human
***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: Context Perioperative oral carbohydrate intake is beneficial to general surgery patients . Total hip arthroplasty is a common surgical procedure , and even a moderate improvement in patient outcome could have a significant effect on the re sources needed for these patients . However , few studies have focused on the effects of carbohydrate intake on orthopaedic patients . Objective The purpose of this study was to investigate if perioperative oral carbohydrate intake alters the postoperative course for patients undergoing total hip arthroplasty . The primary hypothesis was that pain scores would be lower in patients treated with carbohydrate . Design A r and omised , double-blind , controlled trial . Setting This study was carried out between September 2009 and April 2011 at a district Swedish hospital that specialises in orthopaedic surgery . Patients Sixty ASA physical status I – III patients scheduled for elective total hip arthroplasty were included . Exclusion criteria were obesity , diabetes , prior hip surgery to the same hip , ongoing infection , immunological deficiency or age less than 50 or more than 80 years . Interventions Patients were given 400 ml of either an oral 12.5 % carbohydrate solution or a placebo beverage ( flavoured water ) 1.5 h before and 2 h after surgery . Main outcome measures Visual analogue scales were used to score six discomfort parameters . Results Immediately prior to surgery , the carbohydrate-treated patients were less hungry ( median score 9.5 vs. 22 mm ) and experienced less nausea ( 0 vs. 1.5 mm ) ( P < 0.05 ) . Postoperatively , patients in the carbohydrate group experienced less pain at 12 , 16 and 20 h ( median scores 20 , 30 and 34 vs. 7 , 5 and 0 mm ; P < 0.05 ) . Conclusion This study shows that there is limited benefit from administering oral carbohydatre prior to total hip arthroplasty Postoperative insulin resistance is a well-characterized metabolic state that has been shown to correlate with the length of postoperative stay in hospital . Preoperative intravenous or oral carbohydrate treatment has been shown to attenuate the development of postoperative insulin resistance measured 1 day after surgery . To study the effects of preoperative oral carbohydrate treatment on postoperative changes in insulin resistance and substrate utilization , in the absence of postoperative confounding factors , 15 patients were double-blindly treated with either a carbohydrate-rich beverage ( 12.5 % ) ( n = 8) or placebo ( n = 7 ) before undergoing total hip replacement surgery .  Insulin sensitivity , endogenous glucose release , and substrate oxidation rates were measured before and immediately after surgery . Whole body insulin sensitivity decreased by 18 % in the treatment group vs. 43 % in the placebo group ( P < 0.05 , Student 's t-test for unpaired data ) . In both groups , the major mechanism of insulin resistance was an inhibition of insulin-induced nonoxidative glucose disposal after surgery . The better preservation of insulin sensitivity in the treatment group was attributable to a less reduced glucose disposal in peripheral tissues and increased glucose oxidation rates Background Surgery induces insulin resistance that might be alleviated by a nutritional drink given preoperatively . The authors hypothesized that some of the beneficial effects of the drink could be attributed to the volume component ( approximately 1 L ) rather than to the nutrients . Methods Sixty patients scheduled for elective total hip replacement under spinal anesthesia were recruited to a clinical trial , and r and omly allocated to preoperative fasting , to oral ingestion of tap water , or to oral ingestion of a carbohydrate drink . An intravenous glucose tolerance test calculated glucose clearance and insulin sensitivity on the day before surgery , in the postoperative ward , and on the day after surgery . Other parameters were stress ( cortisol in plasma and urine ) , muscle catabolism ( urinary 3-methylhistidine ) , and wellbeing . Results Fifty-seven patients completed the study . In the postoperative ward , the glucose clearance and the insulin response had decreased from the previous day by 23 % and 36 % , respectively . Insulin sensitivity did not decrease until the next morning ( −48 % ) and was due to an increased insulin response ( + 51 % ) . Cortisol excretion was highest on the day of surgery , while 3-methylhistidine increased 1 day later . Follow-up on the third postoperative day showed an average of 1.5 complications per patient . Wellbeing was better 2 weeks after than before the surgery . None of the measured parameters differed significantly between the study groups . Conclusions Preoperative ingestion of tap water or a nutritional drink had no statistically significant effect on glucose clearance , insulin sensitivity , postoperative complications , or wellbeing in patients undergoing elective hip surgery . Trial registration Registration number : NCT 01211184 ( http://www . clinical trials.gov Background Multimodal protocol s of perioperative care may enhance postoperative recovery . However , limited information is available on preoperative immune and carbohydrate (CHO)-enriched drinks in patients undergoing hip arthroplasty . We aim ed to investigate the effect of a multimodal protocol ( ACERTO protocol ) plus preoperative immune nutrition on the length of stay ( LOS ) and the postoperative acute phase response of patients undergoing total hip arthroplasty . Methods Thirty-two patients ( mean age , 58 years ; range , 26–85 years ; 16 males ) were r and omized to receive either the  ACERTO protocol  ( n = 15 , ACERTO Group ) , which consisted of 6 h preoperative fasting for solids , an oral drink ( 200 mL of 12.5 % maltodextrin ) up to 2 h before induction of anesthesia , restricted intravenous fluids ( only 1000 mL of crystalloid fluid after surgery ) and preoperative immune nutrition ( 600 mL/day of Impact - Nestlé , Brazil ) for five days prior to surgery , or traditional care ( n = 17 ; control group ) , which consisted of 6–8 h preoperative fasting , intravenous hydration until the 1st postoperative day and no preoperative immune supplementation . The main endpoint was LOS . C-reactive protein ( CRP ) was the secondary endpoint and was assessed during induction of anesthesia and on postoperative day 2 . Results Neither deaths nor postoperative complications occurred . The median LOS was 3 ( 2–5 ) days in the ACERTO group and 6 ( 3–8 ) days in controls ( P < 0.01 ) . Postoperative CRP was higher in the control group ( P < 0.01 ) . Conclusion The ACERTO multimodal protocol of perioperative care plus preoperative immune nutrition may decrease LOS and postoperative CRP levels in total hip arthroplasty . Trial registration Clinical Trials : BACKGROUND By the year 2030 , 3.48 million older U.S. adults are projected to undergo total knee arthroplasty ( TKA ) . Following this surgery , considerable muscle atrophy occurs , result ing in decreased strength and impaired functional mobility . Essential amino acids ( EAAs ) have been shown to attenuate muscle loss during periods of reduced activity and may be beneficial for TKA patients . METHODS We used a double-blind , placebo-controlled , r and omized clinical trial with 28 older adults undergoing TKA . Patients were r and omized to ingest either 20 g of EAAs ( n = 16 ) or placebo ( n = 12 ) twice daily between meals for 1 week before and 2 weeks after TKA . At baseline , 2 weeks , and 6 weeks after TKA , an MRI was performed to determine mid-thigh muscle and adipose tissue volume . Muscle strength and functional mobility were also measured at these times . RESULTS TKA patients receiving placebo exhibited greater quadriceps muscle atrophy , with a -14.3 ± 3.6 % change from baseline to 2 weeks after surgery compared with -3.4 ± 3.1 % for the EAA group ( F = 5.16 , P = 0.036 ) and a -18.4 ± 2.3 % change from baseline to 6 weeks after surgery for placebo versus -6.2 ± 2.2 % for the EAA group ( F = 14.14 , P = 0.001 ) . EAAs also attenuated atrophy in the nonoperated quadriceps and in the hamstring and adductor muscles of both extremities . The EAA group performed better at 2 and 6 weeks after surgery on functional mobility tests ( all P < 0.05 ) . Change in quadriceps muscle atrophy was significantly associated with change in functional mobility ( F = 5.78 , P = 0.021 ) . CONCLUSION EAA treatment attenuated muscle atrophy and accelerated the return of functional mobility in older adults following TKA . TRIAL REGISTRATION Clinical trials.gov NCT00760383 OBJECTIVES Total knee arthroplasty ( TKA ) performed in knee osteoarthritis patients is reported to be immediately followed by a decrease in quadriceps muscle strength . We investigated the effects of supplementation with a combination β-hydroxy-β-methyl butyrate , L-arginine , and L-glutamine ( HMB/Arg/Gln ) on the postoperative recovery of quadriceps muscle strength in patients after TKA . METHODS Study subjects were 23 patients ( 12 women ; mean age : 70.5 ) who underwent TKA . The patients were r and omly allocated into the control group or the group that consumed HMB/Arg/Gln supplementation ( HMB/Arg/Gln group ) . HMB/Arg/Gln supplementation or control food were consumed for 5 days before the surgery and for 28 days after the surgery , and maximal quadriceps strength was measured at 7 days before the surgery , and at 14 , 28 and 42 days after the surgery . During the study , total energy expenditure was measured using a lifestyle recording device . The two groups followed the rehabilitation in the same way . RESULTS The maximal quadriceps strength was 1.1±0.62 Nm/Kg before surgery and 0.7±0.9 Nm/Kg after surgery 14 days in the control group ( p=0.02 ) , and 1.1±0.3 Nm/Kg before surgery and 0.9±0.4 Nm/Kg after surgery 14 days in the HMB/Arg/Gln group . Although the control group experienced a significant loss of muscle strength after the surgery , the HMB/Arg/Gln group did not . There was no significant difference in total energy expenditure between the two groups . CONCLUSIONS Consuming HMB/Arg/Gln supplementation may suppress the loss of muscle strength after TKA . Intervention with exercise and nutrition appears to enable patients to maintain their quadriceps strength UNLABELLED Infusions of carbohydrates before surgery have been shown to reduce postoperative insulin resistance . Presently , we investigated the effects of a carbohydrate drink , given shortly before surgery , on postoperative insulin sensitivity . METHODS Insulin sensitivity and glucose turnover ( [ 6 , 6,(2)H(2)]-D-glucose ) were measured using hyper-insulinemic , normoglycemic clamps before and after elective surgery . Sixteen patients undergoing total hip replacement were r and omly assigned to preoperative oral carbohydrate administration ( CHO-H , n = 8) or the same amount of a placebo drink ( placebo , n = 8) before surgery . Insulin sensitivity was measured before and immediately after surgery . Patients undergoing elective colorectal surgery were studied before surgery and 24 h postoperatively ( CHO-C ( n = 7 ) , and fasted ( n = 7 ) , groups ) . The fasted group underwent surgery after an overnight fast . In both studies , the CHO groups received 800 ml of an isoosmolar carbohydrate rich beverage the evening before the operation ( 100 g carbohydrates ) , as well as another 400 ml ( 50 g carbohydrates ) 2 h before the initiation of anesthesia . RESULTS Immediately after surgery , insulin sensitivity was reduced 37 % in the placebo group ( P < 0.05 vs. preoperatively ) while no significant change was found in the CHO-H group ( -16 % , p = NS ) . During clamps performed 24h postoperatively , insulin sensitivity and whole-body glucose disposal was reduced in both groups , but the reduction was greater compared to that in the CHO-C group ( -49 + /- 6 % vs. -26 + /- 8 % , P > > 0.05 fasted vs. CHO-C ) . CONCLUSIONS Patients given a carbohydrate drink shortly before elective surgery displayed less reduced insulin sensitivity after surgery as compared to patients undergoing surgery after an overnight fast BACKGROUND & AIMS Postoperative metabolism is characterised by insulin resistance and a negative whole-body nitrogen balance . Preoperative carbohydrate treatment reduces insulin resistance in the first day after surgery . We hypothesised that 
    Output:
    
agent
Intake of a carbohydrate-containing fluid is reported to improve insulin-like growth factor levels , reduce hunger , nausea , and length of stay , and attenuate the decrease in whole-body insulin sensitivity and endogenous glucose release .
Amino acid supplementation is reported to reduce muscle atrophy and accelerate return of functional mobility .
There is limited evidence for nutritional supplementation in THR and TKR pathways ; however , the low risk profile and potential benefits to adjunctive treatment methods , such as exercise programs , suggest nutritional supplements may have a role .
Optimizing nutritional status pre-operatively may help manage the surgical stress response , with a particular benefit for undernourished , frail , or elderly individuals
***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: Context Perioperative oral carbohydrate intake is beneficial to general surgery patients . Total hip arthroplasty is a common surgical procedure , and even a moderate improvement in patient outcome could have a significant effect on the re sources needed for these patients . However , few studies have focused on the effects of carbohydrate intake on orthopaedic patients . Objective The purpose of this study was to investigate if perioperative oral carbohydrate intake alters the postoperative course for patients undergoing total hip arthroplasty . The primary hypothesis was that pain scores would be lower in patients treated with carbohydrate . Design A r and omised , double-blind , controlled trial . Setting This study was carried out between September 2009 and April 2011 at a district Swedish hospital that specialises in orthopaedic surgery . Patients Sixty ASA physical status I – III patients scheduled for elective total hip arthroplasty were included . Exclusion criteria were obesity , diabetes , prior hip surgery to the same hip , ongoing infection , immunological deficiency or age less than 50 or more than 80 years . Interventions Patients were given 400 ml of either an oral 12.5 % carbohydrate solution or a placebo beverage ( flavoured water ) 1.5 h before and 2 h after surgery . Main outcome measures Visual analogue scales were used to score six discomfort parameters . Results Immediately prior to surgery , the carbohydrate-treated patients were less hungry ( median score 9.5 vs. 22 mm ) and experienced less nausea ( 0 vs. 1.5 mm ) ( P < 0.05 ) . Postoperatively , patients in the carbohydrate group experienced less pain at 12 , 16 and 20 h ( median scores 20 , 30 and 34 vs. 7 , 5 and 0 mm ; P < 0.05 ) . Conclusion This study shows that there is limited benefit from administering oral carbohydatre prior to total hip arthroplasty Postoperative insulin resistance is a well-characterized metabolic state that has been shown to correlate with the length of postoperative stay in hospital . Preoperative intravenous or oral carbohydrate treatment has been shown to attenuate the development of postoperative insulin resistance measured 1 day after surgery . To study the effects of preoperative oral carbohydrate treatment on postoperative changes in insulin resistance and substrate utilization , in the absence of postoperative confounding factors , 15 patients were double-blindly treated with either a carbohydrate-rich beverage ( 12.5 % ) ( n = 8) or placebo ( n = 7 ) before undergoing total hip replacement surgery .  Insulin sensitivity , endogenous glucose release , and substrate oxidation rates were measured before and immediately after surgery . Whole body insulin sensitivity decreased by 18 % in the treatment group vs. 43 % in the placebo group ( P < 0.05 , Student 's t-test for unpaired data ) . In both groups , the major mechanism of insulin resistance was an inhibition of insulin-induced nonoxidative glucose disposal after surgery . The better preservation of insulin sensitivity in the treatment group was attributable to a less reduced glucose disposal in peripheral tissues and increased glucose oxidation rates Background Surgery induces insulin resistance that might be alleviated by a nutritional drink given preoperatively . The authors hypothesized that some of the beneficial effects of the drink could be attributed to the volume component ( approximately 1 L ) rather than to the nutrients . Methods Sixty patients scheduled for elective total hip replacement under spinal anesthesia were recruited to a clinical trial , and r and omly allocated to preoperative fasting , to oral ingestion of tap water , or to oral ingestion of a carbohydrate drink . An intravenous glucose tolerance test calculated glucose clearance and insulin sensitivity on the day before surgery , in the postoperative ward , and on the day after surgery . Other parameters were stress ( cortisol in plasma and urine ) , muscle catabolism ( urinary 3-methylhistidine ) , and wellbeing . Results Fifty-seven patients completed the study . In the postoperative ward , the glucose clearance and the insulin response had decreased from the previous day by 23 % and 36 % , respectively . Insulin sensitivity did not decrease until the next morning ( −48 % ) and was due to an increased insulin response ( + 51 % ) . Cortisol excretion was highest on the day of surgery , while 3-methylhistidine increased 1 day later . Follow-up on the third postoperative day showed an average of 1.5 complications per patient . Wellbeing was better 2 weeks after than before the surgery . None of the measured parameters differed significantly between the study groups . Conclusions Preoperative ingestion of tap water or a nutritional drink had no statistically significant effect on glucose clearance , insulin sensitivity , postoperative complications , or wellbeing in patients undergoing elective hip surgery . Trial registration Registration number : NCT 01211184 ( http://www . clinical trials.gov Background Multimodal protocol s of perioperative care may enhance postoperative recovery . However , limited information is available on preoperative immune and carbohydrate (CHO)-enriched drinks in patients undergoing hip arthroplasty . We aim ed to investigate the effect of a multimodal protocol ( ACERTO protocol ) plus preoperative immune nutrition on the length of stay ( LOS ) and the postoperative acute phase response of patients undergoing total hip arthroplasty . Methods Thirty-two patients ( mean age , 58 years ; range , 26–85 years ; 16 males ) were r and omized to receive either the  ACERTO protocol  ( n = 15 , ACERTO Group ) , which consisted of 6 h preoperative fasting for solids , an oral drink ( 200 mL of 12.5 % maltodextrin ) up to 2 h before induction of anesthesia , restricted intravenous fluids ( only 1000 mL of crystalloid fluid after surgery ) and preoperative immune nutrition ( 600 mL/day of Impact - Nestlé , Brazil ) for five days prior to surgery , or traditional care ( n = 17 ; control group ) , which consisted of 6–8 h preoperative fasting , intravenous hydration until the 1st postoperative day and no preoperative immune supplementation . The main endpoint was LOS . C-reactive protein ( CRP ) was the secondary endpoint and was assessed during induction of anesthesia and on postoperative day 2 . Results Neither deaths nor postoperative complications occurred . The median LOS was 3 ( 2–5 ) days in the ACERTO group and 6 ( 3–8 ) days in controls ( P < 0.01 ) . Postoperative CRP was higher in the control group ( P < 0.01 ) . Conclusion The ACERTO multimodal protocol of perioperative care plus preoperative immune nutrition may decrease LOS and postoperative CRP levels in total hip arthroplasty . Trial registration Clinical Trials : BACKGROUND By the year 2030 , 3.48 million older U.S. adults are projected to undergo total knee arthroplasty ( TKA ) . Following this surgery , considerable muscle atrophy occurs , result ing in decreased strength and impaired functional mobility . Essential amino acids ( EAAs ) have been shown to attenuate muscle loss during periods of reduced activity and may be beneficial for TKA patients . METHODS We used a double-blind , placebo-controlled , r and omized clinical trial with 28 older adults undergoing TKA . Patients were r and omized to ingest either 20 g of EAAs ( n = 16 ) or placebo ( n = 12 ) twice daily between meals for 1 week before and 2 weeks after TKA . At baseline , 2 weeks , and 6 weeks after TKA , an MRI was performed to determine mid-thigh muscle and adipose tissue volume . Muscle strength and functional mobility were also measured at these times . RESULTS TKA patients receiving placebo exhibited greater quadriceps muscle atrophy , with a -14.3 ± 3.6 % change from baseline to 2 weeks after surgery compared with -3.4 ± 3.1 % for the EAA group ( F = 5.16 , P = 0.036 ) and a -18.4 ± 2.3 % change from baseline to 6 weeks after surgery for placebo versus -6.2 ± 2.2 % for the EAA group ( F = 14.14 , P = 0.001 ) . EAAs also attenuated atrophy in the nonoperated quadriceps and in the hamstring and adductor muscles of both extremities . The EAA group performed better at 2 and 6 weeks after surgery on functional mobility tests ( all P < 0.05 ) . Change in quadriceps muscle atrophy was significantly associated with change in functional mobility ( F = 5.78 , P = 0.021 ) . CONCLUSION EAA treatment attenuated muscle atrophy and accelerated the return of functional mobility in older adults following TKA . TRIAL REGISTRATION Clinical trials.gov NCT00760383 OBJECTIVES Total knee arthroplasty ( TKA ) performed in knee osteoarthritis patients is reported to be immediately followed by a decrease in quadriceps muscle strength . We investigated the effects of supplementation with a combination β-hydroxy-β-methyl butyrate , L-arginine , and L-glutamine ( HMB/Arg/Gln ) on the postoperative recovery of quadriceps muscle strength in patients after TKA . METHODS Study subjects were 23 patients ( 12 women ; mean age : 70.5 ) who underwent TKA . The patients were r and omly allocated into the control group or the group that consumed HMB/Arg/Gln supplementation ( HMB/Arg/Gln group ) . HMB/Arg/Gln supplementation or control food were consumed for 5 days before the surgery and for 28 days after the surgery , and maximal quadriceps strength was measured at 7 days before the surgery , and at 14 , 28 and 42 days after the surgery . During the study , total energy expenditure was measured using a lifestyle recording device . The two groups followed the rehabilitation in the same way . RESULTS The maximal quadriceps strength was 1.1±0.62 Nm/Kg before surgery and 0.7±0.9 Nm/Kg after surgery 14 days in the control group ( p=0.02 ) , and 1.1±0.3 Nm/Kg before surgery and 0.9±0.4 Nm/Kg after surgery 14 days in the HMB/Arg/Gln group . Although the control group experienced a significant loss of muscle strength after the surgery , the HMB/Arg/Gln group did not . There was no significant difference in total energy expenditure between the two groups . CONCLUSIONS Consuming HMB/Arg/Gln supplementation may suppress the loss of muscle strength after TKA . Intervention with exercise and nutrition appears to enable patients to maintain their quadriceps strength UNLABELLED Infusions of carbohydrates before surgery have been shown to reduce postoperative insulin resistance . Presently , we investigated the effects of a carbohydrate drink , given shortly before surgery , on postoperative insulin sensitivity . METHODS Insulin sensitivity and glucose turnover ( [ 6 , 6,(2)H(2)]-D-glucose ) were measured using hyper-insulinemic , normoglycemic clamps before and after elective surgery . Sixteen patients undergoing total hip replacement were r and omly assigned to preoperative oral carbohydrate administration ( CHO-H , n = 8) or the same amount of a placebo drink ( placebo , n = 8) before surgery . Insulin sensitivity was measured before and immediately after surgery . Patients undergoing elective colorectal surgery were studied before surgery and 24 h postoperatively ( CHO-C ( n = 7 ) , and fasted ( n = 7 ) , groups ) . The fasted group underwent surgery after an overnight fast . In both studies , the CHO groups received 800 ml of an isoosmolar carbohydrate rich beverage the evening before the operation ( 100 g carbohydrates ) , as well as another 400 ml ( 50 g carbohydrates ) 2 h before the initiation of anesthesia . RESULTS Immediately after surgery , insulin sensitivity was reduced 37 % in the placebo group ( P < 0.05 vs. preoperatively ) while no significant change was found in the CHO-H group ( -16 % , p = NS ) . During clamps performed 24h postoperatively , insulin sensitivity and whole-body glucose disposal was reduced in both groups , but the reduction was greater compared to that in the CHO-C group ( -49 + /- 6 % vs. -26 + /- 8 % , P > > 0.05 fasted vs. CHO-C ) . CONCLUSIONS Patients given a carbohydrate drink shortly before elective surgery displayed less reduced insulin sensitivity after surgery as compared to patients undergoing surgery after an overnight fast BACKGROUND & AIMS Postoperative metabolism is characterised by insulin resistance and a negative whole-body nitrogen balance . Preoperative carbohydrate treatment reduces insulin resistance in the first day after surgery . We hypothesised that 
    Output:
    