Earthquake-triggered landslides along the Hyblean-Malta Escarpment (off Augusta, eastern Sicily, Italy) – assessment of the related tsunamigenic potential

Abstract. Eastern Sicily is affected by earthquakes and tsunamis of local and remote origin, which is known through numerous historical chronicles. Recent studies have put emphasis on the role of submarine landslides as the direct cause of the main local tsunamis, envisaging that earthquakes (in 1693 and 1908) did produce a tsunami, but also that they triggered mass failures that were able to generate an even larger tsunami. The debate is still open, and though no general consensus has been found among scientists so far, this research had the merit to attract attention on possible generation of tsunamis by landslides off Sicily. In this paper we investigate the tsunami potential of mass failures along one sector of the Hyblean-Malta Escarpment (HME). facing Augusta. The HME is the main offshore geological structure of the region running almost parallel to the coast, off eastern Sicily. Here, bottom morphology and slope steepness favour soil failures. In our work we study slope stability under seismic load along a number of HME transects by using the Minimun Lithostatic Deviation (MLD) method, which is based on the limit-equilibrium theory. The main goal is to identify sectors of the HME that could be unstable under the effect of realistic earthquakes. We estimate the possible landslide volume and use it as input for numerical codes to simulate the landslide motion and the consequent tsunami. This is an important step for the assessment of the tsunami hazard in eastern Sicily and for local tsunami mitigation policies. It is also important in view of tsunami warning system since it can help to identify the minimum earthquake magnitude capable of triggering destructive tsunamis induced by landslides, and therefore to set up appropriate knowledge-based criteria to launch alert to the population

Landslide deposits

Eastern Sicily is affected by earthquakes and tsunamis of local and remote origin, which is known through numerous historical chronicles. Recent studies have put emphasis on the role of submarine landslides as the direct cause of the main local tsunamis, envisaging that earthquakes (in 1693 and 1908) did produce a tsunami, but also that they triggered mass failures that were able to generate an even larger tsunami. The debate is still open, and though no general consensus has been found among scientists so far, this research had the merit to attract attention on possible generation of tsunamis by landslides off Sicily. In this paper we investigate the tsunami potential of mass failures along one sector of the Hyblean-Malta Escarpment (HME). facing Augusta. The HME is the main offshore geological structure of the region running almost parallel to the coast, off eastern Sicily. Here, bottom morphology and slope steepness favour soil failures. In our work we study slope stability under seismic load along a number of HME transects by using the Minimun Lithostatic Deviation (MLD) method, which is based on the limit-equilibrium theory. The main goal is to identify sectors of the HME that could be unstable under the effect of realistic earthquakes. We estimate the possible landslide volume and use it as input for numerical codes to simulate the landslide motion and the consequent tsunami. This is an important step for the assessment of the tsunami hazard in eastern Sicily and for local tsunami mitigation policies. It is also important in view of tsunami warning system since it can help to identify the minimum earthquake magnitude capable of triggering destructive tsunamis induced by landslides, and therefore to set up appropriate knowledge-based criteria to launch alert to the population

The AD 365 Crete Earthquake/Tsunami Submarine Impact on the Mediterranean Region

The Calabrian and Hellenic subduction systems accommodate the African Eurasian plate convergence in the Mediterranean Sea and are the site of large earthquakes in the forearc region facing the northern African coasts. Some of the historical earthquakes were associated with the generation of tsunami waves affecting the entire Mediterranean basin. We investigated the submarine effects of the AD 365 Crete earthquake on the sedimentary records through the integrated analysis of geophysical data, turbidite deposits, and tsunami modelling. Seismic reflection images show that some turbidite beds are thick and marked by acoustic transparent layers at their top. Radiometric dating of the most recent of such mega-beds, the Homogenite/Augias turbidite (HAT), provide evidence for synchronous basin-wide sedimentation during a catastrophic event which has occurred in the time window of AD 364–415, consistent with the AD 365 Mw = 8.3–8.5 Crete earthquake/tsunamis. The HAT (up to 25 m thick) contains components from different sources, implying remobilization of material from areas very far from the epicentre. Utilizing the expanded stratigraphy of the HAT and the heterogeneity of the sediment sources of the Mediterranean margins, we reconstructed the relative contribution of the Italian, Maltan and African margins to the turbidite deposition. Our sedimentological reconstructions combined with tsunami modelling suggest that the tsunami following the Crete earthquake produced giant turbidity currents along a front over 2000 km long, from northern Africa to Italy. Our cores suggests that during the last 15,000 years, only two similar turbidites have been deposited in the deep basins, pointing to a large recurrence time of such extreme sedimentary events

Multimodal imaging for clinical target volume definition in prone whole-breast irradiation: a single institution experience

Aim: The aim was identification of reference structures for breast clinical target volume (CTV) in prone position, throughout image fusion process. Materials & methods: We analyzed breast glandular tissue distribution in 20 diagnostic MRIs, referring to structures reported in ESTRO guidelines for supine irradiation. The volume containing breast glandular tissue in all cases was defined as MRI prone CTV (MRIpCTV). Then in ten subsequent patients planned for prone irradiation, MRI and computed tomography (CT) simulation was acquired. MRIpCTV was defined followed by our findings and transferred to CT for definitive delineation. Results: MRIpCTV was defined by the caudal edge of clavicular head, 3 mm above inframammary fold, by the medial thoracic artery, by a plane passing through the lateral surface of pectoralis muscles, by the anterior surface of pectoralis muscles and 3 mm from the skin. Deformed CTV was consistent with anatomy on CT; the limits chosen for MRIpCTV fit adequately also for CT. Conclusion: Prone irradiation is an alternative set up for selected cases, so the sample is very small. However, our suggestions could be of aid in defining prone CTV. The good consistency between MRI and CT seems to confirm that MRI may be unnecessary in routine practice

Current Role of Minimally Invasive Radical Cholecystectomy for Gallbladder Cancer

Background. For Tis and T1a gallbladder cancer (GbC), laparoscopic cholecystectomy can provide similar survival outcomes compared to open cholecystectomy. However, for patients affected by resectable T1b or more advanced GbC, open approach radical cholecystectomy (RC), consisting in gallbladder liver bed resection or segment 4b-5 bisegmentectomy, with locoregional lymphadenectomy, is considered the gold standard while minimally invasive RC (MiRC) is skeptically considered. Aim. To analyze current literature on perioperative and oncologic outcomes of MiRC for patients affected by GbC. Methods. A Medline review of published articles until June 2016 concerning MiRC for GbC was performed. Results. Data relevant for this review were presented in 13 articles, including 152 patients undergoing an attempt of MiRC for GbC. No randomized clinical trial was found. The approach was laparoscopic in 147 patients and robotic in five. Conversion was required in 15 (10%) patients. Postoperative complications rate was 10% with no mortality. Long-term survival outcomes were reported by 11 studies, two of them showing similar oncologic results when comparing MiRC with matched open RC. Conclusions. Although randomized clinical trials are still lacking and only descriptive studies reporting on limited number of patients are available, current literature seems suggesting that when performed at highly specialized centers, MiRC for GbC is safe and feasible and has oncologic outcomes comparable to open RC

Better survival of patients with oligo- compared with polymetastatic cancers: a systematic review and meta-analysis of 173 studies

Background: The modern concept of oligometastatic (OM) state has been initially developed to describe patients with a low burden of disease and with a potential for cure with local ablative treatments. We systematically assessed the risk of death and relapse of oligometastatic (OM) cancers compared to cancers with more diffuse metastatic spread, through a meta-analysis of published data. Methods: PubMed, the Cochrane Library, and EMBASE were searched for studies reporting prognosis of patients with OM solid tumors. Risk of death and relapse were extracted and pooled to provide an adjusted hazard ratio with a 95% confidence interval (HR 95%CI). The primary outcome of the study refers to overall mortality in OM vs. polymetastatic (PM) patients. Results. Mortality and relapse associated with OM state in patients with cancer were evaluated among 104,234 participants (n=173 studies). Progression-free survival was better in patients with OM disease (hazard ratio [HR] = 0.62, 95% CI 0.57–0.68; P <.001; n=69 studies). Also, OM cancers were associated with a better OS (HR = 0.65, 95% CI 0.62-0.68; P<.01; n=161 studies). In colorectal (CRC), breast, non-small cell lung cancer (NSCLC) and renal cell carcinoma (RCC) the reduction in the risk of death for OM patients were 35, 38, 30 and 42%, respectively. Conclusions. Patients with oligometastases have a significantly better prognosis than those with more widespread stage IV tumors. We suggest that a treatment strategy that involves bot the primary and the metastases should be identified at the time of diagnosis

Aflibercept Plus FOLFIRI in the Real-life Setting: Safety and Quality of Life Data From the Italian Patient Cohort of the Aflibercept Safety and Quality-of-Life Program Study

Abstract Background Aflibercept combined with FOLFIRI (folinic acid, 5-fluorouracil, irinotecan) as second-line treatment of metastatic colorectal cancer (mCRC) significantly improved survival compared with FOLFIRI alone in the pivotal VELOUR (aflibercept vs. placebo in combination with irinotecan and 5-fluorouracil in the treatment of patients with metastatic colorectal cancer after failure of an oxaliplatin-based regimen) trial. No quality-of-life assessment was performed in VELOUR; therefore, the ASQoP (Aflibercept Safety and Quality-of-Life Program) trial was designed to capture the safety and health-related quality of life (HRQL). Patients and Methods ASQoP was an international, open-label, single-arm trial evaluating the safety and HRQL of aflibercept combined with FOLFIRI administered in a real-life setting to 781 patients with mCRC, pretreated with an oxaliplatin-based regimen with or without bevacizumab. The Italian subset of ASQoP enrolled 200 patients from 28 institutions. The primary endpoint was safety; HRQL was a secondary endpoint, assessed by validated questionnaires (European quality of life 5-dimension instrument 3-level; European Organization for Research and Treatment for Cancer Quality of Life Questionnaire Core 30, version 3; and EORTC-CR29) at baseline, during treatment, and at the end of treatment. Results The median age of the Italian ASQoP population was 63 years; the median number of aflibercept and FOLFIRI cycles was 7. Treatment-emergent adverse events were reported in 97.5% of patients. Hypertension (28.5%), neutropenia (27.5%; from laboratory data), asthenic conditions (20.0%), diarrhea (17.0%), and stomatitis (13.0%) were the most frequent (incidence, ≥ 5%) grade 3/4 toxicities. One toxic death occurred during the study period due to sepsis, without neutropenic complications. No significant worsening of HRQL was shown during treatment. Conclusion Aflibercept combined with FOLFIRI was well tolerated when administered as second-line treatment for patients with mCRC in a real-life setting. It did not affect HRQL and showed similar rates of treatment-emergent adverse events as those observed in the VELOUR trial. No new safety signals were identified

Nab-paclitaxel/gemcitabine combination is more effective than gemcitabine alone in locally advanced, unresectable pancreatic cancer - A GISCAD phase II randomized trial

The role of combination chemotherapy has not yet been established in unresectable locally advanced pancreatic cancer (LAPC) lacking dedicated randomized trials

Initial therapy with FOLFOXIRI and bevacizumab for metastatic colorectal cancer

A fluoropyrimidine plus irinotecan or oxaliplatin, combined with bevacizumab (a monoclonal antibody against vascular endothelial growth factor), is standard first-line treatment for metastatic colorectal cancer. Before the introduction of bevacizumab, chemotherapy with fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFOXIRI) showed superior efficacy as compared with fluorouracil, leucovorin, and irinotecan (FOLFIRI). In a phase 2 study, FOLFOXIRI plus bevacizumab showed promising activity and an acceptable rate of adverse effects