***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: To comprehend the results of a r and omised controlled trial ( RCT ) , readers must underst and its design , conduct , analysis , and interpretation . That goal can be achieved only through total transparency from authors . Despite several decades of educational efforts , the reporting of RCTs needs improvement . Investigators and editors developed the original CONSORT ( Consoli date d St and ards of Reporting Trials ) statement to help authors improve reporting by use of a checklist and flow diagram . The revised CONSORT statement presented here incorporates new evidence and addresses some criticisms of the original statement . The checklist items pertain to the content of the Title , Abstract , Introduction , Methods , Results , and Discussion . The revised checklist includes 22 items selected because empirical evidence indicates that not reporting this information is associated with biased estimates of treatment effect , or because the information is essential to judge the reliability or relevance of the findings . We intended the flow diagram to depict the passage of participants through an RCT . The revised flow diagram depicts information from four stages of a trial ( enrolment , intervention allocation , follow- up , and analysis ) . The diagram explicitly shows the number of participants , for each intervention group , included in the primary data analysis . Inclusion of these numbers allows the reader to judge whether the authors have done an intention- to-treat analysis . In sum , the CONSORT statement is intended to improve the reporting of an RCT , enabling readers to underst and a trial 's conduct and to assess the validity of its results Abstract Inflammatory pathways are involved in the development of atherosclerosis . Interaction of vessel wall cells and invading monocytes by cytokines may trigger local inflammatory processes . 3-Hydroxy-3-methylglutaryl coenzyme A reductase inhibitors ( statins ) are st and ard medications used in cardiovascular diseases . They are thought to have anti-inflammatory capacities , in addition to their lipid-lowering effects . We investigated the anti-inflammatory effect of statins in the cytokine-mediated-interaction-model of human vascular smooth muscle cells ( SMC ) and human mononuclear cells ( MNC ) . In this atherosclerosis-related inflammatory model LPS ( lipopolysaccharide , endotoxin ) , as well as high mobility group box 1 stimulation result ed in synergistic ( i.e. over-additive ) IL-6 ( interleukin-6 ) production as measured in ELISA . Recombinant IL-1 , tumour necrosis factor-α and IL-6 mediated the synergistic IL-6 production . The st and ard anti-inflammatory drugs aspirin and indomethacin ( Indo ) reduced the synergistic IL-6 production by 60 % . Simvastatin , atorvastatin , fluvastatin or pravastatin reduced the IL-6 production by 53 % , 50 % , 64 % and 60 % , respectively . The inhibition by the statins was dose dependent . Combination of statins with aspirin and /or Indo result ed in complete inhibition of the synergistic IL-6 production . The same inhibitors blocked STAT3 phosphorylation , providing evidence for an autocrine role of IL-6 in the synergism . MNC from volunteers after 5 day aspirin or simvastatin administration showed no decreased IL-6 production , probably due to drug removal during MNC isolation . Taken together , the data show that anti-inflammatory functions ( here shown for statins ) can be sensitively and reproducibly determined in this novel SMC/MNC coculture model . These data implicate that statins have the capacity to affect atherosclerosis by regulating cytokine-mediated innate inflammatory pathways in the vessel wall OBJECTIVES Our aim was to investigate if the peroxisome proliferator-activated receptor (PPAR)-gamma agonist pioglitazone modulates inflammation through PPARalpha mechanisms . BACKGROUND The thiazolidinediones ( TZDs ) pioglitazone and rosiglitazone are insulin-sensitizing PPARgamma agonists used to treat type 2 diabetes ( T2DM ) . Despite evidence for TZDs limiting inflammation and atherosclerosis , questions exist regarding differential responses to TZDs . In a double-blinded , placebo-controlled 16-week trial among recently diagnosed T2DM subjects ( n = 34 ) , pioglitazone-treated subjects manifested lower triglycerides and lacked the increase in soluble vascular cell adhesion molecules (sVCAM)-1 evident in the placebo group . Previously we reported PPARalpha but not PPARgamma agonists could repress VCAM-1 expression . Since both triglyceride-lowering and VCAM-1 repression characterize PPARalpha activation , we studied pioglitazone 's effects via PPARalpha . METHODS Pioglitazone effects on known PPARalpha responses -- lig and binding domain activation and PPARalpha target gene expression -- were tested in vitro and in vivo , including in wild-type and PPARalpha-deficient cells and mice , and compared with the effects of other PPARgamma ( rosiglitazone ) and PPARalpha ( WY14643 ) agonists . RESULTS Pioglitazone repressed endothelial TNFalpha-induced VCAM-1 messenger ribonucleic acid expression and promoter activity , and induced hepatic IkappaBalpha in a manner dependent on both pioglitazone exposure and PPARalpha expression . Pioglitazone also activated the PPARalpha lig and binding domain and induced PPARalpha target gene expression , with in vitro effects that were most pronounced in endothelial cells . In vivo , pioglitazone administration modulated sVCAM-1 levels and IkappaBalpha expression in wild-type but not PPARalpha-deficient mice . CONCLUSIONS Pioglitazone regulates inflammatory target genes in hepatic ( IkappaBalpha ) and endothelial ( VCAM-1 ) setting s in a PPARalpha-dependent manner . These data offer novel mechanisms that may underlie distinct TZD responses Introduction The benefit of corticosteroids as adjunctive treatment in patients with severe community-acquired pneumonia ( CAP ) requiring hospital admission remains unclear . This study aim ed to evaluate the impact of corticosteroid treatment on outcomes in patients with CAP . Methods This was a prospect i ve , double-blind and r and omized study . All patients received treatment with ceftriaxone plus levofloxacin and methyl-prednisolone ( MPDN ) administered r and omly and blindly as an initial bolus , followed by a tapering regimen , or placebo . Results Of the 56 patients included in the study , 28 ( 50 % ) were treated with concomitant corticosteroids . Patients included in the MPDN group show a more favourable evolution of the pO2/FiO2 ratio and faster decrease of fever , as well as greater radiological improvement at seven days . The time to resolution of morbidity was also significantly shorter in this group . Six patients met the criteria for mechanical ventilation ( MV ) : five in the placebo group ( 22.7 % ) and one in the MPDN group ( 4.3 % ) . The duration of MV was 13 days ( interquartile range 7 to 26 days ) for the placebo group and three days for the only case in the MPDN group . The differences did not reach statistical significance . Interleukin (IL)-6 and C-reactive protein ( CRP ) showed a significantly quicker decrease after 24 h of treatment among patients treated with MPDN . No differences in mortality were found among groups . Conclusions MPDN treatment , in combination with antibiotics , improves respiratory failure and accelerates the timing of clinical resolution of severe CAP needing hospital admission . Trial Registration International St and ard R and omized Controlled Trials Register , IS RCT N22426306 Objective To determine whether statins protect against all cause mortality after a diagnosis of pneumonia . Design Cohort study using propensity score based method to control for differences between people prescribed and not prescribed statins . Setting United Kingdom Health Improvement Network data base , which contains electronic primary care medical records of more than six million patients . Participants Every patient starting a statin between 1995 and 2006 ( 129 288 ) matched with up to five non-statin users ( n=600 241 ) ; 9073 patients had a recorded diagnosis of pneumonia , of whom 1398 were using a statin . Main outcome measure All cause mortality within six months of diagnosis of pneumonia . Results Among users and non-users of statins with comparable propensity scores , 95/942 users and 686/3615 non-users died on the day that pneumonia was diagnosed . In the following six month period , 109/847 statin users died compared with 578/2927 non-users , giving an adjusted hazard ratio of 0.67 ( 0.49 to 0.91 ) . If these observed benefits translated into clinical practice , 15 patients would need to be treated with a statin for six months after pneumonia to prevent one death . Conclusions Compared with people who were not taking statins , the risk of dying in the six month period after pneumonia was substantially lower among people who were already established on long term statin treatment when the pneumonia occurred . Whether some or all of this protective effect would be obtained if statin treatment begins when a patient first develops pneumonia is not known . However , given that statins are cheap , safe , and well tolerated , a clinical trial in which people with pneumonia are r and omised to a short period of statin treatment is warranted Recent studies suggest that statins and angiotensin-converting enzyme ( ACE ) inhibitors may have beneficial effects for some types of infections . The present study aim ed to examine the association of outpatient use of these medications on 30-day mortality for subjects aged > 65 yrs and hospitalised with community-acquired pneumonia . A retrospective national cohort study was conducted using the Department of Veterans Affairs administrative data including subjects aged ≥65 yrs hospitalised with community-acquired pneumonia , and having ≥1 yr of prior Veterans Affairs outpatient care . In total , 8,652 subjects were identified with a mean age of 75 yrs , 98.6 % were male , and 9.9 % of subjects died within 30 days of presentation . In this cohort , 18.1 % of subjects were using statins and 33.9 % were using ACE inhibitors . After adjusting for potential confounders , current statin use ( odds ratio ( OR ) 0.54 , 95 % confidence interval ( CI ) 0.42–0.70 ) and ACE inhibitor use ( OR 0.80 , 95 % CI 0.68–0.89 ) were significantly associated with decreased 30-day mortality .  Use of statins and angiotensin-converting enzyme inhibitors prior to admission is associated with decreased mortality in subjects hospitalised with community-acquired pneumonia . R and omised controlled trials are needed to examine whether the use of these medications in patients hospitalised with community-acquired pneumonia may be beneficial Background Recent studies suggested that administration of corticosteroids may improve clinical outcomes in patients with severe pneumonia . Objectives The aim of this study was to assess the effectiveness of corticosteroids as an adjunctive therapy in community-acquired pneumonia ( CAP ) requiring hospitalization . Design and Setting An open label , prospect i ve , r and omized control study was conducted from September 2003 to February 2004 in a community general hospital in Japan . Patients Thirty-one adult CAP patients who required hospitalization were enrolled . Measurements and Results Fifteen patients received 40 mg of prednisolone intravenously for 3 days ( steroid group ) . Sixteen patients did not receive prednisolone ( control group ) . Both groups were also evaluated for their adrenal function . The primary endpoint was length of hospital stay . Secondary endpoints were duration of intravenous ( IV ) antibiotics and time required to stabilize vital signs . Both groups demonstrated similar baseline characteristics and length of hospital stay , and yet a shorter duration of IV antibiotics was observed in the steroid group ( p < 0.05 ) . In addition , vital signs were stabilized earlier in the steroid group ( p < 0.05 ) . These differences were more prominent in the moderate – severe subgroup but not as significant in the mild – moderate subgroup . The prevalence of relative adrenal insufficiency ( RAI ) in both groups was high ( 43 % ) , yet there was no difference in baseline characteristics between patients , with or without RAI . In multiple regression models , RAI seemed to have no influence on clinical courses . Conclusions In moderate – severe CAP , administration of corticosteroids promotes resolution of clinical symptoms and reduces the duration of intravenous antibiotic therapy In the study presented here , data collected prospect ively from 340 adult patients hospitalised in five countries with bacteremic pneumococcal CAP and treated with a ß-lactam + /− a macrolide  were analysed retrospectively to evaluate the efficacy of this antimicrobial combination . Univariate and multivariate analyses revealed no significant effect on case fatality rate when a macrolide/ß-lactam regimen was used as initial therapy . Results were not affected by severity of illness , or by excluding patients who died within 2 days of admission . Identified predictors of death in a multivariate regression model were age > 65 years ( OR=2.6 ) , two or more lung lobes affected ( OR=2.2 ) , and severity of disease as estimated using the acute physiology score (APS)>8 Objective To determine if statin therapy reduces the incidence of severe sepsis and the levels of inflammatory cytokines in patients with acute bacterial infection . Design Double-blind placebo controlled r and omized clinical trial . Setting Department of medicine and medical intensive care unit in a tertiary university medical center . Patients and participants A total of 83 patients with suspected or 
    Output:
    
Although r and omized control trials have not been done , clinical evidence favors the addition of a macrolide to a beta-lactam for the treatment of pneumococcal pneumonia and supports a role for macrolides in the treatment of all-cause CAP without regard to their anti-microbial activity .
The weight of several retrospective studies suggests that statins be considered in treating acute CAP .
Further support for the use of statins derives from the high association between pneumonia and acute myocardial infa rct ion .
Aspirin might also be of benefit in treating patients hospitalized for pneumonia  because of its anti-inflammatory activity as well as its benefits in acute myocardial infa rct ion .
Ibuprofen is not of benefit in treating sepsis in humans and glitazones may increase the risk of severe pneumonia