Background:
This study was aimed at investigating the clinical significance and curative effect of global glomerulosclerosis (GS) and segmental glomerulosclerosis (S) in adult-onset IgA vasculitis ...with nephritis (IgAV-N) patients since there was no consensus pathological grading method for adult IgAV-N.
Methods:
A total of 188 biopsy-proven IgAV-N patients were prospectively identified. Patients were separately assigned to GS0/GS1/GS2 group and S0/S1/S2 based on the scores of global glomerulosclerosis and segmental glomerulosclerosis (0% /0–15% />15%, respectively).
Results:
GS0, GS1, and GS2 occurred in 56.4, 29.2, and 14.4% of the adult-onset IgAV-N, respectively. Patients in GS2 group tended to have the most serious renal deterioration and the highest levels of blood pressure. IgAV-N patients were also divided into S0 group (64.4%), S1 group (20.7%), and S2 group (14.9%), where no obvious differences in baseline data were noted. K–M curves indicated that GS2 group had the worst renal outcome (
P
= 0.05) while there seemed to be no significant differences between GS0 group and GS1 group. In addition, no remarkable differences in primary outcome were found among S0 group, S1 group, and S2 group though the prognosis of S2 group tended to be the worst. However, the prognosis of S0/S1 group was markedly better than that of S2 (
P
= 0.04). The discrimination of poor prognosis could be improved by adding the pathological indicators of global glomerulosclerosis and segmental glomerulosclerosis. Most importantly, immunosuppressive treatment might be a superior alternative in IgAV-N patients without sclerosis scores or with lower level of sclerosis scores. But addition of immunosuppression was not recommended in patients with higher sclerosis scores.
Conclusions:
Global glomerulosclerosis and segmental sclerosis might be used for management and treatment of adult-onset IgAV-N.
Aim:
This study aimed to investigate the clinicopathological features and prognosis of immunoglobulin A nephropathy (IgAN) with arterial-arteriolar sclerosis (AS).
Methods:
Patients with ...biopsy-proven IgAN from the West China Hospital of Sichuan University were retrospectively enrolled. Clinicopathological features were collected. Patients were categorized based on the presence and the severity of the AS. All the patients were regularly followed-up until a composite end point. The correlation between AS and prognosis of IgAN was assessed.
Results:
A total of 1,424 patients were recruited and followed for 60.0 ± 28.7 months. Patients with AS tended to have older age, higher blood pressure, heavier proteinuria, higher serum creatinine, uric acid, and total triglyceride (TG). Meanwhile, they were more likely to have a lower estimated glomerular filtration rate (eGFR), hemoglobin, and albumin. At the end of follow-up, 126 patients in the AS group and 47 patients in the non-AS group had reached the composite end point (
p
< 0.001). AS was associated with the renal outcome (log-rank
p
< 0.001) and was an independent risk factor for the progression of IgAN (
p
= 0.049). The severity of AS was associated with renal outcomes (log-rank
p
< 0.001) and there was a trend that it might serve as an independent risk marker for progression of IgAN. In the subgroup analysis, patients presenting with AS and lower eGFR, albumin, and hemoglobin or higher proteinuria, uric acid, and TG had a significant trend for a shorter time to reach the end point (log-rank
p
< 0.001).
Conclusion:
AS was commonly seen in patients with IgAN and was independently associated with the poor prognosis.
Gastrointestinal cation exchangers that can bind potassium in the gut, including sodium polystyrene sulfonate (SPS), calcium polystyrene sulfonate (CPS), patiromer and sodium zirconium cyclosilicate ...(SZC), are emerging medications for the treatment of hyperkalemia with chronic kidney disease (CKD). However, which might be the best alternative for patients with chronic kidney disease and hyperkalemia remains disputed.
We performed this systematic review and network meta-analysis with the Bayesian approach to conduct direct and indirect comparisons among potassium binders regarding their efficacy and safety. The surface under the cumulative ranking curve analysis (SUCRA) was used to calculate the best intervention for each outcome.
All four potassium binders had a promising effect regarding potassium reduction. SPS had favorable efficacy and safety for short-term use (MD: −0.94; 95% CIs: −1.4 to −0.48; SUCRA = 94.69%), but long-term treatment required strict dose control and assessment of gastrointestinal conditions. CPS had a positive effect on reducing potassium, and could especially maintain the serum potassium concentration in patients receiving renin-angiotensin-aldosterone system inhibitors (RAASi). Patiromer might reduce all-cause mortality in CKD patients with hyperkalemia and have a positive effect on potassium-lowering, though it had significant gastrointestinal adverse effects. SZC had a potassium-lowering effect in both the short-term and long-term, and can be a promising long-term treatment for the hyperkalemia in CKD patients, especially in combination with RAASi.
These four potassium binders had their own advantages and disadvantages, and the medication should be selected according to the clinical situation of the patient.
•Metabolic profile of IgAN was significantly different with healthy controls.•Thirty-nine differential metabolites were identified as potential biomarker for IgAN.•Lanosterol, vitamin K1, vitamin K2, ...and beta-elemonic acid showed a promising predictive ability of IgAN.•Metabolic pathways were altered in IgAN, including lipids metabolism and vitamin K biosynthesis.
We investigated alterations in the serum metabolomic profile of IgA nephropathy (IgAN) patients and screen biomarkers of IgA nephropathy based on ultra-performance liquid chromatography-mass spectrometry (UPLC-MS).
Serum samples from 65 IgAN patients and 31 healthy controls were analyzed by ultra-performance liquid chromatography-mass spectrometry (UPLC-MS). Univariate and multivariate analysis were performed to screen the differential metabolites. Differential metabolites should meet both the following two criteria: adjusted P < 0.05 in the univariate analysis and VIP value > 1 in the multivariate model. Pathway analysis was performed to reveal the metabolic pathways that were significantly influenced in IgAN. Spearman correlation analysis was applied to explore the correlation between metabolites and between the metabolites and clinicopathological features of IgAN. A random forest model and Logistics regression analysis were conducted to evaluate the predictive ability of the metabolites.
The metabolic profile was significantly altered in IgAN patients compared with healthy controls. Thirty-nine metabolites were identified, including glycerophospholipids, sphingolipids, vitamin K1, vitamin K2, bile acids and amino acids. Sphingolipid metabolism, ubiquinone and other terpenoid-quinone biosynthesis, and glycerophospholipid metabolism were found to be significantly disturbed in the pathway analysis. Differential metabolites were found to be associated with the clinical and pathological features of IgAN patients. Lanosterol, vitamin K1, vitamin K2, and β-elemonic acid were found to have promising predictive ability for IgAN.
We confirmed the differences in the metabolic profiles of IgAN patients and healthy controls and identified the differential metabolites of IgAN, which may help with the further exploration of the pathogenesis and treatment of IgAN.
Breast cancer develops from local tissue but is characterized by a distinct metastatic pattern involving regional lymph nodes and distant organs, which is the primary cause of high mortality in ...breast cancer patients. Herein, optimal docking nanoparticles (NPs) composed of a laurate-functionalized Pt(IV) prodrug (Pt(lau)), human serum albumin (HSA), and lecithin were predicted by computational modeling, prepared by nanoprecipitation, and validated by fluorescence spectroscopy. As macrophages have been reported to be preferentially recruited by breast cancer, Rex, the exosome spontaneously secreted by murine RAW 264.7 cells, was isolated to encapsulate the NPs. This high-performance delivery system, called NPs/Rex, possessed the desired physicochemical properties, enhanced colloidal stability, and redox-triggered release profile. Investigations of cytodynamics proved that NPs/Rex was internalized through multiple pathways, avoided entrapment by bilayers, and successfully platinized nucleic acids after bioreduction in the cytosol. Intracellular activation of Pt(lau) was confirmed by observing the characteristic effects of cisplatin on cell proliferation and the cell cycle following treatment with NPs/Rex. During in vivo application, the bioinspired Rex coating endowed docking NPs with prolonged blood circulation, smart organ tropism, and enhanced biocompatibility, as well as robust platinum (Pt) chemotherapy for breast cancer cells in orthotopic tumors of fat pads and metastatic nodules of lungs. Therefore, this favorable nanoplatform might provide valuable insight into the derivatization and development of Pt anticancer drugs used currently in the clinic.
Background
Chronic kidney disease (CKD) is characterized as a progressive dysfunction of the kidney, and it might have a close relationship with insulin resistance. We utilized the ...triglyceride–glucose (TyG) index, a reliable marker of insulin resistance, to evaluate the association between the TyG index and CKD in adults from the general population.
Methods
This was a cross-sectional study obtaining data from the 2015–2018 National Health and Nutrition Examination Survey. The estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (UACR) served as kidney function indicators. We defined CKD as the existence of either low eGFR (eGFR < 60 mL/min/1.73 m
2
BSA) or albuminuria (UACR > 30 mg/g). Multivariate regressions, correlated subgroup analyses, and interaction terms were performed in this study.
Results
For 4361 recruited participants, the mean TyG index was 8.60 ± 0.68, and the prevalence of CKD was 13.35%. Participants with a higher TyG index showed a higher UACR level (
β
= 25.10, 95% CI: 6.76, 43.44,
P
= 0.0074) and higher levels of CKD (OR = 1.34, 95% CI: 1.13, 1.59,
P
= 0.0006). The positive relationship between the TyG index and CKD became stronger and remained significant in the overweight (OR = 1.61, 95% CI: 1.18, 2.20,
P
= 0.0027) and obese (OR = 2.48, 95% CI: 1.95, 3.15,
P
< 0.0001) groups and in people with diabetes (OR = 1.94, 95% CI: 1.46, 2.56,
P
< 0.0001).
Conclusions
Higher TyG index was strongly associated with a higher UACR level and higher values of albuminuria and CKD, which might be useful in kidney function screening especially among people in disadvantageous socioeconomic conditions with no availability for direct measurement of kidney function. However, more well-designed studies are still needed to validate this relationship.
Purpose
Patients with chronic kidney disease (CKD) are frail and have high risk of cardiovascular disease. This study was performed to assess the effects of aerobic exercise training in adults with ...CKD.
Methods
MEDLINE, EMBASE, CENTRAL, Web of Science were searched up to December 2018 to identify eligible randomized controlled trials (RCTs) that studied aerobic exercise in adults with CKD. Primary outcomes include oxygen consumption at peak exercise (VO
2
peak), exercise capacity, blood pressure, heart rate, and health-related quality of life (HRQoL). Statistical analysis was performed using Review Manager 5.2.1 software.
Results
Thirty-one trials, containing 1305 adults with CKD, were included. The most used aerobic exercise program was characterized as moderate intensity (15/31), 3 times/week frequency (22/31), 30 min duration (9/31) and 3 months follow-up (12/31). Significant improvement was observed in cardiorespiratory function (VO
2
peak) (
P
< 0.0001), exercise duration (
P
< 0.0001), HDL-C (
P
= 0.03) and pain (
P
= 0.007), physical role (
P
= 0.03), general health (
P
= 0.007) of HRQoL after aerobic exercise in patients with CKD. A marginal difference was observed in HR max (
P
= 0.07). However, no statistical difference was noticed in exercise capacity, blood pressure, resting heart rate, serum lipid and serum creatinine between aerobic training group and control. No subgroup differences were altered in all outcomes when studies were divided based on intensity of exercise training, the treatment of dialysis or the length of intervention.
Conclusions
Aerobic exercise training could benefit adult CKD patients in increasing cardiorespiratory function, exercise duration, HDL-C level and improve health quality of life.
Accurately classifying colorectal polyps, or differentiating malignant from benign ones, has a significant clinical impact on early detection and identifying optimal treatment of colorectal cancer. ...Convolution neural network (CNN) has shown great potential in recognizing different objects (e.g. human faces) from multiple slice (or color) images, a task similar to the polyp differentiation, given a large learning database. This study explores the potential of CNN learning from multiple slice (or feature) images to differentiate malignant from benign polyps from a relatively small database with pathological ground truth, including 32 malignant and 31 benign polyps represented by volumetric computed tomographic (CT) images. The feature image in this investigation is the gray-level co-occurrence matrix (GLCM). For each volumetric polyp, there are 13 GLCMs, computed from each of the 13 directions through the polyp volume. For comparison purpose, the CNN learning is also applied to the multi-slice CT images of the volumetric polyps. The comparison study is further extended to include Random Forest (RF) classification of the Haralick texture features (derived from the GLCMs). From the relatively small database, this study achieved scores of 0.91/0.93 (two-fold/leave-one-out evaluations) AUC (area under curve of the receiver operating characteristics) by using the CNN on the GLCMs, while the RF reached 0.84/0.86 AUC on the Haralick features and the CNN rendered 0.79/0.80 AUC on the multiple-slice CT images. The presented CNN learning from the GLCMs can relieve the challenge associated with relatively small database, improve the classification performance over the CNN on the raw CT images and the RF on the Haralick features, and have the potential to perform the clinical task of differentiating malignant from benign polyps with pathological ground truth.
•A novel end-to-end deep learning Generative Adversarial Network-based lung segmentation schema – LGAN.•The LGAN schema employs EM distance to perform pixel-wised semantic segmentation.•The LGAN ...schema is applied to five different GAN structures for lung segmentation.•Evaluate five LGAN segmentation algorithms and the baseline U-net model using LIDC-IDRI and QIN datasets.•Compare them with different metrics including segmentation quality and shape similarity.•The proposed LGAN schema outperforms current state-of-the-art methods.
Lung segmentation in Computerized Tomography (CT) images plays an important role in various lung disease diagnosis. Most of the current lung segmentation approaches are performed through a series of procedures with manually empirical parameter adjustments in each step. Pursuing an automatic segmentation method with fewer steps, we propose a novel deep learning Generative Adversarial Network (GAN)-based lung segmentation schema, which we denote as LGAN. The proposed schema can be generalized to different kinds of neural networks for lung segmentation in CT images. We evaluated the proposed LGAN schema on datasets including Lung Image Database Consortium image collection (LIDC-IDRI) and Quantitative Imaging Network (QIN) collection with two metrics: segmentation quality and shape similarity. Also, we compared our work with current state-of-the-art methods. The experimental results demonstrated that the proposed LGAN schema can be used as a promising tool for automatic lung segmentation due to its simplified procedure as well as its improved performance and efficiency.
•The HM/FM/XN design employs double interfacial effects on the PMA of the Pd/CMS/AlN/Pd multilayer structure.•Inserting AlN layer to Pd/CMS/Pd form Pd/CMS/AlN/Pd structure can increase RHall by 300%, ...Hc by 76% and Keff by 135%.•The PMA depends on the orbital hybridization effect of Pd5d-Co3d and Co3d-N2p electrons, and the crystallinity of each layer.
In this paper, the perpendicular magnetic anisotropy（PMA）of Pd/Co2MnSi (CMS)/AlN/Pd multilayer film is studied, which is designed based on the two-interface interaction, the orbital hybridization effect of Pd5d-Co3d electrons at the Pd/CMS interface and the orbital hybridization effect of Co3d-N2p electrons at the CMS/AlN interface. Compared with the Pd/CMS/Pd multilayer film, the PMA of the Pd/CMS/AlN/Pd structure shows significant enhancement with the insertion of the AlN layer. The Hall resistance (RHall) of the Pd/CMS/AlN/Pd structure reached 0.02 Ω (increased by 300 %) and the coercive force (Hc) is 388 Oe (increased by about 76 %). The magnetic anisotropic energy density (Keff) is 0.61Merg/cm3 (increased by about 135 %). The PMA was optimized with the film factor (layer thickness) of Pd(6 nm)/CMS(5 nm)/AlN(6 nm)/Pd(6 nm). The X-Ray Diffraction（XRD）and High Resolution Transmission Electron Microscope（HRTEM）analysis showed that the PMA is affected by the crystallinity and interface quality of multilayer films.
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