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 In the United Kingdom , patients with locally advanced rectal cancer routinely receive neoadjuvant chemoradiotherapy . However , the effects of this on physical fitness are unclear . This pilot study is aim ed to investigate the effect of neoadjuvant chemoradiotherapy on objective ly measured in vivo muscle mitochondrial function and whole-body physical fitness . Methods We prospect ively studied 12 patients with rectal cancer who completed st and ardized neoadjuvant chemoradiotherapy , recruited from a large tertiary cancer centre , between October 2012 and July 2013 . All patients underwent a cardiopulmonary exercise test and a phosphorus magnetic resonance spectroscopy quadriceps muscle exercise-recovery study before and after neoadjuvant chemoradiotherapy . Data were analysed and reported blind to patient identity and clinical course . Primary variables of interest were the two physical fitness measures ; oxygen uptake at estimated anaerobic threshold and oxygen uptake at Peak exercise ( ml.kg−1.min−1 ) , and the post-exercise phosphocreatine recovery rate constant ( min−1 ) , a measure of muscle mitochondrial capacity in vivo .  Results Median age was 67 years ( IQR 64–75 ) . Differences ( 95%CI ) in all three primary variables were significantly negative post-NACRT : Oxygen uptake at estimated anaerobic threshold −2.4 ml.kg−1.min−1 ( −3.8 , −0.9 ) , p = 0.004 ; Oxygen uptake at Peak −4.0 ml.kg−1.min−1 ( −6.8 , −1.1 ) , p = 0.011 ; and post-exercise phosphocreatine recovery rate constant −0.34 min−1 ( −0.51 , −0.17 ) , p<0.001 . Conclusion The significant decrease in both whole-body physical fitness and in vivo muscle mitochondrial function raises the possibility that muscle mitochondrial mechanisms , no doubt multifactorial , may be important in deterioration of physical fitness following neoadjuvant chemoradiotherapy . This may have implication s for targeted interventions to improve physical fitness pre-surgery . Trial Registration Clinical trials.gov registration Abstract Background : Colorectal cancer ( CRC ) is the second most prevalent type of cancer in the world . Surgery is the most common therapeutic intervention , and associated with 20–40 % reduction in physiological and functional capacity . Postoperative complications occur in up to 50 % of patients result ing in higher mortality rates and greater hospital costs . The number and severity of complications is closely related to patients ’ preoperative performance status . The aim of this study was to identify the most important preoperative modifiable risk factors that could be part of a multimodal prehabilitation program . Methods : Prospect ively collected data of a consecutive series of Dutch CRC patients undergoing colorectal surgery were analyzed . Modifiable risk factors were correlated to the Comprehensive Complication Index ( CCI ) and compared within two groups : none or mild complications ( CCI < 20 ) , and severe complications ( CCI ≥20 ) . Multivariate logistic regression analysis was done to explore the combined effect of individual risk factors . Results : In this 139 patient cohort  , smoking , malnutrition , alcohol consumption , neoadjuvant therapy , higher age , and male sex , were seen more frequently in the severe complications group ( CCI ≥20 ) . Patients with severe complications had significantly longer hospital stay ( 16 vs. 6 days , p < 0.001 ) . The risk for severe complications was increased in patients with ASA score III [ adjusted odds ratio ( OR ) 4.4 , 95 % CI 1.04–18.6 ] , and hemoglobin level < 7 mmol/l ( adjusted OR 3.3 , 95 % CI 1.3–8.2 ) . Compared to having no risk factors , more than one risk factor increased OR of severe complications ( crude OR 5.2 , 95 % CI 1.8–15 ) . Conclusion : This study revealed that the risk of getting severe complications increases with the number of risk factors present preoperatively . Several preoperative patient-related risk factors are modifiable . Multimodal prehabilitation may improve patients ’ preoperative status and should be tested in a multicenter r and omized controlled trial . With an international consortium ( Copenhagen , Montreal , Paris , Eindhoven ) we initiated a r and omized controlled trial ( NTR5947 ) BACKGROUND Anastomotic  leak is a serious complication of gastrointestinal surgery . Abnormal vital signs are often cited in retrospective peer review and medicolegal setting s as evidence of negligence in the failure to make an early diagnosis . We aim ed to profile the postoperative courses of patients who undergo intestinal anastomosis and determine how reliably abnormal vital signs predict anastomotic leaks . STUDY DESIGN Consecutive patients undergoing bowel resection with anastomosis at an academic medical center from July 2009 through July 2011 were identified from a prospect i ve complication data base . The electronic medical record was queried for postoperative vital signs and laboratory studies , which were digitally abstract ed . Abnormal values were defined as temperature > 38 ° C , white blood cell count ≤4,000 or ≥12,000 cells/uL , systolic blood pressure ≤80 mmHg or diastolic blood pressure ≤50 mmHg , pulse ≥100 beats per minute , and respiratory rate ≥20 breaths per minute . Patients who developed an anastomotic leak were compared with those with an uncomplicated postoperative course . RESULTS Of the 452 patients , 141 ( 31.2 % ) suffered a total of 271 complications , including 19 anastomotic leaks . Even in " uncomplicated " recoveries , tachycardia and tachypnea were almost routine , occurring in more than half of the patients frequently throughout the postoperative period . Hypotension , fever , and leukocytosis were also remarkably common . The positive predictive value of any aberrant vital sign or white blood cell count ranged between 4 % and 11 % . CONCLUSIONS Abnormal vital signs are extremely common after bowel resection with anastomosis . Even sustained aberrant vital signs and /or leukocytosis are not necessarily suggestive of a leak or other postoperative complication BACKGROUND Abdominal surgery represents a physiologic stress and is associated with a period of recovery during which functional capacity is often diminished . " Prehabilitation " is a program to increase functional capacity in anticipation of an upcoming stressor . We reported recently the results of a r and omized trial comparing 2 prehabilitation programs before colorectal surgery  ( stationary cycling plus weight training versus a recommendation to increase walking coupled with breathing exercises ) ; however , adherence to the programs was low . The objectives of this study were to estimate : ( 1 ) the extent to which physical function could be improved with either prehabilitation program and identify variables associated with response ; and ( 2 ) the impact of change in preoperative function on postoperative recovery . METHODS This study involved a re analysis of data arising from a r and omized trial . The primary outcome measure was functional walking capacity measured by the Six-Minute Walk Test ; secondary outcomes were anxiety , depression , health-related quality of life , and complications ( Clavien classification ) . Multiple linear regression was used to estimate the extent to which key variables predicted change in functional walking capacity over the prehabilitation and follow-up periods . RESULTS We included 95 people who completed the prehabilitation phase ( median , 38 days ; interquartile range , 22 - 60 ) , and 75 who were also evaluated postoperatively ( mean , 9 weeks ) . During prehabilitation , 33 % improved their physical function , 38 % stayed within 20 m of their baseline score , and 29 % deteriorated . Among those who improved , mental health , vitality , self-perceived health , and peak exercise capacity also increased significantly . Women were less likely to improve ; low baseline walking capacity , anxiety , and the belief that fitness aids recovery were associated with improvements during prehabilitation . In the postoperative phase , the patients who had improved during prehabilitation were also more likely to have recovered to their baseline walking capacity than those with no change or deterioration ( 77 % vs 59 % and 32 % ; P = .0007 ) . Patients who deteriorated were at greater risk of complications requiring reoperation and /or intensive care management . Significant predictors of poorer recovery included deterioration during prehabilitation , age > 75 years , high anxiety , complications requiring intervention , and timing of follow-up assessment . CONCLUSION In a group of patients undergoing scheduled colorectal surgery , meaningful changes in functional capacity can be achieved over several weeks of prehabilitation . Patients and those who care for them , especially those with poor physical capacity , should consider a prehabilitation regimen to enhance functional exercise capacity before colectomy Objective To assess the effect of a multimodal group exercise intervention , as an adjunct to conventional care , on fatigue , physical capacity , general wellbeing , physical activity , and quality of life in patients with cancer who were undergoing adjuvant chemotherapy or treatment for advanced disease . Design R and omised controlled trial . Setting Two university hospitals in Copenhagen , Denmark . Participants 269 patients with cancer ; 73 men , 196 women , mean age 47 years ( range 20 - 65 ) representing 21 diagnoses . Main exclusion criteria were brain or bone metastases . 235 patients completed follow-up . Intervention Supervised exercise comprising high intensity cardiovascular and resistance training , relaxation and body awareness training , massage , nine hours weekly for six weeks in addition to conventional care , compared with conventional care . Main outcome measures European Organization for Research and Treatment of Cancer Quality of Life Question naire ( EORTC QLQ-C30 ) , Medical Outcomes Study Short Form ( MOS SF-36 ) , Leisure Time Physical Activity Question naire , muscular strength ( one repetition maximum ) , maximum oxygen consumption ( Vo2max ) . Statistical methods The general linear model was used for continuous outcome while analysis of associates between categorical outcomes was performed as analysis of marginal homogeneity in contingency tables . Results Adjusted for baseline score , disease , and demographic covariates , the intervention group showed an estimated improvement at six weeks for the primary outcome , fatigue , of −6.6 points ( 95 % confidence interval −12.3 to −0.9 , P=0.02 ; effect size=0.33 , 0.04 to 0.61 ) . Significant effects were seen on vitality ( effect size 0.55 , 95 % CI 0.27 to 0.82 ) , physical functioning ( 0.37 , 0.09 to 0.65 ) , role physical ( 0.37 , 0.10 to 0.64 ) , role emotional ( 0.32 , 0.05 to 0.59 ) , and mental health ( 0.28 , 0.02 to 0.56 ) scores . Improvement was noted in physical capacity : estimated mean difference between groups for maximum oxygen consumption was 0.16 l/min ( 95 % CI 0.1 to 0.2 , P<0.0001 ) and for muscular strength ( leg press ) was 29.7 kg ( 23.4 to 34.9 , P<0.0001 ) . No significant effect was seen on global health status/ quality of life . Conclusion A supervised multimodal exercise intervention including high and low intensity components was feasible and could safely be used in patients with various cancers who were receiving adjuvant chemotherapy or treatment for advanced disease . The intervention reduced fatigue and improved vitality , aerobic capacity , muscular strength , and physical and functional activity , and emotional wellbeing , but not quality of life . Trial registration Current Controlled trials IS RCT N05322922 BACKGROUND Neoadjuvant chemoradiotherapy ( NACRT ) followed by surgery for resectable locally advanced rectal cancer improves outcome compared with surgery alone . Our primary hypothesis was that NACRT impairs objective ly-measured physical fitness . We also wished to explore the relationship between fitness and postoperative outcome . METHOD In an observational study , we prospect ively studied 27 consecutive patients , of whom 25 undertook cardiopulmonary exercise testing ( CPET ) 2 weeks before and 7 weeks after st and ardized NACRT , then underwent surgery . In-hospital post-operative morbidity and mortality were recorded . Patients were followed up to 1 year for mortality . Data was analysed blind to clinical details . Receiver-operating characteristic ( ROC ) analysis defined the predictive value of CPET for in-hospital morbidity at day 5 . RESULTS Oxygen uptake ( [ Formula : see text ] in ml kg(-1 ) min(-1 ) ) at estimated lactate threshold ( θˆL ) and at peak exercise ( [ Formula : see text ] at peak in ml kg(-1 ) min(-1 ) ) both significantly decreased post-NACRT : [ Formula : see text ] at θˆL 12.1 ( pre-NACRT ) vs. 10.6 ( post-NACRT ) , p < 0.001 ( 95%CI -1.7 , -1.2 ) ; [ Formula : see text ] at peak 18.1 vs. 16.7 , p < 0.001 ( 95%CI -3.1 , -1.0 ) . Optimal [ Formula : see text ] at θˆL and peak pre-NACRT for predicting postoperative morbidity were 12.0 and 18.1 ( [ Formula : see text ] at θˆL - AUC = 0.71 , 77 % sensitive and 75 % specific ; [ Formula : see 
    Output:
    
agent
Endurance training alone was found to increase both lower extremity strength and endurance capacity .
***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 In the United Kingdom , patients with locally advanced rectal cancer routinely receive neoadjuvant chemoradiotherapy . However , the effects of this on physical fitness are unclear . This pilot study is aim ed to investigate the effect of neoadjuvant chemoradiotherapy on objective ly measured in vivo muscle mitochondrial function and whole-body physical fitness . Methods We prospect ively studied 12 patients with rectal cancer who completed st and ardized neoadjuvant chemoradiotherapy , recruited from a large tertiary cancer centre , between October 2012 and July 2013 . All patients underwent a cardiopulmonary exercise test and a phosphorus magnetic resonance spectroscopy quadriceps muscle exercise-recovery study before and after neoadjuvant chemoradiotherapy . Data were analysed and reported blind to patient identity and clinical course . Primary variables of interest were the two physical fitness measures ; oxygen uptake at estimated anaerobic threshold and oxygen uptake at Peak exercise ( ml.kg−1.min−1 ) , and the post-exercise phosphocreatine recovery rate constant ( min−1 ) , a measure of muscle mitochondrial capacity in vivo .  Results Median age was 67 years ( IQR 64–75 ) . Differences ( 95%CI ) in all three primary variables were significantly negative post-NACRT : Oxygen uptake at estimated anaerobic threshold −2.4 ml.kg−1.min−1 ( −3.8 , −0.9 ) , p = 0.004 ; Oxygen uptake at Peak −4.0 ml.kg−1.min−1 ( −6.8 , −1.1 ) , p = 0.011 ; and post-exercise phosphocreatine recovery rate constant −0.34 min−1 ( −0.51 , −0.17 ) , p<0.001 . Conclusion The significant decrease in both whole-body physical fitness and in vivo muscle mitochondrial function raises the possibility that muscle mitochondrial mechanisms , no doubt multifactorial , may be important in deterioration of physical fitness following neoadjuvant chemoradiotherapy . This may have implication s for targeted interventions to improve physical fitness pre-surgery . Trial Registration Clinical trials.gov registration Abstract Background : Colorectal cancer ( CRC ) is the second most prevalent type of cancer in the world . Surgery is the most common therapeutic intervention , and associated with 20–40 % reduction in physiological and functional capacity . Postoperative complications occur in up to 50 % of patients result ing in higher mortality rates and greater hospital costs . The number and severity of complications is closely related to patients ’ preoperative performance status . The aim of this study was to identify the most important preoperative modifiable risk factors that could be part of a multimodal prehabilitation program . Methods : Prospect ively collected data of a consecutive series of Dutch CRC patients undergoing colorectal surgery were analyzed . Modifiable risk factors were correlated to the Comprehensive Complication Index ( CCI ) and compared within two groups : none or mild complications ( CCI < 20 ) , and severe complications ( CCI ≥20 ) . Multivariate logistic regression analysis was done to explore the combined effect of individual risk factors . Results : In this 139 patient cohort  , smoking , malnutrition , alcohol consumption , neoadjuvant therapy , higher age , and male sex , were seen more frequently in the severe complications group ( CCI ≥20 ) . Patients with severe complications had significantly longer hospital stay ( 16 vs. 6 days , p < 0.001 ) . The risk for severe complications was increased in patients with ASA score III [ adjusted odds ratio ( OR ) 4.4 , 95 % CI 1.04–18.6 ] , and hemoglobin level < 7 mmol/l ( adjusted OR 3.3 , 95 % CI 1.3–8.2 ) . Compared to having no risk factors , more than one risk factor increased OR of severe complications ( crude OR 5.2 , 95 % CI 1.8–15 ) . Conclusion : This study revealed that the risk of getting severe complications increases with the number of risk factors present preoperatively . Several preoperative patient-related risk factors are modifiable . Multimodal prehabilitation may improve patients ’ preoperative status and should be tested in a multicenter r and omized controlled trial . With an international consortium ( Copenhagen , Montreal , Paris , Eindhoven ) we initiated a r and omized controlled trial ( NTR5947 ) BACKGROUND Anastomotic  leak is a serious complication of gastrointestinal surgery . Abnormal vital signs are often cited in retrospective peer review and medicolegal setting s as evidence of negligence in the failure to make an early diagnosis . We aim ed to profile the postoperative courses of patients who undergo intestinal anastomosis and determine how reliably abnormal vital signs predict anastomotic leaks . STUDY DESIGN Consecutive patients undergoing bowel resection with anastomosis at an academic medical center from July 2009 through July 2011 were identified from a prospect i ve complication data base . The electronic medical record was queried for postoperative vital signs and laboratory studies , which were digitally abstract ed . Abnormal values were defined as temperature > 38 ° C , white blood cell count ≤4,000 or ≥12,000 cells/uL , systolic blood pressure ≤80 mmHg or diastolic blood pressure ≤50 mmHg , pulse ≥100 beats per minute , and respiratory rate ≥20 breaths per minute . Patients who developed an anastomotic leak were compared with those with an uncomplicated postoperative course . RESULTS Of the 452 patients , 141 ( 31.2 % ) suffered a total of 271 complications , including 19 anastomotic leaks . Even in " uncomplicated " recoveries , tachycardia and tachypnea were almost routine , occurring in more than half of the patients frequently throughout the postoperative period . Hypotension , fever , and leukocytosis were also remarkably common . The positive predictive value of any aberrant vital sign or white blood cell count ranged between 4 % and 11 % . CONCLUSIONS Abnormal vital signs are extremely common after bowel resection with anastomosis . Even sustained aberrant vital signs and /or leukocytosis are not necessarily suggestive of a leak or other postoperative complication BACKGROUND Abdominal surgery represents a physiologic stress and is associated with a period of recovery during which functional capacity is often diminished . " Prehabilitation " is a program to increase functional capacity in anticipation of an upcoming stressor . We reported recently the results of a r and omized trial comparing 2 prehabilitation programs before colorectal surgery  ( stationary cycling plus weight training versus a recommendation to increase walking coupled with breathing exercises ) ; however , adherence to the programs was low . The objectives of this study were to estimate : ( 1 ) the extent to which physical function could be improved with either prehabilitation program and identify variables associated with response ; and ( 2 ) the impact of change in preoperative function on postoperative recovery . METHODS This study involved a re analysis of data arising from a r and omized trial . The primary outcome measure was functional walking capacity measured by the Six-Minute Walk Test ; secondary outcomes were anxiety , depression , health-related quality of life , and complications ( Clavien classification ) . Multiple linear regression was used to estimate the extent to which key variables predicted change in functional walking capacity over the prehabilitation and follow-up periods . RESULTS We included 95 people who completed the prehabilitation phase ( median , 38 days ; interquartile range , 22 - 60 ) , and 75 who were also evaluated postoperatively ( mean , 9 weeks ) . During prehabilitation , 33 % improved their physical function , 38 % stayed within 20 m of their baseline score , and 29 % deteriorated . Among those who improved , mental health , vitality , self-perceived health , and peak exercise capacity also increased significantly . Women were less likely to improve ; low baseline walking capacity , anxiety , and the belief that fitness aids recovery were associated with improvements during prehabilitation . In the postoperative phase , the patients who had improved during prehabilitation were also more likely to have recovered to their baseline walking capacity than those with no change or deterioration ( 77 % vs 59 % and 32 % ; P = .0007 ) . Patients who deteriorated were at greater risk of complications requiring reoperation and /or intensive care management . Significant predictors of poorer recovery included deterioration during prehabilitation , age > 75 years , high anxiety , complications requiring intervention , and timing of follow-up assessment . CONCLUSION In a group of patients undergoing scheduled colorectal surgery , meaningful changes in functional capacity can be achieved over several weeks of prehabilitation . Patients and those who care for them , especially those with poor physical capacity , should consider a prehabilitation regimen to enhance functional exercise capacity before colectomy Objective To assess the effect of a multimodal group exercise intervention , as an adjunct to conventional care , on fatigue , physical capacity , general wellbeing , physical activity , and quality of life in patients with cancer who were undergoing adjuvant chemotherapy or treatment for advanced disease . Design R and omised controlled trial . Setting Two university hospitals in Copenhagen , Denmark . Participants 269 patients with cancer ; 73 men , 196 women , mean age 47 years ( range 20 - 65 ) representing 21 diagnoses . Main exclusion criteria were brain or bone metastases . 235 patients completed follow-up . Intervention Supervised exercise comprising high intensity cardiovascular and resistance training , relaxation and body awareness training , massage , nine hours weekly for six weeks in addition to conventional care , compared with conventional care . Main outcome measures European Organization for Research and Treatment of Cancer Quality of Life Question naire ( EORTC QLQ-C30 ) , Medical Outcomes Study Short Form ( MOS SF-36 ) , Leisure Time Physical Activity Question naire , muscular strength ( one repetition maximum ) , maximum oxygen consumption ( Vo2max ) . Statistical methods The general linear model was used for continuous outcome while analysis of associates between categorical outcomes was performed as analysis of marginal homogeneity in contingency tables . Results Adjusted for baseline score , disease , and demographic covariates , the intervention group showed an estimated improvement at six weeks for the primary outcome , fatigue , of −6.6 points ( 95 % confidence interval −12.3 to −0.9 , P=0.02 ; effect size=0.33 , 0.04 to 0.61 ) . Significant effects were seen on vitality ( effect size 0.55 , 95 % CI 0.27 to 0.82 ) , physical functioning ( 0.37 , 0.09 to 0.65 ) , role physical ( 0.37 , 0.10 to 0.64 ) , role emotional ( 0.32 , 0.05 to 0.59 ) , and mental health ( 0.28 , 0.02 to 0.56 ) scores . Improvement was noted in physical capacity : estimated mean difference between groups for maximum oxygen consumption was 0.16 l/min ( 95 % CI 0.1 to 0.2 , P<0.0001 ) and for muscular strength ( leg press ) was 29.7 kg ( 23.4 to 34.9 , P<0.0001 ) . No significant effect was seen on global health status/ quality of life . Conclusion A supervised multimodal exercise intervention including high and low intensity components was feasible and could safely be used in patients with various cancers who were receiving adjuvant chemotherapy or treatment for advanced disease . The intervention reduced fatigue and improved vitality , aerobic capacity , muscular strength , and physical and functional activity , and emotional wellbeing , but not quality of life . Trial registration Current Controlled trials IS RCT N05322922 BACKGROUND Neoadjuvant chemoradiotherapy ( NACRT ) followed by surgery for resectable locally advanced rectal cancer improves outcome compared with surgery alone . Our primary hypothesis was that NACRT impairs objective ly-measured physical fitness . We also wished to explore the relationship between fitness and postoperative outcome . METHOD In an observational study , we prospect ively studied 27 consecutive patients , of whom 25 undertook cardiopulmonary exercise testing ( CPET ) 2 weeks before and 7 weeks after st and ardized NACRT , then underwent surgery . In-hospital post-operative morbidity and mortality were recorded . Patients were followed up to 1 year for mortality . Data was analysed blind to clinical details . Receiver-operating characteristic ( ROC ) analysis defined the predictive value of CPET for in-hospital morbidity at day 5 . RESULTS Oxygen uptake ( [ Formula : see text ] in ml kg(-1 ) min(-1 ) ) at estimated lactate threshold ( θˆL ) and at peak exercise ( [ Formula : see text ] at peak in ml kg(-1 ) min(-1 ) ) both significantly decreased post-NACRT : [ Formula : see text ] at θˆL 12.1 ( pre-NACRT ) vs. 10.6 ( post-NACRT ) , p < 0.001 ( 95%CI -1.7 , -1.2 ) ; [ Formula : see text ] at peak 18.1 vs. 16.7 , p < 0.001 ( 95%CI -3.1 , -1.0 ) . Optimal [ Formula : see text ] at θˆL and peak pre-NACRT for predicting postoperative morbidity were 12.0 and 18.1 ( [ Formula : see text ] at θˆL - AUC = 0.71 , 77 % sensitive and 75 % specific ; [ Formula : see 
    Output:
    