***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 
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    Input: Background The gut microbiota is interlinked with obesity , but direct evidence of effects of its modulation on body fat mass is still scarce . We investigated the possible effects of Bifidobacterium animalisssp . lactis 420 ( B420 ) and the dietary fiber Litesse ® Ultra polydextrose ( LU ) on body fat mass and other obesity-related parameters . Methods 225 healthy volunteers ( healthy , BMI 28–34.9 ) were r and omized into four groups ( 1:1:1:1 ) , using a computer-generated sequence , for 6 months of double-blind , parallel treatment : 1 ) Placebo , microcrystalline cellulose , 12 g/d ; 2 ) LU , 12 g/d ; 3 ) B420 , 1010 CFU/d in microcrystalline cellulose , 12 g/d ; 4 ) LU + B420 , 12 g + 1010 CFU/d . Body composition was monitored with dual-energy X-ray absorptiometry , and the primary outcome was relative change in body fat mass , comparing treatment groups to Placebo . Other outcomes included anthropometric measurements , food intake and blood and fecal biomarkers . The study was registered in Clinical trials.gov ( NCT01978691 ) . Findings There were marked differences in the results of the Intention-To-Treat ( ITT ; n = 209 ) and Per Protocol ( PP ; n = 134 ) study population s. The PP analysis included only those participants who completed the intervention with > 80 % product compliance and no antibiotic use . In addition , three participants were excluded from DXA analyses for PP due to a long delay between the end of intervention and the last DXA measurement . There were no significant differences between groups in body fat mass in the ITT population . However , LU + B420 and B420 seemed to improve weight management in the PP population . For relative change in body fat mass , LU + B420 showed a − 4.5 % ( − 1.4 kg , P = 0.02 , N = 37 ) difference to the Placebo group , whereas LU ( + 0.3 % , P = 1.00 , N = 35 ) and B420 ( − 3.0 % , P = 0.28 , N = 24 ) alone had no effect ( overall ANOVA P = 0.095 , Placebo N = 35 ) . A post-hoc factorial analysis was significant for B420 ( − 4.0 % , P = 0.002 vs. Placebo ) . Changes in fat mass were most pronounced in the abdominal region , and were reflected by similar changes in waist circumference . B420 and LU + B420 also significantly reduced energy intake compared to Placebo . Changes in blood zonulin levels and hsCRP were associated with corresponding changes in trunk fat mass in the LU + B420 group and in the overall population . There were no differences between groups in the incidence of adverse events . Discussion This clinical trial demonstrates that a probiotic product with or without dietary fiber controls body fat mass . B420 and LU + B420 also reduced waist circumference and food intake , whereas LU alone had no effect on the measured outcomes Objective To evaluate the potential clinical , metabolic , and economic advantages of enteral nutrition over total parenteral nutrition . Design Prospect i ve , r and omized clinical trial . Setting Department of surgery in a university hospital . Patients Two hundred and fifty-seven patients with cancer of the stomach ( n = 121 ) , pancreas ( n = 110 ) , or esophagus ( n = 26 ) were r and omized to receive postoperative total parenteral nutrition ( TPN group , n = 131 ) or early enteral nutrition ( EEN group , n = 126 ) . The nutritional goal was 25 kcal/kg/day . The two nutritional formulas were isocaloric and isonitrogenous , and they were continued until oral intake was at least 800 kcal/day . Measurements Morbidity , mortality , length of hospital stay , and treatment costs were evaluated in all patients . In 40 consecutive patients , selected nutritional , immunologic and inflammatory variables were studied . Moreover , intestinal oxygen tension was evaluated by micropolarographic implantable probes . Main Results The nutritional goal was reached in 100/126 ( 79.3 % ) patients in the EEN group and in 128/131 ( 97.7 % ) patients in the TPN group ( p < .001 ) . In the EEN group , hyperglycemia ( serum glucose , > 200 mg/dL ) was observed in 4.7 % of the patients vs. 9.1 % in the TPN group ( p = NS ) . Alteration of serum electrolyte levels was 3.9 % in the EEN group vs. 13.7 % in the TPN group ( p < .01 ) . No significant difference was found in nutritional , immunologic , and inflammatory variables between the two groups . The overall complication rate was similar ( 40.4 % for TPN vs. 35.7 % , for EEN;p = .52 ) . No difference was detected for either infectious or noninfectious complications , length of hospital stay , and mortality . From postoperative day 5 , intestinal oxygen tension recovered faster in the EEN group than in the TPN group ( 43 ± 5 mm Hg vs. 31 ± 4 mm Hg at day 7;p < .001 ) . EEN was four-fold less expensive than TPN ( $ 25 vs. $ 90.60/day , respectively ) . Conclusion EEN represents a rational alternative to TPN in patients who undergo upper gastrointestinal tract surgery for cancer and who clinical ly require postoperative artificial nutrition BACKGROUND The clinical value of synbiotics in patients undergoing esophagectomy remains unclear . This study investigated the effects of synbiotics on intestinal microflora and surgical outcomes in a clinical setting . METHODS We studied 70 patients with esophageal cancer who were scheduled to undergo esophagectomy . They were r and omly allocated to 2 groups : 1 group received synbiotics before and after surgery , and the other did not .  Fecal microflora and organic acid concentrations were determined . Postoperative infections , abdominal symptoms , and duration of systemic inflammatory response syndrome ( SIRS ) were recorded . RESULTS Of the patients , 64 completed the trial ( synbiotics , 30 ; control , 34 ) . The counts of beneficial bacteria and harmful bacteria in the group given synbiotics were significantly larger and smaller , respectively , than those in the control group on postoperative day ( POD ) 7 . The concentrations of total organic acid and acetic acid were higher in the synbiotics group than in the control group ( P < .01 ) , and the intestinal pH in the synbiotics group was lower than that in the control ( P < .05 ) on POD 7 . The rate of infections was 10 % in the synbiotics group and 29.4 % in the control group ( P = .0676 ) . The duration of SIRS in the synbiotics group was shorter than in the control group ( P = .0057 ) . The incidence of interruption or reduction of enteral nutrition by abdominal symptoms was 6.7 % in the synbiotics group and 29.4 % in the control group ( P = .0259 ) . CONCLUSION Perioperative administration of synbiotics in patients with esophagectomy is useful because they suppress excessive inflammatory response and relieve uncomfortable abdominal symptoms through the adjustment of the intestinal microfloral environment Apart from the intestinal environment , inulin induces physiological effects , which includes a reduction in glucose and lipid concentrations and modulation of gastrointestinal motility through the release of different peptides . We hypothesized that inulin-enriched pasta may also improve small intestine permeability in relation to zonulin and glucagon-like peptide 2 ( GLP-2 ) levels in healthy young subjects . Twenty healthy , young male volunteers completed a r and omized , double-blind crossover study consisting of a 2-week run-in period and two 5-week study periods ( 11 % inulin-enriched or control pasta ) , with an 8-week washout period in between . The intestinal barrier function was assessed by lactulose-mannitol excretion in urine . Zonulin values and GLP-2 release were evaluated by enzyme-linked immunosorbent assay . In the inulin group , the urinary lactulose recovery was significantly lower than the other 2 groups . There were no significant differences in urinary mannitol levels between groups . Accordingly , the lactulose-mannitol excretion ratio was significantly decreased in the inulin-enriched pasta group compared with the other 2 groups . The inulin-enriched pasta group had significantly lower zonulin serum values and significantly higher GLP-2 basal values when compared with the baseline and control pasta groups . The dietary use of inulin-enriched pasta preserves intestinal mucosal barrier functioning and modulates circulating levels of zonulin and GLP-2 , suggesting that prebiotics could be used in the prevention of gastrointestinal diseases and metabolic disorders BACKGROUND Although the effect of synbiotic therapy using prebiotics and probiotics has been reported in hepatobiliary surgery , there are no reports of the effect on elective living-donor liver transplantation ( LDLT ) . METHODS Fifty adult patients undergoing LDLT between September 2005 and June 2009 were r and omized into a group receiving 2 days of preoperative and 2 weeks of postoperative synbiotic therapy ( Bifidobacterium breve , Lactobacillus casei , and galactooligosaccharides [ the BLO group ] ) and a group without synbiotic therapy ( the control group ) . Postoperative infectious complications were recorded as well as fecal microflora before and after LDLT in each group . RESULTS Only 1 systemic infection occurred in the BLO group ( 4 % ) , whereas the control group showed 6 infectious complications ( 24 % ) , with 3 cases of sepsis and 3 urinary tract infections with Enterococcus spp ( P = .033 vs BLO group ) . No other type of complication showed any difference between the groups . CONCLUSIONS Infectious complications after elective LDLT significantly decreased with the perioperative administration of synbiotic therapy OBJECTIVE Enteral administration of synbiotics has been reported to be beneficial during various types of surgery , but its clinical value in elderly surgical patients remains unclear . The aim of this study was to quantitatively evaluate the changes in gut microbiota and environment induced by perioperative synbiotic therapy , and to investigate whether it is possible to reduce infectious complications in elderly patients undergoing gastroenterological surgery . METHODS Forty-eight patients over the age of 70 y were r and omized into a group receiving 7 d of preoperative and 10 d of postoperative synbiotic therapy ( S group ) and a control group without synbiotic therapy ( C group ) . A fecal sample collected before and after surgery in each group was used for a quantitative evaluation of the microbiota . RESULTS Forty-eight patients completed the trial ( 25 in the S group and 23 in the C group ) . Synbiotic therapy significantly maintained the status of Bifidobacterium and Lactobacillus , whereas the number of Enterobacteriaceae , Staphylococcus , and Pseudomonas was significantly decreased . The total organic acid and short-chain fatty acid concentrations were increased , and the pH was markedly decreased , in the S group compared with the C group . The incidence of postoperative infectious complications was 12 % in the S group and 36 % in the C group , however , the difference did not reach statistical significance ( P = 0.06 ) . A multivariate analysis revealed that only the use of perioperative blood transfusion was an independent risk factor for infectious complications . CONCLUSIONS Synbiotic therapy improved the intestinal microbial environment , and might decrease the incidence of infectious complications in elderly surgical patients This study was design ed to mainly evaluate the anti-infective effects of perioperative probiotic treatment in patients receiving confined colorectal cancer ( CRC ) respective surgery . From November 2011 to September 2012 , a total of 60 patients diagnosed with CRC were r and omly assigned to receive probiotic ( n = 30 ) or placebo ( n = 30 ) treatment . The operative and post-operative clinical results including intestinal cleanliness , days to first - flatus , defecation , fluid diet , solid diet , duration of pyrexia , average heart rate , length of intraperitoneal drainage , length of antibiotic therapy , blood index changes , rate of infectious and non-infectious complications , postoperative hospital stay , and mortality were investigated . The patient demographics were not significantly different ( p > 0.05 ) between the probiotic treated and the placebo groups . The days to first flatus ( 3.63 versus 3.27 , p = 0.0274 ) and the days to first defecation ( 4.53 versus 3.87 , p = 0.0268 ) were significantly improved in the probiotic treated patients . The incidence of diarrhea was significantly lower ( p = 0.0352 ) in probiotics group ( 
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RESULTS Most of the review ed articles presented satisfactory results related to the prevention of surgical inflammation in patients undergoing resection of CRC when using strains of Lactobacillus genus , predominantly .
CONCLUSIONS Probiotics are suggested to prevent surgical inflammation of CRC , at the same time that the combination of particular microorganisms administered is beneficial to the treatment and surgical recovery