Effects of glutamine on plasma protein and inflammation in postoperative patients with colorectal cancer: a meta-analysis of randomized controlled trials.

OBJECTIVE: To evaluate the effects of glutamine on the plasma protein and inflammatory responses in colorectal cancer (CRC) patients following radical surgery. METHODS: We thoroughly retrieved online databases (EMBASE, MEDLINE, PubMed, and others) and selected the randomized controlled trials (RCTs) with glutamine vs. conventional nutrition or blank treatment up until March 2023. The plasma protein associated markers indicators (consisting of albumin (ALB), prealbumin (PA), nitrogen balance (NB), total protein (TP)), inflammatory indicators (including TNF-α, CRP, infectious complications (ICs)), and matching 95% confidence intervals (CIs) were evaluated utilizing the pooled analysis. Subsequently, meta-regression analysis, contour-enhanced funnel plot, Egger's test, and sensitivity analysis were carried out. RESULTS: We discovered 26 RCTs, included an aggregate of 1678 patients, out of which 844 were classified into the glutamine group whereas 834 were classified into the control group. The findings recorded from pooled analysis illustrated that glutamine substantially enhanced the plasma protein markers (ALB [SMD[random-effect] = 0.79, 95% CI: 0.55 to 1.03, I2 = 79.4%], PA [SMD[random-effect] = 0.94, 95% CI: 0.69 to 1.20, I2 = 75.1%], NB [SMD[random-effect] = 1.11, 95% CI: 0.46 to 1.75, I2 = 86.9%). However, the content of TP was subjected to comparison across the 2 groups, and no statistical significance was found (SMD[random-effect] = - 0.02, 95% CI: - 0.60 to 0.57, P = 0.959, I2 = 89.7%). Meanwhile, the inflammatory indicators (including TNF-α [SMD[random-effect] = - 1.86, 95% CI: - 2.21 to - 1.59, I2 = 56.7%], CRP [SMD[random-effect] = - 1.94, 95% CI: - 2.41 to - 1.48, I2 = 79.9%], ICs [RR[fixed-effect] = 0.31, 95% CI: 0.21 to 0.46, I2 = 0.00%]) were decreased significantly followed by the treatment of glutamine. CONCLUSIONS: The current study's findings illustrated that glutamine was an effective pharmaco-nutrient agent in treating CRC patients following a radical surgical operation. PROSPERO registration number: CRD42021243327.

Efficacy and safety of total neoadjuvant therapy in locally advanced rectal cancer: a meta-analysis.

PURPOSE: The standard of care for locally advanced rectal cancer (LARC) has changed from a single radical surgical treatment to the current multimodality treatment (standard chemoradiotherapy (CRT) and total neoadjuvant therapy (TNT)). The efficacy and safety of both TNT and standard CRT are evaluated in randomized controlled trials (RCTs). METHODS: RCTs were comprehensively searched in Chinese and English electronic databases. The experimental and control groups were TNT and the standard CRT, respectively, included in this meta-analysis. The outcomes were assessed through a fixed-effect or random-effect model of pooled odds (OR) or hazard ratios (HR). RESULTS: Eleven RCTs, involving 3,101 patients were included in the final analysis. TNT showed increase in the pathological complete response (pCR) (OR = 1.95, 95% confidence interval (CI): 1.57-2.41; P < 0.05) and the R0 resection (OR = 1.19, 95% CI: 0.99-1.43; P = 0.062). There was no significant difference in local recurrence-free survival (LRFS) (HR = 0.97, P = 0.803), but TNT had better 3-year disease-free survival (DFS) (HR = 0.82, 95% CI: 0.72-0.93, P < 0.05), overall survival (OS) (HR = 0.87, 95% CI: 0.74-1.02, P = 0.08) and distant metastasis-free survival (DMFS) (HR = 0.79, 95% CI: 0.67-0.93, P < 0.05) than standard CRT. CONCLUSIONS: TNT was safe and feasible as it improved pCR and survival outcomes, and reduced the risk of distant metastasis compared with standard CRT. TNT may be a superior strategy for LARC, but more RCTs are needed to prove it. REGISTRATION AND PROTOCOL: PROSPERO CRD42022327697. We added the Chinese database after registration because of the inclusion of fewer RCTs www.crd.york.ac.uk/PROSPERO/ .

Meta-analysis of Glutamine on Immune Function and Post-Operative Complications of Patients With Colorectal Cancer.

The aim of this meta-analysis was to evaluate the clinical significance of glutamine in the management of patients with colorectal cancer (CRC) after radical operation. Electronic databases, including PubMed, EMBASE, MEDLINE, Cochrane Library, Chinese Biomedical Database (CBM), China National Knowledge Infrastructure (CNKI), VIP medicine information system (VIP), and Wanfang electronic databases were comprehensively searched from inception to 30, July 2021. Prospective randomized trials with glutamine vs. routine nutrition or blank therapy were selected. The immune function related indicators (including IgA, IgG, IgM, CD4+, CD8+, and the ratio of CD4+/CD8+), post-operative complications [including surgical site infection (SSI), anastomotic leakage, and length of hospital stay (LOS)], and corresponding 95% confidence intervals (CIs) were assessed in the pooled analysis. Subsequently, the heterogeneity between studies, sensitivity, publication bias, and meta-regression analysis were performed. Consequently, 31 studies which contained 2,201 patients (1,108 in the glutamine group and 1,093 in the control group) were included. Results of pooled analysis indicated that glutamine significantly improved the humoral immune function indicators [including IgA (SMD = 1.15, 95% CI: 0.72-1.58), IgM (SMD = 0.68, 95% CI: 0.48-0.89), and IgG (SMD = 1.10, 95% CI: 0.70-1.50)], and the T cell immune function indicators [including CD4+ (SMD = 0.76, 95% CI: 0.53-0.99) and the ratio of CD4+/CD8+ (SMD = 0.92, 95% CI: 0.57-1.28)]. Meanwhile, the content of CD8+ was decreased significantly (SMD = -0.50, 95% CI: -0.91 to -0.10) followed by glutamine intervention. Pooled analysis of SSI (RR = 0.48, 95% CI: 0.30-0.75), anastomotic leakage (RR = 0.23, 95% CI: 0.09-0.61), and LOS (SMD = -1.13, 95% CI: -1.68 to -0.58) were decreased significantly in glutamine group compared with control group. Metaregression analysis revealed that the covariate of small-sample effects influenced the robustness and reliability of IgG outcome potentially. Findings of the present work demonstrated that glutamine ought to be applied as an effective immunenutrition therapy in the treatment of patients with CRC after radical surgery. The present meta-analysis has been registered in PROSPERO (no. CRD42021243327). Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO, Identifier: CRD42021243327.

Discrimination Improvement Through Undesirable Feedback in Coupling Object Manipulation Tasks.

Subjective effort can significantly affect the ability of humans to act optimally in dynamic manipulation tasks. In a previous study, we designed a complex object coupling manipulation task that required tight performance and induced high cognitive workload. We hypothesize that strong-effort-related physiological reactivity during the dynamic manipulation task improves the user performance in an undesired task feedback situation. To test this hypothesis, using the motor intentions' discrimination from electroencephalogram (EEG) measurements, we evaluate the effort expended by 20 participants in a controlling task with constraints involving complex coupling objects. Specifically, the finer motor decisions are obtained from the controlling information in EEG by using two fingers from the same hand rather than two hands. The motor intention is decoded from a task-dependent EEG through a regularized discriminant analysis, and the area under the curve is [Formula: see text]. Furthermore, we compare the undesired and desired task feedback conditions along with the individual's effort dynamic adjustment, and investigate whether the undesired task feedback improved the discrimination of the motor activities. A stronger effort to attain the desired feedback state corresponds to improved motor activity discrimination from the EEG in the undesired task feedback scenario. The differences in the brain activities under the undesired and desired task feedback conditions are analyzed using brain-network-based topographical scalp maps. Our experiment provides preliminary evidence that inducing strong effort can improve discrimination performance during highly demanding tasks. This finding can advance our understanding of human attention, potentially improve the accuracy of intention recognition, and may inspire better EEG acquisition contexts.

Automatic Detection of Epileptic Seizures in EEG Using Sparse CSP and Fisher Linear Discrimination Analysis Algorithm.

In order to realize the automatic epileptic seizure detection, feature extraction and classification of electroencephalogram (EEG) signals are performed on the interictal, the pre-ictal, and the ictal status of epilepsy patients. There is no effective strategy for selecting the number of channels and spatial filters in feature extraction of multichannel EEG data. Therefore, this paper combined sparse idea and greedy search algorithm to improve the feature extraction of common space pattern. The feature extraction can effectively overcome the repeating selection problem of feature pattern in the eigenvector space by the traditional method. Then we used the Fisher linear discriminant analysis to realize the classification. The results show that the proposed method can get high classification accuracy using fewer data. For 10 subjects, the averaged accuracy of epilepsy detection is more than 99%. So, the detection of an epileptic seizure based on sparse features using Fisher linear discriminant analysis classifiers is more suitable for a reliable, automatic epileptic seizure detection system to enhance the patient's care and the quality of life.

[Recognition method of single trial motor imagery electroencephalogram signal based on sparse common spatial pattern and Fisher discriminant analysis].

This paper aims to realize the decoding of single trial motor imagery electroencephalogram (EEG) signal by extracting and classifying the optimized features of EEG signal. In the classification and recognition of multi-channel EEG signals, there is often a lack of effective feature selection strategies in the selection of the data of each channel and the dimension of spatial filters. In view of this problem, a method combining sparse idea and greedy search (GS) was proposed to improve the feature extraction of common spatial pattern (CSP). The improved common spatial pattern could effectively overcome the problem of repeated selection of feature patterns in the feature vector space extracted by the traditional method, and make the extracted features have more obvious characteristic differences. Then the extracted features were classified by Fisher linear discriminant analysis (FLDA). The experimental results showed that the classification accuracy obtained by proposed method was 19% higher on average than that of traditional common spatial pattern. And high classification accuracy could be obtained by selecting feature set with small size. The research results obtained in the feature extraction of EEG signals lay the foundation for the realization of motor imagery EEG decoding.

Improvement Motor Imagery EEG Classification Based on Regularized Linear Discriminant Analysis.

Mental tasks classification such as motor imagery, based on EEG signals is an important problem in brain computer interface systems (BCI). One of the major concerns in BCI is to have a high classification accuracy. The other concerning one is with the favorable result is guaranteed how to improve the computational efficiency. In this paper, Mu/Beta rhythm was obtained by bandpass filter from EEG signal. And the classical linear discriminant analysis (LDA) was used for deciding which rhythm can give the better classification performance. During this, the common spatial pattern (CSP) was used to project data subject to the ratio of projected energy of one class to that of the other class was maximized. The optimal projection dimension was determined corresponding to the maximum of area under the curve (AUC) for each participant. Eventually, regularized linear discriminant analysis (RLDA) is possible to decode the imagined motor sensed using electroencephalogram (EEG). Results show that higher classification accuracy can be provided by RLDA. And optimal projection dimensions determined by LDA and RLDA are of consistent solution, this improves computational efficiency of CSP-RLDA method without computation of projection dimension.