Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 5 appraisals
PloS one
Long term evaluation of the safety and efficacy of local cooling anesthesia during intravitreal injections: The COOL-2 Trial
BACKGROUND/OBJECTIVE: To evaluate the safety and effectiveness of a medical device providing cooling anesthesia to the eye as local anesthesia for intravitreal (IVT) injections. SUBJECTS/METHODS: As a multicenter, open label, dose escalation clinical trial, subjects receiving at least 3 IVT injections in the study eye were recruited to participate. All patients received subconjunctival lidocaine as their anesthesia for previous IVT injections. Subjects receiving IVT injections were assigned (non-randomized) to four groups in which the cooling device was applied to the conjunctiva at the location of the intravitreal injection: Group 1: -10˚C for 20 seconds; Group 2: -15˚C for 10 seconds; Group 3: -15˚C for 15 seconds; and Group 4: -15˚C for 20 seconds. The primary outcome was pain during IVT injection assessed by a visual analog scale (0-10). RESULTS: Eighty subjects were enrolled at 2 sites. The mean number of prior IVT injections was 20.3 for Group 2 and 15.0 for Group 3. Pain was significantly less for the 10 second vs the 15 second application (2.2 vs 3.6, p = 0.0255). The mean pain score was lower for Group 2 (-15°C for 10 seconds) ranging a score of 1.0 to 2.9 across the study visits, compared with Group 3 (-15°C for 15 seconds) with a mean range of 3.2 to 5.2 across the study visits. Treatment order (visit) significantly decreased by 0.10 pain units per visit (p = 0.0002). Punctate epithelial erosions (PEE) were reported in 20 of 56 eyes (35.7%) in Group 2, none were reported in Group 3. CONCLUSION: Cooling anesthesia device reduced the severity of pain associated with IVT injection during the procedure, although mild and transient PEE may be associated with treatment. TRIAL REGISTRATION: ClinicalTrials.gov identifier, NCT03956797.
13 June 2026
Read appraisal →Nano letters
Hierarchical Structural-Interfacial Engineering with Dynamic Soft-Hard Cross-Linking Enables Full-Range, Ultrasensitive MXene Piezoresistive Sensors
Human tactile perception inspires flexible piezoresistive sensors, yet simultaneously achieving high sensitivity, a wide pressure range, and mechanical robustness remains challenging. Here, we report a hierarchical stress-regulation strategy that integrates multiscale surface microstructures with a dynamically cross-linked MXene/carboxymethyl cellulose/borax sensing network. Replicated microtopographies induce progressive and spatially distributed stress localization, while heterogeneous soft-hard cross-linking regulates nanoscale deformation through adaptive hydrogen bonding and rigid borate anchoring. This coupled structural-interfacial regulation generates abundant stress-concentrated sites, stabilizes conductive pathways, and enables continuous resistance modulation across a broad pressure spectrum. Consequently, the sensor exhibits ultrahigh sensitivity (774.48 kPa-1), a wide working range (334.16 kPa), and fast response/recovery times (8.58/17.22 ms). It reliably captures both subtle physiological signals and large mechanical loads and further supports gesture recognition and robotic control when integrated with real-time feedback and machine learning. This work establishes a general framework for designing robust, full-range tactile sensors through hierarchical stress regulation.
30 May 2026
Read appraisal →ACS applied materials & interfaces
Boosting Piezoelectricity and Mechanical Properties of Silk Fibroin Films via Polyethylene Glycol Phase Manipulation
Piezoelectric silk fibroin (SF) shows great potential in fabricating sustainable wearable electronics toward health monitoring and human-machine interfacing, yet the processing difficulty and brittleness restrict its practical applications severely. This study proposes a simple strategy to achieve the boosted piezoelectricity and mechanical properties in electrospun regenerated silk fibroin (RSF) nanofiber mats by adding polyethylene glycol (PEG) with different molecular weights to induce the formation of β-sheets via hydrogen bonding and the regulation of PEG phase morphology. Specifically, RSFs consisting of PEG of 2000 and 1000 Da exhibit a significant improvement in the tensile strength (from 6.1 to 9.92 MPa) and elongation at break (from 5.72% to 117.58%), respectively. Meanwhile, RSFs consisting of PEG with a molecular weight of 2000 and 400 Da show a direct piezoelectric force sensitivity of 0.2 mV/N·μm and 0.14 mV/N·μm respectively, superior to that of pure RSF (0.04 mV/N·μm). The piezoelectric force sensors fabricated with RSFs show potential applications in the detection of diverse human motions, including finger tapping for Morse code, grip strength, and knee flexion. Thus, this work unveils a facile strategy to fabricate RSF-based biodegradable piezoelectric force sensors with a trade-off in processability, mechanical ductility, and piezoelectricity.
28 May 2026
Read appraisal →Science advances
Augmenting ultrasound for continuous glucose monitoring via a wearable acoustically readable microneedle patch
Continuous glucose monitoring (CGM) represents substantial advancement, yet poses a challenge in wearable health care development. Current enzymatic CGM faces limitations in stability, cost, and durability. We introduce an enzyme-free, wearable acoustically readable microneedle patch (ARMPatch) composed of glucose-responsive hydrogel. Positioned between a standard ultrasound probe and the skin, ARMPatch acts as an acoustic interface enabling CGM using conventional ultrasound. Its hydrogel microneedles minimally penetrate the epidermis, allowing interstitial fluid to trigger variable swelling of the microneedles in response to glucose fluctuations. ARMPatch delivers stable and selective glucose readings for up to 56 days. Glucose variations with millimolar resolution are obtained via ultrasound within a response time of 30 to 60 minutes. In vivo CGM in animal models for 7 days reveals a reversible correlation between microneedle swelling and glucose variations. Acting as "accessory" for standard ultrasound probes, this approach offers a minimally invasive, cost-effective, and long-lasting solution to non-enzymatic CGM, expanding the utility of ultrasound in wearable biosensing.
5 May 2026
Read appraisal →ACS applied materials & interfaces
Physically Cross-Linked Biopolymer-Based Strong and Stretchable Organohydrogel with Self-Healing and Biocompatibility for Environmentally Tolerant Strain Sensors
The development of wearable strain sensors increasingly focuses on multifunctional materials that integrate mechanical robustness, self-repairing capacity, temperature-resilient conductivity, and biocompatibility. Herein, we developed a physically cross-linked biopolymer-based organohydrogel by incorporating gelatin (Gel) and β-cyclodextrin-grafted chitosan (CDCS), designated as Gel/CDCS, reinforced through hydrogen bonding, ionic interactions, and host-guest complexation. The optimized Gel/CDCS1 organohydrogel with 1% of CDCS exhibited outstanding stretchability, with a tensile strain at break of 410.9% and a tensile strength of 92.2 kPa, while maintaining 85% of its mechanical properties after self-healing at 40 °C. The introduction of kosmotropic salts (Na3Cit and NaCl) and a glycerol-water binary solvent system conferred remarkable environmental adaptability, allowing stable performance from -20 to 37 °C. Notably, it achieved a high ionic conductivity of 0.946 S m-1 at room temperature, alongside 0.606 S m-1 at -20 °C and 0.330 S m-1 at 37 °C, ensuring operation under extreme conditions. The strain sensor displayed high sensitivity with a gauge factor (GF) increasing from 1.06 to 1.34 over a broad strain range and maintained a stable electrical response over 600 consecutive stretching cycles. Additionally, it enabled reliable detection of diverse human motions, including facial expressions, joint bending, and breathing, demonstrating excellent conformability and signal stability during on-body monitoring. Additionally, Gel/CDCS1 exhibited excellent biodegradability, degrading by over 80% in soil within 4 days, and showed high biocompatibility with fibroblast viability of around 80%. These attributes establish Gel/CDCS1 as a promising eco-friendly candidate for next-generation flexible electronics, wearable strain sensors, and biomedical applications.
10 Apr 2026
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