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Shi S, Wang F, Chen B, Pan J, Luo D, Pei C, Huang D, Wang X, Wang Y, Shen Z, Li W, Wu Y, He Y, Wang Z. Efficacy and Safety of Shenfu Injection for Severe Pneumonia in the Elderly: A Systematic Review and Meta-Analysis Based on Western and Eastern Medicine. Front Pharmacol 2022; 13:779942. [PMID: 36091817 PMCID: PMC9454296 DOI: 10.3389/fphar.2022.779942] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 06/22/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Although increasing clinical trials studying Shenfu injection (SFI) comprising panaxoside 0.8 mg/ml extracted from Panax ginseng C.A. Mey. and aconitine 0.1 mg/ml extracted from Aconitum carmichaeli Debeaux for elderly patients with severe pneumonia on biomarkers associated with COVID-19 progression are emerging, there is no evidence-based evaluation for the effect of SFI on elderly severe pneumonia. Objectives: To evaluate the effect of SFI on elderly patients with severe pneumonia providing hints for treating critical COVID-19, we conducted a systematic review and meta-analysis. Methods: Nine databases, namely, PubMed, EMBASE, Web of Science, Science Direct, Google Scholar, Wanfang, Chongqing VIP Database, CNKI, and SinoMed were used to search clinical trials reporting the effect of SFI as an adjuvant for elderly severe pneumonia on outcomes of interest. Primary outcomes were total effective rate, Acute Physiology and Chronic Health Evaluation (APACHE) II score, mortality, and safety. Secondary outcomes were predictors associated with COVID-19 progression. Duplicated or irrelevant articles with unavailable data were excluded. Cochrane Collaboration’s tool was used to evaluate the risk of bias by two reviewers independently. All data were analyzed by Rev Man 5.4. Continuous variables were shown as weighted mean difference (WMD) or standard mean difference (SMD) with 95% confidence intervals (95% CI), whereas dichotomous data were calculated as the risk ratio (RR) with 95% CI. Results: We included 20 studies with 1, 909 participants, and the pooled data showed that compared with standard control, SFI could improve the total effective rate (RR = 1.25, 95% CI = 1.14–1.37, and n = 689), APACHE II score (WMD = −2.95, 95% CI = −3.35, −2.56, and n = 809), and predictors associated with COVID-19 progression (brain natriuretic peptide, creatine kinase, stroke volume, cardiac output, left ventricular ejection fraction, cardiac index, sE-selectin, von Willebrand factor, activated partial thromboplastin time, platelet counts, D-Dimer, procalcitonin, and WBC count). SFI may reduce mortality (RR = 0.52, 95% CI = 0.37–0.73, and n = 429) and safety concerns (RR = 0.29, 95% CI = 0.17–0.51, and n = 150) for elderly severe pneumonia. Conclusion: SFI as an adjuvant may improve the total effective rate, APACHE II score, gas exchange, and predictors associated with COVID-19 progression, reducing mortality and safety concerns for elderly patients with severe pneumonia.
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Affiliation(s)
- Shihua Shi
- Department of Geriatric, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- Faculty of Science, University of Basel, Basel, Switzerland
- *Correspondence: Shihua Shi, ; Jie Pan, ; Zhenxing Wang,
| | - Fei Wang
- Department of Geriatric, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Bonan Chen
- State Key Laboratory of Translational Oncology, Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Jie Pan
- Department of Pathology, Stanford University School of Medicine, Palo Alto, CA, United States
- *Correspondence: Shihua Shi, ; Jie Pan, ; Zhenxing Wang,
| | - Dan Luo
- Department of Geriatric, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Caixia Pei
- Department of Geriatric, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Demei Huang
- Department of Geriatric, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiaomin Wang
- Department of Geriatric, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yilan Wang
- Department of Geriatric, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zherui Shen
- Department of Geriatric, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Weihao Li
- Cardiology Division, West China Hospital, Sichuan University, Chengdu, China
| | - Yongcan Wu
- Chongqing Key Laboratory of Traditional Chinese Medicine for Prevention and Cure of Metabolic Diseases, Chongqing, China
- College of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, China
| | - Yacong He
- Department of Geriatric, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zhenxing Wang
- Department of Geriatric, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- *Correspondence: Shihua Shi, ; Jie Pan, ; Zhenxing Wang,
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Protective Effect of Shenfu Injection () on Vascular Endothelial Damage in a Porcine Model of Hemorrhagic Shock. Chin J Integr Med 2022; 28:794-801. [PMID: 35023060 DOI: 10.1007/s11655-021-2876-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the effects of Shenfu Injection (, SFI) on endothelial damage in a porcine model of hemorrhagic shock (HS). METHODS After being bled to a mean arterial pressure of 40±3 mm Hg and held for 60 min, 32 pigs were treated with a venous injection of either shed blood (transfusion group), shed blood and saline (saline group), shed blood and SFI (SFI group) or without resuscitation (sham group). Venous blood samples were collected and analyzed at baseline and 0, 1, 2, 4, and 6 h after HS. Tumor necrosis factor-α (TNF-α), serum interleuking (IL)-6, and IL-10 levels were measured by enzyme-linked immunosorbent assay (ELISA); expressions of vascular cell adhesion molecule-1 (VCAM-1), intercellular adhesion molecule 1 (ICAM -1), von Willebrand factor (vWF), plasminogen activator inhibitor-1 (PAI-1) and Bcl-2, Bax, and caspase-3 proteins were determined by Western blot. RESULTS The serum level of TNF-α in the SFI group was significantly lower than in the other groups at 0, 1, and 2 h after HS, while the level of IL-6 was lower at 4 and 6 h compared with the saline group (P<0.01 or P<0.05). The concentration of serum IL-10 was significantly higher in the SFI group than in the other groups at 0, 1, 4, and 6 h after HS (P<0.01). Western blot and immunohistochemistry of vascular tissue showed that the expression of caspase-3 was downregulated, and that of Bcl-2 and Bax was upregulated in the SFI group compared to other groups (P<0.05). CONCLUSION SFI attenuated endothelial injury in the porcine model of HS by inhibiting cell apoptosis, suppressing the formation of proinflammatory cytokines, and reducing endothelial activation.
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Yuan W, Wu J, Zhang Q, Liang Y, Zhang M, Qin H, Li CS. Shen-fu injection alleviates acute renal injury by reducing cytokine levels and modulating apoptosis in a porcine hemorrhagic shock model. Acta Cir Bras 2021; 36:e360405. [PMID: 34076082 PMCID: PMC8184256 DOI: 10.1590/acb360405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/16/2021] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Shen-fu injection (SFI) was used to intervene in the resuscitation of porcine hemorrhagic shock (HS) model to study its protective effects on acute kidney injury. METHODS After 60 min of HS, 28 animals were randomly assigned into four groups. The groups were as follows: hemorrhagic shock group (HS); HS resuscitation with shed-blood group (HSR); HS resuscitation with shed-blood and SFI (1 mL·kg-1) group (HSR-SFI); and the sham operation group (Sham). The bloods were analyzed for serum creatinine (sCr), cystatin C (CysC) and neutrophil gelatinase-associated lipocalin (NGAL). BAX, Bcl-2, and caspase-3 protein expressions by Western blot analysis and immunohistochemical staining. The renal tissues were removed and pathologic changes were observed. RESULTS Mean aortic pressure (MAP) in HSR-SFI groups were higher than that in HSR groups after shock. At the 6th hour after shock, the urine volume per hour in the HSR-SFI groups was more than that in the HSR groups. The sCr, NGAL, CysC and cytokine levels of HSR-SFI groups were lower. The Bcl-2 expression was increased in the HSR-SFI groups. The BAX and caspase-3 expressions were reduced. The histopathologic score in the HSR-SFI was lower. CONCLUSIONS SFI may reduce the risk of acute kidney injury (AKI) following hemorrhagic shock by attenuating systemic inflammatory responses, and regulating the expression of apoptosis-related proteins.
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Affiliation(s)
- Wei Yuan
- Capital Medical University, China
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Qiu Q, Huang Y, Liu X, Huang F, Li X, Cui L, Luo H, Luo L. Potential Therapeutic Effect of Traditional Chinese Medicine on Coronavirus Disease 2019: A Review. Front Pharmacol 2020; 11:570893. [PMID: 33343347 PMCID: PMC7741169 DOI: 10.3389/fphar.2020.570893] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/18/2020] [Indexed: 12/15/2022] Open
Abstract
The Coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 has been rapidly spreading globally and has caused worldwide social and economic disruption. Currently, no specific antiviral drugs or clinically effective vaccines are available to prevent and treat COVID-19. Traditional Chinese medicine (TCM) can facilitate syndrome differentiation and treatment according to the clinical manifestations of patients and has demonstrated effectiveness in epidemic prevention and control. In China, TCM intervention has helped to control the epidemic; however, TCM has not been fully recognized worldwide. In this review, we summarize the epidemiology and etiological characteristics of severe acute respiratory syndrome coronavirus 2 and the prevention and treatment measures of COVID-19. Additionally, we describe the application of TCM in the treatment of COVID-19 and the identification of small molecules of TCM that demonstrate anti-coronavirus activity. We also analyze the current problems associated with the recognition of TCM. We hope that, through the contribution of TCM, combined with modern technological research and the support of our international counterparts, COVID-19 can be effectively controlled and treated.
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Affiliation(s)
- Qin Qiu
- Graduate School, Guangdong Medical University, Zhanjiang, China
| | - Yuge Huang
- Department of Pediatrics, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Xiaohua Liu
- Graduate School, Guangdong Medical University, Zhanjiang, China
| | - Fangfang Huang
- Graduate School, Guangdong Medical University, Zhanjiang, China
| | - Xiaoling Li
- Animal Experiment Center, Guangdong Medical University, Zhanjiang, China
| | - Liao Cui
- Guangdong Key Laboratory for Research and Development of Natural Drugs, Guangdong Medical University, Zhanjiang, China
| | - Hui Luo
- The Marine Biomedical Research Institute, Guangdong Medical University, Zhanjiang, China
| | - Lianxiang Luo
- The Marine Biomedical Research Institute, Guangdong Medical University, Zhanjiang, China
- The Marine Biomedical Research Institute of Guangdong Zhanjiang, Zhanjiang, China
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Wang C, Sun S, Ding X. The therapeutic effects of traditional chinese medicine on COVID-19: a narrative review. Int J Clin Pharm 2020; 43:35-45. [PMID: 32974857 PMCID: PMC7513902 DOI: 10.1007/s11096-020-01153-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 09/11/2020] [Indexed: 02/06/2023]
Abstract
Background The Coronavirus Disease 2019 (COVID-19) is a new, highly infective virus. In the absence of specific vaccines and antiviral drugs, the China National Health Commission has released a series of COVID-19 treatment guidelines, which include symptomatic treatment, antiviral treatment, and traditional Chinese medicines (TCM). Aim of the review To analyze and summarize the role of TCMs in the treatment of COVID-19. Methods Relevant studies on TCMs related to the study aim were undertaken through a literature search to synthesize the extracted data. Results The China National Health Commission guidelines recommend 15 oral and injectable TCMs for COVID-19. Studies on TCMs have demonstrated that these compounds possess broad-spectrum antiviral and antibacterial properties, and they have certain advantages in the treatment of viral pneumonia and other emergent infectious diseases. Many TCMs also have potent anti-inflammatory and immunomodulatory effects. Treatment based on syndrome differentiation is one of the significant features in TCM. TCM compounds contain a variety of active ingredients that have proven multi-target effects, making it difficult for viruses to develop drug resistance. A variety of clinical pathways are involved in the actions of these TCMs. These properties allow TCMs to be used in the treatment of COVID-19. Conclusion TCMs have been widely used in the treatment of COVID-19 in China. The unique properties of TCM compounds allow TCMs to have a role in the management of COVID-19.
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Affiliation(s)
- Can Wang
- Department of Pharmacy, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 211198, China
| | - Shusen Sun
- Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Western New England University, Springfield, MA, 01119, USA. .,Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China. .,The Hunan Institute of Pharmacy Practice and Clinical Research, Changsha, 410008, Hunan, China.
| | - Xuansheng Ding
- Department of Pharmacy, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 211198, China.
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Wang X, He C, Cai Y, Sun D, Hu G, Zhou J. Shen fu injection for patients with septic shock: Protocol for an updated systematic review. Medicine (Baltimore) 2019; 98:e17004. [PMID: 31567937 PMCID: PMC6756633 DOI: 10.1097/md.0000000000017004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 08/08/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Septic shock is a serious disease with high morbidity, which will lead to organ dysfunction. Shen fu injection (SFI) has been widely used for septic shock as a treatment in China. Many clinical trials have been reported that it could assess the efficacy and safety of SFI to cure septic shock and accelerate resuscitation. Reassessing the efficacy and safety of SFI as a treatment of patients with septic shock is the objective of this updated systematic review. METHODS The following electronic databases major in English and Chinese will be conducted a systematic search until September 2018: PubMed, EMBASE, Cochrane Library, Chinese National Knowledge Infrastructure, Chinese Science and Technology Periodical Database, Chinese BioMedical Literature Database, and Wan-fang Database. Randomized controlled trials of SFI will be included. Review Manager 5.2 software will be used for assessment of risk of bias, data synthesis, and subgroup analysis. We will conduct the GRADE system to assess the quality of evidence, if possible. RESULTS This study will provide a rational synthesis of current evidences for SFI on septic shock. CONCLUSION We hope our research results will provide an objective and reliable evidence to patients, clinicians and healthcare policymakers who are concerning the treatment options of SFI in septic shock. REGISTRATION PROSPERO CRD42016049332.
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Affiliation(s)
- Xiaojun Wang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine
| | - Canfeng He
- Guangzhou University of Chinese Medicine
| | - Yinhe Cai
- Guangzhou University of Chinese Medicine
| | | | - Guangyun Hu
- The Second Hospital of Traditional Chinese Medicine in Guangdong, Guangzhou, China
| | - Jian Zhou
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine
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ECMO attenuates inflammation response and increases ATPase activity in brain of swine model with cardiac arrest compared with CCPR. Biosci Rep 2019; 39:BSR20182463. [PMID: 31253699 PMCID: PMC6639466 DOI: 10.1042/bsr20182463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 05/21/2019] [Accepted: 06/11/2019] [Indexed: 12/16/2022] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) could increase survival rate and neurological outcomes of cardiac arrest (CA) patients compared with conventional cardiopulmonary resuscitation (CCPR). Currently, the underlying mechanisms how ECMO improves neurological outcomes of CA patients compared with CCPR have not been revealed. A pig model of CA was established by ventricular fibrillation induction and then underwent CCPR or ECMO. Survival and hemodynamics during the 6 h after return of spontaneous circulation (ROSC) were compared. The levels of inflammatory cytokines and Ca2+-ATPase and NA+-K+-ATPase activities were detected. Brain tissues histology and ultra-microstructure in CCPR and ECMO groups were also examined. Results suggested that ECMO significantly improved the survival of pigs compared with CCPR. Heart rate (HR) decreased while cardiac output (CO) increased along with the time after ROSC in both ECMO and CCPR groups. At each time point, HR in ECMO groups was lower than that in CCPR group while CO and mean arterial pressure in ECMO group was higher than CCPR group. In ECMO group, lower levels of IL-1, IL-1β, IL-6, TNFα, and TGFβ, especially IL-1, IL-6, TNFα, and TGFβ, were found compared that in CCPR group while no difference of IL-10 between the two groups was observed. Similar with the results from enzyme-linked immunosorbent assay, decreased expressions of IL-6 and TGFβ were also identified by Western blotting. And Ca2+-ATPase and NA+-K+-ATPase activities were increased by ECMO compared with CCPR. Hematoxylin and eosin staining and ultra-microstructure examination also revealed an improved inflammation situation in ECMO group compared with CCPR group.
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Wei J, Wang P, Li Y, Dou Q, Lin J, Tao W, Lin J, Fu X, Huang Z, Zhang W. Inhibition of RHO Kinase by Fasudil Attenuates Ischemic Lung Injury After Cardiac Arrest in Rats. Shock 2018; 50:706-713. [DOI: 10.1097/shk.0000000000001097] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Wada T. Coagulofibrinolytic Changes in Patients with Post-cardiac Arrest Syndrome. Front Med (Lausanne) 2017; 4:156. [PMID: 29034235 PMCID: PMC5626829 DOI: 10.3389/fmed.2017.00156] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 09/11/2017] [Indexed: 01/08/2023] Open
Abstract
Whole-body ischemia and reperfusion due to cardiac arrest and subsequent return of spontaneous circulation constitute post-cardiac arrest syndrome (PCAS), which consists of four syndromes including systemic ischemia/reperfusion responses and post-cardiac arrest brain injury. The major pathophysiologies underlying systemic ischemia/reperfusion responses are systemic inflammatory response syndrome and increased coagulation, leading to disseminated intravascular coagulation (DIC), which clinically manifests as obstruction of microcirculation and multiple organ dysfunction. In particular, thrombotic occlusion in the brain due to DIC, referred to as the "no-reflow phenomenon," may be deeply involved in post-cardiac arrest brain injury, which is the leading cause of mortality in patients with PCAS. Coagulofibrinolytic changes in patients with PCAS are characterized by tissue factor-dependent coagulation, which is accelerated by impaired anticoagulant mechanisms, including antithrombin, protein C, thrombomodulin, and tissue factor pathway inhibitor. Damage-associated molecular patterns (DAMPs) accelerate not only tissue factor-dependent coagulation but also the factor XII- and factor XI-dependent activation of coagulation. Inflammatory cytokines are also involved in these changes via the expression of tissue factor on endothelial cells and monocytes, the inhibition of anticoagulant systems, and the release of neutrophil elastase from neutrophils activated by inflammatory cytokines. Hyperfibrinolysis in the early phase of PCAS is followed by inadequate endogenous fibrinolysis and fibrinolytic shutdown by plasminogen activator inhibitor-1. Moreover, cell-free DNA, which is also a DAMP, plays a pivotal role in the inhibition of fibrinolysis. DIC diagnosis criteria or fibrinolysis markers, including d-dimer and fibrin/fibrinogen degradation products, which are commonly tested in patients and easily accessible, can be used to predict the mortality or neurological outcome of PCAS patients with high accuracy. A number of studies have explored therapy for this unique pathophysiology since the first report on "no-reflow phenomenon" was published roughly 50 years ago. However, the optimum therapeutic strategy focusing on the coagulofibrinolytic changes in cardiac arrest or PCAS patients has not yet been established. The elucidation of more precise pathomechanisms of coagulofibrinolytic changes in PCAS may aid in the development of novel therapeutic targets, leading to an improvement in the outcomes of PCAS patients.
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Affiliation(s)
- Takeshi Wada
- Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Efficacy and Safety of Combination Therapy of Shenfu Injection and Postresuscitation Bundle in Patients With Return of Spontaneous Circulation After In-Hospital Cardiac Arrest: A Randomized, Assessor-Blinded, Controlled Trial. Crit Care Med 2017; 45:1587-1595. [PMID: 28661970 DOI: 10.1097/ccm.0000000000002570] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Postresuscitation care bundle treatment after return of spontaneous circulation in patients experiencing in-hospital cardiac arrest can improve patients' survival and quality of life. The aim of the study was to evaluate the efficacy and safety of combined therapy of Shenfu injection and postresuscitation care bundle in these patients. DESIGN Prospective, randomized, controlled clinical study. SETTING Fifty hospitals in China. PATIENTS Adult patients had experienced in-hospital cardiac arrest between 2012 and 2015. INTERVENTIONS Based on the standardized postresuscitation care bundle treatment, patients were randomized to a Shenfu injection group (Shenfu injection + postresuscitation care bundle) or control group (postresuscitation care bundle) for 14 days or until hospital discharge. In the Shenfu injection group, 100 mL Shenfu injection was additionally administered via continuous IV infusion, bid. MEASUREMENTS AND MAIN RESULTS The primary outcome was 28-day survival after randomization. The secondary outcomes included 90-day survival as well as the duration of mechanical ventilation and the hospital stay and the total cost of hospitalization. Of 1,022 patients enrolled, a total of 978 patients were allocated to the two groups: the control (n = 486) and Shenfu injection (n = 492) groups. The Shenfu injection group had a significantly greater 28-day survival rate (42.7%) than the control group (30.1%). Also, the Shenfu injection group had a significantly higher survival rate at 90 days (39.6%) than the control group (25.9%). Compared with patients in the control group, patients in the Shenfu injection group had lower risks of 28-day mortality (hazard ratio, 0.61; 95% CI, 0.43-0.89; p = 0.009) and 90-day mortality (hazard ratio, 0.55; 95% CI, 0.38-0.79; p = 0.002). In the Shenfu injection group, the duration of mechanical ventilation (8.6 ± 3.2 vs 12.7 ± 7.9 d; p < 0.001) and the hospital stay (8.7 ± 5.9 vs 13.2 ± 8.1 d; p < 0.001) were significantly less than in the control group. Irreversible brain damage was the main cause of death in both groups. No serious drug-related adverse event was recorded. CONCLUSIONS This study demonstrates that Shenfu injection in combination with conventional postresuscitation care bundle treatment is effective at improving clinical outcomes in patients with return of spontaneous circulation after in-hospital cardiac arrest.
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Effects of Shenfu Injection (参附注射液) on cerebral metabolism in a porcine model of cardiac arrest. Chin J Integr Med 2016; 23:33-39. [DOI: 10.1007/s11655-016-2616-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Indexed: 10/21/2022]
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Li Y, Zhang X, Lin P, Qiu H, Wei J, Cao Y, Pan S, Walline J, Qian C, Shan Z, Yu X. Effects of Shenfu Injection in the Treatment of Septic Shock Patients: A Multicenter, Controlled, Randomized, Open-Label Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2016; 2016:2565169. [PMID: 27446222 PMCID: PMC4944053 DOI: 10.1155/2016/2565169] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 05/13/2016] [Accepted: 06/07/2016] [Indexed: 12/11/2022]
Abstract
The effect of Shenfu on biochemical parameters and survival during resuscitation in patients with septic shock was examined. This was a multicenter, controlled, randomized, open-label trial carried out in 210 patients with septic shock from seven medical centers in China. They were randomized to Shenfu or saline. The primary outcome was lactate clearance. The secondary outcomes were shock index normalization, dose of vasopressors, ICU stay, hospital stay, and mortality. A total of 199 patients completed the trial. Blood pressure, heart rate, and other routine lab tests showed no difference between the groups. Lactate levels and lactate clearance were similar between the two groups. Hospital and ICU stay were similar between the two groups. When considering all patients, the 7- and 28-day mortality were similar between the two groups, but when considering only patients with lactate levels ≥4.5 mmol/L, the Shenfu group showed a better 7-day survival than the control group (7 days: 83.3% versus 54.5%, P = 0.034; 28 days: 72.7% versus 47.6%, P = 0.092). Shenfu may improve the 7-day survival in patients with impaired lactate clearance (≥4.5 mmol/L), but the mechanism for this effect is unclear. Additional studies are necessary to characterize the hemodynamic changes after Shenfu infusion. This trial is registered with ChiCTR-TRC-11001369.
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Affiliation(s)
- Yi Li
- Emergency Department, Peking Union Medical College Hospital, Beijing 100730, China
| | - Xinchao Zhang
- Emergency Department, Beijing Hospital of the Ministry of Health, Beijing 100005, China
| | - Peihong Lin
- Emergency Department, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
| | - Haibo Qiu
- Emergency Department, Zhongda Hospital, Dongnan University, Nanjing 210009, China
| | - Jie Wei
- Emergency Department, Hubei Provincial Hospital, Wuhan 430000, China
| | - Yu Cao
- Emergency Department, The First Affiliated Hospital of Huaxi Medical College of Sichuan University, Chengdu 610044, China
| | - Shuming Pan
- Emergency Department, Xinhua Hospital, Shanghai Jiao Tong University, Shanghai 200093, China
| | - Joseph Walline
- Emergency Department, Saint Louis University, Saint Louis, MO 63130, USA
| | - Chuanyun Qian
- Emergency Department, The First Affiliated Hospital of Kunming Medical University, Kunming 650034, China
| | - Zhigang Shan
- Emergency Department, PLA 263 Hospital, Beijing 101199, China
| | - XueZhong Yu
- Emergency Department, Peking Union Medical College Hospital, Beijing 100730, China
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Effects of Shen-Fu injection on coagulation-fibrinolysis disorders in a porcine model of cardiac arrest. Am J Emerg Med 2016; 34:469-76. [DOI: 10.1016/j.ajem.2015.12.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 11/25/2015] [Accepted: 12/08/2015] [Indexed: 01/05/2023] Open
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Wu W, Jiang RL, Wang LC, Lei S, Xing X, Zhi YH, Wu JN, Wu YC, Zhu MF, Huang LQ. Effect of Shenfu injection on intestinal mucosal barrier in a rat model of sepsis. Am J Emerg Med 2015; 33:1237-43. [DOI: 10.1016/j.ajem.2015.01.056] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 01/29/2015] [Accepted: 01/31/2015] [Indexed: 12/17/2022] Open
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Song Y, Zhang N, Jiang Y, Li J, Zhao Y, Shi S, Tu P. Simultaneous determination of aconite alkaloids and ginsenosides using online solid phase extraction hyphenated with polarity switching ultra-high performance liquid chromatography coupled with tandem mass spectrometry. RSC Adv 2015. [DOI: 10.1039/c4ra14088e] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Simultaneous determination of ten aconite alkaloids and thirteen ginsenosides using online solid phase extraction hyphenated with polarity switching ultra-high performance liquid chromatography coupled with tandem mass spectrometry.
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Affiliation(s)
- Yuelin Song
- Modern Research Center for Traditional Chinese Medicine
- Beijing University of Chinese Medicine
- Beijing 100029
- China
| | - Na Zhang
- Modern Research Center for Traditional Chinese Medicine
- Beijing University of Chinese Medicine
- Beijing 100029
- China
- School of Chinese Materia Medica
| | - Yong Jiang
- State Key Laboratory of Natural and Biomimetic Drugs
- School of Pharmaceutical Sciences
- Peking University
- Beijing 100191
- China
| | - Jun Li
- Modern Research Center for Traditional Chinese Medicine
- Beijing University of Chinese Medicine
- Beijing 100029
- China
| | - Yunfang Zhao
- Modern Research Center for Traditional Chinese Medicine
- Beijing University of Chinese Medicine
- Beijing 100029
- China
| | - Shepo Shi
- Modern Research Center for Traditional Chinese Medicine
- Beijing University of Chinese Medicine
- Beijing 100029
- China
| | - Pengfei Tu
- Modern Research Center for Traditional Chinese Medicine
- Beijing University of Chinese Medicine
- Beijing 100029
- China
- State Key Laboratory of Natural and Biomimetic Drugs
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16
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Protective effect of shen-fu injection on neuronal mitochondrial function in a porcine model of prolonged cardiac arrest. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 2014:523847. [PMID: 25505924 PMCID: PMC4258377 DOI: 10.1155/2014/523847] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Accepted: 10/31/2014] [Indexed: 11/29/2022]
Abstract
Background. Shen-Fu injection (SFI) following cardiac arrest exhibits neurological effects, but its effect on neurological dysfunction is unclear. This study sought to investigate the protective effect of SFI on nerve cells in a porcine model of cardiac arrest. Methods. After eight minutes of untreated ventricular fibrillation (VF) and 2 minutes of basic life support, 24 pigs were randomized and divided into three cardiopulmonary resuscitation groups, which received central venous injection of either Shen-Fu (SFI group; 1.0 ml/kg), epinephrine (EP group; 0.02 mg/kg), or saline (SA group). Surviving pigs were sacrificed at 24 h after ROSC and brains were removed for analysis for morphologic changes of mitochondria by electron microscopy, for mitochondrial transmembrane potential (MTP) by flow cytometry, and for opening of the mitochondrial permeability transition pore (MPTP) by mitochondrial light scattering. Results. Compared with the EP and SA groups, SFI treatment reduced opening of MPTP, showing higher MMP. In addition, animals treated with SFI showed slight cerebral ultrastructure damage under the electron microscopy. Conclusion. Shen-Fu injection alleviated brain injury, improved neurological ultrastructure, stabilized membrane potential, and inhibited opening of MPTP. Therefore, SFI could significantly attenuate postresuscitation cerebral ischemia and reperfusion injury by modulating mitochondrial dysfunction of nerve cells.
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Zhang Q, Li CS, Wang S, Gu W. Effects of Chinese medicine shen-fu injection on the expression of inflammatory cytokines and complements during post-resuscitation immune dysfunction in a porcine model. Chin J Integr Med 2014; 22:101-9. [PMID: 25253551 DOI: 10.1007/s11655-014-1857-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To investigate the action of Shen-Fu Injection (SFI) in regulating the expression of the serum complements and inflammatory cytokines synthesized and released in response to the stress of global ischemia accompanying cardiac arrest (CA) and resuscitation. METHODS Thirty pigs were randomly divided into the sham (n=6) and 3 returns of spontaneous circulation (ROSC) groups (n=24). After 8-min untreated ventricular fibrillation and 2-min basic life support, 24 pigs of the ROSC groups were randomized into three groups (n=8 per group), which received central venous injection of SFI (SFI group), epinephrine (EP group), or saline (SA group). Hemodynamic status and blood samples were obtained at 0, 0.5, 1, 2, 4, 6, 12, and 24 h after ROSC. RESULTS Serum concentrations of specific activation markers of the complement system C3, C4 and C5b-9 were increased during cardiopulmonary resuscitation through 24 h after ROSC. There were intense changes of various pro-inflammatory cytokines and anti-inflammatory cytokines as early as 0.5 h after CA. Compared with the EP and SA groups, SFI treatment reduced the proinflammatory cytokines levels of interleukin (IL)-6, IL-8 and tumor necrosis factor α (TNF-α, P<0.05), and increased the anti-inflammatory cytokine levels of IL-4 and IL-10 (P<0.05). Further, SFI treatment decreased the values of C3, C4 and C5b-9 compared with the EP and SA groups. CONCLUSIONS SFI, derived from the ancient Chinese medicine, has significant effects in attenuating post-resuscitation immune dysfunction by modulating the expression of complements and cytokines levels. The current study provided an experimental basis for the clinical application of a potential pharmacologic target for post resuscitation immune dysfunction.
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Affiliation(s)
- Qian Zhang
- Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Chun-sheng Li
- Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China.
| | - Shuo Wang
- Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Wei Gu
- Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
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18
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Cour M, Abrial M, Jahandiez V, Loufouat J, Belaïdi E, Gharib A, Varennes A, Monneret G, Thibault H, Ovize M, Argaud L. Ubiquitous protective effects of cyclosporine A in preventing cardiac arrest-induced multiple organ failure. J Appl Physiol (1985) 2014; 117:930-6. [PMID: 25213634 DOI: 10.1152/japplphysiol.00495.2014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Opening of the mitochondrial permeability transition pore (mPTP) appears to be a pivotal event in myocardial ischemia-reperfusion (I/R) injury. Resuscitated cardiac arrest (CA) leads to the post-CA syndrome that encompasses, not only myocardial dysfunction, but also brain injury, failure of other organs (kidney, liver, or lung), and systemic response to I/R. We aimed to determine whether cyclosporine A (CsA) might prevent multiple organ failure following CA through a ubiquitous mPTP inhibition in each distant vital organ. Anesthetized New Zealand White rabbits were subjected to 15 min of CA and 120 min of reperfusion. At the onset of resuscitation, the rabbits received CsA, its non-immunosuppressive derivative NIM811, or vehicle (controls). Survival, hemodynamics, brain damage, organ injuries, and systemic I/R response were analyzed. Fresh mitochondria were isolated from the brain, heart, kidney, liver, and lung to assess both oxidative phosphorylation and permeability transition. CsA analogs significantly improved short-term survival and prevented multiple organ failure, including brain damage and myocardial dysfunction (P < 0.05 vs. controls). Susceptibility of mPTP opening was significantly increased in heart, brain, kidney, and liver mitochondria isolated from controls, while mitochondrial respiration was impaired (P < 0.05 vs. sham). CsA analogs prevented these mitochondrial dysfunctions (P < 0.05 vs. controls). These results suggest that CsA and NIM811 can prevent the post-CA syndrome through a ubiquitous mitochondrial protective effect at the level of each major distant organ.
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Affiliation(s)
- Martin Cour
- Hospices Civils de Lyon, Groupement Hospitalier Edouard Herriot, Service de Réanimation Médicale, Lyon, France; Faculté de Médecine Lyon-Est, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France; INSERM UMR 1060, CarMeN, Lyon, France
| | | | - Vincent Jahandiez
- Hospices Civils de Lyon, Groupement Hospitalier Edouard Herriot, Service de Réanimation Médicale, Lyon, France; Faculté de Médecine Lyon-Est, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France; INSERM UMR 1060, CarMeN, Lyon, France
| | | | | | | | - Annie Varennes
- Laboratoire de Biochimie, Hospices Civils de Lyon, Groupement Hospitalier Edouard Herriot, Lyon, France
| | - Guillaume Monneret
- Laboratoire d'Immunologie Clinique, Hospices Civils de Lyon, Groupement Hospitalier Edouard Herriot, Lyon, France; and
| | - Hélène Thibault
- INSERM UMR 1060, CarMeN, Lyon, France; Explorations Fonctionnelles Cardiovasculaires & Centre d'Investigations Cliniques de Lyon, Hospices Civils de Lyon, Groupement Hospitalier Est, Lyon, France
| | - Michel Ovize
- INSERM UMR 1060, CarMeN, Lyon, France; Explorations Fonctionnelles Cardiovasculaires & Centre d'Investigations Cliniques de Lyon, Hospices Civils de Lyon, Groupement Hospitalier Est, Lyon, France
| | - Laurent Argaud
- Hospices Civils de Lyon, Groupement Hospitalier Edouard Herriot, Service de Réanimation Médicale, Lyon, France; Faculté de Médecine Lyon-Est, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France; INSERM UMR 1060, CarMeN, Lyon, France;
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The roles of traditional chinese medicine: shen-fu injection on the postresuscitation care bundle. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:319092. [PMID: 24066009 PMCID: PMC3771486 DOI: 10.1155/2013/319092] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 05/20/2013] [Accepted: 07/31/2013] [Indexed: 01/04/2023]
Abstract
Survival rates following in-hospital and out-of-hospital cardiac arrests remain disappointingly low. Organ injury caused by ischemia and hypoxia during prolonged cardiac arrest is compounded by reperfusion injury that occurs when a spontaneous circulation is restored. A bundle of procedures, which may need to be administered simultaneously, is required. The procedures include prompt identification and treatment of the cause of cardiac arrest, as well as a definitive airway and ventilation together. Additional benefit is possible with appropriate forms of early goal-directed therapy and achieving therapeutic hypothermia within the first few hours, followed by gradual rewarming and ensuring glycaemic control to be within a range of 6 to 10 mmol/L. All these would be important and need to be continued for at least 24 hours. Previous studies have showed that the effects of Shen-Fu injection (SFI) are based on aconitine properties, supplemented by ginsenoside, which can scavenge free radicals, improve energy metabolism, inhibit inflammatory mediators, suppress cell apoptosis, and alleviate mitochondrial damage. SFI, like many other complex prescriptions of traditional Chinese medicine, was also found to be more effective than any of its ingredient used separately in vivo. As the postresuscitation care bundle is known to be, the present paper focuses on the role of SFI played on the postresuscitation care bundle.
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Effects of Shen-Fu Injection on the Expression of T-Cell-Specific Transcription Factors T-bet/Gata-3 in Porcine Postresuscitation Lung Injury. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:464650. [PMID: 23573129 PMCID: PMC3610339 DOI: 10.1155/2013/464650] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 02/17/2013] [Indexed: 12/21/2022]
Abstract
Shen-Fu injection (SFI) derived from the ancient traditional Chinese medicine. In this study, the effects of SFI on the expression of T-bet/GATA-3 and its potential mechanisms causing the shift of T cells from Th2 to Th1 on postresuscitation lung injury were examined in a porcine model of cardiac arrest. 30 pigs were randomly divided into SHAM (n = 6) and three return of spontaneous circulation (ROSC) groups (n = 8
per group); 24 pigs were subjected to 8 min of electrically induced cardiac arrest and 2 min of basic life support, which received central venous injection of Shen-Fu (SFI), epinephrine (EP) or saline (SA). After successful ROSC, 18 surviving pigs were sacrificed at 24 h after ROSC (n = 6 per group). The levels of serum and lung tissue interleukin (IL)-4 and interferon (IFN)-γ were measured by ELISA, and the protein and mRNA levels of GATA-3 and T-bet in the lung tissue were determined by western blotting and quantitative real-time polymerase chain reaction, respectively. Compared with the EP and SA groups, SFI treatment reduced the levels of IL-4 (P < 0.05), increased levels of IFN-γ (P < 0.05), and induced T-bet mRNA upregulation and GATA-3 mRNA downregulation (P < 0.05). SFI attenuated lung injury and regulated lung immune disorders. Therefore, SFI could protect postresuscitation lung injury by modulating a Th1/Th2 imbalance.
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Shenfu injection attenuates neonatal hypoxic-ischemic brain damage in rat. Neurol Sci 2013; 34:1571-4. [DOI: 10.1007/s10072-013-1288-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 12/12/2012] [Indexed: 10/27/2022]
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Gu W, Li CS, Yin WP, Hou XM, Zhang J, Zhang D, Guo Z. Expression imbalance of transcription factors GATA-3 and T-bet in post-resuscitation myocardial immune dysfunction in a porcine model of cardiac arrest. Resuscitation 2012. [PMID: 23200999 DOI: 10.1016/j.resuscitation.2012.11.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND This study investigated whether an imbalance in Th1/Th2 cells is involved in the post-resuscitation myocardial immune dysfunction. METHODS 26 Wuzhishan miniature pigs were randomly divided into return of spontaneous circulation (ROSC) group (n=20) and sham-operated group (n=6), 20 pigs were subjected to 8min of electrically induced cardiac arrest, After successful ROSC, the 16 surviving pigs were randomly assigned to be sacrificed (n=8 per group) at 12 and 24h after ROSC, respectively. CD4(+) and CD8(+) lymphocyte subsets were determined by flow cytometry, interleukin (IL)-4 and interferon (IFN)-γ in the myocardium were measured by ELISA, and protein and mRNA levels of GATA-3 and T-bet were detected in the myocardium by Western blotting and quantitative real-time PCR in the post-ROSC group (n=8 per group) at 12 and 24h after ROSC and sham-operated group (n=6) at 24h after ROSC, respectively. RESULTS CD4(+) lymphocyte subsets were significantly lower in the post-ROSC group compared with the sham-operated group (P<0.05) at 12 and 24h after ROSC. The levels of myocardium IFN-γ were markedly increased, while IL-4 was significantly decreased in the post-ROSC group compared with the sham-operated group (P<0.05) at 12 and 24h after ROSC. Protein expression and mRNA levels of T-bet were markedly increased in the myocardium of pigs in the post-ROSC group compared with the sham-operated group (P<0.05) at 12 and 24h after ROSC, while GATA-3 was significantly reduced (P<0.05). CONCLUSION The myocardial immune dysfunction induced by the change in expression levels of the transcription factors GATA-3 and T-bet may be involved in the process of post-resuscitation myocardial injury in a porcine model of cardiac arrest.
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Affiliation(s)
- Wei Gu
- Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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