Change of Th1/Th2 Cytokine Equilibrium in Rats with Severe Sepsis and Therapeutic Effect of Recombinant Interleukin-12 and Shenmai Injection (参麦注射液)

Objective: To evaluate the dynamic change of Th1/Th2 cytokines in serum, peritoneal lavage fluid (PLF) and splenic macrophages (SM) in rats with severe peritonitis, and to observe the therapeutic effects of recombinant interleukin-12 (rIL-2) and Shenmai injection (SMI, 参麦注射液), a Chinese medicinal preparation.Methods: Severe peritonitis (SP) model was induced by intraperitoneal injection of E. coli and B. frag, and mild peritonitis (MP) model was induced by cecal ligation and punching. Then the following experiments were done: (1) Survival rates of animals after every 6 hrs in the 72 hrs after modeling were recorded, serum and PLF levels of cytokines, including tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ), and interleukin-10 (IL-10), 6 hrs, 12 hrs, 24 hrs and 48 hrs after modeling were measured. (2) Model rats were treated with rIL-12 or SMI, the survival rate was recorded and serum levels of TNF-α, INF-γ, and IL-10 before and after treatment were measured, and (3) amount of these cytokines produced by SM were determined 6 hrs, 12 hrs and 24 hrs after treatment. The survival rates and levels of cytokines were then compared between the groups (model group treated with rIL-12 or SMI, untreated model group, and blank group).Results: Serum and PLF levels of IFN-γ, TNF-α at all the time points in SP rats were significantly lower than those in MP rats while those of IL-10 6 hrs and 12 hrs after modeling were significantly higher in the former than that in the latter (P<0.05). IFN-γ secretion of SM in SP rats was significantly higher than that in MP rats 6 hrs after modeling (P<0.05). Administration of rlL-12 or SMI given before modeling could improve the survival rate of the model rats (P<0.05) and cause significant increase of the serum level and SM secretion of IFN-γ. Conclusion: Imbalance in promoting/antagonizing inflammatory cytokines and Th2 response dominance appear in SP rats early at the initiating stage, and SM secretion of inflammation promoting factor also reduces. Administration in time of rIL-12 and SMI, may increase the survival rate, and its mechanism may be related with their immuno-stimulating action.

Clinical observation of Shenmai injection in the treatment for adverse reactions of chemotherapy on advanced non-small cell lung cancer

Objective: To observe the efficacy of Shenmai injection in the treatment for adverse reactions of chemotherapy on advanced non-small cell lung cancer (NSCLC). Methods: 45 NSCLC patients with stages IIIb-IV were randomly divided into two groups: the treatment group (treated by chemotherapy combined with Shenmai injection) and the control group (treated by chemotherapy only). The efficacy of the two groups was evaluated after 3 cycles of treatment. Results: There was no significant difference between the two groups in the recent curative effects (P > 0.05), while there were significant differences between them in Karnofsky score and weight (P < 0.05). The treatment group was better than the control group in preventing leucopenia and decreased hemoglobin, and significant differences were found between them (P < 0.05). The incidence of thrombocytopenia, nausea and vomiting, hepatic and renal dysfunction in the treatment group was lower than that in the control group, but no significant differences were found between them (P > 0.05). Conclusion: Shenmai injection would not influence the efficacy of chemotherapy on advanced NSCLC patients, while it could improve the quality of life, increase the body weight of patients, alleviate adverse reactions of chemotherapy as myelosuppression so as to improve the tolerance of organism to chemotherapy.

Authentication and distinction of Shenmai injection with HPLC fingerprint analysis assisted by pattern recognition techniques

In this paper, the feasibility and advantages of employing high performance liquid chromatographic （HPLC） fingerprints combined with pattern recognition techniques for quality control of Shenmai injection were investigated and demonstrated. The Similarity Evaluation System was employed to evaluate the similarities of samples of Shenmai injection, and the HPLC generated chromatographic data were analyzed using hierarchical clustering analysis （HCA） and soft independent modeling of class analogy （SIMCA）. Consistent results were obtained to show that the authentic samples and the blended samples were successfully classified by SIMCA, which could be applied to accurate discrimination and quality control of Shenmai injection. Furthermore, samples could also be grouped in accordance with manufacturers. Our results revealed that the developed method has potential perspective for the original discrimination and quality control of Shenmai injection.

Identification of bioactive anti-angiogenic constitutes targeting tumor endothelial cells in Shenmai Injection using multidimensional pharmacokinetics

OBJECTIVE To identify the bioactive anti-angiogenic constitutes targeting tumor endothelial cells(TECs)in Shenmai Injection(SMI).METHEODS For pharmacokinetic(PK)studies,Balb/c mice harboring human colorectal cancer(LoVo)xenografts were treated with SMI 10 mL·kg^-1 daily for 1 or 8 d.Multidimensional PK profiles of ginsenosides in plasma,subcutaneous tumors,and TECs were investigated.For PD studies,the tumor-bearing mice Intravital multi-photon imaging and CD31 immunofluorescence staining were used to evaluate the number of microves⁃sels and braches.Double staining of CD31 and α-SMA was performed to evaluate pericytes coverage ratios around vessels.ELISA was performed to determine the concentrations of VEGF and FGF in tumor tissues.For synergistic anti-tumor study,the tumor-bearing mice were treated with SMI 10 mL·kg^-1 daily,Rd 5 mg·kg^-1 daily with or without 5-FU 15 mg·kg^-1 every 3 d for 20 d.HPLC-MS/MS was used to determine the concentrations of 5-FU in plasma and tumor tissues.RESULTS SMI decreased the number of microvessels(P<0.05)and vessel branches(P<0.05)and improved vascular pericytes coverage(P<0.05).PK studies showed that the concentrations of protopanaxadiol-type(PPD)ginsenosides(Rb1,Rb2/Rb3,Rc,and Rd)in both,plasma and tumors,were higher than those of protopanaxatriol-type(Rg1 and Re)and oleanane-type(Ro)ginsenosides.Among PPD ginsenosides,Rd exhibited the greatest concentrations in tumors and TECs after repeated injection.In fact,the proportion of Rd in the detectable components of SMI gradually increased in the following order:SMI formula(2.8%),plasma(16.0%),tumor tissues(34.3%),and TECs(40.3%).In vivo bioactivity results showed that Rd 5 mg·kg^-1 daily significantly decreased the number of microvessels(P<0.05)and vessel branches(P<0.05)and increased pericytes coverage(P<0.05)while Rd 0.5 mg·kg^-1 daily,Rb1 and Rg1 had no significant effect on them.Rd 5 mg·kg^-1 suppressed the expression of VEGF and FGF simultaneously.Rd 5 mg·kg^-1 enhanced the antitumor effect of 5-FU via increasing the distribution of 5-FU in tumor tissues(P<0.05)in xenograft mice.CONCLUSION Ginsenoside Rd may be the major bioactive anti-angiogenic constituent targeting TECs after SMI treatment.

Clinical Study on Effect of Shenmai Injection in Treating Congestive Heart Failure

Objective: To observe the therapeutic effect of Shenmai Injection (SI) in treating congestive heart failure (CHF). Methods: The changes in cAMP, cGMP, serum cardiac troponin T (cTnT, a specific marker reflecting myocardial injury), creatine kinase (CK) and creatine kinase isoenzyme (CK-

Shenmai Injection attenuated doxorubicin-induced cardiac dysfunction via maintaining mitochondrial homeostasis

OBJECTIVE Shenmai Injection(SMI)is widely used in the treatment of cardiovascular diseases,such as heart failure and myocardial ischemia.In clinic,SMI showed protective effects on doxorubicin(Dox)-induced cardiac toxicity.In current study,we investigate the mitochondrial protective mechanisms of SMI on Dox-induced myocardial injury.METHODS C57BL/6 mice were divided into four groups:①control group;②Dox injury group;③SMI+Dox group and dexrazoxane(DRZ)+Dox group.Dex was a positive control.Myocardial injury was evaluated by echocardiography,HE and TUNEL staining,myocardial markers measurement.H9C2 cardiomyocytes pretreatment with SMI for 24 h were exposed to Dox.Cell viability and apoptosis were measured by CCK8,Hoechst33342 staining,and Annexin V/PI staining.MitoSOX,mitochondrial membrane potential,and mitochondrial respiratory function were measured to evaluate mito⁃chondrial function.RESULTS SMI decreased mortality rate of Dox-injected mice,serum CK and CK-MB levels in vivo.SMI significantly prevented Dox-induced cardiac dysfunction and apoptosis and increased expression level of PI3K,p-Akt,and p-GSK-3β.Moreover,SMI significantly inhibited Dox-induced apoptosis,mitochondrial ROS production,and reduction of mitochondrial membrane potential in H9C2 cells.Mechanismly,the cardio-protective effect of SMI was suppressed by PI3K inhibitor LY294002.CONCLUSION SMI prevents Dox-induced cardiotoxicity and mitochondrial damage through activation of PI3K/Akt signaling pathway.

Research on Applications of Shenmai Injection on Hypertensive ICH Combined with Cerebrocardiac Syndromes

Objective: This study is to observe the therapeutic effects of Shenmai injection on patients with hypertensive ICH and cerebrocardiac syndromes as well as its effects on prognosis. Methods: A total of 72 patients with severe hypertensive ICH and cerebrocardiac syndromes were selected and divided into the control group and the experimental group (Shenmai injection group) randomly, 36 patients in each group. The control group was treated by conventional therapy, while the experimental group was administrated by intravenous drip of the mixture of 50 ml Shenmai injection and 250 ml 5% glucose injection based on the treatment of the control group, once everyday, 2 weeks continuously. Results: Myocardial enzyme indexes of two groups at 3d, 7d and 14d were observed (Table 1). Myocardial enzyme index of the experimental group was improved quickly and significantly. Myocardial enzyme data of two groups at 3d, 7d and 14d were P < 0.05. According to the electrocardiographic examinations results, ECG anomalies of the experimental group at 7d and 14d were also improved quickly (P < 0.05). There are no evident anomalies in GCS scores of two groups at 7d, but GCS score of the experimental group at 14d of the medication was significantly higher than that of the control group (P < 0.05). Conclusions: Shenmai injection has some therapeutic effects on cerebral injuries and myocardial damages. It can treat brain and heart simultaneously, realize the goal of addressing both symptoms and root causes, and improve prognosis of patients with severe hypertensive ICH.

Shenmai injection combined with Western medicine in the treatment of acute pancreatitis: a systematic review and meta-analysis

Background:To evaluate the efficacy and safety of the classic ancient prescription Shenmai injection(the classic ancient presciption)combined with Western medicine in the treatment of acute pancreatitis.Method:PubMed,the Cochrane Library,EMBASE,the Web of Science,China National Knowledge Infrastructure,Wanfang database,VIP Database and Chinese BioMedicine Literature Database were searched from database establishment to January 2021.After 2 researchers independently screened the literature,extracted data and evaluated the bias risk included in the study.A meta-analysis of randomized controlled trials of the classic ancient prescription Shenmai injection combined with Western medicine in the treatment of acute pancreatitis was conducted with the Revman 5.0 software.Result:A total of 19 randomized controlled trials were included,including 1,507 patients.The results of meta-analysis showed that the test group had advantage over the control group in total effective rate(RR=1.23,95%CI(1.17,1.34),P<0.00001),serum amylase level(stand mean difference=−2.92,95%CI(−3.75,−2.09),P<0.00001),C-reactive protein level and IL-6 level with statistically significant.Conclusion:The current evidence shows that the classic ancient prescription Shenmai injection combined with Western medicine can achieve better curative effect in the treatment of acute pancreatitis than using Western medicine alone.It has more advantages in terms of the total effective rate,reducing the level of serum amylase level and inflammatory cytokines.

Clinical Efficacy of Shenmai Injection in the Treatment of Cerebral Vasospasm after Ruptured Aneurysm Surgery

Objective: To investigate the therapeutic effect of Shenmai Injection on postoperative cerebral vasospasm in patients with ruptured aneurysms. Methods: Seventy patients undergoing craniotomy for ruptured aneurysms in our hospital were selected as study subjects and randomly divided into control (n = 33) and research (n = 37) groups, they were treated with nimodipine and nimodipine combined with Shenmai injection after operation. The blood flow velocity in the middle cerebral artery (MCA) before and at 1, 3, 7, 11 and 14 days after surgery and the incidence of cerebral vasospasm during these days were compared, and the GCS scores at 14 days postoperatively and GOS scores at 6 months postoperatively were compared between the two groups. Results: There were no statistically significant differences in the occurrence of cerebral vasospasm, GCS or GOS scores between the two groups (P > 0.05), but the period of postoperative cerebral vasospasm in the study group was significantly shorter than that in the control group. Conclusion: Shenmai injection has the effect of shortening the cycle of occurrence of cerebral vasospasm after the operation of ruptured aneurysms, promoting patients to recover as early as possible and reducing their physical and mental burden.

Effects of Shenmai Injection(参麦注射液)Combined with Meglumine Adenosine Cyclophosphate Injection on Cardiac Function and Peripheral Serum Levels of TNF-α,TGF-β1 and IFN-γ in Patients with Viral Myocarditis

Objective: To explore effects of Shenmai Injection(参麦注射液) combined with Meglumine Adenosine Cyclophosphate Injection on cardiac function and peripheral serum levels of tumor necrosis factor-α(TNF-α), transforming growth factor-β1(TGF-β1) and interferon-γ(IFN-γ) in patients with viral myocarditis.Methods: A total of 70 patients with viral myocarditis admitted in Cardiovascular Medicine Department of our hospital from June 2016 to June 2018 were selected and divided into a control group(treated with Meglumine Adenosine Cyclophosphate Injection) and an observation group(additionally treated with Shenmai Injection(参麦注射液) on the treatment basis of the control group) according to random number method, with 35 cases in each group.Before and after the treatment, cardiac functional indexes like cardiac index(CI), left ventricular ejection fraction(LVEF) and left ventricular shortening fraction(FS), serum levels of TNF-α, TGF-β1 and IFN-γ, clinical efficacy and adverse reactions occurred in the 2 groups were recorded and compared.Results: Therapeutic effective rate in the observation group was 88.57%, higher than 68.57% in the control group(P < 0.05).After the treatment, cardiac functional indexes like CI, LVEF and FS were higher than those in the control group(P < 0.05).After the treatment, the serum expression levels of TNF-α and TGF-β1 were lower than those in the control group(P < 0.05), while the serum expression level of IFN-γ was higher than that in the control group(P < 0.05).There was no statistically significant difference in the adverse reaction rates between the 2 groups(P > 0.05).Conclusion: The treatment of patients with viral myocarditis by Shenmai Injection(参麦注射液) combined with Meglumine Adenosine Cyclophosphate Injection is more effective, reducing inflammation and restoring cardiac function.

Shenmai Injection Improves Hypertensive Heart Failure by Inhibiting Myocardial Fibrosis via TGF-β1/Smad Pathway Regulation

Objective: To study effects of Shenmai Injection on hypertensive heart failure and its mechanism for inhibiting myocardial fibrosis. Methods: Salt-sensitive(Dahl/SS) rats were fed with normal diet(0.3% Na Cl) and the high-salt diet(8% Na Cl) to observe the changes in blood pressure and heart function, as the control group and the model group. Salt-insensitive rats(SS-13BN) were fed with the high-salt diet(8% Na Cl) as the negative control group. After modeling, the model rats were randomly divided into heart failure(HF) group, Shenmai Injection(SMI) group and pirfenidone(PFD) group by a random number table, with 6 rats in each group. They were given sterilized water, SMI and pirfenidone, respectively. Blood pressure, cardiac function, fibrosis and related molecular expression were detected by sphygmomanometer, echocardiogram, enzyme linked immunosorbent assay(ELISA),hematoxylin-eosin staining, Masson staining, immunofluorescence and qPCR analysis. Results: After high-salt feeding, compared with the control and negative control group, in the model group the blood pressure increased significantly, the left ventricular ejection fraction(LVEF) and left ventricular fraction shortening(LVFS) were significantly reduced, and the serum NT-pro BNP concentration increased significantly(all P<0.05);furthermore,the arrangement of myocardial cells was disordered, the edema was severe, and the degree of myocardial fibrosis was also significantly increased(P<0.05);the protein and m RNA expressions of collagen type Ⅰ(Col Ⅰ) were up-regulated(P<0.05), and the mRNA expressions of transforming growth factor β1(TGF-β1), Smad2 and Smad3 were significantly up-regulated(P<0.05). Compared with HF group, after intervention of Shenmai Injection, LVEF and LVFS increased, myocardial morphology was improved, collagen volume fraction decreased significantly(P<0.05), and the mRNA expressions of Col Ⅰ, TGF-β1, Smad2 and Smad3, as well as Col Ⅰprotein expression, were all significantly down-regulated(all P<0.05). Conclusion: Myocardial fibrosis is the main pathological manifestation of hypertensive heart failure, and Shenmai Injection could inhibit myocardial fibrosis and effectively improve heart failure by regulating TGF-β1/Smad signaling pathway.

Effects of shenmai injection on expression of TNF-α mRNA in peritoneal macrophages of scald mice

Objective To explore the effect of shenmai injection (SI) on expression of TNF-α mRNA in peritoneal macrophages (pMΦs) of scald mice.Methods BALB/c mice were inflicted with 11% of body surface area Ⅲ degree scald and injected intraperitoneally (ip) with SI daily for 5 days, and expression of TNF-α mRNA in pMΦs was determined by semi-quantitative RT-PCR.Results In scald mice, the expression of TNF-α mRNA in pMΦs increased significantly, but it was reduced obviously (P<0.01) after SI administration, while the livability was increased markedly (P<0.05).Conclusions For scald mice, the cause of death at early stage might be related to the high expression of TNF-α mRNA in pMΦs and the use of SI can decrease the death rate.

Simultaneous determination of ginsenosides Rg_1,Re and Rb_1 in rat plasma by HPLC and its application to pharmacokinetic study of SHENMAI injection

In the present study, we developed a sensitive and efficient high performance liquid chromatography （HPLC） method for the simultaneous determination of three ginsenosides （Rg1, Re, Rb1） in rat plasma. Chromatographic separation was performed on a C18 （150 min×4.6 mm） column utilizing gradient elution profile and a mobile phase consisting of （A） water and （B） acetonitrile. The calibration curve, with a great correlation coefficient greater than 0.998, was linear over the range of 1.0-30.0 μg/mL for ginsenoside Rgl, 0.5-15.0 μg/mL for ginsenoside Re, and 0.5-200.0 μg/mL for ginsenoside Rb1. The intra- and inter-day precisions for three ginsenosides （Rg1, Re, Rb1） were all less than 6.0%, and average recovery, examined at three concentration levels, ranged from 96.1% to 118.6%. The samples was stable within 24 h at 4 ℃ storage, and 30 d at -20 ℃ storage with three freeze-thaw-assay cycles. The low limits of quantification （LOQ） were 1.0, 0.5 and 0.5 μg/mL for Rg1, Re and Rb1, respectively. Taken together, the newly developed method was successfully applied to study the pharmacokinetics of ginsenoside Rg1, Re and Rb1 in rat plasma after intravenous administration of SHENMAI injection （SMI）.

Effect of Two Administration Routes of Shenmai Injection(参麦注射液)on Pulmonary Gas Exchange Function after Tourniquet-Induced Ischemia-Reperfusion

Objective： To compare the effect between nebulized and intravenous administration of Shenmai Injection （参麦注射液） on pulmonary gas exchange function of patients following tourniquet-induced lower limb ischemia-repeffusion. Methods： Thirty-eight patients scheduled for lower extremity surgery were randomized into three groups using the closed envelop method： Shenmai Injection was administered 30 min before tourniquet inflation by nebulization [0.6 mL/kg in 10 mL normal saline （NS）] in the nebulization group or by intravenous drip （0.6 mL/kg dissolved in 250 mL of 10% glucose） in the intravenous drip group, and equal volume of NS was given intravenously in the NS group; 15 in each group. Arterial blood gases were analyzed, serum levels of malonaldehyde （MDA） and interleukine-6 （IL-6） and interleukine-8 （IL-8） were determined using the method of thiobarbituric acid reaction and enzyme-linked immuno sorbent assay respectively just before tourniquet inflation （TO）, and at 0.5 h （T1）, 2 h （TZ）, 6 h （T3） after tourniquet deflation. Results： Compared with baselines at TO, MDA levels significantly increased at TZ, T3 in the NS group and at T3 in the nebulization group, and IL-6 and IL-8 levels were significantly increased at TZ, T3 in NS, the intravenous drip and the nebulization groups （P〈0.05）. Arterial pressure of oxygen （PaO2） at T3 was decreased, while alveolar- arterial oxygen tension showed difference （PA-aDO2） at T3 in the NS group; RI at T3 in both intravenous drip and the nebulization groups were enhanced （P〈0.05）. Compared with the NS group, MDA and IL-8 levels at TZ, T3, 11-6 at T3 in the intravenous drip group, and IL-8 at T3 in the nebulization group were all remarkably increased （P〈0.05）. Additionally, MDA level at T3 in the nebulization group was higher than that in the intravenous drip group （P〈0.05）. Conclusions： Intravenous administration of Shenmai Injection provided a better protective effect than nebulization in mitigating pulmonary gas exchange dysfunction in patients following tourniquet-induced limb ischemia-repertusion.

Shenmai Injection Attenuates Myocardial Ischemia/Reperfusion Injury by Targeting Nrf2/GPX4 Signalling-Mediated Ferroptosis

Objective:To examine the effect of Shenmai Injection(SMJ)on ferroptosis during myocardial ischemia reperfusion(I/R)injury in rats and the underlying mechanism.Methods:A total of 120SPF-grade adult male SD rats,weighing 220–250 g were randomly divided into different groups according to a random number table.Myocardial I/R model was established by occluding the left anterior descending artery for 30 min followed by 120 min of reperfusion.SMJ was injected intraperitoneally at the onset of 120 min of reperfusion,and erastin(an agonist of ferroptosis),ferrostatin-1(Fer-1,an inhibitor of ferroptosis)and ML385(an inhibitor of nuclear factor erythroid-2 related factor 2(Nrf2))were administered intraperitoneally separately 30 min before myocardial ischemia as different pretreatments.Cardiac function before ischemia,after ischemia and after reperfusion was analysed.Pathological changes in the myocardium and the ultrastructure of cardiomyocytes were observed,and the myocardial infarction area was measured.Additionally,the concentration of Fein heart tissues and the levels of creatine kinase-MB(CK-MB),troponin I(cTnI),malondialdehyde(MDA)and superoxide dismutase(SOD)in serum were measured using assay kits,and the expressions of Nrf2,glutathione peroxidase 4(GPX4)and acyl-CoA synthetase long-chain family member 4(ACSL4)were examined by Western blot.Results:Compared with the sham group,I/R significantly injured heart tissues,as evidenced by the disordered,ruptured and oedematous myocardial fibres;the increases in infarct size,serum CK-MB,cTnI and MDA levels,and myocardial Feconcentrations;and the decreases in SOD activity(P<0.05).These results were accompanied by ultrastructural alterations to the mitochondria,increased expression of ACSL4 and inhibited the activation of Nrf2/GPX4 signalling(P<0.05).Compared with the I/R group,pretreatment with 9 mL/kg SMJ and 2 mg/kg Fer-1 significantly reduced myocardial I/R injury,Feconcentrations and ACSL4 expression and attenuated mitochondrial impairment,while 14 mg/kg erastin exacerbated myocardial I/R injury(P<0.05).In addition,cardioprotection provided by 9 mL/kg SMJ was completely reversed by ML385,as evidenced by the increased myocardial infarct size,CK-MB,cTnI,MDA and Feconcentrations,and the decreased SOD activity(P<0.05).Conclusions:Ferroptosis is involved in myocardial I/R injury.Pretreatment with SMJ alleviated myocardial I/R injury by activating Nrf2/GPX4 signalling-mediated ferroptosis,thereby providing a strategy for the prevention and treatment of ischemic heart diseases.

Identification of bioactive anti-angiogenic components targeting tumor endothelial cells in Shenmai injection using multidimensional pharmacokinetics

Shenmai injection(SMI)is a well-defined herbal preparation that is widely and clinically used as an adjuvant therapy for cancer.Previously,we found that SMI synergistically enhanced the activity of chemotherapy on colorectal cancer by promoting the distribution of drugs in xenograft tumors.However,the underlying mechanisms and bioactive constituents remained unknown.In the present work,the regulatory effects of SMI on tumor vasculature were determined,and the potential anti-angiogenic components targeting tumor endothelial cells(TECs)were identified.Multidimensional pharmacokinetic profiles of ginsenosides in plasma,subcutaneous tumors,and TECs were investigated.The results showed that the concentrations of protopanaxadiol-type(PPD)ginsenosides(Rb1,Rb2/Rb3,Rc,and Rd)in both plasma and tumors,were higher than those of protopanaxatriol-type(Rg1 and Re)and oleanane-type(Ro)ginsenosides.Among PPD-type ginsenosides,Rd exhibited the greatest concentrations in tumors and TECs after repeated injection.In vivo bioactivity results showed that Rd suppressed neovascularization in tumors,normalized the structure of tumor vessels,and improved the anti-tumor effect of 5-fluorouracil(5 FU)in xenograft mice.Furthermore,Rd inhibited the migration and tube formation capacity of endothelial cells in vitro.In conclusion,Rd may be an important active form to exert the anti-angiogenic effect on tumor after SMI treatment.

Effect of Shenmai Injection(参麦注射液)on Ventricular Diastolic Function in Patients with Chronic Heart Failure:An Assessment by Tissue Doppler Imaging

Objective：To assess the effect of Shenmai Injection（参麦注射液,SMI） on left ventricular diastolic function（LVDF） in patients with chronic heart failure（CHF） by tissue Doppler imaging（TDI）.Methods：Sixty-four CHF patients were randomly assigned to two groups,the observation group and the control group.Basic treatment including polarized liquid therapy was given to all the patients.In addition,SMI was given to patients of the observation group.The treatment duration was 14 days.TDI was performed in all the patients 3 days prior to the initiation of the treatment and one week after the medication to measure the average movement velocity of the mitral ring of the left ventricle at the early systolic stage and late diastolic stage（Ea and Aa）;the outcomes were compared with the corresponding parameters obtained from blood flow Doppler echocardiography, namely,the velocity of the E-wave（E） and A-wave（A）.Results：After treatment,Ea and Ea/Aa increased and Aa decreased significantly in the observation group（P〈0.05）.In the control group,although some improvement was seen,there was no statistically significant change（P〉0.05）.No statistical significance was shown between groups in these parameters after treatment.Conclusion：TDI assessment shows that SMI could effectively improve the LVDF in CHF patients.

Effects of shenmai injection on pulmonary aquaporin 1 in rats following traumatic brain injury

Background Aquaporin-1 （AQP1） has involved in fluid transport in diverse pulmonary edema diseases. Our study aimed to explore the dynamic changes of AQP1 in pulmonary water metabolism in rats following traumatic brain injury （TBI） and the protective effect provided by shenmai injection.Methods Sixty male Sprague Dawley rats weighting 280-300 g were randomly divided into three groups： the normal control group, the model group and the shenrnai injection （SMI） group. One piece skull was taken away without injuring cerebral tissue in normal control group, while rats in model group and SMI group were subject to free fall injury in the cerebral hemisphere. Rats in model group received intraperitoneal normal sodium （15 mi/kg） at one hour post-injury and the same dose of shenmai injection instead in SMI group, respectively. The expression of AQP1 was detected by immunohistochemical analysis and semi-quantitative RT-PCR at 0 hour, 10 hours, 72 hours and 120 hours after TBI.Arterial blood gas analysis and lung wet to dry were also measured.Results AQP1 was mainly presented in the capillary endothelium and slightly alveolar epithelial cells in three groups, but the expression of AQP1 in the normal control group was positive and tenuous, weakly positive in the model and SMI groups,respectively. Compared with normal control group, AQP1 mRNA levels were down regulated in the model and SMI groups at 10 hours, 72 hours and 120 hours （P ￡1/40.05）. While AQP1 mRNA levels in the SMI group was up-regulated than that in the model group （P￡1/40.05）. Lung wet to dry weight ratio （W/D） in the model and SMI groups at 10 hours were higher than that in normal control group （P ￡1/40.05）. Compared with normal control group, PaO2 was markedly lower in the model and SMI groups （P ￡1/40.05）, but there were no statistically significant differences between model and SMI groups （P ￡3/40.05）.Conclusions The decreased AQP1 expression may be involved in the increased lung water content and dysfunction of pulmonary water metabolism following TBI. The treatment with SMI could improve water metabolism by promoting AQP1 expression.

Shenmai Injection(参麦注射液) Inhibiting the Extracellular Signal Regulated Kinase-lnduced Human Airway Smooth Muscle Proliferation in Asthma

Objective： To investigate the relationship between the proliferation of sensitized human airway smooth muscle cells （HASMCs） and the expression of extracellular signal regulated kinase （ERK） and the effect of Shenmai Injection （参麦注射液, SMI） on HASMCs. Methods： The HASMCs cultured in vitro were divided into three groups： （1） control group; （2） sensitized group： containing 10% asthmatic serum; （3） SMI group： further divided into three different concentration subgroups interferred with 10 μL/mL, 50 μL/mL, and 100 μL/mL SMI, respectively. The proliferation of HASMCs was detected using MTT method, the expression of proliferating cell nucleus antigen （PCNA） in HASMCs was detected using immunocytochemical staining, and the expression of phosphoration-ERK1/2 （p-ERK1/2） protein was detected using Western-blot. Results： After passive sensitization, the optical density value （A49o value） of HASMCs was significantly increased from 0.366± 0.086 to 0.839 ± 0.168 （P〈0.05）. In addition, the expression of PCNA was significantly increased from 28.7% ± 5.9% in the control group to 69.8% ±7.5% in the sensitized group （P〈0.05）. At the same time, the expression of p-ERK1/2 in passively sensitized HASMCs was significantly increased compared with the control group （all P〈0.05）. Affer application of 10 μL/mL, 50 μL/mL, and 100 μL/mL SMI to the cultured media of passively sensitized group, the A570 value was significantly decreased from 0.839 ±0.168 to 0.612 ±0.100, 0.412 ± 0.092, and 0.339 ± 0.077, respectively （P〈0.05）. Moreover, the expression of PCNA was significantly decreased from 69.8% ±7.5% to 57.8% ± 6.2%, 40.7%±5.4%, and 26.1% ± 5.2%, respectively. At the same time, the expression of p-ERK1/2 in each SMI group was significantly decreased compared with the sensitized group （all ,P〈0.05）. Conclusion： ERK signal transduction pathway may be involved in the airway remodeling in asthma. The expression of ERK can be inhibited by SMI in a dose-dependent manner, thus preventing the proliferation of HASMCs.

Effectiveness and safety of Shenmai injection in treatment of shock:a Meta-analysis

OBJECTIVE:To evaluate the effectiveness and safety of Shenmai injection for shock.METHODS: Randomized controlled trials(RCTs)that evaluated the therapeutic effect of Shenmai injection on shock(including septic shock, cardiogenic shock, hypovolemic shock, neurogenic shock and anaphylactic shock) were included in this analysis. The major electronic databases were searched until May 2015. The methodological quality of the trials was assessed according to the Cochrane Handbook. Review Manager 5.3 and Stata 12.0 software were applied for data analysis.RESULTS: Thirty RCTs involving 2038 participants were included. The methodological quality of the trials was generally passable. The combined use of Shenmai injection and conventional medicine was significantly more effective at managing shock compared to conventional medicine alone in the outcomes of total effective rate [risk ratio(RR 1.25,95% confidence interval(CI) 1.18 to 1.31] and mortality rate [risk difference(RD)-0.10, 95% CI-0.17 to-0.02]. Likewise, improvements were observed in other metrics. Three trials reported adverse events, but no trial reported serious adverse effects.CONCLUSION: Our results indicated the potential effectiveness of Shenmai injection combined with conventional medicine treatment for shock. However, further rigorously designed trials are needed to collect and weigh up all the evidence for the use of Shenmai injection.