Articoli di riviste: "Combined or multimodal treatments"

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Carrillo, Jose, Naveed Wagle, Garni Barkhoudarian, Daniel Kelly, Annie Heng, Jaya Gill, Tiffany Juarez e Santosh Kesari. "MNGI-05. COMBINED MULTIMODAL TREATMENT REGIMEN IN RECURRENT MENINGIOMAS". Neuro-Oncology 21, Supplement_6 (novembre 2019): vi140. http://dx.doi.org/10.1093/neuonc/noz175.587.

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Abstract Meningiomas are the most common primary brain tumor, subsequent tumor progression can be problematic for surgical treatment options based upon location. Currently there is limited activity of various single agent medical therapies. We evaluated a combined treatment modality in recurrent Meningiomas. Patients were consented to NOC study protocol JWCI-17–0401 in this retrospective analysis. Treatment consisted of combination Octreotide LAR, Everolimus, Hydroxyurea, and Mifepristone. Patient characteristics in the combined treatment meningioma group (n=12) had a median age 60, 50% male, 47% WHO grade I, 37% WHO grade II, 11% WHO grade III, 67% skull base location, median number of recurrences is 2.2, with median number of surgeries of 1.7. Total comparison meningioma patients (n=19) with median age 62, 42% male, 42% WHO grade I, 50% WHO grade II, 17% WHO grade III, 58% skull base location, median number of recurrences is 2.2, with median number of surgeries of 2.2. Median PFS in recurrence prior to initiation of multimodal combined therapy, mPFS=283 days. Median PFS with subsequent multimodal combined therapy, mPFS=318 days. Multimodal therapy may prolong mPFS in recurrent meningiomas. Our pilot data supports further clinical trials in combined multimodal treatments.

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D’Amico, Agata Grazia, Grazia Maugeri, Luca Vanella, Valeria Pittalà, Dora Reglodi e Velia D’Agata. "Multimodal Role of PACAP in Glioblastoma". Brain Sciences 11, n. 8 (28 luglio 2021): 994. http://dx.doi.org/10.3390/brainsci11080994.

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Glioblastoma multiforme (GBM) is the deadliest form of brain tumors. To date, the GBM therapeutical approach consists of surgery, radiation-therapy and chemotherapy combined with molecules improving cancer responsiveness to treatments. In this review, we will present a brief overview of the GBM classification and pathogenesis, as well as the therapeutic approach currently used. Then, we will focus on the modulatory role exerted by pituitary adenylate cyclase-activating peptide, known as PACAP, on GBM malignancy. Specifically, we will describe PACAP ability to interfere with GBM cell proliferation, as well as the tumoral microenvironment. Considering its anti-oncogenic role in GBM, synthesis of PACAP agonist molecules may open new perspectives for combined therapy to existing gold standard treatment.

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AJISAKA, Hideyuki, Yutaka YOSHIMITSU, Yoshiaki ISOBE e Yasuo TAKESHITA. "MULTIMODAL TREATMENT COMBINED WITH HYPERTHERMIA FOR MALIGNANCIES". Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 60, n. 2 (1999): 351–58. http://dx.doi.org/10.3919/jjsa.60.351.

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Levy, Florence. "Implications for Australia of the Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder". Australian & New Zealand Journal of Psychiatry 35, n. 1 (febbraio 2001): 45–48. http://dx.doi.org/10.1046/j.1440-1614.2001.00850.x.

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Objectives: This paper reviews the implications of the large-scale USA Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder (MTA) by the MTA Cooperative group for planning of clinical services for children with attention deficit hyperactivity disorder in Australia. Method: The MTA study findings of no significant difference between active medication treatment alone, and combined medication combined with behaviour therapy treatments, on core symptom outcomes, are examined. Service traditions, workforce issues, diagnostic and ethical and philosophical considerations are discussed in relation to their impact on service planning in Australia. Implications of pharmacogenomic research are examined. Ethical and philosophical questions are raised in relation to the use of stimulant medications for subthreshold symptoms and for socialization of children. Results: A critical evaluation of results reveals that combined treatments allow the use of lower medication doses, and that multimodal treatments are effective for comorbid symptoms. Completion of the Human Genome Project promises increasing technological advances. Arguments for and against a technological approach to child rearing are posited. Conclusions: The MTA study raises not just service planning questions, but also important ethical and philosophical considerations about optimal degree of medicalization of services in an increasingly technological society. Child psychiatrists will be required to have an understanding of technological developments if they wish to contribute to future debates.

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Carvalho, M., D. Estevens e O. Tur. "Efficacy of Combined Treatments, Psychological and Pharmacological, for Depression in Adults". European Psychiatry 24, S1 (gennaio 2009): 1. http://dx.doi.org/10.1016/s0924-9338(09)70938-1.

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According to the state of the art, combined treatments for depression are more efficacious than a unique approach. However, studies on the efficacy of different psychological treatments are scarce. We will present the results of an on-going research, carried out with the main purpose of analysing the efficacy of two psychological empirically validated treatments for depression, Cognitive-Behavioral Therapy (CBT) and Interpersonnal Therapy (IPT), combined with psychopharmacological approach. A sample of 30 adult females will be randomly assigned to one of three conditions: 1) CBT and pharmacological treatment; 2) IPT and pharmacological treatment; and 3) only pharmacological treatment. A multimodal assessment matrix will be used to evaluate depression, suicidal ideation and intention, and individual, social, and environmental factors commonly related to the onset of major depression, namely hopelessness and pessimism, cognitive processing, interpersonal relations, life events, before, at the end of treatments, and at follow-up. We expect that both combined approaches will be more efficacious in the reduction of depressive symptoms, including suicidal behaviours, compared to the pharmacological approach. We also expect to understand the sensitivity to change of the assessed psychological processes underlying each form of psychotherapy.

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Kazdin, Alan E. "Combined and Multimodal Treatments in Child and Adolescent Psychotherapy: Issues, Challenges, and Research Directions". Clinical Psychology: Science and Practice 3, n. 1 (marzo 1996): 69–100. http://dx.doi.org/10.1111/j.1468-2850.1996.tb00059.x.

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Tang, Zhao-You, e Giammaria Fiorentini. "Hepatoma Today: Therapeutic Experiences of Multimodal Approach". Tumori Journal 79, n. 3 (giugno 1993): 166–69. http://dx.doi.org/10.1177/030089169307900302.

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Aims and Background Hepatocellular carcinoma (HCC) ranks third of cancer deaths in China, it kills 100,000 patients every year. In Italy HCC is an increasing malignant tumor and kills about 7000 patients every year. Fortunately, due to a multimodal approach to the treatment of this fatal disease, HCC has been changed from « Incurable » to « partly curable ». The authors report and comment the methods and the strategies that have been used to increase the cure-rate of HCC. Methods The actual approaches, developed in the last thirty years mainly in China, included: screening of cirrhotic patients, early resection, new surgical criteria for cirrhotic liver, early detection of subclinical recurrence and re-resection, multimodality treatment for cytoreduction of huge HCC, sequential resection after cytoreduction of unresectable HCC, targeting therapy using radiolabelled antibodies and lipiodol, transarterial embolization, radiotherapy combined with Chinese herbs, other regional cancer therapy and biological response modifiers. Results Are that these methods have reached a marked increase series 5-year survival rate and number of 5-year survivors in more expert institutions. Conclusions We conclude that further biological and genetic studies on HCC are warranted and that it is mandatory to perform large clinical randomized trials comparing the more promising treatments.

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Rodrigo-Yanguas, Maria, Marina Martin-Moratinos, Angela Menendez-Garcia, Carlos Gonzalez-Tardon, Ana Royuela e Hilario Blasco-Fontecilla. "A Virtual Reality Game (The Secret Trail of Moon) for Treating Attention-Deficit/Hyperactivity Disorder: Development and Usability Study". JMIR Serious Games 9, n. 3 (1 settembre 2021): e26824. http://dx.doi.org/10.2196/26824.

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Background Attention-deficit/hyperactivity disorder (ADHD) affects between 4% and 8% of children worldwide. The treatment of choice is multimodal treatment. Multimodal interventions for ADHD may be improved by incorporating new treatments, such as treatment via serious video games. The Secret Trail of Moon (TSTM) is a virtual reality serious video game that was designed for cognitive training related to core ADHD symptoms and executive dysfunction. Objective We aimed to describe the development and usability of TSTM. Methods The usability study included 37 children and adolescents who tested TSTM during the early usability stage (preinclusion) of a randomized controlled clinical trial for testing the effectiveness of TSTM. Chi-square tests were performed to compare patients with ADHD (ADHD combined subtype vs inattentive subtype) and to compare frequent and infrequent video game players in the second study. We used SPSS version 20 for Macintosh (IBM Corporation). Results A total of 31/37 (86%) and 30/37 (83%) of participants liked playing TSTM and wanted to continue playing TSTM, respectively. Further, 5/37 (14%) of participants reported that they experienced either perceived dizziness or virtual reality motion sickness. We found no statistically significant differences after comparing the ADHD combined subtype to the inattentive subtype and frequent video game players to infrequent video game players. Conclusions Serious video games, such as TSTM, may complement the current multimodal approach for treating ADHD. Trial Registration ClinicalTrials.gov NCT04355065; https://clinicaltrials.gov/ct2/show/NCT04355065

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Han, Charles C., Davin Prasetyo e Gavin M. Wright. "Endobronchial Palliation Using Nd:YAG Laser Is Associated with Improved Survival when Combined with Multimodal Adjuvant Treatments". Journal of Thoracic Oncology 2, n. 1 (gennaio 2007): 59–64. http://dx.doi.org/10.1097/jto.0b013e31802bff2d.

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Bernstein, Cheryl, Andrea G. Gillman, Di Zhang, Anna E. Bartman, Jong-Hyeon Jeong e Ajay D. Wasan. "Identifying Predictors of Recommendations for and Participation in Multimodal Nonpharmacological Treatments for Chronic Pain Using Patient-Reported Outcomes and Electronic Medical Records". Pain Medicine 21, n. 12 (25 giugno 2020): 3574–84. http://dx.doi.org/10.1093/pm/pnaa203.

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Abstract Objective High-quality chronic pain care emphasizes multimodal treatments that include medication and nonpharmacological treatments. But it is not clear which patients will participate in nonpharmacological treatments, such as physical therapy or mental health care, and previous research has shown conflicting evidence. Methods We used the Patient Outcomes Repository for Treatment (PORT) registry, which combines patient-reported outcomes data with electronic medical records. In this retrospective observational study, we performed two separate multinomial regression analyses with feature selection to identify PORT variables that were predictive of 1) recommendation of a nonpharmacological treatment by the provider and 2) patient participation in nonpharmacological treatments. Two hundred thirty-six patients were recommended (REC) or not recommended (NO REC) a nonpharmacological treatment, and all REC patients were classified as participating (YES) or not participating (NO) in the recommendations. Results Female gender and a diagnosis of Z79 “Opioid drug therapy” were significant positive and negative predictors of nonpharmacological treatment recommendations, respectively. Schedule II opioid use at initial presentation and recommendations for rehabilitation therapy were significant predictors of nonparticipation. Conclusions Patients using opioids are less likely to be recommended nonpharmacological treatments as part of multimodal chronic pain care and are less likely to participate in nonpharmacological treatments once recommended. Males are also less likely to be recommended nonpharmacological treatments. Patients referred for rehabilitation therapies are less likely to comply with those recommendations. We have identified patients in vulnerable subgroups who may require additional resources and/or encouragement to comply with multimodal chronic pain treatment recommendations.

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Quinto, Christopher A., Priya Mohindra, Sheng Tong e Gang Bao. "Multifunctional superparamagnetic iron oxide nanoparticles for combined chemotherapy and hyperthermia cancer treatment". Nanoscale 7, n. 29 (2015): 12728–36. http://dx.doi.org/10.1039/c5nr02718g.

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Han, C., G. Wright e D. Praseyatpo. "CT20P ENDOBRONCHIAL PALLIATION USING ND:YAG LASER IS ASSOCIATED WITH IMPROVED SURVIVAL WHEN COMBINED WITH MULTIMODAL ADJUVANT TREATMENTS". ANZ Journal of Surgery 77, s1 (maggio 2007): A12. http://dx.doi.org/10.1111/j.1445-2197.2007.04115_20.x.

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Frosch, Jennifer, Ilia Leontari e John Anderson. "Combined Effects of Myeloid Cells in the Neuroblastoma Tumor Microenvironment". Cancers 13, n. 7 (6 aprile 2021): 1743. http://dx.doi.org/10.3390/cancers13071743.

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Despite multimodal treatment, survival chances for high-risk neuroblastoma patients remain poor. Immunotherapeutic approaches focusing on the activation and/or modification of host immunity for eliminating tumor cells, such as chimeric antigen receptor (CAR) T cells, are currently in development, however clinical trials have failed to reproduce the preclinical results. The tumor microenvironment is emerging as a major contributor to immune suppression and tumor evasion in solid cancers and thus has to be overcome for therapies relying on a functional immune response. Among the cellular components of the neuroblastoma tumor microenvironment, suppressive myeloid cells have been described as key players in inhibition of antitumor immune responses and have been shown to positively correlate with more aggressive disease, resistance to treatments, and overall poor prognosis. This review article summarizes how neuroblastoma-driven inflammation induces suppressive myeloid cells in the tumor microenvironment and how they in turn sustain the tumor niche through suppressor functions, such as nutrient depletion and generation of oxidative stress. Numerous preclinical studies have suggested a range of drug and cellular therapy approaches to overcome myeloid-derived suppression in neuroblastoma that warrant evaluation in future clinical studies.

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Sadeghi, Fatemeh, David Mockler, Emer M. Guinan, Juliette Hussey e Suzanne L. Doyle. "The Effectiveness of Nutrition Interventions Combined with Exercise in Upper Gastrointestinal Cancers: A Systematic Review". Nutrients 13, n. 8 (18 agosto 2021): 2842. http://dx.doi.org/10.3390/nu13082842.

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Malnutrition and muscle wasting are associated with impaired physical functioning and quality of life in oncology patients. Patients diagnosed with upper gastrointestinal (GI) cancers are considered at high risk of malnutrition and impaired function. Due to continuous improvement in upper GI cancer survival rates, there has been an increased focus on multimodal interventions aimed at minimizing the adverse effects of cancer treatments and enhancing survivors’ quality of life. The present study aimed to evaluate the effectiveness of combined nutritional and exercise interventions in improving muscle wasting, physical functioning, and quality of life in patients with upper GI cancer. A comprehensive search was conducted in MEDLINE, EMBASE, Web of Science, Cochrane Library, and CINHAL. Of the 4780 identified articles, 148 were selected for full-text review, of which 5 studies met the inclusion criteria. Whilst reviewed studies showed promising effects of multimodal interventions on physical functioning, no significant differences in postoperative complications and hospital stay were observed. Limited available evidence showed conflicting results regarding the effectiveness of these interventions on preserving muscle mass and improving health-related quality of life. Further studies examining the impact of nutrition and exercise interventions on upper GI patient outcomes are required and would benefit from reporting a core outcome set.

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Roukos, Dimitrios H., Georgios Baltogiannis e Christos G. Katsios. "Thresholds and combined quality control in the multimodal treatment of colorectal cancer". Surgical Endoscopy 24, n. 7 (7 gennaio 2010): 1789–90. http://dx.doi.org/10.1007/s00464-009-0846-z.

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Burgert, E. O., M. E. Nesbit, L. A. Garnsey, E. A. Gehan, J. Herrmann, T. J. Vietti, A. Cangir, M. Tefft, R. Evans e P. Thomas. "Multimodal therapy for the management of nonpelvic, localized Ewing's sarcoma of bone: intergroup study IESS-II." Journal of Clinical Oncology 8, n. 9 (settembre 1990): 1514–24. http://dx.doi.org/10.1200/jco.1990.8.9.1514.

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Two hundred fourteen eligible patients with previously untreated, localized Ewing's sarcoma of bone were randomized on IESS-II to receive Adriamycin (ADR; doxorubicin; Adria Laboratories, Columbus, OH), cyclophosphamide, vincristine, and dactinomycin by either a high-dose intermittent method (treatment [trt] 1) or a moderate-dose continuous method (trt 2) similar to the four-drug arm of IESS-I. Patient characteristics (sex, primary site, type of surgery) were stratified at the time of registration; these and other patient characteristics (age, time from symptoms to diagnosis, race) were distributed similarly between treatments. Surgical resection was encouraged, but not mandatory. Local radiation therapy was the same as for IESS-I. The median follow-up time is 5.6 years. The overall outcome was significantly better on trt 1 than on trt 2. At 5 years, the estimated percentages of patients who were disease-free, relapse-free, and surviving were 68%, 73%, and 77% for trt 1 and 48%, 56%, and 63% for trt 2 (P = .02, .03, and .05, respectively). The major reason for treatment failure for both treatment groups was the development of metastatic disease. The lung was the most common site of metastases followed by bone sites. The combined incidence of severe or worse toxicity (67%) was comparable between the treatments; however, severe or worse cardiovascular toxicity was significantly greater on trt 1. Tne only treatment-associated deaths (N = 3) were on trt 1 and were cardiac-related.

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Matsugasumi, Toru, Koji Masui, Kaori Yamada, Sho Watanabe, Koji Okihara, Nana Kozawa, Yasuhiro Yamada, Hideya Yamazaki, Kei Yamada e Osamu Ukimura. "Challenge and Outcome for the Prostate Squamous Cell Carcinoma Which Developed 8 Years after Low-Dose-Rate Brachytherapy Approached by a Combined Multimodal Treatment with High-Dose-Rate Interstitial Brachytherapy, External Beam Radiation Therapy, and Chemotherapy". Case Reports in Oncology 14, n. 2 (11 giugno 2021): 854–60. http://dx.doi.org/10.1159/000516034.

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Prostate squamous cell carcinoma (pSCC) rarely develops as a secondary cancer after treatment with low-dose-rate brachytherapy (LDR-BT). There is no established effective treatment for the disease condition. Herein, we present a 78-year-old man who developed pSCC 8 years after LDR-BT. He was subsequently selected to receive a combined multimodal treatment with high-dose-rate interstitial brachytherapy (HDR-ISBT), external beam radiation therapy, and chemotherapy for his pSCC. Eleven months later, he displayed no biochemical failure nor clinical radiographic recurrence. However, MRI detected a newly developed prostatic-rectal fistula (grade 4), and a colostomy was performed to relieve pain and inflammation. To our knowledge, this is the first report to perform a combined multimodal treatment with HDR-ISBT for pSCC suspected as a secondary cancer due to LDR-BT.

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Atri, Alireza. "Current and Future Treatments in Alzheimer's Disease". Seminars in Neurology 39, n. 02 (29 marzo 2019): 227–40. http://dx.doi.org/10.1055/s-0039-1678581.

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AbstractThe foundation of current Alzheimer's disease (AD) treatment involves pharmacological and nonpharmacological management and care planning predicated on patient-centered psychoeducation, shared goal-setting, and decision-making forged by a strong triadic relationship between clinician and the patient-caregiver dyad. Food and Drug Administration (FDA) approved AD medications, cholinesterase-inhibitors (ChEIs), and the N-methyl-d-aspartate (NMDA) antagonist memantine, when utilized as part of a comprehensive care plan, while generally considered symptomatic medications, can provide modest “disease course-modifying” effects by enhancing cognition, and reducing loss of independence. When combined, pharmacologic and nonpharmacologic treatments can meaningfully mitigate symptoms and reduce clinical progression and care burden. AD pharmacotherapy first involves identification and elimination of potentially harmful medications and supplements. First line treatment for neuropsychiatric symptoms and problem behaviors is nonpharmacological and involves psychoeducation, trigger identification, and implementation, iterative evaluation, and adjustment of behavioral and environmental interventions. Intensive research efforts are underway to develop more accurate and practical AD diagnostic biomarkers and clinical tools and better therapeutics. Ongoing research studies for primary and secondary prevention of AD and clinical trials evaluating symptomatic and disease-modifying treatments in symptomatic AD are directed at diverse therapeutic targets including neurochemicals, amyloid and tau pathological processes, mitochondria, inflammatory pathways, neuroglia, and multimodal lifestyle interventions.

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Gomon, N. L., e I. P. Shlapak. "Multimodal combined anasthesia / analgesia in complex treatment of surgical patients with abdominal profile". Novosti Khirurgii 22, n. 6 (15 dicembre 2014): 721–26. http://dx.doi.org/10.18484/2305-0047.2014.6.721.

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Kvietkauskas, Mindaugas, Viktorija Zitkute, Bettina Leber, Kestutis Strupas, Philipp Stiegler e Peter Schemmer. "The role of melatonin in colorectal cancer treatment: a comprehensive review". Therapeutic Advances in Medical Oncology 12 (gennaio 2020): 175883592093171. http://dx.doi.org/10.1177/1758835920931714.

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Colorectal cancer (CRC) is one of the most common types of cancer worldwide, known as the second leading cause of cancer-related deaths annually. Currently, multimodal treatment strategies, including surgical resection, combined with chemotherapy and radiotherapy, have been used as conventional treatments in patients with CRC. However, clinical outcome of advanced stage disease remains relatively discouraging, due mainly to appearance of CRC chemoresistance, toxicity, and other detrimental side effects. New strategies to overcome these limitations are essential. During the last decades, melatonin (MLT) has been shown to be a potent antiproliferative, anti-metastatic agent with cytotoxic effects on different types of human malignancies, including CRC. Hence, this comprehensive review compiles the available experimental and clinical data analyzing the effects of MLT treatment in CRC patients and its underlying molecular mechanisms.

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Pellino, Gianluca, e Francesco Selvaggi. "Surgical Treatment of Perianal Fistulizing Crohn’s Disease: From Lay-Open to Cell-Based Therapy—An Overview". Scientific World Journal 2014 (2014): 1–8. http://dx.doi.org/10.1155/2014/146281.

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Background. Perianal Crohn’s disease (CD) can be challenging. Despite the high incidence of fistulizing CD, literature lacks clear guidelines. Several medical, surgical, and combined treatment modalities have been proposed, but evidences are scarce.Methods. We searched the literature to assess the facets of perianal CD, with particular focus on complex fistulae. Disease epidemiology, classification, diagnosis, activity scoring systems, and medical-surgical treatments were assessed.Results. Perianal fistulizing CD is common, frequently associated with upper gastrointestinal and colorectal CD. Complex fistulas often require repeated treatments. Continence is a major concern when dealing with repeated procedures. A prudent pathway is to resolve active sepsis and to limit damages, delaying a definitive treatment to the time when acute phase has been controlled. The improved diagnostic techniques allow better preoperative planning and are useful in monitoring the response to treatment. Besides newer devices, cell-based treatments are promising tools which have recently enriched the treatment portfolio. However, the need for proctectomy is still disturbingly high in CD patients with complex perianal fistulae.Conclusions. Perianal CD can impair quality of life and lead to need for proctectomy. A staged approach is reasonable. Treatment success can be improved by multimodal treatment and collaborative management by experienced gastroenterologists and surgeons.

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Rybiński, Mikołaj, Zuzanna Szymańska, Sławomir Lasota e Anna Gambin. "Modelling the efficacy of hyperthermia treatment". Journal of The Royal Society Interface 10, n. 88 (6 novembre 2013): 20130527. http://dx.doi.org/10.1098/rsif.2013.0527.

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Multimodal oncological strategies which combine chemotherapy or radiotherapy with hyperthermia, have a potential of improving the efficacy of the non-surgical methods of cancer treatment. Hyperthermia engages the heat-shock response (HSR) mechanism, the main component of which are heat-shock proteins. Cancer cells have already partially activated HSR, thereby hyperthermia may be more toxic to them relative to normal cells. On the other hand, HSR triggers thermotolerance, i.e. hyperthermia-treated cells show an impairment in their susceptibility to a subsequent heat-induced stress. This poses questions about efficacy and optimal strategy for anti-cancer therapy combined with hyperthermia treatment. To address these questions, we adapt our previous HSR model and propose its stochastic extension. We formalize the notion of a HSP-induced thermotolerance. Next, we estimate the intensity and the duration of the thermotolerance. Finally, we quantify the effect of a multimodal therapy based on hyperthermia and a cytotoxic effect of bortezomib, a clinically approved proteasome inhibitor. Consequently, we propose an optimal strategy for combining hyperthermia and proteasome inhibition modalities. In summary, by a mathematical analysis of HSR, we are able to support the common belief that the combination of cancer treatment strategies increases therapy efficacy.

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Halama, Niels, Inka Zoernig e Dirk Jaeger. "Advanced Malignant Melanoma: Immunologic and Multimodal Therapeutic Strategies". Journal of Oncology 2010 (2010): 1–8. http://dx.doi.org/10.1155/2010/689893.

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Immunologic treatment strategies are established in malignant melanoma treatment, mainly focusing on Interleukin-2 in advanced disease and interferon alpha in the adjuvant situation. In advanced disease, therapies with IL-2, interferon and different chemotherapeutic agents were not associated with better patient survival in the vast majority of patients. Therefore, an overview of novel immunological agents and combined therapeutic approaches is presented in this review, covering allogenic and autologous vaccine strategies, dendritic cell vaccination, strategies for adoptive immunotherapy and T cell receptor gene transfer, treatment with cytokines and monoclonal antibodies against the CTLA-4 antigen. As emerging treatment strategies are based on individual molecular and immunological characterization of individual tumors/patients, tailored targeted drug therapies move into the focus of treatment strategies. Multimodal combination therapies with considerable potential in altering the immune response in malignant melanoma patients are currently emerging. As oncology moves forward into the field of personalized therapies, a careful molecular and immunological characterization of patients is crucial to select patients for individual targeted treatment.

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Nakayama, Don K., e Patrick C. Bonasso. "The History of Multimodal Treatment of Wilms’ Tumor". American Surgeon 82, n. 6 (giugno 2016): 487–92. http://dx.doi.org/10.1177/000313481608200607.

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Multimodal therapy—surgery, radiation therapy, and chemotherapy—the foundation of modern cancer treatment, has led to dramatic improvements in survival. How the three disciplines coalesced to conquer Wilms’ tumor is a compelling story that includes two of history's greatest discoveries, X-rays and antibiotics. By the mid-20th century both fields had matured to where dedicated clinicians and creative scientists could apply them to Wilms’ tumor and achieve successive improvements in survival. William Ladd was able to achieve a zero operative mortality by 1940, but was left with a 32 per cent survival with surgery alone. Robert Gross and Edwin Neuhauser combined surgery and radiotherapy and achieve 47 per cent survival rate in 1950. Sidney Farber and his colleagues added an antibiotic, dactinomycin, to the treatment regimen and reached 80 per cent survival rate in 1966. The National Wilms’ Tumor Study, organized in 1968, was a multidisciplinary effort of surgeons, radiotherapists, and pediatric oncologists across the country. By the 1990s, the National Wilms’ Tumor Study achieved survival rates above 95 per cent while minimizing long-term effects through shortening courses of chemotherapy and radiation. The story of Wilms’ tumor serves as a paragon for all types of cancer, in both children and adults.

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Haas Jr., Orion, Crescente Betina Belloc., Machado-Fernández Agustín, Favoreto André Xavier Padilha, Scolari Neimar e de Oliveira Rogério Belle. "Multimodal Protocol for the Treatment of Odontogenic Keratocysts". Open Dentistry Journal 15, n. 1 (16 febbraio 2021): 11–16. http://dx.doi.org/10.2174/1874210602115010011.

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Purpose: The aim of this study is to evaluate longitudinally the effectiveness of a multimodal protocol based on decompression followed by enucleation combined with the use of liquid nitrogen under local anesthesia for the treatment of odontogenic keratocysts. Methods: Seven patients with a diagnosis of odontogenic keratocyst were evaluated longitudinally to clinical and histological features, and pre- and postoperative radiographs were analyzed. Data were collected on the epidemiological profile of patients and on cysts, including the presence of recurrence, duration of drainage device use, lesion site, and presence of postoperative complications. Results: No recurrence was observed during follow-up. Mean follow-up was 59.57 months (range, 18-96 months). No pathological fracture was observed. None of the patients had persistent paresthesia of the inferior alveolar nerve. Substantial reduction in cyst size and epithelial differentiation were observed in all patients after multimodal treatment. Conclusion: Based on these results, the multimodal protocol proposed here was effective in the treatment of odontogenic keratocysts by reducing lesion size, avoiding possible damage to adjacent anatomical structures, and allowing a surgical procedure with less morbidity. The longitudinal follow-up of patients showed that this treatment modality is associated with a low recurrence rate compared with alternative therapies.

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Fennell, Vernard S., Nikolay L. Martirosyan, Gursant S. Atwal, M. Yashar S. Kalani, Francisco A. Ponce, G. Michael Lemole, Travis M. Dumont e Robert F. Spetzler. "Hemodynamics Associated With Intracerebral Arteriovenous Malformations: The Effects of Treatment Modalities". Neurosurgery 83, n. 4 (18 dicembre 2017): 611–21. http://dx.doi.org/10.1093/neuros/nyx560.

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Abstract The understanding of the physiology of cerebral arteriovenous malformations (AVMs) continues to expand. Knowledge of the hemodynamics of blood flow associated with AVMs is also progressing as imaging and treatment modalities advance. The authors present a comprehensive literature review that reveals the physical hemodynamics of AVMs, and the effect that various treatment modalities have on AVM hemodynamics and the surrounding cortex and vasculature. The authors discuss feeding arteries, flow through the nidus, venous outflow, and the relative effects of radiosurgical monotherapy, endovascular embolization alone, and combined microsurgical treatments. The hemodynamics associated with intracranial AVMs is complex and likely changes over time with changes in the physical morphology and angioarchitecture of the lesions. Hemodynamic change may be even more of a factor as it pertains to the vast array of single and multimodal treatment options available. An understanding of AVM hemodynamics associated with differing treatment modalities can affect treatment strategies and should be considered for optimal clinical outcomes.

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Plitt, Aaron R., Ankur R. Patel, Cameron M. McDougall, Ashleigh A. Halderman, Samuel L. Barnett e Babu G. Welch. "Combined Microsurgical, Endovascular, and Endoscopic Approach to the Treatment of a Giant Vertebrobasilar Aneurysm". Operative Neurosurgery 17, n. 2 (24 novembre 2018): 149–56. http://dx.doi.org/10.1093/ons/opy341.

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Abstract BACKGROUND Dolichoectasia is defined as elongation and dilatation of a blood vessel. In the intracranial circulation, the basilar artery is affected in 80% of cases. These are challenging lesions with an aggressive natural history, and treatment carries a relatively high rate of morbidity and mortality. We describe a case of multimodal treatment including endovascular, open microsurgical, and endoscopic endonasal approach (EEA) for management. OBJECTIVE To describe the technical nuance of the addition of the EEA for management of posterior circulation dolichoectasia METHODS A 44-yr-old Hispanic woman with a 2-mo history of progressive headaches, gait disturbance, and lower cranial nerve dysfunction presented with acute neurologic decline. MRI demonstrated a dolichoectatic vertebrobasilar system with a giant 4.5-cm fusiform basilar aneurysm. RESULTS She underwent concomitant endovascular bilateral vertebral artery sacrifice with suction decompression and trapping by clip ligation distal to the lesion. Postoperatively, she developed symptomatic pontine compression. She was then taken for a transclival EEA for intra-aneurysmal thrombectomy. Thereafter, she made a significant functional recovery. CONCLUSION The addition of endoscopic reconstruction to the treatment of a dolichoectatic basilar aneurysm is an operative nuance that can be employed in treating these highly morbid lesions. This case describing a multimodal treatment paradigm including EEA reconstruction can serve as an example for the future of treatment select cases of dolichoectasia of the vertebrobasilar complex.

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Mazitova, M. I., e E. R. Mustafin. "Fast track surgery - a multimodal strategy for managing surgical patients". Kazan medical journal 93, n. 5 (15 ottobre 2012): 799–802. http://dx.doi.org/10.17816/kmj1714.

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Multiple factors are involved in the recovery of patients without significant complications and in reduction of the duration of their stay in hospital. The search for effective treatment methods for surgical patients with minimal risk led to the emergence and development of a new concept - fast track surgery. This is a package of healthcare services, which provides a modern approach to the preoperative, intraoperative and postoperative phases of patient management, the combined effect of which is in the reduction of complications, postoperative pain, stress responses and organ dysfunction, as well as early rehabilitation. Reducing the cost of treatment, time of in-hospital stay, faster return to normal life and work - are the benefits of a multimodal strategy for management of surgical patients. Promising initial results obtained using the fast track program, raise the issue of the need to change the traditional system of surgical care in order to improve postoperative results and to further study of each component of this program. Further improvement of this technique requires combined use of minimally invasive surgeries, pharmacological suppression of stress and effective multimodal non-opioid analgesia with active rehabilitation techniques.

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Salvatore, D., G. Shaw, J. Wright, I. Teh, J. Koch-Paszkowski, L. Murray, A. Scarsbrook, J. Schneider, L. Ottobrini e S. Short. "P11.13 Radiotherapy combined with a multimodal imaging approach in a glioblastoma preclinical model". Neuro-Oncology 21, Supplement_3 (agosto 2019): iii45. http://dx.doi.org/10.1093/neuonc/noz126.159.

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Abstract BACKGROUND Glioblastoma multiforme (GBM) carries a poor prognosis, partly due to biological and anatomical heterogeneity. Although radiotherapy (RT) is effective, high doses damage surrounding healthy tissues. Multimodal imaging with Magnetic Resonance (MRI) and Positron Emission Tomography (PET) may represent a useful approach for identifying GBM heterogeneity and visualising metabolic tumour properties. PET radiotracer [18F]-fluciclovine is preferentially accumulated in gliomas compared to healthy brain tissue via the cellular transport systems, LAT1 and ASCT2. In this study the effect of fractionated RT using multimodal imaging including [18F]-fluciclovine uptake and immunohistochemistry (IHC) in a GBM preclinical model will be validated. MATERIAL AND METHODS Two C57BL/6J mice cohorts were injected intracranially (i.c.) with murine CT2A-luc cells and subsequently submitted to multiparametric MRI and [18F]-fluciclovine PET imaging during hemi-brain RT (3Gy on 2 days/each week) for maximum 25 days after i.c. injection. Brains were collected for IHC characterization including LAT1 and ASCT2 staining. RESULTS Preliminary data showed that both MRI and PET were effective modalities to track tumour growth in this model. PET data revealed up to greater than 3-fold increase in SUVmax from regions of interest around the tumour site compared to healthy brain tissue. Time activity curves showed a steady increase in tumour uptake over 90 minutes. MRI showed a 25% increase in T2 values in tumours relative to unaffected contralateral regions. Confirmation of treatment response through matched imaging and IHC are ongoing, from which changes in glioma cell biology as well as amino acid transporter protein levels will be analysed. CONCLUSION These preliminary results show that multimodal imaging presents novel data in the assessment of treatment response in this model and will permit parallel IHC analyses to better define GBM tumour heterogeneity aligned with imaging changes. These data will also inform an on-going clinical study using the same imaging modalities. Work at authors’ labs are supported by an Investigator initiated project from Blue Earth Diagnostics (AS, SCS) and a University of Leeds Biswas studentship (SCS, DS). Daniela Salvatore is also supported by a Scholarship provided by Molecular and Translational Medicine Doctorate School of University of Milan (Italy).

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John, Flóra, Natasha L. Robinette, Alit J. Amit-Yousif, Edit Bosnyák, Geoffrey R. Barger, Keval D. Shah, Sandeep Mittal e Csaba Juhász. "Multimodal Imaging of Nonenhancing Glioblastoma Regions". Molecular Imaging 18 (1 gennaio 2019): 153601211988522. http://dx.doi.org/10.1177/1536012119885222.

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Background: Clinical glioblastoma treatment mostly focuses on the contrast-enhancing tumor mass. Amino acid positron emission tomography (PET) can detect additional, nonenhancing glioblastoma-infiltrated brain regions that are difficult to distinguish on conventional magnetic resonance imaging (MRI). We combined MRI with perfusion imaging and amino acid PET to evaluate such nonenhancing glioblastoma regions. Methods: Structural MRI, relative cerebral blood volume (rCBV) maps from perfusion MRI, and α-[11C]-methyl-l-tryptophan (AMT)-PET images were analyzed in 20 patients with glioblastoma. The AMT uptake and rCBV (expressed as tumor to normal [T/N] ratios) were compared in nonenhancing tumor portions showing increased signal on T2/fluid-attenuated inversion recovery (T2/FLAIR) images. Results: Thirteen (65%) tumors showed robust heterogeneity in nonenhancing T2/FLAIR hyperintense areas on AMT-PET, whereas the nonenhancing regions in the remaining 7 cases had homogeneous AMT uptake (low in 6, high in 1). AMT and rCBV T/N ratios showed only a moderate correlation in the nonenhancing regions ( r = 0.41, P = .017), but regions with very low rCBV (<0.79 T/N ratio) had invariably low AMT uptake. Conclusions: The findings demonstrate the metabolic and perfusion heterogeneity of nonenhancing T2/FLAIR hyperintense glioblastoma regions. Amino acid PET imaging of such regions can detect glioma-infiltrated brain for treatment targeting; however, very low rCBV values outside the contrast-enhancing tumor mass make increased AMT uptake in nonenhancing glioblastoma regions unlikely.

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Penn, David L., Arianna B. Lanpher, Jennifer M. Klein, Harry P. W. Kozakewich, Kristopher T. Kahle, Edward R. Smith e Darren B. Orbach. "Multimodal treatment approach in a patient with multiple intracranial myxomatous aneurysms". Journal of Neurosurgery: Pediatrics 21, n. 3 (marzo 2018): 315–21. http://dx.doi.org/10.3171/2017.9.peds17288.

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The most common primary cardiac tumor is myxoma, typically originating in the left atrium. Emboli to the central nervous system can cause cerebral infarction or, rarely, seed tumor growth within vessel walls, causing myxomatous aneurysms. Fewer than 60 myxomatous aneurysms have been reported, including 2 cases in children. Here, the authors describe 2 different growing myxomatous aneurysms in a child successfully managed using a combined multidisciplinary approach. A 12-year-old boy developed a sudden headache, diplopia, gait instability, and speech difficulty. Magnetic resonance imaging revealed a left parietal hemorrhage and multifocal cerebral infarction, suspicious for an embolic etiology. A cardiac myxoma was identified in the left atrium and resected. Follow-up cranial vasculature imaging demonstrated multiple intracranial myxomatous aneurysms. These lesions were followed up, and serial imaging identified marked growth of 2 of them (right occipital and left parietal), prompting invasive intervention. The deep occipital lesion was better suited to endovascular treatment, while the superficial parietal lesion was amenable to resection. The patient underwent embolization of an enlarging fusiform aneurysm of the distal right posterior cerebral artery, followed by a left parietal craniotomy for a lesion of the distal left middle cerebral artery. Both procedures were performed without complications and achieved successful obliteration of the lesions, as confirmed by catheter angiography at the 30-month follow-up. To the authors’ knowledge, this report illustrates the first combined endovascular and open surgical treatment of 2 myxomatous aneurysms in a single patient. While acknowledging the rarity of this condition, this report illustrates the clinical manifestations and treatment challenges posed by myxoma and details a successful strategy that could be employed in similar scenarios.

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Di Carlo, Paola, Roberto Pirrello, Giuliana Guadagnino, Pierina Richiusa, Antonio Lo Casto, Caterina Sarno, Francesco Moschella e Daniela Cabibi. "Multimodal Surgical and Medical Treatment for Extensive Rhinocerebral Mucormycosis in an Elderly Diabetic Patient: A Case Report and Literature Review". Case Reports in Medicine 2014 (2014): 1–6. http://dx.doi.org/10.1155/2014/527062.

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Diabetes is a well-known risk factor for invasive mucormycosis with rhinocerebral involvement. Acute necrosis of the maxilla is seldom seen and extensive facial bone involvement is rare in patients with rhino-orbital-cerebral mucormycosis. An aggressive surgical approach combined with antifungal therapy is usually necessary. In this report, we describe the successful, personalized medical and surgical management of extensive periorbital mucormycosis in an elderly diabetic, HIV-negative woman. Mono- or combination therapy with liposomal amphotericin B (L-AmB) and posaconazole (PSO) and withheld debridement is discussed. The role of aesthetic plastic surgery to preserve the patient’s physical appearance is also reported. Any diabetic patient with sinonasal disease, regardless of their degree of metabolic control, is a candidate for prompt evaluation to rule out mucormycosis. Therapeutic and surgical strategies and adjunctive treatments are essential for successful disease management. These interventions may include combination therapy. Finally, a judicious multimodal treatment approach can improve appearance and optimize outcome in elderly patients.

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Mhtare, Priti, Mona Gajre, Sagar Karia, Nidhi Chheda, Dinesh Saroj e Avinash De Sousa. "Effect of multimodal therapy on children with attention deficit hyperactivity disorder". International Journal of Contemporary Pediatrics 4, n. 2 (22 febbraio 2017): 495. http://dx.doi.org/10.18203/2349-3291.ijcp20170696.

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Background: Attention deficit hyperactivity disorder (ADHD) is the most common neurobehavioral disorder affecting school aged children. Multimodal treatment is the most effective form of treatment which includes multiple elements like parent and child education about diagnosis and treatment, specific behaviour management techniques, medications and appropriate educational programs. This study was planned to study effect of multimodal intervention i.e. medication along with behavioral modification therapy and occupational therapy given to children with ADHD.Methods: This was a longitudinal, prospective study carried out from January 2014 to October 2014, in which children coming to pediatric neuro-developmental centre and diagnosed as ADHD were included. Cognitive behavior therapy (CBT) was given along with required medications to these children. Improvement in symptoms was checked by Conner scale 3TM long form given to both parents and teachers. Results: 41 out of 50 children complied with our study and majority were of ADHD- combined type (92.6%). 31 out of 41 students achieved non-significant, T- score at the end of 6 months on Global score of Conner Scale.Conclusions: Multimodal intervention was found effective in treating children with ADHD.

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Dygdon, Judith A., Anthony J. Conger e Esther Y. Strahan. "Multimodal Classical Conditioning of Fear: Contributions of Direct, Observational, and Verbal Experiences to Current Fears". Psychological Reports 95, n. 1 (agosto 2004): 133–53. http://dx.doi.org/10.2466/pr0.95.1.133-153.

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The authors propose that a multimodal classical conditioning model be considered when clinicians or clinical researchers study the etiology of fears and anxieties learned by human beings. They argue that fears can be built through the combined effects of direct, observed, and verbally presented classical conditioning trials. Multimodal classical conditioning is offered as an alternative to the three pathways to fear argument prominent in the human fear literature. In contrast to the three pathways position, the authors present theoretical arguments for why “learning by observation” and “learning through the receipt of verbal information” should be considered classical conditioning through observational and verbal modes. The paper includes a demonstration of how data, commonly collected in research on the three pathways to fear, would be studied differently using a multimodal classical conditioning perspective. Finally, the authors discuss implications for assessment, treatment, and prevention of learned fears in humans.

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Yennu, Sriram, Karen Basen-Engquist, Valerie Klairisa Reed, Cindy L. Carmack, Andrew Lee, Usama Mahmood, Seungtaek Choi et al. "Multimodal therapy for cancer related fatigue in patients with prostate cancer receiving radiotherapy and androgen deprivation therapy." Journal of Clinical Oncology 35, n. 15_suppl (20 maggio 2017): 10114. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.10114.

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10114 Background: There are limited studies to evaluate treatments that target causative mechanisms of Cancer-related-fatigue (CRF) using validated tools in a defined population. The objective is to determine the feasibility, and the preliminary estimates of the effects of various combinations of standardized exercise, cognitive behavioral therapy (CBT), and methylphenidate (multimodal therapy, or MMT) on CRF as measured by AUC of Functional Assessment of Chronic Illness Therapy- Fatigue (FACIT-F) subscale scores in Pts with prostate cancer receiving radiotherapy with androgen deprivation therapy. Methods: Prostate cancer Pts with CRF scheduled to receive radiotherapy with androgen deprivation therapy were eligible. Using a double blind (patient, investigators) randomized factorial study design, eligible Pts were randomized into 1 of the 8 arms, which included all possible combinations of the interventions (exercise, CBT, and methylphenidate) and/or their corresponding placebo treatments for a duration of 8 weeks. Results: 62/69 (89%) randomized Pts were evaluable. There were no differences in the demographics and baseline fatigue between groups. The adherence rates for pills, exercise and CBT were 96.5%, 67%, and 90% respectively. The study was feasible and there was no significant difference in adverse events by groups. Table 1 shows the comparison of AUC by treatment. For Pts receiving drug compared to placebo, the median FACIT-F AUC was 2328 vs 2095. The drug effect (estimate, 95% CI) in Pts who received Exercise was 596 (68.3, 1125); CBT was 354 (-121, 830); combined Exercise and CBT was -187 (-802,427); and control Exercise, control CBT was 294 (-192,781). Conclusions: Methylphenidate containing combinations were superior to no drug combinations. Methylphenidate + Exercise provided the best signal and should proceed to large randomized control trials. Clinical trial information: NCT01410942. [Table: see text]

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Neroeva, N. V., V. V. Neroev, M. V. Ryabina, A. G. Karmokova e O. A. Losanova. "Mixed (combined) phenotype of the late stage of age-related macular degeneration". Russian Ophthalmological Journal 14, n. 2 (20 giugno 2021): 69–75. http://dx.doi.org/10.21516/2072-0076-2021-14-2-69-75.

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With multimodal visualization of the chorioretinal complex structures using modern research methods, it was possible to isolatea mixed, or combined, phenotype of the late stage of age-related macular degeneration (AMD). Early detection of this AMD form is of vital importance not only for accurate diagnosis, but for choosing optimal management tactics for patients. The paper presents two clinical cases with different variants of the development of the mixed phenotype of the late AMD stage. In one case, the long-lasting “geographic atrophy” (GA) was complicated by the development of choroidal neovascularization, while in the other case GA appeared during the treatment of wetAMD.

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Perez Algorta, Guillermo, Heather A. MacPherson, L. Eugene Arnold, Stephen P. Hinshaw, Lily Hechtman, Margaret H. Sibley e Elizabeth B. Owens. "Maternal personality traits moderate treatment response in the Multimodal Treatment Study of attention-deficit/hyperactivity disorder". European Child & Adolescent Psychiatry 29, n. 11 (20 dicembre 2019): 1513–24. http://dx.doi.org/10.1007/s00787-019-01460-z.

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AbstractSome mothers of children with attention-deficit/hyperactivity disorder (ADHD) present with maladaptive personality profiles (high neuroticism, low conscientiousness). The moderating effect of maternal personality traits on treatment outcomes for childhood ADHD has not been examined. We evaluate whether maternal neuroticism and conscientiousness moderated response in the Multimodal Treatment Study of Children with ADHD. This is one of the first studies of this type. In a randomized controlled trial (RCT), 579 children aged 7–10 (M = 8.5); 19.7% female; 60.8% White with combined-type ADHD were randomly assigned to systematic medication management (MedMgt) alone, comprehensive multicomponent behavioral treatment (Beh), their combination (Comb), or community comparison treatment-as-usual (CC). Latent class analysis and linear mixed effects models included 437 children whose biological mothers completed the NEO Five-Factor Inventory at baseline. A 3-class solution demonstrated best fit for the NEO: MN&MC = moderate neuroticism and conscientiousness (n = 284); HN&LC = high neuroticism, low conscientiousness (n = 83); LN&HC = low neuroticism, high conscientiousness (n = 70). Per parent-reported symptoms, children of mothers with HN&LC, but not LN&HC, had a significantly better response to Beh than to CC; children of mothers with MN&MC and LN&HC, but not HN&LC, responded better to Comb&MedMgt than to Beh&CC. Per teacher-reported symptoms, children of mothers with HN&LC, but not LN&HC, responded significantly better to Comb than to MedMgt. Children of mothers with high neuroticism and low conscientiousness benefited more from behavioral treatments (Beh vs. CC; Comb vs. MedMgt) than other children. Evaluation of maternal personality may aid in treatment selection for children with ADHD, though additional research on this topic is needed.

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Rebstock, Alicia M., e Sarah E. Wallace. "Effects of a Combined Semantic Feature Analysis and Multimodal Treatment for Primary Progressive Aphasia: Pilot Study". Communication Disorders Quarterly 41, n. 2 (10 settembre 2018): 71–85. http://dx.doi.org/10.1177/1525740118794399.

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Primary progressive aphasia (PPA) is a neurodegenerative condition characterized by language and cognitive decline. Word-retrieval deficits are the most common PPA symptom and contribute to impaired spoken expression. Intense semantic interventions show promise for improving word retrieval in people with PPA. In addition, people with PPA may learn to use alternative communication modalities when they are unable to retrieve a word. However, executive function impairments can cause people to struggle to switch among modalities to repair communication breakdowns.This study examined the effects of a combined semantic feature analysis and multimodal communication program (SFA+MCP) on word-retrieval accuracy, switching among modalities, and overall communicative effectiveness in a person with PPA. An adult female with PPA completed SFA+MCP. Baseline, probe, intervention, and postintervention sessions were completed to measure word-retrieval accuracy and switching between communication modalities. A postintervention listener task was completed to measure communicative effectiveness. Changes in word-retrieval accuracy and switching were minimal. However, the listeners’ identification of the participant’s communication attempts was more accurate following treatment, suggesting increased overall communicative effectiveness. Further investigations of SFA+MCP, specifically relative to timing, intensity, and appropriate modifications for people with cognitive impairments associated with PPA are warranted.

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Luo, Sean X., Diana Martinez, Kenneth M. Carpenter, Mark Slifstein e Edward V. Nunes. "Multimodal predictive modeling of individual treatment outcome in cocaine dependence with combined neuroimaging and behavioral predictors". Comprehensive Psychiatry 55, n. 8 (novembre 2014): e54. http://dx.doi.org/10.1016/j.comppsych.2014.08.028.

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Luo, Sean X., Diana Martinez, Kenneth M. Carpenter, Mark Slifstein e Edward V. Nunes. "Multimodal predictive modeling of individual treatment outcome in cocaine dependence with combined neuroimaging and behavioral predictors". Drug and Alcohol Dependence 143 (ottobre 2014): 29–35. http://dx.doi.org/10.1016/j.drugalcdep.2014.04.030.

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Bratu, Angelica, Adrian Cursaru, Adina Comanelea, Bogdan Şerban e Cătălin Cîrstoiu. "Multimodal analgesia in primary bone tumors". Romanian Journal of Orthopaedic Surgery and Traumatology 4, n. 1 (1 giugno 2021): 30–37. http://dx.doi.org/10.2478/rojost-2021-0006.

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Abstract Introduction: A worrying increase in the number of bone tumors that appear at younger ages justifies the efforts aimed at optimizing perioperative management practices in orthopedic tumor surgery. Pain control is critical in the prognosis and postoperative outcome of these procedures. Material and methods: Our study included a group of 11 patients diagnosed with bone malignancies. These patients were hospitalized in the Orthopedic Clinic of the University Emergency Hospital Bucharest. Under our supervision, they underwent surgical treatment of the tumor under combined general anesthesia and epidural anesthesia for the pelvic limb, and general anesthesia only for the upper limb. We performed perioperative pain management with multimodal analgesia (continuous epidural analgesia with ropivacaine 0,2% and fentanyl 2 mcg/ml in association with systemic analgesics). Following this procedure, we measured the intensity of the postoperative pain at intervals of 48 hours and one week after surgery and compared with preoperative pain intensity using the visual analogue pain scale (VAS). Results: Multimodal analgesia (epidural analgesia associated with systemic analgesics – paracetamol, COX2 inhibitor, gabapentinoids) was performed well in the postoperative pain of the tumor prosthesis, with a significant decrease in VAS from a mean value of 7.63 preoperatively to an average of 3 in the first 48 hours postoperatively. After the removal of the epidural catheter, which also coincided with patient mobilization, the level of pain registered a slight increase to a mean value of 3.23. Conclusions: Multimodal analgesia is currently considered the gold standard in perioperative pain management. The use of multimodal analgesia during perioperative period in patients with bone tumors has been shown to decrease the length of hospital stay, improve surgical outcome, reduce the number of systemic complications, and improve the long-term prognosis of the patient. Efficacy of analgesia correlates with tumor site and vascularization.

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Bambakidis, Nicholas C., John Butler, Eric M. Horn, Xukui Wang, Mark C. Preul, Nicholas Theodore, Robert F. Spetzler e Volker K. H. Sonntag. "Stem cell biology and its therapeutic applications in the setting of spinal cord injury". Neurosurgical Focus 24, n. 3-4 (marzo 2008): E20. http://dx.doi.org/10.3171/foc/2008/24/3-4/e19.

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✓ The development of an acute traumatic spinal cord injury (SCI) inevitably leads to a complex cascade of ischemia and inflammation that results in significant scar tissue formation. The development of such scar tissue provides a severe impediment to neural regeneration and healing with restoration of function. A multimodal approach to treatment is required because SCIs occur with differing levels of severity and over different lengths of time. To achieve significant breakthroughs in outcomes, such approaches must combine both neuroprotective and neuroregenerative treatments. Novel techniques modulating endogenous stem cells demonstrate great promise in promoting neuroregeneration and restoring function.

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Fontana, Lucia, Alfonso Mastropietro, Elisa Scalco, Denis Peruzzo, Elena Beretta, Sandra Strazzer, Filippo Arrigoni e Giovanna Rizzo. "Multi-Steps Registration Protocol for Multimodal MR Images of Hip Skeletal Muscles in a Longitudinal Study". Applied Sciences 10, n. 21 (4 novembre 2020): 7823. http://dx.doi.org/10.3390/app10217823.

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Image registration is crucial in multimodal longitudinal skeletal muscle Magnetic Resonance Imaging (MRI) studies to extract reliable parameters that can be used as indicators for physio/pathological characterization of muscle tissue and for assessing the effectiveness of treatments. This paper aims at proposing a reliable registration protocol and evaluating its accuracy in a longitudinal study. The hips of 6 subjects were scanned, in a multimodal protocol, at 2 different time points by a 3 Tesla scanner; the proposed multi-step registration pipeline is based on rigid and elastic transformations implemented in SimpleITK using a multi-resolution technique. The effects of different image pre-processing (muscle masks, isotropic voxels) and different parameters’ values (learning rates and mesh sizes) were quantitatively assessed using standard accuracy indexes. Rigid registration alone does not provide satisfactory accuracy for inter-sessions alignment and a further elastic step is needed. The use of isotropic voxels, combined with the muscle masking, provides the best result in terms of accuracy. Learning rates can be increased to speed up the process without affecting the final results. The protocol described in this paper, complemented by open-source software, can be a useful guide for researchers that approach for the first time the issues related to the muscle MR image registration.

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Dongol, Udaya Man Singh, e Roshan Ghimire. "Multimodal management of forgotten encrusted ureteral stents". Journal of Kathmandu Medical College 5, n. 4 (1 dicembre 2017): 116–19. http://dx.doi.org/10.3126/jkmc.v5i4.18607.

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Background: Forgotten ureteral stents are seen in urologic practice because of ignorance of patients or failure of physician to counsel the patients. They can cause significant morbidity and pose a management and legal dilemma.Objectives: To evaluate the effi cacy and feasibility of different endourological approaches like percutaneous nephrolithotomy, ureteroscopic lithotripsy, cystolithotripsy and extracorporeal lithotripsy in the treatment of forgotten encrusted ureteral stents.Methods: Total 10 patients with forgotten encrusted double J stents from January 2013 to Nov 2015 were included. Mean age of the patients was 38.4 years (1.5 -5 years). All patients were evaluated for stent encrustation and associated stone burden by X-ray KUB and Intravenous Urography. Combined endourological procedures like percutaneous nephrolithotomy, ureteroscopic lithotripsy, cystolithotripsy and extracorporeal lithotripsy and even open surgery was done to remove these stents. The patients characteristics, indications for stenting, indwelling time, site of encrustation, hospital stay etc were all noted.Results: Total 10 patients presented with forgotten Double J stents. Out of three patients with large encrustations both in renal pelvis and urinary bladder, one patient underwent percutaneous nephrolithotomy and cystolithotripsy. Rest two patients underwent extracorporeal lithotripsy for two sessions for renal pelvic encrustation and cystolithotripsy for urinary bladder encrustation. Four patients underwent ureteroscopic and cystolithotripsy. Two patients in whom all fractured coils were in urinary bladder, underwent cystolithotripsy. All the stents were removed under C-arm fluoroscopic guidance. In one patient, open ureterotomy was done to remove the knotted stent.Conclusion: The use of Double J stent should be limited. The combination of various endourological techniques and extracorporeal lithotripsy can achieve effective stent and stone treatment with minimal morbidity and hospital stay.Journal of Kathmandu Medical College, Vol. 5, No. 4, Issue 18, Oct.-Dec., 2016, page: 116-119

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Mandour, Cherkaoui, Miloudi Gazzaz e Brahim El Mostarchid. "Hyperbaric oxygen therapy in the treatment of brain abscess: about a case". Romanian Neurosurgery 32, n. 1 (1 marzo 2018): 125–28. http://dx.doi.org/10.2478/romneu-2018-0015.

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Abstract The management of brain abscess remains a challenging topic usually involving a multimodal concept. The efficiency of hyperbaric oxygen therapy is currently being used in many areas, and has been proven in infections with deep and superficial location. We report our experience with hyperbaric oxygen therapy combined with antibiotics in the treatment of this disease in a children case. The evolution was very favourable; we believe that the hyperbaric oxygen therapy is a reliable adjuvant therapy for brain abscess.

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Mehta, Sanjiv, Vijay Mehta, Sagar Mehta, Devesh Shah, Ashok Motiwala, Jay Vardhan, Naina Mehta e Devendra Mehta. "Multimodal Behavior Program for ADHD Incorporating Yoga and Implemented by High School Volunteers: A Pilot Study". ISRN Pediatrics 2011 (11 agosto 2011): 1–5. http://dx.doi.org/10.5402/2011/780745.

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A low-cost resource approach to ADHD therapy would be a practical approach to treating children in developing countries. Research has shown that ADHD is prevalent in all areas of the world, and yet treatment for children in more impoverished countries is still lacking. The approach taken was to combine yoga and meditation combined with multimodal behavioral therapy program for children ageing 6 to 11. The program was kept low cost by using trained high school volunteers and integrating the program within the public school. After 6 weeks of the program, 90.5% of children showed improvement as measured by their performance impairment score, a measurement of academic performance. Parent and Teacher evaluations of behavior also found improvement as 25 of the 64 children (39.1%) improved into the normal range as measured by the Vanderbilt questionnaire. Moreover, children could successfully learn both yoga and meditation from high school students irrespective of their age, ADHD type, or initial performance impairment. The results demonstrate efficacy of a multimodal behavioral program incorporating yoga and meditation. The use of high school volunteers from schools in the area demonstrates an effective low-cost and universally applicable approach.

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Nugroho, Hari Wahyu, Mei Neni Sitaresmi e Indria Laksmi Gamayanti. "Behavioral parent training for ADHD children: a mixed methods study". Paediatrica Indonesiana 57, n. 3 (22 giugno 2017): 145. http://dx.doi.org/10.14238/pi57.3.2017.145-8.

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Background Management of ADHD requires multimodal treatments. Parental participation is one of the most important factors for effective ADHD treatment.Objective To investigate the effectiveness of behavioral parent training combined with routine clinical care, in reducing ADHD symptoms in children.Methods Quantitative and qualitative methods were combined in this study. This study was conducted at 3 growth and developmental clinics in Central of Java, on June-July 2016. The quantitative aspect was assessed by comparing ADHD quotient scores at pre- and post-intervention, while the qualitative aspect by intensive parental interviews. Parents of children with ADHD were randomized with block random sampling. In the treatment group, parents received behavioral training for 7 weeks, along with weekly routine clinical care for their children. The control group received only routine clinical care of the children. Six parents in the treatment group were randomly selected for intensive interviews.Results A total of 67 parents with their children were involved. Both groups’ ADHD quotient scores improved post-intervention. The treatment group ADHD quotient score was reduced from 120.53 to 116.41 (effect size Cohen’s d 0.68). The control group ADHD quotient score was reduced from 121.74 to 119.83 (effect size Cohen’s d 0.23). Mean difference post-intervention in both group was not significant (p=.161). After behavioral parent training, communication between parents and children increased and parents’ capability in directing their children’s daily activity increased.Conclusion Behavioral parent training can not enhacing effectiveness of routine clinical care to reduce ADHD symptoms in children.

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Lalic, Nensi, Dragana Tegeltija, Ivan Kuhajda, Sanja Tomic e Ivica Lalic. "Metastatic atypical lung carcinoid treated with combined therapeutic modalities". Srpski arhiv za celokupno lekarstvo 147, n. 11-12 (2019): 769–72. http://dx.doi.org/10.2298/sarh190312060l.

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Introduction. Lung carcinoids are considered a rare and uncommon group of lung tumors, making about 1% of all primary lung tumors. Atypical carcinoids are more aggressive than typical ones, with higher metastatic potential and worse prognosis and a 10-year survival rate of less than 60%. Case outline. In 2012, a 61-year-old male underwent the right lower lobectomy and the histopathological finding was an atypical lung carcinoid tumor. At the beginning of 2016, radiological and bronchoscopic progression of the disease was reported. Magnetic resonance imaging revealed enhanced nodular lesions compatible with liver metastases. The patient received endoluminal brachytherapy. Subsequently, the first line chemotherapy according to the cisplatin/etoposide (PE) protocol was applied. In August 2016, the somatostatin receptor scintigraphy (SRS) revealed secondary deposits with somatostatin receptor (SR) expression in the liver and lungs. The treatment with lanreotide injections was initiated. After five treatment courses, progression of the disease in the bronchial tree was verified and electro-cauterization and argon plasma cauterization of the tumor in the right main bronchus were performed. In September 2017, progression of the disease was verified again. The Oncology Board introduced the third line therapy with everolimus. Conclusion. The evidence supporting optimal treatment strategies for an atypical lung carcinoid tumor is lacking, but some recent publications indicate that multimodal treatment is associated with prolonged survival.

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Freriks, Roel D., Jochen O. Mierau, Jurjen van der Schans, Annabeth P. Groenman, Pieter J. Hoekstra, Maarten J. Postma, Erik Buskens e Qi Cao. "Cost-Effectiveness of Treatments in Children With Attention-Deficit/Hyperactivity Disorder: A Continuous-Time Markov Modeling Approach". MDM Policy & Practice 4, n. 2 (luglio 2019): 238146831986762. http://dx.doi.org/10.1177/2381468319867629.

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Objectives. This study aimed to assess the cost-effectiveness of treatments for attention-deficit/hyperactivity disorder (ADHD) in children through prevention of serious delinquent behavior. Cost-effectiveness was assessed in net-monetary benefit (NMB). Methods. To evaluate the three major forms of ADHD treatment (medication management, behavioral treatment, and the combination thereof) relative to community-delivered treatment (control condition), we used data from 448 children, aged 7 to 10, who participated in the National Institute of Mental Health’s Multimodal Treatment Study of Children with ADHD. We developed a three-state continuous-time Markov model (no delinquency, minor to moderate delinquency, serious delinquency) to extrapolate the results 10 years beyond the 14-month trial period at a 3% discount rate. Serious delinquency was considered an absorbing state to enable assessment in life-years (LYs) of serious delinquent behavior prevented. The willingness-to-pay (WTP) threshold was set equal to the annual cost associated with serious delinquency in children with ADHD of $12,370. Results. Modeled and observed outcomes matched closely with a mean difference of 6.9% in LYs of serious delinquent behavior prevented. The economic evaluation revealed a NMB of $95,449, $88,553, $90,536 and $98,660 for medication management, behavioral treatment, combined treatment, and routine community care, respectively. Estimates remained stable after linearly increasing the WTP threshold between $0 and $50,000 in the deterministic sensitivity analyses. Conclusions. This study assessed the cost-effectiveness of treatments for ADHD in children using continuous-time Markov modeling. We show that treatment evaluation in broader societal outcomes is essential for policy makers, as the three major forms of ADHD treatment turned out to be inferior to the control condition.

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Sahnan, Kapil, Samuel O. Adegbola, Ana Fareleira, Ailsa Hart e Janindra Warusavitarne. "Medical-surgical Combined Approach in Perianal Fistulizing Crohn's Disease (CD): Doing it Together". Current Drug Targets 20, n. 13 (2 settembre 2019): 1373–83. http://dx.doi.org/10.2174/1389450120666190520103454.

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Fistulising perianal Crohn’s disease (pCD) is an aggressive phenotype, and patients not only suffer from perianal manifestations but also a worsening course for their luminal disease. This article describes the 6 key steps clinicians need to consider when managing patients with pCD which include; (i) ensuring a prompt diagnosis, (ii) multi-disciplinary management, (iii) psychological support, (iv) using multimodal medical and surgical treatment strategies, (v) continually monitoring and optimising therapy and (vi) ensuring that patients have a way of accessing care if required. Patients with fistulising pCD often have an unpredictable disease course and complete remission can be elusive. As such, a considered and nuanced approach is essential keeping the wider multi-disciplinary team and the patient involved in all decision making.

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