***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Oxidative stress ( OS ) in acute pancreatitis ( AP ) has been pathologically linked with the systemic inflammatory response and antioxidant supplementation may have a clinical benefit . METHODS In this prospect i ve , r and omised open label , controlled pilot study , patients admitted within 72 hours of onset of pain were r and omised to receive either placebo ( only st and ard medical treatment ; SMT ) or antioxidants ( vitamin C 500 mg , N-acetyl cysteine 200 mg 8 hourly and antoxyl forte 1 capsule hourly with st and ard medical treatment ; SMT + AO ) daily , following informed consent . Patients with co-morbid illness and pregnancy were excluded . Primary efficacy measures were length of hospital stay and complications whilst secondary measures were biochemical markers of oxidative stress ( thiobarbituric acid reactive substances [ TBARS ] and superoxide dismutase [ SOD ] and total antioxidant capacity [ TAC ] and vitamin C ) at Days 1 , 3 and 7 . RESULTS Of 53 patients , 30 patients were r and omised to SMT and 23 patients to SMT + AO .  The mean duration of hospital stay in the SMT group ( 10.3 + /- 7 days ) was more compared to SMT + AOT ( 7.2 + /- 5 days ) , but was not statistically significant ( p=0.07 ) , complications were similar in the 2 groups . At Day 7 , OS was significantly lower in the SMT + AO group when compared with the SMT group ( TBARS , p=0.05 ; SOD , p=0.03 ) with a significant increase in FRAP and vitamin C ( p=0.01 ) . CONCLUSIONS Antioxidant supplementation may decrease the length of hospital stay and complication rate in patients with AP , but a larger clinical trial is needed to support this hypothesis . Further , it decreased the OS and improved the antioxidant status in patients with AP OBJECTIVE To investigate the effects of continuous early enteral nutrition ( EEN ) supplemented with glutamine and arginine on gut barrier function in patients with severe acute pancreatitis ( SAP ) . METHODS Thirty two patients with a diagnosis of acute pancreatitis predicted to develop severe disease were r and omized into 2 groups : EEN group ( n = 18 ) and EEN + glutamine and arginine group ( enteral immunonutrition group , n = 14 ) . EEN was initiated when homeostasis was achieved within 72 hours after attack , and both group received isocaloric isonitrogenous nutrition . Glutamine and arginine were administered into jejunum in the enteral immunonutrition group . Serum amylase , plasma diamine oxidase ( DAO ) , C-reactive protein ( CRP ) , plasma endotoxin , urinary excretion of lactulose ( L ) , and mannitol ( M ) were measured , and APACHE-II scores were recorded on days 1 , 7 , and 14 . Complications , and length and cost of hospitalization were recorded as well . RESULTS EEN and enteral immunonutrition were both tolerated well . There was no difference in APACHE-IIscore between the two groups ( P > 0.05 ) . The DAO , CRP , plasma endotoxin , and urinary L/M levels decreased with the course of SAP . However , the plasma endotoxin and urinary L/M on day 7 of the enteral immunonutrition group were ( 10.0 + /- 3.8 ) EU/ml and 0.29 + /- 0.15 respectively , both significantly higher than those of the EEN group [ ( 7.9 + /- 2.8 ) EU/ml and 0.16 + /- 0.08 respectively , both P < 0.05 ] . The length of hospital stay and cost showed no differences between the two groups . CONCLUSION EEN is safe and feasible in treatment of SAP . Enteral immunonutrition containing glutamine and arginine improves the gut barrier function by reducing the gut permeability and decreasing plasma endotoxin level in the early stage of SAP In acute pancreatitis ( AP ) tumor necrosis factor-α mediates multi-organ failure ; in animal models its blockade with pentoxifylline ameliorates AP . The efficacy of pentoxifylline in predicted severe AP ( pSAP ) was tested in a double-blinded , r and omized , control trial . Twenty-eight patients with pSAP were r and omized within 72 hours of diagnosis to pentoxifylline or placebo . Baseline characteristics were similar in both groups .  The pentoxifylline group had fewer intensive care unit admissions and shorter intensive care unit and hospital stays of longer than 4 days ( all P < .05 ) . Patients receiving pentoxifylline  had no adverse effects  . Pentoxifylline within 72 hours of pSAP is safe ; a larger study of pentoxifylline in AP is needed to confirm efficacy . Clinical Trials.gov number : NCT01292005 Thirty patients with acute pancreatitis were allocated to indomethacin suppositories , 50 mg twice daily , or identical-looking placebo suppositories for 7 days in a controlled double-blind trial . The groups of patients were not different with regard to age , sex , etiology , or number of Ranson criteria . The number of days with pain and number of opiate injections were significantly less in patients treated with indomethacin . The median values of serum amylase and serum calcium were not different before or at any day during treatment . Bleeding from the gastrointestinal tract was not seen BACKGROUND / AIMS Experimental and clinical studies demonstrated that probiotics containing lactobacilli significantly improve the outcome of acute pancreatitis . In a prospect i ve , r and omized , double-blinded study the role of " Synbiotic 2000 " , a new synbiotic composition with high colony forming unit ( CFU ) was evaluated in the treatment of severe acute pancreatitis . METHODOLOGY Patients with severe acute pancreatitis were r and omized into two groups . Nasojejunal feeding was commenced within 24 hours after admission in both groups and continued for at least seven days . The first group of patients received four different lactobacilli preparations with 1010 CFU , respectively , and prebiotics containing four bioactive fibers ( inulin , beta-glucan , resistant starch and pectin ) in addition . Patients in the second ( control ) group received only prebiotics . RESULTS 62 patients with severe acute pancreatitis completed the study . Altogether 8 patients died . Lower incidence of multiorgan failure ( MOF ) , septic complications and mortality were detected in the first group compared to the control , but the differences were not significant statistically . The total incidence of systemic inflammatory response syndrome ( SIRS ) and MOF were significantly different between the two groups ( 8 vs. 14 ; p < 0.05 ) . Furthermore , the number patients recovering with complications were significantly less in the first group receiving modern synbiotic therapy compared to the control ( p < 0.05 ) . Finally , lower rate of late ( over 48 hours ) organ failure was detected in the first versus the control group ( 3.0 % vs. 17.2 % ) . CONCLUSIONS The results suggest that early nasojejunal feeding with synbiotics may prevent organ dysfunctions in the late phase of severe acute pancreatitis . In addition , the data also indicate that the infection of pancreatic necrosis may be associated with early phase organ failure Pancreatic infection is the main indication for surgery and the principal determinant of prognosis in acute necrotizing pancreatitis . Previous studies on the effects of antibiotics have not , however , uniformly demonstrated any reduction in the need for surgery or any decrease in mortality among these patients , although the incidence of pancreatic infections was significantly reduced . This single-center r and omized study was design ed to compare early vs. delayed imipenem treatment for acute necrotizing pancreatitis . Ninety patients with acute necrotizing pancreatitis ( C-reactive protein > 150 mg/L , necrosis on CT ) were r and omized within 48 hours either to a group receiving  imipenem ( 1.0 g plus cilastatin intravenously 3 times a day ) or a control group . Not included were those who had been started on antibiotics at the referring clinic , those who were taken directly to the intensive care unit for multiorgan failure , and those who refused antibiotics or might have had adverse reactions . Thirty-two patients were excluded because they were over 70 years of age ( not potentionally operable ) or for any study violation . There were 25 patients in the imipenem group and 33 patients in the control group . The main end point was the indication for necrosectomy due to infection ( i.e. , after the initial increase and decrease , there was a second continuous increase in temperature , white blood cell count [ > 30 % ] and C-reactive protein [ > 30 % ] , with other infections ruled out , or bacteria were found on Gram stain of the pancreatic fine-needle aspirate ) . In the control group , imipenem was started when the operative indication was fulfilled . Conservative treatment was continued for at least 5 days before necrosectomy . The study groups did not differ from each other with regard to sex distribution , patient age , etiology , C-reactive protein concentration , and extent of pancreatic necrosis on CT . Two ( 8 % ) of 25 patients in the imipenem group compared to 14 ( 42 % ) of 33 in the control group fulfilled the operative indications ( P = 0.003 ) . Nine patients in the control group responded to delayed  antibiotics  but five had to undergo surgery . Of those receiving antibiotics , 2 ( 8 % ) of 25 in the early antibiotic ( imipenem ) group needed surgery compared to 5 ( 36 % ) of 14 in the delayed antibiotic ( control ) group ( P = 0.04 ) . Two ( 8 % ) of 25 patients in the imipenem group and 5(15 % ) of 13 patients in the control group died ( P = NS [ no significant difference ] ) . Seven ( 28 % ) of 25 in the imipenem group and 25 ( 76 % ) of 33 in the control group had major organ complications ( P = 0.0003 ) . Based on the preceding criteria , early imipenem-cilastatin therapy appears to significantly reduce the need for surgery and the overall number of major organ complications in acute necrotizing pancreatitis , and reduces by half the mortality rate ; this is not , however , statistically significant in a series of this size BACKGROUND The pharmacological inhibition of exocrine pancreatic secretion with the somatostatin analogue octreotide has been advocated as a specific treatment of acute pancreatitis . AIM To investigate the efficacy of octreotide in acute pancreatitis in a r and omised , placebo controlled trial . METHODS 302 patients from 32 hospitals , fulfilling the criteria for moderate to severe acute pancreatitis within 96 hours of the onset of symptoms , were r and omly assigned to one of three treatment groups : group P ( n=103 ) received placebo , while groups O1 ( n=98 ) and O2 ( n=101 ) received 100 and 200 μg of octreotide , respectively , by subcutaneous injection three times daily for seven days . The primary outcome variable was a score composed of mortality and 15 typical complications of acute pancreatitis . RESULTS The three groups were well matched with respect to pretreatment characteristics . An intent to treat analysis of all 302 patients revealed no significant differences among treatment groups with respect to mortality ( P : 16 % ; O1 : 15 % ; O2 : 12 % ) , the rate of newly developed complications , the duration of pain , surgical interventions , or the length of the hospital stay . A valid for efficacy analysis ( 251 patients ) also revealed no significant differences . CONCLUSIONS This trial shows no benefit of octreotide in the treatment of acute pancreatitis AIM To compare the beneficial effects of early enteral nutrition ( EN ) with prebiotic fiber supplementation in patients with severe acute pancreatitis ( AP ) . METHODS Thirty consecutive patients with severe AP , who required stoppage of oral feeding for 48 h , were r and omly assigned to nasojejunal EN with or without prebiotics .  APACHE II score , Balthazar 's CT score and CRP were assessed daily during the study period . RESULTS The median duration of hospital stay was shorter in the study group [ 10 + /- 4 ( 8 - 14 ) d vs 15 + /- 6 ( 7 - 26 ) d ] ( P < 0.05 ) . The median value of days in intensive care unit was also similar in both groups [ 6 + /- 2 ( 5 - 8 ) d vs 6 + /- 2 ( 5 - 7 ) d ] . The median duration of EN was 8 + /- 4 ( 6 - 12 ) d vs 10 + /- 4 ( 6 - 13 ) d in the study and control groups , respectively ( P > 0.05 ) . Deaths occurred in 6 patients ( 20 % ) , 2 in the study group and 4 in the control group . The mean duration of APACHE II normalization ( APACHE II score < 8) was shorter in the study group than in the control group ( 4 + /- 2 d vs 6.5 + /- 3 d , P < 0.05 ) . The mean duration of CRP normalization was also shorter in 
    Output:
    
There was no evidence of any differences in short-term mortality in any of the comparisons ( very low- quality evidence ) .
AUTHORS ' CONCLUSIONS Very low- quality evidence suggests that none of the pharmacological treatments studied decrease short-term mortality in people with acute pancreatitis .
However , the confidence intervals were wide and consistent with an increase or decrease in short-term mortality due to the interventions .
We did not find consistent clinical benefits with any intervention .