Occurrence Of Rupture Research Articles

Life-threatening spontaneous splenic rupture in congenital afibrinogenemia: Two case reports and systematic literature review.

Spontaneous splenic rupture is a rare life-threatening finding with a challenging diagnosis which is largely ignored in the literature. Hematological disorders such as afibrinogenemia are reported to cause bleeding disorders mostly cerebral hemorrhage. Despite being a life-threatening condition, data about spontaneous splenic rupture in patients with Afibrinogenemia remain scarce. Such fatal incidents should warrant diligent efforts to establish and adopt prevention measures in this particularly vulnerable population. We report two new cases of spontaneous splenic rupture in two siblings, diagnosed with congenital afibrinogenemia since early childhood. In addition, we report the results of a systematic review of the literature of cases that have reported the occurrence of splenic rupture in afibrinogenemia, with the aim of filling the gap in the clinical course of such an uncommon event. We conduced a systematic review of English and French language publications cataloged in Pubmed, and Google Scholar up to December 2022. We opted to include articles written in other languages if an English language abstract was available and contained the information needed for our report. The following MeSH (medical subject heading) search criteria were used: ''splenic rupture'' AND ''afibrinogenemia.'' The above search strategy was further combined with a supplementary strategy that included the MeSH terms ''spleen'', AND ''rupture'' AND ''Afibrinogenemia''. In order to reduce the selection bias in searching on the Google Scholar database, we searched for articles containing these MeSH terms in their titles. We reported two cases of splenic rupture in two family members who were diagnosed with afibrinogenemia at the age of 1 year. The splenic rupture was misdiagnosed by clinicians in the brother's case, resulting in his death and presenting as a forensic case. However, the sister underwent a splenectomy one week before her brother's death following the onset of asthenia and acute abdominal pain. Then we conducted a literature review of relevant studies of spontaneous splenic rupture in Afibrinogenemia. A selection of 13 relevant studies was included in the final review, describing a total of 25 cases of spontaneous splenic rupture in Afibrinogenemia. One paper was an international cross-sectional study across 25 different countries involving 211 patients with fibrinogen disorders, showing that 11 patients with afibrinogenemia had developed spontaneous splenic rupture. The remaining 12 articles were case reports or case series, describing a total of 14 cases of atraumatic splenic rupture in afibrinogenemia, ranging from 0 to 28 years old, with a median age of 14.5 years, where the majority were infants (age inferior to 18) with the most cases occurred in the age group of 10-15 years old. Congenital afibrinogenemia is a rare disease with a wide range of clinical symptoms and with challenging management. While the most common presenting symptoms are bleeding and thrombosis, spontaneous spleen rupture is rare and probably underdiagnosed which consequently may lead to death. Studies about the topic remain scarce, hence, further studies are needed to ascertain this risk and establish target preventive measures for this vulnerable population.

Effect of plaque micro-watershed changes on carotid atherosclerosis.

The study aims to elucidate the mechanisms underlying plaque growth by analyzing the variations in hemodynamic parameters within the plaque region of patients' carotid arteries before and after the development of atherosclerotic lesions. The study enrolls 25 patients with common carotid artery stenosis and 25 with tandem carotid artery stenosis. Based on pathological analysis, three-dimensional models of the actual blood vessels before and after the lesion are constructed for two patients within a two-year period. Computational fluid dynamics is employed to conduct unsteady periodic non-Newtonian fluid numerical simulations, enabling an in-depth investigation into the changes in the micro-environment of blood flow. During the systolic phase of the cardiac cycle, vortex regions are particularly prone to developing at the bifurcation point between the common carotid artery and the distal end of the internal carotid artery. In the early diastolic phase, blood reflux phenomena can be observed within the carotid artery. Towards the end of diastole, there is an expansion of vortex regions at the bifurcation point of the carotid artery. The shoulder region of initial small plaques within the blood vessel is susceptible to developing a low-speed recirculation zone, characterized by significantly reduced shear stress compared to the surrounding areas. Following vascular stenosis, the wall shear stress within the plaque domain generally increases; however, it maintains a consistent pattern of high central values and low upper shoulder values. The shear stress at the upper shoulder of the plaque of tandem carotid stenosis is below 0.4 Pa, whereas the central and lower shoulder regions exhibit shear stress exceeding 40 Pa. The dynamic parameters of the blood flow micro-environment exhibit variations throughout the cardiac cycle, and temporal disparities exist in local lesions within the carotid artery. Both common and tandem carotid artery stenosis are particularly prone to developing lesions at the shoulder of initial small plaques. The micro-flow characteristics within the plaque domain undergo alterations prior to and following the onset of carotid artery disease. Furthermore, the occurrence of restenosis and rupture is associated with the location of plaque growth.

Fragility of Highway Embankments Exposed to Permanent Deformations Due to Underlying Fault Rupture

Seismic risk expresses the expected degree of damage and loss following a catastrophic event. An efficient tool for assessing the seismic risk of embankments is fragility curves. This research investigates the influence of embankment’s geometry, the depth of rupture occurrence, and the underlying sandy soil’s conditions on the embankment’s fragility. To achieve this, the response of three highway embankments resting on sandy soil was examined through quasi-static parametric numerical analyses. For the establishment of fragility curves, a cumulative lognormal probability distribution function was used. The maximum vertical displacement of the embankments’ external surface and the fault displacement were considered as the damage indicator and the intensity measure, respectively. Damage levels were categorized into three qualitative thresholds: minor, moderate, and extensive. All fragility curves were generated for normal and reverse faults, as well as the combination of those fault types (dip-slip fault). Finally, the proposed curves were verified via their comparison with those provided by HAZUS. It was concluded that embankment geometry and depth of fault rupture appearance do not significantly affect fragility, as exceedance probabilities show minimal differences (<4%). However, an embankment founded on dense sandy soil reveals slightly higher fragility compared to the one founded on loose sand. Differences regarding the probability of exceedance of a certain damage level are restricted by a maximum of 7%.

Improving the Quality of Reshaped EoL Components by Means of Accurate Metamodels and Evolutionary Algorithms

The reshaping of End-of-Life (EoL) components by means of the sheet metal forming process has been considered largely attractive, even from the social and economic point of view. At the same time, EoL parts can often be characterized by non-uniform thicknesses or alternation of work-hardened/undeformed zones as the result of the manufacturing process. Such heterogeneity can hinder a proper reshaping of the EoL part, and residual marks on the reformed blanks can still be present at the end of the reshaping step. In a previous analysis, the authors evaluated the effectiveness of reshaping a blank with a deep-drawn feature by means of the Sheet Hydroforming (SHF) process: it was demonstrated that residual marks were still present if the deep-drawn feature was located in a region not enough strained during the reshaping step. Starting from this condition and adopting a numerical approach, additional investigations were carried out, changing the profile of the load applied by the blank holder and the maximum oil pressure. Numerical results were collected in terms of overall strain severity and residual height of the residual marks from the deep-drawn feature at the end of the reshaping step. Data were then fitted by accurate Response Surfaces trained by means of interpolant Radial Basis Functions and anisotropic Kriging algorithms, subsequently used to carry out a virtual optimization managed by multi-objective evolutionary algorithms (MOGA-II and NSGA-II). Optimization results, subsequently validated via experimental trials, provided the optimal working conditions to achieve a remarkable reduction of the marks from the deep-drawn feature without the occurrence of rupture.

Spontaneous Uterine Rupture in Pregnancy After Treatment of Asherman Syndrome

Study objectiveWomen with Asherman syndrome are at high risk of recurrent adhesions and pregnancy complications. Spontaneous uterine rupture is a rare but life-threatening complication, associated with severe maternal and fetal morbidity and mortality. Uterine ruptures can occur after extended induction of labor or a history of cesarean section, whereas spontaneous uterine rupture in an unscarred uterus is rare. Aim of this study is to evaluate the incidence of spontaneous uterine rupture among women with Asherman syndrome treated by hysteroscopy and without a history of cesarean section. DesignProspective cohort study. SettingAsherman Expertise Center of the Spaarne Gasthuis, The Netherlands. PatientsWomen were defined by as patients with Asherman syndrome when they had one or more clinical features and the presence of hysteroscopically confirmed intrauterine adhesions. InterventionsHysteroscopic adhesiolysis and a second-look hysteroscopy two months after the initial procedure. Measurements and resultsData on the severity of adhesions and ongoing pregnancy after treatment were collected prospectively. A total of 428 women with Asherman syndrome were included, 4 women (0.9%) experienced spontaneous uterine rupture. The timing varied, none of the affected women were in active labor and the occurrence of uterine rupture was not related to the severity of adhesions. Ruptures were all found in the fundus. One woman had a history of perforation of the uterine wall located in the fundus. Neonatal outcomes were poor, two cases had intrauterine neonatal death and two cases had long-term lifelong disability. One woman had a second uterine rupture. ConclusionWomen with Asherman syndrome are at risk of uterine rupture, a pregnancy complication with significant consequences that is challenging to predict and may also be associated with history of uterine perforation. Clinicians should be aware of this risk in women treated with hysteroscopic adhesiolysis and consider counseling these patients accordingly prior to treatment.

Clinical characteristics and outcomes of preterm versus term uterine rupture: a nationwide observational study.

To assess and compare the clinical aspects of uterine rupture by dividing the gestational age at uterine rupture occurrence into < 37-week (preterm) and ≥ 37-week (term) groups. This retrospective cohort study analyzed data from 187 acute-care hospitals across Japan and included patients who experienced uterine rupture. Data were sourced from the Diagnosis Procedure Combination inpatient database, spanning July 2010 to March 2022. The patients' characteristics, in-hospital procedures, and outcomes were compared between those with uterine rupture at < 37 and ≥ 37weeks of gestation. The main outcomes were hysterectomy, complications, proportion of blood transfusions, and postoperative length of stay. A total of 298 patients were identified, with 161 in the preterm group and 137 in the term group. Placenta accreta spectrum occurred more frequently in the preterm group than in the term group (18.0% vs. 6.6%, respectively; P = 0.003). Vacuum delivery (19.0% vs. 0.6%, P < 0.001) and uterine fundal pressure (2.9% vs. 0.0%, P = 0.004) were more likely to be applied in the term group. The maternal need for mechanical ventilation (26.3% vs. 12.4%, P = 0.003), the proportion of disseminated intravascular coagulation (40.1% vs. 25.5%, P = 0.009), and the requirement for platelet transfusions (32.8% vs. 15.5%, P < 0.001) were greater in the term. The postoperative hospital stays were also longer in the term group. This study shows that individual characteristics vary with the gestational age at uterine rupture, and maternal morbidity is notably higher in term compared to preterm ruptures.

Splenic rupture in dairy cattle: Report of 24 cases.

Splenic rupture in cattle is scarcely described in the literature. The aim of this work was to report the occurrence of splenic rupture in cattle in southern Brazil as well as to describe the causes of the condition. Between 2013 and 2022, 24 of the 1769 bovine necropsies performed in southern Brazil were due to splenic rupture, accounting for 1.36% of the diagnoses. Animals died due to hemoperitoneum caused by a rupture in the splenic capsule, typically associated with marked splenomegaly and a large hematoma between the capsule and the parenchyma. Clinical signs were described in a subset of cases (11 of 24 cases, 46%) and included apathy, abdominal pain, mucosal pallor, tachycardia, and respiratory distress. However, the majority (13 of 24 cases, 54%) presented as sudden death. The underlying cause of splenic rupture was established as follows: 16 cases (67%) secondary to babesiosis, 4 cases (17%) due to lymphoma, 1 case (4%) due to a thrombus, 1 case (4%) due to external trauma, 1 case due to a ruptured nodular lymphoid hyperplasia (4%), and 1 case of undetermined cause (4%). Hypovolemic shock caused by splenic rupture is an important cause of death of dairy cattle, and babesiosis and bovine leukemia virus-associated lymphoma are among the most common etiologic diagnoses (84% of cases). The description of the causes of this condition is important to clarify the pathogenesis and occurrence of splenic rupture in dairy cattle.

A nomoscore of four genes for predicting the rupture risk in abdominal aortic aneurysm patients with osteoarthritis

BackgroundAbdominal aortic aneurysm (AAA) represents one of the most life-threatening cardiovascular diseases and is increasingly becoming a significant global public health concern. The aneurysms-osteoarthritis syndrome (AOS) has gained recognition, as patients with this syndrome often exhibit early-stage osteoarthritis (OA) and have a substantially increased risk of rupture, even with mild dilation of the aneurysm. The aim of this study was to discover potential biomarkers that can predict the occurrence of AAA rupture in patients with OA. MethodsTwo gene expression profile datasets (GSE98278, GSE51588) and two single-cell RNA-seq datasets (GSE164678, GSE152583) were obtained from the GEO database. Functional enrichment analysis, PPI network construction, and machine learning algorithms, including LASSO, Random Forest, and SVM-RFE, were utilized to identify hub genes. In addition, a nomogram and ROC curves were generated to predict the risk of rupture in patients with AAA. Moreover, we analyzed the immune cell infiltration in the AAA tissue microenvironment by CIBERSORT and validated key gene expression in different macrophage subtypes through single-cell analysis. ResultsA total of 105 intersecting DEGs that showed consistent changes between rAAA and OA dataset were identified. From these DEGs, four hub genes (PAK1, FCGR1B, LOX and PDPN) were selected by machine learning. High predictive performance was observed for the nomogram based on these hub genes, with an AUC of 0.975 (95 % CI: 0.942–1.000). Abnormal immune cell infiltration was detected in rAAA and correlated significantly with the hub genes. Ruptured AAA cases exhibited higher nomoscore values and lower M2 macrophage infiltration compared to stable AAA. Validation in animal models (PPE+BAPN-induced rAAA) confirmed the significant role of these biomarkers in AAA pathology. ConclusionThe present study successfully identified four potential hub genes (PAK1, FCGR1B, LOX and PDPN) and developed a robust predictive nomogram to assess the risk of AAA rupture. The findings also shed light on the connection between hub genes and immune cell components in the microenvironment of rAAA. These findings support future research on key genes in AAA patients with OA, providing insights for novel management strategies for AAA.

Comparative effects of insulin pump and injection on gestational diabetes mellitus pregnancy outcomes and serum biomarkers

BACKGROUND Insulin injection is the basic daily drug treatment for diabetic patients. AIM To evaluate the comparative impacts of continuous subcutaneous insulin infusion (CSII). METHODS Based on the treatment modality received, the patients were allocated into two cohorts: The CSII group and the multiple daily injections (MDI) group, with each cohort comprising 210 patients. Comparative assessments were made regarding serum levels of serum-secreted frizzled-related protein 5, homocysteine, and C1q/TNF-related protein 9. Furthermore, outcomes such as fasting plasma glucose, 2-hour postprandial glucose levels, pain assessment scores, and the incidence of complications were evaluated post-treatment. RESULTS The CSII group displayed notably lower fasting plasma glucose and 2-h postprandial glucose levels in comparison to the MDI group (P &lt; 0.05). Subsequent analysis post-treatment unveiled a significantly higher percentage of patients reporting no pain in the CSII group (60.00%) in contrast to the MDI group (36.19%) (P &lt; 0.05). Additionally, the CSII group exhibited a markedly reduced occurrence of fetal distress and premature rupture of membranes compared to the MDI group (P &lt; 0.05). However, there were no significant variances observed in other pregnancy outcomes between the two groups (P &gt; 0.05). A statistical analysis revealed a significant difference in the incidence of complications between the groups (χ 2 = 11.631, P = 0.001). CONCLUSION The utilization of CSII via an insulin pump, as opposed to MDI, can significantly enhance the management of insulin administration in patients with GDM by diversifying the sites of insulin delivery. This approach not only promotes optimal glycemic control but also regulates metabolic factors linked to blood sugar, reducing the likelihood of adverse pregnancy outcomes and complications. The clinical relevance and importance of CSII in GDM management highlight its wide-ranging clinical usefulness.

Small bowel obstruction in ruptured male pelvic dermoid with situs inversus totalis: a singular case presentation

BackgroundPelvic dermoid cysts are extremely rare in males, with an even rare occurrence of rupture. Only a handful of cases of male pelvic dermoid cysts have been published with no reported case of ruptured male pelvic dermoid causing small bowel obstruction to the best of our knowledge.Case presentationHerein we report a case of ruptured pelvic dermoid presenting with intestinal obstruction in an adult male patient with situs inversus totalis.ConclusionPelvic dermoid cyst should be considered even in males the presence of classical radiological signs. Knowledge of usual and unusual imaging signs as well as the associated life-threatening complications of a ruptured dermoid cyst can help in prompt diagnosis and timely patient management.

Clinical effects of early rehabilitation treatment after repair surgery of skin and soft tissue defects accompanied by extensor tendon injury on the back of hand

Objective: To explore the clinical effects of early rehabilitation treatment after repair surgery of skin and soft tissue defects accompanied by extensor tendon injury on the back of hand. Methods: This study was a retrospective non-randomized controlled study. From February 2015 to February 2023, 24 patients (15 males and 9 females, aged 12-55 years) with skin and soft tissue defects accompanied by extensor tendon injury on the back of hand, who met the inclusion criteria and were repaired with flap transplantation and tendon grafting or tendon anastomosis, were admitted to the First Affiliated Hospital of Air Force Medical University. According to different intervention time for postoperative rehabilitation treatment of patients, the patients were divided into conventional rehabilitation group and early rehabilitation group, with 12 cases in each group. Patients in early rehabilitation group received rehabilitation treatment immediately after surgery under the rehabilitation guidance of specialized rehabilitation physicians based on the characteristics of different postoperative periods. Patients in conventional rehabilitation group began rehabilitation treatment from the third week after surgery, and their rehabilitation treatment was the same as that of patients in early rehabilitation group from the second week after surgery. The patients in 2 groups were treated in the hospital until the sixth week after surgery. The occurrence of flap vascular crisis and tendon rupture were observed within 6 weeks after surgery. After 6 weeks of surgery, the manual muscle test was used to measure the pinching force between the index finger and thumb, lateral pinching force, three-point pinching force, and grip force of the affected hand; the total action motion method was used to evaluate the finger joint range of motion of the affected hand, and the excellent and good ratio was calculated; the Carroll upper extremity function test was used to score and rate the function of the affected hand. Results: Within 6 weeks after surgery, only 1 patient in conventional rehabilitation group suffered from venous crisis, and the flap survived after the second surgical exploration and anastomosis of blood vessels; there was no occurrence of tendon rupture in patients of 2 groups. After 6 weeks of surgery, there were no statistically significant differences in pinching force between the index finger and thumb, lateral pinching force, three-point pinching force, or grip force of the affected hand between the two groups of patients (P>0.05); the excellent and good ratio of the finger joint range of motion of the affected hand of patients in early rehabilitation group was 11/12, which was higher than 7/12 in conventional rehabilitation group, but there was no statistically significant difference (P>0.05); the affected hand function score of patients in early rehabilitation group was 90±6, which was significantly higher than 83±8 in conventional rehabilitation group (t=2.41, P<0.05); the function rating of the affected hand of patients in early rehabilitation group was obviously better than that in conventional rehabilitation group (Z=2.04, P<0.05). Conclusions: Early rehabilitation treatment for patients with skin and soft tissue defects accompanied by extensor tendon injury on the back of hand after repair surgery can improve hand function, but it would not increase surgery related complications, which is worthy of clinical promotion and application.

Temporal Trend in Maternal Morbidity and Comorbidity.

This study aimed to examine the temporal trends of severe maternal morbidity (SMM) in the U.S. population in relation to trends in maternal comorbidity. We performed a repeated cross-sectional analysis of data from individuals at 20 weeks' gestation or greater using U.S. birth certificate data from 2011 to 2021. Our primary outcome was SMM defined as the occurrence of intensive care unit admission, eclampsia, hysterectomy, uterine rupture, and blood product transfusion. We also examined the proportions of maternal comorbidity. Outcomes of the adjusted incidence rate ratio (IRR) with 99% confidence intervals (99% CIs) for 2021 m12 compared with 2011 m1 were calculated using negative binomial regression, controlling for predefined confounders. There were 42,504,125 births included in the analysis. From 2011 m1 to 2021 m12, there was a significant increase in the prevalence of advanced maternal age (35-39 [45%], 40-44 [29%], and ≥45 [43%] years), morbid obesity (body mass index 40-49.9 [66%], 50-59.9 [91%], and 60-69.9 [98%]), previous cesarean delivery (14%), chronic hypertension (104%), pregestational diabetes (64%), pregnancy-associated hypertension (240%), gestational diabetes (74%), and preterm delivery at 34 to 36 weeks (12%). There was a significant decrease in the incidence of multiple gestation (9%), preterm delivery at 22 to 27 weeks (9%), and preterm delivery at 20 to 21 weeks (22%). From 2011 m1 to 2021 m12, the incidence of SMM increased from 0.7 to 1.0% (crude IRR 1.60 [99% CI 1.54-1.66]). However, the trend was no longer statistically significant after controlling for confounders (adjusted IRR 1.01 [95% CI 0.81-1.27]). The main comorbidity that was associated with the increase in SMM was pregnancy-associated hypertension. The rise in the prevalence of comorbidity in pregnancy seems to fuel the rise in SMM. Interventions to prevent SMM should include the management and prevention of pregnancy-associated hypertension. · The rise in maternal mortality is related to morbidity.. · Pregnancy-associated hypertension increases morbidity.. · There were increasing trends in age, body mass index, and medical conditions..

Efficacy and safety of atezolizumab plus bevacizumab in patients with portal hypertension for unresectable hepatocellular carcinoma.

Atezolizumab plus bevacizumab combination therapy (Atezo + Beva) is used as the first-line therapy for unresectable hepatocellular carcinoma (u-HCC). Serious adverse events (AEs), including rupture of esophagogastric varices, have been seen during treatment. Therefore, the relationships of efficacy, safety, and portal hypertension (PH) were analyzed. A total of 146 patients with u-HCC and Child-Pugh Scores of 5-7 received Atezo + Beva. Prophylactic treatment for varices was performed for patients with the risk of rupture of varices before the start of Atezo + Beva. A propensity score-matched cohort was created to minimize the risk of potential confounders. Efficacy was assessed in 41 propensity score-matched pairs. AEs were assessed between patients without PH (n = 80) and with PH (n = 66). In patients without PH and with PH, median overall survival was 18.4 months and 18.8 months (p = 0.71), and median progression-free survival was 8.6 months and 5.8 months (p = 0.92), respectively. On the best radiological response evaluation for Response Evaluation Criteria in Solid Tumors, the objective response rate was 31.7% and 26.8% (p = 0.81), respectively. Variceal rupture occurred in three patients with PH, but there were no significant differences in the occurrence of variceal rupture (p = 0.090) and Grade 3-4 AEs between patients without and with PH. No significant differences in efficacy and safety were observed with PH. Prophylactic treatment for varices before the start of Atezo + Beva would allow treatment to continue relatively safely.

P-49 Unexpected spontaneous evolution of a symptomatic Rathke's cleft cyst

Abstract Introduction Rathke's cleft cysts (RCCs) are relatively rare sellar and suprasellar lesions that arise from remnants of Rathke's pouch, an embryonic precursor to the anterior pituitary gland. These cysts are often found incidentally during neuroimaging studies for unrelated issues. Despite their non-neoplastic nature, RCCs can lead to a spectrum of clinical manifestations due to their potential to compress surrounding structures, including the pituitary gland, optic chiasm, and adjacent neurovascular structures. However, the majority of Rathke's cysts will remain asymptomatic and typically do not necessitate any medical intervention. Instances of spontaneous regression of these cysts are infrequent, and cases of regression occurring after a recurrence are exceptionally rare. Clinical Case The patient is a 57-year-old individual with a medical history of well-controlled type 2 diabetes and high blood pressure. Additionally, the patient had a history of right ocular trauma in 1989 resulting in a decrease of visual acuity. The patient presented with persistent chronic headaches, leading to the detection of a Rathke's cleft cyst as revealed by a pituitary MRI showing a cystic structure measuring 15×11 mm in the sellar region. The cyst displayed a predominant left-sided lateralization and was characterized by T1 hypointensity as well as T2 hyperintensity. No enhancement was observed on post-gadolinium contrast injection. The cyst exerted a mass effect on the optic chiasm. Hypophyseal axis assessment revealed intact function. Notably, the patient exhibited significant visual field impairment in the right eye, marked by loss of the superior, nasal, and inferior fields, while the right visual field remained unaffected. The patient was managed conservatively based on the rationale that the visual disturbances were attributed to the ocular trauma and not linked to the RCC. Follow-up hypothalamo-hypophysial MRI conducted in April 2023 demonstrated complete spontaneous regression of the Rathke's cleft cyst, with an improvement of his chronic headache. Conclusion The natural history of RCCs is multifaceted leading to heterogenous outcomes ranging from volume progression with hormonal deficiencies and/or visual disturbances to stability over time to even spontaneous involution. The precise mechanism underlying the latter remains unclear. One possible explanation could involve disruptions in the equilibrium between the secretion and absorption of the cystic fluid, or even the potential occurrence of cyst rupture. The potential for involution or stability of the cyst is influenced by the cyst size. The likelihood of spontaneous involution advocates for a conservative strategy in cases of symptomatic RCCs where headaches are the sole presenting symptom.

Late-onset Rupture of the Intrahepatic Pseudoaneurysm Developed by Endoscopic Ultrasonography-guided Hepaticogastrostomy: A Case Report and Literature Review.

Endoscopic ultrasonography-guided hepaticogastrostomy (EUS-HGS) has emerged as an alternative drainage technique for patients with malignant biliary obstruction. However, few reports have discussed the occurrence of late-onset rupture of hepatic artery pseudoaneurysms following EUS-HGS. A recently available drill dilator equipped with a long screw segment was used in the dilation step of EUS-HGS. We highlight the potential concern that this long screw segment may increase the risk of damage to the hepatic artery, leading to late-onset life-threatening rupture of a pseudoaneurysm.

HUBUNGAN CARA MENERAN DENGAN KEJADIAN RUPTUR PERINEUM PADA IBU BERSALIN DALAM PERSALINAN KALA II DI PMB DESA SUKASARI KECAMATAN RUMPIN KABUPATEN BOGOR

A tear of the birth canal becomes the second cause of postpartum hemorrhage. Technique straning can affect the occurrence of perineal rupture in mothers who give birth spontaneously. The biggest cause of maternal death is bleeding, which is 30.3% and old partus is the lowest cause at 1.8%, but better treatment is needed so that it does not occur during labor (Ministry of Health, 2018). This study aims to analyze how to straining with incidence of perineal rupture in maternity mothers in Kala II Labor at PMB Sukasari Village, Rumpin District, Bogor Regency. The research method used is an observational analytical with a cross sectional approach. The population in this study was 55 people with a sample of 35 primiparous mothers. This research instrument uses SOP observation sheets for how to run and partograph sheets. Data processing is carried out univariately and bivariately with Chi Square Test with the help of SPSS computer program. The results of the study indicate that there is a relationship how to straining the Valsalva technique and the perineal rupture whith a volue ρ = 0.004 &lt; α = 0.005 indicating that how to straining the valsava technique affects the incidence of perineal rupture. The results of the study concluded that the way of straining can affect the incidence of perineal rupture at the time of labor. It is recommended that pregnant women in the third trimester can learn to straining properly so that there is no perineal rupture at the time of delivery

Effect of levels of water stress on some physiological and chemical traits of wheat cultivars (Triticum aestivum L.)

A field experiment was carried out at the second agricultural experiment station of the College of Agriculture - Al-Muthanna University during the agricultural season of 2022-2023. The objective of the study was to investigate the physiological and chemical responses of different bread wheat varieties to incomplete irrigation. The experiment was conducted utilising the randomised complete block design (RCBD) employing the split plot method, with three replications. The primary factors investigated in this study were related to irrigation deficiencies, which were represented by four different stages: D1 (control), D2 (tillering stage), D3 (elongation stage), and D4 (booting stage). The secondary factors examined in this research were different cultivars, denoted as V1 (Mawadah), V2 (Bohuth 22), V3 (Baraka), and V4 (Ibaa 99). The statistical analysis revealed significant variations among the stages of water stress. The D2 treatment exhibited the highest proline content at 41.692 mg per 100g, while the D4 treatment demonstrated the greatest thickness of vascular bundles in the roots at 201.23 μm. Regarding the cultivars under investigation, it was observed that the Baraka variety exhibited a higher chlorophyll content (54.24 SPAD units). In contrast, the Bohooth22 cultivar displayed a larger diameter of the vascular bundle in the roots (209.78 μm). Additionally, the Mawada variety demonstrated a greater thickness of the leaf vascular bundles (102.38 μm), while the cultivar IPA99 exhibited a higher content of Proline (35.481 mg per 100g). In terms of interference, treatment D3V1 exhibited a higher proline content of 48.607 mg/100g, indicating its superiority. The results of histological analysis showed the superiority of the combination D2V1 in the diameter of the vascular bundles of the roots (247.33) micrometers, and the occurrence of rupture and damage in the cells of the basal tissue of the root tissue in (D2V1, D3V1, D3V2) and in (D2V1, D2V2, D3V2), in addition to the occurrence of rupture and damage in the upper and lower epidermal cells in the tissue of its leaves, while the combination D2V3 wrinkled and damaged mesophyll cells, and excelled in the thickness of the leaf vascular bundles (142.40) µm, as well as showed that detachment and rupture of the upper epidermis from the mesophyll occurred in D2V4. The results of histological cutting of root cells showed that bundle damage appeared in the root tissue of combination D3V3. Also, fracture and separation occurred in the region of the vascular bundle from the underlying tissue, and some wood vessels were also damaged in the root tissue of the treatment D4V1, and in D4V3 there was a rupture in the lower epidermis of the leaf tissue, and a break in the cells of the cortex and epidermis of the root tissue, while in D4V4, damage was observed in the bundle and cells of the cortex, in addition to the occurrence of a tear in the lower epidermis of the leaves.

LONG-TERM CLINICAL OUTCOMES AFTER SINGLE- VERSUS DOUBLE-BUNDLE ACL RECONSTRUCTION: A MATCHED-PAIR ANALYSIS FROM THE SANTI STUDY GROUP

IntroductionIt has been contentious whether an anatomic double-bundle technique for anterior cruciate ligament reconstruction (ACLR)is superior to that of a single-bundle technique. It has been hypothesized in the literature that the double-bundle technique could provide function closer to that of the anatomical knee joint. The purpose of this study was to compare the long-term clinical outcomes after single-bundle ACLR versus double-bundle ACLR. We hypothesized that the double-bundle technique would not be superior to the single-bundle technique.MethodsA retrospective, non-randomized, matched-paired comparative study was performed. Patients undergoing primary anterior cruciate ligament reconstruction, using either a double-bundle or single-bundle technique, between 2003 and 2008 were included and matched 1:1. Matching included age, sex, BMI, time from injury to surgery, side of injury and type of sport. Patients who underwent revision procedures, multiligament reconstruction or other ACLR techniques were excluded. Patients were subsequently followed up, noting occurrence of graft rupture and any other complications.ResultsA total of 1377 ACLRs were performed during the study period. Seven hundred and fifty-six patients were excluded, leaving 396patients to be included in the matching (198 matched pairs). Mean follow-up time was 176.7 +/− 7.7 months (range, 166–211 months). Overall, 40 patients (10.1%) suffered from a graft rupture which consisted of 22 patients (11.1%) in the single-bundle group and 18patients (9.1%) in the double-bundle group. A multivariate analysis was performed using the Cox model and demonstrated that graft failure had no significant association with the surgical technique (hazard ratio (HR), 0.857(0.457;1.609), p=0.6313). (Figure 1) Five patients (2.5%) in the single-bundle group and 7 patients (3.5%) in the double-bundle group underwent secondary surgery for cyclops syndrome(p=0.5637). Three patients (1.5%) in the single-bundle group and 2 patients (1.0%) in the double-bundle group underwent arthrolysis(p=0.6547). Seven patients (3.5%) in the single-bundle group underwent secondary meniscectomy compared to 6 patients (3.0%) in the double-bundle group (p=0.7630).ConclusionDouble-bundle ACLR is not superior to single-bundle ACLR at long-term follow up. Therefore, orthopaedic surgeons do not need to use a double-bundle technique when performing ACL reconstruction.For any figures or tables, please contact authors directly.

Abstract 18938: Identification and Diagnosis of Culprit Lesions by Optical Coherence Tomography (OCT) in Patients With Non-ST Elevated Acute Coronary Syndromes

Introduction and Hypothesis: Optical coherence tomography (OCT) is a reliable imaging modality for plaque characterization in patients with acute coronary syndromes (ACS). While numerous studies have provided insight into the utility of OCT in ST-elevated ACS patients, our study sought to evaluate the frequency and morphological characters of lesions in patients with non-ST elevated acute coronary syndromes (Unstable angina (UA) and Non-ST elevated myocardial infarction (NSTEMI)). Methods: This multi-center, observational study included 170 patients admitted with a working diagnosis of NST-elevated ACS from October 2021 to January 2023. OCT imaging was obtained during coronary angioplasty for lesion characterization and morphology. Frequencies were compared between UA and NSTEMI sub-groups. Results: OCT imaging in patients with non-ST elevated acute coronary syndromes showed plaque erosion in 46% (n= 78), plaque rupture in 35% (n= 60), tight stenosis in 13% (n= 22), and calcified nodules in 6% (n= 10). Sub-group comparative analysis showed a statistically significant increase in plaque erosion in NSTEMI compared to UA (p&lt;0.005), while tight stenosis was significantly more common in UA (p=0.017). Morphological analysis showed a high presence of calcified nodules and red thrombus in NSTEMI patients compared to UA patients (p&lt;0.005). Conclusions: Our study concluded that optical coherence tomography is reliable in identifying and characterizing lesions in patients with non-ST elevated ACS. NSTEMI patients have a higher occurrence of plaque erosion, plaque rupture, calcified nodules, and red thrombus than patients with unstable angina.

Prediction of Tubal Rupture in Ectopic Pregnancy Using Methotrexate Treatment Protocols and Hematological Markers.

Ectopic pregnancy is a pregnancy complication in which the embryo implants outside the uterine cavity. Although medical treatment is chosen first, sometimes a rupture may occur, and surgical treatment may be required. The parameters to predict rupture have been the subject of many studies. This study aimed to compare the efficacy of different methotrexate protocols in the treatment of ectopic pregnancy and determine the parameters and methotrexate treatment protocols that can predict the risk of rupture. A total of 128 patients diagnosed with ectopic pregnancy were included in this study. Patients were separated into three categories based on their treatment protocols. Regarding the occurrence of rupture, all three groups were compared. The hematological parameters and methotrexate treatment protocols were analyzed and compared between groups. The mean age was 31.9 years. Parity was significantly higher in patients who received multiple doses of methotrexate compared to the other groups. There were significant variations observed among the groups regarding parity, initial β-hCG values, hematocrit (HTC), and mean corpuscular volume (MCV) (p = 0.048, p < 0.001, p = 0.019, and p = 0.047, respectively). According to receiver operating characteristic analysis, neutrophil-to-lymphocyte ratio (NLR) levels were significantly associated with histopathologically confirmed tubal rupture (p < 0.05). NLR levels should be examined in ectopic pregnancy, and the possibility of rupture should be considered in cases with high NLR levels. The potential of NLR to predict ectopic pregnancy rupture should be explored in multicenter prospective studies.