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.

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).

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 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.

Abdominal Trauma during Pregnancy with Splenic Rupture and Fetal Death in Utero at Bogodogo University Hospital: A Case Report

Splenic injury caused by abdominal trauma during pregnancy is rare. Splenic injury associated with fetal death in utero following a fall from a tree top is even rarer. The authors report a case of splenic trauma associated with fetal death in utero following a fall from the top of a tree in a 19-year-old pregnant woman at 30 weeks amenorrhoea. She was referred from a 1st level health facility for trauma that had occurred the day before admission. She was in poor general condition (WHO performance status IV) and had a cardiovascular collapse. Ultrasound was used to diagnose haemoperitoneum and fetal death in utero. A CT scan was used to diagnose splenic lesions. Treatment consisted of splenectomy and caesarean section after resuscitation.

Subconjunctival trypsin injection for anterior chamber fibrin exudates in eyes with globe rupture following vitrectomy

AIM:To compare the safety and clinical outcomes of subconjunctival trypsin and dexamethasone(DEX)injections in the treatment of anterior chamber fibrin exudates in eyes with globe rupture following primary wound repair and vitrectomy.METHODS:A retrospective analysis included 42 males and 10 females(mean age 46.0±6.0y,range 34 to 58y)who underwent primary wound sutures and vitrectomy for globe rupture.Patients with pupil-covered fibrinous exudate or/and membrane in the anterior chamber were treated.On the first postoperative day,subconjunctival injections of either 5000 units(0.4 mL)of trypsin solution(n=25)or 0.5 mL(1 mg)DEX(n=27)were administered to accelerate exudate absorption.Efficacy was assessed by observing break time and partial absorption of the fibrin exudate membrane.Safety and comfort were evaluated by monitoring intraocular pressure(IOP),allergy,pain,and foreign body sensation.RESULTS:Both groups achieved 1/3 absorption of the anterior chamber fibrin exudate membrane,but the trypsin group exhibited shorter break time and partial absorption time compared to the DEX group(P<0.05).Trypsin treatment was also less irritating to patients.No adverse reactions were reported,and IOP remained stable.Visual acuity improved in both groups without statistical difference.CONCLUSION:Compared to DEX,trypsin demonstrates a shorter absorption time for the fibrin exudate membrane with a more comfortable process in treating pupil-covered fibrinous exudate or/and membrane after vitrectomy for globe rupture.

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.

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.

Ruptured Ectopic Pregnancy: Epidemiology and Management in the General Surgery Department of the Ignace Deen National Hospital, Conakry University Hospital

Introduction: The aim of this study was to contribute to improving the quality of GEUR management in the general surgery department and in the maternity ward of the Ignace Deen national hospital, Conakry University Hospital. Methodology: This was a retrospective, descriptive study lasting two years (January 1, 2020 to December 31, 2022), carried out in the general surgery and gyneco-obstetrics departments of the Ignace Deen national hospital, Conakry University Hospital. We included all patients with a ruptured ectopic pregnancy who received surgical treatment during the study period. Results: We collected 13,524 cases of surgical interventions in the two services, among them, we recorded 89 cases or 0.66% GEUR. The average age of the patients was 24.26 years. Brides were the most represented with 80.96% of cases. Women practicing a liberal profession were 51.69% (n = 46) and housewives 26.97% (n = 24). Clinically, amenorrhea was noted in all patients, i.e. 100%, abdominal-pelvic pain in 95.2% (n = 85) of cases, metrorrhagia in 94.08% (n = 84), abdominal-pelvic sensitivity in 97.44% (n = 87) of cases and anemia in 85.39% of cases. The GEUR was ampullary in 69.66% (n = 62) cases. Salpingectomy was performed in 90.72% (n = 81). The surgical outcomes were satisfactory in 98.87% (n = 88) of cases. We recorded one case of surgical site infection. We have not recorded any deaths. The average length of hospitalization was 4 days. Conclusion: GEUR is relatively high in our context. A good understanding of the prognostic factors of GEUR, awareness and family planning could reduce GEUR.

Is Induction of Labor with Early Rupture of Membranes Associated with an Increased Rate of Clinical Chorioamnionitis?

Objective: The objective of this study was to determine if early rupture of membranes (ROM) in women undergoing induction of labor (IOL) at term is associated with an increased rate of clinical chorioamnionitis. Study Design: A retrospective cohort study was performed on women undergoing IOL. Early ROM was defined as ROM at a modified Bishop score less than 5, cervical dilation less than 4 cm, or cervical effacement less than 80%. The rate of clinical chorioamnionitis was compared between women with early and late ROM. Results: The rate of clinical chorioamnionitis was 8.6% (24/279). ROM at an effacement of less than 80% was associated with a rate of clinical chorioamnionitis of 15.4% (12/78) compared to 6.0% (12/201) at an effacement of equal to or greater than 80%, p = 0.017. The rate of cesarean delivery was higher for patients with early ROM by any definition: 32% compared to 17.5% by modified Bishop score (p = 0.031), 32.4% versus 18.2% by cervical dilation (p = 0.049), and 33.3% versus 14.9% by cervical effacement (p = 0.001). Conclusions: In patients undergoing IOL, early ROM may be associated with an increased rate of clinical chorioamnionitis when performed at a cervical effacement of less than 80% and an increased rate of cesarean delivery.

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.

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.

Formation and rupture of liver hematomas caused by intrahepatic gallbladder perforation:A case report and review of literature

BACKGROUND Gallbladder perforation is a serious complication of acute cholecystitis.Such perforation is a rare but life-threatening situation that can lead to the formation and rupture of liver hematomas.Here,we report a case of a ruptured intrahepatic hematoma caused by intrahepatic gallbladder perforation,and we present a literature review.CASE SUMMARY A 70-year-old male was admitted to the hospital with a complaint of right upper quadrant abdominal pain,flustering and dizziness.The preoperative diagnosis was a ruptured malignant liver tumor,and the patient’s medical images and increased level of carbohydrate antigen-199 suggested that the gallbladder had been invaded.However,the tumor was proven to be a liver hematoma secondary to gallbladder perforation after surgery.The patient was discharged uneventfully on the fifteenth postoperative day.CONCLUSION Intrahepatic gallbladder perforation is difficult to diagnose preoperatively.Radiological examinations play a crucial role in the diagnosis but only for partial cases.Early diagnosis and appropriate surgery are key to managing this rare condition.

Increased Risk of Neonatal Pneumonia in Pregnant Women with Atypical Pre-Labor Rupture of Membrane Assessed at Pregnancy Week 39

Purpose: Neonatal pneumonia is a major newborn disease with a high morbidity rate. We aimed to evaluate whether atypical prelabor rupture of membranes (PROM) is a high-risk factor for causing neonatal pneumonia in a prospective real-world study. Patients and Methods: A total of 250 pregnant women at pregnancy week 39 were non-selectively recruited. All were examined by PROM and neonatal pneumonia related clinical, bedside and lab tests, including body temperature, blood pressure, increased vagina discharge, posterior vault pooling, abdominal tenderness, WBC count, nitrazine test, amniotic fluid index, Leakection (a sICAM-1 based lateral flow immunoassay) and vagina streptococcus examinations. Increased vagina discharge with a Leakection positivity was adopted as a working criterium for identifying atypical PROM. Neonatal pneumonia was diagnosed based on the clinical presentation and lab tests. Results: Twenty cases of neonatal pneumonia (8.0%) were diagnosed after the deliveries of the 250 pregnant women. In these neonatal pneumonia cases, 12 (16.7%) occurred in 72 deliveries with atypical PROM, 2 (16.7%) in 12 deliveries with typical PROM, and 6 (3.6%) in 166 deliveries with non-PROM. Conclusion: In this real-world study, we find that a systematic screening at pregnancy week 39 was very meaningful in revealing atypical PROM. Moreover, atypical PROM is a major risk factor for neonatal pneumonia. Therefore, an early diagnosis and intervention on atypical PROM could potentially reduce the occurrence of neonatal pneumonia.

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.

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.

Successful splenic artery embolization in a patient with Behçet’s syndrome-associated splenic rupture:A case report

BACKGROUND Splenic rupture associated with Behçet’s syndrome(BS)is extremely rare,and there is no consensus on its management.In this case report,a patient with BSassociated splenic rupture was successfully treated with splenic artery embolization(SAE)and had a good prognosis after the intervention.CASE SUMMARY The patient was admitted for pain in the left upper abdominal quadrant.He was diagnosed with splenic rupture.Multiple oral and genital aphthous ulcers were observed,and acne scars were found on his back.He had a 2-year history of BS diagnosis,with symptoms of oral and genital ulcers.At that time,he was treated with oral corticosteroids for 1 month,but the symptoms did not alleviate.He underwent SAE to treat the rupture.On the first day after SAE,the patient reported a complete resolution of abdominal pain and was discharged 5 d later.Three months after the intervention,a computed tomography examination showed that the splenic hematoma had formed a stable cystic effusion,suggesting a good prognosis.CONCLUSION SAE might be a good choice for BS-associated splenic rupture based on good surgical practice and material selection.

Hemoperitonium: Atypical Presentation Caused by Spontaneous Rupture of Hepatocellular Carcinoma in an Undiagnosed Patient

Introduction: Acute hemoperitoneum due to the spontaneous rupture of hepatocellular carcinoma (HCC) is a rare case of non-traumatic intra-abdomen bleeding that requires a high index of suspicion to approach, especially if no known history of HCC. It can mislead the physicians when the patient presents in an atypical way. Case Presentation: In this case report, we describe a fortuitous rupture of hepatocellular carcinoma in a 58-year-old male who was not previously diagnosed as having HCC and who came with atypical symptoms and signs of hemoperitoneum. He was then treated by trans-arterial embolectomy. Discussion: Diagnosis of hemoperitoneum in a case with bradycardia and hypotension is uncommon, as it goes more towards cardiogenic shock than hypovolemic shock, especially in a patient who is previously not symptomatic and has no risk factor for hepatocellular carcinoma. Conclusion: physicians should be alert to the possibility of encountering a hemorrhagic shock, although no trauma injury in any hypotensive patient with no clear reason for his condition.

Safety and Effectiveness of Stent-Assisted Coil Embolization for Ruptured Intracranial Aneurysm

Background: It has been conclusively established that intracranial aneurysms measuring a diameter below 7 mm pose a minimal risk of rupture. Conversely, those exhibiting irregular morphology or featuring the presence of a sac necessitate a more stringent and rigorous management approach. Objective: The primary aim of this study is to delve into the morphological features of ruptured aneurysms situated in distinct regions of the brain. Furthermore, we endeavor to assess the degree of safety and efficacy associated with stent-assisted embolization as a treatment modality for these ruptured aneurysms. Methods: This retrospective study encompassed a cohort of 467 patients who presented with intracranial ruptured aneurysms and were diagnosed through a combination of computed tomography (CT) and digital subtraction angiography (DSA) at Nanfang Hospital of Southern Medical University, spanning from January 2009 to December 2019. The following clinical parameters were meticulously recorded: aneurysm height, width, neck measurements, immediate Raymond grade assessments, and any perioperative complications experienced. Results: Within the study population, the average dimensions of ruptured aneurysms were found to be 4.26 ± 2.10 mm (width), 4.86 ± 2.38 mm (height), and 4.04 ± 1.87 mm (neck). Categorically, the most prevalent types of aneurysms were 170 cases of anterior communicating artery aneurysms (accounting for 36.4%), followed by 161 cases of posterior communicating artery aneurysms (34.5%), 56 cases of middle cerebral artery aneurysms (12.0%), 13 cases of anterior cerebral artery aneurysms (2.8%), 45 cases of paraclinoid aneurysms (9.6%), 6 cases of superior pituitary artery aneurysms (1.3%), 7 cases of anterior choroidal artery aneurysms (1.5%), and 9 cases of vertebrobasilar artery aneurysms (2.0%). Notably, 18 patients (3.9%) presented with ruptured aneurysms coexisting with ascus. Regarding treatment approaches, 228 cases (48.8%) underwent stent-assisted embolization, 234 cases (50.1%) received coils embolization, and 5 cases (1.1%) were treated with the dual-catheter technique. Immediately post-treatment, 422 patients (90.4%) attained a Raymond Class I status, with a procedure-related complication rate of 0.9%. Importantly, no statistically significant differences were observed in the incidence of perioperative complications across the three distinct treatment groups (P = 0.505). Conclusion: The outcomes of this study affirm the safety and efficacy of stent-assisted embolization as a treatment modality for ruptured aneurysms.

Preliminary report of coseismic surface rupture(part)of Türkiye's M_(W)7.8 earthquake by remote sensing interpretation

Both M_(W) 7.8 and M_(W) 7.5 earthquakes occurred in southeastern Türkiye on February 6,2023,resulting in numerous buildings collapsing and serious casualties.Understanding the distribution of coseismic surface ruptures and secondary disasters surrounding the epicentral area is important for post-earthquake emergency and disaster assessments.High-resolution Maxar and GF-2 satellite data were used after the events to extract the location of the rupture surrounding the first epicentral area.The results show that the length of the interpreted surface rupture zone(part of)is approximately 75 km,with a coseismic sinistral dislocation of 2-3 m near the epicenter;however,this reduced to zero at the tip of the southwest section of the East Anatolia Fault Zone.Moreover,dense soil liquefaction pits were triggered along the rupture trace.These events are in the western region of the Eurasian Seismic Belt and result from the subduction and collision of the Arabian and African Plates toward the Eurasian Plate.The western region of the Chinese mainland and its adjacent areas are in the eastern section of the Eurasian Seismic Belt,where seismic activity is controlled by the collision of the Indian and Eurasian Plates.Both China and Türkiye have independent tectonic histories.