RESUMEN
Hepatocellular carcinoma (HCC) is responsible for a significant number of cancer-related deaths worldwide and its incidence is increasing. Locoregional treatments, which are precision procedures guided by imaging to specifically target liver tumors, play a critical role in the management of a substantial portion of HCC cases. These therapies have become an essential element of the HCC treatment landscape, with transarterial chemoembolization (TACE) being the treatment of choice for patients with intermediate to advanced stages of the disease. Other locoregional therapies, like radiofrequency ablation, are highly effective for small, early-stage HCC. Nevertheless, the advent of targeted immunotherapy has challenged these established treatments. Tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs) have shown remarkable efficacy in clinical settings. However, their specific uses and the development of resistance in subsequent treatments have led clinicians to reevaluate the future direction of HCC therapy. This review concentrates on the distinct features of both systemic and novel locoregional therapies. We investigate their effects on the tumor microenvironment at the molecular level and discuss how targeted immunotherapy can be effectively integrated with locoregional therapies. We also examine research findings from retrospective studies and randomized controlled trials on various combined treatment regimens, assessing their validity to determine the future evolution of locoregional therapies within the framework of personalized, comprehensive treatment.
RESUMEN
As a quasi-layered ferrimagnetic material, Mn3Si2Te6 nanoflakes exhibit magnetoresistance behavior that is fundamentally different from their bulk crystal counterparts. They offer three key properties crucial for spintronics. First, at least 106 times faster response compared to that exhibited by bulk crystals has been observed in current-controlled resistance and magnetoresistance. Second, ultralow current density is required for resistance modulation (â¼5 A/cm2). Third, electrically gate-tunable magnetoresistance has been realized. Theoretical calculations reveal that the unique magnetoresistance behavior in the Mn3Si2Te6 nanoflakes arises from a magnetic field induced band gap shift across the Fermi level. The rapid current induced resistance variation is attributed to spin-orbit torque, an intrinsically ultrafast process (â¼nanoseconds). This study suggests promising avenues for spintronic applications. In addition, it highlights Mn3Si2Te6 nanoflakes as a suitable platform for investigating the intriguing physics underlying chiral orbital moments, magnetic field induced band variation, and spin torque.
RESUMEN
Zeolite microspheres have been successfully applied in commercial-scale separators such as oxygen concentrators. However, further enhancement of their applications is hampered by the post-synthetic shaping process that formulates the zeolite powder into packing-sized spherical bodies with various binders leading to active site blockage and suboptimal performance. Herein, binderless zeolite microspheres with a tunable broad size range from 2 µm to 500 µm have been developed with high crystallinity, sphericity over 92%, monodispersity with a coefficient of variation (CV) less than 5%, and hierarchical pore architecture. Combining precursor impregnation and steam-assisted crystallization (SAC), mesoporous silica microspheres with a wide size range could be successfully transformed into zeolite. For preserved size and spherical morphology, a judicious selection of the synthesis conditions is crucial to ensure a pure phase, high crystallinity, and hierarchical architecture. For the sub-2-µm zeolite microsphere, low-temperature prolonged aging was important so as to suppress external zeolization that led to a large, single macroporous crystal. For the large 500 µm sphere, ultrasound pretreatment and vacuum impregnation were crucial and facilitated spatially uniform gel matrix dispersion and homogenous crystallization. The obtained zeolite 5A microspheres exhibited excellent air separation performance, while the 4A microspheres displayed ammonium removal capabilities. This work provides a general strategy to overcome the existing limitations in fabricating binder-free technical bodies of zeolites for various applications.
RESUMEN
Achieving room-temperature high anisotropic magnetoresistance ratios is highly desirable for magnetic sensors with scaled supply voltages and high sensitivities. However, the ratios in heterojunction-free thin films are currently limited to only a few percent at room temperature. Here, we observe a high anisotropic magnetoresistance ratio of -39% and a giant planar Hall effect (520 µΩâ cm) at room temperature under 9 T in ß-Ag2Te crystals grown by chemical vapor deposition. We propose a theoretical model of anisotropic scattering - induced by a Dirac cone tilt and modulated by intrinsic properties of effective mass and sound velocity - as a possible origin. Moreover, small-size angle sensors with a Wheatstone bridge configuration were fabricated using the synthesized ß-Ag2Te crystals. The sensors exhibited high output response (240 mV/V), high angle sensitivity (4.2 mV/V/°) and small angle error (<1°). Our work translates the developments in topological insulators to a broader impact on practical applications such as high-field magnetic and angle sensors.
RESUMEN
BACKGROUND: Biogenic amines (BAs) in high concentrations are toxic and may cause a series of health symptoms. A sensitive measurement of BA levels is essential for human health. Capillary electrophoresis (CE) has emerged for the separation of eight BAs due to simple sample preparation and highly efficient separation. However, an important drawback for CE is low sensitivity. Magnetic solid-phase extraction (MSPE) has become a technique of interest owing to its brief operation and low solvent consumption. Hence, MSPE as a pretreatment has great potential to improve CE sensitivity for the analysis of BAs in complex food. RESULTS: Results showed that the Pt-Co-MWCNTs-COOH possessed strong magnetism, good reusability, and high adsorptive ability toward eight biogenic amines based on the hydrogen bonding between the -COOH of Pt-Co-MWCNTs-COOH and -NH2 groups of BAs. Using it as an adsorbent, a magnetic solid-phase extraction coupled with capillary electrophoresis (MSPE-CE) method was developed to effectively extract and sensitively analyze eight BAs. Under optimal conditions, the MSPE-CE method has wide linearities (10.0-1000.0 µg L-1 ) and low limits of detection (1.0-6.1 µg L-1 ). The accuracy of the developed method yielded recovery values from 82.07% to 102.58%. Meanwhile, the BAs contents in two samples were analyzed using the MSPE-CE method, with the results consistent with those detected by a high-performance liquid chromatography method. CONCLUSION: Given those advantages, the established MSPE-CE method promises the practical guidance of monitoring a variety of BAs and provides a foundation for the detection of other food hazards. © 2023 Society of Chemical Industry.
Asunto(s)
Aminas Biogénicas , Electroforesis Capilar , Humanos , Electroforesis Capilar/métodos , Cromatografía Líquida de Alta Presión/métodos , Aminas Biogénicas/análisis , Extracción en Fase Sólida/métodos , Fenómenos Magnéticos , Límite de DetecciónRESUMEN
Arsenic is a human carcinogen widely distributed in the environment, and arsenic exposure from drinking water has received widespread attention as a global public health problem. Curcumin is a natural bioactive substance with high efficiency and low toxicity extracted from turmeric, which has a variety of biological properties such as antioxidation, anti-inflammation, anticancer, and immuno-modulatory activities. Curcumin is widely used in daily life as a food additive and dietary supplement. However, its protective effects in lung injuries by chronic arsenic exposure orally remain unexplored. In this study, curcumin treatment not only significantly accelerated arsenic elimination and improved lung tissue morphology, but also decreased arsenic-generated ROS by activating Nrf2 and its down-stream antioxidants. Further, curcumin alleviated inflammatory changes in mice exposed to arsenic for 6 and 12 weeks, as manifested by lung MPO levels, total protein and cellular levels in bronchoalveolar lavage fluid (BALF), serum IL-4 levels, and MAPK/NF-κB expression in lung tissue. Notably, our study also confirmed that curcumin could promote the expression and nuclear translocation of the transcription factor EB (TFEB), as well as activate TFEB-regulated autophagy in lung tissue of arsenic-treated mice, accompanied by inhibition of the AKT-mTOR signaling pathway. Overall, our study here suggests that natural bioactive compound curcumin could alleviate arsenic-induced pulmonary oxidative stress and inflammation in vivo, which is closely related to enhanced TFEB activity and induction of the autophagic process.
Asunto(s)
Arsénico , Curcumina , Ratones , Humanos , Animales , Arsénico/toxicidad , Curcumina/farmacología , Curcumina/metabolismo , Estrés Oxidativo , Pulmón , Antioxidantes/farmacología , FN-kappa B/metabolismo , Inflamación/tratamiento farmacológico , Inflamación/metabolismo , AutofagiaRESUMEN
Synthetic pigment Ponceau 4 R is a commonly used additive in the process of various foods. Due to its potential toxicity to humans, realizing high sensitivity and rapid detection of Ponceau 4 R is extremely important. In this study, we synthesized a novel dual-network magnetic conductive hydrogel (MCHG) via a simple one-pot low temperature stirring method. In MCHG, cationic guar gum (CGG) and ß-cyclodextrin (ß-CD) formed a primary three-dimensional network cross-linked by N, N-methylene bisacrylamide. A second network was formed in MCHG by CGG, ß-CD and magnetite@carboxylate-terminated carbon nanotubes (Fe3O4@COOH-MWCNTs) through hydrogen bonding and electrostatic interactions. Fe3O4@COOH-MWCNTs enhanced cross-linking in the MCHG hydrogel, whilst also boosting the equilibrium adsorption capacity of Ponceau 4 R (61.8 mg g-1), electrical conductivity and electrocatalytic performance. Application of MCHG to a glassy carbon electrode (GCE) created a highly sensitive electrochemical sensor for the detection of Ponceau 4 R. Under optimized testing conditions, the sensor offered a very wide linear range (0.01-200.0 µM) and a low limit of detection (1.8 nM) for Ponceau 4 R. When the sensor was applied to the detection of Ponceau 4 R in spiked honey and liqueur samples, excellent recoveries were achieved (88.2%-107.0%). Furthermore, analyses of commercial biscuit and candy samples using the MCHG/GCE sensor and a national standard ultraviolet spectrophotometry method afforded identical results. Results demonstrate that multifunctional hydrogels show great promise as signal amplification agents in electrochemical detection of target compounds in foods.
Asunto(s)
Técnicas Biosensibles , Nanotubos de Carbono , Humanos , Nanotubos de Carbono/química , Hidrogeles , Fenómenos Magnéticos , Técnicas Electroquímicas/métodos , Electrodos , Límite de DetecciónRESUMEN
In clinical practice, the wound on the surface of the skin is prone to bacterial infection, for which healing of infected wounds has always been a tremendous challenge for clinics and research institutions. We developed a multifunctional bactericidal, recyclable, and slow-release graphene oxide-based hydrogel for bacterial wound healing and real-time monitoring of bacterial infection in this study. At the same time, the material has a sensing function, which can be used in the connection between the injured skin and the continuous detection equipment. QNGH (quaternarized N-halamine-grafted GO hydrogel) is manufactured by hydrogen bonding between quaternized N-halamine-modified graphene oxide and polyvinyl alcohol (PVA). The results show that in the mouse model of full-thickness skin repair, the hydrogel can continuously release germicidal ions and recyclability, promoting wound healing and contraction. Further, the graphene oxide-based hydrogel has excellent strain sensing performance. It detects the bending and stretching movements of different parts of the human body quickly, stably, and sensitively to show an excellent real-time monitoring performance of human motion. The sensing function of the hydrogel further broadens its application field. Therefore, this hydrogel material is expected to be a candidate material for sensing devices at the wound.
Asunto(s)
Infecciones Bacterianas , Hidrogeles , Humanos , Animales , Ratones , Hidrogeles/farmacología , Cicatrización de Heridas , Antibacterianos/farmacología , Infecciones Bacterianas/tratamiento farmacológicoRESUMEN
BACKGROUND: Antineutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis (AAGN) is characterized by rapidly progressive glomerulonephritis, and timely initiation of treatment and evaluation is critical to prevent the progression of renal disease to end-stage renal disease (ESRD). The aim of this study was to evaluate predictive value of the renal risk score (RRS), Birmingham vasculitis activity score (BVAS), and renal vascular lesions (RVLs) score for renal prognosis in AAGN. METHODS: A retrospective analysis of ninety-four patients diagnosed with AAGN after renal biopsy was performed. The RRS, BVAS, and RVLs score were evaluated in relation to clinicopathologic features and renal prognosis. A receiver operating characteristic curve (ROC) was used to evaluate their renal prognostic value. RESULTS: The median follow-up time was 36 months. Thirty-eight patients progressed to ESRD. Survival analysis showed that renal prognosis worsened in the RRS group in order of low, medium, and high RRS (P < 0.05). Within the RVLs group, the renal prognosis of the groups with severe and moderate RVLs was worse than that of the group without RVLs (P = 0.012, P < 0.001), and the group with mild RVLs was close to that of the group without RVLs. ROC analysis showed that the AUC of RRS, BVAS, RVLs score, RVLs score combined with RRS (RVLs score & RRS, RR), RVLs score, and RRS combined with BVAS (RVLs score & RRS & BVAS, RRB) were 0.865, 0.624, 0.763, 0.910, and 0.942, respectively. The predictive power of RRB and RR was comparable and significantly better than the RRS, BVAS, and RVLs score. Based on simplicity and validity, RR was selected as the best predictor, and the relationship between RRS, RVLs score, and RR was calculated using a linear fit, resulting in the linear equation RR = -0.4766 + 0.1231 × RVLs score + 0.395 × RRS (P < 0.001). CONCLUSIONS: In AAGN, the predictive power of RR for renal prognosis was superior to that of RRS, BVAS, and RVLs score. RR may serve as a new predictor of renal prognosis in AAGN.
Asunto(s)
Glomerulonefritis , Fallo Renal Crónico , Humanos , Anticuerpos Anticitoplasma de Neutrófilos , Estudios Retrospectivos , Glomerulonefritis/diagnóstico , PronósticoRESUMEN
In this study, a simple and sensitive surface-enhanced Raman scattering (SERS) sensor based on gold nanostars@reduced graphene oxide (AuNS@rGO) was successfully developed for the detection of benzo[a]pyrene in foods. The detection strategy involved benzo[a]pyrene adsorption on reduced graphene oxide, followed SERS detection of adsorbed molecules. Owing to the large electric fields generated by the gold nanostars under laser irradiation, which greatly amplified the Raman signals of benzo[a]pyrene, very high sensitivity for the target analyte was achieved. Under optimized conditions, the SERS sensor exhibited a wide linear detection range for benzo[a]pyrene (from 0.1 µg L-1 to 10000 µg L-1), with a low limit of detection of 0.0028 µg L-1. Chicken samples spiked with benzo[a]pyrene were assayed using the sensor, with recoveries ranging from 89.20% to 100.80%. The benzo[a]pyrene content in roasted mutton sample was quantified using the SERS sensor and a reversed-phase high-performance liquid chromatography method, with similar results being obtained.
Asunto(s)
Benzo(a)pireno , Grafito , Benzo(a)pireno/análisis , Oro/química , Espectrometría Raman/métodos , Grafito/químicaRESUMEN
Herein, we prepared a self-crosslinked conductive molecularly imprinted gel (CMIG) using cationic guar gum (CGG), chitosan (CS), ß-cyclodextrin (ß-CD), amaranth (AM) and multi-walled carbon nanotubes (MWCNTs) by a simple one-pot low temperature magnetic stirring method. The imine bonds, hydrogen-bonding interactions and electrostatic attractions between CGG, CS and AM facilitated CMIG gelation, while ß-CD and MWCNTs enhanced the adsorption capacity and conductivity of CMIG, respectively. Next, the CMIG was deposited onto the surface of a glassy carbon electrode (GCE). After selective removal of AM, a highly sensitive and selective CMIG-based electrochemical sensor was obtained for AM determination in foods. The CMIG allowed specific recognition of AM and could also be used for signal amplification, thus improving the sensitivity and selectivity of the sensor. Due to the high viscosity and self-healing properties of the CMIG, the developed sensor was very durable retaining a 92.1% of original current after 60 consecutive measurements. Under optimal conditions, the CMIG/GCE sensor showed a good linear response for AM detection (0.02-150 µM) with a limit of detection of 0.003 µM. AM recovery tests were performed in milk powder and white vinegar samples, yielding satisfactory recoveries (89.00%-111.00%). Furthermore, the levels of AM in two kinds of carbonated drinks were analyzed with the constructed sensor and an ultraviolet spectrophotometry method, with no significant difference found of the two methods. This work demonstrates that CMIG based electrochemical sensing platforms allow the cost-effective detection of AM, with the CMIG technology likely being widely applicable to the detection of other analytes.
Asunto(s)
Técnicas Biosensibles , Quitosano , Impresión Molecular , Nanotubos de Carbono , Impresión Molecular/métodos , Nanotubos de Carbono/química , Técnicas Electroquímicas/métodos , Polímeros/química , Límite de Detección , Técnicas Biosensibles/métodos , Colorante de Amaranto , Electrodos , Quitosano/químicaRESUMEN
Quantum key distribution (QKD) allows two remote parties to share information-theoretic secret keys. Many QKD protocols assume the phase of encoding state can be continuous randomized from 0 to 2π, which, however, may be questionable in the experiment. This is particularly the case in the recently proposed twin-field (TF) QKD, which has received a lot of attention since it can increase the key rate significantly and even beat some theoretical rate-loss limits. As an intuitive solution, one may introduce discrete-phase randomization instead of continuous randomization. However, a security proof for a QKD protocol with discrete-phase randomization in the finite-key region is still missing. Here, we develop a technique based on conjugate measurement and quantum state distinguishment to analyze the security in this case. Our results show that TF-QKD with a reasonable number of discrete random phases, e.g., 8 phases from {0,π/4,π/2, ,7π/4}, can achieve satisfactory performance. On the other hand, we find the finite-size effects become more notable than before, which implies that more pulses should be emit in this case. More importantly, as a the first proof for TF-QKD with discrete-phase randomization in the finite-key region, our method is also applicable in other QKD protocols.
RESUMEN
Background: Diabetic kidney disease (DKD) has become the leading cause of chronic kidney disease (CKD) in many countries. Recent studies have shown that circular RNA and pyroptosis play an important role in pathogenesis of DKD. Methods: We analyzed expression patterns of circRNAs in human kidney biopsy tissues obtained from type 2 DKD (n = 9) and nephrectomy (n = 9) patients. Next, we cultured human renal tubular epithelial cells (HK2) in high glucose condition and detected circ_0004951, miR-93-5p, NLR Pyrin Domain Containing 3 (NLRP3) inflammasome-related indicators and pyroptosis. Furthermore, we performed Bioinformatics analysis and dual-luciferase reporter assay to analyze the relationship among circ_0004951, miR-93-5p and NLRP3. Results: Circ_0004951 was significantly upregulated in kidney tissues from DKD patients and HK2 in high glucose condition vs. control. Knockdown of circ_0004951 mediated a significant suppression of HK2 pyroptosis, while results from bioinformatics analysis revealed that circ_0004951 has binding sites with miR-93-5p and miR-93-5p could bind to NLRP3. Results from dual-luciferase reporter assay further corroborated this finding. Finally, observations from rescue experiments showed that down-regulation of miR-93-5p and upregulation of NLRP3 markedly attenuated the anti-pyroptosis and anti-inflammatory effects of circ_0004951 knockdown on HK2. Conclusion: Circ_0004951 promotes pyroptosis of renal tubular epithelial cells in DKD via the miR-93-5p/NLRP3 inflammasome pathway, suggesting its potential for clinical diagnosis and treatment of DKD.
RESUMEN
We explored the effects of C:N ratio in root exudates of Robinia pseudoacacia plantations on soil nutrient cycling and microbial activity on the Loess Plateau. We collected in-situ soil from the R. pseudoacacia plantations with essentially identical habitat conditions and growing time of 15, 25, 35, and 45 years. By adding root exudates with different C:N ratios (N only, C:N=10, C:N=50, C:N=100, C only) to the soil and using deionized water as a control, we analyzed the effects of C:N ratio of root exudates on the physicochemical properties of elements such as carbon, nitrogen and phosphorus, soil pH, and soil respiration. The results showed that: 1) Organic carbon content was positively correlated with the C:N ratio of root exudates. Soil organic carbon (SOC) decomposition was faster when root exudates C:N=10. Higher C:N ratio of root exudates (C:N=100) could inhibit SOC decomposition, but only C addition had no significant effect on SOC. 2) Different root exudate C:N produced no significant influence on the total nitrogen. The addition of carbon promoted microbial uptake of ammonium nitrogen, while the addition of nitrogen promoted the nitrification of ammonium nitrogen. As the C:N ratio of root exudates increased, soil ammonium nitrogen content decreased. 3) The addition of nitrogen would reduce soil pH and increase soil total phosphorus content. 4) Soil respiration of R. pseudoacacia plantations was positively correlated with the C:N ratio of root exudates. With the increases of C:N ratio, the promoting effect of root exudates on soil respiration at 25 and 35 years R. pseudoacacia plantations was stronger. In conclusion, higher C:N ratio of root exudates will significantly promote the effect on soil respiration of R. pseudoacacia plantations. Our results improved the understan-ding of the root-soil-microbial interactions in forests.
Asunto(s)
Compuestos de Amonio , Robinia , Carbono/análisis , China , Exudados y Transudados/química , Nitrógeno/análisis , Fósforo , Respiración , Suelo/químicaRESUMEN
The current status of cardiopulmonary resuscitation in China were introduced. The function and working principle of cardiopulmonary resuscitation equipment were described. The research status of cardiopulmonary resuscitation equipment was summarized. The main problem existing in cardiopulmonary resuscitation equipment were analyzed. Finally, according to the main technical direction involved in the conception, the existing technologies were reviewed from four aspects: path planning, human-computer interaction, automatic defibrillation and intelligent compression.
Asunto(s)
Reanimación Cardiopulmonar , Humanos , ChinaRESUMEN
Topological edge states (TES) exhibit dissipationless transport, yet their dispersion has never been probed. Here we show that the nonlinear electrical response of ballistic TES ascertains the presence of symmetry breaking terms, such as deviations from nonlinearity and tilted spin quantization axes. The nonlinear response stems from discontinuities in the band occupation on either side of a Zeeman gap, and its direction is set by the spin orientation with respect to the Zeeman field. We determine the edge dispersion for several classes of TES and discuss experimental measurement.
RESUMEN
Monolayer WTe2 is predicted to be a quantum spin Hall insulator (QSHI), and its quantized edge transport has recently been demonstrated. However, one of the essential properties of a QSHI, spin-momentum locking of the helical edge states, has yet to be experimentally validated. Here, we measure and observe gate-controlled anisotropic magnetoresistance (AMR) in monolayer WTe2 devices. Electrically tuning the Fermi energy into the band gap, a large in-plane AMR is observed and the minimum of the in-plane AMR occurs when the applied magnetic field is perpendicular to the current direction. In line with the experimental observations, the theoretical predictions based on the band structure of monolayer WTe2 demonstrate that the AMR effect originates from spin-momentum locking in the helical edge states of monolayer WTe2. Our findings reveal that the spin quantization axis of the helical edge states in monolayer WTe2 can be precisely determined from AMR measurements.
RESUMEN
The purpose of this study was to evaluate the clinicopathological features of different degrees of extraglomerular renal vascular lesions (RVLs) in patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated renal vasculitis and explore their clinical determinants. This is a retrospective study of 186 patients with ANCA-associated renal vasculitis diagnosed at the First Affiliated Hospital of Zhengzhou University from January 2014 to April 2019. The patients who met the inclusion criteria were divided into non-renal RVLs, mild RVLs, moderate RVLs, and severe RVLs. It was found that there were significant differences in serum creatinine (SCR), estimated glomerular filtration rate (eGFR), erythrocyte sedimentation rate (ESR), high-density lipoprotein (HDL), systolic blood pressure (SBP), the prevalence rate of hypertension, the proportion of normal glomeruli, and the proportion of sclerotic glomeruli and interstitial fibrosis integral. SCR and ESR are independent risk factors for RVLs. The participants were followed up for 1 year, and the progression to end-stage renal disease (ESRD) and death was defined as endpoint events. We found that the survival rate of patients without RVLs was significantly higher than that of patients with RVLs and that the RVLs were an independent risk factor for ESRD or death. Early intervention in the progression of RVLs can improve the prognosis.
RESUMEN
The main objective of this study is to analyze the clinical and pathological features and prognosis of patients with Hepatitis B associated membranous nephropathy (HBV-MN) and idiopathic membranous nephropathy (IMN) complicated with hepatitis B virus (HBV) infection. This study will provide more basis for diagnosis and prognosis evaluation. A total of 50 patients with HBV-MN were included in this study. 56 IMN patients complicated with HBV infection diagnosed during the same period formed the control group. Parameters including blood routine, urine routine and plasma levels of albumin (ALB), serum creatinine (SCR), blood urea nitrogen (BUN), urea acid (UA), total cholesterol (T-CHO), triglycerides (TG), complement C3 and C4, glutamic pyruvic transaminase (ALT), glutamic pyruvic transaminase (AST), 24-h urinary protein quantification (24 h-TP), renal phospholipase A2 receptor (PLA2R) and HBV related markers during the hospitalization and outpatient follow-up study period were collected for all the patients. The proportion of male patients was high in both groups. The average age of the HBV-MN group was 37.2 ± 14.187 years old, it was younger compared with the IMN group (P = 0.003). Nephrotic syndrome was the major clinical manifestation among patients. There was no significant difference between the two groups in the levels of anemia, microscopic hematuria, renal dysfunction, liver dysfunction, liver cirrhosis. The level of serum C3 and C4 in the HBV-MN group was lower compared with the IMN group (P = 0.002, P = 0.014). In the HBV-MN group, serum HBV markers were negative in 6 (12%) patients, 4 patients (8%) were positive for PLA2R in serum, and 5 patients (10%) were positive for PLA2R in renal tissue. Stronger IgG1 and C1q and weaker IgG4 staining were found in HBV-MN group renal tissues (P = 0.003, P = 0.025, and P = 0.001, respectively). There were no statistical differences compared with serum and renal PLA2R between HBV-MN and IMN groups (P = 0.098, P = 0.109). During the 1-year follow-up, there was no significant difference in complete remission rate between the two groups (P = 0.7739). Renal biopsy is crucial to diagnose HBV-MN. IgG subtypes in the HBV-MN group were mainly IgG1 deposition, while those in IMN complicated with HBV infection group were mainly IgG4 deposition. When HBV-associated antigen and PLA2R are present in renal tissue, lower level of serum C3 and C4, high intensity of renal C1q and IgG1 is more supportive of HBV-MN. The positive of PLA2R in serum and renal tissue in differentiating HBV from IMN complicated with HBV infection remains to be discussed.
Asunto(s)
Glomerulonefritis Membranosa/diagnóstico , Glomerulonefritis Membranosa/etiología , Virus de la Hepatitis B , Hepatitis B/complicaciones , Adolescente , Adulto , Biomarcadores , Biopsia , Proteínas del Sistema Complemento/inmunología , Diagnóstico Diferencial , Susceptibilidad a Enfermedades , Femenino , Glomerulonefritis Membranosa/complicaciones , Glomerulonefritis Membranosa/mortalidad , Hepatitis B/inmunología , Hepatitis B/virología , Virus de la Hepatitis B/inmunología , Humanos , Inmunoglobulina G/inmunología , Riñón/inmunología , Riñón/metabolismo , Riñón/patología , Pruebas de Función Renal , Masculino , Persona de Mediana Edad , Pronóstico , Adulto JovenRESUMEN
INTRODUCTION: Primary membranous nephropathy (PMN) is one common cause of end-stage kidney disease. There is no optimal treatment for PMN patients with sub-nephrotic proteinuria currently. Tripterygium wilfordii polyglycoside (TWG) is a widely used traditional medicine in China and has been used to treat nephropathy for decades. OBJECTIVE: To investigate the effect of TWG combined with angiotensin receptor blocker (ARB) on the treatment of PMN with sub-nephrotic proteinuria. METHODS: Biopsy-proven sub-nephrotic PMN patients with normal kidney function and treated with TWG combined with ARB or ARB alone were retrospectively analyzed. The primary outcome was remission rate (complete or partial remission), and the secondary outcomes included proteinuria, serum albumin levels, estimated glomerular filtration rate (eGFR), relapse rate, and adverse events. RESULTS: The clinical trial included 55 patients. The overall remission rates for the TWG + ARB and ARB groups after 9 months of treatment were 74.3% and 35%, respectively (p = 0.004). Moreover, the complete remission (CR) rate for the TWG + ARB and ARB groups in the 9th month were 45.7% and 15%, respectively (p = 0.044). Treatment with TWG + ARB was the independent predictor of complete remission of proteinuria (p = 0.048). Besides, the remission rate was higher in the TWG + ARB group than in the ARB group among patients who were positive for anti-phospholipase A2 receptor (PLA2R) antibodies (65.4% vs. 21.4%, p = 0.02). CONCLUSIONS: These data demonstrate that TWG may be a promising treatment for PMN patients with sub-nephrotic proteinuria, whether anti-PLA2R antibody is positive or negative.