BACKGROUND:Ischemic stroke refers to a disorder in the blood supply to a local area of brain tissue for various reasons and is characterized by high morbidity,mortality,and disability.Early reperfusion of brain tissue...BACKGROUND:Ischemic stroke refers to a disorder in the blood supply to a local area of brain tissue for various reasons and is characterized by high morbidity,mortality,and disability.Early reperfusion of brain tissue at risk of injury is crucial for the treatment of acute ischemic stroke.The purpose of this study was to evaluate comfort levels in managing acute stroke patients with hypoxemia who required endotracheal intubation after multidisciplinary in situ simulation training and to shorten the door-to-image time.METHODS:This quality improvement project utilized a comprehensive multidisciplinary in situ simulation exercise.A total of 53 participants completed the two-day in situ simulation training.The main outcome was the self-reported comfort levels of participants in managing acute stroke patients with hypoxemia requiring endotracheal intubation before and after simulation training.A 5-point Likert scale was used to measure participant comfort.A paired-sample t-test was used to compare the mean self-reported comfort scores of participants,as well as the endotracheal intubation time and door-to-image time on the fi rst and second days of in situ simulation training.The door-to-image time before and after the training was also recorded.RESULTS:The findings indicated that in situ simulation training could enhance participant comfort when managing acute stroke patients with hypoxemia who required endotracheal intubation and shorten door-to-image time.For the emergency management of hypoxemia or tracheal intubation,the mean post-training self-reported comfort score was signifi cantly higher than the mean pre-training comfort score(hypoxemia:4.53±0.64 vs.3.62±0.69,t=-11.046,P<0.001;tracheal intubation:3.98±0.72 vs.3.43±0.72,t=-6.940,P<0.001).We also observed a decrease in the tracheal intubation and door-to-image time and a decreasing trend in the door-to-image time,which continued after the training.CONCLUSION:Our study demonstrates that the implementation of in situ simulation training in a clinical environment with a multidisciplinary approach may improve the ability and confi dence of stroke team members,optimize the fi rst-aid process,and eff ectively shorten the door-to-image time of stroke patients with emergency complications.展开更多
BACKGROUND Hepatocellular carcinoma(HCC),a major contributor to cancer-related deaths,is particularly prevalent in Asia,largely due to hepatitis B virus infection.Its prognosis is generally poor.This case report contr...BACKGROUND Hepatocellular carcinoma(HCC),a major contributor to cancer-related deaths,is particularly prevalent in Asia,largely due to hepatitis B virus infection.Its prognosis is generally poor.This case report contributes to the medical literature by detailing a unique approach in treating a large HCC through multidisciplinary collaboration,particularly in patients with massive HCC complicated by ruptured bleeding,a scenario not extensively documented previously.CASE SUMMARY The patient presented with large HCC complicated by intratumoral bleeding.Treatment involved a multidisciplinary approach,providing individualized care.The strategy included drug-eluting bead transarterial chemoembolization,sorafenib-targeted therapy,laparoscopic partial hepatectomy,and standardized sintilimab monoclonal antibody therapy.Six months after treatment,the patient achieved complete radiological remission,with significant symptom relief.Imaging studies showed no lesions or recurrence,and clinical assessments confirmed complete remission.This report is notable as possibly the first docu-mented case of successfully treating such complex HCC conditions through integrated multidisciplinary efforts,offering new insights and a reference for future similar cases.CONCLUSION This study demonstrated effective multidisciplinary treatment for massive HCC with intratumoral bleeding,providing insights for future similar cases.展开更多
Objective Contact precautions,especially the initiation of isolation,are important measures to prevent and control multidrug-resistant organisms(MDROs).However,the implementation in clinical practice remains weak.This...Objective Contact precautions,especially the initiation of isolation,are important measures to prevent and control multidrug-resistant organisms(MDROs).However,the implementation in clinical practice remains weak.This study aimed to analyze the impact of multidisciplinary collaborative intervention on isolation implementation in multidrug-resistant infection,and determine the factors that affect the implementation of isolation measures.Methods A multidisciplinary collaborative intervention related to isolation was conducted at a teaching tertiary hospital in central China on November 1,2018.The information of 1338 patients with MDRO infection and colonization at 10 months before and after the intervention was collected.Then,the issuance of isolation orders was retrospectively analyzed.Univariate analysis and multivariate logistic regression analysis were performed to analyze the factors that affected the isolation implementation.Results The overall issuance rate of isolation orders was 61.21%,which increased from 33.12%to 75.88%(P<0.001)after the implementation of the multidisciplinary collaborative intervention.The intervention(P<0.001,OR=0.166)was a promoting factor for the issuance of isolation orders,in addition to the length of stay(P=0.004,OR=0.991),department(P=0.004),and microorganism(P=0.038).Conclusion The isolation implementation remains far lower than policy standards.Multidisciplinary collaborative interventions can effectively improve the compliance to isolation measures implemented by doctors,thereby promoting the standardized management of MDROs,and providing reference for further improving the quality of hospital infection management.展开更多
BACKGROUND Perioperative nursing can reduce the stress reaction and improve the prognosis of children.AIM To elucidate the influence of multidisciplinary collaborative nursing for enhanced recovery after surgery(ERAS)...BACKGROUND Perioperative nursing can reduce the stress reaction and improve the prognosis of children.AIM To elucidate the influence of multidisciplinary collaborative nursing for enhanced recovery after surgery(ERAS)with family care in perioperative nursing children with an inguinal hernia and its impact on the prognosis.METHODS The data of 100 children with inguinal hernia were retrospectively analyzed.The participants were divided into three groups according to different nursing methods:Groups A(n=38),B(n=32),and C(n=30).Group A received multidisciplinary collaborative ERAS nursing combined with family care nursing;Group B received multidisciplinary collaborative nursing for ERAS;and Group C received routine nursing.The postoperative recovery results of the three groups were compared,including intraoperative blood loss and postoperative feeding time,time of getting out of bed,hospitalization time,and defecation time.Furthermore,the incidence of common complications was also compared between the three groups.RESULTS There was less intraoperative blood loss in Groups A and B than in Group C(P<0.05),and the time of getting out of bed and postoperative hospitalization and defecation times were also decreased in Group C(P<0.05).There was no significant difference in postoperative feeding time among the three groups(P>0.05).Each index had no statistical significance between Groups A and B(P>0.05).The incidence of urinary retention,infection,hematoma,and hernia recurrence in Group A was less than that in Group C(P<0.05).No significant difference was observed in the overall complication rate between Groups A and B and between Groups B and C(P>0.05).CONCLUSION The application of multidisciplinary collaborative nursing combined with family care in the perioperative care of children with an inguinal hernia for ERAS may promote postoperative rehabilitation for children and reduce the incidence of complications.展开更多
To enhance the efficiency of system modeling and optimization in the conceptual design stage of satellite parameters,a system modeling and optimization method based on System Modeling Language and Co-evolutionary Algo...To enhance the efficiency of system modeling and optimization in the conceptual design stage of satellite parameters,a system modeling and optimization method based on System Modeling Language and Co-evolutionary Algorithm is proposed.At first,the objectives of satellite mission and optimization problems are clarified,and a design matrix of discipline structure is constructed to process the coupling relationship of design variables and constraints of the orbit,payload,power and quality disciplines.In order to solve the problem of increasing nonlinearity and coupling between these disciplines while using a standard collaborative optimization algorithm,an improved genetic algorithm is proposed and applied to system-level and discipline-level models.Finally,the CO model of satellite parameters is solved through the collaborative simulation of Cameo Systems Modeler(CSM)and MATLAB.The result obtained shows that the method proposed in this paper for the conceptual design phase of satellite parameters is efficient and feasible.It can shorten the project cycle effectively and additionally provide a reference for the optimal design of other complex projects.展开更多
In uncertainty analysis and reliability-based multidisciplinary design and optimization(RBMDO)of engineering structures,the saddlepoint approximation(SA)method can be utilized to enhance the accuracy and efficiency of...In uncertainty analysis and reliability-based multidisciplinary design and optimization(RBMDO)of engineering structures,the saddlepoint approximation(SA)method can be utilized to enhance the accuracy and efficiency of reliability evaluation.However,the random variables involved in SA should be easy to handle.Additionally,the corresponding saddlepoint equation should not be complicated.Both of them limit the application of SA for engineering problems.The moment method can construct an approximate cumulative distribution function of the performance function based on the first few statistical moments.However,the traditional moment matching method is not very accurate generally.In order to take advantage of the SA method and the moment matching method to enhance the efficiency of design and optimization,a fourth-moment saddlepoint approximation(FMSA)method is introduced into RBMDO.In FMSA,the approximate cumulative generating functions are constructed based on the first four moments of the limit state function.The probability density function and cumulative distribution function are estimated based on this approximate cumulative generating function.Furthermore,the FMSA method is introduced and combined into RBMDO within the framework of sequence optimization and reliability assessment,which is based on the performance measure approach strategy.Two engineering examples are introduced to verify the effectiveness of proposed method.展开更多
BACKGROUND Liver metastasis is the most common form of distant metastasis in colorectal cancer,and the only possible curative treatment for patients with colorectal liver metastases(CRLM)is hepatectomy.However,approxi...BACKGROUND Liver metastasis is the most common form of distant metastasis in colorectal cancer,and the only possible curative treatment for patients with colorectal liver metastases(CRLM)is hepatectomy.However,approximately 25%of patients with CRLM have indications for liver resection at the initial diagnosis.Strategies aimed at downstaging large or multifocal tumors to enable curative resection are appealing.CASE SUMMARY A 42-year-old man was diagnosed with ascending colon cancer and liver metastases.Due to the huge lesion size and compression of the right portal vein,the liver metastases were initially diagnosed as unresectable lesions.The patient was treated with preoperative transcatheter arterial chemoembolization(TACE)consisting of 5-fluorouracil/Leucovorin/oxaliplatin/Endostar®.After four courses,radical right-sided colectomy and ileum transverse colon anastomosis were performed.Postoperatively,the pathological analysis revealed moderately differentiated adenocarcinoma with necrosis and negative margins.Thereafter,S7/S8 partial hepatectomy was performed after two courses of neoadjuvant chemotherapy.Pathological examination of the resected specimen revealed a pathologically complete response(pCR).Intrahepatic recurrence was detected more than two months after the operation,and the patient was then treated with TACE consisting of irinotecan/Leucovorin/fluorouracil therapy plus Endostar®.Subsequently,the patient was treated with aγ-knife to enhance local control.Notably,a pCR was reached,and the patient's overall survival time was>9 years.CONCLUSION Multidisciplinary treatment can promote the conversion of initially unresectable colorectal liver metastasis and facilitate complete pathological remission of liver lesions.展开更多
BACKGROUND The multidisciplinary team(MDT)has been carried out in many large hospitals now.However,given the costs of time and money and with little strong evidence of MDT effectiveness being reported,critiques of MDT...BACKGROUND The multidisciplinary team(MDT)has been carried out in many large hospitals now.However,given the costs of time and money and with little strong evidence of MDT effectiveness being reported,critiques of MDTs persist.AIM To evaluate the effects of MDTs on patients with synchronous colorectal liver metastases and share our opinion on management of synchronous colorectal liver metastases.METHODS In this study we collected clinical data of patients with synchronous colorectal liver metastases from February 2014 to February 2017 in the Chinese People’s Liberation Army General Hospital and subsequently divided them into an MDT+group and an MDT-group.In total,93 patients in MDT+group and 169 patients in MDT-group were included totally.RESULTS Statistical increases in the rate of chest computed tomography examination(P=0.001),abdomen magnetic resonance imaging examination(P=0.000),and preoperative image staging(P=0.0000)were observed in patients in MDT+group.Additionally,the proportion of patients receiving chemotherapy(P=0.019)and curative resection(P=0.042)was also higher in MDT+group.Multivariable analysis showed that the population of patients assessed by MDT meetings had higher 1-year[hazard ratio(HR)=0.608,95%confidence interval(CI):0.398-0.931,P=0.022]and 5-year(HR=0.694,95%CI:0.515-0.937,P=0.017)overall survival.CONCLUSION These results proved that MDT management did bring patients with synchronous colorectal liver metastases more opportunities for comprehensive examination and treatment,resulting in better outcomes.展开更多
BACKGROUND Gastrointestinal tumors are a major cause of cancer-related deaths and have become a major public health problem.This study aims to provide a scientific basis for improving clinical treatment effects,qualit...BACKGROUND Gastrointestinal tumors are a major cause of cancer-related deaths and have become a major public health problem.This study aims to provide a scientific basis for improving clinical treatment effects,quality of life,and prognosis of patients with gastrointestinal tumors.AIM To explore the clinical effect of the multidisciplinary diagnosis and treatment(MDT)nutrition intervention model on patients with gastrointestinal tumors.METHODS This was a case control study which included patients with gastrointestinal tumors who received radiotherapy at the Department of Oncology between January 2021 and January 2023.Using a random number table,120 patients were randomly divided into MDT and control groups with 60 patients in each group.To analyze the effect of MDT on the nutritional status and quality of life of the patients,the nutritional status and quality of life scores of the patients were measured before and after the treatment.RESULTS Albumin(ALB),transferrin(TRF),hemoglobin(Hb),and total protein(TP)levels significantly decreased after the treatment.The control group had significantly lower ALB,TRF,Hb,and TP levels than the MDT group,and the differences in these levels between the two groups were statistically significant(P<0.05).After the treatment,the MDT group had significantly more wellnourished patients than the control group(P<0.05).The quality of life total score,somatic functioning,role functioning,and emotional functioning were higher in the MDT group than in the control group.By contrast,pain,fatigue,nausea,and vomiting scores were lower in the MDT group than in the control group(P<0.05).CONCLUSION MDT nutritional intervention model effectively improves the nutritional status and quality of life of the patients.The study provides a rigorous theoretical basis for improving the prognosis of cancer patients.In the future,we intend to provide additional treatment methods for improving the quality of life of patients with cancer.展开更多
BACKGROUND Perioperative hypothermia(PH)negatively affects the physical and mental health of patients to varying degrees.Currently,there is no effective multidisciplinary team(MDT)intervention for gynecological patien...BACKGROUND Perioperative hypothermia(PH)negatively affects the physical and mental health of patients to varying degrees.Currently,there is no effective multidisciplinary team(MDT)intervention for gynecological patients with PH.AIM To apply the best evidence on the prevention and management of PH in gynecological patients,improve the quality of perioperative evidence-based care based on treatment by an MDT for gynecological patients and analyze the effect of MDT-and evidence-based practice(EBP)projects on the psychological status and cognitive function of gynecological patients with PH.METHODS Under the guidance of knowledge translation and combined with the opinions of involved stakeholders and clinical experts,the best evidence for PH prevention and management in gynecological patients was selected and adjusted to suit the practice setting.Based on the evidence,the practice plan was developed,and the MDT intervention was carried out in the preoperative ward,the preoperative preparation room,the intraoperative operating room,the postanesthesia care unit,and the 24-hour postoperative gynecological ward through the EBP program.The incidence of hypothermia,the nurses’awareness,the implementation rate of examination indicators,and the thermal comfort level,psychological status and cognitive function of patients were compared before and after the implementation of the program.RESULTS The incidence of PH in gynecological patients decreased from 43.33%to 13.33%after the implementation of the scheme.The implementation rate of examination indicators 6-10,12,14,16-18,21,and 22 reached 100%,and that of other indicators was above 90%,except for examination indicators 5 and 13,which was 66.67%;the indices were significantly improved compared with the baseline(before evidence application)(P<0.05).The score of nurses'awareness of PH prevention and management in gynecological patients increased from 60.96±9.70 to 88.08±8.96,and the difference was statistically significant(P<0.001).The total score of the perioperative thermal comfort level of patients undergoing gynecological surgery was 27.97±2.04,which was significantly increased compared with the score of 21.27±1.57 observed by researchers at baseline(P<0.001).The perioperative Hamilton Depression Scale and Hamilton Anxiety Scale scores of patients undergoing gynecological surgery decreased from 15.03±3.16 and 13.93±2.64 to 4.30±1.15 and 3.53±0.78,respectively,with statistically significant differences(P<0.001).The perioperative Montreal Cognitive Assessment Scale score of the gynecological surgery patients increased from 23.17±1.68 to 26.93±1.11,also with statistical significance(P<0.001).CONCLUSION MDT-based EBP for PH prevention and management in gynecological patients during the perioperative period can standardize nursing operations,improve nurses'awareness and behavioral compliance with gynecological hypothermia management,and reduce the occurrence of PH in gynecological patients while playing a positive role in reducing patients’negative emotions and enhancing their cognitive function.展开更多
Objective: To study the establishment and clinical application of multidisciplinary collaborative rapid rehabilitation nursing model in patients with brucellosis spondylitis during the perioperative period. Method: Fr...Objective: To study the establishment and clinical application of multidisciplinary collaborative rapid rehabilitation nursing model in patients with brucellosis spondylitis during the perioperative period. Method: From January 2009 to January 2013, 39 patients diagnosed with brucellosis spondylitis were treated with focal clearance combined with posterior pedicle internal fixation. Nursing was randomly divided into 2 groups: 19 cases of routine nursing as the control group (group A);20 cases of implementation of the nursing path as the intervention group (group B). In the intervention group, analgesic nursing plan, daily activity ability training path, medication compliance and health education path were used to effectively intervene on the evaluation parameters affecting rapid recovery and clinical efficacy (VAS score, daily activity ability mastery, Oswestry disability index and medication Morisky-Green index). The nursing effect and clinical evaluation of the two groups were compared. Results: As time went by, VAS pain score, mastery of daily activity ability, Oswestry disability index and medication compliance between the two groups at the same time point were significantly different (P Conclusions: The nursing path of brucellosis spondylitis is positively correlated with rapid recovery and clinical efficacy. Compared with routine nursing, it has a significant effect on accelerating postoperative rehabilitation and clinical efficacy.展开更多
Background:Pressure ulcers are one of the most common and dangerous sequelae of spinal cord injuries.Pressure ulcers treatment represents one of the most challenging clinical problems faced by clinicians.Method:This r...Background:Pressure ulcers are one of the most common and dangerous sequelae of spinal cord injuries.Pressure ulcers treatment represents one of the most challenging clinical problems faced by clinicians.Method:This report examines a case of complicated stage-4 pressure ulcers in a young adult who had gunshot injury in his spine above T-11 level treated following a multidisciplinary approach.A multidisciplinary team formulated a multifaceted program that includes meticulous pressure relief program,wound care and flap reconstructive surgery,osteomyelitis treatment,nutrition optimization,post-operative physiotherapy,patient education,and psychological support,that recruited for this patient over the course of his stay at our unit.Results:During the third day postoperatively showed good blood circulation without necrosis or hematoma and site of ulcer completely has healed.Conclusion:Implementation of a multidisciplinary approach was key to optimizing surgical outcomes in spinal cord injury patients who have pressure sores,achieving a low recurrence rate and reducing readmissions.展开更多
Liver metastasis is the commonest form of distant metastasis in colorectal cancer.Selection criteria for surgery and liver-directed therapies have recently been extended.However,resectability remains poorly defined.Tu...Liver metastasis is the commonest form of distant metastasis in colorectal cancer.Selection criteria for surgery and liver-directed therapies have recently been extended.However,resectability remains poorly defined.Tumour biology is increasingly recognized as an important prognostic factor;hence molecular profiling has a growing role in risk stratification and management planning.Surgical resection is the only treatment modality for curative intent.The most appropriate surgical approach is yet to be established.The primary cancer and the hepatic metastasis can be removed simultaneously or in a two-step approach;these two strategies have comparable long-term outcomes.For patients with a limited future liver remnant,portal vein embolization,combined ablation and resection,and associating liver partition and portal vein ligation for staged hepatectomy have been advocated,and each has their pros and cons.The role of neoadjuvant and adjuvant chemotherapy is still debated.Targeted biological agents and loco-regional therapies(thermal ablation,intra-arterial chemo-or radio-embolization,and stereotactic radiotherapy) further improve the already favourable results.The recent debate about offering liver transplantation to highly selected patients needs validation from large clinical trials.Evidencebased protocols are missing,and therefore optimal management of hepatic metastasis should be personalized and determined by a multi-disciplinary team.展开更多
Use of multidisciplinary analysis in reliabilitybased design optimization(RBDO) results in the emergence of the important method of reliability-based multidisciplinary design optimization(RBMDO). To enhance the effici...Use of multidisciplinary analysis in reliabilitybased design optimization(RBDO) results in the emergence of the important method of reliability-based multidisciplinary design optimization(RBMDO). To enhance the efficiency and convergence of the overall solution process,a decoupling algorithm for RBMDO is proposed herein.Firstly, to decouple the multidisciplinary analysis using the individual disciplinary feasible(IDF) approach, the RBMDO is converted into a conventional form of RBDO. Secondly,the incremental shifting vector(ISV) strategy is adopted to decouple the nested optimization of RBDO into a sequential iteration process composed of design optimization and reliability analysis, thereby improving the efficiency significantly. Finally, the proposed RBMDO method is applied to the design of two actual electronic products: an aerial camera and a car pad. For these two applications, two RBMDO models are created, each containing several finite element models(FEMs) and relatively strong coupling between the involved disciplines. The computational results demonstrate the effectiveness of the proposed method.展开更多
Pancreatic neuroendocrine tumors(PNETs) are a rare and diverse group of tumors; nonfunctional(NF) PNETs account for the majority of cases. Most patients with NF-PNETs have metastatic disease at the time of presentatio...Pancreatic neuroendocrine tumors(PNETs) are a rare and diverse group of tumors; nonfunctional(NF) PNETs account for the majority of cases. Most patients with NF-PNETs have metastatic disease at the time of presentation. A variety of treatment modalities exist, including medical, liver directed, and surgical treatments. Aggressive surgical management is associated with prolonged survival, however available data are limited by selection bias and the frequent combination of PNETs with carcinoid tumors. Although few patients with metastatic disease will be cured, application of currently available therapies in a multidisciplinary setting can lead to excellent outcomes with prolonged patient survival.展开更多
BACKGROUND:Pancreatoduodenectomy offers the only chance of cure for patients with periampullary cancers.This,however,is a major undertaking in most patients and is associated with a significant morbidity and mortality...BACKGROUND:Pancreatoduodenectomy offers the only chance of cure for patients with periampullary cancers.This,however,is a major undertaking in most patients and is associated with a significant morbidity and mortality.A multidisciplinary approach to the workup and follow-up of patients undergoing pancreatoduodenectomy was initiated at our institution to improve the diagnosis,resection rate,mortality and morbidity.We undertook the study to assess the effect of this approach on diagnosis,resection rates and short-term outcomes such as morbidity and mortality.METHODS:A prospective database of patients presenting with periampullary cancers to a single surgeon between April 2004 and April 2010 was reviewed.All cases were discussed at a multidisciplinary meeting comprising surgeons,gastroenterologists,radiologists,oncologists,radiation oncologists,pathologists and nursing staff.A standardized investigation and management algorithm was followed.Complications were graded according to the Clavien-Dindo classification.RESULTS:A total of 295 patients with a periampullary lesion were discussed and 178 underwent pancreatoduodenectomy (resection rate 60%).Sixty-one patients (34%) required either a vascular or an additional organ resection.Eighty-nine patients experienced complications,of which the commonest was blood transfusion (12%).Thirty-four patients (19%) had major complications,i.e.grade 3 or above.There was no in-hospital,30-day or 60-day mortality.CONCLUSIONS:Pancreatoduodenectomy can safely be performed in high-volume centers with very low mortality.The surgeon's role should be careful patient selection,intensive preoperative investigations,use of a team approach,and an unbiased discussion at a multidisciplinary meeting to optimize the outcome in these patients.展开更多
In the case of the given design variables and constraint functions, this paper is concerned with the rapid overall parameters design of trajectory, propulsion and aerodynamics for long-range ballistic missiles based o...In the case of the given design variables and constraint functions, this paper is concerned with the rapid overall parameters design of trajectory, propulsion and aerodynamics for long-range ballistic missiles based on the index of the minimum take-off mass.In contrast to the traditional subsystem independent design, this paper adopts the research idea of the combination of the subsystem independent design and the multisystem integration design.Firstly, the trajectory, propulsion and aerodynamics of the subsystem are separately designed by the engineering design, including the design of the minimum energy trajectory, the computation of propulsion system parameters, and the calculation of aerodynamic coefficient and dynamic derivative of the missile by employing the software of missile DATCOM. Then, the uniform design method is used to simplify the constraint conditions and the design variables through the integration design, and the accurate design of the optimized variables would be accomplished by adopting the uniform particle swarm optimization(PSO) algorithm. Finally, the automation design software is written for the three-stage solid ballistic missile. The take-off mass of 29 850 kg is derived by the subsystem independent design, and 20 constraints are reduced by employing the uniform design on the basis of 29 design variables and 32 constraints, and the take-off mass is dropped by 1 850 kg by applying the combination of the uniform design and PSO. The simulation results demonstrate the effectiveness and feasibility of the proposed hybrid optimization technique.展开更多
Inspired by natural porous architectures,numerous attempts have been made to generate porous structures.Owing to the smooth surfaces,highly interconnected porous architectures,and mathematical controllable geometry fe...Inspired by natural porous architectures,numerous attempts have been made to generate porous structures.Owing to the smooth surfaces,highly interconnected porous architectures,and mathematical controllable geometry features,triply periodic minimal surface(TPMS)is emerging as an outstanding solution to constructing porous structures in recent years.However,many advantages of TPMS are not fully utilized in current research.Critical problems of the process from design,manufacturing to applications need further systematic and integrated discussions.In this work,a comprehensive overview of TPMS porous structures is provided.In order to generate the digital models of TPMS,the geometry design algorithms and performance control strategies are introduced according to diverse requirements.Based on that,precise additive manufacturing methods are summarized for fabricating physical TPMS products.Furthermore,actual multidisciplinary applications are presented to clarify the advantages and further potential of TPMS porous structures.Eventually,the existing problems and further research outlooks are discussed.展开更多
Anxiety and depression in Parkinson's disease(PD)reduce well-being of the patients.Emotional alterations influence motor skills and cognitive performance;moreover,they contribute significantly and independently to...Anxiety and depression in Parkinson's disease(PD)reduce well-being of the patients.Emotional alterations influence motor skills and cognitive performance;moreover,they contribute significantly and independently to worsen rehabilitative treatment response.We investigated anxiety,depression,and quality of life in PD patients subjected to multidisciplinary rehabilitative training.The self-controlled study included 100 PD patients(49 males and 51 females with the mean age of 64.66 years)admitted to 60 days hospitalization rehabilitative program,between January 2017 and December 2018.Motor,cognitive,linguistic abilities,and functional independence were evaluated at admission(T0 baseline visit)and 60 days after(T1)the multidisciplinary rehabilitation including motor exercises,speech therapies,and cognitive intervention.The multidisciplinary rehabilitation improved functional status in PD patients and exerted its positive effects on mood,motor abilities,autonomy in the activities of daily life,perception of quality of life,cognitive performance and speech skills.Non-motor symptoms may worsen severe disability and reduce quality of life.They are often poorly recognized and inadequately treated.Nonetheless,multidisciplinary rehabilitative training represents an optimal strategy to improve disease management.The study was approved by Istituito di Ricovero e Cura a Carattere Scientifico(IRCCS)Centro Neurolesi"Bonino-Pulejo"Ethical Committee(approval No.6/2016)in June 2016.展开更多
BACKGROUND Cerebral infarction patients need to be bedridden for long periods of time often resulting in pressure injuries,which may represent a serious threat to patients'life and health.An effective nursing prog...BACKGROUND Cerebral infarction patients need to be bedridden for long periods of time often resulting in pressure injuries,which may represent a serious threat to patients'life and health.An effective nursing program should be adopted for timely intervention in patients with pressure wounds.AIM To explore the value of nursing services based on a multidisciplinary collaborative treatment team in patients with pressure injury wounds following cerebral infarction.METHODS Patients with cerebral infarction pressure injury wounds in our hospital from December 2016 to January 2021 were selected and divided into one study group and one control group based on the simple random number table method.The control group was treated with conventional nursing care(CNC),and the study group was treated with care services based on multidisciplinary collaborative care(MDCC).The Pressure Ulcer Scale for Healing(PUSH),healing effect,Self-Perceived Burden Score(SPBS),and satisfaction with the intervention were calculated before and after 2 and 4 wk of intervention in both groups.RESULTS Sixty-two patients were enrolled,and 31 patients were assigned to each group.The results of the interventions were as follows:(1)There was no significant difference between the PUSH scores of the MDCC group(11.19±2.46)and CNC group(12.01±2.79)before the intervention(P>0.05),and the PUSH scores were lower after 2 and 4 wk of intervention in the MDCC group(6.63±1.97 and 3.11±1.04)than in the CNC group(8.78±2.13 and 4.96±1.35 points)(P<0.05);(2)The rate of wound healing in the MDCC group(96.77%)was higher than that in the CNC group(80.65%)(P<0.05);(3)There was no significant difference between the SPBS scores of emotional factors(21.15±3.11),economic factors(9.88±2.15),and physical factors(8.19±2.23)in the two groups before the intervention.The scores of emotional factors(13.51±1.88),economic factors(6.38±1.44),and physical factors(5.37±1.08)were lower in the MDCC group than in the CNC group(16.89±2.05,7.99±1.68 and 7.06±1.19)after 4 wk of intervention(P<0.05);and(4)Satisfaction with the intervention was higher in the MDCC group(93.55%)than in the CNC group(74.19%)(P<0.05).CONCLUSION Interventions for patients with cerebral infarction pressure wounds based on an MDCC treatment team can effectively reduce patients'self-perceived burden,improve pressure wound conditions,facilitate wound healing,and increase patient satisfaction with the intervention.展开更多
基金supported by Hangzhou Construction Fund of Key Medical Disciplines(OO20200265)Zhejiang Medical and Health Science and Technology Plan Project(2020KY687)+1 种基金Hangzhou Science and Technology Development Project(20200401B04)Hangzhou Biomedical and Health Industry Development Supporting Technology Projects(2021WJCY256).
文摘BACKGROUND:Ischemic stroke refers to a disorder in the blood supply to a local area of brain tissue for various reasons and is characterized by high morbidity,mortality,and disability.Early reperfusion of brain tissue at risk of injury is crucial for the treatment of acute ischemic stroke.The purpose of this study was to evaluate comfort levels in managing acute stroke patients with hypoxemia who required endotracheal intubation after multidisciplinary in situ simulation training and to shorten the door-to-image time.METHODS:This quality improvement project utilized a comprehensive multidisciplinary in situ simulation exercise.A total of 53 participants completed the two-day in situ simulation training.The main outcome was the self-reported comfort levels of participants in managing acute stroke patients with hypoxemia requiring endotracheal intubation before and after simulation training.A 5-point Likert scale was used to measure participant comfort.A paired-sample t-test was used to compare the mean self-reported comfort scores of participants,as well as the endotracheal intubation time and door-to-image time on the fi rst and second days of in situ simulation training.The door-to-image time before and after the training was also recorded.RESULTS:The findings indicated that in situ simulation training could enhance participant comfort when managing acute stroke patients with hypoxemia who required endotracheal intubation and shorten door-to-image time.For the emergency management of hypoxemia or tracheal intubation,the mean post-training self-reported comfort score was signifi cantly higher than the mean pre-training comfort score(hypoxemia:4.53±0.64 vs.3.62±0.69,t=-11.046,P<0.001;tracheal intubation:3.98±0.72 vs.3.43±0.72,t=-6.940,P<0.001).We also observed a decrease in the tracheal intubation and door-to-image time and a decreasing trend in the door-to-image time,which continued after the training.CONCLUSION:Our study demonstrates that the implementation of in situ simulation training in a clinical environment with a multidisciplinary approach may improve the ability and confi dence of stroke team members,optimize the fi rst-aid process,and eff ectively shorten the door-to-image time of stroke patients with emergency complications.
基金Supported by Gansu Provincial Hospital Internal Medicine Research Fund Project,No.22GSSYD-47"Innovation Star"Project for Graduate Students of Gansu University of Chinese Medicine,No.2023CXZX-756the Natural Science Foundation of Gansu Province,No.21JR11RA187.
文摘BACKGROUND Hepatocellular carcinoma(HCC),a major contributor to cancer-related deaths,is particularly prevalent in Asia,largely due to hepatitis B virus infection.Its prognosis is generally poor.This case report contributes to the medical literature by detailing a unique approach in treating a large HCC through multidisciplinary collaboration,particularly in patients with massive HCC complicated by ruptured bleeding,a scenario not extensively documented previously.CASE SUMMARY The patient presented with large HCC complicated by intratumoral bleeding.Treatment involved a multidisciplinary approach,providing individualized care.The strategy included drug-eluting bead transarterial chemoembolization,sorafenib-targeted therapy,laparoscopic partial hepatectomy,and standardized sintilimab monoclonal antibody therapy.Six months after treatment,the patient achieved complete radiological remission,with significant symptom relief.Imaging studies showed no lesions or recurrence,and clinical assessments confirmed complete remission.This report is notable as possibly the first docu-mented case of successfully treating such complex HCC conditions through integrated multidisciplinary efforts,offering new insights and a reference for future similar cases.CONCLUSION This study demonstrated effective multidisciplinary treatment for massive HCC with intratumoral bleeding,providing insights for future similar cases.
基金supported by the National Natural Science Foundation of China(No.71473098).
文摘Objective Contact precautions,especially the initiation of isolation,are important measures to prevent and control multidrug-resistant organisms(MDROs).However,the implementation in clinical practice remains weak.This study aimed to analyze the impact of multidisciplinary collaborative intervention on isolation implementation in multidrug-resistant infection,and determine the factors that affect the implementation of isolation measures.Methods A multidisciplinary collaborative intervention related to isolation was conducted at a teaching tertiary hospital in central China on November 1,2018.The information of 1338 patients with MDRO infection and colonization at 10 months before and after the intervention was collected.Then,the issuance of isolation orders was retrospectively analyzed.Univariate analysis and multivariate logistic regression analysis were performed to analyze the factors that affected the isolation implementation.Results The overall issuance rate of isolation orders was 61.21%,which increased from 33.12%to 75.88%(P<0.001)after the implementation of the multidisciplinary collaborative intervention.The intervention(P<0.001,OR=0.166)was a promoting factor for the issuance of isolation orders,in addition to the length of stay(P=0.004,OR=0.991),department(P=0.004),and microorganism(P=0.038).Conclusion The isolation implementation remains far lower than policy standards.Multidisciplinary collaborative interventions can effectively improve the compliance to isolation measures implemented by doctors,thereby promoting the standardized management of MDROs,and providing reference for further improving the quality of hospital infection management.
文摘BACKGROUND Perioperative nursing can reduce the stress reaction and improve the prognosis of children.AIM To elucidate the influence of multidisciplinary collaborative nursing for enhanced recovery after surgery(ERAS)with family care in perioperative nursing children with an inguinal hernia and its impact on the prognosis.METHODS The data of 100 children with inguinal hernia were retrospectively analyzed.The participants were divided into three groups according to different nursing methods:Groups A(n=38),B(n=32),and C(n=30).Group A received multidisciplinary collaborative ERAS nursing combined with family care nursing;Group B received multidisciplinary collaborative nursing for ERAS;and Group C received routine nursing.The postoperative recovery results of the three groups were compared,including intraoperative blood loss and postoperative feeding time,time of getting out of bed,hospitalization time,and defecation time.Furthermore,the incidence of common complications was also compared between the three groups.RESULTS There was less intraoperative blood loss in Groups A and B than in Group C(P<0.05),and the time of getting out of bed and postoperative hospitalization and defecation times were also decreased in Group C(P<0.05).There was no significant difference in postoperative feeding time among the three groups(P>0.05).Each index had no statistical significance between Groups A and B(P>0.05).The incidence of urinary retention,infection,hematoma,and hernia recurrence in Group A was less than that in Group C(P<0.05).No significant difference was observed in the overall complication rate between Groups A and B and between Groups B and C(P>0.05).CONCLUSION The application of multidisciplinary collaborative nursing combined with family care in the perioperative care of children with an inguinal hernia for ERAS may promote postoperative rehabilitation for children and reduce the incidence of complications.
基金supported by Open Fund of State Key Laboratory of Digital Manufacturing Equipment and Technology of China (Grant No.DMETKF2022015).
文摘To enhance the efficiency of system modeling and optimization in the conceptual design stage of satellite parameters,a system modeling and optimization method based on System Modeling Language and Co-evolutionary Algorithm is proposed.At first,the objectives of satellite mission and optimization problems are clarified,and a design matrix of discipline structure is constructed to process the coupling relationship of design variables and constraints of the orbit,payload,power and quality disciplines.In order to solve the problem of increasing nonlinearity and coupling between these disciplines while using a standard collaborative optimization algorithm,an improved genetic algorithm is proposed and applied to system-level and discipline-level models.Finally,the CO model of satellite parameters is solved through the collaborative simulation of Cameo Systems Modeler(CSM)and MATLAB.The result obtained shows that the method proposed in this paper for the conceptual design phase of satellite parameters is efficient and feasible.It can shorten the project cycle effectively and additionally provide a reference for the optimal design of other complex projects.
基金support from the Key R&D Program of Shandong Province(Grant No.2019JZZY010431)the National Natural Science Foundation of China(Grant No.52175130)+1 种基金the Sichuan Science and Technology Program(Grant No.2022YFQ0087)the Sichuan Science and Technology Innovation Seedling Project Funding Projeet(Grant No.2021112)are gratefully acknowledged.
文摘In uncertainty analysis and reliability-based multidisciplinary design and optimization(RBMDO)of engineering structures,the saddlepoint approximation(SA)method can be utilized to enhance the accuracy and efficiency of reliability evaluation.However,the random variables involved in SA should be easy to handle.Additionally,the corresponding saddlepoint equation should not be complicated.Both of them limit the application of SA for engineering problems.The moment method can construct an approximate cumulative distribution function of the performance function based on the first few statistical moments.However,the traditional moment matching method is not very accurate generally.In order to take advantage of the SA method and the moment matching method to enhance the efficiency of design and optimization,a fourth-moment saddlepoint approximation(FMSA)method is introduced into RBMDO.In FMSA,the approximate cumulative generating functions are constructed based on the first four moments of the limit state function.The probability density function and cumulative distribution function are estimated based on this approximate cumulative generating function.Furthermore,the FMSA method is introduced and combined into RBMDO within the framework of sequence optimization and reliability assessment,which is based on the performance measure approach strategy.Two engineering examples are introduced to verify the effectiveness of proposed method.
文摘BACKGROUND Liver metastasis is the most common form of distant metastasis in colorectal cancer,and the only possible curative treatment for patients with colorectal liver metastases(CRLM)is hepatectomy.However,approximately 25%of patients with CRLM have indications for liver resection at the initial diagnosis.Strategies aimed at downstaging large or multifocal tumors to enable curative resection are appealing.CASE SUMMARY A 42-year-old man was diagnosed with ascending colon cancer and liver metastases.Due to the huge lesion size and compression of the right portal vein,the liver metastases were initially diagnosed as unresectable lesions.The patient was treated with preoperative transcatheter arterial chemoembolization(TACE)consisting of 5-fluorouracil/Leucovorin/oxaliplatin/Endostar®.After four courses,radical right-sided colectomy and ileum transverse colon anastomosis were performed.Postoperatively,the pathological analysis revealed moderately differentiated adenocarcinoma with necrosis and negative margins.Thereafter,S7/S8 partial hepatectomy was performed after two courses of neoadjuvant chemotherapy.Pathological examination of the resected specimen revealed a pathologically complete response(pCR).Intrahepatic recurrence was detected more than two months after the operation,and the patient was then treated with TACE consisting of irinotecan/Leucovorin/fluorouracil therapy plus Endostar®.Subsequently,the patient was treated with aγ-knife to enhance local control.Notably,a pCR was reached,and the patient's overall survival time was>9 years.CONCLUSION Multidisciplinary treatment can promote the conversion of initially unresectable colorectal liver metastasis and facilitate complete pathological remission of liver lesions.
文摘BACKGROUND The multidisciplinary team(MDT)has been carried out in many large hospitals now.However,given the costs of time and money and with little strong evidence of MDT effectiveness being reported,critiques of MDTs persist.AIM To evaluate the effects of MDTs on patients with synchronous colorectal liver metastases and share our opinion on management of synchronous colorectal liver metastases.METHODS In this study we collected clinical data of patients with synchronous colorectal liver metastases from February 2014 to February 2017 in the Chinese People’s Liberation Army General Hospital and subsequently divided them into an MDT+group and an MDT-group.In total,93 patients in MDT+group and 169 patients in MDT-group were included totally.RESULTS Statistical increases in the rate of chest computed tomography examination(P=0.001),abdomen magnetic resonance imaging examination(P=0.000),and preoperative image staging(P=0.0000)were observed in patients in MDT+group.Additionally,the proportion of patients receiving chemotherapy(P=0.019)and curative resection(P=0.042)was also higher in MDT+group.Multivariable analysis showed that the population of patients assessed by MDT meetings had higher 1-year[hazard ratio(HR)=0.608,95%confidence interval(CI):0.398-0.931,P=0.022]and 5-year(HR=0.694,95%CI:0.515-0.937,P=0.017)overall survival.CONCLUSION These results proved that MDT management did bring patients with synchronous colorectal liver metastases more opportunities for comprehensive examination and treatment,resulting in better outcomes.
文摘BACKGROUND Gastrointestinal tumors are a major cause of cancer-related deaths and have become a major public health problem.This study aims to provide a scientific basis for improving clinical treatment effects,quality of life,and prognosis of patients with gastrointestinal tumors.AIM To explore the clinical effect of the multidisciplinary diagnosis and treatment(MDT)nutrition intervention model on patients with gastrointestinal tumors.METHODS This was a case control study which included patients with gastrointestinal tumors who received radiotherapy at the Department of Oncology between January 2021 and January 2023.Using a random number table,120 patients were randomly divided into MDT and control groups with 60 patients in each group.To analyze the effect of MDT on the nutritional status and quality of life of the patients,the nutritional status and quality of life scores of the patients were measured before and after the treatment.RESULTS Albumin(ALB),transferrin(TRF),hemoglobin(Hb),and total protein(TP)levels significantly decreased after the treatment.The control group had significantly lower ALB,TRF,Hb,and TP levels than the MDT group,and the differences in these levels between the two groups were statistically significant(P<0.05).After the treatment,the MDT group had significantly more wellnourished patients than the control group(P<0.05).The quality of life total score,somatic functioning,role functioning,and emotional functioning were higher in the MDT group than in the control group.By contrast,pain,fatigue,nausea,and vomiting scores were lower in the MDT group than in the control group(P<0.05).CONCLUSION MDT nutritional intervention model effectively improves the nutritional status and quality of life of the patients.The study provides a rigorous theoretical basis for improving the prognosis of cancer patients.In the future,we intend to provide additional treatment methods for improving the quality of life of patients with cancer.
基金The study was approved by the Institutional review board of The Affiliated Hospital of Southwest Medical University,No.KY2023184.
文摘BACKGROUND Perioperative hypothermia(PH)negatively affects the physical and mental health of patients to varying degrees.Currently,there is no effective multidisciplinary team(MDT)intervention for gynecological patients with PH.AIM To apply the best evidence on the prevention and management of PH in gynecological patients,improve the quality of perioperative evidence-based care based on treatment by an MDT for gynecological patients and analyze the effect of MDT-and evidence-based practice(EBP)projects on the psychological status and cognitive function of gynecological patients with PH.METHODS Under the guidance of knowledge translation and combined with the opinions of involved stakeholders and clinical experts,the best evidence for PH prevention and management in gynecological patients was selected and adjusted to suit the practice setting.Based on the evidence,the practice plan was developed,and the MDT intervention was carried out in the preoperative ward,the preoperative preparation room,the intraoperative operating room,the postanesthesia care unit,and the 24-hour postoperative gynecological ward through the EBP program.The incidence of hypothermia,the nurses’awareness,the implementation rate of examination indicators,and the thermal comfort level,psychological status and cognitive function of patients were compared before and after the implementation of the program.RESULTS The incidence of PH in gynecological patients decreased from 43.33%to 13.33%after the implementation of the scheme.The implementation rate of examination indicators 6-10,12,14,16-18,21,and 22 reached 100%,and that of other indicators was above 90%,except for examination indicators 5 and 13,which was 66.67%;the indices were significantly improved compared with the baseline(before evidence application)(P<0.05).The score of nurses'awareness of PH prevention and management in gynecological patients increased from 60.96±9.70 to 88.08±8.96,and the difference was statistically significant(P<0.001).The total score of the perioperative thermal comfort level of patients undergoing gynecological surgery was 27.97±2.04,which was significantly increased compared with the score of 21.27±1.57 observed by researchers at baseline(P<0.001).The perioperative Hamilton Depression Scale and Hamilton Anxiety Scale scores of patients undergoing gynecological surgery decreased from 15.03±3.16 and 13.93±2.64 to 4.30±1.15 and 3.53±0.78,respectively,with statistically significant differences(P<0.001).The perioperative Montreal Cognitive Assessment Scale score of the gynecological surgery patients increased from 23.17±1.68 to 26.93±1.11,also with statistical significance(P<0.001).CONCLUSION MDT-based EBP for PH prevention and management in gynecological patients during the perioperative period can standardize nursing operations,improve nurses'awareness and behavioral compliance with gynecological hypothermia management,and reduce the occurrence of PH in gynecological patients while playing a positive role in reducing patients’negative emotions and enhancing their cognitive function.
文摘Objective: To study the establishment and clinical application of multidisciplinary collaborative rapid rehabilitation nursing model in patients with brucellosis spondylitis during the perioperative period. Method: From January 2009 to January 2013, 39 patients diagnosed with brucellosis spondylitis were treated with focal clearance combined with posterior pedicle internal fixation. Nursing was randomly divided into 2 groups: 19 cases of routine nursing as the control group (group A);20 cases of implementation of the nursing path as the intervention group (group B). In the intervention group, analgesic nursing plan, daily activity ability training path, medication compliance and health education path were used to effectively intervene on the evaluation parameters affecting rapid recovery and clinical efficacy (VAS score, daily activity ability mastery, Oswestry disability index and medication Morisky-Green index). The nursing effect and clinical evaluation of the two groups were compared. Results: As time went by, VAS pain score, mastery of daily activity ability, Oswestry disability index and medication compliance between the two groups at the same time point were significantly different (P Conclusions: The nursing path of brucellosis spondylitis is positively correlated with rapid recovery and clinical efficacy. Compared with routine nursing, it has a significant effect on accelerating postoperative rehabilitation and clinical efficacy.
文摘Background:Pressure ulcers are one of the most common and dangerous sequelae of spinal cord injuries.Pressure ulcers treatment represents one of the most challenging clinical problems faced by clinicians.Method:This report examines a case of complicated stage-4 pressure ulcers in a young adult who had gunshot injury in his spine above T-11 level treated following a multidisciplinary approach.A multidisciplinary team formulated a multifaceted program that includes meticulous pressure relief program,wound care and flap reconstructive surgery,osteomyelitis treatment,nutrition optimization,post-operative physiotherapy,patient education,and psychological support,that recruited for this patient over the course of his stay at our unit.Results:During the third day postoperatively showed good blood circulation without necrosis or hematoma and site of ulcer completely has healed.Conclusion:Implementation of a multidisciplinary approach was key to optimizing surgical outcomes in spinal cord injury patients who have pressure sores,achieving a low recurrence rate and reducing readmissions.
文摘Liver metastasis is the commonest form of distant metastasis in colorectal cancer.Selection criteria for surgery and liver-directed therapies have recently been extended.However,resectability remains poorly defined.Tumour biology is increasingly recognized as an important prognostic factor;hence molecular profiling has a growing role in risk stratification and management planning.Surgical resection is the only treatment modality for curative intent.The most appropriate surgical approach is yet to be established.The primary cancer and the hepatic metastasis can be removed simultaneously or in a two-step approach;these two strategies have comparable long-term outcomes.For patients with a limited future liver remnant,portal vein embolization,combined ablation and resection,and associating liver partition and portal vein ligation for staged hepatectomy have been advocated,and each has their pros and cons.The role of neoadjuvant and adjuvant chemotherapy is still debated.Targeted biological agents and loco-regional therapies(thermal ablation,intra-arterial chemo-or radio-embolization,and stereotactic radiotherapy) further improve the already favourable results.The recent debate about offering liver transplantation to highly selected patients needs validation from large clinical trials.Evidencebased protocols are missing,and therefore optimal management of hepatic metastasis should be personalized and determined by a multi-disciplinary team.
基金supported by the Major Program of the National Natural Science Foundation of China (Grant 51490662)the Funds for Distinguished Young Scientists of Hunan Province (Grant 14JJ1016)+1 种基金the State Key Program of the National Science Foundation of China (11232004)the Heavy-duty Tractor Intelligent Manufacturing Technology Research and System Development (Grant 2016YFD0701105)
文摘Use of multidisciplinary analysis in reliabilitybased design optimization(RBDO) results in the emergence of the important method of reliability-based multidisciplinary design optimization(RBMDO). To enhance the efficiency and convergence of the overall solution process,a decoupling algorithm for RBMDO is proposed herein.Firstly, to decouple the multidisciplinary analysis using the individual disciplinary feasible(IDF) approach, the RBMDO is converted into a conventional form of RBDO. Secondly,the incremental shifting vector(ISV) strategy is adopted to decouple the nested optimization of RBDO into a sequential iteration process composed of design optimization and reliability analysis, thereby improving the efficiency significantly. Finally, the proposed RBMDO method is applied to the design of two actual electronic products: an aerial camera and a car pad. For these two applications, two RBMDO models are created, each containing several finite element models(FEMs) and relatively strong coupling between the involved disciplines. The computational results demonstrate the effectiveness of the proposed method.
文摘Pancreatic neuroendocrine tumors(PNETs) are a rare and diverse group of tumors; nonfunctional(NF) PNETs account for the majority of cases. Most patients with NF-PNETs have metastatic disease at the time of presentation. A variety of treatment modalities exist, including medical, liver directed, and surgical treatments. Aggressive surgical management is associated with prolonged survival, however available data are limited by selection bias and the frequent combination of PNETs with carcinoid tumors. Although few patients with metastatic disease will be cured, application of currently available therapies in a multidisciplinary setting can lead to excellent outcomes with prolonged patient survival.
文摘BACKGROUND:Pancreatoduodenectomy offers the only chance of cure for patients with periampullary cancers.This,however,is a major undertaking in most patients and is associated with a significant morbidity and mortality.A multidisciplinary approach to the workup and follow-up of patients undergoing pancreatoduodenectomy was initiated at our institution to improve the diagnosis,resection rate,mortality and morbidity.We undertook the study to assess the effect of this approach on diagnosis,resection rates and short-term outcomes such as morbidity and mortality.METHODS:A prospective database of patients presenting with periampullary cancers to a single surgeon between April 2004 and April 2010 was reviewed.All cases were discussed at a multidisciplinary meeting comprising surgeons,gastroenterologists,radiologists,oncologists,radiation oncologists,pathologists and nursing staff.A standardized investigation and management algorithm was followed.Complications were graded according to the Clavien-Dindo classification.RESULTS:A total of 295 patients with a periampullary lesion were discussed and 178 underwent pancreatoduodenectomy (resection rate 60%).Sixty-one patients (34%) required either a vascular or an additional organ resection.Eighty-nine patients experienced complications,of which the commonest was blood transfusion (12%).Thirty-four patients (19%) had major complications,i.e.grade 3 or above.There was no in-hospital,30-day or 60-day mortality.CONCLUSIONS:Pancreatoduodenectomy can safely be performed in high-volume centers with very low mortality.The surgeon's role should be careful patient selection,intensive preoperative investigations,use of a team approach,and an unbiased discussion at a multidisciplinary meeting to optimize the outcome in these patients.
文摘In the case of the given design variables and constraint functions, this paper is concerned with the rapid overall parameters design of trajectory, propulsion and aerodynamics for long-range ballistic missiles based on the index of the minimum take-off mass.In contrast to the traditional subsystem independent design, this paper adopts the research idea of the combination of the subsystem independent design and the multisystem integration design.Firstly, the trajectory, propulsion and aerodynamics of the subsystem are separately designed by the engineering design, including the design of the minimum energy trajectory, the computation of propulsion system parameters, and the calculation of aerodynamic coefficient and dynamic derivative of the missile by employing the software of missile DATCOM. Then, the uniform design method is used to simplify the constraint conditions and the design variables through the integration design, and the accurate design of the optimized variables would be accomplished by adopting the uniform particle swarm optimization(PSO) algorithm. Finally, the automation design software is written for the three-stage solid ballistic missile. The take-off mass of 29 850 kg is derived by the subsystem independent design, and 20 constraints are reduced by employing the uniform design on the basis of 29 design variables and 32 constraints, and the take-off mass is dropped by 1 850 kg by applying the combination of the uniform design and PSO. The simulation results demonstrate the effectiveness and feasibility of the proposed hybrid optimization technique.
基金financially supported by National Key R&D Program of China(No.2020YFC1107103)Key Research and Development Program of Zhejiang Province(No.2021C01107)+1 种基金China Postdoctoral Science Foundation(No.2020M681846)Science Fund for Creative Research Groups of National Natural Science Foundation of China(No.51821093).
文摘Inspired by natural porous architectures,numerous attempts have been made to generate porous structures.Owing to the smooth surfaces,highly interconnected porous architectures,and mathematical controllable geometry features,triply periodic minimal surface(TPMS)is emerging as an outstanding solution to constructing porous structures in recent years.However,many advantages of TPMS are not fully utilized in current research.Critical problems of the process from design,manufacturing to applications need further systematic and integrated discussions.In this work,a comprehensive overview of TPMS porous structures is provided.In order to generate the digital models of TPMS,the geometry design algorithms and performance control strategies are introduced according to diverse requirements.Based on that,precise additive manufacturing methods are summarized for fabricating physical TPMS products.Furthermore,actual multidisciplinary applications are presented to clarify the advantages and further potential of TPMS porous structures.Eventually,the existing problems and further research outlooks are discussed.
基金supported by a grant from the Italian Health Minister,No.GR-2013-02359069。
文摘Anxiety and depression in Parkinson's disease(PD)reduce well-being of the patients.Emotional alterations influence motor skills and cognitive performance;moreover,they contribute significantly and independently to worsen rehabilitative treatment response.We investigated anxiety,depression,and quality of life in PD patients subjected to multidisciplinary rehabilitative training.The self-controlled study included 100 PD patients(49 males and 51 females with the mean age of 64.66 years)admitted to 60 days hospitalization rehabilitative program,between January 2017 and December 2018.Motor,cognitive,linguistic abilities,and functional independence were evaluated at admission(T0 baseline visit)and 60 days after(T1)the multidisciplinary rehabilitation including motor exercises,speech therapies,and cognitive intervention.The multidisciplinary rehabilitation improved functional status in PD patients and exerted its positive effects on mood,motor abilities,autonomy in the activities of daily life,perception of quality of life,cognitive performance and speech skills.Non-motor symptoms may worsen severe disability and reduce quality of life.They are often poorly recognized and inadequately treated.Nonetheless,multidisciplinary rehabilitative training represents an optimal strategy to improve disease management.The study was approved by Istituito di Ricovero e Cura a Carattere Scientifico(IRCCS)Centro Neurolesi"Bonino-Pulejo"Ethical Committee(approval No.6/2016)in June 2016.
文摘BACKGROUND Cerebral infarction patients need to be bedridden for long periods of time often resulting in pressure injuries,which may represent a serious threat to patients'life and health.An effective nursing program should be adopted for timely intervention in patients with pressure wounds.AIM To explore the value of nursing services based on a multidisciplinary collaborative treatment team in patients with pressure injury wounds following cerebral infarction.METHODS Patients with cerebral infarction pressure injury wounds in our hospital from December 2016 to January 2021 were selected and divided into one study group and one control group based on the simple random number table method.The control group was treated with conventional nursing care(CNC),and the study group was treated with care services based on multidisciplinary collaborative care(MDCC).The Pressure Ulcer Scale for Healing(PUSH),healing effect,Self-Perceived Burden Score(SPBS),and satisfaction with the intervention were calculated before and after 2 and 4 wk of intervention in both groups.RESULTS Sixty-two patients were enrolled,and 31 patients were assigned to each group.The results of the interventions were as follows:(1)There was no significant difference between the PUSH scores of the MDCC group(11.19±2.46)and CNC group(12.01±2.79)before the intervention(P>0.05),and the PUSH scores were lower after 2 and 4 wk of intervention in the MDCC group(6.63±1.97 and 3.11±1.04)than in the CNC group(8.78±2.13 and 4.96±1.35 points)(P<0.05);(2)The rate of wound healing in the MDCC group(96.77%)was higher than that in the CNC group(80.65%)(P<0.05);(3)There was no significant difference between the SPBS scores of emotional factors(21.15±3.11),economic factors(9.88±2.15),and physical factors(8.19±2.23)in the two groups before the intervention.The scores of emotional factors(13.51±1.88),economic factors(6.38±1.44),and physical factors(5.37±1.08)were lower in the MDCC group than in the CNC group(16.89±2.05,7.99±1.68 and 7.06±1.19)after 4 wk of intervention(P<0.05);and(4)Satisfaction with the intervention was higher in the MDCC group(93.55%)than in the CNC group(74.19%)(P<0.05).CONCLUSION Interventions for patients with cerebral infarction pressure wounds based on an MDCC treatment team can effectively reduce patients'self-perceived burden,improve pressure wound conditions,facilitate wound healing,and increase patient satisfaction with the intervention.
