Gastrointestinal stromal tumor(GIST),with a certain malignant potential,are currently the most common subepithelial tumors of the gastrointestinal tract.Early diagnosis and prediction of malignant potential are very important for the formulation of a treatment plan and determining the prognosis of GIST.Deep learning technology has made significant progress in the diagnosis of digestive tract diseases,and it can also effectively assist physicians in diagnosing GIST and predicting their malignant potential,preoperatively.The application of deep learning technology in the diagnosis of GIST includes CT,gastrointestinal endoscopy and endoscopic ultrasound.This paper aims to review the application of deep learning technology in the diagnosis and prediction of malignant potential of GIST.

Objective:To investigate the clinical characteristics, treatment and prognosis of primary vitreoretinal lymphoma (PVRL) diagnosed and treated in our hospital during the past 10 years.Methods:A retrospective clinical study. From 2011 to 2021, 126 eyes of 67 patients with PVRL who were diagnosed and treated in Department of Ophthalmology, Eye-ENT Hospital, Fudan University were included in the study. Among them, there were 23 males (34.3%, 23/67) and 44 females (65.7%, 44/67); the average age was 57.1 years. There were 59 cases with both eyes (88.1%, 59/67) and 8 cases with one eye (11.9%, 8/67). At the initial eye diagnosis, 22 cases had a clear history of primary central nervous system lymphoma (PCNSL); 5 cases were found to have intracranial lesions by head imaging examination; 40 cases had no central nervous system involvement. Twenty cases were treated with glucocorticoids due to misdiagnosed uveitis. All patients received intravitreal injection of methotrexate (IVM) treatment. The treatment regimen was twice a week in the induction period for 2 weeks, once a week in the consolidation period for 1 month, and once a month in the maintenance period. Patients with PCNSL or both eyes received concurrent systemic chemotherapy (chemotherapy), and some in combination with radiation therapy to the brain (radiotherapy). The mean follow-up time was 39.3 months. The clinical manifestations, treatment and prognosis of the patients were retrospectively analyzed. The visual acuity before and after treatment was compared by t test. Results:Among the 22 cases with a clear history of PCNSL at the initial eye diagnosis, the average time from intracranial diagnosis to eye diagnosis was 22.9 months. Among the 40 cases without central nervous system involvement at first, 14 cases (20.9%, 14/67) developed central nervous system lesions during follow-up period. The mean time from ocular diagnosis to intracranial diagnosis was 9.9 months. Among the 126 eyes, 42 eyes (33.3%, 42/126) had anterior segment inflammation. vitreous inflammation type, retinal type, and vitreous retinal type were 58 (46.0%, 58/126), 7 (5.6%, 7/126), and 61 (48.4%, 61/126) eyes, and 9 of them (7.1%, 9/126) had optic nerve involvement at the same time. Patients received an average of 12 IVM treatments. IVM combined with systemic chemotherapy in 59 cases (88.1%, 59/67), of which 16 cases were combined with brain radiotherapy. All patients achieved complete remission after completing the treatment cycle (100.0%, 67/67). After treatment, 21 eyes (16.7%, 21/126) had ocular recurrence; 22 (32.8%, 22/67) had intracranial recurrence; 8 cases (11.9%, 8/67) died. The mean progression-free survival of patients was 23.7 months; the mean survival time was 43.6 months; the 5-year overall survival rate was 72.5%.Conclusions:The manifestations of PVRL are complex and diverse, and most of them are accompanied by involvement of the central nervous system. It can be divided into vitreitis type, retinal type and vitreoretinal type, and the optic nerve can be involved at the same time; IVM combined with systemic treatment can completely relieve the disease.

Objective:To explore the application value of preoperative multimodal image fusion 3D reconstruction technology in brain tumor surgery.Methods:The preoperative cranial CT and MR imaging data of 46 patients with brain tumors admitted to our hospital from October 2019 to September 2020 were collected. The image registration and fusion of above imaging data were performed by AW workstation software (GE company), and 3D reconstruction was performed to construct 3D digital anatomic image of brain tumor and its surrounding anatomic structure. Based on this, the surgical approach and surgical plan were designed, and its application value was evaluated by consistency grading.Results:The reconstructed 3D digital anatomical image could clearly show the size, location, shape of the tumors and the anatomical relationships between the tumors and surrounding structures, which was consistent with the original image before and during the surgery. Among the 46 patients, 43 were completely resected and 3 were partially resected. There were no approach-related complications after surgery. The application value of preoperative 3D image fusion was evaluated as 36 with outstanding value, 8 with value, and 2 without value.Conclusion:Preoperative multimodal image fusion 3D reconstruction technology can provide a large amount of visual information during brain tumor surgery, guide the choice of surgical approach and precise resection of tumors.

Objective To design and evaluate a new type of acromion & clavicle anatomic plate with combinatorial hinge more suitable for acromioclavicular joint dislocation and distal clavicular fracture.Methods The new type of acromion & clavicle anatomic plate with combinatorial hinge we had designed was used in 21 patients (21 shoulders) who were treated for acromioclavicular joint dislocation or distal clavicular fracture from October 2016 to April 2017 at Department Ⅰ of Orthopaedics,The 2nd People's Hospital of Lu'an.They were 15 men and 6 women,aged from 24 to 63 years(average,41.5 ±4.2 years).Of the 14 cases of acromioclavicular joint dislocation,7 were type Ⅲ,5 type Ⅳ and 2 type Ⅴ,according to the Rockwood classification;all the 7 distal clavicular fractures were Neer type Ⅱ.They were all treated by open reduction and internal fixation with our self-designed acromion & clavicle plate with combinatorial hinge.They were followed up at the outpatients department at 3 weeks,3,6,12 and 15 months postoperatively for evaluation of their shoulder functions by Constant-Murley score,changes in coracoclavicular clearance before and after operation and loss of coracoclavicular clearance after removal of internal fixation by X-ray.Results All the 21 patients were effectively followed up for 15 to 20 months (average,18 months).As for their Constant-Murley scores,preoperation (49.7±4.9) ＜3 weekspostoperation (57.6±5.9) ＜3 monthspostoperation (83.2±5.7) ＜6 months postoperation (90.4 ±4.0) ＜ 12 months postoperation (94.3 ±4.2) ＜ 15 months postoperation (98.1 ±4.2),with significant differences between different time points (P ＜ 0.05).The postoperative coracoclavicular clearances at different time points were all significantly decreased than the preoperative value (P ＜ 0.05).With the aid of our new type of acromion & clavicle anatomic plate,the shoulder functions of the patients were gradually improved,the postoperative acromioclavicular joint and reduction of the distal clavicular fracture were stable,and no re-dislocation occurred after removal of internal fixation.Conclusion Our new handy type of acromion & clavicle anatomic plate with combinatorial hinge can provide more effective internal fixation for acromioclavicular joint dislocation and clavicular distal fracture,facilitating functional recovery of the shoulder.

Further healthcare system reform calls for desirable pathway design. This paper introduced the logical framework of the new healthcare system reform pathway design and typical practical experience in Hangzhou.Known for " Internet+Smart healthcare" forerunner, Hangzhou has pioneered the reform of public hospitals and the construction of smart handy service for the public.With the aim of fully protecting the health rights and interests of urban and rural residents, comprehensive policy has been taken to deepen the reform of public hospitals; with the comprehensive promotion of contracted services and the primary level sharing of resources as a carrier, we will build a hierarchical medical service system of vertical linkage.We will also innovate and practice the governing philosophy of " Medicine has its limitations but we have the courage to overcome, service is boundaryless and we must pursue excellence".Promotion of party building in the industry also ranks high.Deepening the reform of " one visit for all" in the field of medical and health services as a measure to enhance people′s sense of gain; The " public-private partnership" to encourage the development of the social governance system and legalization in healthcare proves successful at this stage. However, there are still many challenges in the information security maintenance of smart healthcare, the balance of stakeholder interests in public hospitals, the all-round advancement of hierarchical medical service, standardizing and streamlining the reform of " one visit for all".

OBJECTIVE:To explore the incidence,clinical manifestations and influential factors of ADR induced by Xuebi-jing injection,and to provide reference for safe and rational use of it. METHODS:The inpatients who used Xuebijing injection in our hospital during Jan. 2012 to Dec. 2016 was registered and monitored centrally,and analyzed statistically in respects of clinical characteristics,occurrence time of ADR,clinical manifestation,outcome,etc.RESULTS:A total of 3 300 patients records were in-cluded,involving 81 ADR cases with incidence of 2.45%. There was no correlation between ADR and gender. The incidence of ADR was in high level in the patients with age over 60 years(6.53%),history of allergy(72.84%),original diseases as respirato-ry disease(3.33%),blood system disease(3.11%)and central nervous system disease(3.03%),and receiving combination of TCM injection(34.57%),antibiotics(25.93%)and immune enhancer(14.81%). Single-day culmulative amount with no more than 50 mL had relatively higher proportion(36.67%),and there was no statistical significance in the ADR with different sin-gle-day culmulative amounts(P>0.05). 38.27% of ADR occurred within 30 min after first medication. Organs/systems involved in ADR were mainly skin and its appendants(37.04%),cardiovascular system(19.75%)and gastrointestinal system(14.81%). To-tally 15 cases had severe ADR,which were mainly anaphylactic shock(33.33%,5/15)and systemic rash(20.00%,3/15). All ADR were recovered after drug withdrawal or symptomatic treatment. CONCLUSIONS:ADR induced by Xuebijing injection are mainly anaphylactic type. The incidence of ADR is higher in patients with primary respiratory disease,blood system disease,drug combination,allergic history and advanced age. The part of them are not mentioned in drug package inserts.Manufacturers are sug-gested to collect ADR information and improve drug package insets in time.

Objective To analyze the principal components and trends of total health expenditure from 1995 to 2011 in Xinjiang,in order to put forward policy recommendations to improve health financing.Methods Calculating the total health expenditure in Xinjiang using the financing source method,and analyzing the calculation results.Results Total health expenditure increase in Xinjiang averaged 14.75％ from 1995 to 2011.The total health expenditure in Xinjiang and per capita health expenses maintained a growing trend,and the level of financing was higher than regional economic development,but the health consumption elasticity coefficient was unstable; Residents' individual health burden was gradually decreasing,the health expenses of financing structure were relatively reasonable; Urban and rural residents health care spending grew faster than the per capita income,and the proportion in people's living consumption was found rising.Conclusion It is recommended to continue with the health reform,make full use the policy of strategic health support to Xinjiang,promote primary health service equity,develop economy and improve the urban and rural income,strengthen social health care security systems,tighten macro-control and curb the fast rising trend of health expenses.

OBJECTIVE:To establish a method to determine the content of chlorogenic acid in Yinhuang qinghuo capsule. METHODS:HPLC was performed on the column of Acclaim120? C18 with mobile phase of acetonitrile-0.4% phosphoric acid(12:88,V/V)at flow rate of 1 ml/min,the detection wavelength was 327 nm,column temperature was 25 ℃,and volume injection was 10 μl. RESULTS:The linear range of chlorogenic acid was 56-224 μg;RSDs of precision,stability and reproduciblity tests were lower than 3.0%,recovery was 96.91%-104.76%(RSD=1.46%,n=9). CONCLUSIONS:The method is simple and reproducible, and can be used for the quality control of Yinhuang qinghuo capsule.

Objective To optimize conditions for extraction of alkaloids from Evodia rutaecarpa by means of 732 cation exchange resin and performe its anti-breast cancer bioactivity.Methods The optimum processing route on extraction of alkaloids from Evodia rutaecarpa was investigated by means of 732 cation exchange resin.The performance of 732 cation exchange resin was compared with tranditonal process ( aqueous extraction-ethanol precipitation in extraction-purification process).The alkaloid reagent-potassium mercuric iodide test and MTT test were performed on the crudes.Results Compared with traditional purification process, it was much better to use 732 cation exchange resin approach for extraction of alkaloids from Evodia rutaecarp with high yield(16.81%) The best eluent should be saturated brine with excellent purification.No obvious correlations were found between the toxin of breast cancer cell and concentration of total alkaloids.When the concentration of total alkaloids was 50μmol/mL, cellular survival rate was 68%afterward 24 h.When the concentration of total alkaloids comes to 100 μmol/mL and 150 μmol/mL, cellular survival rates were slightly decreased by 66% and 60%.Conclusion 732 cation exchange resin performes much higher than traditional process in purification of total alkaloids extracted from Evodia rutaecarpa.Simultaneously, the extracted total alkaloids showe remarkable inhibition in breast cancer cell.

Objective To systemically review the efficacy and safety of low dose spironolatone combined with angiotensin convertig enzyme inhibitors (ACEI) or angiotensin Ⅱ receptor blockers (ARB) on diabetic nephropathy.Methods PubMed,the Cochrane library (Issue 4,2014),CBM,CNKI,VIP and WanFang Data were searched from inception to July 2014 for randomized controlled trials (RCTs) concerning ACEI or ARB combined with low-dose spironolatone in the treatment of diabetic nephropathy.Two reviewers screened literature according to the inclusion and exclusion criteria,extracted data,and assessed the methodological quality of included studies.Then Meta analysis was performed using RevMan 5.2 software.Results A total of 19 RCTs involving 1313 patients were included in this study.The results of Meta-analysis showed that compared with ACEI or ARB treatment alone,ACEI or ARB combined with low-dose spironolatone had lower urinary albumin excretion rate (UAER) [mean difference (MD) =21.03,95％ CI:18.51-23.56,P＜ 0.01] and proteinuria (MD=171.29,95％ CI:81.96-260.62,P＜0.01),and had no influence on plasma albumin (Alb) (MD=-0.25,95％ CI:-0.66-0.17,P＞0.05),meanwhile had lower serum creatinine (Scr) (MD=2.63,95％CI:0.92-4.34,P＜0.05),but had higher concentration of blood potassium (MD=-0.26,95％ CI:-0.37-0.14,P＜0.01).Conclusions ACEI or ARB combined with low-dose spironolactone can significantly reduce the urinary albumin level and delay the deterioration of renal function.Blood potassium concentrations in most patients are within the normal range,although it is increased after the treatment of ACEI or ARB combined with low-dose spironolactone.