Successful emergency surgical intervention in acute non-STsegment elevation myocardial infarction with rupture:A case report

BACKGROUND The incidence of acute myocardial infarction(AMI)is rising,with cardiac rupture accounting for approximately 2%of deaths in patients with acute ST-segment elevation myocardial infarction(STEMI).Ventricular free wall rupture(FWR)occurs in approximately 2%of AMI patients and is notably rare in patients with non-STEMI.Types of cardiac rupture include left ventricular FWR,ventricular septal rupture,and papillary muscle rupture.The FWR usually leads to acute cardiac tamponade or electromechanical dissociation,where standard resuscitation efforts may not be effective.Ventricular septal rupture and papillary muscle rupture often result in refractory heart failure,with mortality rates over 50%,even with surgical or percutaneous repair options.CASE SUMMARY We present a rare case of an acute non-STEMI patient who suffered sudden FWR causing cardiac tamponade and loss of consciousness immediate before undergoing coronary angiography.Prompt resuscitation and emergency open-heart repair along with coronary artery bypass grafting resulted in successful patient recovery.CONCLUSION This case emphasizes the risks of AMI complications,shares a successful treatment scenario,and discusses measures to prevent such complications.

Parameters of Coseismic Reverse- and Oblique-Slip Surface Ruptures of the 2008 Wenchuan Earthquake,Eastern Tibetan Plateau

On May 12th, 2008, the Mw7.9 Wenchuan earthquake ruptured the Beichuan, Pengguan and Xiaoyudong faults simultaneously along the middle segment of the Longmenshan thrust belt at the eastern margin of the Tibetan plateau. Field investigations constrain the surface rupture pattern, length and offsets related to the Wenchuan earthquake. The Beichuan fault has a NE-trending rightlateral reverse rupture with a total length of 240 km. Reassessment yields a maximum vertical offset of 6.5±0.5 m and a maximum right-lateral offset of 4.9±0.5 m for its northern segment, which are the largest offsets found; the maximum vertical offset is 6.2±0.5 m for its southern segment. The Pengguan fault has a NE-trending pure reverse rupture about 72 km long with a maximum vertical offset of about 3.5 m. The Xiaoyudong fault has a NW-striking left-lateral reverse rupture about 7 km long between the Beichuan and Pengguan faults, with a maximum vertical offset of 3.4 m and left-lateral offset of 3.5 m. This pattern of multiple co-seismic surface ruptures is among the most complicated of recent great earthquakes and presents a much larger danger than if they ruptured individually. The rupture length is the longest for reverse faulting events ever reported.

Rapid Identification and Emergency Investigation of Surface Ruptures and Geohazards Induced by the M_s 7.1 Yushu Earthquake

The rapid identification based on InSAR technology was proved to be effective in our emergency investigation of surface ruptures and geohazards induced by the Yushu earthquake.The earthquake-generating fault of the Yushu earthquake is the Yushu section of the Garze-Yushu faults zone.It strikes NWW-NW,23 km long near the Yushu County seat,dominated by left-lateral strike slip,and appearing as a surface rupture zone.The macroscopic epicenter is positioned at Guo-yang-yan -song-duo of Gyegu Town（33°03＇11＂N,96°51＇26＂E）,where the co-seismic horizontal offset measured is 1.75 m.Geohazards induced by the Yushu earthquake are mainly rockfalls,landslides,debris flows, and unstable slopes.They are controlled by the earthquake-generating fault and are mostly distributed along it.There are several geohazard chains having been established,such as earthquake,canal damage,soil liquefying,landslide-debris flow,earthquake,soil liquefying,roadbed deformation,etc.In order to prevent seismic hazards,generally,where there is a visible surface rupture induced by the Yushu earthquake,reconstruction should be at least beyond 20 m,on each side,from it.Sufficient attention should also be given to potential geohazards or geohazard chains induced by the earthquake.

Analysis of Remote Sensing Images of Ground Ruptures Resulting from the Kunlun Mountain Pass Earthquake in 2001

On November 14, 2001, an earthquake measuring a magnitude of 8.1 occurred to the west of the Kunlun Mountain Pass which is near the border between Xinjiang and Qinghai of China. Since its epicenter is located in an area at an elevation of 4900 m where the environment is extremely adverse, field investigation to this event seems very difficult. We have performed interpretation and analysis of the satellite images of ETM, SPOT, Ikonos, and ERS-1/2SAR to reveal the spatial distribution and deformation features of surface ruptures caused by this large earthquake. Our results show that the rupture zone on the ground is 426 km long, and strikes N90-110°E with evident left-lateral thrusting. In spatial extension, it has two distinct sections. One extends from the Bukadaban peak to the Kunlun Mountain Pass, with a total length of 350 km, and trending N95-110°E. Its fracture plane is almost vertical, with clear linear rupture traces and a single structure, and the maximum left-lateral offset is 7.8 m. This section is the main rupture zone caused by the earthquake, which is a re-fracturing along an old fault. The other is the section from Kushuihuan to the Taiyang Lake. It is 26 km long, trending N90-105°E, with the maximum strike-slip displacement being 3 m, and is a newly-generated seismic rupture. In a 50 km-long section between the Taiyang Lake and the Bukadaban peak, no rupture is found on the ground. The eastern and western rupture zones may have resulted from two earthquakes. The macroscopic epicenter is situated at 65 km east of the Hoh Sai Lake. The largest coseismic horizontal offset in the macroscopic epicenter ranges from 7 m to 8 m. Based on the dislocation partition of the whole rupture zone, it is suggested that this rupture zone has experienced a process of many times of intensification and fluctuation, exhibiting a remarkable feature of segmentation.

Deformation of the Most Recent Co-seismic Surface Ruptures Along the Garzê–Yushu Fault Zone(Dangjiang Segment)and Tectonic Implications For the Tibetan Plateau

The Garzê–Yushu strike-slip fault in central Tibet is the locus of strong earthquakes（M 〉 7）. The deformation and geometry of the co-seismic surface ruptures are reflected in the surface morphology of the fault and depend on the structure of the upper crust as well as the pre-existing tectonics. Therefore, the most recent co-seismic surface ruptures along the Garzê–Yushu fault zone（Dangjiang segment） reveal the surface deformation of the central Tibetan Plateau. Remote sensing images and field investigations suggest a 85 km long surface rupture zone（striking NW-NWW）, less than 50 m wide, defined by discontinuous fault scarps, right-stepping en echelon tensional cracks and left-stepping mole tracks that point to a left-lateral strike-slip fault. The gullies that cross fault scarps record systematic left-lateral offsets of 1.8 m to 5.0 m owing to the most recent earthquake, with moment magnitude of about M 7.5, in the Dangjiang segment. Geological and geomorphological features suggest that the spatial distribution of the 1738 co-seismic surface rupture zone was controlled by the pre-existing active Garzê–Yushu fault zone（Dangjiang segment）. We confirm that the Garzê–Yushu fault zone, a boundary between the Bayan Har Block to the north and the Qiangtang Block to the south, accommodates the eastward extrusion of the Tibetan Plateau and generates strong earthquakes that release the strain energy owing to the relative motion between the Bayan Har and Qiangtang Blocks.

Segmentations of active normal dip-slip faults around Ordos block according to their surface ruptures in historical strong earthquakes

From the results of researches of active faults in resent years, a correlation analysis between segments of the faults according to surface ruptures in nine historical strong earthquakes occurring in downfaulted system and active structures around Ordos block is conducted in paper. The result shows that there is a good correlation between them, except few individual data that have more uncertain parameters. It shows that intensity and segments of surface ruptures in these strong earthquakes are intrinsically related with the active structures. These strong earthquakes produced stable and unstable rupture boundaries of characteristic-earthquake type and successive occurrence of strong earthquakes on the different boundary faults in the same tectonic unit.

Comparison of surgical intervention with functional treatment for acute ruptures of lateral ankle ligmant:a meta-analysis

Objective:To compare the effect of surgical intervention on functional treatment.Methods: By searching the MEDLINE(1966 to October 2011),EMBASE(1980 to October 2011),the Chinese Biomedical Database Databases(1980 to October 2011),a total of 9 related RCT studies comparing surgical intervention with functional treatment were included in our study.RevMan software was taken to analyze the data.Results:These 9 studies Involved a total of 1 268 mostly young adults,including 580 patients with surgical treatment and 688 patients with functional treatment.The results showed the stability of ankle activity in surgical treatment group was better than that in functional treatment group,with the OR and 95%CI of 0.72(0.52-0.99).No significant difference was found in the recurrence of the surgical and functional group.However, the movement disorder in the surgical treatment suggested increased risk than that in functional group,with the OR and 95%CI of 2 39(0.98-5.85).Surgical group found more complication than the function group,such as deep vein thrombosis,deep venous thrombosis,tenderness of scar and sensory loss.Conclusions:In conclusion,our finding showed that surgical treatment could gain better efficacy than functional treatment,but may bring more complication.Therefore,further large sample size RCT is warranted.

Multiple esophageal variceal ruptures with massive ascites due to myelofibrosis-induced portal hypertension

A 75-year old man had been diagnosed at 42 years of age as having polycythemia vera and had been monitored at another hospital. Progression of anemia had been recognized at about age 70 years, and the patient was thus referred to our center in 2008 where secondary myelofibrosis was diagnosed based on bone marrow biopsy findings. Hematemesis due to rupture of esophageal varices occurred in January and February of 2011. The bleeding was stopped by endoscopic variceal ligation. Furthermore, in March of the same year, hematemesis recurred and the patient was transported to our center. He was in irreversible hemorrhagic shock and died. The autopsy showed severe bone marrow fibrosis with mainly argyrophilic fibers, an observation consistent with myelofibrosis. The liver weighed 1856 g the spleen 1572 g, indicating marked hepatosplenomegaly. The liver and spleen both showed extramedullary hemopoiesis. Myelofibrosis is often complicated by portal hypertension and is occasionally associated with gastrointestinal hemorrhage due to esophageal varices. A patient diagnosed as having myelofibrosis needs to be screened for esophageal/gastric varices. Myelofibrosis has a poor prognosis. Therefore, it is necessary to carefully decide the therapeutic strategy in consideration of the patient's concomitant conditions, treatment invasiveness and quality of life.

Seismic source ruptures of several strong earth-quakes of 1989 in Sichuan region of China

Several strong earthquakes occurred in the regions of Batang and Xiaojin of Sichuan Province in 1989. This paper uses broadband waveform data from GDSN, by the forward trial-and-error modeling for multiple subevent, in terms of analysis on quasi-source time function or qSTF of station, to study source rupture characteristics of these strong earthquakes and to discuss tectonic background of earthquake occurrence regions preliminarily.

High-resolution structure-from-motion models covering 160 km-long surface ruptures of the 2021 M_(W)7.4 Madoi earthquake in northern Qinghai-Tibetan Plateau

The May 222021 M_(W)7.4 Madoi,Qinghai,China earthquake presented a rare opportunity to apply the modern unmanned aerial vehicle(UAV)photography method in extreme altitude and weather conditions to image surface ruptures and near-field effects of earthquake-related surface deformations in the remote Tibet.High-resolution aerial photographs were acquired in the days immediately following the mainshock.The complex surface rupture patterns associated with this event were covered comprehensively at 3-6 cm resolution.This effort represents the first time that an earthquake rupture in the interior of the Qinghai-Tibetan Plateau has been fully and systematically captured by such high-resolution imagery,with an unprecedented level of detail,over its entire length.The dataset has proven valuable in documenting subtle and transient rupture features,such as the significant mole-tracks and opening fissures,which were ubiquitous coseismically but degraded during the subsequent summer storm season.Such high-quality imagery also helps to document with high fidelity the fractures of the surface rupture zone(supplements of this paper),the pattern related to how the faults ruptured to the ground surface,and the distribution of off-fault damage.In combination with other ground-based mapping efforts,the data will be analyzed in the following months to better understand the mechanics of earthquake rupture related to the fault zone rheology,rupture dynamics,and frictional properties along with the fault interface.

New physics of supersonic ruptures

Until recently,it is believed that the rupture speed above the pressure wave is impossible since spontaneously propagating ruptures are driven by the energy released due to the rupture motion,which is transferred through the medium to the rupture tip region at the maximum speed equal to the pressure wave speed.However,the apparent violation of classic theories has been revealed by new experimental results demonstrating supersonic shear ruptures.This paper presents a detailed analysis of the recently discovered shear rupture mechanism(fan hinged),which suggests a new physics of energy supply to the tip of supersonic ruptures.The key element of this mechanism is the fan‐shaped structure of the head of extreme ruptures,which is formed as a result of an intense tensile cracking process with the creation of intercrack slabs that act as hinges between the shearing rupture faces.The fan structure is featured with the following extraordinary properties:extremely low friction approaching zero;amplification of shear stresses above the material strength at low applied shear stresses;creation of a self‐disbalancing stress state causing a spontaneous rupture growth;abnormally high energy release;generation of driving energy directly at the rupture tip which excludes the need to transfer energy through the medium.The fan mechanism operates in intact rocks at stress conditions corresponding to seismogenic depths and in pre‐existing extremely smooth interfaces due to identical tensile cracking processes at these conditions.This is Paper 1(of two companion papers)which discusses the fan theory and extreme ruptures in experiments on extremely smooth interfaces.Paper 2 entitled“Fan‐hinged shear instead of frictional stick‐slip as the main and most dangerous mechanism of natural,induced and volcanic earthquakes in the earth's crust”considers extreme ruptures in intact rocks.Further study of this subject is a major challenge for deep underground science,earthquake and fracture mechanics,physics,and tribology.

Mercury indicating inflow zones and ruptures along the Wenchuan Ms 8.0 earthquake fault

During the Wenchuan Fault Scientific Drilling Project,we determined the values of total mercury(HgT)and gaseous elemental mercury(GEM) from drilled cores and drilling mud,respectively.Geochemical analysis shows HgT values ranging from 0.24 to 6.45 ng/g for the Penguan complex and from 2.90 to 137.54 ng/g for T3 sediment.The average levels of HgT for the Penguan complex and T3 sediments are 1.81 ± 0.26 ng/g and23.96 ± 4.80 ng/g,respectively.Major anomalous peaks of HgT appear at depth of 614,731,993 and 1,107 m,which correspond to the long-term high seismic activity during crustal deformation in response to tectonic stresses.Gaseous elemental mercury dissolved in drilling mud was also analyzed.We found fluid inflow zones with high GEM at depths of 590-750 m,suggesting that fluid-filled ruptures exist in the LMS fault zone.It indicates that mercury provides geochemical evidence for inflow zones and ruptures/fault zones in the Wenchuan Ms 8.0 earthquake fault.

Best approach for the repair of distal biceps tendon ruptures

The preferred treatment of distal biceps tendon ruptures is by operative repair. However, the best approach for repair(single vs double incision) is still subject of debate. Grewal and colleagues recently presented the results of a randomized clinical trial evaluating two different surgical approaches for the repair of distal biceps tendon ruptures. Despite the fact that this article currently presents the highest level of evidence for the surgical repair of distal biceps tendon ruptures, we have some comments on the study that might be interesting to discuss. We think that some of the results and conclusions presented in this study need to be interpreted in the light of these comments.

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).

Relationship between the Pre-existing Active Kunlun Fault and Co-seismic Surface Ruptures Produced by the 2001 Mw 7.8 Central Kunlun Earthquake, China

Field investigations allow to constrain the co-seismic surface rupture zone of ～400 km with a strike-slip up to 16.3 m associated with the 2001 Mw 7.8 Central Kunlun earthquake that occurred along the western segmentof the Kunlun fault, northern Tibet. The co-seismic rupture structures are almost duplicated on the pre-existing fault traces of the Kunlun fault. The deformational characteristics of the co-seismic surface ruptures reveal that the earthquake had a nearly pure strike-slip mechanism. The geologic and topographic evidence clearly shows that spatialdistributions of the co-seismic surface ruptures are restricted by the pre-existing geological structures of the Kunlun fault.

Exploration of Suspected Surface Ruptures of the M_S8.0 Wenchuan Earthquake at Frontal Areas of Longmenshan Using Shallow Seismic Reflection

The great M_S8.0 Wenchuan earthquake on May 12,2008 was generated by abrupt faulting in the Yingxiu-Beichuan fault along the Longmenshan fault zone. The earthquake not only produced surface ruptures along the Yingxiu-Beichuan and Guanxian-Jiangyou faults,but also surface ruptures,arching of highway pavement,sand-boils and waterspouts in various degrees in areas such as Shifang and Mianzhu on the Chengdu Plain. To understand the shallow geological structures under the surface rupture zone,a 6350m long high-resolution shallow seismic reflection profile in near-EW direction was performed. This profile is located at Shigu town,Shifang city,where a suspected earthquake surface rupture zone was discovered. In this study,a group interval of 3m,shotpoint interval of 18m,and a 300-channel 25-fold observation system were used. In consideration of both near-surface reflections and dipping interface imaging,we adopted the split-spread geometry and asymmetrical zero-offset receiving technique. To better suppress random-noise and raise the signal-to-noise ratio of seismic data,30 times vertical stacking of vibrator signals was made for each common-shot gather after correlation of individual records. By using the above work method and spread geometry,we obtained high-resolution images of structures in the depth range of 15m～800m after data processing. The result shows the existence of buried thrust faults thrusting to the plain area and back-thrust faults under the surface rupture zone. It also shows that the activity of the buried thrust faults may be the main cause for folding and deformation in near-surface strata and coseismic surface rupturing.

Relocating ruptures of two M6 earthquakes in Zhongba, South-central Tibet in 2004 and 2005 with seismological and geodetic methods

To better understand repeatability of strong earthquakes in previously ruptured zones during one seismogenic period, we studied the rupture zones of the doublet of M6 earthquakes in Zhongba region of southcentral Tibet, China, in 11 July 2004 and 7 April 2005, respectively. We focused on the overlapping degree of two strong quakes’ aftershock areas one week after the mainshocks by using the SQH station in China Seismic Network and a 68-stations temporary broadband seismic array, a part of the international HI-CLIMB project. About 115 local earthquakes were recorded in one week after the mainquakes, and we located these earthquakes by master event relative location （MERL） method. We also used this method to relocate 31 other M3.7 ＋ earthquakes from 1 July 2004 to 1 July 2005. Meanwhile, we studied two mainshocks’ coseismic ruptures with satellite interferometric synthetic aperture radar （InSAR）. Our results show that the ruptured zones of the two earthquakes do not overlapp substantially, either from early aftershock data or from InSAR inversions.

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.

Hybrid Repair of Two Consecutive Acute Ventricular Septal Ruptures after Evolving Myocardial Infarction: Case Report

Background: Acute Ventricular septal rupture is one of dreadful complications of acute evolving myocardial infarction. Despite urgent management is lifesaving, it is still challenging and has a high risk of mortality particularly if recurrent or residual defects occurred. Evolving of skillfulness in transcatheter intervention of heart diseases paved the way for successful hybrid management of challenging cardiac cases specially for residual complicated cases post cardiac surgery. Case Presentation: We described here a successful hybrid two stage technique (surgical then transcatheter approach) to close two consecutive acute ventricular septal ruptures in 75 years old female presented with cardiogenic shock post evolving myocardial infarction. Conclusion: Hybrid repair by surgical and transcatheter interventions may be a good therapeutic modality for acute septal ruptures specially for residual or new defects after initial closure.

Jejuno-Ileal Ruptures after Blunt Abdominal Trauma at the Teaching Hospital of Bouake

Objective: The aim of this study is to determine the causes, pattern, management, and outcome of jejunal-ileal rupture following blunt abdominal trauma at the teaching Hospital of Bouake. Methods: The study included 27 patients who underwent laparotomy for jejunoileal injuries from blunt abdominal trauma at the Teaching Hospital of Bouake over a period of 14 years from January 2007 to December 2020. A retrospective study was conducted and the patients were analyzed with respect to patient demographics data, cause, injury mechanisms, presentation, anatomical distribution, diagnostic methods, associated injuries, treatment and outcomes. Results: During the 14 year period from 2007 to 2020, 27 patients with blunt small bowel injuries were treated at our Teaching Hospital. That is 2.9% of all blunt abdominal trauma. Male to female ratio was 4.4:1 and the average age was 26.3 years (range: 15 and 50 years). The majority (66.7% 18 cases) were Victims of road traffic accident. Median delay between injury and arrival at hospital for these patients was 10.1 hours (range: 1 - 72 h). A single intestinal injury was present in 22 patients, while 5 patients suffered from 2 injuries. There were 32 perforations of the small intestine in 27 patients with two perforations being transection. All perforations were located on the antimesenteric border of the intestine. Out of the 32 jejuno-ileal ruptures 18 were located on the jejunum while 14 were located on the ileum. Associated intra-abdominal injuries were present in 6 patients and nineteen associated extra-abdominal injuries were present in 10 (70.4%) patients. A one-stage therapeutic strategy was performed in 20 cases (74.1%) and a two-stage strategy was performed in seven cases (25.9%). Intestinal continuity was restored 93.8 days later (range 60 and 140 days). The average length of hospital stay of the operated patients was 11.4 days. The operative morbidity was 25.9%. Conclusion: Jejuno-ileal ruptures are rare and characterized by a delay in management. An early diagnosis could improve the vital prognosis of the patients.