***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: Bacterial infections frequently occur early after liver transplantation . We recently reported significant progress with a synbiotic composition , consisting of one lactic acid bacteria ( LAB ) and one fiber , which reduced the infection rate from 48 % ( with selective bowel decontamination ) to 13 % . Now , our aim is to study if a combination of different LAB and fibers would further improve outcome Background : Bacterial translocation occurs in surgical patients and may predispose to postoperative septic morbidity . Many factors are thought to influence the prevalence of bacterial translocation , one of which is the composition of the gut microflora . The aim of this prospect i ve and r and omised study was to assess the effect of the probiotic Lactobacillus plantarum 299v on the incidence of bacterial translocation , gastric colonisation , and septic complications in elective surgical patients . Methods : Patients undergoing elective major abdominal surgery were r and omised to either a treatment or control group . The treatment group received an oral preparation containing Lactobacillus plantarum 299v ( Proviva ) for at least one week preoperatively and also in the postoperative period . Bacterial translocation was determined by culture of a mesenteric lymph node and serosal scraping obtained at laparotomy . Gastric colonisation was assessed by microbiological culture of nasogastric aspirates . All postoperative septic complications were recorded . Results : A total of 129 patients completed the study ( probiotic group n=64 ) . There was no significant difference between the two groups in terms of bacterial translocation ( 12 % v 12 % ; p=0.82 ) , gastric colonisation with enteric organisms ( 11 % v 17 % ; p=0.42 ) , or septic morbidity ( 13 % v 15 % ; p=0.74 ) . Conclusions : Administration of Lactobacillus plantarum 299v  in elective surgical patients does not influence the rate of bacterial translocation , gastric colonisation , or incidence of postoperative septic morbidity Objective : Patients undergoing pancreas resection carry several risk factors for nosocomial bacterial infections . Pre- and probiotics ( synbiotics ) are potentially useful for prevention of these infections . Summary Background Data : First trials in patients following major abdominal surgery including liver transplantation using one Lactobacillus ( LAB ) and one fiber showed significant reduction of infection rates and reduced length of antibiotic therapy compared with a control group . The present study was design ed to analyze whether a combination of different LAB and fibers would further improve outcome . Methods : A prospect i ve r and omized monocentric double-blind trial was undertaken in 80 patients following pylorus-preserving pancreatoduodenectomy ( PPPD ) . All patients received enteral nutrition immediately postoperatively . One group ( A ) received a composition of 4 LAB and 4 fibers , and another group ( B ) received placebo ( fibers only ) starting the day before surgery and continuing for 8 days . Thirty-day infection rate , length of hospital stay , duration of antibiotic therapy , noninfectious complications , and side effects were recorded . Results : The incidence of postoperative bacterial infections was significantly lower with LAB and fibers ( 12.5 % ) than with fibers only ( 40 % ) . In addition , the duration of antibiotic therapy was significantly shorter in the latter group . Fibers and LAB were well tolerated . Conclusion : Early enteral nutrition supplemented with a mixture of LAB and fibers reduces bacterial infection rates and antibiotic therapy following PPPD UNLABELLED To determine the current quality of reporting of r and omized clinical trials ( RCTs ) in the field of gastroenterology and hepatology , we evaluated the method ological reporting of  RCTs in six major gastroenterology and hepatology journals . The method ological quality , including generation of the allocation sequence , allocation concealment , double-blinding , and sample size calculation ; number of patients ; disease area ; and funding source was also retrieved from each trial , and the relevant trials were identified by search ing MEDLINE in 2006 using a highly sensitive search strategy . The status of reporting the method ological quality of RCTs was descriptively reported . One hundred five trials were included in the final analysis ; of these , 81 % ( 85/105 ) reported adequate generation of the allocation sequence , 61 % ( 64/105 ) reported adequate allocation concealment , 51 % ( 54/105 ) were double-blind , and 75 % ( 79/105 ) reported adequate sample size calculation . The reported method ological quality greatly improved when compared with historical cohorts . CONCLUSION This study shows that there was substantial improvement in the reported method ological quality in the major gastroenterology and hepatology journals , but this quality can be further improved 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 Aim . The aim of the study was to assess the impact of the long-term use of the composite probiotics in patients after restorative proctocolectomy . Method . Forty-three patients ( 20 females and 23 males , aged 21 to 68 years ) after restorative proctocolectomy were included in the study . After r and omization patients were divided into placebo group and treatment group with oral intake of probiotic containing Lactobacillus acidophilus , Lactobacillus delbrueckii subsp . bulgaricus , and Bifidobacterium bifidus . Patients were investigated during initial visit and during final visit after 9 months . All patients were subjected to st and ard clinical and endoscopic examination with microscopic study of the specimens . Concentrations of calprotectin and pyruvate kinase isoenzyme M2-PK were determined in all cases . Results . The average severity of pouchitis and the number of patients with pouchitis significantly decrease after 9 months of the probiotic taking . The concentrations of calprotectin and pyruvate kinase isoenzyme M2-PK significantly decreased after the therapy . Conclusions . Nine months of the probiotic treatment ( Lactobacillus acidophilus , Lactobacillus delbrueckii subsp . bulgaricus , and Bifidobacterium bifidus ) reduced the number of patients with pouchitis , decreased the PDAI score , and also decreased the fecal pyruvate kinase and calprotectin . The long-term probiotics use is safe and well accepted and can be an effective method of the pouchitis prevention Introduction Roux-en-Y gastric bypass ( RNYGB ) surgery  offers an effective and enduring treatment for morbid obesity . Gastric bypass may alter gastrointestinal ( GI ) flora possibly result ing in bacterial overgrowth and dysmotility . Our hypothesis was that daily use of probiotics would improve GI outcomes after RNYGB . Methods Forty-four patients undergoing RNYGB  were r and omized to either a probiotic or control group ; 2.4 billion colonies of Lactobacillus were administered daily postoperatively to the probiotic group . The outcomes of H2 levels indicative of bacterial overgrowth , GI-related quality of life ( GIQoL ) , serologies , and weight loss were measured preoperatively and at 3 and 6 months postoperatively . Categorical variables were analyzed by χ2 test and continuous variables were analyzed by t test with a p < 0.05 for significance . Results At 6 months , a statistically significant reduction in bacterial overgrowth was achieved in the probiotic group with a preoperative to postoperative change of sum H2 part per million ( probiotics = −32.13 , controls = 0.80 ) . Surprisingly , the probiotic group attained significantly greater percent excess weight loss than that of control group at 6 weeks ( controls = 25.5 % , probiotic = 29.9 % ) and 3 months ( 38.55 % , 47.68 % ) . This trend also continued but was not significant at 6 months ( 60.78 % , 67.15 % ) . The probiotic group had significantly higher postoperative vitamin B12 levels than the control group . Both probiotic and control groups significantly improved their GIQoL. Conclusion In this novel study , probiotic administration improves bacterial overgrowth , vitamin B12 availability , and weight loss after RNYGB . These data may provide further evidence that altering the GI microbiota can influence weight loss Purpose The aim of this study was to assess the effect of perioperative oral administration of synbiotics on the surgical outcome in patients undergoing laparoscopic colorectal resection . Methods In this single-center r and omized , controlled trial , patients scheduled to undergo elective laparoscopic colorectal surgery were eligible to participate and r and omly assigned to a synbiotics group or a control group . The primary study outcome was the development of infectious complications , particularly surgical site infection ( SSI ) , within 30 days of surgery . Results In this study , 379 patients were enrolled and r and omly assigned ( 173 to the synbiotics group and 206 to the control group ) , of whom 362 patients ( 168 to the synbiotics group and 194 to the control group ) were eligible for this study . SSI occurred in 29 ( 17.3 % ) patients in the synbiotics group and 44 ( 22.7 % ) patients in the control group ( OR : 0.761 , 95 % CI 0.50–1.16 ; p = 0.20 ) . Overall , the rate of postoperative complications , including anastomotic leakage , did not differ significantly between the two groups . Synbiotics treatment reversed the changes in fecal bacteria and organic acids after surgery and suppressed the increases in potentially pathogenic species , such as Clostridiumdifficile . Conclusion The efficacy of perioperative administration of synbiotics was not vali date d as a treatment for reducing the incidence of infectious complications after laparoscopic colorectal resection . However , the microbial imbalance , in addition to the reduction in organic acids , could be improved by perioperative synbiotics treatment Background : It is possible to manipulate the composition of the gastrointestinal microflora by administration of pre- and probiotics . This may help to preserve gut barrier function and reduce the incidence of septic morbidity . Aims : To assess the effects of a combination of pre- and probiotics ( synbiotic ) on bacterial translocation , gastric colonisation , systemic inflammation , and septic morbidity in elective surgical patients . Patients : Patients were enrolled two weeks prior to elective abdominal surgery . Seventy two patients were r and omised to the synbiotic group and 65 to the placebo group . Patients were well matched regarding age and sex distribution , diagnoses , and POSSUM scores . Methods : Patients in the synbiotic group received a two week preoperative course of Lactobacillus acidophilus La5 , Bifidobacterium lactis Bb-12 , Streptococcus thermophilus , and Lactobacillus bulgaricus , together with the prebiotic oligofructose . Patients in the placebo group received placebo capsules and sucrose powder . At surgery , a nasogastric aspirate , mesenteric lymph node , and scrapings of the terminal ileum were harvested for microbiological analysis . Serum was collected preoperatively and on postoperative days 1 and 7 for measurement of C reactive protein , interleukin 6 , and antiendotoxin antibodies . Septic morbidity and mortality were recorded . Results : There were no significant differences between the synbiotic and control groups in bacterial translocation ( 12.1 % v 10.7 % ; p = 0.808 , χ2 ) , gastric colonisation 
    Output:
    
Conclusion : Probiotics and synbiotics may prevent postoperative infections in patients undergoing gastrointestinal surgery .