Shallow magma transfer is difficult to detect at poorly monitored volcanoes. Magma transfer before the last 1538 eruption at Campi Flegrei caldera (Italy) was exceptionally tracked using historical, ...archeological, and geological data. Here, we extend that data set to 1650 to uncover any magma transfer during post‐eruptive subsidence. Results show two post‐eruptive subsidence phases, separated by a previously undocumented uplift during 1540–1582. Uplift highlights the pressurization of the central (∼3.5 km depth) and peripheral (∼1 km depth) pre‐eruptive sources, suggesting an aborted eruption. The subsidence events mainly require the depressurization of the central source and pressurization of a deeper magmatic layer (∼8 km depth). Therefore, despite the overall post‐eruptive deflation, after 1538 the deeper reservoir experienced continuous magma supply, with magma almost erupting between 1540 and 1582, challenging the common assumption of post‐eruptive deflation. This underlies the importance of monitoring the deeper magmatic systems, also after eruptions, to properly assess their eruptive potential.
Plain Language Summary
Today, volcanic activity is monitored by satellite and ground networks. However, very little is known about the pre‐ and post‐eruptive behavior of volcanoes before the instrumental era. Here, we present a unique set of archeological records related to the elevation changes at Campi Flegrei caldera (Italy) during 1515–1650, mainly focusing on its behavior after the last 1538 eruption at Monte Nuovo. After the eruption, subsidence occurred from 1538 to 1540, followed, from 1540 to 1582, by a previously unreported uplift; the latter was followed by renewed subsidence until 1650 at least. Modeling the sources responsible for the deformation, we find that, despite the depressurization of shallow sources, after 1538, a deeper magmatic layer (∼8 km depth) experienced continuous magma supply, with magma almost erupting between 1540 and 1582. This questions the common notion of post‐1538 deflation at Campi Flegrei, where the depressurization of the shallower sources masks the pressurization of the deeper magmatic system for more than a century.
Key Points
20 archeological sites at Campi Flegrei show two post‐1538 eruption subsidence phases, separated by an undocumented uplift in 1540–1582
During 1540–1582, a central sill‐like source (∼3.5 km depth) transfers magma below Monte Nuovo, representing an aborted eruption
From 1538 to 1650 a deeper magmatic layer (∼8 km depth) experienced continuous magma supply, also during caldera subsidence
The long-term mortality of patients with myocardial infarction and nonobstructed coronary arteries (MINOCA) remains poorly defined. This study aimed to determine the long-term mortality of patients ...with MINOCA and to identify potential prognostic determinants of long-term outcome.
We searched PubMed, EMBASE, and Cochrane databases and reviewed cited references up to December 31, 2018 to identify studies with >6 months’ follow-up data.
We selected 44 studies including 36,932 patients (20,052 women and 16,880 men). During a median follow-up of 25 months (interquartile range: 23-39 months), 1409 patients had died (3.8%). Overall, annual mortality rate was 2.0% (95% confidence interval CI: 1.5% to 2.4%), with significant heterogeneity (I2 = 80%, P < .001). Meta-analysis of the 26 studies comparing patients with MINOCA with those with myocardial infarction and obstructive coronary artery disease showed that annual rates of long-term total mortality were 2.2% (95% CI: 1.7% to 2.7%) and 5.0% (95% CI: 4.1% to 5,9%), respectively, with a significant difference between the two groups (relative risk: 0.60, 95% CI: 0.46 to 0.78, P < .001). Meta-regression analysis demonstrated that normal ejection fraction (P ≤ .0001) and normal coronary arteries at angiography (P = .004) were inversely related to long-term mortality, whereas use of beta-blockers during follow-up (P = .010) and ST depression on the admission electrocardiogram (P = .016) were directly related with worse outcome.
The long-term mortality after MINOCA is lower than that in patients with myocardial infarction and obstructive coronary artery disease, but it is not trivial. Reduced ejection fraction, nonobstructive coronary artery disease, use of beta-blockers during follow up and ST depression on the admission electrocardiogram are significant predictors of long-term prognosis.
Abstract
Aims
Low-grade endotoxaemia is detectable in human circulation but its role in thrombosis is still unclear.
Methods and results
We measured serum lipopolysaccharide (LPS) concentration, ...soluble P-selectin (sP-selectin), a marker of platelet activation, and zonulin, a marker of gut permeability, in peripheral circulation, coronary thrombi, and intracoronary blood of patients with ST-elevation myocardial infarction (STEMI, n = 50) and stable angina (SA) (n = 50), respectively, and in controls (n = 50). Experimental study was carried out in mice to assess if Escherichia coli-LPS (E. coli-LPS) possess thrombotic property. Coronary thrombi from STEMI showed higher concentrations of LPS, sP-selectin vs. intracoronary blood of SA and peripheral blood of controls (P < 0.001). Zonulin was higher in STEMI compared to the other two groups 4.57 (3.34–5.22); 2.56 (0.41–4.36); 1.95 (1.22–2.65) ng/mL; P < 0.001 and correlated with LPS (Rs = 0.585; P < 0.001). Escherichia coli DNA was positive in 34% of STEMI vs. 12% of SA and 4% of controls (P < 0.001). In a subgroup of 12 STEMI, immunohistochemical analysis of coronary thrombi showed positivity for leucocyte Toll-like receptor 4 (TLR4), cathepsin G, and LPS from E. coli in 100%, 80%, and 25% of samples, respectively. E. coli-LPS injected in mice to reach LPS concentrations like those detected in coronary thrombi was associated with enhanced artery thrombosis and platelet activation, an effect blunted by TLR4 inhibitor co-administration. In vitro study demonstrated that LPS from E. coli enhanced platelet aggregation via TLR4-mediated leucocyte cathepsin G activation.
Conclusion
ST-elevation myocardial infarction patients disclose an enhanced gut permeability that results in LPS translocation in human circulation and eventually thrombus growth at site of artery lesion via leucocyte–platelet interaction.
A set of about 25,000 residential reinforced concrete (RC) buildings has been investigated in this study to define fragility curves. The sample originates from a wide database, reported in the online ...Da.D.O. (
Database of Observed Damage
) platform, related to about 320,000 buildings inspected in the aftermath of the nine most devastating earthquakes occurred in Italy between 1976 and 2012 (Friuli 1976; Irpinia 1980; Abruzzo 1984; Umbria-Marche 1997; Pollino 1998; Molise 2002; Emilia 2003; L’Aquila 2009; Emilia 2012). The coherence of data has been guaranteed by a thorough critical analysis among all databases. Then a refined procedure dealing with the completeness of survey campaigns at Municipality level has been applied to avoid biases in fragility fitting. The final sample is then subdivided in different structural design types, determined as a function of the evolution of seismic classification for investigated areas and the sequence of technical codes enforced through the years. The available shakemaps in terms of PGA values, derived by National Institute of Geophysics and Volcanology, are used to characterize seismic ground motion at buildings’ site. The opportunity of enriching the sample of data with undamaged supplementary buildings, located in areas very far from epicenter but missing in the database (only because survey inspections were not required) is deeply discussed and investigated. Finally, according to such a set of data, different classes of buildings representative of existing RC building portfolio in Italy are defined and relevant vulnerability and fragility curves are determined.
Abstract Spironolactone was first developed over 50 years ago as a potent mineralocorticoid receptor antagonist with undesirable side effects; it was followed a decade ago by eplerenone, which is ...less potent but much more mineralocorticoid receptor-specific. From a marginal role as a potassium-sparing diuretic, spironolactone has been shown to be an extraordinarily effective adjunctive agent in the treatment of progressive heart failure. Also, spironolactone is safe and protective in arterial hypertension, particularly in patients with so-called resistant hypertension. Eplerenone is the second oral aldosterone antagonist available for the treatment of arterial hypertension and heart failure. Treatment with eplerenone has been associated with decreased blood pressure and improved survival for patients with heart failure and reduced left ventricular ejection fraction. Due to the selectivity of eplerenone for the aldosterone receptor, severe adverse effects such as gynecomastia and vaginal bleeding seem to be less likely in patients who take eplerenone than in those who take spironolactone. The most common and potentially dangerous side effect of spironolactone – hyperkalemia – is also observed with eplerenone but the findings from clinical trials do not indicate more hyperkalemia induced drug withdrawals. Treatment with eplerenone should be initiated at a dosage of 25 mg once daily and titrated to a target dosage of 50 mg once daily preferably within 4 weeks. Serum potassium levels and renal function should be assessed prior to initiating eplerenone therapy, and periodic monitoring is recommended, especially in patients at high risk of developing hyperkalemia.
Knowing the "point of view" of the immune system is essential to understand the characteristic of a pandemic, such as that generated by the Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV)-2, ...responsible for the Coronavirus Disease (COVID)-19. In this review, we will discuss the general host/pathogen interactions dictating protective immune response or immunopathology, addressing the role of immunity or immunopathology in influencing the clinical infection outcome, and debate the potential immunoprophylactic and immunotherapy strategies required to fight the virus infection.
The purpose of this study is the analysis of vulnerability trends, with particular emphasis to the evolution of the seismic behaviour of masonry buildings over the years due to the improvements in ...construction practices and to the enhancement of building materials over the years, also related to the subsequent enactment of seismic prescriptions. To this aim, residential masonry buildings damaged after the 2009 L'Aquila earthquake are considered, coming from the online platform Da.D.O. (
Database di Danno Osservato
, Database of Observed Damage) recently released from the Italian Department of Civil Protection. General features of all the parameters available from the original database are thoroughly analysed, a selection of which is used for vulnerability analysis, namely the period of construction and the design type, the presence of structural interventions, the type of horizontal structure. Vulnerability curves are obtained through an optimization technique, minimizing the deviation between observed and predicted damage. PGA from ShakeMap is used for ground motion characterization. Damage levels defined according to the European Macroseismic Scale are considered, obtained from the observed damage for vertical structures collected during the inspections. Vulnerability curves are firstly obtained as a function of period of construction and horizontal structural types, limited to the irregular layout and bad quality vertical type only, highlighting their clear influence on seismic behaviour. Lastly, the effectiveness of retrofit intervention is evaluated comparing the vulnerability curves for strengthened masonry buildings compared to those not subjected to any retrofit interventions.
The Department of Civil Protection (DPC), in compliance with the EU decision 1313/2013 and at the request of the Sendai Framework for Disaster Risk Reduction 2015–2030 to update the disaster risk ...assessments by various countries, released the latest National Risk Assessment for Italy at the end of 2018. Specifically, as regards the seismic risk assessment, six research units belonging to two centres of competence of the DPC collaborated under its guidance to update the risk maps of the Italian residential heritage. This extensive collaboration complied with the recent Italian code for Civil Protection, which requires a broad scientific consensus for risk assessment. During this research activity, six fragility models were developed, according to some common criteria (four for masonry buildings and two for RC buildings). These models were then implemented by the DPC for the definition of the national seismic risk. Within this context, the aim of this paper is to evaluate the risk results provided by these models, compare their features, and assess and validate their prediction capabilities. In particular, this paper shows the comparison of predicted and observed damage scenarios and consequences on building stock and the population of two seismic events, i.e. L’Aquila 2009 and Amatrice 2016. Furthermore, the paper provides some interesting damage and risk predictions at a national level. Overall, the forecasts and comparisons made in this study demonstrate the validity of the approach adopted by the DPC for the assessment of national seismic risk.
Abstract Takotsubo syndrome is a relatively frequent clinical entity presenting typically as an acute coronary syndrome in the absence of obstructive coronary artery disease and characterized ...angiographically by transient left ventricular systolic dysfunction, sparing the basal segments of the left ventricle (“apical ballooning”). Takotsubo syndrome characteristically affects peri- or postmenopausal women, albeit recent series show that men also are at risk. Takotsubo syndrome is characteristically triggered by severe emotional or physical stress, which suggests a pathogenic role for increased sympathetic activity leading to myocardial perfusion abnormalities and ventricular dysfunction. The reasons why severe emotional and physical stress result in the development of takotsubo syndrome in certain individuals but not others is still a matter of speculation, but strongly suggests the existence of predisposing factors/mechanisms in certain subjects. The present article reviews the different factors that can play a role in the development of takotsubo syndrome in different patients. We propose that triggers (ie, emotional stressors, physical stressors, iatrogenic stressors, and neurologic triggers), pathogenic mechanisms (ie, increased catecholamine levels, coronary vasomotor abnormalities leading to myocardial ischemia), and predisposing factors (ie, cardiovascular risk factors, endothelial dysfunction, comorbidities) all interact in a complex fashion and possibly differently in different patients to cause takotsubo syndrome. Identifying these factors may help in preventing and managing the condition more effectively.
Earthquakes that have occurred in the last twenty years in the Mediterranean area have had significant economic and social impacts. Most of the economic losses of reinforced concrete (RC) frames was ...due to nonstructural component damage, particularly masonry infills and partitions. Therefore, the seismic behaviour of masonry infills should be reliably characterized. The main goals of this study for a more reliable loss estimation for infilled RC frames are: (i) the analysis of the inter-story drift ratio (IDR) capacity at given damage states (DSs) with the aim to define drift-based fragility functions and (ii) analyse direct losses due to infill damage following seismic events. First, a database of experimental tests performed on 1-bay, 1-story scaled RC frames infilled with clay bricks or concrete blocks is collected. Drift-based fragility curves are obtained, which depend on the infill brick materials and properties. Then, the drift capacity threshold at each DS is correlated to the in-plane response of the infill panel to directly quantify the relationship that exists among them. The influence of openings on drift capacities is also evaluated. Then, seismic losses related to infills are computed, providing expected monetary losses depending on the infill typology. The required reparation activities and their costs are also listed. The bearing of each activity and cost at each DS is explicitly evaluated. Additionally, loss functions that directly depend on IDR demand are provided, thus fusing together the damage analysis and loss analysis. Finally, a simplified formulation for loss functions is proposed for a simple, practice-oriented loss calculation.
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