Objective To analyze the prognostic factors and causes of death of patients with systemic lupus erythematosus (SLE).Methods A database with 319 patients were developed.They were newly diagnosed SLE in the Department of Rheumatology and Immunology,Affiliated Drum Tower Hospital of Nanjing University Medical School from 1999 to 2009.Normal distribution of measurement data was presented using mean±standard deviation.The skewed distribution of data was described by median(interquartile range).Using the rate or proportions,the character of classification data was also stated.Survival rate of SLE patients over time was studied by the Kaplan-Meier method,and prognostic factors were analyzed by COX proportional hazards model.Results The 5 year and 10-year survival rates was 96.2%, 88.7%, respectively Prognostic factors affecting survival included duration from onset to diagnosis, anemia, white blood cells in urine, low serum albumin,low C4 level,abnormal ECG and ultrasound echocardiography, pulmonary arterial hypertension (PAH) and systemic lupus erythematosus disease activity index (SLEDAI). However, PAH,duration from onset to diagnosis, low serum albumin were the independent poor prognostic factors and the relative risk and 95% confidence interval were 2.419 (1.052-5.564), 1.162 (1.043-1.294), 0.924 (0.873-0.978), respectively. Renal failure, pulmonary hypertension and infection were the main causes of death,followed by multiple organ failure and lupus encephalopathy. Conclusion PAH, duration from onset to diagnosis, low serum albumin are the important factors predicting poor prognosis. Early diagnosis, timely treatment of SLE organ damages and preventing complications are the key factors to improve the prognosis of patients with SLE.

Objeefive To explore the clinical efficacy and safety of allogenic bone marrow derived mesenchymal stem cells transplantation(MSCT) in patients with refractory systemic lupus erythematosus(SLE).Methods Eleven patients with refractory SLE(nine females and two males aged from 16～41 years(mean 25±8).were entailed in the study.The infcIrmed consents which were approved by the Ethics Committee of the Affiliated Drum Tower Hospital of Naniing University Medical School were obtained from all participants.Bone marrow of healthy donors were obtained and the mesenchymal stem cells(MSC)were expanded in vitro.Each patient was infused MSC 1×106/kg body weight intravenously.Before MSCT.all patients were administrated with cvclophosphamide (CTX)800～1800 mg divided by two to three days.The clinical manifestations and laboratory tests were compared before and after MSCT.Results The eleven patients were followed up for one to thirteen months after MSCT.A11 patients did not develop transplantation related complications.The systemic lupus erythematosus disease activity index (SLEDAI)score decreased from 1 1.7±5.1 to 5.6±3.4 one month after MSCT(n=11,P＜0.01).Ufine protein excretion decreased from(1989+842)mg/24 h to(1118±700)mg/24 h one month after MSCT(n=10,P=0.02).Five patients were followed up for six months and their urine protein excretion decreased significantly [(522±151)mg/24 h vs (2478±797)rag/24 h.n=5.P＜0.01j.The serum albumin level of 5 patients with hypoalbuminemia increased gradually one month after MSCT [(28±6)g/L vs (32±7)g/L,n=5,P＜0.05].Serum complement C3 level increased from(0.50±0.12) g/L to(0.75±0.10)g/L (n=9.P＜0.01) and their anti-nuclear antibody (ANA) titer decreased one month after MSCT.In two patients with chronic renal failure.the serum creatinine decreased gradually.Conclusion Allogenic MSCT is an effective and safe approach for the treatment of refractory SLE.However.extensive follow-up study is needed for long-term benefit evaluation.

Objective:To investigate the clinical practicability of positive end-expiratory pressure (PEEP) titrated by lung stretch index (SI) in patients with acute respiratory distress syndrome (ARDS).Methods:A parallel randomized controlled trial was conducted. Patients with moderate to severe ARDS who required mechanical ventilation admitted to the department of critical care medicine of General Hospital of the Yangtze River Shipping from August 2022 to February 2023 were enrolled. They were randomly divide into SI guided PEEP titration group (SI group) and pressure-volume curve (P-V curve) inspiratory low inflection point (LIP) guided PEEP titration group (LIP group). All patients were ventilated in a supine position after admission, with the head of the bed raised by 30°. The primary disease was actively treated, prone position ventilation for 12 h/d, and lung protective ventilation strategies such as controlled lung expansion were used for lung recruitment. On this basis, mechanical ventilation parameters were titrated with SI in the SI group; the LIP group titrated mechanical ventilation parameters with P-V curve inspiratory LIP+2 cmH 2O (1 cmH 2O ≈ 0.098 kPa). The oxygenation index (PaO 2/FiO 2), and respiratory mechanics indicators such as lung dynamic compliance (Cdyn), peak airway pressure (Pip) were monitored before recruitment maneuver and after 1, 3, and 5 days of treatment. The therapeutic effect of the two groups was compared. Results:There were 41 patients in the SI group and 40 patients in the LIP group. There was no significant difference in general information such as gender, age, and disease type between the two groups. The mechanical ventilation time and the length of intensive care unit (ICU) stay in the SI group were significantly shorter than those in the LIP group (days: 9.47±3.36 vs. 14.68±5.52, 22.27±4.68 vs. 27.57±9.52, both P < 0.05). Although the 28-day mortality of the SI group was lower than that of the LIP group, the difference was not statistically significant [19.5% (8/41) vs. 35.0% (14/40), P > 0.05]. On the fifth day, the PaO 2/FiO 2 was higher in SI group [mmHg (1 mmHg≈0.133 kPa): 225.57±47.85 vs. 198.32±31.59, P < 0.05], the Cdyn was higher in SI group (mL/cmH 2O: 47.39±6.71 vs. 35.88±5.35, P < 0.01), the Pip was lower in SI group (mmHg: 35.85±5.77 vs. 43.87±6.68, P < 0.05). The Kaplan-Meier survival curve showed no statistically significant difference in the 28 days cumulative survival rate between the two groups (Log-Rank: χ2 = 2.348, P = 0.125). Conclusion:The application of SI titration with PEEP in the treatment of ARDS patients may improve their prognosis.