Tumor lysis syndrome (TLS) is a life-threatening oncologic condition that is most commonly linked with hematologic malignancies and uncommonly seen in solid tumors, including colorectal cancer (CRC). Therefore, a lack of awareness regarding TLS in CRC could lead to significant morbidity and mortality. This study aims to explore the clinical characteristics and outcomes of TLS in patients with CRC. A systematic review of the literature was performed by searching PubMed using the keywords "tumor lysis syndrome" and "colorectal cancer". The English-language case reports and abstracts that the search results yielded were reviewed, and additional articles of interest were identified from reference lists. Information regarding the patients (age at diagnosis, presentation, and comorbidities), the tumors (histology, grade, and stage), radiologic investigations, treatment modalities (surgery, radiation, and systemic therapy), and the outcomes (response, adverse events) were recorded, when available. Descriptive statistics, such as frequency counts, medians, and ranges, were used to characterize the pooled sample. Nine case reports of TLS in CRC were identified in the literature; one additional case was added from our patient database. The median age of these patients was 58.5 years (range: 42-82 years) with 70% of these patients being male. Of note, 100% of these patients had metastatic colon cancer and 80% had metastatic involvement of the liver; 70% of these cases were associated with therapyinduced TLS with the median time-to-event being three days (range: 18 hours-30 days) after receiving chemotherapy. When looking at laboratory parameters, uric acid and lactate dehydrogenase (LDH) were consistently elevated in all the cases, but 50% of the cases had hyperkalemia and 50% had hyperphosphatemia. Treatment of TLS included supportive measures with IV hydration. Five out of 10 patients received urate oxidase and only one underwent hemodialysis. The overall mortality was 60%. TLS can occur with CRCs that demonstrate a high tumor burden. While most cases are associated with therapy, some cases are spontaneous in nature. Keeping in mind the high mortality associated with TLS, physicians should have a high degree of suspicion and should be aware of the fatal complications associated with TLS. Timely implementation of prophylactic and therapeutic measures including IV hydration as well as the use of xanthine oxidase inhibitors such as allopurinol can be life-saving in these cases.

Endoscopic cystogastrostomy using lumen-apposing metal stent (LAMS) is considered the first-line therapy for symptomatic pancreatic fluid collections (PFCs). Routine coaxial placement of a double-pigtail stent (DPS) through LAMS is debated. We report the case of a patient with delayed massive gastrointestinal bleed eight weeks after LAMS placement due to splenic artery pseudoaneurysm leading to a complicated hospitalization. Theoretically, coaxial placement of DPS through LAMS can prevent the relatively sharp LAMS from eroding into the mucosa of the collapsed cavity of PFCs, decreasing the risk of bleeding. Our case adds to the growing need to further explore the utility of this combined intervention.

The risk of inflammatory bowel disease-associated colorectal cancer (IBD-CRC) is known to increase with primary sclerosing cholangitis (PSC) and a family history of CRC. However, the impact of comorbidities such as liver disease, obesity, diabetes, chronic lung, heart, and renal disease, and psychiatric illness on the risk of IBD-CRC remains unclear. We evaluated the effect of these comorbidities on the risk of IBD-CRC. MethodsA retrospective review from 2009 to 2014 was conducted using the National Inpatient Sample data for adults 18 years and older. Patients with IBD (360,892), of whom 2,831 had CRC were identified using the International Classification of Diseases, Ninth Revision codes (ICD-9). Data on comorbidities were also obtained. Adjusted odds ratios (aOR) and confidence intervals (CI) were computed via logistic regression to evaluate the effect of comorbidities on the risk of IBD-CRC; the p-value was set at <0.05. ResultsThe mean age of IBD patients in this study was 52.36±0.03. A majority of the patients with IBD-CRC were white and were significantly older compared to those without cancer (60 vs 52 years, p<0.05). The risk of colon cancer in IBD was increased by having a non-cholestatic liver disease (aOR 1.51, CI 1.23-1.86, p<0.01). Also, patients younger than 50 years with liver disease were at an increased risk of IBD-associated colon cancer in comparison to older patients (aOR 1.83 vs 1.34, p<0.05). Notably, diabetes, chronic pulmonary disease, renal failure, psychiatric illnesses, and rheumatoid diseases, were inversely associated with the risk of IBD-CRC (p<0.05). After stratifying by IBD subtypes, non-cholestatic liver disease was still independently associated with a higher risk for colon cancer in patients with ulcerative colitis or Crohn's disease (ulcerative colitis: aOR 1.43, CI 1.08-1.89; Crohn's disease: aOR 1.46, CI 1.10-2.00). ConclusionsPatients with IBD who have non-cholestatic liver disease might have a higher risk for colon cancer, even at a younger age. These patients may require close colon cancer surveillance.

Sirtuins (SIRT) are a class of histone deacetylases that regulate important metabolic pathways and play a role in several disease processes. Of the seven mammalian homologs currently identified, sirtuin 1 (SIRT1) is the best understood and most studied. It has been associated with several neurodegenerative diseases and cancers. As such, it has been further investigated as a therapeutic target in the treatment of disorders such as Parkinson’s disease (PD), Huntington’s disease (HD), and Alzheimer’s disease (AD). SIRT1 deacetylates histones such as H1 lysine 26, H3 lysine 9, H3 lysine 56, and H4 lysine 16 to regulate chromatin remodeling and gene transcription. The homolog has also been observed to express contradictory responses to tumor suppression and tumor promotion. Studies have shown that SIRT1 may have anti-inflammatory properties by inhibiting the effects of NF-κB, as well as stimulating upregulation of autophagy. The SIRT1 activators resveratrol and cilostazol have been shown to improve Alzheimer’s Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) scores in AD patients. In this review, we aim to explore the various roles of SIRT1 with regard to neuroprotection and neurodegeneration.

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