Objective:This study aims to explore the relationship between the abundance of Lachnoclostridium genus in the gut microbiome and inflammatory markers with cognitive impairment in patients with first-episode schizophrenia. Methods:A total of 87 medication-naive patients with first-episode schizophrenia (patient group) and 87 matched healthy controls (control group) who visited the Department of Psychiatry, the First Affiliated Hospital of Zhengzhou University between January 2020 and December 2022 were selected for this study. A 24-week follow-up was conducted for the patients, and all patients received treatment with risperidone. Venous blood and fecal samples were collected from the subjects at baseline and week 24 to measure the levels of superoxide dismutase-1, erythrocyte sedimentation rate, and the abundance of Lachnoclostridium. The severity of symptoms in patients with schizophrenia was assessed using the Positive and Negative Syndrome Scale, and the cognitive function of all subjects was evaluated using MATRICS Consensus Cognitive Battery tests. The differences in the abundance of Lachnoclostridium, inflammatory markers, and cognitive scores between groups were analyzed using t-tests, and the correlations between Lachnoclostridium abundance, inflammatory markers, and cognitive scores were analyzed using Pearson correlation analysis. Results:(1) At baseline, compared with the control group, patients with first-episode schizophrenia had lower levels of superoxide dismutase-1( t=6.83, P<0.001) and total cognitive function test scores( t=6.35, P<0.001), and higher abundance of Lachnoclostridium( Z=-4.64, P<0.001). (2) At baseline, the levels of superoxide dismutase-1 in patients with first-episode schizophrenia were positively correlated with social cognition( r=0.30, P=0.005), while erythrocyte sedimentation rate was negatively correlated with information processing speed and social cognition( r=-0.23, -0.31, both P<0.050). The abundance of Lachnoclostridium genus was negatively correlated with speed of processing( r=-0.28, P=0.009), working memory( r=-0.22, P=0.040), and visual memory( r=-0.32, P=0.003). (3) After 24 weeks of risperidone treatment, the levels of superoxide dismutase-1( t=-2.07, P=0.045) and total cognitive function test scores( t=-3.47, P=0.001) increased in patients, while erythrocyte sedimentation rate( t=2.21, P=0.033) decreased. The abundance of Lachnoclostridium genus showed a decreasing trend( Z=1.52, P=0.128) and did not differ significantly from the control group( Z=1.68, P=0.094). (4) Among the 39 patients who completed the 24-week follow-up, the baseline abundance of Lachnoclostridium genus was negatively correlated with attention and vigilance( r=-0.39, P=0.014) and total cognitive function test scores( r=-0.34, P=0.032) at week 24. The baseline erythrocyte sedimentation rate was positively correlated with the differences in speed of processing, working memory, social cognition, and total cognitive function test scores between baseline and week 24( r=0.42, 0.32, 0.41, 0.36, all P<0.050). (5) At baseline, the abundance of Lachnoclostridium genus had predictive value for erythrocyte sedimentation rate( r=0.45, P=0.004), attention and vigilance( r=-0.39, P=0.014), and total cognitive function test scores( r=-0.34, P=0.032) at week 24. Conclusion:In first-episode schizophrenia patients, there is a significant correlation between the abundance of gut Lachnoclostridium and inflammation and cognitive function.

Objective:To explore the role of interaction between stearidonic acid (SDA) and fatty acid desaturase 2 ( FADS2) rs174570 genotyping in the cognitive function of schizophrenia (SCH). Methods:This study is a case-control study, patients with first-episode, drug-na?ve schizophrenia were recruited from the First Affiliated Hospital of Zhengzhou University′s Department of Psychiatry from October 2017 to October 2019. Healthy controls were recruited through advertisements and medical examinations during the same period. Peripheral blood SDA levels of the SCH patient group and the control group were measured and compared using liquid chromatograph-mass spectrometer (LC-MS), and paired sample t-test was conducted to analyze the changes in the patient group before and after treatment with risperidone. Genome-wide association study (GWAS) was used for analyzing the key enzyme of SDA, and analysis of variance was performed to evaluate the relationship between FADS2 single nucleotide polymorphism (SNP) genotyping and the level of SDA. The Positive and Negative Syndrome Scale (PANSS) and the MATRICS Consensus Cognitive Battery (MCCB) were used to assess the severity of psychotic symptoms and cognitive function, the comparison between the two groups was conducted by independent sample t-test, and the changes before and after risperidone treatment were analyzed by paired sample t-test. Linear regression analysis was performed to investigate the relationship between the interaction of SDA and FADS2 rs174570 genotyping, and cognitive impairment in SCH. Results:SDA levels were significantly lower in the SCH group compared to the control group ( t=-10.67, P<0.001). Cognitive score in patients with SCH were lower than that of HCs ( t=-10.30—-3.30, P<0.05 for all). Low levels of SDA in patients with SCH were positively correlated with the score of speed of processing (SOP; r=0.406, P<0.001) at baseline. After six months of treatment with risperidone, serum levels of SDA increased from (3.6±1.9) μmol/L to (4.4±2.3) μmol/L, and paired t-tests showed significant difference ( t=-2.29, P=0.024). The change of SDA levels before and after risperidone treatment was positively correlated with the change of SOP scores ( r=0.327, P=0.002). FADS2 rs174570 genotyping were significantly associated with SDA levels ( F=3.74, P=0.027) and cognitive function scores of SOP ( F=4.28, P=0.017), and attention/vigilance (AV; F=6.74, P=0.002). Pairwise comparisons showed that CC carriers of rs174570 genotype had higher SDA levels than CT and TT carriers ( P=0.024, and 0.048, respectively), and higher total scores of SOP, AV and MCCB than CT carriers ( P=0.006, 0.001, and 0.002, respectively). The interaction of SDA and FADS2 rs174570 genotyping were associated with cognitive function SOP scores in patients with SCH (β=1.82, P=0.029). Conclusion:The interaction of SDA and FADS2 rs174570 genotyping is associated with the cognitive function in patients with SCH.

Objective:This study aims to explore the relationship between the abundance of Lachnoclostridium genus in the gut microbiome and inflammatory markers with cognitive impairment in patients with first-episode schizophrenia. Methods:A total of 87 medication-naive patients with first-episode schizophrenia (patient group) and 87 matched healthy controls (control group) who visited the Department of Psychiatry, the First Affiliated Hospital of Zhengzhou University between January 2020 and December 2022 were selected for this study. A 24-week follow-up was conducted for the patients, and all patients received treatment with risperidone. Venous blood and fecal samples were collected from the subjects at baseline and week 24 to measure the levels of superoxide dismutase-1, erythrocyte sedimentation rate, and the abundance of Lachnoclostridium. The severity of symptoms in patients with schizophrenia was assessed using the Positive and Negative Syndrome Scale, and the cognitive function of all subjects was evaluated using MATRICS Consensus Cognitive Battery tests. The differences in the abundance of Lachnoclostridium, inflammatory markers, and cognitive scores between groups were analyzed using t-tests, and the correlations between Lachnoclostridium abundance, inflammatory markers, and cognitive scores were analyzed using Pearson correlation analysis. Results:(1) At baseline, compared with the control group, patients with first-episode schizophrenia had lower levels of superoxide dismutase-1( t=6.83, P<0.001) and total cognitive function test scores( t=6.35, P<0.001), and higher abundance of Lachnoclostridium( Z=-4.64, P<0.001). (2) At baseline, the levels of superoxide dismutase-1 in patients with first-episode schizophrenia were positively correlated with social cognition( r=0.30, P=0.005), while erythrocyte sedimentation rate was negatively correlated with information processing speed and social cognition( r=-0.23, -0.31, both P<0.050). The abundance of Lachnoclostridium genus was negatively correlated with speed of processing( r=-0.28, P=0.009), working memory( r=-0.22, P=0.040), and visual memory( r=-0.32, P=0.003). (3) After 24 weeks of risperidone treatment, the levels of superoxide dismutase-1( t=-2.07, P=0.045) and total cognitive function test scores( t=-3.47, P=0.001) increased in patients, while erythrocyte sedimentation rate( t=2.21, P=0.033) decreased. The abundance of Lachnoclostridium genus showed a decreasing trend( Z=1.52, P=0.128) and did not differ significantly from the control group( Z=1.68, P=0.094). (4) Among the 39 patients who completed the 24-week follow-up, the baseline abundance of Lachnoclostridium genus was negatively correlated with attention and vigilance( r=-0.39, P=0.014) and total cognitive function test scores( r=-0.34, P=0.032) at week 24. The baseline erythrocyte sedimentation rate was positively correlated with the differences in speed of processing, working memory, social cognition, and total cognitive function test scores between baseline and week 24( r=0.42, 0.32, 0.41, 0.36, all P<0.050). (5) At baseline, the abundance of Lachnoclostridium genus had predictive value for erythrocyte sedimentation rate( r=0.45, P=0.004), attention and vigilance( r=-0.39, P=0.014), and total cognitive function test scores( r=-0.34, P=0.032) at week 24. Conclusion:In first-episode schizophrenia patients, there is a significant correlation between the abundance of gut Lachnoclostridium and inflammation and cognitive function.

Objective:To explore the role of interaction between stearidonic acid (SDA) and fatty acid desaturase 2 ( FADS2) rs174570 genotyping in the cognitive function of schizophrenia (SCH). Methods:This study is a case-control study, patients with first-episode, drug-na?ve schizophrenia were recruited from the First Affiliated Hospital of Zhengzhou University′s Department of Psychiatry from October 2017 to October 2019. Healthy controls were recruited through advertisements and medical examinations during the same period. Peripheral blood SDA levels of the SCH patient group and the control group were measured and compared using liquid chromatograph-mass spectrometer (LC-MS), and paired sample t-test was conducted to analyze the changes in the patient group before and after treatment with risperidone. Genome-wide association study (GWAS) was used for analyzing the key enzyme of SDA, and analysis of variance was performed to evaluate the relationship between FADS2 single nucleotide polymorphism (SNP) genotyping and the level of SDA. The Positive and Negative Syndrome Scale (PANSS) and the MATRICS Consensus Cognitive Battery (MCCB) were used to assess the severity of psychotic symptoms and cognitive function, the comparison between the two groups was conducted by independent sample t-test, and the changes before and after risperidone treatment were analyzed by paired sample t-test. Linear regression analysis was performed to investigate the relationship between the interaction of SDA and FADS2 rs174570 genotyping, and cognitive impairment in SCH. Results:SDA levels were significantly lower in the SCH group compared to the control group ( t=-10.67, P<0.001). Cognitive score in patients with SCH were lower than that of HCs ( t=-10.30—-3.30, P<0.05 for all). Low levels of SDA in patients with SCH were positively correlated with the score of speed of processing (SOP; r=0.406, P<0.001) at baseline. After six months of treatment with risperidone, serum levels of SDA increased from (3.6±1.9) μmol/L to (4.4±2.3) μmol/L, and paired t-tests showed significant difference ( t=-2.29, P=0.024). The change of SDA levels before and after risperidone treatment was positively correlated with the change of SOP scores ( r=0.327, P=0.002). FADS2 rs174570 genotyping were significantly associated with SDA levels ( F=3.74, P=0.027) and cognitive function scores of SOP ( F=4.28, P=0.017), and attention/vigilance (AV; F=6.74, P=0.002). Pairwise comparisons showed that CC carriers of rs174570 genotype had higher SDA levels than CT and TT carriers ( P=0.024, and 0.048, respectively), and higher total scores of SOP, AV and MCCB than CT carriers ( P=0.006, 0.001, and 0.002, respectively). The interaction of SDA and FADS2 rs174570 genotyping were associated with cognitive function SOP scores in patients with SCH (β=1.82, P=0.029). Conclusion:The interaction of SDA and FADS2 rs174570 genotyping is associated with the cognitive function in patients with SCH.

Objective:Hepatic amyloidosis is a metabolic disease with a low incidence rate. However, because of its insidious onset, the rate of misdiagnosis is high, and it usually progresses to a late stage when it is diagnosed. This article analyzes the clinical features of hepatic amyloidosis by combining clinical pathology in order to improve the clinical diagnosis rate.Methods:Clinical and pathological data of 11 cases of hepatic amyloidosis diagnosed at the China-Japan Friendship Hospital from 2003 to 2017 were summarized and analyzed retrospectively.Results:The clinical manifestations of 11 cases mainly included abdominal discomfort (4/11), hepatomegaly (7/11), splenomegaly (5/11), fatigue (6/11), etc. Biochemical test results showed that most patients' alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, γ-glutamyl transferase, total bilirubin, direct bilirubin, and total bile acids, accompanied by hypoalbuminemia were elevated, while some patients' 24-h urinary protein, creatinine, and blood urea nitrogen were elevated.Conclusion:All patients had slightly elevated aspartate transaminase levels (within 5 times the upper limit of normal), and 72% had slightly elevated alanine transaminase. Alkaline phosphatase and γ-glutamyl transferase levels were significantly raised in all cases, with the highest result for γ-glutamyl transferase being 51 times the upper limit of normal. Damage to the hepatocytes has an effect on the biliary system as well, leading to symptoms such as portal hypertension and hypoalbuminemia [(0.54~0.63) × upper limit of normal value, 9/11]. Amyloid deposits within the artery wall (54.5% of patients) and portal vein (36.4% of patients) were also indicative of vascular injury. A liver biopsy should be recommended for patients with unexplained elevated transaminases, bile duct enzymes, and portal hypertension in order to establish a definitive diagnosis.

Objective:To investigate the current situation of economic income and quality of life of patients with Kashin-Beck disease (KBD) , and to analyze the impact of different economic levels on quality of life of patients with KBD, and to provide evidence for selection of target and key populations setting of poverty alleviation in KBD area.Methods:The anrual family income and quality of life of adults with KBD in Yongshou County and Linyou County, Shaanxi Province were investigated from May 2017 to May 2019. Patient's quality of life were evaluated using Chinese version of European five-dimensional five-level health scale (EQ-5D-5L) and its utility value conversion system was used to calculate the EQ-index. The ratio of income difference to quality of life difference in different income KBD patients was calculated.Results:A total of 290 patients with KBD participated in the survey. The average annual income of families with KBD was 11 462.41 Yuan of which the average annual income of low (< 5 000 Yuan), medium (5 000 ~ 10 000 Yuan) and high-income (> 10 000 Yuan) groups was 2 663.48, 9 262.75 and 28 397.26 Yuan, respectively. The ratios of income difference to quality of life difference between low-income and medium-income groups (109.99 × 10 4, 94.28 × 10 4, 94.28 × 10 4) were bigger than the ratios of income difference to quality of life difference (55.94 × 10 4, 91.91 × 10 4,-3.20 × 10 3) between low-income and high-income groups in terms of mobility, usual activity, and EQ-index. The ratios of income difference to quality of life difference were negative in terms of self care, anxiety/depression and VAS score (- 131.99 × 10 4,-65.99 × 10 4,-65.99 × 10 3). Conclusions:Patients with KBD have low income level and large income gap. The KBD patients whose annual income less than 10 000 Yuan could be the key population of poverty alleviation, and family income level of more than 10 000 Yuan could be the target of poverty alleviation.

Objective:To evaluate the life quality of patients with Kashin-Beck disease (KBD), and to analyze its influencing factors.Methods:From September 2017 to May 2019, adult KBD patients aged 18 years old and over were selected as the study subjects in the historical serious disease areas (Yongshou County and Linyou County) of KBD in Shaanxi Province. KBD patients were investigated by using the basic information questionnaire and the Chinese version of the European Five-dimensional Five-level Health Scale (EQ-5D-5L), the distribution of health status in the five dimensions of mobility, self-care ability, daily activity, pain/discomfort, and anxiety/depression were described, and each dimension included five levels of no problem, mild problem, moderate problem, severe problem, and extreme problem. EQ index (- 0.391 - 1.000) was used to evaluate the quality of life of patients based on group perspective, the higher EQ index was, the better life quality of the group would be; visual analogue system (VAS) score (0 - 100 points) was used to evaluate the life quality of patients based on individual perspective, the higher VAS score was, the better life quality of the individual would be. At the same time, multiple linear regression analysis was used to analyze the life quality of KBD patients.Results:A total of 245 KBD patients were included, aged (60.37 ± 7.10) years old. The mild problems of self-care ability and anxiety/depression of KBD patients, accounted for the largest proportion, which were 31.8% (78/245) and 27.3% (67/245), respectively; in terms of daily activity, the moderate problem accounted for the largest proportion, which was 32.7% (80/245); in terms of mobility and pain/discomfort, the severe problem accounted for the largest proportion, which were 46.9% (115/245) and 45.7% (112/245), respectively. EQ index [median (quartile range)] was 0.311 (0.059, 0.563), and VAS score was 42.5 (30.0, 60.0) points. After multiple linear regression analysis, the effects of education level, pain level, body deformity inferiority complex, and social participation barrier on EQ index were statistically significant ( P < 0.01); the effects of economic level, pain level, body deformity inferiority complex, and social participation barrier on VAS score were statistically significant ( P < 0.05). Conclusion:The life quality of KBD patients is poor, it is affected by physical, psychological and social aspects, so relevant medical workers should pay attention to the overall health of KBD patients.

Objective: To systematically review the barriers and facilitators affecting the implementation of clinical pathways for the clinical pathways. Methods: PubMed, Embase, CNKI, CBM, Wanfang, Cvip databases were searched to collect articles about clinical pathways implementation barriers and facilitators from inception to January 4th, 2019. The tool of confidence in the evidence from reviews of qualitative research(CERQual)was used to grade the confidence of each study. Results: A total of 43 articles from 12 countries were included.There were 8 main categories and 31 subcategories of the barriers about clinical pathways, including content of the clinical pathways, negative outcomes of clinical pathways, physicians knowledge, physicians attitude, resource availability, implementation of activities, patients factors and social factors. The first three barriers of high confidence were lacking of time, capital, equipment, staff and other resources(15 articles, 34.9%), increasing workload(14 articles, 32.6%), unrecognizing pathways(12 articles, 27.9%). There were 6 main categories and 28 subcategories of the facilitators about clinical pathways, including pathways content related, physician related, resource factor and implementation activity. The first three facilitators of high confidence were communication, education and training(25 articles, 58.1%), supporting from managers and colleagues(21 articles, 48.8%)and establishing a clinical pathway facilitation committee(17 articles, 39.5%). Conclusions The successful implementation of clinical pathways connects with its development process, aftereffect evaluation and feedback. It will be implemented effectively only by the completely and environmentally acceptable pathways design, adequate resources, effective organizational activities, continuous audit, evaluation and feedback and physicians active cooperation.

Objective To explore the efficacy of group cognitive behavioral therapy for improving depressive symptoms and social functional in patients with major depressive disorder.Methods A total of 160 patients with major depressive disorder were randomly divided into intervention group (n=80) and control group (n=80).Intervention group was treated with conventional antidepressants combined with group cognitive behavioral therapy.Control group was treated with one conventional antidepressants.All participants were assessed with Hamilton Depression Scale (HAMD)and Scale of Social function of Psychosis Inpatients (SSFPI) before and 8 weeks after the treatment.Results After 8 weeks treatment,the scores of HAMD (14.76±9.48) was significantly reduced and the scores of SSFPI(30.09±4.34) were significantly increased in intervention group compared with the baseline ((37.91± 10.58),(12.40±2.56),all P＜0.01).The scores of HAMD were significantly lower and the scores of SSFPI were significantly higher in intervention group than that in control group((20.71±7.85),(22.63±3.63),all P＜0.01).Conclusion Group cognitive behavioral therapy is effective for major depressive disorder patients by reducing depressive symptom and improving social function.

ObjectiveTo investigate the experience and attitude of discrimination among family members of hospitalized patients with schizophrenia.Methods A total of 83 family members of hospitalized patients with schizophrenia were investigated using questionnaires of families experienced by discrimination and families' view on social discrimination of patients with mental illness.Results In the study,the three most common experiences included:68.7% of family members kept patients' schizophrenia as a secret in fear of discrimination;48.2% of family members failed in love or divorced because of discrimination;40.7% of family members were despised by neighbors. For the attitude of family members to discrimination,84.3% of family members thought that discrimination put too much stress on family members;79.5% of family members thought that social discrimination to patients with schizophrenia were more severe than to other disabled patients;71.0% of family members thought that social discrimination reduced their social activities;43.3% of family members thought that people discriminated patients with schizophrenia;and 77.1% of family members thought that in the past 20 years there was no reduction in the discrimination of patients with mental illness.Conclusions Discrimination commonly exists in schizophrenia patients' families and seriously affects family members both on psychological and social life. Doctors and nurses should assess the discrimination as part of the standard work not only for patients with mental illness but also for the family members,identify the high risk individual and help family members reduce the effects of discrimination on their lives.