation of this information was possible from the combined images.

Adult↗
PubMed2006

Therapy of brain arteriovenous malformations: multimodality treatment from a balanced standpoint.

The three therapeutic modalities for arteriovenous malformation (AVM) treatment (surgery, embolization, and radiotherapy) developed in the past years with specific tools, each tool with its own qualities. Soon after the implementation of embolization for treatment of AVMs, this technique was used in combination with microsurgery; since the development of radiosurgery, treatment algorithms combining embolization with surgery and eventual subsequent radiosurgery, embolization with radiosurgery, or surgery with subsequent radiosurgery have been reported. These different combinations have been in use under the term multimodality treatment for many years, but the algorithms regarding the combination of tools, which tool has priority, and how the risk levels of each tool are assessed shows great variability among institutions. Centers with a surgical background see embolization as a technique to increase surgical feasibility and radiosurgery as a tool to complete subtotal AVM excision. Institutions with an endovascular background embolize AVMs with the aim of maximal occlusion rates and view surgery or radiosurgery as a technique to be used if the goal of total endovascular occlusion cannot be achieved. Radiosurgeons receive patients after incomplete embolization or surgical extirpation or a combination of both.

Blood Vessel Prosthesis↗
PubMed1998

Adaptive multimode lubrication in natural synovial joints and artificial joints.

To examine the lubrication mechanisms in both natural synovial joints and artificial joints with artificial cartilages, pendulum tests of pig shoulder joints and simulator tests of sliding pairs of a stainless steel spherical component and natural articular cartilage or artificial cartilage have been conducted. Firstly, it was shown in pendulum tests of pig shoulder joints that both concentration of hyaluronic acid or viscosity and adsorbed film formation of proteins and phospholipids exerted a significant effect on frictional behaviour in swinging motion immediately after a loading of 100 N. Under a high load of 1 kN, low friction was observed under wide-ranging viscosity conditions, since a high load similar to body weight probably enhanced the squeeze film effect due to improved congruity. Next, frictional behaviour of sliding pairs in knee joint models, consisting of a stainless steel spherical surface and either specimens of pig tibial cartilage or polyvinylalcohol (PVA) hydrogel, was examined during walking in simulator tests. In these tests, the influences of lubricant viscosity and addition of protein on frictional behaviour were evaluated. For both compliant materials, the appropriate addition of gamma-globulin to sodium hyaluronate (HA) solution maintained low friction and protected rubbing surfaces under thin film conditions. These phenomena are discussed from the viewpoint of adaptive multimode lubrication.

Animals↗
PubMedDate not supplied

Endoluminal recanalization in a patient with phlegmasia cerulea dolens using a multimodality approach.

Phlegmasia cerulea dolens, a rare complication of deep venous thrombosis, has traditionally been difficult to treat. The patient described in this report posed additional therapeutic challenges based on a history of heparin-induced thrombocytopenia. She presented with severe leg pain and swelling, and a venogram showed occlusion of both her inferior vena cava and right iliac vein. The use of a multimodality approach, both chemical and mechanical, was successful in removing the venous occlusion, thereby preventing further complications, such as circulatory shock, postphlebitic syndrome, and venous gangrene.

Catheterization↗
PubMed2003

Three-mode analysis of multimode covariance matrices.

Multimode covariance matrices, such as multitrait-multimethod matrices, contain the covariances of subject scores on variables for different occasions or conditions. This paper presents a comparison of three-mode component analysis and three-mode factor analysis applied to such covariance matrices. The differences and similarities between the non-stochastic and stochastic approaches are demonstrated by two examples, one of which has a longitudinal design. The empirical comparison is facilitated by deriving, as a heuristic device, a statistic based on the maximum likelihood function for three-mode factor analysis and its associated degrees of freedom for the three-mode component models. Furthermore, within the present context a case is made for interpreting the core array as second-order components.

Analysis of Variance↗
PubMed2005

Multimodal effects of available drugs for ischemic stroke.

Recent research demonstrates the complexity and variety of pathophysiologic processes underlying cerebral ischemia. This review will focus on the multimodal effects of the various drugs currently used for stroke prevention. The most recent clinical studies of each will also be reviewed, and the implications for clinical use and future research discussed. An evolving approach for stroke prevention will include a combination of antiplatelets, increased use of statins, ACE inhibitors and possibly vitamin therapy.

Antihypertensive Agents↗
PubMed2002

Athermalized low-loss echelle-grating-based multimode dense wavelength division demultiplexer.

A high-density wavelength division demultiplexer (DEMUX) capable of demultiplexing eight-channel 200-GHz optically spaced signals into a 62.5-microm multimode-fiber array is reported. The wavelength range of operation is from 1549.32 to 1560.61 nm within the International Telecommunication Union grid. The measured wavelength accuracy is within 0.04 nm. The mean insertion loss of this DEMUX is 1.95 dB. Thermal analysis and temperature testing results are reported. The temperature test cycling from 20 degrees C to 60 degrees C indicates that the wavelength thermal drift is less than 0.8 pm/degrees C. Adjacent cross talk is measured to be better than -45 dB. The measured data transmission bit rate of this device is higher than 3.5 Gb/s.

Journal Article↗
PubMed2002

Design issues of a multimode interference-based 3-dB splitter.

We have investigated important issues such as the power loss, the loss imbalance the fabrication tolerances, and the wavelength dependence for the design of a multimode interference-based 3-dB splitter on deeply etched InP waveguides under general, restricted, and symmetric interference mechanisms. For this investigation, we used the finite-element-based beam propagation approach. Results are presented.

Journal Article↗
PubMed2003

Synthesis of Hadamard transformers by use of multimode interference optical waveguides.

We propose a synthesis method of optical Hadamard transformer using multimode interference (MMI) couplers. By using the signal transfer matrix of 2 x 2, 4 x 4, and 8 x 8 MMI couplers, we show that sum and difference units of input signals can be synthesized. An interchange unit of two signals can also be synthesized. One synthesis method of Hadamard transformers is a combination of only 2 x 2 units, and the other is a combination of N x N(N > or = 4) units as well as 2 x 2 units. The design examples of operation units are shown, and the size and the output power of Hadamard transformers are estimated.

Journal Article↗
PubMed2003

Coupling light from a laser diode into a multimode fiber.

A parabolalike fiber end to couple the light from a high-power laser diode into a multimode fiber is presented. The formula for the coupling efficiency of such a system is given, and numerical evaluation shows that the theoretical coupling efficiency can be as high as 92% without an antireflection coating on the fiber's end face. This beam-shaping system can be fabricated easily and has a large alignment tolerance.

Journal Article↗