The repair of bone defects is heavily influenced by the dynamic osteogenic microenvironment. Static scaffolds constructed by traditional 3D printing technology cannot simulate the dynamic nature of the microenvironment during bone defect repair due to the fixed structure, uncontrollable release of active factors, and difficult regeneration of blood vessels, among other factors. Breaking through the limitations of these static scaffolds and realizing the intelligent and dynamic regulation of the osteogenic microenvironment is a key scientific issue in the field of bone tissue engineering. 4D printing technology combines the dynamic responsiveness of bone restoration materials with the concept of intelligent design to regulate the micro and macro structure of scaffolds. This technology provides a new method for bone tissue engineering by responding to endogenous and exogenous stimuli and creating a better osteogenic microenvironment through functionalized design, including drug delivery and antibacterial function. However, this technology currently suffers from challenges related to dynamic response material design, insufficient precision of printing technology, and mismatches between multi-stimulus response systems, metabolic rhythms of bone tissue, and functionalized composite scaffolds. Future research should focus on the development of smart response materials with excellent dynamic responses and bioactivity, the creation of new printing technologies, and the design of personalized and precise bone repair solutions. The aim of this paper is to review the current research status of 4D printing for bone tissue engineering in terms of material types, response mechanisms, and applications to provide a theoretical basis for the development and clinical application of functional bone repair materials in the future.

Objective To investigate the clinical effect of minimally invasive orthopedics combined with Akin surgical segmental osteotomy in the treatment of hallux valgus.Methods Clinical data of hallux valgus patients who underwent minimally invasive orthopedics combined with Akin surgical segmental osteotomy in Wangjing Hospital of China Academy of Chinese Medical Sciences from June 2020 to June 2022 were collected.Hallux valgus angle(HVA),intermetatarsal angle(IMA),distal metatarsal articular angle(DMAA),visual analogue scale(VAS)score,American Orthopedic Foot and Ankle Society(AOFAS)scale score and complications were compared before and after surgery.Results A total of 186 patients with hallux valgus(328 feet)were included in the study.All patients successfully completed the operation and the follow-up period was 6 months.Six months after surgery,HVA,IMA and DMAA were significantly lower than before surgery,VAS score was significantly lower than before surgery,and AOFAS scale score was significantly higher than before surgery(P＜0.05).There were no postoperative complications such as wound infection,delayed union or nonunion of the osteotomy,and metastatic metatarsalgia.Conclusion Minimally invasive orthopedic combined with Akin surgical segmental osteotomy is safe and effective in treatment of hallux valgus,which has the advantages of less injury,good deformity correction and less postoperative complications,and is worthy of clinical application and promotion.

Objective To investigate the clinical effect of minimally invasive orthopedics combined with Akin surgical segmental osteotomy in the treatment of hallux valgus.Methods Clinical data of hallux valgus patients who underwent minimally invasive orthopedics combined with Akin surgical segmental osteotomy in Wangjing Hospital of China Academy of Chinese Medical Sciences from June 2020 to June 2022 were collected.Hallux valgus angle(HVA),intermetatarsal angle(IMA),distal metatarsal articular angle(DMAA),visual analogue scale(VAS)score,American Orthopedic Foot and Ankle Society(AOFAS)scale score and complications were compared before and after surgery.Results A total of 186 patients with hallux valgus(328 feet)were included in the study.All patients successfully completed the operation and the follow-up period was 6 months.Six months after surgery,HVA,IMA and DMAA were significantly lower than before surgery,VAS score was significantly lower than before surgery,and AOFAS scale score was significantly higher than before surgery(P＜0.05).There were no postoperative complications such as wound infection,delayed union or nonunion of the osteotomy,and metastatic metatarsalgia.Conclusion Minimally invasive orthopedic combined with Akin surgical segmental osteotomy is safe and effective in treatment of hallux valgus,which has the advantages of less injury,good deformity correction and less postoperative complications,and is worthy of clinical application and promotion.

Acute kidney injury (AKI) is a critical clinical condition characterized by rapid renal function decline, with high morbidity, mortality, and healthcare costs. Traditional Chinese medicine (TCM) has shown potential effects on mitigating oxidative stress and programmed cell death in AKI models. Scutellaria barbata D. Don (SB) and Scleromitrion diffusum (Willd.) R. J. Wang (SD), a classic TCM herbal pair exhibited anti-inflammatory and antioxidant activities. Using advanced chromatographic separation technology, we enriched the effective fractions of water extracts from SB-SD, obtaining self-assembled herbal nanoparticles (SB and SD nanoparticles, SSNPs) rich in flavonoids and terpenoids. These SSNPs demonstrated robust antioxidant properties in vitro and mitigated AKI progression in vivo by activating the nuclear factor erythroid 2-related factor 2 (Nrf2) signaling pathway. Oral administration of SSNPs in mice resulted in absorption into the bloodstream, formation of a protein corona, reduced macrophage phagocytosis, and enhanced bioavailability and renal targeting. Furthermore, we investigated the self-assembly principle of SSNPs using representative flavonoids and terpenoids. Kinetic studies and in situ transmission electron microscopy (in situ TEM) revealed that these compounds self-assemble via supramolecular forces like hydrogen bonding and π-π interactions, forming stable nanostructures. This study elucidates the renoprotective effects and mechanisms of SB and SD, and provides a novel approach for the development of TCM-based nanomedicines, highlighting the potential of nano-TCM in AKI treatment.

Objective:To observe the clinical efficacy of Chinese materia medica soaking therapy combined with cervical rotation-traction manipulation in the treatment of cervical spondylotic radiculopathy (CSR).Methods:A randomized controlled trial was conducted. Totally 84 CSR patients from the Orthopedics Department of Shunyi Hospital, Beijing Traditional Chinese Medicine Hospital from April 2023 to May 2024 were selected as the observation subjects. They were divided into two groups using a random number table method, with 42 patients in each group. The treatment for both groups lasted for 14 d. VAS scale was used to assess pain levels before and after treatment, OASTCSR was used to evaluate cervical function, and NDI was used to assess cervical functional status; adverse reactions during treatment were observed and recorded, and clinical efficacy was evaluated.Results:The total effective rate was 95.24% (40/42) in the treatment group and 80.95% (34/42) in the control group, with statistical significance ( χ2=4.36, P=0.029). After treatment, the VAS score (1.60±1.21 vs. 2.91±1.12, t=-1.89), the OASTCSR score (5.17±2.14 vs. 9.31±3.82, t=-11.57), and the NDI score (9.17±2.13 vs. 13.36±3.45, t=-10.82) in the treatment group were lower than those in the control group ( P<0.001 or P<0.05). During the treatment period, neither group experienced any adverse reactions. Conclusion:The combination of Chinese materia medica soaking therapy and cervical rotation-traction manipulation can significantly improve the clinical symptoms and quality of life of patients with CSR, and its efficacy is superior to the use of cervical rotation-traction manipulation alone.

Objective:To observe the clinical effect of Shenfu injection in preventing septic cardiomyopathy (SIC) in septic patients.Methods:From June 2022 to January 2023, patients with sepsis or septic shock who did not develop SIC were randomly divided into treatment group and control group according to the ratio of 1:1. In the treatment group, Shenfu injection (50 mL) was pumped intravenously once every 12 hours for 5 days. In the control group, 50 mL of normal saline was pumped intravenously once every 12 hours, and the course of treatment was 5 days. The primary end point was the incidence of SIC in the first 5 days. The secondary end points were the application time of vasoactive drugs, fluid balance in the previous week, hospitalization time in ICU, total ventilation time and 28-day mortality.Results:112 patients were randomly divided into two groups. Seven patients in the treatment group were excluded twice, and finally 49 patients were included in the analysis, while six patients in the control group were excluded twice and 50 patients included in the analysis. The total incidence of SIC in the treatment group within 5 days was significantly lower than that in the control group (42.9% vs. 64.0%, P = 0.035). Among them, the left ventricular systolic dysfunction in the treatment group was significantly lower than that in the control group (24.5% vs 52.0%, P=0.005), and there was no significant difference in the incidence of left ventricular diastolic dysfunction between the two groups. The incidence of right ventricular dysfunction in the control group was 28.0%, which was significantly higher than 10.2% in the treatment group ( P = 0.025). The duration of using vasoconstrictors in the treatment group was 75(48, 97) hours, which was significantly lower than 97(66, 28) hours in the control group ( P = 0.039). The duration of inotropic drugs use in the treatment group was 32(18, 49) h, which was also significantly shorter than 44(25, 61) h in the control group ( P=0.046). The fluid balance of the control group in the first week was (1 260±850) mL, which was significantly higher than (450±520) mL in the treatment group ( P=0.008). There was no statistical difference in ICU stay, total ventilation time and 28-day mortality between the two groups (all P > 0.05). Conclusion:Early application of Shenfu injection can significantly reduce the incidence of SIC, accompanied by less use of vasoactive drugs and positive fluid balance, which has a good clinical application prospect.

Sepsis-induced liver injury (SILI) is an important cause of septicemia deaths. BaWeiBaiDuSan (BWBDS) was extracted from a formula of Panax ginseng C. A. Meyer, Lilium brownie F. E. Brown ex Miellez var. viridulum Baker, Polygonatum sibiricum Delar. ex Redoute, Lonicera japonica Thunb., Hippophae rhamnoides Linn., Amygdalus Communis Vas, Platycodon grandiflorus (Jacq.) A. DC., and Cortex Phelloderdri. Herein, we investigated whether the BWBDS treatment could reverse SILI by the mechanism of modulating gut microbiota. BWBDS protected mice against SILI, which was associated with promoting macrophage anti-inflammatory activity and enhancing intestinal integrity. BWBDS selectively promoted the growth of Lactobacillus johnsonii (L. johnsonii) in cecal ligation and puncture treated mice. Fecal microbiota transplantation treatment indicated that gut bacteria correlated with sepsis and was required for BWBDS anti-sepsis effects. Notably, L. johnsonii significantly reduced SILI by promoting macrophage anti-inflammatory activity, increasing interleukin-10⁺ M2 macrophage production and enhancing intestinal integrity. Furthermore, heat inactivation L. johnsonii (HI-L. johnsonii) treatment promoted macrophage anti-inflammatory activity and alleviated SILI. Our findings revealed BWBDS and gut microbiota L. johnsonii as novel prebiotic and probiotic that may be used to treat SILI. The potential underlying mechanism was at least in part, via L. johnsonii-dependent immune regulation and interleukin-10⁺ M2 macrophage production.

To summarize the reform measures of nursing vertical management in our hospital under the background of diagnosis related groups,including refined performance management,cancellation of nursing main pharmacy classes,implementation of attending nursing working group,establishment of DRGs nursing quality control coder position,head nurse responsible for bed allocation,deepening nursing quality management and other measures,so as to provide references for other hospitals to carry out the reform of nursing vertical management under the background of DRGs.

[This corrects the article DOI: 10.1016/j.apsb.2022.10.016.].

Objective:To provide a reference for the choice of electronic data capture system used in clinical research, the function and performance of some tool software were expounded and compared.Methods:We selected three freely available systems of REDCap, Commcare, and OpenEDC as research objects, describing and comparing their user license acquisition path, data capture related functions, and information security assurance measures. This article reflected how the three kinds of tool software ensure research data privacy and scientificity, and presented the consideration of system security and accessibility.Results:REDCap was the most mature system of the three, which had a fairly comprehensive design in functional integrity, data security, user friendliness, and system scalability. Commcare system featured in the mobile collection, and supported the most abundant types of collected data, while OpenEDC was characteristic of low threshold and flexible deployment.Conclusions:REDCap system is widely applicable to small and medium scale medical research, including clinical trials, retrospective studies, cohort studies, and translational research. Commcare system is the preferred option for medical investigations represented by epidemiologic surveys, while OpenEDC is particularly suitable for investigator initiated studies.