Miracle-dz/UniFAR-FTUs huggingface dataset:
Validación de la Escala INFLESZ para evaluar la legibilidad de los textos dirigidos a pacientes

Background: The readability of written texts aimed at patients is an indicator of quality. Szigriszt made an adaptation of the RES Flesch Score, calling it “Escala de Nivel de Perspicuidad” (Clarity Level Scale), to measure the difficulty in reading a text. But Szigriszt used a text sample that was neither representative nor random, which is why the conclusions are not sufficiently consistent. The aim of this article is to complete the process begun by Szigriszt, review the Szigriszt Scale, comparing it with Flesch’s scale, and propose a scale according to Spanish reading habits. Methods. Descriptive study. Two hundred and ten documents of 3 types were selected at random: Stationary magazines, school textbooks and scientific magazines. Three fragments of at least 500 words were chosen at random from each one, from the beginning, middle and end. The Flesch-Szigriszt Index (Indice de Legibilidad de Flesch-Szigriszt [IFSZ]), available on the INFLESZ program, was calculated. The scores were classified according to the Flesch and Szigriszt scales. Results. The readability of the stationary magazines is 60, of scientific magazines 37.9, and school textbooks 67.39. Conclusions. Only the scientific magazines are situated between 0 and 50. There are no publications with scores lower than 15. Szigrsizt locates “Normal” from 50; Flesch from 60. An intermediate position is adopted and a new scale is proposed: the INFLESZ Scale, which establishes 5 sections: “Very difficult” ( 80). Neither the Clarity Level Scale of Szigriszt nor the RES Flesch Score are adapted to Spanish reading habits. In the case of texts on health, there is a greater probability of their being read and understood if they exceed 55.
Comparison of Nonlocking Plates and Locking Plates for Intraarticular Calcaneal Fracture

Background: The optimal treatment of displaced intraarticular calcaneal fractures remains challenging. Currently, there is no uniform method to treat such fractures. The purpose of this study was to compare the radiographic and clinical outcome of nonlocking plates and locking plates in the treatment of intraarticular calcaneal fractures. Methods: A retrospective comparative study was performed including 42 patients with intraarticular calcaneal fractures that were treated by nonlocking plate (n = 18) or locking plates (n = 24) between January 2010 and June 2012. Radiological and functional outcomes were compared between the 2 groups. Results: At the final follow-up, all fractures were healed, and the patients with a locking plate had a significantly better Bohler’s angle and Gissane’s angle compared with the nonlocking plate group (P < .05). No complications occurred for the patients in the locking plate group, and 3 patients in the nonlocking plate group had implant loosening that led to loss of reduction (P < .05). The average American Orthopaedic Foot and Ankle Society hindfoot score in the locking plate group was significantly higher than that in the nonlocking plate group (P < .05). No statistically significant difference between the 2 groups was found regarding SF-36 (P > .05). Conclusion: This study supports the view that locking plates may provide better stability and functional recovery in the treatment of intraarticular calcaneal fractures. Level of Evidence: Level III, comparative case series.
Controller Synthesis for Positive Linear Systems With Bounded Controls

This brief solves some synthesis problems for a class of linear systems for which the state takes nonnegative values whenever the initial conditions are nonnegative. In particular, the synthesis of state-feedback controllers is solved in terms of linear programming problem, including the requirement of positiveness of the controller and its extension to uncertain plants. In addition, the synthesis problem with nonsymmetrical bounds on the stabilizing control is treated
Growth factors in the aqueous humor and their therapeutic implications in glaucoma and anterior segment disorders of the human eye

The presence of growth‐promoting substances in the aqueous humor has been suspected for the past decade, but it has been only during the last 2 years that the existence of growth factors such as basic fibroblast growth factor, epidermal growth factor, transforming growth factorp, transferrin, and insulin‐like growth factors in the aqueous humor has been demonstrated. The structures that border the anterior and posterior chambers of the eye syn‐ thesize some of these growth factors and release them into the aqueous humor. A breakdown of the blood‐aqueous‐barrier increases the amounts of growth factors and may also bring platelet‐derived growth factor, nerve growth factor, and interleukin‐6 into the aqueous humor. Growth factors maintain the normal function of ocular tissues in health and have a significant role in the pathogenesis and possible management of several disorders of the eye. The outcome of the pathogenetic process and its modulation are determined by a complex coordination and interactions of the growth factors in the aqueous humor and their eventual effect on the target tissues. We discuss the therapeutic implications of growth factors and their antagonists in the treatment of certain disorders of the anterior segment of the eye, including rubeosis iridis, neovascular glaucoma, primary open‐angle glaucoma, sand wound after filtration Surgery.
Comparison of Rates of Union and Hardware Removal Between Large and Small Cannulated Screws for Calcaneal Osteotomy

Background: The calcaneal osteotomy is a common procedure to correct hindfoot malalignment. Reported union rates are high, utilizing fixation methods including staples, plates, and most commonly cannulated screws. We began our practice using 6.5 mm and 7.3 mm cannulated screws, but complaints of postoperative posterior heel pain led to hardware removal in many patients. A switch to smaller 4.5 mm cannulated screws resulted in fewer symptoms, thus we hypothesized that using a smaller screw would decrease screw removal while maintaining an equally high union rate. Methods: The records of patients who underwent a calcaneal osteotomy by 2 surgeons between January 1996 and April 2012 were retrospectively reviewed. The rates of hardware removal and union were compared between osteotomies held with two 7.3 mm, 6.5 mm, and 4.5 mm cannulated screws. Results: There were 272 feet that met the inclusion criteria. The hardware removal rate for 130 osteotomies held with two 7.3 mm screws was 29.2% and the removal rate for 115 osteotomies held with 4.5 mm screws was 13.0%, which was significantly different (P < .05). The removal rate for 27 osteotomies with 6.5 mm screws was 33.3%. The union rate for all groups was 100%. Conclusion: Fixation of calcaneal osteotomies with two 4.5 mm screws is advantageous over larger screws with respect to future hardware removal. There was no loss of position from the smaller screws and we feel that the 4.5mm cannulated screw provides sufficient compression and achieves a high rate of union equal to that of the larger screws. Level of Evidence: Level IV, retrospective case series.
Reproducibility of Computed Tomography to Evaluate Ankle and Hindfoot Fusions; Statistical Issue to Avoid Misinterpretation

Dear Editor: I was interested to read the report by Cerrato et al in the November 2014 issue of Foot & Ankle International. The authors aimed to evaluate the interrater reliability of computed tomographic (CT) scans to assess the status of hindfoot or ankle fusions among orthopedic foot and ankle surgeons. Forty-one CT scans were identified retrospectively from the tertiary referral practices of 4 fellowship-trained orthopedic foot and ankle surgeons. Images were stripped of any patient identifiers. All 4 surgeons individually reviewed the blinded scans and determined whether the arthrodesis site was greater than or less than 50% fused. Interrater reliability was assessed by using κ analysis. Regarding reliability (precision), for qualitative variables, the weighted κ statistic should be used with caution, because simple κ has its own limitations. Two important weaknesses of the κ statistic to assess the agreement of a qualitative variable are that it depends on the prevalence in each category, which means that it is possible to have different κ values with the same percentages for both concordant and discordant cells. Figures 1a and 1b depicts two situations in which the prevalence of concordant cells is 80% and that of discordant cells 20%, but different κ values are obtained (0.38, indicating fair agreement, and 0.60, indicating moderate to good agreement). Because the degree of fusion identified on a CT scan has been correlated with functional outcome, with an arthrodesis area of 25% to 50% necessary for clinical success, I would prefer to estimate weighted κ using 2 cutoff points, 25% and 50%, making the outcome an ordinal variable with 3 categories. The reason is that κ also depends on the number of categories, such that the more categories, the lower the value of κ. Cerrato et al reported that on the basis of κ analysis, there was high interrater reliability in the assessment of subtalar arthrodesis, but there was no statistical significance for the evaluation of ankle arthrodesis. It is crucial to note that a statistically significant finding is completely different from the clinical importance of the results. On the basis of their conclusions, the reliability of orthopedic surgeons to ascertain the status of subtalar arthrodesis on CT scans is demonstrated. Such a conclusion may lead to a misleading message due to the incomplete and inappropriate use of statistical tests to assess reliability. The take-home message is that for reliability analysis, appropriate tests should be applied. Otherwise, misdiagnosis and mismanagement of patients cannot be avoided.
Prostaglandin‐mediated inhibition of noradrenaline release

The effect of indomethacin, a prostaglandin (PG) synthesis inhibitor, on some cardiovascular reflexes was studied in healthy subjects. Heart rate (HR) and respiratory sinus arrhythmia (RSA) in the basal state and during carotid stimulation (neck suction), Valsalva ratio, and changes in heart rate and blood pressure (BP) during an orthostatic test were measured before and one hour after administration of indomethacin (1.5 mg/kg). The efficacy of the PG synthesis inhibitor was monitored by analysis of platelet aggregation induced by arachidonic acid. Following indomethacin no change was observed in basal HR. Carotid stimulation depressed the HR and this effect was of the same amplitude before and after indomethacin. The amplitude of RSA was not affected by indomethacin, either in the basal state or during carotid stimulation. The Valsalva ratio and the changes in HR and BP during the orthostatic test were similar before and after the drug. Circulating levels of noradrenaline were unaffected by indomethacin. These data demonstrate that inhibition of PG bioformation in man does not affect major cardiovascular reflexes. Consequently they disfavour the hypothesis that endogenously formed PG would be involved in the normal activity of the afferent, central or efferent pathways for cardiovascular regulation.
A cross-sectional survey on the lifestyle and health-seeking behaviour of Basotho patients with diabetes

Abstract Objectives: The objectives of the study were to determine the level of practice of a healthy lifestyle, to assess the health education provided to patients with diabetes and to determine the prevalence of obesity among Basotho patients with diabetes. Design: A cross-sectional study enrolled 192 patients between November 2004 and July 2005. Descriptive statistics on demographic, socio-economic and lifestyle data were computed. Weight, waist circumference and hip circumference measurements were taken to compute body mass index (BMI), waist-to-hip ratio (WHpR) and waist-to-height ratio (WHtR). Setting and subjects: Patients with diabetes attending three hospitals in Lesotho were recruited in the study. Outcome measures: These included obesity indices, the quality and quantity of physical exercises, the quality and quantity of provided health education and the frequency with which the subjects sought medical help. Results: The participants' mean age was 54.73 years. The prevalence of smoking (14.6%) was higher than that of drinking (9.4%). Only 20.8% of the participants participated in recommended physical exercise. Most participants (95%) consulted their physicians on a regular basis. The Health Education Quantity Index was very low: 49.9%. The prevalence of obesity measured by BMI, WHpR and WHtR was 67.7%, 69.8% and 95.3% respectively. Conclusion: The practice of a healthy lifestyle was suboptimal, but help-seeking behaviour was satisfactory among participants. It is recommended that health education and the promotion of a healthy lifestyle are encouraged, that diabetes education is rendered by accredited educators or healthcare providers trained in communicating health messages, and that the fight against obesity is made a priority.
The Effect of Obesity on Functional Outcomes and Complications in Total Ankle Arthroplasty

Background: The prevalence of obesity in the United States is staggering. Currently, the effect of obesity on third-generation total ankle replacement (TAR) is unknown. Methods: We prospectively identified a consecutive series of 455 primary TARs operated between May 2007 and September 2013 who had a minimum follow-up of 2 years. We identified 266 patients with a body mass index (BMI) <30 (control), 116 with a BMI between 30 and 35 (Obese I), and 73 with a BMI >35 (Obese II). Clinical outcomes including wound issues, infection rate, complications, and failure rates were compared. Functional outcomes including American Orthopaedic Foot & Ankle Society hindfoot score, Short Form–36 (SF-36), Short Musculoskeletal Function Assessment (SMFA), Foot and Ankle Disability Index (FADI), and Foot and Ankle Outcome Score (FAOS) were compared. Average patient follow-up in the Obese I group was 44.7 ± 17.3 months, Obese II was 42.7 ± 16.4 months, and 45.2 ± 17.4 months in the control group. Results: Age, race, and smoking history in the obese group were not significantly higher than the control group; however, sex was significantly related to BMI. There was no difference in complication, infection, or failure rates between the groups. Preoperatively, the Obese II group had significantly lower SF-36 scores and higher SMFA function, FADI, and FAOS Symptoms scores. For each of the Obese I, Obese II, and control groups, all functional outcome scores 1 year postoperatively and at most recent follow-up were significantly improved. However, at most recent follow-up, Obese II patients had lower FAOS Pain and SF-36 scores and higher FADI and SMFA Functional scores. Conclusion: Total ankle arthroplasty in obese patients was a relatively safe procedure. Although obese patients after TAR had lower functional outcome scores compared to their nonobese counterpart, they did experience significant functional and pain improvements at most recent follow-up. Level of Evidence: Level III, comparative series.
Experiences of Thrombolytic Therapy for Ischemic Stroke in Tuzla Canton, Bosnia and Herzegovina

Aim. To demonstrate our experiences of thrombolytic therapy in acute ischemic stroke. Subjects and Methods. Patients with ischemic stroke treated with rt-PA, admitted at the Department of Neurology, Tuzla, Bosnia and Herzegovina, in the period between April 1, 2008, and December 31, 2012, were included. Results. Between April 2008 and December 2012, intravenous rt-PA was given to 87 patients with acute ischemic stroke, which represents 3.2% of patients with acute ischemic stroke admitted to our department in that period. Hypertension was the leading stroke risk factor. The mean NIHSS score before thrombolysis was 12 (range 4–21). Large artery arteriosclerosis was the most common stroke etiology. The mean door-to-needle time was 72 minutes and onset-to-needle time 152 minutes. Half of patients (44/87) had a significant improvement within the first 24 hours. Parenchymal hemorrhage occurred in 5 patients (6%) and was fatal in two cases. At 3-month follow-up, 45% of patients (39/87) had good outcome (mRS 0 or 1). Sixteen patients were dead at 3 months, and mean baseline stroke severity was significantly higher in patients who died (NIHSS 16.5 versus 11, ). Conclusion. The number of patients with acute ischemic stroke treated using rt-PA in the Department of Neurology, Tuzla, is lower than in developed countries. Thrombolytic therapy is safe and leads to favorable outcome in half of the patients.
Vaginal bacteria modify HIV tenofovir microbicide efficacy in African women

Analysis of HIV clinical trials shows that the vaginal microbiome underlies varied responses to microbicide-based preexposure prophylaxis. Vaginal microbiome influences HIV acquisition Tenofovir is a preexposure drug used to prevent HIV infection. In clinical trials, tenofovir was effective for men, but not women. Klatt et al. now show that tenofovir efficacy in women depends on the composition of the vaginal microbiome (see the Perspective by Tuddenham and Ghanem). In a clinical trial of 688 women, tenofovir was three times as effective among those with a Lactobacillus-dominant vaginal microbiome as it was among other women. Gardnerella vaginalis tended to predominate in the women for whom tenofovir was less effective, and the authors found that the organism could rapidly metabolize and thereby inactivate the drug. Science, this issue p. 938; see also p. 907 Antiretroviral-based strategies for HIV prevention have shown inconsistent results in women. We investigated whether vaginal microbiota modulated tenofovir gel microbicide efficacy in the CAPRISA (Centre for the AIDS Program of Research in South Africa) 004 trial. Two major vaginal bacterial community types—one dominated by Lactobacillus (59.2%) and the other where Gardnerella vaginalis predominated with other anaerobic bacteria (40.8%)—were identified in 688 women profiled. Tenofovir reduced HIV incidence by 61% (P = 0.013) in Lactobacillus-dominant women but only 18% (P = 0.644) in women with non-Lactobacillus bacteria, a threefold difference in efficacy. Detectible mucosal tenofovir was lower in non-Lactobacillus women, negatively correlating with G. vaginalis and other anaerobic bacteria, which depleted tenofovir by metabolism more rapidly than target cells convert to pharmacologically active drug. This study provides evidence linking vaginal bacteria to microbicide efficacy through tenofovir depletion via bacterial metabolism.
Corrections to "VLSI Design of Diminished-One Modulo 2n + 1 Adder Using Circular Carry Selection" [Sep 08 897-901]

In a recent paper by Lin and Sheu, the authors have proposed a new circular-carry-selection technique that is applied in the design of an efficient diminished-one modulo 2n +1 adder. The proposed modulo adder in the aforementioned paper consists of a dual-sum carry look-ahead (DS-CLA) adder, a circular carry generator, and a multiplexer, which can reduce both area-time (AT) and time-power (TP) products compared with previous modulo adders. However, in our investigation, there will be incorrect results on the calculation of modulo addition because the carry-in of the DS-CLA adder is equal to zero. To remedy this drawback, we propose the corrected architecture of the DS-CLA adder based on the equations proposed in the aforementioned paper, which can perform correct modulo addition. The complexity of the corrected architecture is almost the same as the one proposed by Lin and Sheu but with less area cost, which can also have the same merits of both AT and TP products.
MRI Evaluation of Achilles Tendon Rotation and Sural Nerve Anatomy

Background: Limited-open and percutaneous Achilles tendon (AT) repair techniques have limited visibility, which may result in sural nerve violation and poor tendon targeting. The goal of this study was to assess the in vivo rotation of the AT and its distance to the sural nerve in ruptured and nonruptured ATs to develop guidelines to aid in limited-open and percutaneous repair techniques. Methods: A retrospective review was conducted to identify magnetic resonance imaging (MRI) studies of patients with ruptured and healthy (nonruptured) ATs. AT rotation and distance to the sural nerve in the anterior-posterior (A-P) and medial-lateral (M-L) planes were measured at the level of and proximal to the ankle. Results: The AT was externally rotated in both ruptured and nonruptured cohorts. Ruptured ATs showed greater external rotation than nonruptured ATs at the ankle (15.8 ± 16.2 degrees vs 5.9 ± 9.0 degrees, P = .008) but not at 10 cm proximal to the tendon’s insertion (10.9 ± 10.9 degrees vs 6.1 ± 8.4 degrees, P = .139). Proximal AT rotation was negatively correlated with rupture height (r = −0.477, P = .029). At 4 cm proximal to the AT insertion, the sural nerve was closer anteriorly to and farther laterally from the AT in ruptures than in nonruptures (P < .001). At 10 cm proximal to the AT insertion, the sural nerve was farther posteriorly and laterally from the AT in ruptures than in nonruptures (P = .027 and P < .001, respectively). Conclusion: We found that the AT was more externally rotated in ruptured than in nonruptured tendons at the ankle and that its distance to the sural nerve differed between the 2 cohorts in the A-P and M-L planes, likely due to increased AT rotation and swelling with ruptures. To minimize sural nerve injury and improve tendon targeting, we suggest an external rotation of 11 degrees at the proximal end of the rupture and 16 degrees at the distal end when using percutaneous and limited-open AT repair devices to try to minimize sural nerve violation and increase tendon capture, which can decrease rates of complication and rerupture. Level of Evidence: Level III, retrospective comparative study.