Objective To evaluate the therapeutic effects and adverse events on treatment of primary premature ejaculation (PE) with paroxetine hydrochloride and/or tamsalosin .Methods 225 cases of healthy men ,a history of lifelong PE and an intravaginal e‐jaculation latency time(IELT) < 120 sec were included in this study .The patients were divided into three groups(with 75 cases in each group) .Group A were given paroxetine hydrochloride 20 mg/d for 8 weeks ;group B were given tamsalosin 0 .2 mg/d for 8 weeks ;group C were given paroxetine hydrochloride and tamsalosin for 8 weeks .The effects and adverse events were evaluated by the overall change and fold increase in average IELT and the mean change in all four measures of the premature ejaculation profile (PEP) .Results The reliable data from 198 patients were achieved .The mean IELT after treatment were significantly improved in all groups than that of before treatment (P<0 .05) .The mean IELT in group C was increased for 8 .15 min after treatment .The in‐creased folds of mean IELT in group C (8 .02 folds) was significantly higher than that in group B (1 .98 folds)and group A (6 .92 folds)(P<0 .01) .The mean PEP scores that include measures of perceived control over ejaculation ,satisfaction with sexual inter‐course ,ejaculation‐related personal distress ,ejaculation‐related interpersonal difficulty were significantly improved in all groups after treatment .The mean PEP scores in group C had more significant improvements than that in group A and B .The prevalence of ad‐verse events in group A ,B ,C were 10 cases(13 .3% ) ,2 cases(2 .6% ) and 9 cases(12 .0% ) ,respectively .Conclusion Paroxetine hydrochloride combined with tamsalosin lead to better therapeutic effects and could be a priority selection for the treatment of pri‐mary PE .

Objective To explore the clinical significance of STING in peripheral blood in patients with primary biliary cirrho-sis.Methods Admitted 28 PBC patients hospitalized in Shanghai Changhai Hospital and Shanghai Changzheng Hospital from January 2014 to October 2015.Also enrolled 28 healthy controls.Baseline data and laboratory indicators were extrac-ted,and STING mRNA expression was determined using q-PCR.The correlation between STING and clinical parameters were analyzed.The changes of STING mRNA in 5 followed-up patients with PBC were analyzed.Results Compared with healthy controls,STING mRNA was significantly increased in PBC patients and was increased in patients with severer dis-ease stages (U=0.00,P<0.05).STING was positively correlated with Mayo risk and GGT (R=0.45,R=0.42,P<0.05),and not AST,ALT or ALP (R=0.33,0.21,0.27,P>0.05).After therapy,STING mRNA were significantly re-duced in 5 PBC patients (U=0.00,P<0.05).Conclusion STING may be involved in PBC pathogenesis.

Objective To investigate the efficiency and mechanism of differentiation of reprogrammed adipose-derived stem cells (ADSCs) to neurons in vitro.Methods ADSCs from rats were cultured in vitro and then purified and identified.ADSCs at the third passage were divided into three groups:ADSCs without lentivirus-mediated gene transfection (blank group),ADSCs transfected with lentivirus carrying no neurogenin2 (Ngn2) (empty virus group) and ADSCs with lentivirus-mediated transfection of Ngn2 (Ngn2 group).All groups were induced in the medium containing cell growth factor for 15 days.The positive expression of neuron-specific nuclear protein (NeuN) in three groups was detected using immunofluorescence method so as to observe the efficiency of neuron differentiation.Expression variances of Mash1,Hes1 and Dll1 in each group were detected by Western blot analysis and the mechanism of differentiation was also discussed.Results After 15 days of induction,positive expression rate of NeuN in Ngn2 group,empty virus group,blank group was 90.12％,45.34％ and 40.26％ respectively,with significant differences among groups (P ＜ 0.01).Western blot analysis showed that Ngn2 group had a significantly higher expression of Dll1 (P ＜0.01) and obvious lower expressions of Hes1 and Mash1 (P ＜0.01),as compared with empty virus group and blank group.However,there were no significant differences of expression levels of Dll1,Mash1 and Hes1 between empty virus group and blank group (P ＞ 0.05).Conclusions After induction,the ratio of neuron differentiation of reprogrammed ADSCs is increased by almost 99％,as compared with simple ADSCs.The increased dfferentiation of reprogrammedADSCs to neurons may be associated with the inhibition of notch signaling through up-regulating Dll1 and down-regulating Mash1 and Hesl.

Objective To test the expression of MIF in peripheral blood mononuclear cells (PBMCs)from patients with Cry-tococcal Meningitis and further discuss its clinical significance.Methods Peripheral blood from 42 patients with Crytococcal Meningitis diagnosed in Changhai Hospital,Shanghai and 42 healthy individuals examined at the same time was collected from August,2012 to November,2015.PBMCs were separated by density gradient centrifugation method,mRNA relative expression of MIF in PBMCs was measured by PCR,the level of MIF,IL-17,IL-1β,TNF-α,IFN-γand IL-4 in plasma was tested by Enzyme-linked immunosorbent assay (ELISA).The comparison for expression level of cytokines between the two groups was by two-independent samples t test.Pearson correlation coefficient was used to measure the relation between MIF and other cytokines.Results The protein levels of MIF in experimental and controlled groups were 34.17±7.88 ng/ml vs 10.89±2.76 ng/ml(t=18.07,P<0.0001),while relative expression of RNA was 2.87±0.94 vs 1.95±0.89(t=4.606,P<0.0001),and there was statistical significance (P<0.005).Pearson correlation analysis showed that MIF was positively related with IL-1β,IL-17 (r=0.467,0.401,P<0.01),with statisticaldifference.Conclusion MIF may involve in the im-mune regulation for Crytococcal Meningitis by affecting the secretion and function of cytokines as IL-1β,IL-17,and it was potential target and monitored biomarker for this disease.

Objective To test the expression level of IL-37 in peripheral blood mononuclear cells (PBMCs)of patients with primary biliary cirrhosis (PBC)and further explore its clinical significance in the pathological process of PBC.Methods Pe-ripheral blood samples were collected from 42 patients diagnosed as PBC and 38 health individuals examined at the same time during June 2013 to August 2015 in Changhai Hospital.PBMCs were separated by sucrose density gradient centrifugation, qualified Real Time-Polymerase Chain Reaction (qRT-PCR)was used to measure IL-37 mRNA expression level in PBMCs. Enzyme-Linked Immuno Sorbent Assay (ELISA)was to measure the protein level of IL-37,IL-6,IL-17,TNF-α,TGF-β,IL-18 and IL-23 in plasma.Meanwhile,the pathological stages of PBC cases were recorded.Pearson correlation analysis was performed on IL-37 and IL-6,TNF-α,IL-17,TGF-β,IL-18 and IL-23.Spearman rank correlation analysis was on IL-37 and pathological stages of PBC.Results The mRNA and protein level of IL-37 in experimental and controlled group were 2.81 ±0.94 vs 1.09±0.56,356.14±169.36 pg/ml vs 86.68±48.23 pg/ml separately(t=9.811,9.462,P<0.000 1),with sta-tistical differences.The correlation analysis showed that IL-37 was positively related with IL-17,TNF-α,IL-6 and TGF-β(r=0.561 2,0.661 9,0.672 1,0.765 3,P<0.001),and disease stages (Ⅰ~Ⅳ)(rs=0.348 9,P<0.05).Conclusion IL-37 might involve in the pathological process of PBC,and it is significant for disease prediction and diagnosis.

Objective To analyze the affection and clinical significance of CD26/DPP4 on CD4+T cells and its cytokines in patients withCrytococcalMeningitis.Methods Peripheral blood was collected from 36 patients diagnosed withCrytococcal Meningitis in Changhai Hospital and Changzheng Hospital,Shanghai from August,2011 to December,2015,meanwhile 36 health controls’was also acquired.Peripheral blood mononuclear cell (PBMC)was separated by density gradient centrifuga-tion,CD26+CD4+T and CD26-CD4+T cell groups were classified by Flow Cytometry,the expression level of cytokines was tested by reverse transcriptase-polymerase chain reaction (RT-PCR).The correlation between DPP4 activity,CD26+CD4+T (%)and APACHE II score,IL-17,TNF-α,IL-4,IFN-γwas measured by Pearson coefficient.Results CD26+CD4+T(%)between experimental and control groups was 13.35±3.83 vs 8.39±2.14 (t=6.78,P<0.000 1).DPP4 activity was 50.89±17.21 mU/ml vs 73.83±20.24 mU/ml (t=5.18,P<0.000 1),with statistically significant differences.In ex-perimental groups,CD26+CD4+T (%)was positively related with APACHE II score,IL-17,TNF-α(r=0.431,0.564, 0.688,P=0.003 8,0.001,0.004 6).DPP4 activity was negatively interrelated with APACHE II score,IL-17,TNF-α,IFN-γ(r=-0.544,-0.489,-0.678,-0.734;P<0.001).Conclusion CD26/DPP4 may be involved in the pathogenesis of Crytococcal Meningitis through regulation of Th subgroups,and it was the potential therapeutic target and the predicted marker of the disease.

Objective To test the expression level of CD69+CD4+CD25-T cells in peripheral blood from patients with autoimmune pancreatitis,and further analyze its clinical significance.Methods Peripheral blood samples from 32 patients with AIP diagnosed in hematological department,Changhai Hospital and 32 health individuals examined at the same time were collected from September 2014 to December 2016,they were classified as experimental and control groups,separately.Peripheral blood mononuclear cells (PBMCs) was acquired by density gradient centrifugation,CD69+ CD4 + CD25-T cells in PBMCs were tested by flow cytometry,and the expression level of cytokines in plasm was by ELISA.The comparison of varies between the two groups was measured by two independent samples' t test.The relationship between the two measurement data was measured by pearson correlation coefficient.Results The expression levels of CD69 + CD4 + CD25-T in experimental and control groups were 10.36％±3.68％ vs 3.99％±1.45％ (t=9.110,P＜0.0001).The expression level of TGF-β was 399.86±121.88 vs 143.87±56.22 pg/ml (t=10.79,P＜0.000 1),both with statistical significance.The levels of CD69+CD4+CD25-T in experimental was positively correlated with TGF-β (r=0.653,P＜0.001) and negatively with IL-4,IFN-γ,IL-2 (r=-0.442,-0.567,-0.351,P＜0.05) and there was statistical significance.Conclusion CD69+CD4 +CD25-T cells might involve the immunopathology of AIP and could be the potential biomarker for clinical diagnosis and therapy.

Objective To investigate the expression level of Gas6 in patients with Immune Thrombocytopenia (ITP) and its clinical significance.Methods The experimental group was peripheral blood samples collected from 35 cases diagnosed with ITP in hematology department of Changhai Hospital in Shanghai from October 2013 to December 2015.Control group was peripheral blood from 35 healthy examined individuals at the same time.After separating plasm from the two group samples,the protein level of Gas6,IFN-α,IL-4,IFN-γ and IL-17 were measured by Enzyme-linked immunosorbent assay (ELISA),comparison of expressional level of the two groups was measured by t test.Pearson correlation analysis was used to decide the relation between Gas6 and cytokines such as IFN-α.Results The expression level of Gas6 in experimental and control groups was 27.28±7.56 ng/ml vs 20.51±5.39 ng/ml (t=4.314,P＜0.000 1);IFN-γ was 221.67±57.64 pg/ml vs 45.32 ±16.79 pg/ml (t=17.38,P＜0.000 1);IL-4 was 113.86±26.48 pg/ml vs 49.87±14.98 pg/ml (t=12.44,P＜0.000 1);IL-17 was 168.96±47.88 pg/ml vs 109.56±28.97 pg/ml (t=6.28,P＜0.000 1);IFN-α was 34.83±8.12 pg/ml vs 29.89 ± 5.76 pg/ml (t=2.936,P=0.004 5),all with statistical differences (P＜0.05).Pearson analysis showed that Gas6 was positively related with IL-17,IL-4,IFN γ (r=0.564,0.486,0.449,P＜0.05) and there was difference statistically,but Gas6 was not correlated with IFN-α.Conclusion Gas6 may participate in the disease formation of ITP through affection on cytokines secreted by Th cell subsets,and it was the potential therapeutic and predicted target for this disease clinically.

Objective To explore the change of microRNA let-7b in heat acclimatization/heat stroke rat models and its relation with HSP70,IL-6,TNF-α,TGF-3 and IL-12,and analyze its clinical significance.Methods 60 male rats with almost the same anal temperature,weight,and weeks' age were selected from Laboratory Animal Center in the Second Military Medical University.They were randomly divided into control,heat acclimatization,heat stroke groups averagely.Heat acclimatization/heat stroke rat models were built in hot climate simulated animal tank,blood was collected from cordis apex and serum was separated.Real-time fluorescent quantitative polymerase chain reaction (qRT-PCR) was used to test microRNA let-7b in serum,enzyme-linked immunosorbent reaction (ELISA) was to measure the protein level of HSP70,IL-6,TNF-α,TGF-β and IL-12 in serum.Kruskal-Wallis H test was used to analyze quantitative data in the three groups,Spearman rank correlation coefficient was used to reveal relation between two variables in heat stroke group.Results M values of miRNA let-7b in control,heat acclimatization,heat stroke groups were 0.99,1.04 and 1.93 separately,Q values were 0.30,0.25 and 0.44 (x2 =38.95,P＜0.001),separately,with statistical significance.The results of pairwise comparison showed no statistical difference in control and heat acclimatization (P＞0.05),but there were differences in control and heat stroke,heat acclimatization and heat stroke groups statistically (P＜0.05).Spearman correlation analysis showed that in heat stroke group,let-7b was positively related with HSP70,TNF-α and IL-6 (rs =0.579,0.498 and 0.609,P＜0.05) with statistical significance.Conclusion miR let-7b might involve in the pathology of heat stroke,it provided a potential biomarker for monitoring patients in high temperature and humidity clinically.

Objective To study the variation in numbers of patients attended in the Emergency Department (ER) of a large - scale teaching hospital during weekends or holidays and workdays in order to find out an objective criterion for the assessment of ER overcrowding and the regularity of ER overcrowding.Methods It was a prospective observational study of variation in number of.patient attended in ER during different periods of time round the clock observed from May 1 through October 31 in 2008 -2010 with 110000 emergency patients annually.The roles of diurnal rhythm,holiday phenomenon and medical coverage in the variation in numbers of patients were observed.The multiple logistic regression analysis was used to define the criterion of ED overcrowding.Results During workdays,the regularity of variation in number of critically ill patients seen to in ER was distinctive,the number of patients peaked in the period of 20:00 -22:00 and bottomed out in the period of 4:00 -6:00,while overcrowding scores of both peak and bottom were carried out 2 hours later.The number of emergency patients significantly increased at weekends and long holidays in a form of double peaks,from 10 am to 12 pm and 8 pm to 10 pm.The number of emergency patients was obviously determined by the provisions of medical coverage,but it was only true to non - critical patients,while the number of critical patients did not noticeably change during weekends or holydays.Multivariate regression analysis showed that the number of emergency patient attended in ER ( B =0.027,P ＜0.01 ) and the rate of emergency bed occupancy ( B =5.25,P ＜0.01 ) in the period of two hours significantly correlated with the ER overcrowding in the coming period of two hours (B =0.027,P ＜0.01,B =5.25,P ＜ 0.01,respectively).Conclusions The demand for critical care resources varies up and down all the time.The variation in volume of critical patients is quite regular during workdays and weekdays or holydays.It is important to separate critical patients from non - critical patients in order to divert non - critical patients quickly.Prediction of overcrowding in ER can be made with knowledge of the number of patient attended and the rate of bed occupancy,if the provisions of medical coverage unchanged.This regularity of variation in number of patients can be used as a practical guidance to rational allocation of critical care resources and improvement of patient throughput.