Anti-retroviral (ARV) drugs have been successfully used for HIV/AIDS therapy,and their uses in pre-exposure prophylaxis (PrEP) for HIV infection is becoming increasingly important,and is drawing more attentions.Reports on seven large scale,multicentric clinical trials provide significant clinical data for further study and implementation of PrEP.This article reviews the current situation,necessity,questions,problems and prospects of PrEP for HIV infection.

BACKGROUND:Discogenic pain is a major cause of chronic low back pain,and its inflammation mechanism that is participated by many cytokines is well known by more and more people. However,what is the role of these cytokines in the occurrence and development of pain and how we use them to control pain are still not consistent. OBJECTIVE:To completely learn about the pathogenesis of intervertebral disk herniation,the relative cytokines in the occurrence and development of pain and the advances in the treatment of chronic pain with cytokines. RETRIEVE STRATEGY:A computer-based online search of CNKD was undertaken to identify the relevant articles dated from January 1994 to June 2007 with the Chinese of "cytokine,pain". And totally 153 articles were collected. Meanwhile,PubMed database was searched for English articles published from January 2002 to June 2007 with the keywords of "gene,chronic pain" and 36 were collected. The articles that involved the basic and clinical researches closely related with cytokine were selected. Repetitive articles were excluded. After the trail,6 Chinese and 24 English articles were involved. LITERATURE EVALUATION:Of the 30 articles,10 were focused on the basic research and animal experiment,and 20 were about clinical research. There were 7 of RCT,1 of EBM review,10 of summary analysis,2 of case report,and 10 of experience exchange. DATA SYNTHESIS:The mechanisms of discogenic pain include inflammation and immune ones besides mechanical pressure. Inflammation mechanism of discogenic pain is well known by more and more people,in which many cytokines such as substance P,phospholipase A2,tumor necrosis factor,interleukin,growth factor and NO participate. Meanwhile,the role of immunities should not be ignored. Some researchers have used some cytokines(interleukin 1 receptor antagonist,vascular endothelial growth factor,etc) in clinic to treat pains and got good effect. CONCLUSION:The mechanism of pain and various effects of pain-killer are based on gene. Cytokines play important roles in the occurrence,development and treatment of discogenic pain.

Isotope dilution mass spectrometry is a reliable principle for small molecule analyte measurements.It is a precise,accurate method with very high specificity,which is very suitable for lowconcentration steroid hormones tests.The published reference methods are all based on this principle so far.In this paper,the applications of isotope dilution mass spectrometry in the determination of steroid hormones were reviewed.

Objective To evaluate the clinical effect of different doses of leuprorelin acetate in in vitro fertilization-embryo transfer(IVF-ET).Methods From January 2011 to December 2011,the data of 268 patients undergoing IVF and (or) intracytoplasmic sperm injection (ICSI) in Reproductive Medical Center,Clinical College of PLA,Anhui Medical University were studied retrospectively.All the patients were divided into three groups based on with long protocol and controlled ovarian stimulation (COH) including 83cycles with 1.25 mg of leuprorelin in low dose group,68 cycles with 1.88 mg of leuprorelin in high dose group,117 cycles with 1.25 mg of diphereline in control group.The serum follicle stimulating hormone (FSH),luteinizing hormone (LH),estradiol (E2) and progesterone (P) before gonadotropin (Gn)administration on the days 3-5 of the menstrual cycle and on the day of hCG administration were detected,the dose and duration of Gn,number of oocytes retrieved,number of mature oocytes,the rates of fertilization,embryo cleaved,good-quality embryos clinical pregnancy and early miscarriage were compared among three groups.Results There were no significant differences in age,the level of LH and P on the day of hCG administration among three groups (P ＞ 0.05).The level of FSH was (3.8 ± 1.6) U/L in low dose leuprorelin group,(3.1 ± 1.4) U/L in high dose of leuprorelin group and (2.4 ± 1.3) U/L in diphereline group before Gn administration,which reached statistical difference (P ＜ 0.05).The mean length of Gn stimulation were (9.8 ± 1.7) days in low dose leuprorelin group,(10.5 ± 1.8) days in high dose of leuprorelin group and (11.1 ± 1.4) davs in diphereline group,which reached statistical difference (P ＜0.05).The mean dose of Gn was (24 ± 7) in low dose of leuprorelin group,which was significantly higher than (27 ± 9) in high dose of leuprorelin group and (28 ± 7) in diphereline group (P ＜ 0.05).The level of LH was (2.7 ± 1.6) U/L in low dose of leuprorelin group and (2.2 ± 1.0) U/L in diphereline group before Gn administration,which reached statistical difference(P ＜ 0.05).The cancel cycles were 5 in low dose of leuprorelin group,4 in high dose of leuprorelin group and 7 in diphereline group.The number of ovum was (14 ±7) low dose of leuprorelin group,(13 ±6) in high dose of leuprorelin group,(14 ±6) in diphereline group.The rates of fertilization was 66.26％ (758/1144)in low dose of leuprorelin group,67.01％ (589/879) in high dose of leuprorelin group and 68.54％ (1111/1621) in diphereline group,the rates of goodquality embryos was 64.22％ (472/735) in low dose of leuprorelin group,60.50％ (340/562) in high dose of leuprorelin group and 59.59％ (640/1074) in diphereline group,clinical pregnancy was 49％ (38/78) in low dose of leuprorelin group,42％ (27/64) in high dose of leuprorelin group and 50％ (55/110) in diphereline group,early miscarriage was 18％ (7/38) in low dose of leuprorelin group,15％ (4/27) in high dose of leuprorelin group and 15％ (8/55) in diphereline group,which did not show significant differences (P ＞0.05).Conclusions Both 1.25 mg and 1.88 mg leuprorelin acetate could obtain good downregulation effect and clinical outcomes.1.25 mg leuprorelin acetate could decrease patient's costs by reducing Gn dose and duration.

Objective To investigate the effect of EGB on SOD, MDA of ventilator-induced lung injury in rats and its possible mechanisms. Methods Thirty male SD rats were randomly divided into 3 groups: control group (C group), high tidal ventilation group (H group) and EGB group (E group). The setting mechanical ventilation was VT=30 mL/kg, RR=40/min, I/E=1/3, PEEP=0 cmH2 O and FiO2=21%. The broncho-alveolar lavage fluid (BLAF) and serum were obtained for determination of the levels of SOD and MDA at the end of 4 h mechanical ventilation. The Lungs were removed, and the wet-to-dry weight ratio (W/D) and pulmonary pathologic changes were measured. Results As compared with C group, W/D and the levels of MDA were significantly increased in H group, but the levels of SOD were reduced in H group. As compared with H group, W/D and the levels of MDA were significantly decreased in E group, but the levels of SOD were increased in E group. Pulmonary pathologic changes were alleviated in E group comparing with H group. Conclusion EGB injection may have a protective role against hyperoxia and induced pulmonary damage in rats.

Objective To assess the clinical efficacy and safety of the combination of intracoronary tirofiban infusion(ICTI) plus percutaneous coronary intervention(PCI) in patients with acute ST-elevation myocardial infarction (STEAMI). Methods The 128 cases with STEAMI were enrolled in this study. They were randomly divided into trial group and control group. The 10 μg/kg tirofiban were infused into the infarct related artery (IRA) within 5 minutes through the cather after coronary angiography in trial group (n=64). Normal saline in matched dose was infused into IRA after coronary angiography in control group (n=64). The coronary thrombosis and revascularization status were assessed within 10 minutes after injection. Postoperative bleeding complications were observed in all cases. Adverse cardiovascular events and cardiac function were followed up within 1 month in all cases. Results There were 33 cases whose thrombus burden was reduced within 10 minutes after the infusion of tirofiban in trial group, including 26 cases of thrombolysis in myocardial infarction (TIMI) ≥1. There were 6 cases whose thrombus burden was reduced within 10 minutes after the infusion of normal saline in control group, including 3 cases TIMI ≥ 1. The coronary thrombosis and revascularization status were better in trial group rather than in control group (P＜0.01). Adverse cardiovascular events occurred in 5 cases within 1 month, including 2 cases in trial group and 3 cases in control group (P＞0.05). New York heart association functional class and ejection fraction values were better in trial group rather than in control group within 1 month (P＜0.05). Postoperative bleeding complications occurred in 14 cases by TIMI criteria , including severe and mild bleeding in 2 cases in trial group and 1 cases in control group (P＞0.05), but no significant bleeding occurred in 8 cases in trial group and in 3 cases in control group (P＜0.01). Conclusions The combination of intracoronary infusion of tirofiban plus PCI is effective and safe for thrombolysis and revascularization in IRA in patients with STEAMI.

Objective To investigate the myocardial protection of intraoperative continuous in-fusion of esmolol in elderly patients undergoing laparoscopic surgery.Methods Sixty patients,thirty-two males and twenty-eight females,aged 65-80 years,weighing 40-80 kg,ASA physical status Ⅰ orⅡ,undergoing selective general anesthesia laparoscopic resection of gastrointestinal cancer were ran-domly divided into 2 groups (n = 30 ):esmolol group (group E)and control group (group NS). Group E was administered esmolol 0.3 mg/kg 3 minutes before intubation,then with a continuously infusing rate of 50 μg · kg-1 · min-1 until extubation.Group NS was administered saline instead. MAP,HR,SpO 2 ,PET CO 2 ,BIS and RPP were recorded before intubation (T0 ),intubation (T1 ), pneumoperitoneum (T2 ),the end of surgery (T3 ),extubation (T4 )and 30 minutes after extubation (T5 ).The serum levels of cTnI,CK,CK-MB and LDH were measured before anesthesia and 6,30 hours after surgery.Adverse cardiovascular event happened during perioperation and 3 months follow-ing up was recorded.Results HR,MAP,RPP at T1 ,T2 ,T4 in group E were obviously lower com-pared with group NS (P <0.05).There were no significant differences in the serum levels of cTnI, CK,CK-MB and LDH between two groups at different time points.No major adverse cardiovascular event happened in two groups during perioperation and 3 months following up.Conclusion Intraoper-ative continuous infusion of esmolol 50 μg· kg-1 · min-1 can not significantly influence the serum level of myocardial injury marker in the elderly patients without myocardial damage undergoing lapa-roscopic resection of gastrointestinal cancer.Howerver,it can effectively reduce the cardiovascular re-sponse caused by stimulation,decrease myocardial oxygen consumption,protect myocardial.

With the continuous improvement of various imaging techniques, the morbidity of polypoid lesions in gallbladder is increasing year by year. However, owing to the lack of effective means of diagnosis before undergoing the surgery, there is a large number of patients who do not have definite indications of surgery for prophylactic cholecystectomy. Therefore, this text will carry out a comprehensive narration of the imaging features, epidemiological characteristics and pathological types about the polypoid lesions in gallbladder, summarizing the experience of diagnosis and treatment of the disease, helping the option in clinical treatments.

BACKGROUND:So far, the short-term changes of various organs after injection of umbilical cord mesenchymal stem cells have been reported, but there are few studies on the long-term changes of various organs in healthy rats after repeated intramuscular injection of umbilical cord mesenchymal stem cells. OBJECTIVE:To observe the security of intramuscular injection of heterogeneous umbilical cord mesenchymal stem cells. METHODS:Sixty male SPF Wistar rats were divided into six groups randomly:normal group (suspension liquid of umbilical cord mesenchymal stem cells);control group with culture solution;supernatant group (supernatant of human umbilical cord mesenchymal stem cells);low concentration group (0.25×105 human umbilical cord mesenchymal stem cells);moderate concentration group (1.0×105 human umbilical cord mesenchymal stem cells);high concentration group (4.0×105 human umbilical cord mesenchymal stem cells). Each rat was injected 0.8 mL liquid in muscle, 0.2 mL in each limb, twice at weeks 1 and 4. Biochemical tests were conducted before and after injection. At the end of 8 weeks, al the rats were kil ed and hematoxylin-eosin staining was done with the liver, spleen, lung, kidney, brain and muscle.
RESULTS AND CONCLUSION:There was no abnormal change about biochemical tests and hematoxylin-eosin staining after the intramuscular injection of heterogeneous umbilical cord mesenchymal stem cells. No significant alteration was observed in the liver, spleen, lung, kidney, brain, and muscle of the limb after the injection of heterogeneous umbilical cord mesenchymal stem cells under suitable concentration. These findings indicate intramuscular injection of heterogeneous umbilical cord mesenchymal stem cells at certain concentrations is safe and reliable.

Objective Clinically, the anterior cruciate ligament ( ACL) can be reconstructed by either ligament advanced reinforcement system ( LARS) artificial ligament or hamstring tendon autograft ( HTAG) . This study aims to compare the early clinical outcomes of LARS versus HTAG in the treatment of ACL. Methods This study included 38 cases of ACL injury treated in our de-partment from March 2012 to August 2014, 18 by LARS artificial ligament and the other 20 by HTAG. Before and at 18 months after surgery, we evaluated the clinical outcomes of the tow strategies using the Lysholm knee scoring scale and International Knee Documen-tation Committee ( IKDC) scoring systems, and conducted statistical analysis on the follow-up findings. Results Statistically signifi-cant differences were not observed preoperatively between the LARS and HTAG groups either in the Lyshrolm scores (46.78±1.52 vs 46.80 ±1.89, P>0.05) or in the IKDC scores (42.83±1.47 vs 42.20±1.61, P>0.05), nor at 18 months postoperatively in the Lyshrolm scores (93.52±3.19 vs 94.10±1.37, P>0.05) or the IKDC scores (92.11± 1.45 vs 93.15±1.76, P>0.05). However, both the LARS and HTAG groups showed significant differences in the Lyshrolm and IKDC scores at the baseline as compared with those at 18 months after oper-ation ( P<0.05) . Conclusion Both LARS artificial ligament ham-string tendon autograft can achieve good early clinical outcomes in ACL reconstruction.