Gastric cancer is a common tumor of the gastrointestinal tract, and the global trend in morbidity and mortality are not encouraging. Especially in advanced gastric cancer, patient survival outcome is an essential clinical concern and a vital outcome indicator in clinical outcome assessment. This article reviews the definition of clinical outcome assessment and the measurement tools that can be applied in gastric cancer patients, describes the detailed classification of clinical outcome assessment tools, and reviews the current status of the application of clinical outcome assessment in gastric cancer, analyzing the effects and shortcomings of its application, to provide a reference for the clinical staff in choosing the appropriate tools, and assisting in the comprehensive and holistic assessment of clinical outcomes for the promotion of the development of precision medicine.

Gastric cancer is a common tumor of the gastrointestinal tract, and the global trend in morbidity and mortality are not encouraging. Especially in advanced gastric cancer, patient survival outcome is an essential clinical concern and a vital outcome indicator in clinical outcome assessment. This article reviews the definition of clinical outcome assessment and the measurement tools that can be applied in gastric cancer patients, describes the detailed classification of clinical outcome assessment tools, and reviews the current status of the application of clinical outcome assessment in gastric cancer, analyzing the effects and shortcomings of its application, to provide a reference for the clinical staff in choosing the appropriate tools, and assisting in the comprehensive and holistic assessment of clinical outcomes for the promotion of the development of precision medicine.

Objective To evaluate the role of P16/Ki-67 double dye in the diagnosis of cervical intraepithe-lial lesion(CIN)value,and to analyze its consistency with cervical biopsy.Methods A total of 92 patients with suspected CIN in Shanghai Songjiang District Central Hospital from November 2021 to April 2023 were selected as the research objects.All patients underwent high-risk human papillomavirus(HR-HPV)and P16/Ki-67 double dye.Taking cervical biopsy as the gold standard,the diagnostic value of the two detection meth-ods for CIN was analyzed,as well as the consistency of the two detection methods in the diagnosis of CIN clas-sification and cervical biopsy.Results The results of cervical biopsy showed that 74 cases(80.43%)of 92 suspected CIN patients were positive,including 26 cases of CIN Ⅰ,32 cases of CIN Ⅱ and 16 cases of CIN Ⅲ,and 18 cases(19.57%)were negative.Taking cervical biopsy results as the gold standard,P16/Ki-67 double dye was more accurate than HR-HPV test in the diagnosis of CIN(P<0.05).The receiver operating charac-teristic(ROC)curve showed that the area under the curve of HR-HPV and P16/Ki-67 double dye for CIN di-agnosis was 0.760 and 0.890,respectively,all of them had certain diagnostic value.The consistency between HR-HPV evaluation of CIN classification and cervical biopsy was consistent(Kappa=0.707,P<0.05).The consistency between P16/Ki-67 double dye and cervical biopsy was excellent(Kappa=0.832,P<0.05).Con-clusion P16/Ki-67 double dye with a high diagnostic value in CIN,consistency in determining CIN grade and cervical biopsy is wonderful,which can provide reference for clinical diagnosis.

Objective To investigate the clinical and imaging features of testicular interstitial lesions in children.Methods The clinical and imaging data of 8 children with testicular interstitial lesions confirmed by pathology were analyzed retrospectively.Results There were 8 cases of precocious puberty,5 cases of elevated sex hormones,and 2 cases of congenital adrenal hyperplasia(CAH).The lesions were located in the unilateral testis in 6 cases,bilateral in 2 cases,single in 4 cases,and multiple in 4 cases,with diameters 3-14 mm,all of them with clear boundaries.4 cases of leydig cell hyperplasia(LCH)showed heterogeneous hypoechoic lesions,with slightly significant blood flow signal on color Doppler flow imaging(CDFI);CT showed iso-density lesions with mild enhanced after enhancement;MRI showed iso-signal on T1WI,and T2WI fat suppression were iso-signal mainly with mild enhanced after enhancement.2 cases of leydig cell tumor(LCT)showed heterogeneous hypoechoic lesions with significant blood flow signals inside and around on CDFI,CT showed iso and slightly low density with low-density necrosis,which were inhomogeneously and significantly enhanced after enhancement.2 cases of testicular adrenal rest tumor(TART)showed heterogeneous hypoechoic lesions with significant blood flow signals inside and around on CDFI;CT showed iso and slightly low density,with inhomogeneouly and significantly enhanced after enhancement;MRI showed iso-signal mainly on T1WI,and T2WI fat suppression were slightly low signal mainly with mixed signal,which were inhomogeneously and significantly enhanced after enhancement,complicated with adrenal hyperplasia.Conclusion The imaging findings of testicular interstitial lesions in children have certain characteristics,and the combination of clinical manifestations,basic diseases,laboratory and a variety of imaging examinations are helpful in improving diagnostic efficiency.

Frailty, as a common clinical syndrome in older adults, predisposes them to many adverse health outcomes. Machine learning, as a new modelling method, has the advantages of objectivity, accuracy and science. Therefore, this paper reviews the concept of frailty, the overview of risk prediction models and machine learning, and the current status of research on frailty risk prediction models for older adults based on machine learning, with the aim of providing a reference for the construction of a machine-learning frailty risk prediction model for older adults that meets China's clinical reality, and then promoting the precise prevention and individualised intervention of frailty.

Objective To observe the value of MRI in evaluation on the morphology and function of iliococcygeal muscles in fertile and nulliparous women.Methods Totally 50 healthy fertile women (fertile group,further divided into cesarean section subgroup and spontaneous delivery subgroup according to the mode of delivery) and 17 nulliparous healthy women (nulliparous group) underwent MR scanning in both natural and increased abdominal pressure state.Iliococcygeus thickness (ICT),coronal iliococcygeal angle (cICA) and sagittal iliococcygeal angle (sICA) of different states were measured and compared between the groups.Results In the natural state,the right and bilateral average sICA in the fertile group were larger than those in nulliparous group (both P＜0.05),while no statistical difference of ICT,right,left and bilateral average cICA and left sICA were found between two groups (all P＞0.05);the bilateral average sICA in spontaneous delivery subgroup was larger than that in cesarean section subgroup (P＜0.05).In increased abdominal pressure state,left,right sICA and bilateral average sICA in fertile group were larger than those in nulliparous group (all P＜0.05),while there was no statistical difference of ICT and cICA between two groups (all P＞0.05);no statistical difference of ICT,cICA nor sICA was found between spontaneous delivery subgroup and cesarean section subgroup (all P＞0.05).Conclusion MRI can accurately evaluate morphological and functional changes of iliococcygeal muscle in females.

Objective To observe the therapeutic effect of low dose tolvaptan combined with furosemide in ederly patients with CHF and diuretic resistance (DR).Methods Eighty-five elderly patients with CHF and DR were divided into observation group (n=43) and control group (n=42).The patients in observation group were treated with cardiotonics and hypotensors plus oral tolvaptan (15 mg/d) combined with intravenous furosemide (40 mg/d).The therapeutic effect of low dose tolvaptan combined with furosemide was assessed.Results The average urinary volume was larger,and the LVEDV was significantly lower in two groups after treatment than before treatment (P＜0.05).The urinary volume was significantly larger while the LVEDV was significantly lower in observation group than in control group (2.89±0.87 L/d vs 2.43±0.49 L/d,P=0.01;103.6±21.5 ml vs 116.7±24.3 ml,P=0.01).The total effective rate was significantly higher in observation group than in control group (86.0％ vs 71.4％,P=0.01).Conclusion Low dose tolvaptan combined with furosemide can effectively improve the DR and therapeutic effect in elderly CHF patients,and is thus worth popularization in clinical practice.

Objective To investigate the distribution and antimicrobial resistance of pathogens isolated from blood culture of children in a pediatric intensive care unit (PICU),provide reference for empirical treatment of bloodstream infection in critically ill children.Methods Pathogenic bacteria isolated from blood culture of children in a PICU in 2011-2015 were identified and performed antimicrobial susceptibility testing.Results A total of 180 strains of pathogens were isolated from 3 215 blood specimens,the positive rate was 5.60 ％,153 (85.00 ％) of which were grampositive bacteria and 27 (15.00 ％) were gram-negative bacteria.The top five isolated pathogens were Staphylococcus epidermidis (26.67 ％),Staphylococcus hominis (25.00 ％),Staphylococcus haemolyticus (11.66 ％),Escherichia coli (5.55 ％),and Staphylococcus aureus (3.89 ％).The resistance rates of Staphylococcus spp.to linezolid,vancomycin,and quinupristin/dalfopristin were all 0;the detection rates of methicillin-resistant coagulase-negative staphylococci (MRCNS) and methicillin-resistant Staphylococcus aureus(MRSA) were 70.18％ and 42.68％ respectively;Escherichia coli had high resistance rates to ampicillin,cefazolin,ceftriaxone,gentamycin,and compound sulfamethoxazole (50.00 ％-80.00 ％).Conclusion CNS and Escherichia coli are the main pathogens in blood culture of children in PICU,differences in antimicrobial resistance exist among different types of CNS.

Objective To investigate the clinical distribution situation and drug resistance change of Klebsiella pneumoniae in the Navy General Hospital during 2011‐2015 in order to provide reference for rational use of antibacterial agents in clinic .Methods The clinically isolated Klebsiella pneumoniae in this hospital during 2011‐2015 were selected and performed the analysis on the de‐tection rate ,department distribution ,specimens source ,resistance of antibacterial drugs and change trend of resistance to carbapen‐em antibacterial drugs .Results The number the detected Klebsiella pneumoniae strains and isolation rate during 2011 -2015 showed an increasing trend year by year ,the specimens sources were mainly from 10 departments of intensive care units(ICU) ,hy‐perbaric oxygen department ,respiratory department ,radiation oncology department ,kidney disease department ,etc .;the submitted specimens were dominated by sputum and urine ,accounting for 59 .7% and 21 .4% of submitted specimens ;the drug resistance of Klebsiella pneumoniae during 2011‐2015 showed the increasing trend year by year .Klebsiella pneumoniae had higher resistance rates to piperacillin ,ampicillin ,ampicillin/sulbactam and cefuroxime and had lower resistance rate to amikacin ,imipenem ,meropen‐em and tobramycin ;the resistance rates to imipenem and meropenem were increased year by year ,and pan‐drug resistant Klebsiella pneumoniae showed a rapidly rising trend .Conclusion The drug resistance of Klebsiella pneumonia is serious ,especially carbapene‐ms‐resistant Klebsiella pneumoniae is significantly increased in the recent years ,therefore its drug resistance monitoring should be strengthened for guiding rational drug use in clinic .

Objective To investigate the distribution of pathogens in intensive care units (ICU ) and their drug resistance . Methods 668 strains of pathogens isolated from specimens from ICU were collected .VITEK 2 Compact automated microbial iden-tification and susceptibility analyzer was utilized to conduct the antimicrobial susceptibility tests .Kirby-Bauer disk diffusion suscep-tibility test(K-B) was employed to conduct the antimicrobial susceptibility test for Gram-negative bacteria cefoperazone/sulbactam . Results 668 strains of pathogens were derived from sputum [434 (65 .0% )] ,blood[83(12 .0% )] ,urine[88(13 .0% )] ,drainage [14(2 .0% )] ,secretions[14(2 .0% )] and other[35(5 .2% )] .Acinetobacter baumannii was the major detected pathogen in Gram-negative bacteria and the resistance rates were over 50% toward other drug excepting levofloxacin ,sulfamethoxazole and amikacin . Staphylococcus Staphylococcus was the major detected pathogen in Gram-positive bacteria and it showed good sensitivity toward ni-trofurantoin ,quinupristin/dalfopristin ,tigecycline and vancomycin .Candida albicans demonstrated the highest detection rate in fun-gi .Conclusion ICU pathogens have drug resistance in serious condition ,and pathogens and drug resistance monitoring should be strengthened .