血清C反应蛋白对直肠癌患者术后吻合口瘘的预测价值

目的探究血清C反应蛋白(CRP)对直肠癌行腹腔镜手术后吻合口瘘的预测效果。方法选取2014年1月-2018年11月在江苏大学附属医院行腹腔镜手术的141例患者。其中,发生吻合口瘘的22例患者作为观察组,未发生吻合口瘘的119例患者作为对照组。分析两组手术前后7 d内患者血清CRP水平变化。结果两组血清CRP水平比较,采用重复测量设计的方差分析,结果:①不同时间点血清CRP有差别(F=116.970,P=0.000);②两组血清CRP有差别(F=241.717,P=0.000);③两组血清CRP变化趋势有差别(F=32.776,P=0.000)。行预防性造口组与未行预防性造口组血清CRP水平比较,采用重复测量设计的方差分析,结果:①不同时间点的血清CRP有差别(F=28.057,P=0.000);两组间的血清CRP无差别(F=0.009,P=0.927);③两组血清CRP变化趋势无差别(F=0.029,P=0.993)。低位组与高位组血清CRP水平比较,采用重复测量设计的方差分析,结果:①不同时间点血清CRP有差别(F=22.473,P=0.000);②两组血清CRP无差别(F=0.197,P=0.662);③两组血清CRP变化趋势无差别(F=0.017,P=0.997)。术后3 d患者ROC曲线下面积最大,达到0.902(95%CI:0.613,1.000)。血清CRP临界点为80.13 mg/L,预测吻合口瘘的敏感性为0.821(95%CI:0.648,0.994),特异性为0.859(95%CI:0.733,0.985)。结论直肠癌患者行腹腔镜手术后可以通过其血清CRP水平预测吻合口瘘的发生。

Recovery of sympathetic nerve function after lumbar sympathectomy is slower in the hind limbs than in the torso

Local sympathetic denervation by surgical sympathectomy is used in the treatment of lower limb ulcers and ischemia,but the restoration of cutaneous sympathetic nerve functions is less clear.This study aims to explore the recovery of cutaneous sympathetic functions after bilateral L2-4 sympathectomy.The skin temperature of the left feet,using a point monitoring thermometer,increased intraoperatively after sympathectomy.The cytoplasm of sympathetic neurons contained tyrosine hydroxylase and dopamineβ-hydroxylase,visualized by immunofluorescence,indicated the accuracy of sympathectomy.Iodine starch test results suggested that the sweating function of the hind feet plantar skin decreased 2 and 7 weeks after lumbar sympathectomy but had recovered by 3 months.Immunofluorescence and western blot assay results revealed that norepinephrine and dopamineβ-hydroxylase expression in the skin from the sacrococcygeal region and hind feet decreased in the sympathectomized group at 2 weeks.Transmission electron microscopy results showed that perinuclear space and axon demyelination in sympathetic cells in the L5 sympathetic trunks were found in the sympathectomized group 3 months after sympathectomy.Although sympathetic denervation occurred in the sacrococcygeal region and hind feet skin 2 weeks after lumbar sympathectomy,the skin functions recovered gradually over 7 weeks to 3 months.In conclusion,sympathetic functional recovery may account for the recurrence of hyperhidrosis after sympathectomy and the normalization of sympathetic nerve trunks after incomplete injury.The recovery of sympathetic nerve function was slower in the limbs than in the torso after bilateral L（2-4） sympathectomy.

C(sp^2)-H/O-H cross-dehydrogenative coupling of quinoxalin-2(1H)-ones with alcohols under visible-light photoredox catalysis

An efficient and practical route to various 3-alkoxylquinoxalin-2(1 H)-ones through visible-light photocatalytic C(sp^2)-H/O-H cross-dehydrogenation coupling of quinoxalin-2(1 H)-ones and alcohols,employing ambient air as an oxidant at room temperature under metal-free conditions,was developed.