***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: Type 2 diabetes is associated with altered immune and hemostatic responses . We investigated the selective effects of hyperglycemia and hyperinsulinemia on innate immune , coagulation , and fibrinolytic responses during systemic inflammation . Twenty-four healthy humans were studied for 8 hours during clamp experiments in which either plasma glucose , insulin , both , or none was increased , depending on r and omization . Target plasma concentrations were 5 versus 12 mM for glucose , and 100 versus 400 pmol/L for insulin . After 3 hours , 4 ng/kg Escherichia coli endotoxin was injected intravenously to induce a systemic inflammatory and procoagulant response . Endotoxin administration induced cytokine release , activation of neutrophils , endothelium and coagulation , and inhibition of fibrinolysis . Hyperglycemia reduced neutrophil degranulation ( plasma elastase levels , P < .001 ) and exaggerated coagulation ( plasma concentrations of thrombin-antithrombin complexes and soluble tissue factor , both P < .001 ) . Hyperinsulinemia attenuated fibrinolytic activity due to elevated plasminogen activator-inhibitor-1 levels ( P < .001 ) . Endothelial cell activation markers and cytokine concentrations did not differ between clamps . We conclude that in humans with systemic inflammation induced by intravenous endotoxin administration hyperglycemia impairs neutrophil degranulation and potentiates coagulation , whereas hyperinsulinemia inhibits fibrinolysis . These data suggest that type 2 diabetes patients may be especially vulnerable to prothrombotic events during inflammatory states Background : The host inflammatory response has a vital role in carcinogenesis and tumour progression . We examined the prognostic value of  inflammatory markers ( albumin , white-cell count and its components , and platelets )  in pre-treated patients with advanced renal cell carcinoma ( RCC ) . Methods : Using data from a r and omised trial , multivariable proportional hazards models were generated to examine the impact of inflammatory markers and established prognostic factors ( performance status , calcium , and haemoglobin ) on overall survival ( OS ) . We evaluated a new prognostic classification incorporating additional information from inflammatory markers . Results : Of the 416 patients , 362 were included in the analysis .  Elevated neutrophil counts , elevated platelet counts , and a high neutrophil – lymphocyte ratio were significant independent predictors for shorter OS in a model with established prognostic factors . The addition of inflammatory markers improves the discriminatory value of the prognostic classification as compared with established factors alone ( C-statistic 0.673 vs 0.654 , P=0.002 for the difference ) , with 25.8 % ( P=0.004 ) of patients more appropriately classified using the new classification . Conclusion : Markers of systemic inflammation contribute significantly to prognostic classification in addition to established factors for pre-treated patients with advanced RCC . Upon validation of these data in independent studies , stratification of patients using these markers in future clinical trials is recommended 
    Output:
    
Conclusion : Our results show that the pretreatment neutrophil count is associated with mRCC outcomes and can be used as a valuable inflammatory marker for prognosis monitoring