Biological Activities of Citrus aurantium Leaf Extract by Optimized Ultrasound-Assisted Extraction.

Several studies have explored the biological activities of Citrus aurantium flowers, fruits, and seeds, but the bioactivity of C. aurantium leaves, which are treated as waste, remains unclear. Thus, this study developed a pilot-scale ultrasonic-assisted extraction process using the Box-Behnken design (BBD) for the optimized extraction of active compounds from C. aurantium leaves, and their antityrosinase, antioxidant, antiaging, and antimicrobial activities were evaluated. Under optimal conditions in a 150× scaleup configuration (a 30 L ultrasonic machine) of a pilot plant, the total phenolic content was 69.09 mg gallic acid equivalent/g dry weight, which was slightly lower (3.17%) than the theoretical value. The half maximal inhibitory concentration of C. aurantium leaf extract (CALE) for 2,2-diphenyl-1-picrylhydrazyl-scavenging, 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid)-scavenging, antityrosinase, anticollagenase, antielastase and anti-matrix metalloprotein-1 activities were 123.5, 58.5, 181.3, 196.4, 216.3, and 326.4 mg/L, respectively. Moreover, the minimal inhibitory concentrations for bacteria and fungi were 150-350 and 500 mg/L, respectively. In total, 17 active compounds were detected in CALE-with linalool, linalyl acetate, limonene, and α-terpineol having the highest concentrations. Finally, the overall transdermal absorption and permeation efficiency of CALE was 95.9%. In conclusion, our CALE demonstrated potential whitening, antioxidant, antiaging, and antimicrobial activities; it was also nontoxic and easily absorbed into the skin as well as inexpensive to produce. Therefore, it has potential applications in various industries.

Practicing Outside the Lines: Using Acupuncture in the Athletic Training Room and on the Field.

Acupuncture can be used to treat athletes in an outpatient clinic setting, athletic training room, or even on a football field sideline. This article details 3 scenarios, in 3 illustrative cases, in which acupuncture was used for sports medicine in more unconventional settings. The author describes each case and shares his observations about them. First, acupuncture was used on a high-school football field sideline to help alleviate acute calf cramping in a player. Second, acupuncture was used in a division 2 college athletic training room to treat a player with subacute thoracic pain that was not improving with the usual treatments provided by the athletic trainers. Third, acupuncture was used to treat hamstring strain and tightness in a professional National Football League player to enhance his performance. These situations demonstrate the versatility of acupuncture in the realm of sports medicine. Acupuncture is an added-value service for athletes, and acupuncture providers should not be afraid to promote it in this population that is always looking for a competitive advantage.

Experimental checking and modeling of the influence of operation conditions on the first order kinetic constants in free water surface wetlands.

The most commonly used model in constructed wetlands is the first-order removal model, and first order kinetic constants (k) are the key parameters. The presumption is often made that k are constants. However, it is possible that k are functions of operating conditions, but the influence of operation conditions on k is unclear. In this study, response surface methodology was used to explore the variation patterns of ka (area rate constants) and kV (volume rate constants) for the removal of total nitrogen (TN) and total phosphorus (TP) in free water surface (FWS) wetlands. The experimental variables included hydraulic loading rate (HLR), water depth, and inlet concentration (Cin). The results showed that kV was more variable than ka, and the area-based first-order model is more suitable for simulating TN and TP in FWS wetlands. Inlet concentration (Cin) was significant for ka; Cin and water depth were significant for kV; HLR and the interaction between factors were insignificant. The effects of Cin on ka and kV can be described by an upward convex quadratic curve, while the effect of water depth on kV demonstrates a downward convex quadratic curve. The first-order area rate constant for TN removal was given by k = -47.66 + 22.01 Cin - 1.154 Cin2; the first-order area rate constant for TP removal was given by k = -27.75 + 95.88 Cin - 30.73 Cin2. Based on the variation patterns, the traditional k-C model was modified to the kψ-C model. The kψ-C model produced the best results at simulating the outlet concentration and removal efficiency (RE).

An audit of structure-based medical acupuncture by a single provider in patients with musculoskeletal pain using PROMIS scores as the outcome.

BACKGROUND: To assess whether structure-based medical acupuncture (SMA) can improve Patient-Reported Outcomes Measurement Information System (PROMIS) scores in patients presenting with musculoskeletal pain. METHODS: An audit was conducted of all patients presenting with musculoskeletal pain treated by a single provider with SMA in 2017. Inclusion criteria included a pre-treatment and at least one post-treatment PROMIS score. Patient demographics and previous treatments tried were recorded. Documented events other than acupuncture that were thought to interfere with PROMIS scores were recorded, and no further scores were used after these events. A maximum of nine visits after the initial visit were used. The PROMIS domains assessed included anxiety, depression, pain interference and physical function. RESULTS: Seventy-two patients who had been treated with SMA met the inclusion criteria. Sixty-five of the patients (90%) had chronic pain. For their presenting complaint, 59 (82%) had previously sought treatment from another non-operative provider, 60 (83%) had tried physical therapy, and 20 (28%) had even had surgery. Despite this, SMA appeared to be able to significantly improve PROMIS anxiety at visits 1-3 and PROMIS depression at visit 3. After just one treatment, minimal clinically important differences (MCID) were reached in 32%-44% of patients for PROMIS anxiety, 17%-36% for PROMIS depression, 28%-29% for PROMIS physical function, and 21%-36% for PROMIS pain interference, based on low and high cut-offs of a range of quoted MCID values. CONCLUSION: In a difficult patient population with musculoskeletal pain, SMA is a technique that can likely be used to improve PROMIS anxiety and depression, although no firm conclusions can be drawn from this uncontrolled clinical audit. Of note, MCIDs were sometimes obtained even after just one treatment.

Impaired grazing of marine protozoa in sub-lethal exposure to the water accommodated fraction of crude oil and dispersant.

Despite the advances in safety technology and the improved implementation of precautionary measures, crude oil pollution has been occurring in the oceans globally. The water accommodated fraction (WAF) of crude oil and chemical dispersant are hypothesized to cause sub-lethal adverse effects on marine protists that are pivotal consumers of primary production. Exposure experiments were conducted to investigate the effects of crude oil and dispersant pollutants on the growth and grazing, separately, of protozoa species in cultures. In exposure to 0-30 µL L-1 of chemically enhanced WAF (CEWAF), the heterotrophic dinoflagellate Protoperidinium sp. and the ciliate Metacylis sp. showed slower positive population growth or negative population growth even at low concentrations. The dose-response model showed that Protoperidinium sp. and Metacylis sp. were highly susceptible to the CEWAF toxicity (median inhibition concentrations (IC50) at 1.1 and 5.9 µL L-1, respectively) while one algal species Ditylum brightwellii was relatively tolerant to the toxicity (IC50 at 168.7 µL L-1). With suppressed growth and impaired grazing of the protozoan species at high CEWAF concentrations, accumulation of their algal prey in culture containers was observed, as reflected by higher final:initial prey ratios at high CEWAF concentrations. Additionally, exposure experiments to the treatments of WAF, dispersant alone (Disp), and CEWAF of the same concentration revealed that the heterotrophic dinoflagellate Oxyrrhis marina had reduced bulk grazing impact towards its algal prey population in all three treatments when compared to the control treatment (i.e., grazing mortality of prey at 1.05 d-1). Similarly, Protoperidinium sp. and Metacylis sp. had reduced per capita prey ingestion rates in exposure to WAF and CEWAF when compared to the control treatments. This study provides experimental evidence for the potential link between impaired grazing activities and the formation of algal blooms in sub-lethal exposure to crude oil pollutants.

Acupuncture and Dry Needling for Sports Performance and Recovery.

ABSTRACT: Acupuncture and dry needling share many similarities in their proposed mechanisms of action and their sports medicine-related applications. Pain is the most common indication for these needling treatments, but there also are some limited studies on their use for ergogenic purposes. Needling can likely improve muscular strength and power, including increasing jump height, and it also can increase flexibility. In terms of sports recovery, acupuncture can not only be used for pain relief after injury, but also can help with routine recovery, such as in delayed onset muscle soreness. There are numerous case reports of acupuncture and dry needling being used to treat athletes for various diagnoses and conditions, however more high quality studies are needed in order to make more specific evidence-based recommendations. Given the high degree of safety and limited adverse events associated with needling treatments, it can likely be promoted in athletes.

De-coupled phytoplankton growth and microzooplankton grazing in a simulated oil spill event in mesocosms.

Microzooplankton (<200 µm) are essential intermediates between primary production and organisms at the higher trophic levels. Their ecological functions could be substantially affected by crude oil pollution. A natural plankton community was exposed to 10 µL L-1 of chemically dispersed crude oil (DOil) in outdoor mesocosms for 7 days, with control (Ctrl) mesocosms set up for comparison. Dilution experiments were conducted to estimate the grazing rates of microzooplankton on the 2nd and 6th days of the pollutants exposure. Results showed 0.36-2.28 d-1 microzooplankton grazing rates in the Ctrl mesocosms on both days but negative rates in the DOil mesocosms. A significant linear relationship between in situ phytoplankton growth and microzooplankton grazing rates was found in the Ctrl treatment but not in the DOil treatment. This suggests a de-coupling between phytoplankton growth and microzooplankton and the potential for the formation of phytoplankton blooms in seawater after an oil spill event.

From GWAS to drug screening: repurposing antipsychotics for glioblastoma.

BACKGROUND: Glioblastoma is currently an incurable cancer. Genome-wide association studies have demonstrated that 41 genetic variants are associated with glioblastoma and may provide an option for drug development. METHODS: We investigated FDA-approved antipsychotics for their potential treatment of glioblastoma based on genome-wide association studies data using a 'pathway/gene-set analysis' approach. RESULTS: The in-silico screening led to the discovery of 12 candidate drugs. DepMap portal revealed that 42 glioma cell lines show higher sensitivities to 12 candidate drugs than to Temozolomide, the current standard treatment for glioblastoma. CONCLUSION: In particular, cell lines showed significantly higher sensitivities to Norcyclobenzaprine and Protriptyline which were predicted to bind targets to disrupt a certain molecular function such as DNA repair, response to hormones, or DNA-templated transcription, and may lead to an effect on survival-related pathways including cell cycle arrest, response to ER stress, glucose transport, and regulation of autophagy. However, it is recommended that their mechanism of action and efficacy are further determined.

Postrace Dry Needling Does Not Reduce Subsequent Soreness and Cramping-A Randomized Controlled Trial.

OBJECTIVE: To identify whether a single session of postrace dry needling can decrease postrace soreness and quantity of postrace leg cramps in half-marathon and full-marathon runners. DESIGN: Single-blind, prospective, randomized, controlled trial. SETTING: Finish line of 2018 Salt Lake City Marathon & Half-Marathon. PARTICIPANTS: Runners aged 18 years or older who completed a marathon or half-marathon. INTERVENTIONS: True or sham dry needling of the bilateral vastus medialis and soleus muscles within 1 hour of race completion by 2 experienced practitioners. MAIN OUTCOME MEASURES: The primary outcome measure was numeric pain rating improvements for soreness on days 1, 2, 3, and 7 compared to immediately postrace. Secondary outcome measures included number of postrace cramps and subjective improvement of soreness. RESULTS: Sixty-two runners were included with 28 receiving true and 34 receiving sham dry needling. Objective pain scores showed an increase in pain of the soleus muscles at days 1 and 2 (P ≤ 0.003 and P ≤ 0.041, respectively) in the dry needling group. No differences were seen in postrace pain in the vastus medialis muscles (P > 0.05). No association was seen between treatment group and presence of postrace cramping at any time point (P > 0.05). Subjectively, there was a nonsignificant trend for those receiving dry needling to feel better than expected over time (P = 0.089), but no difference with cramping (P = 0.396). CONCLUSIONS: A single postrace dry needling session does not objectively improve pain scores or cramping compared to sham therapy.

Ultrasound Visualization of Radial Nerve Excursion During Acupuncture.

Objective: Nerves are likely to be contacted by needles somewhat regularly during acupuncture treatments. However, the effects of this are not well-known or described. The aim of this article is to describe the effects of acupuncture needling to the radial nerve in a single healthy subject. Materials and Methods: In this experiment, conducted at an academic medical center (Washington University School of Medicine in St. Louis, St. Louis, MO), ultrasound-guided acupuncture needling was performed to the radial nerve of one of the authors (C.-T.T.) in the upper arm at acupoint LI 13. The main outcome measures sought were ultrasonic visualization of the nerve during acupuncture needling and the sensations experienced during acupuncture needling of the nerve. Results: The radial nerve was seen to "roll" out of the way when it was needled. Two De Qi responses were elicited en route to the nerve, but, during nerve contact and penetration, minimal-to-no sensation was experienced. Conclusions: Healthy nerves can show side-to-side excursion when needled, and providers and patients cannot know reliably whether or not a nerve has been contacted or penetrated based on the sensations the patient experiences.

Clinical features, antimicrobial susceptibility patterns and genomics of bacteria causing neonatal sepsis in a children's hospital in Vietnam: protocol for a prospective observational study.

INTRODUCTION: The clinical syndrome of neonatal sepsis, comprising signs of infection, septic shock and organ dysfunction in infants ≤4 weeks of age, is a frequent sequel to bloodstream infection and mandates urgent antimicrobial therapy. Bacterial characterisation and antimicrobial susceptibility testing is vital for ensuring appropriate therapy, as high rates of antimicrobial resistance (AMR), especially in low-income and middle-income countries, may adversely affect outcome. Ho Chi Minh City (HCMC) in Vietnam is a rapidly expanding city in Southeast Asia with a current population of almost 8 million. There are limited contemporary data on the causes of neonatal sepsis in Vietnam, and we hypothesise that the emergence of multidrug resistant bacteria is an increasing problem for the appropriate management of sepsis cases. In this study, we aim to investigate the major causes of neonatal sepsis and assess disease outcomes by clinical features, antimicrobial susceptibility profiles and genome composition. METHOD AND ANALYSIS: We will conduct a prospective observational study to characterise the clinical and microbiological features of neonatal sepsis in a major children's hospital in HCMC. All bacteria isolated from blood subjected to whole genome sequencing. We will compare clinical variables and outcomes between different bacterial species, genome composition and AMR gene content. AMR gene content will be assessed and stratified by species, years and contributing hospital departments. Genome sequences will be analysed to investigate phylogenetic relationships. ETHICS AND DISSEMINATION: The study will be conducted in accordance with the principles of the Declaration of Helsinki and the International Council on Harmonization Guidelines for Good Clinical Practice. Ethics approval has been provided by the Oxford Tropical Research Ethics Committee 35-16 and Vietnam Children's Hospital 1 Ethics Committee 73/GCN/BVND1. The findings will be disseminated at international conferences and peer-reviewed journals. TRIAL REGISTRATION NUMBER: ISRCTN69124914; Pre-results.

Effects of four kinds of electromagnetic fields (EMF) with different frequency spectrum bands on ovariectomized osteoporosis in mice.

Electromagnetic fields (EMF) was considered as a non-invasive modality for treatment of osteoporosis while the effects were diverse with EMF parameters in time domain. In present study, we extended analysis of EMF characteristics from time domain to frequency domain, aiming to investigate effects of four kinds of EMF (LP (1-100 Hz), BP (100-3,000 Hz), HP (3,000-50,000 Hz) and AP (1-50,000 Hz)) on ovariectomized (OVX) osteoporosis (OP) in mice. Forty-eight 3-month-old female BALB/c mice were equally assigned to Sham, OVX, OVX + LP, OVX + BP, OVX + HP and OVX + AP groups (n = 8). After 8-week exposure (3 h/day), LP and BP significantly increased serum bone formation markers and osteogenesis-related gene expressions compared with OVX. Bedsides, LP and BP also slightly increased bone resorption activity compared with OVX, evidenced by increased RANKL/OPG ratio. HP sharply decreased serum bone formation and resporption markers and osteogenesis and osteoclastogenesis related gene expressions compared with OVX. AP had accumulative effects of LP, BP and HP, which significantly increased bone formation and decreased bone resporption activity compared with OVX. As a result, LP, BP and HP exposure did not later deterioration of bone mass, microarchitecture and mechanical strength in OVX mice with OP. However, AP stimulation attenuated OVX-induced bone loss.

Effects of extremely low frequency pulsed magnetic fields on diabetic nephropathy in streptozotocin-treated rats.

BACKGROUND: Extremely low frequency pulsed magnetic fields (ELFPMF) have been shown to induce Faraday currents and measurable effects on biological systems. A kind of very high frequency electromagnetic field was reported that it improved the symptoms of diabetic nephropathy (DN) which is a major complication of diabetes. However, few studies have examined the effects of ELFPMF DN at the present. The present study was designed to investigate the effects of ELFPMF on DN in streptozotocin (STZ)-induced type 1 diabetic rats. METHODS: Adult male SD rats were randomly divided into three weight-matched groups: Control (non-diabetic rats without DN), DN + ELFPMF (diabetic rats with DN exposed to ELFPMF, 8 h/days, 6 weeks) and DN (diabetic rats with DN exposed to sham ELFPMF). Renal morphology was examined by light and electron microscopy, vascular endothelial growth factor (VEGF)-A and connective tissue growth factor (CTGF) were measured by enzyme linked immune sorbent assay. RESULTS: After 6 weeks' ELFPMF exposure, alterations of hyperglycemia and weight loss in STZ-treated rats with DN were not found, while both positive and negative effects of ELFPMF on the development of DN in diabetic rats were observed. The positive one was that ELFPMF exposure attenuated the pathological alterations in renal structure observed in STZ-treated rats with DN, which were demonstrated by slighter glomerular and tubule-interstitial lesions examined by light microscopy and slighter damage to glomerular basement membrane and podocyte foot processes examined by electron microscopy. And then, the negative one was that ELFPMF stimulation statistically significantly decreased renal expression of VEGF-A and statistically significantly increased renal expression of CTGF in diabetic rats with DN, which might partially aggravate the symptoms of DN. CONCLUSION: Both positive and negative effects of ELFPMF on the development of DN in diabetic rats were observed. The positive effect induced by ELFPMF might play a dominant role in the procession of DN in diabetic rats, and it is suggested that the positive effect should be derived from the correction of pathogenic diabetes-induced mediators.

Discovery and characterization of GSK256073, a non-flushing hydroxy-carboxylic acid receptor 2 (HCA2) agonist.

Niacin has been used for many years in the treatment of dyslipidemia due to its ability to decrease serum levels of triglycerides and low-density lipoprotein cholesterol and to increase levels of high density lipoprotein cholesterol. However, niacin causes severe flushing resulting in poor patient compliance. The discovery of hydroxy-carboxylic acid receptor 2 (HCA2) as a high affinity receptor for niacin has opened avenues to investigate the mechanism of action of niacin, and to potentially discover agonists which maintain the antilipolytic effects of niacin accessed by a decrease in circulating non-esterified fatty acids (NEFA) and thereby perhaps the lipid/lipoprotein effects, but avoid the flushing effects. Here we describe the strategy we implemented to identify such compounds. This approach resulted in the discovery of GSK256073, a highly potent HCA2 agonist, which produced similar NEFA lowering effects to niacin in preclinical models (rat and guinea pig). A guinea pig model was used to predict flushing, via an increase in ear temperature, and GSK256073 was found to have a minimal effect in this model. These preclinical models appeared to be predictive of human response, since in a first-time-in-human study, GSK256073 displayed long lasting NEFA and triglyceride lowering effects in healthy male subjects, which were not associated with flushing. GSK256073 can be used as a pharmacological tool to better understand the role of HCA2 in lipid metabolism.

Saponin 1 induces apoptosis and suppresses NF-κB-mediated survival signaling in glioblastoma multiforme (GBM).

Saponin 1 is a triterpeniod saponin extracted from Anemone taipaiensis, a traditional Chinese medicine against rheumatism and phlebitis. It has also been shown to exhibit significant anti-tumor activity against human leukemia (HL-60 cells) and human hepatocellular carcinoma (Hep-G2 cells). Herein we investigated the effect of saponin 1 in human glioblastoma multiforme (GBM) U251MG and U87MG cells. Saponin 1 induced significant growth inhibition in both glioblastoma cell lines, with a 50% inhibitory concentration at 24 h of 7.4 µg/ml in U251MG cells and 8.6 µg/ml in U87MG cells, respectively. Nuclear fluorescent staining and electron microscopy showed that saponin 1 caused characteristic apoptotic morphological changes in the GBM cell lines. Saponin 1-induced apoptosis was also verified by DNA ladder electrophoresis and flow cytometry. Additionally, immunocytochemistry and western blotting analyses revealed a time-dependent decrease in the expression and nuclear location of NF-κB following saponin 1 treatment. Western blotting data indicated a significant decreased expression of inhibitors of apoptosis (IAP) family members,(e.g., survivin and XIAP) by saponin 1. Moreover, saponin 1 caused a decrease in the Bcl-2/Bax ratio and initiated apoptosis by activating caspase-9 and caspase-3 in the GBM cell lines. These findings indicate that saponin 1 inhibits cell growth of GBM cells at least partially by inducing apoptosis and inhibiting survival signaling mediated by NF-κB. In addition, in vivo study also demonstrated an obvious inhibition of saponin 1 treatment on the tumor growth of U251MG and U87MG cells-produced xenograft tumors in nude mice. Given the minimal toxicities of saponin 1 in non-neoplastic astrocytes, our results suggest that saponin 1 exhibits significant in vitro and in vivo anti-tumor efficacy and merits further investigation as a potential therapeutic agent for GBM.

Ginsenoside Rd maintains adult neural stem cell proliferation during lead-impaired neurogenesis.

Lead exposure attracts a great deal of public attention due to its harmful effects on human health. Even low-level lead (Pb) exposure reduces the capacity for neurogenesis. It is well known that microglia-mediated neurotoxicity can impair neurogenesis. Despite this, few in vivo studies have been conducted to understand the relationship between acute Pb exposure and microglial activation. We investigated whether the acute Pb exposure altered the expression of a marker of activated microglial cells (Iba-1), and markers of neurogenesis (BrdU and doublecortin) in aging rats. As compared to controls, Pb exposure significantly enhanced the expression of Iba-1 immunoreactivity; increased the expression levels of IL-1ß, IL-6, and TNF-α and decreased the numbers of BrdU(+) and doublecortin(+) cells. Our prior work demonstrated that ginsenoside Rd (Rd), one of the major active ingredients in Panax ginseng, was neuroprotective in a variety of paradigms involving anti-inflammatory mechanisms. Thus, we further examined whether Rd could attenuate Pb-induced phenotypes. Compared with the Pb exposure group, Rd pretreatment indeed attenuated the effects of Pb exposure. These results suggest that Rd may be neuroprotective in old rats following acute Pb exposure, which involves limitation of microglial activation and maintenance of NSC proliferation.

Inhibitory effects of water extract from longan twigs on mutation and nitric oxide production.

This study examines the inhibitory effects of water extract from longan twigs (WLTs) on mutation and nitric oxide (NO) production. The results show that WLT inhibited the mutagenicity of 2-aminoanthracene (2-AA), an indirect mutagen, and 4-nitroquinoline-N-oxide (4-NQO), a direct mutagen toward Salmonella typhimurium TA 98 and TA 100. In addition, WLT in the range 0-0.6 mg/ml showed radical scavenging, reducing activities and chelating activity, as well as decreased lipid oxidative damage. Meanwhile, WLT also inhibited tyrosinase activity and NO generation in lipopolysaccharide (LPS) stimulated macrophages. High performance liquid chromatography analysis suggests that the major phenolic constituents in WLT are epicatechin, ellagic acid and gallic acid. These bioactive components may contribute to the protective effects of WLT. Our data suggests that WLT can be applied to antimutation, anti-inflammation and antityrosinase.

Endoscopic supracerebellar infratentorial retropineal approach for tumor resection.

BACKGROUND: Lesions located in the pineal region represent a surgical challenge. Multiple approaches to this region have been described, each with its advantages and disadvantages. We report the first application of the endoscopic supracerebellar infratentorial approach for complete resection of a pineal tumor. Unlike transventricular endoscopy, this technique poses no risk to the fornices and can be applied independent of ventricular size. CASE DESCRIPTION: A 21-year-old man sought treatment for diplopia. Magnetic resonance images of brain revealed a heterogeneous, contrast-enhancing mass that originated from the pineal gland. This tumor exerted the mass effect on the tectum and invaded to the bilateral dorso-medial thalamus and hypothalamus but caused no obstructive hydrocephalus. The results of a cytological study of the cerebrospinal fluid, alpha-fetoprotein, and beta-human chorionic gonadotropin were negative. The patient was referred for the surgical work-up. TECHNIQUE: The patient was positioned in the semi-sitting position. The supracerebellar infratentoria corridor was accessed through two paramedian burr holes, which provided natural by-gravity cerebellar traction. The excellent illumination and magnification without sacrificing the inferior occipital sinus could be achieved with the aid of the endoscope. The pineal tumor was resected completely via the full-endoscopic approach. Postoperatively, the patient's diplopia resolved completely, and his hospital course was uneventful. CONCLUSIONS: Taking the advantages of the endoscope and peculiar supracerebellar infratentoria corridor, we could successfully remove the gross-total tumor without violating the critical neurovascular structures. Moreover, this approach can be performed regardless of the size of the ventricle. Consequently, it is an excellent minimally invasive surgical option for resection of symptomatic pineal tumor.