Ochratoxin A induced differentiation nephrotoxicity in renal tubule and glomeruli via autophagy differential regulation

Ochratoxin A (OTA) is a mycotoxin that mainly causes nephrotoxicity. The single nephrotoxicity of OTA exposure on glomeruli or renal tubule had been well documented, however, the comparison toxicity between it is still unclear. Here, C57BL/6 mice and two types of nephrocyte were treated with concentration-gradient OTA to explore its differentiation nephrotoxicity. Results showed that OTA induced nephrotoxicity in vivo and in vitro, manifested as the deteriorative kidney function in mice and the cut-down cell viability in nephrocyte. Besides, results of murine kidney pathological section and IC₅₀ of two types nephrocyte indicated that OTA-induced toxicity in renal tubule was higher than its in glomeruli. In addition, OTA exposure induced autophagy signaling differentiation expression. It revealed that autophagy was implicated in OTA-induced differential nephrotoxicity in glomeruli and renal tubule. Altogether, we proved that OTA induces a differentiation nephrotoxicity in glomeruli and renal tubule, and it is related to autophagy differential regulation.     

术中静脉注射吲哚菁绿在慢性萎缩性胆囊炎腔镜手术中的应用

目的探讨术中静脉注射吲哚菁绿在慢性萎缩性胆囊炎腔镜手术中辨清肝外胆管结构的临床价值。方法回顾性分析2020年1月—2021年7月南京医科大学附属常州第二人民医院肝胆胰外科收治的110例诊断为慢性萎缩性胆囊炎行腹腔镜胆囊切除术(LC)的患者资料,术前所有患者均行腹部B超检查明确诊断,按照术中是否静脉注射吲哚菁绿将其分为实验组(n=55)和对照组(n=55),实验组术中经外周静脉注射吲哚菁绿5 mg,术中吲哚菁绿荧光显影技术导航下行LC。对照组行常规LC。统计实验组胆囊管、胆总管、肝总管的显影率及显影时间,比较两组患者的一般临床资料、辨清三管时间、手术时间、术中出血量、放置腹腔引流管及拔管时间、中转开腹及胆管损伤、术后住院时间、术后第一次复查丙氨酸氨基转移酶(ALT)、谷氨酰转移酶(GGT)水平、随访等结果。服从正态分布的计量资料采用均数±标准差(±s)表示,两组比较采用独立样本t检验。偏态分布的计量资料以M(Q₁,Q₃)描述,采用非参数检验中的Mann-Whitney U检验。计数资料组间比较采用χ²检验或Fisher确切概率法。结果两组均成功实施手术,实验组所有患者均成功显影肝总管,54例显影胆总管,52例可显影胆囊管,且显影三管时间为(15.8±1.2)min。实验组中辨清三管时间、手术时间、术中出血量及放置腹腔引流管病例分别为(18.5±1.3)min、(64.0±6.8)min、(16.3±6.7)mL、43例,对照组分别为(46.3±8.1)min、(98.7±10.5)min、(53.6±14.9)mL、55例,实验组均明显低于对照组,两组相比差异有统计学意义(P<0.05)。实验组无中转开腹及胆管损伤病例,对照组有1例中转开腹及1例胆管损伤病例,两组差异无统计学意义(P>0.05)。两组术后拔管时间及术后住院时间差异有统计学意义(P<0.05)。实验组患者术后第一次复查ALT、GGT水平分别为47(31,75)U/L、38(19,114)U/L,对照组分别为62(53,92)U/L、76(63,96)U/L,两组相比差异有统计学意义(P<0.05)。两组患者出院后均随访3个月,实验组无明显并发症,对照组出院后7 d有1例患者出现少量腹腔积液。结论面对慢性萎缩性胆囊炎行LC时,术中静脉注射吲哚菁绿显影肝外胆管有助于辨清其解剖结构避免胆管损伤,提高手术安全性及进度的同时最大限度锻炼并提升术者水平。     

基于“肺膀胱别通”浅析针刺肺经穴调治膀胱病

肺与膀胱相通,上为荣养周身以御邪,下以气化排浊调津液,从肺与膀胱关系可以看出,太阳之气与肺气共同卫外,以顾护肌表皮毛,故临床针刺治疗太阳体证时可考虑从肺经穴入手。临床取肺经穴位调治膀胱及其经脉病时,应辨别虚实,采取对应的补泻手法,考虑大部分肺经穴提插、捻转补泻手法不便施展,笔者认为可根据辨证采用更为合适的迎随补泻、徐疾补泻、开阖补泻,即观其脉证,补泻择之。其实不仅肺经穴可治膀胱病,膀胱经穴亦可治肺病,由于肺与膀胱两者经气互通,其中一条经上的穴位可治疗另一条相通经的循行部位或主治方向的疾病。虽然脏腑别通理论在针灸学上具备广泛应用的基础,但因表里经脏腑相互属络关系,更多被提及、应用的是"肺与大肠相关"。容易忽视"肺膀胱别通"在"卫气供给""津液代谢"上的关联。故在临床针刺治疗膀胱病时,可从有别于常规、传统的选经取穴上论治,亦可基于"肺与膀胱相关"以膀胱经穴治肺病,或以两经同取的方式指导针刺治疗相关病证。     

近红外荧光成像技术在外科手术中的研究进展

作为术中导航的新兴领域,近红外荧光(near-infrared fluorescence,NIRF)成像技术能借助荧光探针对特定的生物组织进行显像,从而在外科手术中实时获取血管、淋巴管和特定组织的视觉信息,从而发现传统方法无法识别的微小灶,正确显示肿瘤切缘,帮助外科医生进行术中决策。该技术由于其操作简单,快速实时,安全无害,具有良好的应用前景。本文将就NIRF成像技术的基本原理,在实时引导肿瘤切除,前哨淋巴结定位,保护正常解剖结构等方面的临床进展进行综述,并且讨论了该技术的局限性和优势并展望其应用前景。     

Near-infrared fluorescence imaging improves the nodal yield in neck dissection in oral cavity cancer – A randomized study

IntroductionLymph node yield (LNY) in neck dissection has been identified as a prognostic factor in oral cavity cancer. The purpose of this study was to investigate the impact of additional use of optical imaging on LNY in therapeutic ND in oral cancer.MethodsConsecutive patients with oral squamous cell carcinoma with clinical neck metastasis planned for primary tumor resection were randomized to conventional neck dissection or near-infrared fluorescence (NIRF)-guided neck dissection, respectively. In the intervention group, patients were injected with ICG-Nanocoll prior to surgery. Intraoperatively, an optical hand-held camera system was used for lymph node identification. Also, NIRF imaging of the neck specimen was performed, and optical signals were pinned with needle markings to guide the pathological examination. The endpoint of the study was LNY per neck side in levels Ib-III.Results31 patients were included with 18 neck sides in the control group and 18 neck sides in the intervention group for evaluation. During NIRF-guided ND, individual lymph nodes could be identified by a bright fluorescent signal and individual tumor-related drainage patterns could be observed in the neck. The LNY in the intervention group was significantly higher compared to the control group (p = 0.032) with a mean of 24 LN (range: 12–33 LN in levels Ib-III compared to 18 LN (range: 10–36 LN) in the control group, respectively.ConclusionsNIRF-guided ND significantly improved the nodal yield compared to the control group. Intraoperative real-time optical imaging enabled direct visualization of tumor-related drainage patterns within the neck lymphatics.