Combined parasacral, vaginal and endorectal approach in surgical treatment of giant rectocele

Authors operated on their Surgical departement 67 years old women with incomplete evacuation, and digital support during defecation, giant rectocele and massive vaginal vault prolaps. Authors realized cinedefecography and detected giant rectocele, depth was 8 cm, anorectal angle was 120 degrees. They stated Resting pressure 40 cm H2O, and Maximum squeeze pressure 50cm H2O by anorectal manometry. Authors verified external anal sphincters defect by endoanal ultrasound and determined Pudendal nerve terminal motor latency (PN TML) and recorded pathologic values of n.pudendal latency ( left branch 2,7 msec., right branch 4,3 msec). In concerning massive vaginal vault prolaps, huge rerectocele and clinical incompletely evacuation with self digital support during defecation with present defect od external anal sphincters and pathologic values of PN TML, authors indicated and made combined transvaginal, endorectal and perineal reconstructive operative performance. In the present time two years after the surgery radiologic mean depth of the rectocele was significantly reduced (preoperatively 8cm; postoperatively 1 cm). Anorectal angle is 100 degrees. Values of the PN TML is normaly (left branch of n. pudendalis 1,7 msec and right branch of n. pudendalis 1,9 msec). Authors recorded Resting pressure 60 cm H2O and Maximum squeeze pressure 110 cm H2O by anorectal manometry. They didnt visualized any external anal sphincters defect by anal ultrasound. Postoperatively difficult evacuation completely disappeared and digital support was no longer necessary during evacuation

Calibration of microscopic traffic flow simulation models using a memetic algorithm with solis and wets local search chaining (MA-SW-Chains)

Traffic models require calibration to provide an adequate representation of the actual field conditions. This study presents the adaptation of a memetic algorithm (MA-SW-Chains) based on Solis and Wets local search chains, for the calibration of microscopic traffic flow simulation models. The effectiveness of the proposed MA-SW-Chains approach was tested using two vehicular traffic flow models (McTrans and Reno). The results were superior compared to two state-of-the-art approaches found in the literature: (i) a single-objective genetic algorithm that uses simulated annealing (GASA), and (ii) a stochastic approximation simultaneous perturbation algorithm (SPSA). The comparison was based on tuning time, runtime and the quality of the calibration, measured by the GEH statistic (which calculates the difference between the counts of real and simulated links)