Background: and Purpose Limited evidence exists on the effectiveness of endovascular treatment (EVT) for acute posterior circulation tandem lesion (PCTL). This study aimed to explore the role of extracranial vertebral artery (VA) stenting in patients with PCTL stroke undergoing EVT. Methods: Individual patient data were pooled from the BASILAR (EVT for Acute Basilar Artery Occlusion Study) and PERSIST (Posterior Circulation Ischemic Stroke) registries. Patients with PCTLs who underwent EVT were included in the present cohort and divided into the stenting and nonstenting groups based on the placement of extracranial VA stents. The primary efficacy outcome was the modified Rankin Scale (mRS) scores at 90 days and 1 year. Safety outcomes included 24-hour symptomatic intracranial hemorrhage (sICH) and all-cause mortality at 90 days and 1 year post-surgery. Results: A combined dataset of 1,320 patients with posterior circulation artery occlusion, including 263 (19.9%) with tandem lesions, of whom 217 (median age, 65 years; 82.9% male) met the inclusion criteria for the analysis. The stenting group had 84 (38.7%) patients, while the non-stenting group had 133 (61.3%). After adjustment for the potential confounders, extracranial VA stenting was associated with favorable shifts in mRS scores at both 90 days (adjusted common odds ratio [OR], 2.30; 95% confidence interval [CI], 1.23–4.28; P<0.01) and 1 year (adjusted OR [aOR], 2.04; 95% CI [1.05–3.97]; P=0.04), along with lower rate of mortality at both 90 days (aOR, 0.45; 95% CI [0.21–0.93]; P=0.01) and 1 year (aOR, 0.36; 95% CI [0.16–0.79]; P=0.01), with no significant difference in sICH incidence (aOR, 0.35; 95% CI [0.06–1.98]; P=0.24). Conclusion Extracranial VA stenting during EVT may improve functional outcomes and reduce mortality in patients with PCTL strokes.

Background: and Purpose Limited evidence exists on the effectiveness of endovascular treatment (EVT) for acute posterior circulation tandem lesion (PCTL). This study aimed to explore the role of extracranial vertebral artery (VA) stenting in patients with PCTL stroke undergoing EVT. Methods: Individual patient data were pooled from the BASILAR (EVT for Acute Basilar Artery Occlusion Study) and PERSIST (Posterior Circulation Ischemic Stroke) registries. Patients with PCTLs who underwent EVT were included in the present cohort and divided into the stenting and nonstenting groups based on the placement of extracranial VA stents. The primary efficacy outcome was the modified Rankin Scale (mRS) scores at 90 days and 1 year. Safety outcomes included 24-hour symptomatic intracranial hemorrhage (sICH) and all-cause mortality at 90 days and 1 year post-surgery. Results: A combined dataset of 1,320 patients with posterior circulation artery occlusion, including 263 (19.9%) with tandem lesions, of whom 217 (median age, 65 years; 82.9% male) met the inclusion criteria for the analysis. The stenting group had 84 (38.7%) patients, while the non-stenting group had 133 (61.3%). After adjustment for the potential confounders, extracranial VA stenting was associated with favorable shifts in mRS scores at both 90 days (adjusted common odds ratio [OR], 2.30; 95% confidence interval [CI], 1.23–4.28; P<0.01) and 1 year (adjusted OR [aOR], 2.04; 95% CI [1.05–3.97]; P=0.04), along with lower rate of mortality at both 90 days (aOR, 0.45; 95% CI [0.21–0.93]; P=0.01) and 1 year (aOR, 0.36; 95% CI [0.16–0.79]; P=0.01), with no significant difference in sICH incidence (aOR, 0.35; 95% CI [0.06–1.98]; P=0.24). Conclusion Extracranial VA stenting during EVT may improve functional outcomes and reduce mortality in patients with PCTL strokes.

Background: and Purpose Limited evidence exists on the effectiveness of endovascular treatment (EVT) for acute posterior circulation tandem lesion (PCTL). This study aimed to explore the role of extracranial vertebral artery (VA) stenting in patients with PCTL stroke undergoing EVT. Methods: Individual patient data were pooled from the BASILAR (EVT for Acute Basilar Artery Occlusion Study) and PERSIST (Posterior Circulation Ischemic Stroke) registries. Patients with PCTLs who underwent EVT were included in the present cohort and divided into the stenting and nonstenting groups based on the placement of extracranial VA stents. The primary efficacy outcome was the modified Rankin Scale (mRS) scores at 90 days and 1 year. Safety outcomes included 24-hour symptomatic intracranial hemorrhage (sICH) and all-cause mortality at 90 days and 1 year post-surgery. Results: A combined dataset of 1,320 patients with posterior circulation artery occlusion, including 263 (19.9%) with tandem lesions, of whom 217 (median age, 65 years; 82.9% male) met the inclusion criteria for the analysis. The stenting group had 84 (38.7%) patients, while the non-stenting group had 133 (61.3%). After adjustment for the potential confounders, extracranial VA stenting was associated with favorable shifts in mRS scores at both 90 days (adjusted common odds ratio [OR], 2.30; 95% confidence interval [CI], 1.23–4.28; P<0.01) and 1 year (adjusted OR [aOR], 2.04; 95% CI [1.05–3.97]; P=0.04), along with lower rate of mortality at both 90 days (aOR, 0.45; 95% CI [0.21–0.93]; P=0.01) and 1 year (aOR, 0.36; 95% CI [0.16–0.79]; P=0.01), with no significant difference in sICH incidence (aOR, 0.35; 95% CI [0.06–1.98]; P=0.24). Conclusion Extracranial VA stenting during EVT may improve functional outcomes and reduce mortality in patients with PCTL strokes.

Objective:To analyze the clinical application value of a novel magnetic navigation ultrasound (MNU) combined with digital subtraction angiography (DSA) dual-guided percutaneous transhepatic biliary drainage (PTCD) through the right hepatic duct for the treatment of malignant obstructive jaundice.Methods:Randomized controlled trial. The clinical data of 64 patients with malignant obstructive jaundice requiring PTCD through the right hepatic duct at the Hepatobiliary Center of the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province People′s Hospital) from December 2018 to December 2021 were retrospectively analyzed. The MNU group ( n=32) underwent puncture guided by a novel domestic MNU combined with DSA, and the control group ( n=32) underwent puncture guided by traditional DSA. The operation time, number of punctures, X-ray dose after biliary stenting as shown by DSA, patients' tolerance of the operation, success rate of the operation, pre- and post-operative total bilirubin, and incidence of postoperative complications were compared between the two groups. Results:The operation time of the MNU group was significantly shorter than that of the control group [(17.8±7.3) vs. (31.6±9.9) min, t=-6.35, P=0.001]; the number of punctures in the MNU group was significantly lower [(1.7±0.6) vs. (6.3±3.9) times, t=-6.59, P=0.001]; and the X-ray dose after biliary stenting as shown by DSA in the MNU group was lower than that in the control group [(132±88) vs. (746±187) mGy, t=-16.81, P<0.001]; Five patients in the control group were unable to tolerate the operation, and two stopped the operation, however all patients in the MNU group could tolerate the operation, and all completed the operation, with a success rate of 100% (32/32) in the MNU group compared to 93.8%(30/32) in the control group; the common complications of PTCD were biliary bleeding and infection, and the incidence of biliary bleeding (25.0%, 8/32) and infection (18.8%, 6/32) in the MNU group was significantly lower than that in the control group, 53.1% (17/32) and 28.1% (9/32), respectively. Conclusion:Magnetic navigation ultrasound combined with DSA dual-guided PTCD through the right biliary system for the treatment of malignant obstructive jaundice is safe and feasible.

Objective:To identify species type and analyze the homology of Brucella in a family cluster infection. Methods:Two patients with brucellosis from the same family who were treated at the First People's Hospital of Lianyungang City, Jiangsu Province in May 2022 were selected as the research subjects. Brucella strains (H4LYG01 and H2LYG02) were isolated through blood culture. The isolated strains were identified for species type and homology analysis using a fully automated microbial mass spectrometry detection system. Molecular typing of the isolated strains was performed using multiple locus variable-number tandem-repeat analysis (MLVA) and multilocus sequence typing (MLST). Results:H4LYG01 and H2LYG02 were both Brucella Maltese, and the credibility scores were 9.745 and 9.627, respectively, and the homology was 100%. The MLVA results showed that the gene loci of H4LYG01 and H2LYG02 were completely identical, with the same genotype. The MLST results showed that the sequence type (ST) of H4LYG01 and H2LYG02 were both ST8 types. Conclusion:The two isolated strains of Brucella from a family with clustered infections are both Brucella Maltese and from the same source.

Objective:To study the distribution of species type, biotype and genotype of human Brucella isolated and identified in Nanjing. Methods:A total of 89 strains of human Brucella were collected from microbiology laboratories of three sentinel hospitals in Nanjing from 2017 to 2022. The species type was identified using biological methods and Brucella nucleic acid detection (BCSP31-PCR and AMOS-PCR). Further biotyping of Brucella melitensis isolates was conducted by serological results of A and M factors. Meanwhile, genotype analysis was performed using multiple-locus variable number tandem repeat analysis (MLVA), multilocus sequence typing (MLST) and single nucleotide polymorphism (SNP). Results:From 2017 to 2022, 89 strains of Brucella isolated and identified in Nanjing were all Brucella melitensis. Among them, Brucella melitensis biotype 3 accounted for 82.02% (73/89), and biotype 1 accounted for 17.98% (16/89). MLVA typing showed that 89 strains of Brucella melitensis belong to the "Eastern Mediterranean" cluster and could be divided into 50 MLVA genotypes; among which panel 1 had 3 genotypes, namely Type 42 (84.27%, 75/89), Type 63 (8.99%, 8/89) and Type 43 (6.74%, 6/89). The results of MLST-9 and MLST-21 were both ST8, and the core genome multilocus sequence typing (cgMLST) classified 89 strains into 11 genotypes. SNP analysis revealed a total of 4 013 SNP loci, with SNPs ranging from 0 to 409 across different strains, involving 59 SNP genotypes. Conclusions:The human Brucella strains isolated and identified in Nanjing are all Brucella melitensis, mainly biotype 3. The MLVA cluster is the "Eastern Mediterranean" cluster. The traditional MLST-9 and MLST-21 typing results are all ST8 type, while cgMLST divides all the strains into 11 genotypes with higher resolution.

Objective:To investigate the distribution and molecular characteristics of Yersinia isolated from diarrhea patients in Jiangsu Province. Methods:From 2017 to 2021, the stool samples of diarrhea patients were collected in Tongshan District of Xuzhou City and Dongtai City of Yancheng City, Jiangsu Province, where the national active monitoring sites of Yersinia enterocolitica, then Yersinia was isolated; meanwhile, suspected Yersinia strains were collected from sentinel hospitals in the province. The DNA of isolated strains was extracted for whole genome resequencing, and the data were uploaded to the EnteroBase database for Yersinia species identification; the original data were cleaned and processed for 16S ribosomal RNA (16S rRNA) gene polymorphism analysis. Five virulence genes (ail, ystA, ystB, yadA, virF) were scanned through the National Center for Biotechnology Information (NCBI) and Pathogen Virulence Factor Database (VFDB), and K-mer Tree was constructed and genomic characteristics were analyzed. Results:From 2017 to 2021, a total of 2 058 stool samples from diarrhea patients were collected, and 57 strains of Yersinia were isolated and identified; meanwhile, two Yersinia strains were collected from the sentinel hospital. Compared with EnteroBase database, 51 strains were identified as Yersinia enterocolitica, 4 strains as Yersinia proxima, 1 strain each as Yersinia aleksiciae, Yersinia massiliensis, Yersinia intermedia and Yersinia canariae. The 16S rRNA gene polymorphism analysis showed that all strains were clustered into 3 groups, which could distinguish Yersinia enterocolitica from other Yersinia. Among the 51 strains of Yersinia enterocolitica, 49 strains were virulence genotype Ⅲ(ail-, ystA-, ystB+, yadA-, virF-), two strains were virulence genotype Ⅱ(ail+, ystA+, ystB-, yadA-, virF-); and 8 other Yersinia strains were virulence genotype Ⅳ (ail-, ystA-, ystB-, yadA-, virF-). K-mer analysis could distinguish Yersinia enterocolitica from other Yersinia, JS-XZ-2020001 strain was far away from other Yersinia enterocolitica isolates, and serotype O8 strains were more concentrated. Conclusions:The clinical isolates of Yersinia enterocolitica from diarrhea patients are mainly Yersinia and other Yersinia co-exist in a small amount in Jiangsu Province, two new Yersinia species ( Yersinia proxima and Yersinia canariae) are discovered. The virulence genotype of Yersinia enterocolitica is mainly type Ⅲ. The 16S rRNA gene polymorphism analysis and K-mer analysis can effectively distinguish Yersinia enterocolitica from other Yersinia.

Objective:To investigate the application value of hepatic vein outflow tract reconstruction with ringed polytetrafluoroethylene vascular in right lobe living donor liver trans-plantation.Methods:The retrospective and descriptive study was conducted. The clinicopatho-logical data of 4 donors and 4 recipients undergoing right lobe living donor liver transplantation in Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School and 17 donors and 17 recipients undergoing right lobe living donor liver transplantation in the First Affiliated Hospital with Nanjing Medical University from June 2015 to August 2018 were collected. Of 21 donors, there were 10 males and 11 females, aged from 35 to 57 years, with a median age of 46 years. The median body mass of 21 donors were 64 kg, with a range from 56 to 72 kg. Of 21 recipients, there were 16 males and 5 females, aged from 21 to 68 years, with a median age of 42 years. The median body mass of 21 recipients were 63 kg, with a range from 47 to 77 kg. Observation indicators: (1) surgical and postoperative situations; (2) follow-up. Follow-up was conducted by outpatient examination or telephone interview to detect graft function, tumor recurrence, vascular graft complications, patency of vascular graft and survival of recipients up to August 2020. All recipients will be followed up for all their lives. Measurement data with normal distribution were represented as Mean±SD and measurement data with skewed distribution were represented as M (range). Count data were represented as absolute numbers or percentages. The Kaplan-Meier method was used to calculate patency rates of hepatic vein outflow tract and survival rates to draw patency curve and survival curve. Results:(1) Surgical and postoperative situations: the operation time, the weight of donor graft, graft to recipient weight ratio and duration of hospital stay of 21 donors were (367±72)minutes, (557±68)g, 0.89%±0.16% and (10+2)days, respectively. No major complication requiring reoperation or intervention occurred in any of the 21 donors. One donor undergoing mild bile leakage preserved peritoneal drainage for one week. All 21 recipients underwent classic orthotopic liver transplantation successfully. The time of hepatic vein outflow tract reconstruction in donor graft, operation time and time of anhepatic phase of 21 recipients were (24±4)minutes, (326±66)minutes and (42±6)minutes, respectively. The number of reconstructed middle hepatic vein in hepatic segment 5 and 8 were 18 and 15, with the diameter of (6.1±1.3)mm and (7.2±1.2)mm, respectively. The number of reconstructed inferior right hepatic vein were 10, with the diameter of (6.3±1.3)mm. The postoperative treatment time at intensive care unit and duration of hospital stay of 21 recipients were (1.5±0.9)days and (22.6±6.7)days, respectively. Ten of 21 recipients underwent postoperative complications. Five recipients underwent graft dysfunction including the level of alanine aminotransferase and aspartate aminotransferase >1 000 IU/L and the level of bilirubin slightly increasing, combined with increased ascites. Enhanced computed tomography scan showed congestion in the right anterior of graft and thrombosis in the middle hepatic vein of hepatic segment 5 and segment 8. All 5 recipients undergoing graft dysfunction recovered with normal liver function and ascites decreasing after symptomatic treatment including liver protection therapy, anticoagulation and albumin infusion. Two recipients underwent inferior vena cava thrombosis and intractable pleural effusion one month after operation. Vena cava venography examination showed thrombosis in the graft vascular. Of the 2 recipients, one case with collateral circulation formation recovered undergoing balloon dilatation and stent placement combined with anticoagulation therapy of warfarin. The other one case recovered after anticoagulation therapy of warfarin. One recipient undergoing bile leakage and abdominal infection with klebsiella pneumoniae recovered after symptomatic treatment. Two recipients undergoing abdominal infection or pulmonary infection recovered after symptomatic treatment. There was no serious complication or death during perioperative period. (2) Follow-up: all 21 recipients were followed up for 10 to 57 months, with a median follow-up time of 38 months. During the follow-up, no recipient underwent graft dysfunction and 2 recipients had tumor recurrence at postoperative 6 months. Six of the 21 recipients died within 2 years after operation including 3 cases dying of tumor recurrence, 2 cases dying of acute hemorrhage and 1 case dying of liver failure. There was no death caused by vascular graft complica-tions. The postoperative 1, 3, 6-month, and 1-year and 2-year potency rates of hepatic vein outflow tract in 21 recipients were 88.4%, 88.4%, 82.4%, 68.0% and 42.1%, respectively. The 6-month, 1-year and 2-year overall survival rates in 21 recipients were 100%, 94.4%, 71.4%, respectively.Conclusion:Application of hepatic vein outflow tract reconstruction with ringed polytetrafluoroethylene vascular in right lobe living donor liver transplantation is safe and feasible.

Objective:To study the genotyping characteristics of Brucella strains isolated from Lianyungang City (non-brucellosis epidemic area) of Jiangsu Province. Methods:Preliminary identification of 13 suspected strains of Brucella isolated from blood culture in Clinical Microbiology Laboratory of the First People's Hospital of Lianyungang City in 2018 was conducted; at the same time, the specific gene bcsp31 and insertion sequence IS-711 of Brucella were detected by quantitative real-time PCR (Real-time PCR), and the identification results were rechecked and typed. Multiple locus variable-number tandem repeat analysis (MLVA) was applied for genotyping, and the sequencing results were edited by Mega 4.0 software. Results:All the 13 strains were identified as Brucella by preliminary identification. Real-time PCR confirmed that all the 13 strains were Brucella melitensis. The results of MLVA showed that 13 strains of Brucella melitensis were divided into 12 genotypes and clustered in the "middle Mediterranean cluster". Among 13 strains of Brucella melitensis, 3 strains were biovar 1, 2 strains were biovar 2 and 8 strains were biovar 3. Conclusion:All the Brucella strains isolated from Lianyungang City are Brucella melitensis and the MLVA cluster is in the "middle Mediterranean cluster".

Objective:To identify human infection with Brucella suis, analyze its biological and molecular characteristics, and to provide basis for prevention and control of brucellosis. Methods:Brucella suis strains were isolated from the body of the first case of human Brucella suis infection in Jiangsu Province. Serum agglutination test was used for serotyping. The specific gene bcsp-31 of Brucella was detected by PCR. AMOS-PCR was used to identify IS-711. The species and biotypes were identified by multiplex PCR. The wboA gene products were sequenced and phylogenetic tree was constructed. Multilocus sequence analysis (MLSA) was used for molecular typing, and cluster analysis was performed with reference strains. Results:The strain was confirmed to be Brucella suis biotype 3 by serum agglutination test and PCR. After sequencing the wboA gene, cluster analysis of the reference sequence showed that the wboA gene was closest to the biotype 3 strain Brucella suis str. 686 (CP007719). MLSA was typed into ST17(1-6-4-1-5-3-5-2-4). Conclusions:Brucella suis biotype 3 is reported in Jiangsu Province for the first time. The MLSA type is ST17. In the future, the prevention and control of human brucellosis should be carried out. We should actively cooperate with the animal husbandry and veterinary department to increase the quarantine, immunization and other control measures.