Objective:To explore the feasibility of rapid detection of AAC(6′)-Ⅰb-cr enzyme-producing Enterobacteriales using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Methods:A total of 55 Enterobacteriales strains isolated from the Department of Clinical Laboratory of Wenzhou TCM Hospital from January to July 2022 were collected. Ciprofloxacin and norfloxacin solutions were used as reaction substrates, incubated with the test strains for 1 hour, followed by centrifugation, and the supernatant was detected by MALDI-TOF MS. In addition, 128 clinical strains isolated from the clinical laboratory of our hospital from March to May 2023 were prospectively collected for the validation study of the method. Results:After ciprofloxacin and norfloxacin were acetylated by the AAC(6′)-Ⅰb-cr enzyme, a mass shift of relative molecular mass 42 occurred, resulting in the appearance of three mass spectral peaks representing the acetylated drugs. No such peak was observed in enzyme-negative strains. Besides, compared with gene sequencing results, the MALDI-TOF MS results of 128 strains used in the validation test showed 100% both in specificity and sensitivity.Conclusion:MALDI-TOF MS can rapidly and accurately detect AAC(6′)-Ⅰb-cr enzyme-producing Enterobacteriaceae bacteria.

Objective:To explore the feasibility of rapid detection of AAC(6′)-Ⅰb-cr enzyme-producing Enterobacteriales using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Methods:A total of 55 Enterobacteriales strains isolated from the Department of Clinical Laboratory of Wenzhou TCM Hospital from January to July 2022 were collected. Ciprofloxacin and norfloxacin solutions were used as reaction substrates, incubated with the test strains for 1 hour, followed by centrifugation, and the supernatant was detected by MALDI-TOF MS. In addition, 128 clinical strains isolated from the clinical laboratory of our hospital from March to May 2023 were prospectively collected for the validation study of the method. Results:After ciprofloxacin and norfloxacin were acetylated by the AAC(6′)-Ⅰb-cr enzyme, a mass shift of relative molecular mass 42 occurred, resulting in the appearance of three mass spectral peaks representing the acetylated drugs. No such peak was observed in enzyme-negative strains. Besides, compared with gene sequencing results, the MALDI-TOF MS results of 128 strains used in the validation test showed 100% both in specificity and sensitivity.Conclusion:MALDI-TOF MS can rapidly and accurately detect AAC(6′)-Ⅰb-cr enzyme-producing Enterobacteriaceae bacteria.

Cryoablation therapy with explicit anti-tumor mechanisms and histopathological manifestations has a long history.A large number of clinical practice has shown that cryoablation therapy is safe and effective,making it an ideal tumor treatment method in theory.Previously,its efficacy and clinical application were constrained by the limitations of refrigerants and refrigeration equipment.With the development of the new generation of cryoablation equipment represented by argon helium knives,significant progress has been made in refrigeration efficien-cy,ablation range,and precise temperature measurement,greatly promoting the progression of tumor cryoablation technology.This consensus systematically summarizes the mechanism of cryoablation technology,indications for oral mucosal melanoma(OMM)cryotherapy,clinical treatment process,adverse reactions and management,cryotherapy combination therapy,etc.,aiming to provide reference for carrying out the standardized cryoablation therapy of OMM.

Objective To analyze the results of acceptance testing of 60 extraoral dental X-ray equipment in Beijing, China from 2021 to 2022, and understand the main types and performance parameters of newly installed extraoral dental X-ray machines in the clinical market of Beijing, as well as the level of installation and trial run of the whole machine by various manufacturers, and to summarize the problems found in acceptance testing for improving equipment testing. Methods Field acceptance testing and evaluation were carried out according to the Specification for Testing of Quality Control in Medical X-Ray Diagnostic Equipment (WS 76—2020). Results The overall qualified rate of 60 extraoral dental X-ray equipment was 98.33%. Under the same condition of the same tube voltage for one dental equipment, the maximum deviation of the tube voltage indicated by the two modes (panorama and skull) is 5.5%, and the maximum difference of the half-value layer of the useful beam is 1.22 mm Al. There is also a certain difference between the exposure time indicating deviation from the panorama and the skull, with a maximum difference of 75.51%. Conclusion Strengthening ex-factory quality control, installing, and debugging of equipment can basically guarantee the performance of newly installed equipment. In the testing process, it is critical to ensure the effective point of measurement of the dose detector located on the central axis of the primary beam.

Objective To analyze the clinical outcomes of a standard protocol of open reduction and internal fixation using a variable angle foot plate for a consecutive series of patients with acute Lisfranc joint injury.Methods This study retrospectively evaluated the clinical outcomes of 11 Chinese patients(13 feet) with acute Lisfranc joint injury who had been treated by open reduction and internal fixation with a variable angle foot plate from December 2016 to June 2017 at Department of Orthopaedics,West China Hospital.They were 8 men(10 feet) and 3 women(3 feet),aged from 19 to 57 years(average,36.4 years).Of them,10 were complicated with fracture of metatarsus,6 with cuneiform fracture and/or dislocation,4 with cuboid fracture,and one with cuboid fracture.According to the Myerson classification for Lisfranc fracture-dislocations,one case(one foot) belonged to type A,2(2 feet) to type Bl,5(6 feet) to type B2,2(3 feet) to type Cl and one(one foot) to type C2.The outcomes were evaluated using the visual analogue scale(VAS) and the midfoot scores of American Orthopedic Foot and Ankle Society(AOFAS).Results This cohort was followed up for 18 to 24 months(average,22 months).Their VAS scores were decreased significantly from preoperative 7.3±1.2(from 6 to 9) to postoperative 1.2±0.2(from 0 to 2)(P<0.05);their AOFAS midfoot scores were increased significantly from preoperative 0 to postoperative 84.6±4.6(P<0.05) Anatomic reduction was obtained in all the patients and all the fractures united successfully without any delayed union or nonunion.Superficial necrosis of the wound edge occurred in 2 cases without deep infection;skin anesthesia occurred in 2 and skin hypesthesia in 4,indicating a lesion of the superficial peroneal nerve.Conclusion Fixation of acute Lisfranc joint injury with a variable angle foot plate can lead to rigid stability,precise reduction and satisfactory short-term clinical outcomes.

Due to the complex anatomical structure of ankle and the various mechanisms of ankle injury, manyeponyms and systematic classifications of ankle fracture have been developed in the past centuries. Before the emergence and constant improvement of classifications of ankle fracture, ankle fractures were most commonly named afterthe physicians who first described them. Now,these ankle fracture eponyms are still found in medical literature, textbooks and even mass media. Many special named ankle fractures can be explained by the Lauge-Hansen classification now, and they may have little practical use. However, it is still necessary to summarize and review these ankle fracture eponyms, in order to correct the wrong usage of these and to remember the sages in this field.We reviewed both common and less frequently used ankle fracture eponyms, focusing on imaging features to identify and differentiate these injuries. We also briefly reviewed the mechanism of each injury, associated complications, its diagnosis and treatment.

Objective To evaluate open reduction and internal fixation (ORIF) combined with Ilizarov joint distraction in the treatment of comminuted talar body fractures.Methods Between July 2010 and May 2016,16 patients with comminuted talar body fracture underwent ORIF followed by ankle joint distraction by Ilizarov external fixator at our department.They were 9 males and 7 females,aged from 17 to 56 years (average,35.6 years).Radiological assessments were conducted by plain radiographs and computed tomography (CT) scans pre-and post-operatively.Clinical outcomes were evaluated according to visual analogue scale (VAS),American Orthopedic Foot and Ankle Society (AOFAS) hindfoot score,the short form (SF)-36 health survey scores and patients' satisfaction.Results Two patients were lost to follow-up.The remaining 14 patients were followed up for an average duration of 33.3 months (from 13 to 52 months).All the fractures united.Superficial wound infection occurred in one case.Eight patients developed post-traumatic osteoarthris;4 patients presented with avascular necrosis.At final follow-ups,the AOFAS scores ranged from 30 to 97 points (mean,69.8 points),the VAS scores from 0 to 6 points (mean,2.5 points),the physical component summary in SF-36 from 18.0 to 55 points (mean,41.7 points),and the mental component summary from 40 to 70 points (mean,54.1 points).Two patients reported strong satisfaction,5 satisfaction,4 moderate satisfaction,and 3 dissatisfaction.Conclusion For comminuted talar body fractures,ORIF combined with Ilizarov joint distraction is a new and effective treatment which can not only provide adequate fixation strength but also reduce the incidence of post-traumatic osteoarthris or avascular necrosis.

Objective To analyze the genotype and plasmid transfer of Enterobacteriaceae carring blaNDM‐1 with blaIMP‐4 or blaKPC‐2 .Methods From April 2012 to October 2014 ,a total of 33 non‐repeatitive carbapenem‐resistant Enterobacteriaceae ( including Imipenem‐resistant , meropenem‐resistant or Ertapenem‐resistant) were isolated from 5 hospitals in Wenzhou and Hangzhou . Identification and antimicrobial susceptibility test were performed using Vitek 2 Compact automatic microbiology analyzer . Phenotypes of carbapenemase were screened using modified Hodge test and ethylenediamine tetraacetic acid‐disk synergy test .Extended spectrum βlactamase test was determined by the double disk combination test which was recommended by Clinical and Laboratory Standards Institute .AmpC activity was tested by a three‐dimensional Cefoxitin method .Drug resistant genes including blaNDM‐1 and linkage of ISAba125‐NDM were detected by polymerase chain reaction (PCR) .The purified PCR products were cloned and sequenced .Plasmid conjugation experiment and elimination method were carried out to test partial bacterial strain and K . pneumoniae carrying blaNDM‐1 with blaIMP‐4 or blaKPC‐2 .Results Of the 33 non‐repeatitive carbapenem‐resistant Enterobacteriaceae ,28 were strains of K .pneumoniae ,1 strain of K . oxytoca,2strainsof Escherichiacoli,1strainof K.planticolaand1strainof E.cloacae.Thirteenstrains were isolated from Hospital of Sir Run Run Shaw of Zhejiang University ,thirteen from Wenzhou Hospital of Traditional Chinese Medicine ,one from Wenzhou People′s Hospital ,three from the First Affiliated Hospital of Wenzhou Medical University and three from Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine .Thirty‐one strains were confirmed as carbapenemase‐producing with 24 of blaKPC‐2 ,3 of blaNDM‐1 ,1 of blaNDM‐5 and 3 of blaIMP‐4 .Among them ,one strain carried blaNDM‐1 with blaIMP‐4 and one strain carried blaNDM‐1with blaKPC‐2 ,respectively .The plasmid transfer and conjugation experiment was performed between strains carrying blaNDM‐1 and Escherichia coli EC600 or K . pneumoniae ATCC13833 and genes of blaNDM‐1 and ISAba125‐NDM were obtained .Conclusions blaKPC‐2 gene is the popular carbapenemase genotype .blaNDM‐1 or blaNDM‐5 may be correlated with linkage gene of ISAba125‐N DM .Coexistence of blaNDM‐1 carrying blaIMP‐4 or blaKPC‐2 is detected in the same strain , respectively . Enough importance should be attached to the strains ,because most of them are multiple drug resistance with related genes located in the plasmid which is easily spread between strains .

Objective To observe the expression of aggrecanase 2 and a tissue inhibitor of metalloproteinase 3 (TIMP-3) in degenerate human lumbar intervertebral discs and their role in degeneration of the nucleus pulposus.Methods Pfirrmann classification was used to class degenerate intervertebral discs observed through MRI.They were divided into three groups:a control group (Pfirrmann grade Ⅰ-Ⅱ),a degeneration group (Pfirrmann grade Ⅲ-Ⅳ),and a severe degeneration group (Pfirrmann grade Ⅴ).A total of 45 cases accepted lumbar spine surgery for removing nucleus pulposus specimens.Each group contained 15 cases.After formalin-fixation and paraffin embedding,immunohistochemistry was used to detect aggrecanase 2 and TIMP-3 expression in the nucleus pulposus cells.Results The percentages of cells positive for aggrecanase 2 were (13.58 ± 7.76) ％,(33.48 ± 13.95) ％ and (56.00 ± 18.39) ％ in the control,degeneration and severe degeneration groups respectively.These differences had statistical significance.The percentages of cells positive for TIMP-3 were (34.78 ± 13.80) ％,(46.77 ± 10.98) ％ and (50.65 ± 16.45) ％,and these differences were again statistically significant.The aggrecanase 2/TIMP-3 ratios were also significantly different.Conclusion As the degree of degeneration of the nucleus pulposus increased,the expression of aggrecanase 2 and TIMP-3 rose,which indicates that both changes were closely connected with the degeneration.Their ratio was correlated with the degree of degeneration of the nucleus pulposus.

Objective To summarize the experiences of treatment of calculus obstructive pyonephrosis with transureteroscopic holium laser lithotripsy. Methods There were 13 patients with flank pain and fever, all patients received antibacterial therapy and nutritional support before operation ,the patients of calculus obstructive pyonephrosis were treated using transureteroscopic holium laser lithotripsy. Results The ureteral calculus were cleared off in 10 cases, and in three cases, the stone moved to pelvis during operation that they needed additional procedure of ESWL, no severe complications were observed. Conclusion Transureteroscopic holium laser lithotripsy is safe,minimal in-vasive and effective method for treatment of calculus obstructive pyonephrosis and the therapeutic scheme can be the first choice.