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 Inflammation is the main cause of disease-associated muscle wasting . In a previous single blind study we have demonstrated improved recovery of muscle endurance following celecoxib treatment in hospitalized geriatric patients with acute infection . Here we further evaluate NSAID treatment with piroxicam in a double blind RCT and investigate the role of cytokines and heat shock proteins ( Hsp ) with respect to muscle performance . We hypothesized that NSAID treatment would preserve muscle performance better than antibiotic treatment alone , by reducing infection-associated inflammation and by increasing expression of cytoprotective Hsp . Methods Consecutive admissions to the geriatric ward were screened . 30 Caucasian patients , median age 84.5 years , with acute infection-induced inflammation and serum levels of CRP > 10 mg/L were included and r and omized to active treatment with 10 mg piroxicam daily or placebo . Assessment comprised general clinical and biochemical parameters , 25 cytokines in serum , intra- and extracellular Hsp27 and Hsp70 , Elderly Mobility Scale ( EMS ) scores , grip strength ( GS ) , fatigue resistance ( FR ) and lean body mass ( LBM ) . Patients were evaluated until discharge with a maximum of 3 weeks after treatment allocation . Results EMS scores , FR and grip work ( GW ) , a measure taking into account GS and FR , significantly improved with piroxicam , but not with placebo . Early decreases in IL-6 serum levels with piroxicam correlated with better muscle performance at week 2 . Basal expression of Hsp27 in monocytes without heat challenge ( WHC ) was positively correlated with FR at baseline and significantly increased by treatment with piroxicam compared to placebo . Profound modifications in the relationships between cytokines or Hsp and changes in muscle parameters were observed in the piroxicam group . Conclusions Piroxicam improves clinical ly relevant measures of muscle performance and mobility in geriatric patients hospitalized with acute infection-induced inflammation . Underlying mechanisms may include modifications in the cytokine network and increases in monocytic expression of cytoprotective Hsp27.Trial registration numberIS RCT N : IS RCT Background / Objectives : This study aims to increase knowledge regarding the association of sarcopenia with hospitalization costs among a wide-ranging sample of adult hospitalized patients .Subjects/ Methods : A prospect i ve study was conducted among hospitalized adult patients . Sarcopenia was identified according to the European Working Group on Sarcopenia in Older People , as low muscle mass , assessed by bioelectrical impedance analysis and low muscle function evaluated by h and grip strength .  Hospitalization cost was calculated for each patient based on discharge diagnosis-related group codes and determined on the basis of a relative weight value . Costs were defined as the percentage of deviation from the cost of a patient with a relative weight equal to one . Multivariable linear regression models were performed to identify the factors independently associated with hospitalization costs . Results : A total of 656 hospitalized patients aged ⩾18 years ( 24.2 % sarcopenic ) composed the study sample . Sarcopenia increased hospitalization costs by [ euro ] 1240 ( 95 % confidence interval ( CI ) : [ euro ] 596–1887 ) for patients aged < 65 years and [ euro ] 721 ( 95 % CI : [ euro ] 13–1429 ) for patients aged ⩾65 years . Sarcopenic overweight was related to an increase in hospitalization costs of [ euro ] 884 ( 95 % CI : [ euro ] 295–1476 ) . Conclusions : Sarcopenia is independently related to hospitalization costs . This condition is estimated to increase hospitalization costs by 58.5 % for patients aged < 65 years and 34 % for patients aged ⩾65 years BACKGROUND Acute inflammation has a negative effect on the muscular system in elderly patients , compromising the outcome of the underlying disease . OBJECTIVE The aim of this study was to evaluate the effect of cyclooxygenase-2 ( COX-2 ) inhibition on muscle performance and mobility in hospitalized elderly patients with acute inflammation of infectious origin . METHODS In this single-blind , controlled trial , consecutively hospitalized elderly patients ( age > or = 70 years ) with inflammation ( C-reactive protein [ CRP ] levels > or = 10 mg/L ) due to acute infection were r and omly assigned to receive 2 weeks of treatment with the COX-2-selective inhibitor celecoxib , acetaminophen , or no supplementary medication ( control ) . The following variables were assessed at baseline and at 1 and 2 weeks ' follow-up : muscle fatigue resistance ( primary outcome measure ) ; grip strength and mobility ( secondary outcome measures ) ; and levels of the acute-phase markers CRP , interleukin (IL)-1beta , IL-6 , IL-10 , tumor necrosis factor-alpha ( TNF-alpha ) , and transforming growth factor-beta ( TGF-beta ) as explanatory variables . RESULTS Forty-three consecutively hospitalized elderly patients ( 31 women , 12 men ; mean [ SD ] age , 84 [ 6 ] years ) were enrolled . Fourteen patients received celecoxib , 14 received acetaminophen , and 15 received no supplementary medication . The change in fatigue resistance was significantly different between groups ( P = 0.021 , Kruskal-Wallis chi-square test ) , with significantly greater improvement in patients receiving celecoxib compared with the acetaminophen and control groups ( 63 % increase from baseline ; P < 0.05 ) . There were no significant between-group differences in changes in grip strength , mobility , IL-1beta , IL-6 , TNF-alpha , or TGF-beta . The changes in levels of IL-10 differed significantly between groups ( P = 0.020 , Kruskal-Wallis chi-square test ) , with greater improvement in the celecoxib group compared with the acetaminophen group ( P = 0.032 ) . CONCLUSION The results of this study suggest that COX-2-selective inhibition has a beneficial effect on muscle fatigue resistance in hospitalized elderly patients with acute inflammation of infectious origin . However , until further trials are conducted , the use of COX-2-selective inhibitors for this indication is not recommended The aim of this trial was to compare  multimodal optimization  with  conventional perioperative management  in a consecutive series of patients undergoing a wide range of colorectal procedures Objective : Postoperatively patients have a reduction in nutritional intake and body weight . We studied the effect of postoperative physical training on nutritional intake and body composition . Methods : Patients ⩾60 y admitted for elective colorectal surgery were  r and omised to train muscular strength ( group A ) or to nonstrengthening exercises ( group B ) for 3 months  . Fat mass ( FM ) and lean body mass ( LBM ) were assessed with bioimpedance preoperatively , 7 , 30 , and 90 days postoperatively . Nutritional intake was registered in a sub population . Results : Of 119 included patients , 60 were r and omised to group A and 59 to B. The changes in LBM at postoperative day 7 were a mean ( s.d . ) of 0.4 ( 2.1 ) kg in group A compared to −0.7 ( 2.0 ) kg in B. The difference between groups of 1.2 ( 0.5 ) kg at day 7 was statistically significant ( P=0.03 ) . At no other time was observed difference between groups in weight , LBM , or FM . The energy and protein intake rose during postoperative day 1–7 and rose further after discharge . At no time were differences between groups . Conclusion : Physical training had little effect on body composition following abdominal surgery . The nutritional intake in well-nourished patients did not increase by training OBJECTIVES To examine the proportion of time spent in three levels of mobility ( lying , sitting , and st and ing or walking ) by a cohort of hospitalized older veterans as measured by vali date d wireless accelerometers . DESIGN A prospect i ve , observational cohort study . SETTING One hundred fifty-bed Department of Veterans Affairs hospital . PARTICIPANTS Forty-five hospitalized medical patients , aged 65 and older who were not delirious , did not have dementia , and were able to walk in the 2 weeks before admission were eligible . MEASUREMENTS Wireless accelerometers were attached to the thigh and ankle of patients for the first 7 days after admission or until hospital discharge , whichever came first . The mean proportion of time spent lying , sitting , and st and ing or walking  was determined for each hour after hospital admission using a previously vali date d algorithm . RESULTS Forty-five male patients ( mean age 74.2 ) with a mean length of stay of 5.1 days generated 2,592 one-hour periods of data . A baseline functional assessment indicated that 35 ( 77.8 % ) study patients were willing and able to walk a short distance independently . No patient remained in bed the entire measured hospital stay , but on average , 83 % of the measured hospital stay was spent lying in bed . The average amount of time that any one individual spent st and ing or walking ranged from a low of 0.2 % to a high of 21 % , with a median of 3 % , or 43 minutes per day . CONCLUSION This is the first study to continuously monitor mobility levels early during a hospital stay . On average , older hospitalized patients spent most of their time lying in bed , despite an ability to walk independently BACKGROUND The aim of this trial was to compare multimodal optimization with conventional perioperative management in a consecutive series of patients undergoing gastrectomy procedures . METHODS According to r and omized controlled studies and conclusions made by meta-analyses in colorectal surgery , optimized perioperative measures were design ed and applied in gastrectomy surgery . Thirty-three patients were r and omized to the optimized group and 30 patients to a control group .  Two groups were treated in 1 center by a single surgical team in different wards . Both groups used patient-controlled intravenous analgesia for postoperative analgesia . The primary end point was length of postoperative hospital stay . Secondary outcomes included bowel function recovery after surgery , perioperative changes of inflammatory factors , glucocorticoid , insulin resistance , and body composition . Perioperative complications and adverse events were also recorded . RESULTS The groups were similar in terms of age , sex ratio , and Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity ( POSSUM score ) . The optimized group was associated with a significantly shorter postoperative hospital stay compared with the conventional care group ( P < .001 ) . Duration s of urinary catheterization and abdominal drainage were also less ( P < .001 ) . The diet program in the optimization group was well tolerated and was associated with an earlier recovery of gut function ( P < .001 ) . Proinflammatory factors were less elevated and body composition was more stable in the optimized group than in controls . There were no differences in morbidity or mortality between the groups . CONCLUSIONS Optimization of care in gastrectomy can shorten postoperative hospital stay and provides multiple beneficial outcomes , including hastening the return of gut function , without increasing morbidity We determined whether essential amino acid and carbohydrate supplementation could offset the catabolic response to prolonged inactivity . Major outcome measures included mixed muscle fractional synthetic rate ( FSR ) , phenylalanine net balance , lean leg mass , and leg extension strength . On d 1 and 28 , vastus lateralis muscle biopsies and femoral arterio-venous blood sample s were obtained during a primed constant infusion of l-[ring-(2)H(5)]phenylalanine .  Net balance and FSR were calculated over 16 h , during which the control group ( CON ) received a nutritionally mixed meal every 5 h ( 0830 , 1330 , and 1830 h ) . The experimental group ( EXP ) also consumed 16.5 g essential amino acids and 30 g carbohydrate ( 1100 , 1600 , and 2100 h ) . The dietary regimen was maintained during bedrest .  FSR was higher in the EXP group on d 1 ( EXP , 0.099 + /- 0.008%/h ; CON : 0.075 + /- 0.005%/h ) and d 28 ( EXP , 0.093 + /- 0.006%/h ; CON , 0.055 + /- 0.007%/h ) . Lean leg mass was maintained throughout bedrest in the EXP group ( + 0.2 + /- 0.3 kg ) , but fell in the CON group ( -0.4 + /- 0.1 kg ) . Strength loss was more pronounced in the CON group ( EXP , -8.8 + /- 1.4 kg ; CON , -17.8 + /- 4.4 kg ) . Essential amino acid and carbohydrate supplementation may represent a viable intervention for individuals at risk of sarcopenia due to immobility or prolonged bedrest Background Lack of appropriate reporting of method ological details has previously been shown to distort risk of bias assessment s in r and omized controlled trials . The same might be true for observational studies . The goal of this study was to compare the Newcastle-Ottawa Scale ( NOS ) assessment for risk of bias between review ers and authors of cohort studies included in a published systematic review on risk factors for severe outcomes in patients infected with influenza . Methods Cohort studies included in the systematic review and published between 2008–2011 were included . The corresponding or first authors completed a survey covering all NOS items . Results were compared with the NOS assessment applied by review ers of the systematic review . Inter-rater 
    Output:
    
agent
In conclusion , decrease in muscle strength and muscle mass in older patients is dependent on the type of admission .
HIGHLIGHTSPhysical inactivity during hospitalization is associated with detrimental outcome .Muscle strength and muscle mass decreased in electively admitted older patients .Muscle strength and muscle mass did not change in acutely admitted older patients
***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 Inflammation is the main cause of disease-associated muscle wasting . In a previous single blind study we have demonstrated improved recovery of muscle endurance following celecoxib treatment in hospitalized geriatric patients with acute infection . Here we further evaluate NSAID treatment with piroxicam in a double blind RCT and investigate the role of cytokines and heat shock proteins ( Hsp ) with respect to muscle performance . We hypothesized that NSAID treatment would preserve muscle performance better than antibiotic treatment alone , by reducing infection-associated inflammation and by increasing expression of cytoprotective Hsp . Methods Consecutive admissions to the geriatric ward were screened . 30 Caucasian patients , median age 84.5 years , with acute infection-induced inflammation and serum levels of CRP > 10 mg/L were included and r and omized to active treatment with 10 mg piroxicam daily or placebo . Assessment comprised general clinical and biochemical parameters , 25 cytokines in serum , intra- and extracellular Hsp27 and Hsp70 , Elderly Mobility Scale ( EMS ) scores , grip strength ( GS ) , fatigue resistance ( FR ) and lean body mass ( LBM ) . Patients were evaluated until discharge with a maximum of 3 weeks after treatment allocation . Results EMS scores , FR and grip work ( GW ) , a measure taking into account GS and FR , significantly improved with piroxicam , but not with placebo . Early decreases in IL-6 serum levels with piroxicam correlated with better muscle performance at week 2 . Basal expression of Hsp27 in monocytes without heat challenge ( WHC ) was positively correlated with FR at baseline and significantly increased by treatment with piroxicam compared to placebo . Profound modifications in the relationships between cytokines or Hsp and changes in muscle parameters were observed in the piroxicam group . Conclusions Piroxicam improves clinical ly relevant measures of muscle performance and mobility in geriatric patients hospitalized with acute infection-induced inflammation . Underlying mechanisms may include modifications in the cytokine network and increases in monocytic expression of cytoprotective Hsp27.Trial registration numberIS RCT N : IS RCT Background / Objectives : This study aims to increase knowledge regarding the association of sarcopenia with hospitalization costs among a wide-ranging sample of adult hospitalized patients .Subjects/ Methods : A prospect i ve study was conducted among hospitalized adult patients . Sarcopenia was identified according to the European Working Group on Sarcopenia in Older People , as low muscle mass , assessed by bioelectrical impedance analysis and low muscle function evaluated by h and grip strength .  Hospitalization cost was calculated for each patient based on discharge diagnosis-related group codes and determined on the basis of a relative weight value . Costs were defined as the percentage of deviation from the cost of a patient with a relative weight equal to one . Multivariable linear regression models were performed to identify the factors independently associated with hospitalization costs . Results : A total of 656 hospitalized patients aged ⩾18 years ( 24.2 % sarcopenic ) composed the study sample . Sarcopenia increased hospitalization costs by [ euro ] 1240 ( 95 % confidence interval ( CI ) : [ euro ] 596–1887 ) for patients aged < 65 years and [ euro ] 721 ( 95 % CI : [ euro ] 13–1429 ) for patients aged ⩾65 years . Sarcopenic overweight was related to an increase in hospitalization costs of [ euro ] 884 ( 95 % CI : [ euro ] 295–1476 ) . Conclusions : Sarcopenia is independently related to hospitalization costs . This condition is estimated to increase hospitalization costs by 58.5 % for patients aged < 65 years and 34 % for patients aged ⩾65 years BACKGROUND Acute inflammation has a negative effect on the muscular system in elderly patients , compromising the outcome of the underlying disease . OBJECTIVE The aim of this study was to evaluate the effect of cyclooxygenase-2 ( COX-2 ) inhibition on muscle performance and mobility in hospitalized elderly patients with acute inflammation of infectious origin . METHODS In this single-blind , controlled trial , consecutively hospitalized elderly patients ( age > or = 70 years ) with inflammation ( C-reactive protein [ CRP ] levels > or = 10 mg/L ) due to acute infection were r and omly assigned to receive 2 weeks of treatment with the COX-2-selective inhibitor celecoxib , acetaminophen , or no supplementary medication ( control ) . The following variables were assessed at baseline and at 1 and 2 weeks ' follow-up : muscle fatigue resistance ( primary outcome measure ) ; grip strength and mobility ( secondary outcome measures ) ; and levels of the acute-phase markers CRP , interleukin (IL)-1beta , IL-6 , IL-10 , tumor necrosis factor-alpha ( TNF-alpha ) , and transforming growth factor-beta ( TGF-beta ) as explanatory variables . RESULTS Forty-three consecutively hospitalized elderly patients ( 31 women , 12 men ; mean [ SD ] age , 84 [ 6 ] years ) were enrolled . Fourteen patients received celecoxib , 14 received acetaminophen , and 15 received no supplementary medication . The change in fatigue resistance was significantly different between groups ( P = 0.021 , Kruskal-Wallis chi-square test ) , with significantly greater improvement in patients receiving celecoxib compared with the acetaminophen and control groups ( 63 % increase from baseline ; P < 0.05 ) . There were no significant between-group differences in changes in grip strength , mobility , IL-1beta , IL-6 , TNF-alpha , or TGF-beta . The changes in levels of IL-10 differed significantly between groups ( P = 0.020 , Kruskal-Wallis chi-square test ) , with greater improvement in the celecoxib group compared with the acetaminophen group ( P = 0.032 ) . CONCLUSION The results of this study suggest that COX-2-selective inhibition has a beneficial effect on muscle fatigue resistance in hospitalized elderly patients with acute inflammation of infectious origin . However , until further trials are conducted , the use of COX-2-selective inhibitors for this indication is not recommended The aim of this trial was to compare  multimodal optimization  with  conventional perioperative management  in a consecutive series of patients undergoing a wide range of colorectal procedures Objective : Postoperatively patients have a reduction in nutritional intake and body weight . We studied the effect of postoperative physical training on nutritional intake and body composition . Methods : Patients ⩾60 y admitted for elective colorectal surgery were  r and omised to train muscular strength ( group A ) or to nonstrengthening exercises ( group B ) for 3 months  . Fat mass ( FM ) and lean body mass ( LBM ) were assessed with bioimpedance preoperatively , 7 , 30 , and 90 days postoperatively . Nutritional intake was registered in a sub population . Results : Of 119 included patients , 60 were r and omised to group A and 59 to B. The changes in LBM at postoperative day 7 were a mean ( s.d . ) of 0.4 ( 2.1 ) kg in group A compared to −0.7 ( 2.0 ) kg in B. The difference between groups of 1.2 ( 0.5 ) kg at day 7 was statistically significant ( P=0.03 ) . At no other time was observed difference between groups in weight , LBM , or FM . The energy and protein intake rose during postoperative day 1–7 and rose further after discharge . At no time were differences between groups . Conclusion : Physical training had little effect on body composition following abdominal surgery . The nutritional intake in well-nourished patients did not increase by training OBJECTIVES To examine the proportion of time spent in three levels of mobility ( lying , sitting , and st and ing or walking ) by a cohort of hospitalized older veterans as measured by vali date d wireless accelerometers . DESIGN A prospect i ve , observational cohort study . SETTING One hundred fifty-bed Department of Veterans Affairs hospital . PARTICIPANTS Forty-five hospitalized medical patients , aged 65 and older who were not delirious , did not have dementia , and were able to walk in the 2 weeks before admission were eligible . MEASUREMENTS Wireless accelerometers were attached to the thigh and ankle of patients for the first 7 days after admission or until hospital discharge , whichever came first . The mean proportion of time spent lying , sitting , and st and ing or walking  was determined for each hour after hospital admission using a previously vali date d algorithm . RESULTS Forty-five male patients ( mean age 74.2 ) with a mean length of stay of 5.1 days generated 2,592 one-hour periods of data . A baseline functional assessment indicated that 35 ( 77.8 % ) study patients were willing and able to walk a short distance independently . No patient remained in bed the entire measured hospital stay , but on average , 83 % of the measured hospital stay was spent lying in bed . The average amount of time that any one individual spent st and ing or walking ranged from a low of 0.2 % to a high of 21 % , with a median of 3 % , or 43 minutes per day . CONCLUSION This is the first study to continuously monitor mobility levels early during a hospital stay . On average , older hospitalized patients spent most of their time lying in bed , despite an ability to walk independently BACKGROUND The aim of this trial was to compare multimodal optimization with conventional perioperative management in a consecutive series of patients undergoing gastrectomy procedures . METHODS According to r and omized controlled studies and conclusions made by meta-analyses in colorectal surgery , optimized perioperative measures were design ed and applied in gastrectomy surgery . Thirty-three patients were r and omized to the optimized group and 30 patients to a control group .  Two groups were treated in 1 center by a single surgical team in different wards . Both groups used patient-controlled intravenous analgesia for postoperative analgesia . The primary end point was length of postoperative hospital stay . Secondary outcomes included bowel function recovery after surgery , perioperative changes of inflammatory factors , glucocorticoid , insulin resistance , and body composition . Perioperative complications and adverse events were also recorded . RESULTS The groups were similar in terms of age , sex ratio , and Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity ( POSSUM score ) . The optimized group was associated with a significantly shorter postoperative hospital stay compared with the conventional care group ( P < .001 ) . Duration s of urinary catheterization and abdominal drainage were also less ( P < .001 ) . The diet program in the optimization group was well tolerated and was associated with an earlier recovery of gut function ( P < .001 ) . Proinflammatory factors were less elevated and body composition was more stable in the optimized group than in controls . There were no differences in morbidity or mortality between the groups . CONCLUSIONS Optimization of care in gastrectomy can shorten postoperative hospital stay and provides multiple beneficial outcomes , including hastening the return of gut function , without increasing morbidity We determined whether essential amino acid and carbohydrate supplementation could offset the catabolic response to prolonged inactivity . Major outcome measures included mixed muscle fractional synthetic rate ( FSR ) , phenylalanine net balance , lean leg mass , and leg extension strength . On d 1 and 28 , vastus lateralis muscle biopsies and femoral arterio-venous blood sample s were obtained during a primed constant infusion of l-[ring-(2)H(5)]phenylalanine .  Net balance and FSR were calculated over 16 h , during which the control group ( CON ) received a nutritionally mixed meal every 5 h ( 0830 , 1330 , and 1830 h ) . The experimental group ( EXP ) also consumed 16.5 g essential amino acids and 30 g carbohydrate ( 1100 , 1600 , and 2100 h ) . The dietary regimen was maintained during bedrest .  FSR was higher in the EXP group on d 1 ( EXP , 0.099 + /- 0.008%/h ; CON : 0.075 + /- 0.005%/h ) and d 28 ( EXP , 0.093 + /- 0.006%/h ; CON , 0.055 + /- 0.007%/h ) . Lean leg mass was maintained throughout bedrest in the EXP group ( + 0.2 + /- 0.3 kg ) , but fell in the CON group ( -0.4 + /- 0.1 kg ) . Strength loss was more pronounced in the CON group ( EXP , -8.8 + /- 1.4 kg ; CON , -17.8 + /- 4.4 kg ) . Essential amino acid and carbohydrate supplementation may represent a viable intervention for individuals at risk of sarcopenia due to immobility or prolonged bedrest Background Lack of appropriate reporting of method ological details has previously been shown to distort risk of bias assessment s in r and omized controlled trials . The same might be true for observational studies . The goal of this study was to compare the Newcastle-Ottawa Scale ( NOS ) assessment for risk of bias between review ers and authors of cohort studies included in a published systematic review on risk factors for severe outcomes in patients infected with influenza . Methods Cohort studies included in the systematic review and published between 2008–2011 were included . The corresponding or first authors completed a survey covering all NOS items . Results were compared with the NOS assessment applied by review ers of the systematic review . Inter-rater 
    Output:
    