***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 Endomyocardial biopsy is the st and ard method of monitoring for rejection in recipients of a cardiac transplant . However , this procedure is uncomfortable , and there are risks associated with it . Gene-expression profiling of peripheral-blood specimens has been shown to correlate with the results of an endomyocardial biopsy . METHODS We r and omly assigned 602 patients who had undergone cardiac transplantation 6 months to 5 years previously to be monitored for rejection with the use of gene-expression profiling or with the use of routine endomyocardial biopsies  , in addition to clinical and echocardiographic assessment of graft function . We performed a noninferiority comparison of the two approaches with respect to the composite primary outcome of rejection with hemodynamic compromise , graft dysfunction due to other causes , death , or retransplantation . RESULTS During a median follow-up period of 19 months , patients who were monitored with gene-expression profiling and those who underwent routine biopsies had similar 2-year cumulative rates of the composite primary outcome ( 14.5 % and 15.3 % , respectively ; hazard ratio with gene-expression profiling , 1.04 ; 95 % confidence interval , 0.67 to 1.68 ) . The 2-year rates of death from any cause were also similar in the two groups ( 6.3 % and 5.5 % , respectively ; P=0.82 ) . Patients who were monitored with the use of gene-expression profiling underwent fewer biopsies per person-year of follow-up than did patients who were monitored with the use of endomyocardial biopsies ( 0.5 vs. 3.0 , P<0.001 ) . CONCLUSIONS Among selected patients who had received a cardiac transplant more than 6 months previously and who were at a low risk for rejection , a strategy of monitoring for rejection that involved gene-expression profiling , as compared with routine biopsies , was not associated with an increased risk of serious adverse outcomes and result ed in the performance of significantly fewer biopsies . ( Clinical Trials.gov number , NCT00351559 . Purpose This prospect i ve study was to evaluate the significance of fecal calprotectin and lactoferrin for the prediction of ulcerative colitis ( UC ) relapse . Methods Eighty UC patients in remission for ≥3 months on mesalamine as maintenance therapy were included . At entry , stool sample s were collected for the measurement of calprotectin and lactoferrin . All patients were followed up for the following 12 months . To identify predictive factors for relapse , time-dependent analyses using the Kaplan-Meier graphs and Cox 's proportional hazard model were applied . Results During the 12 months , 21 patients  relapsed . Mean calprotectin and lactoferrin levels were significantly higher in patients with relapse than those in remission ( calprotectin—173.7 vs 135.5 μg/g , P = 0.02 ; lactoferrin—165.1 vs 130.7 μg/g , P = 0.03 ) . A cutoff value of 170 μg/g for calprotectin had a sensitivity of 76 % and a specificity of 76 % to predict relapse , while a cutoff value of 140 μg/g for lactoferrin had a sensitivity of 67 % and a specificity of 68 % . In a multivariate analysis , calprotectin ( ≥170 μg/g ) was a predictor of relapse ( hazard ratio , 7.23 ; P = 0.002 ) . None of the following parameters were significantly associated with relapse : age , gender , duration of UC , number of UC episode , severity of the previous episode , extent of UC , extraintestinal manifestation , and lactoferrin level . Conclusions Fecal calprotectin showed a higher sensitivity and specificity than fecal lactoferrin for predicting UC relapse . Fecal calprotectin level appeared to be a significant predictor of relapse in patients with quiescent UC on mesalamine as maintenance therapy Background : This study examined whether fecal calprotectin can be used in daily practice as a marker to monitor patients with ulcerative colitis ( UC ) receiving infliximab maintenance therapy . Methods : This prospect i ve multicenter study enrolled adult patients with UC in clinical remission under infliximab maintenance therapy .  Fecal calprotectin levels were measured every 4 weeks . Sigmoidoscopies were performed at inclusion and at study end . Relapse was defined as a clinical need for change in treatment or an endoscopic Mayo subscore of ≥2 at week 52 . Sustained deep remission was defined as a partial Mayo score <3 at all points and an endoscopic Mayo score 0 at week 52 . Results : Full analysis was possible for 87 of 113 included patients with UC ( 77 % ) . Of these patients , 30 ( 34.4 % ) were considered to be in sustained deep remission and 13 ( 14.9 % ) to have relapsed . Calprotectin levels in patients with sustained deep remission remained very low ( median < 40 mg/kg at all time points ) . Patients who flared had significantly higher calprotectin levels ( median > 300 mg/kg ) already 3 months before the flare . Further receiver operator curve analysis suggested that a calprotectin level > 300 mg/kg had a reasonable sensitivity ( 58.3 % ) and specificity ( 93.3 % ) to model flare . Two consecutive calprotectin measurements of > 300 mg/kg with 1-month interval were identified as the best predictor of flare ( 61.5 % sensitivity and 100 % specificity ) . Conclusions : Fecal calprotectin can be used in daily practice to monitor patients with UC receiving infliximab maintenance therapy . Two consecutive measurements > 300 mg/kg is more specific than a single measurement for predicting relapse BACKGROUND & AIMS Unfractionated heparin has been found to reduce symptoms and improve healing as adjuvant therapy in patients with ulcerative colitis . The current study evaluated the efficacy and safety of unfractionated heparin in the treatment of ulcerative colitis in comparison with methylprednisolone . METHODS A multicenter r and omized trial with blinded endpoint evaluation was conducted in patients hospitalized for moderate or severe ulcerative colitis . Patients were r and omized to receive heparin as a continuous infusion or methylprednisolone ( 0.75 - 1 mg x kg(-1 ) x day(-1 ) ) . RESULTS Twenty-five patients entered the study : 13 received methylprednisolone and 12 received heparin . By day 10 , 69 % of patients in the methylprednisolone group , but none in the heparin group , achieved significant improvement or remission . C-reactive protein levels significantly decreased in the methylprednisolone group but not in the heparin group . Three patients in the heparin group were withdrawn before day 10 because of an adverse event : rectal bleeding needing transfusion ( 2 cases ) or surgery ( 1 case ) . The proportion of patients with persistent rectal bleeding at day 10 was 31 % in the methylprednisolone group and 90 % in the heparin group ( P<0.05 ) . CONCLUSIONS Unfractionated heparin as monotherapy is not effective in the treatment of moderate or severe ulcerative colitis and is associated with significant bleeding complications Background and Aims Microarray analysis of RNA expression allows gross examination of pathways operative in inflammation . We aim ed to determine whether genes expressed in whole blood early following initiation of intravenous corticosteroid treatment can be associated with response . Methods From a prospect ively accrued cohort of 128 pediatric patients hospitalized for intravenous corticosteroid treatment of severe UC , we selected for analysis 20 corticosteroid responsive ( hospital discharge or PUCAI ≤45 by day 5 ) and 20 corticosteroid resistant patients ( need for second line medical therapy or colectomy , or PUCAI > 45 by day 5 ) .  Total RNA was extracted from blood sample s collected on day 3 of intravenous corticosteroid therapy .  The eluted transcriptomes were quantified on Affymetrix Human Gene 1.0 ST arrays . The data was analysed by the local-pooled error method for discovery of differential gene expression and false discovery rate correction was applied to adjust for multiple comparisons . Results A total of 41 genes differentially expressed between responders and non-responders were detected with statistical significance . Two of these genes , CEACAM1 and MMP8 , possibly inhibited by methylprednisolone through IL8 , were both found to be over-expressed in non-responsive patients . ABCC4 ( MRP4 ) as a member of the multi-drug resistance superfamily was a novel c and i date gene for corticosteroid resistance . The expression pattern of a cluster of 10 genes selected from the 41 significant hits were able to classify the patients with 80 % sensitivity and 80 % specificity . Conclusions Elevated expression of several genes involved in inflammatory pathways was associated with resistance to intravenous corticosteroid therapy early in the course of treatment . Gene expression profiles may be useful to classify resistance to intravenous corticosteroids in children with severe UC and assist with clinical management decisions BACKGROUND & AIMS In a prospect i ve study of children with severe ulcerative colitis ( UC ) , we aim ed to assess outcomes and to identify predictors of nonresponse to intravenous corticosteroids . METHODS A total of 128 children ( 47 % males ; 12.9 + /- 3.9 y ) hospitalized for severe UC were enrolled from 10 pediatric centers . Clinical and laboratory data and the Pediatric UC Activity Index ( PUCAI ) were recorded throughout the admission . Patients were followed up for 1 year postdischarge . RESULTS Thirty-seven ( 29 % ; 95 % confidence interval [ CI ] , 22%-37 % ) children failed intravenous corticosteroids and received , within 10.5 + /- 6.4 days , cyclosporine ( n = 1 ; 3 % ) , colectomy ( n = 3 ; 8 % ) , or infliximab ( n = 33 ; 89 % ) . Several predictors were associated with intravenous  corticosteroids  failure , but the best model included number of stools , amount of blood , age , and new-onset disease ( odds ratio [ OR ] , 1.9 ; 95 % CI , 1.1 - 3.5 ; OR , 2.5 ; 95 % CI , 1.3 - 4.6 ; OR , 1.2 ; 95 % CI , 1.04 - 1.36 ; and OR , 0.27 ; 95 % CI , 0.1 - 0.7 , respectively ) . The PUCAI , followed closely by the Travis rule , strongly predicted response when compared with other measures ( Seo and Lindgren indices , C-reactive protein level , and fecal calprotectin level ) ( P < .001 ) . Aim ing for sensitivity on day 3 , a PUCAI greater than 45 screened for patients likely to fail intravenous corticosteroids ( negative predictive value , 94 % ; positive predictive value , 43 % ; P < .001 ) . Aim ing for specificity on day 5 , a PUCAI score greater than 70 optimally guided implementation of salvage therapy ( positive predictive value , 100 % ; negative predictive value , 79 % ; P < .001 ) . Twenty-five of 33 children treated with infliximab responded . The overall cumulative colectomy rate was 9 % and 19 % by discharge and 1-year , respectively . The day 3 PUCAI score predicted response up to 1 year postdischarge ( P < .001 ; time to salvage therapy ) . CONCLUSIONS The PUCAI , calculated on days 3 and 5 of steroid therapy , can identify patients requiring salvage therapy . Infliximab is an effective therapy in steroid-refractory pediatric UC OBJECTIVES : Ustekinumab induction therapy was studied in a placebo-controlled trial of patients with Crohn 's disease ( CD ; n=104 ) . In patients receiving ustekinumab  , 49 % achieved clinical response at week 8 vs. 40 % for placebo ( P=0.34 ) . In a subgroup of patients previously treated with infliximab ( n=49 ) , 59 % receiving ustekinumab responded vs. 26 % receiving placebo ( P=0.02 ) . METHODS : C-reactive protein ( CRP ) concentrations were analyzed from serum collected at baseline and at week 8 . Change from baseline CRP concentration after treatment , the relationship between baseline CRP concentration and clinical response , and the relationship between baseline CRP concentration and disease location were investigated . RESULTS : Mean changes from baseline CRP at week 8 in the primary group were −0.3 and −3.1 mg/l after treatments with placebo ( n=43 ) and ustekinumab ( n=46 ) , respectively ( P=0.074 ) . In the infliximab-experienced subgroup , the mean changes were + 2.0 ( placebo , n=23 ) and −2.6 mg/l ( ustekinumab , n=20 ) ( P=0.004 ) . Patients with  baseline CRP  ≥10 mg/l tended to have lower placebo and a higher ustekinum 
    Output:
    
In Crohn disease , elevated CRP levels at baseline predict response to anti-tumour necrosis factor agents , and normalization is usually associated with clinical and endoscopic remission .
CRP and hemoglobin levels can be used to help predict clinical relapse in the context of withdrawal of therapy .