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Learning Objectives: Accumulating evidence implicates the role of systemic inflammation in the pathogenesis of pulmonary arterial hypertension (PAH). C -reactive protein (CRP) is an established marker of inflammation that is active in the physiopathology of the vascular wall. It is hypothesized that the proinflammatory properties of CRP contribute to pulmonary vascular remodeling via modulation of the nuclear factor-kappa B pathway. The association between CRP and PAH is unclear. We conducted a meta-analysis to evaluate the relationship between serum CRP levels and PAH. Methods: We searched MEDLINE, CINAHL and COCHRANE databases for studies reporting serum CRP levels in the PAH and non PAH study population. We included case controls, cohort and cross-sectional studies. We calculated the weighted standardized mean difference (SMD) in serum CRP levels between the PAH and control groups. Results: Our search strategy yielded 124 articles. We included eight studies enrolling 861 participants. PAH was diagnosed either by doppler echocardiography (52%) or right heart catheterization (48%). The median age of the PAH group was 55 yr. (IQR 41 -61) vs 48 yr. in the control group. The median body mass index in the PAH group was 25.6 kg/m2 (IQR 24.7-26.4) vs 25.9 kg/m2 (IQR 25.1-27.3) in the control group. The unweighted median serum CRP levels in the PAH group were 6.75 mg/l (IQR 3.9-12.5) vs 3.15 mg/l (IQR 2 -6.9) in the control group. The SMD of CRP level was 0.75 (95% CI 0.31 -1.18) p<0.001 comparing the PAH group vs the control group. Conclusions: An elevated serum CRP level is significantly associated with the presence of PAH. Given the significance of elevated CRP levels in PAH, directing further studies in understanding the role or CRP in the etio-pathogenesis of PAH would help determine newer modalities of therapeutic options and prognostic indicators.

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Purpose: The purpose of this study was lo evaluate our use of active posterior rhinomanomelry for the evaluation of nasal airway patency pre- and post-operatively. While it is difficult to avoid discussion of surgical technique, an evaluation of the various surgical procedures was not the primary focus of this investigation.