IN BRIEF
“Quality Improvement Success Stories” are published by the American Diabetes Association in collaboration with the American College of Physicians, Inc., and the National Diabetes Education Program. This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors of
Clinical Diabetes
. The following article describes a successful effort to improve glycemic control in presurgical patients with an A1C >8%.
Anecdotal evidence has long suggested that patients with lower urinary tract symptoms (LUTS) develop mood disorders, such as depression and anxiety, at a higher rate than the general population and recent prospective studies have confirmed this link. Breakthroughs in our understanding of the diseases underlying LUTS have shown that many have a substantial inflammatory component and great strides have been made recently in our understanding of how this inflammation is triggered. Meanwhile, studies on mood disorders have found that many are associated with central neuroinflammation, most notably in the hippocampus. Excitingly, work on other diseases characterized by peripheral inflammation has shown that they can trigger central neuroinflammation and mood disorders. In this review, we discuss the current evidence tying LUTS to mood disorders, its possible bidirectionally, and inflammation as a common mechanism. We also review modern theories of inflammation and depression. Finally, we discuss exciting new animal studies that directly tie two bladder conditions characterized by extensive bladder inflammation (cyclophosphamide-induced hemorrhagic cystitis and bladder outlet obstruction) to neuroinflammation and depression. We conclude with a discussion of possible mechanisms by which peripheral inflammation is translated into central neuroinflammation with the resulting psychiatric concerns.
To date, multiple studies have proposed that right-sided colon cancers (proximal to the splenic flexure) and leftsided colon cancers (distal to the splenic flexure) are two distinct diseases. 1 Colon cancer sidedness has been shown to influence clinical presentation, treatment response, and survival outcomes. [2][3][4] In a pooled analysis of six clinical trials, patients with unresectable RAS wild-type metastatic right-sided tumors had worse overall survival (OS), progression free survival, and objective response rates compared with patients with unresectable RAS wild-type metastatic left-sided tumors. Patients with left-sided tumors were also more likely to demonstrate a response to chemotherapy plus estimated glomerular filtration rate (eGFR) antibody therapy. 4 Similar survival trends have been observed in patients with non-metastatic colon cancer, i.e. patients with right-sided colon cancer have worse OS compared with patients with left-sided colon cancer. 5,6 Conversely, some studies, all retrospective and populationbased, have found no survival difference based on tumor sidedness, and a few studies have actually demonstrated improved survival in patients with right-sided colon cancer compared with left-sided colon cancer. 2,7,8 In this issue of Annals of Surgical Oncology, Klose et al. evaluated the 5-year survival for patients with right-versus left-sided stage I-III colon cancer using a prospectively maintained database. 9 Using a risk-adjusted Cox regression
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