Enigma of the Olyutorskii Earthquake Resolved by SAR interferometry (preprint)

The Mw 7.6 Olyutorskii earthquake of April 20, 2006, struck the southern edge of the Koryak Highland, in a region of great complexity at the junction of the North American, Eurasian, and Pacific plates. This seismic event was notable for several remarkable features. Firstly, it had an unexpectedly large magnitude, leading to a reassessment of the seismic hazard in the Northern Kamchatka region. Secondly, the GCMT focal mechanism solution showed two nodal planes corresponding to nearly thrusting displacements on a 40-510 dipping rupture plane. However, geological field studies conducted in the epicentral area allow to map at the surface three primary segments of a120 km long rupture zone. The central segment showed predominant right-lateral strike-slip displacements, while the NE and SW segments exhibited mostly thrusts steeply dipping SE with smaller strike-slip components. Thirdly, aftershocks were recorded in an area extending over 200 km southwestward from the surface ruptures mapped in the field, with an intense activity observed in a vast area 75 km to the NW from the surface ruptures. Fourthly, although the ruptures found during fieldwork were dipping to the SE, most aftershocks occurred NW of them, with their depth decreasing in the NW direction. SAR interferometry resolved this apparent discrepancy between seismological and field-geology data, indicating that the primary displacements occurred northwest from the central and southwest segments of the ruptures at the earth's surface. We present in our study a new rupture model based on SAR, GPS, and field geology data. The model consists of a major blind thrust extending NW and three rear subvertical ruptures that reached the earth's surface and were mapped during the field survey. Additionally, models of the main Мw6.6 aftershocks that occurred on April 29, 2006, and May 22, 2006, are presented. Our new model reconciles all collected data, with a direction of movements on the major thrust agreeing with the rotation of the previously suggested Beringia microplate around a pole situated in the North of the Chukotka peninsula.

Telerehabilitation intervention in transitional care for people with COVID-19: Pre-post study with a non-equivalent control group (preprint)

SARS-CoV-2 infection and its resulting sequelae have increased the prevalence of people with respiratory symptoms, with impacts on functional capacity, quality of life, anxiety, depression, and mental health. To mitigate this problem, one challenge has been the design and implementation of interventions that simultaneously allow for education, rehabilitation, and monitoring of people with long COVID, at a time when health services were on the verge of rupture due to the volume of people with active COVID and in need of intensive care. Telerehabilitation emerged as a mode for providing rehabilitative care that brought professionals closer to patients and enabled continuity of care. The present study aimed to evaluate the results of a telerehabilitation intervention for people with injuries associated with SARS-CoV-2 infection in hospital-community transitions, considering degree of dependence in performing activities of daily living, respiratory symptoms, fatigue, gait capacity, muscle strength, and anxiety and depression. A pre-post study with a non-equivalent control group was carried out with a total of 49 participants (intervention group n=24; control group n=25). The post-intervention results showed an increase in saturation, a decrease in heart rate, an improvement in the impact of post-COVID functionality, a decrease in fatigue, a decrease in perceived effort, and a decrease in depressive and anxiety symptoms. The telerehabilitation intervention, which combined educational strategies with respiratory and motor rehabilitation, helped improve global functionality and self-care, with clinical and functional impacts.

Increased incidence of acute achilles tendon ruptures in the peri-pandemic COVID era with parallels to the 2021-22 NFL season.

PURPOSE: Acute Achilles tendon ruptures (AATRs) are a common sporting injury, whether for recreational athletes or elite athletes. Prior research has shown returning to physical activity after extended periods of inactivity leads to increased rates of musculoskeletal injuries. The purpose of this study was to investigate rates of acute Achilles' tendon ruptures at a single academic institute in the peri-COVID era, with corollary to the recent NFL season. METHODS: A retrospective search was conducted using current procedural terminology to identify the total number of Achilles acute primary repair surgeries performed from years 2017 to 2021. Non-operatively managed AATRs were identified from the same electronic medical record using ICD-10 codes. NFL data were obtained from publicly available sites according to previously validated studies. RESULTS: A total of 588 patients who sustained AATRs and underwent primary surgical repair were identified, primarily men (75.7%, n = 445), with an average age of 43.22 ± 14.4 years. The number and corresponding incidence of AATR repairs per year was: 2017: n = 124 (21.1%), 2018: n = 110 (18.7%), 2019: n = 130 (22.1%), 2020: n = 86 (14.6%), 2021: n = 138 (23.5%), indicating a 7.5% decrease in rate of AATRs from 2019 to 2020, followed by an 8.9% increase in incidence from 2020 to 2021. Within the NFL, the number of AATRs resulting in an injured reserve stint increased every regular season from 2019 to 2020: n = 11 (21.2%), to 2020-2021: n = 17 (32.7%), to this past 2021-2022 season: n = 24 (46.2%). CONCLUSION: AATR surgeries seem to have increased in 2021 following a 2020 COVID pandemic-induced quarantine for recreational athletes at a single academic institution and for professional athletes in the NFL, although these results are of questionable clinical significance. This provides prognostic information when counseling patients and athletes on return to activity or sport. LEVEL OF EVIDENCE: Level IV.

Primary Cardiac Angiosarcoma With Pulmonary Metastasis in a Young Female: A Case Report and Review of Literature (preprint)

Background: Sarcomas are the most prevalent type of malignant primary cardiac tumor. Clinical presentation differs according to the size and location of the tumor and involvement  of other structures. Case presentation: In this article, we present a 38 years old lady as a case of primary cardiac angiosarcoma with a huge challenge in diagnosis and management of the disease. On the 4th of June 2020, she emergently presented to the hospital with the chief complaint of cough and tachypnea, diarrhea, and malaise, and a history of blunt chest trauma three weeks ago. Based on the presentation and transthoracic echocardiography which was compatible with cardiac tamponade, emergent pericardiocentesis was performed. The first imaging showed bilateral pleural effusion, pericardial effusion, and no significant parenchymal lung involvement, which was not compatible with rheumatologic diseases or COVID-19. Based on cardiac CT angiography and evidence of dye entrance to the peri-right atrial area, right atrial free wall rupture was suspected as the cause of the massive pericardial effusion. Following multidisciplinary consensus, she underwent cardiac surgery; in addition to the 3*3 cm right atrium free wall rupture repair, concomitant sampling from the lung nodules, lymph nodes, pericardium, and also the surrounding tissue of the right atrium ruptured defect was performed. Based on immunohistochemistry, the diagnosis was compatible with cardiac angiosarcoma with metastasis to the lung. Due to the advanced stage of the tumor, oncologists advised against chemotherapy or radiotherapy and she went through palliative care. Finally, after a 53-day ICU stay and due to right-sided heart failure, the patient unfortunately died. Conclusion: COVID-19 pandemic has brought diagnostic challenges regarding differentiating SARS-CoV-2 infection from other diagnostic entities. On the other hand, due to the rarity and fatality of primary cardiac angiosarcomas, early diagnosis and possible management seem crucial for prolonged survival. Involving cardiac angiosarcoma in the initial differential diagnosis could warrant timely diagnosis and assessment of various therapies for cure or palliative care.

Life threatening rupture of the diaphragm after Covid 19 pneumonia: a case report.

BACKGROUND: The incidence of diaphragmatic rupture is low; however, it may be life threatening. Normally caused by blunt trauma, some cases are reported after pulmonary infections with extensive coughing. Covid 19 causes pulmonary infections and pneumonia and has been associated with weakening of the diaphragm after prolonged ventilation. We present a patient who suffered from diaphragmatic rupture 2 months after recovering from a severe Covid 19 pneumonia. CASE: A 71 years old male patient presented with massive thoraco-abdominal pain and severe dyspnea. At the time of admission, the patient was diagnosed with rupture of the diaphragm and developed cardiogenic shock. Intraoperatively there was a 4 cm diameter large rupture of the diaphragm with enterothorax (transverse colon, stomach, spleen, parts of the jejunum). Avulsion of the mesenteric arteries made a segmental resection of the jejunum together with the spleen necessary. A jejuno-jejunostomy was performed and organs were replaced into the abdomen. The rupture of the diaphragm underwent primary closure with non-resorbable suture material. The patient has shown an uneventful post-operative course, fully recovered and was discharged on day 11 after surgery. CONCLUSION: Covid 19 is a disease that is known to have various effects on different organs. The diaphragm is only paid heed in case of dysfunction. Also in the setting of Covid 19 it is not known as prominent effector organ. Nevertheless its affection by coughing caused by Covid 19 can lead to life threatening complications.

Post COVID-19 pneumo-hematocele: clinical presentation and treatment pathway.

OBJECTIVES: The appearance of characteristic pulmonary lesions has been noted after COVID-19, being described as post-COVID-19 pneumo-hematocele. The aim of this study is to describe the clinical, histopathologic, and imaging features of pneumo-hematocele and to suggest a treatment algorithm for these patients. METHODS: A retrospective study was performed in patients admitted with a diagnosis of SARS-CoV2 infection from March 2020 to September 2021 who presented a pneumo-hematocele on imaging studies. Clinical and demographic variables were recorded, and CT scans were analyzed. A secondary analysis was performed to estimate the risk provided by the pneumo-hematocele diameter of developing pneumothorax. RESULTS: 37 patients were diagnosed with pneumo-hematoceles, 97.3% were males with a median age of 41 ± 13 years and 51% were smokers. The mean diameter of the pneumatocele was 6.3 ± 2.8 cm; they were more common on the subpleural surface and in the inferior lobe. Thirty patients had ruptured pneumo-hematoceles and developed pneumothorax (81.1%); a total of 26 patients required surgery (70.3%). Lesions measuring 5 cm had a high risk of rupture (OR 6.8, CI 95% 1.1-42); those measuring 3 cm were prone to this complication. For each centimeter that the pneumo-hematocele diameter increases, the OR for rupture increases 1.5. CONCLUSIONS: It appears that post-COVID-19 pneumo-hematocele occurs secondary to encapsulation of blood accumulation inside the lung, as a result of micro-capillary bleeding, with partial reabsorption of blood and subsequent air filling. We recommend surgery for patients with pneumo-hematoceles of 5 cm and those with persistent lesions of 3 cm. TRIAL REGISTRATION: Clinical Trial Registration: NCT05067881.

Iatrogenic tracheal rupture in a patient with acute respiratory distress syndrome due to SARS-CoV-2 pneumonia.

Iatrogenic tracheal rupture (ITR) is a serious complication secondary to procedures such as emergent orotracheal intubation or tracheostomy, among others. The management of ITR depends on the size, extension and location of the injury, along with the patient's respiratory status and comorbidities. The priority of treatment is to keep the airway permeable to ensure adequate ventilation. We present the case of a tracheal rupture after performing a percutaneous tracheostomy, in a patient diagnosed with severe acute respiratory distress syndrome secondary to bilateral interstitial pneumonia due to SARS-Cov-2. The issues are discussed, such as the management (conservative vs. surgical) depending on the features of the injury and the patient, in the extraordinary context that the COVID-19 pandemic has entailed.

Renal angiomyolipoma rupture in a young female with COVID-19.

While primarily a respiratory illness, infection with the novel coronavirus (COVID-19) is associated with pathologic changes in coagulation, characterized by both thromboembolic and bleeding events. We present the case of a 22-year-old female diagnosed with renal angiomyolipoma (AML) rupture 2 weeks after COVID-19 infection, ultimately requiring admission for hemorrhage control via endovascular embolization. Emergency medicine physicians should maintain a high index of suspicion for renal AML rupture and other spontaneous bleeding events in patients with recent COVID-19 infection due to a possible correlation between the two.

Numerical simulation of pulmonary airway reopening by the EOS-based multiphase lattice Boltzmann method (preprint)

The aerosol formation is associated with the rupture of the liquid plug during the pulmonary airway reopening. The fluid dynamics of this process is difficult to predict because the rupture involved complex liquid-gas transition. Equation of state (EOS) plays a key role in the thermodynamic process of liquid-gas transition. Here, we propose an EOS-based multiphase lattice Boltzmann model, in which the nonideal force is directly evaluated by EOSs. This multiphase model is used to model the pulmonary airway reopening and study aerosol formation during exhalation. The numerical model is first validated with the simulations of Fujioka et al.(2008). and the result is in reasonable agreement with their study. Furthermore, two rupture cases with and without aerosol formation are contrasted and analyzed. It is found that the injury on the epithelium in the case with aerosol formation is essentially the same that of without aerosol formation even while the pressure drop in airway increases by about 67%. Then extensive simulations are performed to investigate the effects of pressure drop, thickness of liquid plug and film on aerosol size and the mechanical stresses. The results show that aerosol size and the mechanical stresses increase as the pressure drop enlarges and thickness of liquid plug become thicken, while aerosol size and the mechanical stresses decrease as thickness of liquid film is thicken. The present multiphase model can be extended to study the generation and transmission of bioaerosols which can carry the bioparticles of influenza or coronavirus.

Anaesthetic management in a patient requiring one lung ventilation during COVID-19 pandemic.

Placement of a double-lumen tube to achieve one lung ventilation is an aerosol-generating procedure. Performing it on a patient with COVID-19 will put healthcare workers at high risk of contracting the disease. We herein report a case of its use in a patient with traumatic diaphragmatic rupture, who was also suspected to have COVID-19. This article aims to highlight the issues, it presented and ways to address them as well as the perioperative impact of personal protective equipment.

Ultrasound-based Control of Micro-Bubbles for Exosome Delivery in Treating COVID-19 Lung Damage (preprint)

The recent COVID-19 pandemic has resulted in high fatality rates, especially for patients who suffer from underlying health issues. One of the more serious symptoms exhibited from patients suffering from an acute COVID-19 infection is breathing difficulties and shortness of breath, which is largely due to the excessive fluid (cellular leakage and cytokine storm) and mucoid debris that have filled lung alveoli, and reduced the surfactant tension resulting in heavy and stiff lungs. In this paper, we propose the use of micro-bubbles filled with exosomes that can be released upon exposure to ultrasound signals as possible rescue therapy in deteriorating COVID-19 patients. Recent studies have shown that exosomes can be used to repair and treat lung damage for patients who have suffered from viral infection. We have conducted simulations to show the efficacy of the ultrasound signals that will penetrate through layers of tissues reaching the alveoli that contain the micro-bubbles. Our results have shown that ultrasound signals with low frequencies are required to oscillate and rupture the polymer-based micro-bubbles. Our proposed system can be used for patients who require immediate rescue treatments for lung damage, as well as for recovered patients who may suffer from viral relapse infection, where the micro-bubbles will remain dormant for a temporary therapeutic window until they are exposed to the ultrasound signals.

Bleeding In Head And Neck Malignancy : Institution Based Management And Review (preprint)

Introduction:Squamous cell carcinoma constitutes for >90% of head and neck cancers. Acute rupture of irradiated, large vessels is life-threatening complication. The distribution of bleeding foci is diverse and can range from internal or common carotid arteries to branches of the external carotid artery. We intend to assess the management of patients presented in our institution with such acute bleeding episodes and also review the management of carotid blowout syndrome which is an oncological emergency.Methods:Retrospective observational study of 27 cases presented in our institution with acute bleeding due to head and neck cancer for period of two years. After resuscitation and necessary consents, emergency open tracheostomy was done with universal precautions. ECA/CCA ligation was done. All the patients were started on low molecular weight heparin 8 hours post surgery. Therapeutic outcomes were assessed based on simple frequencies and proportions.Results:Of the 27 cases presented in our institution, 19 of them underwent ECA ligation while 8 of them CCA ligation for the control of active bleeding. 12 of 27 patients were receiving definitive chemoradiation of which 7 of them were ongoing. Remaining 15 patients were receiving adjuvant radiotherapy following surgery.19 patients who underwent ECA ligation, had no further bleeding episodes. 8 patients who underwent CCA ligation, had only wound related complications and none of them had neurological deficits. 11 patients were operated during covid-19 period. 4 patients turned out covid positive. None of the medical personnel contacted the infection.Conclusion:Radiotherapy is one the major contributor for CBS. Endovascular procedures can be used for local tumour bleed, threatened, impending and stable acute CBS. Surgical CCA ligation done in bleeds unsuccessful by endovascular procedure and in acute unstable CBS. ECA ligation is safe and effective method to control local tumor bleed. Surgical finesse, careful planning, adherence to universal precautions and institutional protocol can reduce Covid-19 transmission to medical personnel in this testing times.

Left Ventricular Free Wall Rupture as a Result of Delayed Presentation of an Inferior ST-Elevation Myocardial Infarction Due to Fear of COVID-19 (preprint)

BackgroundLeft ventricular free wall rupture (LVFWR) is a rare complication after myocardial infarction and usually occurs one to four days after the infarct. Over the past decade, the overall incidence of LVFWR has decreased given the advancements in reperfusion therapies. However, during the COVID-19 pandemic, there has been a significant delay in hospital presentation of patients suffering myocardial infarctions, leading to a higher incidence of mechanical complications from myocardial infarctions such as LVFWR.Case PresentationWe present a case in which a patient suffered a LVFWR as a mechanical complication from myocardial infarction due to delay in seeking care over fear of contracting COVID-19 from the medical setting. The patient had been having chest pain for a few days but refused to seek medical care due to fear of contracting COVID-19 from within the medical setting. He eventually suffered a cardiac arrest at home from a massive inferior myocardial infarction and found to be in cardiac tamponade from a left ventricular perforation. He was emergently taken to the operating room to attempt to repair the rupture but he ultimately expired on the operating table.ConclusionsThe occurrence of LVFWR has been on a more significant rise over the course of the COVID-19 pandemic as patients delay seeking care over fear of contracting COVID-19 from within the medical setting. Clinicians should consider mechanical complications of MI when patients present as an out-of-hospital cardiac arrest, particularly during the COVID-19 pandemic, as delay in seeking care is often the exacerbating factor. 

TAE Combined with Microwave Ablation in the Treatment of Rare Giant Hepatic Hemangioma:Case Report and Literature Review (preprint)

Background: hepatic hemangioma is the most common benign tumor of the liver. However, patients with large hemangiomas that cause compression symptoms or that are at risk of rupture may need further intervention. It is necessary to explore additional minimally invasive and personalized treatment options.Case presentation: A 47-year-old female was diagnosed with right hepatic hemangioma for more than 10 years. Abdominal contrast-enhanced CT and CEUS revealed that there was a large hemangioma in the right liver, with a size of approximately 95x97x117 mm. Due to the patient's refusal of surgical treatment, hepatic artery embolization was performed in the first stage, then after 25 days of liver protection treatment, the liver function indexes decreased to normal levels. Then, B-ultrasound-guided microwave ablation of the giant hepatic hemangioma was performed. Ten days after the surgery, hepatobiliary ultrasonography showed that the hemangioma of the right liver was smaller than the previous size (the volume was reduced by approximately 30%). Then the patient was discharged from the hospital, and CT suggested that the hepatic hemangioma is significantly smaller two months after discharge. Because of COVID-19, the patient's CT examination was delayed.Conclusions: TAE combined with microwave ablation is a safe and effective minimally invasive treatment for hepatic hemangioma.