Objective:To investigate the change regularity and influencing factors of subfoveal choroidal thickness (SFCT) with age among adults.Methods:A cross-sectional study was adopted.A total of 281 Chinese adults, aged between 21 and 90, were selected from working staff and retired staff of an institution who underwent routine physical examinations from June to October 2016 in Beijing Tongren Hospital.One eye of each subject was included in the study according to the random number table method.The subjects were divided into different age groups including 21-30 years group, 31-40 years group, 41-50 years group, 51-60 years group, 61-70 years group, 71-80 years group and 81-90 years group.The SFCT was measured at the fovea and at 500 μm, 1 000 μm and 2 000 μm nasal (N) and temporal (T) to fovea by high definition-optical coherence tomography.Multiple linear regression equation was used to analyze the influence of ages, gender, intraocular pressure (IOP), spherical equivalent (SE) and retinal thickness on SFCT.This study followed the Declaration of Helsinki and was approved by the Ethics Committee of Beijing Tongren Hospital, Capital Medical University (No.TRECKY2016-012). Written informed consent was obtained from each patient prior to any examination.Results:Mean SFCT of eligible 229 subjects (229 eyes) was (218.73±79.69)μm.Choroid became thinner gradually towards nasal and temporal part.There were significant differences in SFCT, N2 000, N1 000, N500, T500, T1 000 and T2 000 among all age groups ( F=27.05, 22.85, 25.38, 29.11, 32.55, 29.22, 28.70, all at P<0.01). Choroidal thicknesses of all locations showed age-related linear decrease with a steep drop after 50 years old ( R2ranged 0.35-0.47, all at P<0.01). SFCT was associated with SE (β=-10.07, P<0.01) and age (β=-2.43, P<0.01) but not related with gender (β=-19.69, P=0.057), foveal thickness (β=0.02, P=0.897) or IOP (β=-0.86, P=0.466). Conclusions:SFCT shows an age related linear decrease with a steep decline after 50 years old, which was associated with aging and higher SE in myopia, but not related with gender, foveal thickness or IOP within the normal range.

Objective:To understand the clinical characteristics of bosentan-related liver injury.Methods:PubMed, Ovid, Web of Science, Embase, Springer-link, Wiley Oline Library, CNKI, Wanfang and VIP databases were searched as of April 2020 and case reports on bosentan-related liver injury were collected. General information, primary diseases, comorbidities, bosentan use, combined medication, and occurrence, treatment and outcome of liver injury in patients were extracted and analyzed by descriptive statistical method.Results:A total of 10 case reports on bosentan-related liver injury were included, involving 12 patients (3 from China, 3 from Japan, 2 from Italy, and 4 from Australia, Brazil, Canada, and Sweden respectively). The 12 patients were all female, aged from 29 to 79 years with an average age of 55 years. The primary diseases were systemic sclerosis-associated pulmonary hypertension (PAH) in 5 patients, connective tissue disease-associated PAH in 2 patients, idiopathic, secondary, chronic thromboembolic, biliary cirrhosis-associated, and non-hepatic portal hypertension-associated PAH in 5 patients, respectively. Four patients had comorbidities. All the 12 patients had combined medications,which included 1-9 kinds of drug. Liver injury occurred in patients 20 days to 57 months after bosentan administration (<1 month in 3 patients, 1-3 months in 4 patients, and >12 months in 5 patients) and was manifested as elevated transaminases, accompanied by elevated bilirubin in 5 patients; the clinical manifestations in 6 patients were described, including yellow staining of skin and sclera in 4 cases, anorexia in 4 patients, nausea in 3 patients, fatigue in 3 patients, and vomiting, weight loss, and drowsiness in 3 patients, respectively; liver biopsy was performed in 1 patient, showing autoimmune hepatitis. After liver injury, bosentan was discontinued or continued with a halved dose; symptomatic treatments were given depending on the specific situation of liver injury; among the 12 patients, 9 had normal liver function, 2 had improved liver function, and 1 died of multiple organ failure.Conclusions:Bosentan-related liver injury may occur within 20 days to 57 months of medication and often within 3 months, with similar clinical manifestations to those induced by other drugs. Some patients may have no clinical symptoms but only abnormal liver function while severe liver injury may occur in a small number of patients. Liver function can usually return to normal or be improved after discontinuation of bosentan.

Objective:To understand the clinical characteristics of bosentan-related liver injury.Methods:PubMed, Ovid, Web of Science, Embase, Springer-link, Wiley Oline Library, CNKI, Wanfang and VIP databases were searched as of April 2020 and case reports on bosentan-related liver injury were collected. General information, primary diseases, comorbidities, bosentan use, combined medication, and occurrence, treatment and outcome of liver injury in patients were extracted and analyzed by descriptive statistical method.Results:A total of 10 case reports on bosentan-related liver injury were included, involving 12 patients (3 from China, 3 from Japan, 2 from Italy, and 4 from Australia, Brazil, Canada, and Sweden respectively). The 12 patients were all female, aged from 29 to 79 years with an average age of 55 years. The primary diseases were systemic sclerosis-associated pulmonary hypertension (PAH) in 5 patients, connective tissue disease-associated PAH in 2 patients, idiopathic, secondary, chronic thromboembolic, biliary cirrhosis-associated, and non-hepatic portal hypertension-associated PAH in 5 patients, respectively. Four patients had comorbidities. All the 12 patients had combined medications,which included 1-9 kinds of drug. Liver injury occurred in patients 20 days to 57 months after bosentan administration (<1 month in 3 patients, 1-3 months in 4 patients, and >12 months in 5 patients) and was manifested as elevated transaminases, accompanied by elevated bilirubin in 5 patients; the clinical manifestations in 6 patients were described, including yellow staining of skin and sclera in 4 cases, anorexia in 4 patients, nausea in 3 patients, fatigue in 3 patients, and vomiting, weight loss, and drowsiness in 3 patients, respectively; liver biopsy was performed in 1 patient, showing autoimmune hepatitis. After liver injury, bosentan was discontinued or continued with a halved dose; symptomatic treatments were given depending on the specific situation of liver injury; among the 12 patients, 9 had normal liver function, 2 had improved liver function, and 1 died of multiple organ failure.Conclusions:Bosentan-related liver injury may occur within 20 days to 57 months of medication and often within 3 months, with similar clinical manifestations to those induced by other drugs. Some patients may have no clinical symptoms but only abnormal liver function while severe liver injury may occur in a small number of patients. Liver function can usually return to normal or be improved after discontinuation of bosentan.

Older patients often experience a loss of physical,cognitive and social functioning during an acute illness-caused hospitalization.The loss of function could be due to a traditional model of hospital care,which focuses only on diagnosis and treatment of acute disease.Restoration of elderly patients' lost functions is important for better prognosis of hospitalized elderly patients and would reduce the cost of additional medical treatment.Acute care for the elderly (ACE) is a new model of care aiming at function restoration by practicing a geriatric assessment in the special ACE unit of hospital.The ACE intervention includes interdisciplinary team rounds,discharge planning of hospital,medical care review,a prepared environment,and patient-centered care.Multiple randomized control trials have demonstrated that ACE unit can improve the functional status and prognosis of old patients,reduce the cost of hospitalization,and improve patients' satisfaction.Currently,ACE care model is poorly known by Chinese hospitals and doctors.This article introduces the concepts of ACE unit,technical elements and the clinical evidence of its effectiveness.

Objective: To explore the relationship between monocyte-to-lymphocyte ratio (MLR) in peripheral blood of patients with pulmonary sarcomatoid carcinoma (PSC) and their clinicopathological features and prognosis, and to investigate its clinical significance. Methods: A retrospective analysis was carried out to analyze the complete case data of 80 patients with PSC from October 2010 to April 2017 in Tianjin Cancer Hospital (monocyte and lymphocyte counts of peripheral blood, clinicopathological features, and survival follow-up). The receiver operating curve (ROC) was used to determine the best cut-off value of MLR for the prediction of overall survival time (OS). The patients were divided into high MLR group and low MLR group. Kaplan-Meier method was used to calculate OS and draw survival curves. The Log-Rank test was used to compare the difference in OS between the two groups. The variables with statistical significance in univariate analysis were included into the COX risk regression model to verify and calculate thehazard ratio (HR)and 95% confidence interval (95%CI). Results: The absolute median values of monocytes and lymphocytes were 0.63×109/L and 1.84×109/L, respectively. The best cut-off value of MLR is 0.44. Univariate analysis shows that MLR≥0.44 (P<0.01), no radical surgery (P<0.01), clinical stage Ⅲ+Ⅳ (P<0.01), tumor maximal diameter > 3 cm (P<0.01), and LDH>247 U /L (P<0.01) are the poor prognostic factors affecting overall survival. Multivariate analysis shows that MLR≥0.44（HR=3.554; 95%CI=1.671-6.125; P<0.01), and clinical stage Ⅲ+Ⅳ（HR=3.275; 95%CI=2.047-9.399; P<0.01) are the independent risk factors for the overall survival of PSC, and radical surgery is an independent protective factor affecting the overall survival of PSC（HR=0.360; 95%CI=0.195-0.848; P<0.01). Conclusion: High MLR is an independent risk factor for poor prognosis in patients with PSC.

[Abstract] Objective: To explore the relationship between the preoperative blood indicators (platelets, monocytes, neutrophils-to-lymphocyte ratio) and clinicopathological characters and the prognosis of the early stage malignant melanoma（MM）patients. Methods: Clinicopathological data of 120 cases of stage I-III MM patients, who received initial treatment and radical operation in the Cancer Hospital of Tianjin Medical University from January 2007 to May 2012, were obtained for this study. The correlations between parameters of PLR (platelet-to-lymphocyte ratio), LMR (lymphocyte-to-monocyte ratio), NLR (neutrophil-to-lymphocyte ratio), hemoglobin, neutrophils, lymphocytes, monocytes, eosinophils, basophils, platelets, lactate dehydrogenase, age, stage as well as ulcer and the prognosis of the patients were evaluated. Results: Patients whose tumor with ulceration have higher NLR and basophilic granulocyte (all P< 0.05）. Univariate analysis showed that NLR, PLR, LMR, neutrophil, lymphocyte, monocyte, lactic dehydrogenase, age, stage and ulceration were the risk factors of poor 5-year overall survival (P<0.05). The multivariate analysis identified PLR（HR=4.206， 95%CI:1.65410.696， P<0.01），stage（HR=7.670， 95%CI:3.977-14.795， P<0.01）and ulceration（HR=1.931， 95%CI:1.029-3.623， P<0.05）as independent risk factors for the prognosis of the MM patients. Conclusion: Higher preoperative PLR can be used as a predictive factor for poor prognosis of the early stage MM patients.