Soil deformation analysis through fluid-dynamic modelling and DInSAR measurements: a focus on groundwater withdrawal in the Ravenna area (Italy)

This study aims at assessing the deformation processes affecting an area NW of the city of Ravenna (northern Italy), caused by groundwater withdrawal activities. In situ data, geologic and structural maps, piezometric measurements, underground water withdrawal volumes, and satellite C-band SAR data were used to jointly exploit two different techniques: 1) fluid-dynamic and geomechanical modelling (by RSE S.p.A), and 2) Differential Synthetic Aperture Radar Interferometry (DInSAR) analysis (by CNR - IREA). The results of the comparative analysis presented in this work brought new evidence about the contribution of groundwater withdrawal to the total subsidence affecting the area during the 2000-2017 time interval. In particular, they show an increase of the subsidence from year 2000 to 2010 and a decrease from year 2010 to 2017. These results are generally in line with groundwater withdrawal data that report a reduction of the extracted water volumes during the considered temporal interval. Meantime, they show a delay effect in the subsidence process, partially recovered during the 2010-2017 thanks to a stabilisation of the extracted groundwater volumes. The presented results shade new light on the groundwater withdrawal contribution to the subsidence of the analysed zone, although further investigations are foreseen to better clarify the ongoing scenario

Heart failure in elderly: progress in clinical evaluation and therapeutic approach

Chronic heart failure (CHF) represents a major and growing health problem, due to its high incidence and prevalence, its poor prognosis and its impact on health-care costs. Although CHF patients are mainly elderly, few studies were aimed at testing the efficacy of diagnostic and therapeutic approaches in this population. The difficulty in CHF diagnosis among the elderly is related to different factors, such as: the frequent presence of co-morbidity conditions mimicking or masking heart failure signs and symptoms; the different diagnostic cut-offs of natriuretic peptides; and the need to correctly evaluate diastolic function in order to assess CHF with preserved ejection fraction. Furthermore, the therapy of elderly CHF patients has not been well defined, considering the few studies involving very aged patients and the absence of a therapeutic strategy demonstrated to improve prognosis of CHF patients with preserved ejection fraction. The aim of this review is to focus on the most recent issues concerning the diagnosis and therapy of elderly patients affected by CHF

Evaluation of chronic kidney disease in chronic heart failure: From biomarkers to arterial renal resistances

Chronic kidney disease and its worsening are recurring conditions in chronic heart failure (CHF) which are independently associated with poor patient outcome. The heart and kidney share many pathophysiological mechanisms which can determine dysfunction in each organ. Cardiorenal syndrome is the condition in which these two organs negatively affect each other, therefore an accurate evaluation of renal function in the clinical setting of CHF is essential. This review aims to revise the parameters currently used to evaluate renal dysfunction in CHF with particular reference to the usefulness and the limitations of biomarkers in evaluating glomerular dysfunction and tubular damage. Moreover, it is reported the possible utility of renal arterial resistance index (a parameter associated with abnormalities in renal vascular bed) for a better assesment of kidney disfunction

Renal Arterial Resistance Index

The kidney is a profusely vascularized organ which, unlike other organs, does not regulate renal blood flow (RBF) mainly by oxygen demand. Reflex (myogenic effect and tubular-glomerular feedback) and neurohormonal mechanisms modulate RBF and renal resistances by regulating the tone of afferent and efferent arterioles as well as that of the major resistance vessels in the kidneys. Arterial renal resistances are also influenced by a number of other pathophysiological factors, such as increased arterial stiffness, arterial atherosclerosis, renal parenchymal abnormalities, and intra-abdominal and central venous pressure. Finally, renal resistances can be permanently increased if a microvascular disease and vascular rarefaction occur as a result of vasoconstriction-related ischemia, endothelial dysfunction, and inflammatory cytokine activity. In this setting, a parameter reflecting renal resistances could offer a useful tool to better characterize renal disease and the risk of progression. This chapter focuses on renal resistance index (RRI), a parameter obtained by pulsed Doppler which reflects renal arterial resistances. The possible clinical usefulness of RRI has been demonstrated in studies which show the pathophysiological correlates and prognostic role in predicting a greater risk of chronic kidney disease progression and cardiovascular events

Evaluation of chronic kidney disease in chronic heart failure: From biomarkers to arterial renal resistances

Chronic kidney disease and its worsening are recurring conditions in chronic heart failure (CHF) which are independently associated with poor patient outcome. The heart and kidney share many pathophysiological mechanisms which can determine dysfunction in each organ. Cardiorenal syndrome is the condition in which these two organs negatively affect each other, therefore an accurate evaluation of renal function in the clinical setting of CHF is essential. This review aims to revise the parameters currently used to evaluate renal dysfunction in CHF with particular reference to the usefulness and the limitations of biomarkers in evaluating glomerular dysfunction and tubular damage. Moreover, it is reported the possible utility of renal arterial resistance index (a parameter associated with abnormalities in renal vascular bed) for a better assesment of kidney disfunction