http://chineseinput.net/에서 pinyin(병음)방식으로 중국어를 변환할 수 있습니다.
변환된 중국어를 복사하여 사용하시면 됩니다.
Designing agenerichuman-machineframeworkforreal-timesupply chain planning
Jonathan Gaudreault,Claude-Guy Quimper,Philippe Marie,Mathieu Bouchard,François Chéné,Jean Bouchard 한국CDE학회 2017 Journal of computational design and engineering Vol.4 No.2
Mixed-Initiative-Systems (MIS)arehybriddecision-makingsystemsinwhichhumanandmachinecollaborateinordertoproduceasolution. This paperdescribedanMISadaptedtobusinessoptimizationproblems.Theseproblemscanusuallybesolvedinlessthananhourastheyshowa linearstructure.However,thisdelayisunacceptableforiterativeandinteractivedecision-makingcontextswhereusersneedtoprovidetheirinput. Therefore,weproposeasystemprovidingthedecision-makerswithaconvexhullofoptimalsolutionsthatminimize/maximizethevariables ofinterest.Theuserscaninteractivelymodifythevalueofavariableandthesystemisabletorecomputeanewoptimalsolutioninafew milliseconds.Fourreal-timereoptimizationmethodsaredescribedandevaluated.Wealsoproposeanimprovementtothisbasicschemeinorder toallowausertoexplorenear-optimalsolutionsaswell.Examplesshowingrealcaseofhowwehaveexploitedthisframeworkwithininteractive decisionsupportsoftwarearegiven.
Frigault Jonathan,Morin Geneviève,Drolet Sébastien,Bouchard Philippe,Bouchard Alexandre,Ngo Thanh-Quan Philips,Letarte François 대한대장항문학회 2023 Annals of Coloproctolgy Vol.39 No.4
Purpose: Transanal total mesorectal excision (TaTME) has been proposed to overcome surgical difficulties encountered during rectal resection, especially for patients having high body mass index or low rectal cancer. The aim of this study was to evaluate oncologic outcomes following TaTME. Methods: This retrospective study included all consecutive patients with rectal cancer who had a TaTME from 2013 to 2019. The main outcome was the incidence of locoregional recurrence by the end of the follow-up period. Results: Among a total of 81 patients, 96.3% were male, and their mean age was 63±9 years. The mean body mass index was 30.3±5.7 kg/m2, and the median distance from tumor to anal verge was 5.0 cm (interquartile range [IQR], 4.0–6.0 cm). Most patients had a low anterior resection performed (n=80, 98.8%) with a diverting ileostomy (n=64, 79.0%). Distal and circumferential resection margins were positive in 2.5% and 6.2% of patients, respectively. Total mesorectal excision was complete or near complete in 95.1% of patients. A successful resection was achieved in 72 patients (88.9%). After a median follow-up of 27.5 months (IQR, 16.7–48.1 months), 4 patients (4.9%) experienced locoregional recurrence. Anastomotic leaks were observed in 21 patients (25.9%). At the end of the follow-up, 69 patients (85.2%) were stoma-free. Conclusion: TaTME was associated with acceptable oncological outcomes, including low locoregional recurrence rates in selected patients with low rectal cancer. Although associated with a high incidence of postoperative morbidities, the use of TaTME enabled a high rate of successful sphincter-saving procedures in selected patients who posed a technical challenge.
Frigault Jonathan,Avoine Samuel,Drolet Sébastien,Letarte François,Bouchard Alexandre,Gagné Jean-Pierre,Thibault Claude,Grégoire Roger C.,Bouthillette Naomee Jutras,Gosselin Maude,Bouchard Philippe 대한대장항문학회 2023 Annals of Coloproctolgy Vol.39 No.2
Purpose: Laparoscopic right hemicolectomy (LRH) can be performed with an intracorporeal anastomosis (IA) or extracorporeal anastomosis (EA). It is not clear which technique is best. This study evaluated the impact of each anastomosis technique on perioperative safety and postoperative evolution. Methods: We performed a retrospective study at a tertiary colorectal surgery center. All patients who had an elective LRH from 2015 to 2019 were analyzed according to the anastomosis technique used. Results: In total, 285 patients were included in the study. IA was performed in 64 patients (22.5%). Mean operative time was longer in the patients with IA (IA, 160±31 minutes vs. EA, 138±42 minutes; P<0.001). No differences were observed in intraoperative complications, time to first bowel movement, length of stay, reoperation, or rehospitalization. Time to first flatus was longer in the patients with IA (P=0.049). At 30 days after surgery, there were no differences in the frequency of anastomotic leak (IA, 0% vs. EA, 2.3%; P=0.59), bleeding (IA, 3.1% vs. EA, 2.7%; P>0.99), or intraabdominal abscess (IA, 0% vs. EA, 0.5%; P>0.99). During follow-up, we noted more incisional hernias in patients with EA (IA, 1.6% vs. EA, 11.3%; P=0.01) and a trend toward more hernia in patients with EA in multivariate analysis (hazard ratio, 7.13; P=0.06). Anastomosis technique had no influence on recurrence. Conclusion: For LRH, both IA and EA are safe, with a low incidence of complications when performed by experienced surgeons. IA may be associated with a lower incidence of incisional hernia.