Onset Of Rupture Research Articles

Giant splenic artery aneurysm presenting with massive upper gastrointestinal bleeding: A case report and review of literature

BACKGROUNDSplenic artery aneurysm (SAA) and pseudoaneurysm are rare vessel’s lesions. Pseudoaneurysm is often symptomatic and secondary to pancreatitis or trauma. True SAA is the most common aneurysm of visceral vessels. In contrast to pseudoaneurysm, SAA is usually asymptomatic until the rupture, with high mortality rate. The clinical onset of SSA’s rupture is a massive life-threatening bleeding with hemodynamic instability, usually into the free peritoneal space and more rarely into the gastrointestinal tract.CASE SUMMARYWe describe the case of a 35-year-old male patient, with negative past medical history, who presented to the emergency department for massive upper gastrointestinal bleeding, severe anemia and hypotension. An esophagogastroduodenoscopy performed in emergency showed a gastric bulging in the greater curvature/posterior wall with a small erosion on its surface, with a visible vessel, but no active bleeding. Endoscopic injection therapy with cyanoacrylate glue was performed. Urgent contrast-enhanced computed tomography was carried out due to the clinical scenario and the unclear endoscopic aspect: The radiological examination showed a giant SAA which was adherent to posterior stomach wall, and some smaller aneurysms of the left gastric and ileocolic artery. Because of the high risk of a two-stage rupture of the giant SAA with dramatic outcome, the patient underwent immediate open surgery with aneurysmectomy, splenectomy and distal pancreatectomy with a good postoperative outcome.CONCLUSIONThe management of a ruptured giant SAA into the stomach can be successful with surgical approach.

Biomechanical properties and histomorphometric features of aortic tissue in patients with or without bicuspid aortic valve.

BackgroundWe sought to investigate and compare biomechanical properties and histomorphometric findings of thoracic ascending aorta aneurysm (TAA) tissue from patients with bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) in order to clarify mechanisms underlying differences in the clinical course.MethodsCircumferential sections of TAA tissue in patients with BAV (BAV-TAA) and TAV (TAV-TAA) were obtained during surgery and used for biomechanical tests and histomorphometrical analysis.ResultsIn BAV-TAA, we observed biomechanical higher peak stress and lower Young modulus values compared with TAV-TAA wall. The right lateral longitudinal region seemed to be the most fragile zone of the TAA wall. Mechanical stress-induced rupture of BAV-TAA tissue was sudden and uniform in all aortic wall layers, whereas a gradual and progressive aortic wall breakage was described in TAV-TAA. Histomorphometric analysis revealed higher amount of collagen but not elastin in BAV-TAA tunica media.ConclusionsThe higher deformability of BAV-TAA tissue supports the hypothesis that increased wall shear stress doesn’t explain the increased risk of sudden onset of rupture and dissection; other mechanisms, likely related to alteration of specific genetic pathways and epigenetic signals, could be investigated to explain differences in aortic dissection and rupture in BAV patients.

The Ductile‐to‐Brittle Transition Recorded in the Balmuccia Peridotite Body, Italy: Ambient Temperature for the Onset of Seismic Rupture in Mantle Rocks

AbstractTo constrain the conditions of the brittle‐ductile transition in peridotite, we studied the deformation sequence of a small‐displacement fault system developed in the Balmuccia peridotite body, northern Italy. The ambient pressure‐temperature conditions of the deformation were estimated using equilibrium mineral assemblages and mineral compositions. Fault‐related deformed rocks, including pseudotachylytes, cataclasites, and mylonites, were classified into three groups according to the metamorphic facies at the time of their formation: Group 1 consists of mylonites, cataclasites, and pseudotachylytes of the spinel‐lherzolite facies; Group 2 consists of cataclasite and pseudotachylyte, but no mylonite, of the plagioclase‐lherzolite facies; and Group 3 consists of cataclasite and pseudotachylyte of a lower‐grade hydrous facies. Cataclasite of the spinel‐lherzolite facies coeval with fault‐vein pseudotachylyte was identified for Group 1 and ambient temperature of the earthquake was determined by applying geothermometers to the mylonite and cataclasite. Among the deformed rocks of the spinel‐lherzolite facies (Group 1), mylonite is truncated by veins of pseudotachylyte. However, the mineral compositions of the mylonite and the cataclasite associated with the pseudotachylyte are essentially identical, yielding a temperature for the ductile‐to‐brittle transition in the peridotite of ~720 °C at a pressure of ~0.6–1.6 GPa. In the pressure range, low‐pressure side, which overlaps with conditions of surrounding crustal rocks, is more consistent with obtained fault structures and regional tectonics. This condition lies on a geotherm of an oceanic lithosphere of the age of ~10 Ma and is consistent with a predicted temperature and depth using published flow laws of olivine.

A Retrospective Review of Neonatal Sepsis among GBS-Colonized Women Undergoing Planned Cesarean Section after Labor Onset or Rupture of Membranes.

Background Sepsis is a leading cause of mortality and morbidity in neonates, with group B streptococcus (GBS) remaining the most frequent pathogen isolated from term infants. Surveillance data showed that the majority of cases of early-onset GBS disease were neonates born to women who either received no or suboptimal intrapartum antibiotic prophylaxis with a notable portion of those women having a missed opportunity to receive ≥4 hours of chemoprophylaxis. Women planning delivery by cesarean section who present in labor or rupture of membranes prior to their scheduled surgery are unlikely to receive optimal GBS chemoprophylaxis and thus their neonates are at risk of having sepsis. Materials and Methods. A retrospective cohort study of women-infant dyads was extracted from the Consortium on Safe Labor dataset. Women who had an unlabored cesarean section at ≥37 + 0 week gestation were selected and divided into four groups based on GBS status and timing of cesarean section with respect to onset of labor or rupture of membranes. The rate of neonatal sepsis and the patterns of intrapartum antibiotic chemoprophylaxis were determined. Results The sepsis rate (4.5%) among neonates of GBS-colonized women having their unlabored cesarean section after onset of labor or rupture of membranes was significantly higher than that in any other group in this study. In this group, 9.4% of women received chemoprophylaxis for ≥4 hours, while 31% had a missed opportunity to receive ≥4 hours of chemoprophylaxis. Conclusion This study suggests that neonates of GBS-colonized women having a planned cesarean section after onset of labor or rupture of membranes are at increased risk of having a sepsis diagnosis. This finding suggest the need for additional studies to assess the risk of sepsis among neonates of women in this group.

ГИСТОПАТИЧЕСКИЙ РАЗРЫВ МАТКИ ВО ВРЕМЯ БЕРЕМЕННОСТИ

Rupture of the uterus, or a violation of the integrity of its walls, is a severe manifestation of obstetric injury. The decrease in the frequency of uterine ruptures due to mechanical causes, careless obstetric interventions gave way to histopathic organ ruptures due to cesarean section surgery, conservative myomectomy, tubectomy. This publication presents a clinical case of the onset of rupture due to the failure of the suture on the uterus after an ectopic pregnancy in the interstitial section of the fallopian tube, diagnosed at 33 weeks of gestation and culminating in a newborn weighing 2 176 grams, 46 cm long in severe asphyxiation. The case presented is a rare severe obstetric pathology with a high risk of maternal and infant mortality.

Gait and electromyographic alterations due to early onset of injury and eventual rupture of the cranial cruciate ligament in dogs: A pilot study.

Identify relevant electromyography (EMG), kinematic, and kinetic changes resulting from monopolar radiofrequency energy (MRFE)-induced cranial cruciate ligament (CCL) injury and eventual rupture in dogs. Experimental, repeated measures. Five purpose-bred female dogs free of orthopedic and neurologic disease. Surface EMG, joint kinematics, and ground reaction forces were assessed at a trot in the pelvic limbs at baseline, at 2 and 4 weeks after unilateral MRFE-induced CCL injury, and at 4, 8, and 16 weeks after CCL rupture (CCLR). After MRFE-induced injury, average hip joint range of motion (ROM) during stance decreased within the untreated pelvic limb. After CCLR, stifle flexion angles decreased within the treated limb at 8 weeks and within the untreated pelvic limb at all time points, whereas average tarsal joint ROM decreased in the treated limb and increased in the untreated limb. Peak vertical ground reaction force and impulse decreased within the treated limb. Qualitative alterations of many EMG values were noted after MRFE-induced injury and CCLR, although significant differences between limbs or from baseline values were not detected. Monopolar radiofrequency energy-induced injury altered contralateral hip kinematics, suggesting early regional compensatory gait alterations. After CCLR, additional compensatory gait patterns occurred in both pelvic limbs. The qualitative analysis of trial-averaged EMG data in this small population supports a relationship between neuromuscular function and induced CCL injury leading to rupture.

Machine Learning Prediction of Tissue Strength and Local Rupture Risk in Ascending Thoracic Aortic Aneurysms

A Multi-layer Perceptron (MLP) neural network model [1] is developed to predict the strength of ascending thoracic aortic aneurysm (ATAA) tissues using tension-strain data and assess local rupture risk. The data were collected through in vitro inflation tests on ATAA samples from 12 patients who underwent surgical intervention [2]. An inverse stress analysis was performed to compute the wall tension at Gauss points. Some of these Gauss points are at or near sites where the samples eventually ruptured, while others are at locations where the tissue remained intact. A total of 27,648 tension- strain curves, including 26,676 2223 nonrupture and 972 rupture were garnered and each fitted to a third order NURBS function with 3 knot intervals. A typical fitted curve is shown in Fig. 1, which has a J-shape with a compliant elastin-dominated region at the low strain range, a transition phase in the middle, and a stiff collagen-dominated region at the high strain end. Eight features associated with the low strain region response are extracted: the tension, strain, slope and curvature at the maximum curvature point and a transition point (Figure 1). These features are subsequently fed to the machine learning model. <br/> As a first step, the model is trained using data in the rupture group. A 12-fold cross-validation method is employed. Specifically, among all 12 samples, the model is repeatedly trained using data from 11 samples and tested on the one left. Fig. 2 shows the predicted rupture tension vs actual rupture tension. As we can see from the figure, the strength is well predicted. The average mean absolute error (AMAE) and average cross-validation R² score are 0.096 and 0.954, respectively. <br/> The results above confirm the feasibility of predicting the ATAA tissue strength using pre-rupture responses features extracted from the tension-strain curves. To further validate the model, we use the same protocol to train the model; however, the trained model is applied to all curves in both rupture and nonrupture groups in each sample. Fig. 3(a) shows the predicted strength versus the end tension in all curves. The results are evaluated from two perspectives. First, within the non-rupture group, we consider a strength prediction greater than the end tension as a positive prediction (PP), otherwise a negative prediction (NP), The positive predictions account for around 86 % for all samples (Fig. 3(b)), indicating that the model is reasonably trustworthy in terms of PP output. Secondly, a local rupture risk factor, which is the ratio of the end tension to the predicted rupture tension, is defined. The risk factor distribution and the actual rupture image for each sample are compared and presented in Fig. 4 (only 10 samples showed due to the page limit). A purple square is used to mark the ‘hot spot’ (regions of peak risk factor) and the location of the onset of rupture. samples). These two spots match generally well in 10 samples (including two unshown samples). For sample 6 (the first one on rows 3 and 4), there are two ‘hot spots’ and one matches with the rupture location. For sample 2, the hot spot does not closely match the rupture site. However, this sample bears a V-shape crack in the proximity of the boundary. It is unclear where exactly the crack initiates, and also, it is possible that rupture is caused by fixture. In sum, these examinations further validate the model and demonstrate the promise of predicting local rupture propensity.

Earthquake Early Warning Using Future Generation Gravity Strainmeters

AbstractRecent studies reported the observation of prompt elastogravity signals during the 2011 M9.1 Tohoku earthquake, recorded with broadband seismometers and gravimeter between the rupture onset and the arrival of the seismic waves. Here we show that to extend the range of magnitudes over which the gravity perturbations can be observed and reduce the time needed for their detection, high‐precision gravity strainmeters under development could be used, such as torsion bars, superconducting gradiometers, or strainmeters based on atom interferometers. These instruments measure the differential gravitational acceleration between two seismically isolated test masses and are initially designed to observe gravitational waves around 0.1 Hz. Our analysis involves simulations of the expected gravity strain signals generated by fault rupture, based on an analytical model of gravity perturbations in a homogeneous half‐space. We show that future gravity strainmeters should be able to detect prompt gravity perturbations induced by earthquakes larger than M7, up to 1,000 km from the earthquake centroid within P waves travel time and up to 120 km within the first 10 s of rupture onset, provided a sensitivity in gravity strain of 10−15 Hz−1/2 at 0.1 Hz can be achieved. Our results further suggest that, in comparison to conventional P wave‐based earthquake‐early warning systems, gravity‐based earthquake‐early warning systems could perform faster detections of large offshore subduction earthquakes (at least larger than M7.3). Gravity strainmeters could also perform earlier magnitude estimates, within the duration of the fault rupture, and therefore complement current tsunami warning systems.

Rupture of the scarred and unscarred gravid uterus: Outcomes and risk factors analysis

ObjectiveTo study the maternal and fetal outcomes and assess the risk factors in patients with rupture at the lower-segment or non-lower-segment scarred, or unscarred gravid uterus. Materials and MethodsGravid patients with uterine rupture were retrospectively collected in Chang-Gung Memorial Hospital from November 2004 to July 2017. The rupture timing and location in association with maternal and fetal outcomes were collected as well as the possible risk factors including surgical history and interval prior to conception were analyzed. ResultsThirty patients were included [mean age (±SEM), 34.4 ± 0.7 years; mean body mass index, 25.0 ± 0.6 kg/m2] with mean onset of rupture at 34.2 ± 0.9 weeks, in which, 12 occurred at term and 18 at preterm (range 20–34 weeks). Four fetal demises, 22 transferals to neonatal intensive care unit, and 17 maternal blood transfusions without maternal mortality were noted. Twenty-two patients presented with acute abdominal pain and/or abnormal fetal heart rate tracing were managed with emergent cesarean delivery. Four ruptures were found in postpartum of vaginal delivery, in which 3 were after trials of labor after cesarean delivery and 1 was unscarred uterus, and two of the four eventually underwent hysterectomy. Unscarred uterus (n = 6) without identifiable risk factor ruptured in significantly later gestation associated with higher fetal birthweights than those of the scarred uterus (n = 24) (both p < 0.05), both of which yielded morbidity. The rupture timing between patients of non-lower-segment scar (n = 14) and lower-segment scar (n = 10) were not significantly different. ConclusionRupture of gravid uterus prevalently occurred after 30 weeks of gestation with remarkable morbidity. Unscarred uterus could rupture in later gestation than the scarred ones without identifiable risk factor. Alertness to the acute abdominal pain, atypical from uterine contraction or the suspicious fetal heart rate tracing is the key to the timely rescue and successful management.

Modeling injection-induced seismicity through calculation of radiated seismic energy

Seismicity induced by the injection of fluid into the fractured ground is one of the most challenging issues facing geothermal and deep wastewater disposal industries. This paper introduces an energy-based numerical methodology to study roles of fluid injection in triggering rupture (seismic slip) along preexisting faults. The methodology is developed in the Universal Distinct Element Code (UDEC) using its quasi-static and dynamic schemes and calculates the total seismic energy radiated by a rupture when more energy is made available in the system than can be stored or consumed. As an example of the application of the developed methodology, we study effects of fluid injection on rupture dynamics by pressurizing a single fault surrounded by impermeable rock, representing a simplified analogy for the injection process in deep wastewater disposal and geothermal activities. We discuss effects of raising the fluid pressure on initiating rupture over well-oriented (or critically loaded) and misoriented faults. Results show that fluid injection can trigger a rupture along both well-oriented and misoriented faults although the notion of seismicity may be observed along the well-oriented fault as early as the beginning of the injection process. The well-oriented fault generates higher seismic energy magnitude as more energy is available for rupture due to the higher peak shear stress and stress drop on the fault. Making simplifying assumptions, this study also found that fluid can be injected under a high-pressure increment before and after the fault initial activation while the radiated seismic energy remains relatively insignificant. However, gradually increasing the fluid pressure at the onset of rupture reduces the radiated seismic energy by 30%. Comparing the seismic moment and radiated seismic energy for each event reveals that while radiated seismic energy varies between different values of pressure increment, the calculated seismic moment stays constant, showing the possible ineffectiveness of the seismic moment in representing the intensity of injection-induced ruptures.

Genetic Associations With Gestational Duration and Spontaneous Preterm Birth

(Abstracted from N Engl J Med 2017;377:1156–1167) Preterm birth, caused by idiopathic onset of uterine contractions or rupture of fetal membranes, is a major risk factor for death in neonates and children younger than 5 years. Although there is evidence that preterm birth and gestational duration are affected by both maternal and fetal genomes, robust associations with genetic variations are still not established.

844: Rapid diagnosis of chorioamnionitis by urinalysis reagent strip

To evaluate amniotic fluid leukocyte esterase (LE), measured by urinalysis reagent strips, as a predictor of histologic chorioamnionitis in term pregnancies. In this pilot study, women with singleton pregnancies at 37w0d gestation or greater undergoing cesarean delivery were recruited. Amniotic fluid was aspirated at the time of amniotomy during the cesarean and tested for LE using a urinalysis reagent strip. A LE result of at least 1+ was considered positive. All placentas were examined for histologic chorioamnionitis by a pathologist blinded to the LE results. Histologic chorioamnionitis was defined by the presence of an acute inflammatory infiltrate (neutrophils) involving the subchorionic fibrin and/or chorionic plate of the placenta or an acute inflammatory cell infiltrate involving the chorionic and/or amniotic layers of the fetal membranes. Clinical chorioamnionitis was defined as 2 or more of the following: maternal temperature 38.0 C or greater, maternal heart rate 100 bpm or greater, or fetal heart rate baseline 160 bpm or greater. Sensitivity, specificity, positive predictive value, and negative predictive values of amniotic fluid LE for histologic chorioamnionitis were calculated. A total of 40 women were recruited, 20 with and 20 without clinical chorioamnionitis. Women without clinical chorioamnionitis underwent cesarean prior to labor or rupture of membranes while the women with clinical chorioamnionitis underwent cesarean after onset of labor or rupture of membranes. Amniotic fluid leukocyte esterase was highly predictive of histologic chorioamnionitis (Table 1). Amniotic fluid leukocyte esterase, when measured by urinalysis reagent strips, may be highly predictive of both clinical and histologic chorioamnionitis. Further study is needed to assess the effect of labor or ruptured membranes on this potential point-of-care diagnostic and research tool.

Experimental and numerical investigation of the formability of an ultra-thin copper sheet

The aim of this study is to investigate the forming limits of an ultra-thin copper sheet (0.1mm thickness) that is used for connection applications. The first step consists in characterising the mechanical behaviour under different strain paths, up to necking and final rupture, such as uniaxial and biaxial tension, in order to investigate the largest range of triaxiality ratios for this material. Nakazima tests are performed on specific samples with a designed-on-purpose device in order to determine experimentally the onset of rupture. Strain distribution over the surface in tension is measured with digital image correlation technique. The forming limits are characterised experimentally for different strain paths and compared to predictions given by macroscopic fracture criteria. It is shown that when the macroscopic criterion involves a sufficient number of parameters, it is able to predict limit forming curves with a reasonable accuracy.

ARHGAP18 Protects Against Thoracic Aortic Aneurysm Formation by Mitigating the Synthetic and Proinflammatory Smooth Muscle Cell Phenotype.

Thoracic aortic aneurysm (TAA) is a potentially lethal condition, which can affect individuals of all ages. TAA may be complicated by the sudden onset of life-threatening dissection or rupture. The underlying mechanisms leading to TAA formation, particularly in the nonsyndromal idiopathic group of patients, are not well understood. Thus, identification of new genes and targets that are involved in TAA pathogenesis are required to help prevent and reverse the disease phenotype. Here we explore the role of ARHGAP18, a novel Rho GAP expressed by smooth muscle cells (SMCs), in the pathogenesis of TAA. Using human and mouse aortic samples, we report that ARHGAP18 levels were significantly reduced in the SMC layer of aortic aneurysms. Arhgap18 global knockout (Arhgap18-/-) mice exhibited a highly synthetic, proteolytic, and proinflammatory smooth muscle phenotype under basal conditions and when challenged with angiotensin II, developed TAA with increased frequency and severity compared with littermate controls. Chromatin immunoprecipitation studies revealed this phenotype is partly associated with strong enrichment of H3K4me3 and depletion of H3K27me3 at the MMP2 and TNF-α promoters in Arhgap18-deficient SMC. We further show that TAA formation in the Arhgap18-/- mice is associated with loss of Akt activation. The abnormal SMC phenotype observed in the Arhgap18-/- mice can be partially rescued by pharmacological treatment with the mTORC1 inhibitor rapamycin, which reduces the synthetic and proinflammatory phenotype of Arhgap18-deficient SMC. We have identified ARHGAP18 as a novel protective gene against TAA formation and define an additional target for the future development of treatments to limit TAA pathogenesis.

Histologic chorioamnionitis prevalence in patients with premature rupture membranes

This was a retrospective cohort study between 2002 and 2011. A total number of 150 singleton pregnancies with preterm premature rupture of membranes (PROM) (before 34 weeks) were analyzed. Histological chorioamnionitis (Blanc grade III) was significantly increased over three days from onset of premature rupture of membranes. The positive relationship was strengthened (odds ratios, 3.5; 95% confidence intervals, 1.5-5.2) over three days from onset of preterm PROM. PROM is a risk factor important for histological chorioamnionitis. To avoid neonatal infection, early termination is recommended in preterm PROM patients.

Elastic wave velocity evolution of shales deformed under uppermost crustal conditions

AbstractConventional triaxial tests were performed on a series of samples of Tournemire shale along different orientations relative to bedding (0°, 90°). Experiments were carried out up to failure at increasing confining pressures ranging from 2.5 to 80 MPa, and at strain rates ranging between 3 × 10−7 s−1 and 3 × 10−5 s−1. During each experiment, P and S wave elastic velocities were continuously measured along many raypaths with different orientations with respect to bedding and maximum compressive stress. This extensive velocity measurement setup allowed us to highlight the presence of plastic mechanisms such as mineral reorientation during deformation. The evolution of elastic anisotropy was quantified using Thomsen's parameters which were directly inverted from measurement of elastic wave velocity. Brittle failure was preceded by a change in P wave anisotropy, due to both crack growth and mineral reorientation. Anisotropy variations were largest for samples deformed perpendicular to bedding, at the onset of rupture. Anisotropy reversal was observed at the highest confining pressures. For samples deformed parallel to bedding, the P wave anisotropy change is weaker.

Prevalence and risk factors related to preterm birth in Brazil.

BackgroundThe rate of preterm birth has been increasing worldwide, including in Brazil. This constitutes a significant public health challenge because of the higher levels of morbidity and mortality and long-term health effects associated with preterm birth. This study describes and quantifies factors affecting spontaneous and provider-initiated preterm birth in Brazil.MethodsData are from the 2011–2012 “Birth in Brazil” study, which used a national population-based sample of 23,940 women. We analyzed the variables following a three-level hierarchical methodology. For each level, we performed non-conditional multiple logistic regression for both spontaneous and provider-initiated preterm birth.ResultsThe rate of preterm birth was 11.5 %, (95 % confidence 10.3 % to 12.9 %) 60.7 % spontaneous - with spontaneous onset of labor or premature preterm rupture of membranes - and 39.3 % provider-initiated, with more than 90 % of the last group being pre-labor cesarean deliveries. Socio-demographic factors associated with spontaneous preterm birth were adolescent pregnancy, low total years of schooling, and inadequate prenatal care. Other risk factors were previous preterm birth (OR 3.74; 95 % CI 2.92–4.79), multiple pregnancy (OR 16.42; 95 % CI 10.56–25.53), abruptio placentae (OR 2.38; 95 % CI 1.27–4.47) and infections (OR 4.89; 95 % CI 1.72–13.88). In contrast, provider-initiated preterm birth was associated with private childbirth healthcare (OR 1.47; 95 % CI 1.09–1.97), advanced-age pregnancy (OR 1.27; 95 % CI 1.01–1.59), two or more prior cesarean deliveries (OR 1.64; 95 % CI 1.19–2.26), multiple pregnancy (OR 20.29; 95 % CI 12.58–32.72) and any maternal or fetal pathology (OR 6.84; 95 % CI 5.56–8.42).ConclusionThe high proportion of provider-initiated preterm birth and its association with prior cesarean deliveries and all of the studied maternal/fetal pathologies suggest that a reduction of this type of prematurity may be possible. The association of spontaneous preterm birth with socially-disadvantaged groups reaffirms that the reduction of social and health inequalities should continue to be a national priority.

Severe abdominal pain exacerbated by fetal movement is an early sign of the onset of uterine rupture

ObjectiveUterine rupture is a rare but serious obstetric complication. However, prediction and diagnosis at an early stage remain difficult. Herein, we report a case of primary uterine rupture found earlier by a specific symptom. Case ReportA 29-year-old patient was scheduled to undergo a cesarean section (CS) due to placenta previa. However, at Week 35, she began experiencing abdominal pain and uterine contractions. Subsequently, she began experiencing severe pain, which was enhanced by fetal movements. An emergency CS was performed due to continuous uncontrollable pain. When the abdominal cavity was opened, we found that much of the amniotic cavity had prolapsed outside the uterus. Despite performing total hysterectomy, both the mother and child had positive clinical courses. Uterine rupture was discovered early because of emergency CS. ConclusionThis case suggests that abnormal pain exacerbated by fetal movement can be a characteristic early sign of uterine rupture.

Scaling relation between earthquake magnitude and the departure time from P wave similar growth

AbstractWe introduce a new scaling relation between earthquake magnitude (M) and a characteristic of initial P wave displacement. By examining Japanese K‐NET data averaged in bins partitioned by Mw and hypocentral distance, we demonstrate that the P wave displacement briefly displays similar growth at the onset of rupture and that the departure time (Tdp), which is defined as the time of departure from similarity of the absolute displacement after applying a band‐pass filter, correlates with the final M in a range of 4.5 ≤ Mw ≤ 7. The scaling relation between Mw and Tdp implies that useful information on the final M can be derived while the event is still in progress because Tdp occurs before the completion of rupture. We conclude that the scaling relation is important not only for earthquake early warning but also for the source physics of earthquakes.

Perinatal HIV transmission and prevention

Perinatal HIV transmission occurs during pregnancy, labor, delivery or breastfeeding. Maternal factors associated with increased perinatal transmission include timing of infection, immune status, mode of delivery, co-existing sexually transmitted diseases, illicit drug use, increased duration of ruptured membranes, chorioamnionitis, viral load & invasive procedures. Infant risk factors include premature birth, low birth weight, skin & mucous membrane lesions. Preventive measures include anti retroviral therapy, treatment of chorioamnionitis with antibiotics, opting for caesarean section & avoiding breastfeeding. Early appropriate treatment of subclinical chorioamnionitis & virocidal cleaning of birth canal reduces perinatal HIV transmission. Caesarean section before onset of labour & membrane rupture reduces risk of mother–infant transmission by almost 50%. Vertical HIV transmission can occur through breast-feeding mostly during first 6 weeks of life & hence avoiding breastfeeding reduces transmission. Interrupting intrapartum transmission like giving ART in late gestation/ peri-partum & elective caesarean section reduce vertical HIV acquisition. As monotherapy & dual therapy are less effective, current guidelines recommend 2 nucleoside reverse transcriptase inhibitors & either a nonnucleoside reverse transcriptase inhibitor or a protease inhibitor. Perinatal HIV transmission can be reduced through a comprehensive approach including Universal access to prenatal care & routine HIV counselling & testing, access to antiretroviral therapy during pregnancy, at delivery & postpartum, education about treatment options & regimen adherence.