Bojungikki-tang (BT), an Asian herbal remedy, has been prescribed to increase the vitality of debilitated patients. Since a compromised, weakened vitality often leads to illness, BT has been widely used to treat various diseases. However, little is known about the mechanism by which BT exerts its effect. Given that BT ameliorates inflammatory pulmonary diseases including acute lung injury (ALI), we investigated whether BT regulates the function of key inflammatory factors such as NF-κB and Nrf2, contributing to suppressing inflammation. Results show that BT interrupted the nuclear localization of NF-κB and suppressed the expression of the NF-κB-dependent genes in RAW 264.7 cells. In similar experiments, BT induced the nuclear localization of Nrf2 and the expression of the Nrf2-dependent genes. In a lipopolysaccharide-induced ALI mouse model, a single intratracheal administration of BT to mouse lungs ameliorated alveolar structure and suppressed the expression of proinflammatory cytokine genes and neutrophil infiltration to mouse lungs. Therefore, our findings suggest that suppression of NF-κB and activation of Nrf2, by which BT suppresses inflammation, are ways for BT to exert its effect.
Churg-Strauss syndrome (CSS) is known to mainly involve small vessels; thus, in the event of large-vessel disease, other causes must be taken into consideration. We report a case of CSS with recurrent arterial dissection of the cervicocephalic arteries. A 74-yearold man with CSS visited the emergency department because of sudden left hemiparesis. He had been taking corticosteroids as CSS treatment for 12 years. He had a confirmed right vertebral dissection 10 years before and a right distal internal carotid artery dissection 1 year before. As the arterial dissection occurred in the same vessel region a year before, a stent was deployed in the region. A large cervicocephalic artery dissection in patients with CSS that is well regulated with immunotherapy is likely caused by the long-term corticosteroid therapy weakening the vessel wall; therefore, replacement with the appropriate immunotherapy should be considered.
Obstructive sleep apnea (OSA) and dizziness are common conditions observed in the general population, and several epidemiological studies have reported an association between OSA and dizziness. Vestibular dysfunction, autonomic instability, and cerebellar degeneration secondary to recurrent hypoxia are implicated as mechanisms underlying dizziness in patients with OSA. Moreover, OSA is a risk factor for many diseases associated with dizziness, including Meniere disease, stroke, and psychiatric conditions. A dizziness questionnaire, vestibular function tests, and tests for autonomic function are useful for evaluation of OSA and concomitant dizziness. A growing body of evidence has shown that effective treatment of OSA including continuous positive airway pressure therapy reduces dizziness in these patients. Greater attention to dizziness is warranted in patients with OSA.
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