Risk Factors For Rupture Research Articles

Rupture prediction of medium to large-sized abdominal aortic aneurysm combining wall shear stress-related parameters and anatomical characteristics: A computational, experimental, and statistical analysis

A diameter of 50 or 55 mm is the primary clinical criterion for assessing abdominal aortic aneurysm (AAA) rupture risk. However, although larger diameters may induce higher rupture risk, not all AAAs exceeding intervention threshold will rupture, highlighting the need for indicators besides diameter to help rupture prediction and treatment of AAA ≥ 50 mm. The study aims to combine computation, experiment, and statistics to establish rupture prediction models for AAAs ≥ 50 mm and explore the optimal predictors of AAA rupture with different diameters by anatomical and hemodynamic characteristics. Through numerical simulation and in vitro experiment, morphological and hemodynamic parameters were obtained from 82 AAAs (41 ruptured) ≥ 50 mm. The results of significance test and logistic regression indicate that low time-averaged wall shear stress (TAWSS) of AAA and maximum diameter of common iliac artery, and high oscillatory shear index (OSI) of AAA, TAWSS of iliac artery and tortuosity of abdominal aorta increase rupture risk of AAA ≥ 50 mm. The prediction model combining these variables was established with high accuracy (area under curve = 0.978). Furthermore, univariable analyses for AAAs of different diameters imply the OSI is a risk factor for AAA rupture of 50–65 mm, while higher TAWSS decreases the risk of AAA rupture of 65–80 and ≥ 80 mm. The findings may contribute to accurate rupture prediction and personalized management of AAAs ≥ 50 mm and with different diameters, and further demonstrate potential value and application prospects of combining morphology and hemodynamics in clinical practice.

Anatomical differences as a risk factor for anterior cruciate ligament rupture in female athletes: Systematic review

Introduction: women's participation in the world of sport has increased significantly in recent years, as has their rate of injury. Anterior cruciate ligament rupture is associated with various risk factors, where the female sex predominates.Objective: to determine the anatomical differences as a risk factor in anterior cruciate ligament rupture in female athletes.Methods: an exhaustive bibliographic review was carried out from the PubMed database. The search focused on articles published from 2005 onwards, in order to collect the largest amount of information associated with the risk of suffering an anterior cruciate ligament rupture secondary to the specific anatomical condition presented by female athletes.Results: there are various anatomical variables responsible for the increased risk of anterior cruciate ligament injury in female athletes. It was found that they refer to a smaller femoral intercondylar notch, an increase in the lateral tibial slope and a lesser depth of the medial tibial slope, compared to the male gender.Conclusion: it was determined that there are specific anatomical characteristics that determine the incidence of cruciate ligament injuries in female athletes compared to male athletes. More research is needed to reduce the incidence and also to encourage the participation of athletes in essential prevention programs

Re-rupture rate and complications after percutaneous Tenolig® repair in acute midsubstance rupture of Achilles tendon.

Acute midsubstance Achilles tendon ruptures are the most common tendon injuries in adults and the choice of surgical technique is still debated. The objective of this study is to evaluate the rate of iterative ruptures and postoperative complications at a minimum follow-up of oneyear of percutaneous sutures of the Achilles tendon, as well as to investigate the risk factors for rupture. In this single-center retrospective study, 142 patients (119 men and 23 women, mean age of 46years) were reviewed at a mean follow-up of 24 (12-38)months. Percutaneous sutures with the Tenolig® device was performed by several senior surgeons. We studied the rate of re-ruptures, scar-related complications, sural nerve damage, and thromboembolic complications. The mechanism leading to the rupture was also identified, as were the risk factors. 3 patients (2.11%) presented a re-rupture. No damage of the sural nerve was found. Three superficial skin ulcerations were identified, and three patients presented superficial venous thrombosis of the lower limb. Football was the highest risk activity (34.51%). The risk factors for a first episode of rupture were smoking and a BMI over than 25kg/m2. Nevertheless, no statistically significant risk factors could be identified for re-ruptures. Percutaneous sutures of the Achilles tendon using Tenolig® provides a low risk of re-rupture, a low complication rate, particularly scar-related complications, and a respect for tendon vascularization. 3.

Identification of Key Risk Factors for Rupture in Small Intracranial Aneurysms: A Multicenter Study.

Predicting rupture risk in small intracranial aneurysms (IAs) < 5 mm is crucial for guiding clinical decisions. This study aims to identify key clinical and morphological risk factors associated with rupture in small IAs, providing better insight for decision-making. A retrospective analysis was performed on patients with small IAs from one center, with external validation data from another center. Logistic regression identified significant risk factors for aneurysm rupture, which were incorporated into a predictive model. The model's performance was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC), calibration plots, and the Hosmer-Lemeshow (H-L) goodness-of-fit test. Clinical utility was assessed via decision curve analysis (DCA). The training cohort consisted of 226 patients (ruptured, n = 181; unruptured, n = 92), while 136 patients (ruptured, n = 100; unruptured, n = 59) were used for external validation. Significant risk factors included hypertension, smoking, anterior communicating artery aneurysms (AcomA), daughter sacs, aspect ratio (AR), and size ratio (SR). The model demonstrated strong predictive ability with AUCs of 0.969 and 0.967 in the training and validation cohorts, respectively. Calibration plots indicated a good agreement between predicted and observed rupture risks, while DCA highlighted the model's clinical relevance. This study identifies and validates critical risk factors associated with small IA rupture and presents a clinically useful, high-accuracy predictive model to aid in individualized patient management.

Discriminators of Paraclinoid Aneurysm Rupture Based On Morphological Computer-Assisted Semiautomated Measurement (CASAM) and Hemodynamic Analysis.

Paraclinoid aneurysms, arising from the proximal dural ring and extending to the origin of the posterior communicating artery of the internal carotid artery (ICA), represent asignificant proportion of all intracranial aneurysms (IAs). Accurate prediction of the rupture risk of paraclinoid aneurysms is crucial for optimal management. The objective of this study was to identify risk factors for the rupture of paraclinoid aneurysms on the basis of computer-assisted semiautomated measurement (CASAM) and hemodynamics. The clinical, demographic and radiological data of the 304 paraclinoid aneurysms (285 unruptured and 19 ruptured) included were extracted from the Chinese Intracranial Aneurysm Project (CIAP) database. Morphological parameters were quantified via CASAM, and hemodynamic simulations were performed via computational fluid dynamics (CFD). Univariate and multivariate logistic regression analyses were conducted to identify independent risk factors for aneurysm rupture. The mean age of the patients was 56.91 ± 11.0 years, with afemale predominance (71.7%). Univariate analysis revealed that the undulation index (UI) and nonsphericity index (NSI) were significantly greater in ruptured paraclinoid aneurysms than in unruptured aneurysms. The proportion of ruptured paraclinoid aneurysms located laterally on the ICA was significantly lower than that of those located anteriorly (p = 0.002). Multivariate logistic regression analysis revealed that agreater UI (OR = 1.086, 95% CI 1.012-1.165; p = 0.022) and larger low shear area (LSA) (OR = 1.034, 95% CI 1.004-1.064; p = 0.028) were independent risk factors for rupture. Our findings indicate that agreater UI and alarger LSA are independent risk factors for the rupture of paraclinoid aneurysms. Compared with aneurysms in other orientations, paraclinoid aneurysms located anteriorly to the ICA are more prone to rupture. These findings may be useful in developing more consummate predictive models to enhance the management and surveillance of paraclinoid aneurysms in the future, leading to improved clinical decision-making and better patient outcomes.

Influence of clinical risk factors for preterm premature rupture of membranes (PPROM) on the elastic strength of fetal membranes at term: A prospective study.

Premature rupture of membranes (PROM) before 37 weeks of gestation is a common obstetrical event, whose pathophysiology is still poorly understood. Our objective was to study the mechanical strength of fetal membranes in women with a clinical risk factor for preterm premature rupture of membranes (PPROM). We included, in a prospective, descriptive, single-center study, patients scheduled for cesarean section at term (≥ 37 weeks of gestation). For each patient, we performed uniaxial tensile tests on fetal membranes with a universal testing machine equipped with a force sensor (EZ20®, Lloyds), allowing the recording of an applied force/time curve. We collected maximum force (Fmax), maximum stress (σMax), and Young's modulus of elasticity. The thickness of each membrane sample was also measured. We compared the values obtained according to certain clinical risk factors for PPROM such as age, body mass index, gravidity, parity, a history of PPROM or preterm birth, smoking, gestational diabetes, geographic origin, and socioeconomic level. We analyzed 31 patients and found no association between the studied risk factors and σMax. Fmax was lower in primiparous patients (p = 0.02) but increased with patient parity (p = 0.005). Gestational diabetes was associated with a higher Fmax (p = 0.033) and sub-Saharan geographical origin with a greater thickness (p = 0.0043). As membrane thickness increased, σMax (p = 0.009) and Young's modulus decreased (p = 0.037). Primiparous patients have lower membrane mechanical strength than patients who have had one or more deliveries. Mechanically, the thicker membranes are less rigid and less resistant.

Risk factors for complete uterine rupture in patients with trial of labor after cesarean delivery.

Vaginal birth after cesarean delivery (VBAC) attempt is promoted to reduce cesarean-related morbidity, but it carries a risk of uterine rupture, posing significant maternal and neonatal risks. This study evaluated uterine rupture incidence and risk factors in a high VBAC attempt population. This was a 16-year retrospective multicenter case-control cohort study (2002-2018). Eleven French university hospitals participated. Women were included if they had a complete uterine rupture during a VBAC attempt. Two controls, defined as a VBAC attempt without uterine rupture, were randomly included for each case. We analyzed the risk factors of uterine rupture among the overall population and then among women who had labor induction and those who had spontaneous labor. Logistic regression was used to compute crude odds ratios (ORs) and 95% confidence intervals (CIs) for uterine rupture. Multivariable logistic regression was used to calculate adjusted ORs (aORs) and 95% CIs. Among 48 124 patients with a single prior cesarean section, 31668 (65.8%, 95% CI 65.3-66.2) had a VBAC attempt and 23 086 (72.9% 95% CI 72.4-73.4) had a successful vaginal delivery. The complete uterine rupture frequency was 0.63%. There were 199 cases of complete uterine rupture (0.63%, 95%CI 0.54-0.71) and 396 controls. Among the overall population, the odds of uterine rupture was inversely associated with prior vaginal delivery (adjusted odds ratio [aOR] 0.3, CI 95% 0.2-0.5) and positively with induction of labor (aOR 2.2, 95% CI 1.4-3.4). For women with spontaneous labor, the odds of uterine rupture was positively associated with a Bishop score<6 (aOR 1.8, 95%CI 1.0-3.0), arrest of cervical dilatation of at least 1 hr. (aOR, 1.8 95%CI 1.1-2.9) and oxytocin augmentation (aOR 2.2 95% CI 1.3-3.7). For women undergoing labor induction, no factors were significantly associated with uterine rupture. Uterine rupture frequency was low among women with high rates of VBAC attempt and successful vaginal delivery and was reduced with previous vaginal birth and increased with induction of labor, regardless of the method used. It was associated with any dystocia during spontaneous labor and suspected macrosomia in induced women, which should be managed with caution.

The relation of anti-phosphatidylserine/prothrombin antibodies and premature rupture of membranes: A retrospective cohort study.

Existing literature supports the association between atypical phospholipid antibodies - anti-phosphatidylserine/prothrombin antibodies (aPS/PT) and adverse pregnancy outcomes. This study aimed to investigate the relationship between aPS/PT and premature rupture of membranes (PROM). A retrospective cohort study analysis was conducted on 408 pregnant women who had experienced at least one unexplained miscarriage. They were tested for aPS/PT IgM and IgG, and clinical data, test results, and follow-up pregnancy outcomes were collected. A positive correlation was observed between aPS/PT IgM or IgG and PROM in both single-factor and multi-factor regression analysis. After adjusting for potential confounders, the odds ratio (OR) values for aPS/PT IgM and aPS/PT IgG were 1.03 (95 % CI: 1-1.05, P = 0.025) and 1.03 (95 % CI: 1.01-1.06, P = 0.016) respectively. When aPS/PT was divided in three groups, djusted OR values for aPS/PT IgG of the third tertiles compared to the first tertiles (were 2.11(95 % CI: 1.11-4, P = 0.022). Subgroup analysis supported these findings. Curve fitting revealed a linear relationship between aPS/PT IgM and aPS/PT IgG with PROM. This study suggests that aPS/PT IgG and aPS/PT IgM are independent risk factors for premature rupture of membranes, with aPS/PT IgG showing a higher significance compared to aPS/PT IgM.

The presence of coexisting ICA occlusion (ICAO) is the main associated factor of posterior cerebral artery (PCA) aneurysm rupture

BackgroundPosterior cerebral artery (PCA) aneurysms are rare but clinically significant due to their critical location and complex management. The risk factor of the PCA aneurysms rupture remains unclear. This study aimed to investigate the associated factor of PCA aneurysms rupture in a large Chinese cohort. MethodsWe conducted a cross-sectional study including patients diagnosed with PCA aneurysms between January 2017 and December 2020. The study population comprised 143 patients, with 95 in the ruptured group and 48 in the unruptured group. Data on demographic characteristics, aneurysm features, medical history, and treatment outcomes were collected and analyzed using SPSS 27.0. Univariate and multivariate logistic regression analyses were performed to identify associated factors for PCA aneurysm rupture. ResultsThe presence of coexisting ICA occlusion (ICAO) was identified as an independent associated factor for PCA aneurysm rupture (odds ratio [OR] = 4.74, 95% confidence interval [CI] 1.22-18.42, p=0.03). Ischemic stroke (OR=0.44, 95% CI: 0.20-0.97, p=0.02) and multiple aneurysms (OR=0.41, 95% CI: 0.19-0.87, p=0.04) were found to be potential protective factors against rupture. The study also revealed a higher incidence of ICAO in the ruptured group (18.9%) compared to the unruptured group (6.3%), indicating a significant association with aneurysm rupture. ConclusionsThis is the first multicenter study to highlight the coexistence of ICAO as a major associated factor for PCA aneurysm rupture in the Chinese population.

Which risk factors are involved in a distal biceps tendon injury? A systematic review.

Distal biceps tendon rupture is a rare injury predominately occurring in middle-aged men. This study aimed to collect relevant risk factors associated with distal biceps tendon rupture from the published literature. This systematic review aimed to collect and tabulate the risk factors for distal biceps tendon rupture. Studies published in English were searched concerning risk factors for distal biceps tendon ruptures until July 2022; cohort studies, case series and randomized controlled trials were subjected to analysis. Case studies, cadaveric studies and reviews in any form were excluded. The studies were quantitatively and qualitatively reviewed. One hundred twenty-one articles presenting risk factors for distal biceps tendon ruptures were identified, recruiting a total of 7,484-7,576 patients. The average age of the individuals was 46.8 years, with 96.7% being males and 94.7% having affinity for sports activities. In 56.7% of the cases, the dominant arm was involved, and in 54.6%, the right arm was affected. The use of tobacco was found in 20.8% of cases and of anabolic steroids in 2.5% of cases. On average, 55.8% of distal biceps tendon rupture patients had a physical occupation and the most common mechanism of the injury was related to heavy weight lifting observed in 53.2% of subjects. The most common and outstanding reported risk factors for distal biceps tendon ruptures were age, sex and sports activity, i.e., middle-aged males being still physically active and practicing sports. Steroid usage does not seem to increase significantly the risk of the distal biceps tendon rupture.

Prevalence and risk factors for Achilles tendon rupture in the military population from 2006 to 2015: a retrospective cohort study

IntroductionAchilles tendon rupture (ATR) is a serious musculoskeletal injury that results in substantial functional decline, especially in highly physically demanding occupations such as service in the military. The purpose of...

Acromial Tilt, Lateral Acromial Angle, and Acromiohumeral Interval as Risk Factors for Full-Thickness Supraspinatus Tendon Ruptures.

Introduction The aim of this study was to investigate whether the morphology of the acromion and the inclination of the glenoid are associated with the risk of supraspinatus (SSP) tendon ruptures. Materials and methods A total of 106 patients were enrolled in this study between August 2012 and February 2014, including 55 symptomatic patients with an SSP tendon rupture (ruptured group) and 51 patients with an intact SSP (control group). MRI of the shoulder was performed for all patients in both groups. All MR images were analyzed by two blinded observers to measure the acromiohumeral interval (AHI), critical shoulder angle (CSA), acromial slope (AS), acromial tilt (AT), lateral acromial angle (LAA), acromion index (AI), and glenoid inclination (GI). Furthermore, both observers analyzed tendon integrity and quality on all MRIs in both groups. The results of the radiological examination concerning acromial and glenoidal morphology were compared between the control group with intact SSP tendons and the rupture group. Results Patients with an SSP tendon rupture had a narrower AHI (9.1 ± 1.4 mm vs. 7.8 ± 2.1 mm; p < 0.01), a greater AT (36.0 ± 5.4° vs. 39.7 ± 5.9°; p < 0.01), and a lower LAA (81.1 ± 7.2° vs. 76.2 ± 5.0°; p < 0.01). Patients with an AHI smaller than 8.2 mm(OR1.88 [95% CI 1.2 to 2.7]; p < 0.01)or an AT greater than 36.5°(OR 3.56 [95% CI 1.57 to 8.01]; p = 0.03)or a LAA lower than 80.5°(OR 4.04 [95% CI 2.04 to7.90]; p < 0.01) hadhigher risk for an SSP tendon rupture. No differences between either group were found in relation to the AS, CSA, AI, or glenoid inclination. Conclusions The results of this study showed that the AHI, LAA and AT correlated with SSP tendon rupture. It should be noted that the preoperative AHI less than 8.2 mm, AT greater than 36.5° or LAA less than 80.5° may be associated with SSP tendon ruptures.

Differences in internal carotid artery tortuosity in ruptured and unruptured anterior circulation aneurysms. A matched case-control study

ObjectiveTortuosity of the internal carotid artery is believed to contribute to the formation of intracranial aneurysms, although there is scant literature on its role as a risk factor for rupture specifically. Therefore, this study investigated the influence of cervical internal carotid artery (cICA) tortuosity on rupture of aneurysms of the anterior cerebral circulation. MethodsAngiographic imaging studies from patients who underwent endovascular embolisation for anterior circulation aneurysms at a tertiary centre were identified. 83 patients with a history of aneurysmal rupture and subarachnoid haemorrhage (SAH group) were matched for age, aneurysm location and size, history of subarachnoid haemorrhage and hypertension to 83 subjects with unruptured aneurysms (control group). cICA tortuosity was assessed utilising subjective (kinks, loops or coils) and objective (tortuosity index) parameters. ResultsSubjective cICA tortuosity was identified in 33.7% and 56.6% of patients in the SAH and control groups respectively (OR 0.39 [95% CI 0.21–0.75]). Objective cICA tortuosity was present in 35.7% and 46.8% of SAH and control patients (OR 0.63 [95% CI 0.32–1.27]). OR values are suggestive of cICA tortuosity as a negative predictor of aneurysmal rupture, with more predictive power attributed to the subjective assessment, despite the limited statistical significance of the objective results. ConclusionsThis study demonstrated an increased presence of cICA tortuosity in unruptured aneurysms compared to ruptured aneurysms, suggesting it is unlikely to represent a risk factor for rupture. Further research in the form of longitudinal observational studies of untreated aneurysms would aid in investigating cICA tortuosity as a protective factor.

Abstract 423: The Impact of Periodontal Diseases and Oral Microbiota on Intracranial Aneurysms: Preliminary Results of DentIA Study

Introduction/Purpose Intracranial aneurysms (IAs) are vascular‐wall abnormalities of the intracranial arteries that can result in life‐threatening hemorrhages if ruptured. While various risk factors for IA development, growth, and rupture have been documented in the medical literature, the potential influence of periodontal diseases (PDs), oral microbiota, and immunoinflammatory markers on these processes is not yet fully elucidated.This study will present the preliminary findings from the DentIA study, an ongoing cross‐sectional study designed to explore the relationship between periodontopathogenic microorganisms, associated inflammation, and their presence in the microbiome of patients with IAs. Material and Methods A prospective cohort study was designed, enrolling patients with IAs and control patients without identifiable aneurysms. These participants were divided into the following subgroups: (1) Control group, (2) Stable aneurysms, (3) Previously unruptured, currently unruptured treated aneurysms, (4) Previously ruptured, currently unruptured treated aneurysms, (5) Previously unruptured, currently ruptured aneurysms, and (6) Previously ruptured, currently ruptured aneurysms. For all participants, saliva samples were collected to analyze inflammatory markers (IL‐1β, IL‐6, IL‐17, MPO, MMP‐8, MMP‐9, TNF‐α, and NO) and specific periodontopathogenic microorganism DNA. Blood samples were also collected: peripheral blood for the control group and stable aneurysms subgroup, and both peripheral and intra‐aneurysmal blood for the aneurysm subgroups 3‐6. These samples will be analyzed to detect the presence of periodontopathogenic microorganisms and inflammatory biomarkers. Additionally, each participant will complete a pre‐constructed questionnaire to gather data on sociodemographic variables, risk factors, quality of life, and oral health history. Results The preliminary results from the DentIA study include data from both control patients and those with IAs. The analysis focuses on comparing the presence of specific bacterial DNA, immunological cells, and inflammatory biomarkers within the oral microbiome, peripheral blood, and intra‐aneurysmal blood samples. The comparison will extend across different subgroups, considering sociodemographic variables, risk factors, quality of life, and oral health history. The goal will be to identify differences between patients with and without aneurysms, as well as variations among different types of aneurysm status and clinical scenarios, contributing to a better understanding of the relationship between PDs and IA formation, progression, rupture, and regrowth after aneurysm treatment. Conclusion The DentIA study aims to provide valuable insights into the association between periodontopathic microorganisms, immunoinflammatory markers, and the risk of IA development and rupture. By further elucidating the specific role of PD in the pathophysiology of IA formation and progression, this research could guide future aneurysm management strategies, potentially extending care beyond the existent intracranial abnormality to include periodontal health as a significant factor to consider in IA risk assessment and treatment.

Evaluation of Lateral and Medial Parts of the Hamstring Muscle Fatigue Symmetry in Professional Footballers Cleared to Play After ACL Reconstruction.

Objectives: Rupture of the anterior cruciate ligament (ACL) is a severe injury common in sports. It also has a high rate of re-injury. The aim of this work was to assess hamstring muscle fatigue in active football players after ACL reconstruction who were cleared to play and to determine symmetry between the lateral and medial hamstring muscles. Methods: In professional football players post ACL reconstruction (n = 25) and non-injured players (n = 26), the bioelectrical activity of the medial (biceps femoris-BF) and lateral (semimembranosus and semitendinosus-SEM) hamstring muscles was measured during 60 s of isometric contraction. The fatigue variables were calculated using the Continuous Wavelet Transform (CWT) tool. Results: The football players following ACL reconstruction demonstrated significant asymmetry in fatigue of the lateral and medial hamstring muscles, with greater fatigue in the SEM compared to the BF muscle. Moreover, in those after reconstruction, the changes are more pronounced, with higher muscle fatigue in both limbs (they have lower MDF than non-injured players) and more severe SEM muscle insufficiency (noted in both limbs but with greater intensity in the non-operated one). Conclusions: The higher SEM muscle fatigue observed in this study influenced the lateral-to-medial activation ratio within the hamstring muscle, which may be a probable cause of this muscle's insufficiency in laterally stabilizing the knee in the frontal and transverse plane. Furthermore, the hamstring muscles after reconstruction were more fatigued in both limbs, which may be another risk factor for ACL graft rupture. Therefore, increased fatigue in specific hamstring muscles may indicate the direction in which knee stabilization is compromised due to ACL overload. A muscle that becomes fatigued and inefficient more quickly also becomes ineffective in performing its function sooner, which can lead to increased overloading forces acting on the ACL graft.

Incidence and risk factors for cardiac rupture after ST-segment elevation myocardial infarction in contemporary era: findings from the improving care for cardiovascular disease in China-Acute Coronary Syndrome project.

Cardiac rupture (CR) is fatal mechanical complication of ST-segment elevation myocardial infarction (STEMI). We systematically analyzed the clinical features of STEMI patients with CR, as well as predictors and treatments associated with risk of CR in contemporary era. In this nationwide database, 49,284 patients admitted within 48 h after STEMI were enrolled, and were stratified according to CR status. We analyzed patients' clinical characteristics, case fatality rate, and independent correlates of CR. A total of 188 (0.38%) patients had CR, of which 42.6% died during hospitalization. Older age, female gender, higher heart rate, history of diabetes, and worse cardiac function were risk factors of CR in patients with STEMI, while a previous history of myocardial infarction was associated with a reduced risk of CR. CR patients were less likely to undergo primary percutaneous coronary intervention (PCI). After adjustment, primary PCI was associated with 56% decreased risk of CR (OR 0.44, 95% CI 0.29-0.67). This result was consistent in the propensity-score matching analysis and inverse probability of treatment weighting analysis. CR was associated with high in-hospital mortality among STEMI patients. Multiple factors were associated with CR occurrence, primary PCI was associated with lower risk of CR, indicating that early intervention targeting the risk factors and implementation of primary PCI may improve its prognosis. Clinical trial registration ClinicalTrials.gov; Number: NCT02306616; URL: www.clinicaltrials.gov.

Analysis of the role of perfusion parameters in predicting rupture of brain arteriovenous malformations: a multi-center study

This study aimed to investigate the potential correlation between the perfusion parameters of brain arteriovenous malformations (bAVMs) as determined by multiphase CT angiography and bAVM rupture. Based on the occurrence of bAVM-related hemorrhage, 480 diagnosed bAVM patients were divided into hemorrhage (n = 220) and non-hemorrhage (n = 260) groups in this retrospective multi-center study spanning 2010 to 2020. On initial rupture CT images, the bAVM nidus and major draining vein were segmented, and time-density curves were extracted to compute perfusion parameters including mean transit time (MTT), time to peak (TTP), blood volume (BV), and blood flow (BF). To examine the potential correlation between these parameters and bAVM rupture, logistic regression was utilized to analyze multifactorial data and compare differences between the two groups. The ruptured group demonstrated a bAVM nidus characterized by an increased BF, a shorter TTP and MTT, and a higher peak density. The veins that were draining exhibited a reduced TTP, MTT, and peak density. A nidus TTP of less than 4s was identified by the multifactorial analysis as a critical risk factor for bAVM rupture. The statistical results highlight the noteworthy correlation between nidus TTP and bAVM rupture, presenting an original framework for assessing the risk of rupture.

Hypothesizing the interplay of thrombus formation, wall enhancement, and perifocal edema as predictive factors for rupture in brain AVMs

The presence of shear stress within intracranial AVMs (arteriovenous malformations) due to high flow, perinidal angiogenesis, intranidal aneurysms, and biological factors are presumed risk factors for rupture. However, emerging imaging and histological evidence suggests that risk factors for AVM rupture may extend beyond the classical understanding. The presence of perifocal edema at the time of rupture, luminal thrombosis, and vessel wall enhancement on vessel wall MRI elucidate the possibility of an underlying inflammatory process within AVMs, which may predispose them to instability and eventual rupture. We hypothesize that for some AVM ruptures, the occurrence of thrombosis within vascular outpouchings of the AVM initiates a cascade of events, including local hypoxia, inflammation, breakdown of the blood–brain barrier and wall matrix degradation, which is evident from the presence of perifocal edema and vessel wall enhancement observed on imaging. These changes might ultimately raise the risk of AVM rupture and subsequent hemorrhage. Understanding this inflammatory component offers promising insights into AVM pathogenesis and may facilitate the development of preventive strategies to mitigate rupture risk.

Preoperative clinical characteristics and risk assessment in Sun’s modified classification of Stanford type A acute aortic dissection

ObjectivesThis study aims to retrospectively analyze the clinical features of Stanford type A acute aortic dissection (TAAAD) based on Sun’s modified classification, and to investigate whether the Sun’s modified classification can be used to assess the risk of preoperative rupture.MethodsClinical data was collected between January 2018 and June 2019. Data included patient demographics, history of disease, type of dissection according to the Sun’s modified classification, time of onset, biochemical tests, and preoperative rupture.ResultsA total of 387 patients with TAAAD who met the inclusion criteria of Sun’s modified classification were included. There were more complex types, with 75, 151 and 140 patients in the type A1C, A2C and A3C groups, respectively. The age of the entire group of patients was 51.46 ± 12.65 years and 283 (73.1%) were male. The time from onset to the emergency room was 25.37 ± 30.78 h. There were a few cases of TAAAD combined with stroke, pericardial effusion, pleural effusion, and lower extremity and organ ischemia in the complex type group. The white blood cell count (WBC), neutrophil count (NEC) and blood amylase differed significantly between the groups. Three independent risk factors for preoperative rupture were identified: neutrophil count, blood potassium ion level, and platelet count. Binary logistic regression analysis showed that the Sun’s modified classification could not be used to assess the risk of preoperative rupture in TAAAD.ConclusionTAAAD was classified as the complex type in most patients. WBC, NEC and blood amylase were significantly different between the groups. NEC and serum potassium ion level were independent risk factors for preoperative rupture of TAAAD, while platelet count was its protective factor. More samples are needed to determine whether Sun’s modified classification can be used to evaluate the risk of preoperative rupture.

Predictive models for cholesterol crystals and plaque vulnerability in acute myocardial infarction: Insights from an optical coherence tomography study

BackgroundCholesterol crystals (CCs) are recognized as a risk factor for vulnerable atherosclerotic plaque rupture (PR) and major adverse cardiovascular events. However, their predictive factors and association with plaque vulnerability in patients with acute myocardial infarction (AMI) remain insufficiently explored. Therefore, This study aims to investigate the association between CCs and plaque vulnerability in culprit lesions of AMI patients, identify the factors influencing CCs formation, and develop a predictive model for CCs. MethodsA total of 431 culprit lesions from AMI patients who underwent pre-intervention optical coherence tomography (OCT) imaging were analyzed. Patients were divided into groups based on the presence or absence of CCs and PR. The relationship between CCs and plaque vulnerability was evaluated. A risk nomogram for predicting CCs was developed using the least absolute shrinkage and selection operator and logistic regression analysis. ResultsCCs were identified in 64.5 % of patients with AMI. The presence of CCs was associated with a higher prevalence of vulnerable plaque features, such as thin-cap fibroatheroma (TCFA), PR, macrophage infiltration, neovascularization, calcification, and thrombus, compared to patients without CCs. The CCs model demonstrated an area under the curve (AUC) of 0.676 for predicting PR. Incorporating CCs into the TCFA model (AUC = 0.656) significantly enhanced predictive accuracy, with a net reclassification improvement index of 0.462 (95 % confidence interval [CI]: 0.263–0.661, p < 0.001) and an integrated discrimination improvement index of 0.031 (95 % CI: 0.013–0.048, p = 0.001). Multivariate regression analysis identified the atherogenic index of plasma (odds ratio [OR] = 2.417), TCFA (OR = 1.759), macrophage infiltration (OR = 3.863), neovascularization (OR = 2.697), calcification (OR = 1.860), and thrombus (OR = 2.430) as independent risk factors for CCs formation. The comprehensive model incorporating these factors exhibited reasonable discriminatory ability, with an AUC of 0.766 (95 % CI: 0.717–0.815) in the training set and 0.753 (95 % CI: 0.704–0.802) in the internal validation set, reflecting good calibration. Decision curve analysis suggested that the model has potential clinical utility within a threshold probability range of approximately 18 % to 85 %. ConclusionsCCs were associated with plaque vulnerability in the culprit lesions of AMI patients. Additionally, this study identified key factors influencing CCs formation and developed a predictive model with potential clinical applicability.