OBJECTIVE:To detect and analyze the safety signals of pemetrexed in post-marketing,and provide references for rational drug use in the clinic. METHODS:A form of data mining techniques was used to detect the safety signals of pemetrexed in American adverse events reporting system and the analysis of signal effect factors i.e.,gender,age,dosage and indication was per-formed by SPSS 19.0. RESULTS:173 signals related to pemetrexed were excavated in 5 397 235 reports,and the number of report-ed adverse event in blood-lymphatic system was the most(491)and the number of signals in gastrointestinal system was the most (17). There was no statistical significance in the distribution of blood-lymphatic system and gastrointestinal system in gender(P=0.075) and age (P=0.726) compared to other system adverse event,but there was statistical significance in dosage (P=0.007) and indication(P=0.001). CONCLUSIONS:Adverse events induced by pemetrexed in blood-lymphatic system and gastrointestinal system should be monitored at the same time,especially combined with non-steroidal anti-inflammatory drugs.

〔Abstract〕 The paper analyzes problems existing in the traditional outpatient diagnosing distribution process of hospitals , redesigns and optimizes the triage process .It designs a unified diagnosing distribution system , introduces the advantages , system composition , queuing rules and treatment priority strategies of the optimized process , and illustrates the application effects of the diagnosing distribution system with the outpatient of obstetrics and gynecology department of a large grade -III level-a hospital as an example .

Purpose To investigate the clinicopathological features, histogenesis, morphological characteristics, immunophenotypes and differential diagnosis of primary extragonadal yolk sac tumor ( eYST) . Methods Clinicopathological data, morphological charac-teristics and immunophenotypes results of 40 cases of eYST were retrospectively studied and the relevant literatures were reviewed. Re-sults All 40 patients, which included 24 male and 16 female, aged from 6 months to 42 years with a 12 years average age and 17 (42.5%) cases were over 12 years old. Mediastinum, sacrococcygeal, retroperitoneal, pineal gland and vagina were involved in 16 (40.0%), 12(30.0%), 5(12.5%), 4(10.0%) and 3(7.5%), respectively. All 40 cases included 32(80.0%) cases pure YSTs, while other 8(20.0%) cases contained other one or two types of germ cell tumor (GCT) components. Conclusions Primary eYST is rare, mediastinum and sacrococcygeal are the most common anatomic sites for eYST, and these mediastinal tumor patients are overwhelmingly confined to adult males, whose average age are significantly older than that in sacrococcygeal, retroperitoneal, pineal gland and vaginal tumor patients (P<0.05), while other sites eYST are restricted to prepubertal children. Adult eYST contain other types of GCT components in some cases, and children's counterparts are always pure YST. Extragonadal eYST manifestate pleomorphic histological features, which combine with immunohistochemical markers is definite value for diagnosis, differential diagnosis.

Objective To test the efficacy of cognitive behavioral self help therapy for chronic insomnia (CBTI-SH) patients with hypnotic long-term use.Methods A total of 60 adults with chronic insomnia and common comorbidities were recruited.Participants were randomly assigned to either intervention group (IG,n =30) if they had used hypnotics more than 6 months,or control group(CG,n =30) if they had never used hypnotics in the past 6 months.All the patients were given CBTI-SH for 4 weeks.The primary outcome was self-report symptom,based on sleep diaries (including Sleep Latency(SL),Wake after Sleep Onset(WASO),Total Sleep Time(TST),Time In Bed(TIB),Sleep Efficiency(SE) which were evaluated on baseline and at the end of the 2nd,4th week treatment.Continuous variables were evaluated by repeated-measures multivariate analyses of variance (MANOVA).At the conclusion of treatment,each participant was asked how many days per week they enacted each of 6 core elements of the CBT regimen.Linear regression models were examined to determine net predictors of CBTI-SH adherence.Results The MANOVA showed a significant treatment group × time interaction,as well as time main effects for SE,TIB and WASO(P＜0.05).The patients in CG made better improvements than those in IG on SE,TIB and WASO((0.19 ±0.08) vs(0.09 ±0.09),(92.48 ± 32.64) vs (78.06 ±60.05),(103.08 ±64.82) vs (64.92 ±56.36),respectively) (P ＜ 0.05).Effect size were 1.14,0.85 and 0.62 respectively.Self-ratings of treatment adherence showed patients in the IG reported less adherence to standard rise time and TIB prescription than those in CG.(P ＜ 0.05).According to the linear regression models,both age and the comorbidity of chronic somatic diseases explained net associations with CBTI-SH adherence (P ＜ 0.05).Conclusion Chronic insomnia patients with hypnotic long-term use show less sleep improvement and less adherence to CBTI-SH compared with those who don' t use these medicines.Both age and the comorbidity of chronic somatic diseases explain net associations with CBTI-SH adherence.

Objective to evaluate the validation of atypical depression among Chinese outpatients with depressive episodes and explore the role of atypical depressive symptoms in distinguishing bipolar depression from unipolar depression.Methods Structural clinical interviews with self-compiled questionnaires were performed on 276 outpatients with current depressive episode,then comparison of clinical characteristics including age of onset,gender proportion,seasonality,comorbidity of anxiety disorder,bipolar property,psychotic features,number of depressive episodes,and maximum duration of depressive episode were conducted between atypical (defined by DSM-Ⅳ-TR) and nonatypical depression.then the rate of atypical depressive symptoms were compared between unipolar depression and bipolar depression.Results The proportion of atypical depression among all the participants was 23.9％.Compared to nonatypical depression,psychotic features were more likely seen in atypical depression (20.0％ vs 9.1％,P＜0.05),but no difference was found in other clinical features between atypical and nonatypical depression.Except mood reactivity,atypical symptoms including oversleeping(45.5％ vs 26.0％),overeating (22.7％ vs 15.4％),weight gain(24.1％ vs 14.6％),leaden paralysis (56.6％ vs 47.2％),interpersonal rejection sensitivity(66.7％ vs 34.2％) were more likely to occur in bipolar depression than in unipolar depression,the difference was statistically significant for oversleeping and interpersonal rejection sensitivity (P ＜ 0.05).Patients with mood reactivity differed little from those without mood reactivity in other clinical features.No association was found between mood reactivity,leaden paralysis and other criteria symptoms of atypical depression.Conclusion-Atypical depression might be a useful concept,but its diagnostic criteria needs further validation among Chinese population.

Objective To observe the effects of Suoquan Wan(SQW) on the endocrine and immune function of the polyuria rats with kidney-yang deficiency. Methods The model rats were induced by gastric infusion of adenine(250 mg/kg) for 4 weeks, then treated respectively with SQW (at low, middle and high dose respectively), Shenqi Wan and desmopressin for another 4 weeks. The bodyweight and organ index were recorded, and serum cortisone concentration were detected. T cell subsets in peripheral blood were determined by flow cytometry. Results The bodyweight of rats in model group was lower than that in the normal control group. And the bodyweight of rats in desmopressin group, middle-and high-dose SQW groups differed from that in the model group (P < 0. 05 or P < 0. 01). The decreased organ indexes of pituitary, adrenal and thymic glands were found in the model group (P < 0. 05 or P < 0. 01 compared with the normal group). The thymus index was elevated in all the medication groups except the low-dose SQW group (P < 0. 05). The elevated organ indexes of pituitary and adrenal glands were only found in Shenqi Wan group and high-dose SQW group (P < 0. 05). In the model group serum cortisone concentration was decreased (P < 0. 01). In Shengqi Wan group and middle-and high-dose SQW groups, the cortisone concentration was significantly increased (P < 0. 05 or P < 0. 01, compared with the model group). In the model group, the percentages of CD3+ and CD3+/CD4+ T cell subsets in pe-ripheral blood were decreased, and the percentage of CD3+/CD8+ T cell subset was increased (P < 0. 05 or P < 0. 01 compared with the normal group). Compared to the model group, the percentages of CD3+ and CD3+/CD4+ T cell sub-sets were increased and the percentage of CD3+/CD8+ T cell subset was decreased in SQW group and Shenqi Wan group. But the differences of T lymphocyte subsets were insignificant between desmopressin group and the model group. Conclu-sion SQW can regulate the endocrine and immune function of the polyuria ratwith kidney-yang deficiency.

Objective To explore the relationship between sleep disorder and management strategies in the elderly patients with primary hypertension.Methods The sleep status of 122 elderly patients with primary hypertension was evaluated by Pittsburgh Sleep Quality Index(PSQI) and Coping Style Questionnaire(CSQ).Results The mean score of PSQI was 8.34±3.81,and 63.93% (78/122) of the participants experienced sleep disorder.The most commonly used management strategy wag "problem-solving" (0.74±0.18) and "rationalization" (0.56±0.19).The management strategies were different by gender and age.The lowest score was found in the "ask-for-help" group(t=2.326,P=0.022),which was negatively related with sleep disorders (r=-0.208,P=0.022).Conclusions Intervention of management strategy in elderly patients with primary hypertension may help to improve their sleep quality.

Objective To explore the relationships between different marital satisfaction of women with childbearing age and sexual life satisfaction, personality characteristics, coping style and social support. Method-s Three hundred and fifty-one complete cases were randomly obtained by means of ENRICH's marital satisfaction and sexual life satisfaction,EPQ,and etc,and further divided into high marital satisfaction(group A, n=170) and low marital satisfaction(group B, n=181) according to the mean score of the whole sample's macital satisfaction.Then comparisons were carried out between the two groups. Results (1)The means of sexual life satisfaction,Lacores and four indexes of social support in group A were significantly higher than those in group B(P<0.05),but P's and N's scores in group A lower than those in group B (P<0.05). (2) Stepwise multiple regression ana-lyses showed that only sexual life satisfaction (sβ=0.487) and objective social support (sβ=0. 158) entered the equation in whole sample (r=0.290). Conclusion (1) There axe significant differences of sexual life satisfac-tion, personality characteristics and social support among the women with different marital satisfactions. (2)Sexual life satisfaction, personality characteristics and social support are important influencing factors to marital satisfaction among the women.

BACKGROUND:Retinoic acid is the most promising inducer for neuroblastoma minimal residual lesion, and it can induce cel differentiationin vivo, accompanied by reducing tumor cel proliferation.
OBJECTIVE:To study the effect of nanoparticle labeling on biological characteristics of neuroblastoma stem cels, and the role of 13-cis retinoic acid to induce differentiation of neuroblastoma stem cels.
METHODS:Neuroblastoma stem cels were isolated and culturedin vitro using serum-free suspension culture method, labeled with polylysine-modified γ-Fe2O3 nanoparticles and induced in culture medium containing 13-cis retinoic acid. RT-PCR was used to detect the expression of Oct-4 before and after labeling as wel as before and after induction. Immunofluorescence method was used to detect the expression of nestin before and after labeling as wel as before and after induction.
RESULTS AND CONCLUSION:Neuroblastoma stem cels were successfuly cultured in the bone marrow samples from 5 of 20 cases. Polylysine-modified γ-Fe2O3 nanoparticle labeling did no influence the viability and proliferation ability of neuroblastoma stem cels, and also had no effect on Oct-4 mRNA and nestin expression. After cultured in the culture medium containing 13-cis retinoic acid, the cel shape changed and the growth rate slowed down. Moreover, the expression of Oct-4 mRNA and nestin was gradualy reduced. These findings indicate that polylysine-modified gamma-Fe2O3 nanoparticles can be used to label neuroblastoma stem cels, and 13-cis retinoic acid can induce the differentiation of neuroblastoma stem cels.

Objective To discuss the aetiological agent,prevention and treatment of the ureteroscopy lithotripsy concurrence urosepsis.Methods Retrospective analysis of 180 cases with ureteroscopy lithotripsy postoperative clinical data of 8 cases in urosepis patients.Results Eight patients with early active anti-infection,anti-shock treatment,eight patients were recovered and discharged,curative effect is satisfied.Conclusion Ureteroscopy lithotripsy postoperative patients concurrent urosepsis is dangerous,early detection,early diagnosis,early treatment is the key.