Attachment to Caregivers and Type 1 Diabetes in Children

Attachment is a behavioral and physiological system, which enables individual’s dynamic adaptation to its environment. Attachment develops in close interaction between an infant and his/her mother, plays an important role in the development of the infant’s brain, and influences the quality of interpersonal relationships throughout life.Security of attachment is believed to influence individual response to stress, exposing insecurely organized individuals to deregulated autonomic nervous system and exaggerated hypothalamic-pituitary-adrenal activity, which, in turn, produces increased and prolonged exposure to stress-hormones. Such stress responses may have considerable implications for the development of diverse health-risk conditions, such as insulin resistance and hyperlipidemia, shown by numerous studies.Although the mechanisms are not yet fully understood, there is compelling evidence highlighting the role of psychological stress in the development of type 1 diabetes (T1D). One of the possible contributing factors for the development of T1D may be the influence of attachment security on individual stress reactivity. Thus, the suggestion is that insecurely attached individuals are more prone to experience increased and prolonged influence of stress hormones and other mechanisms causing pancreatic beta-cell destruction.The present paper opens with a short overview of the field of attachment in children, the principal attachment classifications and their historic development, describes the influence of attachment security on individual stress-reactivity and the role of the latter in the development of T1D. Following is a review of recent literature on the attachment in patients with T1D with a conclusion of a proposed role of attachment organization in the etiology of T1D.     

Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery: Diagnoses and Surgical Results in 12 Pediatric Patients

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital condition. It responds well to early diagnosis and treatment, but otherwise the prognosis is poor. We present our case series of 12 patients (mean age, 2 ± 2.58 yr; age range, 2 mo–8 yr), emphasizing the diagnostic process and discussing our surgical results. The diagnosis of ALCAPA should be suspected in infants who have dilated cardiomyopathy with electrocardiographic changes that suggest ischemia, and in older children who have isolated mitral regurgitation. When clinical suspicion is high, the results of 2-dimensional echocardiography combined with color-flow Doppler studies in expert hands can establish the diagnosis, thus avoiding angiography in critically ill infants. The treatment of choice in our patients was transfer and reimplantation of the left coronary artery onto the ascending aorta. There were 2 deaths: both were infants in extremis who underwent emergency surgery. An older child with severe ventricular dysfunction was given mechanical ventricular assistance and then heart transplantation. As of this report, all 10 survivors remained well and asymptomatic.     

疏肝健脾法治疗腹泻型肠易激综合征1例

肠易激综合征（IBS）是一种常见的功能性疾病，中医病名为"肠郁"。郭朋教授根据IBS生理、病理特点，以疏肝健脾法调和肝脾，辨证施治，取得良好疗效。文章从病因病机、辨证论治及经典案例介绍等几个方面对郭教授治疗IBS经验进行系统阐述，以期为中医药治疗IBS提供理论和方法学参考。     

A Reminder of Methylene Blue's Effectiveness in Treating Vasoplegic Syndrome after On-Pump Cardiac Surgery

The inflammatory response induced by cardiopulmonary bypass decreases vascular tone, which in turn can lead to vasoplegic syndrome. Indeed the hypotension consequent to on-pump cardiac surgery often necessitates vasopressor and intravenous fluid support. Methylene blue counteracts vasoplegic syndrome by inhibiting the formation of nitric oxide.We report the use of methylene blue in a 75-year-old man who developed vasoplegic syndrome after cardiac surgery. After the administration of methylene blue, his hypotension improved to the extent that he could be weaned from vasopressors. The use of methylene blue should be considered in patients who develop hypotension refractory to standard treatment after cardiac surgery.     

衣原体、支原体引起的难治性支气管—肺部感染分析

目的 探讨难治性支气管—肺部感染(难治组)衣原体、支原体两种病原体的表达。方法 应用ELISA法检测了29例难治性支气管—肺部感染两种非典型病原体急性感染指标，衣原体抗体IgM、支原体抗体IgM及冷凝集实验，并常规细菌学检查，与同期住院的普通性下呼吸道感染(普通组)40例，门诊及住院的急性上呼吸道感染(上感组)30例进行比较。结果 难治组衣原体急性感染率68．9％，显著高于普通组、上感组，上感组最低；支原体急性感染率难治组34、5％，显著高于普通组、上感组；衣原体混合支原体、衣原体混合其他致病菌感染均显著高于普通组和上感组。结论 难治性下呼吸道感染中衣原体、支原体感染率较高，且易与多种病原体混合感染，衣原体的慢性感染可能是难治感染的重要原因。     

Guillain-Barré syndrome in South-West Stockholm, 1973–1991, 3. Clinicoepidemiological subgroups

Using hierarchical cluster analysis, applied to 47 cases of Guillain-Barre Syndrome (GBS) incident in South-West Stockholm (SWS) during the period from January 1973 to June 1992, we identified three major clinicoepidemiological subgroups. The first subgroup, 25.5% of the cases (26.7 ± 6.7 years), recorded a peak incidence at ages 20–29 years and presented significant differences from other subgroups, a high proportion of cases with onset at low age preceded by respiratory infection (83.3%) and with normal motor conduction velocity (50.0%). Also found, were less affected biological parameters, a rapidly progressive course and independence in gait at one month after onset. A second subgroup, 27.7% of cases, was severely affected, clinically and functionally. It consisted predominantly of young individuals (22.7 ± 11.1 years), with a high incidence (69.2% of cases) in autumn. A third subgroup, comprising 40.47; of cases, was older (61.1 ± 11.0 years) and, in general, also severely affected. The incidence of this form appeared to be invariant with time.     

高度近视的病因学研究进展

高度近视发生的内因、外因，包括遗传倾向，相关基因定位，巩膜胶原白体免疫学说，视网膜生物活性物质失调学说，环境因素等，本研究就这些因素对高度近视发病的影响做一综述。现统一的认识有：①高度近视具有明显的遗传倾向。②迄今为止，已找到4个高度近视相关基因，它们的遗传方式均为常染色体显性遗传。③高度近视的巩膜组织病理改变和胶原代谢障碍引发了人们对高度近视免疫相关基因的深入研究。已发现HLAⅡ类基因与部分高度近视具有相关性。④视网膜中存在的生物活性物质直接或间接参与了形觉剥夺性近视的形成。⑤环境因素并非高度近视发病的决定因素，它仅起一定程度的促进作用。将今后的工作重点放在高度近视基因定位的研究，基因表达的调控及巩膜胶原代谢、网膜生物活性物质之间的关系研究上，无疑会进一步揭示高度近视的病因，为防治高度近视开辟新途径。     

紫外线对晶状体上皮细胞损伤的研究进展

紫外线，特别是紫外线B，是老年性白内障的环境致病因素，晶状体上皮细胞生理状态的改变是白内障发生的早期表现。本综述总结了近年来国内外关于紫外线损伤对晶状体上皮细胞影响的研究，以及紫外线对晶状体上皮细胞的生物损伤效用和损伤机制。     

实验性尘细胞灶与胸片细网状阴影形成的关系

本文从21只实验性矽肺家兔中筛选出5只胸片有细网状阴影者,用病理与 X 线对照观察的方法,探讨了实验性矽肺尘细胞灶与死后胸片细网状阴影形成的关系。证明,分布在肺细叶内直径约1mm 的尘细胞灶,其分布密度为113个/cm~2以上时,可构成胸片细网状阴影。实验排除了弥漫性肺间质纤维化的结论。并对胸片细网状阴影的形成从肺细叶解剖与 X 线投影进行了讨论。     

1 108例终末期肾脏疾病血液透析病人原发疾病构成及相关因素分析

目的 回顾性研究终末期肾脏疾病（end stage renal disease，ESRD）血液透析病人原发疾病构成及其相关因素。方法 收集ESRD血液透析病人1108例，分析其原发疾病构成、年龄、性别、透析治疗持续时间、转归、生存率和死亡原因。结果 301例病人透析时间超过3个月，其中43．9％仍在进行血液透析治疗，最长者已存活13年；13．0％病人已行肾脏移植；19．9％转至外院治疗；7．3％改为腹膜透析；1．3％因经济困难放弃治疗；14．6％病人死亡。ESRD维持性血液透析病人1年生存率为93．53％，3年生存率为68．92％。5年生存率62．51％。死亡原因为心血管事件占54．5％，脑血管意外占20．5％。结论 本组病人以中、老年为主，男性多见。ESRD血液透析病人主要原发疾病为慢性肾小球肾炎，主要死亡原因为心血管事件和脑血管意外。