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: OBJECTIVE Nutritive immunomodulation of patients after major surgery . DESIGN Prospect i ve , r and omized controlled double-blind study . PATIENTS Forty patients undergoing major intestinal surgery . Patients were divided into two groups : one received a total parenteral nutrition enriched with omega-3 fatty acids for 5 days postoperatively , the other an isocaloric , control nutrition . MATERIAL S AND METHODS We analyzed the leukocyte ability to release leukotrienes from whole blood leukocytes stimulated with the calcium ionophore A23187 ( 5 micromol/L ) by reverse phase high-performance liquid chromatography and circulating cytokines by enzyme-linked immunosorbent assay . RESULTS Leukocytes from patients of the omega-3 fatty acids group generated significantly higher amounts of less biologically active leukotriene B5 as compared to the control group ( p < or = 0.001 ) . This was accompanied by a significant decrease in the generation of proinflammatory leukotriene B4 ( p < or = 0.006 ) in the study group . In contrast to interleukin-1beta , interleukin-6 , and interleukin-10 systemic levels of tumor necrosis factor-alpha ( p < or = 0.05 ) were postoperatively decreased in the study group . CONCLUSION Our data provide evidence that a total parenteral nutrition enriched with omega-3 fatty acids modulates the lipid mediator pattern and systemic tumor necrosis factor-alpha levels Cancer chemotherapy is associated with neutropenia and impaired neutrophil function . This study aim ed to investigate whether supplementation with low dose fish oil ( FO ) , providing n-3 polyunsaturated fatty acids , in cancer patients receiving chemotherapy after surgical tumor ( mainly gastrointestinal ) removal is able to improve the function of blood neutrophils .  Patients ( n = 38 ) receiving chemotherapy ( 5-fluorouracil and leucovorin )  were r and omized into two groups ; one group ( control ) did not receive a supplement , while the other group ( FO ) received 2 g FO/day for 8 weeks ; the FO provided 0.3 g eicosapentaenoic acid plus 0.4 g docosahexaenoic acid per day . Patients in the control group lost an average of 2.5 kg of weight over the 8 weeks of the study . The number of blood polymorphonuclear cells ( PMNC ) , mainly neutrophils , and their functions ( phagocytosis and hydrogen peroxide production ) decreased in the control group ( average decreases of approximately 30 , 45 and 17 % , respectively ) . FO prevented these decreases and actually increased body weight ( average of 1.7 kg weight gain ; p < 0.002 vs. control group ) , PMNC number ( average 29 % increase ) , phagocytosis ( average 14 % increase ) and superoxide production ( average 28 % increase ) . FO may be useful in preventing chemotherapy-induced decline in neutrophil number and function Abstract Background A lipid emulsion composed of soybean oil ( long-chain triglycerides , LCT ) , medium-chain triglycerides ( MCT ) and n-3 poly-unsaturated fatty acids ( PUFAs ) was evaluated for immune-modulation efficacy , safety , and tolerance in patients undergoing major surgery for gastric and colorectal cancer . Methods In a prospect i ve , r and omized , double-blind study , 99 patients with gastric and colorectal cancer receiving elective surgery were recruited and r and omly assigned to either the study group , receiving the n-3 PUFAs enriched intravenous fat emulsion ( IVFE ) , or the control group , receiving a lipid emulsion comprised of soybean oil and MCTs ( 0.8 – 1.5 g · kg-1 · day-1 ) as part of total parenteral nutrition ( TPN ) regimen from surgery ( day -1 ) up to post-operative day 7 . Safety and efficacy parameters were assessed on day -1 and post-operative visits on day 1 , 3 , and 7 . Adverse events were documented daily and compared between the groups . Results Pro-inflammatory markers , laboratory parameters , and adverse events did not differ prominently between the 2 groups , with the exception of net changes ( day 7 minus day -1 ) of free fatty acids ( FFAs ) , triglyceride , and high-density lipoprotein ( HDL ) . Net decrease of FFAs was remarkably higher in the study group , while the net increase of triglyceride and decrease of HDL was significantly lower . Conclusions The n-3 PUFA-enriched IVFE showed improvements in lipid metabolism . In respect of efficacy , safety and tolerance both IVFE were comparable . In patients with severe stress , there is an inflammation-attenuating effect of n-3 PUFAs . Further , adequately powered clinical trials will be necessary to address this question in postsurgical GI cancer patients .Trial registration US Clinical Trials.gov NCT00798447 Specific immunonutrients may reduce the incidence of postoperative complications and shorten recovery time . This r and omized trial evaluated the clinical efficacy of a fish oil emulsion on outcome and immune function after gastrointestinal cancer surgery Background Nutrients such as ω-3 fatty acids including fish oil components eicosapentaenoic acid ( EPA ) and docosahexaenoic acid ( DHA ) suppress the growth and promote apoptosis of tumor cells , improve immune function and reduce the effects of systemic inflammatory response syndrome . We sought to investigate the effect of ω-3 fish oil fat emulsion-based parenteral nutrition ( PN ) on nutritional state , immune function , inflammatory reaction , expression of tumor factors and complication incidence in patients after surgical resection of gastric cancer . Methods Forty-eight patients after surgical operation of gastric tumor in hospital were r and omly divided into the control group and intervention group . Patients in both groups were treated with iso-nitrogen and iso-caloric parenteral nutrition support . In addition , the intervention group received ω-3 fish oil fat emulsion and the control group received soybean oil . The indicators of nutrition , immune function and inflammation in the two groups were detected on the day before the operation and postoperative day 6 . The rate of complication was compared between the two groups . Results There was no significant difference in nutritional state , liver function and renal function between the two groups ( P > 0.05 ) . However , the levels of inflammatory markers were significantly decreased ( P < 0.01 ) , and the rate of complication was also decreased in the intervention group as compared with the control group . Conclusions ω-3 fish oil fat emulsion-based parenteral nutrition alleviates the inflammatory reaction and reduces the rate of inflammatory complications OBJECTIVES Recent studies in animal models of sepsis-induced acute respiratory distress syndrome ( ARDS ) have shown that a low-carbohydrate , high-fat diet combining the anti-inflammatory and vasodilatory properties of eicosapentaenoic acid ( EPA ; fish oil ) , gamma-linolenic acid ( GLA ; borage oil ) ( EPA+GLA ) , and antioxidants improves lung microvascular permeability , oxygenation , and cardiopulmonary function and reduces proinflammatory eicosanoid synthesis and lung inflammation . These findings suggest that enteral nutrition with EPA+GLA and antioxidants may reduce pulmonary inflammation and may improve oxygenation and clinical outcomes in patients with ARDS . DESIGN Prospect i ve , multicentered , double-blind , r and omized controlled trial . SETTING Intensive care units of five academic and teaching hospitals in the United States . PATIENTS We enrolled 146 patients with ARDS ( as defined by the American-European Consensus Conference ) caused by sepsis/pneumonia , trauma , or aspiration injury in the study . INTERVENTIONS Patients meeting entry criteria were r and omized and continuously tube-fed either EPA+GLA or an isonitrogenous , isocaloric st and ard diet at a minimum caloric delivery of 75 % of basal energy expenditure x 1.3 for at least 4 - 7 days . MEASUREMENTS AND MAIN RESULTS Arterial blood gases were measured , and ventilator setting s were recorded at baseline and study days 4 and 7 to enable calculation of PaO2/FIO2 , a measure of gas exchange . Pulmonary neutrophil recruitment was assessed by measuring the number of neutrophils and the total cell count in bronchoalveolar lavage fluid at the same time points . Clinical outcomes were recorded . Baseline characteristics of 98 evaluable patients revealed that key demographic , physiologic , and ventilatory variables were similar at entry between both groups . Multiple bronchoalveolar lavages revealed significant decreases ( approximately 2.5-fold ) in the number of total cells and neutrophils per mL of recovered lavage fluid during the study with EPA+GLA compared with patients fed the control diet . Significant improvements in oxygenation ( PaO2/FIO2 ) from baseline to study days 4 and 7 with lower ventilation variables ( FIO2 , positive end-expiratory pressure , and minute ventilation ) occurred in patients fed EPA+GLA compared with controls . Patients fed EPA+GLA required significantly fewer days of ventilatory support ( 11 vs. 16.3 days ; p = .011 ) , and had a decreased length of stay in the intensive care unit ( 12.8 vs. 17.5 days ; p = .016 ) compared with controls . Only four of 51 ( 8 % ) patients fed EPA+GLA vs. 13 of 47 ( 28 % ) control patients developed a new organ failure during the study ( p = .015 ) . CONCLUSIONS The beneficial effects of the EPA+GLA diet on pulmonary neutrophil recruitment , gas exchange , requirement for mechanical ventilation , length of intensive care unit stay , and the reduction of new organ failures suggest that this enteral nutrition formula would be a useful adjuvant therapy in the clinical management of patients with or at risk of developing ARDS Summary Previous studies have suggested that administration of oral eicosapentaenoic acid ( EPA ) will stabilize weight in patients with advanced pancreatic cancer . The aim of the present study was to determine if a combination of EPA with a conventional oral nutritional supplement could produce weight gain in these patients . Twenty patients with unresectable pancreatic adenocarcinoma were asked to consume two cans of a fish oil-enriched nutritional supplement per day in addition to their normal food intake . Each can contained 310 kcal , 16.1 g protein and 1.09 g EPA . Patients were assessed for weight , body composition , dietary intake , resting energy expenditure ( REE ) and performance status . Patients consumed a median of 1.9 cans day–1 . All patients were losing weight at baseline at a median rate of 2.9 kg month–1 . After administration of the fish oil-enriched supplement , patients had significant weight-gain at both 3 ( median 1 kg , P = 0.024 ) and 7 weeks ( median 2 kg , P = 0.033 ) . Dietary intake increased significantly by almost 400 kcal day–1 ( P = 0.002 ) . REE per kg body weight and per kg lean body mass fell significantly . Performance status and appetite were significantly improved at 3 weeks . In contrast to previous studies of oral conventional nutritional supplements in weight-losing cancer patients , this study suggests that an EPA-enriched supplement may reverse cachexia in advanced pancreatic cancer It has been increasingly reported that administration of n-3 fatty acids is beneficial in patients with inflammatory processes . This effect is most likely caused by different biological characteristics , including an immunomodulating effect of the products derived from n-3 fatty acids through eicosanoid metabolism . The aim of this study was to investigate the effect of perioperative administration of n-3 fatty acids on inflammatory and immune responses as well as on the postoperative course of patients with extended surgical interventions of the abdomen . In particular , the effect of n-3 fatty acids on interleukin-6 release and on granulocyte/monocyte function ( HLA-DR expression ) was studied . There was a downregulation of the inflammatory response , and , simultaneously , a smaller postoperative immune suppression in the n-3  fatty acid group . In addition , we observed shorter postoperative periods in the intensive care unit and on the regular medical wards as well as lower rates of severe infections . The results suggest that perioperative administration of n-3 fatty acids may have a favourable effect on outcome in patients with severe surgical interventions by lowering the magnitude of inflammatory response and by modulating the immune response AIM To investigate the effect of omega-3 fatty acid parenteral supplementation postoperatively on clinical outcomes and immunomodulation in colorectal cancer patients . METHODS Forty-two patients undergoing radical colorectal cancer resection with an indication for total parenteral nutrition postoperatively were enrolled in this prospect i ve , double-blind , r and omized , controlled study . Patients received total parenteral nutrition supplemented with either soybean oil ( LCT ; Intralipid , Fresenius-Kabi , SO group , n = 21 ) or a combination of omega-3 fish oil and soybean oil ( LCT : fish oil = 5:1 , fish oil ; Omegaven , Fresenius-Kabi , FO group , n = 21 ) , up to a total of 1.2 g lipid/kg per day for 7 d postoperatively . A same volume calorie and nitrogen was administrated . Routine blood test , biochemistry , systemic levels 
    Output:
    
agent
***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: OBJECTIVE Nutritive immunomodulation of patients after major surgery . DESIGN Prospect i ve , r and omized controlled double-blind study . PATIENTS Forty patients undergoing major intestinal surgery . Patients were divided into two groups : one received a total parenteral nutrition enriched with omega-3 fatty acids for 5 days postoperatively , the other an isocaloric , control nutrition . MATERIAL S AND METHODS We analyzed the leukocyte ability to release leukotrienes from whole blood leukocytes stimulated with the calcium ionophore A23187 ( 5 micromol/L ) by reverse phase high-performance liquid chromatography and circulating cytokines by enzyme-linked immunosorbent assay . RESULTS Leukocytes from patients of the omega-3 fatty acids group generated significantly higher amounts of less biologically active leukotriene B5 as compared to the control group ( p < or = 0.001 ) . This was accompanied by a significant decrease in the generation of proinflammatory leukotriene B4 ( p < or = 0.006 ) in the study group . In contrast to interleukin-1beta , interleukin-6 , and interleukin-10 systemic levels of tumor necrosis factor-alpha ( p < or = 0.05 ) were postoperatively decreased in the study group . CONCLUSION Our data provide evidence that a total parenteral nutrition enriched with omega-3 fatty acids modulates the lipid mediator pattern and systemic tumor necrosis factor-alpha levels Cancer chemotherapy is associated with neutropenia and impaired neutrophil function . This study aim ed to investigate whether supplementation with low dose fish oil ( FO ) , providing n-3 polyunsaturated fatty acids , in cancer patients receiving chemotherapy after surgical tumor ( mainly gastrointestinal ) removal is able to improve the function of blood neutrophils .  Patients ( n = 38 ) receiving chemotherapy ( 5-fluorouracil and leucovorin )  were r and omized into two groups ; one group ( control ) did not receive a supplement , while the other group ( FO ) received 2 g FO/day for 8 weeks ; the FO provided 0.3 g eicosapentaenoic acid plus 0.4 g docosahexaenoic acid per day . Patients in the control group lost an average of 2.5 kg of weight over the 8 weeks of the study . The number of blood polymorphonuclear cells ( PMNC ) , mainly neutrophils , and their functions ( phagocytosis and hydrogen peroxide production ) decreased in the control group ( average decreases of approximately 30 , 45 and 17 % , respectively ) . FO prevented these decreases and actually increased body weight ( average of 1.7 kg weight gain ; p < 0.002 vs. control group ) , PMNC number ( average 29 % increase ) , phagocytosis ( average 14 % increase ) and superoxide production ( average 28 % increase ) . FO may be useful in preventing chemotherapy-induced decline in neutrophil number and function Abstract Background A lipid emulsion composed of soybean oil ( long-chain triglycerides , LCT ) , medium-chain triglycerides ( MCT ) and n-3 poly-unsaturated fatty acids ( PUFAs ) was evaluated for immune-modulation efficacy , safety , and tolerance in patients undergoing major surgery for gastric and colorectal cancer . Methods In a prospect i ve , r and omized , double-blind study , 99 patients with gastric and colorectal cancer receiving elective surgery were recruited and r and omly assigned to either the study group , receiving the n-3 PUFAs enriched intravenous fat emulsion ( IVFE ) , or the control group , receiving a lipid emulsion comprised of soybean oil and MCTs ( 0.8 – 1.5 g · kg-1 · day-1 ) as part of total parenteral nutrition ( TPN ) regimen from surgery ( day -1 ) up to post-operative day 7 . Safety and efficacy parameters were assessed on day -1 and post-operative visits on day 1 , 3 , and 7 . Adverse events were documented daily and compared between the groups . Results Pro-inflammatory markers , laboratory parameters , and adverse events did not differ prominently between the 2 groups , with the exception of net changes ( day 7 minus day -1 ) of free fatty acids ( FFAs ) , triglyceride , and high-density lipoprotein ( HDL ) . Net decrease of FFAs was remarkably higher in the study group , while the net increase of triglyceride and decrease of HDL was significantly lower . Conclusions The n-3 PUFA-enriched IVFE showed improvements in lipid metabolism . In respect of efficacy , safety and tolerance both IVFE were comparable . In patients with severe stress , there is an inflammation-attenuating effect of n-3 PUFAs . Further , adequately powered clinical trials will be necessary to address this question in postsurgical GI cancer patients .Trial registration US Clinical Trials.gov NCT00798447 Specific immunonutrients may reduce the incidence of postoperative complications and shorten recovery time . This r and omized trial evaluated the clinical efficacy of a fish oil emulsion on outcome and immune function after gastrointestinal cancer surgery Background Nutrients such as ω-3 fatty acids including fish oil components eicosapentaenoic acid ( EPA ) and docosahexaenoic acid ( DHA ) suppress the growth and promote apoptosis of tumor cells , improve immune function and reduce the effects of systemic inflammatory response syndrome . We sought to investigate the effect of ω-3 fish oil fat emulsion-based parenteral nutrition ( PN ) on nutritional state , immune function , inflammatory reaction , expression of tumor factors and complication incidence in patients after surgical resection of gastric cancer . Methods Forty-eight patients after surgical operation of gastric tumor in hospital were r and omly divided into the control group and intervention group . Patients in both groups were treated with iso-nitrogen and iso-caloric parenteral nutrition support . In addition , the intervention group received ω-3 fish oil fat emulsion and the control group received soybean oil . The indicators of nutrition , immune function and inflammation in the two groups were detected on the day before the operation and postoperative day 6 . The rate of complication was compared between the two groups . Results There was no significant difference in nutritional state , liver function and renal function between the two groups ( P > 0.05 ) . However , the levels of inflammatory markers were significantly decreased ( P < 0.01 ) , and the rate of complication was also decreased in the intervention group as compared with the control group . Conclusions ω-3 fish oil fat emulsion-based parenteral nutrition alleviates the inflammatory reaction and reduces the rate of inflammatory complications OBJECTIVES Recent studies in animal models of sepsis-induced acute respiratory distress syndrome ( ARDS ) have shown that a low-carbohydrate , high-fat diet combining the anti-inflammatory and vasodilatory properties of eicosapentaenoic acid ( EPA ; fish oil ) , gamma-linolenic acid ( GLA ; borage oil ) ( EPA+GLA ) , and antioxidants improves lung microvascular permeability , oxygenation , and cardiopulmonary function and reduces proinflammatory eicosanoid synthesis and lung inflammation . These findings suggest that enteral nutrition with EPA+GLA and antioxidants may reduce pulmonary inflammation and may improve oxygenation and clinical outcomes in patients with ARDS . DESIGN Prospect i ve , multicentered , double-blind , r and omized controlled trial . SETTING Intensive care units of five academic and teaching hospitals in the United States . PATIENTS We enrolled 146 patients with ARDS ( as defined by the American-European Consensus Conference ) caused by sepsis/pneumonia , trauma , or aspiration injury in the study . INTERVENTIONS Patients meeting entry criteria were r and omized and continuously tube-fed either EPA+GLA or an isonitrogenous , isocaloric st and ard diet at a minimum caloric delivery of 75 % of basal energy expenditure x 1.3 for at least 4 - 7 days . MEASUREMENTS AND MAIN RESULTS Arterial blood gases were measured , and ventilator setting s were recorded at baseline and study days 4 and 7 to enable calculation of PaO2/FIO2 , a measure of gas exchange . Pulmonary neutrophil recruitment was assessed by measuring the number of neutrophils and the total cell count in bronchoalveolar lavage fluid at the same time points . Clinical outcomes were recorded . Baseline characteristics of 98 evaluable patients revealed that key demographic , physiologic , and ventilatory variables were similar at entry between both groups . Multiple bronchoalveolar lavages revealed significant decreases ( approximately 2.5-fold ) in the number of total cells and neutrophils per mL of recovered lavage fluid during the study with EPA+GLA compared with patients fed the control diet . Significant improvements in oxygenation ( PaO2/FIO2 ) from baseline to study days 4 and 7 with lower ventilation variables ( FIO2 , positive end-expiratory pressure , and minute ventilation ) occurred in patients fed EPA+GLA compared with controls . Patients fed EPA+GLA required significantly fewer days of ventilatory support ( 11 vs. 16.3 days ; p = .011 ) , and had a decreased length of stay in the intensive care unit ( 12.8 vs. 17.5 days ; p = .016 ) compared with controls . Only four of 51 ( 8 % ) patients fed EPA+GLA vs. 13 of 47 ( 28 % ) control patients developed a new organ failure during the study ( p = .015 ) . CONCLUSIONS The beneficial effects of the EPA+GLA diet on pulmonary neutrophil recruitment , gas exchange , requirement for mechanical ventilation , length of intensive care unit stay , and the reduction of new organ failures suggest that this enteral nutrition formula would be a useful adjuvant therapy in the clinical management of patients with or at risk of developing ARDS Summary Previous studies have suggested that administration of oral eicosapentaenoic acid ( EPA ) will stabilize weight in patients with advanced pancreatic cancer . The aim of the present study was to determine if a combination of EPA with a conventional oral nutritional supplement could produce weight gain in these patients . Twenty patients with unresectable pancreatic adenocarcinoma were asked to consume two cans of a fish oil-enriched nutritional supplement per day in addition to their normal food intake . Each can contained 310 kcal , 16.1 g protein and 1.09 g EPA . Patients were assessed for weight , body composition , dietary intake , resting energy expenditure ( REE ) and performance status . Patients consumed a median of 1.9 cans day–1 . All patients were losing weight at baseline at a median rate of 2.9 kg month–1 . After administration of the fish oil-enriched supplement , patients had significant weight-gain at both 3 ( median 1 kg , P = 0.024 ) and 7 weeks ( median 2 kg , P = 0.033 ) . Dietary intake increased significantly by almost 400 kcal day–1 ( P = 0.002 ) . REE per kg body weight and per kg lean body mass fell significantly . Performance status and appetite were significantly improved at 3 weeks . In contrast to previous studies of oral conventional nutritional supplements in weight-losing cancer patients , this study suggests that an EPA-enriched supplement may reverse cachexia in advanced pancreatic cancer It has been increasingly reported that administration of n-3 fatty acids is beneficial in patients with inflammatory processes . This effect is most likely caused by different biological characteristics , including an immunomodulating effect of the products derived from n-3 fatty acids through eicosanoid metabolism . The aim of this study was to investigate the effect of perioperative administration of n-3 fatty acids on inflammatory and immune responses as well as on the postoperative course of patients with extended surgical interventions of the abdomen . In particular , the effect of n-3 fatty acids on interleukin-6 release and on granulocyte/monocyte function ( HLA-DR expression ) was studied . There was a downregulation of the inflammatory response , and , simultaneously , a smaller postoperative immune suppression in the n-3  fatty acid group . In addition , we observed shorter postoperative periods in the intensive care unit and on the regular medical wards as well as lower rates of severe infections . The results suggest that perioperative administration of n-3 fatty acids may have a favourable effect on outcome in patients with severe surgical interventions by lowering the magnitude of inflammatory response and by modulating the immune response AIM To investigate the effect of omega-3 fatty acid parenteral supplementation postoperatively on clinical outcomes and immunomodulation in colorectal cancer patients . METHODS Forty-two patients undergoing radical colorectal cancer resection with an indication for total parenteral nutrition postoperatively were enrolled in this prospect i ve , double-blind , r and omized , controlled study . Patients received total parenteral nutrition supplemented with either soybean oil ( LCT ; Intralipid , Fresenius-Kabi , SO group , n = 21 ) or a combination of omega-3 fish oil and soybean oil ( LCT : fish oil = 5:1 , fish oil ; Omegaven , Fresenius-Kabi , FO group , n = 21 ) , up to a total of 1.2 g lipid/kg per day for 7 d postoperatively . A same volume calorie and nitrogen was administrated . Routine blood test , biochemistry , systemic levels 
    Output:
    