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Table of Content

    25 March 2024, Volume 45 Issue 3
    Previous Issue   
    The value of CT measurement of abdominal fat and skeletal muscle in nutritional assessment of patients with gastric cancer
    HE Xiao-xiao1, MA Guo-hong2, LIU Yu2, LI Min1, YOU Yang1, YANG Li1
    2024, 45(3):  254-259.  doi:10.3969/j.issn.1007-3205.2024.03.002
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    Objective To investigate the value of CT measurement of abdominal fat and skeletal muscle in the nutritional assessment of patients with gastric cancer. 
    Methods Fifty-six patients with gastric cancer were consecutively collected, and clinical nutritional assessment indexes, nutritional risk screening 2002 (NRS2002) scores and patient-generated subjective global assessment (PG-SGA) scores were recorded. Visceral fat volume (VFV) and subcutaneous fat volume (SFV) of the umbilical plane and whole abdomen were measured, respectively. Then visceral-to-subcutaneous fat volume ratio (VSR) and visceral fat percentage (VF%) were calculated. Skeletal muscle volume (SMV) of the third lumbar transverse plane and the third lumbar vertebra plane were measured, and skeletal muscle index (SMI) was calculated. The correlations of CT measurements with clinical nutrition scores and clinical quantitative indexes were analyzed. 
    Results The single CT measurement results of abdominal fat and skeletal muscle had no correlation with NRS2002 and PG-SGA scores, while 2D and 3D measurements of VFV and SFV showed positive correlations (r=0.906, 0.921, P＜0.001). VFV and SFV were positively correlated with BMI (P＜0.001). SMI, 2D and 3D SMV were positively correlated with right upper arm muscle circumference and grip strength (P＜0.001). 
    Conclusion CT measurement indexes of abdominal fat and skeletal muscle are correlated with quantitative indexes of clinical nutritional assessment, which have certain value for nutritional assessment of gastric cancer patients.

    Effects of lipid-lowering drug Orlistat on proliferation and apoptosis of hepatocellular carcinoma cellline HepG2 through targeted lipid metabolism pathway
    DUAN Wei-jing, LYU Dong-ju, ZHAO Xing-min, LI Ying
    2024, 45(3):  260-270.  doi:10.3969/j.issn.1007-3205.2024.03.003
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    Objective To explore the function of fatty acid synthase (FASN) in the progression of hepatocellular carcinoma (HCC), in order to provide a favorable theoretical basis for the treatment of HCC. 
    Methods The expression and enrichment pathway of FASN in HCC tumor tissues were analyzed by bioinformatics. Cell Counting Kit-8 (CCK-8), colony formation and flow cytometry were used to detect cell viability, proliferation and apoptosis, respectively. Quantitative real-time polymerase chain reaction (qRT-PCR) was used to detect the level of FASN. The expression of BCL2-associated X (Bax) and B-cell lymphoma-2 (Bcl-2) was detected by Western blot. Lipophilic fluorescent dye BODIPY 493/503 was used to detect the accumulation of neutral lipids, and the levels of free fatty acids and glycerol were detected by reagent kit. 
    Results The expression of FASN in HCC tumor tissue was higher than that in paracancerous tissues. Based on verification in an in vitro cell model, the results showed that compared with MIHA cells, the expression of FASN was significantly upregulated in HCC cell lines (Huh-7, HepG2, Hep3B) (P＜0.05). Compared with the control group, the expression of FASN decreased in cells in the si-FASN group, but increased in the oe-FASN group (P＜0.05). Compared with the control group, the si-FASN group showed a decrease in HepG2 cell viability and clone count, while the oe-FASN group showed an increase in Hep3B cell viability and clone count (P＜0.05). Compared with the control group, the apoptosis rate of HepG2 cells increased in the si-FASN group, but decreased in the oe-FASN group (P＜0.05). Compared with the control group, the si-FASN group showed an increase in Bax expression and a decrease in Bcl-2 expression in cells. The expression of Bax decreased and the expression of Bcl-2 increased in the oe-FASN group cells (P＜0.05). Compared with the control group, the neutral lipid content decreased in the si-FASN group, but increased in the oe-FASN group (P＜0.05). Compared with the control group, the levels of free fatty acids and glycerol decreased in the si-FASN group but increased in the oe-FASN group (P＜0.05). Compared with the oe-NC+DMSO group, the expression of FASN decreased in the oe-NC+Orlistat group cells decreased, while compared with the oe-NC+Orlistat group, the expression of FASN in the oe-FASN+Orlistat group cells increased (P＜0.05). Compared with the oe-NC+DMSO group, the proliferation level of cells in the oe-NC+Orlistat group decreased and apoptosis was induced. Compared with the oe-NC+Orlistat group, the oe-FASN+Orlistat group showed increased cell proliferation and inhibited cell apoptosis (P＜0.05). Compared with the oe-NC+DMSO group, the expression of pro-apoptotic factor Bax increased in cells of the oe-NC+Orlistat group, while the expression of anti apoptotic factor Bcl-2 was reduced. Compared with the oe-NC+Orlistat group, the expression of pro-apoptotic factor Bax in the Orlistat+oe FASN group cells significantly reduced, while the expression of anti-apoptotic factor Bcl-2 increased (P＜0.05). Compared with the oe-NC+DMSO group, the neutral lipid content, free fatty acid level, and glycerol level in the oe-NC+Orlistat group cells reduced.  Compared with the oe-NC+Orlistat group, the neutral lipid content, free fatty acid level, and glycerol level in the oe-FASN+Orlistat group cells increased (P＜0.05). 
    Conclusion The results of this study emphasize the role of FASN in the promotion of HCC progression and lipid metabolism. The fatty acid synthase inhibitor Orlistat can inhibit FASN expression, which can inhibit HCC progression by regulating reprogramming in fatty acid metabolism.

    Analysis of the effect of m6A methylation regulatory factors on the prognosis of lung adenocarcinoma based on TCGA database
    WU Qi-fei, ZHANG Dong
    2024, 45(3):  271-277.  doi:10.3969/j.issn.1007-3205.2024.03.004
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    Objective To investigate the expression and prognosis of m6A methylation regulatory factors in lung adenocarcinoma by bioinformatics analysis. 
    Methods The transcriptome data and clinical data of 516 cases of lung adenocarcinoma were downloaded from TCGA database. The expression differences of 20 m6A methylation regulatory factors in lung adenocarcinoma tissues and paracancerous tissues were compared using R software analysis, and survival analysis was performed by univariate Cox regression analysis. Consensus Cluster Plus R method was used to perform m6A cluster survival analysis. 
    Results Sixteen m6A methylation regulatory factors were differentially expressed in lung adenocarcinoma, of which 5 m6A methylation regulatory factors (IGF2BP1, IGF2BP3, HNRNPC, RBMX, YTHDC2) were significantly associated with tumor stage, 7 m6A methylation regulatory factors (IGF2BP1, IGF2BP3, HNRNPC, RBMX, METTL3, YTHDF2, METTL14) were significantly associated with T stage, and 2 m6A methylation regulatory factors (IGF2BP3, YTHDC2) were significantly associated with N stage. Cox regression analysis showed that 6 m6A methylation regulatory factors (IGF2BP1, IGF2BP2, IGF2BP3, HNRNPA2B1, HNRNPC, RBM15) were independent prognostic factors of lung adenocarcinoma. 
    Conclusion m6A methylation regulatory factors are associated with the progression of lung adenocarcinoma. In addition, the 6 m6A methylation regulatory factors can be used as potential biomarkers to predict the prognosis of lung adenocarcinoma patients. 

    Establishment and validation of probability prediction model for benign and malignant pulmonary nodules
    HUANG Yu-yan1, DENG Tai-bing2, PANG Min1, JIANG Yong-jie1, JIANG Li1
    2024, 45(3):  278-283.  doi:10.3969/j.issn.1007-3205.2024.03.005
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    Objective To analyze the clinical characteristics and imaging manifestations of pulmonary nodules, to screen the factors that affect the malignancy of pulmonary nodules, and to establish and validate prediction models, thus providing a reference basis for the differentiation of benign and malignant pulmonary nodules. 
    Methods A total of 1 160 patients with pulmonary nodules were selected as the research subjects, and then randomly divided into two groups at a ratio of 2〖DK〗∶1: a modeling group (n=773) and a validation group (n=387). Univariate analysis was conducted on the data of modeling group, and variables with statistically significant differences were included in binary logistic regression analysis to obtain independent predictive factors for benign and malignant pulmonary nodules, and to establish a probability prediction model for benign and malignant lesions. The predictive performance of this model with traditional classic models such as Mayo model, Brock model, VA model, and model of Peking University People′s Hospital was verified and compared. 
    Results Age, gender, family history of lung cancer, nodule texture, nodule diameter, lobulation sign, vacuolar sign, vascular bundle sign, calcification sign, bronchiolitis sign, and pleural traction sign were independent predictors of benign and malignant pulmonary nodules (P＜0.05). The area under the receiver operating characteristic (ROC) curve (AUC) of this model (0.856) was higher than that of the Mayo model (0.604), Brock model (0.447), VA model (0.569), and model of Peking University People′s Hospital (0.677), with a predictive sensitivity of 86.10% and a specificity of 73.70%. 
    Conclusion The prediction model constructed in this study is with good diagnostic efficacy, which may be superior to the traditional models, which has greater reference value for clinicians to distinguish the benign and malignant pulmonary nodules. 

    Effect of peripheral blood CD8+ T lymphocyte level and CTC expression on the prognosis of stage Ⅲ colorectal cancer patients undergoing adjuvant radiochemotherapy after radical surgery
    XIONG Lu-ning, DONG Jiu-xing, ZHAO Jia, REN Ji-yong, LIU Jun
    2024, 45(3):  284-288.  doi:10.3969/j.issn.1007-3205.2024.03.006
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    Objective To explore the effect of peripheral blood cluster of differentiation 8-positive cells （CD8+） T lymphocyte level and expression of circulating tumor cells (CTC) on the prognosis of stage Ⅲ colorectal cancer (CRC)patients undergoing adjuvant radiochemotherapy after radical surgery. 
    Methods We selected 156 CRC patients undergoing adjuvant radiochemotherapy after radical surgery in our hospital as research subjects. They were followed up for 6 months.According to presence of recurrence during the follow-up period, they were divided into non-rercurrence group (n=112) and recurrence group (n=44). T lymphocyte subsetlevel and CTC expression levels were detected in patients at 1 d after surgery, to explore the relationship between the positive rate of CTC expression and the clinicopathological characteristics of patients, and to investigate the predictive value of the above indicators for prognosis of patients. 
    Results Compared with non-recurrence group, recurrence group had lower CD3+, CD4+, and CD4+/CD8+ levels, but higher CD8+ levels (P＜0.05). CTC expression in the peripheral blood of patients was determined, and CTC count was (2.56±0.87) in non-recurrence group and (6.68±2.74) in recurrence group, suggesting significant differences (t=9.782, P＜0.05). CTC expression of patients was not related to gender, age, lymph node metastasis, or degree of tissue differentiation of patients (P＞0.05). Receiver operating characteristic (ROC) curve was used to analyze the predictive value of T lymphocyte subset levels and CTC expression for recurrence, and the area under the curve (AUC) of CD3+, CD4+, CD8+, CD4+/CD8+ and CTC expression was 0.852, 0.703, 0.712, 0.747, and 0.920, respectively. The AUC of the combined application of the above indexes in predicting the recurrence of the patients was 0.954. 
    Conclusion Low expression of CD3+, CD4+, CD4+/CD8+, and high expression of CD8+ and CTC in patients with stage Ⅲ CRC undergoing adjuvant chemoradiotherapy after radical surgery will increase the postoperative recurrence rate, and the combined detection of all indicators has certain predictive value for the prognosis of patients. 

    Significance of detection of contrast-enhanced ultrasound quantitative parameter in patients with ovarian epithelial tumors
    JIANG Xue-qing, LI Xiao-qing, LI Xiao-tong, CHENG Wei-ran
    2024, 45(3):  289-295.  doi:10.3969/j.issn.1007-3205.2024.03.007
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    Objective To investigate the application of contrast-enhanced ultrasound (CEUS) quantitative parameters in differential diagnosis of ovarian epithelial tumors and its correlation with neovascularization in malignant transformation. 
    Methods In total, 102 patients with ovarian epithelial tumors were selected and divided into malignant group (n=51) and benign group (n=51). CEUS parameters of the two groups were collected, and receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic value of CEUS parameters for the differential diagnosis of ovarian epithelial tumors. Logistic regression analysis was used to investigate the relationship between CEUS parameters and the incidence of ovarian epithelial cancer. Correlation analysis was used to investigate the relationship between CEUS parameters, microvascular density (MVD), International Federation of Gynecology and Obstetrics(FIGO) stage, differentiation degree, and lymph node metastasis in the malignant group, as well as the relationship between CEUS parameters and MVD in the malignant group. 
    Results The initial increase time and peak time in the malignant group were lower than those in the benign group, while the peak intensity, enhancement rate, and area under the time-intensity curve were higher than those in the benign group(P＜0.05). The area under the ROC curve (AUC) of various CEUS parameters in combination in diagnosing ovarian epithelial tumors was greater than that of each parameter alone (P＜0.05). Logistic regression results showed that the initial increase time, peak time, peak intensity, enhancement rate, and area under the time-intensity curve were all associated with the development of ovarian epithelial cancer (P＜0.05).The initial increase time, peak time in the malignant group were negatively correlated with FIGO stage and lymph node metastasis, and positively correlated with differentiation degree, while peak intensity, enhancement rate, area under the time-intensity curve, and MVD were positively correlated with FIGO stage and lymph node metastasis, and negatively correlated with differentiation degree (P＜0.05). The initial increase time, peak time in the malignant group were negatively correlated with MVD, while PI, enhancement rate, and area under the time-intensity curve were positively correlated with MVD (P＜0.05). 
    Conclusion CEUS quantitative parameters have certain diagnostic value in the identification of ovarian epithelial tumors, and malignant tumors in patients are closely related to FIGO stage, lymph node metastasis, degree of differentiation, and neovascularization, which can provide reference for clinical identification of ovarian epithelial tumors. 

    Construction of Nomogram model for predicting the risk of postoperative incisional infection in patients with cervical cancer combined with diabetes mellitus
    YU Jing, WANG Miao, JIANG Qian
    2024, 45(3):  296-302.  doi:10.3969/j.issn.1007-3205.2024.03.008
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    Objective To construct a nomogram model to predict the risk of postoperative incisional infection in patients with cervical cancer combined with diabetes mellitus (DM)undergoing radical hysterectomy and to evaluate the model. 
    Methods A total of 267 patients with cervical cancer and DM who received radical hysterectomy in our hospital were selected as the research subjects, including 97 patients with postoperative incision infection (infection group) and 170 patients without infection (uninfection group). Univariate and multivariate logistic regression analyses were used to screen for independent influencing factors related to postoperative incision infection. A nomogram model was plotted using R software and related packages. 
    Results Compared with the uninfection group, the proportion of patients with age ≥ 55 years, body mass index (BMI) ≥ 25, retention time of drainage tube ≥ 7 days, length of hospital stay ≥ 14 days, and serum albumin<30 g/L in the infection group was significantly increased (P＜0.05). Compared with the uninfection group, the infection group had significantly increased levels of serum interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), C-reactive protein (CRP) and procalcitonin (PCT) (P＜0.05). Multivariate logistic regression analysis showed that age ≥ 55 years, BMI ≥ 25, retention time of drainage tube ≥ 7 days, length of hospital stay ≥ 14 days, as well as elevated levels of serum IL-6, TNF-α, CRP and PCT were independent risk factors for postoperative incision infection (P＜0.05). The nomogram used to assess the risk of postoperative incision infection in patients with cervical cancer and DM had good prediction accuracy (C index was 0.947), discrimination ［area under the receiver operating characteristic(ROC) curve (AUC)was 0.947］, consistency (mean absolute error of Hosmer Lemeshow goodness of fit test was 0.011), and clinical efficacy. 
    Conclusion In this study, a nomogram model for predicting postoperative incisional infection in patients with cervical cancer combined with DM was constructed based on perioperative characteristics. The model may help to enhance awareness of infection control and provide a reference for the management of high-risk patients after radical hysterectomy.

    Correlation analysis of FBXO22 expression with HPV genotype and histopathologic findings in patients with cervical cancer
    HUANG Xin-rui, GAO Fu-xian, WANG Chun-xiao, BAI Xue, XU Yan-yan
    2024, 45(3):  303-307.  doi:10.3969/j.issn.1007-3205.2024.03.009
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    Objective To explore the correlation between the expression of F-box only protein 22 (FBXO22) and human papilloma virus (HPV) genotypes and pathological findings in patients with cervical cancer. 
    Methods A total of 108 patients with cervical cancer were selected for HPV test, and HPV genotyping was performed. The expression of FBXO22 protein was detected by immunohistochemistry, and correlation among indicators was evaluated by Spearman rank correlation analysis. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic performance. 
    Results The positive expression rate of FBXO22 was 91.67% in high-risk HPV patients and 69.44% in low-risk HPV patients. The positive expression rate of FBXO22 in the high-risk HPV group was higher than that in the low-risk HPV group (P＜0.05). With an increase in the number of stages Ⅰ to Ⅳ of squamous cell carcinoma, the positive expression rate of FBXO22 also increased (P＜0.05). With the increase in the degree of differentiation, the positive expression rate of FBXO22 decreased (P＜0.05). There was a positive correlation between high-risk and low-risk HPV infection and FBXO22 protein levels (r=0.859, 0.704, P=0.005, 0.009). The degree of differentiation and clinical stage were positively correlated with FBXO22 protein levels (r=0.884, 0.873, P=0.002, 0.003). The ROC curve analysis results showed that the specificity and the area under the ROC curve (AUC) of FBXO22 protein combined with hrHPV DNA detection were 89.23% and 0.823%, respectively, which were significantly higher than those detected by each indicator alone (P＜0.001). 
    Conclusion The expression of FBXO22 in cervical cancer patients is closely related to high-risk HPV infection, and also reflects the differentiation degree and clinical stage of cervical cancer patients. The combined detection of FBXO22 and high-risk HPV is of great significance for the early prevention and treatment of cervical cancer.

    Anxiety preconditioning exacerbates motor behavior impairment in mice with MPTP-induced acute Parkinson′s disease
    YUAN Xiao-yang1, GU Ping1, LIU Jun-qian1, QIU Fu-cheng1, LI Dong1, LYU Jun-li2
    2024, 45(3):  313-320.  doi:10.3969/j.issn.1007-3205.2024.03.011
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    Objective To investigate the impact of anxiety preconditioning on movement, emotion and cognition in an1-methyl-4-phenyl-1， 2， 3， 6-tetrahydropridine (MPTP)-induced Parkinson′s disease (PD) mice model. 
    Methods Sixty-eight healthy male C57BL/6J mice (aged 13 weeks) were randomly divided into 4 groups: control group (n=17), anxiety preconditioning group (n=17), acute PD model group (n=17), and acute PD model with anxiety preconditioning group (n=17). Based on open field test, elevated plus maze test, pole climbing test, water maze test and changes of tyrosine hydroxylase positive (TH+) neurons in the nigra-striatum, the effects of anxiety preconditioning on motor, emotion and cognition and dopaminergic neurons of PD mice were investigated. 
    Results On the 2nd day after anxiety preconditioning, the elevated plus maze test showed that the percentage of open arm entries (OE%) and open arm retention time (OT%) in the anxiety preconditioning group were lower than those in the control group. The OE% and OT% in the acute PD model group were lower than those in the acute PD model with anxiety preconditioning group (P＜0.05). On the 6th day after anxiety preconditioning, the elevated plus maze test showed no statistically significant difference in OE% and OT% among the four groups (P＞0.05). On the 5th day after anxiety preconditioning, an open field test was conducted, and there was no significant difference in the percentage of center distance, time, and number of grid crossings among the four groups (P＞0.05). On the 7th day after anxiety preconditioning, the pole climbing test showed that compared with the control group, anxiety preconditioning group, and acute PD model group, the pole climbing time of the acute PD model with anxiety preconditioning group increased (P＜0.05). On the 8th to 13th day after anxiety preconditioning, the water maze test showed that compared with the control group and anxiety preconditioning group, the mice in the acute PD model with anxiety preconditioning group had a longer latency for seeking the platform, a shorter retention time in the target platform quadrant, a longer exercise distance, and a larger number of platform crossings (P＜0.05). The number of TH+neurons in the substantia nigra of the acute PD model group and the acute PD model with anxiety preconditioning group was lower than that of the control group and the anxiety preconditioning group, and the difference was statistically significant (P＜0.05). There was no statistically significant difference in the number of TH+neurons in the substantia nigra between the acute PD model with anxiety preconditioning group and the acute PD model group (P＞0.05). The mean optical density (MOD) of TH+neurons in the striatum of the acute PD model group was lower than that of the control group, and lower in the acute PD model with anxiety preconditioning group than in the anxiety preconditioning group (P＜0.05). 
    Conclusion Anxiety preconditioning could probably to some extent damage striatum dopaminergic neurons and aggravate the damage of the motor function in MPTP-induced acute PD mice. 

    Effect of upper limb rehabilitation robot-assisted rehabilitation training on upper limb motor function in patients with subacute hemiplegia after stroke
    LIU Yang-yang, XU Chang, LIU Yang
    2024, 45(3):  321-325.  doi:10.3969/j.issn.1007-3205.2024.03.012
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    Objective To explore the effect of upper limb rehabilitation robot-assisted rehabilitation training on upper limb motor function in patients with subacute hemiplegia after stroke. 
    Methods A total of 76 patients with subacute hemiplegia after stroke who were admitted to the hospital were selected and divided into research group (n=38) and control group (n=38) according to the random number table method. The two groups were treated with rehabilitation training, and the research group was additionally given upper limb rehabilitation robot-assisted therapy. Both groups received intervention for 3 weeks. Fugl-Meyer Motor Function Scale score, functional independence score, Brotez hand function score and activity of daily living (ADL) score were compared between two groups. 
    Results After treatment, Fugl-Meyer Motor Function Scale score, functional independence score, Brotez hand function score and ADL score in both groups were higher than those before treatment, and higher in the research group (28.73±4.88, 84.32±15.27, 27.28±4.83, 81.47±12.81), respectively than in the control group (24.62±4.35, 76.15±13.44, 23.54±4.19, 73.58±12.25) (P＜0.05). 
    Conclusion The upper limb rehabilitation robot-assisted training can improve recovery of motor function of the upper limbs and the quality of life. 

    Effects of plasma Hcy and ApoE gene polymorphisms on cognitive function and therapeutic effect in patients with vascular dementia
    LI Kang-rui, YE Min, SHANG Yu
    2024, 45(3):  326-331.  doi:10.3969/j.issn.1007-3205.2024.03.013
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    Objective To investigate the effect of serum homocysteine (Hcy) and apolipoprotein E (ApoE) gene polymorphisms on cognitive function in patients with vascular dementia. 
    Methods Retrospective analysis was performed on 100 patients with vascular dementia treated in hospitals as research subjects. The cognitive function of the patients was evaluated by the mini-mental state examination (MMSE). Patients with MMSE score of 21-26 were included in the mild group, those with MMSE score of 10-20 were included in the moderate group, and those with MMSE score of 0-9 were included in the severe group. According to the Chinese Guidelines for the Diagnosis and Treatment of Dementia and Cognitive Dysfunction, the patients were given conventional treatment. The main examination items before treatment included plasma Hcy and ApoE gene polymorphisms, and the clinical efficacy was recorded at 3 months after treatment. The relationship of ApoE gene polymorphism and Hcy with cognitive impairment and clinical efficacy in patients with vascular dementia was analyzed. 
    Results The MMSE score of 100 patients with vascular dementia was 16.50 (9.00, 20.00), including 24 mild cases, 49 moderate cases and 27 severe cases; the proportion of patients with APOE gene phenotype of ε2/4 and ε4/4 in the severe group was higher than that in the mild and moderate group, and the plasma Hcy level at admission was higher than that in the mild and moderate group, suggesting significant difference (P＜0.05). Multivariate logistic regression analysis showed that plasma Hcy and ApoE genes were risk factors for exacerbation of cognitive impairment in patients with vascular dementia (P＜0.05). In 100 patients with vascular dementia, at 3 months after treatment, 47 cases showed significant improvement, 30 cases were improved, 23 cases were ineffective, and the total effective rate was 77.00%. Binary logistic regression analysis showed that plasma Hcy and ApoE genes could affect the therapeutic effect of patients with vascular dementia (P＜0.05). 
    Conclusion ApoE gene polymorphism and Hcy are closely related to the severity and clinical significance of cognitive impairment in patients with vascular dementia. In the future, the severity of cognitive impairment and the risk of ineffective treatment can be evaluated by detecting the ApoE gene polymorphism and Hcy level of patients. Targeted interventions can be taken to improve the clinical efficacy of patients with serious conditions and high risk of ineffective treatment.

    Gender difference in grip strength and cognitive function: A cross-sectional study from National Health and Nutrition Examination Survey 2011-2014
    ZHANG Nan-nan1, LIU Ye-song1, LI Xiao-jie1, WANG Xiao-jie2, QIN Pei2
    2024, 45(3):  332-342.  doi:10.3969/j.issn.1007-3205.2024.03.014
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    Objective To investigate the gender difference in the association between grip strength and cognitive function. 
    Methods Cross-sectional study was conducted using database of the National Health and Nutrition Examination Survey (NHANES) 2011-2014, to evaluate four cognitive domains: immediate memory, delayed memory,  speech fluency, and attention. Weighted linear regression, weighted Logistic regression and interaction analysis were applied. 
    Results Regression analysis showed that in males, compared with the group with the lowest grip strength, the group with the highest grip strength had a lower overall cognitive function decline (OR=0.377, 95%CI: 0.182-0.781) and a lower risk of immediate memory decline (OR=0.409, 95%CI: 0.221-0.759). In femlaes, grip strength was significantly and negatively correlated with overall cognitive function decline (OR=0.405, 95%CI: 0.224-0.733), decreased speech fluency (OR=0.567, 95%CI: 0.356-0.902), and decreased attention (OR=0.357, 95%CI: 0.211-0.607). Meanwhile, there was a significant interaction between gender and grip strength in overall cognitive function verbal fluency and attention, but no significant interaction was detected in the two cognitive domains of immediate memory, and delayed recall. 
    Conclusion There is significant gender difference in the association between grip strength and overall cognitive function and cognitive domains. The finding suggests that strengthening grip strength levels, especially in females, may be beneficial in preventing cognitive decline. 
    Detection and clinical significance of triglyceride glucose index and LP-PLA2 level in elderly patients with H-type hypertension and acute cerebral infarction
    LI Ju-rong, WANG Meng-xu, LUO Xiu-fang
    2024, 45(3):  343-347.  doi:10.3969/j.issn.1007-3205.2024.03.015
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    Objective To investigate the triglyceride glucose (TyG) index and lipoprotein-associated phospholipase A2 (LP-PLA2) levels and their clinical significance in elderly patients with H-type hypertension and acute cerebral infarction (ACI). 
    Methods A total of 97 elderly patients with H-type hypertension complicated with ACI (research group) and 148 elderly patients with H-type hypertension (control group) were retrospectively analyzed. The clinical data, and TyG and LP-PLA2 levels were compared between the two groups. According to the area of cerebral infarction, the elderly patients with H-type hypertension and ACI were divided into three subgroups: mild infarction group (n=31), moderate infarction group (n=42) and severe infarction group (n=24). The levels of TyG and LP-PLA2 in elderly patients with H-type hypertension and different degrees of ACI were compared. Pearson correlation analysis was used to analyze the relationship between TyG, LP-PLA2 levels and cerebral infarction volume. Multivariate Logistic regression analysis was used to determine the influencing factors of ACI in elderly patients with H-type hypertension. 
    Results The proportion of grade 2/3 hypertension, systolic blood pressure, diastolic blood pressure, low-density lipoprotein cholesterol, homocysteine (Hcy), TyG, and LP-PLA2 levels in the research group were higher than those in the control group (P＜0.05). The levels of TyG (7.46±1.28, 8.15±1.32) and LP-PLA2 ［(197.85±38.62) μg/L, (229.74±47.51) μg/L］ in moderate infarction group and severe infarction group were higher than those in mild infarction group ［(6.83±1.15) μg/L and (175.68±34.59) μg/L］. The levels of TyG and LP-PLA2 in the severe infarction group were higher than those in the moderate infarction group (P＜0.05). TyG and LP-PLA2 levels were positively correlated with cerebral infarction volume in elderly patients with H-type hypertension and ACI (r=0.547 and 0.623, P=0.026 and 0.018). Multivariate analysis showed that hypertension (OR=2.912, 95%CI: 1.728-4.908), Hcy (OR=2.959, 95%CI: 1.756-4.987), TyG (OR=3.114, 95%CI: 1.848-5.248) and LP-PLA2 (OR=3.364, 95%CI: 1.996-5.668) were all related influencing factors for ACI in elderly patients with H-type hypertension (P＜0.05). 
    Conclusion TyG and LP-PLA2 levels are increased in elderly patients with H-type hypertension and ACI. TyG and LP-PLA2 are closely related to ACI in elderly patients with H-type hypertension. 

    Dynamic changes of VILIP-1, Annexin A2 and sEPCR during intravenous thrombolytic therapy in patients with cerebral infarction and their correlation with outcome of disease
    LI Ci, QI Ling
    2024, 45(3):  348-354.  doi:10.3969/j.issn.1007-3205.2024.03.016
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    Objective To investigate the dynamic changes of Visinin-like protein-1 (VILIP-1), Annexin A2 and soluble endothelium protein c receptor (sEPCR) during the course of intravenous thrombolytic therapy in patients with cerebral infarction and their correlation with outcome of disease, so as to provide reference for clinical prediction and improvement of patient prognosis. 
    Methods One hundred and five patients with acute cerebral infarction (ACI) were selected for a prospective study, and all received intravenous thrombolytic therapy. The patients were followed up during outpatient visit for 28 d. The patients were divided into good and poor groups according to their outcome of disease, and the levels of VILIP-1, Annexin A2, and sEPCR were detected before thrombolysis, and at 1 d and 3 d after thrombolysis in both groups, to analyze their correlation with mRS score. The characteristic variables were screened by random forest algorithm, and the influencing factors of outcome of disease were analyzed. In addition, the value of VILIP-1, Annexin A2, and sEPCR alone and in combination in predicting the outcome of disease at different time points were analyzed. 
    Results The National Institutes of Health Stroke Scale (NIHSS) score, D-dimer (DD), fibrinogen, and triglycerides in the poor group were higher than those in the good group (P＜0.05). The levels of VILIP-1 and sEPCR in the two groups decreased with the prolongation of thrombolysis time, while Annexin A2 increased with the prolongation of thrombolysis time (P＜0.05). The VILIP-1, sEPCR, and Annexin A2 fluctuations in the poor group were higher than those in the good group (P＜0.05). VILIP-1 and sEPCR were positively correlated with mRS scores at 1 day and 3 days after thrombolysis, while Annexin A2 was negatively correlated with mRS scores (P＜0.05). Selecting 390 decision trees, the optimal result was obtained. The top 4 variables in importance ranking were sEPCR, Annexin A2, NIHSS score, and VILIP-1, all of which were correlated with mRS score (P＜0.05). At 3 days after thrombolysis, the combination of the three had the highest AUC, with a predictive sensitivity of 78.79% and a specificity of 95.83%. 
    Conclusion Abnormal expression of serum VILIP-1, Annexin A2 and sEPCR is related to the degree of brain injury and prognosis of thrombolysis in patients with cerebral infarction, and the prognostic value of the combined detection at 3 d after thrombolysis is higher, which can be used as an important marker for prognosis prediction in patients with cerebral infarction. 

    Early staged nutritional support in elderly patients with stroke combined with dysphagia and its effect on immune-inflammation and gastrointestinal tolerance
    ZHAO Li-min, ZHANG Ya-zhou, WEN Li-fen, WANG Yan-jiao, ZHAO Rui-xian, WU Xing-ling
    2024, 45(3):  355-360.  doi:10.3969/j.issn.1007-3205.2024.03.017
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    Objective To investigate the application of early staged nutritional support in elderly patients with stroke combined with dysphagia, and to analyze its effects on immune-inflammation and gastrointestinal tolerance of patients. 
    Methods Using a prospective study method, 86 elderly patients with stroke were selected and divided into the control group (n=43) and the observation group (n=43) according to the random number table method. The control group was given conventional nutritional support, the observation group was given early staged nutritional support, and both groups were continuously intervened for 2 weeks. The nutritional status ［hemoglobin (Hg), serum albumin (SA), prealbumin (PAB)］, abdominal circumference, upper arm circumference, triceps skinfold thickness on the healthy side, immuno-inflammatory indexes ［total lymphocyte count (TLC), interleukin-6 (IL-6), interleukin-33 (IL-33), hypersensitive C-reactive protein (hs-CRP)］ before and at 2 weeks after intervention were compared between two groups, and the gastrointestinal tolerance of the two groups was observed. 
    Results At two weeks after intervention, the observation group had higher Hg, SA, PAB levels, abdominal circumference, and TLC than the control group, and lower IL-6, IL-33, and hs-CRP than the control group (P＜0.05). The gastrointestinal tolerance of the observation group was higher than that of the control group (P＜0.05). 
    Conclusion Early staged nutritional support can help maintain the nutritional status of elderly stroke patients with dysphagia, which can improve immune-inflammatory status, and enhance gastrointestinal tolerance. 

    Diagnostic value of TG/Cys-C ratio combined with MDA level in patients with type 2 diabetes mellitus complicated with nephropathy
    CHU Li1, REN Chuan-lu1, DING Jun2, XIAO Li 1, WU Wei1, ZHOU Xin1
    2024, 45(3):  368-372.  doi:10.3969/j.issn.1007-3205.2024.03.019
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    Objective To investigate the diagnostic value of triglyceride/cystatin C (TG/Cys-C) ratio combined with malondialdehyde (MDA) level in patients with type 2 diabetes mellitus (T2DM). 
    Methods The clinical data of 300 patients with T2DM were collected, and the patients were divided into T2DM group and diabetic kidney disease (DKD) group according to complication of kidney disease. The influencing factors of DKD in T2DM patients were analyzed, and the levels of triglycerides (TG), cystatin C (Cys-C), and MDA were detected. The diagnostic value of the levels of TG/Cys-C and MDA alone and in combination for the diagnosis of DKD in T2DM patients was analyzed by receiver operating characteristic (ROC) curve. 
    Results The TG/Cys C ratio in the T2DM and DKD group was lower than that in the T2DM group, while the levels of MDA, ACR, and SCR were higher than those in the T2DM group, with statistical significance (P＜0.05). Logistic regression analysis showed that the TG/Cys C ratio and MDA level were independent risk factors for T2DM and DKD patients (P＜0.05). The area under the ROC curve (AUC) values of TG/Cys C ratio and MDA level for the diagnosis of T2DM patients with nephropathy were 0.809 and 0.837 respectively (95%CI: 0.760-0.852, 0.791-0.877, respectively). The AUC value for the combined diagnosis of the two was 0.915 (95%CI: 0.877-0.944). 
    Conclusion Both TG/Cys-C ratio and MDA levels have certain reference value for the diagnosis of DKD in T2DM patients, and the combination of TG/ CyS-C ratio and MDA level is of higher value for the diagnosis of DKD in T2DM patients.