腹腔镜子宫肌瘤剔除术与妊娠期子宫破裂的研究进展

子宫肌瘤是育龄期女性常见多发疾病,腹腔镜子宫肌瘤剔除术是目前临床最常用的治疗方法。子宫肌瘤剔除术后妊娠期子宫破裂(uterine rupture during pregnancy,URDP)是最严重的远期并发症,可能会造成灾难性的后果,必须引起临床医生的足够重视。本文对腹腔镜子宫肌瘤剔除术后URDP的预后因素进行文献总结,为妇科医生手术提供临床依据,提高手术技巧,将URDP的风险降到最低。

Rapid report of the December 18,2023 M_(S)6.2 Jishishan earthquake,Gansu,China

On December 18,2023,the Jishishan area in Gansu Province was jolted by a M_(S) 6.2 earthquake,which is the most powerful seismic event that occurred throughout the year in China.The earthquake occurred along the NWtrending Lajishan fault(LJSF),a large tectonic transformation zone.After this event,China Earthquake Networks Center(CENC)has timely published several reports about seismic sources for emergency responses.The earthquake early warning system issued the first alert 4.9 s after the earthquake occurrence,providing prompt notification that effectively mitigated panics,injuries,and deaths of residents.The near real-time focal mechanism solution indicates that this earthquake is associated with a thrust fault.The distribution of aftershocks,the rupture process,and the recorded amplitudes from seismic monitoring and GNSS stations,all suggest that the mainshock rupture predominately propagates to the northwest direction.The duration of the rupture process is~12 s,and the largest slip is located at approximately 6.3 km to the NNW from the epicenter,with a peak slip of 0.12 m at~8 km depth.Seismic station N0028 recorded the highest instrumental intensity,which is 9.4 on the Mercalli scale.The estimated intensity map shows a seismic intensity reaching up to IX near the rupture area,consistent with field survey results.The aftershocks(up to December 22,2023)are mostly distributed in the northwest direction within~20 km of the epicenter.This earthquake caused serious casualties and house collapses,which requires further investigations into the impact of this earthquake.

Rapid rupture characterization for the 2023 M_(S)6.2 Jishishan earthquake

On December 18, 2023, the M_(S)6.2 Jishishan earthquake occurred in the northeastern region of the QinghaiXizang Plateau, causing heavy casualties and property damage in Gansu and Qinghai Provinces. In this study,we integrate space imaging geodesy, finite fault inversion, and back-projection methods to decipher its rupture property, including fault geometry, coseismic slip distribution, rupture direction, and propagation speed. The results reveal that the seismogenic fault dips to the southwest at an angle of 29°. The major slip asperity is dominated by reverse slip and is concentrated within a depth range of 7–16 km, which explains the significant uplift near the epicenter observed by both the Sentinel-1 ascending and descending In SAR data. Moreover, the teleseismic array waveforms indicate a northwest propagating rupture with an overall slow rupture velocity of~1.91 km/s(AK array) or 1.01 km/s(AU array).

Cascading multi-segment rupture process of the 2023 Turkish earthquake doublet on a complex fault system revealed by teleseismic P wave back projection method

In this study,the vertical components of broadband teleseismic P wave data recorded by China Earthquake Network are used to image the rupture processes of the February 6th,2023 Turkish earthquake doublet via back projection analysis.Data in two frequency bands(0.5-2 Hz and 1-3 Hz)are used in the imaging processes.The results show that the rupture of the first event extends about 200 km to the northeast and about 150 km to the southwest,lasting~90 s in total.The southwestern rupture is triggered by the northeastern rupture,demonstrating a sequential bidirectional unilateral rupture pattern.The rupture of the second event extends approximately 80 km in both northeast and west directions,lasting~35 s in total and demonstrates a typical bilateral rupture feature.The cascading ruptures on both sides also reflect the occurrence of selective rupture behaviors on bifurcated faults.In addition,we observe super-shear ruptures on certain fault sections with relatively straight fault structures and sparse aftershocks.

Hepatic rupture secondary to HELLP syndrome: outcomes in three cases

Hypertensive disorders of pregnancy,including chronic hypertension,gestational hypertension,and preeclampsia,are the most common complications in pregnant women,affecting approximately 15%of pregnancies.[1,2]Hemolysis,elevated liver enzymes,and low platelet count(HELLP syndrome)can occur in 0.2%-0.6%of all pregnancies,and 10%-15%of patients are diagnosed with preeclampsia.[3,4]Among its severe complications,liver hematoma is remarkable and may lead to liver rupture.Prompt identification of HELLP syndrome is crucial for proper therapeutic management and to avoid fatal outcomes[4,5]since when a hepatic hematoma occurs,the risk of rupture increases to 12%.[3,5]

A rare co-occurrence of spontaneous pneumomediastinum,pneumothorax,and pneumoperitoneum:Macklin effect

Spontaneous pneumomediastinum (SPM) is characterized by free air or gas located within the mediastinum that is not associated with any noticeable cause,such as chest trauma,intrathoracic infections,surgery,other organ rupture or mechanical ventilation.

A case of post traumatic mitral chordae rupture mimicking acute respiratory distress syndrome

Traumatic mitral chordae rupture is a rare and known cause of acute mitral valve regurgitation and de novo heart failure.Concomitant pathologies in a trauma patient may mask the findings of de novo heart failure due to mitral chordae rupture.Trauma patients may also have other potential pre-diagnoses that could explain symptoms related to heart failure,such as tachycardia,circulatory shock,and acute hypoxemia.The possibility of traumatic chordae tendinea rupture being a preventable cause of mortality should be carefully evaluated.

A novel mitigation measure for normal fault-induced deformations on pile-raft systems

Evidence from recent earthquakes has shown destructive consequences of fault-induced permanent ground movement on structures.Such observations have increased the demand for improvements in the design of structures that are dramatically vulnerable to surface fault ruptures.In this study a novel connection between the raft and the piles is proposed to mitigate the hazards associated with a normal fault on pile-raft systems by means of 3D finite element(FE)modeling.Before embarking on the parametric study,the strain-softening constitutive law used for numerical modeling of the sand has been validated against centrifuge test results.The exact location of the fix-head and unconnected pile-raft systems relative to the outcropping fault rupture in the free-field is parametrically investigated,revealing different failure mechanisms.The performance of the proposed connection for protecting the pile-raft system against normal fault-induced deformations is assessed by comparing the geotechnical and structural responses of both types of foundation.The results indicate that the pocket connection can relatively reduce the cap rotation and horizontal and vertical displacements of the raft in most scenarios.The proposed connection decreases the bending moment response of the piles to their bending moment capacity,verging on a fault offset of 0.6 m at bedrock.

Mechanical behaviors of mylonitic granite and granitic protomylonite in a deep ductile shear zone

For projects near the tectonic belt,mylonite of varying metamorphic degrees may be present.The matrix proportion of rock reflects its internal microscopic characteristics,thus it is beneficial for engineering geology to study the effect of the matrix proportion on the mechanical properties and rupture behaviors of rock.Samples of mylonitic granite and granitic protomylonite with varying matrix proportions were obtained from a ductile shear zone for a series of uniaxial compression and acoustic emission(AE)tests.The results showed that with the increase in matrix proportion,the average strength and elastic modulus of the samples increased,and the rock sample with the largest matrix proportion exhibited the maximum peak stress of 244.42 MPa,which was 45.86%greater than the average peak stress of the rock samples with the smallest matrix proportions.For the rock samples with larger matrix proportion,their mechanical parameters exhibited greater dispersion and the large-scale appearance of AE events occurred earlier,showing a relatively gradual failure process.These samples had larger accumulated AE parameter values and greater degree of failure.In contrast,for samples with smaller matrix proportions,the large-scale appearance of AE events occurred close to the peak stress,indicating that the occurrence of damage and fractures was centralized and instantaneous.These samples had lower accumulated AE parameter values and fewer cracks after failure.Additionally,for the rock samples with more matrix proportion,the average variance of the b-value was 1.1,which was lower than that of rock samples with the smallest matrix proportion(the average variance of the b-value was 3.7).Furthermore,it can be predicted that under certain stress,the failure depth around a tunnel is generally smaller when the strength of rock samples with larger matrix proportion is greater.

Finite Element Simulations of the Localized Failure and Fracture Propagation in Cohesive Materials with Friction

Strain localization frequently occurs in cohesive materials with friction(e.g.,composites,soils,rocks)and is widely recognized as a fundamental cause of progressive structural failure.Nonetheless,achieving high-fidelity simulation for this issue,particularly concerning strong discontinuities and tension-compression-shear behaviors within localized zones,remains significantly constrained.In response,this study introduces an integrated algorithmwithin the finite element framework,merging a coupled cohesive zone model(CZM)with the nonlinear augmented finite elementmethod(N-AFEM).The coupledCZMcomprehensively describes tension-compression and compressionshear failure behaviors in cohesive,frictional materials,while the N-AFEM allows nonlinear coupled intraelement discontinuities without necessitating extra nodes or nodal DoFs.Following CZM validation using existing experimental data,this integrated algorithm was utilized to analyze soil slope failure mechanisms involving a specific tensile strength and to assess the impact of mechanical parameters(e.g.,tensile strength,weighting factor,modulus)in soils.

Evaluation of crustal deformation and associated strong motions induced by the 2022 Paktika earthquake,Afghanistan

The 2022 Paktika earthquake(moment magnitude:6.2) occurred on June 22,2022,near the border between the Khost and Paktika Provinces of Afghanistan,causing heavy damage and casualties in Paktika Province.This study evaluated the crustal deformation and associated strong motions induced by the Paktika earthquake.Crustal deformations were determined using the Differential Interferometric Synthetic Aperture Radar(DInSAR) technique and three-dimensional finite element method(3DFEM) and the results were compared.The permanent ground displacements obtained from the DInSAR and 3D-FEM analyses were similar in terms of amplitude and areal distribution.Strong motions were estimated using the 3D-FEM with and without considering regional topography.The estimations of maximum ground acceleration,velocity,and permanent ground deformations were compared among each other as well as with those inferred from failures of some simple structures in the Spera and Gayan districts.The inferred maximum ground acceleration and velocity from the failed adobe structures were more than 300 Gal and 50 cm/s,respectively,nearly consistent with the estimates obtained using empirical methods.The empirical method yielded a maximum ground acceleration of 347 Gal,whereas the maximum ground velocity was approximately50 cm/s.In light of these findings,some surface expressions of crustal deformations and strong ground motions,such as failures of soil and rock slopes and rockfalls,have been presented.The rock slope failures in the epicentral area were consistent with those observed during various earthquakes in Afghanistan and worldwide.

Numerical simulations of earthquake rupture induced by pressure perturbation

The subsurface fluid injection can cause pressure increase within faults,leading to earthquake occurrences.However,the factors controlling earthquake rupture due to pressure perturbation remain poorly understood.To resolve this problem,we simulate the physical processes of earthquake nucleation and rupture on strike-slip faults perturbated by pressure migration based on the slip-weakening law.Multiple kinds of factors,including background stress,fluid injection rates,the area of the pressurized region,fault geometry,and fault friction coefficients,are considered in our simulations.Our simulation results reveal that the ratio of shear stress to normal stress rather than their absolute values controls the rupture behavior.With the large stress ratios,high injection rates,and large pressurized areas,earthquakes are prone to propagate as runaway ruptures.Additionally,faults with large aspect ratios of length to width are also favorable for causing runaway ruptures.In contrast,the factors of fault strike,dip angles and friction coefficients have minor influence on rupture behavior.

FPR1 Antagonist (BOC-MLF) Inhibits Amniotic Epithelial-mesenchymal Transition

Objective:Premature rupture of membranes(PROM)is a common pregnancy disorder that is closely associated with structural weakening of fetal membranes.Studies have found that formyl peptide receptor 1(FPR1)activates inflammatory pathways and amniotic epithelial-mesenchymal transition(EMT),stimulates collagen degradation,and leads to membrane weakening and membrane rupture.The purpose of this study was to investigate the anti-inflammatory and EMT inhibitory effects of FPR1 antagonist(BOC-MLF)to provide a basis for clinical prevention of PROM.Methods:The relationship between PROM,FPR1,and EMT was analyzed in human fetal membrane tissue and plasma samples using Western blotting,PCR,Masson staining,and ELISA assays.Lipopolysaccharide(LPS)was used to establish a fetal membrane inflammation model in pregnant rats,and BOC-MLF was used to treat the LPS rat model.We detected interleukin(IL)-6 in blood from the rat hearts to determine whether the inflammatory model was successful and whether the anti-inflammatory treatment was effective.We used electron microscopy to analyze the structure and collagen expression of rat fetal membrane.Results:Western blotting,PCR and Masson staining indicated that the expression of FPR1 was significantly increased,the expression of collagen was decreased,and EMT appeared in PROM.The rat model indicated that LPS caused the collapse of fetal membrane epithelial cells,increased intercellular gaps,and decreased collagen.BOC-MLF promoted an increase in fetal membrane collagen,inhibited EMT,and reduced the weakening of fetal membranes.Conclusion:The expression of FPR1 in the fetal membrane of PROM was significantly increased,and EMT of the amniotic membrane was obvious.BOC-MLF can treat inflammation and inhibit amniotic EMT.

Determining the surface fault-rupture hazard zone for the Pazarcık segment of the East Anatolian fault zone through comprehensive analysis of surface rupture from the February 6,2023,Earthquake(Mw 7.7)

Following surface rupture observations in populated areas affected by the KahramanmaraşEarthquake(Mw 7.7)on February 6th,2023,along the Pazarcık segment of the East Anatolian Fault Zone(EAFZ),this study presents novel insights into physical criteria for delineating surface fault-rupture hazard zones(SRHZs)along ruptured strike-slip faults.To achieve this objective,three trench studies across the surface rupture were conducted on the Pazarcık segment of the EAFZ to collect field data,and earthquake recurrence intervals were interpreted using Bayesian statistics from previously conducted paleoseismological trenchings.The results of the proposed model indicate that the Pazarcık segment produced five significant surface-rupturing earthquakes in the last∼11 kyr:E1:11.13±1.74 kyr,E2:7.62±1.20 kyr,E3:5.34±1.05 kyr,E4:1.82±0.93 kyr,and E5:0.35±0.11 kyr.In addition,the recurrence intervals of destructive earthquakes on the subject in question range from 0.6 kyr to 4.8 kyr.Considering that the last significant earthquake occurred in 1513,the longest time since the most recent surface fault rupturing earthquake on this particular segment was 511 years.These results indicate that,in terms of the theoretical recurrence interval of earthquakes that can create surface ruptures on the Pazarcık segment,the period in which the February 6,2023,earthquake occurred was within the end of the expected return period.As a result,the potential for a devastating earthquake in the near future is not foreseen on the same fault.Finally,the SRHZ proposed for the Pazarcık section of Gölbaşıvillage was calculated as a 61-meter-wide offset on the fault lineament to reduce the negativities that may occur in the ruptured area in the future.It is recommended to take into account this width in the settlement of this area and nearby areas.

Rupture of a giant jejunal mesenteric cystic lymphangioma misdiagnosed as ovarian torsion: A case report

BACKGROUND Cystic lymphangioma is a rare benign tumor that affects the lymphatic system.Mesenteric lymphangiomas in the small bowel are extremely uncommon.CASE SUMMARY We present a 21-year-old female patient who complained of abdominal pain.The diagnosis of ovarian torsion was suspected after abdominopelvic unenhanced computed tomography and ultrasound revealed a large cyst in contact with the bladder,ovary,and uterus.The patient underwent emergency laparotomy per-formed by gynecologists,but it was discovered that the cystic tumor originated from the jejunum.Gastrointestinal surgeons were then called in to perform a cystectomy.Pathological examination confirmed the diagnosis of cystic lymphangioma of the mesentery.The patient had an uneventful postoperative recovery.CONCLUSION Mesenteric lymphangiomas can cause abdominal pain,and imaging techniques can help determine their characteristics,location,and size.Complete surgical excision and pathological examination are considered the standard treatment and diagnostic method.

A modified stochastic finite-fault method for estimating strong ground motion:Validation and application

We developed a modified stochastic finite-fault method for estimating strong ground motions.An adjustment to the dynamic corner frequency was introduced,which accounted for the effect of the location of the subfault relative to the hypocenter and rupture propagation direction,to account for the influence of the rupture propagation direction on the subfault dynamic corner frequency.By comparing the peak ground acceleration(PGA),pseudo-absolute response spectra acceleration(PSA,damping ratio of 5%),and duration,the results of the modified and existing methods were compared,demonstrating that our proposed adjustment to the dynamic corner frequency can accurately reflect the rupture directivity effect.We applied our modified method to simulate near-field strong motions within 150 km of the 2008 MW7.9 Wenchuan earthquake rupture.Our modified method performed well over a broad period range,particularly at 0.04-4 s.The total deviations of the stochastic finite-fault method(EXSIM)and the modified EXSIM were 0.1676 and 0.1494,respectively.The modified method can effectively account for the influence of the rupture propagation direction and provide more realistic ground motion estimations for earthquake disaster mitigation.

Co and postseismic fault slip models of the 2022 M_(W)6.7 Menyuan earthquake reveal conjugated faulting tectonics at the central section of the Lenglongling fault

The 2022 M_(W)6.7 Menyuan earthquake ruptured the western end of the Tianzhu seismic gap,providing an opportunity to study the regional seismogenic characteristics and seismic hazards.Here we use interferometric synthetic aperture radar(InSAR)and seismic data to study the mainshock rupture,early afterslip and the second largest aftershock of the 2022 Menyuan earthquake sequences.Our modeling results show that the mainshock ruptured the Lenglongling fault and the Tuolaishan fault with a maximum slip of~3 m.Rapid postseismic transient deformation occurred at the center of the Lenglongling fault.Our afterslip modeling reveals that the majority of afterslip occurred in the deeper part of the Lenglongling fault.A high-angle conjugated faulting event is found at the middle section of the Lenglongling fault.We use the stress inversion to investigate the possible triggering mechanism of the conjugated rupture event.The results indicate the maximum principal stress direction is in~222°,forming a~22°angle between the conjugated fault of second largest aftershock and the mainshock.The calculated normal stress changes indicate the region is within a pull-apart stress field,which favors such a conjugated rupturing event.Our study will help understand the rupture behavior of such kind of conjugated fault in other regions.

Spontaneous coronary artery rupture after lung cancer surgery:A case report and review of literature

BACKGROUND Spontaneous coronary artery rupture(SCAR)is a rare and life-threatening complication after lung cancer surgery.We present a case of SCAR following left upper lobectomy,successfully managed through emergency thoracotomy and coronary artery ligation.CASE SUMMARY A 61-year-old male patient underwent left upper lobectomy and mediastinal lymph node dissection for lung cancer.The surgery was performed using singleport video-assisted thoracoscopic surgery,and there were no observed complications during the procedure.However,19 h after surgery,the patient experienced chest discomfort and subsequently developed severe symptoms,including nausea,vomiting,and a drop in blood pressure.Urgent measures were taken,leading to the diagnosis of SCAR.The patient underwent emergency thoracotomy and coronary artery ligation,successfully stopping the bleeding and stabilizing the condition.Despite postoperative complications,the patient made a successful recovery and was discharged from the hospital.CONCLUSION SCAR is a rare but life-threatening complication following lung cancer surgery.Immediate thoracotomy has been shown to be a life-saving measure,while stenting is not the preferred initial approach.

Amebic liver abscess: An update

Amebic liver abscess(ALA)is still a common problem in the tropical world,where it affects over three-quarters of patients with liver abscess.It is caused by an anaerobic protozoan Entamoeba hystolytica,which primarily colonises the cecum.It is a non-suppurative infection of the liver consisting primarily of dead hepatocytes and cellular debris.People of the male gender,during their reproductive years,are most prone to ALA,and this appears to be due to a poorly mounted immune response linked to serum testosterone levels.ALA is more common in the right lobe of the liver,is strongly associated with alcohol consumption,and can heal without the need for drainage.While majority of ALA patients have an uncomplicated course,a number of complications have been described,including rupture into abdomino-thoracic structures,biliary fistula,vascular thrombosis,bilio-vascular compression,and secondary bacterial infection.Based on clinico-radiological findings,a classification system for ALA has emerged recently,which can assist clinicians in making treatment decisions.Recent research has revealed the role of venous thrombosis-related ischemia in the severity of ALA.Recent years have seen the development and refinement of newer molecular diagnostic techniques that can greatly aid in overcoming the diagnostic challenge in endemic area where serology-based tests have limited accuracy.Metronidazole has been the drug of choice for ALA patients for many years.However,concerns over the resistance and adverse effects necessitate the creation of new,safe,and potent antiamebic medications.Although the indication of the drainage of uncomplicated ALA has become more clear,high-quality randomised trials are still necessary for robust conclusions.Percutaneous drainage appears to be a viable option for patients with ruptured ALA and diffuse peritonitis,for whom surgery represents a significant risk of mortality.With regard to all of the aforementioned issues,this article intends to present an updated review of ALA.

Sequential bowel necrosis and large gastric ulcer in a patient with a ruptured femoral artery:A case report

BACKGROUND Severe bleeding as a result of a major vascular injury is a potentially fatal event commonly observed in the emergency department.Bowel necrosis and gastric ulcers secondary to ischemia are rare due to their rich blood supply.In this case,we present the case of a patient who was treated successfully following rupture of his femoral artery resulting in bowel necrosis and an unusually large gastric ulcer.CASE SUMMARY A 28-year-old male patient sustained a knife stab wound to the right thigh,causing rupture of his femoral artery and leading to massive bleeding.He underwent cardiopulmonary resuscitation and received a large blood transfusion.Abdominal surgeries confirmed bowel necrosis,and jejunostomy was performed.The necrotic intestine was removed,the remaining intestine was anastomosed,and the right thigh was amputated.After three surgeries,the patient's overall condition gradually improved,and the patient was discharged from the hospital.However,one day after discharge,the patient was admitted again due to dizziness and melena,and a gastroduodenoscopy revealed a giant banded ulcer.After 2 weeks of treatment,the ulcer had decreased in size without bleeding.Six months after the last surgery,enterostomy and reintroduction surgery were completed.The patient was fitted with a right lower limb prosthesis one year after surgery.After 3 years of follow-up,the patient did not complain of discomfort.CONCLUSION Trauma department physicians need to be aware of the possible serious complications involving the abdomen of trauma patients with massive bleeding.