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Objective:The purpose of this study was to examine the clinical features and initial treatment outcomes of elderly individuals with idiopathic membranous nephropathy.Methods:This study retrospectively analyzed the clinical characteristics and therapeutic effect of hospitalized patients aged 60 years or older with renal-biopsy-proven idiopathic membranous nephropathy for at least one year.Results:This study enrolled a total of 91 elderly patients with IMN, consisting of 51 males(56.0%)and 40 females(44.0%). The median age of the patients was 67 years.The urinary protein creatinine ratio(uPCR)and urinary albumin creatinine ratio(uACR)of the patients were 4 454.3 mg/g and 2 258.5 mg/g, respectively.The median 24-hour urinary protein and urinary albumin levels were 5 098.2 mg/24 h and 2 800.6 mg/24 h, respectively.The average estimated glomerular filtration rate(eGFR)was(60.5±20.4)ml·min -1·1.73 m -2.Out of the total of 61 patients, 67.0% achieved remission, including complete and partial remission, within a year of renal biopsy.The levels of uPCR and uACR were significantly higher in the non-remission group compared to the remission group(5 462.5 vs.2 271.1 mg/g, P<0.001; 2 774.4 vs.1 320.0 mg/g, P=0.001). Additionally, the levels of 24h urinary protein and urinary albumin were significantly higher in the non-remission group compared to the remission group(6 526.4 vs.3 210.4 mg/g, P=0.002; 3 067.7 vs.2 102.4 mg/g, P=0.007). The remission group had a higher proportion of patients receiving immunosuppressive therapy(85.2% vs.33.3%, P<0.001). The remission rates were higher in patients treated with glucocorticoid combined with cyclophosphamide, glucocorticoid combined with calcineurin inhibitors, or glucocorticoid combined with mycophenolate mofetil compared to those receiving conservative treatment(88.2% vs.31.0%, P=0.001; 80.0% vs.31.0%, P<0.001; 100.0% vs.31.0%, P=0.007). There was no significant difference in remission rate between the three immunosuppressive therapy groups( P>0.05). However, upon further analysis, it was found that the levels of uPCR, uACR, and serum cystatin C(CysC)were higher in the immunosuppressive therapy groups compared to conservative treatment.Additionally, serum total protein and albumin were lower in the immunosuppressive therapy groups, and these differences were statistically significant( P<0.05). Conclusions:The majority of elderly patients diagnosed with IMN have multiple comorbidities.For those at high risk with elevated urinary protein levels, early initiation of immunosuppressive therapy may lead to a higher initial urinary protein remission rate.Therefore, it is advisable to develop individualized treatment plans for elderly patients with IMN based on their clinical characteristics, as well as the risks and benefits associated with immunosuppressive therapy.
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Objective To explore the effect of loading density of different rigid containers on wet package of orthopedic instruments in the department of orthopedics and to provide the basis for right loading of rigid container so as to ensure the success of the sterilization. Methods About 120 cases of orthopedic exotic instruments for knee surgery were selected from our hospital, according to size and weight of the knee surgery instrument and then evenly divided into Groups A, B, C, 40 pieces in each group. Each group for loading had the same length and width. In Group A, the loading was at 1/2 of the container height, in Group B, the loading was at 2/3 of the container height and in Group C the loading was 4/5 of the container height. The 3 groups were given high pressure steam sterilization, the sterilization temperature, sterilization time and drying time were the same, while biological and chemical monitoring was done. After sterilization, the three groups were compared in terms of the biological and chemical monitoring results as well as the incidence of wet pack. Results There were no significant differences between the 3 groups in the qualification rate of indicator cards and the biological monitoring after sterilization in the 5 kinds of packages among the 3 groups of rigid containers (P>0.05). The incidence of wet package in Group A was significantly lower than that of Group C (χ2=6.80, P=0.009<0.017), but no difference was found between Groups B and C ,Group B and C Group . Conclusions The loading density of different rigid containers affects the incidence of wet package of the orthopedic instruments. Our findings indicate that the loading of the instruments in a rigid container reaches the 2/3~4/5 height of the container, for it can reduce the incidence of wet package of orthopedic instruments.