BACKGROUND:The implantable artificial pacemaker that needs long-term wear is in direct contact with human body tissue, and thus, biocompatibility of the materials is very important. OBJECTIVE:To investigate the material progress and material-related complications of implantable artificial pacemakers. METHODS:Articles related to implantable artificial pacemaker materials and related complications were searched in Wanfang database and PubMed database from 2000 to 2015. The keywords were pacemaker; materials; pacemaker leads; pacemaker electrode; complication in Chinese and English, respectively. Finaly, 27 articles were included and summarized. RESULTS AND CONCLUSION: The implantable artificial pacemakers are in direct contact with the body tissues through the titanium alloy shell covering the pulser, the electrode wire covering the silicone, polyurethane, epoxy resin, and the electrode materials (including carbon, platinum-iridium alloy, Elgilog alloy). These materials have good physical and chemical properties as well as good cytocompatibility, electrophysiological compatibility and blood compatibility with the human body that have been confirmed in the past decades. However, material-related complications often occur, such as contact dermatitis, wire breakage, dislocation, cardiac perforation, venous thrombosis and tricuspid regurgitation along the wire, capsular infection and hematoma when placing the pulser. With the rapid development of today's microelectronic technology, research on the modification of pacemaker materials and the pacing system has been ongoing and has made considerable progress. Moreover, wireless pacemaker development and clinical application may be the future direction of development.

Aim To investigate the reversal effect of PARP-1 inhibitor PJ34 on cisplatin-resistance in hu-man lung adenocarcinoma A549/DDP cells and the mechanism. Methods A549/DDP cells were treated with PJ34 alone or combined with cisplatin. The effects of proliferation inhibition were assayed by MTT meth-
od. The apoptosis ratios of cells were analyzed by flow cytometry. The protein expression of PARP-1 and LRP, GST-π were measured by Western blot assay. Results PJ34 could inhibit the proliferation of A549/DDP cells alone. The non-toxic dose of PJ34 could signifi-cantly resensitize A 5 4 9/ DDP cells to cisplatin , induce
apoptotic,lower the expression of PARP-1 and resist-ance-associated protein LRP and GST-π. Conclusion PJ34 could inhibit the proliferation of A549/DDP cells and resensitize A549/DDP cells,partially reverse cisplatin-resistance in A549/DDP cells, with a proba-
ble mechanism relating to increased apoptotic rate,and lowered expression of PARP-1 and resistance-associat-ed protein LRP and GST-π.

BACKGROUND:Transforming growth factor-βhas been shown to exert an obvious induction effect on the differentiation of bone marrow mesenchymal stem cells into chondrocytes. Cyclical tensile strain simulates mechanical environment of chondrocytes in the body, and plays an important regulatory role in cellproliferation and differentiation. OBJECTIVE:To discuss the synergy of transforming growth factor-βand cyclical tensile strain in inducing the differentiation of bone marrow mesenchymal stem cells into chondrocyte-like cells. METHODS:A total of 10 2-month-old New Zealand rabbits were selected. Bone needle was used to penetrate the medul ary cavity of bone. 3.0-4.0 mL of bone marrow was extracted for isolation and culture of bone marrow mesenchymal stem cells. Passage 3 cells were randomly assigned to four groups:blank, transforming growth factor-β, cyclical tensile strain and cyclical tensile strain+transforming growth factor-βgroups. After 1, 3 and 6 days, cells were obtained. General morphology was observed using safranin O staining. Glycosaminoglycan levels were detected by alcian blue staining. Matrix metal oproteinase-13 and tissue inhibitor of metal oproteinase-1 levels in supernatant were measured using ELISA. Type II col agen, matrix metal oproteinase-13 and tissue inhibitor of metal oproteinase-1 mRNA relative expression was detected using RT-PCR. RESULTS AND CONCLUSION:Safranin O staining showed fusiform or irregular triangular cells. cellnumber
and matrix secretion increased in each experimental group than in blank group. Glycosaminoglycan levels in the supernatant were greater in the transforming growth factor-βand cyclical tensile strain+transforming growth factor-βgroups than in the blank group (P<0.05). Type II col agen mRNA relative expression was higher in the cyclical tensile strain+transforming growth factor-βgroup than in the blank group (P<0.05). Results indicated that transforming growth factor-βand cyclical tensile strain could induce the differentiation of bone marrow mesenchymal stem cells into chondrocytes, showing an apparent cooperative action.

Objective To determine the effect of using cytomegalovirus-seronegative blood components in preventing transfusion-acquired cytomegalovirus infection,which laid foundation for the application of blood antibody screening of cytomegalovirus.Methods The documents of studies about the comparison in transfusion-acquired cytomegalovirus ratio between using cytomegalovirus-seronegative blood components with using cytomegalovirus-unscreened /non-WBC-reduced blood were retrieved from the databases of PubMed,MEDLINE,Ovid,ProQuest,EBSCO,Cochrane Library,EMbase,CNKI,VIP,CBM and WanFang Library,and the reference in studies were retrieved by hands at the same time.The documents were screened,extracted and evaluated according to inclusion and exclusion criteria,and then given a Meta-analysis by using Rev Man 5.1 software.Results There were totally 7 controlled studies(430 patients) included.The results of Meta-analysis showed that compared with using cytomegalovirus-unscreened/non-WBC-reduced blood,the effect of using cytomegalovirus-seronegative blood components in preventing transfusion-acquired cytomegalovirus infection had a statistical difference(OR=0.07,95%CI:0.03-0.18,P<0.01).Conclusion Application of blood antibody screening of cytomegalovirus is effective in preventing transfusion-acquired cytomegalovirus infection,especially organ transplantation and neonate patients.

Objective:To discuss the distinctive clinical manifestation of primary aspergillus laryngitis.Method:Six cases of primary aspergillus laryngitis in our department were reviewed,among which 3 cases were diabetes patients,and were laryngeal mucosal barrier impairment.2 cases were smoking, 2 cases were over use of voice and 1 case were gastro-pharyngeal reflux . Refractory hoarseness was the main clinical manifestation of all patients. The prophase treatment with antibiotics and glucocorticoid should breakdown the balance of flora and exacerbate the disease.Result:Stop using antibiotics and glucocorticoid and alter to oral administration of itraconazole in 2 to 4 weeks after final diagnosis can effectively cure the disease. No recurrence was found in 6 month to 4 years follow up.Conclusion:Diffuse hyperemia ,pachynsis and scattered lamellar leukasmus of vocal cord were the characteristic physical findings of primary aspergillus laryngitis.Pathology is the major means to get the final diagnosis. Oral administration of itraconazole could be effective.

Objective This study assesses the influence of rizatriptan on calcitonin gene-related peptide (CGRP),proenkephalin (PENK) and cholecystokinin (CCK) mRNA expressions in the trigeminal ganglia of a rat migraine model and investigates the possible mechanisms by which triptans treat migraine.Methods A total of 24 rats were randomly divided into four groups:normal control group (A),migraine model group(B),rizatriptan control group (C) and rizatriptan treatment group(D).Groups C and D were intragastrically perfused with rizatriptan,1 mg/kg per day.After 7 days,nitroglycerin was subcutaneously injected into the buttocks of the groups B and D to induce migraine.Two hours after nitroglycerin injection,the trigeminal ganglia was isolated.CGRP,PENK and CCK mRNA expressions in the trigeminal ganglia were determined using SYBR Green Ⅰ real-time quantitative PCR.Results The copy number of CGRP mRNA (× 107) in 200 ng total RNA of each group was 0.05 ±0.01,1.30 ±0.52,0.23 ±0.12,0.43 ±0.33 ; The copy number of PENK mRNA (× 103) in 200 ng total RNA of each group was 3.30 ± 1.65,0.34 ±0.14,3.91 ± 2.44,0.71 ± 0.13.The copy number of CGRP mRNA in the trigeminal ganglia of group B was significantly higher than that of group A (q =7.854,P ＜ 0.05) ; CGRP mRNA expressions were significantly lower in the trigeminal ganglia of rats in group D compared with group B (q =5.458,P ＜0.05).Compared with group A,PENK mRNA expressions in the trigeminal ganglia of rats were significantly lower in group B (q =4.478,P ＜ 0.05).PENK mRNA expressions were significantly higher in trigeminal ganglia of rats in group C compared with group D (q =4.838,P ＜ 0.05).CCK mRNA expression in trigeminal ganglia of rats was similar among groups.Conelusions Rizatriptan can decrease the expressions of CGRP in the trigeminal ganglia of the migraine rats and exhibits neurogenic inflammation triggered by CGRP.PENK expressions decrease in the trigeminal ganglia of the migraine rats,weaken the analgesic effects of enkephalin.

Objective To introduce a method of arthroscopie treatment of purulent knee arthritis, and to evaluate its clinical value. Methods Twenty-seven cases of knee pyarthrosis were treated by de-bridement and subtotal synovectomy under arthroscope and combined with intravenous antibiotics and systematic postoperative rehabilitation. The clinical results were evaluated through examination of the temperature, joint effusion and range of motion of the knee joint. Results The temperature resumed to normal at an average of three postoperative days. All the knees regained the normal extension and more than 120 degree of flexion at six weeks after operation. 85. 2% of the knee flexion function resumed to normal in 3 months. Lysholm knee function score was 89. 4 ? 4. 1 in average and there is a significant statistical difference ( P

Objective To study the clinical outcome of arthroscopic reconstruction of posterior cruciate ligament (PCL) with hamstring tendons and mini-plate and button. Methods From January 1998 to December 2000, 21 cases of PCL ruptures were reconstructed arthroscopically with five to seven strands of hamstring tendons and mini-plate and button. There were 14 males and 7 females aging from 27 to 49 years with the mean age of 36.4 years. All of the patients were free from posterolateral corner ligament injury. The interval from injury to diagnosis was 2.5 months ranging from 2 weeks to 15 months. There were 3 fresh and 18 old injuries. The patients were followed up for more than 12 months and were evaluated for knee function. Results No extension limitation occurred and the flexion degree were more than 120? in all cases 3 months postoperatively. One year after operation, the quadriceps-hamstrings peak torque ratio reached more than 90% of the uninjured leg; posterior drawer test at 70? flexion were negative in all but two cases who had one-degree instability; posterior drawer test at 30? flexion were one degree positive in six cases, and negative in other cases; the Lysholm knee score were 90.7?2.3. Conclusion Arthroscopic reconstruction of PCL with hamstring tendons and mini-plate and button is relatively simple and reliable for the restoration of knee function.

Objective Of all the knee ligament,the anterior cruciate was totally disrupted the most frequently.Although a high degree of success and satisfactory results of replacement of anterior cruciate liga-ment with autograft tendon by arthroscopy were demonstrated,the objective of the investigation was to retro-spectively analyze miscellaneous pitfalls in anterior cruciate ligament reconstruction procedure and present its treatment.Methods Between January1995and June2002,consecutive194male and female patients between thirteen and fifty-eight years of age who sought treatment for a chronic tear of the anterior cruciate ligament were treated by arthroscopic assisted anterior cruciate ligament reconstruction.The time-interval between the index injury and the surgery was from1.5to37months.The diagnosis of anterior cruciate liga-ment injury was established by Lachman test,pivot-shift examination and MRI.The procedures included au-tograft bone-patellar tendon-bone replacement fixed with Kurosaka interference screws in75cases,allograft bone-patellar tendon-bone with Kurosaka interference screws in13cases,autograft bone-patellar tendon-bone fixed with Aesculap Endobutton suture plates in11cases,allograft bone-patellar tendon-bone with Aesculap Endobutton suture plates in6cases,hamstring autografts fixed by Aesculap Endobutton suture plate in89cases.Results There were39intraoperative pitfalls happened in36cases,in which2intraop-erative complications were unsalvageable.The causes of pitfalls could be classified into tunnel,graft materi-als,fixation and other problems.The most common pitfalls were the mistakes of position and direction of guide wires for bone tunnel occurred in8cases.The interference screw was loosened in2cases.Bending of the guide wire happened in3cases.Short and bifurcated of harvested grafts were the most common problem in reconstruction with hamstring autografts and Aesculap Endobutton suture plate technique.In the present,there were no complications of patellar fracture and breakage of reconstructive materials.Conclusion A deep knowledge and technique are necessary to determine and perform in anterior cruciate ligament recon-struction procedure,only if mastering the essentials of different anterior cruciate ligament reconstruction methods and handling flexibly,could an orthopedist cope with miscellaneous pitfalls rightly.

Objective To report our early experience for treatment of infected total knee arthroplasty (TKA) using antibiotic-loaded articulating cement spacer. Methods From June 2004 to April 2005, 5 patients with periprosthetic knee infection were treated with 2-stage reimplantation protocol. The study group included 1 male and 4 females, with average age of 67 years(range, 57-75 years). The initial procedure consisted of thorough debridement, removal of prosthesis and implantation of antibiotic-loaded articulating cement spacer. The postoperative course consisted of graduated knee motion and partial weight-bearing activity. Each patient received a 6-week course of organism-sensitive antibiotic therapy. The high restricted total knee prosthesis was reimplanted after infection controlled. Results 3 patients had a basic diagnosis of rheumatoid arthritis and two of them took steroid for a long time. The other two patients suffered from osteoarthritis before primary TKA were both with diabetes. Sinuses were emerged in all of 5 patients and blockage phenomenon was found in two of them. There were no cases of fracture, dislocation, or instability associated with articulating cement spacer. The average time between the two stages was 15 weeks. All 5 patients were able to ambulate with assistance and flex the knee without difficulty in the interval before reimplantation. The average knee flexion was 95? and the average knee society score(KSS) was 81 points. A mean ten months follow-up was evaluated after reimplantation. There were no recurrence, or new infections after reimplantation. Conclusion Infection after a TKA can be successfully managed with an antibiotic-loaded articulating cement spacer and knee motion can be preserved in the interval prior to implantation. The end result is effective treatment of infection and facilitation of reimplantation.