***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 : Proinflammatory cytokines , especially tumour necrosis factor α ( TNF-α ) , play a prominent role in the pathogenesis of cancer cachexia . Thalidomide , which is an inhibitor of TNF-α synthesis , may represent a novel and rational approach to the treatment of cancer cachexia . Aims : To assess the safety and efficacy of thalidomide in attenuating weight loss in patients with cachexia secondary to advanced pancreatic cancer . Methods : Fifty patients with advanced pancreatic cancer who had lost at least 10 % of their body weight were r and omised to receive thalidomide 200 mg daily or placebo for 24 weeks in a single centre , double blind , r and omised controlled trial . The primary outcome was change in weight and nutritional status . Results : Thirty three patients ( 16 control , 17 thalidomide ) were evaluated at four weeks , and 20 patients ( eight control , 12 thalidomide ) at eight weeks . At four weeks , patients who received thalidomide had gained on average 0.37 kg in weight and 1.0 cm3 in arm muscle mass ( AMA ) compared with a loss of 2.21 kg ( absolute difference −2.59 kg ( 95 % confidence interval ( CI ) −4.3 to −0.8 ) ; p = 0.005 ) and 4.46 cm3 ( absolute difference −5.6 cm3 ( 95 % CI −8.9 to −2.2 ) ; p = 0.002 ) in the placebo group . At eight weeks , patients in the thalidomide group had lost 0.06 kg in weight and 0.5 cm3 in AMA compared with a loss of 3.62 kg ( absolute difference −3.57 kg ( 95 % CI −6.8 to −0.3 ) ; p = 0.034 ) and 8.4 cm3 ( absolute difference −7.9 cm3 ( 95 % CI −14.0 to −1.8 ) ; p = 0.014 ) in the placebo group . Improvement in physical functioning correlated positively with weight gain ( r = 0.56 , p = 0.001 ) . Conclusion : Thalidomide was well tolerated and effective at attenuating loss of weight and lean body mass in patients with cachexia due to advanced pancreatic cancer Background : The approval of a research ethics committee ( REC ) and obtaining informed consent from patients ( ICP ) could be considered the main issues in the ethics of research with human beings . The aim of this study was to assess both method ological quality and ethical quality , and also to assess the relationship between these two qualities in r and omised phase III cancer trials . Method :  Method ological quality ( Jadad score ) and ethical quality ( Berdeu score ) were assessed for all r and omised controlled trials ( RCTs ) published in 10 international journals between 1999 and 2001 ( n = 231 ) . Results : The mean Jadad score was 9.86 ± 1.117 . The method ological quality was poor in 75 RCTs ( Jadad score < 9 ) . The mean Berdeu score was 0.42 ± 0.133 . The mean ethical quality score for poor method ological quality RCTs ( n = 75 ) was 0.39 ± 0.133 ; it was 0.43 ± 0.133 for good ( n = 156 ) method ological quality RCTs ( p = 0.07 ) . There was improvement in ethical quality according to the year of commencement of the trials ( p < 0.001 ) . There was no correlation between method ological quality and the number of participating patients ( R2 = 0.003 , p = 0.78 ) , between ethical quality and the number of participating patients ( R2 = 0.003 , p = 0.76 ) , or between ethical quality and method ological quality ( R2 = 0.012 , p = 0.1 ) . ICP and REC approval were not obtained for 21 and 77 trials respectively . Conclusion : The association between method ological quality and the reporting of ethical requirements probably reflects the respect shown for patients during the whole research process . These results suggest that closer attention to the conduct of clinical research , as well as the reporting of its ethical aspects , is needed The primary purpose of this study was to investigate the accuracy of the activPAL physical activity monitor in measuring step number and cadence in older adults .  Two pedometers ( New-Lifestyles Digi-Walker SW-200 and New-Lifestyles NL2000 ) used in clinical practice to count steps were simultaneously evaluated . Observation was the criterion measure . Twenty-one participants ( 65 - 87 yr old ) recruited from community-based exercise classes walked on a treadmill at 5 speeds ( 0.67 , 0.90 , 1.12 , 1.33 , and 1.56 m/s ) and outdoors at 3 self-selected speeds ( slow , normal , and fast ) . The absolute percentage error of the activPAL was < 1 % for all treadmill and outdoor conditions for measuring steps and cadence . With the exception of the slowest treadmill speed , the NL-2000 error was < 2 % . The SW-200 was the least accurate device , particularly at slower walking speeds . The activPAL monitor accurately recorded step number and cadence . Combined with its ability to identify primary postures , the activPAL might be a useful and versatile device for measuring activity in older adults Summary The use of megestrol acetate in the treatment of weight loss in gastrointestinal cancer patients has been disappointing . The aim of the present study was to compare the combination of megestrol acetate and placebo with megestrol acetate and ibuprofen in the treatment of weight loss in such patients . At baseline , 4–6 weeks and 12 weeks , patients underwent measurements of anthropometry , concentrations of albumin and C-reactive protein and assessment of appetite , performance status and quality of life using EuroQol-EQ-5D and EORTC QLQ-C30 .  Thirty-eight and 35 patients ( median weight loss 18 % ) were r and omized to megestrol acetate/placebo or megestrol acetate/ibuprofen  , respectively , for 12 weeks . Forty-six ( 63 % ) of patients failed to complete the 12-week assessment . Of those evaluable at 12 weeks , there was a decrease in weight ( median 2.8 kg ) in the megestrol acetate/placebo group compared with an increase ( median 2.3 kg ) in the megestrol acetate/ibuprofen group ( P < 0.001 ) . There was also an improvement in the EuroQol-EQ-5D quality of life scores of the latter group ( P < 0.05 ) . The combination of megestrol acetate/ibuprofen appeared to reverse weight loss and appeared to improve quality of life in patients with advanced gastrointestinal cancer . Further trials of this novel regimen in weight-losing patients with hormone-insensitive cancers are warranted The aim of this study was to investigate the effect of the cyclo-oxygenase inhibitor ibuprofen on the acute-phase protein response and resting energy expenditure ( REE ) of weight-losing patients with pancreatic cancer . Patients with irresectable pancreatic cancer ( n = 16 ) were treated with either ibuprofen ( 1200 mg day-1 for 7 days ( n = 10 ) or placebo ( n = 6 ) . A group of 17 age-related non-cancer subjects were also studied .  Indirect calorimetry , anthropometry , multifrequency bioelectrical impedence analysis and serum C-reactive protein ( CRP ) estimation were performed immediately before and after treatment . Before treatment , total REE was significantly elevated in the pancreatic cancer patients compared with healthy controls ( 1499 + /- 71 vs 1377 + /- 58 kcal ) ( P < 0.02 ) . Following treatment the mean REE of the ibuprofen group fell significantly ( 1386 + /- 89 kcal ) compared with pretreatment values ( 1468 + /- 99 kcal ) ( P < 0.02 ) , whereas no change was observed in the placebo group . Serum CRP concentration was also reduced in the ibuprofen-treated group ( pre-ibuprofen , 51 mg l-1 ; post-ibuprofen , 29 mg l-1 ; P < 0.05 ) . These results suggest that ibuprofen may have a role in abrogating the catabolic processes which contribute to weight loss in patients with pancreatic cancer The regulation of acute phase protein production and the relationship of the acute phase protein response to tumour growth was examined in colorectal cancer patients ( n = 9 ) .  Ibuprofen ( 1200 mg/d ) was administered for 8 - 11 days . Following ibuprofen administration there were reductions in circulating concentrations of C-reactive protein ( P = 0.01 ) , interleukin-6 ( P = 0.06 ) , cortisol ( P = 0.04 ) and also in the platelet count ( P = 0.01 ) . There was no significant change in albumin , insulin and carcinoembryonic antigen . These results indicate that ibuprofen administered over a prolonged period substantially reduces acute protein production via its effect on interleukin-6 and cortisol . It remains to be determined whether ibuprofen is useful in moderating tumour growth in colorectal cancer patients PURPOSE A phase III , r and omized study was carried out to establish the most effective and safest treatment to improve the primary endpoints of cancer cachexia-lean body mass ( LBM ) , resting energy expenditure ( REE ) , and fatigue- and relevant secondary endpoints : appetite , quality of life , grip strength , Glasgow Prognostic Score ( GPS ) and proinflammatory cytokines . PATIENTS AND METHODS Three hundred thirty-two assessable patients with cancer-related anorexia/cachexia syndrome were r and omly assigned to one of five treatment arms : arm 1 , medroxyprogesterone ( 500 mg/day ) or megestrol acetate ( 320 mg/day ) ; arm 2 , oral supplementation with eicosapentaenoic acid ; arm 3 , L-carnitine ( 4 g/day ) ; arm 4 , thalidomide ( 200 mg/day ) ; and arm 5 , a combination of the above . Treatment duration was 4 months . RESULTS Analysis of variance showed a significant difference between treatment arms . A post hoc analysis showed the superiority of arm 5 over the others for all primary endpoints . An analysis of changes from baseline showed that LBM ( by dual-energy X-ray absorptiometry and by L3 computed tomography ) significantly increased in arm 5 . REE decreased significantly and fatigue improved significantly in arm 5 . Appetite increased significantly in arm 5 ; interleukin (IL)-6 decreased significantly in arm 5 and arm 4 ; GPS and Eastern Cooperative Oncology Group performance status ( ECOG PS ) score decreased significantly in arm 5 , arm 4 , and arm 3 . Toxicity was quite negligible , and was comparable between arms . CONCLUSION The most effective treatment in terms of all three primary efficacy endpoints and the secondary endpoints appetite , IL-6 , GPS , and ECOG PS score was the combination regimen that included all selected agents Abstract Under the common denomination of Systemic Immune-Metabolic Syndrome ( SIMS ) , we grouped many symptoms that share a similar pathophysiologic background . SIMS is the result of the dysfunctional interaction of tumor cells , stroma cells , and the immune system , leading to the release of cytokines and other systemic mediators such as eicosanoids . SIMS includes systemic syndromes such as paraneoplastic hemopathies , hypercalcemia , coagulopathies , fatigue , weakness , cachexia , chronic nausea , anorexia , and early satiety among others . Eicosapentaenoic and docosahexaenoic n-3 fatty acids from fish oil can help in the management of persistent chronic inflammatory states , but treatment 's compliance is generally poor . Preferentially , Cox-2 inhibition can create a favorable pattern of cytokines by decreasing the production of certain eicosanoids , although their role in SIMS is unknown . The aim of this study was to test the hypothesis that by modulating systemic inflammation through an eicosanoid-targeted approach , some of the symptoms of the SIMS could be controlled . We exclusively evaluated 12 patients for compliance . Patients were assigned 1 of the 4 treatment groups ( 15- , 12- , 9- , or 6-g dose , fractionated every 8 h ) . For patients assigned to 15 and 12 doses , the overall compliance was very poor and unsatisfactory for patients receiving the 9-g dose . The maximum tolerable dose was calculated to be around 2 capsules tid ( 6 g of fish oil per day ) . A second cohort of 22 patients with advanced lung cancer and SIMS were r and omly assigned to receive either fish oil , 2 g tid , plus placebo capsules bid ( n = 12 ) or fish oil , 2 g tid , plus celecoxib 200 mg bid ( n = 10 ) . All patients in both groups received oral food supplementation . After 6 wk of treatment , patients receiving fish oil + placebo or fish oil + celecoxib showed significantly more appetite , less fatigue , and lower C-reactive protein ( C-RP ) values than their respective baselines values ( P < 0.02 for all the comparisons ) . Additionally , patients in the fish oil + celecoxib group also improved their body weight and muscle strength compared to bas 
    Output:
    
These studies provided some evidence of positive therapeutic effect on quality of life , performance status , inflammatory markers , weight gain and survival , but there was insufficient evidence demonstrated for their widespread use in practice .