***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: Background Chronic fatigue syndrome ( CFS ) presents a challenge for patients , health care providers , and health insurance groups because of its incapacitating nature , unknown cause , and poorly understood prognosis . We conducted a longitudinal population -based study to characterize the clinical course of CFS . Methods Sixty-five CFS subjects were identified from a r and om-digit-dialing survey of Wichita , Kansas residents and followed for up to 3 years . We evaluated changes in CFS classification ( partial or total remission , alternative medical or psychiatric diagnoses ) , CFS case-defining criteria , wellness scores , hours of activities and sleep , and  treatments used to reduce fatigue . Associations between risk factors and outcomes were determined by use of logistic regression and generalized estimating equations models . Results Only 20%-33 % of the subjects were classified as having CFS at follow-up , 56.9 % ever experienced partial or total remission , 10 % sustained total remission , and 23.1 % received alternative diagnoses , of which 20 % were sleep disorders . Higher fatigue severity scores and total number of symptoms were negatively associated with ever remitting . Duration of illness ≤ 2 years was positively associated with sustained remission . Unrefreshing sleep persisted in at least 79 % of the subjects across all periods but , as with most of the CFS symptoms , tended to be less frequent over time . The number of activities affected by fatigue decreased over time , while wellness scores increased . At any follow-up , more than 35 % of subjects reporting reduced fatigue used complementary and alternative medicine therapies , and of those subjects , at least 50 % thought these therapies were responsible for reducing their fatigue . Conclusions The clinical course of CFS was characterized by an intermittent pattern of relapse and remission . Remission rates documented by our population -based study were similar to those reported in clinical studies . Shorter illness duration was a significant predictor of sustained remission , and thus early detection of CFS is of utmost importance . The persistence of sleep complaints and identification of sleep disorders suggest that CFS subjects be evaluated for sleep disturbances , which could be treated AIM To evaluate the effects of a combination probiotic on symptoms and colonic transit in patients with irritable bowel syndrome ( IBS ) and significant bloating . METHODS Forty-eight patients with Rome II IBS were r and omized in a parallel group , double-blind design to placebo or VSL # 3 twice daily ( 31 patients received 4 weeks and 17 patients 8 weeks of treatment ) . Pre- and post-treatment colonic transit measurements were performed using scintigraphy with (111)In charcoal . Symptoms were summarized as an average daily score for the entire period of treatment and separately for the first 4 weeks of treatment . Weekly satisfactory relief of abdominal bloating was assessed . RESULTS Treatment with VSL # 3 was associated with reduced flatulence over the entire treatment period ( placebo 39.5 + /- 2.6 vs VSL # 3 29.7 + /- 2.6 , P = 0.011 ) ; similarly , during the first 4 weeks of treatment , flatulence scores were reduced ( placebo 40.1 + /- 2.5 vs VSL # 3 30.8 + /- 2.5 , P = 0.014 ) . Proportions of responders for satisfactory relief of bloating , stool-related symptoms , abdominal pain and bloating scores were not different . Colonic transit was retarded with VSL # 3 relative to placebo ( colon geometric center 2.27 + /- 0.20 vs 2.83 + /- 0.19 , P = 0.05 respectively ) . CONCLUSION VSL # 3 reduces flatulence scores and retards colonic transit without altering bowel function in patients with IBS and bloating Human intestinal microbiota plays an important role in the maintenance of host health by providing energy , nutrients , and immunological protection . Intestinal dysfunction is a frequent complaint in myalgic encephalomyelitis/chronic fatigue syndrome ( ME/CFS ) patients , and previous reports suggest that dysbiosis , i.e. the overgrowth of abnormal population s of bacteria in the gut , is linked to the pathogenesis of the disease . We used high-throughput 16S rRNA gene sequencing to investigate the presence of specific alterations in the gut microbiota of ME/CFS patients from Belgium and Norway . 43 ME/CFS patients and 36 healthy controls were included in the study . Bacterial DNA was extracted from stool sample s , PCR amplification was performed on 16S rRNA gene regions , and PCR amplicons were sequenced using Roche FLX 454 sequencer . The composition of the gut microbiota was found to differ between Belgian controls and Norwegian controls : Norwegians showed higher percentages of specific Firmicutes population s ( Roseburia , Holdemania ) and lower proportions of most Bacteroidetes genera . A highly significant separation could be achieved between Norwegian controls and Norwegian patients : patients presented increased proportions of Lactonifactor and Alistipes , as well as a decrease in several Firmicutes population s. In Belgian subjects the patient/control separation was less pronounced , however some abnormalities observed in Norwegian patients were also found in Belgian patients . These results show that intestinal microbiota is altered in ME/CFS . High-throughput sequencing is a useful tool to diagnose dysbiosis in patients and could help design ing treatments based on gut microbiota modulation ( antibiotics , pre and probiotics supplementation ) Purpose The aim of this study is to test in a double-blinded , r and omised placebo-controlled study the effects of a commercially available multi-strain symbiotic mixture on symptoms , colonic transit and quality of life in irritable bowel syndrome ( IBS ) patients who meet Rome III criteria . Background There is only one other double-blinded RCT on a single-strain symbiotic mixture in IBS . Methods This is a double-blinded , r and omised placebo-controlled study of a symbiotic mixture ( Probinul , 5 g bid ) over 4 weeks after 2 weeks of run-in . The primary endpoints were global satisfactory relief of abdominal flatulence and bloating . Responders were patients who reported at least 50 % of the weeks of treatment with global satisfactory relief . The secondary endpoints were change in abdominal bloating , flatulence , pain and urgency by a 100-mm visual analog scale , stool frequency and bowel functions on vali date d adjectival scales ( Bristol Scale and sense of incomplete evacuation ) . Pre- and post-treatment colonic transit time ( Metcalf ) and quality of life ( SF-36 ) were assessed . Results Sixty-four IBS patients ( symbiotic n = 32 , 64 % females , mean age 38.7 ± 12.6 years ) were studied . This symbiotic mixture reduced flatulence over a 4-week period of treatment ( repeated- measures analysis of covariance , p < 0.05 ) . Proportions of responders were not significantly different between groups . At the end of the treatment , a longer rectosigmoid transit time and a significant improvement in most SF-36 scores were observed in the symbiotic group . Conclusions This symbiotic mixture has shown a beneficial effect in decreasing the severity of flatulence in IBS patients , a lack of adverse events and a good side-effect profile ; however , it failed to achieve an improvement in global satisfactory relief of abdominal flatulence and bloating . Further studies are warranted Background Recent data suggest a role for the intestinal microbiota in the pathogenesis of functional bowel disorders ( FBDs ) . Probiotic studies in FBDs generated inconsistent results suggesting a strain-specific and product-specific effect . Aim To investigate the clinical efficacy of Lactobacillus acidophilus NCFM ( L-NCFM ) and Bifidobacterium lactis Bi-07 ( B-LBi07 ) in nonconstipation FBDs . Methods A double-blind , placebo-control clinical trial of the probiotic bacterias L-NCFM and B-LBi07 twice a day ( 2 × 1011CFU/d ) versus placebo over 8 weeks . Primary endpoints were global relief of gastrointestinal symptoms and satisfaction with treatment . Secondary endpoints were change in symptoms severity , well-being , and quality of life . Microbiological effect was assessed by quantitative real time polymerase chain reaction on fecal sample s. Results Sixty patients ( probiotic , n=31 ; placebo , n=29 ) , 72 % females , 84 % whites , mean age 37 years . Abdominal bloating improved in the probiotics compared with the placebo group at 4 weeks ( 4.10 vs 6.17 , P=0.009 ; change in bloating severity P=0.02 ) and 8 weeks ( 4.26 vs 5.84 , P=0.06 ; change in bloating severity P<0.01 ) . Analyses on the irritable bowel syndrome subgroup ( n=33 ) showed similar results . Conclusions L-NCFM and B-LBi07 twice a day improve symptoms of bloating in patients with FBDs . These data supports the role of intestinal bacteria in the pathophysiology of FBD and the role for probiotic bacteria in the management of these disorders Certain therapeutic microbes , including Bifidobacteria infantis ( B. infantis ) 35624 exert beneficial immunoregulatory effects by mimicking commensal-immune interactions ; however , the value of these effects in patients with non-gastrointestinal inflammatory conditions remains unclear . In this study , we assessed the impact of oral administration of B. infantis 35624 , for 6‒8 weeks on inflammatory biomarker and plasma cytokine levels in patients with ulcerative colitis ( UC ) ( n = 22 ) , chronic fatigue syndrome ( CFS ) ( n = 48 ) and psoriasis ( n = 26 ) in three separate r and omized , double-blind , placebo-controlled interventions . Additionally , the effect of B. infantis 35624 on immunological biomarkers in healthy subjects ( n = 22 ) was assessed . At baseline , both gastrointestinal ( UC ) and non-gastrointestinal ( CFS and psoriasis ) patients had significantly increased plasma levels of C-reactive protein ( CRP ) and the pro-inflammatory cytokines tumor necrosis factor α ( TNF-α ) and interleukin-6 ( IL-6 ) compared with healthy volunteers . B. infantis 35624 feeding result ed in reduced plasma CRP levels in all three inflammatory disorders compared with placebo . Interestingly , plasma TNF-α was reduced in CFS and psoriasis while IL-6 was reduced in UC and CFS . Furthermore , in healthy subjects , LPS-stimulated TNF-α and IL-6 secretion by peripheral blood mononuclear cells ( P BMC s ) was significantly reduced in the B. infantis 35624-treated groups compared with placebo following eight weeks of feeding . These results demonstrate the ability of this microbe to reduce systemic pro-inflammatory biomarkers in both gastrointestinal and non-gastrointestinal conditions . In conclusion , these data show that the immunomodulatory effects of the microbiota in humans are not limited to the mucosal immune system but extend to the systemic immune system BACKGROUND Therapy trials with bacterial compounds in irritable bowel syndrome ( IBS ) have produced conflicting results and , so far , an E.-coli preparation has not been used . METHODS Two hundred and ninety-eight patients with lower abdominal symptoms diagnosed as IBS were treated for 8 weeks by the compound Symbioflor-2 ( Symbiopharm GmbH , Herborn , Germany ) , an Escherichia coli product ( N = 148 ) , or placebo ( n = 150 ) in a double-blinded , r and omized fashion . Patients were seen weekly by the physician , who assessed the presence of core IBS symptoms . Both an abdominal pain score ( APS ) as well as a general symptom score ( GSS ) were used as primary endpoints . Responders had to have complete absence of IBS core symptoms at > or = 1 visit during treatment . RESULTS The responder rate in GSS to the drug was 27 / 148 ( 18.2 % ) in comparison to placebo with 7 / 150 ( 4.67 % ) ( p = 0.000397 ) . The improvement in APS was 28 / 148 ( 18.9 % ) and 10 / 150 ( 6.67 % ) for placebo ( p = 0.001649 ) . The response was reached from visit 3 onwards with both medication and placebo . Post-hoc analysis revealed no significant differences in efficacy of the drug between the gender and different age groups . CONCLUSION Treatment of IBS with the probiotic Symbioflor-2 is effective and superior to placebo in reducing typical symptoms of IBS patients seen by general practitioners and by gastroenterologists Background and Aim . The efficacy of supplementation treatment with two multispecies probiotic formulates on subjects diagnosed with IBS-C and the assessment of their gut microbiota were investigated . Methods . A r and omized , double-blind , three-arm parallel group trial was carried out on 150 IBS-C subjects divided into three groups ( F_1 , F_2 , and F_3 ) . Each group received a daily oral administration of probiotic mixtures ( for 60 days ) F_1 or F_2 or placebo F_3 , respectively . Fecal microbiological analyses were performed by  species-specific qPCR  to assess the different amount of probiotics . Results . The percentage of responders for each symptom was higher in the probiotic 
    Output:
    
The level of evidence identified for the use of  probiotics  in IBS was excellent in quality ; however , the evidence available for the use of probiotic interventions in CFS/ME was poor and limited .
There is currently insufficient evidence for the use of probiotics in CFS/ME patients , despite probiotic interventions being useful in IBS .