Annals of translational medicine最新文献

Background: Chemoimmunotherapy is the standard treatment for patients with metastatic esophageal squamous cell carcinoma (ESCC), for which 5-fluorouracil (5-FU) is commonly part of the chemotherapy regimen. Given that 5-FU has a mean cardiotoxicity risk of approximately 5%, raltitrexed has often been used as an alternative in patients with a history of fluoropyrimidine-associated cardiotoxicity or significant coronary artery disease (CAD). We report the first case, to our knowledge, of the use of raltitrexed in place of 5-FU in combination with pembrolizumab and platinum-based chemotherapy for the treatment of metastatic esophageal cancer in a patient with CAD.

Case description: A 75-year-old gentleman with preexisting multivessel CAD was diagnosed with metastatic gastroesophageal junction (GEJ) squamous cell carcinoma (SCC) after presenting to medical attention with a 2-month history of worsening chest pain in addition to progressive dysphagia associated with weight loss. Following initial treatment with palliative locoregional radiotherapy to the lower mediastinum, GEJ, and upper abdomen, the decision was made to proceed with palliative systemic therapy. Considering his significant cardiac history, 5-FU was replaced with raltitrexed and combined with carboplatin and pembrolizumab. After a total of 10 months of treatment, the patient presented to hospital with recurrent chest pain and was diagnosed with a non-ST-elevation myocardial infarction (NSTEMI). Despite radiographic evidence of stability of his malignancy on systemic therapy, he was not considered to be a candidate for cardiac intervention. He was thus transitioned to a comfort-focused care approach and passed away shortly thereafter, with the cause of death being acute coronary syndrome.

Conclusions: Although the patient unfortunately passed away prematurely due to preexisting CAD, there was no evidence of disease progression in the 10 months that he received treatment. In addition to an encouraging progression-free survival (PFS), the patient reported an overall improvement in quality of life while on therapy with no signals of toxicity from raltitrexed or immunotherapy. Overall, the present case demonstrates that chemotherapy in combination with immunotherapy for the treatment of advanced esophageal cancer appears to be safe and effective when raltitrexed is substituted for 5-FU, which is of particular relevance due to the many overlapping characteristics of patients with cardiac pathology and esophageal cancer.

[This corrects the article DOI: 10.21037/atm-21-2158.].

[This corrects the article DOI: 10.21037/atm-22-1276.].

Background and objective: Optical coherence tomography (OCT) is a non-invasive imaging tool that can provide rapid cross-sectional images of the retina, cornea, and optic nerve head in live patients. The objective of this review is to provide an overview of the technical advancements and current clinical applications of OCT for managing patients with retinal disorders.

Methods: Narrative overview synthesizing the findings of literature retrieved from searches of computerized database, authoritative texts and authors' clinical experience and expertise.

Key content and findings: Unlike the first-generation time-domain OCT (TD-OCT) instruments, the newer spectral-domain OCT (SD-OCT) instruments use a broadband light source to increase axial image resolution. In addition, the decreased image acquisition time also increases the transverse image resolution, reduces motion artifacts, and allows serial cross-sectional images of the retina to be obtained rapidly. A three-dimensional (3D) image of the retina, reconstructed using serial two-dimensional (2D) OCT images, can be used to quantitate retinal thickness and volume and perform analysis of retinal topography. Currently, commercial SD-OCT instruments are used routinely in clinical practice to obtain morphologic information used to diagnose and manage patients with various retinal disorders including macular degeneration and diabetic retinopathy. Newer swept-source OCT technology with faster image acquisition, provides wider field imaging of the peripheral retina. SD-OCT instruments can be incorporated into surgical microscopes to allow imaging of the retina during retinal surgery so that morphologic changes in the retina from surgical maneuvers can be observed in real time. More recently, OCT angiography (OCTA) has been developed which allows rapid, non-invasive 3D imaging of retinal and choroidal vascular flow. This is achieved by processing rapid serial SD-OCT images to detect movement of blood cells within vessels. Research has been done to further improve image resolution of SD-OCT to a cellular level by adding adaptive optics (AO) technology. The latest in SD-OCT technology is optoretinography (ORG), a technique to derive functional information from OCT images of the retina.

Conclusions: Advancement in OCT technology has made it possible to obtain high resolution retinal images that can provide anatomic, physiologic and functional information of the retina in live patients.

Background: Studies evaluating the association between hemorrhoids and heart failure (HF) have been limited. We aimed to evaluate the association between increased incidence of HF and the presence of hemorrhoids using a population-based longitudinal cohort.

Methods: We included 356,033 participants in this study, derived from health screening data collected between 2003 and 2007 from the South Korean health screening cohort database. Hemorrhoid presence was identified as having a minimum of two claims based on the International Classification of Diseases, Tenth Revision (ICD-10) code I84. Propensity score matching (PSM) was used to assign participants to two groups according to the presence and treatment of hemorrhoids. The primary outcome was the incidence of HF, defined as having two or more claims based on the ICD-10 code I50.

Results: Among the participants, the presence of hemorrhoids was observed in 24,363 (6.8%) individuals. Over a median follow-up period of 13.33 years (interquartile range, 10.4-16.26), 55,167 cumulative cases of HF (15.5%) occurred. In multivariate analysis, the group with hemorrhoids consistently showed a higher incidence of HF compared to those without hemorrhoids, both before [hazard ratio (HR): 1.073; 95% confidence interval (CI): 1.028-1.121] and after PSM (HR: 1.073; 95% CI: 1.018-1.131). Regarding surgical procedures/treatments for hemorrhoids, participants who underwent surgical procedures or treatment for hemorrhoids showed a lower incidence of HF before PSM (HR, 0.919; 95% CI: 0.845-1.001) and after PSM (HR, 0.941; 95% CI: 0.880-1.001).

Conclusions: Our study revealed a significantly increased incidence of HF among participants with hemorrhoids. Therefore, it should be noted that when hemorrhoids are present, the risk of developing HF in the future may be increased.

[This retracts the article DOI: 10.21037/atm-21-3076.].