Rupture Group Research Articles

Correlation between uterine scar condition and uterine rupture for pregnancy women after previous cesarean section

Objective: To investigate the relationship between the previous cesarean scar thickness, previous cesarean scar defect and the occurrence of uterine rupture for pregnancy women after previous cesarean section and to predict the occurrence of uterine rupture in the third trimester for pregnancy women after previous cesarean section by analyzing the lower uterine segment (LUS) situation or quantitatively measure LUS myometrium thickness. Methods: A total of 154 pregnant women who have a prior cesarean from January 2015 to March 2016 were selected, all of them regularly did the prenatal examination in the pregnancy period and finally gave birth in hospital. By the transvaginal sonograph, the LUS myometrium thickness (transverse and longitudinal thickness) and the size of the previous cesarean scar defect were measured in the first trimester, the LUS myometrium thickness (longitudinal thickness) and qualitatively analysis LUS condition were measured in the third trimester. They were divided into two groups according to the pregnancy outcome: uterine rupture group (found in the cesarean operation or during the pregnancy) and without uterine rupture group (including the vaginal delivery women and those without uterine rupture in the cesarean operation period). The sensitivity and specificity of LUS myometrium thickness in the first trimester and the qualitative analysis LUS situation, the quantitative measurement of LUS myometrium thickness in the third trimester were compared in the prediction of occurrence of uterine rupture (dehiscence or complete rupture). Results: The group without uterine rupture included 134 women (6 vaginal delivery and 128 cesarean delivery), and the group with uterine rupture included 20 women (all of them cesarean delivery). The LUS myometrium thickness in the third trimester in the group without uterine rupture was (1.6±0.5) mm, and was (1.1±0.7) mm in the uterine rupture group (P= 0.004). There were no significant difference between two groups in the mean value of age, height, weight, the interdelivery interval, the LUS myometrium thickness (transverse and longitudinal thickness) in the first trimester. Qualitative analysis of LUS condition had higher specificity (99%), higher positive predictive value (92%), higher negative predictive value (94%) and slightly lower sensitivity (60%) than quantitative measure of LUS myometrium thickness in predicting uterine rupture. Conclusions: Measurement of the LUS myometrium thickness in the first trimester is helpful for predicting the occurrence of uterine rupture, so it is not necessary to terminate the pregnancy because of the thin LUS or the little prior cesarean scar defect in the first trimester. However it should be paid close attention to the LUS situation during the whole gestation. Qualitatively analyzing LUS situation is more meaningful than quantitatively measuring LUS myometrium thickness in predicting the uterine rupture in the third trimester.

Construction of risk prediction model for acute type A aortic dissection

Objective To analyze the risk factors associated with acute type A aortic dissection, and to establish an effective predictive scoring model for early clinical intervention. Methods A retrospective review of 200 patients diagnosed as acute type A aortic dissection in the Department of Emergency, Guangdong Provincial People's Hospital between April 1, 2012 and March 31, 2017 was conducted as a modeling group. There were 160 males and 40 females with age of (53.30 ±13.19) years. According to the criteria of dissection rupture within 72 h after CTA examination, patients were divided into a rupture group (100 cases) and an unruptured group (100 cases). A prediction model of rupture risk was established based on the multivariate Logistic regression analysis of the risk factors of acute A-type aortic dissection in the early stage. After the establishment of the model, a prospective review of 80 patients diagnosed as acute type A aortic dissection in our hospital between April 1, 2017 and May 31, 2018 was conducted as a validation group. There were 57 males and 23 females with age of (54.00 ±13.68) years. In the validation group, there were 53 patients with rupture and 27 patients without rupture. Furthermore, this model was verified in the validation group. The scores were divided into low-risk rupture and high-risk rupture according to the best cut-off value of the receiver operating model curve of the modeling group. Results Logistic regression analysis showed that 10 factors were finally established the rupture risk prediction score model. The factors were as following: age >63 years (2 points), women (2 points), ventilator assisted ventilation (3 points), AST >80 U/L (2 points), no distortion of the inner membrane (2 points), diameter of the aortic sinus >41 mm (1 point), maximum diameter of the ascending aorta >48 mm (1 point), ratio of false lumen area to true lumen area >2.12 (2 points), Lac >1.9 mmol/L (3 points), and WBC >14.2×109 /L (1 point). The results of validation showed that the scoring model had a high predictive value (AUC = 0.928, 95% CI: 0.872-0.984, P < 0.001) and goodness of fit (Hosmer-Lemeshow χ2 = 8.331, P = 0.402). Moreover, the scoring model was further divided into low-risk (0-6 points) and high-risk (7-19 points), with sensitivity of 83.0% and specificity of 86.0%. Conclusions The predictive model of dissection risk in the acute type A aortic dissection constructed within 72 h after CTA is helpful for the evaluation of the disease and early intervention, and has certain clinical application value. Key words: aortic dissection; rupture; risk factors; risk score; model

Diagnostic Value of Stress Radiography and Arthrometer Measurement for Anterior Instability in Anterior Cruciate Ligament Injured Knees at Different Knee Flexion Position

To evaluate diagnostic value of stress radiography and arthrometer measurements for anterior instability at different knee flexion angle positions. Forty-three patients with complete anterior cruciate ligament (ACL) rupture (group 1) and 37 normal subjects (group 2) were enrolled prospectively. Arthrometer (KT-1000) measurements and stress radiography by Telos were used to evaluate side-to-side differences. Results were recorded according to the knee position (30°, 45°, 60°, and 90°). Areas under the receiver operating characteristic curves (AUCs) were used to evaluate the diagnostic accuracy of each evaluation method. The calculated cutoff values at 30° position were used to evaluate the sensitivity and specificity of combined evaluation with stress radiography and arthrometer measurements. The side-to-side differences on stress radiography and arthrometer measurements were significantly different between groups (P < .05), except for the values at the 90° position in arthrometer measurements (P= .844). The amount ofanterior translation decreased in both arthrometer measurements and stress radiography between 30° and 45° positions (P< .000); however, no further decrease was observed beyond 45°. The AUC of stress radiography at the 30° position was significantly higher than other values (AUC= 0.955; P= .000). Moreover, the clinical cutoff value of 3mm showed 86.0% sensitivity and 89.2% specificity in stress radiography at 30°, which were higher than those in arthrometer measurements. Combined use of stress radiography and arthrometer measurements at the 30° position showed 100% sensitivity and 59.5% specificity as a screening test. Evaluation at the 30° knee position was significantly superior to that at other positions for both stress radiography and arthrometer measurements, whereas the 90° knee flexion position was not meaningful for any measurements. Evaluation needs to be performed with a 3-mm cutoff value for stress radiography at the 30° knee position; however, combined use of stress radiography and arthrometer measurements at the 30° knee flexion can have a higher diagnostic value. Level I, diagnostic study of established criteria.

Successful repair of kidney graft artery rupture secondary to infection using a preprocessed homologous "Y"-shaped iliac artery.

ObjectivesThis retrospective study aims to describe novel ways of repair kidney allograft artery rupture secondary to infection using a preprocessed homologous “Y”‐shaped iliac artery.MethodsFive patients' whose course was complicated by graft arterial rupture were included in the rupture group, and patients who received the kidney from the same donor were included in the control group. In the rupture group, the iliac artery used for revascularization was harvested from a DCD donor, pre‐treated with absolute diethyl ether, followed by absolute alcohol, and then preserved in 75% alcohol. A biopsy of the arterial graft was obtained and stained using hematoxylin and eosin (H&E). Once a patient was diagnosed with kidney allograft arterial rupture by ultrasound, emergency surgery was conducted and the preprocessed “Y”‐shaped iliac artery was used for bridging.ResultsFive patents were included in the rupture group. The “Y”‐shaped iliac artery grafts were successfully preprocessed, H&E staining and electron microscope observation revealed few visible nuclei, with karyorrhexis and karyolysis. There were no significant differences in the long‐term graft survival between two groups.ConclusionsIn conclusion, using preprocessed homologous “Y”‐shaped iliac artery provides a useful method to bridge the vascular defects from kidney graft artery rupture secondary to infection in renal allograft recipients.

Evaluation of the anterolateral ligament of the knee by magnetic resonance imaging in patients with chronic anterior cruciate ligament rupture

ObjectiveThe purpose of this study was to evaluate the visibility of the anterolateral ligament (ALL) by magnetic resonance imaging (MRI) in patients with chronic anterior cruciate ligament (ACL) rupture. Materials and methodsThis retrospective case – control study compared 1.5 - T MRI scans for 50 patients with a chronic ACL rupture with those of a control group of 50 patients with an intact ACL. The ALL was evaluated in three portions: femoral, meniscal, and tibial. The status of each portion was classified as visualized or non-visualized. Two radiologists separately reviewed all the MRI scans to evaluate interobserver reliability. ResultsAt least one portion of the ALL was visualized in 100% of the control group and 72% of the chronic ACL rupture group. All three portions of the ALL were identified in 72% of the control group but only 10% of the chronic ACL rupture group. In both groups, the most commonly visualized portion was the meniscal portion and the least visualized was the tibial portion. In 18% of the chronic ACL rupture group, no portion of the ALL was visualized. ConclusionsThe visibility of the ALL of the knee was significantly lower in patients with a chronic ACL rupture than in those with an intact one.

The Effect of Preoperative Neutrophil-To-Lymphocyte Ratio and Platelet-To-Lymphocyte Ratio on Predicting Rupture Risk in Tubal Ectopic Pregnancies

Background: Consecutive measurements of β-hCG levels and sonographic evaluation of adnexae are critical for choosing the optimal management in ampullar tubal ectopic pregnancies (EP). To select suitable patients for conservative approach, there is a need for an affordable and reliable marker for determining rupture risk. Evaluation of systemic inflammatory markers in combination with serum β-hCG levels and ultrasound might help to decide the appropriate treatment option. Objective: The purpose of the present study was to evaluate the diagnostic value of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in determining the rupture risk in ampullar tubal EPs and to compare with intraoperative findings. Methods: A total of 142 patients who underwent surgery for tubal EP were included. Seventy-two patients were in the intraoperatively diagnosed tubal rupture group and 70 patients without rupture findings were included in the control group. Both groups were compared for inflammation markers, β-hCG levels, and sonographic findings. Results: Both NLR and PLR levels were found to be significantly higher in the tubal rupture group (4.62 ± 3.13 vs. 2.67 ± 1.43, 162.94 ± 63.61 vs. 115.84 ± 41.15, p < 0.01, respectively). According to the receiver operating characteristic analysis performed for the diagnostic performance of tubal diameter measurement, β-hCG, NLR, and PLR levels were significantly associated with histopathologically confirmed tubal rupture (p < 0.01). Conclusion: Systemic inflammatory markers are feasible and affordable tools for predicting tubal rupture risk in ampullar EPs and might be useful for determining surgery decision especially in low resource settings.

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.

Clinical characteristics and outcomes of open globe injuries in Japan.

To describe the epidemiology and clinical outcomes of open globe injuries (OGIs) in Japan over 10 years, and examine preoperative factors influencing the visual prognosis after surgery. Retrospective, observational, multicenter case-series study. Patients' data were entered into a computerized database for review and statistical analyses. The following parameters were assessed; age, gender, initial and final visual acuity, duration between onset and surgery, presence of lens in the eye, characteristics of injury, presence of ocular complications, and number of surgeries. The records of 374 eyes with OGI were enrolled. The average age of the patients was 56.8 ± 22.1 years, and the majority of patients were men (73.5%). Compared to the overall cohort, work-related OGI was the most common, associated with significantly better final visual acuity, whereas patients with fall-down OGI showed significantly worse final visual acuity (P < 0.05). Among the types of injury, both the initial and final visual acuity were significantly worse in the rupture group than in the laceration group. Multiple liner regression analyses revealed that the final visual acuity was significantly associated with initial visual acuity, type of injury (rupture), retinal detachment, and proliferative vitreoretinopathy. To predict the visual outcome in patients with OGI, ophthalmologists need to pay attention not only to the initial visual acuity but also to initial ocular conditions, such as the presence of ocular complications.

Conditional survival in patients with spontaneous tumor rupture of hepatocellular carcinoma after partial hepatectomy: a propensity score matching analysis

BackgroundSpontaneous tumor rupture (STR) of hepatocellular carcinoma (HCC) is a life-threatening condition. This study investigates the influences of STR on the observed survival and conditional survival of patients received hepatectomy. MethodsA retrospective cohort of patients who underwent hepatectomy from 2009 to 2013 was divided into tumor rupture group and non-rupture group. Propensity score matching (PSM) was used for comparison of the observed survival and conditional survival probabilities between these two groups. Results89 pairs of patients who had comparable background and tumor characteristics were created using PSM analysis. There was significant association between STR and increased risk of OS no matter when before or after PSM (p < 0.01). STR was significantly associated with increased risks of PFS before, while not after PSM. Multivariate Cox regression analyses demonstrated that STR was an independent risk factor associated with OS. There were significant differences in two groups for conditional probabilities of OS and PFS for an additional 6 months and 1 year before PSM, while not after PSM. ConclusionsThis study identified STR but not PFS as an independent risk factor influencing OS, in patients with HCC following hepatectomy. In selected patients with STRHCC, hepatectomy should be performed with acceptable outcomes.

Finite element analysis in symptomatic and asymptomatic abdominal aortic aneurysms for aortic disease risk stratification.

Advanced biomechanical models can provide additional information concerning rupture risk in abdominal aortic aneurysms (AAA). Here we evaluated the predictive value of finite element analysis (FEA) to assess AAA rupture risk. In a case-control study, we compared FEA parameters in a group of symptomatic AAA (sAAA) patients, considered as a high risk of rupture group, with FEA parameters in asymptomatic AAA patients (aAAA). We included 15 sAAA and 28 aAAA patients matched for age- and maximum diameter diagnosed with infrarenal non-ruptured AAA at our center between 2009 and 2013. Mean age was 75±69 years and mean maximum diameter was 77±17 mm. Peak wall stress (PWS) was significantly higher in sAAA patients than in aAAA patients (354.3±139.6 kPa vs. 248.6±81.9 kPa; P=0.001). The C statistic for the ROC curve based on PWS was 0.748 (95% CI: 0.592-0.903; P=0.008). CART analysis classified patients into high and low PWS groups. The high-PWS group (>305.15 kPa; N.=15) had a higher incidence of sAAA (33.3% aAAA, 66.7% sAAA) than the low-PWS-group (≤305.15 kPa; N.=28. 82.1% aAAA, 17.9% sAAA). In conclusion, PWS was significantly higher in sAAA patients. Measuring PWS may help estimate the individual rupture risk in patients with AAA, but larger studies are needed to confirm our results.

Plaque erosion versus rupture characterization by optical frequency domain imaging before and after coronary stenting following successful fibrinolysis for ST-segment elevation myocardial infarction.

Intracoronary thrombus burden affects the quality of myocardial reperfusion in the setting of ST-elevation myocardial infarction (STEMI). We aimed to study the characteristics of the plaque and thrombus assessed by intracoronary optical frequency domain imaging (OFDI) according to the presence of plaque rupture or erosion in STEMI patients treated with successful fibrinolysis. Pre-stenting thrombus and post-stenting atherothrombotic burden were compared between plaque rupture and erosion. Twenty-seven consecutive patients were included: 17 (63%) had OFDI-plaque rupture and 10 (37%) had OFDI-erosion. Thrombus volume and burden were significantly higher in case of rupture compared to erosion at baseline (13.4 ± 18.4 vs 2.8 ± 2.3mm3; p = 0.03 and 33.8 ± 17.5 vs 17.5 ± 9.9%; p = 0.007, respectively). In the rupture group, the core of the thrombus consisted dominantly of red thrombus evenly distributed along the entire culprit plaque. In the erosion group, it consisted dominantly of white thrombus with a focal distribution near the minimal lumen area zone. After stenting, the atherothrombotic volume, burden and its distribution, as well as angiographic estimators of myocardial reperfusion were similar between groups. Our study showed that pre-PCI thrombus amount, typesetting and distribution are mainly linked to the underlying mechanism of STEMI. After stenting, the atherothrombotic burden and its distribution were similar between the groups.

Conditional probability of survival in patients with spontaneous tumor rupture on hepatocellular carcinoma after partial hepatectomy: a propensity score matching analysis

Introduction: We aimed to investigate the influences of tumor rupture on the observed survivals and conditional survival probabilities of patients received hepatectomy. Method: A consecutive cohort of patients who underwent partial hepatectomy for HCC between 2009 and 2013 was divided into tumor rupture group and non-rupture group. Propensity scores analyses were used to compare the observed survivals and conditional survival probabilities between these two groups. Prognostic factors for overall survival(OS) and progressive-free survival(PFS) were identified by univariable and multivariable analyses. Results: 916 HCC patients who underwent curative resection were divided into two groups: the rupture group (106) and the non-rupture group (810). Propensity score matching analysis created 89 pairs of patients with comparative background and tumor characteristics. Tumor rupture was significantly associated with increased risks of OS (p< 0.01). Tumor rupture was significantly associated with increased risks of PFS before, while not after propensity matching. Multivariable Cox regression analyses showed that tumor rupture was an independent risk factor associated with OS. There were significant differences between two groups for conditional probabilities of OS and PFS for additional 6 months and 1 year before propensity matching, while not after propensity matching Conclusions: The present study identified that spontaneous tumor rupture was an independent risk factor influencing OS, while not PFS of patients with HCC following partial hepatectomy. Moreover, the conditional probabilities of OS and PFS of patients for additional 6 months and 1 year in the rupture and non-rupture groups showed no differences after propensity matching.

Volar plate avulsion fracture alone or concomitant with collateral ligament rupture of the proximal interphalangeal joint: A comparison of surgical outcomes.

BackgroundVolar plate avulsion fracture of the proximal interphalangeal (PIP) joint is one of the most common hand injuries. In this study, we divided patients into two groups: patients with pure volar plate avulsion fracture, and patients with volar plate avulsion fracture concomitant with collateral ligament rupture. The purpose of this study was to compare long-term surgical outcomes between the two groups. As a secondary measure, the Mitek bone anchoring and polydioxanone (PDS) bone suturing techniques were compared.MethodsA single-institutional retrospective review of the surgical treatment of volar plate avulsion fracture was performed. The cases were divided into those with pure volar plate avulsion fracture (group A, n=15) and those with volar plate avulsion fracture concomitant with collateral ligament rupture (group B, n=15). Both groups underwent volar plate reattachment using Mitek bone anchoring or PDS bone suturing followed by 2 weeks of immobilization in a dorsal protective splint.ResultsThe average range of motion of the PIP joint and extension lag were significantly more favorable in group A (P<0.05). Differences in age; follow-up period; flexion function; visual analog scale scores; disabilities of the arm, shoulder, and hand scores; and the grip strength ratio between the two groups were non-significant. No significant differences were found in the surgical outcomes of Mitek bone anchoring and PDS bone suturing in group A.ConclusionsOverall, the surgical outcomes of volar plate reattachment were successful irrespective of whether the collateral ligaments were torn. However, greater extension lag was observed in cases of collateral ligament injury.

Tumor rupture of gastric gastrointestinal stromal tumors during endoscopic resection: a risk factor for peritoneal metastasis?

Background and study aims Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors in the gastrointestinal tract. Up to the present time, complete surgical excision has been the standard treatment for primary GISTs greater than 2 cm. It is well known that tumor rupture during surgery is an independent risk factor for peritoneal metastasis; however, it is not known whether the risk of peritoneal metastasis increases in cases where the tumor is ruptured during endoscopic resection. Patients and methods A total of 195 patients treated for GIST between January 2014 and December 2016 in our hospital were enrolled in this study. They were divided into two groups according to whether the tumor was ruptured during endoscopic resection. The rate of peritoneal metastasis in patients in the two groups who also suffered perforation was investigated from the follow-up results. Results Approximately 55.4 % of all patients were female and the average age of the study group was 59.0 ± 10.3 years. Of the 195 patients, the tumors in 27 were ruptured and the remaining 168 patients underwent en bloc resection. There was no statistically significant difference in gender or age between the two groups. The median tumor size (maximum diameter) in all patients was 1.5 cm (0.3 – 5.0 cm): 2.5 cm (0.8 – 5.0 cm) and 1.4 cm (0.3 – 4.0 cm) in the tumor rupture group and en bloc resection group, respectively ( P < 0.001). Most of the tumors were located in the gastric fundus. At a median follow-up of 18.7 ± 10.2 months, neither tumor recurrence (liver metastasis, peritoneal metastasis, local recurrence) nor mortality related to GISTs were detected. Conclusions Tumor rupture during endoscopic resection of gastric GISTs may not be a risk factor for peritoneal metastasis.

Diagnostic value of neutrophil to lymphocyte ratio in differentiation of ruptured ovarian cysts and adnexal torsion.

Objective:Ovarian cyst rupture and adnexal torsion (AT) differential diagnosis is important for early surgical intervention of AT for preserving ovarian function. The aim of this study was to evaluate the diagnostic value of preoperative the neutrophil-to-lymphocyte ratio (NLR) in patients with adnexal torsion and ovarian cyst rupture.Materials and Methods:Data of 80 patients who underwent surgery between 2012 and 2017 for ovarian cyst rupture, adnexal torsion, and unruptured ovarian cyst were analyzed. Patients were categorized as adnexal torsion (n=35), ovarian cyst rupture (n=20), unruptured ovarian cyst (n=25) groups. Preoperative NLR were compared among the three groups of the patients.Results:The adnexal torsion group had a median NLR of 8.0 (range, 4.0-14.1), the ovarian cyst rupture group had a median of NLR 7.5 (range, 3.7-11.5), and median NLR of the unruptured ovarian cyst group was 2.2 (range,1.8-2.7). The NLR was found to have a difference that reached statistical significance among the three groups (p<0.001). When the groups were individually compared, there was no significant difference between the ovarian cyst rupture and adnexal torsion groups (p=0.372), but there was a significant difference between the unruptured ovarian cyst and adnexal torsion groups (p<0.001).Conclusion:NLR may be useful in the differential diagnosis of unruptured ovarian cyst from adnexal torsion, but it has no diagnostic value for the differentiation of ovarian cyst rupture and adnexal torsion.

Previous foot injuries associated with a greater likelihood of Achilles tendon ruptures in professional American football players

ABSTRACTObjectives: The purpose of this study was to build on current understanding of Achilles tendon (AT) ruptures in football through the examination of lower extremity injury rates (IR) in the season prior to AT rupture.Methods: An online review was conducted to document AT ruptures in the National Football League (NFL) from the 2010–11 through 2016–17 seasons. Player-specific information was gathered through the online search, injury reports, or video analysis. Injury incidence was recorded for each season. Descriptive statistics were calculated for all variables. IRs per 1000 athlete-exposures with 95% confidence intervals (CI) were established. Injury rate ratios (IRR) with 95% CI were calculated to evaluate differences in IR with statistical significance established at p < 0.05.Results: From the 2010–11 to 2016–17 NFL seasons, 109 AT ruptures were identified. 36 athletes participated in the NFL the season prior and sustained a total of 40 injuries. Thirty-two (32/40, 80%) of the injuries involved the lower extremity. The most frequent body parts injured in the NFL season prior to AT rupture were the knee (n = 8, 22.5%), upper leg and thigh (n = 7, 17.5%), lower leg and shin (n = 5, 12.5%), and ankle (n = 5, 12.5%). The overall IR for the AT rupture group was not significantly different than the NFL group (IRR: 0.94, 0.68–1.31 95% CI, p = 0.73). The AT rupture group demonstrated a significantly increased rate of foot injuries compared to the NFL cohort (IRR: 2.58, 1.16–5.77 95% CI, p = 0.02).Conclusion: There was an increased identified incidence of AT ruptures in the NFL from 2010 to 2017 compared to AT ruptures reported from 1997 to 2002. There was no significant difference in lower extremity IR the season prior to AT rupture. Only foot injuries demonstrated an increased IR the season prior to AT rupture compared to an NFL cohort. Eleven athletes sustained 2 AT ruptures and all 11 players sustained the subsequent AT rupture to the contralateral limb.

Knee Joint Kinematics and Kinetics During Walking and Running After Surgical Achilles Tendon Repair.

Background:Despite the increasing incidence of Achilles tendon (AT) ruptures, there is a lack of information on the possible risks associated with regular running and walking for exercise after an injury. There are some known kinematic gait changes after an AT rupture, especially at the knee. However, it is not clear whether runners with AT ruptures may be at risk for secondary knee injuries during shod or barefoot running/walking.Purpose/Hypothesis:The purpose of this study was to compare the kinematics and kinetics of barefoot walking and barefoot and shod running between athletes with a history of AT ruptures and a healthy control group. We hypothesized that there would be increased knee joint loads in the affected limb of the AT rupture group, especially during shod running.Study Design:Controlled laboratory study.Methods:Ten patients who had undergone surgical treatment of a unilateral acute AT rupture (6.1 ± 3.7 years postoperatively ) and 10 control participants were matched according to age, sex, physical activity, weight, height, and footfall type. The kinematics and kinetics of barefoot walking and barefoot and shod running were recorded using a high-speed motion capture system synchronized with force platforms.Results:The main outcome measures were lower extremity joint angles and moments during the stance phase of walking and running. After AT repair, athletes had increased internal knee abduction moments during shod and barefoot running compared with the healthy control group (P < .05, η2 > 0.14). There were no significant differences in kinematics and kinetics during walking between the AT rupture and healthy control groups (P ≥ .05).Conclusion:After an AT rupture, athletes had increased internal knee abduction moments during running compared with the healthy control group.Clinical Relevance:The increased abduction loads on the knee in patients with an AT rupture could lead to further running-related injuries. However, barefoot walking may be used as a proprioceptive exercise without an increased risk of overuse injuries in these patients.

Abstract 324: Molecular Imaging of High Risk Atherosclerotic Plaque Using Fibrin-Binding PET Probe

Objectives: There is a need for better stratification of atherosclerotic patients to identify individuals at high risk for a cardiovascular event. Two key hallmarks of plaque at high risk for rupture are intraplaque hemorrhage and evidence of prior rupture. The protein fibrin is strongly associated with both hemorrhage and rupture but it is not present in earlier stages of plaque development, suggesting that fibrin imaging would be sensitive for high risk plaque versus stable/early disease. Here, we describe imaging properties of a fibrin-specific PET probe for atherosclerotic plaque rupture in rabbits. Methods: Rabbits were fed with high cholesterol diet (HCD) for 8 weeks followed by 2 weeks of normal diet. Two weeks after the initiation of HCD, endothelial denudation of abdominal aorta was performed using balloon catheter. At 10 weeks, rabbits were randomly divided into plaque rupture (n=8; triggered by Russell’s viper venom and histamine) and control group (n=4), injected with fibrin-binding probe [ 68 Ga]CM-246, and scanned on a PET/MRI. Then, vessels of interest were removed for ex-vivo PET, autoradiography, and histology. Results: Rabbits with plaque rupture had &gt;2-fold increase in [ 68 Ga]CM-246 signal in the abdominal aorta compared with the control group (A). At 105-120 min post probe injection, there was a clear PET uptake on the aorta in plaque rupture rabbit (B) compared with control rabbit (C). MR images were used to differentiate abdominal aorta (green arrows) and the inferior vena cava (blue arrows). T2-dark blood images confirmed the atherosclerotic plaques in plaque rupture (D) and control rabbits (E). ToF images were used to visualize aortic lumen in plaque rupture (F) and control rabbits (G). Ex vivo PET imaging (H) and autoradiography confirmed in vivo results. Conclusions: We demonstrated that [ 68 Ga]CM-246 detects atherosclerotic plaque rupture in a rabbit model and can be a useful tool for the diagnosis of high-risk atherosclerotic plaque in patients.

OUR APPROACH TO TREATMENT OF NEGLECTED ACHILLES TENDON RUPTURES. IS THERE A SIMPLE SOLUTION?

Introduction. Subcutaneous rupture of achilles tendon is a frequent trauma and most patients with such pathology are men of working age. Even though it is not difficult to diagnose such ruptures, especially those that need surgical treatment, there are numerous cases when patients come to a surgeon with a big delay. In such cases, the rupture becomes «chronic» or «neglected» and can be no longer treated as an acute rupture. There are many techniques of operative treatment of chronic achilles tendon ruptures, but still there is no consensus on which technique is to be considered the most simple, effective and safe.The aim of this study is to evaluate the effectiveness of using peroneus brevis tendon as a graft for treatment of achilles tendon defects type 3 in Kuwada classification. Will this technique bring good and excellent results that are comparable with end-to-end suture after acute achilles tendon ruptures?Materials and methods. The present study includes 13 patients in which peroneus brevis was used for treatment of neglected achilles tendon rupture (group I) and 18 patients after end-to-end suture after acute achilles tendon rupture (group II). Group I consisted of patients with neglected rupture of achilles tendon that was not previously treated due to various reasons and with a significant defect.Results. Mean surgery duration in group I was 91.9±6.6 (Me — 100) min, in group II — 43.2±2.2 (Me — 45) (p = 0.0001). damaged limb was evaluated using achilles Tendon Total Rupture Score, mean post-op follow up was around 1 year. The results were: group I — 86.6±2.28 (Me — 87), group II — 93.4±1.01 (Me — 94) (p = 0.04). This means, that despite quite high scores in group I, they are still statistically worse than scores after suture of acute rupture in group II. There was no difference in post-operative complication rate between the groups (p0.05). The most common complication for both groups was range of motion restriction in ankle joint. None of the patients had ankle joint instability after surgery.Conclusion. Management of neglected ruptures of achilles tendon type 3 (in Kuwada classification) with peroneus brevis autologous graft is an effective and safe technique, that achieves good and excellent results in treatment of this group of patients, in absolute numbers is comparable to functional outcomes after end-to-end suture of acute achilles tendon ruptures, but statistically demonstrates significantly worse results.

Machine learning-aided exploration of relationship between strength and elastic properties in ascending thoracic aneurysm.

Machine learning was applied to classify tension-strain curves harvested from inflation tests on ascending thoracic aneurysm samples. The curves were classified into rupture and nonrupture groups using prerupture response features. Two groups of features were used as the basis for classification. The first was the constitutive parameters fitted from the tension-strain data, and the second was geometric parameters extracted from the tension-strain curve. Based on the importance scores provided by the machine learning, implications of some features were interrogated. It was found that (1) the value of a constitutive parameter is nearly the same for all members in the rupture group and (2) the strength correlates strongly with a tension in the early phase of response as well as with the end stiffness. The study suggests that the strength, which is not available without rupturing the tissue, may be indirectly inferred from prerupture response features.