Notes

All-natural hybridization between types Ligularia nelumbifolia and Cremanthodium stenoglossum (Senecioneae, Asteraceae) indicates underdeveloped reproductive system isolation along with unclear intergeneric border.
Lung ultrasound (LUS) is a dynamic, real-time, non-invasive bedside tool that offers increased sensitivity over standard imaging modalities in identifying pulmonary edema. This case highlights acute post-operative hypoxia secondary to pulmonary edema that was initially missed by chest radiography (CXR) and chest computed tomography (CT). The edema was diagnosed first on same day by bedside LUS, later seen on next day follow-up CXR and resolved with diuresis. LUS has demonstrated superior accuracy compared to CXR, but scant evidence compares it to CT. This case presentation serves to increase awareness of LUS as a highly sensitive and easy-to-use diagnostic tool for hospital providers in the evaluation of acute hypoxia.Transarterial chemoembolization (TACE) is a generally well-tolerated and safe procedure that is increasingly being used in the management of intermediate-stage hepatocellular carcinoma (HCC). Tumor rupture is a rare major complication of TACE. Predisposing factors for tumor rupture include large tumor size and peripherally located tumors; in cases of HCC in cirrhosis secondary to autoimmune hepatitis (AIH), tumor rupture may occur more frequently because of the phenomenon of peliosis that occurs in AIH leading to higher propensity to rupture. Management of tumor rupture can be surgical or conservative depending on the individual case. We describe the first documented case of tumor rupture post-TACE in a patient with AIH cirrhosis and HCC.Identifying drugs that can mitigate dispersal of glioblastoma cells, particularly after patients undergo radiotherapy and concomitant chemotherapy, may increase the length of time to recurrence and improve overall survival. Previous studies have shown that dexamethasone (Dex), a drug currently used to treat brain tumor-related edema, which is tapered immediately after the edema has resolved, induces fibronectin matrix assembly (FNMA) and reduces dispersal of primary human glioblastoma multiforme (GBM) cells in vitro and ex vivo. Here, we utilized an in vivo mouse retina dispersal assay to demonstrate that Dex also inhibits dispersal in vivo. We show that 1) Dex significantly reduces z-axis penetration of glioblastoma cells into mouse retina; 2) treatment alters the morphology of dispersal; 3) without Dex, the presence of fibronectin increases dispersal; 4) treatment activates in vivo FNMA by glioblastoma cells, leading to the containment of the tumor mass; and 5) Dex-mediated activation of FNMA is fibronectin dose-dependent. read more Dispersal inhibition could be achieved at human equivalent doses as low as 1 mg/day, a dose significantly lower than currently used to reduce edema. This is the first step towards future studies in which patients can be potentially maintained on low-dose dexamethasone therapy with the aim of increasing the time between initial resection and recurrence.Cryptococcosis is an opportunistic fungal infection found in both immunocompromised and non-immunocompromised patients; however, it is particularly prevalent in those with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS). Patients with isolated pulmonary cryptococcosis can present with heterogeneous symptoms. The rarity of this entity makes it difficult to recognize and diagnose. We present a case of a 54-year-old female with poorly controlled HIV and seizure disorder, who presented with suspected seizures. Her CD4 count was 7. Due to fever and headache, cryptococcal meningitis was suspected, and she was empirically started on liposomal amphotericin and flucytosine. Computed tomography (CT) of the head was negative for any acute intracranial process. Serum cryptococcal antigen was positive; however cerebrospinal fluid (CSF) studies from lumbar puncture (LP) were entirely negative, including CSF cryptococcal antigen. CT thorax demonstrated interval development of two solid pulmonary nodules in the right upper lobe (RUL). There was no other evidence of disseminated cryptococcal disease. CT-guided biopsy of the larger RUL was compatible with Cryptococcus species. Fungal cultures of sputum and blood were negative. The patient improved, and therapy was de-escalated from liposomal amphotericin and flucytosine to oral fluconazole, with a plan to complete a six- to twelve-month course of therapy. This case illustrates that in rare cases, Cryptococcal disease may still be localized despite having a positive serum Cryptococcal antigen. It also emphasizes the importance of a thorough investigation with multimodal diagnostic tools to evaluate for disseminated Cryptococcal disease, especially in those with a history of immunocompromise.Aneurysmal subarachnoid hemorrhage is a life-threatening event that can cause permanent disability. This life-threatening event can be further complicated by subsequent cardiac and pulmonary disability. The presence of a neurogenic cardiomyopathy and pulmonary edema increases the morbidity and mortality of patients who suffer from aneurysmal subarachnoid hemorrhage. In this paper, we discuss a 39-year-old woman who presented to the emergency department (ED) with a chief complaint of a pounding headache with associated nausea and vomiting for the past three days. She had a past medical history significant only for migraines. During her stay in the ED, she began to exhibit signs of altered consciousness, hemoptysis, and respiratory compromise. Neuroimaging showed evidence of subarachnoid hemorrhage. The exact source of her subarachnoid hemorrhage could not be located with neuroimaging or angiography. Her clinical course was complicated by pulmonary edema and neurogenic stunned myocardium, and is still ongoing.Introduction The aim of this study is to evaluate whether pregnancy rates or semen parameters are affected due to male or female age after microsurgical varicocelectomy. Methods A total of 293 infertile men who underwent microsurgical inguinal varicocelectomy were divided into three groups according to age group 1, patients and their spouses ≥35 years old (n = 46); group 2, patients ≥35 years old and their spouses less then 35 years old (n = 34); and group 3, patients and their spouses less then 35 years old (n = 213). Preoperative and postoperative semen parameters and pregnancy rates were compared. Results The median ages of the patients in groups 1, 2, and 3 were 41, 35.50, and 28 years, respectively. The median ages of the spouses were 36 (35-38 years), 30 (21-34 years), and 25 (18-32 years) years, in groups 1, 2, and 3, respectively. Total motile sperm count (TMC) significantly increased in all groups after varicocelectomy (P less then 0.05). Pregnancy rates after varicocelectomy was higher in group 3 compared to groups 2 and 3, but the differences were not significant (P = 0.
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