Objective To assess the value of bulbocavernosus reflex (BCR) in the differential diagnosis of Parkinson' s disease (PD) and multiple system atrophy (MSA).Methods BCR was compared in 55 patients with PD,20 patients with MSA,and 50 healthy controls,who were enrolled from the Department of Neurology,the First Affiliated Hospital of Wenzhou Medical University from May 2013 to April 2014.The clinical features of autonomic nerves dysfunction were also recorded.Results Among all related autonomic symptoms,the occurrence rate of constipation,urinary urgency and frequency in patients with MSA was higher than those with PD.The elicit percent of BCR in patients with PD was 93％,higher than those with MSA (70％).The average latency of BCR in patients with MSA was longer than those with PD (tmale left =16.275,tmale right =14.269,tfemale left =5.954,tfemmale right =5.905,all P ＜ 0.05).The degree of BCR amplitude decreasing in three groups was MSA ＞ PD ＞ healthy controls.There was statistically significant difference among three groups (Fmale left =75.73,Fmale right =73.13,Ffemale left =72.70,Ffemale right =59.44,all P ＜ 0.05).The area under receiver operating characteristic curve (ROC) in differential diagnosis of PD and MSA of the average latency of BCR in male and female was 0.947 and 0.948.The area under ROC curve in differential diagnosis of PD and MSA of the average amplitude of BCR in male and female was 0.886 and 0.920.The ROC curve showed the average latency of BCR in male of 44.80 ms with a sensitivity of 95％ and a specificity of 84％,and in female of 61.35 ms with a sensitivity of 86％ and a specificity of 88％ ; the average amplitude of BCR in male of 0.37 mV with a sensitivity of 96％ and a specificity of 68％,and in female of 0.36 mV with a sensitivity of 98％ and a specificity of 76％,which were critical cutoff values in differential diagnosis of PD and MSA with the best sensitivity and specificity.Conclusion The latency and amplitude of BCR test helps to increase the accuracy in the differential diagnosis of PD and MSA.

Objective: To investigate the influence of occupational aluminum exposure on cognitive function and glutamate receptor protein expression in peripheral blood lymphocytes in workers and the possibility of glutamate receptor being used as a biomarker for cognitive impairment in aluminum workers. Methods: From October to December, 2014, cluster sampling was performed to select 121 workers in aluminum electrolysis workshop as exposure group and 231 workers in thermoelectric workshop and logistics department as control group. Mini-Mental State Examination, clock drawing test, digit span test (DST) , verbal fluency test (VFT) , and Fuld Object-Memory (FOM) Evaluation were used to analyze cognitive function. Graphite furnace atomic absorption spectrophotometry was used to measure plasma aluminum level as an exposure indicator. Enzyme-linked immunosorbent assay was used to measure the content of glutamate receptor proteins in peripheral blood lymphocytes, including the subunits of N-methyl-D-aspartate receptor NR1, NR2A, and NR2B and metabotropic glutamate receptor 1 (mGluR1) . The correlation between cognitive function indices and the content of glutamate receptor proteins was analyzed. Results: There was no significant difference in plasma aluminum level between the control group and the exposure group (132.52±80.40 μg/L vs 182.88±72.32 μg/L, P>0.05) . According to the plasma aluminum level, the study subjects were divided into control group and low-, medium-, and high-level plasma aluminum groups, and there were significant differences in plasma aluminum level between these groups (all P<0.01) . The high-level plasma aluminum group had a significantly lower memory ability score than the control group and the low- and medium-level plasma aluminum groups (all P<0.05) . The high-level plasma aluminum group had lower DST and digital span forward (DSF) scores than the control group and the low-and medium-level plasma aluminum groups. The low-, medium-, and high-level plasma aluminum groups had lower digital span backward (DSB) scores than the control group. The medium-and high-level plasma aluminum groups had lower VFT scores than the control group and the low-level plasma aluminum group. The high-level plasma aluminum group had significantly lower expression of NR1 and NR2A proteins than the control group and the low-and medium-level plasma aluminum groups, and the medium- and high-level plasma aluminum groups had significantly higher expression of mGluR1 protein than the control group and the low-level plasma aluminum group (all P<0.05) . The expression of NR1 and NR2A proteins was negatively correlated with plasma aluminum level (r=-0.475 and -0.692, both P<0.05) , andthe expression of mGluR1 protein was positively correlated with plasma aluminum level (r=0.756, P<0.05) . The expression of NR1 protein was positively correlated with DSF, DSB, DST, and VFT scores (r_s=0.213, 0.249, 0.271, and 0.228, all P<0.05) , and the expression of NR2A protein was positively correlated with VFT score (r_s=0.206, P<0.05) . Conclusion Occupational aluminum exposure may affect workers’ memory function, and the expression of NR1 and NR2A in peripheral blood lymphocytes is correlated with cognitive function indices and can be used as biomarkers for cognitive impairment in aluminum workers.

Objective: To investigate the expression of phosphorylated tau (p-tau) and Aβ in SH-SY5Y cells induced by aluminum or/and ApoE ε4 allele, and study the interaction between aluminum and ApoE ε4 allele. Methods: SH-SY5Y cells were assigned to control group, 400 μmol/L AlCl₃ group, ApoEε4 transfected group and 400 μmol/L AlCl₃ with Apo Eε4 transfected group. The cell viability was measured by CCK-8 assay; the expressions of p-tau and Aβ was determined with ELISA Kit after AlCl₃ exposure or or/and ApoE ε4 transfection. Results: The viability of cells exposed to 400 μmol/L AlCl₃ or/and ApoE ε4 transfected were significantly lower than that of controls (P<0.05) . The expressions of total tau, tau-181, tau-231, tau-396 and Aβ in 400 μmol/L Al₃+ or/and ApoE ε4 transfected exposed cells showed significantly higher than those of controls (P<0.05) . Based on the factorial design, a significant interaction exists, and there is a synergistic effect between AlCl₃ and ApoE ε4 (P<0.05) . Conclusion Aluminum and ApoE ε4 allele could increase expression of p-tau and Aβ deposition; there was a synergistic interaction between aluminum and ApoE ε4 allele on cell death, tau phosphorylation and Aβ deposition of SH-SY5Y.

Objective To investigate the influence of occupational aluminum exposure on cogmtive function and its relationship with tri-methyl histone H3 lysine residues 4 points (H3K4me3) and brain-derived neurotrophic factor (BDNF) levels.Methods By cluster random sampling method,a total of 235 cases of male workers selected from a Shanxi aluminum factory were recruited in the study in September 2015.Used the occupational epidemiological investigation questionnaire,which included Mini-Mental State Examination (MMSE),Clock Drawing Test (CDT),Digit Span Test (DST,including forward test DSFT and backward test DSBT),Fuild Object Memory Evaluation (FOME) and Verbal Fluency Test (VFT),to collect workers' basic information and assess their cognitive function score.Detected the concentration of aluminum in plasma by graphite furnace atomic absorption spectrometry.Workers were divided into three groups by the 25 percentile and 75 percentile of the aluminum content,such as low,middle and high aluminum concentration groups.The concentrations of H3K4me3 in lymphocyte and BDNF in plasma were determined by enzyme-linked immunosorbent assay.Results The levels of aluminum in plasma was 134.36 (100.14,178.96) μg/L.The scores of MMSE,DSFT,DSBT,DST of high aluminum concentration group were lower than low aluminum group (27.98±1.25 vs 28.83±1.54,9.19±2.00 vs 10.64±2.87,6.08±1.63 vs 7.19±3.07,15.27±3.11 vs 17.81±4.72,all P＜0.05),the scores of CDT,FOME,VFT among three groups had no statistical significance (all P＞0.05).The expression levels of H3K4me3 and BDNF of high aluminum concentration group were lower than the low group [(18.45±9.81) ng/μg Pro vs (23.76±9.89) ng/μg Pro,(26.07±10.18) ng/ml vs (31.66±9.24) ng/ml,all P＜0.05].Multiple correlation analysis showed that aluminum concentration were negatively correlated to H3K4me3,BDNF,MMSE,DSFT,DST,respectively (rs =-0.307、-0.214、-0.252、-0.197,-0.181,all P＜0.01).Conclusion Exposure to occupational aluminum for a long time may change cognitive function,which go along with the decreasing of H3K4me3 level in lymphocyte and BDNF protein expression in plasma.

Objective:To explore the effect of occupational aluminum (Al) exposure on workers' overall cognitive level and speech function.Methods:In July 2019, by using cluster sampling method, the group of 232 exposed to Al from an Al plant in Shanxi Province were selected as the exposed group, and the group of 228 not exposed to Al were selected as the control group. The blood Al concentration was determined by inductively coupled plasma mass spectrometry (ICP-MAS) . The exposed group was divided into high exposure group and low exposure group according to the median ( M) concentration of Al in serum. The general cognitive function and speech function were evaluated with the Montreal Cognitive Assessment Scale (MoCA) , and the differences in the general cognitive function and speech function between the groups were compared, and non-conditional logistic regression was used to analyze the possible influencing factors of mild cognitive impairment (MCI) . Results:There were significant differences in age, working age, education and drinking status between Al exposed group and control group ( P<0.05) . The total MoCA score, animal naming tese (ANT) score and category fluency repetition (CFT) score in Al exposure group were lower than control group and the differences were statistically significant ( P<0.05) . The full rate of ANT was lower than that of CFT in Al exposure group ( P<0.05) . The total MoCA score, ANT score and CFT score in the high exposure group were significantly lower than those in the control group ( P<0.05) . The score of MoCA, ANT and CFT in high exposure group were lower than those in low exposure group between the level of serum aluminum>60 μg/L group and ≤60 μg/L group ( P<0.05) . Logistic regression analysis showed that working age, serun Al concentration, ANT score, CFT score and SR score were the possible influencing factors of MCI in occupational Al exposure workers ( P<0.05) . Conclusion:Occupational Al exposure can lead to impaired speech function of workers, the higher the ANT score, CFT score and SR score, the lower working age and serum Al concentration, the lower risk of MCI.

Objective:To evaluate the effects of occupational aluminum exposure on workers' overall cognitive function and cognitive fields.Methods:From July to August 2019, using the method of cluster sampling, 101 and 117 workers were selected from the electrolytic aluminum workshop of an aluminum plant in a region and the maintenance workshop of a plant in the same region. The venous blood of the subjects was collected, the plasma was extracted, and the blood aluminum concentration was measured by ICP-MS. According to the blood aluminum concentration and type of work, 93 workers who were lower than the median blood aluminum concentration and in the maintenance workshop of a factory were divided into low aluminum exposure group, and 85 workers who were higher than the median blood aluminum concentration and in the electrolytic aluminum workshop of an aluminum factory were divided into high aluminum exposure group. The basic information of the respondents, was collected through the employee physical examination form. The overall cognitive function of workers was evaluated by Beijing Montreal Cognitive Assessment Scale (MoCA) . Multiple linear regression analysis and logistic regression analysis were used for multiple statistical analysis.Results:Compared with the low aluminum exposure group (25.42±1.808) , the total score of MoCA in the high aluminum exposure group (23.84±2.919) was significantly lower, and the scores of visual space, executive function, abstract and delayed recall were significantly lower ( P<0.05) . Linear regression analysis showed that the total score of MoCA, visual space and executive function, naming and delayed recall were negatively correlated with blood aluminum concentration ( β=-0.018、-0.008、-0.003、-0.008, P<0.05) .MOCA total score, visual space and executive function, attention, language, abstraction, orientation were positively correlated with educational level ( β=0.853、0.310、0.216、0.171、0.412、0.122, P<0.05) . Logistic regression analysis showed that adjusting for age, smoking, drinking and education, blood aluminum was a risk factor for mild cognitive impairment ( OR=1.017, P<0.05) ; Education level was the protective factor of mild cognitive impairment ( OR=0.419, P<0.05) . Conclusion:Occupational aluminum exposure can affect the overall cognitive function of workers, and occupational aluminum exposure increases the risk of MCI.

Objective To investigate the influence of occupational aluminum exposure on cogmtive function and its relationship with tri-methyl histone H3 lysine residues 4 points (H3K4me3) and brain-derived neurotrophic factor (BDNF) levels.Methods By cluster random sampling method,a total of 235 cases of male workers selected from a Shanxi aluminum factory were recruited in the study in September 2015.Used the occupational epidemiological investigation questionnaire,which included Mini-Mental State Examination (MMSE),Clock Drawing Test (CDT),Digit Span Test (DST,including forward test DSFT and backward test DSBT),Fuild Object Memory Evaluation (FOME) and Verbal Fluency Test (VFT),to collect workers' basic information and assess their cognitive function score.Detected the concentration of aluminum in plasma by graphite furnace atomic absorption spectrometry.Workers were divided into three groups by the 25 percentile and 75 percentile of the aluminum content,such as low,middle and high aluminum concentration groups.The concentrations of H3K4me3 in lymphocyte and BDNF in plasma were determined by enzyme-linked immunosorbent assay.Results The levels of aluminum in plasma was 134.36 (100.14,178.96) μg/L.The scores of MMSE,DSFT,DSBT,DST of high aluminum concentration group were lower than low aluminum group (27.98±1.25 vs 28.83±1.54,9.19±2.00 vs 10.64±2.87,6.08±1.63 vs 7.19±3.07,15.27±3.11 vs 17.81±4.72,all P＜0.05),the scores of CDT,FOME,VFT among three groups had no statistical significance (all P＞0.05).The expression levels of H3K4me3 and BDNF of high aluminum concentration group were lower than the low group [(18.45±9.81) ng/μg Pro vs (23.76±9.89) ng/μg Pro,(26.07±10.18) ng/ml vs (31.66±9.24) ng/ml,all P＜0.05].Multiple correlation analysis showed that aluminum concentration were negatively correlated to H3K4me3,BDNF,MMSE,DSFT,DST,respectively (rs =-0.307、-0.214、-0.252、-0.197,-0.181,all P＜0.01).Conclusion Exposure to occupational aluminum for a long time may change cognitive function,which go along with the decreasing of H3K4me3 level in lymphocyte and BDNF protein expression in plasma.

Objective:To explore the effect of occupational aluminum (Al) exposure on workers' overall cognitive level and speech function.Methods:In July 2019, by using cluster sampling method, the group of 232 exposed to Al from an Al plant in Shanxi Province were selected as the exposed group, and the group of 228 not exposed to Al were selected as the control group. The blood Al concentration was determined by inductively coupled plasma mass spectrometry (ICP-MAS) . The exposed group was divided into high exposure group and low exposure group according to the median ( M) concentration of Al in serum. The general cognitive function and speech function were evaluated with the Montreal Cognitive Assessment Scale (MoCA) , and the differences in the general cognitive function and speech function between the groups were compared, and non-conditional logistic regression was used to analyze the possible influencing factors of mild cognitive impairment (MCI) . Results:There were significant differences in age, working age, education and drinking status between Al exposed group and control group ( P<0.05) . The total MoCA score, animal naming tese (ANT) score and category fluency repetition (CFT) score in Al exposure group were lower than control group and the differences were statistically significant ( P<0.05) . The full rate of ANT was lower than that of CFT in Al exposure group ( P<0.05) . The total MoCA score, ANT score and CFT score in the high exposure group were significantly lower than those in the control group ( P<0.05) . The score of MoCA, ANT and CFT in high exposure group were lower than those in low exposure group between the level of serum aluminum>60 μg/L group and ≤60 μg/L group ( P<0.05) . Logistic regression analysis showed that working age, serun Al concentration, ANT score, CFT score and SR score were the possible influencing factors of MCI in occupational Al exposure workers ( P<0.05) . Conclusion:Occupational Al exposure can lead to impaired speech function of workers, the higher the ANT score, CFT score and SR score, the lower working age and serum Al concentration, the lower risk of MCI.

Objective:To evaluate the effects of occupational aluminum exposure on workers' overall cognitive function and cognitive fields.Methods:From July to August 2019, using the method of cluster sampling, 101 and 117 workers were selected from the electrolytic aluminum workshop of an aluminum plant in a region and the maintenance workshop of a plant in the same region. The venous blood of the subjects was collected, the plasma was extracted, and the blood aluminum concentration was measured by ICP-MS. According to the blood aluminum concentration and type of work, 93 workers who were lower than the median blood aluminum concentration and in the maintenance workshop of a factory were divided into low aluminum exposure group, and 85 workers who were higher than the median blood aluminum concentration and in the electrolytic aluminum workshop of an aluminum factory were divided into high aluminum exposure group. The basic information of the respondents, was collected through the employee physical examination form. The overall cognitive function of workers was evaluated by Beijing Montreal Cognitive Assessment Scale (MoCA) . Multiple linear regression analysis and logistic regression analysis were used for multiple statistical analysis.Results:Compared with the low aluminum exposure group (25.42±1.808) , the total score of MoCA in the high aluminum exposure group (23.84±2.919) was significantly lower, and the scores of visual space, executive function, abstract and delayed recall were significantly lower ( P<0.05) . Linear regression analysis showed that the total score of MoCA, visual space and executive function, naming and delayed recall were negatively correlated with blood aluminum concentration ( β=-0.018、-0.008、-0.003、-0.008, P<0.05) .MOCA total score, visual space and executive function, attention, language, abstraction, orientation were positively correlated with educational level ( β=0.853、0.310、0.216、0.171、0.412、0.122, P<0.05) . Logistic regression analysis showed that adjusting for age, smoking, drinking and education, blood aluminum was a risk factor for mild cognitive impairment ( OR=1.017, P<0.05) ; Education level was the protective factor of mild cognitive impairment ( OR=0.419, P<0.05) . Conclusion:Occupational aluminum exposure can affect the overall cognitive function of workers, and occupational aluminum exposure increases the risk of MCI.

Objective:To compare the clinical utility of 18F-prostate specific membrane antigen (PSMA)-1007 and 18F-FDG PET/CT imaging in newly diagnosed hepatocellular carcinoma (HCC). Methods:From April 2022 to July 2022, 17 patients (14 males, 3 females, age 36-73(54.4±10.1) years) with newly diagnosed HCC who underwent 18F-FDG and 18F-PSMA-1007 PET/CT imaging within 3 d in the First Affiliated Hospital of Zhengzhou University were prospectively enrolled. ROIs were drawn from normal liver tissue (L), abdominal aorta (A), right gluteus medius (M), and SUV max of these regions were compared with the SUV max of primary tumor (T). Wilcoxon rank sum test and Kruskal-Wallis rank sum test were used to analyze the data. Results:18F-FDG PT/CT, 18F-PSMA-1007 PET/CT and enhanced MRI detected 1(0, 2), 2(1, 5) and 2(1, 4) tumor lesions of the liver in each patient respectively ( H=7.10, P=0.029), and 18F-PSMA-1007 detected more lesions than 18F-FDG ( P=0.024). Although SUV max of 18F-PSMA-1007 in HCC was significantly higher than that of 18F-FDG (25.7(17.1, 45.1) vs 6.3(2.9, 12.4); z=3.39, P=0.001), there was no significant difference of T/L ratio between 18F-PSMA-1007 and 18F-FDG PET/CT imaging (2.7(2.1, 4.7) vs 1.6(1.0, 4.5); z=0.52, P=0.602). T/A and T/M ratios were significantly higher in 18F-PSMA-1007 PET/CT imaging than those in 18F-FDG PET/CT imaging ( z values: 3.15, 3.53, P values: 0.002, <0.001). 18F-PSMA-1007 PET/CT imaging found high uptake foci in the liver and ribs in 2 cases, which were pathologically confirmed as bone metastasis of HCC, while those lesions were not found by 18F-FDG imaging. Conclusion:Compared with 18F-FDG, 18F-PSMA-1007 PET/CT demonstrates higher tumor uptake, more intrahepatic tumors foci and distant bone metastases.