Methotrexate (MTX) intrathecal and intravenous administration is associated with neurotoxicity. We report a 15-year old girl diagnosed with large cell B lymphoma. On eighteen-day after intrathecal MTX presented stroke-like symptoms. Magnetic resonance was informed as a possible stroke in the right frontal lobe. The patient does not meet the criteria for fibrinolysis. MTX neurotoxicity was suspected, and theophylline was initiated. She showed complete recovery after three days of treatment. After describing the case, we review MTX neurotoxicity cases from our centre from January 2010 to December 2018. Also, we added to this data the previously published cases in the literature.

The heart is an infrequent location for primary tumors. When they appear, they usually emerge as myxomas (slow growth bening forms). We present a 68-year-old man who was discovered of a left atrial mass in a routinary echocardiography. A transesophageal test was then performed to better study the finding. We highlight “Transillumination”as a new technology which processes the 3D image by operating with the image’s enlightenment. It provides a better tissue characterization, allowing a superior description of the mass, in this case. The bulk was surgically removed, and its histological analysis established the diagnosis of a myxoma.

The loggerhead (Caretta caretta) is a cosmopolitan sea turtle species that are listed as vulnerable by IUCN and endangered in Brazil. In 2015, the C. caretta Southwest Atlantic subpopulation (SWA) was impacted by the Fundão dam break’ (FFDT) ore tailings plume and heavy metals, reaching the Espírito Santo coast (ES). The SWA is a great regional management unit (RMU) of C. caretta worldwide due to distinctive mtDNA lineage promoted by recent radiation within the Atlantic-Mediterranean region, however, due to the low resolution of mtDNA, the population structure of C. caretta SWA has been shallowly studied. Here, we recovered the genetic diversity and evaluated the population structure of the C. caretta SWA, using both mtDNA and 15 nDNA microsatellite loci, along with four nesting areas, and over 16 years enclosing the periods before and after the FFDT. We detected complex genetic dynamics that reflect on genetic composition at a population-individual level and revealed a spatial-temporal pattern that may be related to its philopatric behavior and relatedness. Further, we detected a genetic signature for the females of the ES nesting area that could be a consequence of recent demographic events and/or environmental responses. Thus, this study deeply evaluated the genetic diversity and provide a fine-scale resolution of the population structure of C. caretta SWA and the effects of environmental accidents (like the FFDT) on its life history. Lastly, for conservation purposes, continuous monitoring is needed to deeply evaluate if the FFDT has considerably impacted its evolutionary dynamics in the next generations.

Abstract: Background: At present, there is no ideal treatment available for CP patients and most of them will still suffer adverse outcomes. NogoA/NgR/Rho pathway is very important to the nerve growth, CP injury is inevitably accompanied by the regeneration and repair of neurons and axons. Purpose: In this study, we might clarify the NogoA/NgR/Rho pathway functional role in mediating HUCMSCs to improve neurobehavioral status and alleviate brain injury in hypoxia/ischemia-induced CP rat model. Methods: The CP rat model was established by ligating the left common carotid artery and anoxia for 2.5 h, and HUCMSCs were intravenous injected to the modeled rats. Results: Compared with CP+PBS group and CP group rats, HUCMSCs transplantation can significantly improve the neurobehavioral situation, attenuated brain pathological injury, inhibit apoptosis of brain nerve cells and the activation of astrocytes in CP rats. The expression of NogoA、NgR、RhoA relative mRNA and protein in brain tissues of rats in the CP+PBS group and CP group rats were significantly lower than those of in the sham+PBS and CP+HUCMSCs group. The expression of Rac-1、Cdc42 relative mRNA and protein in brain tissues of rats in the sham and CP+HUCMSCs group was significantly higher than those of in CP+PBS group and CP group rats. Conclusion: This study confirmed that HUCMSCs can efficiently improve neurobehavioral status and alleviate brain injury in hypoxia/ischemia-induced cerebral palsy rat model via down-regulating the NogoA/NgR/Rho pathway.

The hydrological regime is the main factor governing the functioning of floodplain rivers. An understanding of its dynamic leads to a better idea of the system behaviour for which proper methods must be used. We analysed the daily water level of the Paraná River during the last century at three-gauge stations using linear and non-linear tools to characterise the hydrological dynamic and to analyse to what extent chaotic behaviour prevails. The three water level time series were characterised as non-linear and non-stationary by power spectrum, autocorrelation function, and surrogate test analyses. A strange attractor was developed when the phase space was reconstructed, having a low dimensional chaos, supported by the correlation dimension, the positive maximum Lyapunov exponents, and the recurrence quantification analysis. In line with this, the system resulted unpredictable with a threshold by sample entropy, and with an intermediate hydrological complexity, while Hurst exponent characterised the system as persistent and with sensitive dependence on initial conditions. In a general overview, all the evidence obtained indicated that the Paraná River behaviour is at the edge of chaos. A latitudinal gradient of decreasing chaoticity was observed as the floodplain extent increases, whereas complexity was highest at the intermediate river station due to the inflow of tributaries with different hydrology. This paper attempts to offer some additional insights into the understanding of hydrological behaviour of floodplain rivers and proper methods to catch their complexity.

Objective By investigating into the characteristics of vestibular dysfunction in children, this study attempts to provide some guidance and reference for the diagnosis and treatment of the disease. Methods Retrospective analysis was performed on 80 children, aged between 4 and 17, with peripheral vestibular dysfunction. Results The group aged from 6 to 12 years significantly outnumbered the other two age groups(P<0.001). We also found the positive rate of Mann test was the highest, while the positive rate of cVEMP (cervical vestibular evoked myogenic potential) was the lowest (P=0.007<0.05). The positive rate of caloric testing and Romberg/Mann test was significantly superior to others (P=0.024 <0.05). Among the etiologic factors of vestibular dysfunction in children, Benign paroxysmal vertigo of Childhood was the most common, accounted for 72.50%, following by Vestibular migraine (5.00%) and Vestibular neuritis (10.00%). It should also be noted that 27.50% were associated with other diseases such as sinusitis (18.75%). Conclusion This paper found that there was no obvious difference in age, gender and onset ear side of those children with vestibular dysfunction. However, children in primary school were more likely to suffer from vestibular dysfunction. In most cases, the cause of vestibular dysfunction in children is unclear. Thus special attention should by drawn on differential diagnosis. At the same time, detailed medical history of the children should be acknowledged and appropriate vestibular function examination should be selected, in order to give timely, effective and accurate treatment plan for the children.

Objective: Postpartum social problems, such as postpartum depression and bonding disorders, are important risk factors for child maltreatment. Mothers with such problems are known to need social support. The aim of this study was to develop and validate the Social Life Impact for Mother (SLIM) scale to identify mothers in Japan who need social support during postpartum. Design: A hospital-based prospective study. Setting: Obstetric clinics and hospitals in four populous prefectures in Japan. Sample: A total of 7462 pregnant women. Methods: The participants completed the SLIM scale at first trimester, and postpartum social problems (postpartum depression and bonding disorders) were assessed at one month after delivery (N=5768, follow-up rate: 77.3%). Multivariate logistic regression was applied to investigate the association between the SLIM scale and postpartum social problems. Main outcome measures: Postpartum social problems (postpartum depression and bonding disorders) at one month after delivery. Results: The SLIM scale predicted postpartum social problems in moderate accuracy (AUC=0.63, 95% confidence interval: 0.60-0.65). Further stratification by local clinic and tertiary hospital did not affect the estimates. Conclusion: The SLIM scale at prenatal checkup may be useful for obstetricians to detect mothers with postpartum social problems. Further intervention study using SLIM score is warranted.

The maximum carboxylation rate (Vcmax) of Rubisco and the maximum electron transport rate (Jmax), light compensation point (LCP), light saturation point (LSP), maximum photosynthesis (Amax), and apparent quantum yield (Aqy) are gas exchange characteristics that are derived from the carbon dioxide (CO2) and light response curves. This characteristics can be affected by the level of CO2 and light received by the plant. Moreover, the characteristics determines the photosynthetic capacity of the plant. The present study evaluates the gas exchange characteristics of selected plant species of UTHM. Photosynthetic carbon dioxide (A\Ci) and light (A/Q) response curves were measured using portable photosynthesis system (LICOR). The results shows that both A/Ci and A/Q curves increases as CO2 and light increases but got to a certain point where the curves become saturated. Spathodea campanulata was having the highest Vcmax (52.14±0.005 µmolCO2 m-2s-1), Jmax (104.461±0.011 µmolCO2 m-2s-1) and Aqy (0.072±0.001 mol CO2 mol-1 photons). The highest LCP was observed in Rhaphis excelsa (69.60±0.067 µmol photons m-2s-1) while the highest LSP was recorded for Costus spicatus (1576.69±0.173 µmol photons m-2s-1). It was concluded that the plants need high light intensity and CO2 to achieve their maximum assimilation rate

Sodium uptake is a factor that determines potassium use efficiency in plants as sodium can partially replace potassium in plant cells. Rice (Oryza sativa) roots usually exclude sodium but actively take it up when the plant is deficient in potassium. In rice roots, a sodium transporter OsHKT2;1 mediates the active sodium uptake. We previously revealed that variation in the expression of OsHKT2;1 underlie the variation in sodium uptake between a low-sodium-uptake indica cultivar, IR64, and a high-sodium-uptake japonica cultivar, Koshihikari. In the present study, we evaluated IR64 and its near-isogenic line IR64-K that carrying OsHKT2;1 and neighboring genes inherited from Koshihikari for grain yields. IR64-K had a greater average grain yield and harvest index than IR64 in a pot culture experiment with three levels of potassium fertilizer. The differences were most significant under treatment without potassium fertilizer. IR64-K also showed a slightly higher grain yield than IR64 when grown in a paddy field without potassium fertilizer application. These results suggest that the enhanced ability of sodium uptake improves grain yields of rice plants under low-potassium-input conditions.

Pulmonary alveolar proteinosis (PAP) is a rare syndrome due to increased production or decreased clearance of surfactant in alveoli and terminal bronchi that cause hypoxemic respiratory insufficiency. Here we present a patient with past medical history of PAP whose disease was exacerbated by superimposed COVID-19 pneumonia. He underwent whole pulmonary lavage (WPL). Evaluation of the viral count of the first and the last lavage of the left lung showed viral load in the alveolar space dropped by approximately 10-folds, however the magnitude of the viral load was substantial in both lavage samples. Whole pulmonary lavage may be used as a treatment option on patients with COVID pneumonia superimposed on a pulmonary alveolar proteinosis (PAP) exacerbation.

Background: Pregnant women undergo physiological changes that make them a challenging group of patients during pandemic respiratory diseases. Objective: To compare pregnant and non-pregnant women of childbearing age, regarding their demographic profile, clinical aspects, and mortality during the H1N1 and COVID-19 pandemics. Methods: Cross-sectional analysis of data from the SIVEP-Gripe, a Brazilian national surveillance database for respiratory viruses. Women of childbearing age with Severe Acute Respiratory Syndrome induced by H1N1 (2009/2010) and COVID-19 (2020/2021) were included. For each pandemic, women were divided into two groups according to their gestational status: pregnant or non-pregnant women. Groups were compared regarding epidemiological and clinical characteristics and their outcomes. Additionally, the effect of being pregnant was compared between both pandemics. Results: The analysis included 8,854 women for H1N1 flu pandemic (2,784 pregnant and 6,070 non-pregnant) and 69,607 women for COVID-19 pandemic (5,383 pregnant and 64,224 non-pregnant). In both pandemics, pregnant women were younger than non-pregnant women. Overall, pregnant women had lower frequencies of comorbidities and were less symptomatic. Nonetheless, notification due to hospitalization was more frequent in pregnant women in both pandemics. Among hospitalized women, pregnant women presented lower mortality rates than non-pregnant women (9.7% vs 12.6%, p=0.002 in H1N1 pandemic and 9.7% vs. 17.4%, p<0.001 in COVID-19 pandemic). Conclusion: In both pandemics, pregnant women had a higher rate of notification due to hospitalization than non-pregnant women. Nonetheless, among hospitalized subjects, pregnant women presented lower rates of death than non-pregnant women and this protection effect was more marked during the COVID-19 pandemic.

Non-immune mediated anaphylaxis to Syntocinon during labour Shyam Prakaash Bhagavata Srinivasan, Ishith Seth, Gabriella Bulloch, Alexander Mills# , Nita Dhupar*Wagga Wagga Base Hospital, Murrumbidgee Local Health District, NSW 2650, Australia.# Present address: Princess Alexandra Hospital, Metro South Health, QLD 4102, Australia.* Correspondence: Dr Nita DhuparObstetrician and GynaecologistWagga Wagga Base Hospital, Murrumbidgee Local Health District,NSW 2650, AustraliaEmail: n.dhupar2016@gmail.comPhone: +61434259479Short title: Anaphylaxis to SyntocinonKeywords: Anaphylaxis; Syntocinon; Oxytocin

In today’s world, rapid developments in science and computers are increasingly adding up to larger amounts of data; as a result, numerous problems have emerged in the analysis of big data. Hence, data dimensionality reduction can accelerate data analysis and even yield better results without losing any useful data. This study proposes a novel copula-based method of dimensionality reduction and then compares it with the principal component analysis (PCA), which is usually adopted in data mining. And we show the superiority of the new method. A copula represents an appropriate model of dependence to compare multivariate distributions and better detect the relationships of data. Therefore, a copula was employed in the proposed method to identify and delete noisy data and data of many common features from the original data. Applied to the reduced data, classification methods are finally compared.

DFT , MP2 and G3B3 methods were used to compute the adiabatic and vertical ionization potential for some benzaldehydes. The computed results were compared with the experimental data. Validation of the methods were performed using several error metrics and statistical analysis. Results of G3B3 and DFT method showed an excellent agreement with experimental ones. Substitution effect was also studied. Geometrical structure changes of the examined benzaldehydes upon ionization were followed and analyzed.

In the present studies, modified Pöschl-Teller potential (MPTP) is constructed from second Pöschl-Teller potential through conditions to be satisfied by a diatomic molecule potential. Expressions for bound state energy eigenvalues and molar entropy are derived for the MPTP. The equations obtained are applied to seven diatomic molecules: 7Li2 (a 3Σu+), Na2 (c 1Πu), CO (X 1Σ+), MgO (X 1Σ+), SO (X 3Σ-), SiO (X 2Σ+), and TiO (X 2Σ+). Numerical data are analyzed using average absolute deviation (AAD) from the dissociation energy and mean absolute deviation (MAD) from the Rydberg-Klein-Rees (RKR) data. The AAD and MAD results show that MPTP is superior over the improved Pöschl-Teller potential, and it is approximately equivalent to the improved Tietz potential for most of the diatomic molecules investigated. Expression of analytical molar entropy of the MPTP accurately predicts molar entropy of gaseous CO molecule with a MAD of 0.1993% from experimental data obtained from the literature.

With obesity becoming an epidemic, adipocytes have attracted widespread attention. Growing studies have shown that the function of adipocytes is far more than storing energy. As endocrine organs, adipocytes play a pivotal role in the occurrence and prevention of many diseases. Especially it can secrete cytokines and mediate chronic inflammation, making it one of the assistants of tumor development. Breast cancer is the main cause of cancer death in women, and its development has experienced proliferation, invasion, migration, metastasis, and drug resistance. It reports that the mammary gland is rich in adipocytes. And adipocytes can communicate with breast cancer cells and play a pivotal role in breast cancer development. It displays that adipocytes promote the proliferation, metastasis, and drug resistance of breast cancer. This suggests that focusing on adipocytes may be helpful for tumor treatment. In this paper, we reviewed the regulation mechanism of adipocytes on the development of breast cancer and proposed strategies to treat breast cancer. And this may provide a research basis for the prevention and treatment of breast cancer.

Background and purpose Vascular tone is regulated by the relative contractile state of vascular smooth muscle cells (VSMCs). Several integrins directly modulate VSMC contraction by regulating calcium influx through L-type voltage-gated Ca2+ channels (VGCCs). Genetic variants in ITGA9, which encodes the α9 subunit of integrin α9β1, and SVEP1, a ligand for integrin α9β1, associate with elevated blood pressure, however, neither SVEP1 nor integrin α9β1 have reported roles in vasoregulation. We therefore determined whether SVEP1 and integrin α9β1 can regulate VSMC contraction. Experimental Approach SVEP1 and integrin binding were confirmed by immunoprecipitation and cell binding assays. Human induced pluripotent stem cell-derived VSMCs were used in in vitro [Ca2+]i studies, and aortas from a Svep1+/- knockout mouse model were used in wire myography to measure vessel contraction. Key Results We confirmed the ligation of SVEP1 to integrin α9β1 and additionally found SVEP1 to directly bind to integrin α4β1. Inhibition of SVEP1, integrin α4β1 or α9β1 significantly enhanced [Ca2+]i release in isolated VSMCs to Gαq/11-vasoconstrictors. This response was confirmed in whole vessels where a greater contraction to U46619 was seen in vessels from Svep1+/- mice compared to littermate controls or when integrin α4β1 or α9β1 were inhibited. Inhibition studies suggested that this effect was mediated via VGCCs in a PKC dependent mechanism. Conclusions and Implications Our studies reveal a novel role for SVEP1 and the integrins α4β1 and α9β1 in reducing vascular hyper-contractility. This could provide an explanation for the genetic associations with blood pressure risk at the SVEP1 and ITGA9 loci.

Metformin is one of the first-line and widely-used drugs in patients with T2DM due to its safety profile, clinical efficacy and cheap cost. It is clearly that metformin has benefits on lowering hyperglycemia and diabetes-related complications in clinical use. However, the exact mechanisms of metformin in multiple therapies are still blurred. The classic effect of metformin is to reduce hepatic glucose production by inhibiting gluconeogenesis in liver and increase glucose utilization in peripheral tissues. Metformin targets mitochondrial respiratory chain complex I to specifically reduce reactive oxygen species generation to protect cells against oxidative stress-induced cell apoptosis. AMPK complex is a key factor in the action of metformin; however it is inconclusive that metformin activate AMPK directly or indirectly. Furthermore, the liver-centered mechanism of metformin has been challenged by that of gut microbiota alteration and GLP-1 secretion. Actually, more and more studies showed that metformin act on gut microbiota to exert anti-hyperglycemia effect. In addition, new emerging evidence showed that metformin has off-label function on bone metabolism, cancer inhibition and lifespan extension; however the underlying mechanism of such properties of metformin still remains elusive. Despite most of results are from cells in vitro and model organisms, clinical trials have been recruited by institutes around the world to verify the therapeutic effects of metformin in anti-tumor and anti-aging. Taken together, in this review we provide a new perspective on metformin and repurpose its novel and promising application in the therapy of cancer, bone fracture healing and age-related diseases.

Polycystin-2(PC2) composed of PKD2 gene encoding a transmembrane protein plays an important role in kidney disease, but the role of which in lipopolysaccharide (LPS)-induced acute lung injury (ALI) was unclear. We overexpressed PC2 in lung epithelial cell in vitro and in vivo and examined the role of PC2 in inflammatory response induced by LPS in vitro and in vivo.We demonstrated that overexpression of PC2 significantly decreased the production of inflammatory factors TNF-α, IL-1β, and IL-6 in LPS-treated lung epithelial cells. Moreover, pre-treatment of 3-Methyladenine (3-MA), an autophagy inhibitor, reversed the inhibiting effects of overexpression of PC2 on the secretion of inflammatory factors in LPS-treated lung epithelial cells. We further demonstrated overexpression of PC2 can inhibit LPS-induced downregulating the protein levels of LC3BII/I and upregulating the protein levels of SQSTM1/P62 in lung epithelial cells. Moreover, we found that LPS-induced lung wet/dry weight ratio, and inflammatory cytokines TNF-α, IL-6 and IL-1β in lung tissue were significantly inhibited in mice with overexpression of PC2 in alveolar epithelial cells. However, the protective role of overexpression of PC2 in LPS-induced ALI was reversed by 3-MA pretreatment. Our studies suggest that overexpression of PC2 in the epithelium may alleviated LPS-induced ALI by activating autophagy.

Today, in diverse medical and clinical fields, including cancer treatment, nanoscience has evolved and evolved. Cancer and its forms, on the other hand, have been rumored and inclusive, and many individuals suffer from this fatal and lethal condition. Actually, even with the medicinal effect, current therapeutic approaches, including chemotherapy, radiotherapy, etc., create symptoms that are inconvenient for patients. Scientists and scholars are also working to establish and strengthen the options and methods of therapy to deal with this dangerous illness. Nanoscience and nanotechnology have been popular today, and their different areas, including nanoparticles, are commonly used for a number of applications, especially for drug delivery and diagnostic products and cases of imaging. Release mechanisms focused on nanotechnology have a profound effect on the release of cancer drugs. Biomaterials and bio-engineering developments are leading to novel approaches to nanoparticles that could offer a new way for cancer patients to improve. In the drug release method, nano-technology has had a great effect on the selection of cancer cells, the release of a targeted drug, and the overcoming of traditional chemotherapy limitations. In the body's cells, cancer is caused by mutations. Mutant cells proliferate faster than healthy cells and remove nutrients and oxygen from these cells. A variety of methods, such as surgery, chemotherapy, and radiation therapy, or a combination of these, are used to control the disease.

Background: Prodromes are repetitive complexes of signs or symptoms portending attacks of certain chronic diseases. Recent data suggest that a large majority of patients with Hereditary Angioedema (HAE) have experienced prodromes and able to predict the onset of oncoming attacks. However, prodromes and their clinical significance have not been investigated in a systematic manner and the underlying pathophysiologic basis is unknown. A disease-specific, patient-reported outcome (PRO) instrument suitable for evaluation of prodromes and attacks is an unmet clinical need. We sought to examine and evaluate prodromes and attacks of HAE and its associations, by a new validated PRO instrument (HAE-EPA). Methods: HAE patients participated in a preliminary survey addressing their demographics, social and medical status. A cohort of 66 patients was asked to report their recent experience in prodromes and attacks. Domains (i.e. body locations) and dimentions (i.e. severity, impairment, functionality) were pre-defined for both episodes. Robust bio-statistical methods were used to analyze associations and correlations between both events. Results: Significant correlations were demonstrated between the two interrelated phenomena. Corrleations in severity were high across all domains. Hierarchical Regression analysis demonstrated an interaction between prodromes and the patients’ experience in illness (i.e disease duration). The later can explain associations between patient perception of the intensity of the prodromes and attacks. Conclusions: By using the new instrument HAE patients could effectively distinguish prodromes from attacks. The new validated instrument demonstrated high discriminative ability, acceptability, content validity/reliability, and therefore can be used for the investigation and reporting prodromes, attacks and their relationships.

Bovine ephemeral fever (BEF) disease caused by bovine ephemeral fever virus (BEFV), also known as three-day fever or three-day disease, is an arthropod-borne viral disease of buffalo and domestic cattle. In November 2020, the first possible outbreaks of BEF were reported from two different locations of the Aegean region in Turkey. This study identified the causative agent through molecular characterization as BEFV and subsequently performed sequencing of the viral glycoprotein (G) gene. Phylogenetic analysis of the G-gene region classified the newly described BEFVs within the Middle East lineage. Based on these observations it is plausible that animal movements from other regions were involved in spreading the virus to the Aegean area.

Edwardsiella ictaluri is an emerging bacterial pathogen affecting farmed tilapia ( Oreochromis spp.). This study reports the arrival, establishment and widespread of E. ictaluri in farmed tilapia in Vietnam. Among 26 disease outbreaks from 9 provinces in Northern Vietnam during 2019-2021, 19 outbreaks originated from imported stocked seeds while outbreaks in 7 farms were from domestic sources. Clinically sick fish showed appearance of numerous white spots in visceral organs, and accumulative mortalities reached 30-65%. Twenty-six representative bacterial isolates recovered from 26 disease outbreaks were then identified as E. ictaluri based on a combination of phenotypic tests, genus- and species-specific PCR assays, 16S rRNA and gyrB sequencing and phylogenetic analysis. All isolates harbored the same virulence gene profile esrC +, evpC +, ureA-C +, eseI-, escD- and virD4-. Antimicrobial susceptibility tests revealed 80.8-100% isolates were multidrug-resistant, with resistance to 4-8 antimicrobials in the groups of penicillin, macrolide, sulfonamide, amphenicols, and glycopeptide. Experimental challenge successfully induced disease that mimicked natural infection. The median lethal dose (LD 50) of the tested isolates (n = 4) were 42 to 61 CFU/fish, indicating their extremely high virulence. This emerging pathogen has already been established and spread to various geographical locations and causing serious impact to farmed tilapia in Northern Vietnam. It is likely that this pathogen will continue to occur through possibly contaminated stocks (both imported and domestic sources) and persist spreading. Thus, increased awareness combined with biosecurity measures and emergent vaccination programs are essential to mitigate the negative impact of this emerging disease on the tilapia farming industry.

A 36-year-old female presented with an eclamptic seizure at 36-weeks-gestation. She had an emergent cesarean section, complicated by cardiogenic shock. Although peripartum cardiomyopathy was the initially assumed etiology, echocardiography demonstrated that the underlying cardiac pathology was Takotsubo cardiomyopathy. This impacted the management and expected prognosis for recovery.