Network pharmacology analysis and clinical efficacy of the traditional Chinese medicine Bu-Shen-Jian-Pi. Part 2: Modulation of hypoxia, redox status, and mitochondrial protection in a neuroblastoma cell line, SH-SY5Y.

OBJECTIVE: To examine the mitochondrial protective effects of icariin, naringenin, kaempferol, and formononetin, potentially active agents in Bu-Shen-Jian-Pi formula (BSJP) identified using network pharmacology analysis. MATERIALS AND METHODS: Mitochondrial protection activity was determined using a hypoxia-reoxygenation in vitro model based on the neuroblastoma cell line SH-SY5Y and measurements of anti-ferroptotic activity. RESULTS: Icariin, naringenin, kaempferol, and formononetin showed mitochondrial protective activity involving diverse signaling pathways. The cytoprotective effects of formononetin depended on the inhibition of ferroptosis. Hypoxia-reoxygenation stimulation induced ferroptosis in SH-SY5Y cells. DISCUSSION: Ferroptosis is a key mechanism in nervous system diseases and is associated with hypoxia-reoxygenation injury. Naringenin and kaempferol were devoid of anti-ferroptotic activity. CONCLUSION: Evidence has been obtained showing that the core components: icariin, naringenin, kaempferol, and formononetin in BSJP formula have anti-hypoxic and mitochondrial protective activity of potential clinical importance in the treatment of amyotrophic lateral sclerosis and patients with symptoms of hypoxia.

[Electroacupuncture intervention combined with general anesthesia for craniocerebral operations].

OBJECTIVE: To determine the safety and effectiveness of electroacupuncture (EA) intervention combined with general anesthesia (GA) for craniocerebral tumor-removal surgery involving cerebral eloquent areas. METHODS: A total of 20 patients with cerebral tumors (durosarcoma, neurogliocytoma, metastatic tumor) involving the cerebral eloquent areas were recruited in the present summary. They were equally divided into general anesthesia (GA) group and EA + GA group. Patients of the EA + GA group were treated with EA stimulation (2 Hz/100 Hz) of the bilateral Fengchi (GB 20), Shuaigu (GB 8) and acupuncture stimulation of Quanliao (SI 18), Zulinqi (GB 41) and Taichong (LR 3), and not given intubation during surgery. Patients of the GA group were treated with intravenous administration of Propofol, Fentanyl, Midazolam, Isopropanol, etc. In addition, all the patients were given with controlled hypotension by intravenous injection of Propofol and Fentanyl. Dosages of Propofol and Sulfentanyl used were recorded. Karnofsky performance status scale was used to assess the patient's general well-being and activities of daily life. RESULTS: The craniocerebral tumor-removal surgery was successful in all the 20 patients. Compared with the GA group, the dosages of Sulfentanyl and Propofol of the EA+ GA group were significantly lower (P < 0.05). No significant difference was found between the GA and EA+ GA groups in Karnofsky performance scores (P > 0.05). Patients of the EA+GA group experienced successful tumour-removal surgery without trachea cannula, were awake and could make a good cooperation with the operator during surgery. They had no aggravation of neurofunctional disturbance following the operation. CONCLUSION: EA combined with general anesthesia is safe and effective for patients with craniocerebral tumor-removal operations involving cerebral eloquent areas.

Role of intraoperative microvascular Doppler in the microsurgical management of intracranial aneurysms.

BACKGROUND: The outcome of surgical treatment of intracranial aneurysms may be influenced by incomplete exclusion of the aneurysm or stenosis of the parent vessels. The goal of this study was to evaluate the usefulness and reliability of intraoperative microvascular Doppler (IMD) in guiding optimal clip placement in aneurysm surgery. METHODS: We conducted a retrospective analysis of 79 patients, with a total of 85 intracranial aneurysms, operated between January 2004 and April 2009, who were evaluated with IMD using a 20-MHz probe before and after clip application. IMD was used to examine the aneurysmal sac and adjacent vessels. RESULTS: The findings of IMD helped in adjusting the clip placement. In 9 (10.6%) of the 85 aneurysms, IMD revealed a persistent blood flow through the aneurysmal sac after clip application and the clip was repositioned. IMD showed relevant stenosis of adjacent vessels induced by the clip positioning in 10 of 79 (12.7%) cases. In six cases (7.6%), a blood flow reduction in the artery feeding the aneurysm was evident after clipping; in the other four cases (5.1%), the clip produced a severe blood flow reduction in other adjacent vessels. In addition, in two of these cases, an initial stenosis induced by clip positioning that had escaped detection by visual inspection through the operating microscope was identified by IMD. There were no complications related to the use of IMD. CONCLUSIONS: IMD is a safe, feasible, and very reliable technique and should be used routinely in intracranial aneurysm surgery.

Surgical management of anterior clinoidal meningiomas: a 26-case report.

BACKGROUND: Resection of anterior clinoidal meningiomas remains a major neurosurgical challenge. We determine the surgical technique for removal of tumor and improvement of patient's outcome. METHODS: A retrospective analysis was performed on 26 consecutive patients with anterior clinoidal meningiomas who underwent surgical resection at the Department of Neurosurgery, Renji Hospital, from January 1999 to August 2006. All patients had surgery through the pterional or extended pterional approach. Microvascular Doppler probe was used to protect the internal carotid artery and its branching arteries during dissection of the tumor. Twenty-two of them had severe visual deficits preoperatively. The follow-up period ranged from 3 to 36 months (22.3 +/- 8.8 months). RESULTS: In this series, Simpson grade II resection in 16 cases (61.5%), Simpson grade III resection in 4 cases (15.4%), Simpson grade IV resection in 6 cases (23.1%) were achieved. Sixteen of the patients with preoperative visual impairment experienced significant improvement. No patients died. There was no evidence of tumor recurrence during follow-up. CONCLUSIONS: In the majority of patients, surgery is still the first choice for total resection of the tumors without major complications. Protection of nerves and blood vessels must be a priority concern during removal of tumors.