Monitoring the Outcome of Leprosy Using Leprosy Neuropathy Scale: A Preliminary Study

The disability and progress of leprosy patients is monitored by the WHO disability grading system which has limited sensitivity in leprous neuropathy. This study aims to report the spectrum of leprosy patients at a tertiary care neurology service and compare WHO grading, modified Rankin Scale (mRS) and Leprosy Neuropathy Scale (LNS) in monitoring the treatment outcome. The patients with leprosy diagnosed as per WHO criteria were subjected to medical history and clinical examination. Their disability was graded as per WHO grading scale, modified Rankin scale (mRS) and LNS. These parameters were repeated and compared after six months of multiple drug therapy (MDT). Thirty-eight patients with leprosy, aged 40 (`5-80) years, 33 of whom were males have been evaluated. The duration of symptoms was 24 (91-120) months. Mononeuropathy was present in 14, mononeuropathy multiplex in 24, trophic ulcer in two, claw hand in 11, wrist drop in two, foot drop in four, facial palsy in one, Charcot’s joint in one and lepra reaction in seven patients. Their disability as per WHO grade 1 and 2 was in 19 patients each. After 6 months of MDT, WHO grade improved in two patients, mRS revealed improvement in seven and LNS in nine patients. LNS- a clinical scale, seems more effective and easier to use for monitoring the progress/ outcome of neuropathy in leprosy patients and may complement the WHO grading scale

Diagnosis and treatment strategies for solid organ transplant recipients with SARS-CoV-2 infection / 器官移植

Due to long-term use of immunosuppressive agents, solid organ transplant recipients (SOTR) belong to high-risk populations of multiple pathogenic infection, including SARS-CoV-2. In addition, SOTR are constantly complicated by chronic diseases, such as hypertension and diabetes mellitus, etc. After infected with SARS-CoV-2, the critically ill rate and fatality of SOTR are higher than those of the general population, which captivates widespread attention from experts in the field of organ transplantation. Omicrone variant is currently the significant pandemic strain worldwide, rapidly spreading to more than 100 countries worldwide and causing broad concern. According to the latest international guidelines on the diagnosis and treatment of SARS-CoV-2 infection and relevant expert consensus in China combined with current domestic situation of SARS-CoV-2 pandemic and China's "diagnosis and treatment regimen for SARS-CoV-2 infection (Trial Version 10)", the epidemiology, clinical manifestations and prognosis, diagnosis, clinical classification and treatment of SARS-CoV-2 infection were briefly reviewed.

The influence of MDT mode combined with call-out nursing in the perioperative period of multiple injuries on the recovery time and complications of postoperative patients / 中国实用护理杂志

Objective:To explore the effect of multi disciplinary team (MDT) combined with call-out nursing on postoperative recovery time and complications of patients with multiple injuries during perioperative period.Methods:A total of 87 patients with multiple injuries admitted to our hospital from April 2018 to April 2020 were selected as the research objects. The patients were randomly divided into the control group (43 cases) and the observation group (44 cases) using a random number table method. The control group received routine care, and the observation group used MDT mode combined with call-out nursing based on routine care. The surgical awake rate and recovery time of the two groups were compared, and the scores of Glasgow Coma Scale(GCS), Disability Rating Scale(DRS) and the incidence of postoperative complications of the two groups were analyzed.Results:A total of 36 cases (81.82%) in the observation group were awake, which was significantly more than 22 cases (51.16%) in the control group. There was a statistical difference between the two groups ( χ2 value was 9.197, P<0.05). The recovery time of the observation group was (15.52±8.48) days, shorter than (27.13±10.35) days of the control group with significant difference ( t value was 5.729, P<0.01). Seven cases (15.91%) of complications occurred in the observation group after nursing, which was significantly less than 15 cases (34.88%) of the control group. There was a statistical difference between the two groups ( χ2 value was 4.144, P<0.05). After 1, 3, and 6 months of intervention, the GCS and DRS scores of the two groups of patients were lower than the previous point in time, and the observation group was lower than those of the control group, the difference was statistically significant ( t value was 2.003-11.039, P<0.05). Conclusions:The use of MDT combined with call-out nursing for patients with multiple injuries during the perioperative period can increase the postoperative wakefulness rate, reduce the patients' wakefulness time and the probability of complications, and also effectively reduce the patient's coma during nursing and improve their physiological state. It is worthwhile being promoted in related nursing work.

Clinical application of artificial intelligence to lung nodules diagnosis in regional medical center / 中国胸心血管外科临床杂志

@#Objective    To explore the efficacy of artificial intelligence (AI) detection on pulmonary nodule compared with multidisciplinary team (MDT) in regional medical center. Methods    We retrospectively analyzed the clinical data of 102 patients with lung nodules in the Xiamen Fifth Hospital from April to December 2020. There were 57 males and 45 females at age of 36-90 (48.8±11.6) years. The preoperative chest CT was imported into AI system to record the detected lung nodules. The detection rate of pulmonary nodules by AI system was calculated, and the sensitivity, specificity of AI in the different diagnosis of benign and malignant pulmonary was calculated and compared with manual film reading by MDT. Results    A total of 322 nodules were detected by AI software system, and 305 nodules were manually detected by physicians (P<0.05). Among them, 113 pulmonary nodules were diagnosed by pathologist. Thirty-eight of 40 lung cancer nodules were AI high-risk nodules, the sensitivity was 95.0%, and 25 of 73 benign nodules were AI high-risk nodules, the specificity was 65.8%. Lung cancer nodules were correctly diagnosed by MDT, but  benign nodules were still considered as  lung cancer at the first diagnosis in 10 patients. Conclusion    AI assisted diagnosis system has strong performance in the detection of pulmonary nodules, but it can not content itself with clinical needs in the differentiation of benign and malignant pulmonary nodules. The artificial intelligence system can be used as an auxiliary tool for MDT to detect pulmonary nodules in regional medical center.

Multi-disciplinary team of the treatment of bilateral lung transplantation for pediatric cystic fibrosis / 器官移植

Objective To improve the surgical efficacy of bilateral lung transplantation for pediatric cystic fibrosis through multi-disciplinary team (MDT). Methods Preoperative MDT consultation was delivered for a 10-year-old child with rare end-stage cystic fibrosis to establish the corresponding treatment protocol. Results The child was diagnosed with cystic fibrosis for 5 years, and the indication of lung transplantation were confirmed. After preoperative MDT consultation, bilateral lung transplantation via a Clam-shell incision was determined. The vital signs were maintained stable during operation. Postoperatively, ventilator-assisted ventilation, anti-infection, immunosuppression, acid suppression, prevention of stress ulceration and other treatments were delivered. Individualized treatment was given according to the characteristics of the child, and the child was well recovered. Conclusions Through preoperative MDT consultation, lung transplantation yields satisfactory surgical efficacy in treating pediatric cystic fibrosis and lowers the risk of postoperative complications, which deserves application in clinical practice.

Multi-disciplinary team on renal allograft dysfunction induced by recurrence of primary hyperoxaluria type I after renal transplantation / 器官移植

Objective To investigate the clinical characteristics and the experience of multi-disciplinary team (MDT) on recurrence of primary hyperoxaluria (PH) type I after renal transplantation. Methods One case presenting with unexplained rapid decline of renal allograft function after allogeneic renal transplantation was discussed by MDT. The role of MDT in diagnosing rare hereditary diseases and improving the long-term survival of renal transplant recipients was summarized. Results After MDT consultation, the patient was diagnosed with recurrence of PH type I. Routine immunosuppressive regimen was initiated after the exclusion of rejection. The patient was instructed to drink a large quantity of water, and given with high-quality protein and low-phosphorus diet, vitamin B6, calcium and other conservative therapies to actively prevent and treat postoperative complications. The deterioration of renal graft function was delayed. Nevertheless, regular hemodialysis was resumed at 5 months after renal transplantation until the submission date of this manuscript. Conclusions Recurrence of PH type I after renal transplantation is relatively rare. The main clinical manifestations are recurrent kidney stones and decreased renal function with multiple complications and poor prognosis. The condition of the patient is consulted by MDT for confirming the diagnosis, determining the optimal treatment scheme, delaying the progression and improving the clinical prognosis.

Multi-disciplinary team on acute heart failure complicated with respiratory failure after allograft nephrectomy / 器官移植

Objective To evaluate the effect of multi-disciplinary team (MDT) on acute heart failure (AHF) complicated with respiratory failure after allograft nephrectomy. Methods MDT discussion was performed on a patient with hemorrhagic shock caused by sudden renal graft hemorrhage, who developed acute myocardial infarction (AMI) with AHF, acute pulmonary congestion, pulmonary infection and acute respiratory failure 2 weeks after allograft nephrectomy. And treatment plan was formulated and effect evaluation was conducted. Results Based on the opinions of MDT discussion, the patient was given nasal high-flow oxygen therapy, continuous veno-venous hemodiafiltration (CVVHDF) to reduce cardiac load, anticoagulant, dilating blood vessels, reducing myocardial oxygen consumption, improving myocardial remodeling, lipid regulation, anti-infection, nutritional support, and other comprehensive treatment. The clinical outcome of the patient was good and regular hemodialysis treatment was resumed. Conclusions Application of MDT pattern helps to formulate a comprehensive and effective individualized treatment plan for patients with AHF and respiratory failure after allograft nephrectomy, which can enhance clinical treatment effects and improve prognosis of patient.

Multi-disciplinary team of the treatment of heart transplantation for Danon disease / 器官移植

Objective To improve the understanding of Danon disease and the efficacy of heart transplantation by multi-disciplinary team (MDT) pattern. Methods Prior to heart transplantation, MDT consultation was performed on one case of Danon disease, an extremely rare X-chromosome dominant genetic disease. The content of consultation included surgical indication, preoperative preparation and postoperative precaution, as well as the role of MDT in the treatment of Danon disease was summarized. Results Preoperative echocardiography showed that the patient presented withdilated-phase of hypertrophic cardiomyopathy complicated with heart failure, which was considered as Danon disease with end-stage heart failure. After MDT consultation, the patient received the preoperative treatment including anti-heart failure, reduction of pulmonary artery pressure, intra-aortic balloon pump (IABP) assistance, liver protection, strengthening nutritional support, etc. The patient underwent orthotopic heart transplantation after a suitable donor was matched. The patient developed muscle weakness in the limbs 5 days after operation, which was gradually mitigated after reducing the dose of glucocorticoid. At postoperative 48 days, the patient was discharged in good condition and continually treated with triple immunosuppressive regimen after discharge. Reexamination at postoperative 6 months revealed that the patient was in good health without any abnormality in electrocardiogram and echocardiography images. Conclusions Danon disease is extremely rare and MDT pattern may enhance the efficacy and safety of treatment by heart transplantation.

Multidisciplinary team approach in breast cancer care: Benefits and challenges

The multidisciplinary team approach has been employed internationally for decades, as an attempt to bring collaborative decision-making and concentrate clinical experience from multiple specialties on single patient cases in a systematic fashion. Adoption is not yet worldwide, but is increasing. The role of the histopathologist is central, providing vital information and context to clinical diagnosis and management. Our review summarizes some of the most relevant research on the topic of MDT usage and efficacy in relation to breast cancer, attempting to draw together its advantages and challenges. It is hoped that this review will make a contribution to the current international literature regarding multidisciplinary approaches in breast cancer care.

Multidisciplinary diagnosis and treatment of a child with hepatoblastoma and suspected coronavirus disease / 中国肿瘤临床

Objective: To discuss the diagnosis, treatment, and multidisciplinary management of a child with hepatoblastoma (HB) and suspected coronavirus disease (COVID-19). Methods: A child with HB and suspected COVID-19 was admitted to the Children's Hospital, Zhejiang University School of Medicine, in February 2020. The diagnosis and treatment plan were discussed by a multidisciplinary team (MDT). After the MDT discussion, necessary examinations and tests were performed, including routine blood tests, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ribonucleic acid (RNA) and antibody tests, tumor marker tests, chest and abdomen computed tomography (CT), and an ultrasound. The administered treatment included the cisplatin+5-fluorouracil+vincristine (C5V) regimen and cefotaxime. Results: The patient was diagnosed as low-risk HB and completed the first stage of HB chemotherapy after the diagnosis of COVID-19 was ruled out. After 1 week in the hospital, the patient's body temperature returned to normal, the disposition and appetite improved, and all indexes reached the discharge standard. After 14 days of isolation, the patient was discharged. Conclusions: For children with newly diagnosed HB suspected of having COVID-19 during the pandemic period, clinicians must consider the prevention and control of COVID-19 while diagnosing and treating HB as soon as possible. Multidisciplinary management is beneficial for ensuring the development of a safe and efficient treatment plan.

Formulation And Comparative Evaluation Of Ondansetron Hydrochloride Mouth Dissolving Tablets In India

Objective: The aim of the present study was to prepare the ondansetron hydrochloride Mouth Dissolving Tablets (MDTs) followed by its comparison with ethical and non-ethical (generic) marketed tablets. Methods: Prior to the formulation, drug excipient compatibility study was carried out by FTIR spectroscopy. The λmax was determined by UV spectroscopy. The ondansetron hydrochloride MDTs were prepared by direct compression method using Sodium Starch Glycolate (SSG) as super disintegrant and camphor as a sublimating agent. Then the prepared MDTs were subjected to evaluation of post compression parameters such as thickness and diameter, weight variation, wetting time, hardness, friability, disintegration and dissolution. The results obtained were compared with that of ethical and non-ethical marketed ondansetron hydrochloride 4 mg tablets. Results: The λmax was found at 310 nm. FTIR study revealed that excipients used in the prepared formulations are compatible with the drug. The thickness and diameter was in the range of 2.646 to 3.27 mm and 6.0 to 8.12 mm, respectively. Friability was in the range of 0.43 to 0.88 % and had a slightly higher friability (1.27%) for sublimated tablets. Wetting time and disintegration time were in the range of 15 to 40 sec and 23 to 50 sec, respectively. The 100 % drug release was found within 180 sec for all the codes. These results were then compared with non-ethical film coated ondansetron marketed tablets. Conclusion: Ondansetron hydrochloride MDT 4 mg tablets prepared in the laboratory were under specified IP limits. The experimental findings demonstrated that any of these ethical and non-ethical tablets of ondansetron hydrochloride can be selected, advised by the physician or pharmacist, as per the patient’s need and economical status.

Multidisciplinary treatment discussion of a personalized approach of laparoscopic right hemicolectomy for variant middle colic artery and ileocolic vein / 中国肿瘤临床

Objective: To investigate the variants of middle colic artery (MCA) and ileocolic vein (ICV) and their influence on the deci-sion regarding approach of laparoscopic right hemicolectomy. Methods: We analyzed the diagnosis and treatment of one right colon cancer patient with variant MCA and ICV who was admitted to the Tianjin Medical University Cancer Hospital in March 2018. The pa-tient underwent laparoscopic right hemicolectomy via a limited medial approach after a multidisciplinary treatment (MDT) discussion. Following were the observation indicators: 1) surgical and postoperative recovery situations; 2) postoperative pathological examina-tion; and 3) follow-up situation. Results: 1) Surgical and postoperative recovery situations: the patient successfully underwent laparo-scopic right hemicolectomy via a limited medial approach. No intraoperative or postoperative complications occurred. Duration of postoperative hospital stay was 11 days. 2) Postoperative pathological examination: the number of dissected lymph nodes was 39. Postoperative pathological tumor stage was pT3N0. Postoperative pathological tumor type was moderately differentiated adenocarci-noma. 3) Follow-up situation: the patient was followed-up for 10 months with disease-free survival. Conclusions: Individual and stan-dard surgery will be the best choice for treating colon cancer patients. MDT can facilitate clinical decision-making and benefit patients.

What can we do for the recurrent-tumor patients who underwent hepatectomy for hepatocellular carcinoma / 中国实用外科杂志

Some of the patients with hepatocellular carcinoma could be performed hepatectomy and get optimal postoperative outcomes with tumor-free long-term survival which encourage surgeon to carry on the surgery with tremendous enthusiam.Unfortunately the others are not the case even though surgeons have done their best routinely and standardly and the tumor recurs in the liver in short time after surgery. For the sake of the patient treatment,the confidence should not be lost,there are a lot of things to be done which include re-resection, radio freuquency ablation,transcatheter arterial chemoembolization,liver transplantation respectively and individualizedly in order to receive better prognosis and longer-term survival.

Airborne laser scanning for terrain modeling in the Amazon forest / Escaneamento laser aerotransportado para modelagem de terreno em floresta amazônica

Very few studies have been devoted to understanding the digital terrain model (DTM) creation for Amazon forests. DTM has a special and important role when airborne laser scanning is used to estimate vegetation biomass. We examined the influence of pulse density, spatial resolution, filter algorithms, vegetation density and slope on the DTM quality. Three Amazonian forested areas were surveyed with airborne laser scanning, and each original point cloud was reduced targeting to 20, 15, 10, 8, 6, 4, 2, 1, 0.75, 0.5 and 0.25 pulses per square meter based on a random resampling process. The DTM from resampled clouds was compared with the reference DTM produced from the original LiDAR data by calculating the deviation pixel by pixel and summarizing it through the root mean square error (RMSE). The DTM from resampled clouds were also evaluated considering the level of agreement with the reference DTM. Our study showed a clear trade-off between the return density and the horizontal resolution. Higher forest canopy density demanded higher return density or lower DTM resolution.

São poucos os estudos dedicados a entender a criação de modelo digital de terreno (MDT) para florestas amazônicas. O MDT tem uma importante função quando o escaneamento laser aerotransportado é usado para estimar a biomassa da vegetação. Examinamos a relação da densidade de pulsos, resolução espacial, algoritmos de filtragem, densidade da vegetação e inclinação do terreno com a qualidade do MDT. Três áreas de floresta amazônica foram sobrevoadas usando LiDAR aerotransportado. Cada nuvem de dados original teve sua densidade reduzida objetivando 20; 15; 10; 8; 6; 4; 2; 1; 0,75; 0,5 e 0,25 pulsos por metro quadrado, utilizando um processo de reamostragem aleatória. Os MDTs das nuvens reamostradas foram comparados com o MDT de referência, produzido a partir da nuvem original, calculando o desvio pixel a pixel e resumindo-o por meio do erro padrão da estimativa (RMSE). Os MDTs das nuvens reamostradas também foram avaliados quanto ao nível de correspondência com o MDT de referência. Houve uma clara compensação entre densidade de pontos e resolução horizontal. Dosséis mais densos exigem uma maior densidade de retornos, ou MDT com menor resolução.

Type 2 Reaction Continuing after 15 Years of MDT in an Atypical Pattern: A Case Report

Type 2 reactions may occur in the early stages of the anti-leprosy treatment, however, many cases may present 2–3 years after leprosy diagnosis. Some of such patients have been reported to develop episodes as late as 7 years after starting treatment. A 45 years old male, with a past history of intake of multi drug therapymultibacillary (MDT-MB) pack 15 years back presented with fever, generalized bodyache along with development of vesiculo-bullous lesions over the existing annular lesions of borderline lepromatous (BL) leprosy. Possibility of relapse was ruled out clinically as well as histopathologically and the patient was successfully treated with tapering doses of steroids as a case of severe type 2 reaction. Type 2 reaction is less commonly seen in BL leprosy as compared to lepromatous lepromatous (LL) leprosy. Moreover, development of vesiculo-bullous lesions in an annular pattern over existing lesions of BL leprosy as a manifestation of type 2 reaction has rarely been reported in literature. This case is even rarer as the patient is continuing to get type 2 reaction even after 15 years of completion of MDT-MB and that too in an annular pattern over the existing lesions.

Visualization Analysis of the Multidisciplinary Team Cancer Based on Knowledge Graph / 中国医院管理

Objective To summarize the hot spots and cutting-edges by exploring Multidisciplinary Team (MDT) research in cancer.Methods CiteSpace is used to analyze MDT in cancer visually.Results 2 160 related literatures,10 key literatures,15 main clusters and 29 burst terms are detected.Conclusion MDT research on cancer mainly focuses on operation process,implemention and evaluation of effects.Improving efficiency,cost-effectiveness analysis and randomized controlled trial is the cutting-edge topics.This provides a new perspective for China.

Recent advances in the treatment of colorectal cancer liver metastases / 中华肝胆外科杂志

In recent years,the morbidity of colorectal cancer (CRC) has gradually increased,and trends to be younger.There are 1.2 million new patients suffering from CRC in the worldwide each year.Even undergoing radical mastectomy,there are still 25％ ～ 40％ of patients complicated with heterochronic liver metastasis simultaneously.The colorectal cancer liver metastasis (CRLM) has become one of the difficulties and the major cause of death,which is diagnosed in 20％ of patients at the same time of initial diagnosis.At present,the primary and metastatic cancer on liver resection is recognized as the only way to cure CRLM.In recent years,with the development of surgical technology,the normative use of peri-operative drugs,the collaboration of the mode of multidisciplinary team (MDT) and the development of the technology of targeted therapy,the survival rate of patients has been improved significantly.But the recurrence rate within 1 year is nearly 50 ％ after hepatectomy.Nearly 80 ％ of patients with CRLM missed opportunity for surgery when they were first diagnosed.Facing a huge group of CRLM,how to combine the patients' individual characteristics,the periodization of liver metastasis,the preoperative prognosis evaluation,the peri-operative adjuvant therapy and the directional treatment method etc.to form a systematic and effective therapeutic schedule has become the present focus attention,which still contains some outstanding issues.This article reviews the relevant progress.

Multidisciplinary decision on a rectal cancer patient with multiple synchronous pulmo-nary metastasis / 中国肿瘤临床

Lungs are the second most common distant metastatic organs of colorectal cancer, following the liver. However, clinical re-searches on lung metastasis are insufficient comparing with that on liver metastasis due to its low occurrence and relatively mild bio-logical behavior. This paper aims to investigate the clinicopathological characteristics and prognostic factors of rectal cancer patients with multiple synchronous lung metastases. The patient was from the Second Affiliated Hospital of Zhejiang University, School of Medi-cine underwent multi-disciplinary diagnosis and treatment. Moreover, this article aims to discuss the related existing consensus and controversies on this issue.

Discussion on multidisciplinary treatment mode of advanced schistosomiasis and its standardized implementation / 中国血吸虫病防治杂志

Advanced schistosomiasis is the most serious clinical type of schistosomiasis. Its diagnosis and treatment are relat?ed to many special departments,such as gastroenterology,general surgery,neurology,endocrinology,radiology,traditional Chinese medicine,blood purification,endoscopy,intervention,and ICU. It is necessary to apply a multidisciplinary treatment (MDT)mode. However,the mode has no universal standard and guide in practice. It is very important for the implementation of MDT mode of advanced schistosomiasis to form a treatment expert team,formulate the formal working procedures,and standard?ize the treatment schedules. The standardized implementation of MDT mode will be important to provide a more effective clinical decision on advanced schistosomiasis.

Application of the interactive reading mode of PBL combined with MDT in medical imaging post-graduate clinical teaching / 中华医学教育探索杂志

Medical imaging is an interdisciplinary subject closely related to clinical and pathological subject. Its clinical reading skills' training has become the focus of postgraduate teaching. In the process of clinical teaching, the interactive reading mode of problem-based learning (PBL) combined with multi-disci-plinary team (MDT) was introduced into clinical reading meeting. The tutors chose the reading cases proved by pathology; designed in-depth issues step by step for execution of PBL teaching; guided postgraduates to delineate imaging signs and propose the diagnostic results, evidences and differential diagnoses according to the step from localizing to qualitative and then to pathological diagnosis;then guided postgraduates to attend in-depth case analysis of MDT and analyze the correlation or inconsistency between the imaging diagnosis and clinical and pathological diagnosis; exercise document retrieval and verbalization, multimedia design, and writing level of the records of the reading cases and papers. The interactive reading mode of PBL com-bined with MDT has achieved significant effects, which is worthy of further exploration and promotion.