Objective To investigate the sleep architecture of sleep related bruxism（SB）in adults and the sleep architecture of SB comorbid with obstructive sleep apnea hypopnea syndrome（OSAHS），as well as their correlation with age and other factors. Methods A total of 51 subjects with SB and 67 controls were included in this study to analyze the sleep architecture of SB and compare the sleep architecture of SB comorbid with different severities of OSAHS. Results Compared with the control group，the SB group had a younger age，increases in N1（%TST）and N2（%TST），a reduction in N3（%TST），and an increase in arousal index. The SB group was divided into non-OSAHS group（group 1），mild OSAHS group（group 2），and moderate-to-severe OSAHS group（group 3）. Group 1 had a younger age than group 2 and group 3，and group 3 had increases in body mass index（BMI），N1（%TST），oxygen desaturation index（ODI），and arousal index and a reduction in N3（%TST）. The Spearman's rank correlation analysis showed that BMI，N1（%TST），arousal index，and ODI increased with the increase in apnea-hypopnea index（AHI），while N3（%TST）decreased with the increase in AHI. The binary logistic regression analysis showed that SB was negatively correlated with age and was positively correlated with arousal index. Conclusion SB may affect sleep architecture by increasing light sleep，reducing deep sleep，and increasing the number of awakenings. There are changes in sleep architecture in case of SB comorbid with different severities of OSAHS. SB is negatively correlated with age and is positively correlated with arousal index.
Polysomnography

Objective:To investigate the predictive value of the quantitative parameters of dual-layer detector spectral CT in arterial and venous phases for the differentiation degree and the E-cadherin protein expression of gastric cancer.Methods:This was a cross-sectional study. The preoperative data from the dual-layer detector spectral CT images among 183 patients with gastric adenocarcinoma confirmed by operation and pathology was retrospectively analyzed from October 2021 to October 2022 in the First Affiliated Hospital of Fujian Medical University. According to the differentiation degree and E-cadherin protein expression of gastric cancer, all patients were divided into the moderately well differentiated group ( n=82) and the poorly differentiated group ( n=101), as well as the E-cadherin-negative group ( n=80) and the E-cadherin-positive group ( n=103). The CT images in arterial and venous phases were used to reconstruct the virtual monoenergetic images (VMI) at 40, 50, 60, 70, 80, 90, and 100 keV, effective atomic number (Z eff) images and iodine concentration (IC) images. The CT values (CT keV) from VMI, Z eff and IC were measured, and the normalized Z eff (NZ eff) and the normalized IC (NIC) were calculated. Independent-sample t test or Mann-Whitney U test were used to compare the differences in quantitative parameters between groups. The logistic regression analysis was used to screen for the independent predictors, after which a combined prediction model was constructed. The receiver operating characteristic curves were used to evaluate the predictive efficiency of the parameters for the differentiation degree and the E-cadherin protein expression of gastric cancer. Results:There were statistically significant differences in CT 40 keV to CT 70 keV, NZ eff and NIC in dual-phase, as well as Z eff and IC in the venous phase between the moderately well differentiated group and the poorly differentiated group ( P<0.05). The combined prediction model was constructed by CT 40 keV ( OR=1.03, 95% CI 1.02-1.05, P<0.001) in arterial phase and CT 40 keV ( OR=1.05, 95% CI 1.03-1.07, P<0.001) and Z eff ( OR=1.32, 95% CI 1.06-1.65, P=0.015) in venous phase, of which the area under the curve (AUC) for the prediction of the moderately-well group and the poor group was 0.932 (95% CI 0.897-0.967), with a sensitivity of 90.1% and a specificity of 85.4%. Between the E-cadherin-negative group and the E-cadherin-positive group, CT 40 keV and NZ eff in arterial phase, as well as CT 40 keV to CT 70 keV, Z eff, NZ eff, IC and NIC in venous phase, had statistically significant differences ( P<0.05). The AUC for the combined prediction model established by CT 40 keV ( OR=1.02, 95% CI 1.01-1.04, P<0.001) and Z eff ( OR=1.33, 95% CI 1.09-1.63, P=0.006) in venous phase was 0.800 (95% CI 0.736-0.864), with a sensitivity of 95.0% and a specificity of 60.2%. Conclusion:The combined prediction model from the quantitative parameters of dual-layer spectral detector CT can be used to predict the differentiation degree and the E-cadherin protein expression of gastric cancer preoperatively.

Objective To investigate the association between sleep structure and respiratory events in patients with epilepsy. Methods A total of 95 patients with epilepsy and 66 control patients who attended our hospital from March 2018 to March 2022 were enrolled,and polysomnography was used to compare sleep structure and respiratory events between the epilepsy group and the control group. Results Compared with the control group,the epilepsy group had significant reductions in REM sleep duration and R%,a significant increase in the longest duration of hypoventilation,and a significant reduction in the lowest oxygen saturation. Conclusion Changes in sleep structure are observed in patients with epilepsy,and patients with epilepsy and obstructive sleep apnea-hypopnea syndrome tend to develop hypoxemia.

Objective:To evaluate partial ventral hepatectomy in the treatment of patients with complicated iatrogenic high bile duct injury.Methods:The clinical data of 8 cases of complicated iatrogenic high bile duct injury treated with the assistance of hepatic ventral segmentectomy from Mar 2013 to May 2020 at Hunan Provincial People's Hospital was retrospectively analyzed.Results:Among the 8 patients, 5 patients underwent partial Ⅳb lobectomy, and 3 patients received partial Ⅳb and Ⅴ segmentectomy of the liver. All the operation was successful without death in hospital. One case developed subphrenic infection and seroperitoneum, which was healed by anti-infection treatment and abdominocentesis. The postoperative follow-up time was 5-90 months, and all of patients are doing well. There was no stenosis in intrahepatic bile duct by postoperative cholangiography or MRI.Conclusions:Quadrate lobe hepatectomy provides a wide view for the treatment of complicated iatrogenic high bile duct injury by fully opening the first porta hepatis and exposing the primary and secondary bile duct branch helping establish a wide patent tension free bile duct-jejunostomy.

Objective: To evaluate the efficacy and safety of nifekalan (NIF) on cardioversion in atrial fibrillation (AF) patients post radiofrequency ablation, and investigate the relevant factors related to the cardioversion efficacy of NIF. Methods: We screened patients with sustained AF rhythm after radiofrequency ablation between November 2016 and July 2018. Participants were treated with intravenous NIF 0.4 mg/kg within 5-10 minutes after ablation. We observed the adverse reaction, and monitored the rhythm, heart rate, QT interval and QTc interval before the medication and at 5, 10, 20, 120 min after the medication. According to the drug outcome of NIF, patients were divided into conversion group and non-conversion group, related factors affecting conversion efficacy were evaluated using logistic regression analysis. Results: (1)A total of 116 patients were enrolled in the study (63 males and 53 females, mean age was (64±18) years). Among them, 72 patients were converted to sinus rhythm, and the overall successful rate was 62.1%. There were 84 patients with persistent AF, of which 50 cases (59.2%) were restored to sinus rhythm. There were 32 patients with paroxysmal AF, 22 cases (68.8%) of them were restored to sinus rhythm. The conversion time was 1.5 to 12 (6.8±3.4)min. (2) In 116 patients, the QT interval and QTc interval were significantly longer after medication than before the drug administration (P<0.01), and peaked at about 10th min, and restored to the level before drug administration at about 120th min. (3) There were 8 cases of bradycardia (6.9%), 3 cases of frequent and short ventricular tachycardia (2.6%). (4) The duration of atrial fibrillation was shorter and left atrial diameter was smaller in the cardioversion group than in the non-cardioversion group (both P<0.05). There were no significant differences in gender, disease history, atrial fibrillation type and structural heart disease between the two groups (P>0.05). (5) Multifactorial logistic regression analysis showed that the duration of atrial fibrillation (OR=0.980, 95%CI 0.966-0.994, P=0.004) and the left atrial diameter (OR=0.888, 95%CI 0.814-0.967, P=0.007) were the factors that influence the cardioversion efficacy of NIF on atrial fibrillation post ablation. Conclusions The total effective rate of NIF was 62.1% in patients witrh sustained AF post radiofrequency ablation, was 68.8% in patients with paroxysmal AF. Besides, NIF has the advantage of short conversion time and few adverse reactions. Left atrium diameter and AF duration were relevant factors that influence the efficacy of NIF of cardioversion in patients with sustained AF after radiofrequency ablation.

Objective To evaluate the efficacy and safety of nifekalan (NIF) on cardioversion in atrial fibrillation (AF) patients post radiofrequency ablation, and investigate the relevant factors related to the cardioversion efficacy of NIF. Methods We screened patients with sustained AF rhythm after radiofrequency ablation between November 2016 and July 2018. Participants were treated with intravenous NIF 0.4 mg/kg within 5-10 minutes after ablation. We observed the adverse reaction, and monitored the rhythm, heart rate, QT interval and QTc interval before the medication and at 5, 10, 20, 120 min after the medication. According to the drug outcome of NIF, patients were divided into conversion group and non?conversion group, related factors affecting conversion efficacy were evaluated using logistic regression analysis. Results (1)A total of 116 patients were enrolled in the study (63 males and 53 females, mean age was (64±18) years). Among them, 72 patients were converted to sinus rhythm, and the overall successful rate was 62.1%. There were 84 patients with persistent AF, of which 50 cases (59.2%) were restored to sinus rhythm. There were 32 patients with paroxysmal AF, 22 cases (68.8%) of them were restored to sinus rhythm. The conversion time was 1.5 to 12 (6.8±3.4)min. (2) In 116 patients, the QT interval and QTc interval were significantly longer after medication than before the drug administration (P<0.01), and peaked at about 10th min, and restored to the level before drug administration at about 120th min. (3) There were 8 cases of bradycardia (6.9%), 3 cases of frequent and short ventricular tachycardia (2.6%). (4) The duration of atrial fibrillation was shorter and left atrial diameter was smaller in the cardioversion group than in the non?cardioversion group (both P<0.05). There were no significant differences in gender, disease history, atrial fibrillation type and structural heart disease between the two groups (P>0.05). (5) Multifactorial logistic regression analysis showed that the duration of atrial fibrillation ( OR=0.980, 95%CI 0.966-0.994, P=0.004) and the left atrial diameter ( OR=0.888, 95%CI 0.814-0.967, P=0.007) were the factors that influence the cardioversion efficacy of NIF on atrial fibrillation post ablation. Conclusions The total effective rate of NIF was 62.1% in patients witrh sustained AF post radiofrequency ablation, was 68.8% in patients with paroxysmal AF. Besides, NIF has the advantage of short conversion time and few adverse reactions. Left atrium diameter and AF duration were relevant factors that influence the efficacy of NIF of cardioversion in patients with sustained AF after radiofrequency ablation.

Objective To discuss the correlation between shock index (SI) and severity and the values to forecast the prognosis in patients with septic shock. Methods 127 patients with septic shock admitted to intensive care unit (ICU) of Zhejiang Provincial People's Hospital from January 1st, 2016 to October 31st, 2017 were enrolled, and they were divided into survival group and death group according to the outcomes after 28-day hospitalized. The vital signs, laboratory indexes, acute physiology and chronic health evaluation Ⅱ(APACHEⅡ), sequential organ failure assessment (SOFA), lactate clearance rate (LCR) of 3 hours after fluid resuscitation, and shock index on admission (SI1) and shock index of 3 hours after fluid resuscitation (SI2) were compared between the two groups. The correlation among SI and APACHE Ⅱ, SOFA, LCR was analyzed. The receiver operating characteristic curve (ROC) was drawn to evaluate the prognostic value of SI in patients with septic shock. Results A total of 127 patients were included, 52 in survival group (40.9%) and 75 in death group (59.1%). The SI1, SI2, APACHE Ⅱ and SOFA in the death group were significantly higher than those in the survival group (SI1: 1.62±0.46 vs. 1.35±0.32, SI2: 1.36±0.24 vs. 0.93±0.15, APACHEⅡ:17.5±4.0 vs. 13.6±3.5,SOFA: 9.5±2.3 vs. 6.3±1.5), and LCR was significantly lower than that in the survival group [(14.4±5.2)% vs. (28.6±8.6)%], with statistically significant differences (all P < 0.01). The correlation analysis showed that SI1was significantly positively correlated with APACHEⅡ (r = 0.458, P = 0.000) and SOFA (r = 0.535, P = 0.000), SI2was also significantly positively correlated with APACHEⅡ (r = 0.624, P = 0.000) and SOFA (r = 0.656, P = 0.000), while SI1and SI2were significantly negatively correlated with LCR (r values were -0.348, -0.435, both P = 0.000), and the SI2were more remarkable. ROC curve analysis showed that the area under ROC curve (AUC) of SI1for predicting the prognosis of septic shock was 0.720 [95% confidence interval (95%CI) = 0.620-0.831, P < 0.05]; when SI1= 1.68, the sensitivity, specificity, Yoden index, positive predictive value and negative predictive value were 79.5%, 65.6%, 0.451, 0.759 and 0.636, respectively. The AUC of the SI2to predict prognosis of septic shock was 0.826 (95%CI =0.739-0.826, P < 0.05); when SI2= 1.37, the sensitivity, specificity, Yoden index, positive predictive value and negative predictive value were 85.7%, 87.6%, 0.733, 0.893 and 0.902, respectively. Conclusion Compared with SI1, SI2was more correlated with the severity in patients with septic shock and it had more values to predict prognosis.

Objective To investigate the results and complications of hemispherotomy for drug resistant hemispheric epilepsy.Methods The authors reviewed 5 patients who were diagnosed as drug resistant hemispheric epilepsy and operated in the neurosurgery department of Peking Union Medical College Hospital from 2011 to 2013.All the 5 patients were underwent hemispherotomy after carefully multidisciplinary pre-operation evaluation.Results All patients tolerated the procedure well and the postoperative course was smooth.All the 5 patients didn`t have seizure in the period of following up of 46 to 69 months.Conclusions According to literatures and the authors` experience, hemispherotomy is as safe and efficient for hemispheric epilepsy as hemispherectomy.It is most important advance for hemispherectomy.The procedure of hemispherotomy is complex but not very difficult, illustrating a good prospect of application and extension.

Objective To evaluate the safety and feasibility of totally laparoscopic cholecystolithotomy.Methods Patient baseline characteristics of all 34 totally laparoscopic cholecystolithotomy (TLC) were collected in a database.This group was compared with 34 matched patients who underwent the laparoscopic cholecystectomy (LC) in the same period.Retrospectively,intraoperative and postoperative data were added.Results Operatingtime was significantly longer in the TLC group(124.56 min vs 78.50 min,P ＜0.01).The mean hospitalization expenses of operation was significantly higher in the TLC group(10 970.85 yuan vs 8 666.72 yuan,P ＜0.01).Although not significant less patients have the symptoms of postoperative dyspepsia or diarrhea were seen in the TLC group compared with the LC group (2 vs 6,P =0.26).Intraoperative details and postoperative results such as,blood loss,hospital stay,exhaust time,abdominal bleeding,bile leakage,incision infection have no significant difference.One case of gallstone recurrence was detected in TLC group.No stone recurrence was reported in common bile duct in LC group.Conclusions TLC is effective and feasible for chronic calcular cholecystitis and is particularly favorable for thepatients with medical insurance.However,this approach is technically demanding and should be performed by experienced surgon.

Objective To analyze effects of mindfulness intervention on mindfulness, psychological health and quality of life for uremia patients. Methods A total of 82 uremia patients in Wuxi No.2 People′s Hospital from January 2013 to July 2015 were randomly assigned to the intervention group ( n=41) and the control group ( n=41). Patients in the control group were given routine nursing, while patients in the intervention group were given additional mindfulness intervention. The classification of mindfulness, the status of psychological health and quality of life scores after 8 weeks intervention and before the intervention were compared between two groups. Results After 8 weeks′ intervention, the grading state of mindfulness in the intervention group was obviously superior to the control group. The scores of interpersonal relationship, somatization, compulsion, depression, anxiety, crankiness, fear, nervousness and the total score were significantly lower than those of the control group ( P<0.05) . Quality of life scores in the intervention group (74.22±11.17) was higher than the control group (65.78±10.45)(P<0.05).Conclusions Mindfulness-based intervention is conducive to improve mindfulness of uremia patients and reduce patients′ negative mental states and it is of great significance to improve the quality of life.