Rupture Rate Research Articles

Sudden onset abdominal wall leakages of inguinal hernia in patients undergoing peritoneal dialysis: report of two cases with literature review

BackgroundIn this report, we presented two cases of sudden onset abdominal wall leakages of inguinal hernia in patients undergoing peritoneal dialysis (PD).Case presentationA total of 519 patients with end-stage kidney disease underwent PD at our hospital between March 2006 and March 2023. Among them, 39 patients [7.5%; 36 men (92%); mean age, 66 years; median PD duration, 1.7 years] developed inguinal hernias, with an incidence rate of 0.85 per 100 dialysis patient-years. Two patients (0.4%; both men; age/PD duration, 65/4.6 years and 74/1.7 years) experienced sudden onset abdominal wall leakages of inguinal hernia, with a rupture rate of 0.04 per 100 dialysis patient-years. In these cases of sudden onset abdominal wall leakages, both patients underwent tension-free hernioplasty; one patient was shifted to hemodialysis due to discomfort experienced from the right groin to the thigh area, while the other patient remained on PD.ConclusionsClinicians should consider the possibility of sudden onset abdominal wall leakages of inguinal hernia in PD patients.

Analysis of 179 posterior communicating artery infundibular dilations demonstrating low risk for transformation to aneurysm or rupture and the usefulness of the “round defect”

ObjectiveOutpouchings, particularly those originating from the posterior communicating artery off the internal carotid artery (Pcom-Ops), are often unable to be categorized definitively as aneurysms or infundibula resulting in frequent clinical imaging and follow-up. We aimed to investigate potential correlations between growth and rupture rates and easily definable imaging characteristics in Pcom-Ops. MethodsWe analyzed CT and MR imaging of Pcom-Ops identified in a case series of patients seen between 2007 and 2022. For each outpouching, the length of the base, hypotenuse, and round defect, defined as the deviation from triangular shape, were calculated. These measurements were used to estimate the conical volume and eccentricity of the Pcom-Op. Results179 Pcom-Ops were identified from 152 patients who were followed for an average of for 3.2 ± 3.2 years. Bilateral Pcom-Ops were present in 17.8 % patients and 7.2 % had an underlying connective tissue disease. Only one Pcom-Op in a patient with polycystic kidney disease subsequently became a clear aneurysm after 6.3 years. The average approximated volume and round defect at presentation were 2.3 ± 2.2 mm3 and 0.29 ± 0.16 mm, respectively. Volume and round defect changed minimally over time followed. Outlier analysis of round defect, determined by Z-score more than 3 standard deviations above the mean, was not associated with evolution into clear aneurysms. ConclusionPcom-Ops rarely enlarge or rupture. Pcom-Op eccentricity does not predict high risk Pcom-Ops. Thus Pcom-Ops in general may not require close follow-up over time. However, Pcom-Ops in patients with connective tissue diseases should be monitored more closely.

Epidemiology of Sports-Related Tendon Ruptures Presenting to Emergency Departments in the United States.

Participation in recreational and competitive sports can predispose people to musculoskeletal injuries. Chronic overuse with insufficient recovery, overloading, and direct contact can result in acute primary tendon ruptures. There is scarce literature regarding the epidemiology of sports-related acute primary tendon ruptures in the United States (US). To identify the incidence rate (IR) of sports-related acute primary tendon ruptures presenting to US emergency departments using the National Electronic Injury Surveillance System (NEISS) database and describe the trends in the IR from 2001 to 2020. Descriptive epidemiology study. The NEISS database was queried using injury case narratives; cases with a clear diagnosis of an acute primary tendon rupture were included in the final analysis. National estimates, estimated IRs (reported as per 1,000,000 person-years at risk), and temporal trends in the annual IR (reported as average annual percent change) of acute primary tendon ruptures were calculated using NEISS sample estimates and US Census Bureau population estimates. An estimated total of 141,382 patients (95% confidence interval [CI], 107,478-175,286) presented to US emergency departments with a sports-related tendon rupture over the study period (IR, 22.9 person-years at risk [95% CI, 17.4-28.3]). The mean age was 37.7 years (95% CI, 37.0-38.5). Of all cases of a tendon rupture identified from 2001 to 2020, 60.1% were secondary to exercise/sports-related injury mechanisms. An Achilles tendon rupture was the most common injury, representing 55.9% of cases. Basketball was the most common sports-related injury mechanism, accounting for 36.6% of cases. The overall injury rate in male patients was 7.7 times that of female patients (IR ratio, 7.7 [95% CI, 4.4-13.5]; P < .05). The annual incidence of all sports-related tendon ruptures in the US increased significantly from 2001 to 2020 (average annual percent change, 1.9 [95% CI, 1.0-2.8]; P < .01). Recreational/competitive sports participation accounted for a large proportion of acute primary tendon ruptures in the US during the study period.

Comparison of Results in ACL Reconstruction in Women under 30 Years Old at a Minimum of 2 Years’ Follow-Up between a Bone–Tendon–Bone (BTB) Technique with the Patellar Tendon and a Hamstring Technique Combined with Anterolateral Ligament Reconstruction

Background: Anterior cruciate ligament (ACL) rupture is a frequent injury among athletes, particularly women. Various techniques have shown effectiveness, but their impact on laxity and clinical outcomes varies. This study aims to compare the rupture rates of patellar tendon (PT) reconstruction versus hamstring reconstruction (HR) combined with anterolateral ligament reconstruction (ALLR) in young women. The secondary objectives include comparing functional ACL-RSI and subjective IKDC scores, as well as the Tegner scale, between these two groups. The hypothesis is that adding ALLR to HR will result in rupture rates and functional scores similar to those of PT reconstruction. Methods: Between 2015 and 2019, 96 patients were treated at two facilities, with 70 having an average follow-up of 44 ± 14.5 months: 35 underwent PT reconstruction, and 35 had HR combined with ALLR. Patients were re-evaluated remotely after at least 2 years using a standardised questionnaire and assessing subjective IKDC, ACL-RSI, and Tegner scores. Results: Rupture rates were 5.7% in both groups. The mean subjective IKDC score was 81% for the HR + ALLR group versus 80.8% for the PT group (p = 0.09). The mean ACL-RSI score was 66% for HR + ALLR versus 68% for PT (p = 0.78). The HR + ALLR group lost an average of 0.4 points on the Tegner scale postoperatively, while the PT group lost an average of 0.77 points (p = 0.09). Conclusions: Hamstring surgery combined with anterolateral surgery provides subjective results, as assessed by patients using subjective scales and questionnaires, that are as good as those obtained with PT surgery in young women. Notwithstanding, the results are not corroborated by clinical or radiological examination.

Efficacy of endovascular therapy in short-term two-stage operation for thrombosed giant cerebral aneurysm

Background: Giant cerebral aneurysms have a high rupture rate, are often difficult to treat, and have a poor prognosis. We report two cases in which good results were achieved with a short, two-stage operation using a combination of endovascular treatment (EVT) and direct surgery. Case Description: Case 1 - A 50-year-old man had become immobile due to truncal ataxia after nausea. Magnetic resonance imaging, computed tomography (CT), and angiography revealed a giant thrombosed aneurysm of the right vertebral artery 30 mm in diameter, which compressed medulla oblongata. He underwent endovascular parent artery occlusion (PAO) followed by direct surgical thrombectomy 3 days later.The patient’s outcome was modified Rankin score (mRS) 1 at 7 days after the operation and mRS 0 at 1 year. Case 2 - A 40-year-old man developed a progressive visual disturbance. CT showed a giant thrombosed aneurysm of 50 mm diameter in the C2 portion of the left internal carotid artery. A balloon test occlusion (BTO) and cerebral blood flow single-photon emission computed tomography under BTO suggested partial ischemic tolerance due to PAO. PAO followed by low flow bypass and thrombectomy of the aneurysm by direct surgery was performed on the same day.The patient’s vision was improved with the outcome of mRS 1. Conclusion: EVT in a short-term two-stage operation for a thrombosed giant cerebral aneurysm is effective for the purpose of hemostasis in the thrombectomy designed to decompress the suffered brain or nerve. Complete PAO and meticulous perioperative use of antithrombotic agents are necessary to avoid perforator failure and hemorrhagic complications in this technique.

Learning curves of novice residents on cataract surgery simulator: the E3CAPS pedagogic study

IntroductionTraining novice ophthalmology residents on the EyeSi® simulator increases cataract surgery safety. However, there is no consensus regarding how much training residents should perform before their first time on patients. We evaluated the French national training program through the analysis of the learning curves of novice residents.MethodsThis prospective multicentric pedagogic study was conducted with French novice residents. Each resident completed the recommended four two-hour training sessions and performed a standardized assessment simulating standard cataract surgery before the first session (A0), at the end of the first (A1), second (A2), third (A3) and fourth (A4) sessions. For each surgical step of each attempt, the following data were collected: score, odometer, completion time, posterior capsular rupture and cumulative energy delivered (ultrasounds) during phacoemulsification. A performance threshold was set at a score of 80/100 for each surgical step, 400/500 for the overall procedure. Only descriptive statistics were employed.ResultsSixteen newly nominated ophthalmology residents were included. Median score progressively increased from 95 [IQR 53; 147]) at A0 to 425 [IQR 411; 451] at A4. Despite a significant progression, the “emulsification” step had the lowest A4 scores 86 [IQR 60; 94] without reduction in completion time, odometer or ultrasounds delivered. The rate of posterior capsular rupture decreased linearly from 75% at A0 to 13% at A4 during “emulsification” and from 69 to 0% during “irrigation and aspiration”. At A4, only 25% [8; 53] of residents had > 80 at each step and only 75% [47; 92] had > 400/500 overall.ConclusionA training program consisting of four two-hour sessions on the EyeSi simulator over four consecutive days effectively enhances the surgical skills of novice ophthalmology residents. Undergoing more training sessions may improve scores and decrease the incidence of surgical complications, particularly at the emulsification step of cataract surgery. The learning curves presented here can reassure residents who are progressing normally and help identify those who need a further personalized training program. Trial registrationClinicalTrials registration number: NCT05722080 (first submitted 22/12/2022, first posted 10/02/2023).

Sex Differences in Intracranial Aneurysms: A Matched Cohort Study.

Background: Aneurysmal subarachnoid hemorrhage (SAH) predominantly affects women, accounting for 65% of cases. Women have a 1.3 times higher relative risk than men, with the incidence rising particularly in women aged 55-85 years. Women also have a higher prevalence of unruptured intracranial aneurysms (IAs), especially after the age of 50 years, and are at greater risk of aneurysm growth and rupture. This study aimed to isolate the influence of sex on rupture rate, bleeding severity, functional outcomes, and complications by using a matched cohort, while also examining the impact of sex on aneurysm localization and multiplicity. Methods: We utilized a retrospectively collected database of 300 patients with 511 IAs. Inclusion criteria included the availability of clinical data and 3D angiography for semi-automatic reconstruction of IA morphology. Female patients and their IA were matched with male patients according to clinical parameters and 21 morphological characteristics using an interactive visual exploration tool for multidimensional matching. Results: Contrary to previously published results, our study found no significant sex differences in rupture rates or vasospasm rates between male and female patients. The severity of SAH, functional outcomes, and complications such as hydrocephalus were also similar in women and men. However, women exhibited a higher prevalence of multiple aneurysms and distinct localization patterns. Conclusions: This study underscores the complex role of sex in IA development and rupture. Although sex-specific biological factors influence aneurysm characteristics, they do not necessarily translate into differences in clinical outcomes. Further research is needed to explore these factors and their impact on aneurysm development and management.

Autograft and Allograft ACLR in Patients Greater Than 40 Years Old Have Similar Short-Term Patient-Reported Outcomes with Higher Rates of ACL Graft Failure in Allograft Patients

PurposeThe purpose of this study was to evaluate short-term patient-reported outcomes (PROs) in patients aged 40 and older after primary ACLR between patients that received allograft or autograft. Secondary aims included assessing the effect of pre-existing osteoarthritis on short-term PROs. MethodsA retrospective review of an ambulatory surgery center’s electronic medical record was conducted for patients who underwent primary ACLR between 2009 and 2022. Patients aged younger than 40, those who underwent index revision procedures and/or concomitant ligament repair/reconstructions, and those with incomplete baseline or short-term (1- or 2-year) KOOS scores were excluded. Allograft and autograft patients were matched according to sex and body mass index (BMI) in a 2:1 fashion. PROs used included KOOS and Single Assessment Numeric Evaluation (SANE) at baseline and short-term follow up (minimum of 1 year). Minimum clinically important difference was calculated in a distribution-based fashion. Osteoarthritis severity was determined based on Kellgren-Lawrence grading of perioperative knee x-rays. Preexisting osteoarthritis was defined as KL grade 1 or more. ResultsA total of 331 patients were included after matching (215 allograft and 116 autograft patients). The average age was 47.7 ± 6.0 (range: 40-66). Age differed significantly between the two groups, with the allograft cohort having an average age of 48.6 ± 6.0 years and the autograft cohort having an average age of 46.1 ± 5.7 years (p < 0.001). Short-term change in KOOS and SANE scores did not differ by graft type (p = 0.154, p = 0.556, respectively). Sixty-seven percent of all patients met MCID for KOOS and 82% of patients with complete baseline and short-term SANE scores met MCID for SANE. There was a statistically significant difference in rupture rates between the allograft and autograft cohorts (n = 9 allograft vs n = 0 autograft; p = 0.030). There was no difference in re-operation rates between the autograft and allograft cohorts (p = 0.453). Perioperative Kellgren-Lawrence grading did not affect outcomes for either graft type (allograft: p = 0.905 vs. autograft: p = 0.522). ConclusionMiddle-aged patients undergoing ACLR with allograft or autograft demonstrate similar short-term patient reported outcomes. Pre-existing osteoarthritis similarly did not significantly affect short-term outcomes. However, rerupture rates were significantly higher in the allograft cohort than the autograft cohort. Level of EvidenceLevel III - Therapeutic

The Safety and Outcomes of Elective Endovascular Aneurysm Repair in the Elderly: A Systemic Review and Meta-Analysis.

Prevalence of abdominal aortic aneurysms (AAAs) increases with age. Previous trials confirm that elective endovascular aneurysm repair (EVAR) is an effective intervention for AAA. However, few elderly patients were recruited into randomized trials, whereas in contemporary clinical practice, elective repair is commonly performed on octogenarians. We evaluated the safety and outcome of elective EVAR in elderly patients to inform clinical practice and vascular service provision. A systematic review and meta-analysis of studies reporting risk of complications and death in patients undergoing elective EVAR was performed (PROSPERO CRD: 42022308423). Observational studies and interventional arms of randomized trials were included if the outcome rates or raw data were provided. Primary outcome was 30-day mortality. Secondary outcomes were longer-term mortality, 30-day major adverse events, and aneurysm-related mortality. Primary and secondary outcomes were compared between octogenarians and non-octogenarians. Exclusion criteria were emergency procedures, non-infrarenal aneurysms, and lack of octogenarian data. A total of 41 studies were eligible from 10 099 citations, including 10 national and 5 international registries, 26 retrospective studies, and our own prospective cohort. The analysis included 208 997 non-octogenarians (mean age=70.19 [SD=0.62]) and 106 188 octogenarians (mean age=83.75 [SD=0.35]). The 30-day mortality post-elective EVAR was higher in octogenarians (1.08% in non-octogenarians, 2.31% in octogenarians, odds ratio [OR]=2.27 [2.08-2.47], p<0.0001). Linear regression demonstrated a 0.83% increase in 30-day mortality for every 10-year age increase above 60 years old. Mortality for octogenarians increased significantly during follow-up: 11.35% (OR=1.87 [1.65-2.13], p<0.001), 22.80% (OR=1.89 [1.52-2.35], p<0.001), 32.00% (OR=1.98 [1.66-2.37], p<0.001), 47.53%, and 51.08% (OR=2.40 [1.90-3.03], p<0.001) at 1-through-5-year follow-up, respectively. The 30-day major adverse events after elective EVAR were higher in octogenarians (OR=1.75-2.83, p<0.001). Octogenarians experience higher but acceptable peri-operative morbidity and mortality compared with younger patients. However, 3-year to 5-year survival is very low among octogenarians. Our findings challenge the notion of routine intervention in elderly patients and support very careful selection for elective EVAR. Many octogenarians with peri-threshold (<6 cm) AAAs may derive no benefit from EVAR due to limited 3-year to 5-year overall survival and low risk of aneurysm rupture with conservative management. An adjusted threshold for intervention in octogenarians may be warranted. Octogenarians with infra-renal AAA are increasingly managed with elective EVAR. Previous studies have demonstrated that EVAR is safer than open repair for octogenarians, with lower peri-operative mortality and major adverse events. However, randomised trials, on which much of contemporary evidence is based, recruited a relatively younger population of participants. This systematic review and meta-analysis provides a contemporary synthesis of the literature comparing outcomes in octogenarians to younger patients. The results of this analysis, together with low rupture rates amongst octogenarians in existing literature, question the benefit of routine elective intervention for peri-threshold aneurysms and an adjusted threshold for intervention in octogenarians may be warranted.

Characteristics and pregnancy outcomesofsubtypes of gestational diabetes mellitusbased on HOMA-IR and BMI.

To identify the characteristics and pregnancy outcomes across different subgroups of gestational diabetes mellitus (GDM) categorized by insulin resistance index and body mass index (BMI) in early pregnancy. This retrospective study included 1804 women who underwent a 75g-OGTT during 22-28weeks of gestation, categorized into normal glucose tolerance (NGT) (1487) and GDM (317 [17.57%] of the total cohort). Metabolic parameters were assessed, and equation of homeostatic model assessment (HOMA) were utilized to compute indices of insulin resistance (HOMA-IR), β-cell secretory (HOMA-B), and insulin sensitivity (HOMA-%S) in early and mid-pregnancy. The cut-off value of HOMA-IR (1.61) in early pregnancy was determined via ROC curve analysis. This value, combined with pre-pregnancy BMI, further categorized NGT and GDM into six subgroups respectively, based on HOMA-IR levels (≥ 1.61 or < 1.61) and BMI categories (< 18.5kg/m2, 18.5-25kg/m2, or ≥ 25kg/m2). In comparison to women with NGT, those with GDM were notably older, had higher pre-BMI, fasting plasma glucose (FPG), insulin, and lipid levels in early pregnancy. They also exhibited more pronounced insulin resistance in both early and mid-pregnancy, leading to poorer outcomes. Following an oral glucose load, the peaks of glucose and insulin were out of sync in GDM and its subgroups, accompanied by further increases in HOMA-IR, HOMA-B, and a decrease in HOMA-%S, except for the GDM subgroup with HOMA-IR < 1.61/BMI < 18.5kg/m2. Conversely, glucose and insulin secretion in NGT and its subgroups peaked synchronously at 60min. GDM women with HOMA-IR ≥ 1.61/18.5kg/m2 ≤ BMI < 25kg/m2 had higher rates of neonatal jaundice (34.5% vs 13.9%, p < 0.0001), LGA (28.9% vs 13.2%, p = 0.001), macrosomia (9.8% vs 3.7%, p = 0.025) compared to peers, while in GDM women with HOMA-IR ≥ 1.61/BMI ≥ 25kg/m2, the rates of LGA and macrosomia were 26.6% and 8.4%, respectively. The GDM subgroup with HOMA-IR < 1.61/BMI < 18.5kg/m2 exhibited the highest rates of premature rupture of membrane (46.7%) and postpartum hemorrhage (20%), predominantly with vaginal delivery and a 1min Apgar score of 4.5% in GDM women with HOMA-IR < 1.61/18.5kg/m2 ≤ BMI < 25kg/m2. GDM and its subgroups displayed severe insulin resistance and poorer insulin sensitivity, leading to an increased risk of adverse pregnancy outcomes. GDM women with higher IR and normal or over weight were more likely to experience LGA and macrosomia, while those with lower IR and underweight were prone to premature rupture of membrane and postpartum hemorrhage during vaginal delivery.

Laparoscopic Fertility-Sparing Management of Borderline Ovarian Tumors: Surgical and Long-Term Oncological Outcomes.

Objectives: To assess the long-term oncological safety of laparoscopic fertility-sparing surgery (FSS) in borderline ovarian tumors and the impact of laparoscopic surgical factors on recurrences. Primary outcomes were the recurrence rate and time to recurrence after laparoscopic FSS. Secondary outcomes were to evaluate the recurrence rate after a second laparoscopic surgery and to assess factors associated with the risk of relapse. Methods: This is a retrospective single-center observational study in a tertiary university-affiliated hospital. Thirty-four patients diagnosed with borderline ovarian tumors who underwent laparoscopic FSS were recruited. Patients were categorized into two groups: the adnexectomy group, including patients who underwent unilateral adnexectomy, and the cystectomy group, which included patients who underwent unilateral cystectomy, bilateral cystectomy, and unilateral adnexectomy with contralateral cystectomy. Results: Eleven relapses (32.3%) were observed during a median follow-up period of 116.1 [62.5-185.4] months. The recurrence rate was similar for patients who underwent cystectomy (6/19, 31.6%) and adnexectomy (5/15, 33.3%). Cystectomy led to a shorter time to first recurrence (36-month progression-free survival rates of 66% vs. 85%) and higher rates of capsular rupture (71.4% vs. 20%, p = 0.04) compared to adnexectomy. No deaths due to progression of disease were reported. Conclusions: Laparoscopic FSS for borderline ovarian tumors is a safe, long-term oncological option. Although the recurrence rate was similar in patients undergoing adnexectomy or cystectomy, the time to recurrence was shorter in cases treated with cystectomy. Further research is needed to identify eventual laparoscopic risk factors more strongly correlated with recurrence.

Synergistic mechanism of pH control by CO2 and CaO2 pre-oxidation to enhance algae dehydration

This study investigated the improvement of algal dehydration efficiency through CO2 pH adjustment and moderate pre-oxidation with CaO2 to enhance coagulation. Adjusting the pH of algal water to 6.0–9.5 with CO2 significantly affected zeta potential and photosynthesis, enhancing aluminum hydrolysis product aggregation. At pH 6.5, the composition of algal organic matter closely matched the original water, indicating minimal impact on algae and optimal cell activity. CaO2 pre-oxidation effectively reduced residual aluminum content and DOM release after coagulation. The DOM removal rate reached 44.50 % at pH 6.5, with the highest dehydration efficiency of 44.34 % and the lowest cell rupture rate of 5.55 %. Small molecular aromatic proteins decreased, while humic substances increased significantly. The chemical bonding between the EPS membrane and CaO2 improved system density and elasticity, enhancing dehydration performance. This study provides new insights and guidance for the ongoing study of pH and CaO2 enhanced algal dehydration.

Perinatal outcomes with a copper intrauterine device in situ after 28 gestational weeks: A retrospective study of sole center in southeast China.

The purpose of this study was to investigate the pregnancy outcomes with a copper intrauterine device (IUD) in situ after 28 gestational weeks and the association between pregnancy with copper IUDs and neonatal congenital malformations. This retrospective study had compared the singleton pregnancies with the copper IUDs in situ and without after 28 gestational weeks in 1 delivery center of southeast China. The main exposure was a copper IUD in uterine cavity with pregnancy. The pregnant outcomes as preterm birth, premature rupture of membranes, infections were observed and compared. We had also compared neonatal congenital malformations in 2 groups. The statistical analysis was carried out using R (version 4.0.4; R Development Core Team) statistical software. Association between IUD use or duration of IUD use and adverse pregnancy outcomes were estimated using logistic model. Two-tailed P value < .05 was deemed statistically significant. A total of 148 pregnant women were included in our study, 74 with copper IUDs in situ were categorized into case group and 74 without IUDs during pregnancy into control group. No significant difference of maternal age, BMI, birth weight and gender were observed between 2 groups. In case group, the rates of preterm premature rupture of membranes (37.8%) and spontaneous preterm birth (23.0%) were significantly high compared to control group. Odds ratios of premature rupture of membranes and spontaneous preterm birth were 2.86 and 5.22 respectively. Women of elder age (≥35 years) in case group were more likely to experience premature rupture of membranes. The rates of neonatal congenital malformation were 10.8% (8/74) in case group and 1.4% (1/74) in control group respectively. We had found that pregnancy with copper IUD in situ increased the risk of premature rupture of membranes and spontaneous preterm birth after 28 gestation weeks, the risk of spontaneous preterm birth increased 5.22 times. Pregnancy with IUD in situ may be at increased risk of infection and neonatal malformation.

A Single-Surgeon 35-Year Experience With ACL Reconstruction Using Patellar Tendon Auto- and Allografts With the Transtibial Technique.

Long-term follow-up for anterior cruciate ligament reconstruction (ACLR) is limited due to heterogeneity in the number of techniques utilized, the number of surgeons included, and attrition bias. To analyze a single surgeon's 35-year experience with ACLR using the transtibial technique, with an emphasis on temporal trends in graft selection and subanalyses on rates of revision surgery, contralateral ACLR, and nonrevision reoperation among different demographic cohorts of patients. Case series; Level of evidence, 4. All patients who underwent arthroscopically assisted single-bundle ACLR between 1986 and 2021 were identified from a prospectively maintained single-surgeon registry. Outcomes of interest included revision, reoperation, and contralateral rupture rates. A total of 2915 ACLRs were performed during the senior surgeon's career. The mean age for primary ACLR was 29.4 ± 14.8 years. During primary ACLR, 98.4% of patients received a central-third bone-patellar tendon-bone (BPTB) graft. Increasing patient age was associated with increasing allograft usage (P < .01), with a significant temporal increase in allograft usage over the senior surgeon's career (P < .01). There was a higher revision rate among younger patients (P < .01), female patients aged 21 to 25 years (P = .01), and patients who received an allograft during the primary procedure (P = .04). The contralateral rupture rate showed no difference between sexes (P = .34); however, patients who underwent ACLR with autograft had a greater rate of contralateral injury compared with those with allograft (P < .01). The contralateral rupture rate was greater than the revision rate (P < .01). The most common causes of nonrevision reoperation were failed meniscal repair, new meniscal tears, arthrofibrosis, and painful hardware removal. The findings of this single-surgeon registry reveal temporal trends in ACLR over a 35-year career. There was a trend toward increasing BPTB allograft use in ACLR, especially in older patients and revision cases. A greater revision rate was observed among younger patients, female patients, and those receiving allografts during primary surgery. Contralateral ACLR was more common than revision surgery.

Preliminary results of acute Achilles tendon rupture treated with platelet-rich plasma and immobilization

Objective: Evaluate preliminary functional results, return to sport, re-rupture rate of acute Achilles rupture treated with one applicationof platelet-rich plasma (PRP), and immobilization.Methods: A prospective analytical study was performed in patients with acute Achilles tendon rupture treated conservatively, associatedwith a single local application of PRP within 10 days of injury. The sample comprised 28 patients diagnosed and monitored by the sameteam for a minimum of 12 months. The American Foot and Ankle Society Functional Rating Scale (AOFAS), Achilles tendon totalrupture score (ATRS), visual analog scale (VAS), and Achilles tendon resting angle (ATRA) were evaluated, the time of return to sportsactivities and isokinetic strength were evaluated at the different follow-up times and injury site using magnetic resonance imaging.Results: The variance analysis of the AOFAS, ATRA, and VAS scores showed a significant difference at six and 12 months regardingthe initial score and according to the injury site. The mean time to return to sports activities was 197 days, 85.7% had homogeneoustendons, and heel-rise type 2 was achieved in 28.6% at six months and 60.7% at 12 months.Conclusion: The protocol proposed by our study for Achilles tendon rupture significantly improved all the scores evaluated comparedto the initial condition and the isokinetic evaluations, obtaining even better results in proximal injuries. Level of Evidence IV; Therapeutic studies investigating the results of treatment; Case series.

Ruptured AAA: bridging the gap between international guidelines and local clinical realities

BackgroundTreatment of asymptomatic Abdominal Aortic Aneurysms (AAA) presents a clinical challenge, requiring a delicate balance between rupture risk, patient comorbidities, and intervention-related complications. International guidelines recommend intervention for specific AAA size thresholds, but these are based on historical trials with limited female representation. We aimed to analyse disease characteristics, AAA size at rupture, and intervention outcomes in patients with ruptured AAA from 2009 to 2023 to investigate the gap between guidelines and local realities.MethodsThis single-centre retrospective cohort study analysed electronic health records of patients treated for a ruptured AAA, excluding those who were managed palliatively. The study assessed patients’ demographics, risk factors, comorbidities, clinical presentation, radiological characteristics, and outcomes.ResultsOf 164 patients (41 females, 123 males, median age 73.5), 93.3% presented with abdominal or back pain. The median AAA size at rupture was 8.0 cm in males and 7.6 cm in females. No significant correlations were found between demographic characteristics, risk factors, AAA size, repair modality, and outcomes. Trends show a decline in AAA prevalence and rupture rates, aligning with global health initiatives. Post-intervention survival rates at 30 days were 70.7% (67.5% in males and 80.0% in females), and at 2 years were 65.85% (61.7% in males and 70.0% in females).ConclusionEvolving AAA trends and improved post-intervention survival rates warrant a critical reassessment of existing intervention recommendations. Adjusting intervention thresholds to larger sizes may be justified to optimise the risk-benefit ratio.

S-adenosyl-L-methionine supplementation alleviates aortic dissection by decreasing inflammatory infiltration

Methionine, an indispensable amino acid crucial for dietary balance, intricately governs metabolic pathways. Disruption in its equilibrium has the potential to heighten homocysteine levels in both plasma and tissues, posing a conceivable risk of inducing inflammation and detriment to the integrity of vascular endothelial cells. The intricate interplay between methionine metabolism, with a specific focus on S-adenosyl-L-methionine (SAM), and the onset of thoracic aortic dissection (TAD) remains enigmatic despite acknowledging the pivotal role of inflammation in this vascular condition. In an established murine model induced by β-aminopropionitrile monofumarate (BAPN), we delved into the repercussions of supplementing with S-adenosyl-L-methionine (SAM) on the progression of TAD. Our observations uncovered a noteworthy improvement in aortic dissection and rupture rates, accompanied by a marked reduction in mortality upon SAM supplementation. Notably, SAM supplementation exhibited a considerable protective effect against BAPN-induced degradation of elastin and the extracellular matrix. Furthermore, SAM supplementation demonstrated a robust inhibitory influence on the infiltration of immune cells, particularly neutrophils and macrophages. It also manifested a notable reduction in the inflammatory polarization of macrophages, evident through diminished accumulation of MHC-IIhigh macrophages and reduced expression of inflammatory cytokines such as IL1β and TNFα in macrophages. Simultaneously, SAM supplementation exerted a suppressive effect on the activation of CD4 + and CD8 + T cells within the aorta. This was evidenced by an elevated proportion of CD44- CD62L + naïve T cells and a concurrent decrease in CD44 + CD62L- effector T cells. In summary, our findings strongly suggest that the supplementation of SAM exhibits remarkable efficacy in alleviating BAPN-induced aortic inflammation, consequently impeding the progression of thoracic aortic dissection.

Photoangiolysis with the 445-nm Blue Laser and the Potassium-Titanyl-Phosphate Laser: A Comparison.

Photoangiolytic lasers have yielded significant innovation in laryngeal surgery in the last 25 years. After the discontinuation of the potassium titanyl phosphate (KTP) laser, a novel 445-nm blue laser was developed. The optimal balance between a laser's desired tissue effects and collateral tissue damage is a major determinant of laser selection in microlaryngeal surgery. The shell-less incubation system for the chick chorioallantoic membrane (CAM) simulates the microvasculature of the human vocal fold and is useful for testing effects of laser settings and in simulated surgery. The aim of this study is to compare the tissue effects of the KTP and blue lasers using the shell-less CAM model. The shell-less incubation system contains: polymethylpentene film (used as a culture vessel), calcium lactate and distilled water supplementations. By using this system, the chick chorioallantoic membrane (CAM) can be fully exposed with a good field for surgery simulation. The effects of the 2 lasers (532 nm KTP and 445 nm blue) were quantified at clinically relevant energy settings and laser distances from target. Measures included imaging real-time vascular reactions in the CAM model, post-procedure histologic analysis of CAM tissue and temperature changes. Vessel coagulation and rupture rates were less common with the blue laser compared with the KTP laser. Histologic analysis demonstrated less tissue disruption with the blue laser. Temperature changes were less with the blue laser. In this CAM model with specific conditions, the blue laser reveals less tissue damage than the KTP laser. Suitable working distance and power setting of the laser are necessary for desired tissue effects.Level of Evidence: Level 3.

A Benchmarking Method to Rank the Performance of Physics-Based Earthquake Simulations

Abstract Physics-based earthquake simulators are an increasingly popular modeling tool in earthquake forecasting for seismic hazard as well as fault rupture behavior studies. Their popularity comes from their ability to overcome completeness limitations of real catalogs, and also because they allow reproducing complex fault rupture and interaction patterns via modeling the physical processes involved in earthquake nucleation and propagation. One important challenge of these models revolves around selecting the physical input parameters that will yield the better similarity to earthquake relationships observed in nature, for instance, the frictional parameters of the rate-and-state law—a and b—or the initial normal and shear stresses. Because of the scarcity of empirical data, such input parameters are often selected by trial–error exploration and predominantly manual model performance analyses, which can overall be time consuming. We present a new benchmarking approach to analyze and rank the relative performance of simultaneous earthquake simulation catalogs by quantitatively scoring their combined fit to three reference function types: (1) earthquake-scaling relationships, (2) the shape of the magnitude–frequency distributions, and (3) the rates of the surface ruptures from paleoseismology or paleoearthquake occurrences. The approach provides an effective and potentially more efficient approximation to easily identify the models and input parameter combinations that fit more closely to earthquake relations and behavior. The approach also facilitates the exhaustive analysis of many input parameter combinations, identifying systematic correlations between parameters and model outputs that can potentially improve the overall understanding of the physics-based models. Finally, we demonstrate how the method results agree with the published findings in other earthquake simulation evaluations, a fact that reinforces its overall usefulness. The model ranking outputs can be useful for subsequent analyses, particularly in seismic hazard applications, such as the selection of appropriate earthquake occurrence rate models and their weighting for a logic tree.

Abstract We020: Myh9 plays a vital role in cardiac myofibroblast differentiation and is indispensable for cardiac repair after myocardial infarction

After myocardial infarction (MI), quiescent cardiac fibroblasts (CFs) are activated and differentiate into myofibroblasts featured by elevated expression of smooth muscle alpha-actin (SMαA, encoded by Acta2 ), which form contractile stress fibers. However, compared to the matrix formation function of cardiac myofibroblasts, much less is known about the role of their contraction in post-MI cardiac repair. In our previous study using mice lacking Acta2 in CFs, all other 5 actin isoforms were activated to compensate for the loss of Acta2 , suggesting the low feasibility of abolishing cardiac myofibroblast contraction through deleting actin genes. An alternative strategy through targeting myosin was explored. Our transcriptomic study identified Myh9 and Myh10 [encoding non-muscle myosin IIA (NM IIA) and NM IIB, respectively] as the dominant myosin isoforms in cardiac myofibroblasts. In vitro studies found that Myh9 knockout (KO) but not Myh10 KO significantly affected cardiac myofibroblast morphology, completely abolished the stress fiber formation and contractility of these cells, and reduced their proliferation and ability to stabilize the surrounding matrix. Mice lacking Myh9 in CFs have an increased post-MI cardiac rupture rate compared to WT mice regardless of sexes ( p =0.004 and 0.02 for male and female mice, respectively). In vitro and in vivo transcriptomic and proteomics analysis revealed disrupted expression of stress fiber and mesenchymal identity genes/proteins caused by Myh9 KO. Mechanistically, Myh9 KO led to an increased globular to filamentous (G/F) actin ratio. The altered actin dynamics likely trigger multiple epigenetic events, which together lead to significantly altered cardiac myofibroblast gene expression and activities beyond contraction.