Application of single balloon enteroscopy-assisted therapeutic endoscopic retrograde cholangiopancreatography in patients after bilioenteric Roux-en-Y anastomosis: Experience of multi-disciplinary collaboration

BACKGROUND Bilioenteric Roux-en-Y anastomosis is one of the most complicated approaches for reconstructing the gastrointestinal tract, and endoscopic retrograde cholangiopancreatography (ERCP) is technically challenging in patients after bilioenteric Roux-en-Y anastomosis. The optimal endoscopic strategies for such cases remain unknown. AIM To explore the feasibility and effectiveness of single balloon enteroscopy-assisted (SBE-assisted) therapeutic ERCP in patients after bilioenteric Roux-en-Y anastomosis based on multi-disciplinary collaboration between endoscopists and surgeons as well as report the experience from China. METHODS This is a single center retrospective study. All of the SBE-assisted therapeutic ERCP procedures were performed by the collaboration between endoscopists and surgeons. The operation time, success rate, and complication rate were calculated. RESULTS Forty-six patients received a total of 64 SBE-assisted therapeutic ERCP procedures, with successful scope intubation in 60 (93.8%) cases and successful diagnosis in 59 (92.2%). All successfully diagnosed cases received successful therapy. None of the cases had perforation or bleeding during or after operation, and no post-ERCP pancreatitis occurred. CONCLUSION Based on multi-disciplinary collaboration, SBE-assisted therapeutic ERCP in patients after bilioenteric Roux-en-Y anastomosis is relatively safe and effective and has a high success rate.

多学科协作的I-PDCA模式在结直肠癌学科建设中的实践与思考

目的 探讨北京大学肿瘤医院结直肠癌学科建设中多学科协作模式及实施情况,为医院学科建设和创新管理提供借鉴。方法 本中心7年来将创新设计与传统PDCA管理方法相融合,针对医疗、科研、人才培养开展了五阶段I-PDCA新模式的多学科协作。结果 该模式弥补了传统PDCA四阶段模式缺乏创造力的弊端,促进了本院结直肠癌学科相关资源在多个维度的高效配置,在结直肠癌学科建设中发挥了重要作用。结论 结直肠癌多学科协作的I-PDCA模式有利于提升医疗服务、科研成果产出和人才培养水平,为学科未来发展提供助力。

Transforming Multidisciplinary Customer Requirements to Product Design Specifications

With the increasing of complexity of complex mechatronic products, it is necessary to involve multidis- ciplinary design teams, thus, the traditional customer requirements modeling for a single discipline team becomes difficult to be applied in a multidisciplinary team and project since team members with various disciplinary backgrounds may have different interpretations of the customers＇ requirements. A new synthesized multidisci- plinary customer requirements modeling method is pro- vided for obtaining and describing the common understanding of customer requirements （CRs） and more importantly transferring them into a detailed and accurate product design specifications （PDS） to interact with dif- ferent team members effectively. A case study of designing a high speed train verifies the rationality and feasibility of the proposed multidisciplinary requirement modeling method for complex mechatronic product development. This proposed research offersthe instruction to realize the customer-driven personalized customization of complex mechatronic product.

Multi-features Based Approach for Moving Shadow Detection

In the video-based surveillance application, moving shadows can affect the correct localization and detection of moving objects. This paper aims to present a method for shadow detection and suppression used for moving visual object detection. The major novelty of the shadow suppression is the integration of several features including photometric invariant color feature, motion edge feature, and spatial feature etc. By modifying process for false shadow detected, the averaging detection rate of moving object reaches above 90% in the test of Hall-Monitor sequence.

The Large Sky Area Multi-Object Fiber Spectroscopic Telescope (LAMOST)

The Large Sky Area Multi-Object Fiber Spectroscopic Telescope (LAMOST, also called the Guo Shou Jing Telescope) is a special reflecting Schmidt telescope. LAMOST’s special design allows both a large aperture (effective aperture of 3.6 m–4.9 m) and a wide field of view (FOV) (5°). It has an innovative active reflecting Schmidt configuration which continuously changes the mirror’s surface that adjusts during the observation process and combines thin deformable mirror active optics with segmented active optics. Its primary mirror (6.67m×6.05 m) and active Schmidt mirror (5.74m×4.40 m) are both segmented, and composed of 37 and 24 hexagonal sub-mirrors respectively. By using a parallel controllable fiber positioning technique, the focal surface of 1.75 m in diameter can accommodate 4000 optical fibers. Also, LAMOST has 16 spectrographs with 32 CCD cameras. LAMOST will be the telescope with the highest rate of spectral acquisition. As a national large scientific project, the LAMOST project was formally proposed in 1996, and approved by the Chinese government in 1997. The construction started in 2001, was completed in 2008 and passed the official acceptance in June 2009. The LAMOST pilot survey was started in October 2011 and the spectroscopic survey will launch in September 2012. Up to now, LAMOST has released more than 480 000 spectra of objects. LAMOST will make an important contribution to the study of the large-scale structure of the Universe, structure and evolution of the Galaxy, and cross-identification of multiwaveband properties in celestial objects.

A Comparative Study of Acute Hemodynamic Effects of Multi -site Cardiac Pacing in patients with cardiac function NYHA class ⅠtoⅡ without bundle branch block

Objective To compare the acute hemodynamic effects of five different pacing modes in patients with cardiac function NYHA class Ⅰ to Ⅱ without bundle branch block (BBB). Methods This study included 12 patients (SSS 7, Ⅲ°AVB 5) undergoing pacemaker implantation. Right ventricular apex (RVA), right ventricular outflow tract (RVOT), right ventricular bifocal (RV-Bi), left ventricular base (LVB) and bi -ventricular (Bi-Ⅴ) pacing at 60 -80 ppm were done in VVI mode prior to implantation of DDD pacemaker. The cardiac index (CI), mean pulmonary artery pressure (mPAP) and pulmonary capillary wedge pressure (PCWP) were measured with Swan - Ganz thermodilution catheter after 5 minutes of each pacing mode. Results (1) Comparing to pacing at RVA (CI: 2. 41± 0. 38 L/min per m2, PCWP: 16. 7 ±3.3 mmHg), the CI increased and the PCWP decreased significantly in pacing at RVOT(CI: 2. 63 ± 0.46, PCWP: 13. 8±2. 3), LVB(CI: 2. 78±0.52, PCWP: 14. 4±3.1), RV-Bi(CI: 2. 83±0.57, PCWP: 12. 8± 2. 5) and Bi -Ⅴ pacing (CI: 2. 94± 0.60, PCWP: 12. 7±2. 5), P < 0. 01, respectively. (2) The CI of RV-Bi and Bi-Ⅴ pacing was higher than that of RVOT and LVB pacing, the PCWP was lower, P < 0. 05, respectively. (3) There was no significant difference between RV - Bi pacing and Bi-Ⅴ pacing in CI and PCWP. Conclusion There is no significant difference between RV - Bi pacing and Bi -V pacing in the acute hemodynamic effects; however,dual - site pacing is much better than single site pacing in that aspect for patients with cardiac function NYHA class Ⅰ to Ⅱ without BBB. Among single site pacing, the RVOT and LVB pacing is better than RVA pacing in cardiac function.

Research on A Master - slave Multi - microcomputers Control System for Hollow Spindle Fancy Yarn Spinning Machine

In this paper, a successfully studied and developed master - slave muld - microcomputers control system based on PC - BUS for hollow spindle fancy yarn spinning machine, mainly Its overall scheme, software and hardware construction, is introduced. Spinning experiments show that the system achieves satisfactory result. This system can solve the diftkultles of mechatronical fusion between domestic hollow splndk fancy yarn spuming muchine and its microcomputer control technology.

On the Representation of Multi-layer Woven Structure

A quantitative method is developed to identify the structures of multi-layer woven fabric in this study. Six structural parameters are selected to represent the fabric structure. With some design criteria for the reinforcement of textile composites, the relationships among the structural parameters are derived for different binding patterns of the fabric structure. The conditions, which meet the requirements of structural cell stability,are also discussed.

Computer-aided Pattern Design of Multi-bar Warp Knitted Fabrics

To meet the development trend of multi-bar warp knit-ting machine towards high-speed,advanced technologyand computer control and the requirements of variousproducts with small quantity,there are many researcheson the computer-aided pattern design of multi-barwarp knitted fabrics.In terms of the special propertiesof the computer-aided pattern design of multi-barwarp knitted fabrics,the Object Oriented Program(OOP)programming-Object Windows class Library(OWL)programming is selected.According to thecharacters of the OWL programming,various functionsare defined.Pattern design and technical parameters canbe output,which offers a great convenience for the fac-tory.

MODS： A Novel Metaheuristic of Deterministic Swapping for the Multi-Objective Optimization of Combinatorials Problems

This paper states a new metaheuristic based on Deterministic Finite Automata （DFA） for the multi - objective optimization of combinatorial problems. First, a new DFA named Multi - Objective Deterministic Finite Automata （MDFA） is defined. MDFA allows the representation of the feasible solutions space of combinatorial problems. Second, it is defined and implemented a metaheuritic based on MDFA theory. It is named Metaheuristic of Deterministic Swapping （MODS）. MODS is a local search strategy that works using a MDFA. Due to this, MODS never take into account unfeasible solutions. Hence, it is not necessary to verify the problem constraints for a new solution found. Lastly, MODS is tested using well know instances of the Bi-Objective Traveling Salesman Problem （TSP） from TSPLIB. Its results were compared with eight Ant Colony inspired algorithms and two Genetic algorithms taken from the specialized literature. The comparison was made using metrics such as Spacing, Generational Distance, Inverse Generational Distance and No-Dominated Generation Vectors. In every case, the MODS results on the metrics were always better and in some of those cases, the superiority was 100%.

Reducing Paediatric Outpatient Waitlists—A Proposed Allied Health Multidisciplinary Approach

Extremely long Australian paediatric outpatient waiting lists have resulted in large numbers of children waiting to see a paediatrician. Analyses of the patient referrals suggest that a large proportion of children may benefit from allied health input, in addition to being seen by the paediatrician. This paper provides an organisational strategy that involves streamlining Allied Health clinical services in an effort to assist with bringing down a Paediatric Out-patient waitlist. The paper describes principles to guide the formation of a Paediatric Allied Health Multi-Disciplinary team that proposes assessment and brief interventions. The service would focus on supporting the paediatricians through the use of structured procedures, telephone intakes, multidisciplinary triage, shared and standardised assessments, collaborative formulations and reports, brief interventions, clinical-community linkages, and allied health student support. A variety of additional important organisational principles are proposed to facilitate patient flow from the perspective of streamlining administrative processes, having adequate administrative support, shared responsibilities, teamwork, flexibility, carrying out intake assessments, determining which referrals were appropriate for allied health, and working closely with medical staff.

火炮身管-反后坐装置集成优化设计方法研究

为减小火炮发射时的后坐阻力,同时减小火炮身管质量,以节制杆结构参数、身管结构参数和内弹道装药参数为设计变量,以身管刚度、强度、寿命、弹丸初速等为约束,建立火炮身管-反后坐装置集成优化设计模型,并采用两种优化方法进行优化,再比较其结果。首先,采用加权组合法将两个目标函数归一为单个目标,应用模拟退火算法进行优化设计,优化后,后坐阻力减小53%,身管质量减小2.8%。其次,基于Pareto最优理论,采用遗传算法进行优化设计,获得了Pareto最优解集,给设计者提供了更多优化方案;根据工程经验,选取一组优化解,结果发现,对比原设计,后坐阻力减小50.4%,身管质量减小9.8%。研究表明,基于Pareto最优理论和遗传算法可以获得更好的优化方案。该研究提供的集成优化模型和算法为火炮身管-反后坐装置一体化设计提供了新方法。

2019冠状病毒病(COVID-19)诊疗浙江经验

当前2019冠状病毒病(COVID-19)疫情仍处于胶着状态。浙江大学医学院附属第一医院是国家感染性疾病临床医学中心,浙江省COVID-19患者救治中心。疫情一线的专家集智攻关,以国家卫生健康委员会和国家中医药管理局发布的COVID-19诊治指南为依据,以抗病毒、抗休克、抗低氧血症、抗继发感染、维持水电解质和酸碱平衡、维持微生态平衡的“四抗二平衡”救治策略为核心,总结完善诊治方案,聚焦临床实践的一些具体问题,为COVID-19患者临床诊治提供借鉴。推荐以多学科协作诊治个性化治疗提高COVID-19患者救治质量。建议病原学检测、炎症指标监测和肺部影像学动态观察指导临床诊治。痰液的病毒核酸检测阳性率最高,约10%的急性期患者血液中检测到病毒核酸,50%的患者粪便中检测到病毒核酸,粪便中可分离出活病毒,须警惕粪便是否具有传染性;开展细胞因子等炎症指标监测有助于发现是否出现细胞因子风暴,判断是否需要人工肝血液净化治疗。通过以“四抗二平衡”为核心的综合治疗提高治愈率、降低病死率;早期抗病毒治疗能减少重症、危重症发生,前期使用阿比多尔联合洛匹那韦/利托那韦抗病毒显示出一定效果。休克和低氧血症多为细胞因子风暴所致,人工肝血液净化治疗能迅速清除炎症介质,阻断细胞因子风暴,对维持水电解质酸碱平衡也有很好的作用,可以提高危重型患者的疗效。重型病例疾病早期可适量、短程应用糖皮质激素。氧疗过程中,患者氧合指数小于200 mmHg时应及时转入重症医学科治疗;采用保守氧疗策略,不推荐常规进行无创通气;机械通气患者应严格执行集束化呼吸机相关性肺炎预防管理策略;氧合指数大于150 mmHg时,及早减、停镇静剂并撤机拔管。不推荐预防性使用抗菌药物,对于病程长,体温反复升高和血降钙素原水平升高的患者可酌情使用抗菌药物;要关注COVID-19患者继发真菌感染的诊治。COVID-19患者有肠道微生态紊乱,肠道乳酸杆菌、双歧杆菌等有益菌减少,推荐对所有患者进行营养和胃肠道功能评估,以营养支持和补充大剂量肠道微生态调节剂,纠正肠道微生态失衡,减少细菌移位和继发感染。COVID-19患者普遍存在焦虑和恐惧心理,应建立动态心理危机干预和处理。提倡中西医结合辨证施治;优化重型患者护理促进康复。严重急性呼吸综合征冠状病毒2(SARS-CoV-2)感染后病毒清除规律仍不明了,出院后仍须居家隔离2周,并定期随访。以上经验和建议在本中心实行,取得较好效果,但COVID-19是一种新的疾病,其诊治方案及策略仍有待进一步探索与完善。

随机-区间混合不确定性分层序列化多学科可靠性分析方法

针对多学科问题中随机型与区间型不确定性共存的可靠性分析问题,基于序列化变量处理框架,将原问题分解为区间可靠性分析和概率可靠性分析2个子问题,并建立相应的求解过程。其中,在区间可靠性分析中引入了学科间一致性约束,减轻多学科耦合分析带来的计算负担;在可靠性分析中集成先进均值法、圆弧搜索法和有效集拟牛顿法,构造了一套渐进收敛的处理策略。最后,基于宽容分层思想构造两个子过程的迭代关系,实现随机型和区间型不确定性的同时处理。采用1个数值算例和1个飞行器多学科可靠性分析应用算例,从不同角度验证所提出方法的有效性。结果表明:求解效率比已有方法有所提高,且该方法对各种约束函数的可靠性分析问题的适应性能力更强。

“医-药-护”多方协作促进重症加强护理病房患者肠外营养液规范应用的效果研究

目的:探究"医-药-护"多方协作提高重症监护病房患者肠外营养液规范应用水平的效果。方法:选取2017年3月至2018年3月在哈尔滨医科大学附属第一医院重症加强护理病房(intensive care unit,ICU)接受肠外营养的危重症患者124例,按照随机数表法分为观察组和对照组,每组62例。对照组患者采用ICU肠外营养常规治疗及护理方法,观察组在对照组的基础上采用"医-药-护"多方协作的方法。比较两组患者的血红蛋白、前白蛋白、白蛋白及软铁蛋白等指标水平变化情况,感染、操作不当导致的气胸、代谢性并发症等并发症发生情况和护理满意度。结果:干预后,观察组患者平均血红蛋白、前白蛋白、白蛋白及软铁蛋白水平分别为(121.23±13.25)、(0.26±0.07)、(36.80±5.69)及(1.98±0.39) g/L,均明显高于对照组的(117.82±12.91)、(0.23±0.08)、(35.17±4.70)及(1.62±0.32) g/L,差异均有统计学意义(P<0.05);观察组患者并发症发生率为8.06%(5/62),明显低于对照组的25.81%(16/62),差异有统计学意义(P<0.05);观察组患者总体护理满意度为88.71%(55/62),明显高于对照组的74.19%(46/62),差异有统计学意义(P<0.05)。结论:"医-药-护"多方协作可以有效提高ICU使用肠外营养液患者的营养指标水平,降低并发症发生率,提高患者满意度。

基于加速康复外科-多学科团队构架下建立的All in One病房工作模式探索

基于多学科团队(multi-disciplinary team,MDT)参与的加速康复外科(enhanced recovery after surgery,ERAS)(ERAS-MDT)构架下建立的All in One(AO)病房,通过外科联合具有综合属性的内科协助外科治疗作为AO病房的主体病房,纳入在专业治疗上需要进行深度介入干预的相应专业组成的辅助病房以及协助外科完成治疗工作的相关专业组成的支持治疗病房,组成综合性独立单元体,其目标是探索多学科协同促进外科患者围手术期加速康复的策略。通过在加速康复AO病房实施LEER模式工作流程(即“少痛”“早动”“早食”“安心”)来实现患者术后加速康复这一共同目标。通过AO病房的治疗,期望增加老年、危重症患者的手术率,减少术后并发症的发生率,缩短外科患者平均住院时间,加快外科病房周转,节约有限的医疗资源,并拓展ERAS的应用领域。从形式和内容上创新了MDT,不仅有利于医院通过内部资源整合为外科纾困解难,也为进一步探索和深化慢病管理和临床专业协同工作模式提供了一种有益借鉴。

鼻-口腔相关疾病的多学科诊疗

论文依据鼻-口腔解剖区域和学科分布两大维度,通过对外鼻-口腔相关疾病、鼻腔与口腔相关疾病和上颌窦-口腔相关疾病中的代表性疾病的跨区域临床特点描述,提倡应用多学科(MDT)诊疗模式,旨在得到更全面、更规范的个性化治疗方案,从而提高疗效。

MDT与PBL-CBL联合教学模式用于淋巴瘤临床带教的价值研究

目的分析多学科协作诊疗(multi-disciplinary treatment,MDT)与以问题为基础的教学法-案例教学法(problem based learning-case based teaching,PBL-CBL)联合教学模式用于淋巴瘤临床带教的效果及对教学质量的影响。方法选取2021年2月—2022年2月在广州医科大学附属第一医院血液内科接受淋巴瘤临床带教的66名实习生为研究对象,依据不同带教模式分成两组。对照组33名采取常规带教模式,观察组33名采取MDT与PBL-CBL联合教学模式,对比两组实习生的考核成绩、岗位胜任能力、综合能力及对教学质量的评价。结果观察组实习生考核成绩总分(92.69±6.19)分,高于对照组的(83.80±8.21)分,差异有统计学意义(P<0.05)。带教前,两组实习生的岗位胜任能力比较,差异无统计学意义(P>0.05);带教后,两组的岗位胜任能力明显提高,且观察组高于对照组,差异有统计学意义(P<0.05)。带教前,两组实习生的综合能力比较,差异无统计学意义(P>0.05);带教后,两组的综合能力明显更高,且观察组高于对照组,差异有统计学意义(P<0.05)。观察组实习生对于教学质量的评价高于对照组,差异有统计学意义(P<0.05)。结论MDT与PBL-CBL联合教学模式用于淋巴瘤临床带教的效果显著,有助提升其考核成绩、岗位胜任能力及综合能力,促进教学质量进一步提高。

基于MDT的CHS-DRG付费下的管理持续改进

国家医疗保障局于2019年正式启动CHS-DRG付费改革。武汉大学中南医院作为CHS-DRG付费试点医院之一,通过组建DRG管理MDT团队,围绕CHS-DRG付费核心环节,联合开展CHS-DRG付费下的临床路径管理、药品和耗材治理、成本核算与绩效考核、监管病案首页质量、鼓励开展医疗新技术等,优化管理方案。经实践,医院CMI、平均住院日等指标持续改善,医疗新技术开展数量明显增加,改革取得较好成效。但仍需从医保部门合理补偿方面不断完善CHS-DRG付费方案,并积极关注支付方式改革对医疗质量和医院发展的长期影响。

美国2021版《妊娠期肾结石诊治-单中心多学科指南》解读--提高临床诊断能力,加强多学科协作管理

妊娠期肾结石是妊娠期患者非产科因素住院的常见病因,容易出现疼痛、恶心、呕吐、肾功能下降、泌尿道感染等并发症,处理不当会导致流产、早产等不良妊娠结局。美国医学中心多学科联合发布《妊娠期肾结石诊治-单中心多学科指南》,以规范妊娠期肾结石的诊治。本指南共形成10个指南推荐意见,其中4个用于指导诊断和影像学检查,6个用于指导临床治疗。值得关注的是,与国内指南相比,该指南提供了循证依据,证实了妊娠期使用低剂量CT平扫的安全性、有效性,并可以在患者病情变化且诊断不明确时优先使用,本文就以上内容对该指南展开深度解读。