The cardiovascular effects of marijuana have been shown to be a result of the activation of the CB1 and CB2 receptors located in the myocardium and coronary vasculatures. Adverse cardiovascular consequences of recreational use of marijuana and synthetic cannabinoids include stroke, artery dissection, vasospasm, vasculitis, coronary artery thrombosis, myocarditis/pericarditis, postural hypotension, arrhythmias, and acute heart failure. With marijuana being legalized for medicinal purposes and recreational use in more and more states in the United States, physicians should have a low threshold for the possibility of marijuana being the underlying cause of adverse cardiovascular events. Marijuana has been established to increase sympathetic tone and cause blood pressure elevations and severe coronary artery spasm (CAS). Some studies have even indicated that the risks of heart attack, atrial fibrillation, and ischemic stroke are several times higher within an hour of marijuana use. This case series discusses three female patients, aged 27, 39, and 53 years, who were known to smoke marijuana consistently. These patients all presented with signs and symptoms of acute coronary syndrome (ACS) less than 12 hours after smoking recreational marijuana. All patients endorsed smoking marijuana a few hours prior to the onset of chest pain and less than 12 hours prior to the presentation, which was confirmed by a positive urine drug screen (UDS). Coronary artery angiograms revealed coronary artery dissection in the proximal left circumflex (LCX) artery, the mid-distal left anterior descending (LAD) artery, and mid-LAD in the 27 y/o, 39 y/o, and 53 y/o patients respectively. The average age of spontaneous coronary artery dissection (SCAD) cases ranges between 35-40 years. Women account for more than 70% of cases; it is thought to be due to higher levels of estrogen in women, which alters the normal arterial wall architecture. Additionally, the excessive use of marijuana resulting in CAS further increases the susceptibility to spontaneous dissection in female patients.

Pleiotropy is considered to have a significant impact on multi-trait evolution, but its roles in the evolution of domestication-related traits in crop species have been unclear. In soybean, several known quantitative trait loci (QTL) controlling maturity, called the maturity loci, are known to have major effects on both flowering and maturity in a highly correlated pleiotropic manner. Aiming at the identification of non-pleiotropic QTLs that independently control flowering and maturity and dissecting the effects of pleiotropy in these important agronomic traits, we conducted a QTL mapping experiment by creating a population from a cross between domesticated soybean G. max and its wild ancestor G. soja that underwent stringent selection for non-pleiotropy in flowering and maturity. Our QTL mapping analyses using the experimental population revealed novel loci that acted in a non-pleiotropic manner: R1-1 controlled primarily flowering and R8-1 and R8-2 controlled maturity, while R1-1 overlapped with QTL, affecting other agronomic traits. Our results suggest that pleiotropy in flowering and maturity can be genetically separated, while artificial selection during soybean domestication and diversification may have favored pleiotropic loci such as E loci that control both flowering and maturity. The non-pleiotropic loci identified in this study will help to identify valuable novel genes to optimize soybean’s life history traits and to improve soybean’s yield potential under diverse environments and cultivation schemes.

This case illustrates that although advances have been made with diagnosis and treatment of adenocarcinoma of unknown origin with targeted therapy, more research needs to be done on poorly differentiated adenocarcinoma that initially presents with extensive metastases. In this patient’s case, it was beneficial and ethical to reduce the toxicity and emotional burden and thus limit further investigation into her adenocarcinoma. However, it is imperative to recognize that only a small subset of adenocarcinoma of unknown origin are responsive to current therapies and more research is required for the many cases that present with poorly differentiated adenocarcinoma and widespread metastasis.

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Quadricuspid aortic valve (QAV) is a rare congenital cardiac anomaly. A normal aortic valve has three cusps, but cases of unicuspid, bicuspid, and quadricuspid aortic valves have been reported. Although QAV usually appears as an isolated congenital anomaly, it may also be associated with other heart conditions. In comparison to the bicuspid aortic valve (BAV) that results in aortic stenosis by the early 50s due to agerelated early calcification, this case series suggests that patients with QAV are likely to develop moderate to severe aortic regurgitation in their late 40s or early 50s. Most patients with QAV require tricuspidalization, which is the preferred method for QAV surgical repair, especially in patients with associated aortic regurgitation. The condition was previously diagnosed intraoperatively or postpartum. Today, with imaging modalities like transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), and cardiac magnetic resonance imaging, more cases of QAV have been diagnosed in asymptomatic individuals. We present a case series of a previously healthy 49-year-old male and a 47-year-old female who had similar presentations of acute congestive heart failure (CHF). An echocardiogram confirmed that both patients had heart failure with reduced ejection fraction, dilated cardiomyopathy, QAV, and moderate to severe aortic valve regurgitation on echocardiogram. The male patient had an ejection fraction (EF) of 30-35% and a QAV with partial fusion of the leaflets, resulting in a functionally bicuspid aortic valve, while the female patient had an EF of 25-30% with what appears to be a type III QAV according to Nakamura et al. classification. The purpose of this case series is to highlight another potential late complication of congenital QAV.