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 And Objective : Gastric acidity is a major nonimmune defense mechanism against infections . The objective of this study was to investigate whether ranitidine treatment in very low birth weight ( VLBW ) infants is associated with an increased risk of infections , necrotizing enterocolitis ( NEC ) , and fatal outcome . Methods : Newborns with birth weight between 401 and 1500 g or gestational age between 24 and 32 weeks , consecutively observed in neonatal intensive care units , were enrolled in a multicenter prospect i ve observational study . The rates of infectious diseases , NEC , and death in enrolled subjects exposed or not to ranitidine were recorded . Results : We evaluated 274 VLBW infants : 91 had taken ranitidine and 183 had not . The main clinical and demographic characteristics did not differ between the 2 groups . Thirty-four ( 37.4 % ) of the 91 children exposed to ranitidine and 18 ( 9.8 % ) of the 183 not exposed to ranitidine had contracted infections ( odds ratio 5.5 , 95 % confidence interval 2.9–10.4 , P < .001 ) . The risk of NEC was 6.6-fold higher in ranitidine-treated VLBW infants ( 95 % confidence interval 1.7–25.0 , P = .003 ) than in control subjects . Mortality rate was significantly higher in newborns receiving ranitidine ( 9.9 % vs 1.6 % , P = .003 ) . Conclusions : Ranitidine therapy is associated with an increased risk of infections , NEC , and fatal outcome  in VLBW infants . Caution is advocated in the use of this drug in neonatal age Background —The effect of histamine H2receptor antagonists on gastric emptying is controversial . Aims —To determine the effects of ranitidine , famotidine , and omeprazole on gastric motility and emptying . Patients and methods —Fifteen normal subjects underwent simultaneous antroduodenal manometry , electrogastrography ( EGG ) , and gastric emptying with dynamic antral scintigraphy ( DAS ) . After 30 minutes of fasting manometry and EGG recording , subjects received either intravenous saline , ranitidine , or famotidine , followed by another 30 minutes recording and then three hours of postpr and ial recording after ingestion of a radiolabelled meal . Images were obtained every 10–15 minutes for three hours to measure gastric emptying and assess antral contractility . Similar testing was performed after omeprazole 20 mg daily for one week . Results —Fasting antral phase III migrating motor complexes ( MMCs ) were more common after ranitidine ( 9/15 subjects , 60 % ) , famotidine ( 12/15 , 80 % ) , and omeprazole ( 8/12 , 67 % ) compared with placebo ( 4/14 , 29 % ; p<0.05 ) . Postpr and ially , ranitidine , famotidine , and omeprazole  slowed gastric emptying , increased the amplitude of DAS contractions , increased the EGG power , and increased the antral manometric motility index . Conclusions —Suppression of gastric acid secretion with therapeutic doses of gastric acid suppressants is associated with delayed gastric emptying but increased antral motility Objective : To evaluate whether infants treated in neonatal intensive care units have stress-induced bleeding from gastrointestinal tract or gastric lesions and to define risk factors for these findings . Design : Part one : retrospective ; part two : prospect i ve . Setting : Tampere University Hospital , neonatal intensive care unit . Patients and interventions : In part one , 100 consecutive newborn infants treated in intensive care were retrospectively evaluated for gastrointestinal tract bleeding and risk factors , and in part two 89 gastroscopied and mechanically ventilated infants were prospect ively evaluated for further risk factors for gastric mucosal lesions . The statistical evaluation of risk factors was made by multivariate analysis using logistic regression modeling . Main results : Of infants treated in the neonatal intensive care unit 20 % had signs of gastrointestinal bleeding .  Mechanical ventilation was the only risk factor ( OR = 4.06 , 95 % confidence interval 1.21–12.3 ) . In part two , when mechanically ventilated infants were prospect ively evaluated , 53 % had remarkable gastric mucosal lesions . The analysis showed three other risk factors : abnormal and delayed delivery and hypotension after birth . Conclusions : Newborn infants treated in the intensive care unit had a high frequency of stress-induced gastric hemorrhage with gastric lesions similar to adults and children treated in intensive care .  Mechanical ventilation is the main risk factor . Also mode of delivery and hypotension after birth increase the risk of stress-induced gastric lesions . These infants should be the target for prophylactic gastroprotective treatment BACKGROUND Stress ulcer prophylaxis ( SUP ) using ranitidine , a histamine H2 receptor antagonist , has been associated with an increased risk of ventilator-associated pneumonia . The proton pump inhibitor ( PPI ) pantoprazole is also commonly used for SUP . PPI use has been linked to an increased risk of community-acquired pneumonia . The objective of this study was to determine whether SUP with pantoprazole increases pneumonia risk compared with ranitidine in critically ill patients . METHODS The cardiothoracic surgery data base at our institution was used to identify retrospectively all patients who had received SUP with pantoprazole or ranitidine , without crossover between agents . From January 1 , 2004 , to March 31 , 2007 , 887 patients were identified , with 53 patients excluded ( pantoprazole , 30 patients ; ranitidine , 23 patients ) . Our analysis compared the incidence of nosocomial pneumonia in 377 patients who received pantoprazole with 457 patients who received ranitidine .  RESULTS Nosocomial pneumonia developed in 35 of the 377 patients ( 9.3 % ) who received pantoprazole , compared with 7 of the 457 patients ( 1.5 % ) who received ranitidine ( odds ratio [ OR ] , 6.6 ; 95 % confidence interval [ CI ] , 2.9 to 14.9 ) . Twenty-three covariates were used to estimate the probability of receiving pantoprazole as measured by propensity score ( C-index , 0.77 ) . Using this score , pantoprazole and ranitidine patients were stratified according to their probability of receiving pantoprazole . After propensity adjusted , multivariable logistic regression , pantoprazole treatment was found to be an independent risk factor for nosocomial pneumonia ( OR , 2.7 ; 95 % CI , 1.1 to 6.7 ; p = 0.034 ) . CONCLUSION The use of pantoprazole for SUP was associated with a higher risk of nosocomial pneumonia compared with ranitidine . This relationship warrants further study in a r and omized controlled trial OBJECTIVE : The aim of this case-control study was to evaluate the frequency and the type of mucosal lesions in newborn babies with upper GI bleeding ( UGIB ) , the diagnostic role and safety of upper GI endoscopy , and the recognition of risk factors associated with the hemorrhagic event . METHODS : A population of 5180 infants born from June , 1988 to May , 1997 was examined . A case was defined as any patient who had UGIB within 4 days of delivery . The diagnosis was made by endoscopic examination in an endoscopy room . The following parameters were determined : amniotic fluid features , funicular blood pH , Apgar index at 5 min , neonatal weight , body length , gestational age , and the presence of other pathologies . Biochemical profiles were also evaluated . Clinical and demographic data of the mothers of the newborn babies were analyzed . Sera of cases and the respective parents were tested for gastrin and pepsinogen . As a control group , 53 full-term healthy infants matched for sex and age were r and omly selected from the population of infants born in our pediatric department . RESULTS : Sixty-four of 5180 newborn babies ( 1.23 % ) suffered from UGIB within 26.5 ± 20 h of life . In 53 of 64 cases ( mean age = 24.2 ± 25.5 h ) it was possible to carry out an endoscopic examination . In one case , endoscopy was limited to the esophagus because of the presence of multiple mucosal ulcers and substenosis of the viscus . Esophageal damage was observed in 24/53 patients . The esophageal lesions were isolated in nine cases , and occurred jointly with gastric or duodenal damage in 14 cases and one , respectively . Gastric and duodenal lesions were seen in 43/52 and 1/52 patients , respectively . There were 17 cases of gastric ulcers and one case of duodenal ulcer . Blood clots were observed in 14 gastric ulcer patients ; in one case there was evidence of active bleeding at the margins of a gastric ulcer . There was no significant difference with regard to the demographic and clinical characteristics of the cases and controls . Median values of serum gastrin of the cases and controls were similar . Median serum pepsinogen was significantly higher in the case group . CONCLUSIONS : UGIB in the newborn babies is often associated with clinical ly relevant mucosal lesions of the upper GI tract . The evolution , after treatment with antisecretory drugs , is generally rapid and favorable , with clinical recovery usually obtained within 24–48 h. The higher serum pepsinogen levels may only represent a significant risk factor of mucosal lesions and complications Small premature infants are often hypochlorhydric , and frequently their stomachs are colonized by enteric , gram-negative bacteria . We tested a hypothesis that gastric pH affected the colonization of the stomach with enteric bacteria and that this colonization was causally related to the risk or severity of necrotizing enterocolitis . A prospect i ve , double-blind study was conducted that compared a group of infants supplemented with 0.01–0.02 ml of 1 N HCl/ml of milk to a group with a similar supplement of water .  Gastric pH , gastric enteric bacteria counts , and the incidence and severity of necrotizing enterocolitis were monitored . The median gastric pH of the HCl-supplemented group was lower ( 3.0 ) than controls ( 4.0 ) throughout the study ( p < 0.001 ) . The gastric enteric bacterial colonization rate and the quantitative bacterial counts were strongly correlated with gastric pH over 4 ( p < 0.001 ) . Somatic growth rates in infants in the HCl-supplemented group were equal to , or exceeded , those in the control group . There was 1 case of necrotizing entero-colitis among the 34 infants in the HCl-supplemented group and 8 cases among the 34 in the control group ( p = 0.02 ) . It appears that acidifying the feedings of small premature infants to a pH low enough to inhibit bacterial proliferation in the stomach significantly lowers the risk of necrotizing enterocolitis Evaluation of prophylactic effects of omeprazole and /or vitamin E on the formation of free oxygen radicals ( FOR ) and bowel histopathology in the newborn rat model of hypoxia/reoxygenation ( H/R ) that resembles human necrotizing enterocolitis ( NEC ) . Eighty newborn rats were r and omly divided into eight groups . H/R was done using airtight chamber . Rats were exposed to 100 % CO2 for 15 min followed by a reoxygenation for the next 15 min with 100 % O2 . Group 1 ( n = 10 ) was the control group . Group 2 ( n = 10 ) rats received vitamin E. In Group 3 ( n = 10 ) omeprazole was administrated . Group 4 ( n = 10 ) rats received omeprazole and vitamin E. Group 5 ( n = 10 ) rats were subjected to H/R two times for 2 days and one time for 3 days . Group 6 ( n = 10 ) received vitamin E in addition to H/R for 5 days and in Group 7 ( n = 10 ) omeprazole in addition to H/R for 5 days . In Group 8 ( n = 10 ) , vitamin E and omeprazole and H/R were applied for 5 days . Rats were killed at the end of the each process and bowel specimens were harvested for histopathological and biochemical investigations . We administrated vitamin E intramuscularly 300 unit/kg per day and omeprazole orally 20 mg/kg per day . Malondialdehyde ( MDA ) , xanthine oxidase ( XO ) , xanthine dehydogenase ( XDH ) and XO/(XO + XDH ) were measured . Vitamin E and /or omeprazole treated rats had significantly less XO% levels than H/R only group ( 0.36 , 0.38 and 0.57 , respectively ) . Similarly , the MDA levels were significantly lower in vitamin E and /or omepraz 
    Output:
    
agent
Exposure to H2 receptor antagonists may be associated with increased risk of NEC and infections in preterm infants
***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 And Objective : Gastric acidity is a major nonimmune defense mechanism against infections . The objective of this study was to investigate whether ranitidine treatment in very low birth weight ( VLBW ) infants is associated with an increased risk of infections , necrotizing enterocolitis ( NEC ) , and fatal outcome . Methods : Newborns with birth weight between 401 and 1500 g or gestational age between 24 and 32 weeks , consecutively observed in neonatal intensive care units , were enrolled in a multicenter prospect i ve observational study . The rates of infectious diseases , NEC , and death in enrolled subjects exposed or not to ranitidine were recorded . Results : We evaluated 274 VLBW infants : 91 had taken ranitidine and 183 had not . The main clinical and demographic characteristics did not differ between the 2 groups . Thirty-four ( 37.4 % ) of the 91 children exposed to ranitidine and 18 ( 9.8 % ) of the 183 not exposed to ranitidine had contracted infections ( odds ratio 5.5 , 95 % confidence interval 2.9–10.4 , P < .001 ) . The risk of NEC was 6.6-fold higher in ranitidine-treated VLBW infants ( 95 % confidence interval 1.7–25.0 , P = .003 ) than in control subjects . Mortality rate was significantly higher in newborns receiving ranitidine ( 9.9 % vs 1.6 % , P = .003 ) . Conclusions : Ranitidine therapy is associated with an increased risk of infections , NEC , and fatal outcome  in VLBW infants . Caution is advocated in the use of this drug in neonatal age Background —The effect of histamine H2receptor antagonists on gastric emptying is controversial . Aims —To determine the effects of ranitidine , famotidine , and omeprazole on gastric motility and emptying . Patients and methods —Fifteen normal subjects underwent simultaneous antroduodenal manometry , electrogastrography ( EGG ) , and gastric emptying with dynamic antral scintigraphy ( DAS ) . After 30 minutes of fasting manometry and EGG recording , subjects received either intravenous saline , ranitidine , or famotidine , followed by another 30 minutes recording and then three hours of postpr and ial recording after ingestion of a radiolabelled meal . Images were obtained every 10–15 minutes for three hours to measure gastric emptying and assess antral contractility . Similar testing was performed after omeprazole 20 mg daily for one week . Results —Fasting antral phase III migrating motor complexes ( MMCs ) were more common after ranitidine ( 9/15 subjects , 60 % ) , famotidine ( 12/15 , 80 % ) , and omeprazole ( 8/12 , 67 % ) compared with placebo ( 4/14 , 29 % ; p<0.05 ) . Postpr and ially , ranitidine , famotidine , and omeprazole  slowed gastric emptying , increased the amplitude of DAS contractions , increased the EGG power , and increased the antral manometric motility index . Conclusions —Suppression of gastric acid secretion with therapeutic doses of gastric acid suppressants is associated with delayed gastric emptying but increased antral motility Objective : To evaluate whether infants treated in neonatal intensive care units have stress-induced bleeding from gastrointestinal tract or gastric lesions and to define risk factors for these findings . Design : Part one : retrospective ; part two : prospect i ve . Setting : Tampere University Hospital , neonatal intensive care unit . Patients and interventions : In part one , 100 consecutive newborn infants treated in intensive care were retrospectively evaluated for gastrointestinal tract bleeding and risk factors , and in part two 89 gastroscopied and mechanically ventilated infants were prospect ively evaluated for further risk factors for gastric mucosal lesions . The statistical evaluation of risk factors was made by multivariate analysis using logistic regression modeling . Main results : Of infants treated in the neonatal intensive care unit 20 % had signs of gastrointestinal bleeding .  Mechanical ventilation was the only risk factor ( OR = 4.06 , 95 % confidence interval 1.21–12.3 ) . In part two , when mechanically ventilated infants were prospect ively evaluated , 53 % had remarkable gastric mucosal lesions . The analysis showed three other risk factors : abnormal and delayed delivery and hypotension after birth . Conclusions : Newborn infants treated in the intensive care unit had a high frequency of stress-induced gastric hemorrhage with gastric lesions similar to adults and children treated in intensive care .  Mechanical ventilation is the main risk factor . Also mode of delivery and hypotension after birth increase the risk of stress-induced gastric lesions . These infants should be the target for prophylactic gastroprotective treatment BACKGROUND Stress ulcer prophylaxis ( SUP ) using ranitidine , a histamine H2 receptor antagonist , has been associated with an increased risk of ventilator-associated pneumonia . The proton pump inhibitor ( PPI ) pantoprazole is also commonly used for SUP . PPI use has been linked to an increased risk of community-acquired pneumonia . The objective of this study was to determine whether SUP with pantoprazole increases pneumonia risk compared with ranitidine in critically ill patients . METHODS The cardiothoracic surgery data base at our institution was used to identify retrospectively all patients who had received SUP with pantoprazole or ranitidine , without crossover between agents . From January 1 , 2004 , to March 31 , 2007 , 887 patients were identified , with 53 patients excluded ( pantoprazole , 30 patients ; ranitidine , 23 patients ) . Our analysis compared the incidence of nosocomial pneumonia in 377 patients who received pantoprazole with 457 patients who received ranitidine .  RESULTS Nosocomial pneumonia developed in 35 of the 377 patients ( 9.3 % ) who received pantoprazole , compared with 7 of the 457 patients ( 1.5 % ) who received ranitidine ( odds ratio [ OR ] , 6.6 ; 95 % confidence interval [ CI ] , 2.9 to 14.9 ) . Twenty-three covariates were used to estimate the probability of receiving pantoprazole as measured by propensity score ( C-index , 0.77 ) . Using this score , pantoprazole and ranitidine patients were stratified according to their probability of receiving pantoprazole . After propensity adjusted , multivariable logistic regression , pantoprazole treatment was found to be an independent risk factor for nosocomial pneumonia ( OR , 2.7 ; 95 % CI , 1.1 to 6.7 ; p = 0.034 ) . CONCLUSION The use of pantoprazole for SUP was associated with a higher risk of nosocomial pneumonia compared with ranitidine . This relationship warrants further study in a r and omized controlled trial OBJECTIVE : The aim of this case-control study was to evaluate the frequency and the type of mucosal lesions in newborn babies with upper GI bleeding ( UGIB ) , the diagnostic role and safety of upper GI endoscopy , and the recognition of risk factors associated with the hemorrhagic event . METHODS : A population of 5180 infants born from June , 1988 to May , 1997 was examined . A case was defined as any patient who had UGIB within 4 days of delivery . The diagnosis was made by endoscopic examination in an endoscopy room . The following parameters were determined : amniotic fluid features , funicular blood pH , Apgar index at 5 min , neonatal weight , body length , gestational age , and the presence of other pathologies . Biochemical profiles were also evaluated . Clinical and demographic data of the mothers of the newborn babies were analyzed . Sera of cases and the respective parents were tested for gastrin and pepsinogen . As a control group , 53 full-term healthy infants matched for sex and age were r and omly selected from the population of infants born in our pediatric department . RESULTS : Sixty-four of 5180 newborn babies ( 1.23 % ) suffered from UGIB within 26.5 ± 20 h of life . In 53 of 64 cases ( mean age = 24.2 ± 25.5 h ) it was possible to carry out an endoscopic examination . In one case , endoscopy was limited to the esophagus because of the presence of multiple mucosal ulcers and substenosis of the viscus . Esophageal damage was observed in 24/53 patients . The esophageal lesions were isolated in nine cases , and occurred jointly with gastric or duodenal damage in 14 cases and one , respectively . Gastric and duodenal lesions were seen in 43/52 and 1/52 patients , respectively . There were 17 cases of gastric ulcers and one case of duodenal ulcer . Blood clots were observed in 14 gastric ulcer patients ; in one case there was evidence of active bleeding at the margins of a gastric ulcer . There was no significant difference with regard to the demographic and clinical characteristics of the cases and controls . Median values of serum gastrin of the cases and controls were similar . Median serum pepsinogen was significantly higher in the case group . CONCLUSIONS : UGIB in the newborn babies is often associated with clinical ly relevant mucosal lesions of the upper GI tract . The evolution , after treatment with antisecretory drugs , is generally rapid and favorable , with clinical recovery usually obtained within 24–48 h. The higher serum pepsinogen levels may only represent a significant risk factor of mucosal lesions and complications Small premature infants are often hypochlorhydric , and frequently their stomachs are colonized by enteric , gram-negative bacteria . We tested a hypothesis that gastric pH affected the colonization of the stomach with enteric bacteria and that this colonization was causally related to the risk or severity of necrotizing enterocolitis . A prospect i ve , double-blind study was conducted that compared a group of infants supplemented with 0.01–0.02 ml of 1 N HCl/ml of milk to a group with a similar supplement of water .  Gastric pH , gastric enteric bacteria counts , and the incidence and severity of necrotizing enterocolitis were monitored . The median gastric pH of the HCl-supplemented group was lower ( 3.0 ) than controls ( 4.0 ) throughout the study ( p < 0.001 ) . The gastric enteric bacterial colonization rate and the quantitative bacterial counts were strongly correlated with gastric pH over 4 ( p < 0.001 ) . Somatic growth rates in infants in the HCl-supplemented group were equal to , or exceeded , those in the control group . There was 1 case of necrotizing entero-colitis among the 34 infants in the HCl-supplemented group and 8 cases among the 34 in the control group ( p = 0.02 ) . It appears that acidifying the feedings of small premature infants to a pH low enough to inhibit bacterial proliferation in the stomach significantly lowers the risk of necrotizing enterocolitis Evaluation of prophylactic effects of omeprazole and /or vitamin E on the formation of free oxygen radicals ( FOR ) and bowel histopathology in the newborn rat model of hypoxia/reoxygenation ( H/R ) that resembles human necrotizing enterocolitis ( NEC ) . Eighty newborn rats were r and omly divided into eight groups . H/R was done using airtight chamber . Rats were exposed to 100 % CO2 for 15 min followed by a reoxygenation for the next 15 min with 100 % O2 . Group 1 ( n = 10 ) was the control group . Group 2 ( n = 10 ) rats received vitamin E. In Group 3 ( n = 10 ) omeprazole was administrated . Group 4 ( n = 10 ) rats received omeprazole and vitamin E. Group 5 ( n = 10 ) rats were subjected to H/R two times for 2 days and one time for 3 days . Group 6 ( n = 10 ) received vitamin E in addition to H/R for 5 days and in Group 7 ( n = 10 ) omeprazole in addition to H/R for 5 days . In Group 8 ( n = 10 ) , vitamin E and omeprazole and H/R were applied for 5 days . Rats were killed at the end of the each process and bowel specimens were harvested for histopathological and biochemical investigations . We administrated vitamin E intramuscularly 300 unit/kg per day and omeprazole orally 20 mg/kg per day . Malondialdehyde ( MDA ) , xanthine oxidase ( XO ) , xanthine dehydogenase ( XDH ) and XO/(XO + XDH ) were measured . Vitamin E and /or omeprazole treated rats had significantly less XO% levels than H/R only group ( 0.36 , 0.38 and 0.57 , respectively ) . Similarly , the MDA levels were significantly lower in vitamin E and /or omepraz 
    Output:
    