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Results for “multimodal integration”

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At least 469 records · Page 26Linked to original sources

PubMed2006

Improving the accuracy of the diagnosis of schizophrenia by means of virtual reality.

OBJECTIVE: The authors' goal was to improve the diagnosis of schizophrenia by using virtual reality technology to build a complex, multimodal environment in which cognitive functions can be studied (and measured) in parallel. METHOD: The authors studied sensory integration within working memory by means of computer navigation through a virtual maze. The simulated journey consisted of a series of rooms, each of which included three doors. Each door was characterized by three features (color, shape, and sound), and a single combination of features--the door-opening rule--was correct. Subjects had to learn the rule and use it. The participants were 39 schizophrenic patients and 21 healthy comparison subjects. RESULTS: Upon completion, each subject was assigned a performance profile, including various error scores, response time, navigation ability, and strategy. A classification procedure based on the subjects' performance profile correctly predicted 85% of the schizophrenic patients (and all of the comparison subjects). Several performance variables showed significant correlations with scores on a standard diagnostic measure (Positive and Negative Syndrome Scale), suggesting potential use of these measurements for the diagnosis of schizophrenia. On the other hand, the patients did not show unusual repetition of response despite stimulus cessation (called "perseveration" in classical studies of schizophrenia), which is a common symptom of the disease. This deficit appeared only when the subjects did not receive proper explanation of the task. CONCLUSIONS: The ability to study multimodal performance simultaneously by using virtual reality technology opens new possibilities for the diagnosis of schizophrenia with objective procedures.

Adult↗

PubMed1999

[Metastases compromising physical stability].

Multimodal therapy of tumor patients with osseous metastases is an interdisciplinary task. The surgical treatment requires optimal integration, in terms of timing and extent of the procedure, into the overall treatment plan. In addition to surgery, modern therapeutic approaches include systemic chemotherapeutic, hormonal and immunological therapy, radiotherapy, and other drug therapy (i.e. biophosphonates). We use classical stabilization methods with plates and bone cement or intramedullary nailing and also new implants with angular stability like an internal fixator and modular endoprothesis systems in operative therapy. Such stabilizing systems allow bridging of tumor defects in almost all parts of the skeleton. The ultimate goal of any treatment and especially of operative intervention is a mobile patient with little or no pain and a good quality of life.

Bone Neoplasms↗

PubMed1992

Sensory response of cortical neurons in the anterior ectosylvian sulcus, including the area evoking eye movement.

The deep cortical tissue in the caudal portion of the anterior ectosylvian sulcus (AES) of cats anesthetized with alpha-chloralose was explored to examine the sensory response properties of neurons in this area, which is known to contain an area evoking eye movement. Of 873 neurons isolated, 262 (30.0%) were multimodal, i.e. responsive to two or more of the stimulus modalities of visual, auditory, or somatic. The ratio of multimodal neurons to total neurons in the eye-movement-evoking area was significantly larger than this ratio in other areas; 79 (39.5%) of 200 neurons in the eye-movement-evoking area were multimodal, while 183 (27.2%) of 673 neurons in other areas were multimodal. Neuronal minimal latency in response to visual stimulation was widely and bimodally distributed, showing two peaks at 35 ms and 60 ms, whereas latencies to auditory and somatic stimulation were narrowly distributed, with one peak at 10 ms and 15 ms, respectively. There was no remarkable difference either between unimodal neurons and multimodal neurons or between the neurons in the eye-movement-evoking area and those in other areas in distribution of latency. That there was a significant difference in ratio of multimodal to total neurons between the eye movement area and other areas suggests that some convergence or integration of different kinds of sensory input in relation to eye movement might be carried out in the caudal portion of the AES.

Animals↗

PubMed1991

Changing concepts in the management of vulvar cancer.

Vulvar carcinoma varies widely in its clinical presentations and prognosis. The reviewed literature outlines the achievements of conventional surgery, radiation, or chemoradiation therapy in its management. Currently therapeutic concepts are evolving. New treatment strategies replacing the uniform use of radical vulvectomy and bilateral groin dissection are proposed. These strategies are tailored to the clinical and pathological disease extent and location and integrate the possible therapeutic advantages of both surgery and chemoradiation. The testing and use of the proposed multimodality therapy protocols require the expertise of gynecologic, radiation, and medical oncologists. This approach should lead to improved anatomic and functional preservation in early disease and improved locoregional in advanced disease.

Algorithms↗

PubMed2000

Electrical thresholds for biomechanical response in the ankle to direct stimulation of spinal roots L4, L5, and S1. Implications for intraoperative pedicle screw testing.

STUDY DESIGN: A comparison of electrical thresholds for biomechanical response in the ankle and for evoked electromyographic signals from specific leg muscles during intraoperative extradural direct stimulation of roots L4, L5, and S1. OBJECTIVE: To determine whether a biomechanical response in the ankle to direct root stimulation occurs before evoked electromyographic signals and to determine differences in electrical excitability of the roots circumferentially. SUMMARY OF BACKGROUND DATA: Stimulus intensities of 1.2-5.7 mA are reported to evoke electromyographic response in corresponding muscles to direct stimulation of normal roots. Stimulus intensities of 6-8 mA were suggested to detect bony pedicular compromise by stimulation of a hole or a screw during pedicle instrumentation. Electrical thresholds of three-dimensional torque response in the ankle to direct root stimulation have not yet been evaluated and compared with thresholds of evoked electromyogram. METHODS: Direct monopolar stimulation of the surgically exposed roots L4, L5, and S1 was performed from different sites around the root by a cuff multielectrode. Biomechanical response was measured as an isometric torque in the ankle at each of three orthogonal axes. Compound muscle action potentials (CMAPs) from root-specific muscles were detected by a pair of surface or wire electrodes. RESULTS: Mean threshold for biomechanical response in the ankle to stimulation of roots L4, L5, and S1 was 0.72 +/- 0.39 mA and for CMAP response was 1.09 mA +/- 0.36 (N = 13). Thresholds for biomechanical responses were significantly lower than for CMAP responses (P = 0.0004; paired t test). Nerve roots were electrically most excitable on their ventral aspects. CONCLUSION: The biomechanical response in the joint to root stimulation can be used to test all root-related muscles crossing that joint at their individual innervation pattern and their residual innervation and to detect electrical excitation of the root at electric thresholds lower than those for detecting CMAP from single standard root-specific muscle. However, this method does not provide sufficient root specificity. It will be valuable in conjunction with multimodality neurophysiologic monitoring of the roots for earlier and more reliable detection of pedicle bone breakthrough or integrity. Further clinical investigations are suggested.

Ankle↗

PubMed2005

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↗

PubMed1997

Advances in hospice care.

Hospice care developed in part as a reaction to the impersonal and technology-dependent end-of-life care offered by modern medicine. Unique approaches to care that emphasize interdisciplinary team management of troublesome symptoms and the promotion of quality of life as defined by the patient, are finding their way into all aspects of health care. Symptom control measures have expanded to include chemotherapy, radiation therapy, and multimodal therapies. Both the development of a unique knowledge base and advances in research have fostered the integration of hospice and palliative care into mainstream medicine.

Aged↗

PubMed2006

Preoperative evaluation of patients with malignant pleural mesothelioma: role of integrated CT-PET imaging.

Malignant pleural mesothelioma (MPM) is an uncommon neoplasm arising from mesothelial cells of the pleura. The prognosis is poor with a median survival of 8 to 18 months after diagnosis. Multimodality regimens combining chemotherapy, radiotherapy, immunotherapy, and surgery are being used more frequently in patient management. Extrapleural pneumonectomy is the surgical treatment of choice in 10% to 15% of patients who present with resectable disease and is reported to prolong survival. Accurate staging is important to distinguish patients who are resectable from those requiring palliative therapy. Integrated computed tomography-positron emission tomography (CT-PET) increases the accuracy of overall staging in patients with MPM and significantly improves the selection of patients for curative surgical resection. Specifically, CT-PET detects more extensive disease involvement than that shown by other imaging modalities and is particularly useful in identifying occult distant metastases. This article reviews aspects of imaging performed in the initial staging of patients with MPM according to the International Mesothelioma Interest Group staging system and will emphasize the appropriate role of CT-PET imaging in determining the T, N, and M descriptors.

Combined Modality Therapy↗

PubMed1989

Innervation of vascular and cardiac muscle of Aplysia by multimodal motoneuron L7.

1. The cardiovascular system of Aplysia has proven to be a useful preparation for study of the neural control of circulation. To better understand the neural integration of function in this system, we have attempted to gain a more complete picture of its morphology and innervation patterns, with particular emphasis on the abdominal aorta and heart. 2. The vasoconstrictor muscle fibers of the abdominal aorta were found by dye injection to be extensively branched, with many processes that are less than 1 micron in diameter. Because of the wide spacing between individual muscle fibers, these fine processes, which have relatively few contractile filaments, may be required to mediate the electrical coupling that is observed between muscle cells. 3. L7, an identified cell in the abdominal ganglion, had been shown by others to be an excitatory motoneuron for the gill, the siphon, and the sheath-contracting muscles of the pleuroabdominal connectives, and also to excite the gill motoneurons in the branchial ganglion (5, 43, 56). We have found that this multimodal motoneuron also directly excites the auricle of the heart and the vasoconstrictor muscle of the abdominal aorta. 4. The excitatory effect of L7 on the abdominal aorta interacts synergistically with that produced by the other known excitatory inputs to that structure, the LBVc vasoconstrictor motoneurons. 5. The abdominal aorta is also richly innervated by axons immunoreactive for serotonin and for the neuropeptide FMRFamide. Serotonin inhibits the contractions of the aorta elicited by firing either L7 or the LBVC cells. In contrast, FMRFamide selectively inhibits the contractions elicited by the LBVC cells. 6. Our results suggest that a significant amount of the functional integration of the cardiovascular and respiratory systems is achieved by the use of a motoneuron common to both systems, and that there is likely to be extensive peripheral inhibitory modulation of the vasoconstrictor inputs to the abdominal aorta.

Animals↗

PubMed2026

Automated CEAP Classification of Venous Duplex Reports Using Multimodal Artificial Intelligence.

OBJECTIVE: To develop and internally validate a prototype multimodal artificial intelligence system for automated CEAP (Clinical, Etiological, Anatomical and Pathophysiological) classification of venous duplex ultrasound (VDUS) reports, integrating natural language processing of free-text components with computer vision analysis of hand-drawn anatomical diagrams. METHODS: Single centre retrospective observational study using routinely collected clinical data. One thousand consecutive venous duplex ultrasound reports from Cambridge University Hospitals NHS Foundation Trust, UK (July 2024 - May 2025) were labelled according to the CEAP classification, excluding the Etiological component, which could not be reliably determined from duplex reports alone. Transfer learning was applied using ClinicalBERT for text and MobileNetV3 for diagrammatic data. Clinical classes were predicted from request line text. Text- and image-based pathophysiological models were developed for four anatomical territories (Great Saphenous Vein, Small Saphenous Vein, Deep system, Perforators), combined using late fusion with probability averaging. RESULTS: The clinical CEAP model achieved accuracy of 0.91, macro-F1 of 0.82, and macro-AUC of 0.98. Pathophysiological prediction varied, with text models broadly outperforming image models. Fusion yielded heterogeneous benefits, improving SSV performance but reducing Deep system accuracy. The performance of the final pathophysiological CEAP fusion models varied across anatomical territories: accuracy ranged from 0.70-0.92 and macro-AUC from 0.80-0.92. CONCLUSION: This study demonstrates the feasibility of automated CEAP classification from VDUS reports. Despite class imbalance affecting minority class predictions, the strong discriminatory performance validates this multimodal ML model for extracting clinically meaningful information from real-world data. This approach offers potential, pending external validation, to streamline vascular services through automated triage and guideline-compliant decision making.

Artificial intelligence↗

PubMed2006

Formulation of correlations for general-type beams in atmospheric turbulence.

Log-amplitude and phase correlations of general-type beams are formulated in atmospheric turbulence. A general beam is described as the superposition of many sets of multimode contents, each mode being off-axis Hermite-Gaussian. Since the Rytov solution is utilized, the formulas are valid in the weakly turbulent regime. The results are presented in integral forms that should be numerically evaluated for the specific beam type of interest. Our general beam results correctly reduce to the existing solutions for the correlations of limiting-case beams such as higher-order single-mode, multimode, off-axis Hermite-Gaussian, Hermite-sinusoidal-Gaussian, higher-order-annular, flat-topped-Gaussian, and thus naturally fundamental mode, plane, and spherical waves. Scintillation index and phase fluctuations in atmospheric optical links employing such special beams will be examined in future using the results reported here.

Journal Article↗

PubMed2026

Current Concepts and Emerging Technologies in Aesthetic Outcome Assessment of Breast Reconstruction.

Aesthetic outcomes are a crucial determinant of the overall success of breast reconstruction. Recently, aesthetic assessment has evolved from relying mainly on subjective impressions to incorporating more quantitative methods. This systematic review summarizes current concepts and emerging technologies in aesthetic outcome assessment after breast reconstruction. A comprehensive search of studies evaluating aesthetic outcomes following implant-based, autologous or hybrid breast reconstruction was performed between 2000 and 2025. Assessments were classified as subjective or objective. Extracted variables included assessment characteristics, aesthetic outcome domains, and patient-centered outcomes. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. Levels of evidence were classified according to the Oxford Centre for Evidence-Based Medicine. A total of 51 studies involving 7711 participants from 16 countries were included. Subjective tools were most frequently employed, led by the BREAST-Q (35/51, 69%), followed by expert- or panel-based evaluations (17/51, 33%) and the visual analog scale (2/51, 4%). Objective methods were applied in 19 studies and included 3-dimensional surface imaging (8/51, 16%), BCCT.core (7/51, 14%), eye tracking (3/51, 6%), and artificial intelligence-based analyses (3/51, 6%). Although subjective tools captured satisfaction with breast appearance, objective tools quantified morphological parameters and positional landmarks. BREAST-Q remains the cornerstone of outcome evaluation after breast reconstruction, providing patient-centered perspectives, including, but not limited to, aesthetic perception. A progressive shift toward multimodal evaluation was noticed, as no single modality comprehensively addressed all aesthetic domains. Future research should focus on integrating subjective and objective assessment methods within a unified framework. Level of Evidence: 3 (Therapeutic) For image description, please refer to the figure legend and surrounding text.

Humans↗

PubMed1999

Concertina effect and facial aging: nonlinear aspects of youthfulness and skeletal remodeling, and why, perhaps, infants have jowls.

The effect of aging on the orbitomaxillary region is evaluated in the present study. The observation was made that infants look like aged individuals in terms of the midface soft-tissue contours of the midface. Because preliminary work has shown that the facial skeleton remodels throughout life, this observation led to the hypothesis that infants and older individuals appear similar because they have comparable skeletal dimensions, specifically in the orbitomaxillary region. The design is a retrospective analysis of three-dimensional computed tomographic scan data. Three groups of male subjects were studied: infant, ages 1 to 12 months (n = 5); youthful, ages 15 to 24 years (n = 13); and old, ages 53 to 76 years (n = 12). Orbital and zygomaticomaxillary vertical dimensions were measured in both medial and lateral planes between fixed anatomical landmarks. Results were compared by using analysis of variance, Student-Newman-Keuls, and Student's t tests. The findings show that skeletal remodeling is such that the ratio of the maxillary height to orbital height is greatest during youth; during infancy and old age, there is a short maxilla relative to a larger orbit. This finding is significant in the medial plane from orbital rim to pyriform aperture (p < 0.05). Furthermore, there is an actual decrease in vertical maxillary height in this medial plane (p < 0.01) from youth until old age, which occurs secondary to normal skeletal remodeling in the dentate individual. The combined effect of downward expansion of the orbital shelf and the upward migration of the pyriform effectively decreases the space available to support the overlying soft tissues of the midface. An accordion-like or "concertina" effect may lead to compression or restriction of the facial soft tissues over a relatively deficient bony platform. These results highlight the importance of skeletal remodeling in determining the soft-tissue contours of the aging face. The process of skeletal remodeling may also allow for a tentative definition of facial youthfulness. Infants are born with a short maxilla relative to a large orbit, and the maxillary wall is angled posteriorly. This ratio and angle change from infancy until youth, when there is a balance between the bony skeletal support and the overlying soft-tissue envelope, i.e., the skin, facial muscles, and adipose tissue. It is when skeletal remodeling continues past this point that a disharmony occurs. Because the ratio of maxilla/orbit, and the angle of the maxillary wall, in the older person reverts toward that of an infant, the attainment of youth occurs partly in a nonlinear or multimodal manner. This work is part of an emerging concept of facial aging, which we would term an integrated model of facial aging. This model allows facial aging to be viewed as a biological "system," in which there are primary and secondary factors that interact in the process of facial aging. Additional research such as this continues to suggest the importance of bony remodeling in facial aging.

Adolescent↗

PubMed2002

[PIV: a computer-aided portal image verification system].

Portal image verification (PIV) is one of the key actions in QA procedure for sophisticated accurate radiotherapy. The purpose of this study was to develop a PIV software as a tool for improving the accuracy and visualization of portal field verification and computing field placement errors. PIV was developed in the visual C++ integrated environment under Windows 95 operating system. It can improve visualization by providing tools for image processing and multimode images display. Semi-automatic register methods make verification more accurate than view-box method. It can provide useful quantitative errors for regular fields. PIV is flexible and accurate. It is an effective tool for portal field verification.

Algorithms↗

PubMed2003

Inclusion of 3-D computed tomography rendering and immersive VR in a third year medical student surgery curriculum.

Computed tomography (CT) scans are frequently used for preoperative evaluation of patients undergoing complex surgery and are therefore commonly encountered by medical students on their surgical rotations. Interpretation of these CT scan images is therefore an integral component of all medical students' surgical rotations. Additionally, advanced rendering available from modem scanners and registration of multimodal or serial scans require the student to understand how volumetric anatomy relates to cross-sectional anatomy. The utility of three-dimensional (3-D) models for conveying surgical anatomy has been demonstrated. Immersive 3-D VR overcomes many of the conceptual limitations encountered when conveying or teaching 3-D relationships via 2-D images traditionally produced by these scans. We are currently using augmented reality as a teaching tool and have incorporated 3-D immersive environments in the third year medical student Surgery rotation. Initial results suggest that this is an effective tool for teaching third year medical students. 3-D CT rendering and immersive VR provide an effective process for utilizing CT datasets to teach surgical anatomy to medical students.

Computer Simulation↗

PubMed1997

[Surgical and integrated therapy of bronchogenic cancer: results of a personal series].

The results of a series of 3,596 patients affected by lung cancer and submitted to multimodality treatment are reported. Long-term survival at 5 and 10 years of resected patients was related to cancer staging: 5 years after surgery 63% of treated patient died because of metastasis and only 12% because of local recurrence, while after 10 years metastases were observed in 40% and local recurrence almost in none.

Adult↗

PubMed2000

Auditory processing in the vegetative state.

H(2)(15)O-PET was used to investigate changes in regional cerebral blood flow in response to auditory stimulation in patients in the vegetative state. Five patients in a vegetative state of hypoxic origin were compared with 18 age-matched controls. In addition, the cerebral metabolism of these patients and 53 age-matched controls was studied using [(18)F]fluorodeoxyglucose. In control subjects, auditory click stimuli activated bilateral auditory cortices [Brodmann areas (BA) 41 and 42] and the contralateral auditory association cortices (BA 22). In the patients, although resting metabolism was decreased to 61% of normal values, bilateral auditory areas 41 and 42 showed activation as seen in the controls, but the temporoparietal junction cortex (BA 22) failed to be activated. Moreover, the auditory association cortex was functionally disconnected from the posterior parietal association area (BA 40), the anterior cingulate cortex (BA 24) and the hippocampus, as revealed by psychophysiological interaction analysis. Thus, despite altered resting metabolism, the auditory primary cortices were still activated during external stimulation, whereas hierarchically higher-order multi- modal association areas were not. Such a cascade of functional disconnections along the auditory cortical pathways, from the primary auditory areas to multimodal and limbic areas, suggests that the residual cortical processing observed in the vegetative state cannot lead to the integrative processes that are thought to be necessary for the attainment of the normal level of awareness.

Acoustic Stimulation↗

PubMed2003

Indications and limitations of radiotherapy in malignant pleural mesothelioma.

In patients with malignant pleural mesothelioma, radiotherapy is useful in the palliation of symptoms of chest pain and painful masses. Prophylactic chest wall irradiation appears to reduce the incidence of chest wall recurrences at incision sites. An area of active ongoing research is the role of high-dose hemithorax irradiation after extrapleural pneumonectomy for early stage disease. In carefully staged patients, this approach has resulted in a marked reduction in local tumor recurrences, although nearly one half of patients subsequently developed isolated distant metastases. Relevant issues for planning postoperative radiotherapy in such patients are highlighted. These multimodality protocols await evaluation within prospective randomized clinical trials, and effective systemic chemotherapy regimens will also need to be integrated into such approaches.

Chest Pain↗