tbuckley/cabot-search huggingface dataset:
Uterine sarcomas, insight into its risk factors: A systematic review.
Authors: Caroline Hana, Gina Z. D'Amato
Journal: Journal of Clinical Oncology (2020)

e23540 Background: Uterine sarcomas are rare and aggressive malignant tumors that arise from the smooth muscle or connective tissue cells of the uterus. They account for approximately 1% of the female tract malignancies and 3% of all malignant tumors of the uterus. The risk factors that would predispose to uterine sarcomas have always been unknown, with no clear correlation with specific etiologies. This review is to investigate the risk factors that have been looked at by prior studies to have a better understanding of the population at higher risk for uterine sarcomas. Methods: A total of 88 studies were obtained via Pubmed search. The search terms included: Uterus, sarcoma, and risk factors. We also included reviews with the following mesh terms: Uterus, Sarcoma, Etiology and factors. We reviewed studies in English (n = 75) and French (n = 4) languages, human studies and comprising adults. We included only studies with electronic copies. Retrospective, case-control studies and systematic reviews were included. Results: Of the 88 studies, 18 mentioned risk factors and demographic characteristics of the population with uterine sarcomas. Some studies have shown an association with the tumor size – especially more than or equal to 8cm-, uterine weight, patient’s age being &gt; 45-50 years old, age at menarche, obesity, tamoxifen use, previous pelvic irradiation, as well as genetic associations. Mixed evidence has been found regarding the role of the ethnicity, age at menopause, age at first live birth and exogenous estrogen use. Breast cancer has been linked to more aggressive histologic cell types. Conclusions: Given its relatively rare incidence, uterine sarcoma has been mysterious in regards to its risk factors. The results of this review highlight the need for further studies to investigate the risk factors and exposures that may lead to development of uterine sarcomas, as well as linking them to the different histologic types.
新生儿缺氧缺血性脑病的诊断与分度问题
Authors: 刘敬
Journal: BMJ (2009)

迄今,缺氧缺血性脑病(hypoxic-ischemic encephalopathy,HIE)仍是我同新生儿常见的临床问题,也是导致新生儿死亡和远期神经系统功能障碍的主要病因之一,早期、正确的诊断是合理治疗及改善预后的前提,现就HIE的临床诊断及常用的影像学诊断方法等进行简述。
Evaluation of effectiveness of McRoberts maneuver and Woods maneuver in the management of shoulder dystocia
Authors: 王廷涛, 修霞, 齐峰, 赵桂林, 赵晓燕, 王新勇
Journal: BMJ (2006)

目的 对McRoberts手法及Woods手法处理肩难产的效果进行评价.方法 对1996年1月至2004年12月的48例肩难产患者的临床资料进行回顾性分析.结果 按肩难产发生后首先采用的处理方法分为2组:A组28例,采用单一McRoberts手法;B组20例,采用McRoberts手法联合Woods手法.单一手法及联合手法的成功率分别为46%和95%, 差异有统计学意义(P＜0.01).单用McRoberts手法处理非巨大儿及巨大儿肩难产的成功率分别为75%和25%,差异有统计学意义(P＜0.01).McRoberts手法联合Woods手法处理非巨大儿及巨大儿肩难产的成功率差异无统计学意义(P＞0.05).在A组失败的病例中,13例改用McRoberts手法联合Woods手法后全部阴道分娩成功.结论 McRoberts手法及Woods手法是处理肩难产简便易行的方法.肩难产发生时,尤其是预计胎儿体重≥4 000 g者,宜采用McRoberts手法联合Woods手法;若估计胎儿体重＜4 000 g,可采用单一McRoberts手法.采用单一McRoberts手法失败时应及时联合采用Woods手法。
Lymphnode metastasis patterns in primary sites of hypopharyngeal cancer: A retrospective analysis from multicenter data.
Authors: Xiwei Zhang, Changming An, Ying Sun
Journal: Journal of Clinical Oncology (2020)

e18559 Background: Understanding the pattern of lymph node metastasis (LNM) in hypopharyngeal cancers (HPC) could help both surgeons and radiologists make decisions in the management of cervical lymph node. Our objective is to identify the pattern of nodal spread and the relationship between features of primary tumor and LNM in HPC. Methods: 244 newly diagnosed HPC patients during 2014 to 2017 were recruited from 3 specialized cancer hospitals in mainland China. All patients underwent head and neck magnetic resonance imaging(MRI) and received definitive radiotherapy ± concurrent chemotherapy. The features of primary tumor (tumor size, primary location, and extent of invasion) and the involvement of lymph nodes in each level were reassessed. According to the incidence of LNM, these levels were sequenced and sorted into drainage stations. Meanwhile, univariate and multivariate analysis was used to determine the risk factors for bilateral and regional lymph node metastasis. Results: The cohort consisted 195 piriform sinus cancers (PSC), 47 posterior wall cancers (PWC), 2 Post-cricoid cancers (PCC). 176 patients (72.1%) presented with MRI-detectable LNM. The overall LNM rates for level II-VI and retropharyngeal lymph nodes (RPLNs) were 59.0%, 52.9%, 14.3%, 1.6%, 2.9% and 14.7% respectively. Based on the prevalence of LNM in each level, we suppose that the lymphatic drainage of PSC was carried out in sequence along three stations: Level II &amp; III (61.0% &amp; 55.4%), Level IV &amp; RPLN (15.9% &amp; 10.3%), and Level V &amp; VI(1.5% &amp; 3.1%). While, for PWC the lymphatic drainage is carried out along two stations: Level II, III &amp; RPLN (48.9%,40.4% &amp; 34.0%), and Level IV-VI (6.4%, 0% and 2.1%). According to univariate analysis, primary subsite, posterior wall, post-cricoid and non-pyriform sinus invasion were correlated with bilateral LNM. The presence of RPLNs was correlated with larger tumor size(&gt;4cm), primary subsite, posterior wall and non-pyriform sinus invasion. In further multivariate analysis, posterior wall invasion was significantly correlated with bilateral LNM (P = 0.030, HR = 2.853 95%CI, 1.110-7.338). Tumor size &gt; 4cm(P = 0.017, HR = 2.545, 95%CI,1.180-5.488) and posterior wall invasion(P = 0.017, HR = 2.880 95%CI, 1.209-6.862) were correlated with RPLN metastasis. Conclusions: Different primary sites of HPC have different lymphnode metastasis patterns. Piriform sinus cancer tends to metastasize to the ipsilateral Level II&amp;III. Posterior wall cancer tends to metastasize bilaterally to Level II, III and RPLN.
Gene expression profiling involved in response to neoadjuvant therapy in breast cancer.
Authors: Salvador Bofill, Carmen Garrigos, Marta Benavent, Rosario Gonzalez, Alvaro Montaño, Alejandro Falcon Gonzalez
Journal: Journal of Clinical Oncology (2020)

e12618 Background: Neoadjuvant systemic therapy for breast cancer is used increasingly but, there is a group of patients which do not benefit from this therapy. With these premises, we stablished that our main objective was to identify differential expression genes patterns in patients (pts) with the ER/PR- Her2+, ER/PR+ Her2+ and triple negative (TN) subtypes breast cancers according to response to neoadjuvant therapy. Methods: RNA from formalin fixed paraffin embedded tumor samples from 54 pts with breast cancer that had received neoadjuvant therapy was extracted with mirVana miRNA isolation kit (Ambion). Patients with TN subtype received neoadjuvant chemotherapy based on anthracyclines and taxanes and patients with the Her2+ subtype received treatment with taxanos-trastuzumab and anthracyclines. The RNA expression levels were identified by ClariomD Asssay (ThermoFisher). Results were analyzed with Transcriptome Analysis Console and with in-house scripts in R (version 3.5.1). Data were corrected and normalized using Robust Multichip Average method from the oligo package. Expression was summarized at gene level using the corresponding annotation for ClariomD array BrainArray. Expression analyses were performed with limma package. A fold change ≥ 2 and p &lt; 0.05 was considered statistically significant. We defined to groups: R (response, RCB 0) and NR (not response, RCB III) pts. Results: The median age of the pts was 52 years and 58% were menopausal and 42% pre-menopausal. Tumor stage were T1 9%, T2 50%, T3 30%, T4 11% and lymph node involvement were N0 31%, N1 41%, N2 24%, N3 4%. We obtained twelve genes differentially expressed in R vs NR groups. Respect to TN, two genes (AC053503.12, C9orf153) were differentially expressed between R (n = 11) and NR (n = 11). In ER/PR+ Her2+ subgroup, NBPF4 showed a differential expression in R (n = 8) vs NR (n = 7). In pts with ER/PR- Her2+, nine genes (DHRS2, SLCO1B3, UGT2B15, RGS2, SULT1E1, MED23, FKBP5, MIEN1, HER2) were differentially expressed in R (n = 10) vs NR (n = 7). We have started a validation in an independent cohort of pts in ER/PR+ Her2+ subgroup, confirming the results previously obtained. Conclusions: We found twelve genes differentially expressed in the different molecular subtypes of breast cancer involved in the response to neoadjuvant therapy. Several of these genes, especially UGT2B15, SULT1E1, FKBP5, MIEN1 and HER2 have been reported as key genes in tumoral processes, such as cell proliferation, invasion and drug resistant pathways, suggesting that its could be good biomarkers of response to neoadjuvant therapy in breast cancer.
复苏单元在心肺脑复苏中的价值
Authors: 杨耀峰, 顾志宏, 肖光明, 余俊莲, 苏庆琳, 刘春珍, 方红, 陈文娇
Journal: BMJ (2005)

对我院除外恶性肿瘤、脑功能衰竭、多器官功能衰竭的78例心跳呼吸骤停患者,根据其复苏过程中复苏单元是否完整分为复苏单元完整组55例、复苏单元不全组23例,对比分析其心肺脑复苏成功率.结果提示完整的复苏单元有利于提高心肺脑复苏成功率。
Self-reported overall wellbeing (OWb), physical function (PFn), and PRO-CTCAE symptom scores in post-operative and chemotherapy patients.
Authors: Hannah Hazard, Raymond U. Osarogiagbon, Sandra L. Wong, Jessica J Bian, Don S. Dizon, Jason Wedge, Jennifer Mallow, Ethan M. Basch, Andrea Catherine Enzinger, Alexi A. Wright, Scot C. Remick, Leslie Siriya Bradford, Ilana Cass, Joseph D. Phillips, Srinivas J Ivatury, Christina A. Bandera, Nicholas Ryan Faris, Christine Cronin, Michael J. Hassett, Deborah Schrag
Journal: Journal of Clinical Oncology (2020)

2064 Background: A standardized, validated tool for capturing symptoms from cancer patients, PRO-CTCAE, has been used to reduce symptom burden, decrease acute care needs, and preserve quality of life. The association between specific PRO-CTCAE symptom scores and single item measures of OWb and PFn were characterized to understand symptom constellations. Methods: A novel Epic-based symptom management program (eSyM) was deployed for GI, GYN, and thoracic cancer patients starting chemotherapy (Memphis Baptist) or having surgery (WVU Medicine). Patients received automated prompts to complete surveys via the patient portal (MyChart) on a fixed schedule, approximately twice/week. Each survey included one OWb item, one PFn item, and at least 6 PRO-CTCAE items (pain, nausea, vomiting, fatigue, anxiety, insomnia). The OWb and PFn items, which were created de novo, included 5 ordinal response options with corresponding pictograms (emojis from very happy to very sad for OWb; a figure walking to one prone in bed for PFn). Composite scores were generated: 0 for no symptoms, 1-2 for mild/moderate symptoms, and 3 for severe symptoms. We describe OWb and PFn and analyze associations between these items and PRO-CTCAE symptom scores. Results: Between 9/10/19-1/22/20, we collected 908 eSyM responses from 166 chemotherapy patients at Baptist (Age, M = 65), and 480 eSyM responses from 97 postoperative patients at WVU (Age, M = 57). The OWb and PFn scores demonstrated moderate correlation with PRO-CTCAE symptom scores (Baptist r = 0.63; WVU r = 0.75), and moderate correlation with mean symptom scores among surgery patients at WVU (r = 0.74); but lower correlation among chemotherapy patients at Baptist (r = 0.53-0.55). Scores improved over time following surgery, but not after initiation of chemotherapy. Among the 730 eSyM responses with none/mild values for both OWb and PFn (52.9% of all responses), only 4.5% reported any severe symptom; among 651 responses with impairment of OWb and/or PFn, 45.2% reported at least one severe symptom. Conclusions: Integration of eSyM into the Epic EHR enabled tracking of OWb, PFn, and PRO-CTCAE items. When asked alongside PRO-CTCAE symptom items, two single item OWb and PFn measures provided distinct information and correlated with symptom burden. These results demonstrate the feasibility of integrating ePRO collection into routine post-operative and medical oncology care and that PRO-CTCAE items provide information that is distinct from that obtained from global metrics of well-being. Clinical trial information: NCT03850912.
Hypokalemia and periodic paralysis in hyperthyroidism
Authors: Jian-feng Liu, Min Xie, Zong-min Chen, Ran Liu, Jin-jing Wang
Journal: BMJ (2010)

The incidence of hypokalemia and periodic paralysis was retrospectively analyzed in 1225patients with hyperthyroidism. The results showed that 104 patients with hyperthyroidism (8.5%)had hypokalemia, and 82. 7% cases were women, with the potassium levels of 3.10 - 3.42 mmol/L. Periodic paralysis occurred in 60 patients (4. 9% ) and 96. 7% cases were men; 93.3% patients had the potassium levels less than 3. 0 mmol/L. Hypokalemia and periodic paralysis were alleviated after the control of hyperthyroidism.

Key words: 
Hyperthyroidism;  Hypokalemia
A phase III trial of nivolumab with neoadjuvant chemotherapy and adjuvant endocrine therapy in ER+/HER2- primary breast cancer: CheckMate 7FL.
Authors: Sherene Loi, Heather L. McArthur, Nadia Harbeck, Lajos Pusztai, Suzette Delaloge, Kristen Letrent, Tian Chen, Bin Li, Kay Tatsuoka, Dimitrios Zardavas, Giuseppe Curigliano
Journal: Journal of Clinical Oncology (2020)

TPS604 Background: Patients (pts) diagnosed with primary estrogen receptor-positive (ER+), human epidermal growth factor 2-negative (HER2−) breast cancer (BC) of high grade and/or low ER expression are at increased risk of relapse, despite current standard of care (SoC). Promising data assessing programmed death-1 (PD-1) inhibition coupled with neoadjuvant chemotherapy for pts with high-risk ER+, HER2− BC noted improved pathologic complete response (pCR), which is identified as a valid surrogate endpoint for long-term clinical outcomes. Methods: CheckMate 7FL (NCT04109066) is a randomized, double-blind, placebo-controlled, multicenter, global phase 3 study evaluating nivolumab (NIVO) vs placebo (PBO) in combination with neoadjuvant chemotherapy and adjuvant endocrine therapy (ET) in pts with high-risk, ER+, HER2− primary BC. Eligible pts are male or female, aged ≥18 years with newly diagnosed grade 2 with ER expression of 1–9%, or grade 3, T1c-2, cN1-2 (tumor size ≥2 cm) or T3-T4, cN0-cN2 ER+, HER2− BC. Pts eligible for neoadjuvant chemotherapy and surgery, with adequate organ function, ECOG PS of 0 or 1, and tissue available for biomarker assessments will be enrolled. Approximately 1200 pts will be randomized 1:1 to NIVO or PBO, stratified by programmed death ligand 1 (PD-L1) expression, tumor grade (2 or 3), axillary nodal status (+ or −), and anthracycline + cyclophosphamide schedule (Q3W or Q2W). In the neoadjuvant phase, pts will receive NIVO 360 mg Q3W or PBO + paclitaxel 80 mg/m 2 QW for four 3-week cycles, followed by NIVO 360 mg Q3W (or 240 mg Q2W) or matching PBO in combination with either doxorubicin 60 mg/m 2 or epirubicin 90 mg/m 2 and cyclophosphamide 600 mg/m 2 Q3W or Q2W for 4 cycles. Pts will undergo surgery after completion of the neoadjuvant phase. Following surgery, pts will enter the adjuvant phase and receive NIVO 480 mg Q4W or PBO for 7 cycles + investigator’s choice of ET per local SoC. Primary endpoints are pCR (ypT0/is, ypN0) and event-free survival. Secondary endpoints include overall survival, disease-free survival, distant-metastasis-free survival, safety, pCR (ypT0 ypN0 and ypT0/is) rates, overall response rates, residual cancer burden, and quality of life. Interim analyses are planned. The study is currently enrolling. Clinical trial information: NCT04109066 .
Efficacy of hearing aids in treatment of tinnitus and its influencing factors
Authors: Yong Liang
Journal: BMJ (2016)

助听器治疗耳鸣有一定疗效，也可能存在疗效的不稳定性。与其他治疗方法相比，尚不能完全说明助听器治疗具有很大的优势，但对伴有听力下降的耳鸣患者不失为一种有益的选择。不同类型助听器对耳鸣的疗效与患者的耳鸣声学特性等有一定的关系。影响疗效的因素包括年龄、性别、病因、病程、心理状况、耳鸣的声学特性及其波动性变化、听力损失、助听器性能、佩戴方式、专业验配和指导等。全面的听力学评估、选择合适的助听器、制定个性化的治疗方案、提供规范的技术服务是提高疗效的重要措施。
Translational research of voltage-A1: Efficacy predictors of preoperative chemoradiotherapy and subsequent nivolumab monotherapy in patients with microsatellite-stable locally advanced rectal cancer.
Authors: Koji Inamori, Yosuke Togashi, Hideaki Bando, Yuichiro Tsukada, Ayako Suzuki, Yutaka Suzuki, Daisuke Kotani, Shota Fukuoka, Motohiro Kojima, Makoto Fukui, Satoshi Yuki, Yoshito Komatsu, Shigenori Homma, Mamoru Uemura, Takeshi Kato, Masaaki Ito, Hiroyoshi Nishikawa, Takayuki Yoshino
Journal: Journal of Clinical Oncology (2020)

4073 Background: In VOLTAGE-A1, after 5 cycles of nivolumab (240 mg q2 weeks) plus radical surgery following chemoradiotherapy (CRT; 50.4 Gy with capecitabine 1,650 mg/m 2 ), a major pathologic response is observed in 38% (AJCC tumor regression grade 0-1) of 37 patients with microsatellite-stable locally advanced primary rectal cancer. Here, biomarkers for predicting the efficacy of this treatment were investigated. Methods: Serial tumor biopsies and blood collections were performed at 4 time points; before CRT, after CRT, after 3 cycles of nivolumab, and before surgery. Tumor-infiltrating lymphocytes (TILs) and DNA/RNA were extracted from tumor samples, and peripheral blood mononuclear cells (PBMCs) were extracted from blood samples. We analyzed the immune status of the patients by flow cytometry using the collected TILs and PBMCs. Whole exome and RNA sequencing analyses were conducted using the extracted DNA and RNA, respectively. The PD-L1 status of tumor samples was also evaluated by in vitro diagnostic immunohistochemistry staining. Results: Among the 24 patients whose samples were serially collected, 11 (46%) were AJCC grade 0-1 and 13 were 2-3. Before CRT, effector regulatory T (eTreg) cells in TILs were higher in patients with AJCC grade 2-3, and both the CD8 + T cell/eTreg cell ratio in TILs and PD-L1-positive tumor cells (≥1%) were higher in patients with AJCC grade 0-1 (p = 0.047, p = 0.083, respectively). Ki67 expression by CD8 + T cells in TILs was higher before CRT in patients with AJCC grade 0-1 (p = 0.037) and increased after CRT in all patients. Patients with consensus molecular subtype (CMS) 1 and CMS3 achieved AJCC grade 0-1 at rates of 100% (2/2) and 60% (4/6), respectively. In contrast, patients with CMS2 and CMS4 achieved AJCC grade 0-1 at rates of 43% (3/7) and 29% (2/7), respectively. The tumor mutation burden of pre-CRT samples was significantly higher in patients with AJCC grade 0-1 (median 1.45/MB) than in patients with AJCC grade 2-3 (0.84/MB) (p = 0.016). Conclusions: A higher CD8 + T cell/eTreg cell ratio, PD-L1-positive, Ki67 expression by CD8 + T cells in TILs, CMS1 or 3, and higher tumor mutation burden are good predictors of the efficacy of the sequential combination of CRT and nivolumab. Further results will be reported in the meeting. Clinical trial information: NCT02948348 .
Impact of anticoagulation prior to COVID-19 infection: a propensity score–matched cohort study
Authors: Douglas Tremblay, Maaike van Gerwen, Mathilda Alsen, Santiago Thibaud, Alaina Kessler, Sangeetha Venugopal, Iman Makki, Qian Qin, Sirish Dharmapuri, Tomi Jun, Sheena Bhalla, Shana Berwick, Jonathan Feld, John Mascarenhas, Kevin Troy, Caroline Cromwell, Andrew Dunn, William K. Oh, Leonard Naymagon
Journal: Blood (2020)
Phase I study of proton therapy in adjuvant pancreatic cancer (PROTON-PANC).
Authors: Benjamin Adam Weinberg, Hongkun Wang, Aiwu Ruth He, Nicole Villa, Keith Robert Unger
Journal: Journal of Clinical Oncology (2020)

TPS4663 Background: Pancreatic adenocarcinoma (PAC) has a poor prognosis, with a 5-year survival rate of 10%. The current standard of care for patients with resectable disease is surgical resection followed by 6 months of adjuvant modified FOLFIRINOX (FFX, leucovorin, fluorouracil, irinotecan, and oxaliplatin). As survival outcomes and distant recurrence improve with the use of FFX, locoregional recurrence remains a cause of morbidity and mortality. We seek to integrate adjuvant short-course proton radiation therapy (PRT) to the surgical bed in between cycles of FFX. While there is limited literature on the combination of short course PRT and FFX, there are analogous experiences using 5 fraction SBRT or IMRT following FFX in routine clinical practice. The ongoing Alliance 021501 trial of preoperative chemotherapy vs. chemotherapy plus radiation (IMRT using 5 Gy X 5 or SBRT 6.6 X 5) in borderline resectable pancreatic cancer mandates that radiation starts 5 days or more following the last dose of FFX. Additionally, at the Lombardi Comprehensive Cancer Center, we routinely combine 5 fraction SBRT after a 10-14 day interval from FFX. Methods: This is a phase I, single-arm, open-label study. Eligible pts are ≥ 18 years old, have histologically confirmed, resected PAC of the pancreatic head (R0 or R1) on adjuvant FFX, an ECOG performance status of 0-1, and adequate normal bone marrow and hepato-renal function. Exclusion criteria are prior radiation to the upper abdomen (neoadjuvant chemotherapy is allowed). This study will use a 3+3 dose-escalation design to determine the safety and feasibility of combining 5 fractions of adjuvant PRT with FFX using different intervals between cycle 6 of FFX and PRT: dose level 1 uses a 12 day interval, and dose level 2 uses a 5 day interval. The primary endpoint is to determine the RP2D between the 2 proposed schedules. Using a 3+3 dose-escalation schema, 2-12 patients will be required to determine the RP2D. Enrollment began in Q4 2019. Clinical trial information: NCT03885284 .
Clinical significance of expression of toll-like receptor 4 on CD14+ monocytes in peripheral blood from patients with chronic obstructive pulmonary disease
Authors: Li-xia Yang
Journal: BMJ (2013)

Objective
To detect the effects of glucocorticoids on the expression of toll-like receptor 4 (TLR4) on CD14+ monocytes in peripheral blood from patients with chronic obstructive pulmonary disease (COPD) and explore the relationship between inherent immunity deficiency and the pathogenesis of COPD.


Methods
A total of 30 hospitalized acute exacerbations of COPD (AECOPD) patients from 2012 January to March were divided them into 2 groups of mild-moderate (A, n=15) and severe-critical (B, n=15) according to pulmonary functions. The same basic treatment (anti-infection, oxygen inhalation, bronchial smooth muscle relaxing and cough relief) was administered. And glucocorticoids were added to Group B. Two weeks later, AECOPD achieved a clinical remission and it was designated as a stable COPD group. Another 30 healthy cases over the same period were selected as control group. Flow cytometry was used to measure the relative mean fluorescence intensity (rmfi) and relative positive cell percent (rpcp) of TLR4 onr CD14 positive peripheral blood monocytes. Conventional pulmonary function test (FEV1 percentage of predicted value, FEV1/FVC value) was performed.


Results
The value of rmfi for TLR4 of AECOPD group was 5.14±0.26 and rpcp (4.24±0.17)% and they were similar to those of COPD group [4.46±0.24 and (3.49±0.24)% respectively, all P>0.05]. AECOPD and COPD groups were both significantly lower than normal control group [13.75±0.28 and (10.25±0.13)% respectively, all P<0.01]. The rmfi of TLR4 of Group B was 3.12±0.15 and rpcp (3.17±0.10)%. And both were significantly lower than those of Group A [5.48±0.23 and (5.12±0.20)% respectively, all P<0.01]. The value of rmfi for TLR4 of Group B before glucocorticoid treatment was 3.12±0.15 and rpcp (3.17±0.10)%. And both were significantly lower than those of later glucocorticoid treatment [5.24±0.25 and (5.44±0.19)% respectively, all P<0.01]. Both values were significantly lower than those of normal control group [13.75±0.28 and (10.25±0.13)% respectively, all P<0.01]. The expression of TLR4 on CD14+ monocytes in peripheral blood of AECOPD patients was positively correlated with FEV1 percentage of predicted value(r1=0.824, P<0.001) and FEV1/FVC (r2=0.756, P<0.001).


Conclusions
Innate immunodeficiency plays an important role in the pathogenesis of COPD. And the expression of TLR4 is an important indicator for disease severity. Glucocorticoids treat COPD through inhibiting airway inflammation response and enhancing defensive function of innate immune system.


Key words: 
Pulmonary disease, chronic obstructive; CD14+ monocyte; Toll like receptor-4