***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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    ***EXAMPLES*** 
    Input: The effectiveness of wound edge protection devices in reducing surgical site infection after abdominal surgery was investigated . A r and omised controlled trial was undertaken . The intervention was st and ard intraoperative care plus use of a wound edge protection device during the intra-abdominal part of the operation . The control was st and ard intraoperative care alone . The sample size for the trial was based on having 80 % power to detect a 50 % reduction in the infection rate , assuming a rate of 12 % under st and ard care . A total sample size of 710 participants ( 355 in each arm ) was needed . It was necessary to recruit 750 patients to the trial to allow for an estimated 5 % dropout rate . In total , 760 patients undergoing laparotomy were recruited ; 382 patients were allocated to the intervention group and 378 to the control group.1  The primary outcome was surgical site infection within 30 days of surgery , as assessed by clinicians who were blind to the patients ’ device group allocation . Secondary outcomes included quality of life and duration of hospital stay . Subgroup analyses that compared surgical site infection within 30 days of surgery between the device groups were performed , with the aim of establishing whether the intervention was beneficial in particular groups of patients . The analyses incorporated 15 characteristics of the patients and the operations . Six patients in the intervention group and five in the control group did not undergo laparotomy . Furthermore , seven patients in each group were lost to follow-up . Although the proportion of patients with surgical site infection was lower in the intervention group , the difference was not significant ( 24.7 % ( n=91 ) v 25.4 % ( n=93 ) ; odds ratio 0.97 , 95 % confidence interval 0.69 to 1.36 ; P=0.85 ) . No significant difference was seen between the groups in the secondary outcomes ( quality of life and duration of hospital stay ) . The subgroup analysis did not A major complication of abdominoperineal rectum excision for rectal or anal carcinoma is local wound infection . The main reason for this infection is that systemically administered antibiotic prophylaxis does not reach sufficiently high concentrations of antibiotic in the tissue of the sacroperineal wound . Since gentamicin-polymethylmethacrylate ( PMMA ) in the form of chains of beads has been confirmed as a useful tool in the treatment of local infection in bone and soft tissue surgery , we have evaluated its effect on the abdominoperineal rectum excision in a prospect i ve , r and omized trial . Forty-four patients with rectal or anal carcinoma entered the study . Only patients with stage Dukes D were excluded from the trial . Following r and omized selection , the patients were treated either with local gentamicin and drainage ( Group A ) or drainage alone ( Group B ) , using the Lloyd-Davies procedure . The two groups were comparable regarding age , sex , tumor stage and level , and risk factors predisposing for an infectious complication ( anemia , nutritional status , blood transfusion ) . The postoperative mortality rate was 0 % in both series . Analysis of local perineal wound healing revealed a statistically significant higher percentage of primary wound healing in Group A than in Group B ( 87 % versus 46 % ; p less than 0.01 ) . This led to a significantly shorter hospitalization period for patients in Group A ( p less than 0.01 ) . Gentamicin-PMMA chains have been demonstrated to exert a favorable effect on local wound healing and the postoperative outcome of patients with abdominoperineal rectum excision Background Despite the findings of several r and omized clinical studies , the role of gentamicin collagen implant ( GCI ) in rectal cancer surgery is unclear . Local pelvic application of GCI following preoperative radiotherapy and total mesorectal excision ( TME ) was evaluated to determine the risk of surgical site infections ( SSI ) . Methods In this single-center trial , 176 patients with rectal cancer after preoperative , short-term radiotherapy ( 5 × 5 Gy ) were r and omized either to the study group in which  GCI was used or in the control group without GCI . Prior to surgery and intraoperatively five patients were excluded from the study . The remaining 171 patients were analyzed ; 86 were in the study group and 85 in the control group . Results There were no statistically significant differences in the overall rate of early postoperative complications between the study and control group : 25.6 and 34.1 % respectively ; p = 0.245 , relative risk ( RR ) 0.750 [ 95 % confidence interval ( CI ) 0.471–1.195 ] . The reoperation rate was similar in both groups : 12.8 versus 9.4 % ; p = 0.628 ; RR 1.359 ; ( 95 % CI 0.575–3.212 ) . The total rate of SSI and organ space SSI were 22.2 and 15.8 % without differences between the study and control group . In patients without anastomotic leakage , the risk of organ space SSI was significantly reduced in patients who received GCI : 2.6 versus 13.0 % ; p = 0.018 . Conclusions Application of GCI in the pelvic cavity after short-term preoperative radiotherapy and TME may reduce the risk of organ space SSI but only in the absence of anastomotic leakage One hundred ninety patients with peritonitis at the time of abdominal surgery were allocated at r and om to systemic antibiotic treatment alone or systemic antibiotic treatment combined with topical application of antibiotics in the wound at the time of wound closure . The overall wound infection rate was 17 percent without significant difference between the two treatment groups ( P>0.80 ) Background An antimicrobial dressing containing ionic silver was found effective in reducing surgical-site infection in a preliminary study of colorectal cancer elective surgery . We decided to test this finding in a r and omized , double-blind trial . Methods Adults undergoing elective colorectal cancer surgery at two university-affiliated hospitals were r and omly assigned to have the surgical incision dressed with Aquacel ® Ag Hydrofiber dressing or a common dressing . To blind the patient and the nursing and medical staff to the nature of the dressing used , scrub nurses covered Aquacel ® Ag Hydrofiber with a common wound dressing in the experimental arm , whereas a double common dressing was applied to patients of control group . The primary end-point of the study was the occurrence of any surgical-site infection within 30 days of surgery . Results A total of 112 patients ( 58 in the experimental arm and 54 in the control group ) qualified for primary end-point analysis . The characteristics of the patient population and their surgical procedures were similar . The overall rate of surgical-site infection was lower in the experimental group ( 11.1 % center 1 , 17.5 % center 2 ; overall 15.5 % ) than in controls ( 14.3 % center 1 , 24.2 % center 2 , overall 20.4 % ) , but the observed difference was not statistically significant ( P = 0.451 ) , even with respect to surgical-site infection grade 1 ( superficial ) versus grade s 2 and 3 , or grade 1 and 2 versus grade 3 . Conclusions This r and omized trial did not confirm a statistically significant superiority of Aquacel ® Ag Hydrofiber dressing in reducing surgical-site infection after elective colorectal cancer surgery . Trial registration Clinical trials.gov : This study compared Triclosan coated polyglactin 910 ( Vicryl * Plus ) with polyglactin 910 ( Vicryl * ) on abdominal wall healing in colorectal surgery patients . 184 patients with colorectal cancer were included in the study . In 91 , the abdominal wall was closed with the Vicryl * Plus , and in 93 patients with Vicryl*.  Demographic characteristics , biochemical inflammatory parameters , wound appearance , length of hospital stay , postoperative wound complications and post-incisional hernia were recorded . In the Vicryl * Plus group there was a shorter hospital stay ( 13.2 + /- 1.3 days ; 21.4 + /- 2.8 respectively ) . In the Vicryl * Plus group inflammatory parameters decreased to normal within the first week whereas in the Vicryl * group remained increased . In the Vicryl * Plus group four patients had a wound discharge , seven had inflammatory reactions to the skin sutures . One dehiscence was noticed . In the Vicryl * group 12 patients had an SSI , 14 patients had inflammatory reactions to the skin sutures and 7 patients had a wound dehiscence . Closure of the abdominal wall using Vicryl * Plus decreases postoperative wound complications , length of hospital stay and is associated with a more rapid return of inflammatory markers to normal on a number of factors , the most important being the size and virulence of the inoculum of organisms , the resistance of the host , and the presence or absence of a haematoma or foreign body . It is reasonable to assume that most wound infections after operations on the large bowel are initiated in the operatingtheatre , and that the source of the organisms is the bowel . Though sepsis may not be apparent on external inspection of the wound for a week or more , close examination of the BACKGROUND Several pre- and intraoperative factors have been associated with incisional surgical site infection ( SSI ) , but little is known about the influence of postoperative wound care and especially , the use of different dressings on incisional SSI . The aim of this study was to compare 3 methods of wound dressings ( conventional dressing , silver-containing dressing , and mupirocin ointment dressing ) for their ability to prevent SSI , as measured by SSI rates , in patients with colorectal cancer undergoing elective open surgery . STUDY DESIGN A prospect i ve , r and omized study was performed . Inclusion criteria were diagnosis of colorectal neoplasms and plans to undergo elective surgery with curative aims . Patients were r and omized using a 1:1:1 allocation into 3 groups : patients receiving an ionic silver-containing dressing ( ISD ) ( group 1 ) , a mupirocin ointment application ( MOA ) ( group 2 ) , and a conventional dressing ( group 3 or st and ard dressing ) . The primary outcomes variable was occurrence of incisional SSI . Follow-up was 30 days postoperatively . RESULTS A total of 147 patients were included , 49 in each group .  Incisional SSI occurred in 9 patients ( 18.4 % ) in the ISD group , 2 ( 4.1 % ) in the MOA group , and 10 ( 20.4 % ) in the st and ard dressing group ( p = 0.028 ) . Adjusting for multiple comparisons , there were no significant differences between ISD and st and ard dressing groups ; a significant difference was observed between ISD and MOA ( relative risk [ RR ] 4.5 ; 95 % CI ( 1.1 to 19.8 ) ; p = 0.046 ) and between the st and ard group and the MOA group ( RR 5 ; 95 % CI ( 1.2 to 21.7 ) ; p = 0.031 ) . CONCLUSIONS Topical application of mupirocin ointment achieves better results for the prevention of SSI than ionic silver-containing dressing or st and ard dressing in patients undergoing elective open colorectal surgery To evaluate the use of antibiotics given prophylactically of colon surgery , we examined 26 trials published from 1965 to 1980 in which patients given various antibiotic regiments  were compared with controls given no antibiotic treatment .  In 22 ( 85 per cent of these trials ) antibiotics reduced postoperative wound infection ( p less than 0.05 in 14 ) . Combining the results of the trials published from 1965 to 1975 reveals a 95 per cent confidence interval from the true difference in infection rates of 14 + /- 6 per cent ( 36 per cent for control group vs. 22 per cent for treatment group ) and the true difference in death rates of 6.7 + /- 4.4 per cent ( 11.2 per cent for control group vs 4.5 per cent for treatment group ) . Yet trials employing control groups given no treatment continue to be reported . Since the use of such controls is justified only when no effective alternative therapy exists , we believe that any further trials of antibiotic prophylaxis in colon surgery should employ a previously proved st and ard . However , steadily increasing efficacy of treatment means that comparisons of new therapies with st and ard therapies will become prohibitively expensive because of the large number of patients required BACKGROUND In colorectal surgeries , surgical site infections ( SSIs ) frequently cause morbidity ; an incidence of up to 20 % has been shown in previous studies . Recently , to prevent microbial colonization of suture material in operative wounds , triclosan-coated polyglactin suture material s with antimicrobial activity have been developed ; however , their significance in colorectal surgery remains unclear . This r and omized controlled trial was conducted to assess the value of triclosan-coated polyglactin sutures in colorectal surgery . METHODS A total of 410 consecutive patients who had undergone elective colorectal operations were enrolled in this trial . Of those patients , the 206 in the study group underwent wound closure with triclosan-coated polyglactin 910 antimicrobial sutures , and the 204 patients in the control group received conventional wound closures 
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Within the various outcomes of GRADE assessment , even a moderate classification suggests that further studies may well have very different results .. No r and omized trials exist of combinations of two or more of the above interventions to see if there is a combined effect .