Antenatal sonographic assessment of cross sectional area of umbilical cord components and its reference value in normal pregnancy

Background: Measuring the cross-sectional area of umbilical components in normal pregnant women helps in assessing the fetal abnormalities. Very few literatures were available on evaluation of reference values of cross sectional areas of umbilical cord components. The present study was conducted with the aim to determine the normal reference values of cross sectional areas of umbilical arteries, umbilical vein and Wharton’s jelly and to correlate them with the gestational age of the fetus.Methods: A cross sectional study was conducted on 300 normal pregnant women at the Department of Radiodiagnosis, Sri Siddhartha Medical College, Tumakuru, Karnataka to assess the reference range of cross sectional areas of umbilical cord arteries, umbilical vein and Wharton’s jelly at different gestational age of the fetus to analyze their growth.Results: A statistically significant correlation was observed between cross sectional areas of umbilical artery and vein and gestational age before and after 34 weeks (p=0.005 and 0.006 respectively) but no significant correlation was noticed with the cross-sectional area of Wharton’s jelly (p=0.088).Conclusions: Cross sectional area measurements of umbilical cord components can be considered as important tools for estimation of fetal growth

Postoperative outcomes in oesophagectomy with trainee involvement

BACKGROUND: The complexity of oesophageal surgery and the significant risk of morbidity necessitates that oesophagectomy is predominantly performed by a consultant surgeon, or a senior trainee under their supervision. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on postoperative outcomes in an international multicentre setting. METHODS: Data from the multicentre Oesophago-Gastric Anastomosis Study Group (OGAA) cohort study were analysed, which comprised prospectively collected data from patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018. Procedures were grouped by the level of trainee involvement, and univariable and multivariable analyses were performed to compare patient outcomes across groups. RESULTS: Of 2232 oesophagectomies from 137 centres in 41 countries, trainees were involved in 29.1 per cent of them (n = 650), performing only the abdominal phase in 230, only the chest and/or neck phases in 130, and all phases in 315 procedures. For procedures with a chest anastomosis, those with trainee involvement had similar 90-day mortality, complication and reoperation rates to consultant-performed oesophagectomies (P = 0.451, P = 0.318, and P = 0.382, respectively), while anastomotic leak rates were significantly lower in the trainee groups (P = 0.030). Procedures with a neck anastomosis had equivalent complication, anastomotic leak, and reoperation rates (P = 0.150, P = 0.430, and P = 0.632, respectively) in trainee-involved versus consultant-performed oesophagectomies, with significantly lower 90-day mortality in the trainee groups (P = 0.005). CONCLUSION: Trainee involvement was not found to be associated with significantly inferior postoperative outcomes for selected patients undergoing oesophagectomy. The results support continued supervised trainee involvement in oesophageal cancer surgery

Un caso raro de inserción del coracobraquial asociada con variante del nervio músculocutáneo

We report a rare case of the tendinous insertion of coracobrachialis muscle which has not been reported in the literature. The insertion of the novel coraco-brachialis muscle is usually into the medial border of the humerus in a 3-5cm impression at the mid-shaft level. Contrary to this, in the present case, it was seen getting inserted as a sharp slender tendon in the middle of the medial border of the humerus.  Variable insertion of coracobrachialis muscle may be responsible for the causation of compression of surrounding structures like median nerve, musculocutaneous nerve, and brachial artery. This article aims to point out a rare case of the unusual tendinous insertion of coracobrachialis and its association with musculocutaneous nerve, providing necessary information to surgeons performing surgical reconstruction using coracobrachialis.  Presentamos un caso raro de inserción tendinosa del músculo coracobraquial que no se ha informado en la literatura. La inserción del nuevo músculo coraco-braquial generalmente se realiza en el borde medial del húmero en una impresión de 3-5 cm a nivel del eje medio. Contrariamente a esto, en el presente caso, se observó que se insertaba como un tendón delgado y afilado en el medio del borde medial del húmero. La inserción variable del músculo coracobraquial puede ser responsable de la causa de la compresión de las estructuras circundantes, como el nervio mediano, el nervio musculocutáneo y la arteria braquial. Este artículo tiene como objetivo señalar un caso raro de la inserción tendinosa inusual del coracobraquial y su asociación con el nervio musculocutáneo, brindando la información necesaria a los cirujanos que realizan la reconstrucción quirúrgica usando el coracobraquial

Configuración anatómica diversa del nervio ilioinguinal en relación con el nervio cutáneo femoral lateral

The variability in the formation of Ilioinguinal nerve has been documented in the literature especially related to iliohypogastric nerve. But so far very few cadaveric studies have been documented on variation in the branches of ilioinguinal nerve. A case presented which demonstrates aberrancy of its anatomic position. Although the course of ilioinguinal nerve has been well known, nostudies or report have demonstrated a course in relation to lateral femoral cutaneous nerve. This case report serves as a warning to the surgeon to be aware of such bizarre presentation since the consequences of iatrogenic injury to such structures may be serious.La variabilidad en la formación del nervio ilioinguinal ha sido documentada en la literature especialmente relacionada con el nervio iliohipogástrico. Pero hasta ahora se han  documentado muy pocos estudios cadavéricos sobre la variación en las ramas del nervio ilioinguinal. Se presenta un caso que demuestra una aberrancia de su posición anatómica. Aunque el curso del nervio ilioinguinal es bien conocido, ningún estudio ha documentado una variación de su curso en relación con el nervio cutáneo femoral lateral. Este informe de caso sirve como una advertencia al cirujano para que esté al tanto de una presentación tan extraña, ya que las consecuencias de la lesion iatrogénica en tales estructuras pueden ser graves

Design of Aquila Optimization Heuristic for Identification of Control Autoregressive Systems

Swarm intelligence-based metaheuristic algorithms have attracted the attention of the research community and have been exploited for effectively solving different optimization problems of engineering, science, and technology. This paper considers the parameter estimation of the control autoregressive (CAR) model by applying a novel swarm intelligence-based optimization algorithm called the Aquila optimizer (AO). The parameter tuning of AO is performed statistically on different generations and population sizes. The performance of the AO is investigated statistically in various noise levels for the parameters with the best tuning. The robustness and reliability of the AO are carefully examined under various scenarios for CAR identification. The experimental results indicate that the AO is accurate, convergent, and robust for parameter estimation of CAR systems. The comparison of the AO heuristics with recent state of the art counterparts through nonparametric statistical tests established the efficacy of the proposed scheme for CAR estimation

Design of Aquila Optimization Heuristic for Identification of Control Autoregressive Systems

Swarm intelligence-based metaheuristic algorithms have attracted the attention of the research community and have been exploited for effectively solving different optimization problems of engineering, science, and technology. This paper considers the parameter estimation of the control autoregressive (CAR) model by applying a novel swarm intelligence-based optimization algorithm called the Aquila optimizer (AO). The parameter tuning of AO is performed statistically on different generations and population sizes. The performance of the AO is investigated statistically in various noise levels for the parameters with the best tuning. The robustness and reliability of the AO are carefully examined under various scenarios for CAR identification. The experimental results indicate that the AO is accurate, convergent, and robust for parameter estimation of CAR systems. The comparison of the AO heuristics with recent state of the art counterparts through nonparametric statistical tests established the efficacy of the proposed scheme for CAR estimation

Dwarf Mongoose Optimization Metaheuristics for Autoregressive Exogenous Model Identification

Nature-inspired metaheuristic algorithms have gained great attention over the last decade due to their potential for finding optimal solutions to different optimization problems. In this study, a metaheuristic based on the dwarf mongoose optimization algorithm (DMOA) is presented for the parameter estimation of an autoregressive exogenous (ARX) model. In the DMOA, the set of candidate solutions were stochastically created and improved using only one tuning parameter. The performance of the DMOA for ARX identification was deeply investigated in terms of its convergence speed, estimation accuracy, robustness and reliability. Furthermore, comparative analyses with other recent state-of-the-art metaheuristics based on Aquila Optimizer, the Sine Cosine Algorithm, the Arithmetic Optimization Algorithm and the Reptile Search algorithm—using a nonparametric Kruskal–Wallis test—endorsed the consistent, accurate performance of the proposed metaheuristic for ARX identification

Nonlinear Hammerstein System Identification: A Novel Application of Marine Predator Optimization Using the Key Term Separation Technique

The mathematical modelling and optimization of nonlinear problems arising in diversified engineering applications is an area of great interest. The Hammerstein structure is widely used in the modelling of various nonlinear processes found in a range of applications. This study investigates the parameter optimization of the nonlinear Hammerstein model using the abilities of the marine predator algorithm (MPA) and the key term separation technique. MPA is a population-based metaheuristic inspired by the behavior of predators for catching prey, and utilizes Brownian/Levy movement for predicting the optimal interaction between predator and prey. A detailed analysis of MPA is conducted to verify the accurate and robust behavior of the optimization scheme for nonlinear Hammerstein model identification