Antiviral therapy of herpes simplex virus infection: recent developments 1

Since 1981, the standard therapy of herpes simplex virus infections has been based on acyclovir. Valaciclovir, the ^l-valine ester of acyclovir and famciclovir, a pro-drug of penciclovir with an improved oral bioavailability have been recently licensed. HPMPC, an acyclic nucleoside phosponate, is highly active and shows a broad range of activity against all the herpes viruses, and it is far more efficient than ganciclovir against cytomegalovirus. Ribonucleotidase inhibitors have so far been unsuccessful in the treatment of acyclovir-resistant HSV infections. In the future, anti-sense oligonucleotides may play a role in the therapy of herpes virus infections and many efforts continue to be made to develop vaccines which may prevent recurrences in already infected individuals. Resistance to anti-HSV agents is almost exclusively encountered in immunocompromised patients. Failure of acyclovir therapy is mostly due to viral thymidine kinase (TK) deficiency as a result of mutation in the TK gene. Until now, the only alternatives for the treatment of acyclovir-resistant infections have been the intravenous administration of foscarnet, frequently associated with relatively severe side effects, or the topical application of trifluridine either as single agent or in combination with interferon alpha. In vitro observations suggest that the failure of antiviral therapy is not directly due to the emergence of resistant virus isolates. Reduced uptake or activation of acyclovir may represent a selective pressure for resistant isolates in immunocompromised patients. New prodrugs with increased bioavailability, such as valaciclovir and famciclovir will perhaps prevent or delay the emergence of drug resistant isolates in immunocompromised patients since higher intracellular levels of the active compound can be achieved.     

Kinematics of cervical spine injury

Summary This paper, based on functional radiological knowledge of normal cervical spine kinematics, develops the hypothesis that compressive vertebral injury can be produced by abrupt reversal of curve between hyperflexed and hyperextended parts of the cervical spine. Reversal of curve occurs when the main vector of a compressive force passes between two centers of flexion-extension motion. The hypothesis more clearly explains reverse dislocation of fractured vertebrae than the current concept of Whitley and Forsyth of motion of the head through an arc. The mechanism of injuries with characteristics of hyperflexion of one segment and hyperextension of an adjacent segment, e.g., in certain types of hangman's fractures, is better understood. The hypothesis is expected to be helpful in guiding experimental cervical spine injury, as it relates direction of force to level and type of the resulting vertebral injury.     

98株肺炎链球菌的耐药性分析

目的：了解肺炎链球菌的耐药性。方法：常规K-B法(纸片扩散法)对肺炎链球菌进行药物敏感试验。结果：98株肺炎链球菌对红霉素的耐药率最高，达40.8％，青霉素的耐药率为16.3％,对万古霉素的耐药率为0％。结论：万古霉为治疗肺炎链球菌感染的最佳选择。     

Unusual complication of peritoneal drainage: migration of a shunt in the subdural space

Quite a number of cases of upward shunt migration have already been reported in the literature. The authors report the case of a newborn boy who presented a sequential alternate change of pressure gradients based, according to their opinion, on fields of pressures exerted by fluids in different compartments of the patient's body. The authors propose a physicoanatomical explanation on the basis of the surgical findings.     

脑-内脏综合症46例病因机理分析

目的:探讨脑-内脏综合症的发病原理,提供原发病因致其出现的神经解剖学依据,明确其指导意义,并借以提高治愈、好转率。方法:选择重症脑出血致内脏综合症46例,均经CT扫描确认,并按日本多田公式计算出血量不低于50mL。结果:全部病例按本文理论指导治疗,存活率达76％,高于传统的50％。结论:正确认识脑-内脏综合症的发生机理,对降低其死亡率及对引致其发生的常见原因——重症脑出血的诊治,有着重要意义,为理解其临床改变与神经解剖的对应关系,进行了深入的阐明并开拓了新的视野。     

腰椎横突间综合征解剖研究

目的 :阐明腰椎横突间综合征引起腰痛的可能机理。方法 :正常成人 2 0例中男女各 10例 ,腰椎正、侧位 X摄片 ;10副成人尸骨腰椎椎体横径和横突长度测量 ;男尸 4具 8侧 ,腰椎横突间相关结构的解剖。结果 :X线正位片显示第 3腰椎横突两侧末端间距最长 ,为 10 5 .2± 4 .5 mm,其他依次为 L5,L4 ,L2 ,L1 。 X线侧位片显示腰椎横突 1～5排列与腰椎前凸一致 ,第 3腰椎位于脊柱腰部前凸的顶端 ;尸骨第 1～ 5腰椎椎体横径依次递增 (38.6± 4 .4 mm～4 4 .8± 3.6 mm。) ;腰椎左、右侧横突长度以第 3腰椎最长 ,为 36 .9± 4 .6 mm ,36 .8± 4 .9mm。其他横突长度排列依次为L5,L4 ,L2 ,L1 ;尸体腰椎横突间区解剖见腰大肌、腰方肌和胸腰筋膜附着于腰椎 1～ 4横突末端 ,其中以第 3腰椎横突末端最为集中 ,并与脊神经后支 ,横突前动、静脉相邻。结论 :第 3腰椎横突长度最长 ,腰部外伤时可累及第 3腰椎横突处 ,与之相连处的肌肉、筋膜和神经发生损伤。这可能是腰椎横突间综合征引发腰痛的机理     

血红素氧合酶-1在肾缺血再灌注损伤中的作用

血红素氧化酶 (HemeOxygenaseHD)是血红素降解的限速酶 ,可将血红素转变为胆绿素、CO和铁。该文就血红素氧化酶 -Ⅰ在肾缺血再灌注损伤的作用与作用机制进行概述。     

Analyzing mechanism(s) of hallucinogenic drug action with drug discrimination procedures

Some of the advantages of using drug discrimination (DD) procedures to analyze the mechanisms of action of hallucinogenic and related drugs were illustrated by reviewing research with lysergic acid diethylamide (LSD). Because they ensure that drug-induced alterations in interoceptive “state” become biologically meaningful “cues,” these procedures are reliable, robust, sensitive and specific. With reference to LSD, many DD experiments suggest: (1) that while hallucinogens substitute for (mimic) LSD (in rats), such substitution does not predict hallucinogenic potency (in humans) but does predict similarities in mechanism(s) of action; (2) the behavioral (in vivo) effects of LSD, unlike those of some of its congeners, are mediated primarily by central, serotonergic (5-HT) neuronal mechanism although LSD may also have (secondary) dopamine (DA) agonist properties; (3) both the locus and the nature of these LSD-5-HT interactions are unclear: cells arising from B-7, B-8 and B-9 regions of the dorsal-medial raphe may be involved; pretreatment with agents that deplete 5-HT and increase the stereospecific binding of ³H-LSD in vitro (p-chlorophenylalanine; 5,7-dihydroxytryptamine) enhance sensitivity to LSD in vivo.     

上海公立医院综合改革研究

该文分析了上海公立医院体制、机制上存在的问题 ,并提出了公立医院综合改革的目标和改革措施。