Insomnia disorder is a common clinical mental disorder.Currently, clinical subtyping of insomnia disorder relies primarily on symptomatic descriptions, lacking objective measures and subtyping-based treatment approaches. In recent years, increasing attention has been drawn to sleep electroencephalography (EEG) as a valuable tool for observing abnormal sleep architecture and continuity of insomnia disorder. Sleep EEG analysis holds the potential to elucidate the underlying biological mechanisms of insomnia disorder, facilitating data-driven subtyping and enhancing personalized therapeutic strategies.Five types of sleep EEG subtypes of insomnia disorder were systematically searched and summarized: classifications derived from objective sleep duration, power spectral characteristics, cyclic alternating pattern, spindle and microarousal.EEG characteristics of each subtype and clinical outcomes are discussed.This review aims to provide evidence-based insights for clinical subtyping and personalized treatment of insomnia disorder.

Paradoxical insomnia(Para-I),also known as pseudoinsomnia or sleep state misperception,is a condition in which the patient complains of severe insomnia but has no objective evidence of sleep disorder,and daytime functioning may be disrupted disproportionately to the degree of patient-reported sleep loss.Para-I is characterized by overestimation of sleep latency(SL)and underestimation of total sleep time(TST).Incorrect assessment of sleep quality hinders the diagnosis,evaluation of severity,and assessment of clinical efficacy of sleep disorders.The pathogenesis of Para-I remains unclear,but may be related to factors such as depression,anxiety,personality traits,social relationships and specific changes in brain structure and function.Studies on the polysomnography(PSG)of the patients with insomnia have found that changes in non-rapid eye movement(NREM)and rapid eye movement(REM)sleep may be related to the degree of subjective-objective sleep discrepancy.PSG is a valuable diagnostic tool for sleep disorders.It allows for the analysis of sleep structure and related physiological and behavioral changes by monitoring various parameters,including electroencephalogram(EEG),electromyogram(EMG),electrooculogram(EOG),oro-nasal airflow,thoracic and abdominal respiratory motions,oxygen saturation,electrocardiogram(ECG)and snoring.In recent years,studies have increasingly explored the sleep EEG and treatment of Para-I with PSG,resulting in significant progress.This article reviews the latest advances in the electroencephalographic characteristics and treatment of Para-I,providing new ideas for precise treatment.

Objective:To explore the feasibility and clinical value of holographic image technology in intracranial tumor surgery.Methods:A total of 40 patients with intracranial tumors in Beijing Tiantan Hospital, Capital Medical University from November 2020 to March 2021 were randomly divided into the experimental group (20 cases) and the control group (20 cases) based on the random number table. Patients in the experimental group underwent craniotomy assisted by holographic technology, while patients in the control group underwent conventional craniotomy. The Karnofsky performance status scores of patients before the operation and 7 days after the operation were recorded, and the self-rating anxiety scale was applied to evaluate the anxiety of the patients' families.Results:The head CT 12 h after surgery showed no tumor cavity hyperdensity in all patients. The head magnetic resonance imaging (MRI) 72 h after surgery revealed 17 cases of total resection and 3 cases of subtotal resection in the experimental group; in the control group, there were 16 cases of total resection and 4 cases of subtotal resection. In the experimental group, 1 patient's left lower limb muscle strength was grade Ⅱ after the operation and recovered to grade Ⅴ-at discharge. In the control group, the left limb muscle strength of 2 patients was grade Ⅲ after the operation and recovered to grade Ⅴ at discharge. The patients with Karnofsky scores of 60, 70, 80, 90, 100 scores were found in 1 case, 5 cases, 8 cases, 6 cases, 0, respectively of the experimental group and 0, 4 cases, 9 cases, 6 cases, 1 case, respectively of the control group before the operation, and the difference was statistically significant ( P > 0.05); the patients with Karnofsky scores of 50, 60, 70, 80, 90, 100 scores were found in 1 case, 0, 0, 7 cases, 9 cases,3 cases, respectively of the experimental group and 0, 3 cases, 6 cases, 4 cases, 5 cases, 2 cases, respectively of the control group after the operation, and the difference was statistically significant ( P = 0.018). The difference of Karnofsky score before and after the operation in the experimental group was statistically significant ( P = 0.029), while there was no statistically significant difference in the Karnofsky score before and after the operation in the control group ( P = 0.241). There were 8 cases, 9 cases, 2 cases and 1 case of non-anxiety, mild anxiety, moderate anxiety, severe anxiety, respectively in the experimental group and 3 cases, 4 cases, 8 cases and 4 cases of non-anxiety, mild anxiety, moderate anxiety, severe anxiety, respectively in the control group before the operation; there were 9 cases, 9 cases, 2 cases and 0 case of non-anxiety, mild anxiety, moderate anxiety, severe anxiety, respectively in the experimental group and 2 cases, 5 cases, 9 cases and 4 cases of non-anxiety, mild anxiety, moderate anxiety, severe anxiety, respectively in the control group after the operation. The preoperative and postoperative anxiety scores of the experimental group were all lower than those of the control group, and the differences were statistically significant (preoperative P = 0.016,postoperative P = 0.002). Conclusions:Holographic technology can assist in formulating an accurate surgical plan before intracranial tumor surgery, intuitively display the anatomical relationship between the tumor and its surrounding important tissues during operation, reduce the surgical side injuries and decrease the anxiety of the patients' family.

ObjectiveTo explore the barriers and facilitators of the adherence of formal practice after mindfulness-based cognitive therapy （MBCT） in psychological counseling outpatients. MethodsOne-on-one interview was conducted in 15 psychological counseling outpatients who attended MBCT at Shanghai Mental Health Center and had been out of treatment 5 months or more. Data was analyzed using thematic analysis. ResultsPoor mood， weak willpower， limited time and space， lack of companionship and supervision， and discomfort with the recording were the five factors that prevented the patients from sticking to their practice. Personality trait， trust， benefit， need for self-care， time/space arrangement， fellow practitioners， therapists， and ease and convenience of practice were the eight factors that promoted the patients to practice. ConclusionThe COM-B model helps therapists and individuals with practice needs to understand the mechanism of formal practice facilitators at a holistic level. Therapists and individuals with practice needs should be concerned about possible barriers on the adherence of formal practice.

Body image flexibility (BIF) is the specific type of psychological flexibility in the research field of body image, which reflects the ability to experience negative body image and related events in an open and acceptive way, and take actions consistent with one's values. Body image is actually not stable. If negative body image could not be adjusted effectively in time, it would develop into body image disturbance (BID), which is one of the core symptoms and psychopathological mechanisms of eating disorder (ED) and body dysmorphic disorder (BDD). BIF is one of the important factors in this development path, gaining more and more attention as a protective factor for body image. So far, most studies focus on eating disorder patients and related sub-clinical populations. Body image-acceptance and action questionnaire is the most widely used measurement. BIF is related to some sample characteristics, such as gender, age and body size.Cultural context also has an impact on it.Positive and negative body image and eating disorder pathological characteristics are also strongly associated with BIF. As to the intervention, the application of mindfulness, acceptance and compassion in treatment may improve BIF. Future studies need to improve the research methods and designs, and pay attention to other samples. More specific interventions need to be developed, of which the therapeutic mechanisms also need to be explored.

The postoperative pathological staging system (pTNM) has become an important reference for the selection of various tumor treatment strategies and prognosis evaluation at a global scale, and is a powerful predictor of the prognosis of a variety of solid tumors, but the prognosis is still different in patients with the same pTNM staging. In recent years, studies have confirmed that the negative lymph nodes count (NLNC) is related to the prognosis of a variety of solid tumors. Higher NLNC can improve the prognosis of cancer patients, and NLNC can reduce staging migration, which is expected to be a supplement to the pTNM staging system. This article reviews the value of NLNC in the prognosis of solid tumors.

Objective To explore the influence of negative lymph node count (NLNC) on the prognosis of patients with gastric signet ring cell carcinoma (GSRC) and develop a prognostic nomogram based on NLNC. Methods On the basis of the SEER database, 2 101 patients diagnosed with GSRC were collected and randomly divided into the modeling group and validation group to test the relationship between clinicopathological characteristics and the prognosis of GSRC. The multivariate Cox proportional hazard regression model was used to analyze the independent risk factors affecting overall survival and establish a prognostic prediction model. The consistency index (C-index), calibration curve, net reclassification index (NRI), integrated discrimination improvement (IDI), and decision curve analysis (DCA) were used to evaluate the accuracy and clinical applicability of the nomogram. Results All patients were divided according to the ratio of 7:3, with 1 473 in the modeling group and 628 in the validation group. NLNC > 10 (HR=0.578, 95%CI: 0.504-0.662, P < 0.001) was a protective factor for the prognosis of patients with GSRC, and the nomogram model was established based on multivariate Cox proportional hazards model. The C-index values of the nomogram were 0.737 (95%CI: 0.720-0.753) and 0.724 (95%CI: 0.699-0.749) in the modeling and validation groups, respectively, showing good discrimination. The calibration curves showed high consistency of the model. NRI=17.77%, continuous NRI=36.34%, and IDI=4.2% indicated that the model had positive returns compared with the traditional model. The DCA was far from the baseline, indicating that the model had good clinical applicability. Conclusion The increase in NLNC is a favorable factor for the prognosis of patients with GSRC, and a relatively accurate nomogram was established to predict the prognosis of patients with GSRC and help clinicians conduct individualized prognostic evaluations.

Objective To explore the characteristics of alexithymia and interoception in patients with panic disorder(PD) and its relationship. Methods Thirty-seven patients with PD and 45 healthy con-trols who met the diagnostic criteria of DSM-Ⅳ were selected. Toronto Alexithymia Scale ( TAS) and state-trait anxiety inventory ( STAI) were used to assess the characteristics of alexithymia and anxiety symptoms respectively. The heartbeat perception levels were tested by the Mental Tracking Paradigm. Results The de-tection rate of alexithymia in patients with panic disorder was 37. 83% (14/37),but the rate in the normal control group was only 4. 44%(2/45),and the difference was statistically significant (χ2=14. 42,P<0. 05). The total score of TAS (55. 11±10. 99),factor Ⅰ (20. 62±6. 78) and factor Ⅱ (14. 68±3. 70) in the PD group were higher than those in the control group (42. 93± 9. 25,12. 82± 4. 99,11. 42±3. 04; F=20. 72, 31. 08,15. 31,P<0. 01). The levels of the heartbeat perception were higher in the PD group than that in the control group (0. 75±0. 15,0. 58±0. 19;t=4. 13,P<0. 05). In PD group,the score of STAI were positively correlated with TAS total score and factor Ⅰ and Ⅱ scores( r=0. 57,0. 61,0. 47;r=0. 54,0. 62,0. 39,P<0. 05). There was no significant correlation between the scores of STAI and the level of interoception. The mediating effect of interoception level on alexithymia and state anxiety was not significant while the mediating effect on alexithymia and trait anxiety was also not significant. Conclusions The alexithymia detection rate and interoception sensitivity in patients with panic disorder were higher than those of healthy people. There may be interaction between alexithymia and anxiety symptoms. Interoception may be a clinical feature of panic disorder.

Objective To explore the functional connectivity (FC) of the fronto-striatal circuitry in patients with bulimia nervosa (BN) based on the resting-state fMRI and its correlation with the inhibitory function.Methods 27 medication-naive female patients with BN and 27 age-and education-matched female healthy control subjects were included in the study.All the subjects performed a stop signal task (SST) and underwent the resting-state fMRI scan,separately.The FC between striatal subregions and the frontal cortex was analyzed.Results Compared with healthy controls,FC between the right ventral rostral putamen (VRP) and the right supplementary motor areas (SMA) decreased (MNI coordinate:x =3,y =-15,z =51,K =27) in patients with BN.And the FC was also decreased between the right VRP and premotor area(PM) (MNI coordinate:x =27,y =0,z =57,K =44).FC between bilateral dorsal caudal putamen (DCP) (MNI coordinate:x=21,y=-6,z=48,K=43) and the right PM(MNI coordinate:x=21,y=-12,z=57,K=24) was decreased in patients with BN (P＜0.05,Alphasim corrected,voxel P＜0.005,clusters ≥ 20 voxels).FC between the right VRP and right SMA was negatively correlated with the stop signal reaction time (SSRT) in patients with BN (r=-0.595,P=0.004).The FC between right DCP and right PM was positively correlated with the impulsivity regulation subscale scores of the Eating Disorder Inventory-Ⅱ in patients with BN(r=0.483,P=0.023).Conclusion There is disrupted FC between the striatum and motor cortex in medication-naive female patients with BN based on resting-state fMRI,which may be related to impaired inhibitory control in patients with BN.