Objective To observe the applicated value of recombinant human growth hormone ( r-hGH) ther-apy in improving difficult weaning .Methods 40 patients with difficult weaning were randomly divided into the treat-ment group (20 cases) and control group (20 cases).The control group received routine ICU treatment .The treat-ment group was given the conventional treatment and subcutaneous injection of r -hGH 8IU,1 time a day,a total of 14 days.The serum total protein,albumin,oxygenation index,peak of blood glucose,independent tidal volume changes were observed before and after treatment , the success rate and mortality rate were compared .Results After treat-ment,the total protein,albumin,tidal volume of the treatment group were (68.1 ±13.4) g/L,(40.8 ±6.0) g/L, (432 ±57)mL,which were significantly higher than those before treatment [(52.3 ±12.5)g/L,(28.4 ±4.5)g/L, (278 ±54)mL](t=3.856,7.394,8.771,all P<0.05).While after treatment,the total protein,albumin,tidal vol-ume in the control group were (58.4 ±14.2)g/L,(31.0 ±5.8)g/L,(398 ±48)mL,compared with before treatment (53.2 ±13.3)g/L,(28.1 ±4.2)g/L,(271 ±49)mL,the differences were not statistically significant (all P>0.05).The success rate was 85% in the treatment group,which was higher than 50% in the control group(χ2 =4.103,P<0.05).In the treatment group,3 cases died,in the control group 9 cases died,there was statistically signif-icant difference between the two groups (χ2 =4.286,P<0.05).Conclusion r-hGH can improve the nutritional sta-tus of critically ill patients ,increase the strength of the respiratory muscles ,improve lung function ,help to improve the weaning rate .

Objective To determine the prevalence of microembolic signals (MES) by using transcranial Doppler (TCD) and to assess their association with neuropsychiatric systemic lupus erythematosus (NPSLE) and clinical presentations in patients with systemic lupus erythematosus (SLE).Methods Forty-four patients with SLE underwent TCD for 30 min were included for MES detection and their clinical information were recorded.In addition to the frequency of patients with MES,patients with MES were followed-up for sixmonth.Mann-Whitney U test and Fisher exact test were applied to investigate the clinical characteristics.Results There were 4 patients with history of NPSLE and the occurrence times were from 8 to 120 month before our study.There were 4 patients had the abnormal neuropsychiatric symptom during our study period.MES were detected in 5/44 patients (11％) with mean 17.6 per 30 min.MES were more prone to be detected in patients with higher systemic lupus erythematosus disease activity index (SLEDAI) score [16(12.5,19) vs 8(5,10),U=14.5,P=0.001],shorter course of disease [1(0.1,48.5) vs 26(13,55),U=38,P=0.028] and neuropsychiatric symptoms [3 vs 1,P=0.003].Conclusion MES may be detected in SLE patients.MES is associated with higher disease activity,shorter course of disease and NPSLE.TCD microemboli detection may be a noninvasive method to evaluate NPSLE patients.

Objective To investigate the effect of lineal polypeptide injection on immune function of severe sepsis patients in ICU.Methods 40 severe sepsis patients in ICU were randomly divided into two groups after signed the consent form:the treatment group (20 cases)and the control group (20 cases).On the 1st day of antibiotic therapy, the patients in the treatment group were simultaneously treated with lineal polypeptide intravenous injection,while the patients in the control group received the same routine treatment,but without lineal polypeptide injection,all with a 10 days treatment course.Blood bacteria culture and drug sensitivity test were completed after entering the hospital. The scores of Sequential Organ Failure Assessment(SOFA)before treatment and at day 3,7 and 10 of therapy were evaluated.The peripheral blood of patients was taken and send to the clinical laboratory.The WBC,NEU%,PCT, hs -CRP,IL -6,total T lymphocytes (CD +3 )and T lymphocyte subgroup (CD +4 ,CD +8 ,CD +4 /CD +8 )were detected in both the treatment group and the control group.Adverse drug events were also detected in the process of therapy. Results Compared with before treatment[(5.56 ±2.03)points],after 7 days of lineal polypeptide therapy,the SOFA score of the treatment group[(3.48 ±1.83)points]decreased significantly(t =2.793,P <0.05),and after 10 days therapy,the descending degree in the treatment group was more significantly and declined earlier than the control group (t =4.401,P <0.01 ).In the aspect of improving the inflammatory markers,two groups were all improved after therapy,but the degree of improvement in the treatment group was better than the control group.After 7 days therapy,IL -6 level was (37.61 ±7.51)mg/L in the treatment group,while (50.49 ±7.68)mg/L in the control group (t =1.969,P <0.01),and the improvement of NEU% was not found in control group.In the aspect of improving the immune function,the CD +3 ,CD +4 ,CD +4 /CD +8 ratios were increased significantly [before therapy:(41.27 ±6.91)%,(19.65 ±5.29)% and (0.96 ±0.42);after 3 days therapy:(46.57 ±7.11 )%,(24.99 ± 7.70)%,(1.27 ±0.39)],and CD +8 [before therapy:(25.62 ±5.18)%,after 3 days therapy:(23.51 ±3.19)%] was decreased dramatically after 3 days of lineal polypeptide injection treatment,there was significant improvement in time and degree in the treatment group compared with the control group (t =1.390,t =1.407,t =3.974,t =2.081, all P <0.05).No severe adverse drug events were found.Conclusion As an immune modulator,lineal polypeptide injection could effectively improve the immune function of severe sepsis patients in ICU.

Objective To identify clinical features and risk factors in adult dermatomyositis (DM) with calcinosis.Methods Four hundred and eighty patients' clinical data were collected.The correlation between calcinosis and no calcinosis in adult DM were calculated by t test,x2 test and Mann-whitney U test.Multifactor logistic regression model was established to analyze independent factors for adult DM with calcinosis.Results Calcinosis occurred in 22 cases among these 480 patients with DM.The incidence of adult DM with calcinosis was 4.6％.Calcinosis was most common in the extremities and trunks.Patients with calcinosis had a longer disease duration [48 (24,120) months vs 10 (3,24) months,U=1993,P=0.000)] and more myothenia (95.5％ vs 76.9％,x2=4.192,P=0.038),panniculitis (9.1％ vs 0.4％,P=0.011),periungual erythematosus (22.7％ vs 5.89％,x2=7.044,P=0.008),skin ulcer (50.0％ vs 5.2％,x2=55.767,P=0.000),Raynaud's phenomenon (27.5％ vs 8.1％,x2=3.956,P=0.047).The anti-NXP2 antibody (27.3％ vs 3.9％,x2=19.416,P=0.000) and antiMDA5 antibody (31.8％ vs 12.9％,x2=4.851,P=0.028) were more frequently found in patients with calcinosis.Multi-factor logistic regression showed that anti-NXP2 antibody [OR=10.899,95％CI (2.593,45.816),P=0.001],long diseases duration [OR=1.105,95％CI(1.008,1.021),P=0.000] and skin ulcer [OR=31.585,95％CI(10.683),93.387,P=0.000] were risk factors for adult DM with calcinosis.Conclusion The incidence of calcinosisis in adult DM is 4.5％ in our cohort.Patients with calcinosis are adistinct clinical subset of adult DM.Long disease duration,skin ulcer and anti-NXP2 positive are independent risk factors for adult DM with calcinosis.

Objective:To determine the serum levels of chemokine CCL27 and its clinical relevancein patients with dermatomyositis (DM).Methods:The serum CCL27 levels of 58 DM patients, 21 polymyositis (PM) patients, 20 systemic lupus erythematosus (SLE) patients and 31 healthy controls were measured by enzyme linked immunosorbent assay (ELISA). The score of disease activity was measured by two physicians-based on the myositis disease activity assessment tool (MDAAT). Its correlation with serum levels of CCL27 was analyzed. The difference between multiple groups were compared using analysis of variance (ANOVA) and t test, and the relevance was analyzed using Spearman correlation analysis and generalized method of moments (GEE) model. Results:Theserum level of CCL27 in DM patients (178±49) pg/ml was significantly higher than PM (110±40) pg/ml, SLE (141±46) pg/ml and healthy controls (137±38) pg/ml ( F=14.192, P<0.01). Crosssectional analysis showed that the serum CCL27 levelwaspositively correlated with global disease activity ( r=0.301, P=0.022) andskin disease activity ( r=0.493, P<0.01). Patients with V sign had higher serum CCL27 levels (191±52) pg/ml than the patients without (153±33) pg/ml ( t=2.839, P<0.01). Patients with holster sign had higher serum CCL27 levels (196±58) pg/ml than the patients without (168±41) pg/ml ( t=2.176, P=0.034). Follow-up study also found that CCL27l evels were positively correlated with global disease activity ( β=0.031, P=0.042) and skin disease activity ( β=0.032, P<0.01). Conclusion:The serum CCL27 levels are increased in patients with DM and can reflect the skin disease activity. The results of this study suggest that CCL27 may be a marker for cutaneous damage and monitoring of therapeutic effect.