Background
This study was designed to explore the role of transcystic bile duct exploration (TCE) as a first line of treatment for patients with suspected or incidental common bile duct (CBD) stones.
...Methods
A prospective, case-control study of clinically comparable groups of patients who underwent laparoscopic cholecystectomy (LC) alone (
n
= 1,854) and combined LC/TCE for CBD stones (
n
= 253) under the care of one surgeon was performed. Other than ultrasonography, no routine preoperative imaging was used; however, we performed routine intraoperative cholangiography on all patients.
Results
There was no difference in age (49 ± 15 vs. 57 ± 19,
p
= 0.7), sex (79% vs. 82% females,
p
= 0.6), and ASA grade (1.9 ± 1 vs. 1.8 ± 1,
p
= 0.7). A larger proportion of the TCE group presented as an emergency (TCE 45% vs. LC alone 27%,
p
= 0.03) and more often presented with acute biliary pain compared with LC alone (27% vs. 13%,
p
= 0.02). Although a majority of the patients in the TCE group had clinical or biochemical risk factors for CBD stones (86%), only 27% had suspected stones on preoperative ultrasound. The incidence of jaundice (6% vs. 20%,
p
= 0.01) was lower in the LC alone group compared with TCE patients. Previous abdominal surgery was noted in 34% patients who underwent LC alone and 30% in LC/TCE (
p
= 0.06). Significantly there was no difference in open conversion between the two groups (LC alone 0.5% vs. LC/TCE 0.6%,
p
= 0.07). Comparison of selected outcome parameters for LC versus TCE showed a postoperative hospital stay of 2 (1–14) vs. 2 (1–17) days (
p
= 0.07), presentation to resolution 1 (1–11) vs. 1 (1–11) weeks (
p
= 0.07), and morbidity 1.07% vs. 1.2% (
p
= 0.07).
Conclusions
The study advocates single-session laparoscopic cholecystectomy with transcystic CBD exploration as a feasible first choice treatment and the logical next step in the management of patients with CBD stones.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
This investigation explored the impact of dietary frankincense resin oil (FO) on growth performance parameters, intestinal histomorphology, fatty acid composition of the breast muscle, and the immune ...status of broilers. We allotted 400, three-day-old, male chicks (Ross 308 broiler) into four treatment groups (ten replicates/group; ten chicks/replicate). They were fed a basal diet with different concentrations of FO (0, 200, 400, and 600 mg kg
). FO supplementation increased the overall body weight (BW) and body weight gain (BWG) by different amounts, linearly improving the feed conversion ratio with the in-supplementation level. Total feed intake (TFI) was not affected. Growth hormones and total serum protein levels also linearly increased with the FO level, while albumin was elevated in the FO600 group. Moreover, total globulins increased linearly in FO400 and FO600 treatment groups. Thyroxin hormone (T3 and T4) levels increased in all FO treatment groups without affecting glucose and leptin serum values. Different concentrations of FO supplementation in the diet increased the activities of Complement 3, lysozyme, and interleukin 10 levels in the serum. Dietary FO in broilers increased the total percentage of n-3 and n-6 fatty acids. It also increased the ratio of n-3 to n-6 linearly and quadratically. Additionally, FO supplementation led to the upregulation of immune clusters of differentiation 3 and 20 (CD3 and CD20) in the spleen, along with improving most of the morphometric measures of the small intestine. In conclusion, FO up to 600 mg kg
as a feed additive in broiler chicken production is valuable for promoting their growth, intestinal histomorphology, and immune status along with enriching breast muscle with polyunsaturated fatty acids (PUFA).
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Urban expansion is undergoing rapid growth, prompting several nations to create financial and administrative capitals outside congested urban areas, leaving the existing buildings unoccupied. To ...investigate the possibilities of changing the real estate’s usage, the owners of these existing buildings turned to feasibility study experts for assistance in making the optimum alternatives. An integrated framework between value engineering and building information modeling, especially appropriate for existing buildings, is required to aid decision-makers in selecting the best options for current building utilization. Previous studies only investigated the value engineering alternatives during the design phase, when they decided to reduce project costs using construction materials alternatives. Still, they overlooked existing building alternatives in terms of changing the kind of usage of such buildings. So, they need an integrated model between value engineering and building information modeling, especially applicable to an existing structure, to determine the optimum usage type for the existing building. Value engineering and building information modeling must be connected to profit from both outputs simultaneously. And used the multi-criteria decision-analysis method. Today’s analytic hierarchy process is the most widely used. This paper provides an integrated framework between value engineering and building information modeling that can be applied to existing buildings to assist in determining the best alternative in terms of the type of usage for such existing structures by conducting BIM methodologies such as a feasibility study which includes present value, cash flow and the bank interest rate, and BIM software such as Revit and Primavera. The multi-criteria decision analysis method was used to focus on what is important, logical, consistent, and easy to use. MCDA which considered a process for evaluating options with conflicting criteria and choosing the best solution, similar to a cost–benefit analysis, but evaluates numerous criteria rather than just cost. The findings revealed that this integrated framework, which includes feasibility studies and comparison tables, may be implemented in the future while taking into account time and location constraints.
This study aimed to investigate the impact of dietary addition of lavender essential oil (Lavandula angustifolia L.) (LEO) on the growth performance, tissue histoarchitecture, and fatty acid profile ...in breast muscles, as well as blood biochemistry and immune expression of pro-inflammatory cytokines of broiler chickens. A total of 200 three-day-old broiler chickens (average body weight 101.3 ± 0.24 g) were assigned to a completely randomized design consisting of four dietary treatments (n = 50 per treatment, each replicate consisting of 10 birds) that included lavender essential oil at concentrations of 0 (control group), 200, 400, and 600 mg Kg−1 diet. The experiment lasted for 35 days. The results revealed that supplementation of lavender essential oil at 200, 400, or 600 mg/kg in broiler diets had no effect (p > 0.05) on the growth performance throughout the experimental periods (3−10, 11−23, and 24−35 days of age). According to the broken line regression model, the optimal level for dietary LEO addition was the 460 mg kg−1 diet based on the total body weight gain and feed conversion ratio results. The diets supplemented with lavender essential oil had no effect (p > 0.05) on the percentages of carcass yield or internal organs. Dietary addition of LEO significantly increased the percentages of omega-3 polyunsaturated fatty acids PUFA (n-3), omega-6 polyunsaturated fatty acids (n-6), and the n-3/n-6 ratio (p < 0.05) in the breast muscles of chickens in a level-dependent manner. The blood concentration of alanine aminotransferase was significantly increased in lavender essential oil at 600 mg kg−1 compared with other treatments. The dietary addition of LEO at 200, 400, and 600 mg kg−1 significantly reduced the malondialdehyde level. Still, they significantly increased the serum enzyme activities of total antioxidant capacity, catalase, superoxide dismutase, and the pro-inflammatory cytokine (interleukine-1 beta and interferon γ) compared with the unsupplemented group. The LEO-supplemented groups showed normal liver histomorphology as in the control group. However, the immunoexpression of the pro-inflammatory cytokine transforming growth factor β was significantly increased by increasing the level of LEO. It can be concluded that lavender essential oil can be included in broiler chicken diets up to 460 mg kg −1 with no positive effect on the bird’s growth. It can improve the antioxidant capacity and enrich the breast muscles with PUFA. An increased level of supplementation (600 mg kg−1) increased the inflammatory responses in broiler chickens.
Semiparametric MEWMA for Phase II profile monitoring Nassar, Sara H.; Abdel‐Salam, Abdel‐Salam G.
Quality and reliability engineering international,
July 2021, 2021-07-00, 20210701, Volume:
37, Issue:
5
Journal Article
Peer reviewed
Open access
A control chart is one of the statistical process techniques that is used to monitor different processes. Some processes are characterized by functions or profiles, and a profile is a functional ...relationship between the dependent and independent variable(s) used to monitor the quality of the process. Several research studies were conducted on linear profiling where only fixed effects are considered. However, in this research, we focus on random effects as they represent the differences between profiles and thus are more proper for interpretation. Two approaches are proposed in this study for Phase II profile monitoring; the first approach is the nonparametric via residuals and the second is the semiparametric approach, where this technique combines the parametric estimates with a portion of the nonparametric estimates to the residuals. Usually, parametric estimations lead to biased estimates when the model is misspecified, whereas nonparametric estimates may give high variances, and thus semiparametric estimates are preferred. New nonparametric and semiparametric multivariate exponential weighted moving average (MEWMA) control charts are introduced and their performances compared to the parametric approach for different samples and shift sizes, and the correlation between and within profiles was considered. The average run length (ARL) and average time to signal (ATS) criteria are used for choosing the best approach. Simulation studies and real datasets were utilized for comparing the performance of the proposed MEWMA charts.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
The aim of this paper is to compute all the Frenet apparatus of non-transversal intersection curves (hyper-curves) of three implicit hypersurfaces in Euclidean 4-space. The tangential direction at a ...transversal intersection point can be computed easily, but at a non-transversal intersection point, it is difficult to calculate even the tangent vector. If three normal vectors are parallel at a point, the intersection is “tangential intersection”; and if three normal vectors are not parallel but are linearly dependent at a point, we have “almost tangential” intersection at the intersection point. We give algorithms for each case to find the Frenet vectors (t,n,b1,b2) and the curvatures (k1,k2,k3) of the non-transversal intersection curve.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Many studies were conducted for fitting models using parametric and non‐parametric techniques; in fact, their fits may be biased and have inflated the estimated variances when the model is ...misspecified, respectively. Thus, semi‐parametric techniques are used for fitting models as they combine the advantages of parametric and non‐parametric fits. In this study, we introduce model robust regression technique‐2 (MRR2) for Phase II profile monitoring, namely, the semi‐parametric approach, where it is a combination of the parametric fit with a portion of a non‐parametric residuals fit. Multivariate CUSUM (MCUSUM) chart unitized for monitoring the slope of the linear mixed models in Phase II based on the random‐effects. A comprehensive simulation study was performed to evaluate the proposed approach for correlated and uncorrelated profiles assuming different profile sizes, sample sizes, and several model misspecification levels. Average run length (ARL) and average time to signal (ATS) criteria were used for comparing the performances of the parametric, non‐parametric, and semi‐parametric MCUSUM charts. The results showed that the semi‐parametric chart had the best performance in detecting different shifts. Also, a real data application was conducted, where it showed that the semi‐parametric chart had the highest sensitivity for the out‐of‐control scenarios.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
In this paper, we consider the problem of how to compute the Frenet apparatus of the non-transversal intersection curves (hyper-curves) of three hypersurfaces (given by their ...implicit-implicit-parametric and implicit-parametric-parametric equations) in Euclidean 4-space. The non-transversal intersection (in which the normal vectors of the intersecting hypersurfaces are linearly dependent) includes two different cases. In each case, on the contrary to transversal intersections, we face some difficulties even finding the tangential direction. To overcome such difficulties, we give some algorithms for finding all Frenet vectors and curvatures of the intersection curve. Finally, we demonstrate our methods by giving several examples.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Many real estate owners change the building in terms of the type of usage in response to changes in economic conditions and the requirements of the surrounding environment to get the best potential ...financial return. To investigate the possibilities of changing the real estate's usage, the owners of these existing structures turned to feasibility study experts for assistance in making the optimum alternatives. So, they need an integrated model between VE and BIM, especially applicable to an existing structure, to determine the optimum usage type for the existing structure. Value Engineering (VE) and Building Information Modeling (BIM) must be connected to profit from both outputs simultaneously. Previous studies only investigated the VE alternatives during the design phase; when they decided to reduce project costs by using construction materials alternatives, they ignored existing structure alternatives significantly when changing the usage type. This study attempts to provide an integrated model between VE and BIM that can be applied to the existing structure to assist in determining the best alternative in terms of the type of usage for such existing structures by conducting BIM methodology such as a feasibility study, including BIM software such as Revit and Primavera. A feasibility study that contains the bank rate of interest. As a result, the maximum financial return is obtained based on predetermined criteria and in compliance with decision-making requirements. Doi: 10.28991/CEJ-2022-08-08-06 Full Text: PDF
Despite a higher risk of classical Hodgkin lymphoma (cHL) in people with HIV and the demonstrated safety and efficacy of PD-1 blockade in cHL, there are limited data on the use of these agents in ...HIV-associated cHL (HIV-cHL).
We retrospectively identified patients with HIV-cHL from the “Cancer Therapy using Checkpoint inhibitors in People with HIV-International (CATCH-IT)” database who received nivolumab or pembrolizumab, alone or in combination with other agents, and reviewed records for demographics, disease characteristics, immune-mediated adverse events (imAEs), and treatment outcomes. Changes in CD4+ T-cell counts with treatment were measured via Wilcoxon signed-rank tests. Overall response rate (ORR) was defined as the proportion of patients with partial or complete response (PR/CR) per 2014 Lugano classification.
We identified 23 patients with HIV-cHL who received a median of 6 cycles of PD-1 blockade: 1 as 1st-line, 6 as 2nd-line, and 16 as ≥3rd-line therapy. Seventeen (74%) patients received monotherapy, 5 (22%) received nivolumab plus brentuximab vedotin, and 1 received nivolumab plus ifosfamide, carboplatin, and etoposide. The median baseline CD4+ T-cell count was 155 cells/µL, which increased to 310 cells/µL at end-of-treatment (P = .009). Three patients had grade 3 imAEs; none required treatment discontinuation. The ORR was 83% with median duration of response of 19.7 months. The median progression-free survival was 21.2 months and did not differ between patients with <200 versus ≥200 CD4+ cells/µL (P = .95).
Our findings support the use of PD-1 blockade in HIV-cHL for the same indications as the general population with cHL.
There are limited data on PD-1 blockade in HIV-associated classical Hodgkin lymphoma (HIV-cHL). We retrospectively identified 23 patients with HIV-cHL safely treated with PD-1 blockade with a response rate of 83% that did not differ by CD4+ T-cell count. Our data support the use of PD-1 blockade in HIV-cHL for the same indications as the general population with cHL.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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