***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 Growth faltering during infancy is a characteristic of life in developing countries . Previous studies have shown that small-intestine mucosal enteropathy , accompanied by endotoxemia and a persistent systemic inflammatory response , accounts for up to 64 % of the growth faltering in Gambian infants . OBJECTIVE The objective was to test whether glutamine , with its putative trophic effects on enterocytes , immune cells , and intestinal integrity , can accelerate the repair of the intestine , lower immunostimulation , and reduce growth faltering . DESIGN Ninety-three infants aged 4 - 10 mo from the West Kiang region of The Gambia were studied in a double-blind , double-placebo , controlled trial . Glutamine ( 0.25 mg/kg body wt ) or a placebo that contained an isonitrogenous , isoenergetic mix of nonessential amino acids was orally administered twice daily throughout the 5-mo rainy season . Anthropometric measurements were made monthly during the supplementation period and for 6 mo after supplementation . Intestinal permeability was measured monthly ( by determining the ratio of lactulose to mannitol ) , and finger-prick blood sample s were collected for the analysis of plasma proteins on 3 occasions . RESULTS Gambian infants showed a seasonal deterioration in growth and persistently elevated acute phase protein concentrations and intestinal permeability . Oral supplementation with glutamine did not improve growth ( x + /- SE : weight gain , 60 + /- 19 and 69 + /- 20 g/mo ; length gain , 1.01 + /- 0.05 and 0.95 + /- 0.03 cm/mo ) or intestinal permeability [ lactulose : mannitol ratio : 0.29 ( 95 % CI : 0.23 , 0.35 ) and 0.26 ( 95 % CI : 0.21 , 0.32 ) ] in the glutamine and placebo groups , respectively . It also had no effect on infant morbidity or on plasma concentrations of immunoglobulins or acute phase proteins . CONCLUSION Glutamine supplementation failed to improve growth or intestinal status in malnourished Gambian infants BACKGROUND The effect of helminth infestation on the nutrition , growth , and physiology of the host is still poorly understood . Anthelmintic treatment of children in developing countries has had varying success in terms of growth improvements . OBJECTIVE The objective of this study was to assess the effect of regular deworming on child growth , physiology , and biochemical status . DESIGN The study was a 12-mo longitudinal intervention in 123 Bangladeshi children aged 2 - 5 y. Treatment ( mebendazole ) or placebo tablets were administered every 2 mo for 8 mo and again at 12 mo . Weight , height , midupper arm circumference , intestinal permeability , plasma albumin , alpha(1)-antichymotrypsin , and total protein concentration were assessed every 2 mo . RESULTS Treatment with mebendazole reduced the prevalence of Ascaris lumbricoides from 78 % to 8 % , of Trichuris trichiura from 65 % to 9 % , and of hookworm from 4 % to 0 % . There was no significant difference in the growth of treated children compared with those given placebo tablets . No changes in intestinal permeability or plasma albumin were observed after deworming . Significant decreases in total protein ( P<0.001 ) and alpha(1)-antichymotrypsin ( P<0.001 ) were observed in the treatment group , indicating possible reductions in inflammation and immunoglobulin concentration after deworming . A significant increase in the prevalence of Giardia intestinalis ( from 4 % to 49 % ) in the treatment group was associated with a short-term reduction in weight ( P = 0.02 ) and higher intestinal permeability ( P < 0.001 ) in infected subjects . No long-term effects of G. intestinalis on growth were observed . CONCLUSION Low-intensity helminth infections , predominantly of A. lumbricoides and T. trichiura , do not contribute significantly to the poor growth and biochemical status of rural Bangladeshi children BACKGROUND Tropical enteropathy is an asymptomatic villous atrophy of the small bowel that is prevalent in the developing world and is associated with altered intestinal function and integrity . The histology of tropical enteropathy resembles that seen in small-bowel bacterial overgrowth . OBJECTIVE This study tested the hypothesis that treatment of 3 - 5-y-old Malawian children with the probiotic Lactobacillus GG would improve their intestinal function and integrity . DESIGN Clinical ly healthy children ( n = 164 ) were enrolled in a placebo-controlled , r and omized , double-blind trial . Intestinal function and integrity were measured by using the site-specific sugar-absorption test before and after 30 d of treatment with Lactobacillus GG or placebo . The primary outcomes were the ratios of urinary lactulose to mannitol ( L : M ) and of urinary sucrose to lactulose ( S : L ) excretion . RESULTS Of the 161 children who completed the study , 119 ( 73 % ) had tropical enteropathy on enrollment ( L : M > 0.10 ) . Children receiving Lactobacillus GG did not differ significantly from the placebo group in the excretion ( in % of dose administered ) of mannitol ( mean + /- SD : 8.9 + /- 4.4 and 8.9 + /- 3.9 , respectively ) , lactulose ( 0.31 + /- 0.20 and 0.33 + /- 0.23 , respectively ) , or sucrose ( 0.078 + /- 0.058 and 0.082 + /- 0.075 , respectively ) . L : M and S : L also did not differ significantly between the Lactobacillus and placebo groups ( 0.19 + /- 0.13 and 0.20 + /- 0.12 , respectively , for L : M ; 0.58 + /- 0.46 and 0.65 + /- 0.57 , respectively , for S : L ) . CONCLUSION Administration of Lactobacillus GG for 30 d had no effect on the intestinal integrity of 3 - 5-y-old Malawian children The interrelationship between diarrhea , malnutrition , and small bowel integrity was investigated prospect ively in 68 Gambian infants aged 0 - 18 mo . Profiles of growth and morbidity were recorded for 8 mo . Each month intestinal permeability was measured by the differential uptake of orally administered lactulose ( L ) and mannitol ( M ) . In well infants the mean L : M ratio was 0.42 ( range 0.11 - 1.42 ) . This ratio was increased slightly for underweight ( 60 - 80 % wt for age ) infants ( mean 0.52 ) but considerably for those with marasmus ( less than 60 % wt for age ) ( mean 1.3 , p less than 0.001 ) , for those with acute or chronic diarrhea ( mean 1.0 and 2.85 , respectively ; p less than 0.001 ) , or with measles ( mean 1.4 , p less than 0.001 ) . Sequential studies of ward patients with malnutrition and diarrhea showed a rapid fall in L : M ratios with resolution of diarrhea . These studies suggest that damage to the small intestine may play an important part in the development of infant malnutrition in The Gambia Background : This study evaluates the effects of retinol on intestinal barrier function , growth , total parasites , and Giardia spp infections  in children in northeastern Brazil . Subjects and Methods : The study was a double-blind , r and omized placebo-controlled trial ( http:// clinical trials.gov ; register no. # NCT00133406 ) involving 79 children who received vitamin A 100,000–200,000 IU ( n = 39 ) or placebo ( n = 40 ) at enrollment , 4 , and 8 months and were followed for 36 months .  Intestinal barrier function was evaluated using the lactulose : mannitol ratio test . Stool lactoferrin was used as a marker for intestinal inflammation . Results : The groups were similar with regard to age , sex , nutritional parameters ( z scores ) , serum retinol concentrations , proportion of lactoferrin-positive stool sample s , and intestinal barrier function . The lactulose : mannitol ratio did not change during the same time of follow-up ( P > 0.05 ) . The proportion of lactoferrin-positive sample s evaluated at 1 month did not change between groups ( P > 0.05 ) . Total intestinal parasitic , specifically new , infections were significantly lower in the vitamin A treatment compared with control group ; these were accounted for entirely by significantly fewer new Giardia infections in the vitamin A treatment group . The cumulative z scores for weight-for-length or height , length or height-for-age z scores , and weight-for-age did not change significantly with vitamin A intervention for 36 months of follow-up . Conclusions : These data showed that total parasitic infection and Giardia spp infections were significantly lower in the vitamin A treatment group when compared with the placebo group , suggesting that vitamin A improves the host 's defenses against Giardia infections In order to test the impact of Giardia and geohelminthic infection on infant growth faltering in Bangladesh , a r and omised double-blind placebo controlled intervention of 36 weeks ' duration was conducted in a rural community located 40 km northwest of Dhaka . Infants aged between 3 and 15 months were r and omly assigned to either anti-Giardia and anthelminthic treatment , anti-Giardia treatment only , or a control .  Weight and supine length were recorded every 4 weeks . Every 12 weeks intestinal permeability ( lactulose/mannitol ratio ) , haemoglobin , plasma albumin , alpha-1-acid glycoprotein , IgG and Giardia-specific IgM ( GSIgM ) and eggs of the three common geohelminths and G. intestinalis cysts were determined . Data on 222 fully compliant infants were analysed . No significant differences in intestinal permeability , biochemical or anthropometric variables were found between the intervention groups , although there were associations between improvement in small intestinal mucosal function and better weight-for-age and weight-for-height ( length ) Z-scores . GSIgM titres indicated high endemicity with rapid re-infection of Giardia among infants ; over 95 % of infants were positive throughout the study , whereas the stool examination showed very few infants with either geohelminth eggs or Giardia cysts Sub clinical mastitis , as diagnosed by an elevated sodium/potassium ratio in milk accompanied by an increased milk concentration of the inflammatory cytokine , interleukin-8 ( IL8 ) , was found to be common among breast feeding women in Bangladesh and Tanzania . Sub clinical mastitis results in leakage of plasma constituents into milk , active recruitment of leukocytes into milk , and possible infant gut damage from inflammatory cytokines . Therefore , we wished to investigate whether sub clinical mastitis was related to known risk factors for postnatal mother-to-child HIV transmission , that is , high milk viral load or increased infant gut permeability . HIV-infected South African women were recruited at the antenatal clinic of McCord 's Hospital , Durban . Risks and benefits of different feeding strategies were explained to them and , if they chose to breast feed , they were encouraged to do so exclusively . Women and infants returned to the clinic at 1 , 6 and 14 weeks postpartum for an interview about infant health and current feeding pattern , a lactulose/mannitol test of infant gut permeability , and milk sample collection from each breast separately for analysis of Na/K ratio , IL8 concentration and viral load in the cell-free aqueous phase . Only preliminary cross-sectional analyses from an incomplete data base are available at this point . Moderately ( 0.6 - 1.0 ) or greatly ( > 1.0 ) raised Na/K ratio was common and was often unilateral , although as a group right and left breasts did not differ . Considering both breasts together , normal , moderately raised or greatly raised Na/K was found , respectively , in 51 % , 28 % , 21 % of milk sample s at 1 week ( n=190 ) ; 69 % , 20 % , 11 % at 6 weeks ( n=167 ) ; and 72 % , 16 % , 12 % at 14 weeks ( n=122 ) . IL8 concentration significantly correlated with both Na/K and viral load at all times . Na/K correlated with viral load at 1 and 14 , but not 6 weeks . At 1 and 14 weeks , geometric mean viral loads in sample s with Na/K > 1.0 were approximately 4 times those in sample s with Na/K < 0.6 . At 1 week but not later times , exclusive breast feeding was associated with lower milk viral load than was mixed feeding . Gut permeability was unrelated to milk Na/K ratio or IL8 concentration and was not significantly increased by inclusion of other foods than breast milk in 
    Output:
    
We conclude that the L : M test has many attributes , including reflecting 2 physiologic processes ( absorption and permeability ) and likely correlation with growth failure consequent to child gut dysfunction .