Regulatory of salinity on assembly of activated sludge microbial communities and nitrogen transformation potential in industrial plants of the lower Yangtze River basin.

This study aims to thoroughly investigate the impact mode of salinity carried by industrial wastewater on the anaerobic-anoxic-oxic (A2O) sludge in wastewater treatment plants (WWTPs). Through comprehensive investigation of the A2O stage activated sludge (AS) from 19 industrial WWTPs in the downstream area of the Yangtze River, China, A total of 38 samples of anaerobic sludge and oxic sludge were collected and analyzed. We found that salinity stress significantly inhibits the growth of the AS community, particularly evident in the anaerobic sludge community. Furthermore, the high-saline environment induces changes in the structure and functional patterns of the AS community, leading to intensive interactions and resource exchanges among microorganisms. Halophilic microorganisms may play a crucial role in this process, significantly impacting the overall community structure, especially in the oxic sludge community. Additionally, salinity stress not only suppresses the nitrogen transformation potential of the AS but also leads to the accumulation of nitrite, thereby increasing the emission potential of both NO and N2O, exacerbating the greenhouse effect of the A2O process in industrial WWTPs. The findings of this study provide necessary theoretical support for maintaining the long-term stable operation of the A2O sludge system in industrial WWTPs, reducing carbon footprint, and improving nitrogen removal efficiency.

Foxo1-induced miR-92b down-regulation promotes blood-brain barrier damage after ischaemic stroke by targeting NOX4.

The blood-brain barrier (BBB) damage is a momentous pathological process of ischaemic stroke. NADPH oxidases 4 (NOX4) boosts BBB damage after ischaemic stroke and its expression can be influenced by microRNAs. This study aimed to probe into whether miR-92b influenced the BBB damage after ischaemic stroke by regulating NOX4 expression. Here, miR-92b expression was lessened in the ischaemic brains of rats and oxygen-glucose deprivation (OGD)-induced brain microvascular endothelial cells (BMECs). In middle cerebral artery occlusion (MCAo) rats, miR-92b overexpression relieved the ameliorated neurological function and protected the BBB integrity. In vitro model, miR-92b overexpression raised the viability and lessened the permeability of OGD-induced BMECs. miR-92b targeted NOX4 and regulated the viability and permeability of OGD-induced BMECs by negatively modulating NOX4 expression. The transcription factor Foxo1 bound to the miR-92b promoter and restrained its expression. Foxo1 expression was induced by OGD-induction and its knockdown abolished the effects of OGD on miR-92b and NOX4 expressions, cell viability and permeability of BMECs. In general, our findings expounded that Foxo1-induced lessening miR-92b boosted BBB damage after ischaemic stroke by raising NOX4 expression.

Long noncoding RNA MALAT1 contributes to inflammatory response of microglia following spinal cord injury via the modulation of a miR-199b/IKKß/NF-κB signaling pathway.

Long noncoding RNA (lncRNA) metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) was widely recognized to be implicated in human cancer, vascular diseases, and neurological disorders. This study was to explore the role and underlying mechanism of MALAT1 in acute spinal cord injury (ASCI). ASCI models in adult rats were established and demonstrated by a numerical decrease in BBB scores. Expression profile of MALAT1 and miR-199b following ASCI in rats and in vitro was determined using quantitative real-time PCR. RNA pull-down assays combined with RIP assays were performed to explore the interaction between MALAT1 and miR-199b. In the present study, MALAT1 expression was significantly increased (2.4-fold that of control) in the spinal cord of the rat contusion epicenter accompanied by activation of IKKß/NF-κB signaling pathway and an increase in the level of proinflammatory cytokines TNF-α and IL-1ß. Upon treatment with LPS, MALAT1 expression dramatically increased in the microglia in vitro, but knockdown of MALAT1 attenuated LPS-induced activation of MGs and TNF-α and IL-1ß production. Next, we confirmed that LPS-induced MALAT1 activated IKKß/NF-κB signaling pathway and promoted the production of proinflammatory cytokines TNF-α and IL-1ß through downregulating miR-199b. More importantly, MALAT1 knockdown gradually improved the hindlimb locomotor activity of ASCI rats as well as inhibited TNF-α, IL-1ß levels, and Iba-1 protein, the marker of activated microglia in injured spinal cords. Our study demonstrated that MALAT1 was dysregulated in ASCI rats and in LPS-activated MGs, and MALAT1 knockdown was expected to attenuate ASCI through repressing inflammatory response of MGs.

Long noncoding RNA MEG3 mediated angiogenesis after cerebral infarction through regulating p53/NOX4 axis.

OBJECTIVE: This study aimed to explore the mechanism of lncRNA MEG3 on angiogenesis after cerebral infarction (CI). METHODS: The rat brain microvascular endothelial cells (RBMVECs) isolated from rat was used to establish CI model, which were treated with oxygen-glucose deprivation/reoxygenation (OGD/R). The genes mRNA and protein expression levels in RBMVECs were determined by the quantitative real-time polymerase chain reaction (RT-qPCR) and western blot, respectively. The flow cytometry was used to measured cell apoptosis and intracellular reactive oxygen species (ROS) generation. The RBMVECs activities was detected by MTT method. The RNA-immunoprecipitation (RIP) assay was used to detect the interaction between MEG3 and p53, and the relationship between p53 and NOX4 was proved by chromatin co-immunoprecipitation (chip) assay. RESULTS: The results showed that OGD or OGD/R increased MEG3 and NOX4 expression, and there was positive correlation between MEG3 and NOX4 expression in RBMVECs. Next, knockdown of MEG3 indicated that inhibition of MEG3 was conducive to protect RBMVECs against OGD/R-induced apoptosis, with decreased NOX4 and p53 expression, further enhanced pro-angiogenic factors (HIF-1α and VEGF) expression, and reduced intracellular ROS generation. And then the RIP and CHIP assay demonstrated that MEG3 could interacted with p53 and regulated its expression, and p53 exerted significant binding in the promoters for NOX4, suggesting that MEG3 regulated NOX4 expression via p53. At last, knockdown of NOX4 indicated that inhibition of NOX4 protected RBMVECs against OGD/R-induced apoptosis, with increased cell viability and pro-angiogenic factors expression, and reduced ROS generation. CONCLUSION: LncRNA MEG3 was an important regulator in OGD/R induced-RBMVECs apoptosis and the mechanism of MEG3 on angiogenesis after CI was reduced ROS by p53/NOX4 axis.

Downregulation of miR-199b promotes the acute spinal cord injury through IKKß-NF-κB signaling pathway activating microglial cells.

Inflammatory response played an important role in the progression of spinal cord injury (SCI). Several miRNAs were associated with the pathology of SCI. However, the molecular mechanism of miRNA involving in inflammatory response in acute SCI (ASCI) was poorly understood. Sprague-Dawley (SD) rats were divided into 2 groups: control group (n=6) and acute SCI (ASCI) group (n=6). The expression of miR-199b and IκB kinase ß-nuclear factor-kappa B (IKKß-NF-κB) signaling pathway were evaluated by quantitative reverse transcription-PCR (qRT-PCR) in rats with ASCI and in primary microglia activated by lipopolysaccharide (LPS). We found that downregulation of miR-199b and activation of IKKß/NF-κB were observed in rats after ASCI and in activated microglia. miR-199b negatively regulated IKKß by targeting its 3'- untranslated regions (UTR) through using luciferase reporter assay. Overexpression of miR-199b reversed the up-regulation of IKKß, p-p65, tumor necrosis factor-α (TNF-α) and interleukin-1ß (IL-1ß) in LPS-treated BV2 cells assessed by western blotting analysis. In addition, BMS-345541 reversed the up-regulation effects of miR-199b inhibitor on the expression of TNF-α and IL-1ß. In the SCI rats, overexpression of miR-199b attenuated ASCI and decreased the expression of IKKß-NF-κB signaling pathway and TNF-α and IL-1ß. These results indicated that miR-199b attenuated ASCI at least partly through IKKß-NF-κB signaling pathway and affecting the function of microglia. Our findings suggest that miR-199b may be employed as therapeutic for spinal cord injury.

Bevacizumab for the Treatment of Gammaknife Radiosurgery-Induced Brain Radiation Necrosis.

BACKGROUND: Radiation necrosis is one of the complications of Gammaknife radiosurgery. The traditional treatment of radiation necrosis carries a high risk of failure, Bevacizumab is an antiangiogenic monoclonal antibody against vascular endothelial growth factor, a known mediator of cerebral edema. It can be used to successfully treat brain radiation necrosis. PATIENT DESCRIPTION: Two patients with a history of small cell lung cancer presented with metastatic disease to the brain. They underwent Gammaknife radiosurgery to brain metastases. Several months later, magnetic resonance imaging showed radiation necrosis with significant surrounding edema. The patients had a poor response to treatment with dexamethasone. They were eventually treated with bevacizumab (5 mg/kg every 2 weeks, 7.5 mg/kg every 3 weeks, respectively), and the treatment resulted in significant clinical and radiographic improvement. CONCLUSION: Bevacizumab can be successfully used to treat radiation necrosis induced by Gammaknife radiosurgery in patients with cerebral metastases. It is of particular benefit in patients with poor reaction to corticosteroids and other medications.

Recurrent cerebral amyloid angiopathy-related hemorrhage.

Cerebral amyloid angiopathy is an important cause of intracerebral hemorrhage in normotensive elder individuals. Surgical treatment for cerebral hematoma due to amyloid angiopathy remains controversial, and some authors emphasized the difficulty of hemostasis during surgery and the risk of recurrent hemorrhage after surgery. A case study of a 68-year-old man with cerebral amyloid angiopathy and recurrent intracerebral hemorrhages is presented.

Association between XRCC3 T241M polymorphism and glioma risk: a meta-analysis.

X-ray repair cross-complementing group 3 (XRCC3) plays a critical role in homologous recombination repair (HRR) accounting for repair of DNA double-strand breaks (DSB). Attention has been drawn upon the association of XRCC3 T241M polymorphism with glioma risk. The present meta-analysis aimed to examine whether XRCC3 T241M polymorphism was associated with glioma risk. Eligible articles were identified for the period up to March 2013. Pooled odds ratios (ORs) with 95 % confidence intervals (CIs) were appropriately derived from fixed effects or random effects models. Eight case-control studies with a total of 3,455 glioma cases and 4,435 controls were included. Overall, no significant association between XRCC3 T241M polymorphism and glioma was found. In subgroup analysis, this polymorphism seemed to be associated with elevated glioma risk in Asians. No publication bias was detected. This meta-analysis suggested that XRCC3 T241M polymorphism did not confer glioma risk.

Bilateral cranial hemophilic pseudotumor.

Hemophilic pseudotumor is a rare but well-known complication of hemophilia manifesting as recurrent hemorrhage and progressive enlargement of hematoma. A patient with severe hemophilia has 1% to 2% chance to develop pseudotumor. The chronic pressure of osseous hemorrhage usually results in bone destruction or resorption. Cranial hemophilic pseudotumors are extremely rare, with only 7 reported cases associated with mild or moderate factor VIII or IX deficiency. A 42-year-old man with a mild factor VIII deficiency developed a pseudotumor of the bilateral skull. Computed tomography and magnetic resonance imaging revealed an extra-axial lesion with bone destruction, and signal changes are consistent with chronic hemorrhage. With adequate factor-deficient replacement therapy, surgical removal was performed. Histologic examination disclosed old blood coagulum. No recurrence was observed in 3 years of follow-up. Cranial hemophilic pseudotumor is extremely rare, and with adequate factor-deficient replacement therapy, surgical management is a safe and effective way for cranial hemophilic pseudotumor treatment.

[Experience of surgical treatment of huge mediastinal tumors].

OBJECTIVE: The diagnosis and surgical treatment of 36 huge mediastinal tumors were summarized in order to evaluate the effect and safety of the operation. METHODS: Thirty-six huge mediastinal tumor patients treated in our department from June 2006 to June 2013 were retrospective analyzed, of whom clinical manifestations, diagnosis, surgical treatment and prognosis were carefully collected. Twenty-three cases were men and 13 were women. The average age was 39.2 years old. The pathology turned out to be benign in 23 cases and malignant in 13 cases. RESULTS: Complete resection was achieved in 34 cases while palliative resection in 2 cases with no perioperative death. Six cases had developed postoperative complications but all recovered after active treatment. Patients who had been diagnosed with benign tumors were all alive after follow-up periods of 6 months to 7 years. Nine malignat tumor patients developed recurrence or metastasis, including seven deaths. CONCLUSION: Surgery played a vital role in the diagnosis and treatment of huge mediastinal tumors. Preoperative diagnosis, accurate surgical approach and careful operation were the key to successful treatment. Benign huge mediastinal tumors had excellent prognosis with surgery.

Temperature-Driven Activated Sludge Bacterial Community Assembly and Carbon Transformation Potential: A Case Study of Industrial Plants in the Yangtze River Delta.

Temperature plays a critical role in the efficiency and stability of industrial wastewater treatment plants (WWTPs). This study focuses on the effects of temperature on activated sludge (AS) communities within the A2O process of 19 industrial WWTPs in the Yangtze River Delta, a key industrial region in China. The investigation aims to understand how temperature influences AS community composition, functional assembly, and carbon transformation processes, including CO2 emission potential. Our findings reveal that increased operating temperatures lead to a decrease in alpha diversity, simplifying community structure and increasing modularity. Dominant species become more prevalent, with significant decreases in the relative abundance of Chloroflexi and Actinobacteria, and increases in Bacteroidetes and Firmicutes. Moreover, higher temperatures enhance the overall carbon conversion potential of AS, particularly boosting CO2 absorption in anaerobic conditions as the potential for CO2 emission during glycolysis and TCA cycles grows and diminishes, respectively. The study highlights that temperature is a major factor affecting microbial community characteristics and CO2 fluxes, with more pronounced effects observed in anaerobic sludge. This study provides valuable insights for maintaining stable A2O system operations, understanding carbon footprints, and improving COD removal efficiency in industrial WWTPs.

Innovative recovery of matrix layered double hydroxide from simulated acid mine wastewater for the removal of copper and cadmium from wastewater.

This study innovatively added biochar to optimize regulation in the neutralization process of simulated acid mine drainage (AMD) and recovered a new type of matrix layered double hydroxides (MLDH), which can be used to remove copper (Cu(II)) and cadmium (Cd(II)) from wastewater. A series of batch experiments show that MLDH with strong selective removal ability of Cu(II) and Cd(II) can be successfully obtained by adding biochar (BC) at pH = 5 end in the neutralization process. Kinetic and isotherm modeling studies indicated that the removal of Cu(II) and Cd(II) by the MLDH was a chemical multilayer adsorption process. The removal mechanism of Cu(II) and Cd(II) was further analyzed through related characterization analysis with contribution rate calculation: the removal rates of Cu(II) and Cd(II) by ion exchange were 42.7% and 26%, while that by precipitation were 34.5% and 49.9%, respectively. This study can provide a theoretical reference and experimental basis for the recovery and utilization of valuable by-products in AMD and the treatment of heavy metal wastewater.

Proteomics shows that brain metastases of lung adenocarcinoma overexpress ribosomal proteins in response to gamma knife radiosurgery.

Gamma knife radiosurgery (GKRS) is recommended as the first-line treatment for brain metastases of lung adenocarcinoma (LUAD) in many guidelines, but its specific mechanism is unclear. We aimed to study the changes in the proteome of brain metastases of LUAD in response to the hyperacute phase of GKRS and further explore the mechanism of differentially expressed proteins (DEPs). Cancer tissues were collected from a clinical trial for neoadjuvant stereotactic radiosurgery before surgical resection of large brain metastases (ChiCTR2000038995). Five brain metastasis tissues of LUAD were collected within 24 h after GKRS. Five brain metastasis tissues without radiotherapy were collected as control samples. Proteomics analysis showed that 163 proteins were upregulated and 25 proteins were downregulated. GO and KEGG enrichment analyses showed that the DEPs were closely related to ribosomes. Fifty-three of 70 ribosomal proteins were significantly overexpressed, while none of them were underexpressed. The risk score constructed from 7 upregulated ribosomal proteins (RPL4, RPS19, RPS16, RPLP0, RPS2, RPS26 and RPS25) was an independent risk factor for the survival time of LUAD patients. Overexpression of ribosomal proteins may represent a desperate response to lethal radiotherapy. We propose that targeted inhibition of these ribosomal proteins may enhance the efficacy of GKRS.

Safety and Efficacy of Anlotinib Hydrochloride Plus Temozolomide in Patients with Recurrent Glioblastoma.

PURPOSE: Glioblastoma (GBM) is a highly vascularized tumor with few treatment options after disease recurrence. Here, we report the efficacy and safety of anlotinib hydrochloride plus temozolomide in patients with recurrent GBM. PATIENTS AND METHODS: Patients with first definite postsurgical progression of histologically confirmed GBM preceded by standard radiotherapy and temozolomide chemotherapy were eligible for inclusion. All patients received temozolomide (150-200 mg/m2, orally, every day (QD) d1-5/4 wk) and anlotinib (10 mg, orally, QD, d1-14/3 wk) until disease progression or unacceptable toxicity. The primary endpoint was investigator-assessed 6-month progression-free survival (PFS) rate by the Response Assessment in Neuro-Oncology (RANO) criteria. RESULTS: Twenty-one patients were enrolled between May 2020 and July 2021, with a median age of 55 (range 27-68) years old. According to the Response Assessment in Neuro-Oncology (RANO) criteria, tumor response occurred in 17 patients, of which 9 patients had a complete response, and the objective response rate was 81.0% [95% confidence interval (CI), 62.6-99.3]. The disease control rate was 95.2% (95% CI, 76.2-99.9), with three additional patients achieving a stable disease without tumor progression. The median PFS was 7.3 months (95% CI, 4.9-9.7), and the 6-month PFS rate was 61.9% (95% CI, 39.3-84.6). The median overall survival was 16.9 months (95% CI, 7.8-26.0). The most common adverse events were leukocytopenia (66.7%), thrombocytopenia (38.1%), and hypertriglyceridemia (38.1%). Five patients had nine grade 3 adverse events, with a 23.8% incidence rate. Two patients discontinued therapy due to ischemic stroke (grade 3) and wound dehiscence (grade 1), respectively. No grade 4 or treatment-related deaths occurred in this study. CONCLUSIONS: Anlotinib combined with temozolomide is efficacious and tolerated in patients with recurrent GBM.

Anlotinib combined with temozolomide for the treatment of patients with diffuse midline glioma: a case report and literature review.

Background: Diffuse midline glioma with a histone H3-K27M mutation is a brand-new tumor entity according to the 2016 edition of World Health Organization (WHO) classification. As diffuse midline gliomas are aggressive and incurable brain tumors, characterized by high levels of intrinsic and acquired resistance to therapy, as well as conventional treatment can hardly work due to an intact blood-brain barrier, leading to very poor outcomes for patients. Anlotinib is a multitarget tyrosine kinase inhibitor and has been used for the treatment of multiple tumor species, with satisfying outcomes. However, anlotinib has not been reported for the treatment of patients with diffuse midline glioma. Case Description: This is a case report about a 51-year-old man suffering from diffuse midline glioma with a histone H3-K27M mutation. After surgery, the patient underwent chemoradiation treatment and then adjuvant temozolomide (TMZ). After 7 months, the tumor had enlarged with severe peritumor edema and hydrocephalus. Bevacizumab was treated for 3 cycles, and then the treatment was changed to anlotinib combined with TMZ. After 8 months, magnetic resonance imaging (MRI) scans showed that the mass was significantly reduced compared with before targeted therapy. Until the present time, the patient has survived for 20 months. Conclusions: Therapy combining anlotinib with TMZ is potential therapeutic option for the patients with diffuse midline glioma.

Learning global dependencies based on hierarchical full connection for brain tumor segmentation.

BACKGROUND AND OBJECTIVE: Because the appearance, shape and location of brain tumors vary greatly among different patients, brain tumor segmentation (BTS) is extremely challenging. Recently, many studies have used attention mechanisms to solve this problem, which can be roughly divided into two categories: the spatial attention based on convolution (with or without channel attention) and self-attention. Due to the limitation of convolution operations, the spatial attention based on convolution cannot learn global dependencies very well, resulting in poor performance in BTS. A simple improvement idea is to directly substitute it with self-attention, which has an excellent ability to learn global dependencies. Since self-attention is not friendly to GPU memory, this simple substitution will make the new attention mechanism unable to be applied to high-resolution low-level feature maps, which contain considerable geometric information and are also important for improving the performance of attention mechanism in BTS. METHOD: In this paper, we propose a hierarchical fully connected module, named H-FC, to learn global dependencies. H-FC learns local dependencies at different feature map scales through fully connected layers hierarchically, and then combines these local dependencies as approximations of the global dependencies. H-FC requires very little GPU memory and can easily replace spatial attention module based on convolution operation, such as Attention Gate and SAM (in CBAM), to improve the performance of attention mechanisms in BTS. RESULTS: Adequate comparative experiments illustrate that H-FC performs better than Attention Gate and SAM (in CBAM), which lack the ability to learn global dependencies, in BTS, with improvements in most metrics and a larger improvement in Hausdorff Distance. By comparing the amount of calculation and parameters of the model before and after adding H-FC, it is prove that H-FC is light-weight. CONCLUSION: In this paper, we propose a novel H-FC to learn global dependencies. We illustrate the effectiveness of H-FC through experiments on BraTS2020 dataset. We mainly explore the influence of the region size and the number of steps on the performance of H-FC. We also confirm that the global dependencies of low-level feature maps are also important to BTS. We show that H-FC is light-weight through a time and space complexity analysis and the experimental results.

Stereotactic radiosurgery for the treatment of esophageal carcinoma brain metastases.

PURPOSE: The authors evaluated the results of stereotactic radiosurgery (SRS) for the treatment of metastatic brain tumors from esophageal carcinoma. METHODS: We retrospectively analyzed the clinical characteristics and treatment outcomes in 21 patients with metastatic brain tumors from esophageal carcinoma who underwent SRS between July 2011 and February 2019. RESULTS: 21 patients (25 SRS procedures) of a total of 88 tumors underwent Gamma knife SRS. Tumor histology was adenocarcinoma in 6 patients (28.6%) and squamous cell carcinoma in 15 patients (71.4%). The median age was 66 years (range 58-73). Eleven patients (52.4%) presented with multiple metastases (range 2-11), and 10 . (47.6%) with a single metastasis. The median tumor volume was 0.55 cm3 (range 0.004-44.64 cm3). No complications related to radiosurgical treatment were identified. The local tumor control rate in this group was 94.2 %. The median survival time from the diagnosis of esophageal cancer was 22 months and the median survival from SRS was 16 months. Higher Karnofsky Performance Scale (KPS) at the time of procedure was associated with increased survival (p=0.003). After SRS, 4 patients had subsequent SRS (1 for boost therapy, 3 for new metastatic deposits), 1 patient underwent craniotomy due to tumor progression. Of the 19 patients who have died, 17 (89.5%) succumbed to systemic disease progression and 2 (10.5%) had neurologic deaths. CONCLUSION: SRS is an effective and minimally invasive treatment that can prolong survival. Accordingly, SRS could be used as the initial treatment modality, if possible, even in patients with multiple metastases.

Low-Dosage Bevacizumab Treatment: Effect on Radiation Necrosis After Gamma Knife Radiosurgery for Brain Metastases.

Cerebral radiation necrosis (RN), a complication of Gamma Knife radiosurgery, is difficult to treat, although bevacizumab seems to be effective. However, clinical data pertaining to bevacizumab treatment for RN are scarce, and its high price is problematic. This study explored the effectiveness of low-dose bevacizumab for RN caused by Gamma Knife. We retrospectively analyzed 22 patients who suffered cerebral RN post-Gamma Knife, and received bevacizumab treatment because of the poor efficacy of glucocorticoids. Low-dose bevacizumab (3 mg/kg) was administered for two cycles at 2-week intervals. T1- and T2-enhanced magnetic resonance imaging (MRI) images were examined for changes in RN status. We also monitored the dose of glucocorticoid, Karnofsky Performance Status (KPS) score, and adverse drug reactions. The mean volume of RN lesions decreased by 45% on T1-weighted images with contrast enhancement, and by 74% on T2-weighted images. All patients discontinued the use of glucocorticoids. According to the KPS scores, all patients showed an improvement in their symptoms and neurological function. No side effects were observed. Low-dosage bevacizumab at a dose of 3 mg/kg every 2 weeks is effective for treating cerebral RN after Gamma knife for brain metastases.

Treatment of hypertensive intracerebral hemorrhage through keyhole transsylvian approach.

The present study investigated the therapeutic effects and indications of keyhole transsylvian approach (KTA) in the treatment of hypertensive intracerebral hemorrhage (HICH). Clinical data of 65 cases of HICH were retrospectively analyzed. All the patients were treated by open surgical evacuation either through KTA (KTA group) or through conventional craniotomy approach (CCA group). The operative time, intraoperative bleeding quantity, the length of hospitalization, mortality, and favorable outcome were compared between the 2 groups. Compared with the CCA group, the KTA group had smaller bleeding quantity and shorter length of hospitalization. Favorable outcome at 3 months after admission was higher in the KTA group than that in the CCA group. The present study suggests that treatment of HICH through KTA is a practical and effective surgical procedure.

[Application of videomediastinoscopy in positive PET finding for mediastinal lymph node of lung cancer].

BACKGROUND AND OBJECTIVE: Positron emission tomography (PET) is used increasingly in staging of non-small cell lung cancer (NSCLC) as a non-invasive tool. However, the role of PET in mediastinal lymphatic staging of NSCLC is not clear. The aim of this study was to demonstrate the efficacy of mediastinoscopy in determining mediastinal lymphatic metastasis in cases of positive PET finding. METHODS: We performed PET preoperatively in 68 patients with clinically operable NSCLC between 2003 and 2008. Mediastinal lymphatic defined as metastasis by PET (SUV(max) > 2.5) was recorded. Mediastinoscopy being performed initially in all patients. Involvement of mediastinal lymph nodes was verified to compare the sensitivity and specificity of mediastinoscopy and the related PET results. RESULTS: From 2003 to 2008, 61 mediastinoscopy were performed. There were 38 men and 23 women, aged from 41 to 81 years (mean 60 years). Localization of the tumor was right lung in 41 patients and left lung in 20 patients. After the operation, 45 patients were demonstrated to have N2 or N3 disease. Ten patients with N3 mediastinal metastasis for chemotherapy, 38 patients with N2 mediastinal metastasis for neuadjuvant chemotherapy while lung resection and systemic mediastinal lymphatic dissection through thoracotomy was performed in the remaining 16 patients with no mediastinal metastasis. The positive prediction value of PET scan was 73.8% (45/61). The sensitivity, specificity, accuracy, positive prediction value and negative prediction value in diagnosis of metastasis of mediastinal lymph nodes were 93.8% (45/48), 100% (13/13), 95.1% (58/61), 100% (45/45), 81.3% (13/16) for mediastinoscopy, respectively. CONCLUSION: PET results do not provide acceptable accuracy rates. Mediastinoscopy still remains the gold standard for mediastinal staging of NSCLC.