Objective: To investigate the efficacy of magnesium-strontium co-doped hydroxyapatite mineralized collagen (MSHA/Col) in improving the bone repair microenvironment and enhancing bone regeneration capacity, providing a strategy to address the insufficient biomimetic composition and limited bioactivity of traditional hydroxyapatite mineralized collagen (HA/Col) scaffolds. Methods: A high-molecular-weight polyacrylic acid-stabilized amorphous calcium magnesium strontium phosphate precursor (HPAA/ACMSP) was prepared. Its morphology and elemental distribution were characterized by high-resolution transmission electron microscopy (TEM) and energy-dispersive spectroscopy. Recombinant collagen sponge blocks were immersed in the HPAA/ACMSP mineralization solution. Magnesium-strontium co-doped hydroxyapatite was induced to deposit within collagen fibers (experimental group: MSHA/Col; control group: HA/Col). The morphological characteristics of MSHA/Col were observed using scanning electron microscopy (SEM). Its crystal structure and chemical composition were analyzed by X-ray diffraction and Fourier transform infrared spectroscopy, respectively. The mineral phase content was evaluated by thermogravimetric analysis. The scaffold's porosity, ion release, and in vitro degradation performance were also determined. For cytological experiments, CCK-8 assay, live/dead cell staining, alkaline phosphatase staining, alizarin red S staining, RT-qPCR, and western blotting were used to evaluate the effects of the MSHA/Col scaffold on the proliferation, viability, early osteogenic differentiation activity, late mineralization capacity, and gene and protein expression levels of key osteogenic markers [runt-related transcription factor 2 (Runx2), collagen type Ⅰ (Col-Ⅰ), osteopontin (Opn), and osteocalcin (Ocn)] in mouse embryonic osteoblast precursor cells (MC3T3-E1). Results: HPAA/ACMSP appeared as amorphous spherical nanoparticles under TEM, with energy spectrum analysis showing uniform distribution of carbon, oxygen, calcium, phosphorus, magnesium, and strontium elements. SEM results of MSHA/Col indicated successful complete intrafibrillar mineralization. Elemental analysis showed the mass fractions of magnesium and strontium were 0.72% (matching the magnesium content in natural bone) and 2.89%, respectively. X-ray diffraction revealed characteristic peaks of hydroxyapatite crystals (25.86°, 31°-34°). Infrared spectroscopy results showed characteristic absorption peaks for both collagen and hydroxyapatite. Thermogravimetric analysis indicated a mineral phase content of 78.29% in the material. The scaffold porosity was 91.6% ± 1.1%, close to the level of natural bone tissue. Ion release curves demonstrated sustained release behavior for both magnesium and strontium ions. The in vitro degradation rate matched the ingrowth rate of new bone tissue. Cytological experiments showed that MSHA/Col significantly promoted MC3T3-E1 cell proliferation (130% increase in activity at 72 h, P < 0.001). MSHA/Col exhibited excellent efficacy in promoting osteogenic differentiation, significantly upregulating the expression of osteogenesis-related genes and proteins (Runx2, Col-Ⅰ, Opn, Ocn) (P < 0.01). Conclusion The MSHA/Col scaffold achieves dual biomimicry of natural bone in both composition and structure, and effectively promotes osteogenic differentiation at the genetic and protein levels, breaking through the functional limitations of pure hydroxyapatite mineralized collagen. This provides a new strategy for the development of functional bone repair materials

Triptolide （TP）， the core active component of the traditional Chinese medicine Tripterygium wilfordii ， exhibits remarkable pharmacological activities including anti-inflammatory， immunosuppressive and anti-tumor effects， and holds broad application prospects in the treatment of major diseases such as autoimmune diseases and malignant tumors. However， TP has a narrow therapeutic window and causes multi-organ toxicities including liver， kidney and reproductive toxicities， which severely restrict its safe clinical application and new drug development. Therefore， toxicity reduction and efficacy enhancement has become a core scientific problem urgently to be solved in this field. This paper systematically reviews the four core strategies for TP toxicity reduction and efficacy enhancement， including structural modification， dosage form improvement， herbal compatibility， and external therapies of traditional Chinese medicine. Among them， structural modification optimizes the toxic and efficacy characteristics of TP from the molecular structure level， with typica l derivatives including （5 R ）-5-hydroxy triptolide， ZT01， PG490-88， etc. Dosage form modification achieves toxicity reduction and efficacy enhancement via targeted and sustained-controlled drug release of diverse delivery systems. It includes triptolide preparations such as nanoparticles， liposomes， microemulsion gels and liquid crystals， possessing favorable clinical transformation potential. The herbal compatibility and external therapies of traditional Chinese medicine conform to the holistic view of traditional Chinese medicine and have a profound clinical application foundation， but their mechanisms of action are insufficiently elucidated， and they lack unified standardized specifications and high-quality evidence-based proof. In the future， we should rely on multi-omics technology to elucidate the toxic and efficacy mechanisms， integrate technologies to optimize preparations， improve the evaluation system and promote clinical transformation.

Extracorporeal membrane oxygenation (ECMO) is a key continuous extracorporeal life support technology that can partially or completely replace a patient's cardiopulmonary function, thereby winning valuable time for the diagnosis and treatment of the primary disease. With the widespread application of ECMO, the need for transport has increased. However, during transfers, the standard heater unit is often large and inconvenient to carry, while alternative warming measures tend to be ineffective. This frequently leads to complications such as hypothermia or the inability to maintain body temperature, which can seriously affect the patient's prognosis. In response to this challenge, the medical and nursing staff of the critical care medicine department at Zhongda Hospital Affiliated to Southeast University jointly designed an insulation device for ECMO transport pipelines. The device was successfully granted a National Utility Model Patent of China (patent number: ZL 2021 2 0653569.3). It primarily consists of key components such as a heating pad, velcro straps, a cover layer, a backing layer, an electric heating layer, and a wiring plug. Its advantages include portability, the ability to effectively wrap around and warm the ECMO circuit during transit, and a reduction in the incidence of hypothermia-related complications. Furthermore, its transparent material design allows for real-time monitoring of the ECMO system's status, making it both economical and practical.
Extracorporeal Membrane Oxygenation/instrumentation* ; Humans ; Equipment Design

Severe open tibiofibular fractures account for approximately 28.1% of all open fractures. Among them, Gustilo-Anderson type IIIB/C fractures present significant clinical challenges due to associated bone and soft tissue defects, high infection rates, and risk of amputation. Inadequate preoperative assessment may lead to suboptimal emergency surgical planning or intraoperative complications. Historically, external fixation was often preferred, but this approach has been associated with limitations such as restricted joint mobility, delayed bone union, joint stiffness, and disuse osteoporosis, resulting in poor functional recovery. With advancements of debridement techniques, standardization of antibiotic use, and popularization of early soft tissue coverage, early internal fixation has gained broader acceptance. Nevertheless, controversies persist regarding the choice of fixation method, timing of definitive fixation, use of reamed versus unreamed intramedullary nailing, and necessity of fibular fixation. To standardize the diagnosis and early management of severe open tibiofibular fractures, reduce complication rates, and improve functional recovery, the Society of Microsurgery of the Chinese Medical Association organized a panel of domestic experts to develop the Evidence-based guideline for the diagnosis and early fixation of severe open tibiofibular fractures ( version 2025), using evidence-based methodology. The guidelines provided 12 recommendations covering diagnostic and early fixation strategies of severe open tibiofibular fractures, aiming to provide clinicians with scientifically grounded and standardized guidance.

Objective:To investigate the efficacy and safety of dupilumab in the treatment of elderly patients (≥ 60 years old) with atopic dermatitis (AD), with particular attention paid to rare adverse reactions.Methods:A single-center retrospective analysis was conducted on data collected from 281 elderly AD patients who received the standard regimen of dupilumab at the Department of Dermatology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from January 2020 to May 2024. Clinical characteristics such as gender, disease duration, skin lesion manifestations, and itch severity were analyzed. Changes in skin lesions and itch severity, as well as related adverse events were recorded during the follow-up period of 0 - 16 weeks. The efficacy and safety of dupilumab in the treatment of elderly AD patients were evaluated.Results:Among the 281 elderly AD patients, 214 were males (76.16%) and 67 were females (23.84%), with the age being 71.13 ± 7.91 years and the age at onset being 59.92 ± 15.72 years. The disease duration ( M[ IQR]) was 5.00 (13.00) years. After standard-regimen dupilumab treatment, the improvement rates of clinical outcome indicators SCORing Atopic Dermatitis (SCORAD) and pruritus numerical rating scale (NRS) scores gradually increased. At week 16, the improvement rates of SCORAD and NRS scores ( M[ IQR]) reached the maxima of 72.37% (23.89%) and 75.00% (29.72%), respectively. The overall incidence of adverse events was relatively low, with only 16 patients (6.05%) reporting adverse events. Common adverse reactions such as conjunctivitis (2 cases, 0.71%) and facial erythema (1 case, 0.36%) were mild and well-tolerated. Phenotype switching occurred in 10 cases (3.56%) . Conclusion:Dupilumab was an effective and safe treatment for elderly AD, but phenotype switching may occur.

Objective:To investigate the efficacy and safety of dupilumab in the treatment of elderly patients (≥ 60 years old) with atopic dermatitis (AD), with particular attention paid to rare adverse reactions.Methods:A single-center retrospective analysis was conducted on data collected from 281 elderly AD patients who received the standard regimen of dupilumab at the Department of Dermatology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from January 2020 to May 2024. Clinical characteristics such as gender, disease duration, skin lesion manifestations, and itch severity were analyzed. Changes in skin lesions and itch severity, as well as related adverse events were recorded during the follow-up period of 0 - 16 weeks. The efficacy and safety of dupilumab in the treatment of elderly AD patients were evaluated.Results:Among the 281 elderly AD patients, 214 were males (76.16%) and 67 were females (23.84%), with the age being 71.13 ± 7.91 years and the age at onset being 59.92 ± 15.72 years. The disease duration ( M[ IQR]) was 5.00 (13.00) years. After standard-regimen dupilumab treatment, the improvement rates of clinical outcome indicators SCORing Atopic Dermatitis (SCORAD) and pruritus numerical rating scale (NRS) scores gradually increased. At week 16, the improvement rates of SCORAD and NRS scores ( M[ IQR]) reached the maxima of 72.37% (23.89%) and 75.00% (29.72%), respectively. The overall incidence of adverse events was relatively low, with only 16 patients (6.05%) reporting adverse events. Common adverse reactions such as conjunctivitis (2 cases, 0.71%) and facial erythema (1 case, 0.36%) were mild and well-tolerated. Phenotype switching occurred in 10 cases (3.56%) . Conclusion:Dupilumab was an effective and safe treatment for elderly AD, but phenotype switching may occur.

Severe open tibiofibular fractures account for approximately 28.1% of all open fractures. Among them, Gustilo-Anderson type IIIB/C fractures present significant clinical challenges due to associated bone and soft tissue defects, high infection rates, and risk of amputation. Inadequate preoperative assessment may lead to suboptimal emergency surgical planning or intraoperative complications. Historically, external fixation was often preferred, but this approach has been associated with limitations such as restricted joint mobility, delayed bone union, joint stiffness, and disuse osteoporosis, resulting in poor functional recovery. With advancements of debridement techniques, standardization of antibiotic use, and popularization of early soft tissue coverage, early internal fixation has gained broader acceptance. Nevertheless, controversies persist regarding the choice of fixation method, timing of definitive fixation, use of reamed versus unreamed intramedullary nailing, and necessity of fibular fixation. To standardize the diagnosis and early management of severe open tibiofibular fractures, reduce complication rates, and improve functional recovery, the Society of Microsurgery of the Chinese Medical Association organized a panel of domestic experts to develop the Evidence-based guideline for the diagnosis and early fixation of severe open tibiofibular fractures ( version 2025), using evidence-based methodology. The guidelines provided 12 recommendations covering diagnostic and early fixation strategies of severe open tibiofibular fractures, aiming to provide clinicians with scientifically grounded and standardized guidance.

Objective:To learn about physicians’ concepts and commonly employed method in hyaluronic acid injection and provide reference data for the standardization of pain management.Methods:This study was a cross-sectional study. Convenient sampling method was used to distribute questionnaires to cosmetic injectors and patients experienced with hyaluronic acid injections to collect data on their views of pain associated with hyaluronic acid injections. The physician portion was collected offline from June 15 to July 20, 2022, and the patient portion was collected from November 14, 2022, to December 6, 2022, via the Questionnaire Star platform. The physician questionnaire consisted of 17 questions, question types included single choice, multiple choice and essay questions. The patient questionnaire consisted of 6 questions, question types included single choice and multiple choice. Relevant data were analyzed using SPSS 22.0 software for descriptive statistics, and data were presented in the form of cases and percentages (%).Results:Sixty-two physician questionnaires and 123 patient questionnaires were collected. 42 (67.74%) physicians observed from their daily practice that more than 50% of their patients were very concerned about pain during injection; 101 (82.11%) patients scored ≥5 out of 10 for concern about impending pain prior to hyaluronic acid filler injection. At the time of treatment, 48 (77.42%) physicians advised patients to choose a lidocaine-containing hyaluronic acid filler for reasons including a significant reduction in injection pain (53 cases, 85.48%) and patient comfort with the treatment experience (59 cases, 95.16%). 60 (48.78%) patients were willing to choose an anesthesia-containing product at the time of injection, but the price of the anesthesia-containing product influenced the patient’ s choice (55 cases 44.72%) .Conclusions:Pain from cosmetic injectable treatments is an important issue to both physicians and patients. Lidocaine-containing hyaluronic acid is recognized by physicians and patients for its analgesic effect and high safety profile. There is no perfect solution for pain in cosmetic injection treatment, and multidisciplinary collaboration may be needed to solve the problem.

Objective:To learn about physicians’ concepts and commonly employed method in hyaluronic acid injection and provide reference data for the standardization of pain management.Methods:This study was a cross-sectional study. Convenient sampling method was used to distribute questionnaires to cosmetic injectors from plastic surgery department of public hospitals or medical beauty institutions and patients experienced with hyaluronic acid injections to collect data on their views of pain associated with hyaluronic acid injections. The physician portion was collected offline from June 15 to July 20, 2022, and the patient portion was collected from November 14 to December 6, 2022, via the Questionnaire Star platform. The physician questionnaire consisted of 17 questions, question types included single choice, multiple choice and essay questions. The patient questionnaire consisted of 6 questions, question types included single choice and multiple choice. Relevant data were analyzed using SPSS 22.0 software for descriptive statistics, and data were presented in the form of cases(%).Results:Sixty-two physician questionnaires and 123 patient questionnaires were collected. 42 (67.74%) physicians observed from their daily practice that more than 50% of their patients were very concerned about pain during injection; 101 (82.11%) patients scored ≥5 out of 10 for concern about impending pain prior to hyaluronic acid filler injection. At the time of treatment, 48 (77.42%) physicians advised patients to choose a lidocaine-containing hyaluronic acid filler for reasons including a significant reduction in injection pain (53 cases, 85.48%) and patient comfort with the treatment experience (59 cases, 95.16%). 60 (48.78%) patients were willing to choose an anesthesia-containing product at the time of injection, but the price of the anesthesia-containing product influenced the patient’s choice (55 cases, 44.72%).Conclusion:Pain from cosmetic injectable treatments is an important issue to both physicians and patients. Lidocaine-containing hyaluronic acid is recognized by physicians and patients for its analgesic effect and high safety profile. There is no perfect solution for pain in cosmetic injection treatment, and multidisciplinary collaboration may be needed to solve the problem.

Objective:To learn about physicians’ concepts and commonly employed method in hyaluronic acid injection and provide reference data for the standardization of pain management.Methods:This study was a cross-sectional study. Convenient sampling method was used to distribute questionnaires to cosmetic injectors and patients experienced with hyaluronic acid injections to collect data on their views of pain associated with hyaluronic acid injections. The physician portion was collected offline from June 15 to July 20, 2022, and the patient portion was collected from November 14, 2022, to December 6, 2022, via the Questionnaire Star platform. The physician questionnaire consisted of 17 questions, question types included single choice, multiple choice and essay questions. The patient questionnaire consisted of 6 questions, question types included single choice and multiple choice. Relevant data were analyzed using SPSS 22.0 software for descriptive statistics, and data were presented in the form of cases and percentages (%).Results:Sixty-two physician questionnaires and 123 patient questionnaires were collected. 42 (67.74%) physicians observed from their daily practice that more than 50% of their patients were very concerned about pain during injection; 101 (82.11%) patients scored ≥5 out of 10 for concern about impending pain prior to hyaluronic acid filler injection. At the time of treatment, 48 (77.42%) physicians advised patients to choose a lidocaine-containing hyaluronic acid filler for reasons including a significant reduction in injection pain (53 cases, 85.48%) and patient comfort with the treatment experience (59 cases, 95.16%). 60 (48.78%) patients were willing to choose an anesthesia-containing product at the time of injection, but the price of the anesthesia-containing product influenced the patient’ s choice (55 cases 44.72%) .Conclusions:Pain from cosmetic injectable treatments is an important issue to both physicians and patients. Lidocaine-containing hyaluronic acid is recognized by physicians and patients for its analgesic effect and high safety profile. There is no perfect solution for pain in cosmetic injection treatment, and multidisciplinary collaboration may be needed to solve the problem.