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The world is currently facing a new energy crisis, which has prompted a focus on energy storage technologies to solve the global energy crisis. Taking advantage of the height difference between two dams and turning them into one is the main difference between gravity energy storage (GES) and pumped hydro storage (PHS) presented in this paper. This paper first introduces the basic principles of each of these two technologies, and then compares the two technologies through economic and parametric perspectives, showing the advantages of GES technology such as higher efficiency, easier construction at less cost, and the promise of GES. Some case studies may not reveal convincing trends in GES development, but they can still be used to compare the technology's present state of development. This research stresses that GES has higher promise as a newly created technology. Both technologies are promising and excellent renewable energy sources, but to truly evaluate which is superior in the long run, economic factors must be analyzed and compared. GES technologies are also being researched to assist the world in alleviating the pressures of the energy crisis and the environmental issues produced by stored energy.

Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary kidney disease, with a prevalence of 1/2,500-1/1,000, and it affects 1.25 million people in China. ADPKD is responsible for nearly 5% of end-stage renal disease cases, which leads to a major burden on public health. In 2016, the Chinese working group developed guidelines for the diagnosis and treatment of ADPKD, which promoted the clinical management of ADPKD in China. In the last 3 years, Chinese clinicians have deepened their understanding and standardized the management of ADPKD, and several basic and clinical studies on ADPKD have been conducted. In combination with international guidelines and research results, the working group updated the ADPKD guidelines in China. This guideline includes 5 chapters: introduction, diagnosis, kidney disease progression monitoring, treatment, and family planning. We highlight the main recommendations and suggestions of the ADPKD guidelines in this summary.

Joint contracture is a fibrotic complication induced by joint immobilization and trauma, which is characterized as excessive myofibroblast proliferation in joint capsule. The treatments of joint contracture are unsatisfied and patients are suffered from joint dysfunction. Our previous study has shown that curcumin can inhibit myofibroblast proliferation in vitro, but the major challenge is the low aqueous solubility and biological activity of curcumin. In this study, hyaluronic acid-curcumin (HA-Cur) conjugate was synthesized to suppress myofibroblasts in joint contracture. Cells were isolated from the joint capsules of joint contracture patients and induced to active myofibroblasts by transforming growth factor-β (TGF-β). The anti-fibrotic function and mechanisms of HA-Cur were investigated by immunohistochemistry, reverse transcription-quantitative polymerase chain reaction (PCR), methylation-specific PCR, western blot, transwell migration assay and proliferation assay. Results showed that 30 μM HA-Cur significantly attenuated the fibrotic functions of myofibroblast in joint contracture in vitro by regulating the methylation of prostaglandin E receptor 2 (PTGER2) and inhibiting TGF-β signaling. This may provide a mechanism for the treatment of joint contracture, and provide a molecular target PTGER2 for therapy during the pathogenesis of joint contracture.

Hip arthroscopy is an effective method for the diagnosis and treatment of hip joint pathologies. However, gaining access to the central and peripheral compartments is challenging. The present study aimed to assess the advantages of using an arthroscopic extra-capsular approach and partial capsulotomy for access and subsequent management of hip diseases. Patients subjected to hip arthroscopy by partial capsulotomy for exposure and treatment of hip diseases between February 2012 and February 2016 were retrospectively analyzed. A total of 32 patients, including 19 males and 13 females, aged 19-48 years (median age, 36 years), had undergone the procedure. Firstly, the distal anterior lateral and anterolateral arthroscopic approach with blunt dissection was performed. Subsequently, a T-shaped partial capsulotomy was established to achieve adequate exposure. The shaver, radiofrequency probe and tissue penetrating suture grasper were then inserted to perform procedures including debridement of the synovium, suturing of the glenoid labrum. During surgery, a probe hook was used to push the capsule section limbs or pull the sutures placed on the capsule section limbs to improve exposure. For patients with pre-operative anterior instability, ligamentous laxity or acetabular dysplasia capsules were sutured to finish capsule closure. The pre-operative and post-operative Visual Analogue Scale (VAS) score and modified Harris hip score (MHHS) were used to assess the effectiveness of the procedure. No obvious post-operative complications were encountered. The mean follow-up time was 22.4 months (range, 18-32 months) and 31 patients completed the follow-up, while 1 patient was lost to follow-up. Compared with the pre-operative score, the MHHS was significantly increased (66.2±6.0 vs. 82.6±5.2; P

The penetration and accumulation of zinc oxide nanoparticles (ZnO NPs) with different sizes in human normal knee joint (NKJ) tissue and knee osteoarthritis (OA) tissue were studied by continuous optical coherence tomography and diffuse reflectance (DR) spectroscopy in this paper, and the effects of ZnO NPs of two sizes (30 nm and 90 nm) and ultrasound (US) on the optical properties of human NKJ and OA tissue were evaluated. The results show that the average attenuation coefficients of NKJ tissue decrease by 14.90%, 26.91%, 33.52% and 37.01%, and the DR spectra increases by 8.444%, 12.901%, 18.219% and 26.125%, respectively, after being treated with 90 nm ZnO NPs, 90 nm ZnO NPs/US, 30 nm ZnO NPs and 30 nm ZnO NPs/US. The average attenuation coefficients of OA tissue are reduced by 32.14%, 49.51%, 57.85% and 72.30%, and the DR spectra increase by 17.426%, 23.116%, 25.218% and 29.326%, respectively, after being treated with 90 nm ZnO NPs, 90 nm ZnO NPs/US, 30 nm ZnO NPs and 30 nm ZnO NPs/US. It is concluded that the optical properties of NKJ and OA tissues are greatly influenced by ZnO NPs and US. Nanoparticles have a greater impact on OA tissue than on NKJ tissue.

Objective To investigate the protective effects of Coptis chinensis decoction on the metabolic index and renal function of rats with fructose-induced metabolism syndrome (MS). Methods From 56 male Wistar rats, 6 were randomly selected as normal control group, the other rats were daily fed with 10% fructose water for 8 weeks to reproduce the MS model. Twenty-four rats were established successfully as MS model and randomly divided into 4 groups (6 each): model group, Coptis decoction group, tauroursodeoxycholic acid (TUDCA) group and berberine hydrochloride (BH) group. The body weight, visceral fat weight, fasting blood glucose (FBG), fasting insulin (FINS), insulin resistance index (HOMA-IR), cholesterol (TC), triglyceride (TG), systolic blood pressure (SBP), diastolic blood pressure (DBP), urinary N-acetyl-β-D-glucosidase (NAG), urine microalbumin (m-ALB), blood urea nitrogen (BUN) and serum creatinine (Scr) levels were compared between the groups, and the renal pathological changes were observed by light microscopy and electron microscopy. Results The levels of body weight, visceral fat weight, FINS, HOMA- IR, TC, TG, SBP, DBP and urinary NAG were obviously higher in the four MS model groups than in normal control group (P0.05). After the intervention, the levels of body weight, visceral fat weight, FINS, HOMA-IR, TC, TG, SBP and DBP decreased significantly in Coptis decoction group than in model group (P0.05). It was observed in model group by light microscopy and electron microscopy that the glomerular swelled obviously, the capillary basement membrane of glomerular and renal tubules thickened, mesangial region and interstitial substances hyperplasia, podocytes swelled markedly and most of fusion, the epithelial cells of renal tubules serious vacuolar degeneration, and a lot of secondary lysosomes formed, autophagy of organelles occurred, and most of endoplasmic reticulum and mitochondria disappeared. The kidney pathological damage reduced obviously after treatment of Coptis decoction, but no significant difference when compared with that in BH group and TUDCA group. Conclusions Coptis decoction may decrease the body weight, reduce the levels of blood lipid and blood pressure, and better improve the insulin resistance when compared with BH and TUDCA. In addition, Coptis decoction can also reduce the renal pathological damage, and has the protective function for kidney. DOI: 10.11855/j.issn.0577-7402.2017.11.06

// Jiarong Cai 1, * , Qingjian Ye 2, * , Suling Luo 3, * , Ze Zhuang 4 , Kui He 5 , Zhen-Jian Zhuo 6 , Xiaochun Wan 7, 8 and Juan Cheng 2 1 Department of Urology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China 2 Department of Gynecology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China 3 Department of Otolaryngology, The First People’s Hospital of Foshan (Affiliated Foshan Hospital of Sun Yat-Sen University), Foshan 528000, China 4 Department of Joint Surgery and Orthopaedic Trauma, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China 5 The Second People’s Hospital of FuTian District, Shenzhen 518000, China 6 School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China 7 Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai 200032, China 8 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China * These authors have contributed equally to this work Correspondence to: Juan Cheng, email: mdchengjuan@sohu.com Xiaochun Wan, email: wach126@163.com Keywords: CASP8, -652 6N insertion/deletion, polymorphism, cancer risk, meta-analysis Received: March 13, 2017 Accepted: April 24, 2017 Published: May 25, 2017 ABSTRACT The CASP8 -652 6N insertion/deletion (I/D) polymorphism reduces expression of caspase 8. We conducted a meta-analysis to clarify the relationship between this polymorphism and cancer risk. Eligible articles were retrieved from PubMed, EMBASE, CNKI, and WANFANG databases through February 2017. A total of 33 articles with 49 studies, including 33,494 cases and 36,397 controls, were analyzed. We found that the CASP8 -652 6N ins/del polymorphism was associated with decreased overall cancer risk in five genetic models [DD vs. II: odds ratio (OR)=0.76, 95% confidence interval (CI)=0.69–0.84, ID vs. II: OR=0.87, 95% CI=0.83–0.92, DD vs. ID/II: OR=0.82, 95% CI=0.75–0.89, ID/DD vs. II: OR=0.85, 95% CI=0.80–0.90, and D vs. I: OR=0.87, 95% CI=0.83–0.91]. Stratified analyses showed that the polymorphism was associated with decreased risk of colorectal, breast, esophageal, renal cell, lung, cervical, bladder, gastric, and other cancers. Overall cancer risk was reduced in Asian and Caucasian patients, both hospital- and population-based studies, and both high and low quality studies. Our results highlight the role of the CASP8 -652 6N ins/del polymorphism in decreasing cancer risk. Further studies with large-cohort populations, especially for specific cancer types and ethnic groups, are needed to confirm our findings.

Osteosarcoma is a highly malignant bone cancer which primarily occurs in children and young adults. Increasing evidence indicates that long noncoding RNAs (lncRNAs), which function as competing endogenous RNAs (ceRNAs) that sponge microRNAs (miRNAs) and messenger RNAs (mRNAs), play a pivotal role in the pathogenesis and progression of cancers. The regulatory mechanisms of lncRNA-mediated ceRNAs in osteosarcoma have not been fully elucidated. In this study, we identified differentially expressed lncRNAs, miRNAs, and mRNAs in osteosarcoma based on RNA microarray profiles in the Gene Expression Omnibus (GEO) database. A ceRNA network was constructed utilizing bioinformatic tools. Kaplan-Meier survival analysis showed that lncR-C3orf35 and HMGB1 were associated with poor prognosis of osteosarcoma patients. Furthermore, results of Gene Set Enrichment Analysis (GSEA) suggested that lncR-C3orf35 may be involved in cellular invasion, the Toll-like receptor signaling pathway, and immune cell infiltration in the tumor microenvironment. Further analysis showed that patients with osteosarcoma metastasis expressed higher levels of lncR-C3orf35 and HMGB1 compared to metastasis-free patients. Moreover, the metastasis-free survival rate of the high lncR-C3orf35/HMGB1 expression group was significantly lower than that of the low expression group. The ESTIMATE algorithm was used to calculate the immune score and stromal scores for each sample. High lncR-C3orf35 and HMGB1 levels were correlated with low immune scores. ImmuCellAI analysis revealed that a low proportion of macrophage infiltration was associated with high lncR-C3orf35 and HMGB1 expression. The differential expression of lncR-C3orf35, miR-142-3p, and HMGB1 was further verified by quantitative real-time PCR. This study indicates that lncR-C3orf35 could be considered as a novel potential biomarker and therapeutic target of osteosarcoma, which may contribute to a better understanding of ceRNA regulatory mechanisms.

Osteosarcoma (OS) is the most common primary solid malignant bone tumor, and its metastasis is a prominent cause of high mortality in patients. In this study, a prognosis risk signature was constructed based on metastasis-associated genes. Four microarrays datasets with clinical information were downloaded from Gene Expression Omnibus, and 256 metastasis-associated genes were identified by limma package. Further, a protein-protein interaction network was constructed, and survival analysis was performed using data from the Therapeutically Applicable Research to Generate Effective Treatments data matrix, identifying 19 genes correlated with prognosis. Six genes were selected by the least absolute shrinkage and selection operator regression for multivariate cox analysis. Finally, a three-gene (MYC, CPE, and LY86) risk signature was constructed, and datasets GSE21257 and GSE16091 were used to validate the prediction efficiency of the signature. The survival times of low- and high-risk groups were significantly different in the training set and validation set. Additionally, gene set enrichment analysis revealed that the genes in the signature may affect the cell cycle, gap junctions, and interleukin-6 production. Therefore, the three-gene survival risk signature could potentially predict the prognosis of patients with OS. Further, proteins encoded by CPE and LY86 may provide novel insights into the prediction of OS prognosis and therapeutic targets.

Background. To assess the clinical outcomes of central tendon-splitting approach and double row anchor suturing for the treatment of insertional Achilles tendinopathy. Methods. 28 patients (28 feet) diagnosed with insertional Achilles tendinopathy were included in this study. The inclusions were symptom of hindfoot pain around the insertion of the Achilles tendon, radiographic demonstration of calcification, or degeneration of the Achilles tendon, showing no symptom improvement even after standard nonsurgical treatment for more than six months. The X-ray revealed that patients had obvious posterior superior calcaneal exostosis with the possibility of friction with the Achilles tendon or intratendinous calcification. Surgical correction by the central tendon-splitting approach and double row Achilles tendon suturing was performed. The ankles were immobilized with plaster for four weeks postoperatively. The American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue score (VAS) were assessed preoperatively and at 2 years postoperatively. At final follow-up, the Manchester-Oxford Foot Questionnaire (MOXFQ) as patient-reported outcome measures (PROMs) was also evaluated. Results. No complication, including postoperative wound infection and tendon rupture, was not found. All the patients resumed their daily activities with no high level of daily activities, such as jumping and jogging after 6 weeks postoperatively. 27 patients were available for follow-up for at least 2 years, while only one patient was lost to follow-up. At postoperative 2 years, the postoperative AOFAS score increased significantly, while the VAS score decreased statistically when compared with preoperative values. At final follow-up, 24 patients had complete alleviation of pain, whereas the remaining 3 patients complained of mild heel pain after walking for a long time. The MOXFQ score showed obvious relief of previous symptoms for all included cases. Conclusions. Central tendon-splitting approach and double row Achilles tendon suture provide excellent intraoperative visual field, larger tendon-bone contact area, and stronger pullout strength and, thus, facilitate early rehabilitation. It can be a safe and effective method for the treatment of insertional Achilles tendinopathy.

Joint contracture is increasingly regarded as a clinical problem that leads to irreversible dysfunction of the joint. It is a pathophysiological process following joint injury, which is marked by the activation of myofibroblasts. There is currently no effective treatment for the prevention of joint contracture. Curcumin is a polyphenol pigment extracted from turmeric, which possesses anti-inflammatory, antioxidative, and antitumor properties. In the present study, we demonstrated that curcumin exerts a protective effect against joint contracture via the inhibition of myofibroblast proliferation and migration in a time- and concentration-dependent manner. Moreover, we indicated that phosphatase and tension homolog (PTEN) was downregulated in myofibroblasts in vitro and in the contracture capsule tissues of patients in vivo. Additionally, western blot analysis revealed a negative correlation between the expression levels of PTEN and the fibrosis marker protein alpha smooth muscle cell actin. Methylation-specific PCR results suggested that curcumin was able to demethylate PTEN in a similar manner to the demethylation agent 5-azacytidine, increasing PTEN expression and further inhibiting phosphoinositide 3-kinase/protein kinase B/mammalian target of rapamycin signaling. In conclusion, our data illustrate part of the mechanism of curcumin inhibition in joint contracture. These results support the hypothesis that curcumin may potentially be used as a novel candidate for the treatment of joint contracture.

Objective To investigate the effect of berberine on endoplasmic reticulum stress PERK apoptosis pathway in HK-2 cells by high fructose. Methods HK-2 cells were grown in DMEM/F12, containing 10% fetal bovine serum (FBS) and divided randomly into four groups: normal control group (Group C); Fructose group (Group F): it contains 25mmol/L fructose culture; Berberine group (Group B): 25mmol/L fructose + 10μmol/L berberine treatment group; TUDCA group (Group T): 25mmol/L fructose +2μmol/L TUDCA culture group; Cells were collected after culturing 24h. The expression of glucose-regulated protein 78 (GRP78), CHOP protein and the phosphorylation levels of PERK, eIF2α were tested by Western blotting. The cell cycles were detected by flow cytometry and the apoptosis of cells were detected by TUNEL staining. Results Western blotting showed that the expression of GRP78 and CHOP protein in group F was significantly higher than that in group C, and the levels of p-PERK and p-eIF2α in group F were significantly higher than those in group F. Compared with group F, GRP78, CHOP, p-PERK and p-eIF2α in group B and T were significantly lower (P0.05). Conclusion Persistent high fructose can activate the intracellular PERK pathway in HK-2 cells, causing endoplasmic reticulum stress. Berberine can inhibit the fructose-induced PERK and eIF2α phosphorylation, down-regulated the expression of GRP78, CHOP protein, thus by regulating PERK Pathways to alleviate cell cycle arrest and reduce cell apoptosis. DOI: 10.11855/j.issn.0577-7402.2017.01.02

Background Joint contracture is a fibrous disease characterized as joint capsule fibrosis that results in joint dysfunction and disability. The purpose of this study was to analyze the biological activities of chaperonin containing T-complex polypeptide (CCT) subunits and to determine the role of CCT chaperone in joint contracture in a rat model. Methods In this study, the rat model of joint contracture was established by immobilizing the rat knee for 8 weeks. Then, fibroblasts were isolated from the posterior joint capsule and were cultured for functional analysis such as qRT-PCR, Western blot, transwell assay, and collagen assay. The effect of CCT subunit was determined by employing a lentivirus containing target gene and transfecting it into fibroblasts. Results Results of qRT-PCR and Western blot showed that among all CCT subunits, CCT6b significantly decreased in the fibroblasts from contractive joints compared to cells from normal joints (p < 0.05). Overexpression of CCT6b by transfection of lentivirus containing CCT6b gene to active fibroblasts significantly inhibited fibrous marker (α-SMA, COL-1) expressions, fibroblast migration, and collagen synthesis (all p < 0.05). Moreover, fibrosis-related chaperone CCT7 expression was decreased with CCT6b overexpression (p < 0.05). Conclusion The biological activities of CCT subunits in fibroblasts from the joint contracture rat model were analyzed in this study. CCT6b significantly decreased in the active fibroblasts, and overexpression of CCT6b significantly inhibited fibroblast functions. These findings indicate that CCT6b appears to be a potential molecular biomarker and therapeutic target for the novel therapies of joint contracture. Electronic supplementary material The online version of this article (10.1186/s13018-019-1161-6) contains supplementary material, which is available to authorized users.

Tenosynovial chondromatosis is an extra-articular version of articular synovial chondromatosis and a relatively rare condition that can affect the tendon sheath, bursa, or joint synovial tissue. Tenosynovial chondromatosis is rarely reported in the literature and is often misdiagnosed. In the present study, a case of extra-articular tenosynovial chondromatosis of the left ring finger in a 23-year-old man is reported. Three different-sized nodules were identified upon surgery and all were removed via synovectomy. The patient was symptom free 6 months postoperatively, and there were no signs of recurrence after 1.5 years of follow-up. The literature describing tenosynovial chondromatosis in the fingers is also reviewed.

To analyze clinical efficiency and intraoperative considerations of ankle arthroscopy for ankle impingement syndrome through anterior and posterior passage.From April 2011 to April 2015, the clinical data of 17 patients diagnosed as ankle impingement syndrome were performed arthroscopy, including 12 males and 5 females, with an average age of 32.4 years (ranging from 22 to 47). Ankle arthroscopy cleaning were carried out according to clinical symptoms and radiological imaging, crashed part were cleaned too. Non steroidal anti-inflammatory drugs and intra-articular injection of sodium hyaluronate were used as conventional postoperatively treatment. AOFAS score and Ogilvie-Harris score were used to assess preoperative situation and postoperative situation.Intra-operative conditions showed 8 cases with anterior lateral impingement syndromes, 2 cases with anterior medial impingement syndromes, 2 cases with posterior impingement syndromes and 3 cases combined with anterior and posterior impingement syndromes. Distal bundle of anterior tibiofibular ligament, anterior talusfibular ligament and synovial tissue and scar tissue were cleared up during operation. Four patients were combined with concomitant articular cartilage injury, and damage area were about 1 mm×3 mm to 1.5 mm×4 mm. Microfracture treatment were performed by 1.2 mm diameter Kirschner wire. All patients were followed up from 8 to 24 months with an average of 14.3 months. AOFAS score increased from 62.3±5.20 preoperatively to 87.6±5.40 postoperatively, Ogilvie-Harris ankle score increased from 6.70±0.98 preoperatively to 12.80±1.21 postoperatively. No neurovascular damage, wound infection or wound healing problem occurred. Ankle swelling were appeared with different degrees, but disappeared at 4 to 8 weeks postoperatively.For ankle impingement syndrome patients, ankle arthroscopy through anterior with posterior passage could effectively clear up bone and soft tissue impingement. Postoperatively non-steroidal anti-inflammatory drugs and intra-articular injection of sodium hyaluronate could effectively relieve ankle pain and swollen and achieve good therapeutic effect.

BackgroundThe disorders associated with metabolic syndrome (MS) can lead to renal disease. IgA nephropathy is the most common form of glomerulonephritis, and many patients with this disorder progress to renal failure.AimsTo identify the effect of MS on IgA nephropathy by retrospectively comparing patients who had IgA nephropathy and MS with those who had IgA nephropathy alone.Methods30 patients with MS and IgA nephropathy (MS group), and 30 matched controls with IgA nephropathy alone (non-MS group) were enrolled. IgA nephropathy was diagnosed by renal biopsy; activity and severity was graded by two classification systems. MS was diagnosed by criteria of the Diabetes Society of the Chinese Medical Association.ResultsSimple and multiple linear regression models (which adjusted for age, gender and body surface area) showed that only hypertension significantly affected serum creatinine, an indicator of the clinical severity of renal disease. Simple and multiple linear regression models (which adjusted for age, gender and body surface area) also showed that hypertensive patients had higher Katafuchi scores, an indicator of the pathological severity of renal disease.ConclusionAmong the disorders associated with MS, hypertension is the most important factor for renal disease.

To observe the expression of nephrin in hepatitis B virus-associated membranous nephropathy (HBV-MN), and investigate the impairment and significance of podocyte in HBV-MN.The protein expression of nephrin in renal biopsy specimens in 35 patients, who were diagnosed as HBV-MN by renal biopsy, was determined by immunohistochemistry and tested by semi-quantitative method. The relationship between the expression of nephrin and clinicopathological data was analyzed.Among the 35 cases with HBV-MN, 6 were in MN phase I, 20 in MN phase II and 9 in MN phase III. A strong intensity expression of nephrin in normal glomerulus was found along capillary loop of glomerulus, while its expression in HBV-MN patients decreased obviously. There was no significantly difference in the expression of nephrin among the different stages of HBV-MN (P0.05). The expression of nephrin in different clinical types was significantly different(P0.05). The expression of nephrin in patients with nephrotic syndrome was significantly lower than that in patients without nephrotic syndrome (P0.01). The expression of nephrin in different grades of 24-hour urinary protein excretion quantity was significantly different(P0.05). There was negative correlation between the expression of nephrin and 24-hour urinary protein excretion quantity(r = -0.378, P0.05). In the patients with HBV-MN phase II, the expression of nephrin in patients with nephrotic syndrome was also significantly lower than that in patients without nephrotic syndrome (P0.01).The damage of podocytes emerge in the early stage of HBV-MN and the expression of nephrin in HBV-MN patients, especially in patients with nephrotic syndrome, are significantly down regulated. The descended expression of nephrin in HBV-MN patients may promote the production of proteinuria.