Impact of referral pattern and timing of repair on surgical outcome after reconstruction of post-cholecystectomy bile duct injury:A multicenter study

Background:Bile duct injury(BDI)after cholecystectomy remains a significant surgical challenge.No guideline exists to guide the timing of repair,while few studies compare early versus late repair BDI.This study aimed to analyze the outcomes in patients undergoing immediate,intermediate,and delayed repair of BDI.Methods:We retrospectively analyzed 412 patients with BDI from March 2015 to January 2020.The patients were divided into three groups based on the time of BDI reconstruction.Group 1 underwent an immediate reconstruction(within the first 72 hours post-cholecystectomy,n=156);group 2 underwent an intermediate reconstruction(from 4 days to 6 weeks post-cholecystectomy,n=75),and group 3 underwent delayed reconstruction(after 6 weeks post-cholecystectomy,n=181).Results:Patients in group 2 had significantly more early complications including anastomotic leakage and intra-abdominal collection and late complications including anastomotic stricture and secondary liver cirrhosis compared with groups 1 and 3.Favorable outcome was observed in 111(71.2%)patients in group 1,31(41.3%)patients in group 2,and 157(86.7%)patients in group 3(P=0.0001).Multivariate analysis identified that complete ligation of the bile duct,level E1 BDI and the use of external stent were independent factors of favorable outcome in group 1,the use of external stent was an independent factor of favorable outcome in group 2,and level E4 BDI was an independent factor of unfavorable outcome in group 3.Transected BDI and level E4 BDI were independent factors of unfavorable outcome.Conclusions:Favorable outcomes were more frequently observed in the immediate and delayed reconstruction of post-cholecystectomy BDI.Complete ligation of the bile duct,level E1 BDI and the use of external stent were independent factors of a favorable outcome.

Map Aided Pedestrian Dead Reckoning Using Buildings Information for Indoor Navigation Applications

Navigation systems play an important role in many vital disciplines. Determining the location of a user relative to its physical environment is an important part of many indoor-based navigation services such as user navigation, enhanced 911 (E911), law enforcement, location-based and marketing services. Indoor navigation applications require a reliable, trustful and continuous navigation solution that overcomes the challenge of Global Navigation Satellite System (GNSS) signal unavailability. To compensate for this issue, other navigation systems such as Inertial Navigation System (INS) are introduced, however, over time there is a significant amount of drift especially in common with low-cost commercial sensors. In this paper, a map aided navigation solution is developed. This research develops an aiding system that utilizes geospatial data to assist the navigation solution by providing virtual boundaries for the navigation trajectories and limits its possibilities only when it is logical to locate the user on a map. The algorithm develops a Pedestrian Dead Reckoning (PDR) based on smart-phone accelerometer and magnetometer sensors to provide the navigation solution. Geospatial model for two indoor environments with a developed map matching algorithm was used to match and project navigation position estimates on the geospatial map. The developed algorithms were field tested in indoor environments and yielded accurate matching results as well as a significant enhancement to positional accuracy. The achieved results demonstrate that the contribution of the developed map aided system enhances the reliability, usability, and accuracy of navigation trajectories in indoor environments.

Beef Meat Allergy in Cow’s Milk Allergic Adults

Milk has been recognized as a leading cause of food allergy in children;however, studies on cow’s milk allergy (CMA) in adults are scanty. The known cross-reactivity of bovine serum albumin and bovine γ-globulin which are present in both milk and beef is recognized, so that, patients with allergy to cow’s milk are often instructed to avoid beef. Our Objective was to determine the prevalence of allergy to beef meat in adult patients with allergy to cow’s milk. Thirty adults with CMA were included in the study. The diagnosis of cow’s milk and beef allergy was based on a thorough history concerning type of allergic symptoms and its link to the ingestion of milk and beef supported by skin prick test (SPT) with fresh milk and raw beef extracts and by determination of their serum specific IgE by enzyme linked immuosorbant assay (ELISA). Finally, cross reactivity test between milk and meat was performed. Three of 30 patients (10%) evaluated for CMA were found to have symptomatic sensitivity to beef, 2 gave urticarial symptoms and one gave gastrointestinal symptoms. Six patients (20%) had a positive SPT response to beef. On the other hand, beef specific IgE were positive in 18 CMA patients (60%). Concordance of positive specific IgE and SPT to meat was found in only 5 patients (17%). Mean cross reactivity between milk and beef was 31.6 ± 13.1% among studied patients. Patients allergic to milk protein are not necessarily to be allergic to beef, so, elimination of beef from the diet of adults with CMA should not be done except after investigations so as not to lose its nutritional value without benefit.