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Transcutaneous electrical acupoint stimulation applied in lower limbs decreases the incidence of paralytic ileus after colorectal surgery: A multicenter randomized controlled trial.
Gao, W, Li, W, Yan, Y, Yang, R, Zhang, Y, Jin, M, Luo, Z, Xie, L, Ma, Y, Xu, X, et al
Surgery. 2021;(6):1618-1626
Abstract
BACKGROUND Postoperative paralytic ileus prolongs hospitalization duration, increases medical expenses, and is even associated with postoperative mortality; however, effective prevention of postoperative paralytic ileus is not yet available. This trial aimed to assess the preventative effectiveness of transcutaneous electrical acupoint stimulation applied in the lower limbs on postoperative paralytic ileus incidence after colorectal surgery. METHODS After ethics approval and written informed consent, 610 patients from 10 hospitals who were scheduled for colorectal surgery between May 2018 and September 2019 were enrolled. Patients were randomly allocated into the transcutaneous electrical acupoint stimulation (stimulated on bilateral Zusanli, Shangjuxu, and Sanyinjiao acupoints in lower limbs for 30 minutes each time, total 4 times) or sham (without currents delivered) group with 1:1 ratio. The primary outcome was postoperative paralytic ileus incidence, defined as no flatus for >72 hours after surgery. RESULTS Compared to the sham treatment, transcutaneous electrical acupoint stimulation lowered the postoperative paralytic ileus incidence by 8.7% (32.3% vs 41.0%, P = .026) and decreased the risk of postoperative paralytic ileus by 32% (OR, 0.68; P = .029). Transcutaneous electrical acupoint stimulation also shortened the recovery time to flatus, defecation, normal diet, and bowel sounds. Transcutaneous electrical acupoint stimulation treatment significantly increased median serum acetylcholine by 55% (P = .007) and interleukin-10 by 88% (P < .001), but decreased interleukin-6 by 47% (P < .001) and inducible nitric oxide synthase by 42% (P = .002) at 72 hours postoperatively. CONCLUSION Transcutaneous electrical acupoint stimulation attenuated the postoperative paralytic ileus incidence and enhanced gastrointestinal functional recovery, which may be associated with increasing parasympathetic nerve tone and its anti-inflammatory actions.
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Physically active individuals have a 23% lower risk of any colorectal neoplasia and a 27% lower risk of advanced colorectal neoplasia than their non-active counterparts: systematic review and meta-analysis of observational studies.
Wang, J, Huang, L, Gao, Y, Wang, Y, Chen, S, Huang, J, Zheng, W, Bao, P, Gong, Y, Zhang, Y, et al
British journal of sports medicine. 2020;(10):582-591
Abstract
BACKGROUND Few studies have examined the associations between physical activity (PA), sedentary behaviour (SB) and risk of colorectal neoplasia (CN). METHODS We systematically searched Medline, Embase, PsyInfo, Cochrane and other sources from their inception to 30 September 2018 for cohort, case-control and cross-sectional studies that evaluated these associations in asymptomatic, average-risk subjects. Random-effect models were used to estimate relative risks (RRs) of any-type CN, advanced CN, and non-advanced CN, respectively, in individuals with the highest versus the lowest level of PA and SB. Dose-response analyses and subgroup analyses were conducted. The I2 statistic was used to examine heterogeneity among studies. RESULTS We identified 32 observational studies, including 17 cross-sectional studies, 10 case-control studies and five longitudinal studies. PA (highest vs lowest) was inversely associated with risk for any-type CN (n=23 studies) and advanced CN (n=15 studies), with a RR of 0.77 (95% CI=0.71 to 0.83, I2=57.5%) and 0.73 (95% CI=0.63 to 0.82, I2=45.5%), respectively. There was no association between PA and non-advanced CN (n=5 studies). There was an as association between PA and any-type CN in both sexes, and also for the distal colon. We found no dose-response relationship between PA and any-type or advanced CN. Based on three studies identified, SB time (longest vs shortest) was associated with an increased risk of advanced CN (RR=1.24, 95% CI 1.04 to 1.49, I2=14.4%). No publication bias was detected by Begg's test. CONCLUSION We report a 23% lower relative risk of any type of CN and a 27% lower risk of advanced CN in people with the highest level of PA compared with those in the lowest.
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Association of Circulating 25-Hydroxyvitamin D Levels with Colorectal Cancer: An Updated Meta-Analysis.
Xu, J, Yuan, X, Tao, J, Yu, N, Wu, R, Zhang, Y
Journal of nutritional science and vitaminology. 2018;(6):432-444
Abstract
A higher serum 25-hydroxyvitamin D (25(OH)D) concentration benefits colorectal cancer prevention. However, whether it can improve the prognosis among patients is still under discussion. This study aims to explore the impacts of high level 25(OH)D on the survival of colorectal cancer patients. PubMed, Embase, and Cochrane were searched from January 2000 to August 2017 for relevant articles. Only published studies focusing on the relationship between 25(OH)D levels at or near the time of diagnosis and survival were considered. Two review authors independently assessed the risk of bias for each study, and any disagreement was resolved by discussion or by involving a third assessor. Eleven studies comprising 7,367 patients were included. In these studies, there were considerable differences between the higher 25(OH)D level group and the lower group in terms of overall survival (OS), progression-free survival (PFS) and colorectal cancer-specific survival (CSS) in a random effect model (OS: HR 0.67, 95% CI 0.56-0.80, p<0.00001; CSS: HR 0.73, 95% CI 0.55-0.97, p=0.03; PFS: HR 0.74, 95% CI 0.61-0.90, p=0.003). Moreover, the combined hazard ratios of OS and CSS had considerably significant heterogeneity which may be explained by subgroup analysis. The relationship between 25(OH)D and tumor characteristics/lifestyle factors was also included in the meta-analysis. BMI (p=0.03), smoking (p=0.03) and physical activity (p=0.002) seemed to be associated with circulating 25(OH)D level. Publication bias was undetected. Colorectal cancer patients with higher circulating 25(OH)D level may have a better prognosis.
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Water Exchange Method Significantly Improves Adenoma Detection Rate: A Multicenter, Randomized Controlled Trial.
Jia, H, Pan, Y, Guo, X, Zhao, L, Wang, X, Zhang, L, Dong, T, Luo, H, Ge, Z, Liu, J, et al
The American journal of gastroenterology. 2017;(4):568-576
Abstract
OBJECTIVES Adenoma detection rate (ADR) is a key colonoscopy quality indicator in Western clinical literature. Our low ADR prompted us to assess novel methods to improve performance. Western retrospective reports suggested that water exchange (WE) could increase ADR. However, most of these studies used pain score or intubation rate as the primary outcome. Here we test the hypothesis that WE significantly increases ADR among Chinese colonoscopists and design a prospective randomized controlled trial using ADR as our primary outcome. METHODS This prospective, randomized controlled trial was performed at six centers in China. Screening, surveillance, and diagnostic cases were randomized to be examined by WE or traditional air insufflation (AI) method. The primary outcome was ADR. RESULTS From April 2014 to July 2015, 3,303 patients were randomized to WE (n=1,653) and AI (n=1,650). The baseline characteristics were comparable. Overall ADR was 18.3% (WE) and 13.4% (AI) (relative risk 1.45, 95% confidential interval: 1.20-1.75, P<0.001). ADR in screening patients using AI was 25.8% (male) and 15.7% (female). ADR in screening patients aged >50 years old was 29.4% (WE) and 22.9% (AI) (relative risk 1.09, 95% confidential interval: 1.00-1.19, P=0.040). The increase by WE was reproducibly observed in all indication categories, and significant in screening and diagnostic cases. The limitation imposed by the unblinded investigators was mitigated by comparable inspection times in cases without polyps, similar adenoma per positive colonoscopy, and reproducible enhancement of ADR and adenoma per colonoscopy by WE across all eight investigators. CONCLUSIONS This prospective study confirms Western retrospective data that WE significantly improves ADR among Chinese colonoscopists. WE may be superior to AI for screening colonoscopy in China. Colonoscopists elsewhere with low ADR might consider evaluating WE for performance improvement.
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Analyzing large-scale samples confirms the association between rs16892766 polymorphism and colorectal cancer susceptibility.
Liao, M, Wang, G, Quan, B, Qi, X, Yu, Z, Feng, R, Zhang, L, Jiang, Y, Zhang, Y, Liu, G
Scientific reports. 2015;:7957
Abstract
Colorectal cancer (CRC) is a common complex disease caused by the combination of genetic variants and environmental factors. Genome-wide association studies (GWAS) have been performed and reported some novel CRC susceptibility variants. The rs16892766 (8q23.3) polymorphism was first identified to be significantly associated with CRC in European ancestry. The following studies investigated this association in Chinese, Japanese, Romanian, Swedish, African American, European American, and Croatian populations. These studies reported consistent and inconsistent results. Here, we reevaluated this association using the relatively large-scale samples from 13 studies (N = 59737, 26237 cases and 33500 controls) using a meta-analysis by searching the PubMed, Google Scholar and CRCgene databases. We observed no significant heterogeneity among the included studies. Our results showed significant association between rs16892766 polymorphism and CRC (P = 1.33E-35, OR = 1.23, 95% CI 1.20-1.27). Collectively, our analysis further supports previous findings that the rs16892766 polymorphism is significantly associated with CRC susceptibility. We believe that our findings will be very useful for future genetic studies on CRC.
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Association between X-ray repair cross-complementing group 1 Arg194Trp polymorphism and colorectal cancer risk.
Mao, D, Zhang, Y, Lu, H, Fu, X
Tumour biology : the journal of the International Society for Oncodevelopmental Biology and Medicine. 2013;(5):2529-38
Abstract
The polymorphism of X-ray repair cross-complementing group 1 (XRCC1) Arg194Trp, a substitution of Arg to Gln at position 194, has been implicated in the development of colorectal cancer (CRC) in a number of case-control studies with contradictory and inconclusive findings. The current meta-analysis of all currently available publications was conducted to assess the gene susceptibility to CRC and improve our understanding of the CRC pathogenesis. The pooled odds ratio (OR) with corresponding 95 % confidence interval (95 % CI) was calculated by use of fixed-effects model or random-effects model when appropriate. A total of 15 eligible case-control studies with 4,501 cases and 8,038 controls were retrieved after a comprehensive search of the PubMed, Embase, Web of science, and Chinese Biomedicine (CBM) databases up to December 2012. The overall meta-analysis identified a positive but not statistically significant association between the XRCC1 Arg194Trp polymorphism and CRC risk under all genetic contrast models (ORTrp vs. Arg = 1.07, 95 % CI 0.90-1.26, P OR = 0.441; ORTrpTrp vs. ArgArg = 1.28, 95 % CI 0.91-1.81, P OR = 0.163; ORArgTrp vs. ArgArg = 1.00, 95 % CI 0.85-1.19, P OR = 0.956; ORArgTrp + TrpTrp vs. ArgArg = 1.06, 95 % CI 0.90-1.24, P OR = 0.502; ORTrpTrp vs. ArgArg + ArgTrp = 1.11, 95 % CI 0.91-1.34, P OR = 0.306). The genotype TrpTrp carriers among Caucasians were more susceptible to CRC, although lack statistical evidence (ORTrpTrp vs. ArgArg = 2.69, 95 % CI 0.97-7.49, P OR = 0.058; ORTrpTrp vs. ArgArg + ArgTrp = 2.77, 95 % CI 0.99-7.72, P OR = 0.051). Interestingly, the XRCC1 Arg194Trp variant was significantly associated with an increased risk of colon cancer. The present meta-analysis suggests that the XRCC1 Arg194Trp polymorphism may modify the risk for CRC, particularly colon cancer. However, the precise genetic association needs to be further estimated in future studies.
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Coffee consumption and risk of colorectal cancer: a meta-analysis of observational studies.
Li, G, Ma, D, Zhang, Y, Zheng, W, Wang, P
Public health nutrition. 2013;(2):346-57
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Abstract
OBJECTIVE Separate meta-analyses based on case-control and cohort studies have reported different results on the relationship between coffee consumption and colorectal cancer risk. To clarify the effect of coffee intake on colorectal cancer risk, we performed a meta-analysis based on both case-control and cohort studies. DESIGN Review study. SETTING We identified case-control and cohort studies related to coffee consumption and colorectal cancer risk listed on MEDLINE, the Cochrane Controlled Trials Register, EMBASE, Science Citation Index and PubMed (until May 2011). SUBJECTS Research literature on the relationship between coffee consumption and colorectal cancer risk. RESULTS Twenty-five case-control (15 522 cases) and sixteen cohort studies (10 443 cases) were included in the meta-analysis. Comparing the highest v. the lowest/non category of coffee consumption, the combined results from case-control studies showed a significant relationship with colorectal cancer (OR = 0·85, 95 % CI 0·75, 0·97) and colon cancer (OR = 0·79, 95 % CI 0·67, 0·95), but not rectal cancer (OR = 0·95, 95 % CI 0·79, 1·15). For cohort studies, there was a slight suggestion of an inverse association with colorectal cancer (relative ratio = 0·94; 95 % CI 0·88, 1·01) and colon cancer (OR = 0·93, 95 % CI 0·86, 1·01), rather than rectal cancer (OR = 0·98, 95 % CI 0·88, 1·09). In subgroup analyses using case-control studies, significant inverse associations were found in females for colorectal cancer and in Europe for colorectal and colon cancer, while the subgroup analyses of cohort studies found that coffee drinks substantially decreased risk of colon cancer only in Asian women. CONCLUSIONS Results from case-control studies suggest coffee consumption can significantly decrease the risks of colorectal cancer and colon cancer, especially in Europe and for females.
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Lack of association between XPD Lys751Gln and Asp312Asn polymorphisms and colorectal cancer risk: a meta-analysis of case-control studies.
Zhang, Y, Ding, D, Wang, X, Zhu, Z, Huang, M, He, X
International journal of colorectal disease. 2011;(10):1257-64
Abstract
PURPOSE The published data on the association between xeroderma pigmentosum group D (XPD) Lys751Gln and Asp312Asn polymorphisms and colorectal cancer remained controversial. The present meta-analysis of literatures was performed to derive a more precise estimation of the relationship. MATERIALS AND METHODS A comprehensive literature search was conducted to identify all case-control studies of Lys751Gln and Asp312Asn polymorphisms on the susceptibility of different tumor site of colorectal cancer (colon, rectum, and colon/rectum cancer). A total of 22 eligible studies were selected for this meta-analysis, including 3,042 cases and 4,627 controls for Lys751Gln and 1,581 cases and 2,846 controls for Asp312Asn. RESULTS Overall, no significantly elevated colorectal cancer risk was found in all genetic models when all studies were pooled into the meta-analysis (for Lys751Gln polymorphism: Lys/Gln vs. Lys/Lys, OR = 1.01, 95% CI = 0.90-1.14; Gln/Gln vs. Lys/Lys, OR = 1.04, 95% CI = 0.85-1.26; dominant model, OR = 1.03, 95% CI = 0.93-1.15; recessive model, OR = 1.04, 95% CI = 0.87-1.25; and for Asp312Asn polymorphism: Asp/Asn vs. Asp/Asp, OR = 1.11, 95% CI = 0.91-1.35; Asn/Asn vs. Asp/Asp, OR = 1.13, 95% CI = 0.87-1.47; dominant model, OR = 1.09, 95% CI = 0.94-1.26; recessive model, OR = 1.11, 95% CI = 0.88-1.41). And for the additive model, individuals carrying the 751Gln or 312Asn allele were not significantly associated with increased risk to colorectal cancer (OR = 1.02, 95% CI = 0.94-1.11, OR = 1.07, 95% CI = 0.95-1.20). CONCLUSION This meta-analysis suggests that XPD Lys751Gln and Asp312Asn polymorphisms may not be associated with colorectal cancer development.
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Meta analysis of risk factors for colorectal cancer.
Chen, K, Qiu, JL, Zhang, Y, Zhao, YW
World journal of gastroenterology. 2003;(7):1598-600
Abstract
AIM: To study the risk factors for colorectal cancer in China. METHODS A meta-analysis of the risk factors of colorectal cancer was conducted for 14 case-control studies, and reviewed 14 reports within 13 years which included 5034 cases and 5205 controls. Dersimonian and Laird random effective models were used to process the results. RESULTS Meta analysis of the 14 studies demonstrated that proper physical activities and dietary fibers were protective factors (pooled OR<0.8), while fecal mucohemorrhage, chronic diarrhea and polyposis were highly associated with colorectal cancer (all pooled OR>4). The stratified results showed that different OR values of some factors were due to geographic factors or different resources. CONCLUSION Risks of colorectal cancer are significantly associated with the histories of intestinal diseases or relative symptoms, high lipid diet, emotional trauma and family history of cancers. The suitable physical activities and dietary fibers are protective factors.