bluuebunny/crossref_metadata_2025 huggingface dataset:
P280 TEAMWORK IS SUCCESSFUL (1): FAVOUREABLE RE–CHALLENGE OF DOUBLE ANTI–HER2 TREATMENT IN SEVERE MYOCARDIAL DYSFUNCTION IN PATIENT WITH ADVANCED BREAST CANCER AND OCCULT TYPE II DIABETES
Authors: Valenti C , Moretti G , Copelli S , Di Cicilia R , Manca F , Cioni E , Gasparini E , Pinto C , Navazio A , Tarantini L
Published: May 2023

Introduction

Cardiovascular diseases (CVD) and Cancer (C), the most important causes of mortality worldwide. share many risk factors and common pathophysiological processes such as chronic inflammation and unfavorable cardio–metabolic profile. Progress in oncological treatments improved the survival of oncological patients (Pt) but have increased the likelihood of short– and long–term CV cardiovascular complications. The multidisciplinary collaboration between cardiologist and onco–hematologists is the task of Cardioncology, an emerging new sub–specialization of clinical cardiology that often make available personalized treatment with a favorable outcome also in clinically complex patients. Here we present a case of severe acute heart failure in a woman with advanced breast C (BC).

Clinical Case

2021 April: 55–year–old woman with G3 BC, (ER 0%PgR 0%,Ki6770%HER2+) (T4N3M1), (chest wall and liver) on well tolerated treatment with Docetaxel X 6 and continuous double antiHER2 block (Trastuzumab + Pertuzumab) X 4 and steroids as ancillary therapy. After about 6 months of therapy a lower airways infection occurred and acute congestive heart failure (HF) with severe left ventricular systolic dysfunction (LVEF 25%) ensued requiring hospitalization in the ICU, where newly detected type II diabetes was diagnosed. Appropriate HF therapy with insulin and anticoagulant was established and congestive clinical state resolved. On outpatient basis B–Blocker and anti–RAAS therapy was titrated switching to empagliflozin. About 7 months after discharge, we registered the full recovery up to a normalization of systolic function (LVEF 55%) and the disappearance of the intraventricular thrombus. For progression of C, pt underwent chemotherapy with Capecitabine at metronomic and in October 2022 after cardio–oncological collegial discussion, anti–HER2 therapy resumed. Paz started Trastuzumab–Emtansine, well tolerated with substantial stability of the clinical picture (NYHA I–II) and instrumental and echocardiographic evaluation (LVEF 65%).

Conclusions

This clinical case reaffirms that close collaboration between cardiologist and oncologist is fundamental for the successful management of complex patients and surveillance must also extend during (and after) treatment. It also demonstrates that an early diagnosis and an "evidence–based" cardiological therapy can allow the recovery of the cardio–toxic effect of anti–HER2 drugs and may allow to resume the therapy successfully.
P297 INTRAVENOUS CANGRELOR INFUSION IN HIGH BLEEDING RISK PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION: PRELIMINARY RESULTS OF THE ICARUS REGISTRY
Authors: Benenati S , Gragnano F , Scalamera R , Schettino M , Bertero E , Capolongo A , De Sio V , Musumeci G , Annibali G , Campagnuolo S , Galasso G , Silverio A , Bellino M , Centore M , Menozzi A , Caretta G , Rezzaghi M , De Luca L , Veneziano F , De Nardo D , Cirillo P , De Rosa G , Calabrò P , Porto I
Published: May 2023

Aims

To investigate the prevalence of high bleeding risk (HBR) criteria and compare clinical outcomes between HBR and non–HBR patients receiving cangrelor in the peri–percutaneous coronary intervention (PCI) phase.

Methods

Consecutive patients treated with cangrelor in 7 Italian institutions were retrospectively enrolled in the ICARUS (“Intravenous CAngrelor in high–bleeding Risk patients Undergoing percutaneouS coronary intervention”, NCT05505591) registry. HBR status was assessed according to the Academic Research Consortium (ARC–HBR) definition. The primary endpoint was net adverse clinical events (NACE), defined as a composite of cardiovascular death, myocardial infarction, stroke, definite or probable stent thrombosis and Bleeding Academic Research Consortium (BARC) 2, 3 or 5 bleeding, at 48 hours. Secondary endpoints were assessed at 48 hours and throughout the hospital stay.

Results

We enrolled 551 patients undergoing PCI with cangrelor between January 2019 and August 2022. HBR definition was met in 33% of cases. HBR patients were older (76±10 vs. 63±10 years, p<0.001), more frequently affected by peripheral arterial disease (16% vs. 8%, p=0.010), atrial fibrillation (24% vs. 2%, p<0.001), chronic kidney disease (35% vs. 3%, p<0.001), active cancer (7% vs. 0%, p<0.001) and heart failure (17% vs. 7%, p<0.001). At 48 hours, HBR patients had a significantly higher rate of NACE (13% vs. 6%, p=0.004), and BARC 2, 3 or 5 bleeding (12% vs. 4%, p=0.001). In the HBR group, the frequency of the primary endpoint increased proportionally to the HBR score. There was no significant difference with respect to other 48–hour and in–hospital endpoints.

Conclusions

Among consecutive patients treated with cangrelor in the peri–PCI phase, about 30% fulfilled the ARC–HBR definition. In the HBR subpopulation, the incidence of 48–hour adverse events was higher than in the non–HBR subgroup, primarily driven by a higher rate of clinically relevant and major bleeding.
P310 CARDIOPULMONARY EXERCISE TEST IN THE EVALUATION OF A PATIENT WITH HFREF: THE IMPORTANCE IN THE ANALYSIS OF GAS KINETICS
Authors: Palermo P , Mapelli M , Campodonico J , Vignati C , Agostoni P
Published: May 2023

Introduction

exertional dyspnea is a symptom present in several diseases, identifying the origin is of fundamental diagnostic and therapeutic importance. Cardiorespiratory exercise testing (CPET) is a valuable tool not only to assess functional capacity but also for diagnostic and prognostic purposes.

Clinical case

55–year–old patient with a history of episode of acute pulmonary edema. Echocardiogram showed FE 35% with diffuse left ventricular (LV) hypokinesis and mild–to–moderate mitral insufficiency (MI). Diagnostic coronarography showed lesion–free coronary tree. An interrupted CPET at 140W showed peak O2 consumption of 23.6 mL/kg/min that excluded indication for cardiac transplantation. An echocardiogram from us confirmed dilated cardiomyopathy (CMPD) with FE=32%, diffuse VS hypokinesia and mild–to–moderate functional MI. CPET was repeated, maximal for respiratory quotient (1.42) interrupted due to muscle exhaustion, indicative of moderate reduction in functional capacity with peak VO2 at 64% of predicted, preserved anaerobic threshold at 51% of VO2 max and reduced VO2/W and Pulse Oxygen Ratio (VO2/HR) values from cardiogenic limitation. Also evident drop in VO2/HR during the final stages of the test and associated change in slope of the VO2/Work relationship a sign of decline in stroke volume and cardiogenic efficiency. Absent signs of ventilatory limitation, pulmonary vascular (Ve/VCO2=20.8 in normal range), or exercise desaturation. In the final phase of the test increase in VCO2 and Ve/VCO2 and Ve/VO2 equivalents. In order to find the explanation to the data collected by CPET, exercise echocardiogram was performed, which revealed the development of severe mitral valvular insufficiency and subsequent pulmonary hypertension justifying the behavior of the parameters collected by CPET.

Discussion

The oxygen pulse represents a metabolic surrogate for stroke volume. Normally during the active phases of exertion there is a progressive increase followed by a plateau. The evident flattening of the VO2/Work curve during the final phases of exercise and the concomitant decrease in oxygen pulse denote inadequate cardiac performance relative to the increased energy demands during exercise.

Conclusions

CPET proves to be a valuable clinical tool to guide the diagnostic–therapeutic pathway, particularly in the presence of complex heart disease (CMPD or IM).
P328 PROTOCOL OF REPEATED OUTPATIENT INFUSIONS OF LEVOSIMENDAN IN ELDERLY PATIENTS WITH ADVANCED HEART FAILURE: PRELIMINARY DATA FROM A REAL–WORLD EXPERIENCE
Authors: Camartini V , Orso F , Herbst A , Verga F , Salucci C , Virciglio S , Baldasseroni S , Ungar A , D‘errico G
Published: May 2023

Background

Intermittent infusions of Levosimendan (L) have been shown to reduce hospitalizations and improve quality of life in patients with advanced heart failure (HF). "Real–world" experience is currently insufficient, particularly in older patients. Purpose: Since November 2020 we treated elderly outpatients with advanced HF with repeated L infusions. Here, we present the preliminary analysis of the collected data.

Methods

The protocol involves three infusions of L given 14 days apart. The duration of each session was approximately 8 hours. The starting infusion rate is 0.05 μg/Kg/min, titrated every 30/60‘ to a maximum of 0.2 μg/Kg/min based on blood pressure, heart rate and rhythm recorded on telemetry. We evaluated patients by clinical, labatorily and echocardiographic at baseline and two weeks after the end of treatment.

Results

The treated population had a mean age of 79 years, a long history of disease (mean 12 years) and high comorbidities (mean Charlson Comorbidity Index of 6.8). As shown in Table 1, we compared our population with that of leading international trials on this type of treatment, and we found that our population was significantly older and more complex. Of the 19 patients enrolled, 15 completed the expected treatment of infusions while 4 were lost due to hospitalizations for cardiovascular causes and/or social issues. In the 50 infusions performed, we observed good tolerance to the therapy with a failure rate of 2 % and good safety profile in the absence of major adverse effects, particularly in terms of arrhythmias (Figure 1). At the end of the infusion cycles, there was significant improvement of clinical and hemodynamic parameters (Figure 2). Moreover, we found a decrease in systemic congestion in terms of VD–AD gradient reduction (p=0.031) associated with a downward trend in average daily furosemide dose, clinical congestion scores and mean NTproBNP value.

Conclusions

Our preliminary analysis seems to confirm the safety and tolerability of the developed treatment scheme. Further data are needed to confirm its efficacy in clinical, hemodynamic, and therapy effects.
P351 FATAL RECURRING SYSTEMIC THROMBOEMBOLYSM IN A PATIENT WITH CARDIAC AL AMYLOIDOSIS WITHOUT EVIDENCE OF ATRIAL FIBRILLATION
Authors: Ajmone F , Costantino J , Manguso G , Ciaramella P , Ballatore F , Maggio E , Vernile A , Alfarano M , Lavalle C , Vizza C , Chimenti C
Published: May 2023

Backgound: Cardiac amyloidosis is associated with an increased thromboembolic risk. While the need to anticoagulate patients in atrial fibrillation regardless of the CHA2DS2–VASc score is evident, it is not clear whether and which patients in sinus rhythm should be treated with anticoagulant drugs

Case Presentation

A 51–year–old man presented with repeated episodes of chest pain and exertional dyspnea. The ECG showed synus rhythm, left–axis deviation, 1st degree AV–block, left anterior hemiblock and no significant anomalies of ventricular repolarisation. Transthoracic echocardiography revealed markedly thickened left ventricular (IN) walls (maximum interventricular septum dimension 18 mm) with a granular–sparkling appearance of the myocardium, bi–atrial enlargement, preserved LV ejection fraction (EF 52%), restrictive mitral flow pattern with a very small A–wave, thickened interatrial septum and atrio– ventricular valves; circumferential pericardial effusion ( maximum 11mm). Laboratory tests showed an increase in troponin and NTproBNP levels and serum and urine immunoelectrophoresis showed a monoclonal component in zone kappa. A periumbilical fat biopsy was negative for amyloidosis so the patient underwent an endomyocardial biopsy which showed positive Congo red, and immunohistochemistry positive for kappa light chains and negative for transthyretin. A diagnosis of cardiac amyloidosis AL was then made and the patient was referred to the hematologist to perform specific therapy. One week after discharge he was hospitalized for acute pain in the lower limbs due to acute thrombosis of the left common femoral artery treated with Fogarty embolectomy. Discharged in therapy with low molecular weight heparin after a few days he was again symptomatic for pain in the lower limbs and went to the emergency room where he died of electromechanical dissociation.

Conclusions

Our case demonstrates that cardiac AL amyloidosis is associated with an increased thromboembolic risk, irrespective of the presence of atrial fibrillation, for the hematological disease itself and for the infiltration of the atrium by the amyloid substance. This suggests that in selected cases, with reduced A–wave amplitude and evidence of impaired atrial mechanics, empirical anticoagulation should be considered even in sinus rhythm.
P358 FATAL CONSPIRACY: MIDVENTRICULAR OBSTRUCTIVE HYPERTROPHIC CARDIOMYOPATHY COMPLICATED BY GIANT APICAL ANEURYSM AND SEVERE MITRAL REGURGITATION
Authors: Capodaglio I , Lombardi G , Vagnarelli F , Lofiego C , Tofoni P , Pietrucci F , Schicchi N , Esposto Pirani P , Perna G
Published: May 2023

This case refers to a 69–year–old woman with a history of hypertrophic cardiomyopathy (HCM) with severe mid–ventricular obstruction complicated by apical aneurysm and restrictive phenotype. This patient had no left ventricular outflow tract obstruction and previous examinations showed moderate mitral regurgitation (MR) with suboptimal echocardiographic follow–up. ICD was previously implanted for primary prevention. Disease progression was complicated by episodes of acute heart failure (HF) caused by atrial fibrillation/tachycardia (AF or AT) with rapid ventricular response despite pharmacological therapy and a transcatheter ablation attempt. The patient was admitted to our Cardiac Intensive Care Unit with acute pulmonary oedema and extreme general frailty. EKG showed normal sinus rhythm alternating with AT with high ventricular rate. Transthoracic (TTE) and transesophageal (TEE) echocardiograms gave evidence of severe hypertrophy of left ventricular (LV) mid–cavity segments (mid IVS = 26 mm) with mid–ventricular systolic obliteration (with no more evidence of significant gradient) and a large apical aneurysm (37x35 mm) resulting in an “hourglass” shaped LV cavity (Figure 1). In addition the examinations highlighted systolic dysfunction with severe stroke volume reduction and severe MR caused by annulus dilatation with anterior jet direction due to leaflets abnormal coaptation (Figure 2). HF was multifactorial, caused not only by MR and atrial tachyarrhythmias but also due to the abnormal large apical aneurysm and the small left ventricular chamber with low compliance. The anatomical features obtained from TEE and cardiac CT (Figure 3) were analyzed by the Heart Team. Surgery with aneurysmectomy and mitral valve repair or replacement was excluded due to patient‘s frailty. Despite the suboptimal valve and LV chamber anatomy, percutaneous mitral valve repair with MitraClip was considered but also deferred owing to the unstable hemodynamic conditions. Further hemodynamic deterioration led to the patient’s exitus.

Discussion

HCM with mid–ventricular obstruction may be complicated by apical aneurysm. Large apical aneurysms can reduce LV contractile efficiency and the combination with severe MR can cause further loss of anterograde cardiac output leading to a progressive and fatal deterioration. A better outcome can only be achieved through careful follow–up and early detection and management of disease complications.
P425 TEAMWORK IS SUCCESSFUL (3): IMMUNOTHERAPY WITH IMMUNE CHECKPOINT INHIBITORS (ICIS) FAVOURABLE RESPONSE AND CARDIOVASCULAR COMPLICATION. A CASE REPORT
Authors: Piroli F , Stefanelli U , Di Girolamo S , Masini C , Cerasa F , Azzarone M , Leuzzi C , Pinto C , Navazio A , Tarantini L
Published: May 2023

Immunotherapy in recent years has revolutionized the oncology practice. ICIs targeting T lymphocyte antigen–4 (CTLA–4) and programmed death–1/ligand–1 (PD–1/PD–L1) transformed treatment landscape of many different cancers. The answers occur in a substantial fraction of patients and are often durable. ICI‘s combined block (CB) (CTLA–4 + PD–1/PD–L1) seems to improve even further clinical outcomes compared to monotherapies. However, this treatment exposes patients to the risk of immune adverse events (iAE) including cardiovascular (CV) iAE, which can be potentially fatal and, in any case, compromise the continuation of oncological treatment. Here we present the case of a young woman with advanced renal cancer (Stage IV, T3b, N0, M1) in ICI combined block therapy (Nivolumab + Ipilumab) complicated early by a pericardial effusion (PE) Clinical case Oct 2021: a 48 yrs old woman with sarcomatoid and rhabdoid renal cell cancer with liver metastases underwent left radical nephrectomy and splenectomy + cavotomy for neoplastic thrombus removal. Dec 21, she started ICIs CB (Nivolumab + Ipilumab) X 4 and sequential Nivolumab. March 2022: on CT assessment for disease restaging at the end of induction therapy with nivolumab + Ipilumab a favorable response of metastases was detected but incidental finding of G2–G3 PE was identified (figure 1). Therapy with prednisone (1 mg/kg/day) and Colchicine 0.5 mg/day was promptly started with progressive reduction of the effusion in the serial cardiological checks without recurrence although maintenance immunotherapy with Nivolumab was rechallenged. ICIs was permanently discontinued in June 2022 due to gastrointestinal G4 toxicity. At MRI evaluation after 6 months ICIs discontinuation (December 2022), liver metastases were further reduced compared to previous assessments.

Conclusion

This case confirms that the association between iAE side effects and efficacy of ICIs is a real possibility. Vigilant surveillance and close collaboration between oncologists and cardiologists facilitate timely capture of CV iAE and appropriate management to allow effective management.
P440 PREVALENCE OF HYPOVITAMINOSIS D OVER THE YEARS AND ITS RELATIONSHIP WITH DIABETES MELLITUS AND ANEMIA IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION
Authors: Aleksova A , Fluca A , D‘errico S , Munaretto L , Zhou X , Sinagra G , Janjusevic M
Published: May 2023

Background

Hypovitaminosis D is a common condition among patients with cardiovascular diseases and it is closely associated with inflammation, oxidative stress, endothelial dysfunction, diabetes mellitus (DM), insulin resistance and anemia. Aims and methods: We aim to assess the prevalence and persistence of hypovitaminosis D (<20 ng/ml) over years among 1510 patients with acute myocardial infarction (AMI), admitted at the University Hospital in Trieste. To access changes in vitamin D values over the years, we separated the patients into 4 groups according to the year of enrolment: group 1 (2009–2010), group 2 (2014–2016), group 3 (2017–2019) and group 4 (2020–2022).

Results

The median vitamin D concentration in our cohort was 17.15 (10.2 – 24.7) ng/ml, meaning that the majority of enrolled patients were vitamin D deficient (59.7%). Comparing the defined groups, it is observed that the plasma vitamin D values significantly increased during the years respectively: 14.45 (7.73 – 22.58) ng/ml vs 17.3 (10.28 – 24.2) ng/ml vs 18.95 (11.63 – 26.78) ng/ml vs 19.05 (12.5 – 27.3) ng/ml, p<0.0001 (Figure 1). Vitamin D was negatively correlated with Galactin–3, glucose levels, HbA1C and pro–inflammatory markers such as CRP, TNF–α and Il–1β. Patients with DM have significantly lower levels of vitamin D compared to patients without (respectively: 18.95 (13.25 – 27.18) ng/ml vs 22.8 (14.1 – 31.5) ng/ml p<0.001). Furthermore, anemic patients have lower vitamin D levels compared to patients without (respectively, 13.7 (8.0 – 22.65) ng/ml vs 18.4 (11.5 – 25.5) ng/ml, p<0.0001). In a multivariate analysis, hypovitaminosis D was predicted by fall–winter sampling (p<0.0001), higher body mass index (p=0.001), DM (p=0.001), smoking (p=0.001), older age (p=0.008), increased triglyceride levels (p=0.01) and female gender (p=0.038).

Conclusions

Hypovitaminosis D remains common among patients with AMI, although there is a trend of increasing vitamin D values over the years probably due to media awareness. Supplementation of vitamin D should be mandatory in patients with cardiovascular diseases given its close relationship with DM and anemia and their association with mortality.
P482 CALCIFIED AORTIC VALVES EXPLANTED FROM CHIP CARRIERS REVEAL IMMUNE INFILTRATION AND INCREASED RISK OF 1–YEAR MORTALITY AFTER SURGERY
Authors: Mikus E , Savini C , Tripodi A , Rizzo P , Fortini F , Fiorentino F , Vieceli Dalla Sega F
Published: May 2023

Background and aims

Blood cell clones carrying cancer–related mutations are frequently present in the elder, often without determining symptomatic hematological disease. This condition is defined clonal hematopoiesis of inderminate potential (CHIP). In recent years, epidemiological investigations have clearly shown that CHIP increases not only the risk of blood cancer but also the risk of atherosclerosis and cardiovascular mortality. The present study aims to evaluate the possible association between CHIP and aortic valve stenosis and to explore the pathological mechanism of calcified aortic valve disease (CAVD) in CHIP carriers.

Methods

We enrolled 105 CAVD patients undergoing surgical aortic valve replacement in which we assessed the presence of CHIP by next generation sequencing (NGS) of DNA extracted from blood cells. Moreover, we investigated the effect of CHIP on 1–year all–cause mortality. Finally, to reveal possible mechanisms linking CHIP to CAVD, we extracted the RNA from a subset of explanted aortic valves and compared the whole transcriptome of patients with or without CHIP.

Results

We found that CHIP is present in patients with CAVD, with a frequency of around 30%. Analysis of the transcriptome of aortic valves revealed that high immune infiltration and immunoglobulins presence frequently occur in CHIP patients. Importantly, we observed that the presence of CHIP is associated with increased mortality within 12 months after surgery.

Conclusions

Our findings indicate that the broad cellular and humoral immune response in the aortic valves of the CHIP patients reflects alterations in the immune cells that may be linked to the poor prognosis after valve replacement.
P493 ASSOCIATION BETWEEN IMPROVEMENT IN PHYSICAL FITNESS AND ANTHROPOMETRIC PARAMETERS WITH MAINTENANCE OF PHYSICAL EXERCISE HABITS IN A POPULATION OF PATIENTS WITH ISCHEMIC HEART DISEASE UNDERGOING A REHABILITATION CYCLE WITH 6 MONTHS FOLLOW–UP
Authors: Schenal N , Bugana R , Fent M , Menegon F , Piergentili C , Bonso A
Published: May 2023

Background

Increased physical activity is associated with a reduction in all–cause mortality and may increase life expectancy, an effect strongly linked to a reduction in the risk of cardiovascular (CV) disease. Regular aerobic exercise (EX) results in modest reductions in waist circumference (CIRC) (associated with CV mortality) and visceral adipose tissue. Vigorous intensity EX may offer greater benefits than moderate intensity. Aim of the study: To evaluate whether the continuation of EX after Cardiac Rehabilitation (CR) leads to an improvement in physical capacity and parameters related to CV pathology of patients (PZ) with ischemic heart disease (IC).

Methods

retrospective observational study on patients referred to the Outpatient CR of the O.C. S.M. del Prato (Feltre) from January 2018 to May 2021. Of the initial population of 270 PZ, 47 did not show up at the f.–up, 22 did not perform 6MWT at the f.–up and 33 had CR indications other than IC. The Outpatient CR consisted of 10 monthly sessions with 3 modalities: • educational (ED) + supervised EX • ED only • online (Covid period). Supervised EX: soft bodyweight gymnastics (30 min) + 30 minutes monitored moderate to vigorous supervised EX on stationary bikes and treadmills ED: frontal lessons (1–2 h) multidisciplinary (doctor, nurse, dietician, psychologist) aimed at improving the patient‘s management of CV disease and risk factors. On–line: soft bodyweight gymnastics (30 min) + ED by videoconference The f.–up was on average 6 months after the CR. Statistical processing with Jamovi 2.3.13 Materials and methods: At admission to CR and at f.–up, weight, height, CIRC, calculated BMI were measured, performed 6–minute walk test (6MWT) with Borg scale detection. At the f.–up a questionnaire was self–administered and adherence to EX, bodyweight exercise, how often, attendance at a gym, use of heart rate monitor (CF), etc. were declared.

Conclusions

The 6MWT improves in a statistically significant way in all PZs at f.–up except in those who declare not to perform EF. Significant improvements in CIRC, BMI and Borg were observed in PCS performing EX more frequently weekly (2–4 times), using CF and in PCS undergoing complete RC (ED + EX). No predictors of improvement at 6 months of the examined variables were identified.
Seismicity parameters dependence on main shock-induced co-seismic stress
Authors: Sharma Shubham , Hainzl Sebastian , Zöller Gert
Published: May 2023

The Gutenberg–Richter (GR) and the Omori–Utsu (OU) law describe the earthquakes’ energy release and temporal clustering and are thus of great importance for seismic hazard assessment. Motivated by experimental results, which indicate stress-dependent parameters, we consider a combined global data set of 127 main shock–aftershock sequences and perform a systematic study of the relationship between main shock-induced stress changes and associated seismicity patterns. For this purpose, we calculate space-dependent Coulomb Stress (ΔCFS) and alternative receiver-independent stress metrics in the surrounding of the main shocks. Our results indicate a clear positive correlation between the GR b-value and the induced stress, contrasting expectations from laboratory experiments and suggesting a crucial role of structural heterogeneity and strength variations. Furthermore, we demonstrate that the aftershock productivity increases nonlinearly with stress, while the OU parameters c and p systematically decrease for increasing stress changes. Our partly unexpected findings can have an important impact on future estimations of the aftershock hazard.
Automatic velocity analysis using interpretable multimode neural networks
Authors: Zhang Haifeng , Yuan Sanyi , Zeng Huahui , Yuan Huan , Gao Yang , Wang Shangxu
Published: May 2023

Seismic velocity analysis is the basis for seismic imaging and understanding complex subsurface geological structures. Although the performance of automatic velocity analysis methods based on Common Middle Point (CMP) data or Velocity Spectra (VS) is encouraging, particularly deep learning methods. However, most methods ignore the complementarity between CMP data and VS data, and only one of them is selected for velocity modelling. We propose a multimodal neural network (MMN) that combines the advantages of CMP data details representation and simplification of VS. MMN includes multilayer convolution structures and auto-encoder structures, which are used to extract time–space amplitude information from CMP gathers and energy groups features from VS data, respectively. This paper compared MMN with the CMP single-modal network (CSN) and the velocity spectra single-modal network (VSSN). Based on synthetic data, we investigated their differences in terms of continuity, accuracy, noise resistance and generalization. The MMN prediction results makes a trade-off between the overall continuity and local details. Visualization analysis of the intermediate feature maps explains the MMN velocity prediction mechanism, that is, the multi-angle representation and complementary fusion of velocity information. Finally, the performance of the proposed method is demonstrated using the braided river deposited field data example.
Potential for efficient microbial remediation of Cr(VI) in wastewater using Deinococcus wulumuqiensis R12
Authors: Sun Shengmiao , Shen Bowen , Jiang Ling , Zhu Liying
Published: May 2023

Aims

This study aimed to investigate the potential of Deinococcus wulumuqiensis R12 (D. wulumuqiensis R12) as a bioadsorbent for Cr(VI) removal from aqueous solutions.

Methods and results

Effects of various factors, including initial concentration of Cr(Ⅵ), pH, adsorbent dosage, and time were explored. The maximal Cr removal efficiency was achieved by adding D. wulumuqiensis R12 to the solution at pH 7.0 for 24 h, with an initial Cr concentration of 7 mg l−1. Characterization of bacterial cells showed that Cr was adsorbed to the surface of D. wulumuqiensis R12 by combining with functional groups, such as carboxyl and amino groups on the surface. Furthermore, D. wulumuqiensis R12 was able to keep its bioactivity in the presence of Cr and tolerate Cr concentrations as high as 60 mg l−1.

Conclusions

Deinococcus wulumuqiensis R12 demonstrates a comparatively high adsorption capacity for Cr(VI). Under the optimized conditions, the removal ratio reached 96.4% with 7 mg l−1 Cr(VI), and the maximal biosorption capacity was 2.65 mg g−1. More importantly, it was found that D. wulumuqiensis R12 still had strong metabolic activity and maintained its viability after adsorbing Cr(VI), which is beneficial for biosorbent stability and reuse.
Well-being at a Military Medical School and Implications for Military Retention
Authors: Soh Michael , Bunin Jessica , Uijtdehaage Sebastian , Artino Anthony R , Barry Erin S , Durning Steven J , Grunberg Neil E , Landoll Ryan R , Maranich Ashley , Moores Lisa K , Servey Jessica , Torre Dario , Williams Pamela M , Dong Ting
Published: May 2023

Introduction

Physical and psychological well-being play a critical role in the academic and professional development of medical students and can alter the trajectory of a student’s quality of personal and professional life. Military medical students, given their dual role as officer and student, experience unique stressors and issues that may play a role in their future intentions to continue military service, as well as practice medicine. As such, this study explores well-being across the 4 years of medical school at Uniformed Services University (USU) and how well-being relates to a student’s likelihood to continue serving in the military and practicing medicine.

Methods

In September 2019, 678 USU medical students were invited to complete a survey consisting of three sections—the Medical Student Well-being Index (MSWBI), a single-item burnout measure, and six questions regarding their likelihood of staying in the military and medical practice. Survey responses were analyzed using descriptive statistics, analysis of variance (ANOVA), and contingency table analysis. Additionally, thematic analysis was conducted on open-ended responses included as part of the likelihood questions.

Results

Our MSWBI and burnout scores suggest that the overall state of well-being among medical students at USU is comparable to other studies of the medical student population. ANOVA revealed class differences among the four cohorts, highlighted by improved well-being scores as students transitioned from clerkships to their fourth-year curriculum. Fewer clinical students (MS3s and MS4s), compared to pre-clerkship students, indicated a desire to stay in the military. In contrast, a higher percentage of clinical students seemed to “reconsider” their medical career choice compared to their pre-clerkship student counterparts. “Medicine-oriented” likelihood questions were associated with four unique MSWBI items, whereas “military-oriented” likelihood questions were associated with one unique MSWBI item.

Conclusion

The present study found that the overall state of well-being in USU medical students is satisfactory, but opportunities for improvement exist. Medical student well-being seemed to have a stronger association with medicine-oriented likelihood items than with military-oriented likelihood items. To obtain and refine best practices for strengthening engagement and commitment, future research should examine if and how military and medical contexts converge and diverge throughout training. This may enhance the medical school and training experience and, ultimately, reinforce, or strengthen, the desire and commitment to practice and serve in military medicine.
Profiles of Military Medical Students’ Well-being, Burnout, and Retention
Authors: Ma Ting-Lan , Dong Ting , Soh Michael , Artino Anthony R , Landoll Ryan R , Schreiber-Gregory Deanna N , Durning Steven J
Published: May 2023

Background

Well-being concerns among medical students are more prevalent than their age-matched peers in the United States. It remains unknown, however, if individual differences in well-being exist among U.S. medical students serving in the military. In this study, we sought to identify profiles (i.e., subgroups) of well-being in military medical students and examine the associations between these well-being profiles and burnout, depression, and intended retention in military and medical fields.

Methods

Using a cross-sectional research design, we surveyed military medical students and then conducted latent class analysis to explore profiles of well-being, and applied the three-step latent class analysis method to assess predictors and outcomes of well-being profiles.

Results

Heterogeneity in well-being was identified among the 336 military medical students surveyed, portraying medical students’ falling into three distinct subgroups: High well-being (36%), low well-being (20%), and moderate well-being (44%). Different subgroups were associated with different risks of outcomes. Students in the subgroup of low well-being were at the highest risk of burnout, depression, and leaving medicine. In contrast, students in the moderate well-being group were at the highest risk of leaving military service.

Conclusions

These subgroups may be clinically important as burnout, depression, and intention to leave medical field and/or military service occurred with varying likelihoods among medical students across the different well-being subgroups. Military medical institutions may consider improving recruitment tools to identify the best alignment between students’ career goals and the military setting. Besides, it is crucial for the institution to address diversity, equity, and inclusion issues that may lead to alienation, anxiety, and a sense of wanting to leave the military community.
Career Accomplishments of Uniformed Services University of the Health Sciences Medical Graduates: Classes 1980–2017
Authors: Jung Eulho , McBee Elexis , Schreiber-Gregory Deanna N , Teng Yating , Dong Ting , Durning Steven J
Published: May 2023

Background

The current study reports career accomplishments of Uniformed Services University (USU) graduates in four areas: (1) positions held over the course of their entire career, (2) military awards, decorations, and rank, (3) first residency completed, and (4) academic achievements.

Method

Utilizing the responses to the alumni survey sent to USU graduates in the Class 1980 to 2017, we extracted relevant data and reported descriptive statistics.

Results

1,848 out of 4,469 responded to the survey (41%). 86% (n = 1,574) of respondents indicated having served as a full-time clinician (seeing patients at least 70% of the time during a typical week), while many of them serve in leadership such as educational, operational, or command leadership roles. 87% (n = 1,579) of respondents are ranked from O-4 to O-6, and 64% (n = 1,169) of the respondents received a military award or medal. Family medicine, internal medicine, and pediatrics were the most chosen medical specialties, which is similar to the national patterns reported by AAMC. 45% (n = 781) held an academic appointment.

Conclusion

USU graduates continue to make significant contributions to military medicine. USU graduates’ medical specialty preferences are similar to the past, which calls for further investigation to identify driving factors on such preference.
On the period–density relations and lower period limit of contact binaries
Authors: Zhang Xiaobin , Chen Xinghao , Fu Jianning , Li Yan
Published: May 2023

The theoretical relations between the orbital period and mean densities of component stars of contact binaries are deduced. It is found that the orbital period of a contact binary is inversely proportional to the square root of the mean densities of component stars with the slopes as functions of mass ratio and fill-out factor of system. A test of 148 well-studied contact binaries with physical parameters determined from comprehensive photometric and spectroscopic solutions shows that the upper limit of secondaries’ mean densities depends strongly on the total masses, M1 + M2, of the contact systems. For a low-mass contact system with $(M_{}+M_{2})\le 2\, \mathrm{M}_{\odot }$, the maximum mean density of the secondary is strictly lower than that of a 5 Gyr star with a mass of (M + M2)/2. Taking this as the basic constraint, the derived period–density relation was applied to simulate the orbital period distribution of low-mass contact binaries over the total-mass range of 1–2 $\, \mathrm{M}_{\odot }$. It reproduces a period cut-off at 0.12–0.16 d, depending on the fill-out factor.
MOJAVE – XXI. Decade-long linear polarization variability in AGN jets at parsec scales
Authors: Zobnina D I , Aller H D , Aller M F , Homan D C , Kovalev Y Y , Lister M L , Pashchenko I N , Pushkarev A B , Savolainen T
Published: May 2023

Using stacking of images obtained at different epochs, we studied the variability properties of linear polarization of active galactic nucleus (AGN) jets on parsec-scales. Our sample is drawn from the MOJAVE programme, and consists of 436 AGNs manifesting core-jet morphology and having at least five VLBA observing epochs at 15 GHz from 1996 January through 2019 August, with some additional archival VLBA data reduced by us. We employed a stacking procedure and constructed maps of (i) standard deviation of fractional polarization and electric vector position angle (EVPA) over epochs as the measure of variability and (ii) median polarization degree to quantify typical values in time. The distributions of these values along and across the jet were analysed for the whole sample for the first time. We found that core EVPA variability is typically higher than that of the jet, presumably due to component blending and outflow bends in the core. The BL Lacertae object cores have lower EVPA variability, compared to that of quasars, possibly due to lower Faraday rotation measure, suggesting a stronger ordered magnetic field component. The EVPA becomes more stable down the jet. Most of the sources showing this trend have a time coverage of more than 12 yr and at least 15 epochs. The possible cause could be the increase of stability in the magnetic field direction, reflecting an increase in the fraction of the magnetic field that is ordered. There are no significant optical-class-dependent or spectral-class-dependent relations in the EVPA variability properties in AGN jets.
Constraints on star formation in Orion A from Gaia
Authors: Alzate Jairo A , Bruzual Gustavo , Kounkel Marina , Magris Gladis , Hartmann Lee , Calvet Nuria , Cao Lyra
Published: May 2023

We develop statistical methods within a Bayesian framework to infer the star formation history from photometric surveys of pre-main-sequence populations. Our procedures include correcting for biases due to extinction in magnitude-limited surveys, and using distributions from subsets of stars with individual extinction measurements. We also make modest corrections for unresolved binaries. We apply our methods to samples of populations with Gaia photometry in the Orion A molecular cloud. Using two well-established sets of evolutionary tracks, we find that, although our sample is incomplete at youngest ages due to extinction, star formation has proceeded in Orion A at a relatively constant rate between ages of about 0.3 and 5 Myr, in contrast to other studies suggesting multiple epochs of star formation. Similar results are obtained for a set of tracks that attempt to take the effects of strong magnetic fields into account. We also find no evidence for a well-constrained ‘birthline’ that would result from low-mass stars appearing first along the deuterium-burning main sequence, especially using the magnetic evolutionary tracks. While our methods have been developed to deal with Gaia data, they may be useful for analysing other photometric surveys of star-forming regions.
Effect of centrifugal force on transmission spectroscopy of exoplanet atmospheres
Authors: Banerjee Agnibha , Barstow Joanna K , Haswell Carole A , Lewis Stephen R
Published: May 2023

Transmission spectroscopy is one of the most successful methods of learning about exoplanet atmospheres. The process of retrievals using transmission spectroscopy consists of creating numerous forward models and comparing them to observations to solve the inverse problem of constraining the atmospheric properties of exoplanets. We explore the impact of one simplifying assumption commonly employed by forward models of transiting exoplanets: namely that the planet can be treated as an isolated, non-rotating spherical body. The centrifugal acceleration due to a planet’s rotation opposes the gravitational pull on a planet’s atmosphere and increases its scale height. Conventional forward models used for retrievals generally do not include this effect. We find that atmospheric retrievals produce significantly different results for close-in planets with low gravity when this assumption is removed, e.g. differences between true and retrieved values of gas abundances greater than 1σ for a simulated planet analogous to WASP-19b. We recommend that the correction to the atmospheric scale height due to this effect be taken into account for the analysis of high-precision transmission spectra of exoplanets in the future, most immediately JWST Cycle 1 targets WASP-19b and WASP-121b.
Evidence for marine sedimentary rocks in Utopia Planitia: Zhurong rover observations
Authors: Xiao Long , Huang Jun , Kusky Timothy , Head James W , Zhao Jiannan , Wang Jiang , Wang Le , Yu Wenchao , Shi Yutong , Wu Bo , Qian Yuqi , Huang Qian , Xiao Xiao
Published: May 2023

Decades of research using remotely sensed data have extracted evidence for the presence of an ocean in the northern lowlands of Mars in the Hesperian (∼3.3 Ga), but these claims have remained controversial due to the lack of in situ analysis of the associated geologic unit, the Vastitas Borealis Formation (VBF). The Tianwen-1/Zhurong rover was targeted to land within the VBF near its southern margin and has traversed almost 2 km southward toward the interpreted shoreline. We report here on the first in situ analysis of the VBF that reveals sedimentary structures and features in surface rocks that suggest that the VBF was deposited in a marine environment, providing direct support for the existence of an ancient (Hesperian) ocean on Mars.
Rhythm Man
Authors: Crease Stephanie Stein
Published: May 2023

Rhythm Man: Chick Webb and the Beat That Changed America is the first complete biography of William Henry “Chick” Webb (1905–39), the innovative father of modern jazz drumming and a leading bandleader of the Swing Era, whose band and music thrilled dancers and audiences across the country. Webb was born in East Baltimore and had chronic spinal tuberculosis as a child, leaving him only four feet tall with a hump on his back. He moved to Harlem in 1925, in the midst of the Harlem Renaissance, and, thanks to Duke Ellington, formed a jazz dance band that in the early 1930s became resident band at Harlem’s Savoy Ballroom. The Savoy, the “World’s Most Famous Ballroom,” was the trendsetting place for advances in jazz and the dance that evolved along with swing music, the Lindy Hop. In 1935 Webb hired unknown teenage singer Ella Fitzgerald; by 1937 they topped polls and radio charts, and in the next two years packed theaters and ballrooms across the country, breaking through racial barriers. Webb’s band was in the era’s most legendary band battles, with Benny Goodman and Count Basie. He died in June 1939, at the height of his band’s national popularity, at age thirty-four, of complications from his chronic disease.
Introduction
Authors: Crease Stephanie Stein
Published: May 2023

This book is the first complete biography of William Henry “Chick” Webb (1905–39), innovative drummer and bandleader in Harlem, who ushered an unknown teenage vocalist named Ella Fitzgerald to national fame during the Swing Era, when his big band became one of the most popular in the country. Webb was born in East Baltimore and had spinal tuberculosis as a child, leaving him only four feet tall with a hump on his back. He moved to Harlem in 1925, in the midst of the Harlem Renaissance, and, thanks to Duke Ellington, formed a dance band that became one of the top Black big bands of the 1930s as house band at Harlem’s trendsetting Savoy Ballroom, home of the Lindy Hop and legendary “big band battles.” Webb’s band also performed at the Apollo Theater and toured frequently. He was one of the most influential drummers of the Swing Era to Gene Krupa, Jo Jones, and younger drummers like Max Roach and Art Blakey, and others later on. Several of his early hires, in addition to Ella Fitzgerald, have had a lasting impact on American jazz and pop music. Webb’s life was cut short when chronic illness finally overcame him at age thirty-four. He died in June of 1939 at the beginning of an East Coast tour, at the peak of his band’s success.
Baltimoreans in the Music World
Authors: Crease Stephanie Stein
Published: May 2023

The rich diversity of Baltimore’s sound world—which included church music, brass bands, parade bands, ragtime, and early jazz groups—was a training ground for Webb. Baltimore’s ragtime and early jazz ensembles played music similar to the sound of James Reese Europe’s small groups: upbeat cakewalks and marches, and “ragged” versions of popular songs for dancing. Many musicians were classically trained and also played “hot” jazz in small clubs in East Baltimore and along Pennsylvania Avenue. Webb’s first professional jobs were with small bands at the dance halls and basement clubs around Pennsylvania Avenue. In the early 1920s Webb joined the Jazzeola Orchestra, led by clarinetist Percy Glascoe, which played on Captain George Brown’s excursion steamboat on Chesapeake Bay. Many of Baltimore’s best musicians moved or had moved to New York and Harlem in what might be called the Musicians’ Migration. Webb would be one.
Savoy
Authors: Crease Stephanie Stein
Published: May 2023

The founding of the Savoy Ballroom is the story of intersecting migrations in Harlem: of Afro-Americans, Afro-Caribbeans, and Eastern European Jews. The seed money came from the Galewskis (Gales), a family of Jewish immigrants in the leather business. Founding owners Moe Gale and I. Jay Faggen hired Charles Buchanan, born in the British West Indies, as manager. The Savoy’s inaugural ball, Friday, March 12, 1926, was attended by city officials, and the featured bands were Fess Williams and His Royal Flush Orchestra, the Savoy Bearcats, and Fletcher Henderson’s Orchestra. The Savoy, built for Harlem to have its own elegant ballroom, was an economic engine with a staff of over a hundred people. During the Swing Era, the Savoy attracted more white visitors: musicians and jazz and dance fans. The Savoy’s showcase dance was the Lindy Hop, which at first was too wild to be performed alongside conventional dancers. In the late 1920s, Webb’s band had occasional gigs at the Savoy and the Lafayette Theater. In October 1927, the band landed a steady engagement at Rose Danceland, a small dance hall for white patrons on 125th Street, which had a radio wire. Webb’s band was heard live on broadcasts three times a week and got booked on a vaudeville tour in January 1928. The tour collapsed, and Webb and the band returned to New York with no money and lost their job at Rose Danceland.