Superior Technique Research Articles

Single Surgeon Comparison of Midline Versus Overlapping Locoregional Flap Closure Following Spinal Instrumentation

BackgroundTwo techniques for paraspinous muscle flap closure of spine surgeries have been described: one with tension-free mobilization of the muscle flaps approximated at the midline and one with perforators more aggressively dissected to allow for overlapping of the flaps. We seek to compare the surgical outcomes in patients who underwent either type of complex spinal closure as no investigation has yet evaluated a superior technique. MethodsAn IRB-approved retrospective analysis was conducted on all patients who underwent spine surgery followed by locoregional muscle flap complex closure performed by a single plastic surgeon between January 2016 and July 2021. Patients were divided into two groups based on which closure method was employed. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed by multivariable logistic regression with Firth’s correction. Results110 patients with similar baseline demographics were included. There were significantly more smokers (15% vs. 0%, p = 0.02) and a significantly greater rate of post-operative radiation (40% vs. 17%, p = 0.009) in the overlapping group. After controlling for smoking and post-operative radiation, the incidence of surgical site infection, skin necrosis, dehiscence, hematoma, and seroma did not differ between the groups. The procedure length per centimeter of closure was shorter in the midline approximation group, although this data fell just short of significance (3.2 vs. 3.8 minutes/cm, p = 0.08). ConclusionThe present study demonstrates that both the overlapping and midline approximation of muscle flaps are equally safe and effective strategies for locoregional closure of spinal wounds.

Unveiling Insights: A Knowledge Discovery Approach to Comparing Topic Modeling Techniques in Digital Health Research

This paper introduces a knowledge discovery approach focused on comparing topic modeling techniques within the realm of digital health research. Knowledge discovery has been applied in massive data repositories (databases) and also in various field studies, which use these techniques for finding patterns in the data, determining which models and parameters might be suitable, and looking for patterns of interest in a specific representational. Unfortunately, the investigation delves into the utilization of Latent Dirichlet Allocation (LDA) and Pachinko Allocation Models (PAM) as generative probabilistic models in knowledge discovery, which is still limited. The study's findings position PAM as the superior technique, showcasing the greatest number of distinctive tokens per topic and the fastest processing time. Notably, PAM identifies 87 unique tokens across 10 topics, surpassing LDA Gensim's identification of only 27 unique tokens. Furthermore, PAM demonstrates remarkable efficiency by swiftly processing 404 documents within an incredibly short span of 0.000118970870 seconds, in contrast to LDA Gensim's considerably longer processing time of 0.368770837783 seconds. Ultimately, PAM emerges as the optimum method for digital health research's topic modeling, boasting unmatched efficiency in analyzing extensive digital health text data.

Modified trichrome stain for faster and improved detection of intestinal protozoan parasites.

Permanent stains such as trichrome have better sensitivity but are time-consuming and the fixative includes toxic mercuric chloride. Thus, a newer modification was tested and found to be a superior, faster and safer staining technique for intestinal parasitic detection. Our study lasted 9 months and a single stool sample was collected from each enrolled patient. We evaluated classical trichrome (T1 - using Schaudinn fixative) with newer modifications, which involved different fixatives with mordant combinations (T2 - acetic acid + hydrated aluminium sulphate, T3 - citric acid + copper sulphate hydrate). Conventional PCR targeting Entamoeba histolytica, Giardia lamblia and Cryptosporidium spp. was taken as the reference. Out of 175 stool samples, 25.1% protozoa were identified by wet mount, 24% by each T1 and T2, 25.7% by T3. Statistically, T3 and T2 had higher sensitivity as compared to T1 and wet mount when PCR was used as reference.

Infiltration of local anesthetic in the Interspace between the popliteal artery and capsule of the posterior knee "IPACK block" versus adductor canal block "ACB" for pain relief after open wedge high tibial osteotomy: a randomized clinical trial.

A high tibial osteotomy is usually associated with severe postoperative pain. Both adductor canal block (ACB) and interspace between the popliteal artery and capsule of the posterior knee (IPACK) have been described as effective block techniques for providing analgesia after knee surgeries, with few comparisons in wedge osteotomy cases. We aim to compare the postoperative analgesic profile of the previously mentioned two block techniques in patients undergoing tibial osteotomies. Sixty patients were enrolled in this randomized prospective trial (30 received IPACK and 30 received ACB). Both blocks were installed before the spinal anesthesia after infiltration of 2 mL lidocaine 2%. Twenty mL of bupivacaine 0.25% mixed with dexamethasone as anesthetic adjuvant were used for both blocks. The postoperative analgesic profiles were compared between the two groups. Postoperative pain scores were lower in the IPACK group, and that decrease was evident throughout the first 10 hours postoperatively. Additionally, the duration of analgesia was much prolonged with the same block (487.50±82.39 vs. 301.93±92.06 minutes with ACB). There was a significant decline in postoperative analgesic consumption (1.27±0.45 vs. 1.8±0.61 gm, P=0.000), and a significant increase in the ambulation distance (19.10±0.60 vs. 17.73±0.45 m, P=0.000) with a significant decline in the duration of hospitalization (43.27±7.61 vs. 54±8.35 hours) in the IPACK group compared to the ACB group. IPACK is a superior block technique compared to ACB in patients undergoing high tibial osteotomy regarding postoperative analgesia, ambulation distance, and patient satisfaction with little rate of adverse events in both groups.

Robotic True D3 Lymph Node Dissection With Superior Mesenteric Vein-Taping Technique for Right-Sided Colon Cancer.

D3 is unaffected by anatomic factors even when the ileocolic artery runs along the dorsal side of the superior mesenteric vein. Complete "true D3" lymph node dissection in minimally invasive surgery for right-sided colon cancer could be beneficial for certain patients with lymph node metastases. The study aimed to determine the safety and feasibility of robotic true D3 lymph node dissection for right-sided colon cancer using a superior mesenteric vein-taping technique. The superior mesenteric vein was slowly and gently separated from the surrounding tissues and taped. Lifting the tape with the robotic third arm and fixing it in place using rock-stable tractions provides a good surgical view, which cannot otherwise be obtained. As a result, the ileocolic artery that branches from the superior mesenteric artery can be accurately exposed. Handling of the taping then enables expansion to a different surgical view. As the lymph nodes are originally concealed on the dorsal side of the superior mesenteric vein, this technique provides a good view for lymph node dissection. The root of the ileocolic artery was clipped and separated, and true D3 was thus completed. Fourteen patients underwent robotic true D3 lymph node dissection for right-sided colon cancer. No Clavien-Dindo classification grade II or higher intraoperative or postoperative complications were observed. The 30-day mortality rate was 0%. Our robotic true D3 lymph node dissection with superior mesenteric vein-taping technique is considered safe and feasible; it might be a promising surgical procedure for treating advanced right-sided colon cancer. Even when the ileocolic artery runs along the dorsal aspect of the superior mesenteric vein, the technique seems promising for facilitating robotic D3 lymph node dissection.

Recent Phenomenal and Investigational Subsurface Landslide Monitoring Techniques: A Mixed Review

Landslides are a common and challenging geohazard that may be caused by earthquakes, rainfall, or manmade activity. Various monitoring strategies are used in order to safeguard populations at risk from landslides. This task frequently depends on the utilization of remote sensing methods, which include the observation of Earth from space, laser scanning, and ground-based interferometry. In recent years, there have been notable advancements in technologies utilized for monitoring landslides. The literature lacks a comprehensive study of subsurface monitoring systems using a mixed review approach that combines systematic and scientometric methods. In this study, scientometric and systematic analysis was used to perform a mixed review. An in-depth analysis of existing research on landslide-monitoring techniques was conducted. Surface-monitoring methods for large-scale landslides are given first. Next, local-scale landslide subsurface monitoring methods (movement, forces and stresses, water, temperature, and warning signs) were examined. Next, data-gathering techniques are shown. Finally, the physical modeling and prototype field systems are highlighted. Consequently, key findings about landslide monitoring are reviewed. While the monitoring technique selection is mainly controlled by the initial conditions of the case study, the superior monitoring technique is determined by the measurement accuracy, spatiotemporal resolution, measuring range, cost, durability, and applicability for field deployment. Finally, research suggestions are proposed, where developing a superior distributed subsurface monitoring system for wide-area monitoring is still challenging. Interpolating the complex nonlinear relationship between subsurface monitoring readings is a clear gap to overcome. Warning sign systems are still under development.

Therapeutic approaches of diametaphyseal radius fractures in children.

There are clear standards for when to operate on both distal epiphyseal and diaphyseal forearm fractures in children. However, paediatric surgeons are often faced with fractures in the transition zone between metaphysis and diaphysis. This aim of the study is to compare different treatment approaches for diametaphyseal forearm fractures, to classify different types of these fractures, and to define further assessment parameters and treatment recommendations. This retrospective study included all patients with diametaphyseal radial fractures who were seen at a paediatric surgery clinic between 01.01.2010 and 31.12.2013. Patients were treated either non-surgically (C) or surgically using bicortical Kirschner wire (BC-KW), intramedullary K-wire (IM-KW), elastic stable intramedullary nailing (ESIN), or combined bicortical and intramedullary K-wire (BCIM-KW). During the study period, 547 patients presented with forearm fractures of which 88 patients (16%) had a fracture in the diametaphyseal region. The majority of diametaphyseal fractures were greenstick fractures (54.4%) followed by transverse fractures (44.3%). Distal fractures were predominantly treated with bicortical K-wiring (BC-KW, 40.5%) or non-surgically (C, 26.2%). Proximal fractures were treated by ESIN osteosynthesis (50%), followed by IM-KW (30%). Intermediate fractures were just as likely to be treated with one out of the 5 above-mentioned techniques. The ulna was involved in 64 of 88 cases. Depending on the type of fracture, it was treated either by ESIN osteosynthesis or non-surgically. No superior operative technique was identified. The description of diametaphyseal fractures as a separate entity is important, because the therapy of these fractures is heterogeneous and challenging. A classification into proximal, intermediate, and distal may be useful in clinical decision-making. Despite the retrospective nature of this study, our data suggest that the use of a K-wire or combined technique BCIM-KW-technique, whenever technically feasible, achieves better radiological results without secondary dislocation. Further prospective studies are needed to provide better guidance to trauma surgeons.

Favour the best in case of emergency cricothyroidotomy-a randomized cross-over trial on manikin focused training and simulation of common devices.

Performing an emergency cricothyroidotomy (EC) is extremely challenging, the devices used should be easy to handle and the selected technique reliable. However, there is still an ongoing debate concerning the most superior technique. Three different techniques were compared using a standardized, simulated scenario regarding handling, performing, training and decision making: The scalpel-bougie technique (SBT), the surgical anatomical preparation technique (SAPT) and the Seldinger technique (ST). First, anaesthesia residents and trainees, paramedics and medical students (each group n = 50) performed a cricothyroidotomy randomly assigned with each of the three devices on a simulator manikin. The time needed for successful cricothyroidotomy was the primary endpoint. Secondary endpoints included first-attempt success rate, number of attempts and user-satisfaction. The second part of the study investigated the impact of prior hands-on training on both material selection for EC and on time to decision-making in a simulated "cannot intubate cannot ventilate" situation. The simulated scenario revealed that SBT and SAPT were significantly faster than percutaneous EC with ST (p < 0.0001). Success rate was 100% for the first attempt with SBT and SAPT. Significant differences were found with regard to user-satisfaction between individual techniques (p < 0.0001). In terms of user-friendliness, SBT was predominantly assessed as easy (87%). Prior training had a large impact regarding choice of devises (p < 0.05), and time to decision making (p = 0.05; 180 s vs. 233 s). This study supports the use of a surgical technique for EC and also a regular training to create familiarity with the materials and the process itself.The trial was registered before study start on 11.11.2018 at ClinicalTrials.gov (NCT: 2018-13819) with Nicole Didion as the principal investigator.

Superior versus inferior conjunctival rotational flap in primary pterygium surgery

Background Conjunctival rotational flap is one of the surgical treatment options for pterygium with variable recurrence rates. Taking a conjunctival flap from the superior bulbar area is sometimes unfeasible due to scarring, ocular surface disease, or previous trabeculectomy. Aim This study aimed to compare the superior versus the inferior conjunctival rotational flap results following primary pterygium excision. Patients and methods This is a retrospective, interventional, comparative study that enrolled 120 patients having primary pterygium. The patients were recruited from the Ophthalmology Department, Beni Suef University Hospital, Beni Suef, Egypt during the period from June 2020 to June 2022. The patients were classified into two groups: group I that included 73 (60.8%) patients who underwent the superior conjunctival flap technique, and group II that included 47 (39.2%) patients who underwent the inferior flap technique. Slit-lamp findings were reported during the scheduled appointments, with a focus on pterygium recurrence and other complications. Postoperative follow-up was performed for 6–18 months. Results The recurrence rate among the inferior conjunctival flap group (12.8%) was higher than in the superior conjunctival flap group (9.6%), with no statistically significant difference (P=0.585). No additional postoperative complications, such as flap separation, dullen formation, or granulomas occurred in either group. Conclusion There was no statistically significant difference in the outcome of the superior and inferior conjunctival rotational flaps in primary pterygium excision. We propose that inferior conjunctival flap preference can result in favorable outcomes in circumstances where the superior bulbar conjunctiva is required for protection or cannot be used.

Comparison the Effect of Fractional RF Laser with Microneedling on Facial Skin Rejuvenation, Open Pores and Skin Lightening: A Non-Randomized Controlled Clinical Trial.

Effective skin rejuvenation treatments with RF technologies exist, with potential for personalized combination therapies based on individual factors. We compared microneedling and fractional RF laser effectiveness in rejuvenation, pore healing, and skin lightening. The research was a non-randomized clinical trial study conducted in 2021 at Ilam Skin Clinic, Ilam, western Iran on people applying for rejuvenation, skin lightening and improvement of open pores. People were voluntarily divided into two groups based on personal preferences (group A: microneedling, 25 people, group B: fractional RF, 25 people). After data collection, SPSS22 software was used for data analysis. The study revealed significant differences in the rates of low, moderate, and severe pain between the microneedling and fractional groups (10 vs. 16, 14 vs. 4, 1 vs. 5, respectively). Erythema showed no significant difference, with low, moderate, and severe cases reported in both groups. Swelling was lower in the microneedling group, but the difference was not significant. Bruising was similar in both groups, and staining was minimal. No herpes or infections were reported. The microneedling group showed better improvement in skin pores and skin lightening compared to the fractional group, with outcomes rated as good and excellent. Microneedling surpassed the fractional group in skin rejuvenation, lightening, and improved pores. Considering RF lasers are approximately three times more expensive than microneedling, the research indicates that choosing microneedling is not only more cost-effective but also a superior rejuvenation technique.

Modelling Cost-Risk Impact on Nigerian Highway Projects Using Multiple Linear Regression and Artificial Neural Networks

Cost predictive models for highway projects are relatively scarce in developing countries, despite the frequency and magnitude of project cost overruns in such countries. This study identified critical cost risks impacting highway projects and modelled their impacts on the actual cost of the projects. Historical cost data on highway projects published by the Nigerian Federal Ministry of Power, Works and Housing in 2017 served as a preliminary list of projects for the study, while further cost data were obtained from highway engineers and quantity surveyors across Nigeria using the snowballing technique until 103 highway projects were identified. Project participants were purposively chosen to fill out questionnaires on costrisks factors associated with highway construction projects. The relative importance index and Pareto 80/20 rule were used to analyse the collected primary data. Thereafter, multiple linear regression and artificial neural network models were developed. Findings revealed that the increase in the cost of construction materials and labour and the fluctuations in foreign exchange rates were the most significant risks impacting highway project cost performance. A comparison of the models indicated that the artificial neural networks model performed better. Hence, the artificial neural networks model is a superior technique for modelling the relationship between cost risks and cost performance of highway projects.

Optimizing Real-Time Bidding Strategies: An Experimental Analysis of Reinforcement Learning and Machine Learning Techniques

This research provides an experimental analysis and comparison of several RTB (real-time bidding) methods. These experiments are based on practical validation through the utilization of real-world datasets, with the primary attention being placed on the dynamic and complex nature of the RTB ecosystem. Simulations are run on various real-world advertising campaigns as part of the experimentation. These simulations take into account different campaign budgets, bid request dynamics, and user interaction pattern variations. The efficiency of each algorithm is evaluated based on performance indicators such as click-through rates (CTRs), conversion rates (CR), return on investment (ROI), win rates, cost per mille (CPM), and effective cost per click (E-CPC). The results provide useful insights into the advantages and disadvantages of each technique used, and the experimental analysis indicates the Constrained Markov Decision Process (CMDP)-based model as a promising and superior technique for RTB optimization. It provides valuable information on applications of reinforcement learning in the dynamic RTB ecosystem. Hence, via these comparisons, this paper aims to contribute to the advancement of RTB methodologies and proposes a viable route for future research.

Optimal feature selection based on OCS for improved malware detection in IoT networks using an ensemble classifier

The increasing amount of IoT devices increases the size of network traffic data, causing an increase in the incidence of security breaches in IoT networks. Cybercriminals have developed malware to compromise the security of sensitive data, among other cyber threats. In the presence of inadequate and robust security mechanisms, sensitive data is prone to vulnerability. Hence, protecting data in the IoT environment is becoming a mandatory task. Various approaches have addressed malware detection using network data features. However, there is still room for improvement in developing superior techniques and utilizing more comprehensive datasets. This paper presents a novel lightweight ensemble voting classifier to detect malware traffic by deploying the best possible network data. The merits of the correlation coefficient and Opposition-Based Crow Search Algorithm (OCS) have been leveraged to compute the best possible features. Another advantage of this proposed experiment is its focus on a dataset tailored to malware traffic features. This focus enables highly accurate malware detection. After feature selection using OCS, the proposed malware classifier is trained and validated with both 5-fold and 10-fold cross-validation techniques. The tested results confirm that the presented malware classifier performs best using a minimal feature set, which is highly advantageous for IoT networks due to resource constraints.

A Five-Year Retrospective Closed Cohort Study to Find a Superior Anaesthetic Technique for Caesarean Section From a Haemodynamic Perspective.

Background A cesarean section (CS) is common and requires a safe and effective anesthetic technique for the safety of both the mother and the fetus. This study aims to compare the intraoperative hemodynamic safety profile with general anesthesia (GA) and regional anesthesia (RA) and propose a superior technique for cesarean from the hemodynamic perspective. Methods After obtaining ethical committee approval, a retrospective closed cohort study was conducted on patients who underwent cesarean with GA and RA. This study was conducted at a tertiary-level university hospital in Oman from January 2015 to December 2019. The investigators collected maternal and fetal data (hypotension, bradycardia, blood loss, APGAR score, fetal mortality, complications, and length of stay) from January 2015 to December 2019. The primaryoutcome was the incidence of intraoperative hypotension, and the secondaryoutcomes studied were significant blood loss and APGAR score in both anesthesia techniques. Results A total of 2500 cesarean patients were studied, of whom 1379 received RA and 1121 received GA. The overall hypotension (systolic BP<90 mm Hg) rate observed was 40.1%; it was significantly lower with GA as compared to RA (32.1% versus 46.5%, respectively, P<0.001, OR 0.545, 95% CI 0.462 to 0.643). Consequently, the requirement for vasopressors was low with GA compared to RA (1.6% versus 23.1%, P<0.001, OR 0.054, 95% CI 0.034 to 0.088). Blood loss (>1 L) was remarkably higher in GA as compared to the RA (15.5% versus 8.9%, respectively, P<0.001, OR 1.916, 95% CI 1.499 to 2.448). APGAR scores were lower with GA than RA (2.8% versus 0.9%, P<0.001). Bradycardia and fetal mortality were almost equal in both groups. Conclusion GA is associated with significantly better hemodynamic stability during the cesarean section.

Quantitative Strategic Planning Matrix as a Superior Strategic Management Tools and Techniques in Evaluating Decision Alternatives

Evaluation of alternatives to making decisions still remains as the most difficult field for every manager. Considering that uncertainty, stress, emotions and many other factors still remain insurmountable during decision-making in the work of managers. The research will bring a contemporary approach to the evaluation of alternatives through the multi-stage method by conducting a series of exhibitions for an effective decision. Model will create a logical structure derivation of exhibitions by revealing options and paths toward strategic leadership. The research used mixed methods of data collection to create a more meaningful and integrative research design. The sample was elongated over a survey of 250 organizations. The research brings to the surface a clear analysis of the following path as a guide and practically used to gain differentiating advantages towards the long-term through Strategic Attractiveness Position in Industry (ST-API). From this analysis structure, a clearness leadership orientation is created for managers, a recommendation for strategic leadership, revealing a group of strategies to undertake depending on the ST-API dimension IFE (Internal Factor Evaluation) or ST-API dimension EFE (External Factor Evaluation) through crafting "Option's" since the organizations are concentrated in the vicinity of the corner (nook) in quad IV, conclusively in "growth and build". Occurrated in this axle, organizations are advised to orient their actions towards the "develop products" in order to go towards longevity and leaderism in the industry.

Bitcoin volatility in bull vs. bear market-insights from analyzing on-chain metrics and Twitter posts.

Cryptocurrencies have emerged as a popular investment vehicle, prompting numerous efforts to predict market trends and identify metrics that signal periods of volatility. One promising approach involves leveraging on-chain data, which is unique to cryptocurrencies. On-chain data, extracted directly from the blockchain, provides valuable information, such as the hash rate, total transactions, or the total number of addresses that hold a specified amount of cryptocurrency. Some studies have also explored the relationship between social media sentiment and Bitcoin, using data from platforms such as Twitter and Google Trends. However, the quality of Twitter sentiment analysis has been lackluster due to suboptimal extraction techniques. This research proposes a novel approach that combines a superior sentiment analysis technique with various on-chain metrics to improve predictions using a deep learning architecture based on long-short term memory (LSTM). The proposed model predicts outcomes for multiple time horizons, ranging from one day to 14 days, and outperforms the Martingale (random walk) approach by over 9%, as measured by the mean absolute percentage error metric, as well as recent results reported in literature. To the best of our knowledge, this study may be among the first to employ this combination of techniques to improve cryptocurrency market prediction.

Addressing the inspection selection challenges of in-service pipeline girth weld using ensemble tree models

Natural gas transportation predominantly utilizes pipelines, and the safety of these systems largely hinges on the integrity of girth welds. However, once pipelines are buried post-construction, pinpointing weld inspection sites becomes complex. Presently, weld risk assessments rely on costly and specialized inspections. Hence, enhancing the accuracy in identifying defective welds and discovering superior inspection techniques is paramount. Our research employed machine learning, specifically an ensemble model of RandomForest and CatBoost, to prioritize weld inspections. After analyzing the West-East Gas Pipeline Girth Weld Dataset and addressing data imbalances using the SMOTE technique, we refined the model parameters. The culminating model yielded an F1-score of 0.815 and an average accuracy of 0.836, outperforming standalone models. Employing the SHAP method improved the model’s transparency, facilitating a more informed decision-making process regarding pipeline inspections. This study underscores the potential of machine learning in elevating oil and gas pipeline safety measures.

Investigation of the Flexural Behavior of Bacterial Concrete Beams

Abstract Bacterial self-healing concrete is an eco-friendly and superior treatment technique that has efficient bonding capacity and compatibility with concrete compositions. It is capable of filling deep microcracks and healing the crack autonomously by calcium carbonate precipitating phenomenon which results in sustainable construction materials. The purpose of this research is to investigate the use of microorganisms Bacillus Subtilis to improve the mechanical properties and the efficiency of self-healing of reinforced concrete beams for two types of concrete, reactive powder concrete (RPC), and lightweight self-compacting concrete (LWASCC), by two methods of addition (direct addition, and encapsulation). The experimental program consists of casting six simply supported beams tested under monotonic and repeated loading. Incorporate bacteria and the precursor (calcium lactate) in concrete mixtures show an improvement in compressive strength, splitting, and flexural strength by up to 21.74 %, 10.92 %, 21.21 % by encapsulation method, and 17.7 %, 18.0 %, 20.84 % by direct addition. In addition, there is an enhancement in the first crack load and ultimate load. Microscopical image demonstrated that calcium carbonates had been deposited in the crack up to 1.0 mm width by bacterial activity within 32 days.

Multi-threshold Image Segmentation based on an improved Salp Swarm Algorithm: Case study of breast cancer pathology images

Breast cancer poses a significant risk to women’s health, and it is essential to provide proper diagnostic support. Medical image processing technology is a key component of all supporting diagnostic techniques, with Image Segmentation (IS) being one of its primary steps. Among various methods, Multilevel Image Segmentation (MIS) is considered one of the most effective and straightforward approaches. Many researchers have attempted to improve the quality of image segmentation by combining different metaheuristic algorithms with MIS. However, these methods often suffer from issues such as low convergence accuracy and a proclivity for converging towards Local Optima (LO). To overcome these challenges, this study introduces an integrated approach that combines the Salp Swarm Algorithm (SSA), Slime Mould Algorithm (SMA) and Differential Evolution (DE) algorithm. In this manuscript, we introduce an innovative hybrid MIS model termed SDSSA, which leverages elements from the SSA, SMA and DE algorithms. The SDSSA model fundamentally relies on non-local means 2D histogram and 2D Kapur’s entropy. To evaluate the proposed method effectively, we compare it initially with similar algorithms using the IEEE CEC2014 benchmark functions. The SDSSA showcases enhanced convergence velocity and precision relative to similar algorithms. Furthermore, this paper proposes an excellent MIS method. Subsequently, IS experiments were conducted separately at both low and high threshold levels. The test results demonstrate that the segmentation outcomes of MIS, at both low and high threshold levels, outperform other methods. This validates SDSSA as a superior segmentation technique that provides practical assistance for future research in breast cancer pathology image processing.

Open Minimally Invasive Parathyroidectomy Versus Minimally Invasive Video-Assisted Parathyroidectomy: A Systematic Review and Meta-Analysis.

Various minimally invasive techniques exist for surgical parathyroidectomy. The aim of this study was to conduct a meta-analysis comparing two popular minimally invasive techniques: minimally invasive video-assisted parathyroidectomy (MIVAP) and open minimally invasive parathyroidectomy (OMIP). An extensive search was conducted of online databases to identify all previous studies that had compared MIVAP and OMIP. The primary outcome measures considered were visual analog scale(VAS) score 24 hours postoperatively, conversion of operation (to open), failure rate and analgesic consumption. The data from these studies was extracted and compiled into a meta-analysis. The literature search yielded 104 studies of which four were included, enrolling 903 patients in this analysis. A significant difference was found regarding rates of conversion to open parathyroidectomy between the two groups, with the OMIP group demonstrating fewer conversions (MD = 3.52, CI = (2.04-6.08), P< 0.00001). No statistically significant differences were found between the two groups when comparing postoperative VAS scores at 24 hours (MD = -1.75, CI = (-9.8-6.3), P = 0.67), consumption of analgesia (OR = 0.49, CI = 0.07-3.54, P = 0.48) or failure rates (OR = 1.81, CI = 0.58-5.72, P = 0.31). OMIP was seen to require less need to convert to open parathyroidectomy with shorter operative times, while similar complication rates and scar lengths to MIVAP. More studies are required to evaluate the superior technique for parathyroidectomy.