摘要：Insulin is widely used in treating diabetes, but still needs to be administered by needle injection. This study investigated a new needle-free approach for insulin delivery. A portable powder needleless injection（PNI） device with an automatic mechanical unit was designed. Its efficiency in delivering insulin was evaluated in alloxan-induced diabetic rabbits. The skin irritation caused by the device was investigated and the results were analyzed in relation to aerodynamic parameters. Inorganic salt-carried insulin powders had hypoglycemic effects, while raw insulin powders were not effective when delivered by PNI, indicating that salt carriers play an important role in the delivery of insulin via PNI. The relative delivery efficiency of phosphate-carried insulin powder using the PNI device was 72.25%. A safety assessment test showed that three key factors（gas pressure, cylinder volume, and nozzle distance） were related to the amount of skin irritation caused by the PNI device. Optimized injection conditions caused minimal skin lesions and are safe to use in practice. The results suggest that PNI has promising prospects as a novel technology for delivering insulin and other biological drugs.

摘要：自2019年12月新型冠状病毒肺炎(Coronavirus Disease 2019, COVID-19)暴发以来,已有大量相关临床研究完成注册或已启动。然而,不同研究间临床结局指标存在显著的异质性,同时一些不关键的指标会造成研究资源的浪费。本研究旨在构建COVID-19临床试验核心结局指标集(core outcome set, COS),为相关临床研究方案设计、开展和证据转化提供参考。本研究的实施参照《有效性试验核心结局指标(COMET)手册》(1.0版),研究组成员包括呼吸系统和危重医学、中医学、循证医学、临床药理学、统计学专家以及医学杂志编辑等。通过检索临床试验注册网站(***和***)中COVID-19相关临床研究方案,提取方案中的结局指标,形成指标池。78个COVID-19临床试验方案纳入研究,收集结局指标259个,合并规范后确定132个结局指标,涉及7个指标域。经遴选,形成了包括58个结局指标在内的初始指标清单。经过两轮德尔菲调查和一轮共识会议,最终确立针对COVID-19不同临床分型的核心指标集(COS-COVID)。COS-COVID包括1个轻型指标(病毒核酸检测转阴时间)、4个普通型指标(住院时间、复合事件发生率、临床症状积分和病毒核酸检测转阴时间)、5个重型指标(复合事件发生率、住院时间、PaO2/FiO2、机械通气时间和病毒核酸检测转阴时间)、1个危重型指标(全因死亡率)及1个康复期指标(肺功能)。COS-COVID作为目前临床评价COVID-19干预效果最具临床价值及操作性的指标集合,对证据评估和决策具有重要意义。随着对疾病认知的不断深入和COS-COVID应用的反馈,课题组将对本核心指标集进行进一步完善并更新。

摘要：Objectives Even though guidelines are available to guide dysphagia identification and management practice,there is still a gap between evidence and practice,which requires *** purpose of this study was to determine the effect of using tailored,multifaceted strategies to improve evidence-based post-stroke dysphagia identification and management practice in a community *** Guided by the Knowledge to Action framework,the tailored,multifaceted strategies were developed and implemented for 5 months in a community hospital using a before-and-after study *** strategies consisted of training intervention,policy intervention,and audit and feedback ***’level of knowledge and adherence,were collected in March 2019 and again in January ***’quality of life and satisfaction were evaluated during the pre-intervention period(between February 2019 and April 2019)and the post-intervention period(between November 2019 and January 2020).Results A total of 55 patients with post-stroke dysphagia(28 in the pre-intervention period and 27 in the post-intervention period)and 17 registered nurses were *** implementation,there were statistically significant improvements in patients’outcomes(quality of life and satisfaction)and nurses’outcomes(level of knowledge and adherence).Conclusions This study assists in closing the research-practice gap by using tailored,multifaceted strategies to increase the use of evidence-based nursing care for dysphagia identification and management practices.

摘要：Atrial fibrillation is an “invisible killer” of human health. It often induces high-risk diseases, such as myocardial infarction, stroke, and heart failure. Fortunately, atrial fibrillation can be diagnosed and treated early. Low-level vagus nerve stimulation(LL-VNS) is a promising therapeutic method for atrial fibrillation. However, some fundamental challenges still need to be overcome in terms of flexibility,miniaturization, and long-term service of bioelectric stimulation devices. Here, we designed a closedloop self-powered LL-VNS system that can monitor the patient’s pulse wave status in real time and conduct stimulation impulses automatically during the development of atrial fibrillation. The implant is a hybrid nanogenerator(H-NG), which is flexible, light weight, and simple, even without electronic circuits,components, and batteries. The maximum output of the H-NG was 14.8 V and 17.8 μA(peak to peak). In the in vivo effect verification study, the atrial fibrillation duration significantly decreased by 90% after LLVNS therapy, and myocardial fibrosis and atrial connexin levels were effectively improved. Notably, the anti-inflammatory effect triggered by mediating the NF-κB and AP-1 pathways in our therapeutic system is observed. Overall, this implantable bioelectronic device is expected to be used for self-powerability,intelligentization, portability for management, and therapy of chronic diseases.

摘要：Objective： To systematically assess the effect of traditional chinese medicine washing （TCM washing） combined withmassage for the treatment of neonatal *** and analysis： Databases, including PubMed, the Cochrane Library, Embase, Web of Science, the chineseBiomedical Literature Database （CBM）, CNKI, and Wanfang Data were electronically searched for randomizedcontrolled trials （from inception to July 2017）. The methodological qualities of included trials were evaluated by theCochrane risk of bias assessment tool. The meta-analysis was performed by using RevMan 5.3 ***： Overall, thirteen trials with a total of 1998 participants were included. The results of meta-analysis indicatedthat TCM washing combined with massage group was significantly superior to the control group in the first meconiumtime （MD, -16.67; 95% CI, -24.59 to -8.74; P〈0.001）, time for transformation of meconium （MD, -15.44; 95% CI,-23.59 to -7.28; P〈0.001）, transcutaneous bilirubin index changes [after treating three days （MD, -1.99; 95% CI, -2.57 to-1.40; P〈0.001）, after treating four days （MD, -1.86; 95% CI, -2.77 to -0.95; P〈0.001）, after treating five days （MD,-2.44; 95% CI, -3.47 to -1.42; P〈0.001）, after treating six days （MD, -2.23; 95% CI, -3.30 to -1.16; P〈0.001）, and thechanges of serum bilirubin levels [after treating five days （MD, -3.17; 95% CI, -5.83 to -0.50; P=0.02）, after treating sixdays （MD, -1.63; 95% CI, -3.10 to -0.16; P=0.03）, after treating fifteen days （MD,-1.20; 95% CI, -1.99 to -0.41; P=0.003）.Conclusions： TCM washing combined with massage may be an effective therapy for the treatment of neonatal *** can accelerate the excretion of meconium, shorten the time for transformation of meconium, and decreasetranscutaneous bilirubin index and the level of serum bilirubin. But it should be careful to interpreting these ***-designed RCTs are needed to further clarify the conclusion.