Morphology of the Cardiac Conduction System in Patientswith Electrophysiologically Proven Dual Atrioventricular Nodal Pathways

Conduction System in Dual AV Nodal Pathways. Introduction: Although the electrophysiologic criteria for dual atrioventricular nodal pathways are well established, the anatomical substrate is still unclear.
Methods and Results: We examined the hearts from 10 patients who had been studied electrophysiologically prior to cardiac transplantation. All 10 patients were male, aged 22 to 60years. Nine of the 10 patients had dual atrioventricular nodal pathways according to acceptedcriteria. Histologic studies of the atrioventricular conduction system showed normal structureof the atrioventricular node in all 10 hearts, with minor variations within the node in 3 cases, within the penetrating bundle in 3 cases, and within the nonbranching bundle in 3 cases. Theatrial approaches to the atrioventricular node were generally scanty in 6 hearts. The solitarycase that was shown electrophysiologically to lack dual pathways had no obvious difference inthe structure of the nodal area other than sparsity of transitional cells. We were unable tolocate any extranodal atrial tracts as described by other investigators.
Conclusion: The anatomical substrate for conduction over dual pathways may he too subtleto be detected by gross morphologic studies. Since dual pathways were unmasked in allpatients but one during electrophysiologic studies, it may be that the potential for these pathways is ubiquitous.     

CLINICAL,PHYSIOLOGICAL AND PATHOLOGICAL OBSERVATIONS IN A CASE OF PROGRESSIVE AUTONOMIC NERVOUS SYSTEM DEGENERATION ASSOCIATED WITH HOLMES-ADIE SYNDROME AND PERIPHERAL NEUROPATHY

The case history is reported of a woman aged 40 years who presented with weight loss, postural hypotension and paræsthesia in the hands and feet. The diagnosis of widespread autonomic nervous system degeneration with associated peripheral neuropathy and Holmes-Adie syndrome was made from the results of a series of clinical and physiological tests. Laboratory investigation failed to disclose a cause for the degenerative changes, and symptomatic treatment with 9-alpha fluorohydrocortisone and digitalis was commenced in an effort to combat the patient's postural hypotension. On this régime there was transient improvement in her clinical state, but over a period of six months her general condition gradually deteriorated and she eventually died. At autopsy, widespread amyloid infiltration of the sympathetic ganglia, peripheral nerves, heart and alimentary canal was found, and this appears to have been the pathological basis for the clinical and physiological findings.     

Girls with Premature Thelarche Younger than 3 Years of Age May Have Stimulated Luteinizing Hormone Greater than 10 IU/L

Objective:Premature thelarche (PT) is defined as isolated breast development in girls before eight years of age. Gonadotropin-releasing hormone (GnRH) stimulation test is sometimes used to distinguish between PT and central precocious puberty (CPP), although the interpretation of the test at early ages is challenging. The objective of this study was to determine the follicle stimulating hormone (FSH) and luteinizing hormone (LH) responses to GnRH stimulation in girls with PT below 3 years of age.Methods:A standardized GnRH stimulation test, bone age and pelvic ultrasound were evaluated and those without pubertal progression after a minimum of one-year follow up were included in the study.Results:On GnRH stimulation test, the median (range) baseline LH was 0.29 (0.10-0.74) IU/L, baseline FSH was 4.96 (3.18-7.05) mIU/mL, and the peak median LH was 5.75 (3.31-8.58) IU/L with the peak mean±standard deviation FSH was 40.38±20.37 mIU/mL. Among the patients, 33.3% (n=10) had baseline LH >0.3 IU/L, 67% (n=20) had peak LH >5 IU/l and 16.6% (n=5) >10 IU/L. The mean peak LH/FSH ratio was 0.17±0.09 and was ≤0.43 in all participants.Conclusion:Although consensus statements usually define baseline LH >0.3-0.5 IU/L, peak LH >5 IU/L, and LH/FSH ratios >0.66-1.0 as diagnostic cut-offs for CPP, in children below 3 years of age, the baseline and peak LH values may be similar to pubertal values, possibly due to mini-puberty. A dominant FSH response on GnRH stimulation test is more valuable than the peak LH response in the diagnosis of PT.     

The initial phase of graft‐versus‐host disease is associated with a decrease of CD4+CD25+ regulatory T cells in the peripheral blood of patients after allogeneic stem cell transplantation

The mechanisms that induce and control the alloimmune inflammation of graft‐versus‐host disease (GvHD) after allogeneic stem cell transplantation (allo‐SCT) are still incompletely understood. In the murine system, GvHD can be suppressed by CD4⁺CD25⁺ regulatory T cells (TREG), which are generally involved in the suppression of inflammatory reactions. A disruption of the homeostasis between TREG and conventional T cells might therefore be associated with the inflammatory reactions of GvHD. We repetitively measured the frequency of TREG in the peripheral blood of 29 patients within the first 71–373 days after allo‐SCT and correlated the results with the clinical course. We demonstrate that the initial phase of GvHD is associated with a significant reduction of TREG in the peripheral blood, while at later stages and during intensified immunosuppressive therapy, increased numbers of TREG appear. These results might indicate a pathogenic role for reduced numbers of TREG in the induction of human GvHD.     

Trizivir^TM治疗80例HIV／AIDS患者临床研究

目的1．评估Trizivir^TM（AZT＋3TC＋ABC，TZV）治疗中国HIV／AIDS患者的疗效和安全性；2．HIV／AIDS患者的依从性；3．考察中国社区内HIV／AIDS患者服用固定剂量三联片治疗的可行性。方法80例HIV／AIDS患者进入治疗组。是一项单中心、开放式、无对照的临床试验。患者接受36个月的治疗，在治疗1，2，3，4，5，6，9，12，18，24，30和36个月按时到门诊随访。结果57例（71．3％）患者完成36个月治疗随访，23例（28．7％）在治疗过程中因药物不良反应、机会性感染复发、依从性不好或治疗失败而退出。57例治疗36个月后，CD4＋ T淋巴细胞计数平均增加252／μL，93．0％的患者显示病毒载量〈400拷贝／mL。在36个月的治疗期间，有4例患者出现耐药。结论TZV抗病毒效果显著，对于病毒载量〉500000拷贝／mL的患者也有很好的效果，CD4＋T淋巴细胞计数均显示明显增加。TZV不良反应较少，与其他药物的相互作用较少，服用方便，患者服药依从性好，对某些患者尤其有毒瘾者不失为一种可以选用的治疗方案。