Accurate hematoma volume estimation in chronic subdural hematoma (cSDH) is crucial for clinical decision-making. The commonly used 1/2ABC formula, originally developed for small, regular hematomas, may be inaccurate for cSDH due to its irregular morphology. A rapid, reliable, and practical method for bedside assessment is needed. This post hoc analysis of a multicenter, real-world study compared seven simplified computed tomography-based formulas with volumetric measurements obtained using three-dimensional (3D) Slicer in a derivation cohort of 129 patients with cSDH. We further evaluated the newly proposed 3.5/6SH formula in an independent validation cohort of 60 additional patients. Accuracy, agreement, and efficiency were evaluated using estimation error, percentage deviation, intraclass correlation coefficients (ICCs), and Bland-Altman (BA) analysis. In the derivation cohort, the 3.5/6SH formula yielded the lowest median volume deviation (-0.82 mL, interquartile range [IQR] 13.12 mL), the smallest percentage deviation (-1.00%, IQR 17.08%), and the highest ICC (0.973), indicating high accuracy and close agreement with the 3D Slicer reference standard. In contrast, the widely used 1/2ABC formula exhibited a larger negative percentage deviation (-4.64%) and a lower ICC (0.910). BA analysis further confirmed that 3.5/6SH had the narrowest limits of agreement and a clinically acceptable maximum absolute percentage deviation (29.33%), whereas the maximum deviation for 1/2ABC (65.04%) exceeded the clinical acceptability threshold (33%). In an independent validation cohort of 60 patients, 3.5/6SH maintained a small bias (median deviation -1.29 mL; percentage deviation -1.27%) and excellent agreement with 3D Slicer (ICC = 0.979). Inter- and intrarater ICCs for 3.5/6SH measurements in the validation cohort were 0.994 and 0.998, respectively, supporting excellent reproducibility. The average calculation time was 77.95 sec for 3.5/6SH-longer than for 1/2ABC (35.95 sec), but substantially shorter than for 3D Slicer (19.04 min). The 3.5/6SH formula showed high accuracy and agreement with 3D Slicer across all metrics and offers a reliable, simplified method for bedside cSDH volume estimation that may facilitate more consistent volume assessment in multicenter research and clinical practice, particularly for more sensitive monitoring of hematoma changes in resource-limited environments.

BACKGROUND:Accurate segmentation of pelvic and sacral tumors (PSTs) in multi-sequence magnetic resonance imaging (MRI) is essential for effective treatment and surgical planning. PURPOSE:To develop a deep learning (DL) framework for efficient segmentation of PSTs from multi-sequence MRI. MATERIALS AND METHODS:This study included a total of 616 patients with pathologically confirmed PSTs between April 2011 to May 2022. We proposed a practical DL framework that integrates a 2.5D U-net and MobileNetV2 for automatic PST segmentation with a fast annotation strategy across multiple MRI sequences, including T1-weighted (T1-w), T2-weighted (T2-w), diffusion-weighted imaging (DWI), and contrast-enhanced T1-weighted (CET1-w). Two distinct models, the All-sequence segmentation model and the T2-fusion segmentation model, were developed. During the implementation of our DL models, all regions of interest (ROIs) in the training set were coarse labeled, and ROIs in the test set were fine labeled. Dice score and intersection over union (IoU) were used to evaluate model performance. RESULTS:The 2.5D MobileNetV2 architecture demonstrated improved segmentation performance compared to 2D and 3D U-Net models, with a Dice score of 0.741 and an IoU of 0.615. The All-sequence model, which was trained using a fusion of four MRI sequences (T1-w, CET1-w, T2-w, and DWI), exhibited superior performance with Dice scores of 0.659 for T1-w, 0.763 for CET1-w, 0.819 for T2-w, and 0.723 for DWI as inputs. In contrast, the T2-fusion segmentation model, which used T2-w and CET1-w sequences as inputs, achieved a Dice score of 0.833 and an IoU value of 0.719. CONCLUSIONS:In this study, we developed a practical DL framework for PST segmentation via multi-sequence MRI, which reduces the dependence on data annotation. These models offer solutions for various clinical scenarios and have significant potential for wide-ranging applications.

The vertebrobasilar artery (VBA) exhibits substantial inter-individual variation that must be considered in diagnosis and surgical planning. We conducted 3-dimensional reconstruction of the bilateral VBA based on head and neck computed tomography angiography (CTA) to assess bilateral, individual, age-dependent, and sex-dependent differences in anatomical parameters. A retrospective study was performed. Individual 3-dimensional models of the VBA and skull were constructed and morphology evaluated based on head and neck CTA data from 199 adults. According to morphological and anatomical variation, the VBA was divided into 3 types: balanced, L, and S. The diameters and lengths of basilar and bilateral vertebral artery (VA) intracranial segments as well as VBA blending length, and bilateral distances of the vertebral arteries moving up the atlas were measured and statistically compared. The L-type was the most common VBA morphology, and anatomic type distribution differed significantly by age (P < .05). VA diameter was 3.34 ± 0.68 mm on the left side and 3.09 ± 0.71 mm on the right side, while bending length was 5.62 ± 3.35 mm on the left and 4.94 ± 3.41 mm on the right side. Balanced basilar arteries measured 3.41 ± 0.61 mm in diameter, 2.83 ± 0.33 cm in length, and 2.55 ± 2.45 mm in bending length. The L-type basilar artery measured 3.48 ± 0.71 mm in diameter, 3.06 ± 0.44 cm in length, and 2.78 ± 0.37 mm in bending length. Finally, S-type basilar arteries measured 3.84 ± 0.86 mm in diameter, 3.38 ± 0.61 cm in length, and 3.67 ± 4.39 mm in bending length. The distance traveled by the VA across the atlas differed significantly between left and right sides as well as between males and females (P < .05). The vertebrobasilar arteries in the general healthy population were successfully fused and 3-dimensionally reconstructed based on the CTA, and an observational study was conducted on their morphological and anatomical characteristics. Three-dimensional reconstruction of the VBA using CTA is feasible for anatomical research and also has diagnostic value for the variations and anatomical parameters of the VBA.

This study developed an end-to-end deep learning (DL) model using non-enhanced MRI to diagnose benign and malignant pelvic and sacral tumors (PSTs). Retrospective data from 835 patients across four hospitals were employed to train, validate, and test the models. Six diagnostic models with varied input sources were compared. Performance (AUC, accuracy/ACC) and reading times of three radiologists were compared. The proposed Model SEG-CL-NC achieved AUC/ACC of 0.823/0.776 (Internal Test Set 1) and 0.836/0.781 (Internal Test Set 2). In External Dataset Centers 2, 3, and 4, its ACC was 0.714, 0.740, and 0.756, comparable to contrast-enhanced models and radiologists (P > 0.05), while its diagnosis time was significantly shorter than radiologists (P < 0.01). Our results suggested that the proposed Model SEG-CL-NC could achieve comparable performance to contrast-enhanced models and radiologists in diagnosing benign and malignant PSTs, offering an accurate, efficient, and cost-effective tool for clinical practice.

This study aimed to report the three-dimensional reconstruction of the foramen ovale (FO) based on computed tomography angiography and describe its shape and related angles. A retrospective analysis of 199 adult patients who were hospitalised at the Department of Neurosurgery, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China, from January to December 2020 was conducted. The original DICOM files of patients' computed tomography scans were processed by 3D Slicer software to reconstruct the three-dimensional skull. The morphological characteristics of the FO on both sides were analysed. Their size, related angles and volumes, and the differences between the two sides and gender were compared. A total of 398 FO from 199 patients were studied. The most frequent shape of the FO was oval, accounting for 54.27%. The mean lengths of the right and the left sides were 5.40±1.51 and 5.10±1.18mm, respectively. The mean width on the right and left sides was 3.23±1.16 and 3.33±1.19 mm, respectively. The FO is most commonly oval in shape. Clinicians may use the anatomical characteristics regarding the size and shape of the FO for diagnosis and treatment. Key Words: Foramen ovale, Computed tomographic angiography, 3-Dimensional anatomy.

Abstract Purpose: To explored Relationship between uric acid and cerebral amyloid angiopathy; Materials and methods: ZO-1 and RAGE in HBMECs were detected by western blotting, and then, we analyzed ZO-1, occludin, and RAGE mRNA expression levels in different treatment groups using RTPCR. Cell counts and the relative αSMA fluorescence intensity were measured in order to evaluate the protective effect of uric acid against injury to HBVSMCs. Analysis of variance showed that LDH leakage rate was used to verify the uric acid protective effect on the injury induced by Aβ1–40. After that, the level of uric acid in serum and Aβ1–40 in brain tissue was analyzed by western blotting and immunohistochemistry to evaluate the protective effect of uric acid in the brain of APP23 mice. Meanwhile, Occludin, ZO-1, and RAGE protein levels were measured by western blotting; Results: Uric acid reduced the negative effects of Aβ on the vascular endothelium and smooth muscle cells and protected the vascular wall in vitro. In APP23 mice, Aβ1–40 and Aβ1–42 levels were significantly elevated in brain tissues and further increased after uric acid concentration was decreased. In APP23 mice, ZO-1 and occludin expression levels were both significantly lower than those in wild-type animals. After uric acid concentration was lowered in APP23 mice, ZO-1 and occludin expression levels were significantly lower than those in untreated animals; Conclusions: Uric acid in the blood protects the blood vessels from CAA damage to the blood vessel wall, and reduces the occurrence of cerebral hemorrhage.

Epidermoid cysts originate from ectopic embryonic epithelial cells and are a very common type of benign intracranial tumor. However, the incidence of intraventricular epidermoid cysts is low, and lateral intraventricular epidermoid cysts are even rarer. Here, we present a case of lateral intraventricular epidermoid cyst and review the relevant literature. A 54-year-old female complained of recurrent headaches over a 5-year period, with aggravated symptoms during the last 2 months or more. A computed tomography of the brain showed a low-density mass in the lateral ventricle and enlargement of the right ventricle. Cranial magnetic resonance imaging further confirmed that the mass was an epidermoid cyst. The patient underwent microscopic surgical resection combined with endoscopy using an interhemispheric craniotomy approach. The mass was satisfactorily removed, and the patient recovered well. Lateral intraventricular epidermoid cysts often present with clinical symptoms due to the invasion of surrounding brain tissue or blockage of the cerebrospinal fluid system. Diagnosis relies on examination by magnetic resonance imaging, and treatment relies on surgical resection. The prognoses of patients are mostly excellent and depend on whether the tumor is resected cleanly or not.

Abstract Background Haemorrhage transformation (HT) is a serious complication of intravenous thrombolysis (IVT) in acute ischaemic stroke (AIS). Accurate and timely prediction of the risk of HT before IVT may change the treatment decision and improve clinical prognosis. We aimed to develop a deep learning method for predicting HT after IVT for AIS using noncontrast computed tomography (NCCT) images. Methods We retrospectively collected data from 828 AIS patients undergoing recombinant tissue plasminogen activator (rt-PA) treatment within a 4.5-h time window (n = 665) or of undergoing urokinase treatment within a 6-h time window (n = 163) and divided them into the HT group (n = 69) and non-HT group (n = 759). HT was defined based on the criteria of the European Cooperative Acute Stroke Study-II trial. To address the problems of indiscernible features and imbalanced data, a weakly supervised deep learning (WSDL) model for HT prediction was constructed based on multiple instance learning and active learning using admission NCCT images and clinical information in addition to conventional deep learning models. Threefold cross-validation and transfer learning were performed to confirm the robustness of the network. Of note, the predictive value of the commonly used scales in clinics associated with NCCT images (i.e., the HAT and SEDAN score) was also analysed and compared to measure the feasibility of our proposed DL algorithms. Results Compared to the conventional DL and ML models, the WSDL model had the highest AUC of 0.799 (95% CI 0.712–0.883). Significant differences were observed between the WSDL model and five ML models (P < 0.05). The prediction performance of the WSDL model outperforms the HAT and SEDAN scores at the optimal operating point (threshold = 1.5). Further subgroup analysis showed that the WSDL model performed better for symptomatic intracranial haemorrhage (AUC = 0.833, F1 score = 0.909). Conclusions Our WSDL model based on NCCT images had relatively good performance for predicting HT in AIS and may be suitable for assisting in clinical treatment decision-making.

Objective: To explore the mechanism by which microRNA-29b (miRNA-29b) is involved in the occurrence of intracranial aneurysms via mediation of the target gene Beclin1 to regulate smooth muscle cell autophagy. Methods: The 22 human intracranial aneurysm tissues included in this study were all taken from patients with intracranial aneurysms admitted to our hospital between January 2013 and May 2015. The 22 normal cerebral artery tissues were collected from brain tumor patients who underwent craniotomy at our hospital during the same period. We collected 42 SPF rats and randomly selected 21 intracranial aneurysm rat models; the remaining 21 rats were left untreated, and their normal cerebral artery tissues were taken. The relative expression levels of miRNA-29b in human and rat intracranial aneurysm tissues and normal cerebral artery tissues were compared. Human aortic smooth muscle cells were cultured and randomly divided into a negative control group (transfected with miRNA-29b mimics NC) and a miRNA-29b group (transfected with miRNA-29b mimics). Twenty-four hours after transfection, some cells in the miRNA-29b group were treated with 20 mg/L ox-LDL, while the negative control group was not treated. At 48 hours after transfection of the remaining cells, the miRNA-29b, Beclin1 and Beclin1, and LC3II/I protein expression levels of the two groups of cells were compared. The cell proliferation rates of the two groups were further analyzed. Results: The relative expression level of miRNA-29b in human intracranial aneurysm tissue was significantly lower than that in normal brain arteries (p<0.01). The relative expression level of miRNA-29b in rat intracranial aneurysm tissue was significantly lower than that in normal cerebral artery tissue (p<0.01). After ox-LDL intervention, the relative expression of miRNA-29b in smooth muscle cells of miRNA-29b group was significantly lower than that of the negative control group (p<0.01). After 48h post-transfection, the relative expression and protein expression of Beclin1 in smooth muscle cells from the miRNA-29b group were significantly lower than those of the negative control group, while the expression of the LC3II/I protein was significantly higher than in the control group (p<0.01). At 48 hours after transfection, the proliferation capacity of smooth muscle cells in the miRNA-29b group was significantly lower than that in the control group (p<0.01). Conclusion: miRNA-29b can participate in the occurrence of intracranial aneurysms by mediating the target gene Beclin1 to regulate smooth muscle cell autophagy.

This study aimed to develop a deep learning (DL) model to improve the diagnostic performance of EIC and ASPECTS in acute ischemic stroke (AIS). Acute ischemic stroke patients were retrospectively enrolled from 5 hospitals. We proposed a deep learning model to simultaneously segment the infarct and estimate ASPECTS automatically using baseline CT. The model performance of segmentation and ASPECTS scoring was evaluated using dice similarity coefficient (DSC) and ROC, respectively. Four raters participated in the multi-reader and multicenter (MRMC) experiment to fulfill the region-based ASPECTS reading under the assistance of the model or not. At last, sensitivity, specificity, interpretation time and interrater agreement were used to evaluate the raters’ reading performance. In total, 1391 patients were enrolled for model development and 85 patients for external validation with onset to CT scanning time of 176.4 ± 93.6 min and NIHSS of 5 (IQR 2–10). The model achieved a DSC of 0.600 and 0.762 and an AUC of 0.876 (CI 0.846–0.907) and 0.729 (CI 0.679–0.779), in the internal and external validation set, respectively. The assistance of the DL model improved the raters’ average sensitivities and specificities from 0.254 (CI 0.22–0.26) and 0.896 (CI 0.884–0.907), to 0.333 (CI 0.301–0.345) and 0.915 (CI 0.904–0.926), respectively. The average interpretation time of the raters was reduced from 219.0 to 175.7 s (p = 0.035). Meanwhile, the interrater agreement increased from 0.741 to 0.980. With the assistance of our proposed DL model, radiologists got better performance in the detection of AIS lesions on NCCT.

The biological function of miRNA (miR)-424-5p in glioma has not been clarified. This study was to explore the roles of miR-424-5p/Bifunctional apoptosis regulator (BFAR) axis in glioma. Ninety-six pairs of human glioma tissues and their adjacent non-cancer tissues were collected. The levels of BFAR and miR-424-5p were detected by quantitative polymerase chain reaction (qPCR) in glioma tissues and cell lines. Moreover, the biological roles of miR-424-5p and BFAR in glioma cells were assessed. We found a miR-424-5p binding site in the 3’UTR of BFAR by using TargetScan 7.2 online database. The miR-424-5p level was dramatically decreased in glioma tissues and cell lines, and the BFAR expression was significantly increased. The BFAR expression was negatively related to the miR-424-5p level in glioma tissues. Compared to patients with high miR-424-5p levels in glioma tissues, patients with low miR-424-5p levels had significantly lower survival rate (χ2 = 13.728 and P < 0.001). Compared to patients with high BFAR levels in glioma tissues, patients with low BFAR levels had significantly higher survival rate (χ2 = 5.516 and P = 0.027). Furthermore, up-regulation of miR-424-5p obviously restrained glioma cells proliferation and invasion, and promoted apoptosis. Besides, knockdown of BFAR also could markedly inhibit the proliferation and invasion, and promote apoptosis. Finally, overexpression of BFAR in glioma cells partially reversed the inhibited effects of miR-424-5p mimic. Knockdown of miR-424-5p restrained glioma cell apoptosis and promoted invasion and proliferation via regulation of BFAR.

Introduction: Papillary meningioma is an extremely rare malignant lesion with high degree of invasiveness, high recurrence rate, and perivascular pseudopapillary structure. The incidence of cystic degeneration in papillary meningiomas is relatively low, and cystic papillary meningiomas growing in the ventricle are even rarer. Here, we present a case of cystic meningioma and review the literature to propose the diagnosis, treatment, immunohistochemical features, and prognosis of the same. Patient concerns: In July 2013, a 35-year-old male Chinese patient presented with dizziness that lasted for a week, without relief. Magnetic resonance imaging (MRI) revealed a 2.0 cm x 1.5 cm x 3.0 cm-sized mass located in the left lateral ventricle trigone. The tumor was small and likely non-malignant. Therefore, the patient received conservative treatment and regular follow-ups. In June 2017, the patient experienced sudden severe headache, dizziness, and vomiting. Diagnosis and intervention: MRI revealed that the mass in the left lateral ventricle trigone had increased to 5.0 cm x 7.0 cm x 8.0 cm over 4 years. The patient underwent surgical resection via the left parietal-occipital approach. Two months postoperatively, the patient received 60 Gy local radiotherapy. The postoperative histopathology suggested that the mass was a cystic papillary meningioma. Outcomes: Two years after the operation, the patient was asymptomatic, and no recurrence of the lesion was noted on MRI. Conclusion: The diagnosis of intraventricular cystic papillary meningioma depends mainly on its histology and imaging features. Total resection and adjuvant radiotherapy can result in a relatively good prognosis of patients with intraventricular cystic papillary meningiomas.

AIM:To evaluate the feasibility and long-term clinical results of combined surgical resection and high-dose methotrexate (HD-MTX) chemotherapy for primary central nervous system lymphoma (PCNSL) of the brain.MATERIAL AND METHODS:Fifty-eight patients were diagnosed with PCNSL by histopathological examination of brain biopsy specimens at the Second Affiliated Hospital of Bengbu Medical College from March 2013 to December 2017. All patients received MTX at adose of 3.5 g/m2 every 2 weeks for 6 cycles. Clinical information, including ages, number of lesions, and tumor locations, were retrospectively collected from the medical records.RESULTS:The complete remission rates in patients treated with MTX plus craniotomy for surgical resection and those treated with MTX alone were 70.0% and 32.1%, respectively (p=0.021). Adding craniotomy to MTX chemotherapy did not increase the complication rate. The most common adverse events were hematological toxicity, liver toxicity, and gastrointestinal reaction were similar between groups. Multivariate analysis showed that surgical resection was associated with longer progression-free survival (PFS) (OR: p=0.002).CONCLUSION:Combining craniotomy for surgical resection and MTX-based chemotherapy may be safe and effective for treating PCNSL.

Intrahepatic cholangiocarcinoma (ICC) originates from the epithelial cells of the secondary branches that are distant from the intrahepatic bile duct. ICC is a rare pathological type of primary liver cancer, with a high malignancy rate and poor prognosis. However, patients with ICC metastasis to the skull are extremely rarely encountered. Herein, we present a case of a metastatic skull tumor from ICC, along with a literature review.A 50-year-old right-handed man who did not smoke was diagnosed with a poorly differentiated ICC (T2aN0M0) in segment VI of the liver in February 2017. Hepatectomy was performed. The patient then presented with a painful mass in the posterior occipital region with dizziness experienced since 1 month, for which he underwent posterior occipital craniotomy. Postoperative specimens were sent for pathological examination.We diagnosed the patient with a metastatic skull tumor from ICC.The patient underwent posterior occipital craniotomy and total resection of the tumor.The patient received chemotherapy 1 month after surgery, and after 6 months of follow-up, the patient was alive.ICC often shows metastases to the vertebrae. Therefore, physicians should consider the possibility of metastasis in patients with ICC, especially in those who show a painful skull mass of unknown origin; moreover, among patients with vertebral metastasis, physicians should be very vigilant about an occipital mass. We believe that the craniospinal venous system may be the pathway for occipital metastasis in patients with ICC.

OBJECTIVE: To investigate the factors associated with recanalization after stent retriever thrombectomy in patients with acute ischemic stroke due to large vessel occlusion. METHODS: We retrospectively analyzed the medical records of 56 patients with an acute anterior circulation macrovascular occlusion who underwent successful stent retriever thrombectomy. Patients were classified as successful recanalization or futile recanalization at the follow-up. Univariate analysis and binary logic regression analysis were used to explore the association between patients' demographic and clinical characteristics and futile recanalization. RESULTS: The rate of futile recanalization was signifi-ntly higher after stent retrieval thrombectomy in patients with an Alberta Stroke Program Early CT (ASPECT) score <= 7 points versus >7 points (P < 0.001), >= 5 passes with the stent retriever versus <5 passes with the stent retriever (P = 0.036), or a longer recanalization time (P = 0.008). The influence of number of stent retriever pass is foremost, followed by ASPECT and occurrence to recanalization. CONCLUSIONS: Improving technical expertise with mechanical thrombectomy and shortening the therapeutic time window may improve the prognosis of patients with acute ischemic stroke due to large vessel occlusion.

Rationale: Intrahepatic cholangiocarcinoma (ICC) originates from the epithelial cells of the secondary branches that are distant from the intrahepatic bile duct. ICC is a rare pathological type of primary liver cancer, with a high malignancy rate and poor prognosis. However, patients with ICC metastasis to the skull are extremely rarely encountered. Herein, we present a case of a metastatic skull tumor from ICC, along with a literature review. Patient concerns: A 50-year-old right-handed man who did not smoke was diagnosed with a poorly differentiated ICC (T2aN0M0) in segment VI of the liver in February 2017. Hepatectomy was performed. The patient then presented with a painful mass in the posterior occipital region with dizziness experienced since 1 month, for which he underwent posterior occipital craniotomy. Postoperative specimens were sent for pathological examination. Diagnoses: We diagnosed the patient with a metastatic skull tumor from ICC. Interventions: The patient underwent posterior occipital craniotomy and total resection of the tumor. Outcomes: The patient received chemotherapy 1 month after surgery, and after 6 months of follow-up, the patient was alive. Lessons: ICC often shows metastases to the vertebrae. Therefore, physicians should consider the possibility of metastasis in patients with ICC, especially in those who show a painful skull mass of unknown origin; moreover, among patients with vertebral metastasis, physicians should be very vigilant about an occipital mass. We believe that the craniospinal venous system may be the pathway for occipital metastasis in patients with ICC.

Rationale:Fenofibrate is a fibric acid derivative indicated for use in hypertriglyceridemia and mixed dyslipidemia treatment among adults. Rhabdomyolysis is a syndrome characterized by muscle necrosis and the release of intracellular muscle contents into the systemic circulation, which is the most serious and fatal side effect of fenofibrate. The objective of this paper is to discuss fatal side effect of fenofibrate and keep safe medication.Patient concerns:A patient with hypothyroidism who presented with rhabdomyolysis during fenofibrate monotherapy for hypertriglyceridemia was reported.Diagnoses:Fenofibrate Monotherapy Induced Rhabdomyolysis.Interventions:Fenofibrate was stopped. Adequate fluid resuscitation, mannitol diuresis, myocardium protection, hepatoprotection and urine alkalinization with sodium bicarbonate were performed.Outcomes:Blood tests were normal and the patient was good and discharged 2 weeks later.Lessons:13 cases associated with fenofibrate monotherapy-induced rhabdomyolysis were reviewed, which had been published in the English literature. The severity of fenofibrate muscle toxicity may be the result of the combination of two rhabdomyolysis enhancers, such as hypothyroidism and female gender. To avoid it, strict clinical and laboratory monitoring should be maintained, particularly hypothyroidism. Patients should be informed of possible potentially irreversible effects after taking fibrates.

RATIONALE:Choriocarcinoma is the most malignant type of gestational trophoblastic neoplasia. Brain metastasis is the main cause of death and disability in choriocarc- inoma patients. Brain metastasis of choriocarcinoma easily invades the vessel wall to form microaneurysms, so we have reason to believe that multiple intracerebral hemorrhage is related to neoplastic intracranial microaneurysms.PATIENT CONCERNS:We report a rare case of brain metastasis of choriocarcinoma that caused six hemorrhages in four lesions within 50 days and anterior cerebral artery aneurysm.DIAGNOSES:We diagnosed multiple intracerebral hematoma, choriocarcinoma and intracranial aneurysms.INTERVENTIONS:Evacuation of hematoma by craniotomy.OUTCOMES:The patient finally asked to terminate the treatment and was discharged. One month later, the patient died of upper gastrointestinal bleeding.LESSONS:more than 20 cases of oncotic aneurysm from choriocarcinoma have been reported in the English literature, but few had multiple hematomas. Therefore, this case is unique. Brain metastasis of choriocarcinoma should be considered when patients experience unexplained cerebral hemorrhage, especially repeated intracranial hemorrhage in women of childbearing age. Early and intensive treatment can help achieve a better prognosis and avoid a fatal outcome. Multiple intracranial hematomas are related to neoplastic intracranial microaneurysms.

Basic transcription factor 3 (BTF3), a general RNA polymerase II transcription factor, is aberrantly expressed in several kinds of malignancies including cervical cancer. Applying immunohistochemistry, we detected BTF3 in cervical cancers (n=87) and normal tissues (n=38), and analyzed its relationships with clinicopathological variables. Our results showed that BTF3 staining significantly increased from normal tissue to cervical cancer. BTF3 expression was increased from worse differentiation to better differentiation (38% vs.72%, P=0.0019). And BTF3 expression was decreased from cervical cancers in stage I and II to those in stage III and IV (76% vs. 37%, P=0.00028). In conclusion, BTF3 overexpression may be an early event in cervical cancer development and could be a useful biomarker for the early stage of cervical cancer.