Tear Down the Curtain Essay - 1246 Words

Title Tearing Down the Curtain In 1987 President Ronald Reagan gave an introspective speech in front of the Brandenburg gate in Berlin. That said speech is known to us as â€Å"Remarks at the Brandenburg Gate†. When Reagan gave this speech he was toward the end of his political career, he had served two terms as president of the United States, and was well-known for his role as a gifted mediator and peacemaker. It was also during the Cold war between the United States and the Soviet Union. To the west of Berlin was the free democratic countries of Western Europe. To the east was what was known as the iron curtain an area controlled by the soviet union and its allies. Inside the iron curtain freedoms were restricted and liberty denied.†¦show more content†¦He topped it off by using a common German phrase of endearment –â€Å"Ich hab noch einen Koffer in Berlin† which means: I still have a suitcase in Berlin (page 1). While listening to the actual video record of this statement; the cro wd stood up and cheered. At that point President Reagan had achieved his goal of winning over the crowd. After Ronald Reagan had successfully reached common ground with the present crowd he turned his attention to the speech’s intended audience which was that of East Berlin and the Soviet Union. He immediately tried to reach out to by stating that he wished to extend his warmest greetings and good will of the American people (page 1). Reagan then goes on to state that he has one unshakable conviction that there is only one Berlin. In this statement he says two things; he first uses the language of the German people. It is important to realize that the language he choose was not Russian but German. This displayed the fact that his comments were meant for the people of East Berlin and not to their Soviet overseers. He then foreshadows the fact that Berlin and the greater extent East Germany should be rejoined with its Western neighbor which would make it whole free, democ ratic state. To first justify Reagans position he explained that Germany should again be a whole freeShow MoreRelatedDo You Ever Feel Like You re Being Watched?867 Words   |  4 Pagescouldn’t take it anymore. Sweat started to slowly slide down the sides of my forehead from how much I’ve been moving in bed in an attempt to go back to sleep. I sprung up from my bed and as I reached for my not so thick but not thin turquoise curtains I felt eyes looking through them, I felt a presence and I became terrified. Eyes, big but dull, round, and hazel with blood tears streaming down its face was there when I opened the curtains. A thin torso wearing a black torn up trench coat accompaniedRead MoreShort Story918 Words   |  4 PagesBrennan, Im just so glad you and your friends still like to build snowmen! It adds such a festive touch to our front yard,† Mom says as she sets the buns on the table and pulls out her chair to sit for dinner. Unamused, Brennan bobs his head up and down and raises his eyebrows in response to my mom as he pours himself a glass of milk. I stare at my water-filled glass with a small, vibrant Mt. Rushmore design on one side as my family continues their usual dinner small talk. †What am I gonna do to stayRead MoreA Dog s Life : Charlie Chaplin1190 Words   |  5 Pagesmake a living. Lastly, another cultural reference is the transition into the lively jazz-age. When Edna sings an â€Å"Old Song† everyone in the audience is brought to tears, and she eventually loses her job; the audience prefers the upbeat, lively performance by the band. The ideal of the â€Å"American Dream† plays a role in this film, as three down-under-their-luck individuals have nothing, and eventually live in a nice country house. Scene 1 (28:05) The first scene that exemplifies style of this film isRead MoreEssay on The Fall of Communism1064 Words   |  5 Pagesgovernment with a communist government. . At the end of WWII, most of Eastern and Central Europe’s countries were being occupied by the soviet army. They came to be controlled by the Soviet government and pulled back behind an â€Å"iron Curtain†. Winston Churchill’s famed Iron curtain remark refers to the countries that fell under the spell of the Soviet Union and shut out the western world ways of capitalism. The countries of Eastern Poland, Hungary, Czechoslovakia, Bulgaria, Yugoslavia, Romania, Albania andRead MoreTickets Please By James Mutters1298 Words   |  6 Pagesfloor. Each table has a flickering candle on top of a silk table runner. There are other seats around the room just without the central view. At the far end of the room curtains fall over lofted area where James could see stands. People are anxiously waiting for the curtain s to rise and the mood to set. James takes a single step down onto the area with the 16 tables, and an usher wearing a red uniform rushes over to greet him before he can do anything else. â€Å"Hello sir do you happen to have a ticketRead MoreThe Crucible By Arthur Miller1210 Words   |  5 Pagesidentify the witches in the village. The witch trials are the ultimate expression of intolerance because hanging witches is a way for the townsmen to restore the purity the community once had. In Act III, Danforth states the hot fire of court â€Å"melts down all concealment† which means the court burns away all lies to get to the truth and burns away what they want to burn away. The relationship that is tested the most is the Proctor marriage. John Proctor’s marriage creates and atmosphere of distrustRead MoreThe Greatest Day Of My Life1253 Words   |  6 Pages â€Å"OK, I’m sorry, I’m awake,† I grumbled, moving to a sitting position, in the vexatious bed the hospital provided for me. â€Å"Well, I will see you down there, the nurse is taking me to the delivery room; they have to start my epidural,† she groaned, leaning over to hug me, before dashing out of the room. November 15, 2011. Eight a.m. I’m running down the cold, white, concrete halls, of Baptist Regional Medical Center. The only sound I could hear, was my own heart-drumming in my ears. â€Å"Stay calm,Read MoreStatement As A Phlebotomist For The Transbay Office944 Words   |  4 Pagesa blood draw. I was on my way out to lunch when she stepped in but from what I could hear on the other side of the curtain she was very nervous and scared about the blood draw. I left the lab confident that my colleague would do an exceptional job as always with making our patient feel at ease. As I returned from lunch, I could hear the same patient on the other side of the curtain telling our phlebotomist that she was extremely terrified of needles. My colleague had done everything that she couldRead MoreThe Church Echoed From Sweet Sobs860 Words   |  4 Pages The church echoed back sweet sobs; sobs with as much intent and passion as any man could give. He was there, at the altar, the church , standing beside his endearing princess. The only sound that resonated past loving tears was the confession to his dearest: an unfathomable promise to keep her forever in his heart. To have and to hold as any grown man should. At least, as he would, if he had been an adult. Last year filled with joy. Before the church, before the storm. â€Å"My liege† said his brotherRead MoreThe Tortilla Curtain By. Boyle1390 Words   |  6 Pageshowever, problems arise when certain cliques look down on different ethnic groups to the point of damaging and hurting those individuals and minorities. The Tortilla Curtain, written by T.C. Boyle, points out many of the problems seen among different ethnic groups. In the book, Boyle demonstrated the difficulties that can develop among individuals when communication is limited, but also when we discriminate against others. In The Tortilla Curtain, T.C. Boyle argues that communication is essential

The River Mountain By N. Scott Momaday Essay - 1654 Words

The Way to Rainy Mountain is a by N. Scott Momaday influential novel in today s time, as it depicts the history of the Kiowa culture of how they came to be, their traditions and beliefs along with the truth of how their culture came to an abrupt end. As Momaday undergoes a journey to visit Rainy Mountain, he creates an identity for himself in the Kiowa culture that is portrayed through his use of memory, setting, and structure. The use of memory is vital to the creation of Momaday s identity within the Kiowas. Momaday contrasts his personal memories of Kiowa culture and traditional tribal narratives to create an impression of the Native American way of life that is both well-grounded and accurate to their history. Not only did the ancestral Kiowa stories contribute to the overall influence on his character but also the landscape and journey as he merges his individual memories with the ancestral memories. It is stated that Aho, Momaday’s grandmother, was born when the Kiowas were living the last great moments of their history. Almost a decade before she was born, a majority of Kiowa warriors were captured and imprisoned by the US Calvary at the old stone corral at Fort Sill. Also, it is told that when she was seven, Aho experienced the last of her people s Sun Dance culture when the last Kiowa Sun Dance was held in 1887 on the Washita River above Rainy Mountain Creek. Therefore, many, if not all, of the memories that Momaday can recall of the Kiowas and their culture areShow MoreRelated A Writers Style Essay1219 Words   |  5 PagesPulitzer Prize winning writer N. Scott Momaday has become known as a very distinctive writer who depicts the stories of the Native American life in almost poetic ways. He does an excellent job of transporting the reader from the black and white pages of a book, to a world where every detail is pointed out and every emotion felt when reading one of Momaday’s books or other writings. This style of writing that Momaday uses is very evident in his work â€Å"The Way to Rainy Mountain,† and made even more apparentRead MoreA Writers Style - N. Scott Momaday Review1246 Words   |  5 PagesPulitzer Prize winning writer N. Scott Momaday has become known as a very distinctive writer who depicts the stories of the Native American life in almost poetic ways. He does an excellent job of transporting the reader from the black and white pages of a book, to a world where every detail is pointed out and every emotion felt when reading one of Momadays books or other writings. This style of writing that Momaday uses is very evident in his work The Way to Rainy Mountain, and made even more apparentRead MoreEssay about The Journey to Self Discovery1029 Words   |  5 PagesJoan Didion’s essay â€Å"On Going Home and, N. Scott Momaday’s essay The Way to Rainy Mountain. For Joan Didion, returning home is a source of comfort, confusion, and conflict. The life she lives with her husband and child are a world apart from the life she grew up in. Her memories are a part of who she is and the kind of mother and wife she hopes to be. Perhaps in her quest, she will find the best parts of her to pour into her new life. In contrast, N. Scott Momaday’s â€Å"home† is his grandmother.Read MoreAnalysis Of Scott Momaday s The Great Gatsby Essay2188 Words   |  9 PagesN.Scott Momaday On February 27 in 1934 Navarre Scott Momaday was born, in Lawton, Oklahoma. He was born in the Kiowa and Comanche Indian Hospital, and was then registered with having seven-eighths Indian blood. N. Scott Momaday was born of, Natachee Scott Momaday, having a mix of English, Irish, French, and Cherokee blood while, his father, Alfred Morris Momaday was a full blood Kiowa. He stated, â€Å"my father was my mentor, he was a painter and he taught art. He once said to me, I never knewRead MoreThe, Legend, Lore, And Hearsay Essay1651 Words   |  7 Pagesthemselves; they had dared to image and determine who they were,† (Momaday, 77). Here Momaday addresses the migration of his ancestors. As a result, the people had been modified by their journey, and so finally they began to consider who they were and what they were meant to become. â€Å"What remains is fragmentary: mythology, legend, lore, and hearsay--and of course the idea itself, as crucial and complete as it ever was. Tha t is the miracle,† (Momaday, 77). In regards to his culture, Momday expresses his perceptionRead MoreA Spiritual Journey1839 Words   |  8 PagesChance It is a great feeling going to a place where it’s a huge matter in one’s life. â€Å"Revisiting Sacred Ground† N. Scott Momaday had made a pilgrimage which his Kiowa ancestors. Momaday has said,† There are certain villages, and towns mountains and plains that, having seen them, walked in them, lived in them, even for a day, we keep forever in the mind’s eye.† Just like how Momaday relived his ancestor’s trails, I had a chance as well. I was lucky enough to be able to go on such a sacred journeyRead MoreValue Of Tradition And Culture1805 Words   |  8 PagesFor example, the author in â€Å"The Way to Rainy Mountain† N. Scott Momaday, seems to describe his life as a man who left his family’s homeland to make his own, but always had a strong relationship with his grandmother. Momaday describes the sense of self-identity by connecting his essay about his family history. He reveals his emotions into his grandmother’s d eath when he stated, â€Å"Although my grandmother lived out her long life in the shadow of Rainy Mountain†¦.wanted to see in reality what she had seen†¦

Performance and Director Free Essays

A director is in charge of all aspects of the production, a director’s job is to tie up all performance element together. The director must have vision of how should the character moves, the lighting that help enhance the mood of the play, the sets and props. As an Actor we often find problem such as, don’t know how to pose our hand, where to stand and which way to walk. We will write a custom essay sample on Performance and Director or any similar topic only for you Order Now We are â€Å"floating† in the stage, because we are not sure what our role is. Then it is the director’s role to direct and told the actor what to do so they will not be â€Å"floating† anymore. First the director have to read and understand the script, know what is the meaning of the play, understand each character in the play so that he or she can make choice or decision during rehearsal. The next step is to start rehearsal. Director have to position actors on stage. Usually the director will decide where is the 5 acting area, but it can be more. For example for realistic play, the 5 acting area can be sofa, kitchen, dining table, bed, beside window, and etc. A director will start to draw the set in a groundplan. When a play is directed by a good director, the audience won’t get distracted by something or someone else on the play. A good director can provide focus of the play, where the audience should see and focus on. If the audience get distracted or confuse during the play, it’s the director’s fault. A play is symbolic, it’s artificial. All the elements of the play on the stage is symbolic. The actor represent another person on the stage. The set and probs is symbolic too, because it represent the chair in the play storyline. Then why people go to see a play? Because we can relate the play to us in the real world. View pointing is using different form from traditional As an actor physically awkward,dunno wat to do with hand. View pointing help or not? at is d intention, wat d director want us to do. Ans: viewpointing tu diff approach. View pointing tu, dr awal acara gk ad plot,cuma ad movement. Director Don’t make movement that is not important how to solve problem tgn yg gk tau taru dimn. Kenapa tgn kita tak tau mau ngap. karna kt gk yakin apa yg harus kt lakukan, gk yakin ttg role mrk. Role,space, body. Viewpointing is using different from from traditional Collaborative-haresh sharma messy†¦ Base of my knowledge from blabla 5acting areas. Provide the focus, if audience distracted with someone else, don’t put that on purpose. Director’s fault. A PLAY IS artificial. How to cite Performance and Director, Papers

Immunology Pathogenesis of Asthma

Question: Discuss about theImmunology for Pathogenesis of Asthma. Answer: Introduction: Asthma is a chronic inflammatory disease of lungs and conducting airways. In asthma cells of both immune system like innate and adaptive immune systems work collectively on epithelial cells of airways. The innate immune cells like mast cells, eosinophils, basophils, macrophages, neutrophils and dendritic cells are responsible for the pathogenesis of asthma. The adaptive immune cells like B cells and TH2 cells are involved in the pathogenesis of asthma. Due to action of 7 innate and adaptive immune cells following pathological changes occur in asthma patient: bronchial hyper-reactivity (BHR), goblet cell hyperplasia, mucus overproduction, airway wall remodeling and airway narrowing. Most common symptoms of Asthma are frequent episodes of shortness of breath, coughing, sneezing, runny nose, wheezing and chest tightness, pain. There are two types of clinical asthma occur like allergic and non-allergic asthma. Allergic (extrinsic) asthma mainly caused due to inhalation or ingestion of al lergens like house dust mite, peanuts, fungal spores, plant pollen and animal dander. In allergic asthma serum immunoglobulin E (IgE) antibodies are present and patients with allergic asthma exhibits positive skin-prick test to the lipoproteins of allergens. Nonallergic (intrinsic) asthma occurs in the late age and generally related with chronic rhinosinusitis, nasal polyps and obesity. Intrinsic asthma is not associated with IgE and exhibits negative skin-prick test. T cells, specifically TH2 cells plays important role in the inflammatory process of asthma, hence it became potential target for the treatment of asthma. There are increased CD4+T cells in the airways and T helper 2 (TH2) cells are predominant in these increased CD4+T cells . TH2 produces immune response by secreting the cytokines IL-4, IL-3, IL-9 and IL-13. These cytokines facilitate IgE production by B cells. IL-5 plays significant role in the eosinophil differentiation in bone marrow. IL-9 attracts and facilitates the differentiation of mast cells. In the early stage of asthma, allergens are detected by the dendritic cells and these allergens are presented by the antigen presenting cells to the T cells. Due to these allergens T cell differentiated in the TH2 type of cells. TH2 type of cells produce TH2 type of response which produces interleukin 4, 5 and 13 and it is associated with stimulation of IgE and eosinophilic response. Under the influence of interleukin-4 (IL-4), TH2 cell s interact with lymphocytes like B cells and these B cells procures antibodies like IgE. IgE circulates in the blood and it binds to the mast cell and basophils through IgE specific receptor like FcRI (a type of Fc receptor). By binding on the cells these IgE sensitize these cells to the allergens inhaled or ingested. When person gets exposed to the same allergen in the later time, this allergen bind to the IgE which is bound on the surface of the mast cells and basophils. When same allergen molecule binds to the more than one IgE-receptor complex, there is the crosslinking of IgE and Fc receptor. Due to this crosslinking there is the degranulation of mast cells and release of histamine, cytokines, interleukins, leukotrienes and prostaglandins in the surrounding tissues. These inflammatory mediators produces different effects like vasodilation, smooth muscle contraction, mucous hypersecretion and nerve stimulation. Late phase response can often occur in asthma. Late phase response o ccurs due to migration of lymphocytes, macrophages, eosinophils and in chronic cases neutrophils to the initial site. Cytokines produced form mast cells like necrosis factor-alpha (TNF-alpha), IL-1, IL-6, IL-8, and IL-13 are responsible persistent pathological changes in asthma. Bronchoconstriction: One of the important characteristic of the asthmatic respiratory tract is narrowing of the airways and this leads to the improper airflow during respiration. During episodes of acute exacerbations of asthma, airways gets exposed to the stimuli in the form of allergens and irritants and these allergens and irritants produces contraction of bronchial smooth muscle. These allergens produces bronchoconstriction by virtue of immunoglobulin E (IgE) reliant mediators like histamine, tryptase, leukotrienes, and prostaglandins. There is also non-IgE dependent bronchoconstriction. Airway edema: As the disease progresses and in the absence of treatment measures for impaired immune mechanism, bronchoconstiction of the airways and consequently resistance to airflow increases. This augmented airflow resistance is mainly due to edema in the airways, mucus hypersecretion from goblet cells and deposition of thickened mucus plugs. Airway hyperresponsiveness: Airway hyperresponsiveness in asthmatic patients can be measured by evaluating augmented bronchoconstrictor response to muscarinic receptor agonist like methacholine. It is called as Bronchial challenge test. Factors responsible for the airway hyperresponsiveness are inflammation of airways, impaired neuroregulation and structural changes of airways and lung like hypertrophy and hyperplasia. Degree of airway hyperresponsiveness shows a relationship with methacholine contractile response and severity of asthma. Airway remodeling : In asthma structural changes resembling hypertrophy and hyperplasia of the airway smooth muscle occurs. Structural alterations of airways lead to augmented airflow obstruction, airway responsiveness and consequently results in the progressive loss lung function. Currently available medications for asthma are not fully useful for asthma management. Airway remodeling comprises of sub-basement membrane thickening, subepithelial fibrosis, hypertrophy and hyperplasia of airway smooth muscle, blood vessel proliferation and dilation, mucous gland hyperplasia and mucus hypersecretion (1). Fig.1 Immune mechanism in Asthma Diagnosis: Flow Cytometry: Flow cytometry analysis delivers a rapid qualitative and quantitative explanation of several features of individual cells. With the help of flow cytometry cell size, granularity of cell, features of DNA and RNA, characteristic of cell surface and nuclear markers which are specific for individual cells can be analysed. Bronchoalveolar lavage (BAL) fluid provides very important information for asthma and other lung inflammatory diseases. Flow cytometer analysis of BAL provides profile of different types of white blood cells and corresponding acute and chronic pathological alterations in the lung. In Asthma, composition of BAL in flow cytometry analysis comprised of TH2 T-cells, eosinophils, dendritic cells and in chronic stages neutrophils. Flow cytometry analysis provides information about surface markers of eosinophils, dendritic cells, basophils, mast cells and neutrophil by using specific antibodies against these surface markers. Commercial antibodies like MHCII, CCR3, CD3, B220 an d CD11c are available for the surface markers on T and B cells. By using these antibodies, flow cytometry can be used to differentiate subsets of these cells like TH1, TH2, TH17, TH22 of T cells. Mainly TH2 cytokines like IL-4, IL-5, and IL-13 and IgE plays prominent role in asthma pathology. Flow cytometry analysis of BAL provides information about these cytokines and chemokines in association with cluster of differentiation (CD) markers. Frequency of occurrence of these inflammatory cells and cytokines in the BAL of the asthmatic patients depend on the severity of the disease. In severe cases of asthmatic patients there is the manifestation of dual TH2/TH17 cells. These inflammatory cells can also measured in the peripheral blood by means of flow cytometry. In the diagnosis of asthma using flow cytometry, these cells can analyzed in the induced sputum of the patient, however it has been observed that there is more variability in the data obtained from the sputum sample. Even thoug h, flow cytometry is not used in routine practice for diagnosis of asthma, it is beneficial in the differential diagnosis of inflammatory lung disease (2, 5). Fig.2 Flow diagram for Flow Cytometry procedure For flow cytometer analysis BAL fluid should be analyzed immediately after collection and cells should be isolated by means of centrifugation. After centrifugation, supernatant should be distributed in small aliquots. Isolated cells should be either cultured with RPMI 1640 with 10% FBS overnight or immediately fixed in 4 % paraformaldehyde for processing in flow cytometer. Cells should be stained with respective antibodies. Enzyme-Linked Immunosorbent Assay (ELISA): ELISA test is a method of analyzing immune response of body by reaction of immune components and chemicals. Components of ELISA are enzyme which catalyzes biochemical reaction and antigen or antibody which act as immunogenic molecules. Most of the cytokines detected in the asthma patients can be analyzed by ELISA and ELISpot Immunoassays. Cytokines are analyzed by sandwich ELISA. In sandwich ELISA plate is coated with antibody, to this sample containing antigen is added, subsequently antigen capture antibody IS added, detecting antibody binds to antigen, enzyme linked secondary antibody is added which binds to detecting antibody, then substrate is added which is converted to detectable form by enzyme. In asthma patient cytokines can be analyzed in BAL, blood and sputum using ELISA method. ELISA has been used utilized in the cytokine estimation in the urine of asthma patients. Commercial ELISA kits are available for the cytokines is asthma patients like IL-4, IL-5, and IL-13, chemokin es like CCL11, CXCL10 and CCL17. Markers of the airway remodeling in asthma patients like matrix metalloproteinase 9 (MMP-9), tissue inhibitor of metalloproteinase 1 (TIMP-1) and vascular endothelial growth factor can be analyzed in the BAL of asthmatic patient. IgE antibodies in asthma patient can be measured using ELISA (2, 3, 5). Discussion: It has been observed that there is correlation between altered levels of cytokines estimated by means of ELISA and disease severity. There is strong correlation observed between the increased level of IL 4 in BAL of asthma patient and forced expiratory volume 1 (FEV1).With increase in IL4, there is the decrease in FEV1 in patients with asthma. Plasma and BAL TNF- level estimated using ELISA method are negatively correlated with FEV1. Decreased FEV1 is related to the increased airway wall area thickness and decreased luminal area of airway which are airway remodeling in asthma patients. It reflects airway remodeling in asthma patient and it is related to the cytokine level in BAL of asthma patients estimated by means of ELISA. In non-asthmatic people vital capacity (FVC), residual volume (RV), and residual volume/ total lung capacity (RV/TLC) are higher as compared to the asthmatic patient. These all the parameters are particularly useful in the lung function tests. Impaired functioni ng of the lung in asthma reflects altered lung function test and this altered lung function test is correlated with the inflammatory and immune cytokines estimated by means by ELISA method. IL-13 estimated using ELISA gives assessment of treatment effect of antiasthmatic medicine like inhaled corticosteroid/Long-acting beta agonists (ICS/LABA). There is correlation between decreased level of IL-13 and increased FEV1 after treatment with ICS/LABA in asthma patients (2). IL-22 can be estimated both in BAL and serum of asthma patients using ELISA method. It has been observed that IL-22 levels are more in severe asthma patients as compared to mild asthma patients and healthy individuals. It reflects IL-22 estimation using ELISA can be applied in differentiating severity of asthma and plan treatment strategy according to the severity of asthma. T regulatory cells can be analyzed using flow cytometer. CD4 T regulatory cells plays important role in silencing IL-4 genes. Thus T regulatory cells plays important role in controlling lymphocyte associate airway inflammation. There is increased T regulatory cells through FoxP3 expression or CTLA4 expression, analyzed by means of flow cytometer in patients with moderate to severe asthma (3, 4). TH17 cells have important role in the incidence of steroid-resistant (SR) asthma. TH17 cells produce IL-17A and IL-22 cytokines. IL-17A and IL-22 cytokines estimated in the peripheral blood mononuclear cell (PBMC) culture using flow cytometer revealed that there is more percentage of IL-17A and IL-22 cytokines in moderate to severe asthmatic patients as compared to nonasthmatic people. There is more percentage of IL-17A and IL-22 cytokine in the steroid resistant (SR) group as compared to the steroid sensitive (SS) group. This is because glucocorticoids didnt exhibited effect on the IL-17A and IL-22 cytokines. It reflects treatment effect of drugs on cytokines in asthma can be evaluated using flow cytometer. It has been established that there is correlation between the increased IL-17A level and subepithelial fibrosis which is characteristic of airway remodeling in asthma patient. Thus flow cytometer analysis of IL-17A can be directly correlated to the pathological changes in the ast hma patients. Moreover, flow cytometer analysis of IL-17A can be applicable to diffentiate between SR and SS (5). TH2 cells have the capability to differentiate further into dual positive TH2/TH17 cells. In the BAL of asthma patients there was the increased frequency of TH2/TH17 cells analyzed by the flow cytometry (Table 1). Table 1: Comparison of clinical features of the TH2/TH17 low, TH2 predominant, and TH2/TH17predominant subgroups of asthmatic patients. Parameters TH2/TH17low TH2predominant TH2/TH17predominant IL-4 positive cells 3.0 0.5 22.7 2** 12.6 2 IL-17 positive cells 1.2 0.3 5.9 1.6 6.5 1.5 IL-4/ IL-17 positive cells 1.1 0.3 7.3 1.5 20.4 4* Total IgE (kIU/L) 111 26 123 26 230 53 FEV1 (%) 79.6 2 73.9 3 59.6 2.7*$ PC20 (mg/mL) for methacholine 4.6 0.5 2.9 0.4# 1.24 0.2*$ Eosinophils/mL of blood 113 9 422 85# 433 57*@ ICS/LABA 15 22 15 SABA 15 22 15 *P .05 compared with the TH2predominant and TH2/TH17low subgroups. $P .05 compared with the TH2predominant subgroup. #P .05 compared with the TH2/TH17low subgroup, Mann-Whitney U test. @P = .002, all Kruskal Wallis test for multiple comparisons. Increased level of IL 4 and IL17 were also detected in the BAL of asthmatic patients, analyzed by ELISA. Increased TH2/TH17 cell counts and increased production of IL17 correlated with the increased eosinophil counts and FEV1. These TH2/TH17 cells have more steroid resistance as compared to the TH2 cells alone. Airway obstruction and airway hypersensitivity is also more in TH2/TH17 predominant in asthma as compared to the TH2 predominant asthma. As TH2/TH17 cells were identified as prominent reason behind steroid resistance in asthma patients, further research should be directed towards developing TH2/TH17 targeted dugs (2). References: Holgate, S.T. 2012. Innate and adaptive immune responses in asthma. Nature Medicne. 18(5): 673-683. Irvin, C., I. Zafar, J. Good, D. Rollins, C. Christianson, M.M. Gorska, R.J. Martin, and R. Alam. 2014. Increased frequency of dual-positive TH2/TH17 cells in bronchoalveolar lavage fluid characterizes a population of patients with severe asthma. Allergy. Clin. Immunol. 134:1175-86. Takahashi, K., K. Hirose, S. Kawashima, Y. Niwa, H. Wakashin, A. Iwata, et al., IL-22 attenuates IL-25 production by lung epithelial cells and inhibits antigen-induced eosinophilic airway inflammation. J. Allergy. Clin. Immunol. 128:1067-76. Smyth, L.J. C., A. Eustace, U., Kolsum, J. Blaikely, and D. Singh. 2010. Increased Airway T Regulatory Cells in Asthmatic Subjects. Chest, 138(4): 905-912. Nanzer, A.M., E.S. Chambers, K. Ryanna, D.F. Richards, C. Black, et al., 2013. Enhanced production of IL-17A in patients with severe asthma is inhibited by 1,25-dihydroxyvitamin D3 in a glucocorticoid-independent fashion. Allergy. Clin. Immunol. 132:297-304.