Large Rupture Research Articles

Flexural behaviour of BFRP grid/bar reinforced UHPC beams and slabs

This study investigates the integration of Basalt Fiber Reinforced Polymer (BFRP) and Ultra-High Performance Concrete (UHPC), which exhibit significant potential for a durable and sustainable solution in marine and offshore infrastructure. An experimental program of BFRP grid/bar-reinforced UHPC beams and slabs subjected to four-point bending is presented. A total of nine beams and ten slabs were prepared and tested to investigate the effect of BFRP reinforcement ratio (0 %–3.33 %), type of reinforcement (grid and bar), and steel fiber content of UHPC (0 %, 1 %, 2 % and 3 %). The results revealed that the inclusion of BFRP reinforcement, even at a small reinforcement ratio, is feasible to enhance structural ductility due to the large rupture strain and superior strength characteristics of BFRP material. Moreover, the steel fibers played a crucial role in preventing shear failures of UHPC and creep failures of BFRP reinforcement. Within a range of 0–2 %, the steel fiber content not only benefited the load-resistance and deformation capacity but also effectively improved the cracking load. However, high fiber content (3 %) had a minimal contribution to load-bearing capacity and negatively affected ductility. A theoretical model based on the deflection method was employed to forecast the general behaviour of the flexural members. Comparisons between experimental results and numerical predictions confirm its accuracy.

Severe multiple injuries in a 15-year-old boy with pelvic fracture complete anterior dislocation of the sacroiliac joint and rupture of the internal and external iliac arteries: A case report of a rare injury.

Anterior dislocation of the sacroiliac joint combined with pelvic fractures is relatively rare in clinical practice. It is often associated with hemodynamic instability and severe injuries to other regions, resulting in a complex condition, prolonged treatment duration, and high rates of mortality and disability. However, there are few reports in the literature describing the diagnosis and treatment of anterior dislocation of the sacroiliac joint. In this case, the patient sustained a pelvic fracture with anterior sacroiliac joint dislocation and rupture of both the internal and external iliac arteries following a motor vehicle accident, making it an even rarer and more challenging case to treat. Reporting such cases can enhance the understanding of the diagnosis and treatment of anterior sacroiliac joint dislocation with rupture of the iliac arteries and provide valuable references for similar cases. The patient was riding an electric bicycle and was hit by a small truck, resulting in a pelvic fracture, anterior dislocation of the sacroiliac joint, and rupture of the internal and external iliac arteries. The patient was diagnosed with open pelvic fracture (type C1.2), left complete anterior dislocation of the sacroiliac joint, left acetabular fracture, left internal and external iliac arteriovenous rupture. emergency room resuscitation, intensive care unit resuscitation, 6 surgeries and perioperative management. He has been discharged from the hospital for more than 1 year and was rechecked every month after discharge, the fracture has healed, there is no obvious pain and discomfort in and around the wound, he has been fitted with a prosthesis, and he is doing the walking function exercise. Pelvic fracture with anterior sacroiliac dislocation is clinically rare and critical, and is associated with large vessel rupture, severe organ damage, and high mortality and disability rates. Rapid restoration of pelvic stability and hemodynamic stability is the key to treatment. Rapid transfer to a tertiary trauma center, rapid examination through the green channel to clarify the diagnosis, close intensive care, and reasonable multidisciplinary teamwork for surgical intervention are all valuable experiences that we have concluded.

Off-fault deformation feedback and strain localization precursor during laboratory earthquakes

Recent large-scale seismological observations have shown that off-fault strain localization and foreshock migration could serve as an early warning of an impending earthquake. However, this process is still largely unknown. In this study, state-of-the-art friction experiments were conducted in a oil-confined biaxial shear apparatus to investigate the link between stick-slip nucleation and off-fault deformation. Our findings indicate that there is a direct link between stick-slip nucleation and off-fault deformation, provided that the fault is conditionally unstable (a − b < 0). Inelastic off-fault deformation may trigger unstable slip by decreasing the stiffness of the surrounding rock volume, which favors earthquake nucleation. Additionally, the study presents laboratory observation of precursory strain localization around a fault during stick-slip cycles. These findings suggest that volumetric deformation processes could be a main factor in the nucleation of large ruptures and strain localization could be a reliable harbinger of large earthquakes.

Regeneration of full thickness common extensor tendon tear after percutaneous microfragmented adipose graft.

Tennis elbow, also commonly known as lateral epicondylitis or common extensor tendinosis, is a common musculoskeletal injury in the adult population. Currently, the standard treatment regimen prescribed for this injury involves a combination of rest, physical therapy, bracing and anti-inflammatory medications. If refractory to these conservative measures, platelet-rich plasma has been shown effective. However, in the case of full thickness tears, surgery has remained the only treatment option until now. We present a case report of a 56-year-old man with a diagnosis of a left large full thickness tear and rupture with retraction of his common extensor tendon (CET) following a corticosteroid injection. The patient was treated with microfragmented adipose transfer. He was re-evaluated around 7weeks and again at 15weeks post-treatment and demonstrated ultrasound evidence of complete bridging and remodeling of his prior full thickness CET tear and resolution of retraction. This case presents a promising option for patients with full thickness CET tears who would like to refrain from or are unable to have surgery. Further research and possible randomized controlled trials are needed to further assess the full efficacy of microfragmented adipose transfer in the treatment of full thickness CET tears.

Use of tsunami observations for resolving coseismic slip of recent and historic large submarine earthquakes

Tsunamis generated by seafloor displacements accompanying large submarine earthquakes provide sensitivity to absolute slip position and distribution for offshore faulting analogous to that of geodetic observations for landward faulting. Tsunami recordings at deep‐water and near‐shore ocean bottom pressure sensors and tide gauges, along with runup and inundation measurements, can now be reliably modeled using detailed bathymetric structures and robust numerical codes. As a result, tsunami observations now play an important role in quantifying coseismic slip distributions for large submarine earthquakes in subduction zones and other tectonic environments. Applications of joint modeling or inversion of seismic, geodetic and tsunami observations for recent major earthquakes are described, highlighting the specific contributions of the tsunami observations to source model resolution. Tsunami observations provide unique information on the up‐dip extent of earthquake coseismic slip on subduction zone megathrust faults and occurrence of near‐trench slip, which are usually not well constrained by seismic and land‐based geodetic signals. Tsunami signals also help to detect offshore slow slip that is not evident in seismic or land‐based geodetic data and to balance geophysical constraints on ruptures that extend from on‐shore to off‐shore. Tsunami runup measurements and stratigraphic deposits further provide unique constraints on large earthquake ruptures that occurred prior to modern geophysical instrumentation.

Large Rupture Strain Cotton Ropes Hybridized with Affordable Fiberglass Chopped Strand Mat Sheets for Enhanced Compressive Behavior of Reinforced Concrete Columns

The hybrid confinement system combines various fiber types within a single matrix, allowing for the adjustment of volumetric ratios to optimize confinement performance. Synthetic FRPs are more expensive and have a higher carbon footprint due to significant CO2 emissions during production. In response, this study presents an innovative hybrid confinement approach using two natural materials: cotton ropes and FSMS (CFS) to improve concrete strength and ductility. Specimens, standardized at 300 mm height and 150 mm diameter with longitudinal steel bars and stirrups, were divided into two groups based on CFS configurations. The stress-strain response of CFS-confined concrete displayed distinctive behavior: an initial parabolic phase leading to peak compressive stress (ultimate strength), followed by a linearly degrading phase. Across all subgroups, CFS confinement significantly enhanced ultimate strength and corresponding compressive strains, with Subgroup 2A achieving the highest improvements of 246% in ultimate strength and 1477% in strain. Moreover, the ductility gain was reported as high as 20 for CFS-confined concrete. A non-proportional enhancement in the compressive behavior was observed with the increase in confinement ratio. Predictive models were developed for the idealized two-branch response of CFS-confined concrete, encompassing expressions based on nonlinear regression for ultimate strength, corresponding strain, ultimate strain, and elastic modulus. Two existing models were modified to trach each branch of the response. Integrating these two adjusted models closely replicated the experimental compressive curves.

A UTERINE RUPTURE NOT TO OVERLOOK IN THE CONTEXT OF RETROPLACENTAL HEMATOMA

Objective: To report a rare case of uterine rupture in the context of a Couvelaire uterus in a patient with no history of uterine surgery or manipulation and to discuss the clinical challenges and management strategies for such cases. Case Summary: A 34-year-old multiparous woman presented at 34 weeks gestation with intrauterine fetal death (IUFD) and preeclampsia. Despite an unremarkable history with no prior cesarean deliveries or intrauterine interventions, she developed sudden hemodynamic instability and was diagnosed with uterine rupture during an emergency laparotomy. Intraoperatively, a large posterior uterine rupture was identified and repaired. Postoperatively, the patient experienced uterine atony and significant hemorrhage, necessitating additional surgical interventions including Tsirulnikov ligation and the B-Lynch uterine compression technique. The patient recovered well following intensive care management. Discussion: Uterine rupture in an unscarred uterus is an exceedingly rare event, particularly in the absence of classic risk factors. This case occurred in the context of a Couvelaire uterus, where extensive intramyometrial hemorrhage due to placental abruption may have weakened the uterine wall. The nonspecific clinical presentation, including the absence of abdominal pain or vaginal bleeding, poses diagnostic challenges. Immediate surgical intervention is crucial, especially in low-resource settings where advanced treatment options may be limited. This case underscores the importance of maintaining a high index of suspicion for uterine rupture, even in patients without typical risk factors, and highlights the need for adaptable management strategies. Conclusion: Uterine rupture should be considered in the differential diagnosis of acute abdomen in pregnancy, regardless of the patients obstetric history. Early recognition, prompt surgical management, and flexible treatment strategies are essential for optimizing outcomes in such rare but potentially life-threatening situations. Further studies are needed to improve understanding and management of this rare complication.

Fault geometry and kinematics at the intersection of the Zemuhe, Daliangshan and Xiaojiang Faults

The complexity of strike-slip fault segmentation affects the initiation, propagation, and termination of earthquake ruptures and the earthquake magnitude. Studying the fault geometry, kinematics, and segmentation provides fundamental knowledge for mitigating earthquake hazards along faults. The Zemuhe, Daliangshan, and Xiaojiang Faults intersect along the eastern boundary of the Tibetan Plateau in the area from Ningnan in Sichuan Province to Qiaojia in Yunnan Province. Although few large earthquakes have occurred on these faults, the relationships between the intersections of these three faults and earthquake rupture behavior in this region are poorly constrained. The interpretation of aerial photographs and detailed field surveys revealed the geometric pattern and fault kinematics in the area of intersection. The distribution patterns and focal depths near the faults were obtained via analysis of seismic data in the area of intersection. The northern segment of the Xiaojiang Fault deviates approximately 25° northwest of Qiaojia, forming a conspicuous bend. The Xiaojiang Fault continues to extend southeast of the Ningnan Basin, where it intersects with the southern segment of the Zemuhe Fault, forming a pull-apart basin approximately 4.5 km wide. The bend and Ningnan pull-apart basin mark the segmented boundary between the Zemuhe Fault and the Xiaojiang Fault, which may prevent the propagation of large earthquake ruptures along the eastern boundary fault. Moreover, the lack of obvious geometric complexity between the Daliangshan Fault and Xiaojiang Fault might hinder the prevention of earthquake rupture propagation. Additionally, our results suggest that different earthquake prevention and disaster reduction measures should be taken for different cities in the region.

Activity and motion characteristics on the southern segment of the Red River fault zone, Yunnan province, China

The longer time for recording large earthquakes on a plate boundary fault, the better that understanding of large earthquake rupture behavior and seismic hazard on the fault zone. However, large earthquakes (M ≥ 7) are rarely recorded on the boundary fault with slow slipping rate, such as the Red River fault zone (RRFZ), which is an important plate boundary fault that marks the southwestern boundary of the Yangtze platform or south China block. There have been no large earthquake records on the southern segments (including the segment in Vietnam) of the RRFZ since historical earthquake records began in 886 AD, except the 1652 Midu M 7 earthquake and the 1925 Dali M 7 earthquake on the northern segment. The southern segment of the RRFZ will not have a large earthquake in the future or as a large earthquake seismogenic zone with a long period of recurrence, remains controversial, in part because of the absence of constraints from geological evidence. This controversial seriously restricts the risk assessment of future large earthquakes on the southern segment of the RRFZ. By careful interpretations of high resolution remote sensing images, in combination with a detailed field geological and geomorphic survey, we found a series of fault valleys and bedrock outcrops from Gasha toYaojie and Yuangjiang to Hekou on the southern segment of the RRFZ. Multiple trench excavation and radiocarbon dating sample analyses show that the mid valley trace in the southern segment of the RRFZ is an active fault. Geological and geomorphic evidence from Gasha to Yaojie and Yuanjiang to Hekou indicate that the mid valley trace in the southern segment of the RRFZ exhibits dip slip and dextral strike slip motion characteristics. This result is inconsistent with those of previous studies that the mid valley trace is purely strike slip. Furthermore, trenches opened on the range front trace in the southern segment of the RRFZ in Ejia are found to still be active, differing from previous studies. Thus, the seismic hazard on the southern segment of the RRFZ should be reevaluated.

Catastrophic uterine rupture of an unscarred uterus following motor vehicle rollover – a case report

A 22 year old female at 6 months gestation with no history of prior abdominal surgery or previous uterine procedures presented via air transport after highway motor vehicle rollover. Due to hemodynamic instability, the only preoperative imaging that was able to be obtained was bedside sonography, which confirmed free fluid in the upper quadrants and unfortunately, fetal demise. In the operating room, source of bleeding was noted to be multiple large uterine ruptures. Uterine rupture in trauma in the absence of prior uterine surgery is a rare event and has never been reported in the third trimester, however it should remain in the differential for a pregnant trauma patient presenting with hemodynamic instability.

Imaging microearthquake rupture processes using a dense array in Oklahoma

Both large and small earthquakes rupture in complex ways. However, microearthquakes are often simplified as point sources and their rupture properties are challenging to resolve. We leverage seismic wavefields recorded by a dense array in Oklahoma to image microearthquake rupture processes. We construct machine-learning enabled catalogs and identify four spatially disconnected seismic clusters. These clusters likely delineate near-vertical strike-slip faults. We develop a new approach to use the maximum absolute SH-wave amplitude distributions (S-wave wavefields) to compare microearthquake rupture processes. We focus on one cluster with earthquakes located beneath the dense array and have a local magnitude range of -1.3 to 2.3. The S-wave wavefields of single earthquakes are generally coherent but differ slightly between the low-frequency (&lt;12 Hz) and high-frequency (&gt;12 Hz) bands. The S-wave wavefields are coherent between different earthquakes at low frequencies with average correlation coefficients greater than 0.95. However, the wavefield coherence decreases with increasing frequency for different earthquakes. This reduced coherence is likely due to the rupture differences among individual earthquakes. Our results suggest that earthquake slip of the microearthquakes dominates the radiated S-wave wavefields at higher frequencies. Our method suggests a new direction in resolving small earthquake source attributes using dense seismic arrays without assuming a rupture model.

Estimation of confined compressive strength of LRS‐FRP concrete specimens with computational intelligence

AbstractReinforced concrete structures deteriorate due to changes in temperature, corrosion, and attacks of sulfate and chloride contents. Retrofitting techniques like fiber‐reinforced polymer (FRP) jacketing, known for their strength and corrosion resistance, are increasingly used to strengthen and retrofit deteriorated structural elements. Large rupture strain (LRS)‐FRP composite, composed of polyethylene terephthalate and polyethylene naphthalate, both of which have high tensile strength and high strain at rupture have been used in the studies of many researchers. This research aims to develop a reliable and accurate machine learning (ML) model to estimate the compressive strength of LRS‐FRP confined specimens. A total of 303 LRS‐FRP confined specimens were gathered after a thorough literature review to develop ML models, utilizing the linear regression, support vector regression, regression tree, and artificial neural network (ANN) algorithms. Additionally, 44 analytical models (AMs) were used to compare the performance of the developed ML models. The results revealed that the performance of the developed ANN model was higher among all the ML and AMs. The R‐value and the mean absolute percentage error (MAPE) value of the developed ANN model were 0.9822 and 6.17%, respectively. The sensitivity analysis results show that the height of the specimens had the highest impact followed by the diameter of the specimen, the number of FRP layers and thickness, and then the tensile strength of LRS‐FRP. The ANN‐based mathematical expression is simple and easy to use to predict the compressive strength of the LRS‐FRP strengthened specimens.

Majority of Ruptures in Large Continental Strike-Slip Earthquakes Are Unilateral: Permissive Evidence for Hybrid Brittle-to-Dynamic Ruptures

Abstract Finite-element models of neotectonics require transform faults to rupture seismically even where preseismic shear stresses are low, presumably by dynamic-weakening mechanisms. A long-standing objection is that, if a rupture initiated at an asperity with high static friction stresses, which then transitioned to low dynamic-weakening stresses, local stress drop would be near total and on the order of 80 MPa, which is 4×–40× greater than observed. But the 5 Mw ≥ 7.8 transform earthquakes since 2000 initially ruptured on the branch faults of small net slip (Stein and Bird, 2024). If the slip initiates on a branch fault with different slip physics and no dynamic weakening, this solves the stress-drop problem. We propose that most large shallow earthquakes are hybrid ruptures, which begin on branch faults of small slip with high shear stresses, and then continue propagating on a connected dynamically weakened fault of large slip, even where shear stresses are low. One prediction of this model is that most large shallow ruptures should be unilateral. We test this prediction against the 100 largest (m ≥ 6.49) shallow continental strike-slip earthquakes 1977–2022, using information from the Global Centroid Moment Tensor and International Seismological Centre catalogs. The differences in time and location between the epicenter and the epicentroid define a horizontal “migration” velocity vector for the evolving centroid of each rupture. Early aftershock locations are summarized by a five-parameter elliptical model. Using the geometric relations between these (and mapped traces of active faults) and guided by a symmetrical decision table, we classified 55 ruptures as apparently unilateral, 30 as bilateral, and 15 as ambiguous. Our finding that a majority (55%–70%) of these ruptures are unilateral permits the interpretation that a majority of ruptures are hybrids, both in terms of geometry (branch fault to transform) and in terms of the physics of their fault slip.

Super-shear ruptures steered by pre-stress heterogeneities during the 2023 Kahramanmaraş earthquake doublet

The 2023 M7.8 and M7.5 earthquake doublet near Kahramanmaraş, Turkey, provides insight regarding how large earthquakes rupture complex faults. Here we determine the faults geometry using surface ruptures and Synthetic Aperture Radar measurements, and the rupture kinematics from the joint inversion of high-rate Global Navigation Satellite System (GNSS), strong-motion waveforms, and GNSS static displacement. The M7.8 event initiated on a splay fault and subsequently propagated along the main East Anatolian Fault with an average rupture velocity between 3.0 and 4.0 km/s. In contrast, the M7.5 event demonstrated a bilateral supershear rupture of about 5.0–6.0 km/s over an 80 km length. Despite varying strike and dip angles, the sub-faults involved in the mainshock are nearly optimally oriented relative to the local stress tensor. The second event ruptured a fault misaligned with respect to the regional stress, also hinting at the effect of local stress heterogeneity in addition to a possible free surface effect.

Subduction Zone Geometry Modulates the Megathrust Earthquake Cycle: Magnitude, Recurrence, and Variability

AbstractMegathrust geometric properties exhibit some of the strongest correlations with maximum earthquake magnitude in global surveys of large subduction zone earthquakes, but the mechanisms through which fault geometry influences subduction earthquake cycle dynamics remain unresolved. Here, we develop 39 models of sequences of earthquakes and aseismic slip (SEAS) on variably‐dipping planar and variably‐curved nonplanar megathrusts using the volumetric, high‐order accurate code tandem to account for fault curvature. We vary the dip, downdip curvature and width of the seismogenic zone to examine how slab geometry mechanically influences megathrust seismic cycles, including the size, variability, and interevent timing of earthquakes. Dip and curvature control characteristic slip styles primarily through their influence on seismogenic zone width: wider seismogenic zones allow shallowly‐dipping megathrusts to host larger earthquakes than steeply‐dipping ones. Under elevated pore pressure and less strongly velocity‐weakening friction, all modeled fault geometries host uniform periodic ruptures. In contrast, shallowly‐dipping and sharply‐curved megathrusts host multi‐period supercycles of slow‐to‐fast, small‐to‐large slip events under higher effective stresses and more strongly velocity‐weakening friction. We discuss how subduction zones' maximum earthquake magnitudes may be primarily controlled by the dip and dimensions of the seismogenic zone, while second‐order effects from structurally‐derived mechanical heterogeneity modulate the recurrence frequency and timing of these events. Our results suggest that enhanced co‐ and interseismic strength and stress variability along the megathrust, such as induced near areas of high or heterogeneous fault curvature, limits how frequently large ruptures occur and may explain curved faults' tendency to host more frequent, smaller earthquakes than flat faults.

Investigating dilation response in PET FRP-confined reinforced concrete: Experimental study

In compression, concrete undergoes dilation due to the Poisson’s effect. Beyond the elastic limit, rapid crack propagation causes unstable expansion, leading to stiffness degradation, reduced strength, and ductility. External confinement with fiber-reinforced polymer (FRP) composites effectively manages this dilation, maintaining core integrity at high strength and deformation levels. However, internal steel reinforcement, especially when poorly detailed, can hinder FRP's efficacy by inducing stress concentrations from longitudinal bar buckling, resulting in premature FRP failure. This study addresses this challenge by utilizing polyethylene terephthalate (PET) FRP with a large rupture strain (LRS) capacity to delay premature rupture to high strain levels. Experimental results on poorly detailed reinforced concrete (RC) externally confined with PET FRP are presented, with variables including PET FRP layers, longitudinal bar buckling length, and cross-sectional aspect ratio. Detailed discussions on the effects of these variables on lateral to axial strain ratio, dilation rate, and volumetric response of confined concrete are provided. Test results have shown that PET FRP effectively managed the unstable dilation of confined concrete, even with internal steel reinforcement. Following the yielding of lateral ties and the buckling of longitudinal bars, PET FRP efficiently handled local stress concentrations and redistributed internal concrete damage. Despite PET FRP's low elastic modulus causing significant lateral expansion, its LRS capacity maintained the integrity of the entire column under high deformation.

Fault size-dependent fracture energy explains multiscale seismicity and cascading earthquakes.

Earthquakes vary in size over many orders of magnitude, often rupturing in complex multifault and multievent sequences. Despite the large number of observed earthquakes, the scaling of the earthquake energy budget remains enigmatic. We propose that fundamentally different fracture processes govern small and large earthquakes. We combined seismological observations with physics-based earthquake models, finding that both dynamic weakening and restrengthening effects are non-negligible in the energy budget of small earthquakes. We established a linear scaling relationship between fracture energy and fault size and a break in scaling with slip. We applied this scaling using supercomputing and unveiled large dynamic rupture earthquake cascades involving >700 multiscale fractures within a fault damage zone. We provide a simple explanation for seismicity across all scales with implications for comprehending earthquake genesis and multifault rupture cascades.

Enhancing compressive behavior of concrete with novel low-cost hybrid passive confinement including large rupture strain cotton ropes: Experimental findings and a design-oriented model

Recent research have highlighted the potential of hybrid confinement, combining high tensile strength fiber-reinforced polymers with large rupture strain confinement. This study presents experimental findings on 64 cylindrical and square-shaped specimens tested under axial compression, introducing a novel hybrid confinement method utilizing low-cost fiberglass chopped strand mat sheets and cotton ropes (COFS confinement). The experimental and analytical results yielded several key conclusions. Firstly, circular specimens exhibited significant peak strength increases in various subgroups, with enhancements ranging from 97.5 % to 285.5 %, and ultimate strain improvements ranging from 588.6 % to 1650.0 %. Similarly, square specimens under COFS confinement also demonstrated notable enhancements in ultimate strength and strain, with increases up to 244.7 % and 1083.0 %, respectively, particularly evident with higher levels of confinement. The influence of cross-sectional shape on compressive strength, strain, and energy dissipation was noted, with COFS confinement notably improving these factors for circular sections. Additionally, the study found that as the unconfined compressive strength increased, the enhancement in compressive strength, ultimate strain, and energy dissipation decreased. Moreover, the confinement ratio positively affected axial behavior improvement, with a proportional enhancement observed. However, the efficacy of the confinement ratio was influenced by cross-section type and plain concrete strength, emphasizing the need for considering these factors in COFS-based confinement design. Lastly, an analytical design-oriented model proposed for approximating stress vs. strain curves of COFS-confined concrete showed close agreement with experimental results, providing valuable insights for future design considerations.

Non-Traumatic Full-Thickness Duodenal Perforation: A Case Report

Duodenal perforation is a life-threatening condition with high mortality and morbidity. In this study, we aim to present a case of spontaneous duodenal perforation that was detected and treated. The 66-year-old male patient, who applied to the emergency clinic with complaints of malaise, fever, weakness and shortness of breath, had no additional disease other than Chronic obstructive pulmonary disease and dementia. Pneumonia was diagnosed based on physical examination and imaging findings, and he was admitted to the pulmonology clinic and treated. During follow-ups, the patient developed sepsis and an acute abdominal pain. An emergency laparotomy revealed a non-traumatic spontaneous duodenal perforation, which caused near ruptured duodenum. The perforated duodenum part was resected and gastrojejunostomy was performed. The rupture of the duodenum and large duodenal perforation can occur in association with iatrogenic or trauma-related causes. In the patient who had no history of trauma, the most likely cause of perforation was thought to be peptic ulcer. It was thought that possible peptic ulcer perforation expanded with necrosis over time. In cases without a history of trauma, the possibility of large duodenal perforation or rupture should not be ruled out, and if there is suspicion of spontaneous duodenal perforation, laparotomy should not be avoided.

High cure rate and satisfaction in patients with periductal mastitis via the latissimus dorsi myocutaneous flap technique: a retrospective study.

Periductal mastitis (PDM) is a complex benign breast disease with a prolonged course and a high probability of recurrence after treatment. There is a variety of available treatments for PDM, but none of these options have been widely accepted. A standard strategy has been especially difficult to establish in patients with PDM accompanied by large tumors or large skin ruptures, as these seriously affect the appearance of the breasts after surgeries, which can lead to feelings of lower self-esteem among patients. Therefore, finding a reliable volume replacement has become a focus of our research efforts. With the widespread use of latissimus dorsi in breast reconstruction, we attempted to use the latissimus muscle (skin) flap for stage I repair in patients with large-defect PDM. Our study is the first of its kind to evaluate the clinical effect and patient satisfaction of the latissimus dorsi myocutaneous flap (LDMF) technique in PDM. Thirty-two patients with PDM and more than about 20% loss of breast volume admitted to the Department of Breast Surgery of Shanxi Bethune Hospital from March 2017 to July 2021 were enrolled. After lesion removal, the LDMF technique was applied to these patients for immediate completion of breast contour revision. All patients were periodically followed up to assess the efficacy of the procedure and their satisfaction with the breasts' shape. Three patients (9.4%) developed dorsal effusion after removal of the back drain; six patients (18.8%) developed mild limitation of the activity of the affected upper limb; and three patients (9.4%) experienced local recurrence of inflammation after the operation, all of whom underwent a second operation. The cure rate of the patients treated with LDMF was 90.6%, the overall satisfaction rate of the patients was 96.9%, and doctor's evaluation of satisfaction was 90.6%. In patients with poor results after anti-infective and local treatment and those with more than 20% defect volume following lesion removal, the LDMF technique yields a high cure rate and good patient satisfaction.