***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: Multiple sclerosis ( MS ) presents with optic neuritis ( ON ) in 20 % of cases and 50 % of ON patients develop MS within 15 years . In this study , we evaluated the preventive effects of vitamin D3 administration on the conversion of ON to MS ( primary outcome ) and on the MRI lesions ( secondary outcome ) of ON patients with low serum 25 ( OH ) D levels . Thirty ON patients ( 15 in each of 2 groups , aged 20–40 years ) with serum 25 ( OH ) D levels of less than 30 ng/ml were enrolled in a double blind , r and omized , parallel-group trial . The treatment group ( cases ) received 50,000 IU of vitamin D3 weekly for 12 months and the control group ( controls ) received a placebo weekly for 12 months . Finally , the subsequent relapse rate and changes in MRI plaques were compared between the two groups . Risk reduction was 68.4 % for the primary outcome in the treatment group ( relative risk = 0.316 , p = 0.007 ) . After 12 months , patients in the treatment group had a significantly lower incidence rate of cortical , juxtacortical , corpus callosal , new T2 , new gadolinium-enhancing lesions and black holes . The mean number of total plaques showed a marginally significant decrease in the group receiving vitamin D3 supplementation as compared with the placebo group ( p = 0.092 ) . Administration of vitamin D3 supplements to ON patients with low serum vitamin 25 ( OH ) D levels may delay the onset of a second clinical attack and the subsequent conversion to MS Background Flu-like symptoms ( FLS ) are common side effects of interferon beta ( IFN-β ) treatment in patients with Multiple Sclerosis ( PwMS ) and are associated with post-injection cytokine surge . We hypothesized that vitamin D3 supplementation would ameliorate FLS by decreasing related serum cytokines ’ levels . Methods In a r and omized , double blind study of 45 IFNβ-treated PwMS , 21 patients were assigned to  800 IU of vitamin D3 per day ( low dose ) , while 24 patients received 4,370 IU per day ( high dose ) for one year . FLS were assessed monthly by telephonic interviews . Serum levels of 25-hydroxy-D ( 25-OH-D ) , calcium , PTH , IL-17 , IL-10 and IFN-γ were measured periodically . EDSS , relapses , adverse events and quality of life ( QoL ) were documented . Results 25-OH-D levels increased to a significantly higher levels and PTH levels decreased in the high dose group . There was no significant change in FLS . IL-17 levels were significantly increased in the low dose group , while patients receiving high dose vitamin D had a heterogeneous IL-17 response . No significant differences in relapse rate , EDSS , QoL , serum IL-10 and IFNγ were found . Hypercalcemia or other potential major adverse events were not observed . Conclusion Vitamin D supplementation to IFN−β treated PwMS , at the doses used , seems safe and associated with dose-dependent changes in IL-17 serum levels , while not affecting IFN−β related FLS.Trial registration Clinical Trials.gov ID : Abstract Objectives To explore the association between dietary factors including fat , fruit and vegetable intake , dairy and meat consumption , and health-related quality of life ( HRQOL ) , disability and relapse rate in a large international sample of people with multiple sclerosis ( MS ) . Methods Participants with MS were recruited to the study via Web 2.0 platforms and completed a comprehensive survey measuring demographic and clinical characteristics , HRQOL , disability , relapse rate , and the  Diet Habits Question naire ( DHQ ) . Results Of 2469 participants with confirmed MS , 2087 ( 84.5 % ) provided complete data on their dietary habits ( DHQ total score ) . Multivariate regression models demonstrated that every 10-point increase on the DHQ total score was associated with nearly a six-point and five-point increase in physical and mental HRQOL , respectively , and 30.0 % reduced likelihood of a higher level of disability . After controlling for age and gender , and the other dietary covariates , ‘ healthy ’ consumption of fruit and vegetables and dietary fat predicted better quality of life and less likelihood of higher disability when compared to respondents with a ‘ poor ’ diet . For those with relapsing – remitting MS , the DHQ total significantly predicted a lower relapse rate and reduced odds of increasing disease activity , but the model fit was poor and the predicted change only marginal . Discussion This study supports significant associations of healthy dietary habits with better physical and mental HRQOL and a lower level of disability . Further research is urgently required to explore these associations including r and omized controlled trials of dietary modification for people with MS Seventy-five  patients in London and Belfast with multiple sclerosis were given daily supplements of a vegetable oil mixture containing either linoleate or oleate for two years in a double-blind control trial . Relapses tended to be less frequent and were significantly less severe and of shorter duration in the linoleate-supplemented group than in those receiving the oleate mixture , but clear evidence that treatment affected the overall rate of clinical deterioration was not obtained Objective : Low vitamin D status has been associated with multiple sclerosis ( MS ) prevalence and risk , but the therapeutic potential of vitamin D in established MS has not been explored . Our aim was to assess the tolerability of high-dose oral vitamin D and its impact on biochemical , immunologic , and clinical outcomes in patients with MS prospect ively . Methods : An open-label r and omized prospect i ve controlled 52-week trial matched patients with MS for demographic and disease characteristics , with r and omization to treatment or control groups . Treatment patients received escalating vitamin D doses up to 40,000 IU/day over 28 weeks to raise serum 25-hydroxyvitamin D [ 25(OH)D ] rapidly and assess tolerability , followed by 10,000 IU/day ( 12 weeks ) , and further downtitrated to 0 IU/day . Calcium ( 1,200 mg/day ) was given throughout the trial . Primary endpoints were mean change in serum calcium at each vitamin D dose and a comparison of serum calcium between groups . Secondary endpoints included 25(OH)D and other biochemical measures , immunologic biomarkers , relapse events , and Exp and ed Disability Status Scale ( EDSS ) score . Results : Forty-nine patients ( 25 treatment , 24 control ) were enrolled [ mean age 40.5 years , EDSS 1.34 , and 25(OH)D 78 nmol/L ] . All calcium-related measures within and between groups were normal . Despite a mean peak 25(OH)D of 413nmol/L , no significant adverse events occurred . Although there may have been confounding variables in clinical outcomes , treatment group patients appeared to have fewer relapse events and a persistent reduction in T-cell proliferation compared to controls . Conclusions : High-dose vitamin D ( ∼10,000 IU/day ) in multiple sclerosis is safe , with evidence of immunomodulatory effects . Classification of evidence : This trial provides Class II evidence that high-dose vitamin D use for 52 weeks in patients with multiple sclerosis does not significantly increase serum calcium levels when compared to patients not on high-dose supplementation . The trial , however , lacked statistical precision and the design requirements to adequately assess changes in clinical disease measures ( relapses and Exp and ed Disability Status Scale scores ) , providing only Class level IV evidence for these outcomes The aim of this preliminary study was to evaluate the effect of low-dose oral vitamin D in combination with current disease-modifying therapy on the prevention of progression of relapsing-remitting multiple sclerosis ( RRMS ) . A phase II double-blind placebo-controlled r and omized clinical trial conducted between October 2007 and October 2008 included 50 patients with confirmed RRMS aged 25 to 57 years and normal serum 25-hydroxyvitamin D. They were r and omly allocated to receive 12 months of treatment with either escalating calcitriol doses up to 0.5 μg/day or placebo combined with disease-modifying therapy . Response to treatment was assessed at eight-week intervals . In both groups , the mean relapse rate decreased significantly ( P < 0.001 ) . In the 25 patients treated with placebo , the mean ( SD ) Exp and ed Disability Status Scale ( EDSS ) increased from 1.70 ( 1.21 ) at baseline to 1.94 ( 1.41 ) at the end of study period ( P < 0.01 ) . Average EDSS and relapse rate at the end of trial did not differ between groups . Adding low-dose vitamin D to routine disease-modifying therapy had no significant effect on the EDSS score or relapse rate . A larger phase III multicenter study of vitamin D in RRMS is warranted to more assess the efficacy of this intervention Objective To assess whether three novel interventions , formulated based on a systems medicine therapeutic concept , reduced disease activity in patients with relapsing – remitting multiple sclerosis ( MS ) who were either treated or not with disease-modifying treatment . Design A 30-month r and omised , double-blind , placebo-controlled , parallel design , phase II proof-of-concept clinical study . Setting s Cyprus Institute of Neurology and Genetics . Participants 80 participants were r and omised into four groups of 20 each . A total of 41 ( 51 % ) patients completed the 30-month trial . The eligibility criteria were an age of 18–65 ; a diagnosis of relapsing – remitting MS according to the McDonald criteria ; a score of 0.0–5.5 on the Exp and ed Disability Status Scale ( EDSS ) ; MRI showing lesions consistent with MS ; at least one documented clinical relapse and either receiving or not a disease-modifying treatment within the 24-month period before enrolment in the study . Patients were excluded because of a recent ( < 30 days ) relapse , prior immunosuppressant or monoclonal antibody therapy , pregnancy or nursing , other severe disease compromising organ function , progressive MS , history of recent drug or alcohol abuse , use of any additional food supplements , vitamins or any form of polyunsaturated fatty acids , and a history of severe allergic or anaphylactic reactions or known specific nutritional hypersensitivity . Interventions The first intervention ( A ) was composed of Ω-3 and Ω-6 polyunsaturated fatty acids at 1:1 wt/wt . Specifically , the Ω-3 fatty acids were docosahexaenoic acid and eicosapentaenoic acid at 3:1 wt/wt , and the Ω-6 fatty acids were linoleic acid and γ-linolenic acid at 2:1 wt/wt . This intervention also included minor quantities of other specific polyunsaturated , monounsaturated and saturated fatty acids as well as vitamin A and vitamin E ( α-tocopherol ) . The second intervention ( B , PLP10 ) was a combination of A and γ-tocopherol . The third intervention ( C ) was γ-tocopherol alone . The fourth group of 20 participants  received placebo . The interventions were administered per os ( by mouth ) once daily , 30 min before dinner for 30 months . Main outcome measures The primary end point was the annualised relapse rate ( ARR ) of the three interventions versus the placebo at 2 years . The secondary end point was the time to confirmed disability progression at 2 years . Results A total of 41 ( 51 % ) patients completed the 30-month trial . Overall , for the per- protocol analysis of the 2-year primary end point , eight relapses were recorded in the PLP10 group ( n=10 ; 0.40 ARR ) versus 25 relapses in the placebo group ( n=12 ; 1.04 ARR ) , representing a 64 % adjusted relative rate reduction for the PLP10 group ( RRR 0.36 , 95 % CI 0.15 to 0.87 , p=0.024 ) . In a subgroup analysis that excluded patients on monoclonal antibody ( natalizumab ) treatment , the observed adjusted RRR became stronger ( 72 % ) over the 2 years ( RRR 0.28 , 95 % CI 0.10 to 0.79 , p=0.016 ) . The per- protocol analysis for the secondary outcome at 2 years , the time to disability progression , was significantly longer only for PLP10 . The cumulative probability of disability progression at 2 years was 10 % in the PLP10 group and 58 % in the placebo group ( unadjusted log-rank p=0.019 ) . In a subgroup analysis that excluded patients on natalizumab , the cumulative probability of progression was 10 % for the 10 patients in the PLP10 group and 70 % for the 12 patients in the placebo group , representing a relative 86 % decrease in the risk of the sustained progression of disability in the PLP10 group ( unadjusted log-rank p=0.006 ; adjusted HR , 0.11 ; 95 % CI 0.01 to 0.97 , p=0.047 ) . No adverse events were reported . Interventions A ( 10 patients ) and C ( 9 patients ) showed no significant efficacy . Conclusions In this small proof-of-concept , r and omised , double-blind clinical trial ; the PLP10 treatment significantly reduced 
    Output:
    
A pilot test of our newly developed patient education program with 13 participants showed excellent comprehensibility and the MS-specific content was judged as very important .
Development and pilot-testing of an evidence -based patient education program on nutrition and MS is feasible .
Patient satisfaction with the program suffers from the lack of evidence .