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Background Despite similar survival rates, breast-conserving therapy (BCT) remains a distant second choice after simple mastectomy for patients with early-stage breast cancer in Singapore. Uptake of reconstruction after mastectomy is also low (18 per cent). The aim of this study was to explore the factors influencing a patient's choice for mastectomy when eligible for BCT, and why patients decline reconstruction after mastectomy. Methods Patients from the National Cancer Centre Singapore, who were eligible for BCT but chose mastectomy without reconstruction, between December 2014 and December 2015 were included. An interviewer-administered questionnaire focusing on patients' reasons for choosing mastectomy over BCT and not opting for immediate breast reconstruction after mastectomy was used. Tumour characteristics were retrieved from medical records. Spearman's rank correlation coefficient, Mann-Whitney U and Kruskal-Wallis tests were used to analyse the correlation between the patient's self-rated influential factors and variables. Statistical significance was taken as P

Introduction Several studies highlighted an increased risk of cardiovascular disease (CVD) in HIV-HCV co-infected patients without clearly identifying specific virologic factors associated with atherosclerotic CVD (ASCVD) events. Purpose Hence, we analyzed data collection from the French nationwide ANRS CO13 HEPAVIH cohort to determine the incidence of ASCVD events in HIV-HCV co-infected patients and the predictive factors associated with its occurrence. Methods The French multicenter nationwide ANRS CO13 HEPAVIH clinic-based cohort collected prospective clinical and biological data from HIV-HCV co-infected patients followed-up in 28 different university hospitals between December 2005 to November 2016. Participants with at least one year of follow-up were included. Primary outcome was the occurrence of major ASCVD events (cardiovascular death, acute coronary syndrome, coronary revascularization and stroke). Secondary outcomes were total ASCVD events including major ASCVD events and minor ASCVD events (peripheral arterial disease [PAD]). Incidence rates were estimated using Aalen-Johansen method and factors associated with ASCVD identified with Cox proportional hazards models. Results A total of 1213 patients were included: median age 45.4 years [42.1–49.0], 70.3% men, current smoking 70.2%, overweight 19.5%, liver cirrhosis 18.9%, chronic alcohol consumption 7.8%, diabetes mellitus (5.9%), personal history of CVD 2.7%, and statins use 4.1%. After a median follow-up of 5.1 years [3.9–7.0], 44 participants experienced at least one ASCVD event (26 major ASCVD event, and 20 a minor event). Incidences for total, major and minor ASCVD events were of 6.98 [5.19; 9.38], 4.01 [2.78; 6.00], and 3.17 [2.05; 4.92] per 1000 person-years, respectively. Personal history of CVD (Hazard Ratio (HR)=13.94 [4.25–45.66]), high total cholesterol (HR=1.63 [1.24–2.15]), low HDL cholesterol (HR=0.08 [0.02–0.34]) and undetectable HIV viral load (HR=0.41 [0.18–0.96]) were identified as independent factors associated with major ASCVD events while cirrhosis status, liver fibrosis and HCV sustained viral response were not. Cumulative incidence of CV events Conclusion HIV-HCV co-infected patients experience a high incidence of ASCVD events both coronary and peripheral artery diseases. Traditional CV risk factors are the main determinants of ASCVD whereas undetectable HIV viral load seems to be protective. Management of cholesterol abnormalities and controlling viral load are essential to modify this high cardiovascular risk. Acknowledgement/Funding Agence Natoinale de Recherche sur le SIDA et les Hépatites virales

Summary Background Coronary heart disease is rapidly increasing in developing countries, but access to cardiac rehabilitation and secondary prevention remains low. In this study, we aimed to assess the effectiveness of a smartphone-based cardiac rehabilitation and secondary prevention programme delivered via the social media platform WeChat (SMART-CR/SP). Methods In this parallel-group, single-blind, randomised controlled trial, we recruited patients aged 18 years or older with coronary heart disease who had received percutaneous coronary interventions from a large tertiary hospital in Shanghai, China. Participants were randomly assigned (1:1) by block randomisation to either a 2-month intensive programme followed by a 4-month step-down phase of SMART-CR/SP or to usual care. In the SMART-CR/SP group, participants received comprehensive cardiac rehabilitation and secondary prevention via WeChat. The usual care group received standard outpatient cardiology follow-up but without formal cardiac rehabilitation and secondary prevention. Assessments were done at baseline, 2 months, 6 months, and 12 months. The primary outcome was change in functional capacity from baseline, measured by 6-min walk distance, at 2 months and 6 months. Analysis was by intention to treat. Research personnel involved in assessments were blinded to group allocation. Adverse-event analysis was based on percentage of patients who discontinued the study owing to adverse events. SMART-CR/SP programme-related safety issues were also recorded. This study was registered with the Chinese Clinical Trial Registry, number ChiCTR-INR-16009598. Findings Between Nov 17, 2016, and March 18, 2017, 312 patients (mean age 60·5 years [SD 9·2]), of whom 58 (19%) were female and 254 (81%) were male, were recruited and subsequently randomly assigned to SMART-CR/SP (n=156) or usual care (n=156). The improvement in 6-min walk distance at 2 months was significantly greater in the SMART-CR/SP group (from 489·2 m [99·4] at baseline to 539·1 m [68·0]) than in the control group (from 485·0 m [93·5] at baseline to 517·8 m [74.6]), with an adjusted mean difference of 20·64 m (95% CI 7·50–33·77; p=0·034). This improvement was maintained at 6 months (mean 6-min walk distance 543·4 m [67·5] in the SMART-CR/SP group vs 523·5 m [60·2] in the control group), with a mean between-group difference of 22·29 m (8·19–36·38; p=0·027). No adverse events or SMART-CR/SP programme-related safety issues were reported by participants during the study. Interpretation SMART-CR/SP was found to be a cardiac rehabilitation and secondary prevention service model with high efficacy and accessibility and to be easy to use. These results justify the implementation of similar models of care on a broader scale. Funding Curtin University.

Background: Coronary heart disease (CHD) is rapidly increasing in developing countries, but access to cardiac rehabilitation and secondary prevention (CR/SP) remains low. We assessed the effectiveness of SMARTphone and WeChat-based CR/SP (SMART-CR/SP) in the first randomised controlled trial (RCT) of a dedicated social media-based CR/SP program for patients with CHD. Methods: In this parallel-group, single-blind, RCT, CHD patients from a large tertiary hospital in Shanghai, China were randomised (1:1) to an eight-week 'intensive', followed by a 16-week 'step down' program of SMART-CR/SP, or usual care. Assessments were conducted at baseline, eight and 24 weeks. The primary outcome was functional capacity measured by six-minute walk test distance (6MWTD). Secondary outcomes included CHD knowledge, and risk factor control. Analysis was by intention-to-treat. Findings: Between November 17, 2016 and March 18, 2017, 312 patients (mean age, 60.5 [SD 9.2] years, 81.4% male) were randomised to SMART-CR/SP (n=156) or usual care (n=156). The mean increase in 6MWTD was greater at both eight (46.5 vs. 20.9 m; 95% CI 9.6 to 41.5; p=0.002) and 24 weeks (54.2 vs. 26.2 m; 95% CI 10.9 to 44.9; p=0.001) in the SMART-CR/SP group versus controls. The SMART-CR/SP group had a better knowledge of CHD score at eight (17.9 vs. 13.8; 95% CI 2.84 to 5.44; p

Introduction The burden of cardiovascular disease (CVD) is rapidly increasing in developing countries, however access to cardiac rehabilitation and secondary prevention (CR/SP) in these countries is limited. Alternative delivery models that are low-cost and easy to access are urgently needed to address this service gap. The objective of this study is to investigate whether a smartphone and social media-based (WeChat) home CR/SP programme can facilitate risk factor monitoring and modification to improve disease self-management and health outcomes in patients with coronary heart disease (CHD), after percutaneous coronary intervention (PCI) therapy. Methods and analysis We propose a single-blind, randomised controlled trial of 300 patients post-PCI with follow-up over 12 months. The intervention group will receive a smartphone-based and WeChat-based CR/SP programme providing education and support for risk factor monitoring and modification. SMART-CR/SP incorporates core components of modern CR/SP: physical activity tracking with interactive feedback and goal setting; education modules addressing CHD understanding and self-management; remote blood pressure monitoring and strategies to improve medication adherence. Furthermore, a dedicated data portal and a CR/SP coach will facilitate individualised supervision and counselling. The control group will receive usual care but no formal CR/SP programme. The primary outcome is change in exercise capacity measured by 6 minute walk test distance. Secondary outcomes include knowledge and awareness of CHD, risk factor status, medication adherence, psychological well-being and quality of life, major cardiovascular events, re-hospitalisations and all-cause mortality. To assess the feasibility and patients’ acceptance of the intervention, a process evaluation will be performed at the conclusion of the study. Ethics and dissemination Ethics approval was granted by both the Human Research Ethics Committee of Fudan University Zhongshan Hospital (HREC B2016-058) and Curtin University Human Research Ethics Office (HRE2016-0120). Results will be disseminated via peer-reviewed publications and presentations at conferences. Clinical trial registration number ChiCTR-INR-16009598; Pre-results.

Lafarge Infrastructure Team had constructed Malaysia's first hybrid concrete pavement using Jointed Plain Concrete Pavement (JPCP) and Roller Compacted Concrete (RCC) at Lafarge's Kanthan Cement Plant, Ipoh, Malaysia. The main purpose of the project is to showcase and study construction challenges in combining JPCP and RCC hybrid product for road solutions. The progress and pavement performance were monitored recorded and detailed through tests and site observation reports. JPCP pavement was constructed using two (2) type of construction methods; slip form and fixed form, while RCC pavement was laid and constructed using an asphalt paver set. The Quality Assurance & Control (QA/QC) monitored comprises of concrete design mix, concrete slump, concrete delivery, joints insertion, concrete curing, compaction, profile levels, saw cut and sequence of construction activities. Throughout the study, we have managed to table out the "Challenges and Best Practices" on the construction methods which mainly involves labours, machinery and material. All the information has been taken into consideration, to prepare a comprehensive report for the project. The study will enhance the knowledge and understanding for road owners, concrete suppliers, consultants and contractors in understanding the right application of JPCP and RCC in the future. We able to share and propose few best practices based on the challenges that we had face.

Sao Paulo State Univ UNESP, Ctr Human Reprod Prof Franco Jr, Paulista Ctr Diag Res & Training, Dept Gynecol & Obstet,Botucatu Med Sch, Ribeirao Preto, Brazil

A circulation-based discrete vortex method is used on a three-element airfoil system. Kutta conditions and Kelvin's circulation theorem are additional conditions required for this method to determine the circulation distributions on each element and to determine vortex shedding. Discrete shed vortices are introduced near the four sharp edges to represent the sharp-edge vortex shedding caused by unsteady flow separation. The computational procedure warrants neutrally stable solutions of the self-sustained fluctuating flowfield that can provide broad-band spectral information for far-field noise predictions. The near-field vortex method directly calculates the parameters used in an asymptotic formula for far-field sound computation that attributes the noise sources to vortex interactions among the shed vortices and the surface circulations of the three-element airfoil system. The far-field noise characters are then analyzed and compared to the experimental data in the literature.

The healthcare cost of managing osteoporotic fractures is projected to rise because of the change in population demographics. To reduce the fracture epidemic, strategies are needed to identify those at risk early to allow preventative intervention to be implemented. The aim of this study was to investigate if low-cost community-based assessments, such as calcaneal ultrasound and falls risk assessments, can discriminate a group of elderly women at risk of osteoporotic fracture from those at lower risk. Over the period of 2002-2003, 104 community-dwelling women (mean age 71.3, standard deviation 5.8) were recruited via various modes including advertisements in community newspaper and community centres. These women underwent dual-energy X-ray absorptiometry bone mineral density (BMD) and calcaneal quantitative ultrasound (QUS) measurements; spinal radiography; and performance-based assessment of strength, mobility and balance. The women were classified into a 'high risk' (osteoporotic) group, based on low BMD (T-score of

Following the publication on the principle and theory of a newly proposed non-imaging focusing heliostat, this paper presents a report on the design, optical alignment and application of the first prototype heliostat. In the architecture of the first prototype, 25 mirrors, each with a dimension of 40×40 cm, are arranged into five rows and five columns to form a total reflective area of 4 m2. The design of the essential part of the first prototype heliostat will be discussed in this paper, which consists of two primary elements; a rotation–elevation system for tracking a mirror support frame which carries 25 mirror facets, and a separate two-axis tracking system for compensating (each second) off-axis aberrations of 24 slave facets relative to the central mirror, which is fixed in the mirror frame. The rotation–elevation system consists of a pedestal supporting a rotational tracking mechanism carrying a U-shaped arm and a second tracking system for tracking a moving frame in elevation. The moving frame carries a central stationary (relative to the frame) mirror, called a master mirror. Slave mirrors are arrayed in five rows and five columns, and eight stepper motors drive the outer four rows and columns relative to the master mirror via a computer programme implementing newly proposed formulas to eliminate the first-order aberration. With a second stage concentrator comprising a small aperture size parabolic mirror (diameter of 60 cm), a cost-effective high temperature solar furnace was constructed. In our experiment, the highest furnace temperature of 3400°C has been recorded through the melting of pure tungsten wires.

The ‘internet-driven information age’ is a term in common usage, implying that everyone can access all the information they need, when they need it. The purpose of this brief paper is to outline some web sources that highlight the possibilities and potential for accessing web-based knowledge. From this the clinician will be encouraged to follow leads along the labyrinth of links to a greater appreciation of how this resource can be used to shape their practice. Examples of web links are provided for: search engines; library-based sources, including medical databases and electronic journals; evidence-based practice databases, mail-groups; electronic conferences; research centres; and general health sources. Importantly, this review does not aspire to be all-inclusive, for the web changes, chameleon-like, to the seasons. The web is here to stay. It will provide the framework for much education and will guide clients to a greater appreciation of their disease or disability than ever before. It may ultimately be the tool through which health fund agents will promote best practice, including self-help to clients, and therefore direct discriminating individuals to select health practitioners who have been endorsed by professional and fund agencies as providing a contemporary service which conforms to evidence-based practice.

The lower trapezius island myocutaneous flap is a useful flap in head and neck reconstruction. It is thin and pliable and can reach defects in most areas of the head and neck. Its usefulness in head and neck reconstruction has often been limited or discouraged by reports of significant failure rates. In this study, the vascular anatomy and clinical use of the extended lower trapezius myocutaneous flap based solely on the dorsal scapular artery system are elucidated, and experience gained performing 20 flaps over the past 5 years by using the extended lower trapezius myocutaneous flap is reported. The vascular anatomy of the dorsal scapular artery system is reviewed in 13 fresh cadaveric dissections by using methylene blue, latex injection studies, and radiologic examination.

STUDY DESIGN Observational cross-sectional study. OBJECTIVE To perform a psychometric evaluation of Simplified Chinese versions of back pain beliefs questionnaires for use in health care professionals living in mainland China. SUMMARY OF BACKGROUND DATA Back pain beliefs are of importance in the development of chronic low back pain (LBP) and disability. Different types of beliefs exist with regard to LBP and these include inevitable consequences of LBP and fear-avoidance beliefs. LBP beliefs held by health care providers are also known to influence their patients' pain beliefs and can contribute to the development of chronic LBP and disability. At present, validated questionnaires such as the Back Beliefs Questionnaire, Health Care Providers' Pain and Impairment Relationship Scale, and Fear-Avoidance Beliefs Questionnaire are commonly used to investigate back pain beliefs held by health care professionals working in western countries. There are no published nor validated Simplified Chinese versions to allow investigation of back pain beliefs in health care professionals living in mainland China. METHODS The English versions of the earlier mentioned questionnaires were translated and culturally adapted into Simplified Chinese using the double-back-translation method. A psychometric evaluation of the translated questionnaires was conducted on 65 health care professionals (rehabilitation medicine specialists, osteopaths, and nurses), with and without LBP, practicing in Shanghai, China. The questionnaires were completed twice within 7- to 10-day period. RESULTS The Back Beliefs Questionnaire, Health Care Providers' Pain and Impairment Relationship Scale, and Fear-Avoidance Beliefs Questionnaire (work and physical subscales) had acceptable internal consistency (Cronbach α range: 0.70-0.87) and construct validity (r = 0.40-0.49, P < 0.05), good reproducibility (Intraclass correlation coefficients, ICC(2,1) range: 0.85-0.93) and an absence of any floor or ceiling effects. CONCLUSION This study showed that the Simplified Chinese versions of back pain beliefs questionnaires are valid and reliable. Therefore, these questionnaires can be used in research involving Chinese health care professionals living in mainland China.

The Global Financial Crisis (GFC) of 2008/2009 was the largest economic slowdown since the Great Depression. It undermined the growth and development prospects of developing countries. Several recent studies estimate the impact of economic shocks on the poor and vulnerable, especially women and children. Infant and child mortality rates are still likely to continue to decline, but at lower rates than would have been the case in the absence of the GFC. Asia faces special challenges. Despite having been the fastest growing region in the world for decades, and even before the current crisis, this region accounted for nearly 34% of global deaths of children under 5, more than 40% of maternal deaths and 60% of newborn deaths. Global development goals cannot be achieved without much faster and deeper progress in Asia. Current health financing systems in much of Asia are not well placed to respond to the needs of women and their children, or the recent global financial and economic slowdown. Public expenditure is often already too low, and high levels of out-of-pocket health expenditure are an independent cause of inequity and impoverishment for women and their children. The GFC highlights the need for reforms that will improve health outcomes for the poor, protect the vulnerable from financial distress, improve public expenditure patterns and resource allocation decisions, and so strengthen health systems. This paper aims to highlight the most recent assessments of how economic shocks, including the GFC, affect the poor in developing countries, especially vulnerable women and children in Asia. It concludes that conditional cash transfers, increasing taxation on tobacco and increasing the level, and quality, of public expenditure through well-designed investment programmes are particularly relevant in the context of an economic shock. That is because these initiatives simultaneously improve health outcomes for the poor and vulnerable, protect them from further financial distress, improve public financing and/or provide a much-needed counter-cyclical stimulus at times of economic slowdown.

(2000). Asynchronous ovarian torsion in a patient with McCune-Albright syndrome. Journal of Obstetrics and Gynaecology: Vol. 20, No. 2, pp. 204-204.

Rectal carcinoma presenting during pregnancy is rare with a reported incidence of 0.002%. Management of such an emotionally charged condition can be difficult, especially when the twin goals of curing the disease and preserving the pregnancy are divergent. Four cases of rectal carcinoma presenting during pregnancy are reported. In the first or second trimester of pregnancy, it is possible to resect the tumour with preservation of pregnancy, and in the third trimester, it is best to bring the pregnancy to term before removing the tumour. Unfortunately, the prognosis for such rectal cancer is poor.

Questions: Are there any differences in the displacement and endurance of an elevating voluntary pelvic floor muscle contraction in standing and in crook-lying? Are there any differences in these variables between males and females in either test position? Design: An experimental study. Participants: Forty-five nulliparous female and 20 male participants aged 23 years (SD 3) with no symptoms of urinary incontinence or low back pain. Intervention: Voluntary pelvic floor muscle contraction was measured in both standing and crook-lying. Outcome measures: Transabdominal ultrasound was used to measure the displacement (mm) and endurance (s) of pelvic floor elevation. Results: Displacement was greater in standing than in crook-lying (mean difference 2.6 mm, 95% CI 1.5 to 3.7). There was no difference between males and females (mean difference 1.3 mm, 95% CI –0.5 to 3.2). Similarly, endurance of pelvic floor elevation was longer in standing than in crook-lying (mean difference 17.3 s, 95% CI 12.2 to 22.4). Again there was no difference between males and females (mean difference 0.5 s, 95% CI –9.3 to 8.3). Conclusion: Standing was found to be a more effective position for achieving and sustaining an elevation of the pelvic floor compared to crook-lying, regardless of sex, and this should be taken into account when assessing and training pelvic floor muscle contraction. [Kelly M, Tan B-K, Thompson J, Carroll S, Follington M, Arndt A, Seet M (2007) Healthy adults can more easily elevate the pelvic floor in standing than in crook-lying: an experimental study. Australian Journal of Physiotherapy 53: 187–191]

Scintigraphic examination with pertechnetate (99mTc), 123I, 67Ga-citrate and 201Tl-chloride in patients with lymphoma of the thyroid gland is non-specific. Needle aspiration biopsy cytologically indicative of malignant lymphoma together with a clear elevation of serum β2-microgloblin are highly suggestive for this condition.

Bee Kim Tan,1,2 Seng Beng Tan,3 Li-Chia Chen,4 Kian Meng Chang,5 Siew Siang Chua,1,6 Sharmini Balashanker,7 Habiba Nazeera Begum Kamarul Jaman,5 Syed Carlo Edmund,8 Ping Chong Bee3 1Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; 2Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, UCSI University, Kuala Lumpur, Malaysia; 3Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; 4Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, UK; 5Department of Hematology, Ampang Hospital, Ampang, Selangor, Malaysia; 6School of Pharmacy, Faculty of Health and Medical Sciences, Taylor’s University, Lakeside Campus, Subang, Selangor, Malaysia; 7School of Pharmacy, University of Nottingham Malaysia Campus, Semenyih, Selangor, Malaysia; 8Clinical Research Center, Ampang Hospital, Ampang, Selangor, Malaysia Purpose: Poor adherence to tyrosine kinase inhibitors (TKIs) could compromise the control of chronic myeloid leukemia (CML) and contributes to poorer survival. Little is known about how medication-related issues affect CML patients’ adherence to TKI therapy in Malaysia. This qualitative study aimed to explore these issues.Patients and methods: Individual face-to-face, semistructured interviews were conducted at the hematology outpatient clinics of two medical centers in Malaysia from August 2015 to January 2016. CML patients aged ≥18 years who were prescribed a TKI were invited to participate in the study. Interviews were audio-recorded, transcribed verbatim, and thematically analyzed.Results: Four themes were identified from 18 interviews: 1) concerns about adverse reactions to TKIs, 2) personal beliefs regarding the use of TKIs, 3) mismanagement of TKIs in daily lives, and 4) financial burden in accessing treatment. Participants skipped their TKIs due to ineffective emesis control measures and perceived wastage of medication from vomiting. Participants also modified their TKI therapy due to fear of potential harm from long-term use, and stopped taking their TKIs based on belief in curative claims of traditional medicines and misconception about therapeutic effects of TKIs. Difficulty in integrating the dosing requirements of TKIs into daily lives led to unintentional skipping of doses, as well as the risk of toxicities from inappropriate dosing intervals or food interactions. Furthermore, financial constraints also resulted in delayed initiation of TKIs, missed clinic appointments, and treatment interruptions.Conclusion: Malaysian CML patients encountered a range of medication-related issues leading to a complex pattern of nonadherence to TKI therapy. Further studies should investigate whether regular contact with patients to improve understanding of treatment rationale, to elicit and address patients’ concerns about adverse reactions, and to empower patients with skills to self-manage their medications might promote better adherence to TKIs and improve CML patients’ outcome. Keywords: medication-related issues, adherence, tyrosine kinase inhibitors, chronic myeloid leukemia, qualitative study, thematic analysis

Disaster recovery efforts form an essential component of coping with unforeseen events such as earthquakes, hurricanes, floods, and typhoons, some of which will only become more frequent or severe in the face of accelerated climate change. Most of the time, disaster recovery efforts produce net benefits to society. However, depending on their design and governance, some projects can germinate adverse social, political, and economic outcomes. Drawing from concepts in political economy, political ecology, justice theory, and critical development studies, this study first presents a conceptual typology revolving around four key processes: enclosure, exclusion, encroachment, and entrenchment. Enclosure refers to when disaster recovery transfers public assets into private hands or expand the roles of private actors into the public sphere. Exclusion refers to when disaster recovery limits access to resources or marginalize particular stakeholders in decision-making activities. Encroachment refers to when efforts intrude on biodiversity areas or contribute to other forms of environmental degradation. Entrenchment refers to when disaster recovery aggravates the disempowerment of women and minorities, or worsen concentrations of wealth and income inequality within a community. The study then documents the presence of these four inequitable attributes across four empirical case studies: Hurricane Katrina reconstruction efforts in the United States, recovery efforts for the 2004 tsunami in Thailand, Typhoon Yolanda in the Philippines, and the Canterbury earthquakes in New Zealand. It then offers three policy recommendations for analysts, program managers, and climate researchers at large: spreading risks via insurance, adhering to principles of free prior informed consent, and preventing damage through punitive environmental bonds. The political economy of disaster must be taken into account so that projects can maximize their efficacy and avoid marginalizing those most vulnerable to those very disasters.

S A T U R D A Y 163 Mast Cells with a Unique Phenotype Are Highly Elevated in Chronic Rhinosinusitis with Nasal Polyps T. Takabayashi, A. Kato, A. T. Peter, L. A. Suh, R. Carter, J. Norton, L. C. Grammer, B. K. Tan, R. K. Chandra, D. B. Conley, R. C. Kern, S. Fujieda, R. P. Schleimer; The Division of Allergy and Immunology Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, The Division of Otorhinolaryngology Head and Neck Surgery, Department of Sensory and Locomotor Medicine, University of Fukui, Fukui, JAPAN, Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. RATIONALE: Although chronic rhinosinusitis with nasal polyps (CRSwNP) is characterized by Th2 inflammation, the role of mast cells is poorly understood. The objective of this study was to investigate the presence, localization and phenotype of mast cells in affected tissues from patients with chronic rhinosinusitis (CRS). METHODS: We collected nasal tissue and nasal lavage fluid from patients with CRS and control subjects. We analyzed mRNA for the mast cell proteases tryptase, chymase and carboxypeptidase A3 (CPA3), using real-time PCR, and assessed the presence of mast cell proteases using ELISA and immunohistochemistry. We also performed immunofluorescence to observe the pattern of colocalization of the mast cell proteases. RESULTS: Tryptase mRNA and protein were significantly increased in nasal polyps frompatientswithCRSwNPcomparedwith uncinate tissue from patients with CRS or healthy subjects. We made the striking observation that therewere abundantmast cells localizedwithinglands of nasalpolyps and that these mast cells expressed all three proteases. We also observed increased numbers of mast cells in epithelium but not elsewhere within the lamina propria in nasal polyps. The mast cells detected in epithelium in nasal polyps were characterized by expression of tryptase and CPA3 but not chymase. CONCLUSIONS: Herein we demonstrate increased mast cells in epithelium and glands of nasal polyp tissue, and show that nasal polyp mast cells have unique phenotypes that vary by tissue location. These diverse subsets of mast cells may contribute to the pathogenesis of CRSwNP.