Comparative Effects of Different Nutritional Supplements on Inflammation, Nutritional Status, and Clinical Outcomes in Colorectal Cancer Patients: A Systematic Review and Network Meta-Analysis.

Nutritional supplements have been widely used in colorectal cancer (CRC) patients. The aim of this network meta-analysis (NMA) was to compare the effects of different nutritional supplements on inflammation, nutritional status, and clinical outcomes in CRC patients. Four electronic databases were searched until December 2022. Randomized controlled trials (RCTs) comparing nutritional supplements of omega-3 fatty acids (omega-3), arginine, vitamin D, glutamine, probiotics, or their combinations with placebo or standard treatment were selected. The outcomes were inflammatory indicators, nutritional indicators, and clinical outcomes. A random-effects Bayesian NMA was performed to rank the effect of each supplement. In total, 34 studies involving 2841 participants were included. Glutamine was superior in decreasing tumor necrosis factor-α (MD -25.2; 95% CrI [-32.62, -17.95]), whereas combined omega-3 and arginine supplementation was more effective in decreasing interleukin-6 (MD -61.41; 95% CrI [-97.85, -24.85]). No nutritional supplements significantly maintained nutritional indicators in CRC patients. Regarding clinical outcomes, glutamine ranked highest in reducing the length of hospital stay (MD -3.71; 95% CrI [-5.89, -1.72]) and the incidence of wound infections (RR 0.12; 95% CrI [0, 0.85]), and probiotics were rated as best in reducing the incidence of pneumonia (RR 0.38; 95% CrI [0.15, 0.81]). Future well-designed RCTs are needed to further confirm these findings.

Effects of EN combined with PN enriched with n-3 polyunsaturated fatty acids on immune related indicators and early rehabilitation of patients with gastric cancer: A randomized controlled trial.

BACKGROUND & AIMS: Patients who undergo gastrectomy often have a high risk of postoperative complications. This study aimed to investigate the effects of n-3 polyunsaturated fatty acids (PUFAs) on immune function, the inflammatory response, nutritional status, and rehabilitation of patients with gastric cancer. METHODS: A total of 120 patients with gastric cancer who underwent elective radical gastrectomy in the Department of Gastrointestinal Surgery, West China Hospital, Sichuan University from September 2019 to December 2020 were randomly divided into the n-3 PUFAs group (n = 60) and control group (n = 60). Patients in N-3 PUFAs group were treated with enteral nutrition (EN) combined with parenteral nutrition (PN) enriched with n-3 PUFAs from postoperative Day 1 to Day 5, whereas patients in the control group were administered EN combined with PN without n-3 PUFAs. Immune parameters (lymphocyte count [LYM], CD3+, CD4+, CD8+, CD4+/CD8+), inflammatory indicators (white blood cell [WBC], C-reactive protein [CRP], interleukin 6 [IL-6], tumor necrosis factor α [TNF-α]), nutrition parameters (hemoglobin [Hb], total protein [TP], albumin [Alb], prealbumin [PAB], transferrin [TRF]), the incidence of postoperative complications and rehabilitation parameters were compared between the two groups. RESULTS: The immune parameters (LYM, CD3+, CD4+, CD4+/CD8+) and nutritional parameters (TP, Alb, PAB) of the n-3 PUFAs group were significantly increased compared with the control group, and inflammatory indicators (CRP, IL-6, TNF-α) were lower compared with the control group. The rate of postoperative complications in the n-3 PUFAs group (7%) was significantly lower than that in the control group (20%), and the time to first aerofluxus and defecation were earlier in the n-3 PUFAs group. No differences in postoperative length of stay, unplanned 30-day readmission or reoperation after surgery were noted. CONCLUSION: The study shows that n-3 PUFAs contribute to the recovery of immune function, inflammatory response, and early rehabilitations of patients with gastric cancer undergoing gastrectomy. N-3 PUFAs were safe and effective in promoting the rehabilitation of patients with gastrectomy in our study. More high-quality and large sample studies are needed. Registration number of Clinical Trial: ChiCTR1900028381.

[Analysis of prescription regularity of traditional Chinese medicine for colorectal cancer based on data mining].

The tumor prescriptions contained in Dictionary of Tumor Formulas, Compendium of Good Tumor Formulas, Chinese Pharmacopoeia, Ministry of Health Drug Standards for Chinese Medicine Formulas and National Compilation of Standards for Proprietary Chinese Medicines were selected and organized to construct a database for tumor prescriptions, and the data mining techniques were applied to investigate the prescription regularity of colorectal cancer prescriptions. The formula data were extracted after screening in strict accordance with the inclusion and exclusion criteria, and were then analyzed with Microsoft Excel 2010 for frequency statistics, Apriori block provided by SPSS Clementine 12.0 software for correlation rule analysis, and arules and arulesViz packages in R 4.0.2 software for correlation rule visualization. In addition, SPSS 18.0 software was used for cluster analysis and factor analysis, in which cluster analysis was performed by Ochiai algorithm with bicategorical variables in systematic clustering method and factor analysis was performed mainly with principal component analysis. A total of 285 prescriptions were included in the statistical analysis, and the frequency statistics showed that 43 herbs had been used more than 16 times. The association rules analysis showed that 26 high-frequency me-dicine pair rules were obtained, and the association rules for those dispelling evil spirits, strengthening the body, resolving stasis, dispelling dampness, etc. were visualized. In the cluster analysis, we generated a dendrogram from which 7 groups of traditional Chinese medicines with homogeneity were extracted. 10 common factors were obtained in the factor analysis. The types of herbal medicines involved in the colorectal cancer prescription included anti-cancer antidotes, strengthening and tonifying medicines, blood-regulating medicines, and expectorant medicines, corresponding to the treatment for eliminating evil spirits, strengthening, resolving stasis, and expectorating dampness. The prescriptions for anti-cancer detoxification were normally based on the pairs composed of Scutellaria barbata-Hedyotis diffusa and Sophora flavescens, Sargentodoxa cuneata, S. barbata, often combined with stasis relieving drug and dampness eliminating drug, reflecting the characteristics of treatment for both toxicity and stasis, dampness and toxicity simultaneously. The prescriptions for strengthening the righteousness and tonifying the deficiency were composed of Astragalus membranaceus and Atractylodes macrocephala mainly, exerting the effect of benefiting Qi, strengthening the spleen and drying dampness, tonifying kidney and essence, tonifying blood and invigorating blood. Meanwhile, anti-cancer detoxification medicines shall be reduced as much as possible. The compatibility of the medicines for the intestinal tract reflected the principle of using the right medicine for the right condition and eliminating evil spirits or strengthening the body, as appropriate.

Effects of preoperative oral single-dose and double-dose carbohydrates on insulin resistance in patients undergoing gastrectomy:a prospective randomized controlled trial.

BACKGROUND & AIMS: Preoperative oral carbohydrates are strongly recommended for routine use before various elective procedures. The regimen mainly includes preoperative oral single-dose carbohydrate (2-3 h before surgery) and preoperative oral double-dose carbohydrates (10 h before surgery and 2-3 h before surgery). The choice between the two options is still controversial. METHODS: A total of 139 patients with gastric cancer who underwent radical gastrectomy were recruited from a hospital in Sichuan Province, China. The patients were randomly assigned to a single-dose group (n = 70) or a double-dose group (n = 69). Insulin resistance indicators, subjective comfort indicators, inflammatory mediators, immunological indicators, postoperative recovery indexes, and complications were compared between the two groups. RESULTS: There were no differences in insulin resistance indicators (fasting plasma glucose, fasting insulin, and homeostasis model assessment indexes), inflammatory mediators (C-reactive protein, interleukin-6, and tumor necrosis factor-α), immunological indicators (CD3+, CD4+, CD8+, and CD4+/CD8+) between the single-dose group and double-dose group (all P > 0.05) at preoperative day 1, preoperative 3 h, and postoperative day 1. There were no differences in subjective comfort indicators (thirst, hunger, anxiety, nausea, fatigue, and weakness) between the two groups (all P > 0.05) at preoperative day 1, preoperative 3 h, preoperative 1 h, and postoperative day 1. The postoperative recovery indexes and complications (exhaust time, liquid intake time, postoperative hospital stay, complication incidence, unplanned readmission rate, and unplanned reoperation rate 30 days after operation) did not significantly differ between the two groups (all P > 0.05). The number of preoperative nighttime urinations in the double-dose group was higher than that in the single-dose group (88.3% VS 48.5%, P < 0.001), and the number of hours of preoperative sleep in the double-dose group was lower than that in the single-dose group (4.56 ± 0.68 VS 5.71 ± 0.57, P < 0.001). CONCLUSION: Oral carbohydrates administered the night before surgery did not enhance the effects of oral carbohydrates administered 2-3 h before surgery on insulin resistance, subjective comfort, inflammation, and immunity and might affect the patients' night rest. In making a decision between oral carbohydrate regimes, evening carbohydrates could be omitted. TRIAL REGISTRATION: ChiCTR, ChiCTR1900020608. Registered January 10, 2019, http://www.chictr.org.cn: ChiCTR1900020608.

Meta-Analysis of Efficacy of Rhubarb Combined With Early Enteral Nutrition for the Treatment of Severe Acute Pancreatitis.

BACKGROUND: Whether to provide rhubarb combined with early enteral nutrition (rhubarb/EEN) to patients with severe acute pancreatitis (SAP) remains controversial. This study aimed to systematically explore the efficacy and safety of rhubarb/EEN in SAP patients. METHODS: We performed searches in EMBASE, PubMed, Medline, Cochrane Library, Chinese Biomedicine Literature Database (SinoMed), Chinese Scientific Journal Database (VIP), Chinese National Knowledge Infrastructure (CNKI), and Wanfang database to identify relevant literature comparing rhubarb/EEN with EEN for SAP. RESULTS: Eleven randomized controlled trials (724 patients) were included. Meta-analysis showed significantly shorter length of hospital stay (days) (mean difference [MD], -4.49; 95% CI, -6.09 to -2.90; P < .00001), shorter length of intensive care unit stay (days) (MD, -2.82; 95% CI, -4.00 to -1.64; P < .00001), shorter length of severe abdominal pain (days) (MD, -2.20; 95% CI, -2.50 to -1.90; P < .00001), shorter length of abdominal distention (days) (MD, -2.31; 95% CI, -2.84 to -1.78; P < .00001), shorter length of abnormal bowel sounds (days) (MD, -0.98; 95% CI, -1.12 to -0.88; P < .00001), less hospitalization expenditure ($1422.75/¥ 10,000) (MD, -1.40; 95% CI, -1.23 to -0.73; P < .00001), and smaller Acute Physiology and Chronic Health Evaluation II scores (points) (MD, -2.18; 95% CI, -2.81 to -1.56; P < .00001) in the rhubarb/EEN group than in the EEN group. Compared with EEN, rhubarb/EEN group had lower levels of white blood cells (109 /L) (MD, -2.77; 95% CI, -3.80 to -1.74; P < .00001), C-reactive protein (mg/L) (MD, -10.71; 95% CI, -13.40 to -8.02; P < .00001), and interleukin-6 (ng/L) (MD, -8.02; 95% CI, -11.38 to -4.65; P < .00001). However, there were no significant differences (P > .05) between the 2 groups in terms of mortality rate (%) (P = .40), infection rate (%) (P = .28), and incidence of multiple organ dysfunction syndrome (%) (P = .09), but the overall effective rate was higher in the rhubarb/EEN group (MD, 2.57; 95% CI, 1.22 to ≈5.42; P = .01). CONCLUSIONS: Combination of EEN and rhubarb may improve the gastrointestinal function, inhibit systemic inflammation and disease severity, and enhance the efficacy of enteral nutrition, leading to better therapeutic effectiveness in SAP patients.

Effect of Enteral Immunonutrition on Immune, Inflammatory Markers and Nutritional Status in Gastric Cancer Patients Undergoing Gastrectomy: A Randomized Double-Blinded Controlled Trial.

Backgrounds: Enteral immunonutrition (EIN) has received increasing attention, however, evidence on its immunomodulatory and anti-inflammatory function in gastric cancer patients undergoing gastrectomy is poorly investigated. Objectives of this study were to evaluate the effect of EIN on immune function, inflammation response and nutrition status when compared to standard enteral nutrition (SEN). Methods: Totally 124 gastric cancer patients after gastrectomy were randomized to receive early 5-days postoperative EIN (formula enriched with arginine, glutamine, omega-3 fatty acids and nucleotide), or SEN. The primary end-points were CD4+ T-cells, CD3+ T-cells as well as counts of CD4+/CD8+, IgG, IgM, and IgA levels. Second-points included white blood cell (WBC), C-reactive protein (CRP), procalcitonin (PCT), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) levels and nutritional index such as serum albumin, prealbumin, and transferrin concentration. Results: There existed significant difference in primary end-points between EIN group and SEN group. The proportion of CD4+ T-cells, CD3+ T-cells and the counts of CD4+/CD8+, IgG, IgM, and IgA were higher in EIN group eventually. Meanwhile, the level of WBC, CRP and TNF-α were significantly lower in EIN group finally. But there were no other significant differences in nutritional markers between two groups. Conclusion: Early postoperative EIN significantly improves immune function and inflammatory response in gastric cancer patients undergoing gastrectomy.

Meta-Analysis of Efficacy of Sijunzi Decoction Combined with Enteral Nutrition for the Treatment of Gastric Cancer.

Objective: Whether to conduct Sijunzi decoction combined with enteral nutrition (SJZD/EN) in patients with gastric cancer (GC) remains controversial. This study was aimed to systematically analyze the efficacy and safety of SJZD/EN in patients with gastric cancer.Methods: We performed searches in PubMed, MEDLINE, EMBASE, Cochrane Library, Web of Science, Chinese National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), Wanfang database, and Chinese Biomedicine Literature Database (SinoMed) to identify relevant literature comparing SJZD/EN with conventional EN for GC patients. The analysis was carried out with RevMan 5.3.Results: A total of 10 randomized controlled trials (688 patients) were included. Meta-analysis showed a significantly shorter time to flatus (t/h) (MD, -9.45; 95% CI, -10.76 to -8.13; p < 0.00001), a shorter length of hospital stay (t/d) (MD, -5.22; 95% CI, -7.46 to -2.99; p < 0.00001), and a lower incidence of postoperative complications (%) (OR, 0.14; 95% CI, 0.03-0.64; p = 0.01) in the SJZD/EN group than the EN group. Compared with the EN, the SJZD/EN group had a higher level of albumin(g/L) (MD, 2.59; 95% CI, 1.90-3.28; p < 0.00001), prealbumin (mg/L) (MD, 36.81; 95% CI, 13.41-60.20; p = 0.002), transferrin (g/L) (MD, 0.19; 95% CI, 0.10-0.28; p < 0.0001), immunoglobulin G (g/L) (MD, 2.61; 95% CI, 2.12-3.09; p < 0.00001), immunoglobulin A (g/L) (MD, 0.38; 95% CI, 0.31-0.45, p < 0.00001), immunoglobulin M (g/L) (MD, 0.31; 95% CI, 0.22-0.41; p < 0.00001), CD3+ (%) (MD, 6.73; 95% CI, 3.48-9.98; p < 0.0001), CD4+ (%) (MD, 4.32; 95% CI, 3.30-5.33; p < 0.00001), and CD4+/CD8+ (MD, 0.20; 95% CI, 0.11-0.28; p < 0.00001).Conclusions: Sijunzi decoction combined with enteral nutrition appears to have efficacy and safety for gastric cancer.

Arginine residues in the active site of human phenol sulfotransferase (SULT1A1).

Cytosolic sulfotransferases (STs) catalyze the sulfation of hydroxyl containing compounds. Human phenol sulfotransferase (SULT1A1) is the major human ST that catalyzes the sulfation of simple phenols. Because of its broad substrate specificity and lack of endogenous substrates, the biological function of SULT1A1 is believed to be an important detoxification enzyme. In this report, amino acid modification, computer structure modeling, and site-directed mutagenesis were used for studies of Arg residues in the active site of SULT1A1. The Arg-specific modification reagent, 2,3-butanedione, inactivated SULT1A1 in an efficient, time- and concentration-dependent manner, suggesting Arg residues play an important role in the catalytic activity of SULT1A1. According to the computer model, Arg78, Arg130, and Arg257 may be important for SULT1A1 catalytic activity. Site-directed mutagenesis results demonstrated that the positive charge on Arg78 is not critical for SULT1A1 because R78A is still active. In contrast, a negative charge at this position, R78E, completely inactivated SULT1A1. Arg78 is in close proximity to the site of sulfuryl group transfer. Arg257 is located very close to the 3'-phosphate in adenosine 3'-phosphate 5'-phosphosulfate (PAPS). Site-directed mutagenesis demonstrated that Arg257 is critical for SULT1A1: both R257A and R257E are inactive. Although Arg130 is also located very close to the 3'-phosphate of PAPS, R130A and R130E are still active, suggesting that Arg130 is not a critical residue for the catalytic activity of SULT1A1. Computer modeling suggests that the ionic interaction between the positive charge on Arg257, and the negative charge on 3'-phosphate is the primary force stabilizing the specific binding of PAPS.