The Impact of Glucagon-Like Peptide-1 Receptor Agonist on the Cardiovascular Outcomes in Patients With Type 2 Diabetes Mellitus: A Meta-Analysis and Systematic Review.

Background: Since 2005, the cardioprotective effects of glucagon-like peptide 1 receptor agonists (GLP-1 RAs) have garnered attention. The cardioprotective effect could be an added benefit to the use of GLP-1 RA. This systematic review and meta-analysis aimed at summarizing observational studies that recruited type 2 diabetes individuals with fewer cardiovascular (CV) events before enrolling in the research. Methods: Systematically, the databases were searched for observational studies reporting compound CV events and deaths in type 2 diabetics without having the risk of cardiovascular diseases (CVDs) compared to other glucose-lowering agents. A meta-analysis was carried out using random effects model to estimate the overall hazard ratio (HR) with a 95% confidence interval (CI). Five studies were found eligible for the systematic review including a total of 64,452 patients receiving either liraglutide (three studies) or exenatide (two studies). Results: The pooled HR for major adverse cardiac event (MACE) and extended MACE was 0.72 (95% CI: 0.65 - 0.93, I2 = 68%) and 0.93 (95% CI: 0.89 - 0.98, I2 = 29%), respectively. The pooled HR for hospitalization due to heart failure (HHF) and occurrence of HF was 0.84 (95% CI: 0.77 - 0.91, I2 = 79%) and 0.83 (95% CI: 0.75 - 0.94, I2 = 95%), respectively. For stroke, GLP-1 RA was associated with a significant risk reduction of 0.86 (95% CI: 0.75 - 0.98, I2 = 81%). There was no significant myocardial infarction (MI) risk reduction with GLP-1 RA. As for all-cause mortality, the pooled HR for the occurrence of all-cause mortality was 0.82 (95% CI: 0.76 - 0.88, I2 = 0%). The pooled HR for the occurrence of CV death was 0.75 (95% CI: 0.65 - 0.85, I2 = 38%). GLP-1 RA therapy was associated with a significantly low risk of MACE, extended MACE, all-cause mortality, and CV mortality. Except for MACE, the heterogenicity among the studies was low. Conclusion: We conclude that GLP-1 RA is associated with a low risk of CV events composites and mortality. The findings support the cardioprotective effect of GLP-1 RA.

An Unexpected Outcome of Streptococcus sanguinis Endocarditis Associated With Orthodontic Bracing in a Young Healthy Patient.

We present a case of Streptococcus sanguinis endocarditis in a 26-year-old female following orthodontic bracing. The rarity and debilitating consequences of endocarditis caused by Streptococcus sanguinis are elaborated. The patient exhibited severe regurgitation with the eccentric posteriorly directed flow, leading to significant cardiac strain, further accentuated by systolic flow reversal in the right superior pulmonary vein. Surgical intervention, including mitral valve replacement, was crucial in addressing the underlying infection, restoring valve function, and preventing further complications. However, a second mitral valve replacement was performed due to recurrent bioprosthesis endocarditis. This case underscores the unique challenges of Streptococcus sanguinis endocarditis, emphasizing the need for a multidisciplinary approach and individualized decision-making to optimize patient care.

Myopericarditis Associated With Marijuana Intake: A Case Report and Literature Review.

A 26-year-old male who endorses daily cigarette smoking and marijuana vaping presented to the emergency department with acute onset of left-sided chest pain radiating to the left shoulder. Physical examination was unremarkable, but laboratory investigations showed elevated white blood cells, cardiac biomarkers including troponin and creatine kinase, and mildly elevated C-reactive protein levels and erythrocyte sedimentation rate. Electrocardiogram displayed subtle ST-segment elevation in a diffuse pattern, leading to a diagnosis of acute myopericarditis. The patient was treated with anti-inflammatory medication and supportive care and instructed to cease cannabis use.

Breast cancer awareness among women in the Syrian Coast: a cross-sectional study.

Breast cancer is the most common malignancy in women and represents a leading cause of cancer-related mortalities. Females' awareness toward breast cancer is essential for the early diagnosis and detection especially in low and middle-income countries. This study aims to assess the awareness of breast cancer risk factors among females in the Syrian Coast. Methodology: An online cross-sectional survey was conducted among Syrian females during the COVID-19 pandemic. The questionnaire used in the study was derived from the Cancer Research UK questionnaire and modified to fit the perspective of the study. Statistical Package for Social Sciences (SPSS) was used for data analysis. The independent samples t-test and the one-way analysis of variance (ANOVA) were applied to determine whether there is statistical evidence or any statistically significant differences between the variables. Results: A total of 1305 females participated in the study. The majority aged between 18 and 25, (28.8%) of the participants obtained their information related to breast cancer from internet, (36.7%) of were smokers and (82.8%) had a family member with breast cancer. These results suggested a significant correlation between smoking, family history of cancer, marital status, and breast cancer awareness. Conclusion: This study showed which factors are significantly related to women's awareness of breast cancer risk factors. These results can contribute in the implementation of awareness programs and campaigns, thus raising the level of awareness among women.

Characterization and Summarization of the Impact of Electronic Cigarettes on the Cardiovascular System: A Systematic Review and Meta-Analysis.

Electronic cigarettes may increase the risk of long-term cardiovascular morbidity. To protect the heart, awareness should be raised of the risks and limits of E-cigarette aerosol exposure. Thus, this systematic review and meta-analysis assessed the cardiovascular risk of e-smoking. This systematic review was conducted by using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. We searched PubMed, Embase, Scopus, Web of Science, and Science Direct databases in December 2022 to identify studies investigating e-cigarettes' impact on the heart. The study was supported by meta-analysis and qualitative review. Out of the initial 493 papers, only 15 met the inclusion criteria and were included in the study. The cumulative number of participants in the myocardial infarction (MI) group was 85,420, and in the sympathetic groups in whom the systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), and heart rate (HR) were measured, were 332 cigarette smokers. The control group included the "never use," "non-smokers," and "never smoke." The pooled analysis showed a significant difference between the e-cigarette smokers and the control group regarding the risk of developing MI in former smokers (OR= 0.12; 95% CI: 0.01-1.72, P = 0.12) and never smoked (OR= 0.02; 95% CI: 0.00-0.44, P = 0.01) favoring the control group. The pooled analysis of the included studies showed a significant difference between the e-cigarette smokers with nicotine and the control group regarding the mean difference (MD) of the SBP (MD = 2.89; 95% CI: 1.94-3.84; P < 0.001), the DBP (MD = 3.10; 95% CI: 0.42-5.78; P = 0.02), the MBP (MD = 7.05; 95% CI: 2.70-1.40; P = 0.001), and HF (MD = 3.13; 95% CI: 0.96-5.29; P = 0.005) favoring the control group. We conclude that using e-cigarettes has a detrimental effect on cardiac health. The risk of severe cardiac conditions increases with e-cigarettes. Thus, vaping can do more harm than good. Consequently, the misleading notion that e-cigarettes are less harmful should be challenged.

A Case of Lactobacillus casei Endocarditis Associated With Probiotic Intake in an Immunocompromised Patient.

Probiotics are microorganisms, typically bacteria, similar to beneficial microbiota found in the human gut, usually consumed as dietary supplements or fermented foods. Although probiotics are generally safe, several cases of bacteremia, sepsis, and endocarditis associated with probiotics have been reported. Here we report a rare case of Lactobacillus casei endocarditis in a 71-year-old female, immunocompromised due to chronic steroid intake, who presented with a productive cough and low-grade fever. Blood cultures grew L. casei resistant to vancomycin and meropenem. Transesophageal echocardiography showed mitral and aortic vegetations; valve replacement was done after successfully removing vegetations. She was treated with a six-week course of daptomycin and recovered.

An Uncommon Case of Atrial Fibrillation due to a Lung Mass Invasion of the Left Atrial Cavity.

Atrial fibrillation remains one of the most common conditions that clinical physicians encounter on a daily basis in the inpatient setting. This arrhythmia brings with it numerous complications if not treated properly and leads to intensive analysis of its primary etiology which is unique to every patient. In this case, we present a previously asymptomatic individual who presented to the hospital with respiratory complaints and was found to have a large lung mass, consistent with neuroendocrine lung cancer with direct compression of the left atrium leading to new-onset atrial fibrillation.

A Rare Case of Pembrolizumab-Associated Graves' Disease.

Immune checkpoint inhibitors (ICPis), such as pembrolizumab (Keytruda®), are associated with the development of several immune-related adverse events (irAEs). Thyroid dysfunction is a common endocrine irAE associated with pembrolizumab; however, Graves' disease induced by pembrolizumab is extremely rare. Few cases of this condition have been reported in the literature. Here, we report the case of a 50-year-old patient who presented with thyrotoxicosis that was attributed to Graves' disease secondary to pembrolizumab therapy.

Endobronchial metastasis secondary to occulting renal cell carcinoma: literature review and a rare case report.

BACKGROUND: Endobronchial Metastasis from extrathoracic tumors is a rare neoplasm that accounts for approximately 1.1% of total endobronchial malignancies. The most common primary tumors associated with EBM are from the colorectal, breast, and kidney regions. Although it represents a late manifestation in the context of tumor progression, it can rarely antedate the diagnosis of the primary tumor. CASE PRESENTATION: A 67-years-old male was referred from another city hospital to our thoracic surgery department due to a 4-months history of hemoptysis and productive cough. A chest X-ray and computed tomography scan showed a soft-tissue mass within the left main bronchus and atelectasis of the anterior segment of the left upper lobe. Furthermore, a flexible bronchoscopy revealed a hypervascular lesion occluding completely the left upper lobe bronchus. The patient underwent lobectomy and pathological examination suggested endobronchial metastasis from clear cell renal cell carcinoma. A second computed tomography scan of the abdomen and pelvis showed a well-defined mass arising from the lateral aspect of the right kidney; therefore, the patient underwent right radical nephrectomy three weeks later and pathology confirmed the diagnosis of clear renal cell carcinoma with endobronchial metastasis. CONCLUSION: Despite its rarity, physicians should consider the possibility of endobronchial metastases in the setting of endobronchial lesions. Proper diagnostic approaches should also be considered to rule out the potential of asymptomatic extrathoracic neoplasms. In this manuscript, we aimed to report a rare case -the first from Syria to our knowledge- of an endobronchial metastasis that preceded the diagnosis of renal cell carcinoma. Importantly, we reviewed the existing literature and discussed the diagnostic and treatment approaches.

Assessment of Aging Impact on Wax Crystallization in Selected Asphalt Binders.

For a better understanding of the changing trend in crystalline components of asphalt binders, asphalt binders originating from the SHRP Materials Reference Library with different oxidation degrees (unaged, 20 h PAV, and 60 h PAV) were prepared. The native asphalt binders and their oxidized residues were characterized by liquid-state nuclear magnetic resonance (NMR) spectroscopy and high-temperature gas chromatography (HTGC). The results showed that, compared with other carbon types, the content of internal methylene carbons of long paraffinic chains between different SHRP binders was quite different. The NMR average length of a long paraffinic internal methylene chain showed a good correlation with the wax content obtained at -20 °C using the methyl ethyl ketone (MEK) precipitation method and also the recently developed variable-temperature Fourier-transform infrared spectroscopy (VT-FTIR) method. In most cases, the average length of straight internal methylene carbons of a long paraffinic chain terminated by a methyl group increased with the oxidation of the asphalt binder. However, the difference caused by oxidation was significantly smaller than the difference caused by the source of the asphalt binder. In general, oxidation will make the n-alkanes distributed in asphalt binder fall within a narrower range. The carbon number of n-alkanes in the asphalt binder generally grew with oxidation.

Interlayer Shear Characteristics of Bridge Deck Pavement through Experimental and Numerical Analysis.

In order to study the interlayer shear behavior of bridge deck pavement, a numerical simulation was conducted to analyze the influence of varying interfacial conditions on shear stress at the bottom of pavement layers under the moving loading effect. Moreover, the shear strength of the different adhesive and waterproof adhesive materials was evaluated by conducting laboratory tests. The results showed that improving the bonding condition at the upper interlayer led to the reduction of the shear stress at the bottom of the pavement layers. With the increase of the friction coefficient of the upper interface to the full bonding state, the resulting shear stress at the bottom of the upper layer declined to the lowest value, which was about 35% of that of the full slip state. When the lower interlayer was in the full slip or partial bonding state, the resulting shear stress at the bottom of the lower layer decreased linearly with the increase of the friction coefficient of the upper interlayer. Moreover, once the contact state of the upper interlayer reached the full bonding state, the resulting shear stress at the bottom of the lower layer reached the minimum, which is about 88% of that of the full slip state. To improve the integrity and shear resistance of the bridge deck pavement structure, interlayer bonding should be strengthened. In this regard, the resin emulsified asphalt was determined as an appropriate adhesive material to be applied at the upper and lower interlayers. In addition, interlayer shear bond strength, regardless of the type of adhesive materials, was decreased with increasing temperature. Finally, statistical analysis results indicated that all factors of structure type, type of adhesive material, and temperature statistically have a significant effect on interlayer bond strength. The findings of this study could provide a theoretical basis and experimental support for improving the interlayer design and construction in the concrete bridge deck pavement structure.

Molecular genetic analysis reveals a novel B variant allele at the ABO locus.

BACKGROUND: When discrepancies in ABO blood typing emerge, ABO subgroups should be considered. Serological procedures such as the adsorption-elution test, the salivary ABH inhibition test, and the antiA1 (lectin) saline technique might be employed. These serological approaches, however in rare blood types are difficult to understand. As a result, a dependable and cost-effective approach for determining ABO subgroups is of special relevance. METHODOLOGY: for this purpose, DNA sequencing is most reliable solution for accurate results. Exon 1 to 7 5' 3' UTR and intron 6 of ABO gene of a Chinese individual was sequenced because the laboratory was unable to determine the blood group by traditional method. RESULTS: The analysis of the blood showed weak B antigens on their surface. Gene sequencing results revealed a novel B allele, that has one novel identified nucleotide difference from T to C at nucleotide 425. CONCLUSION: The results reported novel B allele which cannot be confirmed by conventional serological methods. Owing to the peculiarity of ABO blood types of inheritance, findings on the incidence and molecular causes of rare blood groups in the Chinese population have substantial therapeutic implications and are worthy of additional investigation in the future.

A challenging case of ALK-negative anaplastic large cell lymphoma in a 12-year-old boy: A rare case report from Syria.

Introduction and importance: Anaplastic Large-cell Lymphoma (ALCL) is a rare but aggressive type of NHL that develop from mature post-thymic T-cells. ALCL constitutes approximately 2% of all lymphoid neoplasm. It is typically found among children and young adults, accounting for 10-15% of pediatric NHL, compared to 2% of adult NHL. Case presentation: A 12-year-old Syrian boy was admitted to our hospital due to epistaxis, anorexia, weight loss and night sweats. The physical examination revealed preauricular, postauricular and submandibular lymphadenopathy. Pathological examination of the biopsy suggested Classical Hodgkin Lymphoma. Later on, Immunohistochemistry staining confirmed the diagnosis of ALK-negative Anaplastic Large Cell Lymphoma. Clinical discussion: Systemic ALCL can be categorized into two major groups based on the expression of Anaplastic Lymphoma Kinase (ALK) protein: Systemic ALK + positive and Systemic ALK-negative. The majority of pediatric cases show an overexpression of (ALK), however, pediatric ALK-negative ALCL can occur in rare cases. Conclusion: The aim of this article is to report a rare case of pediatric ALK-negative anaplastic large cell lymphoma that developed a rapid & aggressive growth within a few months despite the chemotherapy treatment and unfortunately led to the patient's death.

Effects of Wax Molecular Weight Distribution and Branching on Moisture Sensitivity of Asphalt Binders.

Wax is an important factor that affects the durability of asphalt binder. In order to understand the molecular weight distribution and branching of wax on the moisture sensitivity of asphalt binder, pure wax-doped asphalt binders are prepared and the performance of model asphalt binders are evaluated by surface free-energy (SFE) and binder bond strength (BBS) tests. In addition, asphaltene is regarded as an additive in this study. The results show that the addition of eicosane, triacontane, squalane and asphaltene can reduce the moisture sensitivity of asphalt, but not necessarily improve its moisture-induced damage resistance. The physical hardening effect of high-wax asphalt and its model asphalt is stronger than that of the corresponding low-wax asphalt and its model asphalt, and its moisture sensitivity is weaker than that of the low-wax asphalt. For all the model asphalts, there is a good correlation between the cohesion work, cohesion POTS (pull-off tensile strength), POTS ratio (the BBS moisture sensitivity index) and ER (the SFE moisture sensitivity index). When using the BBS test to characterize the moisture sensitivity of high-wax asphalt, it is recommended to leave the sample for some time until it is physically hardened and stable.

Inferior Vena Cava Thrombosis in a Young Patient With COVID-19 Infection.

Inferior vena cava thrombosis (IVCT) is a potentially fatal condition that may rarely occur in young patients with COVID-19 infection. This report describes a young adult female with a recent COVID 19 infection who presented with fever, bilateral flank pain, elevated inflammatory markers, and evidence of thrombosis in the inferior vena cava (IVC) on computed tomography (CT). The patient required treatment with anticoagulation therapy and catheter-directed thrombolysis, IVC filter placement, and mechanical suction-assist thrombectomy.

Routine Screening Mammogram Leading to the Incidental Diagnosis of a Metastatic Neuroendocrine Breast Cancer (NEBC) from an Unrecognized Asymptomatic Small Bowel Neuroendocrine Tumor.

Neuroendocrine neoplasms (NENs) are epithelial neoplasms with predominant neuroendocrine differentiation that arise in the gastrointestinal tract, unique to the site of origin, such as the pancreas and small intestine. Neuroendocrine breast carcinoma (NEBC) is a rare tumor. Diagnosing NEBC is challenging because there is no specific clinical presentation, as it is usually presented as a breast lump. Therefore, diagnosing NEBC before biopsy is difficult. Another challenge in diagnosing NEBC is to know whether it is primary or metastatic. We present a case of a 60-year-old woman found to have a solid left breast nodule during routine screening mammography. Tissue biopsy was found to be consistent with metastatic NEBC. The patient was found to have primary small intestine asymptomatic NENs on further diagnostic tests. Eventually, she had a lumpectomy and started on lanreotide (Somatuline) intramuscular monthly injections. As per literature, metastatic NEBC is infrequent. It was considered a poor prognostic breast tumor, as it is usually presented as hormonally negative breast cancer. Management of metastatic versus primary NEBC is still more controversial. Gastroenteropancreatic NENs are treated with long-acting somatostatin analogs with good prognostic results.

Effects of Geometry and Loading Mode on the Stress State in Asphalt Mixture Cracking Tests.

Currently, a variety of asphalt mixture cracking characterization tests are available as screening tools for the better selection of high-quality raw materials and also for the optimization of mixture design for different applications. However, for a same evaluation index, using different sample geometries and loading modes might lead to obtaining different values, which prevents the application of the evaluation index as a fundamental parameter in pavement design. In this paper, the effects of geometry and loading mode on the stress state in the experimental characterization of asphalt mixture cracking were discussed using numerical simulation. The results showed that applying thermally-induced load in restrained uniaxial test configuration should be considered when performing an asphalt mixture cracking test. Compared with direct tensile configuration, compressive stress clearly existed in other common test configurations, which may prevent the initiation and propagation of cracks. Moreover, it was revealed that nonuniform stress state exists in the dog-bone geometry, which makes it possible to know the failure plane in advance and place gauges at the failure plane for measuring fundamental deformation-related properties.

A Rare Case of Lance-Adams Syndrome: Status Post-Successful Cardiopulmonary Resuscitation.

Lance-Adams syndrome (LAS), also known as chronic post-hypoxic myoclonus (PHM), is a rare condition that may present with intention myoclonus in a patient who has regained consciousness after cardiorespiratory arrest. This case report describes a patient who received successful cardiopulmonary resuscitation (CPR) after going into cardiac arrest. And regaining consciousness, the patient developed myoclonic jerks diagnosed as LAS. The patient responded well to treatment with clonazepam and physical rehabilitation.

Antigen-Multimers: Specific, Sensitive, Precise, and Multifunctional High-Avidity CAR-Staining Reagents.

Although chimeric antigen receptor (CAR) T-cell therapy has transformed cancer treatment, high-quality and universal CAR-staining reagents are urgently required to manufacture CAR T cells, predict therapy response, decipher CAR biology, and engineer new CARs. Here, we developed tetrameric and dodecameric forms of a multifunctional and extensible category of high-avidity CAR-staining reagents: antigen-multimers. Antigen-multimers detected CARs against CD19, HER2, and Tn-glycoside with significantly higher specificity, sensitivity, and precision than existing reagents. In addition to accurate CAR T-cell detection by flow cytometry, antigen-multimers also enabled ≥100-fold magnetic enrichment of rare CAR T cells, selective CAR T-cell stimulation, and high-dimensional CAR T-cell profiling by single-cell multi-omics analyses. Finally, antigen-multimers accurately captured clinical anti-CD19 CAR T cells from patients' cellular infusion products, post-infusion peripheral blood, and tumor biopsies. Antigen-multimers can be readily extended to other CAR systems by switching its antigen ligand. As such, antigen-multimers have broad clinical and research applications.

Digitally Disconnected: Qualitative Study of Patient Perspectives on the Digital Divide and Potential Solutions.

BACKGROUND: As telemedicine utilization increased during the COVID-19 pandemic, divergent usage patterns for video and audio-only telephone visits emerged. Older, low-income, minority, and non-English speaking Medicaid patients are at highest risk of experiencing technology access and digital literacy barriers. This raises concern for disparities in health care access and widening of the "digital divide," the separation of those with technological access and knowledge and those without. While studies demonstrate correlation between racial and socioeconomic demographics and technological access and ability, individual patients' perspectives of the divide and its impacts remain unclear. OBJECTIVE: We aimed to interview patients to understand their perspectives on (1) the definition, causes, and impact of the digital divide; (2) whose responsibility it is to address this divide, and (3) potential solutions to mitigate the digital divide. METHODS: Between December 2020 and March 2021, we conducted 54 semistructured telephone interviews with adult patients and parents of pediatric patients who had virtual visits (phone, video, or both) between March and September 2020 at the University of Chicago Medical Center (UCMC) primary care clinics. A grounded theory approach was used to analyze interview data. RESULTS: Patients were keenly aware of the digital divide and described impacts beyond health care, including employment, education, community and social contexts, and personal economic stability. Patients described that individuals, government, libraries, schools, health care organizations, and even private businesses all shared the responsibility to address the divide. Proposed solutions to address the divide included conducting community technology needs assessments and improving technology access, literacy training, and resource awareness. Recognizing that some individuals will never cross the divide, patients also emphasized continued support of low-tech communication methods and health care delivery to prevent widening of the digital divide. Furthermore, patients viewed technology access and literacy as drivers of the social determinants of health (SDOH), profoundly influencing how SDOH function to worsen or improve health disparities. CONCLUSIONS: Patient perspectives provide valuable insight into the digital divide and can inform solutions to mitigate health and resulting societal inequities. Future work is needed to understand the digital needs of disconnected individuals and communities. As clinical care and delivery continue to integrate telehealth, studies are needed to explore whether having a video or audio-only phone visit results in different patient outcomes and utilization. Advocacy efforts to disseminate public and private resources can also expand device and broadband internet access, improve technology literacy, and increase funding to support both high- and low-tech forms of health care delivery for the disconnected.