Objective To investigate the chemical constituents of Epimedium multiflorum T. S. Ying. Methods The ethanol extract of E. multiflorum was separated and purified by silica gel column chromatography, preparative thin-layer chromatography, and semi-preparative reversed-phase high-performance liquid chromatography. The structures of the compounds were identified by nuclear magnetic resonance spectroscopy and comparison with literature data. Results Ten compounds were isolated and purified, which structures were identified as baohuoside Ⅱ（1），2′′-O-rhamnosyl-icariside Ⅱ（2）, icariin（3）, epimedoside A（4）, ikarisoside B（5）, epimedin C（6）, baohuoside Ⅴ（7）, epimedin A（8）, epimedin B（9）, and ikarisoside C（10）. Conclusion All the isolated flavonoid compounds were obtained from E. multiflorum for the first time.

[Purpose]To analyze the cost-effectiveness of endoscopic screening for upper gastroin-testinal cancer in Yangcheng County of Shanxi Province.[Methods]People aged from 40 to 69 who participated in upper gastrointestinal cancer screening in Yangcheng County in 2018 were se-lected as the study subjects to participate in upper gastrointestinal cancer screening in 2018,and endoscopic examination with iodine staining and indicative biopsy were performed for screening.The detection rates of precancerous lesions and upper gastrointestinal malignancies,and early di-agnosis rates were calculated,and compared among different groups.The data of screening cost were collected;and the per capita screening cost,the average cost of early case detection and ear-ly detection cost index(EDCI)were calculated.[Results]Among 2 950 subjects undergoing en-doscopy,pathological biopsy was completed in 2 073 cases(70.27％),374 cases of precancerous le-sions(12.68％)and 52 cases of malignancies(1.76％)were detected,among which 17 cases were up-per gastrointestinal cancer with a detection rate of 0.58％,there were 44 early cases with an early diagnosis rate of 84.62％.The detection rate of precancerous lesions and positive cases in men was higher than that of women,but the early diagnosis rate of upper gastrointestinal cancer was lower than that of women;the detection rate of positive cases and digestive tract cancer of 50 years and above were higher than those of people aged 40 to 49.The cost of screening for one positive lesion was 25 528.85 CNY,the cost of screening for one early case was 30 170.46 CNY.The EDCI was 0.52,indicating a good cost-effective value.[Conclusion]The study shows that the early diagnosis and early treatment screening program of upper gastrointestinal cancer has achieved remarkable re-sults in Yangcheng County.The follow-up screening work should focus on men and people over 50 years old,and strengthen the publicity of upper gastrointestinal screening for cancer.

Purpose To explore the clinical and pathological features,differential diagnosis,treatment methods and prognosis of urachal adenocarcinoma.Methods Nineteen cases of urachal adenocarcinoma were collected and an-alyzed by combining clinical symptoms,auxiliary examinations,histology,immunohistochemical,and genetic testing and 11 cases of bladder adenocarcinomas.Results Among the 19 patients(15 males,4 females;age range:33-75 years,mean:55 years),tumors were located at the dome or anterior wall of the bladder.Histological subtypes includ-ed mucinous adenocarcinoma(6 cases),adenocarcinoma not otherwise specified(4 cases),enteric-type adenocarci-noma(6 cases),adenocarcinoma with focal mucinous differentiation(1 case),adenocarcinoma with signet-ring cell carcinoma(1 case),and metastatic urachal adenocarcinoma(1 case).Immunophenotypic analysis revealed membra-nous positivity for β-catenin,diffuse positivity for CK34βE 12,MUC-2,and CK20,focal CK7 positivity in some cases,and rare GATA-3 positivity.Mutations in p53 were observed,while KRAS,NRAS,BRAF,and PIK3CA mutations were absent.In colorectal adenocarcinomas,CK34βE12 positivity was 40％,nuclear β-catenin positivity was 48％,and MUC-2 expression was approximately 50％.In bladder adenocarcinomas,GATA-3 and MUC-2 positivity rates were 45％and 63.6％,respectively.Conclusion Distinguishing urachal adenocarcinoma from colorectal and primary bladder adenocarcinomas remains challenging.Urachal adenocarcinoma should be suspected in patients with anterior bladder wall or dome lesions,gross hematuria,or mucinuria.No definitive diagnostic markers currently exist for ura-chal adenocarcinoma.Immunophenotypic features such as membranous β-catenin,MUC-2,and CK7 positivity may fa-vor urachal adenocarcinoma over colorectal adenocarcinoma.Additional markers(e.g.,GATA-3,CK20,CK34βE12)aid in differential diagnosis,though individual markers lack specificity.Comprehensive evaluation integrating clinical presentation,imaging,and clinicopathological features is essential for accurate diagnosis.

Purpose To explore the clinical and pathological features,differential diagnosis,treatment methods and prognosis of urachal adenocarcinoma.Methods Nineteen cases of urachal adenocarcinoma were collected and an-alyzed by combining clinical symptoms,auxiliary examinations,histology,immunohistochemical,and genetic testing and 11 cases of bladder adenocarcinomas.Results Among the 19 patients(15 males,4 females;age range:33-75 years,mean:55 years),tumors were located at the dome or anterior wall of the bladder.Histological subtypes includ-ed mucinous adenocarcinoma(6 cases),adenocarcinoma not otherwise specified(4 cases),enteric-type adenocarci-noma(6 cases),adenocarcinoma with focal mucinous differentiation(1 case),adenocarcinoma with signet-ring cell carcinoma(1 case),and metastatic urachal adenocarcinoma(1 case).Immunophenotypic analysis revealed membra-nous positivity for β-catenin,diffuse positivity for CK34βE 12,MUC-2,and CK20,focal CK7 positivity in some cases,and rare GATA-3 positivity.Mutations in p53 were observed,while KRAS,NRAS,BRAF,and PIK3CA mutations were absent.In colorectal adenocarcinomas,CK34βE12 positivity was 40％,nuclear β-catenin positivity was 48％,and MUC-2 expression was approximately 50％.In bladder adenocarcinomas,GATA-3 and MUC-2 positivity rates were 45％and 63.6％,respectively.Conclusion Distinguishing urachal adenocarcinoma from colorectal and primary bladder adenocarcinomas remains challenging.Urachal adenocarcinoma should be suspected in patients with anterior bladder wall or dome lesions,gross hematuria,or mucinuria.No definitive diagnostic markers currently exist for ura-chal adenocarcinoma.Immunophenotypic features such as membranous β-catenin,MUC-2,and CK7 positivity may fa-vor urachal adenocarcinoma over colorectal adenocarcinoma.Additional markers(e.g.,GATA-3,CK20,CK34βE12)aid in differential diagnosis,though individual markers lack specificity.Comprehensive evaluation integrating clinical presentation,imaging,and clinicopathological features is essential for accurate diagnosis.

[Purpose]To analyze the cost-effectiveness of endoscopic screening for upper gastroin-testinal cancer in Yangcheng County of Shanxi Province.[Methods]People aged from 40 to 69 who participated in upper gastrointestinal cancer screening in Yangcheng County in 2018 were se-lected as the study subjects to participate in upper gastrointestinal cancer screening in 2018,and endoscopic examination with iodine staining and indicative biopsy were performed for screening.The detection rates of precancerous lesions and upper gastrointestinal malignancies,and early di-agnosis rates were calculated,and compared among different groups.The data of screening cost were collected;and the per capita screening cost,the average cost of early case detection and ear-ly detection cost index(EDCI)were calculated.[Results]Among 2 950 subjects undergoing en-doscopy,pathological biopsy was completed in 2 073 cases(70.27％),374 cases of precancerous le-sions(12.68％)and 52 cases of malignancies(1.76％)were detected,among which 17 cases were up-per gastrointestinal cancer with a detection rate of 0.58％,there were 44 early cases with an early diagnosis rate of 84.62％.The detection rate of precancerous lesions and positive cases in men was higher than that of women,but the early diagnosis rate of upper gastrointestinal cancer was lower than that of women;the detection rate of positive cases and digestive tract cancer of 50 years and above were higher than those of people aged 40 to 49.The cost of screening for one positive lesion was 25 528.85 CNY,the cost of screening for one early case was 30 170.46 CNY.The EDCI was 0.52,indicating a good cost-effective value.[Conclusion]The study shows that the early diagnosis and early treatment screening program of upper gastrointestinal cancer has achieved remarkable re-sults in Yangcheng County.The follow-up screening work should focus on men and people over 50 years old,and strengthen the publicity of upper gastrointestinal screening for cancer.

Poly amino acids are a class of polymers composed of α-amino acids as structural units linked by peptide bonds, exhibiting structural similarity to natural proteins. This class can be degraded into polypeptides, amino acids, and small molecules, demonstrating unique advantages in the field of bone repair. Various functionalized amino acid monomers and their polymerization methods have been developed, primarily including ring-opening polymerization, polycondensation, enzymatic catalysis, and solid-phase synthesis. These methods enable the polymerization of poly glutamic acid, poly lysine, poly aspartic acid, and others into polypeptides to meet the requirements for bone injury repair. However, as the number of amino acids increases and the polypeptide chains extend, molecular chains can form secondary structures such as α-helices and β-sheets through non-covalent interactions like hydrogen bonds and van der Waals forces. These structures play a decisive role in the bioactivity and functionality of poly(amino acid). Therefore, the function of poly(amino acid) is highly dependent on its monomer composition, sequence, secondary structure, and charge characteristics, allowing precise design to effectively regulate biological effects. Nevertheless, the major challenges in applying poly (amino acid) to bone defect repair remain unresolved, namely scalable production and long-term safety and efficacy. It is believed that, with interdisciplinary integration, a new generation of poly(amino acid) materials, combining excellent properties, bioactivity, and smart-responsive traits, is expected to advance bone repair strategies toward precision, personalization, and efficiency.

The number of patients with reduced blood volume due to haemorrhage, fractures, severe infections, extensive burns and tumours is increasing, and traditional blood products are no longer able to meet the increasing clinical demand. Therefore, plasma substitutes have become particularly important in fluid resuscitation, especially artificial colloidal solutions, which have a sustained volume expansion time and a good volume expansion effect, and can significantly improve the circulatory status of patients. This article aims to review the classification of artificial colloidal plasma substitutes and their research progress in clinical practice, in order provide a more rigorous, professional and standardized reference for medicine.

Objective:To evaluate the performance of three mainstream large language models (LLMs) in the review of drug reimbursement indications in hospitals, and to explore their potential in improving audit quality and efficiency, thereby safeguarding the medical insurance fund.Methods:A total of 3 247 outpatient prescription records were retrospectively collected from a specialized oncology hospital between January 2, 2022, and June 30, 2023. Manual assessment of the consistency between clinical diagnoses and drug reimbursement indications was used as the gold standard. Three LLMs, Baidu′s ERNIE Bot, Alibaba′s Tongyi Qianwen, and OpenAI′s ChatGPT-4o, were evaluated on the same task. Performance metrics included accuracy, precision, sensitivity, specificity, F1 score, and area under the curve (AUC).Results:The ERNIE Bot model returned 3 242 valid data, which took 314 min; The Tongyi Qianwen model returned a total of 3 162 valid data, taking 384 min; The ChatGPT-4o model returned a total of 3 218 valid data, taking 150 min. ChatGPT-4o demonstrated the best performance, with an accuracy of 88.41%, precision of 60.48%, sensitivity of 78.75%, specificity of 90.24%, F1 score of 0.68, and an AUC of 0.88.Conclusions:LLMs demonstrate stable performance in determining whether prescriptions align with reimbursement indications, with ChatGPT-4o approaching human-level accuracy and exhibiting more conservative specificity. These findings suggest that LLMs have practical value as auxiliary tools in drug indication reviews, contributing to improved audit efficiency and more refined management of medical insurance funds.

Objective:To explore and practice the construction of an innovative ecosystem that integrates innovation in the National Clinical Research Center for Orthopedics and Sports Rehabilitation, providing references and insights for driving high-quality development of medical care.Methods:Guided by a national policy framework and Industry-Academia-Research-Government-Enterprise Collaborative Innovation, the Center had established six innovation platforms and three systemic pillars. The study analyzed its integrated strategy, which encompassed ecosystem design, platform-enabled empowerment, comprehensive system support, end-to-end coverage, a folded innovation approach, and a standardization-driven mechanism.Results:The Center had built a highly integrated innovation ecosystem, creating a powerful driver for technological advancement and commercialization in orthopedics and sports rehabilitation, accelerating the industrialization of key technologies like surgical robots and 3D-printed implants.Conclusions:Guided by the principle of ″simplifying complex surgeries and standardizing common procedures″, the Center will leverage digital intelligence throughout clinical care, aiming to bridge gaps in healthcare quality so that patients can receive top-tier treatment for major diseases within their home provinces. This commitment to homogenized, high-quality care presents a ″China Model″ for global health and advance the national ″Healthy China″ initiative.

Poly amino acids are a class of polymers composed of α-amino acids as structural units linked by peptide bonds, exhibiting structural similarity to natural proteins. This class can be degraded into polypeptides, amino acids, and small molecules, demonstrating unique advantages in the field of bone repair. Various functionalized amino acid monomers and their polymerization methods have been developed, primarily including ring-opening polymerization, polycondensation, enzymatic catalysis, and solid-phase synthesis. These methods enable the polymerization of poly glutamic acid, poly lysine, poly aspartic acid, and others into polypeptides to meet the requirements for bone injury repair. However, as the number of amino acids increases and the polypeptide chains extend, molecular chains can form secondary structures such as α-helices and β-sheets through non-covalent interactions like hydrogen bonds and van der Waals forces. These structures play a decisive role in the bioactivity and functionality of poly(amino acid). Therefore, the function of poly(amino acid) is highly dependent on its monomer composition, sequence, secondary structure, and charge characteristics, allowing precise design to effectively regulate biological effects. Nevertheless, the major challenges in applying poly (amino acid) to bone defect repair remain unresolved, namely scalable production and long-term safety and efficacy. It is believed that, with interdisciplinary integration, a new generation of poly(amino acid) materials, combining excellent properties, bioactivity, and smart-responsive traits, is expected to advance bone repair strategies toward precision, personalization, and efficiency.