Major Rupture Research Articles

White-collar sign as a predictor of outcome after endovascular treatment for cerebral aneurysms

OBJECTIVE The white-collar sign (WCS) is known as a thick neointimal tissue formation at the aneurysm neck after endovascular coil embolization of cerebral aneurysms, which may prevent aneurysm recanalization. The purpose of this study was to evaluate factors involved in the appearance of WCS and to identify radiological and clinical outcomes of treated aneurysms with WCS. METHODS The study included 140 patients with 149 aneurysms in which it was possible to confirm the aneurysm neck between the aneurysm sac and parent artery by using conventional angiography. The WCS was defined as a radiolucent band at the aneurysm neck on the angiogram at 6 months after initial embolization. The radiological outcome was evaluated using MR angiography. RESULTS In 23 of 149 aneurysms (15.4%), a WCS appeared. The WCS-positive group had a significantly smaller neck size (3.3 ± 0.8 mm vs 4.2 ± 1.1 mm, p < 0.001) and smaller aneurysm size (4.3 ± 0.9 mm vs 6.0 ± 2.1 mm, p < 0.001) than the WCS-negative group. Multivariate analysis revealed that WCS appearance was associated with small neck size (OR 0.376, 95% CI 0.179-0.787; p = 0.009). In 106 of 149 aneurysms, the rate of complete occlusion was significantly higher in the WCS-positive group (18/18, 100%) than in the WCS-negative group (n = 54/88, 61.4%; p = 0.001) in the mean follow-up period of 31.0 ± 9.7 months (range 5-52 months). Neither major recanalization nor rupture of the aneurysm occurred in the WCS-positive group. CONCLUSIONS Appearance of the WCS was associated with complete occlusion and good clinical outcome after endovascular coil embolization. The WCS would help to determine the prognosis of cerebral aneurysms after endovascular treatment.

Rehabilitation exercise program after surgical treatment of pectoralis major rupture. A case report

ObjectiveTo present a rehabilitation exercise program and suggest a schedule of activities for daily living and participation in sports after surgical treatment of a pectoralis major rupture. DesignA single case study. SettingHospital-based study, Thessaloniki, Greece. ParticipantsWe present a 30-year-old male athlete (height, 196 cm; weight, 90 kg; right hand dominant) with a complete rupture of the pectoralis major tendon after a fall. Rehabilitation exercise programThe athlete received a post-operative rehabilitation exercise program for 16 weeks. During the program, there was a gradual increase in the exercise program regime and load across the sessions according to the specific case demands. Main outcome measuresShoulder function was evaluated using Constant score. ResultsMagnetic resonance imaging (MRI) confirmed the diagnosis and the patient had surgical treatment repairing-reattaching the tendon back to its insertion using a bone anchor. At the end of the rehabilitation exercise program, the patient had full range of movement, normal muscle power and a return back to his previous level of athletic activities achieved. ConclusionsPost-operatively, a progressive rehabilitation protocol contributed to the patients' full recovery and allowed an early return to activities of daily living and participation in sports.

Injektion von Bauchfett bei radiogenen Wundheilungsstörungen

Wound healing complications in irradiated tissues represent a major clinical challenge. Fistula or even major vessel rupture may occur. The injection of adipose tissue derived stem cells seem to be a promising therapeutical strategy. The article describes the clinical case of a patient suffering from a pharyngo-cutaneous fistula after laryngectomy and radiotherapy. The patient was successfully treated by the injection of fat tissue.

Incidence Rate and Results of the Surgical Treatment of Pectoralis Major Tendon Ruptures in Active-Duty Military Personnel

Background: Pectoralis major tendon ruptures are commonly described as rare injuries affecting men between 20 and 40 years of age, with generally excellent results after surgical repair. However, this perception is based on a relatively small number of case series and prospective studies in the orthopaedic literature. Purpose: To determine the incidence of pectoralis major tendon ruptures in the active-duty military population and the demographic risk factors for a rupture and to describe the outcomes of surgical treatment. Study Design: Case control study; Level of evidence, 3. Methods: We utilized the Military Health System Data Repository (MDR) to identify all active-duty military personnel surgically treated for a pectoralis major tendon rupture between January 2012 and December 2014. Electronic medical records were searched for patients’ demographic information, injury characteristics, and postoperative complications and outcomes. Risk factors for a rupture were calculated using Poisson regression, based on population counts obtained from the MDR. Risk factors for a postoperative complication, the need for revision surgery, and the inability to continue with active duty were determined using univariate analysis and multivariate logistic regression. Results: A total of 291 patients met inclusion criteria. The mean patient age was 30.5 years, all patients were male, and the median follow-up period was 18 months. The incidence of injuries was 60 per 100,000 person-years over the study period. Risk factors for a rupture included service in the Army, junior officer or junior enlisted rank, and age between 25 and 34 years. White race and surgery occurring >6 weeks after injury were significant risk factors for a postoperative complication. Among the 214 patients with a minimum of 12 months’ clinical follow-up, 95.3% were able to return to military duty. Junior officer/enlisted status was a significant risk factor for failure to return to military duty. Conclusion: Among military personnel, Army soldiers and junior officer/enlisted rank were at highest risk of pectoralis major tendon ruptures, and junior personnel were at highest risk of being unable to return to duty after surgical treatment. Although increasing time from injury to surgery was not a risk factor for treatment failure or inability to return to duty, it did significantly increase the risk of a postoperative complication.

Guy Burak, The Second Formation of Islamic Law, The Hanafi School in the Early Modern Ottoman Empire

In his book The Second Formation of Islamic Law, Guy Burak convincingly challenges an outmoded but omnipresent narrative of legal decline in Islamicate lands after 1250s. He does so not only by calling into question the grand narratives of Islamic legal history which situate the second half of the nineteenth century as the momentum of major rupture but also by offering a new periodization. He puts forward a strong argument that some of the supposedly nineteenth-century novelties, such as the codification of Islamic law, are extant already in the sixteenth century.

The Impact of Surgical Experience on Major Intraoperative Aneurysm Rupture and Their Consequences on Outcome: A Multivariate Analysis of 538 Microsurgical Clipping Cases.

The incidence and associated mortality of major intraoperative rupture (MIOR) in intracranial aneurysm surgery is diverse. One possible reason is that many studies failed to consider and properly adjust the factor of surgical experience in the context. We conducted this study to clarify the role of surgical experience on MIOR and associated outcome. 538 consecutive intracranial aneurysm surgeries performed on 501 patients were enrolled in this study. Various potential predictors of MIOR were evaluated with stratified analysis and multivariate logistic regression. The impact of surgical experience and MIOR on outcome was further studied in a logistic regression model with adjustment of each other. The outcome was evaluated using the Glasgow Outcome Scale one year after the surgery. Surgical experience and preoperative Glasgow Coma Scale (GCS) were identified as independent predictors of MIOR. Experienced neurovascular surgeons encountered fewer cases of MIOR compared to novice neurosurgeons (MIOR, 18/225, 8.0% vs. 50/313, 16.0%, P = 0.009). Inexperience and MIOR were both associated with a worse outcome. Compared to experienced neurovascular surgeons, inexperienced neurosurgeons had a 1.90-fold risk of poor outcome. On the other hand, MIOR resulted in a 3.21-fold risk of unfavorable outcome compared to those without it. Those MIOR cases managed by experienced neurovascular surgeons had a better prognosis compared with those managed by inexperienced neurosurgeons (poor outcome, 4/18, 22% vs. 30/50, 60%, P = 0.013).

Combined effects of blasting and geological structure on rock mass stability—a case study from the Marrakech–Agadir highway, Morocco

The Marrakech–Agadir highway crosses mountainous areas of the Western High Atlas of Morocco with a high risk of slope instability. The use of explosives as an excavation method, especially at kilometric point 33 on the Imintanout–Argana section, has triggered major ruptures. The regional geological setting, together with the lithological and structural characteristics of the rock mass, represent the major factors influencing this operation where the degree of disturbance is estimated as 0.82. The studied slope is located along the trajectory of a submeridian fault corridor remobilised because of blasting during excavation works. This slope reveals instabilities associated with tectonic planes (F1 and F2) and/or bedding (S0) and the presence of argillites and siltstones that coincide with bedding. These unconsolidated layers, inclined in the direction of excavation, act as slide planes. Structurally, the Pk33 slope can be subdivided into three zones depending on the displacement type being recorded and may be a fortiori related to the geomechanical properties of the substrate. The rheological characteristics of zones B and C, highly fractured and with low competence, respectively, explain their relatively different displacement patterns from that of zone A. The maximum instantaneous explosive load used for offloading the upper part of the sliding mass has been estimated in order to increase the safety factor for the instable slope.

Further studies on the focal mechanism and source rupture process of the 2012 Haida Gwaii, Canada, 7.8 moment magnitude earthquake

The 28 October 2012 Haida Gwaii, British Columbia, Canada, earthquake with a moment magnitude (MW) of 7.8 occurred along an east-dipping poorly known thrust fault beneath the Queen Charlotte Terrace. It was the largest thrust event ever recorded in this dominated by strike-slip motion region. We studied the focal mechanism and the source rupture process for the event. The retrieved geometric parameters of the fault plane were a strike of 329°, dip of 24°, and slip of 114°. The isotropic moment was negative, and its value was about one-fifth of the total seismic moment released. The earthquake ruptured an area of about 160 km × 60 km, and major slip occurred in an area of about 100 km × 60 km. The maximum slip was about 5.8 m. The slip distribution on the fault plane was highly heterogeneous, with four slip patches. The main slip lay on a large zone above the hypocentre to the sea floor. The maximum and average stress drops calculated using the Brune model were 16.5 and 4.6 MPa, respectively. The major rupture occurred about 10 s after the rupture initiation, and lasted about 25 s. During a subducting earthquake, the leading edge of the overriding plate is assumed to spring seaward and upward, while the landward portion is assumed to extend and drop down, and the generated rapid motions set off a tsunami. The falling-down process seems to be consistent with a negative isotropic moment.

Acute Pectoralis Major Rupture Captured on Video.

Pectoralis major (PM) ruptures are uncommon injuries, although they are becoming more frequent. We report a case of a PM rupture in a young male who presented with axillar pain and absence of the anterior axillary fold after he perceived a snap while lifting 200 kg in the bench press. Diagnosis of PM rupture was suspected clinically and confirmed with imaging studies. The patient was treated surgically, reinserting the tendon to the humerus with suture anchors. One-year follow-up showed excellent results. The patient was recording his training on video, so we can observe in detail the most common mechanism of injury of PM rupture.

Analysis of Climate Variability and Its Influence on the Hydrological Response of the Catchment Area of Kadey (East Cameroon)

Register in the framework of the International Program of Research on Water Resources Management and Protection of Ecosystems, the Congo basin in which lies the catchment area of the Kadey (2647 km2) was selected to better assess the impact climate variability on the water surface in the perspective of supply drinking water both in the rainy season and in periods of low water. Based on new data from rainfall and flow rates obtained in the last fifteen years (1998-2013), the major trends in time series and the scope of the “drought” were identified. The historical rainfall in the basin is characterized by two major ruptures rainfall in 1969 and 1999. These have generated an order deficit of 14% respectively and an excess of nearly 19%. These phenomena also affected the recurrence of cumulative rainfall throughout the Kadey basin. Here, the hydrological response to excess rainfall is over 100%. However, it appears that over the period 1970-2012, the number of years that has undergone a “severe drought” is to play down.

The Impact of Interpersonal Style on Ruptures and Repairs in the Therapeutic Alliance Between Offenders and Therapists in Sex Offender Treatment

The therapeutic relationship is a critical component of psychological treatment. Strain can occur in the relationship, particularly when working with offenders, and more specifically, those offenders with interpersonal difficulties; strain can lead to a rupture, which may affect treatment participation and performance. This study examined ruptures in the therapeutic relationship in sexual offenders participating in offense-focused group treatment. Fifty-four sex offenders rated the therapeutic alliance at the commencement and completion of treatment; at the completion of treatment, they also reported on the occurrence of ruptures and whether they believed these ruptures were repaired. Ruptures were separated by type, according to severity-Each relationship was therefore characterized as experiencing no rupture, a minor rupture, or a major rupture. Offender characteristics including interpersonal style (IPS) and psychopathy were assessed at the commencement of treatment; their relationship with ruptures was examined. Results revealed that more than half of the offenders (approximately 55%) experienced a rupture in the therapeutic alliance, with one in four of these ruptures remaining unresolved. Offenders who did not report a rupture rated the therapeutic alliance significantly higher at the end of treatment compared with those offenders who reported a rupture that was not repaired. Offenders who reported a major rupture in the therapeutic relationship were higher in interpersonal hostility and hostile-dominance. No interpersonal or offense-specific factors affected the likelihood of a rupture repair.

Rapidly Estimated Seismic Source Parameters for the 16 September 2015 Illapel, Chile M w 8.3 Earthquake

On 16 September 2015, a great (M w 8.3) interplate thrust earthquake ruptured offshore Illapel, Chile, producing a 4.7-m local tsunami. The last major rupture in the region was a 1943M S 7.9 event. Seismic methods for rapidly characterizing the source process, of value for tsunami warning, were applied. The source moment tensor could be obtained robustly by W-phase inversion both within minutes (Chilean researchers had a good solution using regional data within 5 min) and within an hour using broadband seismic data. Short-period teleseismic P wave back-projections indicate northward rupture expansion from the hypocenter at a modest rupture expansion velocity of 1.5–2.0 km/s. Finite-fault inversions of teleseismic P and SH waves using that range of rupture velocities and a range of dips from 16°, consistent with the local slab geometry and some moment tensor solutions, to 22°, consistent with long-period moment tensor inversions, indicate a 180- to 240-km bilateral along-strike rupture zone with larger slip northwest to north of the epicenter (with peak slip of 7–10 m). Using a shallower fault model dip shifts slip seaward toward the trench, while a steeper dip moves it closer to the coastline. Slip separates into two patches as assumed rupture velocity increases. In all cases, localized ~5 m slip extends down-dip below the coast north of the epicenter. The seismic moment estimates for the range of faulting parameters considered vary from 3.7 × 1021Nm(dip 16°) to 2.7 × 1021 Nm (dip 22°), the static stress drop estimates range from 2.6 to 3.5 MPa, and the radiated seismic energy, up to 1 Hz, is about 2.2–3.15 × 1016 J.

Accuracy of magnetic resonance imaging in predicting the intraoperative tear characteristics of pectoralis major ruptures

Magnetic resonance imaging (MRI) is the preferred study of choice for pectoralis major ruptures. Because this is a rare injury, no large case series have evaluated the efficacy of MRI for diagnosing and characterizing pectoralis major ruptures. We hypothesized that MRI would be accurate for diagnosis of the location and grade of pectoralis major tears. The study included 36 operative cases of pectoralis major ruptures with detailed descriptions of tear location and grade and satisfactory preoperative MRIs. Two musculoskeletal fellowship-trained radiologists interpreted the MRIs, which were then compared with the operative findings for location: tendon-bone junction or myotendinous junction, and tear grade (G): G2 (incomplete high grade partial tear) or G3 (complete tear). The sensitivity, specificity, positive predictive value, and negative predictive value were calculated. The MRI sensitivity was 1.00 for diagnosing complete G3 tears at the sternal head and clavicular head in acute ruptures. The sensitivity of MRI for diagnosing tendon-bone tears at the sternal and clavicular heads was 0.93 and 0.90, respectively. The sensitivity of MRI in diagnosing myotendinous and G2 tears diminishes, but specificity and negative predictive value remain high for sternal and clavicular head ruptures. Our data support the use of MRI in diagnosing the tear grade and location of pectoralis major tendon ruptures, particularly for acute, tendon-bone, and G3 tears. The diagnostic accuracy of MRI decreases when chronic tears are evaluated. MRI remains a useful adjunct in diagnosing and guiding treatment of pectoralis major ruptures.

Magnetic mineral characterization close to the Yingxiu-Beichuan fault surface rupture zone of the Wenchuan earthquake (Mw 7.9, 2008) and its implication for earthquake slip processes

The 2008 Mw 7.9 Wenchuan Earthquake produced two major rupture zones: one in the Yingxiu-Beichuan fault zone (YBF) and another in the Anxian-Guanxian fault zone (AGF). A shallow trench was dug in Bajiaomiao village, Dujiangyan, Sichuan Province, which experienced a ∼4.3m vertical offset during this large earthquake. The hanging wall of the YBF in this trench includes fault gouge and breccia. Optical microscope observations and X-ray diffraction (XRD) measurements show obvious differences between the fault gouge and breccia. Moreover, rock magnetism measurements were collected and include mass magnetic susceptibility (MS), Isothermal Remnant Magnetization (IRM), Saturation Isothermal Remnant Magnetization (SIRM), high-temperature thermo-magnetism (K–T) and magnetic hysteresis loops. Several cm-thick magnetic mineral anomalies are observed close to the Wenchuan Earthquake surface rupture zone of the YBF. Magnetite and Fe-sulfide are the main magnetic carrier materials for the fault rocks close to the surface rupture zone, including 3cm-thick fault gouge and 3cm-thick fault breccia, while the other fault breccia, further from the surface rupture zone, contains the paramagnetic minerals. The possible magnetic change is attributed to newly-formed magnetite from paramagnetic minerals at high temperatures (>500°C) during the large earthquake, implying that the YBF has ever experienced high-temperature thermal pressurization earthquake slip dynamics. Moreover, the YBF has also experienced high-temperature frictional melting earthquake slip dynamics, constrained by the multiple vein pseudotachylite. These high-temperature earthquake slip processes may be responsible for the high dip angle thrust characteristic of the YBF.

Suture Technique Influences the Biomechanical Integrity of Pectoralis Major Repairs.

Pectoralis major ruptures occur in large, muscular individuals, and repair constructs may experience significant tension. Four different suture techniques were evaluated biomechanically to determine the effect of suture technique on optimizing fixation strength. Forty fresh-frozen cadaveric shoulders were repaired using endosteal buttons. The control group was repaired with #2 polyblend suture in a modified Mason-Allen stitch configuration. The triple group was repaired using the same suture and configuration, but with the addition of triple-loaded buttons. The configuration group was repaired using the same suture in a Krackow/Bunnell configuration. The tape group was repaired using 2-mm polyethylene tape and #5 polyblend suture in the Krackow/Bunnell configuration. Under cyclic loading, there was no significant difference between groups. Under load-to-failure testing, the tape group withstood a significantly greater maximum load (726.0±90.0 N) than the control and triple groups (330.2±20.2 and 400.2±35.2 N, respectively; P<.005), and similar load to the configuration group (509.9±68.6 N; P=.16). The configuration group failed via suture breakage (9/10); the other groups failed via suture pullout, in which suture pulled through tendon (26/30). Pectoralis major repair in a running, locked configuration appears to improve biomechanical performance by preventing suture pullout. Use of a polyethylene tape construct demonstrates the potential for improved failure loads, but its role remains undefined.

High-powered microwave ablation of larger hepatocellular carcinoma: evaluation of recurrence rate and factors related to recurrence

To evaluate the safety and efficacy of high-powered (80-100W) percutaneous microwave ablation (MWA) at a frequency of 2450±10MHz for treating larger hepatocellular carcinoma (HCC) and to predict the risk factors of local recurrence after high-powered MWA. The study was approved by the Institutional Review Board, and informed consent was waived because of the retrospective study design. Forty-five patients with a total of 60 lesions received high-power (80-100W) MWA at a frequency of 2450±10MHz through a percutaneous approach that was guided by ultrasound. Of the 60 lesions with a maximum tumour measuring 3-8cm, 46 lesions were 3-5cm and 14 were 5-8cm. The complete ablation rates, local recurrence rates, complications, and short-term survival were analysed. Ten possible risk factors for local recurrence were analysed. The complete ablation rates were 82.61% for the first ablation and 100% for the second ablation for 3-5cm lesions. The complete ablation rates were 64.29% (82.61% versus 64.29%, p=0.037) for the first ablation and 85.71% (100% versus 85.71%, p=0.055) for the second ablation for 5-8cm lesions. Local recurrence was observed in 11 out of the 45 (24.44%) successfully treated patients. The 1-year and 2-year survival rates were 95.56% (43/45) and 86.67% (39/45), respectively. No procedure-related mortality was observed and no major bleeding, liver rupture, or liver abscesses occurred. Univariate analysis showed that a positive correlation existed between the number of lesions (p=0.022), proximity to the risk area (p=0.001), pre-ablation alpha-fetoprotein (AFP) levels (p=0.025), hepatitis B virus (HBV)-DNA replication (p=0.027) and local recurrence. Multivariate analysis identified HBV-DNA (p=0.031) and proximity to the risk area (p=0.039) as the independent prognosis factors causing postoperative HCC local recurrence. High-powered MWA of larger hepatocellular carcinomas appears to be a safe and effective treatment. HBV-DNA and proximity to the risk area appear to be independent predictors of local tumour recurrence.

Aetiological Classification of Stillbirths: A Case Control Study.

Antepartum stillbirths are a major contributor to perinatal mortality. This study was undertaken to assess the role of the ReCoDe (relevant condition at birth) classification system in evaluation of stillbirths in a tertiary teaching hospital in Central Gujarat. To determine etiology of stillbirths using the ReCoDe classification system. This was a prospective case control study over a period of 1year from September 1st, 2012 to August 31st, 2013. Sample size was calculated as 243 cases and 486 controls. Two controls (live births) per case were matched for gestational age and birth weight. Odd's ratios with 95% confidence intervals were calculated using multivariate logistic regression. Maternal age and parity that appeared to be highly significant factors on univariate analysis were not found to be independent risk factors with multivariate logistic regression. Gestational age and birth weight were not statistically significant risk factors. Other risk factors like previous stillbirth (26.13; 95% CI 3.23-211.29), antepartum hemorrhage (11.63; 95% CI 3.83-35.30), and hypertensive disorders (2.09; 95% CI 1.20-3.63) were found to be highly significant independent risk factors. Major congenital anomaly (P<0.001), birth asphyxia (P=0.0037), cord accidents (P=0.0037), and rupture uterus (P=0.001) were also highly significant. The stillbirth rate was 87.83 per 1000 live births. The ReCoDe primary classification system enabled 74.1% of the cases to be assigned a relevant condition, leaving only 25.9% as unexplained. The single largest condition associated was fetal growth restriction (25.9%).

Critical quantities on the yielding process of waxy crude oils

The yielding behavior of waxy crude oils below the gelation temperature is a fundamental aspect for the production in oil basins located in deep water. Under this state, the material exhibits a diversity of complex non-Newtonian features turning the determination of its rheology a challenging task. We performed different tests monitoring the critical stress and strain where a major rupture occurs. We could infer from these experiments a minimum critical stress value that can be associated to the static yield stress of the material. In addition, the material exhibited a remarkably constant critical strain value, turning this last parameter into a more representative fingerprint of the material.

Complications after neck dissection

Introduction: Neck dissection has been a well-established procedure used to eradicate metastases to the regional lymph nodes of the neck. Most of the complications are inevitable, and various efforts have been made to try and reduce complications by modifying the aggressive surgical procedure. A systematic review of 82 patients who underwent neck dissections has been done. The objective of this study is to report the various complications, complication rates in various neck dissection procedures and to seek improved patient care and outcome. Materials and Methods: A retrospective analysis of complications in 82 patients who underwent neck dissection from May 1, 2010 to December 31, 2013. Results: Out of 82 patients 16 (19.51%) experienced some complication and 7 (8.53%) patients had significant complications that required surgical revision. No major vessel rupture was observed. Conclusion: A careful preoperative assessment, meticulous surgical technique, high-quality postoperative care and appropriate rehabilitation are the cornerstones of preventing and managing complications.

DNA-Induced Viral Assembly Studied in Real-Time by Optical Tweezers, Acoustic Force Spectroscopy and Atomic Force Microscopy

The simian vacuolating virus (SV40) can infect both human and apes and is of interest as capsule for drug delivery since it can efficiently infect a wide range of human cells. The icosahedral virus capsid is assembled from VP1 pentamers, and this assembly is stimulated by the presence of dsDNA. However, the real-time assembly process of SV40 and viruses in general is poorly understood limiting among other things our ability to manipulate capsid re-assembly in vitro for therapeutic purposes.Here, we show the real-time assembly of capsid around dsDNA employing dual-trap optical tweezers (OT). Protein assembly around the DNA leads to a drastic change in the contour length, which is readily observed when dsDNA is incubated with VP1 pentamers, indicating both kinking and crosslinking. Additionally, a new technology, acoustic force spectroscopy (AFS) capable to apply very low constant forces, provides indications of substantial capsid-like-structure formation observable as real-time shortening of DNA in the presence of VP1 combined with major rupture events when stretching the DNA-protein structure afterwards. In order to obtain visual information about protein coverage and arrangement on DNA, we generated atomic force microscope (AFM) images. In these images we observe significant cluster formation on DNA providing a good indication that we observe partial assembly. These results reveal that we can indeed track the assembly of viral capsids and visualize intermediates. This in turn provides a window into the complex kinetics of viral capsid formation.