Confusional arousal (CA) is a rare non-rapid eye movement sleep-related parasomnia and rarely reported in China, leading to misdiagnosis and mistreatment in clinic. A detailed collection of clinical symptoms and simultaneous video polysomnography is very important for diagnosis and differential diagnosis of CA. A elderly patient with CA was diagnosed according to the International classification of sleep disorders, third edition diagnostic criteria. The summary and analysis of the patient is conducted to improve the understanding of CA, meanwhile to avoid misdiagnosis and mistreatment.

【Objective】 To compare the effect of different combinations of filter membranes on the removal of IgA by component Ⅱ solution. 【Methods】 The dissolved solution of component Ⅱ was filtered with different combinations of filter membranes, and the turbidity, IgA residue, molecular size distribution and purity were compared. 【Results】 After filtering through the combination of NA-16+ Millpore 0.5μ, NA-16+ EmphazeTMAEX HP, and ZetaPlus™ + Emphaze™AEX HP filter membranes, the turbidity of the filtrate decreased by 35.5%(22.4/63.1), 39.2%(24.8/63.3) and 59.8%(37.4/62.5), the IgA residue decreased by 5.8%(14.77/253.70), 20.0%(50.90/254.00) and 44.3%(112.13/253.33), respectively.Molecular size distribution was 99.60%, 99.85% and 100%, and the purity was 100%, 100% and 100%, respectively. 【Conclusion】 The combination of ZetaPlus™ + Emphaze™AEX HP filter membrane can not only effectively remove IgA in the dissolution solution of component Ⅱ with other quality indicators remaining high-level, which can be used in IVIG large-scale production process.

Objective:To explore the changes of serum levels of copeptin and α-amylase and their correlations with sleep and cognition in patients with chronic insomnia (CI).Methods:From September 1, 2018 to May 31, 2019, fifty CI outpatients or inpatients from the Department of Sleep Disorder, Affiliated Chaohu Hospital of Anhui Medical University, were enrolled continuously, and thirty good sleepers from the Physical Examination Center of the hospital, were also enrolled to serve as controls. Pittsburgh Sleep Quality Index (PSQI), polysomnography (PSG) and Pre-Sleep Arousal Scale (PSAS) were used to assess the insomnia severity and sleep disorder susceptibility. Montreal Cognitive Assessment scale (MoCA) and Nine-Box Maze were used to respectively assess general cognition and memories. The serum levels of copeptin and α-amylase were detected using enzyme linked immunosorbent assay.Results:Compared to the controls, the CI patients had increased PSQI score (16.0 (15.0, 17.0) vs 4.0 (2.8, 6.0); Z=-7.678, P<0.001) and PSAS score (33.0 (30.0, 37.5) vs 17.0 (16.0, 18.5); Z=-7.350, P<0.001), decreased MoCA score (24.1±2.5 vs 26.7±1.9, t=-4.625, P<0.001), increased numbers of errors in the object working (1.0 (0, 1.0) vs 0 (0, 1.0), Z=-2.099, P=0.036), spatial working (2.0 (1.0, 4.0) vs 1.0 (0, 2.0), Z=-3.935, P<0.001) and object recognition (1.0 (0, 2.0) vs 0 (0, 0), Z=-2.266, P=0.023) memories, and elevated serum levels of copeptin ((35.1±19.9) pg/ml vs (14.8±6.9) pg/ml, t=5.414, P<0.001) and α-amylase ((990.1±193.7) U/L vs (728.9±230.5) U/L, t=5.597, P<0.001). In the CI patients, the level of copeptin was positively correlated with PSQI score ( r=0.338, P=0.013), PSAS score ( r=0.316, P=0.021), sleep latency ( r=0.324, P=0.018), number of awake ( r=0.325, P=0.017) and stage 1 percent of non-rapid eye movement sleep ( r=0.278, P=0.044), and negatively correlated with stage 2 percent of non-rapid eye movement sleep ( r=-0.279, P=0.043); α-amylase was positively correlated with numbers of awake in PSG ( r=0.293, P=0.033). Multiple linear regression analysis showed that copeptin level affected PSQI score (β=0.255, P=0.043) and sleep latency (β=0.254, P=0.043). Conclusion:The levels of copeptin and α-amylase in CI patients elevate, and copeptin may be associated with initial sleep difficulties, but not with cognitive ability, in patients with CI.

Objective: To explore serum levels of brain-derived neurotrophic factor (BDNF) and glial-derived neurotrophic factor (GDNF), and whether changes of BDNF and GDNF are correlated with sleep quality and cognitive function in patients with chronic insomnia disorder (CID). Methods: Fifty-seven CID patients in the Department of Sleep Disorders, Chaohu Hospital of Anhui Medical University and 30 healthy controls were enrolled from May 2017 to July 2018. Pittsburgh Sleep Quality Index (PSQI) was used to assess the degree of insomnia severity (some CID patients were monitored by overnight polysomnography). Montreal Cognitive Assessment (MoCA) scale and Nine-Box Maze were used to assess general cognitive function and specific memory function, respectively. The serum levels of BDNF and GDNF were detected using ELISA. Results: Compared to the controls, CID patients had significantly higher PSQI scores (CID patients: 14.0±2.2, healthy controls: 3.9±1.1; t=28.093, P<0.01), lower MoCA scores (CID patients: 24.5±3.6, healthy controls: 26.5±0.9; t=-2.985, P<0.01), more errors in object working memory (CID patients: 1.0 (0, 1.0), healthy controls: 0 (0, 0.3)), spatial working memory (CID patients: 3.0 (2.0, 4.0), healthy controls: 1.0 (1.0, 2.0)) and object recognition memory (CID patients: 0 (0, 0), healthy controls: 0 (0, 0); Z=-2.896、-5.007、-2.306, P<0.05), and lower serum BDNF (CID patients: (19.48±7.50) ng/ml, healthy controls: (46.49±13.33) ng/ml; t=-10.274, P<0.01) and GDNF (CID patients: (32.76±14.04) pg/ml, healthy controls: (59.63±20.30) pg/ml; t=-7.240, P<0.01). The partial correlation analysis showed that in the CID patients, the levels of BDNF and GDNF were correlated with PSQI scores negatively (r=-0.293, -0.320, P<0.05) and MoCA scores positively (r=0.331, 0.295, P<0.05). The BDNF level was also correlated with the duration of disease and the errors in the spatial working memory test negatively (r=-0.319, -0.393, P<0.05), and the GDNF level was correlated with the total sleep time detected with polysomnogram positively (r=0.520, P<0.05). Conclusion Serum BDNF and GDNF levels in CID patients were lower than those in healthy controls, and correlated with sleep quality and cognitive impairment.

Objective To explore serum level of 25-hydroxy vitamin D3 (25 [OH]D3) and its correlations with sleep quality and cognitive function in patients with chronic insomnia disorder (CID).Methods Fifty CID patients,admitted to our hospital from October 1,2016 to September 1,2018,and 40 healthy controls were enrolled.Pittsburgh Sleep Quality Index (PSQI) was used to assess insomnia severity (objective sleep status being assessed using polysomnography throughout a night in some patients).Montreal Cognitive Assessment scale (MoCA) was used to evaluate the general cognitive function.Serum level of25(OH)D3 was detected by ELISA.Results As compared with the controls,CID patients had significantly higher PSQI scores (P＜0.05) and statistically higher Hamilton's Depression Scale-17 scores (P＜0.05).The CID patients had significantly lower MoCA scores,having more errors in object work,spatial work and object recognition memorizes in Nine-Box Maze Test than the controls.Partial correlation analysis showed that in CID patients,the level of 25(OH)D3 was negatively correlated with PSQI scores (r=-0.320,P=0.030),spatial working memory errors (r=-0.300,P=0.043) and disease course (r=-0.360,P=0.014),whereas it was positively correlated with total sleep time (r=0.515,P=0.014)and MoCA scores (r=0.422,P=0.003).Conclusion The level of 25 (OH)D3 decreases in the CID patients,which is correlated with insomnia severity and course,and may affect the cognitive function.

Objective To compare the preventive effect on bile duct thermal damage of percutaneous transhepatic cholangial drainage (PTCD) intubation with that of endoscopic nasobiliary drainage (ENBD)intubation,through which cooling liquid is continuously infused,in treating hepatocellular carcinoma (HCC)located close to the hepatic hilum by using percutaneous microwave ablation (PMWA) therapy.Methods The clinical data of 23 patients with HCC that was located close to the hepatic hilum,who were admitted to authors' hospital during the period from September 2013 to September 2016 to receive PMWA,were retrospectively analyzed.Among the 23 patients,PTCD intubation was employed in 12 and ENBD intubation was adopted in 11,and the cooling tube was placed in the bile duct near the tumor.Through the tube 4℃ cooling saline was rapidly and continuously infused,meanwhile PMWA was carried out under the guidance of B-ultrasound.The occurrence of thermal damage of the bile duct,the cooling technique-related complications,and the recurrence of HCC were compared between PTCD ~oup and ENBD group.Results The mean follow-up time was 20 months (3.0-36.0 months),and no operation-related death occurred in all 23 patients.In each group,postoperative biloma occurred in one patient.No obvious cooling techniquerelated complications were observed in PTCD group,but in ENBD group 4 patients (36.36％) developed cooling technique-related complications,including hemorrhage after incision of duodenal papilla (n=1,9.09％) and acute pancreatitis (n=3,27.27％);the difference in the incidence of cooling technique-related complications between the two groups was statistically significant (P=0.037).No statistically significant differences in local recurrence rate,intrahepatic recurrence rate and mortality existed between the two gro ups(P=1.00,P=0.77 and P=0.61,respectively).Conclusion For the treatment of HCC located close to the hepatic hilum with radical PMWA therapy,continuous infusion of cooling liquid through PTCD intubation or ENBD intubation to prevent the thermal damage of the bile duct is clinically feasible and effective,and PTCD intubation method has less technique-related complications than ENBD intubation method.

Objective To explore the effects of feedback health education model in breathing exercises among gastric cancer patients after surgery.Methods From June 2015 to June 2016, we selected 98 gastric cancer patients with radical resection of Fudan University Shanghai Cancer Center as subjects by purposive sampling, all of the patients were divided into two groups with the random number table, 49 cases in each group. Patients of control group accepted routine health education model. Patients of observation group were treated with feedback health education model. We compared the compliance of breathing exercises, lung function and 6-minute walking distance of patients in two groups.Results The compliance of breathing exercises and lung function of patients of observation group were better than those of control group 12 months after surgery; the 6-minute walking distance of patients of observation group were longer than those of control group with significant differences (P<0.01).Conclusions The application of feedback health education model in breathing exercises among gastric cancer patients after surgery can improve the compliance of breathing exercises, mid-term lung function and movement ability of gastric cancer patients. It is worth to be used widely in clinical application.

Objective To observe the effects of Wenxinkeli combination use with buspirone on the treatment of cardiac neurosis with ST-T changes.Methods Ninety patients with cardiac neuropathy were randomly divided into placebo group, Wenxin Granule group and combination use group (Wenxinkeli combination use with buspirone),30 cases in each group.The scores of HAMA-14 and HAMD-24 of the three groups were observed at the end of 4 and 8 weeks after treatment when the score of SF-36 and the improvement of ST-T of combination use group were evaluated followed 12 weeks treatment.Results After 4 weeks of treatment, the two scale scores of combination use group and the Wenxinkeli group, including HAMD-24 and HAMA-14, were significantly lower than the placebo group (P<0.05).In comparison with placebo group, the scores of HAMD-24 and the HAMA-14 were significantly lower after 8 weeks treatment.After 12 months of follow-up treatment, the SF-36 scores of combination use group were significantly higher than the other two groups'(P<0.05).Meanwhile, our results showed that the ST-T changes of the combination use group was significantly improved than the other two groups'(P<0.05).Conclusion The treatment of Wenxinkeli combination use with buspirone can significantly decrease anxiety and improve depression in patients with cardiac neurosis, moreover, long-term combination use treatment can distinctly improve patients' quality of life and relieve their physical symptoms of ST-T changes.

Objective To investigate the characteristics of hepatitis virus B ( HBV) reactivation af-ter combined percutaneous microwave ablation ( PMWA ) and transcatheter arterial chemoembolization ( TACE) in patients with hepatocellular carcinoma ( HCC) and to study the therapeutic role of preoperative antiviral therapy .Methods The data on 180 HCC patients who were treated with the combined therapy were analyzed .The antivirus group ( n=90 ) received antiviral therapy , while the control group ( n=90 ) did not.HBV-DNA was used to study the reactivation status of HBV after the combined therapy and the role of antiviral therapy .Results The incidence of HBV reactivation was significantly lower in the antivirus group (8.2%, 7/90) than the control group (20.0%, 18/90, P<0.05).A preoperative HBV-DNA level above 104 copies/ml was the only independent risk factor of HBV reactivation (P<0.05).Conclusions The HBV reactivation rate was relatively high in patients with HBV-related HCC after combined PMWA and TACE.Preoperative antiviral therapy significantly reduced HBV reactivation and thus it should be adminis -trated especially to HCC patients with a preoperative HBV-DNA level above 104 copies/ml.

Objective To investigate the effects of transarterial chemoembolization (TACE)treatment interval on the prognosis of patients with advanced hepatocellular caisinoma(HCC).Methods We retrospectively collected clinical data of 123 advanced HCC patients treated with repeated TACE.The patients were divided into two groups (group A with fixed repeated treatment interval and group B with that according to the clinical needs).Cox regression,survival curve and log-rank test were used to assess the effects of the treat-ment intervals on prognosis.Results The treatment intervals of the group A and group B were (1.1±0.3)months and (3.0±1.5) months,respectively (P <0.001).Multivariate Cox analysis showed the efficacy (P =0.024)and repetition periods (P <0.001 ) were independent prognostic factors.Conclusion TACE interval is independent risk factor for the prognosis of patients with ad-vanced HCC.Repeated TACE treatment according to clinical needs may be more favorable for prognosis of the patients.