***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: Chronic non-A , non-B hepatitis occurs in 50 % of Saudi patients with end-stage renal failure and requires long-term hemodialysis since it is a contraindication to renal transplantation . Thirteen patients with biochemical and histological documented chronic non-A , non-B hepatitis ( 11 with HCV antibodies ) entered a double-blind placebo controlled cross-over study , in which Roferon A 3 MU or placebo were administered subcutaneously 3 times weekly after hemodialysis for 6 months . The mean ALT fell significantly from pretreatment levels of 74.7 ( 95 % confidence interval ( CI ) 54.7 , 92.5 ) ( 13 patients in the 6-month run-in period ) and 66.8 ( CI 47.7 , 85.8 ) ( 7 patients in the run-in period + 6 patients in the placebo period ) ( difference NS ) to 37.6 ( CI 21.0 , 54.2 ) during interferon treatment ( P < 0.005 ) . In 10/13 patients ( 77 % ) ALT levels became normal . In the 6-month follow-up period immediately after therapy , the mean ALT was 45.2 ( CI 28.0 , 62.0 ) . Although this change was not significant ( P = 0.49 ) , only 7 of these 10 patients sustained biochemical remission in the 6-month follow-up period . The corresponding total Histological Activity Index improved from 8.9 ( CI 7.5 , 10.3 ) , 8.9 ( CI 7.2 , 10.7 ) ( difference NS ) to 6.2 ( CI 3.9 , 8.5 ) ( P < 0.05 ; P = 0.052 , respectively ) . Intralobular inflammation and periportal inflammation showed the most significant changes . Five of 13 ( 39 % ) and 2/13 patients ( 15 % ) had complete resolution of piecemeal necrosis and intralobular inflammation , respectively . Toxic effects of interferon were mild , early and self-limiting . ( ABSTRACT TRUNCATED AT 250 WORDS R and omized clinical trials ( RCTs ) provide the most reliable therapeutic information available . Unfortunately , there are no systemic listing of RCTs . We compared a MEDLARS search of 3686 biomedical journals for RCTs with a manual search of the medical literature for the period 1966 - 1982 . For the former search we used subject headings ( 1 ) liver disease or ( 2 ) biliary tract disease and subheadings ( 1 ) drug therapy , ( 2 ) surgery , ( 3 ) radiotherapy , or ( 4 ) therapy , and check tags ( 1 ) comparative study or ( 2 ) clinical research . For the manual search , the contents of 34 arbitrarily selected , gastroenterologic , hepatologic , surgical , or general journals were perused . The MEDLARS search identified 160 RCTs and 29 others were found in the references of the 160 . One hundred fifty-four RCTs were identified by both methods . The manual search identified 208 RCTs and an additional 34 were found in the references of the 208 . The MEDLARS search identified only 107 of 208 RCTs found in the references of the 208 . The MEDLARS search identified only 107 of 208 RCTs found manually in the 36 journals , an efficiency rate of 51 % . We estimate that 330 hepatobiliary RCTs had been published during this 17-year period . Sixty percent of the RCTs found by MEDLARS used the key word " r and omized , " " double blind , " or " controlled " in the title , compared to 36 % in those found by the manual search . In order to retrieve RCTs , it is essential that editors require that RCTs be identified in their titles or key words by specific terms such as " controlled , " " r and omized , " and " double blind , " that papers be so catalogued and indexed , and that search ers be instructed in appropriate search strategies BACKGROUND Traditional and largely qualitative review s of evidence are now giving way to much more structured systematic overviews that use a quantitative method to calculate the overall effect of treatment . The latter approach is dependent on the quality of primary studies , which may introduce bias if they are of poor method ologic quality . OBJECTIVE To test the hypothesis that the inclusion of poor- quality trials in meta-analyses would bias the conclusions and produce incorrect estimates of treatment effect . METHODS An overview of r and omized trials of antiestrogen therapy in subfertile men with oligospermia was performed to test the hypothesis . Data sources included online search ing of MEDLINE and Science Citation Index data bases between 1966 and 1994 , scanning the bibliography of known primary studies and review articles , and contacting experts in the field . After independent , blind assessment , nine of 149 originally identified studies met the inclusion criteria and were selected . We assessed study quality independently . Outcome data from each study were pooled and statistically summarized . RESULTS There was a marginal improvement in pregnancy rate with antiestrogen treatment ( odds ratio , 1.6 ; 95 % confidence interval , 0.9 to 2.6 ) . Sensitivity analyses on the basis of method ologic quality demonstrated that poor- quality studies produced a positive effect with treatment , whereas no benefit was observed with high- quality studies . CONCLUSION The results of a meta- analysis are influenced by the quality of the primary studies included . Method ologically , poor studies tend to exaggerate the overall estimate of treatment effect and may lead to incorrect inferences Mortality rates among hemodialysis patients vary greatly across regions . Representative data bases containing extensive profiles of patient characteristics and outcomes are lacking . The Dialysis Outcomes and Practice Patterns Study ( DOPPS ) is a prospect i ve , observational study of representative sample s of hemodialysis patients in France , Germany , Italy , Japan , Spain , the United Kingdom , and the United States ( US ) that captures extensive data relating to patient characteristics , prescriptions , laboratory values , practice patterns , and outcomes . This report describes the case-mix features and mortality among 16,720 patients followed up to 5 yr . The crude 1-yr mortality rates were 6.6 % in Japan , 15.6 % in Europe , and 21.7 % in the US . After adjusting for age , gender , race , and 25 comorbid conditions , the relative risk ( RR ) of mortality was 2.84 ( P < 0.0001 ) for Europe compared with Japan ( reference group ) and was 3.78 ( P < 0.0001 ) for the US compared with Japan . The adjusted RR of mortality for the US versus Europe was 1.33 ( P < 0.0001 ) . For most comorbid diseases , prevalence was highest in the US , where the mean age ( 60.5 + /- 15.5 yr ) was also highest . Older age and comorbidities were associated with increased risk of death ( except for hypertension , which carried a multivariate RR of mortality of 0.74 [ P < 0.0001 ] ) . Variability in demographic and comorbid conditions ( as identified by dialysis facilities ) explains only part of the differences in mortality between dialysis centers , both for comparisons made across continents and within the US . Adjustments for the observed variability will allow study of association between practice patterns and outcomes BACKGROUND AND AIM Hepatitis C virus ( HCV ) is prevalent in hemodialysis ( HD ) patients . These patients experience more side-effects with antiviral treatment . The aim of the present study was to evaluate the efficacy and tolerability of pegylated interferon ( PEG-IFN ) alpha-2a in chronic hemodialysis patients with chronic hepatitis C. METHODS Twenty-five patients were included into the study . All of the patients were interferon naive , anti-HCV antibodies positive and polymerase chain reaction HCV-RNA positive . Twelve of the patients received PEG-IFN alpha-2a at a dose of 135 microg weekly for 48 weeks ( Group 1 ) . The remaining 13 patients who received no specific treatment were used as controls ( Group 2 ) . The patients were prospect ively followed up for a period of 18 months . Biochemical and virological responses were evaluated at the end of the study period ( end-of-treatment response ) and 6 months after the completion of therapy ( sustained response ) . RESULTS Virological end-of-treatment response was observed in 10 patients ( 83.4 % ) in Group 1 and one patient ( 7.7 % ) in Group 2 ( P < 0.001 ) . Sustained virological response was observed in nine patients ( 75 % ) in Group 1 and one patient ( 7.7 % ) in Group 2 ( P < 0.001 ) . Alanine aminotransferase ( ALT ) levels were initially increased in seven patients in Group 1 and normalized in five of these patients at the end of the treatment and sustained biochemical response was 71.4 % . In contrast , ALT levels in Group 2 were initially high in five patients and normalized in two of them ( 40 % ) at the end of the 48 weeks . Even if most of the patients experienced several side-effects ( anemia 75 % , fatigue 58.3 % , thrombocytopenia 33.3 % and leukopenia 33.3 % ) , they did not impose the discontinuation of the treatment . CONCLUSION The present study showed that PEG-IFN alpha-2a for 48 weeks is efficacious and well tolerated in hemodialysis patients with HCV BACKGROUND Hepatitis C virus ( HCV ) infection represents an important problem for the dialysis population due to its high prevalence and the long-term development of chronic liver disease , particularly following renal transplantation . METHODS In order to assess the efficacy and tolerance of interferon ( IFN ) in the treatment of chronic hepatitis C in haemodialysis ( HD ) patients and their clinical course following renal transplantation , a multicentre , r and omized , open-label study was conducted to compare IFN therapy vs a control group . RESULTS Nineteen HCV RNA-positive patients received 3 x 10(6 ) U of IFN s.c . , three times a week ( post-HD ) , and 17 HCV RNA-positive patients were assigned to the control group . Tolerance to IFN therapy was good in nine patients , while treatment was discontinued in the other 10 due to the occurrence of side effects . HCV RNA was negative at the end of treatment in 14 out of 19 patients ( 74 % ) receiving IFN and in one patient ( 5 % ) in the control group . Six out of the 14 patients who initially responded to IFN therapy had a virological relapse ( 43 % ) . Eight patients ( 42 % ) remained HCV RNA-negative , three of them until the day that renal transplantation ( RT ) was performed ( 7 , 12 and 27 months , respectively ) , as did five patients on HD during the follow-up ( 27+/-5 months ) . Eight out of the nine patients ( 89 % ) who completed therapy were HCV RNA-negative at the end of treatment , and seven of them ( 78 % ) remained HCV RNA-negative during the follow-up on dialysis ( 21+/-8 months ) . Mean transaminase ( ALT ) values were significantly decreased following IFN therapy , while no changes were observed during the follow-up period in the control group . Fifteen patients ( 10 in the treatment group and five in the control group ) underwent RT . Three patients in the treatment group were HCV RNA-negative at RT , and one of them had a virological relapse 20 months after RT , while the other two remained HCV RNA-negative at 3 months and 24 months after RT , respectively . In contrast to the control group , transaminase ( ALT ) remained within normal limits in all patients in the treatment group . Finally , during the post-RT follow-up , the transaminase mean values were significantly lower in treated patients vs patients in the control group ( P<0.05 ) . CONCLUSIONS It is concluded that the biochemical and virological response to IFN therapy is good in HD patients . In addition , IFN therapy appears to exert a beneficial effect on the course of liver disease following RT , regardless of the virological response . Despite the fact that IFN therapy was discontinued in 10 out of the 19 patients due to the occurrence of side effects , these disappeared following discontinuation of therapy . Therefore , IFN therapy is advisable for HCV-infected dialysis patients who are c and i date s for RT Twenty‐eight prospect i ve r and omized controlled clinical trials evaluating the use of total parenteral nutrition ( TPN ) in cancer patients were identified through a search of major indexing sources . The data were pooled across studies to increase the ability to detect therapeutic effects . The impact of publication bias and the quality of reporting each trial were used to critically assess the conclusions drawn from the pooled analysis . The authors conclude that TPN may be useful when used preoperatively in patients with gastrointestinal tract cancer . It appears to be beneficial in reducing major surgical complications ( pooled P = 0.01 ) and operative mortality ( pooled P = 0.02 ) . No statistically significant benefit from TPN could be demonstrated in survival , treatment tolerance , treatment toxicity , or tumor response in patients receiving chemotherapy or radiotherapy . An increase in the risk of developing an infection in chemotherapy patients given TPN ( pooled P > 0.0001 ) underscores the importance of demonstrating significant benefits in r and omized trials before TPN is used routinely in these patients In this prospect 
    Output:
    
Our meta- analysis showed that the viral response was greater in patients with chronic kidney disease who received antiviral therapy than controls .
No difference in the drop-out rate between study and control patients occurred in the subgroup of dialysis patients on IFN monotherapy .
These results support IFN-based therapy for hepatitis C in patients on maintenance dialysis