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 OBJECTIVES To investigate whether systemic inflammation in acutely admitted older medical patients ( age > 65 years ) is associated with physical performance and organ dysfunction . Organ dysfunction´s association with physical performance , and whether these associations are mediated by systemic inflammation , was also investigated . METHODS A cross-sectional study in an Emergency Department . Physical performance was assessed by h and grip strength and de Morton Mobility Index  (  DEMMI  ) , and organ dysfunction by FI-OutRef , the number of st and ard blood tests outside the reference range . Systemic inflammation was assessed by  suPAR , TNFα , and IL-6 . Associations were investigated by regression analyses adjusted for age , sex , cognitive impairment , CRP , and VitalPAC Modified Early Warning Score . RESULTS A total of 369 patients were evaluated . In adjusted analyses , suPAR and TNFα was associated with both physical performance measures ( p<0.001- p=0.004 ) , and IL-6 with h and grip strength ( p=0.007 ) . All inflammation biomarkers were associated with FI-OutRef ( p<0.001 ) . FI-OutRef was also associated with physical performance ( all p<0.001 ) ; suPAR being the inflammatory biomarker with the highest impact when adjusting for inflammation . CONCLUSION Inflammatory biomarkers are potentially feasible for systematic assessment of vulnerability . Moreover , suPAR may be an important mediator between organ dysfunction and physical performance 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 QUESTION Among people who are hospitalised for community-acquired pneumonia , does an inpatient exercise-based rehabilitation program improve functional outcomes , symptoms , quality of life and length of hospital stay more than a respiratory physiotherapy regimen ? DESIGN R and omised trial with concealed allocation , intention-to-treat analysis and blinding of some outcomes . PARTICIPANTS Forty-nine adults hospitalised for community-acquired pneumonia . INTERVENTION The experimental group ( n=32 ) underwent a physical training program that included warm-up , stretching , peripheral muscle strength training and walking at a controlled speed for 15 minutes . The control group ( n=17 ) underwent a respiratory physiotherapy regimen that included percussion , vibrocompression , respiratory exercises and free walking . The intervention regimens lasted 8 days . OUTCOME MEASURES The primary outcome was the Glittre Activities of Daily Living test , which assesses the time taken to complete a series of functional tasks ( eg , rising from a chair , walking , stairs , lifting and bending ) . Secondary outcomes were distance walked in the incremental shuttle walk test , peripheral muscle strength , quality of life , dyspnoea , lung function , C-reactive protein and length of hospital stay . Measures were taken 1 day before and 1 day after the intervention period . RESULTS There was greater improvement in the experimental group than in the control group on the Glittre Activities of Daily Living test ( mean between-group difference 39 seconds , 95 % CI 20 to 59 ) and the incremental shuttle walk test ( mean between-group difference 130 m , 95 % CI 77 to 182 ) . There were also significantly greater improvements in quality of life , dyspnoea and peripheral muscle strength in the experimental group than in the control group . There were no between-group differences in lung function , C-reactive protein or length of hospital stay . CONCLUSION The improvement in functional outcomes after an inpatient rehabilitation program was greater than the improvement after st and ard respiratory physiotherapy . The exercise training program led to greater benefits in functional capacity , peripheral muscle strength , dyspnoea and quality of life . REGISTRATION Clinical Trials.gov , NCT02103400 OBJECTIVES To investigate the combined contribution of processes of hospitalization and preadmission individual risk factors in explaining functional decline at discharge and at 1-month follow-up in older adults with nondisabling conditions . DESIGN Prospect i ve cohort study . SETTING Internal medicine wards in two Israeli medical centers . PARTICIPANTS Six hundred eighty-four individuals aged 70 and older admitted for a nondisabling problem . MEASUREMENTS Functional decline was measured according to change in modified Barthel Index from premorbid to discharge and from premorbid to 1 month after discharge .  In-hospital mobility , continence care , sleep medication consumption , satisfaction with hospital environment , and nutrition intake  were assessed using previously tested self-report instruments . RESULTS Two hundred eighty-two participants ( 41.2 % ) reported functional decline at discharge and 317 ( 46.3 % ) at 1 month after discharge . Path analysis indicated that in-hospital mobility ( st and ardized maximum likelihood estimate ( SMLE ) = -0.48 , P < .001 ) , continence care ( SMLE = -0.12 , P < .001 ) , and length of stay ( LOS ) ( SMLE = 0.06 , P < .001 ) were directly related to functional decline at discharge and , together with personal risk factors , explained 64 % of variance . In-hospital mobility , continence care , and LOS were indirectly related to functional decline at 1 month after discharge through functional decline at discharge ( SMLE = 0.45 , P < .001 ) . Nutrition consumption ( SMLE = -0.07 , P < .001 ) was significantly related to functional decline at 1 month after discharge , explaining , together with other risk factors , 32 % of variance . CONCLUSION In-hospital low mobility , suboptimal continence care , and poor nutrition account for immediate and 1-month posthospitalization functional decline . These are potentially modifiable hospitalization risk factors for which practice and policy should be targeted in efforts to curb the posthospitalization functional decline trajectory The impact of oral nutritional supplementation during an acute exacerbation of COPD on functional status was assessed through measuring change in lung function , strength testing , and general well-being .  Subjects hospitalized for an acute exacerbation of COPD ( n = 33 ) were r and omized to extra nutritional support or the regular hospital care . They consumed an additional 10 kcal/kg/d . Outcome measures were measured at 2 wk as change scores . Forced vital capacity ( % predicted ) improved in the treatment group as compared with the control group ( + 8.7 % versus -3.5 % , p = 0.015 ) , and change in FEV1 was in the same direction but not significantly different ( p = 0.099 ) . There were no changes in h and grip strength or respiratory muscle strength , but there was a trend towards more improvement in the general well-being score ( + 11.96 versus -10.25 , p = 0.066 ) . Almost all subjects were in negative nitrogen balance , indicating muscle wasting . The degree of muscle wasting was strongly correlated with the dose of corticosteroids ( r = 0.73 , p < 0.005 ) . In conclusion , it is difficult to prevent important muscle wasting in patients with COPD treated with corticosteroids , but some small gains were observed with increased dietary intake Objective The aim of this work was to evaluate the time course of changes in strength and functional performance in elderly hospitalized medical patients . Design This was a prospect i ve observational study in elderly medical patients of age 65 years or older at a geriatric department . Measurements were obtained on days 2 to 4 , day 5 to 8 , and days 9 to 13 . Functional performance was measured with  De Morton Mobility Index ( DEMMI ) test  and a 30-second chair st and test ( 30-s CST ) . Muscular strength was measured with h and grip strength . Activity level was determined with  accelerometry ( ActivPAL ) . Results Results in DEMMI and 30-s CST gradually improved ( P < 0.05 ) , whereas h and grip strength remained unchanged ( P > 0.05 ) . Larger functional improvements were observed in patients with “ high ” compared to “ low ” and “ moderate ” activity level ( P < 0.05 ) . Changes in DEMMI score correlated with changes in 30-s CST ( P < 0.05 ) ; however , changes in DEMMI score and 30-s CST were more likely to occur in patients with a low versus high functional level , respectively . Conclusions Functional performance of the lower extremities in geriatric patients improves moderately over the time of a hospital stay of less than 14 days , with larger improvements in patients with high activity level . The DEMMI test and the 30-s CST seem to be complementary to each other when evaluating functional changes in a geriatric hospital population . To Cl aim CME Credits Complete the self- assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME Objectives Upon completion of this article , the reader should be able to ( 1 ) describe changes in mobility and muscle strength of geriatric patients during a hospital stay of less than 14 days , ( 2 ) underst and the significance of physical activity during hospital admission in geriatric patients 
    Output:
    
agent
Inflammation appeared to be associated with greater loss of muscle strength .
There was inconclusive evidence that the level of physical activity affects change in skeletal muscle .
In regard to the effect of interventions , only exercise interventions were consistently associated with improved skeletal muscle outcomes .
CONCLUSIONS Adult patients who undergo an unplanned hospital admission may experience a small reduction in knee extension strength and mid-arm muscle mass .
***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 OBJECTIVES To investigate whether systemic inflammation in acutely admitted older medical patients ( age > 65 years ) is associated with physical performance and organ dysfunction . Organ dysfunction´s association with physical performance , and whether these associations are mediated by systemic inflammation , was also investigated . METHODS A cross-sectional study in an Emergency Department . Physical performance was assessed by h and grip strength and de Morton Mobility Index  (  DEMMI  ) , and organ dysfunction by FI-OutRef , the number of st and ard blood tests outside the reference range . Systemic inflammation was assessed by  suPAR , TNFα , and IL-6 . Associations were investigated by regression analyses adjusted for age , sex , cognitive impairment , CRP , and VitalPAC Modified Early Warning Score . RESULTS A total of 369 patients were evaluated . In adjusted analyses , suPAR and TNFα was associated with both physical performance measures ( p<0.001- p=0.004 ) , and IL-6 with h and grip strength ( p=0.007 ) . All inflammation biomarkers were associated with FI-OutRef ( p<0.001 ) . FI-OutRef was also associated with physical performance ( all p<0.001 ) ; suPAR being the inflammatory biomarker with the highest impact when adjusting for inflammation . CONCLUSION Inflammatory biomarkers are potentially feasible for systematic assessment of vulnerability . Moreover , suPAR may be an important mediator between organ dysfunction and physical performance 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 QUESTION Among people who are hospitalised for community-acquired pneumonia , does an inpatient exercise-based rehabilitation program improve functional outcomes , symptoms , quality of life and length of hospital stay more than a respiratory physiotherapy regimen ? DESIGN R and omised trial with concealed allocation , intention-to-treat analysis and blinding of some outcomes . PARTICIPANTS Forty-nine adults hospitalised for community-acquired pneumonia . INTERVENTION The experimental group ( n=32 ) underwent a physical training program that included warm-up , stretching , peripheral muscle strength training and walking at a controlled speed for 15 minutes . The control group ( n=17 ) underwent a respiratory physiotherapy regimen that included percussion , vibrocompression , respiratory exercises and free walking . The intervention regimens lasted 8 days . OUTCOME MEASURES The primary outcome was the Glittre Activities of Daily Living test , which assesses the time taken to complete a series of functional tasks ( eg , rising from a chair , walking , stairs , lifting and bending ) . Secondary outcomes were distance walked in the incremental shuttle walk test , peripheral muscle strength , quality of life , dyspnoea , lung function , C-reactive protein and length of hospital stay . Measures were taken 1 day before and 1 day after the intervention period . RESULTS There was greater improvement in the experimental group than in the control group on the Glittre Activities of Daily Living test ( mean between-group difference 39 seconds , 95 % CI 20 to 59 ) and the incremental shuttle walk test ( mean between-group difference 130 m , 95 % CI 77 to 182 ) . There were also significantly greater improvements in quality of life , dyspnoea and peripheral muscle strength in the experimental group than in the control group . There were no between-group differences in lung function , C-reactive protein or length of hospital stay . CONCLUSION The improvement in functional outcomes after an inpatient rehabilitation program was greater than the improvement after st and ard respiratory physiotherapy . The exercise training program led to greater benefits in functional capacity , peripheral muscle strength , dyspnoea and quality of life . REGISTRATION Clinical Trials.gov , NCT02103400 OBJECTIVES To investigate the combined contribution of processes of hospitalization and preadmission individual risk factors in explaining functional decline at discharge and at 1-month follow-up in older adults with nondisabling conditions . DESIGN Prospect i ve cohort study . SETTING Internal medicine wards in two Israeli medical centers . PARTICIPANTS Six hundred eighty-four individuals aged 70 and older admitted for a nondisabling problem . MEASUREMENTS Functional decline was measured according to change in modified Barthel Index from premorbid to discharge and from premorbid to 1 month after discharge .  In-hospital mobility , continence care , sleep medication consumption , satisfaction with hospital environment , and nutrition intake  were assessed using previously tested self-report instruments . RESULTS Two hundred eighty-two participants ( 41.2 % ) reported functional decline at discharge and 317 ( 46.3 % ) at 1 month after discharge . Path analysis indicated that in-hospital mobility ( st and ardized maximum likelihood estimate ( SMLE ) = -0.48 , P < .001 ) , continence care ( SMLE = -0.12 , P < .001 ) , and length of stay ( LOS ) ( SMLE = 0.06 , P < .001 ) were directly related to functional decline at discharge and , together with personal risk factors , explained 64 % of variance . In-hospital mobility , continence care , and LOS were indirectly related to functional decline at 1 month after discharge through functional decline at discharge ( SMLE = 0.45 , P < .001 ) . Nutrition consumption ( SMLE = -0.07 , P < .001 ) was significantly related to functional decline at 1 month after discharge , explaining , together with other risk factors , 32 % of variance . CONCLUSION In-hospital low mobility , suboptimal continence care , and poor nutrition account for immediate and 1-month posthospitalization functional decline . These are potentially modifiable hospitalization risk factors for which practice and policy should be targeted in efforts to curb the posthospitalization functional decline trajectory The impact of oral nutritional supplementation during an acute exacerbation of COPD on functional status was assessed through measuring change in lung function , strength testing , and general well-being .  Subjects hospitalized for an acute exacerbation of COPD ( n = 33 ) were r and omized to extra nutritional support or the regular hospital care . They consumed an additional 10 kcal/kg/d . Outcome measures were measured at 2 wk as change scores . Forced vital capacity ( % predicted ) improved in the treatment group as compared with the control group ( + 8.7 % versus -3.5 % , p = 0.015 ) , and change in FEV1 was in the same direction but not significantly different ( p = 0.099 ) . There were no changes in h and grip strength or respiratory muscle strength , but there was a trend towards more improvement in the general well-being score ( + 11.96 versus -10.25 , p = 0.066 ) . Almost all subjects were in negative nitrogen balance , indicating muscle wasting . The degree of muscle wasting was strongly correlated with the dose of corticosteroids ( r = 0.73 , p < 0.005 ) . In conclusion , it is difficult to prevent important muscle wasting in patients with COPD treated with corticosteroids , but some small gains were observed with increased dietary intake Objective The aim of this work was to evaluate the time course of changes in strength and functional performance in elderly hospitalized medical patients . Design This was a prospect i ve observational study in elderly medical patients of age 65 years or older at a geriatric department . Measurements were obtained on days 2 to 4 , day 5 to 8 , and days 9 to 13 . Functional performance was measured with  De Morton Mobility Index ( DEMMI ) test  and a 30-second chair st and test ( 30-s CST ) . Muscular strength was measured with h and grip strength . Activity level was determined with  accelerometry ( ActivPAL ) . Results Results in DEMMI and 30-s CST gradually improved ( P < 0.05 ) , whereas h and grip strength remained unchanged ( P > 0.05 ) . Larger functional improvements were observed in patients with “ high ” compared to “ low ” and “ moderate ” activity level ( P < 0.05 ) . Changes in DEMMI score correlated with changes in 30-s CST ( P < 0.05 ) ; however , changes in DEMMI score and 30-s CST were more likely to occur in patients with a low versus high functional level , respectively . Conclusions Functional performance of the lower extremities in geriatric patients improves moderately over the time of a hospital stay of less than 14 days , with larger improvements in patients with high activity level . The DEMMI test and the 30-s CST seem to be complementary to each other when evaluating functional changes in a geriatric hospital population . To Cl aim CME Credits Complete the self- assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME Objectives Upon completion of this article , the reader should be able to ( 1 ) describe changes in mobility and muscle strength of geriatric patients during a hospital stay of less than 14 days , ( 2 ) underst and the significance of physical activity during hospital admission in geriatric patients 
    Output:
    