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BACKGROUND: Public health guidelines have recommended that elective medical procedures, including deep brain stimulation (DBS) surgery for Parkinson's disease (PD), should not be scheduled during the coronavirus (COVID-19) pandemic to prevent further virus spread and overload on health care systems. However, delaying DBS surgery for PD may not be in the best interest of individual patients and is not called for in regions where virus spread is under control and inpatient facilities are not overloaded. METHODS: We administered a newly developed phone questionnaire to 20 consecutive patients with PD who received DBS surgery in Ruijin Hospital in Shanghai during the COVID-19 pandemic. The questionnaire was designed to gather the patients' experiences and perceptions on the impact of COVID-19 on their everyday activities and access to medical care. RESULTS: Most of the patients felt confident about the preventive measures taken by the government and hospitals, and they have changed their daily living activities accordingly. Moreover, a large majority of patients felt confident obtaining access to regular and COVID-19-related health care services if needed. Routine clinical referral, sense of security in the hospital during the outbreak, and poor control of PD symptoms were the three main reasons given by patients for seeking DBS surgery during the COVID-19 pandemic. CONCLUSION: The COVID-19 pandemic has considerably impacted medical care and patients' lives but elective procedures, such as DBS surgery for PD, do not need to be rescheduled when the health care system is not overloaded and adequate public health regulations are in place.

Li Deng,1,* Yingying Zhang,1,* Lulu Ma,1,5,* Xiaolong Jing,1,3 Xingfa Ke,1,3 Jianhao Lian,1,3 Qiang Zhao,1,3 Bo Yan,1,3 Jinfeng Zhang,4 Jianzhong Yao,2 Jianming Chen1 1Department of Pharmaceutical Science, 2Department of Medicinal Chemistry, School of Pharmacy, Second Military Medical University, Shanghai, People's Republic of China; 3Department of Pharmacy, Fujian University of Traditional Chinese Medicine, Fujian, People's Republic of China; 4Shanghai TCM Integrated Hospital, Shanghai, People's Republic of China; 5Department of Pharmacy, First Affiliated Hospital of Bengbu Medical College, Bengbu, People's Republic of China *These authors contributed equally to this paper Background: Targeted liposome-polycation-DNA complex (LPD), mainly conjugated with antibodies using functionalized PEG derivatives, is an effective nanovector for systemic delivery of small interference RNA (siRNA). However, there are few studies reporting the effect of different conjugation linkers on LPD for gene silencing. To clarify the influence of antibody conjugation linkers on LPD, we prepared two different immunoliposomes to deliver siRNA in which DSPE-PEG-COOH and DSPE-PEG-MAL, the commonly used PEG derivative linkers, were used to conjugate anti-EGFR Fab' with the liposome. Methods: First, 600 µg of anti-EGFR Fab' was conjugated with 28.35 µL of a micelle solution containing DSPE-PEG-MAL or DSPE-PEG-COOH, and then post inserted into the prepared LPD. Various liposome parameters, including particle size, zeta potential, stability, and encapsulation efficiency were evaluated, and the targeting ability and gene silencing activity of TLPD-FPC (DSPE-PEG-COOH conjugated with Fab') was compared with that of TLPD-FPM (DSPE-PEG-MAL conjugated with Fab') in SMMC-7721 hepatocellular carcinoma cells. Results: There was no significant difference in particle size between the two TLPDs, but the zeta potential was significantly different. Further, although there was no significant difference in siRNA encapsulation efficiency, cell viability, or serum stability between TLPD-FPM and TLPD-FPC, cellular uptake of TLPD-FPM was significantly greater than that of TLPD-FPC in EGFR-overexpressing SMMC-7721 cells. The luciferase gene silencing efficiency of TLPD-FPM was approximately three-fold high than that of TLPD-FPC. Conclusion: Different conjugation linkers whereby antibodies are conjugated with LPD can affect the physicochemical properties of LPD and antibody conjugation efficiency, thus directly affecting the gene silencing effect of TLPD. Immunoliposomes prepared by DSPE-PEG-MAL conjugation with anti-EGFR Fab' are more effective than TLPD containing DSPE-PEG-COOH in targeting hepatocellular carcinoma cells for siRNA delivery. Keywords: liposome-polycation-DNA, anti-EGFR Fab', immunoliposomes, small interfering RNA delivery, conjugation technology, hepatocellular carcinoma