5 ml groups were 95.5% and 81.1% respectively. This difference was statistically significant (P5 ml groups were 4.5 % and 32.1%, respectively (P50 Gy was increased statistically, but the occurrence of complications was also increased. Conclusions Stereotactic radiosurgery improves the outcome of the elderly patients with brain metastases. Radiation dosage and tumor volume are significantly related with the therapeutic efficacy and the occurrence of complications.

Objective To evaluate the incidence of aortic valve calcification,and the correlation between valve function and commonly encountered disease in the aged patients.Methods Totally 996 patients who underwent ultrasonic cardiography (UCG) in our hospital were included.They were divide into elderly group and non elderly group,and the elderly group was divided into calcification subgroup and non calcification subgroup.The calcification,stenosis and regurgitation of aortic valve were detected by UCG,and risk factors of calcification were evaluated by Logistic regression analysis.Results The incidence of calcification was higher in elderly group than in non elderly group [71.8％ (526/733) vs.14.6％ (34/233),x2＝237.10,P＜0.01].In elderly group,the incidence of aortic valve stenosis was 2.1％ (11/526) in calcification subgroup and 1.9％ (4/207) in non calcification subgroup (x2＝0.81,P＞0.05).In elderly group,the incidence of aortic valve regurgitation was 63.3％ (333/526) in calcification subgroup and 19.3％ (40/207) in non calcification subgroup (x2＝116.10,P＜0.01).The hazard ratio of aortic valve calcification in different diseases were as follows:hypertension (OR＝2.06,95％CI:1.400-3.031),coronary heart disease (OR＝3.46,95％CI:2.217-5.384),diabetes mellitus (OR ＝ 2.66,95％CI:1.652-4.278),renal dysfunction (OR＝ 2.34,95％ CI:1.415-3.869),osteoporosis (OR＝ 2.33,95％CI:1.119-4.838).Conclusions The incidence of calcification,mainly causing aortic valve regurgitation,is high in elderly patients.Patients with hypertension,coronary heart disease,diabetes mellitus,renal dysfunction and osteoporosis are prone to the development of aortic valve calcification.

Polysaccharides are important large molecules in the body. It has many functions such as activting the lymphocytes like T,B, NK and M? cells, promoting the secretion of cytokines and antibodies through binding to the CR 3 receptor of lymphocytes, affecting the concentrations of cellar [Ca 2+ ] i, cAMP, cGMP, NO and PGE 2, and promoting the gene expression of cytokines. Its function also relate to its molecule weight and structure.

Objective To investigate the prevalence of chronic kidney disease (CKD) and its risk factors in Chinese elderly persons.Methods All of the people who underwent physical examination and treatment in the geriatric department of Beijing Hospital during January 2004 to January 2007 were included in the study.Age, body height, body mass index and blood pressure were recorded.Bloody urine was ascertained by phase-contrast microscope, and urine protein was measured by dipstick test.The hemoglobulin, serum eretinine, blood urea nitrogen, blood lipid and serum uric acid were measured by autobiochemical analyzer.HbsAg was checked by enzyme-linked immunosorbent assay (ELISA).Glomerular filtration rate (GFR) was estimated by Crockeroft-Gauh equation and abbreviated MDRD equation.Binary logistic regression analysis was used to test the risk factors for proteinuria and CKD.Results The prevalence of proteinuria was 4.9% in 1082 elderly persons.And 47.23% of the elderly suffered from decreased renal function.The morbidity of CKD was 48.43%.Binary logistic regression analysis showed that diabetes(OR= 2.257) and microscopic hematuria(OR=5.324) were the risk factors of proteinuria (both P<0.05).And the risk factors for CKD were hypertension(OR= 1.459), coronary arth'erosclerotic heart disease(OR=3.290), chronic obstructive lung diseases(OR=2.094), malignant tumor(OR=2.072), hyperuricemia(OR= 1.928),anemia(OR=8.122)and hematuria( OR= 1.604) (all P<0.05).Conclusions The morbidity of CKD in Chinese elderly persons was 48.43%.And the related risk factors were diabetes,hypertension, hyperuricemia, coronary artherosclerotic heart disease and chronic obstructive lung disease.

Objective To evaluate the relationship between clinical or subclinical hypothyroidism and positive thyroid autoantibody before 20 weeks pregnancy and risk of preterm birth.Methods Literature search was done in PubMed,EMBASE,Wanfang Medical Database,China Academic Journal Network Publishing Database and China Biology Medicine disc databases from January 1st,1980 to December 31th,2013.The following search terms were used:hypothyroidism,subclinical hypothyroidism,hypothyroxinnism,thyroid antibody,preterm labor,preterm birth,etc.(1) Criteria for inclusion:cohort studies and clinical studies were included; only articles that described at least l0 patients were eligible;the exposure was clinical or subclinical hypothyroidism and positive thyroid autoantihody,and outcome was preterm birth.(2) The excluded subjects were articles that described less than 10 patients; controls were pregnant women without eurothyrodisim.Meta-analysis was performed by RevMan 5.The relationship between clinical or subclinical hypothyroidism and positive thyroid autoantibody and risk of preterm birth was evaluated by OR or RR.Results (1) Twenty cohort studies were enrolled.A total of 39 596 cases of preterm birth occurred among 498 418 pregnant women.The controls in these studies were pregnant women with eurothyrodisim.(2) Clinical hypothyroidism in pregnancy:eight studies were included,reported data on 478 418 pregnant women (5 473 women with clinical hypothyroidism and 472 945 euthyroid pregnant women).The risk of preterm birth in pregnant women with clinical hypothyroidism was higher than those eurothyroid pregnant women in control group (OR=1.25,95％ CI:1.15-1.36,P＜0.01).(3) Subclinical hypothyroidism in pregnancy:ten studies were included,reported data on 277 531 pregnant women (5 257 women with subclinical hypothyroidism and 272 274 euthyroid pregnant women).The risk of preterm birth in pregnant women with subclinical hypothyroidism was higher than those in control group by random effects analysis (OR=1.25,95％ CI:1.14-1.36,P＜0.01).(4) Thyroid autoantibodys positive in pregnancy:eleven studies were included,reported data on 28 781 pregnant women (3 036 women with thyroid autoanti body positive and 25 745 euthyroid pregnant women).The risk of preterm birth in pregnant women with positive thyroid autoantibody was higher than those negative thyroid autoantibody in control group (OR=1.47,95％ CI:1.27-1.70,P＜0.01).The funnel plots presented symmetrical graphics,indicating that there was no publication bias.Conclusion Clinical or subclinical hypothyroidism and positive thyroid autoantibody in pregnant women is risk factors of preterm birth.

Objective To investigate the composite prevention strategy for shoulder dystocia.Methods The published articles of randomized controlled trial (RCT)of comparison about the prevention of shoulder dystocia were searched in PubMed,EMBASE,EBSCO databases and Cochrane Library,and these studies were screened under inclusion and exclusion criteria.The quality of included studies were evaluated.And the Meta-analysis using statistic software RevMan 5.1 was completed.Results Totally 16 articles,all English published with no one Chinese article being searched out,were included in this analysis,published from 1993 to 2009.(1)To the gestational diabetes mellitus (GDM)patients,reviewed from 2 articles,it was found that the incidence of shoulder dystocia was reduced significantly by prenatal intervention versus usual care (OR=0.40,95％ CI:0.21-0.75,P=0.004).(2)To the GDM patients with intensive prenatal intervention,reviewed form 5 articles,it was found that the incidence of shoulder dystocia was reduced significantly by intensive intervention (diet control combined with insulin if necessary)versus less intensive intervention (only diet control),OR=0.29 (95 ％ CI:0.11-0.73,P=0.009).(3) To the non-GDM patients with suspected macrosomia,reviewed from 4 articles,it was found that the incidence of shoulder dystocia was not reduced by early artificial induction of parturition (OR=0.85,95 ％ CI:0.41-1.75,P=0.660).(4)To the GDM patients,reviewed form 2 articles,it was found that the incidence of shoulder dystocia was reduced marginal significantly by artificial induction of parturition in 38-39 gestational weeks compared with all spontaneous parturition patients (OR=0.18,95 ％ CI:0.03-0.97,P=0.050) and significantly reduced when compared with those spontaneous parturition patients after 40 gestational weeks (OR=0.13,95 ％ CI:0.02-0.75,P=0.020).(5)To the GDM patients with suspected macrosomia,reviewed from only one article,it was found that the incidence of shoulder dystoeia was reduced marginal significantly by early artificial induction of parturition (OR=0.34,95 ％ CI:0.12-0.99,P=0.050).(6)Reviewed from 2 articles,it was found that the incidence of shoulder dystocia was not significantly reduced by the intrapartum prophylactic maneuvers (OR=0.44,95％ CI:0.16-1.18,P=0.100).Conclusion Some varieties of intervention for the high risk patients could reduced the occurrence of shoulder dystocia.

Objective To assess the relationship between the recurrence of esophageal varices fol?lowing endoscopic esophageal varix ligation (EVL) and esophageal collateral veins(ECV)under endoscopic ultrasound ( EUS) , and analyze the predictive value of EUS for recurrence of esophageal varices. Methods Sixty patients with cirrhotic portal hypertension combined with esophageal varices underwent EVL for eradica?tion of varices. Endoscopy and EUS were performed before ligation to detect and describe the type of esopha?geal varices, and grade, location, and the number of ECV. Over a 12?month period, variceal recurrence was examined. The statistical analyses were performed to assess the relationship between esophageal varices fol?lowing EVL and ECV. Results Of the 60 patients, 29 ( 48?3%) had variceal recurrence within 12 months after EVL. Univariate logistic regression analysis showed that severe peri?ECV ( OR=22?67;95%CI:4?37? 117?47, P<0?001) ,severe para?ECV( OR=16?31;95%CI:0?84?108?14, P=0?018) , multiple peri?ECV ( OR=22?67;95%CI:4?37?117?47, P<0?001) , and the presence of perforating veins ( OR=6?67,95%CI:1?46?30?43,P=0?014) were significantly related to the variceal recurrence after EVL. Multivariate logis?tic regression model showed that severe peri?ECV ( OR=24?39;95%CI:2?34?253?78,P=0?008) and mul?tiple peri?ECV (OR=24?39;95%CI: 2?34?253?78,P=0?008) severe para?ECV(OR=19?42; 95%CI:4?84?148?54,P=0?012) remained independent prognostic factors for variceal recurrence. The sensitivity and specificity of multivariate logistic regression model in predicting variceal recurrence were 89?2% and 90?5%, respectively (prognostic value AUC=0?946).The sensitivity and specificity were 86?4% and 87?7% in pre?dicting variceal recurrence( prognostic value AUC=0?871) . Conclusion Recurrence rate of esophageal var?ices after EVL is high. EUS can clearly depict ECV. Severe peri?ECV and multiple peri?ECV are significant and independent prognostic factors associated with variceal recurrence risk. EUS before EVL will help predict variceal recurrence after EVL.

Objective To assess the clinical value of endoscopic ultrasonography ( EUS ) for predicting esophageal varices ( EV ) progression in patients with hepatitis B virus ( HBV )-related hepatocirrhosis. Methods A retrospective cohort study was performed on 299 HBV-related hepatocirrhosis patients with light EV in Tianjin Second People′s Hospital admitted from September 2014 to September 2015. The diameter and number of peri-esophageal collateral veins ( ECV ) and para-ECV were measured and described by EUS. The first EUS examination time was the starting point, and the follow-up of 24 months or EV progression was the end. Risk factors of EV progression were evaluated by multivariate Cox regression model, and the predictive value of EUS for EV progression was analyzed by receiver operating characteristic ( ROC) curve. Results The cumulative incidence of EV progression was 2. 3％ ( 7/299 ) , 14. 8％( 44/297) , 33. 7％ ( 96/285) and 40. 0％ ( 120/273) at 6 months, 12 months, 18 months and 24 months of follow-up, respectively. The results of multivariate Cox regression analysis showed that the diameter of peri-ECV ( P=0. 0112, HR=1. 3232, 95％CI: 1. 0656-1. 6429 ) , the number of peri-ECV ( P=0. 0001, HR=1. 3666, 95％CI:1. 1634-1. 6052) and para-ECV diameter ( P=0. 0002, HR=1. 3641, 95％CI:1. 1558-1. 6100) were risk factors for EV progression. The use of nucleoside analogues treating HBV (P=0. 0020, HR=0. 4969, 95％CI: 0. 3186-0. 7751) and non-selective β-blockers descending portal venous pressure ( P=0. 0765, HR=0. 5732, 95％CI:0. 3097-1. 0611) were the protective factors for EV progression. The results of ROC curve analysis showed that the diameter of peri-ECV[ P<0. 001, area under the curve (AUC)= 0. 850, 95％CI: 0. 804-0. 895], the number of peri-ECV (P<0. 001, AUC=0. 831, 95％CI: 0. 784-0. 878), the diameter of para-ECV (P<0. 001, AUC=0. 924, 95％CI: 0. 895-0. 954) , and the number of para-ECV ( P<0. 001, AUC=0. 761, 95％CI: 0. 704-0. 817 ) had higher predictive value for EV progression;and the optimum cut-off values of each index were 1. 85 mm, 3. 5, 3. 35 mm, and 4. 5, respectively. The accuracies of prediction for EV progression were 76. 60％, 75. 19％, 84. 48％ and 70. 29％, respectively. Conclusion EUS can be used to predict EV progression in HBV-related hepatocirrhosis patients. Peri-ECV diameter>1. 85 mm, number>3. 5, and para-ECV diameter>3. 35 mm, number>4. 5 suggest a high risk of EV progression. For patients with HBV-related hepatocirrhosis complicated with mild EV, nucleoside analogues to anti-HBV and non-selective β-blockers to reduce portal hypertension can prevent EV progression.

Objective To assess the predictive value of endoscopic ultrasonography(EUS)for esophageal varices(EV)bleeding by studying the relationship between esophageal collateral veins(ECV), portal vein(PV)trunk with its main branches and EV bleeding. Methods A retrospective cohort study of 114 cases of moderate and severe EV was conducted. The ECV level was determined through EUS. At the same time,diameters of PV,azygos vein(AIV)and spleen vein(SV)were measured through EUS. The predictive value of ECV level and diameters of PV, AIV, SV for EV bleeding were assessed during the 1-year follow-up, which started from the first EUS examination to EV bleeding or the end of follow-up. Results Single factor Cox regression analysis showed severe peri-ECV varices had higher risk than mild in EV bleeding(HR=4.081,95%CI:1.833-9.086,P=0.001); severe para-ECV varices had higher risk than mild in EV bleeding(HR= 4.042, 95%CI:1.814-9.005,P= 0.001). Multivariable Cox retrospective analysis showed ECV level was an effective predictor for EV bleeding, when the peri-ECV and para-ECV were severe varices, EV bleeding risk increased to 3.831 3(P=0.004 3)and 3.493 3(P=0.003 1) times compared with mild respectively. Diameters of PV,AIV and SV could predict EV bleeding(PV AUC=0.959,P<0.001;AIV AUC=0.958,P<0.001;SV AUC=0.830,P<0.001).In addition, when diameter of PV>13.65 mm(sensitivity=0.94, specificity=0.84), AIV>8.65 mm(sensitivity=0.94, specificity=0.89),SV>9.45 mm(sensitivity=0.90, specificity=0.67), EV bleeding risk increased significantly. Conclusion EUS is helpful to predict the risk of moderate and severe EV bleeding, and severe varices of ECV,PV,AIV,and SV can be used as indicators to predict risk of EV bleeding.

Objective: To understand the intention of pediatricians turnover in Shenzhen and its influencing factors. Methods: From September to December 2016, a multi-stage stratified cluster sampling method was used to select 948 pediatricians from Shenzhen to conduct a questionnaire survey. The questionnaire cover the following: 1. Basic information: general demographic characteristics(gender, age, marriage, education, etc.); 2. Work status survey: turnover intention, experiences with violence against medical workers, professional job satisfaction, and work stress, etc. Univariate analysis and multivariate analysis were used to identify factors for pediatrician′s turnover intention. Results: Among the 948 pediatricians in Shenzhen, 62.5% had turnover intention; age, title, education, seniority, monthly income, medical institution nature, medical institution level, length of sleep, job satisfaction, work stress, experience with violence and family support all affect the pediatrician′s turnover intention(P<0.05); multivariate logistic regression analysis showed that age, education, monthly income, job satisfaction, work stress and experience with violence were the influencing factors of pediatrician′s turnover intention(P<0.05). Conclusions The pediatrician′s turnover intention in Shenzhen is not low. Relevant measures should be taken by the government, hospital administrators, children patients and their family to ensure the supply of children′s medical services.