Application of multidisciplinary in situ simulation training in the treatment of acute ischemic stroke: a quality improvement project

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.

Multidisciplinary design optimization of a dual-spin guided vehicle

In this research,a Multidisciplinary Design Optimization approach is proposed for the dual-spin guided flying projectile design considering external and internal parts of the body as design variables.In this way,a parametric formulation is developed.All related disciplines,including structure,aerodynamics,guidance,and control are considered.Minimum total mass,maximum aerodynamic control effectiveness,minimum miss distance,maximum yield stress in all subsystems,controllability and gyroscopic stability constraints are some of objectives/constraints taken into account.The problem is formulated in All-At-Ones Multidisciplinary Design Optimization approach structure and solved by Simulated Annealing and minimax algorithms.The optimal configurations are evaluated in various aspects.The resulted optimal configurations have met all design objectives and constraints.

Identifying multidisciplinary problems from scientific publications based on a text generation method

Purpose:A text generation based multidisciplinary problem identification method is proposed,which does not rely on a large amount of data annotation.Design/methodology/approach:The proposed method first identifies the research objective types and disciplinary labels of papers using a text classification technique;second,it generates abstractive titles for each paper based on abstract and research objective types using a generative pre-trained language model;third,it extracts problem phrases from generated titles according to regular expression rules;fourth,it creates problem relation networks and identifies the same problems by exploiting a weighted community detection algorithm;finally,it identifies multidisciplinary problems based on the disciplinary labels of papers.Findings:Experiments in the“Carbon Peaking and Carbon Neutrality”field show that the proposed method can effectively identify multidisciplinary research problems.The disciplinary distribution of the identified problems is consistent with our understanding of multidisciplinary collaboration in the field.Research limitations:It is necessary to use the proposed method in other multidisciplinary fields to validate its effectiveness.Practical implications:Multidisciplinary problem identification helps to gather multidisciplinary forces to solve complex real-world problems for the governments,fund valuable multidisciplinary problems for research management authorities,and borrow ideas from other disciplines for researchers.Originality/value:This approach proposes a novel multidisciplinary problem identification method based on text generation,which identifies multidisciplinary problems based on generative abstractive titles of papers without data annotation required by standard sequence labeling techniques.

Multidisciplinary comprehensive treatment of massive hepatocellular carcinoma with hemorrhage:A case report and review of literature

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.

Multidisciplinary approaches in the management of advanced hepatocellular carcinoma:Exploring future directions

Recently,we read the article“Pathologically successful conversion hepatectomy for advanced giant hepatocellular carcinoma after multidisciplinary therapy:A case report and review of the literature”published in the World Journal of Gastrointestinal Oncology.The prognosis of advanced hepatocellular carcinoma(HCC)is poor,and multidisciplinary comprehensive treatment is currently the main research direction.This case report demonstrated the efficacy of the combination therapy of transcatheter arterial chemoembolization,hepatic arterial infusion chemotherapy,epclusa,lenvatinib and sintilimab for a patient with advanced HCC,and the report can serve as a reference for clinical practice.We would also like to share some of our views.

Application of multidisciplinary team-based integrated traditional Chinese medicine and Western medicine in rotator cuff injury patients undergoing arthroscopic surgery

BACKGROUND Arthroscopic rotator cuff repair is a common surgical treatment for rotator cuff injuries(RCIs).Although this procedure has certain clinical advantages,it requires rehabilitation management interventions to ensure therapeutic efficacy.AIM To investigate the effect of integrated traditional Chinese medicine and Western medicine(TCM-WM)under the multidisciplinary team(MDT)model on the postoperative recovery of patients undergoing arthroscopic surgery for RCIs.METHODS This study enrolled 100 patients who underwent arthroscopic rotator cuff repair for RCIs at the Seventh People’s Hospital of Shanghai University of Traditional Chinese Medicine between June 2021 and May 2024.They were divided into a control group(n=48)that received routine rehabilitation treatment and an experimental group(n=52)that received TCM-WM under the MDT model(e.g.,acupuncture,TCM traumatology and orthopedics,and rehabilitation).The results of the Constant–Murley Shoulder Score(CMS),Visual Analogue Scale(VAS),Shoulder Pain and Disability Index(SPADI),muscular strength evaluation,and shoulder range of motion(ROM)assessments were analyzed.RESULTS After treatment,the experimental group showed significantly higher CMS scores in terms of pain,functional activity,shoulder joint mobility,and muscular strength than the baseline and those of the control group.The experimental group also exhibited significantly lower VAS and SPADI scores than the baseline and those of the control group.In addition,the experimental group showed significantly enhanced muscular strength(forward flexor and external and internal rotator muscles)and shoulder ROM(forward flexion,abduction,and lateral abduction)after treatment compared with the control group.CONCLUSION TCM-WM under the MDT model improved shoulder joint function,relieved postoperative pain,promoted postoperative functional recovery,and facilitated the recovery of muscular strength and shoulder ROM in patients with RCIs who underwent arthroscopic rotator cuff repair.

Multidisciplinary treatment of molten aluminum combined burn:An unusual case report

Molten aluminum is among the most common causes of burns in the metal industry.However,only few reports are available on molten aluminum injuries.Herein,we report an unusual case of molten aluminum burn.The patient had burns not only on the body surface but also in the respiratory tract and esophagus,adding to the difficulty of treatment.Multidisciplinary consultation and cooperation led to the development of a treatment plan for the patient,which included tracheotomy,respiratory management,endoscopic therapy,infection control,and psychological support.To our knowledge,this is the first report of molten aluminum-induced burns involving the face,neck,respiratory tract,esophagus,and eyes.We also describe our experience with multidisciplinary treatment for the management of molten aluminum burns.

Operating Room Nurses’ Role in Multidisciplinary Surgical Coordination for a Patient with a Large Abdominal Tumor and Multiple Pelvic Fractures

In this study,we have summarized the coordination of operating room nurses participating in the multidisciplinary team in diagnosing and treating a patient with a large abdominal tumor and multiple pelvic fractures.To perform surgical treatment on patients with various conditions,it is crucial to consider the patients from a holistic perspective.Thus,the existing medical model has shifted from a“disease-centered”approach focusing on single-disciplinary diagnosis and treatment,to a“patient-centered”approach that involves multiple disciplines in diagnosis and therapy.Operating room nurses,as crucial collaborators of surgeons,should make necessary adjustments to enhance their comprehension of patients,improving the overall quality of surgical coordination.

EFFICIENT METHOD FOR MULTIDISCIPLINARY DESIGN OPTIMIZATION BY CONSIDERING UNCERTAINTY

A new reliability-based multidisciplinary design optimization （RBMDO） framework is proposed by combining the single-loop-based reliability analysis （SLBRA） method with multidisciplinary feasible （MDF） method. The Kriging approximate model with updating is introduced to reduce the computational cost of MDF caused by the complex structure. The computational efficiency is remarkably improved as the lack of iterative process during reliability analysis. Special attention is paid to a turbine blade design optimization by adopting the proposed method. Results show that the method is much more efficient than the commonly used double-loop based RBMDO method. It is feasible and efficient to apply the method to the engineering design.

An Efficient Method for Reliability-based Multidisciplinary Design Optimization

Design for modem engineering system is becoming multidisciplinary and incorporates practical uncertainties; therefore, it is necessary to synthesize reliability analysis and the multidisciplinary design optimization （MDO） techniques for the design of complex engineering system. An advanced first order second moment method-based concurrent subspace optimization approach is proposed based on the comparison and analysis of the existing multidisciplinary optimization techniques and the reliability analysis methods. It is seen through a canard configuration optimization for a three-surface transport that the proposed method is computationally efficient and practical with the least modification to the current deterministic optimization process.

An improved multidisciplinary feasible method using DACE approximation approach

Multidisciplinary feasible method (MDF) is conventional method to multidisciplinary optimization (MDO) and well-understood by users. It reduces the dimensions of the multidisciplinary optimization problem by using the design variables as independent optimization variables. However, at each iteration of the conventional optimization procedure, multidisciplinary analysis (MDA) is numerously performed that results in extreme expense and low optimization efficiency. The intrinsic weakness of MDF is due to the times that it loop fixed-point iterations in MDA, which drive us to improve MDF by building inexpensive approximations as surrogates for expensive MDA. An simple example is presented to demonstrate the usefulness of the improved MDF. Results show that a significant reduction in the number of multidisciplinary analysis required for optimization is obtained as compared with original MDF and the efficiency of optimization is increased.

Effect of multidisciplinary team treatment on outcomes of patients with gastrointestinal malignancy

AIM: To evaluate the effect of multidisciplinary team (MDT) treatment modality on outcomes of patients with gastrointestinal malignancy in China. METHODS: Data about patients with gastric and colorectal cancer treated in our center during the past 10 years were collected and divided into two parts. Part 1 consisted of the data collected from 516 consecutive complicated cases discussed at MDT meetings in Peking University School of Oncology (PKUSO) from December 2005 to July 2009. Part 2 consisted of the data collected from 263 consecutive cases of resect-able locally advanced rectal cancer from January 2001 to January 2005. These 263 patients were divided into neoadjuvant therapy (NT) group and control group. Patients in NT group received MDT treatment, namely neoadjuvant therapy + surgery + postoperative adjuvant therapy. Patients in control group underwent direct surgery + postoperative adjuvant therapy. The outcomes in two groups were compared. RESULTS: The treatment strategy was altered after discussed at MDT meeting in 76.81% of gastric cancer patients and in 58.33% of colorectal cancer patients before operation. The sphincter-preservation and local control of tumor were better in NT group than in control group. The 5-year overall survival rate was also higher in NT group than in control group (77.23% vs 69.75%, P = 0.049). CONCLUSION: MDT treatment modality can significantly improve the outcomes of patients with gastrointestinal malignancy in China.

Colorectal liver metastases:An update on multidisciplinary approach

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.

Multidisciplinary Design Optimization of Vehicle Instrument Panel Based on Multi-objective Genetic Algorithm

Typical multidisciplinary design optimization（MDO） has gradually been proposed to balance performances of lightweight, noise, vibration and harshness（NVH） and safety for instrument panel（IP） structure in the automotive development. Nevertheless, plastic constitutive relation of Polypropylene（PP） under different strain rates, has not been taken into consideration in current reliability-based and collaborative IP MDO design. In this paper, based on tensile test under different strain rates, the constitutive relation of Polypropylene material is studied. Impact simulation tests for head and knee bolster are carried out to meet the regulation of FMVSS 201 and FMVSS 208, respectively. NVH analysis is performed to obtain mainly the natural frequencies and corresponding mode shapes, while the crashworthiness analysis is employed to examine the crash behavior of IP structure. With the consideration of lightweight, NVH, head and knee bolster impact performance, design of experiment（DOE）, response surface model（RSM）, and collaborative optimization（CO） are applied to realize the determined and reliability-based optimizations, respectively. Furthermore, based on multi-objective genetic algorithm（MOGA）, the optimal Pareto sets are completed to solve the multi-objective optimization（MOO） problem. The proposed research ensures the smoothness of Pareto set, enhances the ability of engineers to make a comprehensive decision about multi-objectives and choose the optimal design, and improves the quality and efficiency of MDO.

Triply periodic minimal surface(TPMS)porous structures:from multi-scale design,precise additive manufacturing to multidisciplinary applications

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.

Patterns of local recurrence in rectal cancer after a multidisciplinary approach

Improvements in surgery and the application of combined approaches to fight rectal cancer have succeeded in reducing the local recurrence (LR) rate and when there is LR it tends to appear later and less often in isolation. Moreover, a subtle change in the distribution of LRs with respect to the pelvis has been observed. In general terms, prior to total mesorectal excision the most common LRs were central types (perianastomotic and anterior) while lateral and posterior forms (presa-cral) have become more common since the growth in the use of combined treatments. No differences have been reported in the current pattern of LRs as a function of the type of approach used, that is, neo-adjuvant therapies (short-term or long-course radiotherapy, orchemoradiotherapy versus extended lymphadenectomy, though there is a trend towards posterior or presacral LR in patients in the Western world and lateral LR in Asia. Nevertheless, both may arise from the same mechanism. Moreover, as well as the mode of treatment, the type of LR is related to the height of the initial tumor. Nowadays most LRs are related to the advanced nature of the disease. Involvement of the circumferential radial margin and spillage of residual tumor cells from lymphatic leakage in the pelvic side wall are two plausible mechanisms for the genesis of LR. The patterns of pelvic recurrence itself (pelvic subsites) also have important implications for prognosis and are related to the potential success of salvage curative approach. The re-operability for cure and prognosis are generally better for anastomotic and anterior types than for presacral and lateral recurrences. Overall survival after LR diagnosis is lower with radio or chemoradiotherapy plus optimal surgery approaches, compared to optimal surgery alone.

Reliability-based multidisciplinary design optimization using incremental shifting vector strategy and its application in electronic product design

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.

Multidisciplinary management of nonfunctional neuroendocrine tumor of the pancreas

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.

Effect of Variable Selection on Multidisciplinary Design Optimization:a Flight Vehicle Example

Different multidisciplinary design optimization （MDO） problems are formulated and compared. Two MDO formulations are applied to a sounding rocket in order to optimize the performance of the rocket. In the MDO of the referred vehicle, three disciplines have been considered, which are trajectory, propulsion and aerodynamics. A special design structure matrix is developed to assist data exchange between disciplines. This design process uses response surface method （RSM） for multidisciplinary optimization of the rocket. The RSM is applied to the design in two categories： the propulsion model and the system level. In the propulsion model, RSM determines an approximate mathematical model of the engine output parameters as a function of design variables. In the system level, RSM fits a surface of objective function versus design variables. In the first MDO problem formulation, two design variables are selected to form propulsion discipline. In the second one, three new design variables from geometry are added and finally, an optimization method is applied to the response surface in the system level in order to find the best result. Application of the first developed multidisciplinary design optimization procedure increased accessible altitude （performance index） of the referred sounding rocket by twenty five percents and the second one twenty nine.

Multidisciplinary integrated design of long-range ballistic missile using PSO algorithm

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.