BackgroundPatients with chronic schizophrenia often suffer from cognitive impairment. Traditional cognitive rehabilitation training has problems such as a single form and poor compliance， making it urgent to develop new cognitive intervention methods. ObjectiveTo explore the intervention effect of smartphone games on the cognitive function of patients with chronic schizophrenia， and to analyze the differences in cognitive function improvement between patients of different genders， in order to provide references for the cognitive function intervention of these patients. MethodsThis study was a prospective cohort study. A total of 30 patients who were hospitalized in the Psychiatry Department of Chaohu Hospital Affiliated to Anhui Medical University from March to October 2021， met the diagnostic criteria for schizophrenia as defined in the International Classification of Diseases， tenth edition （ICD-10）， and had a disease duration of above 5 years， were selected as the research subjects. All patients received smartphone game intervention for 12 weeks， 5 times a week， each session lasting 1 hour， in addition to conventional antipsychotic drug treatment. At the baseline and at 3， 6， 9， and 12 weeks of the intervention， the cognitive function was evaluated using the Repeatable Battery for the Assessment of Neuropsychological Status （RBANS）， the Positive and Negative Syndrome Scale （PANSS） was used to assess mental symptoms， and the Problematic Mobile Gaming Questionnaire （PMGQ） was used to assess addiction symptoms. ResultsA total of 26 patients （86.67%） completed the study， including 13 females and 13 males. The time effects， group effects， and interaction effect between time and group for the immediate memory factor score of RBANS in the female group and the male group were all statistically significant （F=36.682， 5.712， 3.090， P<0.05 or 0.01）， and the time effects and group effects for the verbal and delayed memory factors as well as the total score in both groups were also statistically significant （F=3.841， 6.149， 15.372， P<0.05 or 0.01）. The time effects and group effects of the total score of PANSS in both groups had no statistical significance （F=2.041， 0.623， P>0.05 for both）， and the interaction effect between time and group was statistically significant （F=5.728， P<0.01）. The time effects， group effects， and interaction effect of the total score of PMGQ in both groups were all without statistical significance （F=2.672， 0.166， 0.642， P>0.05 for both）. ConclusionSmartphone game intervention may help improve the cognitive function of patients with chronic schizophrenia （especially immediate memory， verbal function， and delayed memory）， and the benefits are greater for female patients. The smartphone game intervention did not induce game addiction， but no significant improvement in psychotic symptoms was observed. ［Funded by Excellent Young Talents Support Program of Anhui Provincial Department of Education （number， gxyqZD2022022）； www.chictr.org.cn number， ChiCTR2100044113］

Objective:To evaluate the outcomes of intensive conservative treatment compared to conventional conservative treatment in patients with acute aortic syndrome(AAS).Methods:The study prospectively enrolled consecutive patients with AAS who were admitted to Beijing Anzhen Hospital, affiliated with Capital Medical University, and Beijing Dawanglu Emergency Rescue Hospital from January 2024 to December 2024. These patients with surgical contraindications or refused surgery for various reasons opted for conservative treatment. A total of 282 patients were included, and 15 patients with missing data or those who died without any treatment were excluded. Finally, 267 patients were enrolled, of whom 94 received intensive conservative treatment, and 173 received conventional conservative treatment, the inverse probability of treatment weighting (IPTW) was used to reduce the influence of confoundings. After adjusting of baseline datas via IPTW, the survival outcomes of the two groups were compared at 14 days, 30 days, and at the end of follow-up.Results:The results showed significant differences in acute phase survival rates between the enhanced conservative treatment group and the conventional conservative treatment group at 14 days(82.40%vs.53.20%, P<0.0001). Significant survival differences were also observed at 30 days and at 276-day mid-term follow-up (96.29% vs.51.60%, P<0.0001; 78.50% vs.48.50%, P<0.0001). In the subgroup analysis, for type A aortic dissection, the enhanced conservative treatment group had higher survival rates compared to the conventional conservative treatment group at 14, 30 and 276 days (63.46% vs.41.35%, P<0.05; 52.17% vs.37.90%, P<0.05; 50.00% vs. 31.97%, P<0.05). However, for type B aortic dissection, although the enhanced conservative treatment group had higher survival rates than the conventional conservative treatment group, no statistically significant differences were observed (96.29% vs. 80.00%, P=0.054; 95.65% vs.78.37%, P=0.067; 94.12% vs.74.20%, P=0.088). Conclusion:For patients diagnosed with AAS are forced to choose conservative treatment if emergency surgery is not possible in the first place, intensive conservative treatment strategies can significantly reduce the mortality in the acute phase compared with conventional conservative treatment. Mid-term follow-up, intensive conservative treatment still has a significant survival advantage.

BackgroundAgomelatine， a novel antidepressant with dual efficacy in mood improvement and sleep regulation， has been widely utilized in clinical treatment of depressive disorders. The association between agomelatine and hepatic dysfunction has garnered increasing attention， yet there remains limited research on its long-term effect of liver function in real clinical scenarios. ObjectiveTo investigate the effect of different doses of agomelatine on liver function in patients with depressive disorders in real clinical scenarios， and to ascertain its safety profile and efficacy differences. MethodsA retrospective study was conducted， enrolling 200 patients diagnosed with depressive disorders according to the International Classification of Diseases， tenth edition （ICD-10）， who received agomelatine treatment at the Department of Psychiatry of Chaohu Hospital Affiliated to Anhui Medical University from January 2019 to December 2024. Longitudinal follow-up was performed based on real-world data. Patients were divided into a low-dose group （25 mg/d） （n=121） and a high-dose group （50 mg/d） （n=79） based on their agomelatine dosage. Follow-up assessments were conducted at baseline， the 2^nd， 6^th， 14^th， and 26^th weeks after treatment initiation. Liver function indicators， including alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， and total bilirubin （TBIL）， were measured using a fully automated biochemical analyzer. Clinical symptoms were evaluated using the Hamilton Depression Scale-24 item （HAMD-24） and the Hamilton Anxiety Scale （HAMA）. ResultsNo statistically significant time effect， intergroup effect， or time-by-group interaction effect was observed for ALT， AST， or TBIL in either the low-dose or high-dose group （P>0.05）. The time effects for both HAMD-24 and HAMA scores in the two groups were statistically significant （F_time=430.573， 395.737， P<0.01）. From the end of the 2^nd week of treatment onward， the scores at each follow-up time point were significantly lower than those at the baseline period （P<0.01）. ConclusionBoth low-dose and high-dose agomelatine may have no significant effect on liver function in patients with depressive disorders， with no difference in liver function impairment was observed between dosage groups. Low-dose and high-dose agomelatine may be equally effective in alleviating depressive and anxiety symptoms in patients with depressive disorders. ［Funded by the Education Work Committee of the Anhui Provincial Committee for Outstanding Young Talents in Colleges and Universities （number， gxyqZD2022022）； the Key Project of Scientific Research Fund of Anhui Institute of Translational Medicine （number， 2023zhyx-B18）］

Objective:To evaluate the outcomes of intensive conservative treatment compared to conventional conservative treatment in patients with acute aortic syndrome(AAS).Methods:The study prospectively enrolled consecutive patients with AAS who were admitted to Beijing Anzhen Hospital, affiliated with Capital Medical University, and Beijing Dawanglu Emergency Rescue Hospital from January 2024 to December 2024. These patients with surgical contraindications or refused surgery for various reasons opted for conservative treatment. A total of 282 patients were included, and 15 patients with missing data or those who died without any treatment were excluded. Finally, 267 patients were enrolled, of whom 94 received intensive conservative treatment, and 173 received conventional conservative treatment, the inverse probability of treatment weighting (IPTW) was used to reduce the influence of confoundings. After adjusting of baseline datas via IPTW, the survival outcomes of the two groups were compared at 14 days, 30 days, and at the end of follow-up.Results:The results showed significant differences in acute phase survival rates between the enhanced conservative treatment group and the conventional conservative treatment group at 14 days(82.40%vs.53.20%, P<0.0001). Significant survival differences were also observed at 30 days and at 276-day mid-term follow-up (96.29% vs.51.60%, P<0.0001; 78.50% vs.48.50%, P<0.0001). In the subgroup analysis, for type A aortic dissection, the enhanced conservative treatment group had higher survival rates compared to the conventional conservative treatment group at 14, 30 and 276 days (63.46% vs.41.35%, P<0.05; 52.17% vs.37.90%, P<0.05; 50.00% vs. 31.97%, P<0.05). However, for type B aortic dissection, although the enhanced conservative treatment group had higher survival rates than the conventional conservative treatment group, no statistically significant differences were observed (96.29% vs. 80.00%, P=0.054; 95.65% vs.78.37%, P=0.067; 94.12% vs.74.20%, P=0.088). Conclusion:For patients diagnosed with AAS are forced to choose conservative treatment if emergency surgery is not possible in the first place, intensive conservative treatment strategies can significantly reduce the mortality in the acute phase compared with conventional conservative treatment. Mid-term follow-up, intensive conservative treatment still has a significant survival advantage.

Objective To investigate the correlation between red blood cell distribution width(RDW),systemic immune-inflammation index(SII)and major depressive disorder(MDD).Methods The clinical data of 176 MDD patients hospitalized in the clinical psychology department of our hospital from 2020 to 2022 and 209 non-MDD comparators who were routinely examined in Hebei General Hospital were retrospectively analyzed.Blood analysis was conducted to obtain values of RDW,SII,and red blood cell distribution width/platelet ratio(RPR).The data was used to plot the receiver operator characteristic(ROC)curve to determine the optimal threshold and the area under the curve(AUC)for RDW to discriminate between patients and controls.Result Patients in the MDD group had significantly higher RDW[median and quartiles:13.20(12.70,13.98)vs.12.80(12.40,13.35)],and SII levels[median and quartiles 510.87(350.95,878.12)vs.405.33(313.74,539.92)]compared with those in non-MDD group(P<0.05).There was no significant difference in RPR between the two groups(P>0.05).Multifactorial logistic regression analysis showed that RDW was positively correlated with MDD after adjusting for confounders(OR=3.086,95% CI:1.926-4.944).ROC curve showed that the optimal threshold for RDW to differentiate the risk of developing MDD was 12.85,with an AUC of 0.647(95% CI:0.592-0.702;P<0.001).Conclusion Present study shows that high RDW is a risk factor for the occurrence of MDD and an important parameter for the risk of developing depression.

Objective:To investigate the effect of triglyceride-glucose index (TyG) on the severity of depression in patients with depression.Methods:The clinical data of 653 patients with depression admitted to Hebei General Hospital from January to December 2021 were retrospectively analyzed. The patients were categorized into mild-moderate depression group ( n=324) and severe depression group ( n=329) according to the 17-item Hamilton depression scale (HAMD-17) score. Patients' demographics and data on fasting plasma glucose (FPG), triglyceride (TG), total cholesterol, high-density lipoprotein, and low-density lipoprotein were extracted from the electronic medical records, and TyG was calculated. Statistical analyses were performed by SPSS 25.0 software.The Mann-Whitney U test was used to compare the differences between the two groups. Spearman correlation analysis and binary Logistic regression analysis were used to investigate the relationship between TyG level and depression severity. Results:(1) In the severe depression group, FPG( 956.9 (118.9) mg/L vs 865.0 (1 44.2) mg/L), TG(1 275.8 (1 027.8) mg/L vs 983.5 (766.4) mg/L), total cholesterol (2 007.0 (477.6) mg/L vs 1 730.5 (547.2) mg/L), high-density lipoprotein (514.3 (168.2) mg/L vs 464.0 (138.2) mg/L), low-density lipoprotein (1 264.5 (326.8) mg/L vs 1 088.6 (412.8) mg/L), and TyG (8.72 (0.77) vs 8.37 (0.78)) were higher than those in the mild-moderate depression group, and the differences were statistically significant (all P<0.05).(2) Both TyG level and HAMA score were positively correlated with HAMD-17 score ( r=0.231, 0.586, both P<0.05); (3) The results of binary logistic regression analysis showed that TyG ( B=1.116, OR=3.054, 95% CI=2.058-4.531, P<0.05) was a risk factor for the severity of depression in patients with depression. Conclusion:The higher the TyG, the more severe the severity of depression in patients. Insulin resistance may affect the severity of depression in patients with depression.

Objective:To investigate the effect of triglyceride-glucose index (TyG) on the severity of depression in patients with depression.Methods:The clinical data of 653 patients with depression admitted to Hebei General Hospital from January to December 2021 were retrospectively analyzed. The patients were categorized into mild-moderate depression group ( n=324) and severe depression group ( n=329) according to the 17-item Hamilton depression scale (HAMD-17) score. Patients' demographics and data on fasting plasma glucose (FPG), triglyceride (TG), total cholesterol, high-density lipoprotein, and low-density lipoprotein were extracted from the electronic medical records, and TyG was calculated. Statistical analyses were performed by SPSS 25.0 software.The Mann-Whitney U test was used to compare the differences between the two groups. Spearman correlation analysis and binary Logistic regression analysis were used to investigate the relationship between TyG level and depression severity. Results:(1) In the severe depression group, FPG( 956.9 (118.9) mg/L vs 865.0 (1 44.2) mg/L), TG(1 275.8 (1 027.8) mg/L vs 983.5 (766.4) mg/L), total cholesterol (2 007.0 (477.6) mg/L vs 1 730.5 (547.2) mg/L), high-density lipoprotein (514.3 (168.2) mg/L vs 464.0 (138.2) mg/L), low-density lipoprotein (1 264.5 (326.8) mg/L vs 1 088.6 (412.8) mg/L), and TyG (8.72 (0.77) vs 8.37 (0.78)) were higher than those in the mild-moderate depression group, and the differences were statistically significant (all P<0.05).(2) Both TyG level and HAMA score were positively correlated with HAMD-17 score ( r=0.231, 0.586, both P<0.05); (3) The results of binary logistic regression analysis showed that TyG ( B=1.116, OR=3.054, 95% CI=2.058-4.531, P<0.05) was a risk factor for the severity of depression in patients with depression. Conclusion:The higher the TyG, the more severe the severity of depression in patients. Insulin resistance may affect the severity of depression in patients with depression.

Objective:To investigate the relationship between white blood cells, neutrophil-lymphocyte ratio(NLR), platelet-lymphocyte ratio(PLR) and monocyte-lymphocyte ratio(MLR) with patients suffering from first episode depression.Methods:This retrospective study was conducted among inpatients of Hebei General Hospital from January 2021 to December 2021.Ultimately, 193 patients with first-episode depression were enrolled.According to the score of Hamilton depression scale-24 (HAMD-24), the patients were divided into mild-moderate depression group(20≤HAMD-24<35 score, n=98) and severe depression group (HAMD-24 score ≥35, n=95). White blood cells and the counts of each cell subtype were detected and the NLR, MLR and PLR were calculated.SPSS 25.0 statistical software was used to analyze the data.Mann-Whitney U test was used to compare differences in the two groups and Binary Logistic regression analyses were performed to recognize the predictive factors of the severity of first episode depression. Results:(1) The white blood cells and NLR in the severe depression group were significantly higher than those in the mild-moderate depression group (white blood cells: 5.77(2.05)×10 9/L vs 5.11(1.31)×10 9/L; NLR: 1.86 (1.04) vs 1.57(0.55), P<0.05). There were no significant differences in PLR and MLR between the two groups ( P>0.05). (2)Multiple regression analysis of NLR, white blood cells and HAMD-24 score showed that there were significant differences in the effect of different white blood cells and NLR levels on HAMD-24 score( B=1.398, P=0.003; B=2.624, P=0.001). (3)Binary Logistic regression revealed that white blood cell count and NLR were risk factors for the severity of depression patients( OR were 1.612 and 2.336, respectively, P<0.05). Conclusion:The results suggest that white blood cells and NLR may be relate with the severity of first episode depression.

Objective:To explore the risk factors of ischemic stroke after coronary artery bypass grafting(CABG) in elderly(≥75 years old)patients, establish a risk prediction model and evaluate it.Methods:From January 2015 to September 2021, a total of 1 553 elderly patients with coronary artery disease who were admitted to Beijing Anzhen Hospital for coronary artery bypass grafting were included retrospectively. Among which 1 121(72%) cases were males, with a median age of 77( IQR 75, 78) years. Clinical data were collected and univariate analysis and multiple logistic regression analysis were used to explore the risk factors of ischemic stroke after CABG in elderly patients. After the establishment of risk prediction model, we constructed the nomogram, and tested the discrimination and calibration of the model. Results:All patients underwent CABG, there were 35 patients with ischemic stroke after operation, with an incidence of 2.25%(35/1 553). Multivariate logistic regression analysis showed that diabetes( OR=2.61, 95% CI: 1.31-5.32), old myocardial infarction( OR=3.62, 95% CI: 1.61-7.63), systolic blood pressure( OR=1.03, 95% CI: 1.01-1.04) and vertebral artery stenosis( OR=1.01, 95% CI: 1.00-1.02) were independent risk factors for postoperative cerebral infarction in patients undergoing CABG. The model was presented by a nomogram, and the model discrimination was evaluated by ROC curve. The area under the curve( AUC) was 0.757, indicating a optimal discrimination. Hosmer- Lemeshow test of goodness of fit was performed to evaluate the model calibration( χ2=6.209, P=0.624). Conclusion:Diabetes mellitus, old myocardial infarction, systolic blood pressure and vertebral artery stenosis are independent risk factors for ischemic stroke in elderly patients after CABG. The established risk prediction model has optimal discrimination and calibration.