BACKGROUND: There are about 20 millions people suffering from mental retardation in China and about 200 thousands newborns of mental retardation are born every year. Mental retardation in children is a result of multiple factors.OBJECTIVE: To explore the popular causes of mental retardation in order to provide scientific evidence for effectively preventing mental retardation.DESIGN: An observational case study taking children with mental retardation as the subjects.SETTING: Population and family plan institute of a hospital.PARTICIPANTS: Totally 1 336 disabled children in 6 counties of Tai' an city diagnosed by family planning authority from January 1998 to December 2001 were selected. Inclusive criteria: intelligence quotient(IQ) < 55 and met the condition of disabled children, aged over 4 years old, those whose parents requested to give birth to the second baby due to mental retardation of the first children. Exclusive criteria: Disabled children with diseases of other systems. A total of 613 disabled kids met the above standards, aged from 4 to 14 years old, including 509 boys and 104 girls with the ratio of boy to girl of 4.9 to 1.INTERVENTIONS: All the children with mental retardation were examined by professional pediatrists and experts of family planning medical appraisal and conducted IQ test by using Chinese Wechsler Intelligence Scale for Children(C-WISC). Uniform survey was made according to all the data and processed by SPSS10. 0.MAIN OUTCOME MEASURES: The main factors caused mental retardation in kids.RESULTS: Among the 1 336 disabled kids in Tai' an city, the incidence rate of mental retardation was 45.88%. There were 112 mild cases and 501 severe cases with mental retardation among the 613 disabled kids. The component ratio of etiological classification on prenatal, perinatal and postnatal factors was 36.7%, 29.85% and 13.21% respectively, and 20. 23% of them were caused by unclear reasons.CONCLUSION: It is the key mean to prevent the occurrence of mental retardation by reinforcing maternal health, improving obstetric quality, preventing acquired disease and paying attention to early education.

Objective To discuss the surgical therapy of primary leiomyosarcoma of the inferior vena cava(PIVCLS).Methods Retrospective analysis of was made 5 patients of PIVCLS from Oct 2009 to May 2011 hospitalized in Department of Vascular Surgery,Provincial Hospital Affiliated to Shandong University.All patients underwent surgical resection,combined with reconstruction of bilateral renal vein and distal inferior vena cava using artificial vascular graft.Results Surgical resection was performed successfully in all patients.The mean operation time was 166.6 min,with mean blood loss 1 560 mL.Leiomyosarcoma intruding the inferior vena cava and right renal vein were observed in all patients during operation.The mean size was 12 cm × 10 cm× 8 cm.The diagnosis of PIVCLS in 5 patients was confirmed by postoperative pathologic examination.All patients did not present lower extremity swelling after surgery and discharged from hospital with normal blood (BUN) and (CREA).All patients were administrated with oral warfarin therapy after discharge.No clinical relapse and pulmonary embolism was observed during the follow-up (range 3 months to 12 months).The ultrasound revealed the patency of artificial vascular grafts in all patients.Conclusions Surgical resection combined with reconstruction of bilateral renal vein and distal inferior vena cava using artificial vascular graft is an effective and feasible treatment of PIVCLS.Leiomyosarcoma is completely eliminated and important abdominal viscera are protected well during the procedure because of minimal impact on hemodynamics.The incidence of postoperative pulmonary embolism also decreases obviously.

Objective To investigate the effects of silenced Racl on invasion and migration in LOVo cells.Methods The expression of Racl mRNA and protein in colorectal cancer cells(including LoVo SW480.SW620.SW1116,HT29)were detected by RT-PCR and Western blot,respectively.The changes of cytoskeleton were observed in LoVO cells after transfected with Racl-shRNA.then invasion and migration were recorded respectively in LoVo cells after transfected with Racl-N17 and Racl-L61.Results Racl mRNA and protein were overexpressed in all selected colorectal cancer cells.Deletion of Racl decreased the cross-linked actin network and pseudopodia,and inhibited the invasion and migration in LoVo cells.The migration experiment showed that the migrated cells were higher in Racl-shRNA[(75±5)cells].Racl-N17 [(93±5)cells]and Racl-L61[(267±7)cells]groups compared with control group[(214±8)cells,P＜0.01,＜O.01 and＜0.05,resprectively].The invasion experimental study revealed that the migrated cells were higher in Racl-shRNA[(35±5)cells],Racl-N17[(42±5)cells]and Racl-L61[(86±7)cells] groups compared with control group[(73±6)cells,P＜0.01,＜0.01 and＜0.05,resprectively].Condusion Deletoin of Racl can inhibit the invasion and migration in LDVo cells.

Objective To discuss the diagnosis and surgical treatment for carotid body tumors (CBT). Methods Retrospective analysis was made on 16 cases of carotid body tumors hospitalized in Shandong Provincal Hospital from January 2003 to October 2010. All patients were diagnosed by digital subtraction angiography, including 3 case of Shamblin type Ⅰ,11 cases of Shamblin type Ⅱ and 2 cases of Shamblin type Ⅲ. Three cases of type Ⅰ and 3 cases of type Ⅱ underwent carotid body tumor resection. Three cases of type Ⅱ underwent carotid body tumor plus external carotid artery resection, 3 cases underwent carotid body tumor plus external carotid artery resection plus carotid artery repairment, 2 cases did carotid body tumor plus external carotid artery resection plus internal carotid artery reconstruction. One of type Ⅲ underwent carotid body tumor plus external carotid artery resection plus carotid artery repairment, and the other one underwent carotid body tumor plus external carotid artery resection plus internal carotid artery reconstruction. Results Diagnosis of CBT was confirmed by pathology in all cases. There was no postoperative death、hemiplegia and blindness. The cranial nerve injury was caused in 7 cases, accounting for 43. 75%. 13 cases ( 81. 25% ) were followed up for 2 to 76 months ( mean 42 months), no tumor recurrence and metastasis was found. Conclusions Digital subtraction angiography (DSA) is important in the diagnosis and therapy of carotid body tumor. Surgical treatment is the choice of therapy for carotid body tumors.

Objective To assess the positive predictive value (PPV) of fetal sex chromosome aneuploidy (SCA) identified by non-invasive prenatal testing (NIPT) and investigate families' acceptance of SCA fetus. Methods All suspected SCA cases screened by NIPT from singletons were reviewed in Prenatal Diagnosis Center of Shanghai First Maternity and Infant Hospital from April 1, 2015 to October 31, 2017. Maternal age, NIPT indications, prenatal diagnosis protocols, testing results and their pregnancy determinations were analyzed. Results NIPT was provided to 35827 singletons and 86 suspected SCA cases were identified out of 35823 successful ones, giving a positive detection rate of 0.24％. The average maternal age was (31.5±5.0) years. After genetic counseling, 20 patients declined prenatal diagnosis,the rest 66 cases proceeded with aminiocentesis and fetal chromosomal testing, of which 32 were cytogenetically diagnosed as SCA with the PPV of 48.5％ . The SCA fetus consisted of 25 sex chromosome trisomies (seven cases of 47,XXX, three cases of 47,XYY and 15 cases of 47,XXY), one monosomy X (45,X), three mosacisms (47,XXY/48,XXYY, 47,XXX/45,X, 45,X/46,XX, one for each) and three microdeletions/microduplications. Besides, two false positive NIPT cases were proved to be low level of maternal mosacism (45,X/46,XX, 5％ and 10％ for each). After genetic counseling, 17 out of 20 who declined prenatal diagnosis and 9 out of 32 who diagnosed fetal SCAs continued their pregnancies, with a combined proportion of continued pregnancy of 50％. Thirty-four pregnancies were also continued after exclusion of SCA. Interestingly, the proportion of continued pregnancy among those sex chromosomal trisomy fetuses was only 32％(8/25). Conclusions As a safe and rapid prenatal testing for common autosomal aneuploidies, NIPT could also identify some types of SCA, but with relatively low PPV. More long-term researches are required to determine its sensitivity and specificity. For some types of SCA with mild phenotypes, some family would continue the pregnancy. Therefore, limitations of NIPT should be appropriately explained during both pre- and post-testing counseling.

OBJECTIVE：To study the distri bution and targeting characteristics of Apigenin nanosuspension （AP-NPs）in mice. METHODS：AP-NPs was prepared with ultrasound microprecipitation. Kunming mice were randomly divided into apigenin （AP） solution group and AP-NPs suspension group ，with 45 mice in each group. The mice were given relevant medicine intragastrically （80 mg/kg）；blood sample of eyeball 500 μL were collected before medication（0 h）and 0.25，0.5，1，2，4，6，8，10 h after medication. After the last blood collection ，the mice were sacrificed and their heart ，liver，spleen，lung，kidney and brain tissues were taken. After protein precipitation with methanol ，HPLC method was adopted for determining plasma and tissues. The determination was performed on Shimadzu ODS-SP column with mobile phase consisted of methanol-water （70 ∶ 30，V/V）at the flow rate of 1.0 mL/min. The detection wavelength was set at 340 nm，and column temperature was 35 ℃. The sample size was 20 μL. The concentration of AP in different samples was calculated according to standard curve，main pharmacokinetic parameters （AUC，cmax）of AP and the ratio of peak concentration （ce），relative uptake rate （RUE），uptake ratio and its change value were calculated with DAS 2.0 software and Excel 2010 software；the tissue distribution and targeting characteristics of AP were analyzed. RESULTS：The linear range of AP in plasma and tissue s were 0.1-25.0 μg/mL（all r＞0.99）；the lower limits of quantification were 0.1 μg/mL. RSDs of intra-day and inter-day were all lower than 15％，and the accuracy were 94.37％-117.48％. The extraction recovery rates were all more than 80％. Compared with AP solution group ，the concentrations of AP in plasma sample （during 0.5-6 h），liver tissue （during 0.25-8 h），spleen tissue （during 0.25-8 h）and cerebral tissue （during 0.25-4 h）were increased significantly in AP-NPs suspension group （P＜0.05 or P＜0.01），and the highest in liver tissue. The concentrations of AP in heart tiusse （6 h），liver tissue （10 h），lung tissue （0.5 h），spleen tissue （during 0.25-10 h）were decreased significantly （P＜ 0.05 or P＜0.01）. There was statistical significance in AUC and cmax of AP in plasma and tissue samples between 2 groups（P＜ 0.05）. The ce，RUE，uptake ratio and its change value of liver tissue were the highest ，being 1.34±0.40，1.99±0.29，48.49％ and 15.71％ . CONCLUSIONS ：After AP is made into nanosus- pension，the distribution of drug tissue is changed ，especially targeting effect on liver tissue is improved.

Lateral epicondylitis is a common clinical disease with characteristics of lateral elbow pain, insidious onset and easy recurrence, which can cause forearm pain and decreased wrist strength, seriously affecting patients′ daily life and work. Although there are various treatment methods for lateral epicondylitis with different effects, standard treatments are still lacking nowadays. Platelet-rich plasma (PRP) has good effects on bone and tendon repair, and is now widely used in the treatment of lateral epicondylitis. However, there is a lack of a unified understanding of the technology and specifications of PRP in the treatment of lateral epicondylitis. Therefore, the Sports Medicine Branch of the Chinese Medical Association and Physical Medicine and Rehabilitation Branch of the Chinese Medical Association organized experts in the fields of sports medicine and rehabilitation medicine in China to formulate the "clinical expert consensus on platelet-rich plasma treatment for lateral epicondylitis (2022 version)", and proposed suggestions based on evidence-based medicine mainly from the concept, epidemiology and pathophysiology of lateral epicondylitis, symptoms, signs and imaging manifestations of lateral epicondylitis, PRP concept and application component requirements, quality control of PRP preparation technology, indications and contraindications of PRP in the treatment of lateral epicondylitis, PRP injection in the treatment of lateral epicondylitis, application of PRP in the operation of lateral epicondylitis, related problems after PRP treatment of lateral epicondylitis, evaluation of the results after PRP treatment of lateral epicondylitis, and health and economic evaluation of PRP treatment of lateral epicondylitis, so as to provide guidance for clinical diagnosis and treatment.

ObjectiveTo explore the underlying mechanism of Bushen Huatan prescription in alleviating postmenopausal osteoporosis （PMOP） by maintaining the balance of osteogenesis and adipogenic differentiation in ovariectomized rats with osteoporosis. MethodSeventy-five 6-month-old non-pregnant female SD rats were randomly divided into sham-operation group， model group， atorvastatin group， liviol group， and Bushen Huatan prescription group. Bilateral ovaries were removed in the four groups except the sham-operation group， while only the same mass of adipose tissue around the ovaries was removed in the sham-operation group. On the 5^th week after surgery， drugs were consecutively administrated for 8 weeks. Rats in the Bushen Huatan prescription group received 9.4 mg·kg^-1 of the prescription， rats in the atorvastatin group received 0.92 mg·kg^-1 of atorvastatin， rats in the Liviol group received 0.23 mg·kg^-1 of liviol， and rats in the model group and the sham-operation group received saline once a day. Micro-computed tomography （Micro CT） was used to detect bone mineral density （BMD） of rat tibia in each group. Hematoxylin-eosin （HE） staining was used to detect the relative area of rat bone marrow adipose tissue （BMAT） in each group. Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR） and Western blot were used to detect the relative expression levels of Runt-related transcription factor 2 （Runx2）， peroxisome proliferator-activated receptor （PPARγ）， leptin （LPN）， and leptin receptor （OBR） in bone tissues. ResultAs compared with the sham operation group， the BMD of rats in the model group decreased （P<0.05）， while the relative area of BMAT increased （P<0.05）. In addition， the expression levels of LPN， OBR， and Runx2 decreased in the model group （P<0.05）， while the level of PPARγ increased （P<0.05）. As compared with the model group， the BMD of rats in the atorvastatin group， the Livial group， and the Bushen Huatan prescription group increased （P<0.05）， and the relative area of BMAT decreased （P<0.05）. The expression levels of LPN， OBR， and Runx2 in these groups increased （P<0.05）， while the expression level of PPARγ decreased （P<0.05）. ConclusionBushen Huatan prescription plays the anti-osteoporosis role in the rat model of PMOP through up-regulating LPN and OBR in bone tissues and maintaining the balance of osteogenesis and adipogenic differentiation， thereby reducing postmenopausal bone loss and playing a role in the prevention and treatment of PMOP.

Objective    To evaluate the clinical value of in vitro fenestration and branch stent repair in the treatment of thoracoabdominal aortic aneurysm in visceral artery area assisted by 3D printing. Methods    The clinical data of 7 patients with thoracoabdominal aortic aneurysm involving visceral artery at the Department of Vascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University from March 2016 to May 2019 were analyzed retrospectively. There were 5 males and 2 females with an average age of 70.2±3.9 years. Among them 4 patients had near-renal abdominal aortic aneurysm, 3 had thoracic aortic aneurysm, 4 had asymptomatic aneurysm, 2 had acute symptomatic aneurysm and 1 had threatened rupture of aneurysm. According to the preoperative CT measurement and 3D printing model, fenestration technique was used with Cook Zenith thoracic aortic stents, and branch stents were sewed on the main stents in vitro, and then the stents were modified by beam diameter technique for intracavitary treatment. Results    All the 7 patients completed the operation successfully, and a total of 18 branch arteries were reconstructed. The success rate of surgical instrument release was 100.0%. The average operation time was 267.0±38.5 min, the average intraoperative blood loss was 361.0±87.4 mL and the average hospital stay was 16.0±4.2 d. Immediate intraoperative angiography showed that the aneurysms were isolated, and the visceral arteries were unobstructed. Till May 2019, there was no death, stent displacement, stent occlusion, ruptured aneurysm or loss of visceral artery branches. Conclusion    3D printing technology can completely copy the shape of human artery, intuitively present the anatomical structure and position of each branch of the artery, so that the fenestration technique is more accurate and the treatment scheme is more optimized.

ObjectiveTo investigate the association between estimated glucose disposal rate （eGDR） and the severity of coronary heart disease. MethodsWe conducted a hospital-based cross-sectional study that included 1258 patients （mean age： 62（53-68） years） who underwent coronary angiography for suspected coronary artery disease （53.9% were male）. Insulin resistance level （IR） was calculated according to eGDR formula： eGDR = 21.158 - （0.09 × WC） - （3.407 × hypertension） - （0.551 × HbA1c） ［hypertension （yes = 1 / no = 0）， HbA1c = HbA1c （%）］. Subjects were grouped according to the eGDR quantile. CAD severity was determined by the number of narrowed vessels： no-obstructive CAD group （all coronary stenosis were<50%， n=704）， Single-vessel CAD group （only one involved major coronary artery stenosis≥50%， n=205）， Multi-vessel CAD group （two or more involved major coronary arteries stenosis≥50%， n=349）； Multivariate logistic regression model was used to analyze the association between eGDR and CAD severity. The linear relationship between eGDR and CAD in the whole range of eGDR was analyzed using restricted cubic spline. Subgroup analyses were used to assess the association between eGDR and CAD severity in different diabetic states. Receiver operating characteristic （ROC） curve analysis were used to evaluate the value of eGDR in improving CAD recognition. ResultsA decrease in the eGDR index was significantly associated with an increased risk of CAD severity （OR： 2.79； 95%CI： 1.72~4.55； P<0.001）. In multivariate logistic regression models， individuals with the lowest quantile of eGDR （T1） were 2.79 times more likely to develop multi-vessel CAD than those with the highest quantile of eGDR （T3） （OR： 2.79； 95%CI： 1.72~4.55； P<0.001）. Multivariate restricted cubic spline analysis showed that eGDR was negatively associated with CAD and multi-vessel CAD （P-nonlinear>0.05）. In non-diabetic patients， compared with the reference group （T3）， the T1 group had a significantly increased risk of CAD （OR： 1.42； 95% CI： 1.00~2.01； P<0.05） and multi-vessel CAD （OR： 1.86； 95%CI： 1.21~2.86； P<0.05）. No statistical association was found between eGDR and CAD in diabetic patients. In ROC curve analysis， when eGDR was added to traditional model for CAD， significant improvements were observed in the model's recognition of CAD and multi-vessel CAD. ConclusionOur study shows eGDR levels are inversely associated with CAD and CAD severity. eGDR， as a non-insulin measure to assess IR， could be a valuable indicator of CAD severity for population.