The survival factor renalase (RNLS) is a recently discovered secretory protein with potent prosurvival and anti-inflammatory effects. Several evolutionarily conserved RNLS domains are critical to its function. These include a 20 aa site that encodes for its prosurvival effects. Its prosurvival effects are shown in GI disease models including acute cerulein pancreatitis. In rodent models of pancreatic cancer and human cancer tissues, increased RNLS expression promotes cancer cell survival but shortens life expectancy. This 37 kD protein can regulate cell signaling as an extracellular molecule and probably also at intracellular sites. Extracellular RNLS signals through a specific plasma membrane calcium export transporter; this interaction appears most relevant to acute injury and cancer. Preliminary studies using RNLS agonists and antagonists, as well as various preclinical disease models, suggest that the immunologic and prosurvival effects of RNLS will be relevant to diverse pathologies that include acute organ injuries and select cancers. Future studies should define the roles of RNLS in intestinal diseases, characterizing the RNLS-activated pathways linked to cell survival and developing therapeutic agents that can increase or decrease RNLS in relevant clinical settings.

Introduction Anal adenocarcinoma is a rare malignancy with a poor prognosis. Methods We present a case of rare anal adenocarcinoma in a patient with normal screening colonoscopy. Using the Surveillance, Epidemiology and End Result database between 2000 and 2016, we performed survival analysis among individuals>20 years old comparing anal and rectal cancers. Results Survival analysis showed that anal adenocarcinoma is associated with worse outcomes compared with rectal adenocarcinoma and anal squamous cell carcinoma. Discussion This case and survival data illustrate the importance of prompt investigation of symptoms irrespective of colorectal cancer screening status with careful attention to examination of the anal area.

Anomalous left coronary artery origin arising from the pulmonary artery (ALCAPA) occurs in less than 0.01% of the general population, with symptoms often manifesting within the first 3 months of life. Without surgical repair, early mortality is the most common outcome. Here, we present the case of a 66-year-old woman who was found to have previously undiagnosed ALCAPA. Our patient did not undergo surgical management and instead became asymptomatic with medical management alone, in part owing to substantial collaterals and a dilated right coronary artery. In rare circumstances, patients with ALCAPA have been known to survive into adulthood without surgical intervention. For patients with ALCAPA presenting in adulthood, surgical intervention must be considered in the setting of symptoms, medical therapy, and surgical risk; conservative therapy may be the most appropriate approach in certain patients.