Shortening Technique Research Articles

Lower leg shortening technique in treatment of the wounded with gunshot tibial fractures

Background. The severity of gunshot wounds to the extremities is due to the formation of bone and soft tissue defects. The relevance of this publication is determined by the need to introduce simple and effective methods into the practice of providing assistance to the wounded. The technique under consideration fully satisfies these requirements. The aims of the study: 1) to optimize the lower leg shortening technique and analyze the short-term results of its application in treatment of the wounded with gunshot tibial fractures; 2) to assess the indications for surgical restoration of the lower leg length after its shortening. Methods. The study enrolled 45 wounded patients with gunshot fractures of the lower leg bones. Reconstructive interventions were performed on 51 segments. In the absence of purulent-necrotic lesions of the fragments ends, closed reduction and convergence to tight contact without resection were performed (13 cases, group I). In the case of necrosis of the fragments ends, resection and convergence were performed with significant shortening of the segment (38 cases, group II). Results. The amount of shortening accounted for 4 cm [3; 6] in group I and 8 cm [7; 10] in group II (p0.001). Due to the convergence of the fragments, the reduction of the soft tissue defect was 25 cm2 [11; 41] and 38 cm2 [20; 81] in group I and II respectively. In 2 (15.4%) patients in group I and 4 (10.5%) patients in group II no fusion occurred. In the remaining cases the fusion occurred, the consolidation period was 50 [45; 59] weeks in group I and 36.5 [29; 43] weeks in group II (p0.001). Conclusions. Depending on the condition of fragments ends, there are two possible options of the shortening technique: without resection and with resection of the fragments ends. Shortening without resection is possible in the absence of signs of fragment necrosis. The disadvantage is the risk of delayed fusion, the advantage is the ability to avoid traumatic intervention in the form of resection of the fragments ends. In case of the fragments ends necrosis, their transverse resection and convergence with the elimination of diastasis between them is necessary. The advantage of this shortening technique is the optimization of conditions and reduction of fusion time, the disadvantage is the formation of significant bone defects. The need for lengthening of the shortened segment does not always arise. Lengthening as a second stage after conducting rehabilitation is considered as an optimal choice.

Artificial deformity creation in treatment of soft tissue wounds and lower leg bones defect: a case report

Background. The problem of treating wounded patients with defects of soft tissues and bones of the extremities continues to be relevant. One of the ways to close soft tissue defects, especially in case of bone tissue loss, after open fractures of the extremities is acute shortening and creation of artificial angular deformity of the segment. The aim of the study — to demonstrate the possibilities of acute shortening and angulation of the segment as a technique to replace soft tissue and bone defects in treatment of a patient with a gunshot wound to the lower leg. Case description. A 30-year-old wounded man was admitted to the clinic with an extensive defect in soft tissues and bones of the lower leg in the middle third. To reduce the wound size, acute shortening and angulation of the lower leg was performed. The intentional angular deformation was 24º, shortening — up to 8 cm. The residual soft tissue wound defect was closed with local tissues and split skin autograft. The tibia was fixed by the Ilizarov hinge-distraction apparatus with following gradual correction of the angular deformity. After that, one performed osteotomy of the tibia in order to eliminate shortening with the Ilizarov method (the distraction rate of 1 mm per day). After restoring the length of the lower leg, in order to replace the defect along the anterior surface of the tibia, a marginal “flake” was formed from a displaced fragment. At a follow-up examination, in 18 months after the injury the patient walks with full weight bearing on the injured limb without any additional means of support, continues to perform military service duties in accordance with his position. Conclusions. The presented clinical case demonstrates that acute shortening of a limb segment with creation of artificial angular deformity is an effective method for temporary closure of a gunshot defect of soft tissues. The technique allowed closing critical soft tissue defect of the lower leg and restoring the anatomy (length) of the segment. Consequently, one was able to achieve satisfactory treatment results and restore the functions of an injured limb. Besides, acute temporary shortening technique eliminated the need to perform technically sophisticated and lengthy microsurgical reconstructions, which are associated with a flap replacement for closure of soft tissue defects in a shotgun fracture area.

Approach to eyelid ptosis in a federal hospital in Rio de Janeiro in 2023

Introduction: The upper eyelid has complex anatomy, which is essential for an aesthetic appearance and proper function. Its normopositioning contributes to pleasant lines and is related to the eyebrow. The levator palpebrae and muller muscles maintain their height and excursion, along with the frontalis muscle. Ptosis can be congenital (myogenic or neurogenic) or acquired (myogenic, neurogenic, traumatic, mechanical, aponeurotic). The aesthetic evaluation considers the symmetry, shape and height of the eyelid. Ptosis is diagnosed when the upper eyelid margin to the reflex margin distance from the cornea is abnormally low. Eyelid fold asymmetry is associated with blepharoptosis and may require surgical correction. Methods: A total of 13 cases operated at the HFA from January to December 2023 were analyzed. All patients were approached anteriorly, with shortening of the aponeurosis of the eyelid levator muscle, after the aponeurotic defect was identified. Results: Of the cases approached (13), there were 7 men and 6 women. 11 bilateral cases and 2 unilateral cases. 1 case already operated on another service. 8 cases were elderly over 60 years old, of which 3 had a history of cataract correction (37.5%). Conclusion: The identification of ptosis in the preoperative evaluation with its consequent correction presented a better overall result, not only aesthetically, but mainly functionally. The MEPS aponeurosis shortening technique demonstrated a low complication rate, which was effective, meeting the needs of the patients and satisfying the surgeon.

Minimally invasive method of surgical treatment of Peyronie's disease

Objective. To improve the results of surgical treatment of Peyronie's disease. Materials and methods. 20 patients with Peyronie's disease aged 22 to 60 were treated in the urological departments of the Private Clinical Hospital “Russian Railways Medicine” and Astrakhan City Clinical Hospital No. 3 named after. C.M. Kirov. A method of surgical treatment of Peyronie's disease using a shortening technique without opening the tunica albuginea includes the application of a pressure tourniquet to the base of the penis, puncture of the cavernous bodies, injection of sterile saline into them until an erection is achieved, determination of the angle of curvature of the penis, removal of the tourniquet and surgery to eliminate curvature of the penis. Results. Neither postoperative complications nor formation of hematomas were observed. The patients were discharged on the 4th day in satisfactory condition. 1.5 years` observation showed no progression of angular deformation of the penis which could impede sexual intercourse. The mobility of the skin of the penis was preserved. Conclusions. In addition to the correction of penile deformity, our method eliminates the need for extensive incisions and preserves the physiological functions of the penis. As a result of using this surgical method, the following goals are achieved: minimal trauma to tissues in the surgical area, absence of scar processes in the plastic area and preservation of the skin of the penis mobility, absence of pronounced postoperative tissue edema, no need to drain the wound, reduction of the duration of the operation and minimal blood loss, short postoperative and rehabilitation period.

Obtaining new classes of optimal linear codes by puncturing and shortening optimal cyclic codes

AbstractIn this paper we use the puncturing and shortening techniques on two already-known classes of optimal cyclic codes in order to obtain three new classes of optimal linear codes achieving the Griesmer bound. The weight distributions for these codes are settled. We also investigate their dual codes and show that they are either optimal or almost optimal with respect to the sphere-packing bound. Moreover, these duals contain classes of almost maximum distance separable codes which are shown to be proper for error detection. Further, some of the obtained optimal linear codes are suitable for constructing secret sharing schemes with nice access structures.

Mitral Leaflet Shortening as an Ancillary Procedure in Obstructive Hypertrophic Cardiomyopathy

BackgroundMitral leaflet elongation is common in hypertrophic cardiomyopathy (HCM), contributes to obstructive physiology, and presents a challenge to the dual surgical goals of abolition of outflow gradients and abolition of mitral regurgitation. Anterior leaflet shortening, performed as an ancillary surgical procedure during myectomy, is controversial. MethodsThis was a retrospective study of all patients undergoing myectomy from January 2010 to March 2020, with analysis of survival and echocardiographic results. The study compared outcomes of patients treated with myectomy and concomitant mitral leaflet shortening with patients treated with myectomy alone. Over this time, the technique for mitral shortening evolved from anterior leaflet plication to residual leaflet excision (ReLex). ResultsMyectomy was performed in 416 patients aged 57.5 ± 13.6 years, and 204 (49%) patients were female. Average follow-up was 5.4 ± 2.8 years. Survival follow-up was complete in 415 patients. Myectomy without valve replacement was performed in 332 patients, of whom 192 had mitral valve shortening (58%). Mitral leaflet plication was performed in 73 patients, ReLex in 151, and both procedures in 32. Hospital mortality for patients undergoing myectomy was 0.7%. At 8 years, cumulative survival was 95% for both the myectomy combined with leaflet shortening group and the myectomy alone group, with no difference in survival between the 2 groups. There was no difference in survival between the anterior leaflet plication and ReLex groups. Echocardiography 2.5 years after surgery showed a decrease in resting and provoked gradients, mitral regurgitation, and left atrial volume and no difference in key variables between patients who underwent ancillary leaflet shortening and patients who underwent myectomy alone. ConclusionsThese results affirm that mitral shortening may be an appropriate surgical judgment for selected patients.

(167) Shaeer’s Corporal Rotation IV: Length and Girth Preserving Technique for Correction of Severe Congenital Ventral Penile Curvature

Abstract Introduction For cases with severe penile curvature, the loss in length with shortening techniques, or the loss in rigidity with incision-grafting can compromise the results, hence the advent of Shaeer’s Corporal Rotation III technique which corrects the most severe degrees of ventral penile curvature without loss in length, though with a certain degree of narrowing. Objective To describe Shaeer’s Corporal Rotation IV, aiming at correction of moderate to severe ventral penile curvature with minimal shortening, minimal narrowing, minimal mobilization of the neurovascular bundle, among other improvements such as using thicker suture material to decease recurrence while inverting the surgical knots. Methods Forty-two patients with congenital ventral penile curvature were selected for the study with the curve ranging from 60 to 90 degrees. Patients were randomized into one of the two groups: Shaeer’s Corporal Rotation III (SCR-III) and Shaeer’s Corporal Rotation IV (SCR-IV). In SCR-IV, rotation is used to correct the main brunt of curvature, up to 70–80% of the curve. Plication is used to correct the residual curvature up to 100% straightness. This keeps the rotation points fewer and closer to the midline, thereby minimizing narrowing and mobilization of the neurovascular bundle. Both groups were compared as regards intra-operative erection angle, length and girth, before and after rotation, as well as subjectively-reported post-operative recurrence, penile sensitivity, satisfaction and IIEF. Results Post-correction angle was zero for all cases in the two groups. Dorsal length decreased by 3% in SCR-IV, compared to 0.5% in SCR-III (2.5% difference). The difference in circumference between narrowest and widest points was 2% in SCR-IV versus 9.3% in SCR-III (7.3% difference). Average operative time was 19.2% shorter with SCR-IV. Girth asymmetry was reported in 1/21 patients in SCR-IV (4.8%), compared to 15/21 in SCR-III (71.4%). Partial hyposensitivity of the penis was reported in 9.5% among SCR-IV compared to 19% in SCR-III. Conclusions Shaeer’s Corporal Rotation IV technique corrects moderate and severe degrees of congenital ventral penile curvature, with little or no compromise in penile length, girth or sensitivity. Disclosure No.

Differential elongation of the gastrocnemius after Achilles tendon rupture: a novel technique of selective shortening to treat push-off weakness with case series and literature review.

Differential elongation of the gastrocnemius after Achilles tendon rupture (ATR) may compromise the ability of athletes to return to competition. Recognition of this differential elongation of the gastrocnemius relative to the soleus is vital to treat patients with weakness in push-off. This paper describes a novel technique performed for selective shortening of the gastrocnemius to treat push-off weakness. Three patients with differential proximal retraction of the gastrocnemius greater than 20mm after treatment for ATR with inability to run and jump underwent surgical correction with this novel technique and were followed-up for 2years. A novel selective shortening of the gastrocnemius with autologous hamstring graft was performed in these patients. The Achilles Tendon Total Rupture Score (ATRS) and American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score were recorded preoperatively and at the final follow-up. All three patients were able to return to running and jumping at final follow-up. The ATRS improved significantly in the strength, fatigue, running and jumping domains but there appeared to be a less notable improvement in activities of daily living domain. The AOFAS score showed improvement with the greatest margin in the domain of activity limitation. This procedure is the first described selective shortening method of the gastrocnemius tendons after differential elongation following ATR. It is a safe and reliable technique providing improved ATRS and AOFAS scores in three patients who were all able to return to running and jumping sports at 2-year follow-up. IV.

The comparison of success status and complications in peyronie disease patients: penile plication versus plaque incision and grating techniques

Aims: This study aimed to evaluate and compare the outcomes of tunical lengthening and shortening techniques for the surgical management of Peyronie's disease (PD) in terms of penile length, patient satisfaction, and complications.
 Methods: A retrospective analysis was conducted on PD patients who underwent surgical procedures between January 2017 and May 2023 at a single institute. Patient demographics, comorbidities, penile curvature, penile length, and surgical techniques were evaluated. The surgical procedures included plaque incision and grafting, and tunical plication. Post-operative data, including penile length, residual curvature, patient satisfaction, adverse events, and erectile function, were collected at 1-12 months of surgery. 
 Results: A total of 36 patients (mean follow-up period: 432.25±121.14 days) underwent surgical procedures for PD. Penile length in the tunical lengthening group (13.04±1.62 cm) was significantly longer than in the tunical shortening group (10.85±1.24 cm, p=0.001). Tunical shortening procedures were associated with a higher rate of penile shortening (57.1% vs. 6.7%, p=0.001) and suture-related discomfort (38.1% vs. 6.7%, p=0.031) compared to tunical lengthening procedures. Patient satisfaction was higher in the tunical lengthening group (80% vs. 66.7%, p=0.378). There was no significant difference in painful erection during penetrations or incapability of intercourse between the groups. The average length of hospital stay was longer for tunical shortening surgery compared to tunical lengthening surgery (1.27±0.27 vs. 1.79±0.39, p=0.023).
 Conclusion: Tunical lengthening procedures demonstrated superior outcomes in terms of penile length and suture-related discomfort compared to tunical shortening procedures for the surgical management of PD. Patient satisfaction was also higher in the tunical lengthening group. Clinicians should consider various factors when selecting the appropriate surgical technique for PD, including penile length, the degree of penile curvature, and surgeon experience. Prospective randomized studies are needed to further validate these findings and assess long-term outcomes.

Analysis of bi-atrial function using CMR feature tracking and long-axis shortening approaches in patients with diastolic dysfunction and atrial fibrillation.

Atrial function can be assessed using advancing cardiovascular magnetic resonance (CMR) post-processing methods: atrial feature tracking (FT) strain analysis or a long-axis shortening (LAS) technique. This study aimed to first compare the two FT and LAS techniques in healthy individuals and cardiovascular patients and then investigated how left (LA) and right atrial (RA) measurements are related to the severity of diastolic dysfunction or atrial fibrillation. Sixty healthy controls and 90 cardiovascular disease patients with coronary artery disease, heart failure, or atrial fibrillation, underwent CMR. LA and RA were analyzed for standard volumetry as well as for myocardial deformation using FT and LAS for the different functional phases (reservoir, conduit, booster). Additionally, ventricular shortening and valve excursion measurements were assessed with the LAS module. The measurements for each of the LA and RA phases were correlated (p < 0.05) between the two approaches, with the highest correlation coefficients occurring in the reservoir phase (LA: r = 0.83, p < 0.01, RA: r = 0.66, p < 0.01). Both methods demonstrated reduced LA (FT: 26 ± 13% vs 48 ± 12%, LAS: 25 ± 11% vs 42 ± 8%, p < 0.01) and RA reservoir function (FT: 28 ± 15% vs 42 ± 15%, LAS: 27 ± 12% vs 42 ± 10%, p < 0.01) in patients compared to controls. Atrial LAS and FT decreased with diastolic dysfunction and atrial fibrillation. This mirrored ventricular dysfunction measurements. Similar results were generated for bi-atrial function measurements between two CMR post-processing approaches of FT and LAS. Moreover, these methods allowed for the assessment of incremental deterioration of LA and RA function with increasing left ventricular diastolic dysfunction and atrial fibrillation. A CMR-based analysis of bi-atrial strain or shortening discriminates patients with early-stage diastolic dysfunction prior to the presence of compromised atrial and ventricular ejection fractions that occur with late-stage diastolic dysfunction and atrial fibrillation. • Assessing right and left atrial function with CMR feature tracking or long-axis shortening techniques yields similar measurements and could potentially be used interchangeably based on the software capabilities of individual sites. • Atrial deformation and/or long-axis shortening allow for early detection of subtle atrial myopathy in diastolic dysfunction, even when atrial enlargement is not yet apparent. • Using a CMR-based analysis to understand the individual atrial-ventricular interaction in addition to tissue characteristics allows for a comprehensive interrogation of all four heart chambers. In patients, this could add clinically meaningful information and potentially allow for optimal therapies to be chosen to better target the dysfunction.

A characterization of optimal locally repairable codes

It is significant to investigate locally repairable codes (LRCs) since they have abundant applications to distributed storage systems. A locally repairable code is called optimal if it achieves the Singleton-like bound. In [27], I. Tamo et al. presented sufficient and necessary conditions for optimal LRCs. However, it is difficult to check these conditions for many parameters. In this work, we show that construction of optimal LRCs is equivalent to construction of a class of matrices with some conditions. With the help of these conditions, we completely determine all the optimal LRCs for some small parameters. In addition, by shortening technique for the matrices with these conditions, we can easily obtain many new optimal LRCs remaining the minimum distance.

Diagnosis and treatment of crouch gait in children with cerebral palsy. Report from the 4th Edition of the Transatlantic Orthopedic Surgery Webinar 2022

Introduction. The fourth edition of the Transatlantic Orthopedic Surgery Webinar 2022 took place on December 12th, 2022. The main theme of the webinar was the treatment of crouch gait in children with cerebral palsy (CP). Speakers from Australia, Canada, China, Germany, India, Poland, Spain, Sweden, Turkey, the United Kingdom, and the United States participated. Results. The first general session presented the biomechanics of crouch gait, the function of the hip and knee muscles in children with CP, the principles of prevention and treatment of crouch gait in spastic diplegia, and the natural course and treatment outcomes of CP in adults. The surgical sessions comprehensively presented the surgical techniques for treating crouch gait: percutaneous myofasciotomy in the posterior knee joint, straightening osteotomy of the distal femur in hemiplegia, asymmetric and symmetric diplegia, techniques for shortening and plastically reconstructing the patellar ligament, anterior hemiepiphysiodesis of the distal femur, and transfer of the hamstring muscles to the rectus femoris muscle. The second general session presented postoperative standing and walking rehabilitation protocols and evaluation of treatment outcomes (pain, fatigue, ambulatory activity, motor function, and quality of life). Summary. The most important conclusions from the event were: do not lengthen the Achilles tendon in zone III in crouch gait; laboratory gait analysis is necessary before lengthening the hamstring muscles; hemiepiphysiodesis of the distal femur can be performed when the predicted growth period is less than two years; distal femur osteotomy should be considered during adolescence for knee flexion contracture of 10-40 degrees; treatment possibilities of tendon transfers and myofasciotomies should be remembered, especially in younger patients. The webinar attracted an audience of approximately 1,600 people from 672 centers located in 57 countries. Most participants came from Poland, the United Kingdom, the United States, Norway, Sweden, and India.

Acute shortening and double-level lengthening versus bone transport for the management of large tibial bone defects after trauma and infection.

The aim of this study was to present our experience with a new modified Ilizarov technique of acute shortening and double-level lengthening (ASDL) for the management of large tibial bone defects after trauma and infection and compare it with bone transport (BT). A retrospective comparative study was performed on 47 patients with large tibial defects after trauma and infection from June 2014 to June 2018. Depending on different Ilizarov methods, these patients were divided into ASDL group (n=21) and BT group (n=26). The difference in bone lengthening time, time in frame, external fixation index, docking site healing time were recorded and compared between the two groups. Bone and functional results were evaluated according to the Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria. Complications encountered in both groups were categorized according to the classification of Paley, including problems (treated nonoperatively), obstacles (treated operatively), and sequelae (unresolved at last). All patients were followed for at least two years since the lengthening frame was removed. All cases achieved complete union at the docking site and consolidation of the regenerate callus. The mean bone loss was 8.9cm (range 6.5-16.0cm) in ASDL group vs. 10.3cm (range 5.2-18.5cm) in BT group. The mean bone lengthening time was 2.4±0.7 months in ASDL group vs. 4.1±1.4 months in BT group (p<0.001); time in frame was 9.1 months (range 7.0-14.5 months) in ASDL group vs. 17.7 months (range 13.5-23.0 months) in BT group (p<0.001); and external fixation index was 1.04 months/cm (range 0.83-1.38 months/cm) in ASDL group vs. 1.91 months/cm (range 1.28-2.70 months/cm) in BT group (p<0.001). The incidence of obstacles occurred in ASDL group was significantly lower than that in BT group (p<0.001). There was no significant difference in the bone (p=0.635) and functional results (p=0.293) between the two groups. Compared with bone transport, our modified technique of acute shortening and double-level lengthening could reduce bone lengthening time, time in frame, external fixation index and postoperative complications. It showed better clinical effects in patients with large tibial bone defects after trauma and infection.

Evaluation of a technique of patellar tendon shortening to correct patella alta associated with severe crouch gait in cerebral palsy.

This study was undertaken to evaluate the results of patella tendon shortening to correct patella alta in the context of surgery for the management of severe crouch gait. Our aim was to ascertain whether the corrected position of the patella and improvement of the power of the quadriceps were maintained for 4 years or more. Twenty older children (mean age: 14.2 years) with long-standing crouch gait secondary to cerebral diplegia underwent surgery to correct crouch gait that included the patellar tendon shortening. The technique for plicating the tendon differed for skeletally mature and immature patients. The length of the patellar tendon was measured by the Koshino Index. The strength of the quadriceps muscle was assessed by manual muscle testing and with a dynamometer and extensor lag, if present, was measured with a goniometer. In all 40 knees, the patella was brought to a more distal position and the position was maintained for a mean duration of 84 months (Koshino Index: preoperative 1.3 ± 0.10; 3-month postoperative 0.95 ± 0.05; final follow-up 0.95 ± 0.04). The results were the same for the techniques used for skeletally mature and immature patients. The power of the quadriceps improved [Medical Research Council (MRC) grade 3 to MRC grade 4] and the improvement was maintained. The technique of patella tendon shortening was effective in correcting patella alta and improving quadriceps power. The shortened patellar tendon did not stretch over the period of follow-up. Level of evidence: III.

Shortening and re-lengthening versus bone transport for the treatment of distal tibial periarticular post-traumatic defects

In the present study, we presented our experience with a new modified technique of shortening and re-lengthening using a monolateral external frame combined with a calcaneal intramedullary nail and compared it with the bone transport technique for the treatment of distal tibial periarticular post-traumatic defects. Forty-one patients were retrospectively analyzed. Among them 19 were treated using our modified shortening and re-lengthening technique (MSR group) and 22 by bone transport (BT group). The difference in external fixation time (EFT), external fixation index (EFI), self-rating anxiety scale (SAS), and complications were compared between the two groups. The mean EFT was 3.4 ± 0.6 months in the MSR group and 7.5 ± 1.4 months in the BT group; the EFI was 0.57 ± 0.06 month/cm and 1.32 ± 0.23 month/cm, respectively. The EFT, EFI, and SAS scores were significantly lower in the MSR group than in the BT Group (p < 0.05). The mean number of complications per patient in the BT group was nearly 2.4 times that of the MSR group (p < 0.05). Our modified shortening and re-lengthening technique reduced the EFI and complication incidence compared to the bone transport technique. Therefore, patients with distal tibial periarticular post-traumatic defects can achieve great satisfaction with this new technique.

Shortened Linear Codes From APN and PN Functions

Linear codes generated by component functions of perfect nonlinear (PN for short) and almost perfect nonlinear (APN for short) functions and the first-order Reed-Muller codes have been an object of intensive study in coding theory. The objective of this paper is to investigate some binary shortened codes of two families of linear codes from APN functions and some <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$p$ </tex-math></inline-formula> -ary shortened codes associated with PN functions. The weight distributions of these shortened codes and the parameters of their duals are determined. The parameters of these binary codes and <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$p$ </tex-math></inline-formula> -ary codes are flexible. Many of the codes presented in this paper are optimal or almost optimal. The results of this paper show that the shortening technique is very promising for constructing good codes.

A Novel Approach for Semantic Extractive Text Summarization

Text summarization is a technique for shortening down or exacting a long text or document. It becomes critical when someone needs a quick and accurate summary of very long content. Manual text summarization can be expensive and time-consuming. While summarizing, some important content, such as information, concepts, and features of the document, can be lost; therefore, the retention ratio, which contains informative sentences, is lost, and if more information is added, then lengthy texts can be produced, increasing the compression ratio. Therefore, there is a tradeoff between two ratios (compression and retention). The model preserves or collects all the informative sentences by taking only the long sentences and removing the short sentences with less of a compression ratio. It tries to balance the retention ratio by avoiding text redundancies and also filters irrelevant information from the text by removing outliers. It generates sentences in chronological order as the sentences are mentioned in the original document. It also uses a heuristic approach for selecting the best cluster or group, which contains more meaningful sentences that are present in the topmost sentences of the summary. Our proposed model extractive summarizer overcomes these deficiencies and tries to balance between compression and retention ratios.

Acute shortening and re-lengthening versus antibiotic calcium sulfate-loaded bone transport for the management of large segmental tibial defects after trauma

BackgroundThe purpose of this paper was to compare the clinical effects of acute shortening and re-lengthening (ASR) technique with antibiotic calcium sulfate-loaded bone transport (ACSBT) technique for the management of large segmental tibial defects after trauma.MethodsIn this retrospective study, 68 patients with large segmental tibial defects were included and completely followed. The bone loss was 3–10 cm. ASR group included 32 patients, while ACSBT group contained 36. There was no significant difference in demographic information between the two groups. The external fixation time (EFT) and external fixation index (EFI) were compared. Bone defect healing and limb functions were evaluated according to the Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria. Complications were compared by Paley classification.ResultsThe mean EFT was 9.2 ± 1.8 months in ASR group and 10.1 ± 2.0 months in ACSBT group, respectively. The mean EFI was 1.5 ± 0.2 month/cm and 1.4 ± 0.3 month/cm. According to the ASAMI criteria, in ASR group bone defect healing was excellent in 22 cases, good in 7 cases and fair in 3 cases. In ACSBT group, it was excellent in 23 cases, good in 11 cases and fair in 2 cases. In ASR group, the limb function was excellent in 15 cases, good in 7 cases and fair in 10 cases, while it was excellent in 14 cases, good in 9 cases and fair in 13 cases with ACSBT group. There was no significant difference in EFI, bone defect healing and limb functions between the two groups (p > 0.05). The mean number of complications per patient in ACSBT group was significantly lower than that in ASR group (p < 0.05).ConclusionBoth techniques can be successfully used for the management of large segmental tibial defects after trauma. There was no significant difference in EFI, limb functions and bone defect healing between the two groups. Compared with ASR group, the complication incidence in ACSBT group was lower, especially the infection-related complications. Therefore, for patients with large segmental bone defects caused by infection or osteomyelitis, ACSBT technique could be the first choice.

Some shortened codes from linear codes constructed by defining sets

&lt;p style='text-indent:20px;'&gt;The puncturing and shortening technologies are two important approaches to construct new linear codes. It is noticed that many works on punctured linear codes have been done in the past few decades, but till now little research on the shortening technique has been done and there are only a handful references on shortened linear codes. In this paper, we use the shortening technology to obtain some shortened codes from linear codes constructed by certain special defining sets, and explicitly determine their parameters. Some of those shortened codes are optimal or almost optimal.&lt;/p&gt;

Knowledge of medical students about perioperative nutritional care in Bahia, Brazil: a transversal study

OBJECTIVE: Evaluate the medical students’ knowledge about perioperative nutritional care. These students are from public and private academic institutions in the state of Bahia, Brazil. METHODS: This is a cross-sectional study to analyze medical students based on an online instrument regarding topics related to perioperative care. For data analysis, absolute and relative frequencies were calculated for categorical variables, and mean and standard deviation were calculated for continuous variables. Fisher's Exact Test and G Test were used to analyze the association. Results: 209 responses were obtained. Regarding the learning on nutritional preparation of the patient submitted to a surgery, 25 (64.9%) students of public institutions and 90 (52.3%) students of private ones reported not knowing or not having been exposed to such knowledge. Regarding the importance of addressing topics related to nutritional therapy (NT), 37 (100%) students from public institutions and 168 (97.7%) from private ones recognize the importance of spreading this knowledge. Unnecessary absolute preoperative fasting, shortening techniques of fasting and bronchoaspiration prevention and reintroduction time of a diet in the postoperative period are unknown to most of the population studied. CONCLUSION: Most students included in this study do not have satisfactory knowledge in NT and for preparing the surgical patient.