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: BACKGROUND Undernutrition and weight loss are important determinants of clinical outcome in older patients after hip fracture but the effectiveness of nutritional support programs in routine clinical practice remains controversial . AIMS OF THE PROJECT : To determine if oral nutritional supplements given daily for 28 days after hip fracture surgery could prevent weight loss and /or lead to improved clinical outcomes ( mortality rates , discharge destination , activities of daily living or length of hospital stay ) in non-malnourished community-dwelling older women with hip fracture . METHODS One hundred and nine women with BMI range 20 - 30 kg/m(2 ) were allocated to either nutritional supplements ( 352 kcal/day ) or usual hospital nutrition using a quasi-r and omisation technique . Body weight changes were monitored at 4 and 8 weeks and clinical outcomes were recorded at discharge and at 6 months . RESULTS No significant differences in weight change or clinical outcomes were seen between the two groups . Compliance with consuming the nutritional supplements was quite variable and there was a significant negative correlation between the amount of supplement consumed and subsequent weight change ( r=-0.36 , P=0.019 ) . CONCLUSIONS Poor compliance with oral nutritional supplements is an important determinant of the effectiveness of oral nutritional interventions in preventing weight loss after hip fracture . Whilst this may explain the lack of clinical improvements seen , our data do not support the routine use of oral nutritional supplements in non-malnourished hip fracture patients PURPOSE : Urinary bladder drainage for several days after pelvic surgery is a common surgical practice , despite insufficient evidence supporting its routine use . The aim of this study was to prospect ively evaluate the utility of urinary bladder drainage after pelvic colorectal surgery . METHODS : Patients undergoing pelvic surgery were prospect ively r and omly assigned to 3 groups . In group A , the Foley catheter was removed on postoperative day 1 , and in groups B and C it was removed on postoperative days 3 and 5 , respectively . Male patients with severe prostatic symptoms were excluded from the study . The main outcome criterion was acute urinary retention requiring reinsertion of the Foley catheter . RESULTS : A total of 118 patients ( 68 males ) at a mean age of 55 years were included in this study ( group A , 41 patients ; group B , 38 ; and group C , 39 ) . Overall , urinary retention after removal of the Foley catheter occurred in 12 ( 10 % ) of the patients : 6 ( 14.6 % ) in group A , 2 ( 5.3 % ) in group B , and 4 ( 10.5 % ) in group C ( P = .39 ) . Symptomatic urinary tract infection was diagnosed in 5 patients in group A , 3 in group B , and 9 in group C , but this difference did not reach statistical significance . Likewise , there were no significant differences in anastomotic leak and intra-abdominal abscess rates among the 3 groups . CONCLUSIONS : Routine prolonged urinary bladder catheterization after pelvic surgery may not be required , and the Foley catheter may be safely removed on postoperative day 1 . Larger studies are needed to confirm the findings of this study BACKGROUND Mild perioperative hypothermia , which is common during major surgery , may promote surgical-wound infection by triggering thermoregulatory vasoconstriction , which decreases subcutaneous oxygen tension . Reduced levels of oxygen in tissue impair oxidative killing by neutrophils and decrease the strength of the healing wound by reducing the deposition of collagen . Hypothermia also directly impairs immune function . We tested the hypothesis that hypothermia both increases susceptibility to surgical-wound infection and lengthens hospitalization . METHODS Two hundred patients undergoing colorectal surgery were r and omly assigned to routine intraoperative thermal care ( the hypothermia group ) or additional warming ( the normothermia group ) . The patient 's anesthetic care was st and ardized , and they were all given cefam and ole and metronidazole . In a double-blind protocol , their wounds were evaluated daily until discharge from the hospital and in the clinic after two weeks ; wounds containing culture-positive pus were considered infected . The patients ' surgeons remained unaware of the patients ' group assignments . RESULTS The mean ( + /- SD ) final intraoperative core temperature was 34.7 + /- 0.6 degrees C in the hypothermia group and 36.6 + /- 0.5 degrees C in the normothermia group ( P < 0.001 ) Surgical-wound infections were found in 18 of 96 patients assigned to hypothermia ( 19 percent ) but in only 6 of 104 patients assigned to normothermia ( 6 percent , P = 0.009 ) . The sutures were removed one day later in the patients assigned to hypothermia than in those assigned to normothermia ( P = 0.002 ) , and the duration of hospitalization was prolonged by 2.6 days ( approximately 20 percent ) in hypothermia group ( P = 0.01 ) . CONCLUSIONS Hypothermia itself may delay healing and predispose patients to wound infections . Maintaining normothermia intraoperatively is likely to decrease the incidence of infectious complications in patients undergoing colorectal resection and to shorten their hospitalizations Objective This prospect i ve r and omized study determined the influence of closed-suction drainage on the incidence of postoperative complications after elective hepatic resection . Summary Background Data Routine drainage is no longer advocated after several intra-abdominal surgical procedures . Methods A series of 81 patients who underwent elective hepatic resection were r and omly allocated to either a nondrainage group ( n = 39 ) and a drainage group with closed-suction drainage ( n = 42 ) . Indications for resection were 42 benign lesions and 39 malignant tumors , including 19 with cirrhosis . Major hepatic resection was performed in 25 patients and minor resection , in 56 . All patients underwent ultrasonography with puncture for bacteriologic cultures of all fluid collection s within the first 5 postoperative days . Results One patient died in each group . Ultrasonography found a significantly higher rate of subphrenic collection s in the drainage group compared with the nondrainage group ( respectively , 36 % vs. 15 % , p < 0.05 ) . These collection s were more frequently infected in the drainage group ( n = 6 ) than in the nondrainage group ( n = 2 ) . After major liver resection , the rate of intra-abdominal postoperative complications ( i.e. , subphrenic fluid collection s , hematomas , and bilomas ) was similar between the two groups . Conclusion Minor liver resection is safer without drainage . Major liver resection can be performed with or without abdominal drainage Objective : To assess with a single-blinded , multicenter , r and omized trial , the postoperative results in patients undergoing sphincter-saving rectal resection for cancer without preoperative mechanical bowel preparation ( MBP ) .  Background : The collective evidence from literature strongly suggests that MBP , before elective colonic surgery , is of no benefit in terms of postoperative morbidity . Very few data and no r and omized study are available for rectal surgery and preliminary results conclude toward the safety of rectal resection without MBP . Methods : From October 2007 to January 2009 , patients scheduled for elective rectal cancer sphincter-saving resection were r and omized to receive preoperative MBP ( ie , retro grade enema and oral laxatives ) or not . Primary endpoint was the overall 30-day morbidity rate . Secondary endpoints included mortality rate , anastomotic leakage rate , major morbidity rate ( Dindo III or more ) , degree of discomfort for the patient , and hospital stay . Results : A total of 178 patients ( 103 men ) , including 89 in both groups ( no-MBP and MBP groups ) , were included in the study . The overall and infectious morbidity rates were significantly higher in no-MBP versus MBP group , 44 % versus 27 % , P = 0.018 , and 34 % versus 16 % , P = 0.005 , respectively . Regarding both anastomotic leakage and major morbidity rates , there was no significant difference between no-MBP and MBP group : 19 % versus 10 % ( P = 0.09 ) and 18 % versus 11 % ( P = 0.69 ) , respectively . Moderate or severe discomfort was reported by 40 % of prepared patients . Mortality rate ( 1.1 % vs 3.4 % ) and mean hospital stay ( 16 vs 14 days ) did not differ significantly between both groups . Conclusions : This first r and omized trial demonstrated that rectal cancer surgery without MBP was associated with higher risk of overall and infectious morbidity rates without any significant increase of anastomotic leakage rate . Thus , it suggests continuing to perform MBP before elective rectal resection for cancer . This study is registered with clinical trials.gov , number NCT00554892 Postoperative oral nutritional supplementation has been shown to be of clinical benefit . This study examined the clinical effects and cost of administration of oral supplements both before and after surgery Background Surgical interventions activate a cascade of reactions that result in an aseptic inflammatory reaction . This inflammatory response initiates the organism ’s innate immunity . Laparoscopic surgery reduces the trauma , and patients benefit from diminished surgical trauma and maintained immune function . Cytokine levels and C-reactive protein ( CRP ) are related to the magnitude of surgical trauma and surgical stress . Toll-like receptors ( TLRs ) 2 and 4 are the first sensor-recognition receptors of the invading pathogens for the innate immune response . This study aim ed to compare the inflammatory response and then the stress response during laparoscopic and open colectomy for cancer by calculating TLR-2 and TLR-4 as the first sensor-recognition receptors together with interleukin-6 ( IL-6 ) , tumor necrosis factor-α ( TNF-α ) , and high-sensitivity CRP ( hsCRP ) . Methods A total 40 patients with colorectal cancer were r and omized in two groups : group A ( open colectomy , n = 20 ) and group B ( laparoscopic colectomy , n = 20 ) .  An epidural catheter was placed in all patients 1 h preoperatively . Rupivocaine was administered perioperatively and 48 h postoperatively . Blood sample s were taken for calculation of IL-6 , TNF-α , hsCRP , TLR-2 , and TLR-4 preoperatively and 5 min after deflation of pneumoperitoneum ( group B ) or 5 min after division of the colon ( group A ) , then 6 and 24 h postoperatively . Results The mean operative time was 115 for group A and 142 min for group B. The mean blood loss was respectively 240 and 105 ml ( P < 0.001 ) , and the mean hospital stay was respectively 8 and 5 days ( P < 0.05 ) . The IL-6 level was significant higher in group A than in group B at 6 and 24 h postoperatively ( P < 0.0001 ) , and the hsCRP level was significant higher in group A than in group B at 24 h postoperatively ( P < 0.001 ) . The TNF-α values did not differ between the two groups . The TLR-2 level was significantly higher in group A than in group B at 5 min ( P = 0.013 ) and 24 h ( P = 0.007 ) postoperatively . The TLR-4 level was significant higher in group A than in group B at 5 min postoperatively ( P = 0.03 ) . Conclusion The inflammatory response and the result ant stress response are significantly less during laparoscopic colectomy than during open colectomy for colorectal cancer . This is an obvious short-term clinical benefit for the patient , providing tinder for further study to investigate the long-term results of laparoscopic colectomy versus open colectomy for colorectal cancer ( Registered clinical trial no. NCT00942461 ; www . clinical trials.gov ) UNLABELLED Infusions of carbohydrates before surgery reduce  postoperative insulin resistance . We in-vestigated the effects of a carbohydrate drink , given shortly before surgery , on postoperative metabolism . METHOD Insulin sensitivity , glucose turnover ( [ 6,6 , 2H2]-D-glucose ) and substrate utilization were measured using hyperinsulinemic normoglycemic clamps and indirect calorimetry in two matched groups of patients before and after elective colorectal surgery . The drink group ( n = 7 ) 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 . The fasted group ( n = 7 ) was operated after an overnight fast . RESULTS After surgery , energy expenditure increased in both groups . Endogenous glucose production was higher after surgery and the difference was significant during low insulin infusion rates in both groups ( P < 0.05 ) . The supressibility of endogenous glucose production by the 
    Output:
    
agent
The present systematic review shows that , with the exception of laparoscopic surgery , objective evidence of the effect of individual components of ERAS protocol s in reducing the stress response following colorectal surgery is limited
***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 Undernutrition and weight loss are important determinants of clinical outcome in older patients after hip fracture but the effectiveness of nutritional support programs in routine clinical practice remains controversial . AIMS OF THE PROJECT : To determine if oral nutritional supplements given daily for 28 days after hip fracture surgery could prevent weight loss and /or lead to improved clinical outcomes ( mortality rates , discharge destination , activities of daily living or length of hospital stay ) in non-malnourished community-dwelling older women with hip fracture . METHODS One hundred and nine women with BMI range 20 - 30 kg/m(2 ) were allocated to either nutritional supplements ( 352 kcal/day ) or usual hospital nutrition using a quasi-r and omisation technique . Body weight changes were monitored at 4 and 8 weeks and clinical outcomes were recorded at discharge and at 6 months . RESULTS No significant differences in weight change or clinical outcomes were seen between the two groups . Compliance with consuming the nutritional supplements was quite variable and there was a significant negative correlation between the amount of supplement consumed and subsequent weight change ( r=-0.36 , P=0.019 ) . CONCLUSIONS Poor compliance with oral nutritional supplements is an important determinant of the effectiveness of oral nutritional interventions in preventing weight loss after hip fracture . Whilst this may explain the lack of clinical improvements seen , our data do not support the routine use of oral nutritional supplements in non-malnourished hip fracture patients PURPOSE : Urinary bladder drainage for several days after pelvic surgery is a common surgical practice , despite insufficient evidence supporting its routine use . The aim of this study was to prospect ively evaluate the utility of urinary bladder drainage after pelvic colorectal surgery . METHODS : Patients undergoing pelvic surgery were prospect ively r and omly assigned to 3 groups . In group A , the Foley catheter was removed on postoperative day 1 , and in groups B and C it was removed on postoperative days 3 and 5 , respectively . Male patients with severe prostatic symptoms were excluded from the study . The main outcome criterion was acute urinary retention requiring reinsertion of the Foley catheter . RESULTS : A total of 118 patients ( 68 males ) at a mean age of 55 years were included in this study ( group A , 41 patients ; group B , 38 ; and group C , 39 ) . Overall , urinary retention after removal of the Foley catheter occurred in 12 ( 10 % ) of the patients : 6 ( 14.6 % ) in group A , 2 ( 5.3 % ) in group B , and 4 ( 10.5 % ) in group C ( P = .39 ) . Symptomatic urinary tract infection was diagnosed in 5 patients in group A , 3 in group B , and 9 in group C , but this difference did not reach statistical significance . Likewise , there were no significant differences in anastomotic leak and intra-abdominal abscess rates among the 3 groups . CONCLUSIONS : Routine prolonged urinary bladder catheterization after pelvic surgery may not be required , and the Foley catheter may be safely removed on postoperative day 1 . Larger studies are needed to confirm the findings of this study BACKGROUND Mild perioperative hypothermia , which is common during major surgery , may promote surgical-wound infection by triggering thermoregulatory vasoconstriction , which decreases subcutaneous oxygen tension . Reduced levels of oxygen in tissue impair oxidative killing by neutrophils and decrease the strength of the healing wound by reducing the deposition of collagen . Hypothermia also directly impairs immune function . We tested the hypothesis that hypothermia both increases susceptibility to surgical-wound infection and lengthens hospitalization . METHODS Two hundred patients undergoing colorectal surgery were r and omly assigned to routine intraoperative thermal care ( the hypothermia group ) or additional warming ( the normothermia group ) . The patient 's anesthetic care was st and ardized , and they were all given cefam and ole and metronidazole . In a double-blind protocol , their wounds were evaluated daily until discharge from the hospital and in the clinic after two weeks ; wounds containing culture-positive pus were considered infected . The patients ' surgeons remained unaware of the patients ' group assignments . RESULTS The mean ( + /- SD ) final intraoperative core temperature was 34.7 + /- 0.6 degrees C in the hypothermia group and 36.6 + /- 0.5 degrees C in the normothermia group ( P < 0.001 ) Surgical-wound infections were found in 18 of 96 patients assigned to hypothermia ( 19 percent ) but in only 6 of 104 patients assigned to normothermia ( 6 percent , P = 0.009 ) . The sutures were removed one day later in the patients assigned to hypothermia than in those assigned to normothermia ( P = 0.002 ) , and the duration of hospitalization was prolonged by 2.6 days ( approximately 20 percent ) in hypothermia group ( P = 0.01 ) . CONCLUSIONS Hypothermia itself may delay healing and predispose patients to wound infections . Maintaining normothermia intraoperatively is likely to decrease the incidence of infectious complications in patients undergoing colorectal resection and to shorten their hospitalizations Objective This prospect i ve r and omized study determined the influence of closed-suction drainage on the incidence of postoperative complications after elective hepatic resection . Summary Background Data Routine drainage is no longer advocated after several intra-abdominal surgical procedures . Methods A series of 81 patients who underwent elective hepatic resection were r and omly allocated to either a nondrainage group ( n = 39 ) and a drainage group with closed-suction drainage ( n = 42 ) . Indications for resection were 42 benign lesions and 39 malignant tumors , including 19 with cirrhosis . Major hepatic resection was performed in 25 patients and minor resection , in 56 . All patients underwent ultrasonography with puncture for bacteriologic cultures of all fluid collection s within the first 5 postoperative days . Results One patient died in each group . Ultrasonography found a significantly higher rate of subphrenic collection s in the drainage group compared with the nondrainage group ( respectively , 36 % vs. 15 % , p < 0.05 ) . These collection s were more frequently infected in the drainage group ( n = 6 ) than in the nondrainage group ( n = 2 ) . After major liver resection , the rate of intra-abdominal postoperative complications ( i.e. , subphrenic fluid collection s , hematomas , and bilomas ) was similar between the two groups . Conclusion Minor liver resection is safer without drainage . Major liver resection can be performed with or without abdominal drainage Objective : To assess with a single-blinded , multicenter , r and omized trial , the postoperative results in patients undergoing sphincter-saving rectal resection for cancer without preoperative mechanical bowel preparation ( MBP ) .  Background : The collective evidence from literature strongly suggests that MBP , before elective colonic surgery , is of no benefit in terms of postoperative morbidity . Very few data and no r and omized study are available for rectal surgery and preliminary results conclude toward the safety of rectal resection without MBP . Methods : From October 2007 to January 2009 , patients scheduled for elective rectal cancer sphincter-saving resection were r and omized to receive preoperative MBP ( ie , retro grade enema and oral laxatives ) or not . Primary endpoint was the overall 30-day morbidity rate . Secondary endpoints included mortality rate , anastomotic leakage rate , major morbidity rate ( Dindo III or more ) , degree of discomfort for the patient , and hospital stay . Results : A total of 178 patients ( 103 men ) , including 89 in both groups ( no-MBP and MBP groups ) , were included in the study . The overall and infectious morbidity rates were significantly higher in no-MBP versus MBP group , 44 % versus 27 % , P = 0.018 , and 34 % versus 16 % , P = 0.005 , respectively . Regarding both anastomotic leakage and major morbidity rates , there was no significant difference between no-MBP and MBP group : 19 % versus 10 % ( P = 0.09 ) and 18 % versus 11 % ( P = 0.69 ) , respectively . Moderate or severe discomfort was reported by 40 % of prepared patients . Mortality rate ( 1.1 % vs 3.4 % ) and mean hospital stay ( 16 vs 14 days ) did not differ significantly between both groups . Conclusions : This first r and omized trial demonstrated that rectal cancer surgery without MBP was associated with higher risk of overall and infectious morbidity rates without any significant increase of anastomotic leakage rate . Thus , it suggests continuing to perform MBP before elective rectal resection for cancer . This study is registered with clinical trials.gov , number NCT00554892 Postoperative oral nutritional supplementation has been shown to be of clinical benefit . This study examined the clinical effects and cost of administration of oral supplements both before and after surgery Background Surgical interventions activate a cascade of reactions that result in an aseptic inflammatory reaction . This inflammatory response initiates the organism ’s innate immunity . Laparoscopic surgery reduces the trauma , and patients benefit from diminished surgical trauma and maintained immune function . Cytokine levels and C-reactive protein ( CRP ) are related to the magnitude of surgical trauma and surgical stress . Toll-like receptors ( TLRs ) 2 and 4 are the first sensor-recognition receptors of the invading pathogens for the innate immune response . This study aim ed to compare the inflammatory response and then the stress response during laparoscopic and open colectomy for cancer by calculating TLR-2 and TLR-4 as the first sensor-recognition receptors together with interleukin-6 ( IL-6 ) , tumor necrosis factor-α ( TNF-α ) , and high-sensitivity CRP ( hsCRP ) . Methods A total 40 patients with colorectal cancer were r and omized in two groups : group A ( open colectomy , n = 20 ) and group B ( laparoscopic colectomy , n = 20 ) .  An epidural catheter was placed in all patients 1 h preoperatively . Rupivocaine was administered perioperatively and 48 h postoperatively . Blood sample s were taken for calculation of IL-6 , TNF-α , hsCRP , TLR-2 , and TLR-4 preoperatively and 5 min after deflation of pneumoperitoneum ( group B ) or 5 min after division of the colon ( group A ) , then 6 and 24 h postoperatively . Results The mean operative time was 115 for group A and 142 min for group B. The mean blood loss was respectively 240 and 105 ml ( P < 0.001 ) , and the mean hospital stay was respectively 8 and 5 days ( P < 0.05 ) . The IL-6 level was significant higher in group A than in group B at 6 and 24 h postoperatively ( P < 0.0001 ) , and the hsCRP level was significant higher in group A than in group B at 24 h postoperatively ( P < 0.001 ) . The TNF-α values did not differ between the two groups . The TLR-2 level was significantly higher in group A than in group B at 5 min ( P = 0.013 ) and 24 h ( P = 0.007 ) postoperatively . The TLR-4 level was significant higher in group A than in group B at 5 min postoperatively ( P = 0.03 ) . Conclusion The inflammatory response and the result ant stress response are significantly less during laparoscopic colectomy than during open colectomy for colorectal cancer . This is an obvious short-term clinical benefit for the patient , providing tinder for further study to investigate the long-term results of laparoscopic colectomy versus open colectomy for colorectal cancer ( Registered clinical trial no. NCT00942461 ; www . clinical trials.gov ) UNLABELLED Infusions of carbohydrates before surgery reduce  postoperative insulin resistance . We in-vestigated the effects of a carbohydrate drink , given shortly before surgery , on postoperative metabolism . METHOD Insulin sensitivity , glucose turnover ( [ 6,6 , 2H2]-D-glucose ) and substrate utilization were measured using hyperinsulinemic normoglycemic clamps and indirect calorimetry in two matched groups of patients before and after elective colorectal surgery . The drink group ( n = 7 ) 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 . The fasted group ( n = 7 ) was operated after an overnight fast . RESULTS After surgery , energy expenditure increased in both groups . Endogenous glucose production was higher after surgery and the difference was significant during low insulin infusion rates in both groups ( P < 0.05 ) . The supressibility of endogenous glucose production by the 
    Output:
    