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: The objective of this study was to create a 5-year survivorship model to identify key clinical features of cystic fibrosis . Such a model could help research ers and clinicians to evaluate therapies , improve the design of prospect i ve studies , monitor practice patterns , counsel individual patients , and determine the best c and i date s for lung transplantation . The authors used information from the Cystic Fibrosis Foundation Patient Registry ( CFFPR ) , which has collected longitudinal data on approximately 90 % of cystic fibrosis patients diagnosed in the United States since 1986 . They developed multivariate logistic regression models by using data on 5,820 patients r and omly selected from 11,630 in the CFFPR in 1993 . Models were tested for goodness of fit and were vali date d for the remaining 5,810 patients for 1993 . The vali date d 5-year survivorship model included age , forced expiratory volume in 1 second as a percentage of predicted normal , gender , weight-for-age z score , pancreatic sufficiency , diabetes mellitus , Staphylococcus aureus infection , Burkerholderia cepacia infection , and annual number of acute pulmonary exacerbations . The model provides insights into the complex nature of cystic fibrosis and supplies a rigorous tool for clinical practice and research AIM The aim of this study was to evaluate whether the previously observed changes in the fatty acid profile , as a result of DHA supplementation , could be maintained during longer study trials and to observe its effect on the clinical outcome of cystic fibrosis ( CF ) patients . METHOD A year-long double-blind placebo-controlled study was performed in DeltaF508 homozygous CF patients above the age of 6 . Clinical data , including pulmonary function and number of infections , were collected . Blood for the determination of the fatty acid ( FA ) composition of serum phospholipid , vitamin E , liver enzymes , immunoglobulins , erythrocyte sedimentation rate and coagulation was drawn at the beginning and then every 6 months after the start of the study . RESULTS Seventeen patients were included ; one dropped out . The treatment group was supplemented with an algal DHA-rich oil and the control group with sunflower seed oil . There was no difference between the control and treatment groups for W/H% , caloric intake , FEV1 % and FVC% at the start of the study and after 1 year of supplements . The phospholipid FA composition did not change in the control group . The treatment group had a significant increase in DHA and eicosapentaenoic acid ( EPA ) concentration . A concomitant decrease of dihomo-gammalinolenic acid , arachidonic acid , 22:5 n-6 and Mead acid was observed . The laboratory results showed no changes in vitamin E level , liver enzymes , albumin , erythrocyte sedimentation rate and IgG concentration in either the placebo or the intervention group . CONCLUSION Although DHA-rich oil shifted the serum phospholipid FAs to a less pro-inflammatory profile , no conclusive clinical improvement could be observed so far Essential fatty acid deficiency as a result of inadequate linoleic acid impairs growth in healthy infants and is common in infants with malabsorption due to cystic fibrosis ( CF ) . We investigated the effect of dietary linoleic acid intake on the growth of infants with CF . In this study , predigested formula preparations A and B , with linoleic acid contents of 12 % and 7 % of energy , respectively , were fed before and after 1989 to infants enrolled in the evaluation and treatment protocol of the Wisconsin CF Neonatal Screening Project . Outcome was assessed from height-for-age ( HAZ ) and weight-for-age ( WAZ ) Z scores on follow-up exams during the first year . Baseline characteristics did not differ significantly between groups A ( n = 43 ) and B ( n = 33 ) . At diagnosis , 53 % of the enrolled infants ( n = 76 ) showed low plasma linoleic acid concentrations and 22 % had a high ratio of triene to tetraene . After correcting for the effect of potentially confounding variables , we found that HAZ ( by .27 , P < 0.05 ) and WAZ ( by 0.26 , P = 0.081 ) were higher in group A than in group B. This occurred despite a significantly higher energy intake in group B. This difference was most pronounced between 6 and 9 mo of age . Our results suggest that a high linoleic acid content in formula benefits infants with CF because it optimizes nutrition , growth , and feeding efficiency BACKGROUND Oxidative stress , as measured by 8-iso-prostagl and in F(2)(alpha ) ( 8-iso-PGF(2)(alpha ) ) , and depleted antioxidant defenses were shown in stable cystic fibrosis ( CF ) patients . The plasma fatty acid status of CF patients was linked to oxidative stress after respiratory exacerbations . OBJECTIVE We examined changes in plasma 8-iso-PGF(2)(alpha ) , antioxidant defenses , plasma fatty acid status , and clinical markers result ing from short-term antioxidant supplementation . DESIGN Forty-six CF patients were r and omly assigned to either group A [ low dose of supplement ( 10 mg vitamin E and 500 micro g vitamin A ) ] or group B [ high dose of supplement ( 200 mg vitamin E , 300 mg vitamin C , 25 mg beta-carotene , 90 micro g Se , and 500 micro g vitamin A ) ] . Plasma concentrations of 8-iso-PGF(2)(alpha ) , vitamins E and C , beta-carotene , zinc , selenium , and copper ; plasma fatty acid composition ; erythrocyte glutathione peroxidase ( EC 1.11.1.9 ) and superoxide dismutase ( EC 1.15.1.1 ) activities ; lung function ; and dietary intake were measured before and after 8 wk of supplementation . RESULTS Antioxidant defenses in group B improved , whereas those in group A did not : in groups B and A , the mean ( + /- SEM ) changes ( Delta ) in vitamin E were 10.6 + /- 1.5 and -1.9 + /- 0.9 micro mol/L , respectively ( P < 0.001 ) , (Delta)beta-carotene were 0.1 + /- 0.04 and -0.01 + /- 0.02 micro mol/L , respectively ( P = 0.007 ) , (Delta)selenium were 0.51 + /- 0.10 and -0.09 + /- 0.04 micro mol/L , respectively ( P < 0.001 ) , and (Delta)glutathione peroxidase activity were 1.3 + /- 0.3 and -0.3 + /- 0.6 U/g hemoglobin , respectively ( P = 0.016 ) . There were no significant differences between the groups in Delta8-iso-PGF(2)(alpha ) , (Delta)vitamin C , (Delta)fatty acid composition , (Delta)superoxide dismutase activity , (Delta)lung function , or (Delta)white cell count . Within group B , (Delta)beta-carotene correlated with (Delta)percentage of forced vital capacity ( r = 0.586 , P = 0.005 ) , (Delta)selenium correlated with (Delta)percentage of forced expiratory volume in 1 s ( r = 0.440 , P = 0.046 ) , and (Delta)plasma fatty acid concentrations correlated with (Delta)percentage of forced expiratory volume in 1 s ( r = 0.583 , P = 0.006 ) and Delta8-iso-PGF(2)(alpha ) ( r = 0.538 , P = 0.010 ) . CONCLUSIONS Whereas increased beta-carotene , selenium , and fatty acid concentrations are linked to improved lung function , increased plasma fatty acid concentrations are linked to oxidative stress . If oxidative stress is deemed to be important to the clinical outcome of CF patients , means of reducing oxidative stress while maintaining a high-fat , high-energy diet must be investigated Background It is possible that cross-over studies included in current systematic review s are being inadequately assessed , because the current risk of bias tools do not consider possible biases specific to cross-over design . We performed this study to evaluate whether this was being done in  cross-over studies included in Cochrane  Systematic Review s ( CSRs ) . Methods We search ed the Cochrane Library ( up to 2013 issue 5 ) for CSRs that included at least one cross-over trial . Two authors independently undertook the study selection and data extraction . A r and om sample of the CSRs was selected and we evaluated whether the cross-over trials in these CSRs were assessed according to criteria suggested by the Cochrane h and book . In addition we reassessed the risk of bias of these cross-over trials by a checklist developed form the Cochrane h and book . Results We identified 688 CSRs that included one or more cross-over studies . We chose a r and om sample of 60 CSRs and these included 139 cross-over studies . None of these CSRs undertook a risk of bias assessment specific for cross-over studies . In fact items specific for cross-over studies were seldom considered anywhere in quality assessment of these CSRs . When we reassessed the risk of bias , including the 3 items specific to cross-over trials , of these 139 studies , a low risk of bias was judged for appropriate cross-over design in 110(79 % ) , carry-over effects in 48(34 % ) and for reporting data in all stages of the trial in 114(82 % ) . Assessment of biases in cross-over trials could affect the GRADE assessment of a review ’s findings . Conclusion The current Cochrane risk of bias tool is not adequate to assess cross-over studies . Items specific to cross-over trials leading to potential risk of bias are generally neglected in CSRs . A proposed check list for the evaluation of cross-over trials is provided OBJECTIVES To compare the absorption of a lysophosphatidylcholine , monoglyceride , and fatty acid matrix ( organized lipid matrix , OLM ) with that of a triacylglycerol (TG)-based fat meal in patients with cystic fibrosis ( CF ) . STUDY DESIGN Five adolescents with CF and 3 control patients were given fat meals supplemented with retinyl palmitate of either OLM or TG at a 2-week interval . In a clinical trial , 73 patients with CF were r and omly assigned to nutritional supplements containing either OLM or TG for a 1-year double-blind trial followed by a 6-month observation period . RESULTS The peak increases and areas under the curve for TG and retinyl palmitate after the fat meal were 10-fold higher after OLM than after the TG fat load and did not differ from values obtained in control patients . OLM led to better clinical outcomes in terms of energy intake from the diet , weight-for-age Z score , essential fatty acid status , vitamin E , and retinol binding protein . Height-for-age Z score and FEV(1 ) only reached statistical significance at the end of the 6-month observation period . CONCLUSIONS These results suggest that OLM is a readily absorbable source of fat and energy in CF and is an effective nutritional supplement Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more BACKGROUND : Children with cystic fibrosis may have a deficiency of micronutrients , including zinc , which may affect their susceptibility to infections . There is a paucity of data on zinc supplementation among children with cystic fibrosis . We hypothesized that a pharmacologic dose of zinc administered daily for 12 months would reduce the need for antibiotics by 50 % . METHODS : This double-blind r and omized placebo-controlled trial was conducted among children with cystic fibrosis to assess the effect of zinc supplementation on the need for antibiotics and pulmonary function tests .  The children , age 5–15 y , of either sex , received either 30-mg zinc tablets or similar looking placebo tablets daily in addition to st and ard care . They were followed up every month for a period of 12 months and whenever they had pulmonary exacerbations . Their serum zinc was estimated at baseline and at 12 months of enrollment . During each visit , the children underwent a pulmonary function test and sputum culture . RESULTS : Of a total of 43 children screened , 40 were enrolled , and of them , 37 completed the study . The median ( interquartile range ) number of days of the administration of antibiotics over 12 months of follow-up among the children receiving zinc was 42 ( 14–97 ) d. In the placebo group , it was 38 ( 15–70 ) d ( P = .79 ) . There were no significant differences in the percent-of-predicted FEV1 or change in FEV1 values at 12 months ( P = .44 ) . The number of children in whose respiratory specimens Pseudomonas was isolated was similar for the 2 groups at different time intervals . The adverse events reported were similar in the 2 groups . CONCLUSION : We did not find any significant difference in the need for antibiotics , pulmonary function tests , hospitalization , colonization with Pseudomonas , or the need for antibiotics for 
    Output:
    
agent
The benefits of antioxidants or DHA/EPA supplementation for CF , although observed in some studies , are not consistent enough to recommend routine use of these supplements .
***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: The objective of this study was to create a 5-year survivorship model to identify key clinical features of cystic fibrosis . Such a model could help research ers and clinicians to evaluate therapies , improve the design of prospect i ve studies , monitor practice patterns , counsel individual patients , and determine the best c and i date s for lung transplantation . The authors used information from the Cystic Fibrosis Foundation Patient Registry ( CFFPR ) , which has collected longitudinal data on approximately 90 % of cystic fibrosis patients diagnosed in the United States since 1986 . They developed multivariate logistic regression models by using data on 5,820 patients r and omly selected from 11,630 in the CFFPR in 1993 . Models were tested for goodness of fit and were vali date d for the remaining 5,810 patients for 1993 . The vali date d 5-year survivorship model included age , forced expiratory volume in 1 second as a percentage of predicted normal , gender , weight-for-age z score , pancreatic sufficiency , diabetes mellitus , Staphylococcus aureus infection , Burkerholderia cepacia infection , and annual number of acute pulmonary exacerbations . The model provides insights into the complex nature of cystic fibrosis and supplies a rigorous tool for clinical practice and research AIM The aim of this study was to evaluate whether the previously observed changes in the fatty acid profile , as a result of DHA supplementation , could be maintained during longer study trials and to observe its effect on the clinical outcome of cystic fibrosis ( CF ) patients . METHOD A year-long double-blind placebo-controlled study was performed in DeltaF508 homozygous CF patients above the age of 6 . Clinical data , including pulmonary function and number of infections , were collected . Blood for the determination of the fatty acid ( FA ) composition of serum phospholipid , vitamin E , liver enzymes , immunoglobulins , erythrocyte sedimentation rate and coagulation was drawn at the beginning and then every 6 months after the start of the study . RESULTS Seventeen patients were included ; one dropped out . The treatment group was supplemented with an algal DHA-rich oil and the control group with sunflower seed oil . There was no difference between the control and treatment groups for W/H% , caloric intake , FEV1 % and FVC% at the start of the study and after 1 year of supplements . The phospholipid FA composition did not change in the control group . The treatment group had a significant increase in DHA and eicosapentaenoic acid ( EPA ) concentration . A concomitant decrease of dihomo-gammalinolenic acid , arachidonic acid , 22:5 n-6 and Mead acid was observed . The laboratory results showed no changes in vitamin E level , liver enzymes , albumin , erythrocyte sedimentation rate and IgG concentration in either the placebo or the intervention group . CONCLUSION Although DHA-rich oil shifted the serum phospholipid FAs to a less pro-inflammatory profile , no conclusive clinical improvement could be observed so far Essential fatty acid deficiency as a result of inadequate linoleic acid impairs growth in healthy infants and is common in infants with malabsorption due to cystic fibrosis ( CF ) . We investigated the effect of dietary linoleic acid intake on the growth of infants with CF . In this study , predigested formula preparations A and B , with linoleic acid contents of 12 % and 7 % of energy , respectively , were fed before and after 1989 to infants enrolled in the evaluation and treatment protocol of the Wisconsin CF Neonatal Screening Project . Outcome was assessed from height-for-age ( HAZ ) and weight-for-age ( WAZ ) Z scores on follow-up exams during the first year . Baseline characteristics did not differ significantly between groups A ( n = 43 ) and B ( n = 33 ) . At diagnosis , 53 % of the enrolled infants ( n = 76 ) showed low plasma linoleic acid concentrations and 22 % had a high ratio of triene to tetraene . After correcting for the effect of potentially confounding variables , we found that HAZ ( by .27 , P < 0.05 ) and WAZ ( by 0.26 , P = 0.081 ) were higher in group A than in group B. This occurred despite a significantly higher energy intake in group B. This difference was most pronounced between 6 and 9 mo of age . Our results suggest that a high linoleic acid content in formula benefits infants with CF because it optimizes nutrition , growth , and feeding efficiency BACKGROUND Oxidative stress , as measured by 8-iso-prostagl and in F(2)(alpha ) ( 8-iso-PGF(2)(alpha ) ) , and depleted antioxidant defenses were shown in stable cystic fibrosis ( CF ) patients . The plasma fatty acid status of CF patients was linked to oxidative stress after respiratory exacerbations . OBJECTIVE We examined changes in plasma 8-iso-PGF(2)(alpha ) , antioxidant defenses , plasma fatty acid status , and clinical markers result ing from short-term antioxidant supplementation . DESIGN Forty-six CF patients were r and omly assigned to either group A [ low dose of supplement ( 10 mg vitamin E and 500 micro g vitamin A ) ] or group B [ high dose of supplement ( 200 mg vitamin E , 300 mg vitamin C , 25 mg beta-carotene , 90 micro g Se , and 500 micro g vitamin A ) ] . Plasma concentrations of 8-iso-PGF(2)(alpha ) , vitamins E and C , beta-carotene , zinc , selenium , and copper ; plasma fatty acid composition ; erythrocyte glutathione peroxidase ( EC 1.11.1.9 ) and superoxide dismutase ( EC 1.15.1.1 ) activities ; lung function ; and dietary intake were measured before and after 8 wk of supplementation . RESULTS Antioxidant defenses in group B improved , whereas those in group A did not : in groups B and A , the mean ( + /- SEM ) changes ( Delta ) in vitamin E were 10.6 + /- 1.5 and -1.9 + /- 0.9 micro mol/L , respectively ( P < 0.001 ) , (Delta)beta-carotene were 0.1 + /- 0.04 and -0.01 + /- 0.02 micro mol/L , respectively ( P = 0.007 ) , (Delta)selenium were 0.51 + /- 0.10 and -0.09 + /- 0.04 micro mol/L , respectively ( P < 0.001 ) , and (Delta)glutathione peroxidase activity were 1.3 + /- 0.3 and -0.3 + /- 0.6 U/g hemoglobin , respectively ( P = 0.016 ) . There were no significant differences between the groups in Delta8-iso-PGF(2)(alpha ) , (Delta)vitamin C , (Delta)fatty acid composition , (Delta)superoxide dismutase activity , (Delta)lung function , or (Delta)white cell count . Within group B , (Delta)beta-carotene correlated with (Delta)percentage of forced vital capacity ( r = 0.586 , P = 0.005 ) , (Delta)selenium correlated with (Delta)percentage of forced expiratory volume in 1 s ( r = 0.440 , P = 0.046 ) , and (Delta)plasma fatty acid concentrations correlated with (Delta)percentage of forced expiratory volume in 1 s ( r = 0.583 , P = 0.006 ) and Delta8-iso-PGF(2)(alpha ) ( r = 0.538 , P = 0.010 ) . CONCLUSIONS Whereas increased beta-carotene , selenium , and fatty acid concentrations are linked to improved lung function , increased plasma fatty acid concentrations are linked to oxidative stress . If oxidative stress is deemed to be important to the clinical outcome of CF patients , means of reducing oxidative stress while maintaining a high-fat , high-energy diet must be investigated Background It is possible that cross-over studies included in current systematic review s are being inadequately assessed , because the current risk of bias tools do not consider possible biases specific to cross-over design . We performed this study to evaluate whether this was being done in  cross-over studies included in Cochrane  Systematic Review s ( CSRs ) . Methods We search ed the Cochrane Library ( up to 2013 issue 5 ) for CSRs that included at least one cross-over trial . Two authors independently undertook the study selection and data extraction . A r and om sample of the CSRs was selected and we evaluated whether the cross-over trials in these CSRs were assessed according to criteria suggested by the Cochrane h and book . In addition we reassessed the risk of bias of these cross-over trials by a checklist developed form the Cochrane h and book . Results We identified 688 CSRs that included one or more cross-over studies . We chose a r and om sample of 60 CSRs and these included 139 cross-over studies . None of these CSRs undertook a risk of bias assessment specific for cross-over studies . In fact items specific for cross-over studies were seldom considered anywhere in quality assessment of these CSRs . When we reassessed the risk of bias , including the 3 items specific to cross-over trials , of these 139 studies , a low risk of bias was judged for appropriate cross-over design in 110(79 % ) , carry-over effects in 48(34 % ) and for reporting data in all stages of the trial in 114(82 % ) . Assessment of biases in cross-over trials could affect the GRADE assessment of a review ’s findings . Conclusion The current Cochrane risk of bias tool is not adequate to assess cross-over studies . Items specific to cross-over trials leading to potential risk of bias are generally neglected in CSRs . A proposed check list for the evaluation of cross-over trials is provided OBJECTIVES To compare the absorption of a lysophosphatidylcholine , monoglyceride , and fatty acid matrix ( organized lipid matrix , OLM ) with that of a triacylglycerol (TG)-based fat meal in patients with cystic fibrosis ( CF ) . STUDY DESIGN Five adolescents with CF and 3 control patients were given fat meals supplemented with retinyl palmitate of either OLM or TG at a 2-week interval . In a clinical trial , 73 patients with CF were r and omly assigned to nutritional supplements containing either OLM or TG for a 1-year double-blind trial followed by a 6-month observation period . RESULTS The peak increases and areas under the curve for TG and retinyl palmitate after the fat meal were 10-fold higher after OLM than after the TG fat load and did not differ from values obtained in control patients . OLM led to better clinical outcomes in terms of energy intake from the diet , weight-for-age Z score , essential fatty acid status , vitamin E , and retinol binding protein . Height-for-age Z score and FEV(1 ) only reached statistical significance at the end of the 6-month observation period . CONCLUSIONS These results suggest that OLM is a readily absorbable source of fat and energy in CF and is an effective nutritional supplement Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more BACKGROUND : Children with cystic fibrosis may have a deficiency of micronutrients , including zinc , which may affect their susceptibility to infections . There is a paucity of data on zinc supplementation among children with cystic fibrosis . We hypothesized that a pharmacologic dose of zinc administered daily for 12 months would reduce the need for antibiotics by 50 % . METHODS : This double-blind r and omized placebo-controlled trial was conducted among children with cystic fibrosis to assess the effect of zinc supplementation on the need for antibiotics and pulmonary function tests .  The children , age 5–15 y , of either sex , received either 30-mg zinc tablets or similar looking placebo tablets daily in addition to st and ard care . They were followed up every month for a period of 12 months and whenever they had pulmonary exacerbations . Their serum zinc was estimated at baseline and at 12 months of enrollment . During each visit , the children underwent a pulmonary function test and sputum culture . RESULTS : Of a total of 43 children screened , 40 were enrolled , and of them , 37 completed the study . The median ( interquartile range ) number of days of the administration of antibiotics over 12 months of follow-up among the children receiving zinc was 42 ( 14–97 ) d. In the placebo group , it was 38 ( 15–70 ) d ( P = .79 ) . There were no significant differences in the percent-of-predicted FEV1 or change in FEV1 values at 12 months ( P = .44 ) . The number of children in whose respiratory specimens Pseudomonas was isolated was similar for the 2 groups at different time intervals . The adverse events reported were similar in the 2 groups . CONCLUSION : We did not find any significant difference in the need for antibiotics , pulmonary function tests , hospitalization , colonization with Pseudomonas , or the need for antibiotics for 
    Output:
    