[Factors influencing patient compliance in colorectal cancer screening: qualitative research synthesis].

OBJECTIVE: To systematically collect and analyze the influencing factors of patient compliance with colorectal cancer screening in qualitative studies so as to provide a theoretical basis for improving compliance. METHODS: The databases of Pubmed, EMbase, CBMdisc, CNKI and VIP and the relevant articles were searched. According to the predefined inclusion and exclusion criteria, the qualitative studies of the influencing factors of patient compliance with screening were included. After selection and critical appraisal of the retrieved studies, a meta-analysis was performed. RESULTS: A total of 15 studies were included. It was found that several factors had a great impact on the patient compliance of screening. They included a lack of knowledge of cancer and screening, screening costs, a feeling of embarrassment, a fear of screening complications or discomfort, barriers to implementation of screening, a lack of communication with physicians and a lack of symptoms and awareness. CONCLUSION: Screening compliance may be improved through enhancing cognitive function in patients, ameliorating physician-patient communication and lowing the screening costs.

High altitude increases the expression of hypoxia-inducible factor 1α and inducible nitric oxide synthase with intest-inal mucosal barrier failure in rats.

BACKGROUND: The failure of intestinal mucosal barrier may induce multiple organ dysfunction and systemic inflammatory response syndrome, but little work has been done on whether hypobaric hypoxia related to the failure of intestinal mucosal barrier. AIMS: To study the expression of hypoxia-inducible factor 1α (HIF-1α), inducible nitric oxide synthase (iNOS) and morphological changes of intestinal mucosa in albino rats at different altitude. METHODS: 30 male Wistar rats raised in plain for one month were randomly divided into 3 groups: Plain 500 m group (n=10), High-altitude (HA) 3842 m group (n=10) and HA4767 m group (n=10). Each group was delivered to different altitude area at the same shipping time and executed after 3 days' exposure to different altitude. Intestinal segments with the same location of all rats were removed for morphological analyses. Morphologic parameters (villous height, crypt depth, mucosal wall thickness and villous surface area) were measured by optical and scanning electron microscope. The expression of iNOS and HIF-1α were detected by immunohistochemistry. RESULTS: Morphological indexes in higher altitude groups were exacerbated obviously compared with those of lower altitude groups. While the expression of iNOS and HIF-1α in higher altitude groups were significantly increased than those of lower altitude groups. Linear correlation analysis showed that the expression of iNOS was positively correlated with that of HIF-1α. CONCLUSIONS: Hypobaric hypoxia increases the expression of HIF-1α and iNOS in intestinal mucosa, however exacerbates the mucous morphologic parameters with altitude increasing. HIF-1α may regulate the expression of iNOS and be involved in the damage of intestinal mucosa.

Activation of autophagy in rats with plateau stress-induced intestinal failure.

Hypobaric hypoxia may damage the intestinal mucosa, which may induce multiple organ dysfunction. However, little work has been done regarding whether high altitude hypoxia is associated with failure of the intestinal mucosal barrier. The aim of this study was to investigate the change of the autophagy after the intestinal failure in rats acutely exposed to plateau stress. Fifty Wistar rats were randomly divided into five groups: the plain group, plateau for 6 h, 12 h, 24 h, and 48 h (n = 10 in each group). The acute exposure to plateau was established at a simulated altitude of 4767 meters (m) in a decompression chamber. Intestinal injury was verified by light microscopy. The autophagosomes in the intestinal epithelial cells were observed by transmission electron microscopy (TEM). The protein expression of Beclin1 and LC3B in the intestinal epithelial cells were analyzed by immunohistochemistry. Compared with the plain group, acute exposure to plateau led to a time-dependent damage of the intestinal epithelium. The autophagosome was observed after the intestinal failure following acute exposure to high altitude for 6 h. The expression of Beclin1 and LC3B protein in the rats exposed to acute plateau for 6 h, 12 h, 24 h and 48 h were significantly higher than those in the plain group. The expression of autophagy also showed a significant increase in rats with intestinal failure following acute exposure to plateau stress.

Adiponectin levels in patients with colorectal cancer and adenoma: a meta-analysis.

Inconsistent results with regard to adiponectin levels in patients with colorectal cancer (CRC) and adenoma have been reported. To evaluate adiponectin levels in patients with CRC and adenoma, a meta-analysis on studies which compared adiponectin levels in patients with CRC or adenoma with healthy controls was carried out. A literature search was performed through Pubmed, EMBASE, and Science Citation Index Expanded database. Pooled-weighted mean differences and 95% confidence intervals (95%CI) were calculated by using random-effects models. Heterogeneity between studies was assessed using the Cochran's Q and I statistics. A total of 13 studies were identified, which included 2632 cases of CRC or adenoma and 2753 healthy controls. Adiponectin levels were significantly lower in patients with CRC or adenoma compared with healthy controls, with significant heterogeneity [weighted mean differences of -1.51 (95% CI: -2.42 to -0.59; Pheterogeneity<0.001) for CRC and -1.29 (95% CI: -2.01to -0.58; Pheterogeneity<0.001) for colorectal adenoma, respectively]. On stratified analysis of CRC, significant difference in adiponectin levels between patients with CRC and healthy controls was reported only in case-control studies or small sample size studies (n<100), but not in nested case-control studies or large sample size studies (n≥100). In addition, metaregression analysis indicated that study design and sample size partly contributed to the significant heterogeneity (P=0.022 for study design and P=0.018 for sample size, respectively). For colorectal adenoma studies, stratified analysis indicated that sample size was one of the heterogeneous factors. Sensitivity analysis showed that there were no changes in the direction of effect when any one study was excluded. No publication bias was detected. Adiponectin levels are lower in patients with CRC or colorectal adenoma compared with those in healthy controls. Future studies are warranted to clarify the association of adiponectin levels and carcinogenesis of the colorectum.

Colorectal cancer screening behavior and willingness: an outpatient survey in China.

AIM: To identity the factors influencing colorectal cancer (CRC) screening behavior and willingness among Chinese outpatients. METHODS: An outpatient-based face-to-face survey was conducted from August 18 to September 7, 2010 in Changhai Hospital. A total of 1200 consecutive patients aged ≥ 18 years were recruited for interview. The patient's knowledge about CRC and screening was pre-measured as a predictor variable, and other predictors included age, gender, educational level, monthly household income and health insurance status. The relationship between these predictors and screening behavior, screening willingness and screening approach were examined using Pearson's χ(2) test and logistic regression analyses. RESULTS: Of these outpatients, 22.5% had undergone CRC screening prior to this study. Patients who had participated in the screening were more likely to have good knowledge about CRC and screening (OR: 5.299, 95% CI: 3.415-8.223), have health insurance (OR: 1.996, 95% CI: 1.426-2.794) and older in age. Higher income, however, was found to be a barrier to the screening (OR: 0.633, 95% CI: 0.467-0.858). An analysis of screening willingness showed that 37.5% of the patients would voluntarily participated in a screen at the recommended age, but 41.3% would do so under doctor's advice. Screening willingness was positively correlated with the patient's knowledge status. Patients with higher knowledge levels would like to participate in the screening (OR: 4.352, 95% CI: 3.008-6.298), and they would select colonoscopy as a screening approach (OR: 3.513, 95% CI: 2.290-5.389). However, higher income level was, again, a barrier to colonoscopic screening (OR: 0.667, 95% CI: 0.505-0.908). CONCLUSION: Patient's level of knowledge and income should be taken into consideration when conducting a feasible CRC screening.

The relationship between new-onset diabetes mellitus and pancreatic cancer risk: a case-control study.

Diabetes mellitus (DM) is widely considered to be associated with pancreatic cancer, however, whether DM is a cause or consequence of pancreatic cancer is controversial. In the present study, 1458 patients with pancreatic ductal adenocarcinoma (PDAC) and 1528 age-, sex- and sociodemographic variables-matched controls were recruited in two university-affiliated hospitals from 1st January 2000 to 31st December 2009. DM was defined as fasting blood glucose (FBG) level of 7.0 mmol/L or greater. An unconditional multivariable logistic regression analysis was used to estimate adjusted odds ratios (AORs) and 95% confidence interval (CI). Compared with controls, a moderate increased risk of PDAC was observed among cases with long-standing diabetes (≥ 2-year duration), with an AOR (95% CI) of 2.11 (1.51-2.94). Interestingly, a significant higher risk was observed among cases with new-onset DM (<2-year duration), with an AOR of 4.43 (3.44-5.72) compared to controls without DM. In addition, we found a synergistic interaction between cigarette smoking and DM on modifying the risk of pancreatic cancer development (AOR=6.17, 95% CI 3.82-9.94). Similarly, a synergistic interaction between new-onset DM and family history of pancreatic cancer was found for pancreatic cancer risk, with an AOR (95% CI) of 11.04 (2.51-48.53). This study suggested that DM could be both an early manifestation of pancreatic cancer and an aetiologic factor. Possible effect modification on DM by family history of pancreatic cancer and smoking status should be further explored in future aetiologic studies.

Plasma miR-216a as a potential marker of pancreatic injury in a rat model of acute pancreatitis.

AIM: To study the potential value and specificity of plasma miR-216a as a marker for pancreatic injury. METHODS: Two rat models were applied in this article: L-arginine-induced acute pancreatitis was used as one model to explore the potential value of plasma miR-216a for detection of pancreatic injury; nonlethal sepsis induced in rats by single puncture cecal ligation and puncture (CLP) was used as the other model to evaluate the specificity of plasma miR-216a compared with two commonly used markers (amylase and lipase) for acute pancreatitis. Plasmas were sampled from rats at indicated time points and total RNA was isolated. Real-Time Quantitative reverse transcriptase-polymerase chain reaction was used to quantify miR-216a in plasmas. RESULTS: In the acute pancreatitis model, among five time points at which plasmas were sampled, miR-216a concentrations were significantly elevated 24 h after arginine administration and remained significantly increased until 48 h after operation (compared with 0 h time point, P < 0.01, Kruskal-Wallis Test). In the CLP model, plasma amylase and lipase, two commonly used biomarkers for acute pancreatitis, were significantly elevated 24 h after operation (compared with 0 h time point, P < 0.01 and 0.05 respectively, Pairwise Bonferroni corrected t-tests), while miR-216a remained undetectable among four tested time points. CONCLUSION: Our article showed for the first time that plasma miR-216a might serve as a candidate marker of pancreatic injury with novel specificity.