ObjectiveTo explore the process and guidelines for ethical review in decentralized drug clinical trials， promote clinical trial progress， and ensure drug development progress. MethodsThe key points of the ethical review were summarized by studying the relevant laws and regulations on decentralized drug clinical trials， analyzing the advantages and challenges of decentralized drug clinical trials， and combining the experience of the ethics committee of the institution in reviewing decentralized drug clinical trials. ResultsRelevant laws and regulations were the basis for the ethical review， and the ethics committee should adopt appropriate review methods based on regulations and hospital ethical standard operating procedures. The ethics committee should focus on the feasibility， applicability， and rationality， the adequacy of informed consent， the protection of rights and interests and privacy of subjects， as well as the qualification and standard operating procedures of electronic platforms for conducting decentralized drug clinical trials. ConclusionDecentralized drug clinical trials are in their early stages and urgently require guidance from relevant laws and regulations. Ethical review is also constantly being refined through exploration. It is necessary to supervise the implementation of responsibilities by all parties， pay attention to the rights and interests of subjects， and gradually promote the implementation of decentralized drug clinical trials.

The aim of this study is to investigate the inhibitory effects and mechanism of three or-ganic acids,including formic acid(FA),butyric acid(BA)and lactic acid(LA),on the pathogenic-ity of Salmonella enteritidis(SE),Escherichia coli(EC)and Staphylococcus aureus(SA).The growth of pathogens was detected by Minimum Inhibitory Concentration(MIC)and Oxford Cup antimicrobial zone assays.The motility of pathogens was detected by soft agar plate method,and the biofilm of pathogens was detected by crystal violet staining.Quantitative real-time polymerase chain reaction(qRT-PCR)was used to measure the expression levels of genes related to the patho-genicity of SE.The results showed that FA and BA significantly inhibited the growth of SE,EC and SA,and FA had a superior inhibitory effect on EC(MIC:0.25 g/L;inhibition zone:20.0 mm)and SA(MIC:0.5 g/L;inhibition zone:25.0 mm).In addition,the three organic acids significantly inhibited the motility of SE,EC and SA as accessed by swimming and swarming assays,and FA showed the best inhibition effect.Besides,the three organic acids,especially FA,markedly inhibited the biofilm formation of SE,EC and SA.Finally,our results showed that the three organic acids in-hibited the expression of the main virulence genes encoded by SPI-1(InvA,InvF,SopE,SopB,SipB,HilA and SipA),SPI-2(SopD2),pili-related genes(FliF,LpfA,SefA and FimF)and flagellum-related genes(FlhD,FliC and FliD)of SE.This study demonstrates that FA,BA,and LA significantly inhibited the growth and pathogenicity of the four pathogens,among which FA showed the most obvious effect on inhibiting the growth,motility,biofilm formation and virulence gene expression.Our study provided a theoretical basis for the application of organic acids in the field of animal husbandry.

The aim of this study is to investigate the inhibitory effects and mechanism of three or-ganic acids,including formic acid(FA),butyric acid(BA)and lactic acid(LA),on the pathogenic-ity of Salmonella enteritidis(SE),Escherichia coli(EC)and Staphylococcus aureus(SA).The growth of pathogens was detected by Minimum Inhibitory Concentration(MIC)and Oxford Cup antimicrobial zone assays.The motility of pathogens was detected by soft agar plate method,and the biofilm of pathogens was detected by crystal violet staining.Quantitative real-time polymerase chain reaction(qRT-PCR)was used to measure the expression levels of genes related to the patho-genicity of SE.The results showed that FA and BA significantly inhibited the growth of SE,EC and SA,and FA had a superior inhibitory effect on EC(MIC:0.25 g/L;inhibition zone:20.0 mm)and SA(MIC:0.5 g/L;inhibition zone:25.0 mm).In addition,the three organic acids significantly inhibited the motility of SE,EC and SA as accessed by swimming and swarming assays,and FA showed the best inhibition effect.Besides,the three organic acids,especially FA,markedly inhibited the biofilm formation of SE,EC and SA.Finally,our results showed that the three organic acids in-hibited the expression of the main virulence genes encoded by SPI-1(InvA,InvF,SopE,SopB,SipB,HilA and SipA),SPI-2(SopD2),pili-related genes(FliF,LpfA,SefA and FimF)and flagellum-related genes(FlhD,FliC and FliD)of SE.This study demonstrates that FA,BA,and LA significantly inhibited the growth and pathogenicity of the four pathogens,among which FA showed the most obvious effect on inhibiting the growth,motility,biofilm formation and virulence gene expression.Our study provided a theoretical basis for the application of organic acids in the field of animal husbandry.

Objective:This study aims to improve the management level and quality of horizontal scientific research contracts in hospitals, reduce the risk of contract management, and explore an efficient mode of information management of horizontal scientific research contract management.Methods:Taking a Tertiary Grade A hospital as an example, this study described and summarized the management status of horizontal scientific research contracts from 2018 to 2022, sorted out the potential risks and prevention and control nodes of the review, signing, performance, and archiving of horizontal scientific research contracts in the whole cycle management process, and designed an information management model according to the relevant elements of risk prevention and control and the standardized requirements of contract management, thereby developing information platform related functions.Results:The horizontal research contract management function of the clinical research platform based on the integration concept was available to meet the requirements of risk prevention and control of horizontal research contracts, and the contract review and signing cycle of the information management mode was shortened by 33.33% and 31.95% respectively compared with the traditional management mode. The platform realized a standardized whole process management of contract submission, review, repair and revision, signing, performance, and filing.Conclusions:Information management can effectively reduce the risk of horizontal scientific research contract management. It is necessary to strengthen the docking and interaction function with other information platforms and further explore the information auxiliary function to improve the refined management effect of horizontal scientific research contracts.

Objective:To explore the management strategies of conflicts of interest(COI) by analyzing the definition, manifestations, and implications of COI related to clinical research.Methods:This study summarized the definitions and types, manifestations, and implications of different groups of COI in clinical research. It explored the management response of medical institutions to the COI related to clinical research.Results:Conflicts of Interest could be divided into economic and non-economic conflicts of interest, showing different manifestations in different groups. COI occurs in a variety of links involved in clinical research, and the overall disclosure ratio of COI is low, which might have adverse effects on institutions, investigators, clinical research quality, and subjects.Conclusions:COI management should be implemented by strengthening the construction of the COI management system, strictly following the principle of public disclosure, and strengthening education and training, to improve the quality and credibility of clinical research.

The number of investigator-initiated trials(IIT)projects in medical institutions has increased rapidly,yet there are certain issues such as uneven quality and insufficient consideration of research design.The scientific review and ethical review of IIT complement each other.To improve the research quality and review efficiency of IIT and reduce review repeatability,this paper described the current situation of scientific review and ethical review of IIT in a tertiary A hospital.Combined with literature analysis,the common issues in scientific review and ethical review were summarized into four types:standardization,reliability,safety,and lag.Corresponding to these common issues,the reasons for their occurrence were analyzed as the lack of unified review points,the ambiguity of each review focus,the lack of review communication and exchange,and the lack of ability and awareness of relevant personnel.The explored solutions included establishing a collaborative review mechanism,by unifying the key points of collaborative review,clarifying the review responsibilities of each committee,building a review communication mechanism with the help of information technology,strengthening training and publicity,and other means.These solutions aimed to promote the organic combination of scientific review and ethical review,fully leverage the synergistic effect,improve the efficiency of review,and promote the high-quality and healthy development of IIT.

The number of investigator-initiated trials(IIT)projects in medical institutions has increased rapidly,yet there are certain issues such as uneven quality and insufficient consideration of research design.The scientific review and ethical review of IIT complement each other.To improve the research quality and review efficiency of IIT and reduce review repeatability,this paper described the current situation of scientific review and ethical review of IIT in a tertiary A hospital.Combined with literature analysis,the common issues in scientific review and ethical review were summarized into four types:standardization,reliability,safety,and lag.Corresponding to these common issues,the reasons for their occurrence were analyzed as the lack of unified review points,the ambiguity of each review focus,the lack of review communication and exchange,and the lack of ability and awareness of relevant personnel.The explored solutions included establishing a collaborative review mechanism,by unifying the key points of collaborative review,clarifying the review responsibilities of each committee,building a review communication mechanism with the help of information technology,strengthening training and publicity,and other means.These solutions aimed to promote the organic combination of scientific review and ethical review,fully leverage the synergistic effect,improve the efficiency of review,and promote the high-quality and healthy development of IIT.

Objective:This study aims to improve the management level and quality of horizontal scientific research contracts in hospitals, reduce the risk of contract management, and explore an efficient mode of information management of horizontal scientific research contract management.Methods:Taking a Tertiary Grade A hospital as an example, this study described and summarized the management status of horizontal scientific research contracts from 2018 to 2022, sorted out the potential risks and prevention and control nodes of the review, signing, performance, and archiving of horizontal scientific research contracts in the whole cycle management process, and designed an information management model according to the relevant elements of risk prevention and control and the standardized requirements of contract management, thereby developing information platform related functions.Results:The horizontal research contract management function of the clinical research platform based on the integration concept was available to meet the requirements of risk prevention and control of horizontal research contracts, and the contract review and signing cycle of the information management mode was shortened by 33.33% and 31.95% respectively compared with the traditional management mode. The platform realized a standardized whole process management of contract submission, review, repair and revision, signing, performance, and filing.Conclusions:Information management can effectively reduce the risk of horizontal scientific research contract management. It is necessary to strengthen the docking and interaction function with other information platforms and further explore the information auxiliary function to improve the refined management effect of horizontal scientific research contracts.

Objective:To explore the management strategies of conflicts of interest(COI) by analyzing the definition, manifestations, and implications of COI related to clinical research.Methods:This study summarized the definitions and types, manifestations, and implications of different groups of COI in clinical research. It explored the management response of medical institutions to the COI related to clinical research.Results:Conflicts of Interest could be divided into economic and non-economic conflicts of interest, showing different manifestations in different groups. COI occurs in a variety of links involved in clinical research, and the overall disclosure ratio of COI is low, which might have adverse effects on institutions, investigators, clinical research quality, and subjects.Conclusions:COI management should be implemented by strengthening the construction of the COI management system, strictly following the principle of public disclosure, and strengthening education and training, to improve the quality and credibility of clinical research.

Objective To evaluate the surgical treatments of refractory sclerosing peritonitis related peritoneal dialysis.Methods Clinical data of 15 patients with refractory sclerosing peritonitis related to peritoneal dialysis treated in the General Surgery Department of the 900th Hospital of the Joint Logistics Support Force of the People's Liberation Army from June 30,2014 to May 30,2018.Among them,5 cases underwent"open abdomen peritoneal catheter removal+intestinal adhesiolysis+abdominal infection flushing and drainage with catheter",4 cases underwent"laparoscopic peritoneal catheter removal+intestinal adhesiolysis+abdominal infection flushing and drainage with catheter",3 cases underwent"laparoscopic peritoneal dialysis catheter removal+abdominal infection flushing and drainage with catheter",2 cases underwent"open abdomen peritoneal dialysis catheter removal+abdominal infection flushing and drainage with catheter",and 1 case underwent"laparoscopic examination combined with laparotomy exploration and removal of lower abdominal catheter+intestinal adhesiolysis+abdominal infection flushing and drainage with catheter".Age,gender,clinical symptoms,abdominal CT examination,peripheral blood routine,blood biochemistry,blood C-reactive protein(CRP),white blood cells,biochemistry,and aetiology of peritoneal dialysis fluid were collected and followed up,and the therapeutic effect was evaluated.Results 15 patients were transferred to the Department of Surgery after ineffective treatment in the Department of Internal Medicine.Preoperatively(after 5 days of antibiotic treatment)compared to before antibiotic treatment,there were no significant changes in blood WBC,blood NEUT％,CRP,and peritoneal fluid WBC(P＞0.05).Laparoscopic exploration or laparotomy exploration was performed,during which the peritoneal dialysis catheter was removed and the abdominal infection focus was cleared.A pelvic cavity washout drainage tube was left in place postoperatively.Fourteen patients had a good recovery after surgery,with effective control of peritonitis symptoms and no complications such as intestinal obstruction or enterocutaneous fistula.After the removal of the peritoneal dialysis catheter,all patients switched to hemodialysis.A comparison of inflammatory markers before and after surgery showed a significant decrease after surgery.Three days postoperatively compared to before surgery(after 5 days of antibiotic treatment),there were no significant changes in blood WBC,blood NEUT％,CRP,and peritoneal fluid WBC(P＞0.05).Seven days postoperatively compared to before surgery(after 5 days of antibiotic treatment),there was a significant decrease in blood WBC[(7.43±2.65)× 109/L VS(10.17±5.24)× 109/L],blood NEUT％[(88.23±9.02)％VS(85.07±11.57)％],and CRP[(152.88±113.01)mg/L VS(114.49±92.97)mg/L](P＜0.05);the peritoneal fluid WBC at 7 days postoperatively showed no significant change compared to before surgery(after 5 days of antibiotic treatment)(P＞0.05).The cases were followed up for at least 22 months,and 13 patients did not experience peritonitis or intestinal obstruction again.One patient died 39 days after surgery due to multiple organ failure,and one patient died from other causes after a 2-year follow-up.Conclusion For refractory sclerosing peritonitis related peritoneal dialysis that is ineffective in medical conservative treatment,On the basis of reasonable and effective antibiotics to control infection,surgical intervention should be actively carried out and surgical methods such as surgery should be used to control the progress of peritonitis,reduce mortality and improve the cure rate.