Gastrodia elata powder capsule enhances anti-epileptic effect of carbamazepine by decreasing P-gp expression

Purpose: To investigate the influence of Gastrodia elata powder capsule (GC) or gastrodin (GTD) on the anti-epileptic effect of carbamazepine (CBZ) on penicillin (PG)-induced epilepsy in rats. Methods: A total 116 rats were used in this study. Rats in the control group (n = 8) were injected with normal saline (NS) in place PG. Epilepsy was induced in the remaining 108 rats on the first day via PG injection. The rats were then divided randomly into six groups (18 rats per group): PG group, CBZ group, CBZ + GC group, CBZ + GTD group, GC group, and GTD group, which were given (p.o.) NS, CBZ (100 mg/kg), CBZ (100 mg/kg.) + GC (350 mg/kg), CBZ (100 mg/kg) + GTD (100 mg/kg), GC (350 mg/kg), and GTD (100 mg/kg), respectively, once a day for 15 days. The behavioral characteristics of the rats were observed and used to assess the anti-epileptic effect of the test drugs. Real-time quantitative reverse transcription-PCR and Western blot assays were employed for the determination of the effect of CBZ, GC and GTD on the expression levels of P-gp. Results: CBZ significantly reduced the symptoms of epilepsy, while GC and GTD enhanced the antiepileptic effect of CBZ, and reversed the CBZ-induced increases in the protein expressions of mrd1a and P-gp (p < 0.05). Conclusion: GC reverses CBZ drug resistance, probably through downregulation of P-gp expression. This finding indicates that GC is a potential anti-epilepsy drug, but it merits further studies

Tranexamic acid may benefit patients with preexisting thromboembolic risk undergoing total joint arthroplasty: a systematic review and meta-analysis

Purpose: This study sought to determine if the use of tranexamic acid (TXA) in preexisting thromboembolic risk patients undergoing total joint arthroplasty (TJA) was linked to an increased risk of death or postoperative complications. Methods: We conducted a comprehensive search for studies up to May 2023 in PubMed, Web of Science, EMBASE, and the Cochrane Library. We included randomized clinical trials, cohort studies, and case–control studies examining the use of TXA during TJA surgeries on high-risk patients. The Cochrane Risk of Bias instrument was used to gauge the excellence of RCTs, while the MINORS index was implemented to evaluate cohort studies. We used mean difference (MD) and relative risk (RR) as effect size indices for continuous and binary data, respectively, along with 95% CIs. Results: Our comprehensive study, incorporating data from 11 diverse studies involving 812 993 patients, conducted a meta-analysis demonstrating significant positive outcomes associated with TXA administration. The findings revealed substantial reductions in critical parameters, including overall blood loss (MD = −237.33; 95% CI (−425.44, −49.23)), transfusion rates (RR = 0.45; 95% CI (0.34, 0.60)), and 90-day unplanned readmission rates (RR = 0.86; 95% CI (0.76, 0.97)). Moreover, TXA administration exhibited a protective effect against adverse events, showing decreased risks of pulmonary embolism (RR = 0.73; 95% CI (0.61, 0.87)), myocardial infarction (RR = 0.47; 95% CI (0.40–0.56)), and stroke (RR = 0.73; 95% CI (0.59–0.90)). Importantly, no increased risk was observed for mortality (RR = 0.53; 95% CI (0.24, 1.13)), deep vein thrombosis (RR = 0.69; 95% CI (0.44, 1.09)), or any of the evaluated complications associated with TXA use. Conclusion: The results of this study indicate that the use of TXA in TJA patients with preexisting thromboembolic risk does not exacerbate complications, including reducing mortality, deep vein thrombosis, and pulmonary embolism. Existing evidence strongly supports the potential benefits of TXA in TJA patients with thromboembolic risk, including lowering blood loss, transfusion, and readmission rates

Protective effect of compound Danshen (Salvia miltiorrhiza) dripping pills alone and in combination with carbamazepine on kainic acid-induced temporal lobe epilepsy and cognitive impairment in rats

Context: Temporal lobe epilepsy (TLE) is resistant to antiepileptic drugs (AEDs) and is associated with cognitive impairment. The modern Chinese medicine, compound Danshen dripping pills (CDDP), is clinically effective in treating epilepsy and improving cognitive impairment. Objective: This study evaluated the protective effects of CDDP alone and in combination with carbamazepine (CBZ) on kainic acid-induced TLE and cognitive impairment in rats. Materials and methods: Sprague–Dawley rats were randomly divided into five groups: control (sham operated), model, CDDP, CBZ and combined. A TLE model was then created via bilateral intrahippocampal injection of 0.35 μg kainic acid (KA). Rats received CDDP (85 mg/kg), CBZ (100 mg/kg) or combined (85 mg/kg CDDP +100 mg/kg CBZ) via intragastric administration for 90 d, respectively. Seizure intensity, apoptosis and glial cell line-derived neurotrophic factor (GDNF) were measured. Furthermore, the improvement in cognitive impairment and hippocampal neuronal damage was evaluated. Results: CDDP combined with CBZ significantly decreased seizure severity and frequency (p < 0.05) and ameliorated cognitive impairment (p < 0.05). The model group showed a significant reduction of neurons and Bcl-2/Bax expression in the hippocampus CA3 area (p < 0.01), the combined groups significantly reversed these change (p < 0.01). GDNF expression in the combined groups showed a clear increase over the model group (p < 0.05). Conclusion: These findings support the use of CDDP as an adjuvant drug for the treatment of TLE and cognitive deficit. Its mechanism might be related to an anti-apoptosis effect and up-regulation of GDNF

Protective effect of compound Danshen (<i>Salvia miltiorrhiza</i>) dripping pills alone and in combination with carbamazepine on kainic acid-induced temporal lobe epilepsy and cognitive impairment in rats

<p><b>Context:</b> Temporal lobe epilepsy (TLE) is resistant to antiepileptic drugs (AEDs) and is associated with cognitive impairment. The modern Chinese medicine, compound Danshen dripping pills (CDDP), is clinically effective in treating epilepsy and improving cognitive impairment.</p> <p><b>Objective:</b> This study evaluated the protective effects of CDDP alone and in combination with carbamazepine (CBZ) on kainic acid-induced TLE and cognitive impairment in rats.</p> <p><b>Materials and methods:</b> Sprague–Dawley rats were randomly divided into five groups: control (sham operated), model, CDDP, CBZ and combined. A TLE model was then created via bilateral intrahippocampal injection of 0.35 μg kainic acid (KA). Rats received CDDP (85 mg/kg), CBZ (100 mg/kg) or combined (85 mg/kg CDDP +100 mg/kg CBZ) via intragastric administration for 90 d, respectively. Seizure intensity, apoptosis and glial cell line-derived neurotrophic factor (GDNF) were measured. Furthermore, the improvement in cognitive impairment and hippocampal neuronal damage was evaluated.</p> <p><b>Results:</b> CDDP combined with CBZ significantly decreased seizure severity and frequency (<i>p</i> < 0.05) and ameliorated cognitive impairment (<i>p</i> < 0.05). The model group showed a significant reduction of neurons and Bcl-2/Bax expression in the hippocampus CA3 area (<i>p</i> < 0.01), the combined groups significantly reversed these change (<i>p</i> < 0.01). GDNF expression in the combined groups showed a clear increase over the model group (<i>p</i> < 0.05).</p> <p><b>Conclusion:</b> These findings support the use of CDDP as an adjuvant drug for the treatment of TLE and cognitive deficit. Its mechanism might be related to an anti-apoptosis effect and up-regulation of GDNF.</p