Objective To discuss the cause and treatment strategy for open laryngotracheal trauma.Methods The clinical data of 38 cases with open laryngotracheal trauma admitted from 1998 to 2012 were collected and analyzed.Of them,one patient died in emergency department despite energetic resuscitation,37 were hospitalized and given advanced treatment after life support measures in emergency department.They were treated with tracheotomy before or during operation.Of them,32 patients were regularly followed up for imaging studies.Result Except 1 patient died of exsanguination from carotid artery rupture,the other 37 survived after successful treatment.Twenty patients were treated with debridement and suture of the wounds and laryngoplasty (20/37,54.1％),8 patients were operated with laryngoplasty plus intraluminal stents implanted (8/37,21.6％) ; the rest 9 patients (9/37,24.3％) were separately given placement of nickel-titanium shape memory alloy stent (n =2),laryngofissure with rubber gloves throat models implanted and laryngoplasty (n =3),linear silicone tube implanted and laryngoplasty with trans-cervical approach (n =1) and tracheoesophageal fistula neoplasty with laryngoplasty and laryngofissure (n =3).The operated patients were followed-up for 0.5 to 3 years after discharge.Of them,35 patients (35/37,94.6％) had successful decannulation,breathing smoothly and swallowing normally,23 patients (23/37,62.2％) had almost normal pronunciation,12 patients (12/37,32.4％) had different degrees in hoarseness of voice,and 2 patients (2/37,5.4％) were referred to other hospital because of failure in extubation with severe stenosis of laryngotrachea.Conclusions When the patients with open laryngotracheal trauma were treated,the essential strategy was to prevent shock,hemorrhage,and asphyxia.In the case of patent respiratory tract and stable vital signs,laryngotracheal reconstruction should be carried out as soon as possible to prevent complications,thereby obtaining good therapeutic effect.

Purpose To explore the value of monitoring liver-shear wave elastography(L-SWE)and spleen-shear wave elastography(S-SWE)by two-dimensional shear wave elastography after transjugular intrahepatic portosystemic shunt(TIPS)in predicting stent dysfunction.Materials and Methods A total of 40 patients with hepatitis B cirrhosis in the First Affiliated Hospital of Anhui Medical University from January 2016 to September 2022 who underwent TIPS were retrospectively selected.Among them,22 patients without stent dysfunction within 1 month were included in the normal group,and 18 patients without stent dysfunction within 1 week but with stent dysfunction within 1 month were included in the dysfunction group.The changes of L-SWE and S-SWE were monitored 1 day before operation,1 week and 1 month after operation.Results Mauchly test showed that the data corresponded to sphericity(P>0.05).There was no significant difference in L-SWE within the two groups before and after operation(Ftime=0.003,Ftime×group=0.842,Fgrous=0.027;all P>0.05),while the S-SWE differences were statistically significant(Ftime=51.249,Ftime×group=30.676,Fgrous=11.986;all P<0.01).The S-SWE in the normal group showed a gradually decreasing trend 1 day before operation,1 week after operation and 1 month after operation,and the difference was statistically significant(P<0.05).The L-SWE in the dysfunction group decreased 1 week after operation compared with 1 day before operation(P<0.05),and the L-SWE increased 1 month after operation,with no significant difference compared with 1 day before operation(P>0.05).The difference of ΔS-SWE(1 month after operation-1 week after operation)and ΔS-SWE(1 month after operation-1 day before operation)was statistically significant(t=-2.612,4.368,P<0.05).Conclusion Quantitative measurement of S-SWE before and after TIPS and observation of its variation trend are helpful to estimate whether there is stent dysfunction and evaluate the surgical effect.

Objective To investigate the role of miRNAs in maternal amniotic fluid exosomes in development of isolated ventriculomegaly(VM)in fetuses.Methods Amniotic fluid samples were collected from 9 cases of moderate isolated VM and 8 normal control cases to extract exosomal miRNA,and miRNA sequencing technique was used to identify differentially expressed miRNAs between the two groups.Three miRNAs with significant differential expression between the two groups,whose high expression was associated with VM,were selected for verification with RT-qPCR.Dual luciferase reporter assays were used to verify the regulatory effect of miR-122-5p on its predicted target genes AKT3 and CCDC88C.Gene ontology(GO)and KEGG pathway analyses were performed to explore the possible roles of the top 40 significant differential miRNAs in the pathophysiology of VM.Results We identified a total of 272 differentially expressed miRNAs in VM cases,including 43 up-regulated and 229 down-regulated miRNAs.The target genes of these differential miRNAs were associated with DNA and transcription factor binding,transmembrane transporter and nucleic acid binding transcription factor activity,and cell developmental process.These miRNAs were mostly enriched in the MAPK,cGMP-PKG and Wnt signaling pathways.Verification with RT-qPCR showed that miR-122-5p expression level was significantly lower in VM group than in the control group(P<0.05),which was consistent with miRNA sequencing results;let-7b-5p expression level was significantly lower in VM group,which was contrary to miRNA sequencing result.Dual luciferase reporter assays showed that miR-122-5p was not capable of regulating AKT3 or CCDC88C expressions.Conclusions The highly abundant differentially expressed miRNAs in maternal amniotic fluid exosomes play important roles in the occurrence of fetal VM possibly by regulating the MAPK,PI3K-Akt,Wnt and cGMP-PKG signaling pathways.

Objective To investigate the role of miRNAs in maternal amniotic fluid exosomes in development of isolated ventriculomegaly(VM)in fetuses.Methods Amniotic fluid samples were collected from 9 cases of moderate isolated VM and 8 normal control cases to extract exosomal miRNA,and miRNA sequencing technique was used to identify differentially expressed miRNAs between the two groups.Three miRNAs with significant differential expression between the two groups,whose high expression was associated with VM,were selected for verification with RT-qPCR.Dual luciferase reporter assays were used to verify the regulatory effect of miR-122-5p on its predicted target genes AKT3 and CCDC88C.Gene ontology(GO)and KEGG pathway analyses were performed to explore the possible roles of the top 40 significant differential miRNAs in the pathophysiology of VM.Results We identified a total of 272 differentially expressed miRNAs in VM cases,including 43 up-regulated and 229 down-regulated miRNAs.The target genes of these differential miRNAs were associated with DNA and transcription factor binding,transmembrane transporter and nucleic acid binding transcription factor activity,and cell developmental process.These miRNAs were mostly enriched in the MAPK,cGMP-PKG and Wnt signaling pathways.Verification with RT-qPCR showed that miR-122-5p expression level was significantly lower in VM group than in the control group(P<0.05),which was consistent with miRNA sequencing results;let-7b-5p expression level was significantly lower in VM group,which was contrary to miRNA sequencing result.Dual luciferase reporter assays showed that miR-122-5p was not capable of regulating AKT3 or CCDC88C expressions.Conclusions The highly abundant differentially expressed miRNAs in maternal amniotic fluid exosomes play important roles in the occurrence of fetal VM possibly by regulating the MAPK,PI3K-Akt,Wnt and cGMP-PKG signaling pathways.

Objective : To investigate the predictive value of platelet volume distribution width ( PDW) , mean platelet volume (MPV) , and D ⁃dimer (D⁃D) on early shunt dysfunction in patients with decompensated cirrhosis treated with transjugular intrahepatic portosystemic shunt(TIPS) . Methods : A total of 28 patients with decompensated cirrhosis who developed shunt dysfunction within 6 months after TIPS were selected as the case group , and a 1 ∶ 2 matched control study was conducted. 56 patients matched by age ( ± 2) and gender who did not develop shunt dysfunction within 6 months after TIPS were selected as the control group. Spss23. 00 software was used to conduct univariate analysis to obtain statistically significant variables , and then conditional Logistic regression analysis was conducted with paired design , with P < 0. 05 being statistically significant. Results : Patients with a history of splenectomy , portal vein thrombosis , and those with poor liver function grade were more likely to have functional dysfunction after TIPS. Platelet count (PLT) , platelet volume distribution width (PDW) , mean platelet volume (MPV) , D ⁃dimer ( D⁃D) and Fibrinogen monomer ( FDPI) had statistically significant differences between the case group and the control group. The values of D ⁃D、PDW、MPV and FDPI in the case group were higher than those in the control group , while the value of PLT in the case group was lower than that in the control group. The OR values of PDW , MPV and D ⁃D were 2. 164 , 3. 826 and 1. 382 , respectively. ROC analysis results showed that the areas under PDW , MPV and D ⁃D curves were 0. 746 , 0. 773 and 0. 690 , respectively. Conclusion Compared with ultrasound , D ⁃D , PLT and PDW could predict shunt dysfunction earlier after TIPS. Patients with normal shunt function indicated by color Doppler ultrasonography in postoperative follow⁃up of TIPS should be closely observed for indicators such as D ⁃D , PLT and PDW , which is of important significance for clinical indication of shunt dysfunction in TIPS.