***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: The existing review s of massage therapy ( MT ) research are either limited to infants , adults , or were conducted prior to the publication of the most recent studies using pediatric sample s. R and omized controlled trials ( RCTs ) of pediatric MT are review ed . A literature search yielded 24 RCTs of pediatric MT  , defined as the manual manipulation of soft tissue intended to promote health and well-being in recipients between 2 and 19 years of age . Because RCTs of pediatric MT varied considerably in the amount and types of data reported , quantitative and narrative review methods were both used . Singledose and multiple-dose effects were examined separately . Among single-dose effects , significant reductions of state anxiety were observed at the first session ( g 1⁄4 0.59 , P < 0.05 ) and the last session ( g 1⁄4 1.10 , P < 0.01 ) of a course of treatment . Effects for salivary cortisol ( g 1⁄4 0.28 ) , negative mood ( g 1⁄4 0.52 ) and behavior ( g 1⁄4 0.37 ) were non-significant . Three of eleven multiple-dose effects were statistically significant . These were trait anxiety ( g 1⁄4 0.94 , P < 0.05 ) , muscle tone ( g 1⁄4 0.90 , P < 0.01 ) and arthritis pain ( g1⁄4 1.33 , P < 0.01 ) . Results of studies not permitting effect size calculation were judged to be generally consistent with quantitative results . MT benefits pediatric recipients , though not as universally as sometimes reported . Numerous weaknesses endemic to MT research ( e.g. low statistical power , frequent failure to report basic descriptive statistics ) are identified , and recommendations for future pediatric MT research are discussed Spirulina platensis is a cyanobacterial species that is surmised to potentiate the immune system leading to suppression of cancer development and viral infection . Here , we identified the molecular mechanism of the human immune potentiating capacity of Spirulina by analyzing blood cells of volunteers with pre and post oral administration of hot water extract of Spirulina .  NK functions represented by IFN gamma production and cytolysis were enhanced after administration of Spirulina in > 50 % subjects . IFN gamma was produced in an IL-12/IL-18-dependent fashion . In vitro stimulation of blood cells with BCG cell wall skeleton ( CWS ) allowed more potent IL-12 p40 production in cells from volunteers given Spirulina than in cells without pre-exposure to Spirulina . As BCG-CWS serves as a lig and for Toll-like receptor ( TLR ) 2 and 4 to raise the maturation stage of monocytes/macrophages , Spirulina may be involved in the signaling responses through Toll in blood cells even when orally administered . These observations indicated that in humans Spirulina acts directly on myeloid lineages and either directly or indirectly on NK cells . The presence of co-operative IL-12 and IL-18 is critically important for NK-mediated IFN gamma production Spirulina represents a blue-green alga that is widely produced and commercialized as a dietary supplement for modulating immune functions , as well as ameliorating a variety of diseases . We have previously shown that the in vitro culture of Spirulina with human peripheral blood mononuclear cells ( P BMC s ) modulated the production of cytokines . In the present study , we evaluated the impact of a Spirulina-based dietary supplement ( Earthrise Nutritionals , Inc. , Irvine , CA ) on patients with allergic rhinitis by assessing the production of cytokines [ interleukin (IL)-4 , interferon (IFN)-gamma , and IL-2 ] critical in regulating immunoglobulin E-mediated allergy . In a r and omized double-blinded crossover study versus placebo , allergic individuals were fed daily with either placebo or Spirulina , at 1,000 mg or 2,000 mg , for 12 weeks . P BMC s isolated before and after the Spirulina feeding were stimulated with phytohemagglutinin ( PHA ) prior to determining the levels of cytokine from cell culture supernatants . Although Spirulina seemed to be ineffective at modulating the secretion of Th1 cytokines ( IFN-gamma and IL-2 ) , we discovered that Spirulina , administered at 2,000 mg/day , significantly reduced IL-4 levels by 32 % from PHA-stimulated cells . These results indicate that Spirulina can modulate the Th profile in patients with allergic rhinitis by suppressing the differentiation of Th2 cells mediated , in part , by inhibiting the production of IL-4 . To our knowledge , this is the first human feeding study that demonstrates the protective effects of Spirulina towards allergic rhinitis The blue-green microalgae Spirulina , used in daily diets of natives in Africa and America , have been found to be a rich natural source of proteins , carotenoids , and other micronutrients . Experimental studies in animal models have demonstrated an inhibitory effect of Spirulina algae on oral carcinogenesis . Studies among preschool children in India have demonstrated Spirulina fusiformis ( SF ) to be an effective source of dietary vitamin A. We evaluated the chemopreventive activity of SF ( 1 g/day for 12 mos ) in reversing  oral leukoplakia in pan tobacco chewers in Kerala , India .  Complete regression of lesions was observed in 20 of 44 ( 45 % ) evaluable subjects supplemented with SF , as opposed to 3 of 43 ( 7 % ) in the placebo arm ( p < 0.0001 ) . When stratified by type of leukoplakia , the response was more pronounced in homogeneous lesions : complete regression was seen in 16 of 28 ( 57 % ) subjects with homogeneous leukoplakia , 2 of 8 with erythroplakia , 2 of 4 with verrucous leukoplakia , and 0 of 4 with ulcerated and nodular lesions . Within one year of discontinuing supplements , 9 of 20 ( 45 % ) complete responders with SF developed recurrent lesions . Supplementation with SF did not result in increased serum concentration of retinol or beta-carotene , nor was it associated with toxicity . This is the first human study evaluating the chemopreventive potential of SF . More studies in different setting s and different population s are needed for further evaluation Background . Millions of people in Bangladesh , India , Taiwan , and Chile are consuming high concentration of arsenic through drinking water , and thous and s of them have already developed chronic arsenic poisoning . There is no specific treatment . Some authors suggest the use of vitamins and minerals for more than 6 months . The present placebo-controlled double-blind study was conducted to evaluate effectiveness of spirulina extract plus zinc in the treatment of chronic arsenic poisoning . Methods . Forty-one patients of chronic arsenic poisoning were r and omly treated orally by either placebo ( 17 patients ) or spirulina extract ( 250 mg ) plus zinc ( 2 mg ) ( 24 patients ) twice daily for 16 weeks . Each patient was supplied with arsenic-safe drinking water by installing a locally made water filter at household level . Effectiveness of spirulina extract plus zinc was evaluated by comparing changes in skin manifestations ( clinical scores ) , arsenic contents in urine and hair , between the placebo- and spirulina extract plus zinc-treated groups . Results . The concentrations of total arsenic in water ( without filtration ) of placebo- and spirulina extract plus zinc-treated groups were 150.1 ±18.3 and 161.7 ± 23.9 μg/l , respectively . Intake of these high concentrations of arsenic lead to increased excretion of arsenic in urine ( 72.1 ± 14.5 μg/l in placebo-treated group and 78.4 ± 19.1 μg/l in spirulina plus zinc-treated group ) . After 2 weeks of using filtered water , there were significant reduction of both arsenic intake through water and urinary arsenic excretion ( 8.3 ± 3.6 μg/l and 18.4 ± 7.3 μg/l in placebo group ; 9.7 ± 5.4 μg/l and 21.6 ± 5.8 μg/l ) in spirulina extract plus zinc-treated group . There was a sharp increase in urinary excretion of arsenic ( 138 ± 43.6 μg/l ) at 4 weeks following spirulina plus zinc administration and the effect was continued for another 2 weeks . Spirulina extract plus zinc removed 47.1 % arsenic from scalp hair . Spirulina extract had no major adverse effect that required physician 's attention . The clinical scores ( median ) for melanosis before and after treatment with placebo was not statistically significant ( p > 0.05 ) , whereas in spirulina extract plus zinc-treated group it was statistically significant ( p < 0.01 ) . In cases of keratosis , the median clinical scores before and after treatment was not statistically significant ( p > 0.05 ) in placebo-treated group . In spirulina extract plus zinc-treated group , the clinical scores for keratosis before and after treatment was statistically significant ( p < 0.05 ) . Conclusions : Results show that spirulina extract ( 250 mg ) plus zinc ( 2 mg ) twice daily for 16 weeks may be useful for the treatment of chronic arsenic poisoning with melanosis and keratosis Idiopathic chronic fatigue is an exclusion diagnosis established when no chronic disease is found . Spirulina platensis is an alga with a rich content of proteins , vitamins , minerals and amino acids and is considered as a bioactive additive with multiple effects , among them being effects against fatigue . However , despite the worldwide utilization of Spirulina , there are only a few quality studies with it and none concerning fatigue . The N-of-1 r and omized trials are made on one patient , and by this kind of study the efficacy of a treatment on that particular patient can be assessed . A series of four N-of-1 double-blind , r and omized trials were performed on four physicians who complained of chronic fatigue . Each patient was his own control and received three pairs of treatments comprising 4 weeks of spirulina and 4 weeks of placebo . Spirulina platensis was administered in a dose of 3 g/day . For each pair , the order of treatments was r and omized . Outcome measures were severity of fatigue measured on a 10-point scale . The scores of fatigue were not significantly different between spirulina and placebo . Spirulina administered in a dose of 3 g/day did not ameliorate fatigue more than the placebo in any of the four subjects , and possibly it has no effect on chronic fatigue OBJECTIVE To assess the effect of alpha-tocopherol and beta-carotene supplementation on the prevalence of oral mucosal lesions in smokers . DESIGN An end-point examination of a r and om sample of participants in a controlled trial for 5 - 7 years ( Alpha-Tocopherol Beta-Carotene Cancer Prevention Study ) in Helsinki , Finl and . SUBJECTS A total of 409 white male cigarette smokers , aged 55 - 74 years who received either alpha-tocopherol ( 50 mg per day ) or beta-carotene ( 20 mg per day ) supplementation , both of these or placebo capsules . METHODS Clinical examination of oral mucosae , histological examination of lesions showing leukoplakia and cytological examination of buccal epithelium . Statistical analysis using Fisher 's exact test . RESULTS No statistically significant differences were found between the study groups either in the prevalence of oral mucosal lesions or in the cells of unkeratinized epithelium . Leukoplakia was present in 24 ( 5.9 % ) of the subjects . Seven lesions showed dysplasia . CONCLUSION The present study on oral health does not support the hypothesis that alpha-tocopherol or beta-carotene supplementation plays an essential role in preventing oral mucosal changes in smokers OBJECTIVE To study the association between dietary and serum antioxidant vitamins and carotenoids and risk for  colorectal cancer in male smokers . DESIGN A prospect i ve cohort study within a r and omised , double-blind , placebo-controlled trial testing supplementation with alpha-tocopherol ( 50 mg/day ) , beta-carotene ( 20 mg/day ) or both in preventing cancer . SUBJECTS AND METHODS Participants of the Alpha-Tocopherol , Beta-Carotene Cancer Prevention Study with complete dietary data and serum sample s available from baseline . These included 26,951 middle-aged male smokers among whom 184 colorectal cancer cases were diagnosed during 8 y of follow-up .  Relative risks were calculated with Cox proportional hazards models adjusting for trial supplementation , age , body mass index , serum cholesterol , cigarettes smoked per day and physical activity . RESULTS There was no significant association between dietary vitamin C or E , alpha-or gamma-tocopherol , retinol , alpha- or beta-carotene , lycopene or lutein+zeaxanthin and risk for colorectal cancer . Serum alpha-tocopherol , beta-carotene or retinol was also not associated with the risk , neither did 
    Output:
    
Multiple studies investigating the efficacy and the potential clinical applications of Spirulina in treating several diseases have been performed and a few r and omized controlled trials and systematic review s suggest that this alga may improve several symptoms and may even have an anticancer , antiviral and antiallergic effects .