***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 Radical cystectomy ( RC ) for bladder cancer is frequently associated with delayed gastrointestinal ( GI ) recovery that prolongs hospital length of stay ( LOS ) . OBJECTIVE To assess the efficacy of alvimopan to accelerate GI recovery after RC . DESIGN , SETTING , AND PARTICIPANTS We conducted a r and omized double-blind placebo-controlled trial in patients undergoing RC and receiving postoperative intravenous patient-controlled opioid analgesics .  INTERVENTION Oral alvimopan 12 mg ( maximum : 15 inpatient doses ) versus placebo . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The two-component primary end point was time to upper ( first tolerance of solid food ) and lower ( first bowel movement ) GI recovery ( GI-2 ) . Time to discharge order written , postoperative LOS , postoperative ileus (POI)-related morbidity , opioid consumption , and adverse events ( AEs ) were evaluated . An independent adjudication of cardiovascular AEs was performed . RESULTS AND LIMITATIONS Patients were r and omized to alvimopan ( n=143 ) or placebo ( n=137 ) ; 277 patients were included in the modified intention-to-treat population . The alvimopan cohort experienced quicker GI-2 recovery ( 5.5 vs 6.8 d ; hazard ratio : 1.8 ; p<0.0001 ) , shorter mean LOS ( 7.4 vs 10.1 d ; p=0.0051 ) , and fewer episodes of POI-related morbidity ( 8.4 % vs 29.1 % ; p<0.001 ) . The incidence of opioid consumption and AEs or serious AEs ( SAEs ) was comparable except for POI , which was lower in the alvimopan group ( AEs : 7 % vs 26 % ; SAEs : 5 % vs 20 % , respectively ) . Cardiovascular AEs occurred in 8.4 % ( alvimopan ) and 15.3 % ( placebo ) of patients ( p=0.09 ) . Generalizability may be limited due to the exclusion of epidural analgesia and the inclusion of mostly high-volume centers utilizing open laparotomy . CONCLUSIONS Alvimopan is a useful addition to a st and ardized care pathway in patients undergoing RC by accelerating GI recovery and shortening LOS , with a safety profile similar to placebo . PATIENT SUMMARY This study examined the effects of alvimopan on bowel recovery in patients undergoing radical cystectomy for bladder cancer . Patients receiving alvimopan experienced quicker bowel recovery and had a shorter hospital stay compared with those who received placebo , with comparable safety . TRIAL REGISTRATION Clinical Trials.gov identifier NCT00708201 Background Postoperative ileus ( POI ) is observed in 20–30 % of patients undergoing colorectal cancer surgery , despite enhanced recovery programs ( ERPs ) . Cyclooxygenase (COX)-2 is identified as a key enzyme in POI , but other arachidonic acid pathway enzymes have received little attention despite their potential as selective targets to prevent POI . The objectives were to compare the expression of arachidonic acid metabolism ( AAM ) enzymes ( 1 ) between patients who underwent colorectal cancer surgery and followed an ERP or not ( NERP ) , ( 2 ) and between ERP patients who experimented POI or not and ( 3 ) to determine the ability of antagonists of these pathways to modulate contractile activity of colonic muscle . Methods This was a translational study . Main outcome measures were gastrointestinal motility recovery data , mRNA expressions of key enzymes involved in AAM ( RT-qPCR ) and ex vivo motility values of the circular colon muscle . Twenty-eight prospect ively included ERP patients were compared to eleven retrospectively included NERP patients that underwent colorectal cancer surgery . Results ERP  reduced colonic mucosal COX-2 , microsomal prostagl and in E synthase ( mPGES1 ) and hematopoietic prostagl and in D synthase ( HPGDS ) mRNA expression . mPGES1 and HPGDS mRNA expression were significantly associated with ERP compliance ( respectively , r2 = 0.25 , p = 0.002 and r2 = 0.6 , p < 0.001 ) . In muscularis propria , HPGDS mRNA expression was correlated with GI motility recovery ( p = 0.002 ) . The pharmacological inhibition of mPGES1 increased spontaneous ex vivo contractile activity in circular muscle ( p = 0.03 ) . Conclusion The effects of ERP on GI recovery are correlated with the compliance of ERP and could be mediated at least in part by mPGES1 , HPGDS and COX-2 . Furthermore , mPGES1 shows promise as a therapeutic target to further reduce POI duration among ERP patients INTRODUCTION While enhanced recovery after surgery ( ERAS ) has been proven to improve results in colorectal operations with regard to morbidity and duration of hospital stay , its impact on recovery of bowel motility is poorly documented . The aims of this study were to assess the impact of ERAS on bowel motility recovery , and to assess the consequences of the definition of postoperative ileus on its reported incidence in the literature . MATERIAL AND METHODS This is a single-center prospect i ve observational study of consecutive patients who underwent colorectal resection with anastomosis over a period of 17 months .  Global resumption of intestinal transit ( GROT ) was defined as passage of stool combined with alimentary tolerance of solid food . RESULTS One hundred and thirty-one patients were included . A median of 14 items ( range : 13 - 16 ) was complied out of 19 observable items in the protocol . Median time to passage of flatus ( MTPF ) was 2 days and the GROT was 3 days . The time interval to MTPF as well as to GROT decreased as adherence to the ERAS protocol increased ( respectively P<0.001 , r2=0.11 and P=0.04 , r2=0.06 ) . The incidence of postoperative " ileus " varied from 1.5 % to 61.8 % depending on the interval chosen to define ileus ( cut-off from 1 to 7 days ) . Adherence to≥85 % of the items in the ERAS protocol protected patients from " prolonged ileus " , i.e. , lasting≥4 days ( OR=0.35 ; 95 % CI=0.15 to 0.83 ) . CONCLUSION The implementation of and compliance with an ERAS protocol allowed a reduction in the time to GROT . There is a need for a consensual definition of postoperative ileus BACKGROUND : Nonsteroidal anti-inflammatory drugs have become an important component of narcotic-sparing postoperative pain management protocol s. However , conflicting evidence exists regarding the adverse association of nonsteroidal anti-inflammatory drug use with intestinal anastomotic healing in colorectal surgery . OBJECTIVE : This study compares patients receiving nonsteroidal anti-inflammatory drugs on postoperative day 1 with patients who did not receive nonsteroidal anti-inflammatory drugs  with regard to the occurrence of anastomotic leaks . DESIGN : This is a retrospective study from a protocol -driven prospect ively collected statewide data base . A propensity score model was used to adjust for differences between the groups in patient demographics , characteristics , comorbidities , and laboratory values . SETTING S : The multicenter data set used in this analysis represents a variety of academic and community hospitals within the state of Michigan from July 2012 through February 2014 . PATIENTS : Nonpregnant patients over the age of 18 who underwent colon and rectal surgery with bowel anastomosis were selected . MAIN OUTCOME MEASURES : Occurrence of anastomotic leak , composite surgical site infection , sepsis , and death within 30 days of surgery were the primary outcomes measured . RESULTS : A total of 4360 patients met inclusion criteria , of which 1297 ( 29.7 % ) received nonsteroidal anti-inflammatory drugs and 3063 ( 70.3 % ) did not receive nonsteroidal anti-inflammatory drugs .  There was no statistically significant difference between the 2 groups in the proportion of cases with anastomotic leak ( OR , 1.33 ; CI , 0.86–2.05 ; p = 0.20 ) , composite surgical site infection ( OR , 1.26 ; CI , 0.96–1.66 ; p = 0.09 ) , or death within 30 days ( OR , 0.58 ; CI , 0.28–1.19 ; p = 0.14 ) . There was a significantly greater risk of sepsis for patients given nonsteroidal anti-inflammatory drugs than for those patients not given nonsteroidal anti-inflammatory drugs ( OR , 1.47 ; CI , 1.05–2.06 ; p = 0.03 ) . LIMITATIONS : This is a nonr and omized study performed retrospectively , and it is based on data collected only within a subset of hospitals in the state of Michigan . CONCLUSIONS : No statistically significant increase in the proportion of patients with anastomotic leak was observed when prescribing nonsteroidal anti-inflammatory drugs for analgesia in the early postoperative period for patients undergoing elective colorectal surgery . Unexpectedly , there was an increased risk of sepsis that warrants further investigation ( see video , Supplemental Digital Content 1 , http://links.lww.com/DCR/A192 , for a synopsis of this study ) Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Endogenous prostagl and ins regulate smooth muscle activity ; prostagl and ins and cyclooxygenase ( COX ) inhibitors influence gastrointestinal motility in inflammatory states such as postoperative ileus in animal models . The objective of this study was to evaluate the effects of two COX-2 inhibitors on gastric emptying and intestinal transit in healthy humans . In a double-blind , placebo-controlled , parallel-group study , 66 healthy volunteers were r and omized to one of two commercially available oral COX-2 inhibitors ( celecoxib and rofecoxib ) , cisapride ( positive control ) , or placebo . Following 7 days on therapy , study participants underwent a test of gastric emptying and small bowel transit of liquids and solids using scintigraphy . Data were analysed using Kruskal-Wallis ( ANOVA on ranks ) and Mann-Whitney rank sum tests . There were significant group effects on transit of solids : gastric emptying ( ANOVA , P = 0.005 ) and small bowel transit ( ANOVA , P = 0.056 ) . However , neither COX-2 inhibitor significantly accelerated the liquid or solid gastric emptying or small bowel transit compared with placebo . The positive control , cisapride , accelerated gastric emptying of solids ( post-lag slope of gastric emptying , P < 0.05 ) , and small bowel transit of solids ( t10 % , P = 0.016 ) . At maximum clinical ly approved dosages , celecoxib and rofecoxib have no significant effects on gastric emptying or small intestinal transit in healthy humans . Cisapride accelerates gastric emptying and small bowel transit in healthy humans Abstract Currently , there is a paucity of study investigating postoperative ileus in gastric cancer surgery . This prospect i ve study aims to identify the risk factors for  prolonged postoperative ileus ( PPOI ) and to use these risk factors to generate a risk stratification scoring system for the occurrence of PPOI . Patients who underwent radical gastrectomy for gastric cancer were included in this study . A multivariate logistic analysis was applied to identify independent risk factors for PPOI and to generate the scoring system . A receiver operating characteristic curve was generated and the area under the curve was calculated to demonstrate the predictive power of the scoring system . Finally , 296 patients were included and analyzed , of whom 96 ( 32.4 % ) developed PPOI . The multivariate analysis showed that age ≥65 years , operative duration ≥4 hours , tumor – node – metastasis ( TNM ) stage = III , open/converted operative technique , and total postoperative opiates dose ( TOD ) ≥0.3 mg/kg were independent risk factors for PPOI . Based on these factors , a risk stratification scoring system was generated , classified by low-risk ( score 0–2 ) , moderate-risk ( score 3–4 ) , and high-risk ( score 5–6 ) groups . The incidence of PPOI increased by 7.5-fold from low-risk to high-risk group . The area under the curve of the scoring system was 0.841 ( 95 % CI , 0.793–0.890 ) , indicating a good predictive capability for the occurrence of PPOI.We have identified independent risk factors for the occurrence of PPOI and used these factors to construct a risk stratification scoring system BACKGROUND Selective cyclooxygenase-2 ( COX-2 ) inhibitors have come under scrutiny because of reports suggesting an increased cardiovascular risk associated with their use . Experimental research suggesting that 
    Output:
    
NSAIDs significantly improve time to gut recovery after elective colorectal surgery .
Current evidence is not adequate to identify whether selective or nonselective drugs should be recommended .