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Background: Orbital, intracranial, and osseous extra-sinus complications can arise from bacterial or fungal sinusitis. Odontogenic sinusitis (ODS) can cause extra-sinus complications, but its prevalence remains poorly characterized. Objective: To determine the frequency of ODS as a cause of operative extra-sinus infectious complications and describe clinical features of all complicated sinusitis cases. Methods: A multi-institutional retrospective review was performed on all operative sinusitis-related extra-sinus complications from 2011 to 2020. ODS was diagnosed by sinus computed tomography (CT) and dental evaluations when available. Demographics, complication types, sinusitis etiologies, and various clinical features were analyzed. Results: Forty-five patients were included (mean age 55.5 years, 56% male). Of the extra-sinus complications, 40% were orbital only, 22% intracranial only, 13% osseous only, and 25% involved combined complications. The 2 most common causes of extra-sinus complications were ODS (40%) and mucopyocele (27%). When invasive fungal etiologies were excluded, and only unilateral maxillary opacification on CT was considered, nearly 60% of extra-sinus complications were due to ODS. Unilateral maxillary sinus opacification on CT was present in 100% of complicated ODS compared to 44% of nonodontogenic cases, and oral anaerobes were only identified in ODS cases. No complicated ODS patients underwent dental interventions during hospitalization. Conclusion: ODS was the most common cause of operative extra-sinus infectious complications. Clinicians should consider ODS high on the differential diagnosis of all patients presenting with complicated sinusitis, especially when sinusitis is unilateral and invasive fungal infection is not suspected. [ABSTRACT FROM AUTHOR]

Background: When chronic rhinosinusitis with nasal polyps (CRSwNP) fails to respond to medical therapy, endoscopic sinus surgery (ESS) plays an integral role in management. Some studies have shown that middle turbinate resection (MTR) during ESS leads to decreased polyp recurrence and revision ESS rates. Other studies suggest MTR can lead to complications. Objective: The purpose of this study was to assess the safety of MTR during ESS for CRSwNP by determining the incidences of intraoperative cerebrospinal fluid (CSF) leak, postoperative epistaxis requiring operative intervention, and postoperative complete frontal stenosis. Methods: A multiinstitutional, prospective case series of 91 adult CRSwNP patients was conducted. Patients with medically refractory CRSwNP underwent primary or revision ESS plus MTR by 3 surgeons. Two of the surgeons performed partial MTRs, and one of the surgeons performed complete MTRs. Patients were evaluated for the following complications: intraoperative CSF leak during MTR, postoperative epistaxis requiring operative intervention, and postoperative complete frontal ostial stenosis. Secondary outcomes included changes from preoperative to postoperative 22-item Sinonasal Outcome Test (SNOT-22) scores and revision ESS rates. Results: Unilateral or bilateral complete ESSs with MTRs were performed on 91 CRSwNP patients. In total, 173 MTRs were performed. Two surgeons performed 97 partial MTRs on 49 patients, and the third surgeon performed 76 complete MTRs on 42 patients. One CSF leak occurred during partial MTR (1/173, 0.57%). No patients suffered postoperative epistaxis requiring operative intervention, and no patients developed complete frontal stenosis. From preoperatively to postoperatively, mean SNOT-22 scores decreased from 53.7 to 13.1 (P =.001). No revision ESS was needed during the follow-up period. Mean follow-up time was 7.5 ± 5.4 months. Conclusions: Partial and complete MTR during ESS for CRSwNP in this cohort resulted in very low, acceptable intraoperative and short-term postoperative complication rates and no detriment to SNOT-22 scores. [ABSTRACT FROM AUTHOR]

Thymosin β4 (Tβ4), a ubiquitous peptide, regulates several cellular processes that include cell morphology, wound healing, and inflammatory response. Administration of exogenous Tβ4 is protective in diabetic nephropathy and in a unilateral ureteral obstruction model. However, the role of endogenous Tβ4 in health and disease conditions remains unclear. To elucidate the pathophysiological role of endogenous Tβ4 in hypertension, we examined angiotensin-II (Ang-II)-induced renal and cardiac damage in Tβ4 knockout (Tβ4 KO) mice. Tβ4 KO and wild-type C57BL/6 mice were infused continuously for 6 weeks with either vehicle or Ang-II (980 ng/kg per minute). At baseline, Tβ4 deficiency did not affect renal and cardiac function. Systolic blood pressure in the Ang-II group was similar in wild-type and Tβ4 KO mice (wild-type Ang-II, 179.25±10.11 mm Hg; Tβ4 KO Ang-II, 169.81±6.54 mm Hg). Despite the similar systolic blood pressure after Ang-II infusion, Tβ4-deficient mice had dramatically increased albuminuria and decreased nephrin expression in the kidney (P<0.005). In the heart of Tβ4 KO mice, Ang-II reduced ejection fraction and shortening fraction (ejection fraction: wild-type Ang-II 77.95%±1.03%; Tβ4 KO Ang-II 62.58%±3.25%; P<0.005), which was accompanied by cardiac hypertrophy and left ventricular dilatation. In addition, renal and cardiac infiltration of CD68 macrophages, intercellular adhesion molecule-1, and total collagen content were increased after Ang-II infusion in Tβ4 KO mice (P<0.005). Overall, our data indicate that endogenous Tβ4 is crucial in preventing tissue injury from Ang-II-induced hypertension. This study gives new insights into the protective role of endogenous Tβ4 in hypertensive end-organ damage. [ABSTRACT FROM AUTHOR]

Complete ophthalmic examinations were performed on 160 Macaroni penguins ( Eudyptes chrysolophus) and 90 Rockhopper penguins ( Eudyptes chrysocome) at eight North American zoological institutions. Cataract prevalence in the Macaroni population was 46.5% ( n = 74) of penguins and 42.3% (135/319) of eyes. Cataract prevalence in the Rockhopper population was 45.5% ( n = 40) of penguins and 40.6% (73/180) of eyes. The mean age of Macaroni penguins without ocular disease was 7.4 ± 5.8 yr, while that of Rockhoppers was 9.8 ± 6.4 yr. Risk factors for cataract were examined through husbandry surveys completed by each institution and by evaluation of light intensity and ultraviolet (UV) light measurements acquired in each penguin exhibit. Risk factors associated with cataract in Macaroni penguins included age, dietary smelt, hand-feeding, and fluorescent exhibit lighting. Risk factors associated with cataract in Rockhopper penguins included age, dietary capelin, increasing population density, and increasing length of minimum photoperiod. Factors associated with decreased odds of cataract in Macaroni penguins included saltwater pool, monitoring of water quality for salinity, pH, and alkalinity; use of water additives; presence of pool filtration and sterilization systems; use of metal halide lightbulbs; increasing light intensity; and UV spectrum lighting. Factors associated with decreased odds of cataract in Rockhoppers included dietary herring and krill, increasing exhibit land area, pool temperature monitoring, increasing maximum photoperiod, and increasing minimum UV light. [ABSTRACT FROM AUTHOR]

Purpose: The purposes of this study were to (1) describe the calibration rates of aneroid blood pressure (BP) devices used in physical therapist (PT) education programs and (2) determine the validity of having the gauge needle resting within the zero-accuracy indicator as a proof of device calibration. Methods: We conducted a prospective descriptive study using a sample of convenience with an estimated 30-35 aneroid BP sphygmomanometers available for calibration check from each of the 6 PT education programs. Calibration of the measurement device used a certified mercury sphygmomanometer following the recommendations of the European Society of Hypertension. Descriptive statistics reported calibration rates, gauge needle position, device brand, cuff sizes, and whether the device was portable or wall mounted. Additionally, BP device calibration rates measured at universities that had or had not performed equipment calibration checks within the previous 2 years were compared using the Chi-square test with significance set at P = .05. Results: Calibration failure was identified in 22.5% of 289 BP gauges, whereas 16.2% of devices with a gauge needle resting in the zero accuracy indicator failed calibration validity measures. Additionally, a significant difference between the calibration rates of equipment from universities that had (n = 47) and had not (n = 242) regularly performed calibration checks was identified (P = .001). Conclusion: This study found that 22.5% of aneroid BP devices used in the participating PT education programs were not in calibration. Additionally, visual confirmation of a gauge needle resting position falling within the zero accuracy indicator did not assure that a device was in calibration. Routine inspection of BP devices is imperative to assure that accurate BP readings are guiding clinical recommendations. [ABSTRACT FROM AUTHOR]

Ophthalmic examinations were performed on 160 macaroni penguins ( Eudyptes chrysolophus) and 90 southern rockhopper penguins ( Eudyptes chrysocome) at eight North American zoos and aquaria. Intraocular pressure (IOP) was measured using rebound tonometry while penguins were held in two different body positions. Correlations between IOP and factors including age, body position, eye pathology, and housing parameters were evaluated. Normal macaroni penguins had a mean IOP of 42.0 ± 9.7 mm Hg. Normal rockhopper penguins had a mean IOP of 32.9 ± 6.2 mm Hg. Neither species had significantly different IOP between sexes or between left and right eyes of the same penguin. In both species, there was a negative linear correlation between age and IOP. In the macaroni population, IOP was significantly higher when IOP measurement was performed before ophthalmic exam; this was not true in rockhoppers. In both species, IOP measured in a horizontal body position was significantly higher than IOP measured in a vertical body position. In both species, eyes with corneal lesions had significantly lower IOP than normal eyes. In the macaroni penguin, eyes with rubeosis iridis had significantly lower IOP than normal eyes. In macaroni penguins, eyes with cataracts had significantly lower mean IOP than normal eyes; this was not true for rockhoppers. [ABSTRACT FROM AUTHOR]

Objective Clinical utility and cost-effectiveness of carotid duplex examination prior to cardiac surgery have been questioned by the multidisciplinary committee creating the 2012 Appropriate Use Criteria for Peripheral Vascular Laboratory Testing. We report the clinical outcomes and postoperative neurologic symptoms in patients who underwent carotid duplex ultrasound prior to open heart surgery at a tertiary institution. Methods Using the combined databases from our clinical vascular laboratory and the Society of Thoracic Surgery, a retrospective analysis of all patients who underwent carotid duplex ultrasound within 13 months prior to open heart surgery from March 2005 to March 2013 was performed. The outcomes between those who underwent carotid duplex scanning (group A) and those who did not (group B) were compared. Results Among 3233 patients in the cohort who underwent cardiac surgery, 515 (15.9%) patients underwent a carotid duplex ultrasound preoperatively, and 2718 patients did not (84.1%). Among the patients who underwent carotid screening vs no screening, there was no statistically significant difference in the risk factors of cerebrovascular disease (10.9% vs 12.7%; P = .26), prior stroke (8.2% vs 7.2%; P = .41), and prior transient ischemic attack (2.9% vs 3.3%; P = .24). For those undergoing isolated coronary artery bypass grafting (CABG), 306 (17.8%) of 1723 patients underwent preoperative carotid duplex ultrasound. Among patients who had carotid screening prior to CABG, the incidence of carotid disease was low: 249 (81.4%) had minimal or mild stenosis (<50%); 25 (8.2%) had unilateral moderate stenosis (50%-69%); 10 (3.3%) had bilateral moderate stenosis; 9 (2.9%) had unilateral severe stenosis (70%-99%); 5 (1.6%) had contralateral moderate stenosis; 2 (0.7%) had bilateral severe stenosis; 4 (1.3%) had unilateral occluded with contralateral less than 50% stenosis, 1 (0.3%) had unilateral occluded with contralateral (70%-99%) stenosis; and 1 had bilateral occluded carotid arteries. Primary outcomes of patients who underwent isolated CABG showed no difference in the perioperative mortality (2.9% vs 4.3%; P = .27) and stroke (2.9% vs 2.6%; P = .70) between patients undergoing preoperative duplex scanning and those who did not. Primary outcomes of patients who underwent open heart surgery also showed no difference in the perioperative mortality (5.1% vs 6.9%; P = .14) and stroke (2.6% vs 2.4%; P = .85) between patients undergoing preoperative duplex scanning and those who did not. Operative intervention of severe carotid stenosis prior to isolated CABG occurred in 2 of the 17 patients (11.8%) identified who underwent carotid endarterectomy with CABG. Conclusions In this study, the correlation between preoperative duplex-documented high-grade carotid stenosis and postoperative stroke was low. Prudent use of preoperative carotid duplex ultrasound should be based on the presence of cerebrovascular symptoms and the type of open heart surgery. [ABSTRACT FROM AUTHOR]

N-acetyl-seryl-aspartyl-lysyl-proline (Ac-SDKP) is a natural tetrapeptide with anti-inflammatory and antifibrotic properties. Its effect on salt-sensitive (SS) hypertension is unknown. We hypothesized that in Dahl SS rats on high-salt (HS) diet, Ac-SDKP prevents loss of nephrin expression and renal immune cell infiltration, leading to a decrease in albuminuria, renal inflammation, fibrosis, and glomerulosclerosis. To test this, Dahl SS rats and consomic SS13BN controls were fed either a low-salt (0.23% NaCl) or HS (4% NaCl) diet and treated for 6 weeks with vehicle or Ac-SDKP at either low or high dose (800 or 1600 μg/kg per day, respectively). HS increased systolic blood pressure in SS rats (HS+vehicle, 186±5 versus low salt+vehicle, 141±3 mm Hg; P<0.005) but not in SS13BN rats. Ac-SDKP did not affect blood pressure. Compared with low salt, HS-induced albuminuria, renal inflammation, fibrosis, and glomerulosclerosis in both strains, but the damages were higher in SS than in SS13BN. Interestingly, in SS13BN rats, Ac-SDKP prevented albuminuria induced by HS (HS+vehicle, 44±8 versus HS+low Ac-SDKP, 24±3 or HS+high Ac-SDKP, 8±1 mg/24 h; P<0.05), whereas in SS rats, only high Ac-SDKP dose significantly attenuated albuminuria (HS+vehicle, 94±10 versus HS+high Ac-SDKP, 57±7 mg/24 h; P<0.05). In both strains, Ac-SDKP prevented HS-induced inflammation, interstitial fibrosis, and glomerulosclerosis. In summary, in SS rats on HS diet, at low and high doses, Ac-SDKP prevented renal damage without affecting the blood pressure. Only the high dose of Ac-SDKP attenuated HS-induced albuminuria. Conversely, in SS13BN rats, both doses of Ac-SDKP prevented HS-induced renal damage and albuminuria. [ABSTRACT FROM AUTHOR]

Elevated interleukin-4 (IL-4) levels are associated with cardiac fibrosis in hypertension and heart failure in both patients and experimental animals. We hypothesized that chronically elevated IL-4 induces cardiac fibrosis, resulting in a predisposition of the heart to angiotensin II–induced damage. Wild-type Balb/c (WT, high circulating IL-4) and IL- 4–deficient Balb/c mice (IL-4−/−) were used. WT mice exhibited cardiac fibrosis (evidenced by an increase in expression of procollagen genes/interstitial collagen fraction), enlarged left ventricle chamber, and declined cardiac function associated with a greater number of mast cells and macrophages in the heart compared with IL-4−/−. In contrast, IL-4−/− mice had normal cardiac architecture/function while showing a 57.9% reduction in heart interstitial collagen compared with WT, despite elevated proinflammatory cytokines in heart tissue. In response to angiotensin II administration, IL-4−/− had reduced interstitial myocardial fibrosis and were protected from developing dilated cardiomyopathy, which was seen in WT mice. This was associated with increased macrophage infiltration into the hearts of WT mice, despite a similar degree of hypertension and increased cardiac transforming growth factor-β1 in both groups. In vitro data demonstrated that IL-4 upregulates procollagen genes and stimulates collagen production in mouse cardiac fibroblasts. This process is mediated by signal transducer and activator of transcription 6 signaling pathway via IL-4 receptor alpha. This study not only establishes a causal relationship between IL-4 and cardiac fibrosis/dysfunction, but also reveals a critical role for IL-4 in angiotensin II–induced cardiac damage. IL-4 could serve as an additional target for the treatment of cardiac fibrosis. [ABSTRACT FROM AUTHOR]

Background Glucagon-like peptide-1 (GLP-1) agonists and dipeptidyl peptidase 4 (DPP-4) inhibitors (GLP-1 agents) may be protective in heart failure (HF). We set out to determine whether GLP-1 agent use is associated with HF risk in diabetics. Methods and Results In this retrospective cohort study of members of a large health system, we identified >19,000 adult diabetics from January 1, 2000, to July 1, 2012. GLP-1 agent users were matched 1:2 to control subjects with the use of propensity matching based on age, race, sex, coronary disease, HF, diabetes duration, and number of antidiabetic medications. The association of GLP-1 agents with time to HF hospitalization was tested with multivariable Cox regression. All-cause hospitalization and mortality were secondary end points. We identified 1,426 users of GLP-1 agents and 2,798 control subjects. Both were similar except for angiotensin-converting enzyme inhibitors/angiotensin receptor blocker use, number of antidiabetic medications, and age. There were 199 hospitalizations, of which 128 were for HF, and 114 deaths. GLP-1 agents were associated with reduced risk of HF hospitalization (adjusted hazard ratio [aHR] 0.51, 95% confidence interval [CI] 0.34–0.77; P = .002), all-cause hospitalization (aHR 0.54, 95% CI 0.38–0.74; P = .001), and death (aHR 0.31, 95% CI 0.18–0.53; P = .001). Conclusions GLP-1 agents may reduce the risk of HF events in diabetics. [ABSTRACT FROM AUTHOR]

Abstract: Background: The aim of this study was to compare the benefit of beta-blockers (BB) in heart failure (HF) with preserved versus reduced ejection fraction (EF). Methods and Results: This was a retrospective study of insured patients who were hospitalized for HF from January 2000 to June 2008. Pharmacy claims were used to estimate BB exposure over 6-month rolling windows. The association between BB exposure and all-cause hospitalization or death was tested with the use of time-updated proportional hazards regression, with adjustment for baseline covariates and other HF medication exposure. The groups were compared by stratification (EF <50% vs ≥50%) and with the use of an EF-group × BB exposure interaction term. A total of 1,835 patients met the inclusion criteria, 741 (40%) with a preserved EF. Median follow-up was 2.1 years. In a fully adjusted multivariable model, BB exposure was associated with a decreased risk of death or hospitalization in both groups (EF <50%: hazard ratio [HR] 0.53 [P < .0001]; EF ≥50%: HR 0.68 [P = .009]). There was no significant difference in this protective association between groups (interaction: P = .32). Conclusions: BB exposure was associated with a similar protective effect regarding time to death or hospitalization in HF patients regardless of whether EF was preserved or reduced. An adequately powered randomized trial of BB in HF with preserved EF is warranted. [Copyright &y& Elsevier]

Background: The aim of this study was to compare the benefit of beta-blockers (BB) in heart failure (HF) with preserved versus reduced ejection fraction (EF).Methods and Results: This was a retrospective study of insured patients who were hospitalized for HF from January 2000 to June 2008. Pharmacy claims were used to estimate BB exposure over 6-month rolling windows. The association between BB exposure and all-cause hospitalization or death was tested with the use of time-updated proportional hazards regression, with adjustment for baseline covariates and other HF medication exposure. The groups were compared by stratification (EF <50% vs ≥50%) and with the use of an EF-group × BB exposure interaction term. A total of 1,835 patients met the inclusion criteria, 741 (40%) with a preserved EF. Median follow-up was 2.1 years. In a fully adjusted multivariable model, BB exposure was associated with a decreased risk of death or hospitalization in both groups (EF <50%: hazard ratio [HR] 0.53 [P < .0001]; EF ≥50%: HR 0.68 [P = .009]). There was no significant difference in this protective association between groups (interaction: P = .32).Conclusions: BB exposure was associated with a similar protective effect regarding time to death or hospitalization in HF patients regardless of whether EF was preserved or reduced. An adequately powered randomized trial of BB in HF with preserved EF is warranted. [ABSTRACT FROM AUTHOR]

Background: There are large and persisting disparities in severe asthma exacerbations by race-ethnicity, and African American subjects are among those at greatest risk. It is unclear whether this increased risk solely represents differences in environmental exposures and health care or whether there is a predisposing genetic component. Objective: We sought to assess the relationship between genetic ancestry and severe exacerbations among African American subjects with asthma. Methods: Participants were part of the Study of Asthma Phenotypes and Pharmacogenomic Interactions by Race-ethnicity (SAPPHIRE). These subjects were 12 to 56 years of age, received care from a single large health system, and had a physician''s diagnosis of asthma. Genetic ancestry was estimated by using a set of validated ancestry informative markers. Severe exacerbations (ie, asthma-related emergency department visits, hospitalizations, and burst oral steroid use) were prospectively identified from health care claims. Results: We assessed genetic ancestry in 392 African American subjects with asthma. The average proportion of African ancestry was 76.1%. A significant interaction was identified between ancestry and sex on severe exacerbations, such that the risk was significantly higher with increasing African ancestry among male but not female subjects. The association among male subjects persisted after adjusting for potential confounders (relative rate, 4.30 for every 20% increase in African ancestry; P = .029). Conclusions: African ancestry was significantly and positively associated with severe exacerbations among male African American subjects. These findings suggest that a portion of the risk of asthma exacerbations in this high-risk group is attributable to a genetic risk factor that partitions with ancestry. [Copyright &y& Elsevier]

The article presents a study that deals with the mechanisms underlying the role of carbon monoxide (CO) in attenuating tubuloglomerular feedback. The study investigated the influence of CO and cGMP-stimulated phosphodiesterase 2 in reducing cAMP in the macula densa, leading to TGF attenuation. It shows that TGF is attenuated by CO through reduction of cAMP via a cGMP-dependent pathway mediated by cGMP-dependent protein kinase.

The article investigates association of β-Blocker exposure with outcomes in heart failure (HF) between African American and White patients. It is indicated that β-Adrenergic antagonists (BB) are therapy cornerstone for systolic HF with morbidity benefits demonstrated in multiple randomized clinical trials. Findings showed that BB appears to be 40 to 50% less effective in preventing health or hospitalization among African American patients with HF compare with white individuals.

Objective: Published reports of robotic-assisted aortic surgery involve a combination of laparoscopy for aortic dissection and a robotic system for vascular reconstruction. The objective of this study is to determine the feasibility and advantage of a total robotic-assisted aortic dissection and vascular reconstruction vs robotic-assisted aortic procedures for aortoiliac occlusive disease (AIOD) and abdominal aortic aneurysm (AAA). Methods: From February 2006 to August 2010, 21 patients were selected for robotic-assisted aortic procedures: aortobifemoral bypass in 12, AAA repair in 6, iliac aneurysm repair in 1, and ligation of type II endoleak after endovascular aneurysm repair in 2. Inclusion criteria included AAA >5 cm, iliac aneurysm >3 cm, and AIOD TransAtlantic InterSociety Classification (TASC) C or D lesions. The da Vinci S Surgical System (Intuitive Surgical Inc, Sunnyvale, Calif) was used for the abdominal aortic dissection in all cases and for the aortic anastomosis in three cases. Results: The 21 patients (6 women, 15 men) were an average age of 65.7 years (range, 44-86 years), had a body mass index (BMI) of 27.23 kg/m 2 , and 90.4% were American Society of Anesthesiologists (ASA) class 3 or 4. Robotic dissection of the abdominal aorta was successful in 20 patients (95.2%). One patient required full conversion to open AAA repair due to trocar injury. Of the remaining 20 patients, the average robotic dissection time of the infrarenal aorta was 113.1 minutes, and the average aortic clamp time was 86 minutes. The procedure in 15 patients was performed with a minilaparotomy using an average abdominal incision of 13 cm to implant the Dacron or polytetrafluoroethylene graft. Five patients underwent a total robotic-assisted procedure with robotic aortic reconstruction or ligation of a type II endoleak. The 30-day survival rate was 100%. Median length of stay was 7.5 days. All grafts were patent at a median follow-up of 32.0 months. Conclusions: For aortic procedures completed total robotically without an abdominal incision, the estimated blood loss was significantly less than in robotic-assisted procedures with a minilaparotomy. In these selected patients, robotic-assisted technology may be part of the armamentarium for the vascular surgeon as another less invasive method for the treatment of complicated occlusive disease or aneurysm. [Copyright &y& Elsevier]

Background: African American patients disproportionately experience uncontrolled asthma. Treatment with an inhaled corticosteroid (ICS) is considered first-line therapy for persistent asthma. Objective: We sought to determine the degree to which African American patients respond to ICS medication and whether the level of response is influenced by other factors, including genetic ancestry. Methods: Patients aged 12 to 56 years who received care from a large health system in southeast Michigan and who resided in Detroit were recruited to participate if they had a diagnosis of asthma. Patients were treated with 6 weeks of inhaled beclomethasone dipropionate, and pulmonary function was remeasured after treatment. Ancestry was determined by genotyping ancestry-informative markers. The main outcome measure was ICS responsiveness defined as the change in prebronchodilator FEV1 over the 6-week course of treatment. Results: Among 147 participating African American patients with asthma, average improvement in FEV1 after 6 weeks of ICS treatment was 11.6%. The mean proportion of African ancestry in this group was 78.4%. The degree of baseline bronchodilator reversibility was the only factor consistently associated with ICS responsiveness, as measured by both an improvement in FEV1 and patient-reported asthma control (P = .001 and P = .021, respectively). The proportion of African ancestry was not significantly associated with ICS responsiveness. Conclusions: Although baseline pulmonary function parameters appear to be associated with the likelihood to respond to ICS treatment, the proportion of genetic African ancestry does not. This study suggests that genetic ancestry might not contribute to differences in ICS controller response among African American patients with asthma. [ABSTRACT FROM AUTHOR]

Background: Adherence to inhaled corticosteroids (ICSs) is known to be poor among patients with asthma; however, little is known about patients who do not fill their ICS prescriptions (ie, primary nonadherence). Objective: To estimate rates of primary nonadherence and to explore associated factors. Methods: The study population was members of a large health maintenance organization in southeast Michigan who met the following criteria: age 5 to 56 years; previous diagnosis of asthma; at least 1 electronic prescription for an ICS between February 17, 2005, and June 1, 2006; and at least 3 months follow-up after the ICS prescription. Adherence was estimated by using electronic prescription information and pharmacy claims data. Multivariable stepwise analysis was used to identify factors associated with primary nonadherence compared with adherent patients. Results: One thousand sixty-four patients met the study criteria and had calculable adherence. Of these patients, 82 (8%) never filled their ICS prescription. Stepwise regression identified the following factors to be associated with an increased likelihood of primary nonadherence: younger age, female sex, African American race-ethnicity, and lower rescue medication use. Factors associated with primary nonadherence differed between race-ethnic groups. Conclusion: Primary nonadherence was associated with lower baseline rescue medication use, which may reflect lower perceived need for ICS therapy in patients with milder asthma. Rates of primary nonadherence and the factors which influenced this outcome differed by race-ethnicity. Clinical implications: Understanding patient characteristics associated with primary nonadherence may be important for disease management, because many patients with asthma do not fill their ICS prescriptions. [Copyright &y& Elsevier]

Background: Epidemiologic data on allergic rhinitis and asthma are frequently based on self-reported symptoms. Objective: This cross-sectional study examined the relationship between self-reported symptoms and histories of allergic rhinitis or asthma and a marker of allergic sensitization, allergen-specific IgE. Methods: We surveyed 702 pregnant women in Michigan. Blood samples were analyzed for specific IgE to 9 allergens: dust mites (Dermatophagoides farinae and Dermatophagoides pteronyssinus), cat, dog, cockroach, ragweed, timothy grass, egg, and Alternaria alternata. Seratopy was defined as a specific IgE greater than or equal to 0.35 kU/L to any allergen. Results: Seroatopy was found in 66.7% of those with hay fever symptoms, 68.3% with a physician''s diagnosis of asthma, and 72.1% of those with both conditions. These results differed significantly from asymptomatic subjects, where 49.8% of patients without hay fever and 50.4% without asthma were seroatopic. Race and education did not modify the relationships. Symptoms related to specific exposures were modest predictors of positive specific IgE to related allergens (positive predictive values from 26.5% to 50.3%). Conclusion: Self-reported symptoms of allergic rhinitis or asthma were significantly associated with allergic sensitization, but the odds ratios were of relatively low magnitude for this historical information to be considered evidence of current allergic sensitization. A 66% to 68% probability existed that those with symptoms of allergic rhinitis or asthma would have a positive specific IgE test. Clinical implications: Self-reported histories of hay fever or asthma alone are only modest predictors of allergic sensitization. When knowledge of allergic sensitization is important, information beyond self-reported symptoms is necessary. [Copyright &y& Elsevier]

This article determines whether an angiotensin-converting enzyme inhibitors (ACEi) or N-acetyl-seryl-aspartyl-lysyl-proline would weaken left ventricular monocyte/macrophage infiltration, phosphorylation of mitogen-activated protein kinases, and collagen deposition in the heart and kidney. Some of the clinical features of aldosterone-salt-induced hypertension include severe fibrosis in the heart and kidney and extensive inflammatory reactions that are central to the stimulation of collagen synthesis.

Angiotensin-converting enzyme inhibitors (ACEis) are known to have antifibrotic effects on the heart and kidney in both animal models and humans. N-acetyl-seryl-aspartyl-lysyl-proline is a natural inhibitor of proliferation of hematopoietic stem cells and a natural substrate of ACEi that was reported to prevent cardiac and renal fibrosis in vivo. However, it is not clear whether N-acetyl-seryl-aspartyl-lysyl-proline participates in the antifibrotic effects of ACEi. To clarify this issue, we used a model of aldosterone-salt-induced hypertension in rats treated with the ACEi captopril either alone or combined with an anti-N-acetyl-seryl-aspartyl-lysyl-proline monoclonal antibody. These hypertensive rats had the following: (1) left ventricular and renal hypertrophy, as well as increased collagen deposition in the left ventricular and the kidney; (2) glomerular matrix expansion; and (3) increased ED1-positive cells and enhanced phosphorylated-p42/44 mitogen-activated protein kinase in the left ventricle and kidney. The ACEi alone significantly lowered systolic blood pressure (P=0.008) with no effect on organ hypertrophy; it significantly lowered left ventricular collagen content, and this effect was blocked by the monoclonal antibody as confirmed by the histological data. As expected, the ACEi significantly decreased renal collagen deposition and glomerular matrix expansion, and these effects were attenuated by the monoclonal antibody. Likewise, the ACEi significantly decreased ED1-positive cells and inhibited p42/44 mitogen-activated protein kinase phosphorylation in the left ventricle and kidney, and these effects were blocked by the monoclonal antibody. We concluded that in aldosterone-salt-induced hypertension, the antifibrotic effect of ACEi on the heart and kidney, is partially mediated by N-acetyl-seryl-aspartyl-lysyl-proline, resulting in decreased inflammatory cell infiltration and p42/44 mitogen-activated protein kinase activation. [ABSTRACT FROM AUTHOR]

Background: Previous studies have shown differences in adherence to inhaled corticosteroids (ICSs) by race-ethnicity, yet little is known about factors that contribute to adherence within these groups. Environmental stressors, such as crime exposure, which has been associated with asthma morbidity, might also predict ICS adherence. Objective: We sought to identify factors associated with ICS adherence among patients with asthma and among African American patients and white patients separately. Methods: Study patients with asthma were aged 18 to 50 years and were enrolled in a large southeast Michigan health maintenance organization between January 1, 1999, and December 31, 2001. The primary outcome, ICS adherence, was calculated by linking prescription-fill data with dosage information. Predictor variables included age, sex, race-ethnicity, measures of socioeconomic status (SES), average ICS copay, existing comorbidities, and crime rate in area of residence. Results: Adherence information was available for 176 patients. ICS adherence was lower among African American patients (n = 75) when compared with white patients (n = 94; 40% vs 58%, respectively; P = .002). Among white patients, adherence was significantly lower for women when compared with men. Among African American patients, age and residential crime rates were positively and negatively associated with ICS adherence, respectively. Area crime remained a predictor of adherence in African American patients, even after adjusting for multiple measures of SES. Conclusions: This study suggests that an environmental stressor, area crime, provides additional predictive insight into ICS-adherent behavior beyond typical SES factors. Clinical implications: Better understanding of environmental factors that influence ICS adherence might aid in efforts to improve it. [Copyright &y& Elsevier]