Late Rupture Research Articles

Strain Partitioning and Strike‐Slip Faulting in the Nanjieshan, North Tibetan Foreland: Progressive Widening of the Altyn Tagh Fault System With Implications for Regional Earthquake Hazards

AbstractLarge continental strike‐slip fault systems typically comprise a principal displacement zone and subordinate splay faults, exhibiting complex geometries, connectivity, and kinematics. Understanding the three‐dimensional arrangement of major and minor faults is important for determining strain distribution, landform development, and potential earthquake behavior. This study examines the Quaternary deformation, fault kinematics, and late Holocene ruptures along the Nanjieshan Fault system (NJSF), a major branch of the Altyn Tagh Fault (ATF) system in the North Tibetan Foreland. The E‐W‐trending NJSF comprises a principal strike‐slip fault flanked by two thrust faults, forming a regional, sinistral positive flower structure. Cosmogenic exposure dating, field data and remote sensing observations indicate that the strike‐slip rate of the main NJSF is ∼0.5 mm/a since ∼45 ka, consistent with the low slip rates observed on other faults northwest of the ATF. Paleoseismological trenches reveal three surface‐rupturing events on the NJSF in the last 2,500 years that may coincide temporally with the last two major earthquakes documented on the principal ATF, suggesting quasi‐simultaneous rupture behavior. Coulomb stress change modeling indicates that a future ATF earthquake is unlikely to trigger failure along the NJSF. Conversely, rupture of the NJSF could induce stress loading on the ATF, potentially bringing it to failure. A synchronous rupture on the ATF and its major branch faults could be facilitated by mechanically weakened fault rocks and supra‐hydrostatic fluid pressures within the deep southward‐dipping branch faults of the North Tibetan foreland. We conclude that improved prediction of future slip behavior along major strike‐slip fault systems requires detailed geochronological analysis of paleo‐earthquake events along subordinate branching faults.

Delayed functional rescue of section of the flexor tendons of the last four (4) fingers at a gold miner in a Sahelian hospital in Niamey (Niger)

Introduction: Secondary reconstructions of flexor tendon section have become rare nowadays. We report the result of delayed functional rescue of a traumatic section of the hand flexor tendons in a young adult. Clinical case: This is a 20-year-old patient, admitted for inability to flex the last 4 fingers of the right hand. The interrogation revealed a history of open trauma to the hand from a stab dating back 3 months following a fight. The physical examination found a transverse scar located on the palmar aspect of the right hand measuring 6 cm in zone three (3) of Verdan. Exploration in the operating room revealed a complete section of the superficial and deep flexor tendons of the last four (4) fingers. An end-to-end suture of the tendons was performed using Kessler stitches using Nylon thread 4.0. After one (1) year and eight (8) months of follow up, we found an excellent result according to the IFSSH (International Federation of Societies for Surgery of the Hand) classification with a score of 88/100. Conclusion: Secondary repair of late flexor tendon ruptures by end-to-end suture gives good results and remains an alternative when a tendon graft is impossible. Keywords: Secondary suture, Flexor tendons, Hand, Niger.

Early and Late Aortic-Related Mortality and Rupture After Fenestrated-Branched Endovascular Aortic Repair of Thoracoabdominal Aortic Aneurysms: A Prospective Multicenter Cohort Study.

Fenestrated-branched endovascular aortic repair (FB-EVAR) has been used as a minimally invasive alternative to open surgical repair to treat patients with thoracoabdominal aortic aneurysms (TAAAs). The aim of this study was to evaluate aortic-related mortality (ARM) and aortic aneurysm rupture after FB-EVAR of TAAAs. Patients enrolled in 8 prospective, nonrandomized, physician-sponsored investigational device exemption studies between 2005 and 2020 who underwent elective FB-EVAR of asymptomatic intact TAAAs were analyzed. Primary end points were ARM, defined as any early mortality (30 days or in hospital) or late mortality from aortic rupture, dissection, organ or limb malperfusion attributable to aortic disease, complications of reinterventions, or aortic rupture. Secondary end points were early major adverse events, TAAA life-altering events (defined as death, permanent spinal cord injury, permanent dialysis, or stroke), all-cause mortality, and secondary interventions. A total of 1109 patients were analyzed; 589 (53.1%) had extent I-III and 520 (46.9%) had extent IV TAAAs. Median age was 73.4 years (interquartile range, 68.1-78.3 years); 368 (33.2%) were women. Early mortality was 2.7% (n=30); congestive heart failure was associated with early mortality (odds ratio, 3.30 [95% CI, 1.22-8.02]; P=0.01). Incidence of early aortic rupture was 0.4% (n=4). Incidence of early major adverse events and TAAA life-altering events was 20.4% (n=226) and 7.7% (n=85), respectively. There were 30 late ARMs; 5-year cumulative incidence was 3.8% (95% CI, 2.6%-5.4%); older age and extent I-III TAAAs were independently associated with late ARM (each P<0.05). Fourteen late aortic ruptures occurred; 5-year cumulative incidence was 2.7% (95% CI, 1.2%-4.3%); extent I-III TAAAs were associated with late aortic rupture (hazard ratio, 5.85 [95% CI, 1.31-26.2]; P=0.02). Five-year all-cause mortality was 45.7% (95% CI, 41.7%-49.4%). Five-year cumulative incidence of secondary intervention was 40.3% (95% CI, 35.8%-44.5%). ARM and aortic rupture are uncommon after elective FB-EVAR of asymptomatic intact TAAAs. Half of the ARMs occurred early, and most of the late deaths were not aortic related. Late all-cause mortality rate and the need for secondary interventions were 46% and 40%, respectively, 5 years after FB-EVAR. URL: https://www.clinicaltrials.gov; Unique identifiers: NCT02089607, NCT02050113, NCT02266719, NCT02323581, NCT00583817, NCT01654133, NCT00483249, NCT02043691, and NCT01874197.

Outcomes following surgical clipping of re-ruptured previously untreated intracranial aneurysms.

Re-rupture of untreated intracranial aneurysm is a potentially life-threatening condition. Despite tremendous advances in the diagnosis and treatment of intracranial aneurysms, such events are not rare and continue to pose a management dilemma. In this study, we examined the clinical, radiological and treatment details of patients who underwent microsurgical clipping for re-rupture of previously untreated intracranial aneurysms. Re ruptures were categorized as early and late re ruptures (< or > 7 days of inter ictus interval respectively). Modified Rankin Score (mRS) was used for functional outcome assessment and logistic regression analysiswas used to test the predictors of long-term outcome. Re-ruptured intracranial aneurysms comprised 5% (n = 32/637) of the aneurysm clippings done at our center in this time span. The mean mRS score at discharge and at last follow-up were 3 and 3.04 respectively. Twenty-four (75%) patients were alive at a mean follow-up of 36 months. Early re-ruptures were associated with worse mean mRS scores at discharge (3.9 vs 2.5, p = 0.03) including the perioperative deaths (n = 4, 12.5%). The functional status at discharge and a poor preoperative clinical grade predicted apoor long-term outcome. Therefore, the long-term outcomes are primarily dependent on the short-term outcomes and to a lesser extent, the clinical grade at presentation. Those presenting with poor preoperative clinical grade, especially in the setting of an early re rupture, have a very poor prognosis and do not benefit from surgery.

Late post-EVAR abdominal aortic aneurysm rupture: a meta-analysis study.

This study presents updated information on post-endovascular aneurysm repair (EVAR) late aortic rupture (LAR) as the data in the literature are limited. It comprises a meta-analysis based on the recent evidence regarding the incidence, causes, treatment outcomes, and prognosis of post-EVAR. A meta-analysis was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were identified by searching electronic databases and scanning bibliographic references from 1991 to April 1, 2023. Our analysis provided evidence that the most common causes of rupture after EVAR were type Ia and Ib Endoleaks (Els). Post-rupture mortality after EVAR was high (35.6%) and comparable to the morbidity of de novo ruptures. Endovascular repair appears to have better results compared to conversion to open repair. A significant number of patients had prior endovascular reoperations and inadequate follow-up. Patient compliance with the surveillance protocol is mandatory.

Association between Gestational Age and Perinatal Outcomes in Women with Late Preterm Premature Rupture of Membranes.

The American College of Obstetricians and Gynecologists (ACOG) suggests expectant management until 34 weeks for patients with preterm premature rupture of membranes (PPROM). New data suggest extending to 37 weeks might enhance neonatal outcomes, reducing prematurity-linked issues. This study aims to assess adverse neonatal outcomes across gestational ages in women with PPROM. A retrospective cohort study was performed using linked vital statistics and the International Classification of Diseases, Ninth Revision data. Gestational age at delivery ranged from 32 to 36 weeks. Outcomes include neonatal intensive care unit (NICU) admission >24 hours, neonatal sepsis, respiratory distress syndrome, necrotizing enterocolitis, intraventricular hemorrhage, and neonatal death. Multivariate regression analyses and chi-square tests were employed for statistical comparisons. In this cohort of 28,891 deliveries, there was a statistically significant decline in all studied adverse neonatal outcomes with increasing gestational age, without an increase in neonatal sepsis. At 32 weeks, 93% of newborns were in the NICU >24 hours compared with 81% at 34 weeks and 22% at 36 weeks (p < 0.001). At 32 weeks, 20% had neonatal sepsis compared with 11% at 34 weeks and 3% at 36 weeks (p < 0.001). At 32 weeks, 67% had respiratory distress syndrome compared with 44% at 34 weeks and 12% at 36 weeks (p < 0.001). In the setting of PPROM, later gestational age at delivery is associated with decreased rates of adverse neonatal outcomes without an increase in neonatal sepsis. · The ACOG recommends expectant management until 34 weeks for patients with PPROM.. · However, expectant management to 37 weeks might improve neonatal outcomes.. · Later gestational age at delivery was associated with decreased rates of adverse neonatal outcomes.. · Later gestational age at delivery was not associated with an increase in neonatal sepsis.. · The management of PPROM is complex and should be individualized..

The 2020 Mw 6.5 Stanley, Idaho, Earthquake and Aftershock Sequence: Complex Faulting at the Northern End of the Basin and Range Province

ABSTRACT The magnitude 6.5 Stanley, Idaho, earthquake occurred on 31 March 2020 in a sparsely populated region north of the Sawtooth normal fault. We used seismic data from temporary and permanent stations to derive a 1D velocity model and relocate 1401 M ≥ 2.4 earthquakes with hypoDD, including a foreshock, the mainshock, and 3 yr of aftershocks. We used broadband data to determine seismic moment tensors for 173 Mw≥3.1 earthquakes. Combining locations and mechanisms shows the mainshock ruptured an unmapped north-trending, steeply west-dipping, left-lateral strike-slip fault. Rupture initiated near the bottom of the seismogenic zone and propagated upward and bilaterally for ∼20 km north and ∼3–5 km south, where the fault likely ends and deformation changes to extension. There, the rupture may have jumped west to another unmapped blind fault accommodating oblique extension. Support for a late mainshock rupture on a northwest-trending, likely east-dipping fault comes from normal faulting aftershocks. The total rupture length is ∼25–30 km, because oblique fault activity ends at the latitude of the northern terminus of the Sawtooth fault, but its trace, if it reached the surface, would be ∼6 km to the west. The Sawtooth fault was not active, even though aftershock clusters indicate that short strike-slip and normal faults are abundant in its footwall and hanging wall. Extension in the northern Basin and Range seems to terminate where major normal faults reach the inactive Eocene Trans-Challis fault system (TCFS), suggesting the TCFS exerts structural control. The deformation north of the TCFS is low, and the strike-slip character was unknown before the Stanley earthquake. Faults rupturing in the Stanley earthquake lack surface expression and are immature with low cumulative displacement. Complex transitions between tectonic regimes are common and may result in blind ruptures on unknown, immature faults, posing an underrated hazard.

Perinatal Outcomes of Late Preterm Rupture of Membranes with or without Latency Antibiotics.

This study aimed to examine whether the addition of latency antibiotics in late preterm rupture of membranes (ROM) decreases neonatal infection and increases latency. This retrospective two-center study was conducted at Holy Family Hospital (HFH) in Nazareth and Emek Medical Center (EMC) in Afula, on data collected between January 2017 and April 2023. HFH is the smaller institution. EMC and HFH implement similar policies regarding ROM at 340/7 to 366/7 weeks' gestation; the only difference is that a 10-day course of latency antibiotics is implemented at EMC. All women with ROM between 340/7 and 366/7 weeks' gestation who were admitted to one of the centers during the study period, and had a live fetus without major malformations, were included. The primary outcome was neonatal sepsis rate. Secondary outcomes included a composite of neonatal sepsis, mechanical ventilation ≥24 hours, and perinatal death. Additionally, gestational age at delivery and delivery mode were examined. Overall, 721 neonates were delivered during the study period: 534 at EMC (where latency antibiotics were administered) and 187 at HFH. The gestational age at ROM was similar (35.8 and 35.9 weeks, respectively, p = 0.14). Neonatal sepsis occurred in six (1.1%) neonates at EMC and one (0.5%) neonate at HFH (adjusted p = 0.71; OR: 1.69; 95% Confidence Interval [CI]: 0.11-27.14). The composite secondary outcome occurred in nine (1.7%) and three (1.6%) neonates at EMC and HFH, respectively (adjusted p = 0.71; OR: 0.73; 95% CI: 0.14-3.83). The gestational age at delivery was 36.1 and 36.2 weeks at EMC and HFH, respectively (mean difference: 5 h; adjusted p = 0.02). The cesarean delivery rate was 24.7% and 19.3% at EMC and HFH, respectively (adjusted p = 0.96). Latency antibiotics administered to women admitted with ROM between 340/7 and 366/7 weeks' gestation did not decrease the rate of neonatal sepsis. · Latency antibiotics in late preterm ROM does not decrease neonatal sepsis.. · Latency antibiotics in late preterm ROM does not prolong gestational age at delivery.. · Latency antibiotics in late preterm ROM does not affect the mode of delivery..

Angiogenic imbalance in pregnancies with preterm prelabor rupture of membranes between 34 and 37 weeks of gestation.

This study aimed to identify whether microbial invasion of the amniotic cavity and/or intra-amniotic inflammation in women with late preterm prelabor rupture of membranes (PPROM) was associated with changes in concentrations of soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF) and its ratio in maternal serum, and whether placental features consistent with maternal vascular malperfusion further affect their concentrations. This historical study included 154 women with singleton pregnancies complicated by PPROM between gestational ages 34+0 and 36+6 weeks. Transabdominal amniocentesis was performed as part of standard clinical management to evaluate the intra-amniotic environment. Women were categorized into two subgroups based on the presence of microorganisms and/or their nucleic acids in amniotic fluid (determined by culturing and molecular biology method) and intra-amniotic inflammation (by amniotic fluid interleukin-6 concentration evaluation): (1) those with the presence of microorganisms and/or inflammation (at least one present) and (2) those with negative amniotic fluid for infection/inflammation (absence of both). Concentrations of sFlt-1 and PlGF were assessed using the Elecsys® sFlt-1 and Elecsys® PlGF immunoassays and converted into multiples of medians. Women with the presence of microorganisms and/or inflammation in amniotic fluid had lower serum concentrations of sFlt-1 and sFlt-1/PlGF ratios and higher concentrations of PlGF compared with those with negative amniotic fluid. (sFlt-1: presence: median 1.0 multiples of the median (MoM), vs negative: median: 1.5 MoM, P = 0.003; PlGF: presence: median 0.7 MoM, vs negative: median 0.4 MoM, P = 0.02; sFlt-1/PlGF: presence: median 8.9 vs negative 25.0, P = 0.001). Higher serum concentrations of sFlt-1 and sFlt-1/PlGF ratios as well as lower concentrations of PlGF were found in the subsets of women with maternal vascular malperfusion than in those without maternal vascular malperfusion. Among women experiencing late PPROM, angiogenic imbalance in maternal serum is primarily observed in those without both microbial invasion of the amniotic cavity and intra-amniotic inflammation. Additionally, there is an association between angiogenic imbalance and the presence of maternal vascular malperfusion.

Ten-year single-center outcomes following endovascular repair for abdominal aortic aneurysm using the INCRAFT device

ObjectiveThis study aimed to report the long-term outcomes beyond 10 years of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms using the low-profile INCRAFT device. MethodsThis was a single-center, retrospective cohort study of all patients undergoing EVAR using the INCRAFT device as part of the regulatory trial between 2012 and 2013. Primary endpoint was aneurysm-related death. Secondary endpoints were all-cause death, reintervention, late open conversion, and aneurysm status (shrinkage, stable, and growth). ResultsThirty patients with a mean age of 71.8 ± 7.7 years were included in this study. The median aneurysm diameter at EVAR was 54.5 mm (interquartile range, 53-56.8 mm). All abdominal aortic aneurysms in this study were treated following the device’s instructions for use. At index EVAR, the INCRAFT device was successfully implanted in all patients using a percutaneous approach under local anesthesia. No patients experienced major adverse events or procedure-related complications 30 days after EVAR. During the median follow-up of 125 months (interquartile range, 98-131 months) with follow-up rates of 100% at 5 years and 96.7% at 10 years, aneurysm-related mortality was 0%, and freedom from all-cause mortality was 82.9% at 5 years and 75.3% at 10 years. Reintervention was required in 10 patients with 15 procedures. Sac growth was observed in 11 patients (36.7%), six of whom eventually required late open conversion; five of these patients underwent open aneurysmorrhaphy with stent graft preservation, and one underwent open surgical repair with endograft explantation. Late rupture was identified in one case, where type Ia endoleak led to rupture at 69 months, and open repair was successfully performed. Freedom from reintervention was 89.0% at 5 years but declined to 60.9% at 10 years; freedom from late open conversion was 100% at 5 years but declined to 70.8% at 10 years. ConclusionsLong-term outcomes of the INCRAFT stent graft showed no aneurysm-related deaths. However, sac growth occurred persistently throughout the follow-up period, resulting in a relatively high rate of reinterventions in the later periods, which highlights the importance of lifelong postoperative surveillance and appropriate reinterventions when indicated.

Childhood Outcomes After Induction of Labor or Expectant Management for Preterm Prelabor Rupture of Membranes: A 10-Year Follow-up of the PPROMEXIL Trials

(Am J Obstet Gynecol. 2023;228:588.e1–588.e13) Managing late preterm prelabor rupture of membranes (PPROM) between 34+0 and 36+6 weeks’ gestation helps balance the advantages of extending the pregnancy with the risk of intra-amniotic infection. Two Dutch PPROM Expectant Management Versus Induction of Labor (PPROMEXIL) trials were conducted between 2007 and 2011. These randomized controlled studies analyzed induction of labor (IOL) compared to expectant management (EM) in pregnant women with late PPROM. While neonatal sepsis risks were similar between both groups, children at 2 years of age did show slightly higher neurodevelopmental delays with EM compared to IOL. Long-term data on child development beyond age 2 in children born after late PPROM are lacking. The aim of this PPROMEXIL follow-up study was to evaluate the effects of IOL versus EM on child outcomes.

Late spontaneous posterior capsule rupture with single-piece hydrophobic acrylic intraocular lens dislocation

In this study, we described and discussed the late onset spontaneous posterior capsule rupture with intraocular lens (IOL) dislocation years after uncomplicated cataract surgery and implantation of hydrophobic acrylic IOLs. Eight patients presented with spontaneous posterior capsule rupture and IOL dislocation 5–20 years after uncomplicated phacoemulsification and IOL (AcrySof, Alcon, US) implantation. None of the patients had undergone posterior capsulotomy in the past. Four of the patients admitted habitual eye rubbing. An intact and well-centered continuous curvilinear capsulotomy edge was observed in all cases. IOLs were dislocated or displaced behind the anterior capsulotomy with a significant decrease in vision. A large rupture with a curled edge of the broken posterior capsule was visible. Dislocated IOLs were removed, and a three-piece IOL was inserted in the sulcus in six cases and suture fixated to the sclera in two cases. Improved vision was achieved in all cases. Although the mechanism underlying this late complication is unclear, habitual eye rubbing or IOL design may play a role. Further investigation is needed to prevent this complication in the future.

Perinatal Outcomes of Late Preterm Premature Rupture of Membranes in Twin Compared with Singleton Pregnancies: A Retrospective Cohort Study

Perinatal Outcomes of Late Preterm Premature Rupture of Membranes in Twin Compared with Singleton Pregnancies: A Retrospective Cohort Study

691 Neonatal outcomes in late preterm premature rupture of the membranes – subpopulation analysis

691 Neonatal outcomes in late preterm premature rupture of the membranes – subpopulation analysis

Effectiveness of Intra-operative Contrast-Enhanced Ultrasound Assessment to Optimize Type II Endoleak Embolization.

To analyze the effectiveness of type II endoleaks (T2E) embolization using intra-operative contrast-enhanced ultrasound (CEUS). Consecutive patients treated for T2E underwent a standardized protocol with trans-arterial or trans-lumbar access, large volume embolization, onlay fusion, and intra-operative CEUS. Technical success was defined by exclusion of endoleak by CEUS. Twenty-six patients (mean age 81 ± 11years old; 89% male) were treated. The mean aneurysm sac enlargement was 11 ± 8mm from T2E diagnosis. Embolization was performed using Onyx® 18 in all patients with adjunctive coils in 13 patients (50%). After the first embolization, CEUS documented residual T2E in 13 patients (50%). Ten patients (38%) had additional embolization, which successfully eradicated the T2E in seven of them. Technical success was 50% after the first embolization attempt and 77% after additional attempts guided by CEUS (P = 0.080). There was no mortality. Median imaging follow-up was 22months. Among the 20 patients with no residual T2E on completion CEUS, 16 (80%) had sac stabilization and none required additional interventions for T2E. Of the six patients with residual T2Es on CEUS, three had sac stabilization (50%) and one required additional reintervention for T2E. There was one late aortic rupture at 56months. One in two patients treated by T2E embolization had residual endoleak on intra-operative CEUS after a first embolization attempt, decreasing to one in four patients after multiple attempts. A negative completion CEUS following embolization was associated with higher rates of sac stabilization and no need for additional T2E embolization.

A Greek Multicentre Study Assessing the Outcome of Late Rupture After Endovascular Abdominal Aortic Aneurysm Repair

Late rupture after endovascular aortic aneurysm repair (EVAR) for an abdominal aortic aneurysm (AAA) is an increasing complication associated with a high mortality rate. This study aimed to analyse the causes and outcomes in patients with AAA rupture after EVAR. A multi-institutional Greek study of late ruptures after EVAR between 2008 - 2022 was performed. Primary outcomes were intra-operative and in hospital death. A total of 70 patients presented with late rupture after EVAR (proportion of ruptured EVARs among all EVARs, 0.6%; 69 males; mean age 77.2 ± 6.7 years). The mean time interval between EVAR and late rupture was 72.3 months (range 6 - 180 months). In all cases the cause of rupture was the presence of an endoleak (type I, 73%) with sac enlargement. Moreover, 34% of subjects with rupture after EVAR had been lost to follow up and 32% underwent a secondary intervention. Additionally, 57 patients (81%) were treated by conversion to open surgical repair (COSR) and the remainder by endovascular correction of endoleak (ECE). Eleven intra-operative deaths (16%) were recorded. The overall in hospital mortality rate was 41% (23% ECE vs. 46% COSR; p= .21). Of the patients who presented as initially haemodynamically stable, 23% died during hospitalisation, while the respective mortality rate for patients who presented as unstable was 78% (odds ratio [OR] 11.8, 95% confidence interval [CI] 3.6 - 39.1; p < .001). Multivariable logistic regression analysis revealed that severity of haemodynamic shock was the most significant risk factor for intra-operative (OR 7.15, 95% CI 1.58 - 32.40; p= .010) and in hospital death (OR 9.53, 95% CI 2.79 - 32.58; p < .001). These data underline the devastating prognosis of late rupture after EVAR. Haemodynamic status at presentation was an important predictive factor for death both in the ECE and COSR groups. Rigorous follow up and prompt evaluation of an unstable patient in case of rupture after EVAR is recommended.

Tectonics or rebound: Pleistocene fault reactivation in the highest mountains of the Carpathians

The steep morphology, highest elevation within the Carpathians, and distinct fault borders of the Tatra Mts. support the assumption of recent tectonic activity. However, for decades, the Quaternary tectonic activity of the Tatra Mts. has been poorly evidenced, and a late Pleistocene fault rupture was discovered recently. Using the protected environment of the caves, we have utilized 230Th/U dating of damaged speleothems to extend the record of Quaternary deformation of the Tatra Mts. up to 0.5 Ma. The results from ten caves reveal five periods of increased activity at 465–332, 280–260, 204.8–188.8, 127–86.6, and 29.5–10.11 ka ago. Three mechanisms of fault reactivation were identified through paleostress analysis of cave passage offsets: (1) gravitational sliding; (2) NNE–SSW transpression, likely associated with the Alps–Carpathians–Pannonian (ALCAPA) NNE motion; and (3) tectonic-driven SE-trending compression that reactivated the strike–slip and the gently dipping oblique lower-order faults. The geochronological data indicate that these three stress regimes operated during the late Pleistocene; however, our fault-slip data do not allow us to identify the dominant process. Herein, we suggest that the fault slip was caused by the isostatic response of the Tatra block to the unloading of mountain glaciers, coupled with sediment evacuation overlapping with regional-scale tectonic processes. These processes are locally obliterated by debuttressing. We also show that the distances between the caves and possible seismic sources (i.e., the Sub-Tatric and Ružbachy faults) are sufficiently short to break speleothems in response to oscillation. Given that for most caves an earthquake of >Mw6.5 would be destructive, it seems co-seismic deformations in caves are highly likely considering the Mw > 7 potential of the Sub-Tatric Fault.

Sex-related Outcomes after Thoracic Endovascular Repair for intact isolated Descending Thoracic Aortic Aneurysm: A Retrospective Cohort Study.

To evaluate the association between sex and outcomes following TEVAR for intact isolated descending thoracic aortic aneurysms (iiDTAA). Data regarding sex-related long-term outcomes after TEVAR for iiDTAA are limited and conflicting results regarding perioperative outcomes have been reported. We included all TEVAR for iiDTAA between 2014-2019 in the Vascular Quality Initiative linked to Medicare claims, allowing reliable assessment of long-term outcome data. Primary outcomes included 5-year mortality, reinterventions, and ruptures of the thoracic aorta. Secondarily we assessed perioperative outcomes. We identified 685 patients, of which 54% were females. Females had higher aortic size index (females vs. males: 3.31 [IQR, 2.81-3.85] cm/m2 vs. 2.93 [IQR, 2.42-3.36] cm/m2; P<.001), were more frequently symptomatic (31% vs. 20%; P=.001), had longer procedure time (111 [IQR, 72-165] min vs. 97 [IQR, 70-146] min) and more iliac procedures (16% vs. 7.6%; P=.001). Compared with males, females had similar rates of 5-year mortality (58% vs. 53%; HR, 0.93; 95%CI 0.71-1.22; P=.61), reinterventions (39% vs. 30%; HR, 1.12; 95%CI 0.73-1.73; P=.60) and late ruptures (0.6% vs. 1.2%; HR, 0.87; 95%CI 0.12-6.18; P=.89). After adjustment, these outcomes remained similar through 5-years. Furthermore, perioperative mortality was not significantly different between sexes (4.1% vs. 2.2%; P=.25), as were rates of any complication as a composite outcome (16% vs. 21%; P=.16), as well as of individual complications (all P>.05). Our findings suggest that females who undergo TEVAR for iiDTAA have similar 5-year and perioperative outcomes as compared with males.

EP14.15: Comparison of perinatal outcome of late preterm premature rupture of membranes in twin and singleton pregnancies

EP14.15: Comparison of perinatal outcome of late preterm premature rupture of membranes in twin and singleton pregnancies

Evidence for a prehistoric multifault rupture along the southern Calico fault system, Eastern California Shear Zone, USA

Abstract Geomorphic mapping and paleoseismologic data reveal evidence for a late Holocene multifault surface rupture along the Calico-Hidalgo fault system of the southern Eastern California Shear Zone (ECSZ). We have identified ~18 km of continuous surface rupture along the combined Calico and Hidalgo faults in the vicinity of Hidalgo Mountain in the southern Mojave Desert. Based on the freshness of geomorphic fault features and continuity of surface expression, we interpret this feature to reflect a simultaneous paleorupture of both faults. Displacement along the paleorupture is defined by 39 field measurements to be generally pure right-slip with a mean offset of 2.3 m. Scaling relationships for this offset amount imply that the original surface rupture length may have been ~82 km (corresponding to a M7.4 earthquake) and that much of the rupture trace was erased by subsequent erosion of sandy and unconsolidated valley alluvium. Eight luminescence ages from a paleoseismic trench across the paleorupture on the Hidalgo fault bracket the timing of the most recent rupture to 0.9–1.7 ka and a possible penultimate event at 5.5–6.6 ka. This timing is generally consistent with the known earthquake clusters in the southern ECSZ based on previous paleoseismic investigations. The ages of these earthquakes also overlap with the age brackets of the most recent events on the Calico fault 42 km to the north and the Mesquite Lake fault 40 km to the south from earlier work. Based on these age constraints and the expected surface rupture length, we propose that the Calico fault system experienced a major, multifault rupture that spanned the entire length of the fault system between the historical Landers and Hector Mine ruptures but preceded these events by ~1–2 k.y. Coulomb stress change modeling shows that the Calico paleorupture may have delayed the occurrence of the Landers-Hector Mine cluster by placing their respective faults in stress shadows and may have also prevented a triggered event from occurring on the Calico fault following the historic events. This work implies that closely spaced ruptures in complex shear zones may repel each other and thereby stretch out the duration of major earthquake clusters. These results also suggest that complex multifault ruptures in the ECSZ may not follow simple, repeatable patterns.