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Lu Zhu,1,&ast; Jing Li,1,&ast; Zhao-Qin Wang,1,2,&ast; Yun-Jia Gu,1 Guo-Na Li,3 Wen-Jia Wang,1 Guang-Bin Pen,1 Qi Li,1 Meng-Die Wu,1 Hui-Rong Liu,1,2 Yan Huang,1,2 Lu-Yi Wu1 1Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China; 2Shanghai Research Institute of Acupuncture and Meridian, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China; 3School of Acupuncture, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Lu-Yi Wu, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, No. 110 Ganhe Road, Hongkou District, Shanghai City, 200437, People’s Republic of China, Email luyitcm@163.com Yan Huang, Shanghai Research Institute of Acupuncture and Meridian, Shanghai University of Traditional Chinese Medicine, No. 650 Wanping South Road, Xuhui District, Shanghai City, 200030, People’s Republic of China, Email huangyan@shutcm.edu.cnObjective: Moderate-to-severe pain is the most common clinical symptom in patients with hepatocellular carcinoma (HCC).This trial aimed to analyze the clinical efficacy of Transcutaneous electrical acupoint stimulation (TEAS) in patients of HCC with severe pain and provide a reliable reference for optimizing the clinical diagnostic and therapeutic strategies of HCC.Methods: A total of 104 eligible patients were randomly allocated to experimental and control groups in a ratio of 1:1.The treatment was administered for 1 week continuously. Patients in both groups were followed up 1 week after the end of the treatment.The primary outcome measure was the Numerical Rating Scale (NRS) score, whereas the secondary outcome measures included Brief Pain Inventory BPI-Q3, Q4, Q5 scores, analgesic dose, frequency of opioid-induced gastrointestinal side effects, Karnofsky Performance Status (KPS), Quality of Life Scale - Liver Cancer (QOL-LC), and Brief Fatigue Inventory (BFI) scores.Results: The NRS scores of experimental group was significantly lower after treatment and at the follow-up than baseline (average P< 0.01), there were also statistical differences between the groups at the above time points (average P< 0.01). BPI-Q3, -Q4, and -Q5 scores in the experimental group were decreased after treatment when compared with those before treatment (average P< 0.01). Furthermore, there were significant improvements of gastrointestinal side effects, KPS, QOL-LC and BPI in the experimental group after treatment, and the above results were statistically significant compared to the control group.Conclusion: 7-day TEAS treatment can significantly enhance the analgesic effect and maintain for the following week, also reduce the incidence of gastrointestinal side effects caused by opioids, and improve the quality of life of patients with moderate-to-severe HCC-related pain, which has reliable safety and certain clinical promotion value.Keywords: hepatocellular carcinoma pain, transcutaneous electrical acupoint stimulation, cancer pain, randomized controlled trial

Yan-Juan Gu1,2,*, Jinping Cheng2,*, Jiefu Jin3, Shuk Han Cheng2, Wing-Tak Wong11Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, 2Department of Biology and Chemistry, The City University of Hong Kong, 3Department of Chemistry, The University of Hong Kong, Hong Kong, China*These authors contributed equally to this workAbstract: Single-walled carbon nanotubes (SWNTs) have been identified as an efficient drug carrier. Here a controlled drug-delivery system based on SWNTs coated with doxorubicin (DOX) through hydrazone bonds was developed, because the hydrazone bond is more sensitive to tumor microenvironments than other covalent linkers. The SWNTs were firstly stabilized with polyethylene glycol (H2N-PEG-NH2). Hydrazinobenzoic acid (HBA) was then covalently attached on SWNTs via carbodiimide-activated coupling reaction to form hydrazine-modified SWNTs. The anticancer drug DOX was conjugated to the HBA segments of SWNT using hydrazine as the linker. The resulting hydrazone bonds formed between the DOX molecules and the HBA segments of SWNTs are acid cleavable, thereby providing a strong pH-responsive drug release, which may facilitate effective DOX release near the acidic tumor microenvironment and thus reduce its overall systemic toxicity. The DOX-loaded SWNTs were efficiently taken up by HepG2 tumor cells, and DOX was released intracellularly, as revealed by MTT assay and confocal microscope observations. Compared with SWNT-DOX conjugate formed by supramolecular interaction, the SWNT-HBA-DOX featured high weight loading and prolonged release of DOX, and thus improved its cytotoxicity against cancer cells. This study suggests that while SWNTs have great potential as a drug carrier, the efficient formulation strategy requires further study.Keywords: carbon nanotubes, drug delivery, controlled release, SWNTs

Jinping Cheng1*, Yan-Juan Gu2*, Yajun Wang3, Shuk Han Cheng1, Wing-Tak Wong21Department of Biology and Chemistry, The City University of Hong Kong, Kowloon, 2Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hung Hom, Kowloon, 3Department of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, People's Republic of China *These authors contributed equally to this work Background: Carbon nanotubes have shown broad potential in biomedical applications, given their unique mechanical, optical, and chemical properties. In this pilot study, carbon nanotubes have been explored as multimodal drug delivery vectors that facilitate antiangiogenic therapy in zebrafish embryos. Methods: Three different agents, ie, an antiangiogenic binding site (cyclic arginine-glycine-aspartic acid), an antiangiogenic drug (thalidomide), and a tracking dye (rhodamine), were conjugated onto single-walled carbon nanotubes (SWCNT). The biodistribution, efficacy, and biocompatibility of these triple functionalized SWCNT were tested in mammalian cells and validated in transparent zebrafish embryos. Results: Accumulation of SWCNT-associated nanoconjugates in blastoderm cells facilitated drug delivery applications. Mammalian cell xenograft assays demonstrated that these antiangiogenic SWCNT nanoconjugates specifically inhibited ectopic angiogenesis in the engrafted zebrafish embryos. Conclusion: This study highlights the potential of using SWCNT for generating efficient nanotherapeutics. Keywords: carbon nanotubes, drug delivery, antiangiogenic therapy

Objective: To investigate the stability and three-dimensional movements of the atlantoaxial joint after artificial atlanto-odontoid joint (AAOJ) arthroplasty by comparing with a conventional method.Methods: After anterior decompression, 24 human cadaveric spinal specimens of C0-C3 were randomly divided into two groups: Group A receiving artificial AAOJ arthroplasty; Group B experiencing anterior transarticular screw (ATAS) fixation. Two groups underwent flexibility test in intact and instrumented states. Rotational angle of the C0-C3 segments was measured to study the immediate stability and function of anterior decompression with AAOJ arthroplasty compared with the intact state and ATAS fixation.Results: Compared with the intact state, anterior decompression with AAOJ arthroplasty resulted in a significant decrease in the range of motion (ROM) and neutral zone (NZ) during flexion, extension and lateral bending (P less than 0.05); however, with regard to axial rotation, there was no significant difference in ROM and NZ (P larger than 0.05). Compared with anterior decompression with ATAS fixation, anterior decompression with AAOJ arthroplasty during flexion, extension and lateral bending, significant difference was found in ROM and NZ (P larger than 0.05); however, as for axial rotation, there was a significant increase in ROM and NZ (P less than 0.05).Conclusion: The self-designed AAOJ has an excellent biomechanical performance, which can restore excellent instant stability and preserve the movement of the atlantoaxial joint. [ABSTRACT FROM AUTHOR]

Objective: To get morphologic parameters of Chinese adults through observation and measurement on axial laminas, to evaluate the feasibility of placing axial laminar screws and to introduce the technique.Methods: Relative parameters of 28 sets of fresh Chinese adults'axial specimens, including distance from the superior and inferior entry points of axial laminar screws to the superior margins of axial laminas, superior, middle, inferior thickness and height of the axial laminas, length and angle of the axial laminar screw trajectories, distance from the entry points of axial laminar screws to the transverse foramen and central points of the inferior articular process, were measured with a digital caliper and a goniometer. Data were statistically analyzed.Results: Averagely, distance from the superior and inferior entry points of axial laminar screws to the superior margins of axial laminas was 5 mm and 9 mm, superior, middle, inferior thickness and the height of the axial laminas were 3.2 mm, 6.7 mm, 5.5 mm and 12.8 mm respectively, and the length of the superior and inferior axial laminar screw trajectories was 26.2 mm and 25.5 mm, respectively.Conclusions: It is feasible and reliable to apply posterior laminar screw fixation techniques to the axes of Chinese adults. Also the C2 laminar screw fixation technique can be taken as a supplementary to conventional posterior screw fixations of C2. [ABSTRACT FROM AUTHOR]

Cardiopulmonary bypass (CPB) leads to a generalized inflammatory reaction, resulting in increased postoperative leucocyte counts and decreased pulmonary function. In adults, removal of leucocytes from the residual heart-lung machine blood after CPB improved postoperative oxygenation. In children, however, the clinical effects of leucocyte filtration of the residual heart-lung machine blood are unknown. Therefore, we measured postoperative leucocyte counts and arterial blood oxygenation in children undergoing congenital cardiac surgery in a randomized prospective study. Anaesthesia and CPB were standardized. After CPB, the residual heart-lung machine blood was collected as usual. In a group of 25 children, this blood was filtered with a leucocyte depletion filter before transfusion. A control group of 25 children received this blood unfiltered. We found that the postoperative leucocyte counts were significantly lower in the filter group than in the control group (p = 0.02, repeated measurements ANOVA). This difference reached a maximum on the second postoperative day (12.9 x 10(9)/L filter versus 15.9 x 10(9)/L control, p = 0.02, Student's t-test). Values for the arterial blood oxygenation on the first postoperative day were not different between the two groups (15.5 +/- 1 kPa filter versus 14.6 +/- 1.3 kPa control, p = 0.57, Student's t-test). We conclude that leucocyte filtration of the residual heart-lung machine blood reduced systemic leucocyte counts, but did not improve arterial blood oxygenation in children after congenital heart surgery. [ABSTRACT FROM AUTHOR]

Improved filter technology may enable the removal of specific substances such as lipids from the blood. Lipids form a heterogeneous group of compounds, but during surgery, the main interest is focussed on triglycerides, glycerol and free fatty acids. Fat emboli have been demonstrated in the brain after cardiac surgery and are associated with ischaemic brain injury. Fat emboli have also been demonstrated in lung and kidney tissue. Lung tissue and leucocytes are especially vulnerable to the effects of free fatty acids. The surgical wound suction blood during cardiac surgery contains a considerable quantity of microemboli. Therefore, as a first step to determining the place of fat filtration during cardiac surgery, the use of a fat removal filter for surgical wound suction blood is advocated. [ABSTRACT FROM AUTHOR]

The method of leucocyte depletion has been recently introduced to the field of cardiopulmonary bypass to reduce leucocyte-mediated organ dysfunction. In this study, we evaluated the efficacy and biocompatibility of the Pall RC400 filters for leucocyte depletion of heparinized cardiopulmonary bypass (CPB) perfusate taken from the heart-lung machine during routine cardiac surgery. For each filter, 700 ml blood were used as filtrate. Filtration was divided into the following groups to study the effect of loading pressure on the efficacy of the filters: under gravity pressure as a control (n = 8), under 100 mmHg (n = 8), 200 mmHg (n = 8), and 300 mmHg loading pressure (n = 8) driven by a roller pump. In addition, heparinized predonation blood taken at the beginning of CPB (n = 8) was filtered under gravity in comparison with the perfusate taken at the end of CPB. The results showed that the average leucocyte removal rate by an RC400 filter for 700 ml of blood was 96.8%. There was no significant difference of leucocyte removal rate between filtration under gravity and under loading pressure up to 300 mmHg. This allows clinical filtration at a speed up to 500 ml/min. The platelet removal rate was significantly higher in blood taken at the beginning of CPB than in blood taken at the end of CPB. Complement split product, C5a, increased only slightly during filtration indicating that this filter, made from polyester, has a good blood compatible characteristic. We conclude that the Pall RC400 leucocyte removal filter is suitable and safe to be used for leucocyte filtration of heparinized CPB perfusate during cardiac surgery. [ABSTRACT FROM AUTHOR]

Surface treatment of a cardiopulmonary bypass circuit with heparin improves its haemocompatibility. However, potential side effects of this layer of heparin are impairment of O2 transfer and CO2 transfer in the oxygenator and heat transfer in the heat exchanger.Therefore we studied these side effects during extracorporeal circulation with moderate hypothermia in 30 patients who underwent elective coronary artery bypass grafting surgery. All patients were heparinized systemically. In 15 patients (Duraflo II-group) we used an extracorporeal circuit (including a Bentley Bos-CM50 membrane oxygenator) which was treated with heparin. The results of this group were compared with those obtained from another group of 15 patients (control-group), who were operated upon with an identical extracorporeal circuit but without heparin surface treatment.We found no significant differences between the two groups in O2 transfer, CO2 transfer or heat transfer during normothermia or hypothermia.We concluded that neither O2 transfer and CO2 transfer of the oxygenator nor heat transfer of the heat exchanger were impaired by Duraflo II heparin surface treatment during clinical cardiopulmonary bypass with moderate hypothermia. [ABSTRACT FROM PUBLISHER]

This clinical study was performed to evaluate the inhibiting effects of heparin- coated extracorporeal circuits on thrombin formation during cardiopulmonary bypass (CPB). Thirty patients undergoing coronary artery bypass grafting were randomly divided into two groups with (Duraflo II, n=15) orwithout (control, n=15) the use of heparin-coated circuits. Standard systemic heparinization was performed in all the patients before CPB. The results showed that thrombin formation during the first phase of CPB was inhibited by heparin-coating identified by the significantly lower concentrations of thrombin-antithrombin III (TAT) complex formed in plasma in the Duraflo II group than in the control group (p <0.05). Heparin concentrations were higher in the Duraflo II group than in the control group at the end of CPB (p <0.05). However, after release of the aortic crossclamp in the second phase of CPB, thrombin became strongly activated in both the Duraflo II and the control groups indicated by a sharp increase of TAT complex as well as fibrinopeptide A. Thus, Duraflo II heparin-coating reduces thrombin formation in the early phase of CPB, however, this beneficial effect was counteracted after aortic crossclamp release by material-independent stimuli. Therefore, adequate systemic heparinization is still required despite improved haemocompatibility of the circuits offered by heparin-coating. [ABSTRACT FROM PUBLISHER]