Background： Common variable immunodeficiency （CVID） is one of the most common symptomatic primary immunodeficiency syndromes. The purpose of this article was to broaden our knowledge about CVID for ...better diagnosis and treatment. Methods： Clinical and immunological features of 40 Chinese patients with CVID were analyzed retrospectively. Results： The median age at onset was 1 l-year-old （range 4-51 years）. The median age at diagnosis was 14.5-year-old （range 5-66 years）. The average time of delay in diagnosis was 5.3 years （range 1-41 years）. The most common main complaint was fever due to infections （35 cases, 87.5%）. Pneumonia （28 cases, 70%） was the most common type of infections. Bronchiectasis was present in 6 patients （15%）. Autoimmune disease was detected in 6 cases of CVID, and malignancy in 2 cases. The median total serum levels of lgG, lgA, and IgM at diagnosis were 1.07 g/L, 0.07 g/L, and 0.28 g/L, respectively. The percentages of CD3^- /CD 19^＋ B-cells were 1%-3.14%. Conclusions： Infection is the most frequent presentation of CVID. Patients with unexplainable infections should receive further examination including serum immunoglobulin （Ig） and lymphocyte subset analysis. Regular and sufficient substitution with lg is recommended.
Background and Aim:Although autonomic alterations are observed in patients with gastroesophageal reflux disease (GERD), the influence of visceral receptor responses on the dynamics of autonomic ...function remains unknown. The aim of this study was to investigate the autonomic functional changes in association with intra-esophageal pH under ambulation. Methods:Thirty patients referred for 48 h ambulatory pH monitoring underwent simultaneous 24 h cardiac monitoring for heart rate variability (HRV). We used linear mixed-effects models to estimate the relationship between esophageal acid exposure and power spectral analysis of HRV, including low-frequency power (0.04 < LF < 0.15 Hz), high-frequency power (0.15 < or = HF < 0.4 Hz), and LF-HF power ratio. Results:Over the 24-h period, patients with pathological reflux had lower average LF and HF powers than patients with functional heartburn, but the LF-HF power ratios were similar for the two patient groups. As we stratified the data according to waking and sleeping times, a significantly higher HF power but lower LF-HF power ratio was found during sleeping time regardless of diagnosis. In the regression analysis, esophageal pH was positively associated with change (not basal tone) of both LF and HF powers during waking, but only with change of HF power during sleeping time. The significant associations between pH values and changes in HRV decreased gradually with time. The LF-HF power ratio did not alter significantly with pH. Conclusion:Esophageal acid exposure is generally associated with decreases in autonomic tone. A predominant parasympathetic fluctuation during sleeping and a superimposed sympathetic interaction during waking dictate diurnal characteristics of autonomic regulation.
Introduction: Although many studies have shown decrease in heart rate variability (HRV) was associated with particulate air pollutants, relatively few studies have investigated its association with ...gaseous air pollutants. Objective: This study was to examine the relationship between nitrogen dioxide (NO2) and HRV in the elderly population. Methods: We used a panel study to investigate short-term effects of air pollution on HRV. Our study subjects are 83 patients (mean age 61) from the cardiology section, Department of Internal medicine, National Taiwan University Hospital in Taipei. Continuous ambulatory electrocardiographic (ECG) monitoring was performed on each study subject, which measured time and frequency domains of HRV, such as standard deviation of normal-to-normal (NN) intervals (SDNN) and the square root of the mean of the squared differences between adjacent NN intervals (r-MSSD), high frequency (HF, 0.15-0.40 Hz) low frequency (LF, 0.04-0.15 Hz). NO2 and other co-pollutants, such as sulfur dioxide (SO2), carbon monoxide (CO), ozone, PM10 (particulate matter less than 10 um in diameter) and PM2.5 (particulate matter less than 2.5 um in diameter) measured at each subject's close-by monitoring stations were used to represent personal exposure. We used linear mixed-effects models in single pollutant and multiple pollutant models to estimate the relationship between air pollution and log10-transformed HRV. Potential confounders, such as subject's age, sex, body mass index (BMI), disease status of coronary heart diseases, smoking status, and ambient temperature were also adjusted in all models. Results: Single pollutant models showed that NO2 is the most consistent air pollutants responsible for both time and frequency domains of HRV decreases among all air pollutants. Such effects occurred at 1 to 4-hour moving averages. CO is also responsible for decreases in SDNN, r-MSSD, LF, and HF at 1-hour moving CO average. By contrast, we found no associations between HRV and PM2.5, PM10, SO2, or ozone. Multiple pollutant models with NO2 and CO further showed that NO2 was responsible for SDNN decreases at 1 to 4-hour moving NO2 average after controlling confounders. The models showed a 1ppb increase in NO2 exposure with 1-4 hour moving averages was associated 0.08-0.17% decreases in SDNN. Discussion: Our findings suggested that exposures to traffic-related air pollutants in urban environment, such as NO2 or CO, are associated with decreased HRV in susceptible population.
The leading cause of mortality in dialysis patients is cardiovascular complications, including ventricular arrhythmias and sudden cardiac death. A reliable non‐invasive predictive test of sudden ...death is therefore important. The interlead variation in duration of the QT interval on the surface electrocardiogram corrected with heart rate (QTc dispersion) might serve as a surrogate for ventricular arrhythmia. Prolonged QTc dispersion is commonly encountered in dialysis patients and possesses an increased risk of all mortality, including cardiovascular mortality. QT dispersion might be affected by shifts of the intracellular electrolytes during dialysis and increasing deposition of iron in cardiac muscles in these patients who have underlying heart diseases. Although no well‐designed study has been done, the factors contributing to prolongation of QTc dispersion should be avoided. We summarize the results of the currently available clinical studies that examined QTc dispersion in dialysis patients.
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