In the geological record, high-frequency sequences at the scale of fourth-order and lower rank stratigraphic frameworks are usually stacked to compose higher rank (lower frequency) systems tracts ...(i.e., sequence sets) along dip-oriented transects. Higher rank transgressive, normal regressive (highstand and/or lowstand) and falling-stage systems tracts are defined by retrogradational, upstepping progradational, and downstepping progradational stacking patterns of component high-frequency sequences, respectively. However, these stacking patterns may vary markedly along depositional strike due to lateral changes in the rates of accommodation and sedimentation, resulting in the coeval deposition of different types of higher rank systems tracts. In this case, surfaces bounding such systems tracts are diachronous along depositional strike. Moreover, if the high-frequency sequences that compose the lower frequency systems tracts are laterally continuous, the higher rank bounding surfaces are discontinuous along depositional strike, consisting of a series of stepped surfaces that can be observed in high-resolution studies. These aspects have important implications for petroleum exploration and need to be considered in high-resolution sequence stratigraphic analysis.
•The variability of vertical and lateral arrangements of high-frequency sequences is explored.•The stacking pattern of high-frequency sequences defines higher rank systems tracts.•Different systems tracts along the depositional strike can occur.•The boundaries of systems tracts can be diachronous and stepped along the depositional strike.
Mud volcanoes (MVs) are abundant along the eastern Mediterranean subduction zones, recording mud breccia extrusion over long timescales (10
6
years), but to date relatively few have been recognised ...in the northern Ionian Sea on the Calabrian accretionary prism (CAP). In the present study, the seafloor distribution and recent activity of MVs is investigated across a 35,600 km
2
sector of the CAP using a regional acoustic dataset (multibeam bathymetric and backscatter imagery, integrated with subbottom profiles) locally ground-truthed by sediment cores. A total of 54 MVs are identified across water depths of 150–2,750 m using up to four geophysical criteria: distinctive morphology, high backscatter, unstratified subbottom facies and, in one case, a hydroacoustic flare. Fourteen MVs are identified from 3–4 criteria, of which five have been previously proven by cores containing mud breccia beneath up to 1.6 m of hemipelagic sediments (Madonna dello Ionio MVs 1–3, Pythagoras MV and the newly named Sartori MV), while nine others are identified for the first time (Athena, Catanzaro, Cerere, Diana, Giunone, Minerva, ‘right foot’, Venere 1 and 2). Forty other as yet unnamed MVs are inferred from 1–2 geophysical criteria (three from distinctive morphology alone). All but one possible MV lie on the inner plateau of the CAP, landwards of the Calabrian Escarpment in a zone up to 120 km wide that includes the inner pre-Messinian wedge and the fore-arc basins, where they are interpreted to record the ascent from depth of overpressured fluids that interacted with tectonic structures and with evaporitic or shale seals within the fore-arc basins. The rise of fluids may have been triggered by post-Messinian out-of-sequence tectonism that affected the entire pre-Messinian prism, but Plio-Quaternary sedimentation rates and depositional styles support the inference that significant mud volcanism has taken place only on the inner plateau. Sedimentation rates across the CAP applied to a 12 khz sonar detection depth of 225 cm imply that all MVs with backscatter signatures (50 of 54) have erupted mud breccias within the last 56 ka, and within the last 12.5 ka in the fore-arc basins. Ages of eruption estimated from the depth of cored mud breccias at five MVs, and a seismo-stratigraphic relationship at a sixth, indicate episodes at the last glacial maximum ca. 20 ka BP and during the postglacial period. Eruptive episodes within the Calabrian MV province constitute recurrent geohazards, separated by longer periods of quiescent (subdued) fluid seepage that are likely to support gas hydrate formation and chemosynthetic ecosystems.
Myotonic dystrophy is a hereditary disorder with systemic involvement. The Italian Neuro-Cardiology Network-"Rete delle Neurocardiologie" (INCN-RNC) is a unique collaborative experience involving ...neurology units combined with cardio-arrhythmology units. The INCN facilitates the creation of integrated neuro-cardiac teams in Neuromuscular Disease Centers for the management of cardiovascular involvement in the treatment of myotonic dystrophy type 1 (MD1).
To assess the proportion and long-term outcomes of patients with idiopathic dilated cardiomyopathy and potential indications for implantable cardioverter-defibrillator before and after optimization ...of medical treatment, 503 consecutive patients with idiopathic dilated cardiomyopathy were evaluated from 1988 to 2006. A total of 245 patients (49%) satisfied the “Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) criteria,” defined as a left ventricular ejection fraction of ≤0.35 and New York Heart Association (NYHA) class II-III on registration. Among these, 162 (group A) were re-evaluated 5.4 ± 2 months later with concurrent β-blockers and angiotensin-converting enzyme inhibitor use. Of the 162 patients, 50 (31%) still had “SCD-HeFT criteria” (group A1), 109 (67%) had an improved left ventricular ejection fraction and/or New York Heart Association class (group A2), and 3 (2%) were in NYHA class IV. Of the 227 patients without baseline “SCD-HeFT criteria” (left ventricular ejection fraction >0.35 or NYHA class I), 125 were evaluated after 5.5 ± 2 months. Of these 227 patients, 13 (10%) developed “SCD-HeFT criteria” (group B1), 111 (89%) remained without “SCD-HeFT criteria” (group B2), and 1 (1%) had worsened to NYHA class IV. The 10-year mortality/heart transplantation and sudden death/sustained ventricular arrhythmia rate was 57% and 37% in group A1, 23% and 20% in group A2 (p <0.001 for mortality/heart transplantation and p = 0.014 for sudden death/sustained ventricular arrhythmia vs group A1), 45% and 41% in group B1 (p = NS vs group A1), 16% and 14% in group B2 (p = NS vs group A2), respectively. In conclusion, two thirds of patients with idiopathic dilated cardiomyopathy and “SCD-HeFT criteria” at presentation did not maintain implantable cardioverter-defibrillator indications 3 to 9 months later with optimal medical therapy. Their long-term outcome was excellent, similar to that observed for patients who had never met the “SCD-HeFT criteria.”
The Southern Apennines (SA) are part of the Apennine-Maghrebian chain, a segment of the circum-Mediterranean Alpine orogenic system. It is a NE-verging fold-and-thrust belt with an about ...N150°-striking axis developed since the late Oligocene-early Miocene. The Geological Map at 1:25,000 scale of the Pergola-Melandro basin area, presents a sector of the axial zone of the SA which represents a key area to reconstruct the tectonic evolution of this chain. The map describes the complex structural and stratigraphic relationships between the three main tectonic units forming this sector of the SA: (1) the carbonate slope succession of the Maddalena Mts Unit, interpreted as the eastern boundary of the Apennine carbonate Platform; (2) the Lagonegro Unit, resulting from the deformation of the homonym pelagic basin; (3) the strongly deformed Argille Variegate Group sandwiched between the two previous units. Three main contractional tectonic stages, occurring from middle Miocene to Pliocene, have been recognized. Since Pliocene times low-angle extensional tectonic contacts and tectono-gravitative detachments affected the tectonic pile.
This book is a practical guide to the differential diagnosis and treatment of patients presenting in the Emergency Department with syncope or arrhythmias, including bradyarrhythmias, atrial ...fibrillation, narrow and wide QRS tachycardias. In addition, clear advice is provided on the management of patients with cardiac devices and possible dysfunction, electrical storm, or a requirement for urgent surgery. For each topic, a literature review of epidemiology, physiopathology, differential diagnosis, and treatment is conducted. Furthermore, practical suggestions are offered for short-term management, e.g., regarding the decision on when and where to hospitalize the patient; these proposals do not replace but rather summarize or integrate the current guidelines. The book is designed both for emergency physicians and cardiologists, who will be the first to evaluate and treat patients with arrhythmias or potentially arrhythmic problems in the emergency setting. It will also be a useful textbook for students and residents in Cardiology and Emergency Medicine.
The sequence stratigraphic architecture includes a complex array of stratal geometries with different degrees of stratigraphic significance. The ‘non-unique’ variability of the sequence stratigraphic ...framework (i.e., stratal geometries which are not diagnostic for the definition of systems tracts and bounding surfaces) is irrelevant to the workflow of sequence stratigraphy. What is relevant is the observation of the ‘unique’ stratal geometries that are diagnostic for the definition of units and surfaces of sequence stratigraphy. In downstream-controlled settings, these unique stratal stacking patterns relate to the forced regressive, normal regressive, and transgressive shoreline trajectories. Multiple controls interact during the formation of each type of stacking pattern, including accommodation, sediment supply, and the energy of the sediment-transport agents. This interplay explains the non-unique variability, but does not change the unique criteria that afford a consistent application of sequence stratigraphy. The distinction between unique and non-unique stratal geometries is critical to the sequence stratigraphic methodology. Failure to rationalize the non-unique variability within the context of unique stratal geometries is counterproductive, and obscures the simple workflow of sequence stratigraphy. This is the case with uncalibrated numerical modeling, which may overemphasize non-unique or even unrealistic stratigraphic scenarios. While useful to test the possible controls on stratigraphic architecture, modeling requires validation with real data, and plays no role in the sequence stratigraphic methodology.
Aims
Although increasingly recognized as a distinct pathological entity, left bundle branch block‐induced cardiomyopathy (LBBB‐ICMP) is not included among the possible aetiologies of acquired dilated ...cardiomyopathies (DCM). While diagnostic criteria have been proposed, its recognition remains principally retrospective, in the presence of clinical and instrumental red flags. We aimed to assess the prevalence and clinical and instrumental features of LBBB‐ICMP in a large cohort of patients with DCM.
Methods and results
We analysed a cohort of 242 DCM patients from a two‐centre registry. Inclusion criteria were age > 18, non‐ischaemic or non‐valvular DCM, and LBBB on electrocardiogram. LBBB‐ICMP was defined according to previously proposed diagnostic criteria: (i) neither family history nor clinically identifiable potential causes for DCM; (ii) negative genetic testing; (iii) echocardiographic features including non‐severe chamber dilation, normal absolute and relative wall thickness, marked dyssynchrony, and normal right ventricular function; and (iv) absence of late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR). From the entire cohort, we identified 30 subjects (similar in terms of New York Heart Association class I or II in 80% vs. 75%, P = 0.56; QRS width of 150 ± 22 vs. 151 ± 24 ms, P = 0.82; and cardiac remodelling of baseline end‐diastolic diameter 66 ± 8 vs. 65 ± 10 mm, P = 0.53) with a comprehensive dataset including CMR and genetic testing, required to verify the presence of the diagnostic criteria proposed for LBBB‐ICMP. The main characteristics of this subgroup were 73% males, age 45 ± 13 years, left ventricular ejection fraction (LVEF) 30 ± 10%, LGE in 38% of patients, and QRS complex of 150 ± 22 ms. Patients were under guideline‐directed medical therapy, and 57% of them were treated with cardiac resynchronization therapy (CRT). Two patients (6.67%, 50% males, age 53 ± 13 years) fulfilled the diagnostic criteria proposed for LBBB‐ICMP. After a follow‐up of 44 (12–76) months, LVEF was normal and QRS width significantly reduced (from 154 ± 25 to 116 ± 52 ms) in patients with LBBB‐ICMP. Both patients were under optimal medical treatment, and one was implanted with CRT‐D. Neither of the two patients experienced death, malignant ventricular arrhythmia, or heart failure hospitalization at follow‐up.
Conclusions
Left bundle branch block‐induced cardiomyopathy emerges as a distinct pathological entity, promptly identifiable in a minority but not negligible proportion of patients with newly diagnosed DCM and LBBB, using a series of diagnostic criteria including CMR and genetic testing. Further studies are needed to better elucidate the clinical course of LBBB‐ICMP.
There are no parameters predicting the individual probability of “full response” to cardiac resynchronization therapy (CRT). The aim of this work was to find prognostic factors of full clinical and ...echocardiographic responses (i.e., ≥50% left ventricular ejection fraction LVEF and New York Heart Association class I) after 1 year of CRT. This was a prospective follow-up study that involved 2 hospitals. Patients (n = 75) with advanced heart failure (64 ± 9 years of age, 87% men, LVEF 24 ± 7%) who received CRT were followed for 17 ± 9 months. Univariate and multivariate regression analyses were used to identify predictors of full CRT response. A nomogram predicting the individual probability of full CRT response during follow-up was calculated. There were 13 patients with restoration of normal LVEF versus 62 without (mean LVEF 56% ± 5% vs 31% ± 8%, respectively, p <0.001). Predictors of full response included cause of heart disease, baseline QRS width, and degree of QRS shortening in response to CRT. Patients with nonischemic heart disease, baseline QRS width ≤150 ms, and QRS shortening ≥40 ms in response to CRT had a >75% probability of restoration of normal LVEF. In conclusion, our nomogram using a combination of cause, baseline QRS width, and degree of QRS shortening in response to CRT allows assessment of individual probability of full response. This observation awaits further confirmation from larger series.
The Serra Mulara canyon is a middle Pleistocene submarine canyon developed along the Ionian coast of Calabria, southern Italy, now exposed on land due to the long-term regional uplift of the area. ...New data have allowed recognizing three depositional sequences in the upper part of the succession, probably glacio-eustatic in origin, documenting an evolution of depositional systems that reflect the emergence of the canyon. Sequence 1 shows a rapid shift from turbidites and hemipelagites accumulated in the upper part of the canyon fill to forced regressive deltaic deposits, which reflect a marked shallowing of the area. Sequence 2 consists of estuarine transgressive and deltaic highstand deposits, whereas Sequence 3 is fully composed of fluvial deposits, testifying the emergence of the area. The upper part of the Serra Mulara succession is an useful example showing the transition from submarine canyon to continental settings, a situation that is not adequately documented in the literature, and is also relevant to better reconstruct the timing of the uplift of this part of Calabria.
•An unusual example documenting the emergence of a submarine canyon is illustrated.•The upward shift from relatively deep-water sedimentation to deltaic, estuarine and then fluvial sedimentation is shown.•New information on the emergence of the Crotone Basin is provided.
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