Assessing Continuous Epidural Infusion and Programmed Intermittent Epidural Bolus for Their Effectiveness in Providing Labor Analgesia: A Mono-Centric Retrospective Comparative Study.

Background and Objectives: Local anesthetics administered via epidural catheters have evolved from intermittent top-ups to simultaneous administration of continuous epidural infusion (CEI) and patient-controlled epidural analgesia (PCEA) using the same device. The latest programmed intermittent epidural bolus (PIEB) model is believed to create a wider and more even distribution of analgesia inside the epidural space. The switch from CEI + PCEA to PIEB + PCEA in our department began in 2018; however, we received conflicting feedback regarding workload from the quality assurance team. This study aimed to investigate the benefits and drawbacks of this conversion, including the differences in acute pain service (APS) staff workload, maternal satisfaction, side effects, and complications before and after the changeover. Materials and Methods: Items from the APS records included total delivery time, average local anesthetic dosage, and the formerly mentioned items. The incidence of side effects, the association between the duration of delivery and total dosage, and hourly medication usage in the time subgroups of the CEI and PIEB groups were compared. The staff workload incurred from rescue bolus injection, catheter adjustment, and dosage adjustment was also analyzed. Results: The final analysis included 214 and 272 cases of CEI + PCEA and PIEB + PCEA for labor analgesia, respectively. The total amount of medication and average hourly dosage were significantly lower in the PIEB + PCEA group. The incidences of dosage change, manual bolus, extra visits per patient, and lidocaine use for rescue bolus were greater in the PIEB + PCEA group, indicating an increased staff workload. However, the two groups did not differ in CS rates, labor time, maternal satisfaction, and side effects. Conclusions: This study revealed that while PIEB + PCEA maintained the advantage of decreasing total drug doses, it inadvertently increased the staff burden. Increased workload might be a consideration in clinical settings when choosing between different methods of PCEA.

Effect of Sulfonation Group on Polyaniline Copolymer Scaffolds for Tissue Engineering with Laminin Treatment under Electrical Stimulation.

Sulfonated copolyanilines (SPANs), SPAN-40 and SPAN-75, were prepared and applied in this tissue engineering study. SPAN scaffolds (SPANs) and control group polyaniline (PANI) were synthesized by performing oxidative polymerization. To further research the effects of neuron regeneration, PC12 cells were cultured on as-prepared PANI and SPANs with laminin (La) treatment under electrical stimulation. The effects on PC12 cell differentiation were investigated by controlling the amount of sulfonated groups (-SO3H) in the SPAN chain, the electrical stimulation voltage, and the presence or absence of La coating. The adhesion and proliferation of cells increased with the degree of sulfonation; La and electrical stimulation further promoted neuronal cell differentiation as increased neurite length was demonstrated in the micrograph analyses. In summary, the sulfonated copolyaniline coated with La had the best effect on neuronal differentiation under electrical stimulation, suggesting its potential as a substrate for nerve tissue engineering.

Association of General Anesthesia and Neuraxial Anesthesia in Caesarean Section with Maternal Postpartum Depression: A Retrospective Nationwide Population-Based Cohort Study.

Although cesarean section (CS) has become a common method of child delivery in recent decades, the choice between general anesthesia (GA) and neuraxial anesthesia (NA) for CS must be carefully considered. Depending on the type of anesthesia used in CS, a major outcome observed is the occurrence of postpartum depression (PPD). This study investigated the association between PPD risk and the anesthesia method used in CS by using data from three linked nationwide databases in Taiwan, namely, the National Health Insurance Research Database, the National Birth Reporting Database, and the National Death Index Database. After propensity score matching by baseline depressive disorders, maternal demographics, status at delivery, infant's health, maternal diseases during pregnancy, and age of partner, we included women who had natural births (n = 15,706), cesarean sections with GA (n = 15,706), and cesarean sections with NA (n = 15,706). A conditional logistic regression was used to estimate the odds ratios and 95% confidence intervals (CIs) of PPDs, including depression, sleep disorder, and medication with hypnotics or antidepressants, under anesthesia during CS. The prevalence rates of combined PPDs were 26.66%, 43.87%, and 36.30% in natural births, CS with GA, and CS with NA, respectively. In particular, the proportions of postpartum use of hypnotic drugs or antidepressants were 21.70%, 39.77%, and 31.84%, which were significantly different. The aORs (95% CIs) were 2.15 (2.05-2.25) for the included depressive disorders, 1.10 (1.00-1.21) for depression, 1.03 (0.96-1.11) for sleep disorder, and 2.38 (2.27-2.50) for medication with hypnotics or antidepressants in CS with GA compared with natural births. Women who underwent CS with GA had a significantly higher risk of depressive disorders and a higher need for antidepressants for sleep problems than those who underwent CS with NA. The risks of PPD were significantly associated with the anesthesia method, especially GA. Our results can assist physicians in carefully considering the appropriate anesthesia method for CS delivery, particularly with regard to postpartum drug abuse and drug safety.

Impact of Computed Tomography Scans on the Risk of Thyroid Disease in Minor Head Injury Patients: A Population-Based Retrospective Cohort Study.

We investigated the association between head computed tomography (CT) scans and the risk of noncancer thyroid diseases in patients with minor head injury in a Taiwanese healthcare setting. For this retrospective population-based cohort study, the 2009-2013 Longitudinal Health Insurance Database was used to include patients with a minor head injury at admission or emergency visit between 2009 and 2013. Multivariate analysis with a multiple Cox regression model was applied to analyze the data. According to whether a CT scan was conducted within 14 days of admission, patients were divided into a CT scan group (n = 14,041) or a non-CT scan group (n = 34,684). No increased incidence of thyroid diseases was observed in the CT scan group regardless of the number of CT scans performed. The incidence rate ratio for one scan was 1.10 (95% confidence interval: 0.94-1.29) and for two or more scans was 1.09 (95% confidence interval: 0.93-1.28). In conclusion, this population-based cohort study showed that a head CT scan is not associated with increased risk of thyroid disease in patients with minor head injury. The short-term adverse effects on the thyroid could be mild when a regular CT scan is appropriately performed.

Relationship between Energy Dosage and Apoptotic Cell Death by Modulated Electro-Hyperthermia.

Modulated electro-hyperthermia (mEHT) is a form of mild hyperthermia (HT) used for cancer treatment. The principle utility of HT is the ability not only to increase cell temperature, but also to increase blood flow and associated pO2 to the microenvironment. While investigational evidence has shown the unique ability of mEHT to elicit apoptosis in cancer cells, in vivo and in vitro, the same trait has not been observed with conventional HT. There is dissension as to what allows mEHT to elicit apoptosis despite heating to only mild temperatures, with the predominant opinion in favor of increased temperature at a cellular level as the driving force. For this study, we hypothesized that in addition to temperature, the amount of electrical energy delivered is a major factor in induction of apoptosis by mEHT. To evaluate the impact of electrical energy on apoptosis, we divided generally practiced mEHT treatment into 3 phases: Phase I (treatment start to 10 min. mark): escalation from 25 °C to 37 °C Phase II (10 min. mark to 15 min. mark): escalation from 37 °C to 42 °C Phase III (15 min. mark to 45 min. mark): maintenance at 42 °C Combinations of mEHT at 18 W power, mEHT at 7.5 W power, water bath, and incubator were applied to each of the three phases. Power output was recorded per second and calculated as average power per second. Total number of corresponding Joules emitted per each experiment was also recorded. The biological effect of apoptotic cell death was assayed by annexin-V assay. In group where mEHT was applied for all three phases, apoptosis rate was measured at 31.18 ± 1.47%. In group where mEHT was only applied in Phases II and III, apoptosis rate dropped to 20.2 ± 2.1%. Where mEHT was only applied in Phase III, apoptosis was 6.4 ± 1.7%. Interestingly, when mEHT was applied in Phases I and II, whether Phase III was conducted in either water bath at 42 °C or incubator at 37 °C, resulted in nearly identical apoptosis rates, 26 ± 4.4% and 25.9 ± 3.1%, respectively. These results showed that accumulation of mEHT at high-powered setting (18 W/sec) during temperature escalation (Phase I and Phase II), significantly increased apoptosis of tested cancer cells. The data also showed that whereas apoptosis rate was significantly increased during temperature escalation by higher power (18 W/sec), apoptosis was limited during temperature maintenance with lower power (7.5 W/sec). This presents that neither maintenance of 42 °C nor accumulation of Joules by mEHT has immediate correlating effect on apoptosis rate. These findings may offer a basis for direction of clinical application of mEHT treatment.

Blood-typing and irregular antibody screening through multi-channel microfluidic discs with surface antifouling modification.

A novel surface modification technology for microfluidic disks was developed for multichannel blood-typing detection and irregular antibody screening. The antifouling material, poly(ethylene glycol) methacrylate (PEGMA), was used to modify the surface of the microfluidic disk for improving its hydrophilicity and blood compatibility. With the modification of PEGMA, the hydrophilicity was sufficiently improved with a 44.5% reduction of water contact angle. The modified microfluidic disk also showed good biocompatibility with a reduction of hemolytic index (from 3.4% to 1.2%) and platelet adhesion (from 4.6 × 104/cm2 to 1.9 × 104/cm2). Furthermore, the PEGMA modification technique conducted on the microfluidic disk achieved successful adjustment of burst frequency for each chamber in the microchannel, allowing a sequential addiction of reagents in the test protocol of manual polybrene (MP) blood typing. Clinical studies showed that the proposed MP microfluidic disk method not only performed at extremely high consistency with the traditional tube method in the identification of ABO/RhD blood types, but also accomplished an effective screening method for detecting irregular antibodies. In conclusion, this study demonstrated that the easily mass-produced MP microfluidic disk exhibited good blood-typing sensitivity and was suitable for clinical applications.

Modulated electro-hyperthermia-enhanced liposomal drug uptake by cancer cells.

PURPOSE: Modulated electro-hyperthermia (mEHT) stands to be a significant technological advancement in the hyperthermia field, utilizing autofocusing electromagnetic power on the cell membrane to create massive apoptosis. Since mEHT possesses the unique ability to excite cell membranes, we hypothesized that mEHT could enhance the uptake of liposomal drugs by enhancing phagocytic activity. MATERIALS AND METHODS: Water bath control and mEHT were used to compare the enhancement of liposome-encapsulated doxorubicin (Lipodox®) uptake by cancer cells. Cancer cells were made visible by doxorubicin fluorescence to investigate drug uptake. Viable cell yield was determined via the Trypan Blue exclusion method. Various substrates were used to investigate the mechanism of drug-uptake enhancement. The murine colon carcinoma model, CT26, was used to confirm the tissue infiltration of Lipodox® and its therapeutic effect. RESULTS: mEHT treatment showed a significant enhancement of Lipodox® uptake of doxorubicin fluorescence compared with 37°C or 42°C water bath treatment. Tumor tissue sections also confirmed that mEHT treatment achieved the highest doxorubicin concentration in vivo (1.44±0.32 µg/g in mEHT group and 0.79±0.32 µg/g in 42°C water bath). Wortmannin was used to inhibit the macropinocytosis effect and 70 kDa dextran-FITC served as uptake substance. The uptake of dextran-FITC by cancer cells significantly increased after mEHT treatment whereas such enhancement was significantly inhibited by wortmannin. CONCLUSION: The result showed mEHT-induced particle-uptake through macropinocytosis. mEHT-enhanced uptake of Lipodox® may amplify the therapeutic effect of liposomal drugs. This novel finding warrants further clinical investigation.

Inhibitory Effect of Photodynamic Therapy with Indocyanine Green on Rat Smooth Muscle Cells.

BACKGROUND: Vascular smooth muscle cells play a critical role in the intimal hyperplasia of restenosis. A previous study of a rat balloon injury model demonstrated that photodynamic therapy (PDT) using indocyanine green (ICG) and near-infrared (NIR) light irradiation reduced intimal hyperplasia in carotid arteries. However, the effect of ICG-PDT on smooth muscle cells remains unclear. This study aimed to evaluate the effects of PDT with ICG and NIR irradiation on the viability of vascular smooth muscle (A-10) cells. METHODS: A-10 cells were incubated with ICG at different concentrations for different time intervals. Intracellular accumulation of ICG inside the cells was observed by light microscopy, ultraviolet-visible (UV-VIS) spectrophotometry and spectrofluorometry. Cell viability and cell death after ICG-PDT were assessed by 3-(4,5-dimethylthiazol-2-yl)- 2,5-diphenyltetrazolium bromide assay and lactate dehydrogenase release assay. Changes in nuclear morphology and cell cycle distribution were evaluated to determine the possible cell death mechanism mediated by ICG-PDT. RESULTS: ICG uptake in A-10 cells increased with the amount of ICG in the culture media. The intracellular accumulation of ICG reached a maximum at 8 h. After ICG-PDT, cell viability decreased and cell death increased in a concentration- dependent manner. The half maximal inhibitory concentration of ICG was 8.3 µM with 4 J/cm2 NIR irradiation. Membrane blebbing and chromatin condensation were observed, and the percentage of cells in the sub-G1 phase increased after ICG-PDT. Thus, apoptosis might be responsible for decreasing the viability of A-10 cells by ICG-PDT. CONCLUSIONS: This study demonstrated that ICG-PDT had an inhibitory effect on smooth muscle cells, possibly via an apoptosis pathway.

Photodynamic therapy of balloon-injured rat carotid arteries using indocyanine green.

Photodynamic therapy (PDT) has been used to inhibit intimal hyperplasia in injured arteries. Because of the limited tissue penetration of visible light, an endovascular light source with a guided wire is often required for effective treatment. Indocyanine green (ICG), a near-infrared (NIR) photosensitizer, has been used in PDT for cancers. An extracorporeal light source may be used for shallow tissue because of the better tissue penetration of NIR light. The aim of this study was to evaluate the effect of ICG-PDT using extracorporeal NIR light on the inhibition of intimal hyperplasia in balloon-injured carotid arteries. A balloon injury (BI) model was used to induce intimal hyperplasia of carotid artery. Sprague-Dawley rats were divided into control, BI, BI + 1 × PDT, and BI + 2 × PDT groups. The control group underwent a sham procedure. PDT was performed 7 days after BI. In the BI + 1 × PDT group, ICG was administered 1 h before light irradiation. External illumination with 780-nm light-emitting diode light at a fluence of 4 J/cm2 was applied. For the BI + 2 × PDT group, PDT was performed again at day 7, following the first PDT. Hematoxylin and eosin (H & E) staining was performed to assess vessel morphology. Arterial wall thickness was significantly larger in the BI group compared with the control group. ICG-PDT significantly reduced arterial wall thickness compared with the BI group. Repeated PDT further decreased arterial wall thickness to the level of the control group. These findings indicate a promising approach for the treatment of restenosis of carotid arteries.

Improving immunological tumor microenvironment using electro-hyperthermia followed by dendritic cell immunotherapy.

BACKGROUND: The treatment of intratumoral dentritic cells (DCs) commonly fails because it cannot evoke immunity in a poor tumor microenvironment (TME). Modulated electro-hyperthermia (mEHT, trade-name: oncothermia) represents a significant technological advancement in the hyperthermia field, allowing the autofocusing of electromagnetic power on a cell membrane to generate massive apoptosis. This approach turns local immunogenic cancer cell death (apoptosis) into a systemic anti-tumor immune response and may be implemented by treatment with intratumoral DCs. METHODS: The CT26 murine colorectal cancer model was used in this investigation. The inhibition of growth of the tumor and the systemic anti-tumor immune response were measured. The tumor was heated to a core temperature of 42 °C for 30 min. The matured synergetic DCs were intratumorally injected 24 h following mEHT was applied. RESULTS: mEHT induced significant apoptosis and enhanced the release of heat shock protein70 (Hsp70) in CT26 tumors. Treatment with mEHT-DCs significantly inhibited CT26 tumor growth, relative to DCs alone or mEHT alone. The secondary tumor protection effect upon rechallenging was observed in mice that were treated with mEHT-DCs. Immunohistochemical staining of CD45 and F4/80 revealed that mEHT-DC treatment increased the number of leukocytes and macrophages. Most interestingly, mEHT also induced infiltrations of eosinophil, which has recently been reported to be an orchestrator of a specific T cell response. Cytotoxic T cell assay and ELISpot assay revealed a tumor-specific T cell activity. CONCLUSIONS: This study demonstrated that mEHT induces tumor cell apoptosis and enhances the release of Hsp70 from heated tumor cells, unlike conventional hyperthermia. mEHT can create a favorable tumor microenvironment for an immunological chain reaction that improves the success rate of intratumoral DC immunotherapy.

Adjustable bioadhesive control of PEGylated hyperbranch brushes on polystyrene microplate interface for the improved sensitivity of human blood typing.

A PEGylated 96-well polystyrene (PS) microplate was first introduced for applications in high-throughput screening for selective blood typing to minimize the risks in blood transfusions. Herein, we present a hemocompatible PS 96-well microplate with adjustable PEGylated hyperbranch brush coverage prepared by ozone pretreated activation and thermally induced surface PEGylation. The grafting properties, hydration capacity, and blood compatibility of the PEGylated hyperbrush immobilized PS surfaces in human blood were illustrated by the combined chemical and physical properties of the surface, and the dependence of the specific absorption of human plasma fibrinogen onto the PEGylated surfaces on the grafting density was analyzed by monoclonal antibodies. The surface coverage of PEGylated brushes plays a major role in the bioadhesive properties of modified PS microplates, which in turn control the level of agglutination sensitivity in blood typing. The bioadhesive resistance toward proteins, platelets, and erythrocytes in human whole blood showed a correlation to the controlled hydration properties of the PEGylated hyperbrush-modified surfaces. Therefore, we suggested that the surface coverage of PEGylated hyperbrushes on PS surfaces can increase the sensitivity of cross-matching blood agglutination by up to 16-fold compared to that of the conventional 96-well virgin PS due to the regulated biorecognition of hematocrit and antibodies of the PEGylated hyperbrush-modified surfaces.

Effects of low level light irradiation on the migration of mesenchymal stem cells derived from rat bone marrow.

Low level light irradiation (LLLI) was found to exert positive effects on various cells in vitro. The aim of this study was to investigate the effect of LLLI on the migration of rat bone marrow mesenchymal stem cells (rbMSCs). Light irradiation was applied at the energy density of 4 J/cm(2) using red (630 nm) and near infrared (NIR, 850 nm) light emitting diodes (LEDs). Wound healing assay showed both red and NIR light irradiation increased cell mobility. Red and NIR light enhanced transmembrane migration of rbMSCs up to 292.9% and 263.6% accordingly. This agreed with enzymatic activities of MMP-2 and MMP-9 enhanced by irradiation. F-actin accumulation and distribution correlated to increased migration in light-irradiated MSCs. Reactive oxygen species production as well as the expression of pFAK and pNF-кB were elevated after red and NIR LLLI. The study demonstrated that red and NIR LLLI increased rbMSCs migration and identified the phosphorylation of FAK and NF-кB as critical steps for the elevated cell migration upon LLLI.

Modulation of osteogenic, adipogenic and myogenic differentiation of mesenchymal stem cells by submicron grooved topography.

Topographic cues have been recognized crucial on the modulation of cell behavior, and subsequent important for the design of implants, cell-based biomedical devices and tissue-engineered products. Grooved topography direct cells to align anisotropically on the substrates, resulting in an obvious morphological difference compared with the flat and the other topographies. This study aimed at investigating the effects of grooved topography on the differentiation of mesenchymal stem cells (MSCs) into osteoblasts, adipocytes and myoblasts. A series of submicron-grooved polystyrene substrates with equal groove-to-ridge ratio but different width and depth (width/depth (nm): 450/100, 450/350, 900/100, and 900/550) were fabricated based on electron beam lithography and soft lithography techniques. Primary rat MSCs (rMSCs) were cultured on these substrates without induction for differentiation for 6 days, and then subjected to induction for osteogenesis, adipogenesis and myogenesis. While the alignment of rMSCs strongly complied with the direction of the grooves and increased with groove depths, cell attachment on day 1 (~1.5 × 10(4)/cm(2)) and cell proliferation after 6 days of culture (~5 × 10(4)/cm(2)) were not significantly affected by substrate types. Osteogenesis, indicated by alkaline phosphatase activities and calcium deposit, was not significantly modulated by the grooved substrates, compared with the flat control, suggesting that cell alignment may not determine osteoinduction of rMSCs. On the other hand, adipogenesis, indicated by lipid production, was significantly enhanced by the grooved substrates compared with the flat surface (P < 0.001). On the other hand, myogenesis, indicated by desmin and MHC staining, was enhanced by the grooves in a time- and groove size-dependent manner compared with the flat control. The results suggested that grooved topography has an in-depth potential for modulating the commitment of the stem cell lineages, which could benefit the development of advanced biomaterials for biomedical applications.

RGD-conjugated UV-crosslinked chitosan scaffolds inoculated with mesenchymal stem cells for bone tissue engineering.

Biomimetic chitosan scaffolds were prepared using two types of chitosan derivatives, one containing photoreactive azides for UV-crosslinking and the other tethered with RGD peptides. Mesenchymal stem cells (MSCs) isolated from rat bone marrow were cultured in the RGD-conjugated, UV-crosslinked chitosan scaffolds for bone tissue engineering. RGD-incorporation to the chitosan-based scaffolds increased the cell contents from 2.4×10(4) to 3.8×10(4) cells/scaffold and 3.4×10(4) to 5.1×10(4) cells/scaffold after 1 and 10 days of culture, respectively. Furthermore, osteogenic differentiation of MSCs, indicated by ALP activity and expression of Runx2 and osteocalcin genes, was enhanced on the RGD-conjugated surface compared with the unmodified surfaces. After 14 days of osteogenic culture, calcium deposition in the RGD-conjugated scaffolds (711 nmol Ca/scaffold) was significantly higher than the control (390 nmol Ca/scaffold). The results demonstrate a potential application of RGD-immobilized, crosslinked chitosan scaffolds for bone tissue engineering applications.

Synthesis, in vitro macrophage response and detoxification of bamboo charcoal beads for purifying blood.

Bamboo charcoal beads (BCBs) were formed by coprecipitating bamboo charcoal particles with chitosan in alkaline solution. The amount of chitosan in the BCBs and their surface properties were measured. When 13-52 mg BCBs were exposed to RAW 264.7 macrophages, the amount of nitric oxide released and the cell viability were close to those of the blank. The amount of cytokine IL-6 secreted by macrophages did not depend on the dose of BCBs but macrophages secreted more TNF-alpha in response to higher doses of BCBs. However, the cytokine levels were relatively low, suggesting the favorable biocompatibility of BCBs. In adsorption experiments, BCBs adsorbed and released bovine serum albumin at particular concentrations, whereas BCBs adsorbed L-phenylalanine without a sign of release. This difference is attributed to the hydrophilicity and the pore size of the BCBs. Finally, the potential of BCBs as biocompatible adsorbents in blood detoxification is considered.

Red-light light-emitting diode irradiation increases the proliferation and osteogenic differentiation of rat bone marrow mesenchymal stem cells.

OBJECTIVE: The objective of this study was to investigate the effects on the proliferation and osteogenic differentiation of rat mesenchymal stem cells (MSCs) by using red-light light-emitting diode (LED) irradiation. BACKGROUND DATA: Low-level light irradiation (LLLI) has been shown to enhance proliferation and cytokine secretion of a number of cells. MSCs are capable of regenerating various mesenchymal tissues and are essential in supporting the growth and differentiation of hematopoietic stem cells within the bone marrow. MATERIALS AND METHODS: Rat bone marrow MSCs were treated with single or multiple doses of LLLI from an LED array (630 nm) at the irradiances of 5 and 15 mW/cm(2), and radiant exposures of 2 and 4 J/cm(2). The proliferation, clonogenic potential, and osteogenic differentiation of MSCs were evaluated after illumination. RESULTS: The growth of MSCs was enhanced by red-light LLLI, and the effect became more obvious at low cell density. A single dose of LLLI led only to a short-term increase in MSCs proliferation. A maximal increase in cell proliferation was observed with multiple exposures of LLLI at 15 mW/cm(2) and 4 J/cm(2). The number of colony-forming unit fibroblasts increased when cells were illuminated under the optimal parameter. During osteogenesis, significant increases (p < 0.01) in both alkaline phosphatase and osteocalcin expressions were found in the MSCs that received light irradiation. CONCLUSION: Our data demonstrated that MSCs proliferation was enhanced by multiple exposures to LLLI from 630-nm LEDs, and cell growth depended on the plating density. Furthermore, multiple dose of LLLI could enhance the osteogenic potential of rat MSCs.

Nanotechology-based strategies to enhance the efficacy of photodynamic therapy for cancers.

Photodynamic therapy (PDT) combines photosensitizer, visible light and oxygen, which has the characteristics of high selectivity, minimal invasiveness, low side effect, and allowing repetitive application. The photophysics and mechanisms leading to cell death mediated by PDT have been studied extensively, and PDT has been approved as the modality for superficial tumors and non-cancerous diseases worldwide. For non-dermatogoical applications, the photosensitizers are delivered systemically. Selective therapeutic effect against tumor tissues can be provided by the nature of drugs and tumor physiology. Improved targeting photosensitizer helps preventing damage to the surrounding healthy tissue and lowering dose of drugs and light. The use of nanotechnology in photosensitizer delivery is an attractive approach because nanomaterials may satisfy the need for enhancing PDT efficacy. Recent advances in the use of nanotechnology for PDT application include formulation of biodegradable and non-degradable nanoparticles as passive carriers for photosensitizing agents as well as synthesizing photosensitizer-specific target moiety conjugates for active targeting. This article focuses on passive and active targeting strategies involving nanotechnology to enhance PDT efficacy for cancers.

Effects of Meropack in the middle meatus after functional endoscopic sinus surgery in children with chronic sinusitis.

OBJECTIVES: The aim of the study was to evaluate the effects and morbidities of Meropack, an absorbable hyaluronic acid packing material, placed in the middle meatus after endoscopic sinus surgery in children with chronic sinusitis. METHODS: Sixty consecutive children with similar degrees of bilateral chronic sinusitis were enrolled in the study. Meropack was randomly inserted into one side of the middle meatus, while the opposite sinus was not packed after functional endoscopic sinus surgery. Patients were investigated 3, 8, and 12 weeks after surgery. The effects and morbidities of nasal dressings in the middle meatus were evaluated with respect to six distinct parameters: blood loss during surgery, postoperative hemorrhage, synechiae, granulation tissue, infection, and patency of the maxillary sinus ostia. RESULTS: Mean blood loss of packed and unpacked sinuses did not significantly differ (p > 0.05). Twenty-nine (15 packed, 14 unpacked) of the 120 sinuses underwent resection of the lateral wall of concha bullosa. Four of 14 unpacked sinuses had postoperative hemorrhaging, while the 15 packed sinuses did not (p < 0.05). The mean synechiae scores at the first follow-up visit for the Meropack filled and unpacked sinuses differed significantly (p < 0.05). For the 8- and 12-week follow-up visits, severity of adhesions, granulation tissue formation, infection rate, and patency of the maxillary sinus ostia did not differ significantly between the Meropack filled sinuses and the unpacked sinuses (p > 0.05 for all). CONCLUSION: Meropack dressings effectively prevented postoperative hemorrhage, but did not significantly reduced synechiae after endoscopic sinus surgery. Therefore, we recommend that Meropack packing is not necessary for routine use following pediatric functional endoscopic sinus surgery (FESS). However, it should be reserved for children who are predisposed to develop postoperative hemorrhages or adhesions, such as resection of the concha bullosa, traumatic surgery with the creation of large raw surfaces on the middle turbinate, and revision surgery with preexisting adhesions.

Clinical effects of far-infrared therapy in patients with allergic rhinitis.

Allergic rhinitis (AR) is the sixth most common chronic illness worldwide, which has a significant impact on patients' quality of life. The actual cost of AR is staggering, approximately $5.6 billion being spent annually in direct medical costs and other indirect costs. Therefore, it should be taken seriously upon its evaluation and treatment. AR is an IgE-mediated inflammation, which symptoms are likely due to increased vascular permeability. Current therapeutic options such as avoidance of allergen, medication and immunotherapy are unsatisfactory. Far-infrared (FIR) is an invisible electromagnetic wave with a wavelength longer than that of visible light. It has been used to treat vascular diseases as a result of an increase in blood flow. The objective of this study was to evaluate the clinical effects of FIR therapy in patients with AR. Thirty-one patients with AR were enrolled in this study. A WS TY101 FIR emitter was placed to face the patient's nasal region at a distance of 30 cm. The treatment was performed for 40 min every morning for 7 days. Every day, patients recorded their symptoms in a diary before and during treatment. Each symptom of rhinitis was rated on a 4-point scale (0-3) according to severity. During the period of FIR therapy, the symptoms of eye itching, nasal itching, nasal stuffiness, rhinorrhea and sneezing were all significantly improved. Smell impairment was not improved until after the last treatment. No obvious adverse effect was observed in the patients during treatment and follow-up. We concluded that FIR therapy could improve the symptoms of AR and might serve as a novel treatment modality for AR.

Effects of low level red-light irradiation on the proliferation of mesenchymal stem cells derived from rat bone marrow.

Mesenchymal stem cells (MSCs) are capable of regenerating various mesenchymal tissues and are essential in supporting the growth and differentiation of hematopoietic stem cells within the bone marrow microenvironment in vivo. To achieve clinically meaningful numbers of cells, many approaches have been used to maintain the differentiation potentialities and expand enough cells for clinical treatments. Previously, we have reported that low level light irradiation (LLLI) using 630 nm light emitting diodes (LEDs) could enhance replicative and colony formation potentials of MSCs derived from human bone marrow. The purpose was to study the effect on the proliferation of MSCs derived from the rat bone marrow by red light LLLI (630 nm) under different parameters of irradiation. The irradiance used was 5, 10 or 15 mW/cm2, and the radiant exposure was 2 or 4 J/cm2. Rat MSCs were irradiated at room temperature with single and multiple exposures. The results showed that the proliferation of MSCs plated at the low density (100 cells/well) and high density (1000 cells/well) was enhanced by multiple exposures of red-light LED treatment. The rate of proliferation of MSCs plated at the high density was not as high as those plated at the low density. The optimal parameter for LLLI was at irradiance of 15 mW/cm2, and radiant exposure of 4 J/cm2. The effect on the proliferation of cells by single dose irradiation was temporary. Multiple stimuli may be necessary for the enhancement of cell growth.