Rapid and ultrasensitive detection of pathogen-associated biomarkers is vital for the early diagnosis and therapy of bacterial infections. Herein, we developed a close-packed and ordered Au@AgPt array coupled with a cascade triggering strategy for surface-enhanced Raman scattering (SERS) and colorimetric identification of the Staphylococcus aureus biomarker micrococcal nuclease (MNase) in serum samples. The trimetallic Au@AgPt nanozymes can catalyze the oxidation of 3,3',5,5'-tetramethylbenzidine (TMB) molecules to SERS-enhanced oxidized TMB (oxTMB), accompanied by the color change from colorless to blue. In the presence of S. aureus, the secreted MNase preferentially cut the nucleobase AT-rich regions of DNA sequences on magnetic beads (MBs) to release alkaline phosphatase (ALP), which subsequently mediated the oxTMB reduction for inducing the colorimetric/SERS signal fade away. Using this "on-to-off" triggering strategy, the target S. aureus can be recorded in a wide linear range with a limit of detection of 38 CFU/mL in the colorimetric mode and 6 CFU/mL in the SERS mode. Meanwhile, the MNase-mediated strategy characterized by high specificity and sensitivity successfully discriminated between patients with sepsis (n = 7) and healthy participants (n = 3), as well as monitored the prognostic progression of the disease (n = 2). Overall, benefiting from highly active and dense "hot spot" substrate, MNase-mediated cascade response strategy, and colorimetric/SERS dual-signal output, this methodology will offer a promising avenue for the early diagnosis of S. aureus infection.

OBJECTIVE To investigate the quality and management of cleaning and disinfection of soft endoscopes in Wuxi hospitals,to analyze the existing problems and put forward suggestions for improvement,and to provide references for endoscope-related infection in hospitals.METHODS From Sep.to Nov.2024,the cleaning and disin-fection status and managements of soft endoscopes were investigated.Endoscopes were sampling for adenosine triphosphate(ATP)biofluorescence and bacteriological testing;final rinsing water,hands of disinfection person-nels,disinfectants and environmental surfaces were collected for bacteriological testing.RESULTS Totally 68.18％of hospitals performed daily leaks test before cleaning,and 81.82％used o-Phthalaldehyde;81.25％of hospitals used peracetic acid in endoscopy sterilization,with only 1 hospital using glutaraldehyde.Totally 86.36％of hospi-tals monitored the concentration of disinfectants before daily works.There were statistically significant differ-ences in full-time,education levels,age and working experience of personnels among different levels of hospitals(P＜0.05).The pass rate of the 60 endoscope ATP specimens was 88.33％,and there were statistically signifi-cant differences in the pass rate of gastroscopic ATP testing among different levels of hospitals(P=0.032).The qualification status differed significantly in the types of endoscopes and the time length of enzyme washing(P＜0.05).All 60 endoscopic bacteriological samples were qualified,while 141 environmental bacteriological samples were with a pass rate of 94.33％.Unqualified samples were mainly for disinfection personnel's hands,rinse tank faucets,final rinse water.Rolestonella piercei and Staphylococcus wolffii were detected in one failed final rinse wa-ter by mass spectrometry.CONCLUSIONS The overall equipment and staffing of the surveyed endoscope centers(rooms)basically meet operational needs and generally follow endoscope cleaning and disinfection guidelines.However,there are still deficiencies in cleaning and disinfection management,equipment maintenance,disinfect-ant concentration monitoring and personnel training.Further efforts are needed to strengthen the disinfection quali-ty monitoring of endoscope and related factors.

Rapid and ultrasensitive detection of pathogen-associated biomarkers is vital for the early diagnosis and therapy of bacterial infections.Herein,we developed a close-packed and ordered Au@AgPt array coupled with a cascade triggering strategy for surface-enhanced Raman scattering(SERS)and colorimetric identification of the Staphylococcus aureus biomarker micrococcal nuclease(MNase)in serum samples.The trimetallic Au@AgPt nanozymes can catalyze the oxidation of 3,3',5,5'-tetramethylbenzidine(TMB)molecules to SERS-enhanced oxidized TMB(oxTMB),accompanied by the color change from colorless to blue.In the presence of S.aureus,the secreted MNase preferentially cut the nucleobase AT-rich regions of DNA sequences on magnetic beads(MBs)to release alkaline phosphatase(ALP),which subsequently mediated the oxTMB reduction for inducing the colorimetric/SERS signal fade away.Using this"on-to-off"triggering strategy,the target S.aureus can be recorded in a wide linear range with a limit of detection of 38 CFU/mL in the colorimetric mode and 6 CFU/mL in the SERS mode.Meanwhile,the MNase-mediated strategy characterized by high specificity and sensitivity successfully discriminated between patients with sepsis(n=7)and healthy participants(n=3),as well as monitored the prog-nostic progression of the disease(n=2).Overall,benefiting from highly active and dense"hot spot"substrate,MNase-mediated cascade response strategy,and colorimetric/SERS dual-signal output,this methodology will offer a promising avenue for the early diagnosis of S.aureus infection.

OBJECTIVE To investigate the quality and management of cleaning and disinfection of soft endoscopes in Wuxi hospitals,to analyze the existing problems and put forward suggestions for improvement,and to provide references for endoscope-related infection in hospitals.METHODS From Sep.to Nov.2024,the cleaning and disin-fection status and managements of soft endoscopes were investigated.Endoscopes were sampling for adenosine triphosphate(ATP)biofluorescence and bacteriological testing;final rinsing water,hands of disinfection person-nels,disinfectants and environmental surfaces were collected for bacteriological testing.RESULTS Totally 68.18％of hospitals performed daily leaks test before cleaning,and 81.82％used o-Phthalaldehyde;81.25％of hospitals used peracetic acid in endoscopy sterilization,with only 1 hospital using glutaraldehyde.Totally 86.36％of hospi-tals monitored the concentration of disinfectants before daily works.There were statistically significant differ-ences in full-time,education levels,age and working experience of personnels among different levels of hospitals(P＜0.05).The pass rate of the 60 endoscope ATP specimens was 88.33％,and there were statistically signifi-cant differences in the pass rate of gastroscopic ATP testing among different levels of hospitals(P=0.032).The qualification status differed significantly in the types of endoscopes and the time length of enzyme washing(P＜0.05).All 60 endoscopic bacteriological samples were qualified,while 141 environmental bacteriological samples were with a pass rate of 94.33％.Unqualified samples were mainly for disinfection personnel's hands,rinse tank faucets,final rinse water.Rolestonella piercei and Staphylococcus wolffii were detected in one failed final rinse wa-ter by mass spectrometry.CONCLUSIONS The overall equipment and staffing of the surveyed endoscope centers(rooms)basically meet operational needs and generally follow endoscope cleaning and disinfection guidelines.However,there are still deficiencies in cleaning and disinfection management,equipment maintenance,disinfect-ant concentration monitoring and personnel training.Further efforts are needed to strengthen the disinfection quali-ty monitoring of endoscope and related factors.

Objective:To investigate the mid-to-long term therapeutic effects of allogeneic bone composite prosthesis reconstruction in patients with large bone defects after the resection of distal femoral tumors.Methods:From June 2013 to December 2018, a total of 19 patients with malignant tumors of the distal femur who underwent reconstruction with allogeneic bone composite prosthesis in the Department of Bone Tumor, Shanghai General Hospital were retrospectively collected. There were 10 males and 9 females, aged 22.3±11 years (range, 11-42 years). The mean body mass index was 19.3±3.4 kg/m 2 (range, 14-27 kg/m 2). There were 18 cases of osteosarcoma and 1 case of Ewing's sarcoma. According to Ennecking staging, there were 17 cases of stage IIB and 2 cases of stage III. The intraoperative blood loss and operation time were recorded, and the prosthesis and patient survival conditions and postoperative complications were observed. The limb function was evaluated by the Musculoskeletal Tumor Society (MSTS) 93 function score. Results:All patients successfully completed the operation. The operation time was 187.3±39.8 min (range, 110-260 min), the intraoperative blood loss was 284.9±87.0 ml (range, 200-500 ml), and the blood transfusion volume was 327±213 ml (range, 100-800 ml). The remaining length of the proximal femur was 153.7±26.6 mm (range, 93-190 mm), and the length of allogeneic bone was 84.1±24.6 mm (range, 39-134 mm). Among the 19 patients, 9 patients (47%) achieved bony union with an average healing time of 16.7±4.8 months (range, 10-25 months), and 7 patients had delayed healing with an average healing time of 18.4±4.0 months (range, 15-25 months). The remaining 10 cases were nonunion between allogeneic bone and host bone. All patients were followed up for 80.7±20.2 months (range, 56-121 months). During the follow-up, 3 cases died due to pulmonary metastasis of bone tumors, and the time of death was 57 months, 63 months, and 59 months after surgery, respectively. At the last follow-up, the patient survival rate was 84% (16/19), and the MSTS 93 function score of the 16 patients was (24.3±2.4) points (range, 21-28 points), with an excellent rate of 100% (16/16). Seven patients underwent revision surgery, 3 cases were aseptic loosening, 3 cases were prosthesis stem fracture at the junction of the allograft bone and the host bone, and 1 case was periprosthetic infection, among which the patient with periprosthetic infection had poor local soft tissue conditions due to preoperative radiotherapy, and the infection was controlled after two revision surgeries. Five cases were revised with allogeneic bone composite prosthesis, and 2 cases were revised with short-stem giant prosthesis with cortical steel plate or locking nail. After revision, the remaining length of the proximal femur was 143.4±31 mm (range, 91-175 mm), and the length of the allograft bone was 92.6±26.6 mm (range, 61-123 mm). The 7 revised patients were still in follow-up. There were no cases of pulmonary infection, nerve injury, deep vein thrombosis or other complications after surgery.Conclusion:The survival period of patients after the surgery to reconstruct large bone defects following the resection of malignant tumors at the distal end of the femur using allogeneic bone composite prosthesis is satisfactory, and the limb function is good. However, the incidence of prosthesis complications is high, which can be reconstructed through revision.

Objective:To explore the construction and application methods of multicenter bone tumor-specific database.Methods:Experts from multiple centers including Shanghai General Hospital, Shanghai Changzheng Hospital, Zhongshan Hospital, Shanghai Sixth People's Hospital, Ruijin Hospital, Fudan University Shanghai Cancer Center and Shanghai Ninth People's Hospital established a standard dataset for bone tumors through research and discussion. Clinical data will be automatically collected and standardized according to standard fields. A database will be built and a users' interface will be developed to ensure secure data storage, while providing services such as exporting raw data, visualizing statistical analysis, establishing clinical queue research projects, et al. Finally, the bone tumor database will be shared by integrating with the Shenkang's Big Data Platform to achieve multi-center data integration.Results:A standard data set for bone tumors containing 603 fields has been established and published. An automated data collection system for bone tumors has been established, including complete data collection, data collation and visualization functions. The data categories include modules such as patients' electronic case information, laboratory information on blood routine, biochemistry and tumor markers, imaging information, surgery information, pathology information and radiotherapy records. Personal information such as patients' names and ID numbers are desensitized and encrypted and can be exported for further research. From 2015 to 2023, the total number of bone tumor cases collected in the database was 10,789. From 2015 to 2019, 112 cases of the osteosarcoma cohort were retrospectively analyzed for admission, with a statistical 5-year survival rate of 68%.Conclusion:A regional bone tumor specialty big data network and data sharing platform has been established, along with data sharing mechanisms and standards including data standards, security standards, and quality evaluation standards. This provides data and efficient new solutions for the construction of China's bone tumor database, as well as a research and development platform for standardized diagnosis and treatment of bone tumors and new technologies.

The adjacent anatomy of the pelvis is complicated, with digestive, urinary, reproductive and other organs as well as important blood vessels and nerves. Therefore, accurate resection of pelvic tumors and precise reconstruction of defects after resection are extremely difficult. The development of medical 3D printing technology provides new ideas for precise resection and personalized reconstruction of pelvic tumors. The “triune” application of 3D printing personalized lesion model, osteotomy guide plate and reconstruction prosthesis in pelvic tumor limb salvage reconstruction treatment has achieved good clinical results. However, the current lack of normative guidance standards such as preparation and application of 3D printing personalized lesion model, osteotomy guide plate and reconstruction prosthesis restricts its promotion and application. The formulation of this consensus provides normative guidance for 3D printing personalized pelvic tumor limb salvage reconstruction treatment.

Objective:Limb salvage treatment for osteosarcoma in the distal tibiais challenging and the incidence of postoperative complications is high. To prove that the use of autologous bone inactivation to replant the ankle joint has a satisfactory clinical effect.Methods:This study retrospectively studied 6 cases (4 males and 2 females) of the osteosarcoma of the distal tibia from June 2018 to April 2019 in our center. The average case age was 16.8 years. All cases were first diagnosed in the center, and classic osteosarcoma was confirmed by biopsy. Before the operation, he received 4 courses of neoadjuvant chemotherapy. The tumor was resected under general anesthesia, and the tumor bone was inactivated and replanted for internal fixation and reconstruction. During the operation, the tumor segment was completely removed, and after a series of treatments, it was immersed in hypertonic saline at 65 °C for 45 min. After removal, the bone defect was filled with bone cement, and internal fixation materials such as plate screws and anchors were placed. Finally, soft tissue was rebuilt after the inactivated bone internal fixation complex (autograft-fixation composite, AFC) was replanted. Patients were treated with plaster for 3 months after surgery. Chemotherapy continued 2 weeks after surgery. Follow-up X-ray of the lower tibia were taken at 3 months, 6 months, and 12 months after the operation to evaluate the MSTS score and ankle function score (AOFAS) to evaluate the ankle function.Results:The patients were followed up for an average of 20 months. At 12 months after operation, no complications such as deep infection, mechanical failure of internal fixation, or local tumor recurrence occurred. The MSTS score averaged 26.7±2.6 points. The AOFAS average was 82.3±8.5 points. The VAS average is 2.7 points. Boneunionwasobserved in 5 cases during follow-up. All cases were satisfied with the treatment results.Conclusion:Limb salvage treatment of distal tibia osteosarcoma is more difficult. This study proves that the use of tumor bone inactivation and internal fixation to reconstruct the ankle joint can not only cure the tumor, but also has satisfactory limb function. It is an ideal strategy for limb salvage reconstruction.

With the rapid development of omics and big data technology, there have been multiple achievements with the use of pre-cision medicine for cancer treatment. Osteosarcoma, the most common primary malignant tumor of the skeletal system, primarily oc-curs in children and adolescents. Since the 1970s, surgical resection and chemotherapy have been the main treatments for osteosarco-ma; however, the survival rate for this type of cancer has been stagnant due to high genetic heterogeneity. Precision medicine can pro-vide a precise diagnosis and tailored treatments based on the patients’biological characteristics using techniques such as omics. Therefore, application of precision medicine is promising for studying osteosarcoma and improving patient survival rates. This study aims to systematically review the progress of precision medicine in advancing osteosarcoma treatment. In addition, it discusses the prospects and future direction of osteosarcoma precision treatment.

Objective To investigate the distribution characteristics and risk factors of intracranial and extracranial aterial lesions in Chinese patients with ischemic stroke . Methods In this multi‐center study ,2 310 continuously inpatients with ischemic stroke diagnosed in 20 stroke screening and prevention project base hospitals from June 2015 to M ay 2016 were enrolled . Carotid ultrasonography and transcranial color‐coded sonography or transcranial Doppler were performed in all patients to confirm the presence of cerebral artery stenosis or occlusion . According to the distribution of lesions ,the subjects were divided into 2 groups :the simple intracranial artery stenosis group and the simple extracranial artery stenosis group . T he difference of risk factors between the two groups was compared . Results Of the 2 310 patients with ischemic stroke ,1 516 ( 65 .6% ) had simple intracranial artery stenosis and 794 ( 34 .4% ) had simple extracranial artery stenosis . T he incidence of anterior circulation artery stenosis was higher in the group of intracranial artery stenosis than that in the extracranial artery stenosis group ( 68 .1% vs 48 .7% , P ＜0 .001) . Posterior circulation artery stenosis and combined anterior with posterior circulation artery stenosis were more common in patients with extracranial artery stenosis group than those in intracranial artery stenosis group ( 36 .4% vs 22 .1% ,14 .9% vs 9 .8% ;all P ＜0 .001) . Univariate analysis of risk factors for stroke showed that patients with intracranial arterial stenosis had a higher prevelence of hypertension , diabetes ,obesity ,and family history of stroke ,and their systolic blood pressure ,diastolic blood pressure , body mass index ( BM I) ,fasting blood‐glucose ,glycosylated hemoglobin ,triacylglycerol ,total cholesterol , and low‐density lipoprotein cholesterol were significantly higher than those in the extracranial arterial stenosis group ( all P ＜ 0 .05 ) . T he proportion of elderly ( ≥ 65 years old ) ,male and smokers in the extracranial arterial stenosis group was significantly higher than that in the intracranial arterial stenosis group ( all P ＜0 .05) . Multivariate logistic regression analysis showed that elderly ( ≥65 years old) ,male , and smoking history were independent risk factors for extracranial arterial stenosis ( OR＝ 2 .012 ,1 .637 , 1 .325 ,respectively ;all P ＜0 .05) . While hypertension ,diabetes ,less physical activity ,and high BM I levels were independent risk factors for simple intracranial arterial disease ( OR ＝ 1 .301 ,1 .252 ,1 .248 ,1 .030 , respectively ;all P ＜0 .05) . Conclusions There are significant differences in the distribution characteristics and risk factors of intracranial and extracranial aterial lesions in patients with ischemic stroke in China .