Key issues in diagnosing and treating acute aortic syndromes: results from the metropolitan area of Bologna network

Background: Survival of patients with Acute Aortic Syndrome (AAS) may relate to the speed of diagnosis. Diagnostic delay is exacerbated by non classical presentations such as myocardial ischemia or acute heart failure (AHF). However little is known about clinical implications and pathophysiological mechanisms of Troponin T elevation and AHF in AAS. Methods and Results: Data were collected from a prospective metropolitan AAS registry (398 patients diagnosed between 2000 and 2013). Troponin T values (either standard or high sensitivity assay, HS) were available in 248 patients (60%) of the registry population; the overall frequency of troponin positivity was 28% (ranging from 16% to 54%, using standard or HS assay respectively, p = 0.001). Troponin positivity was associated with a twofold increased risk of long in-hospital diagnostic time (OR 1.92, 95% CI 1.05-3.52, p = 0.03), but not with in-hospital mortality. The combination of positive troponin and ACS-like ECG abnormalities resulted in a significantly increased risk of inappropriate therapy due to a misdiagnosis of ACS (OR 2.48, 95% CI 1.12-5.54, p = 0.02). Patients with AHF were identified by the presence of dyspnea as presentation symptom or radiological signs of pulmonary congestion or cardiogenic shock. The overall frequency of AHF was 28 % (32% type A vs. 20% type B AAS, p = 0.01). AHF was due to a variety of pathophysiological mechanisms including cardiac tamponade (26%), aortic regurgitation (25%), myocardial ischemia (17%), hypertensive crisis (10%). AHF was associated with increased surgical delay and with increased risk of in-hospital death (adjusted OR 1.97 95% CI1.13-3.37,p=0.01). Conclusions: Troponin positivity (particularly HS) was a frequent finding in AAS. Abnormal troponin values were strongly associated with ACS-like ECG findings, in-hospital diagnostic delay, and inappropriate therapy. AHF was associated with increased surgical delay and was an independent predictor of in-hospital mortality.

Paleosol-based stratigraphy of late Quaternary deposits from the Po basin, between Bologna and the Po river (Northern Italy)

Stratigraphic studies carried out over the last decades in Italy and elsewhere testify a growing interest in Quaternary deposits and in the influence of climate change on their architecture. The subsurface of the Po Plain, in its topmost portion, is made up of alluvial deposits organized in depositional cycles at different scales. This PhD thesis provides millennial-scale stratigraphic reconstruction of the Late Pleistocene-Holocene deposits beneath the southern Po Plain, based on basin-scale correlation of laterally-extensive buried soil horizons. Far from the aim of characterizing palaeosols from a mineralogical and geochemical point of view, we focused on the physical and stratigraphic significance of these horizons. In the Bologna urban area, which hosts an abundance of stratigraphic data, the correlation between seventeen continuously-cored boreholes led to the identification of five vertically-stacked palaeosol-bounded sequences within the 14C time window. In a wide portion of the alluvial plain north of Bologna, far away from the Apenninic margin and from the Po River, where subsurface stratigraphic architecture is dominated by markedly lenticular sediment bodies, palaeosols revealed to be the only stratigraphic marker of remarkable lateral continuity. These horizons are characterized by peculiar resistance values, which make them easily identifiable via pocket penetration tests. Palaeosols reveal specific geometric relationships with the associated alluvial facies associations, allowing reliable estimates of soil development as a function of alluvial dynamics. With the aid of sixty new radiocarbon dates, a reliable age attribution and likely time intervals of exposure were assigned to each palaeosol. Vertically-stacked palaeosols delimitate short-term depositional cycles, likely related to the major episodes of climatic change of the last 40 ky. Through integration of stratigraphic data with 750 archaeological reports from the Bologna area, the impact of human settlements on depositional and pedogenic processes during the late Holocene was investigated.

Integrating new and traditional approaches for the estimate of slip-rates of active faults: examples from the Mw 6.3, 2009 L’Aquila earthquake area, Central Italy

This thesis is based on the integration of traditional and innovative approaches aimed at improving the normal faults seimogenic identification and characterization, focusing mainly on slip-rate estimate as a measure of the fault activity. The L’Aquila Mw 6.3 April 6, 2009 earthquake causative fault, namely the Paganica - San Demetrio fault system (PSDFS), was used as a test site. We developed a multidisciplinary and scale‐based strategy consisting of paleoseismological investigations, detailed geomorphological and geological field studies, as well as shallow geophysical imaging and an innovative application of physical properties measurements. We produced a detailed geomorphological and geological map of the PSDFS, defining its tectonic style, arrangement, kinematics, extent, geometry and internal complexities. The PSDFS is a 19 km-long tectonic structure, characterized by a complex structural setting and arranged in two main sectors: the Paganica sector to the NW, characterized by a narrow deformation zone, and the San Demetrio sector to SE, where the strain is accommodated by several tectonic structures, exhuming and dissecting a wide Quaternary basin, suggesting the occurrence of strain migration through time. The integration of all the fault displacement data and age constraints (radiocarbon dating, optically stimulated luminescence (OSL) and tephrochronology) helped in calculating an average Quaternary slip-rate representative for the PSDFS of 0.27 - 0.48 mm/yr. On the basis of its length (ca. 20 km) and slip per event (up to 0.8 m) we also estimated a max expected Magnitude of 6.3-6.8 for this fault. All these topics have a significant implication in terms of surface faulting hazard in the area and may contribute also to the understanding of the PSDFS seismic behavior and of the local seismic hazard.

Fault delineation and stress orientations from the analysis of background, low magnitude seismicity in Southern Apennines (Italy)

The aim of this work was to show that refined analyses of background, low magnitude seismicity allow to delineate the main active faults and to accurately estimate the directions of the regional tectonic stress that characterize the Southern Apennines (Italy), a structurally complex area with high seismic potential. Thanks the presence in the area of an integrated dense and wide dynamic network, was possible to analyzed an high quality microearthquake data-set consisting of 1312 events that occurred from August 2005 to April 2011 by integrating the data recorded at 42 seismic stations of various networks. The refined seismicity location and focal mechanisms well delineate a system of NW-SE striking normal faults along the Apenninic chain and an approximately E-W oriented, strike-slip fault, transversely cutting the belt. The seismicity along the chain does not occur on a single fault but in a volume, delimited by the faults activated during the 1980 Irpinia M 6.9 earthquake, on sub-parallel predominant normal faults. Results show that the recent low magnitude earthquakes belongs to the background seismicity and they are likely generated along the major fault segments activated during the most recent earthquakes, suggesting that they are still active today thirty years after the mainshock occurrences. In this sense, this study gives a new perspective to the application of the high quality records of low magnitude background seismicity for the identification and characterization of active fault systems. The analysis of the stress tensor inversion provides two equivalent models to explain the microearthquake generation along both the NW-SE striking normal faults and the E- W oriented fault with a dominant dextral strike-slip motion, but having different geological interpretations. We suggest that the NW-SE-striking Africa-Eurasia convergence acts in the background of all these structures, playing a primary and unifying role in the seismotectonics of the whole region.