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: Helium has a low density and the potential of reducing the work of breathing and improving alveolar ventilation when replacing nitrogen in air . A Phase II , double-blind , r and omised , prospect i ve , controlled trial was undertaken to assess whether Heliox28 ( 72 % He/28 % O2 ) compared with oxygen-enriched air ( 72 % N2/28 % O2 ) or medical air ( 78.9 % N2/21.1 % O2 ) could reduce dyspnoea and improve the exercise capability of patients with primary lung cancer and dyspnoea on exertion ( Borg > 3 ) . A total of 12 patients ( seven male , five female patients , age 53–78 ) breathed the test gases in r and omised order via a facemask and inspiratory dem and valve at rest and while performing 6-min walk  tests . Pulse oximetry ( SaO2 ) was recorded continuously . Respiratory rate and dyspnoea ratings ( Borg and VAS ) were taken before and immediately post-walk . Breathing Heliox28 at rest significantly increased SaO2 compared to oxygen-enriched air ( 96±2 cf . 94±2 , P<0.01 ) . When compared to medical air , breathing Heliox28 but not oxygen-enriched air gave a significant improvement in the exercise capability ( P<0.0001 ) , SaO2 ( P<0.05 ) and dyspnoea scores ( VAS , P<0.05 ) of lung cancer patients The usefulness of percutaneous endoscopic gastrostomy ( PEG ) for decompression in patients with unresolving intestinal obstruction by gynecological malignancy is examined . Between April 1993 and August 1995 , 34 consecutive patients with small-bowel obstruction by gynecological cancer , heavily pretreated with surgery and chemotherapy , were admitted to our prospect i ve study .  PEG was performed in 32/34 patients ( 94.1 % ) . Failure in the placing of the tube occurred in 2 patients ( 5.9 % ) . Twenty-seven patients ( 84.4 % ) experienced symptomatic relief after a few days from PEG and tolerated soft and liquid foods . All of these patients were discharged from the hospital and underwent parenteral nutrition at home . The median postoperative hospital stay was 7 days ( range 3 - 45 ) . No major complications due to PEG placement itself occurred in our patients . Only 4 patients ( 12.5 % ) had postprocedure nausea and vomiting that was unresponsive to the conventional therapy . The use of Octreotide ( 0.6 mg/24 hr ) obtained relief from symptoms until death . The gastrostomy remained in place for a median of 74 days ( range 5 - 210 ) . Relief from symptoms after PEG placement and total parenteral nutrition permitted continuation of palliative  chemotherapy  in 8 patients ( 25 % ) . We suggest percutaneous endoscopic drainage gastrostomy technique as the procedure of choice for long-term drainage of unresolving small bowel obstruction in patient with metastatic abdominal gynecologic malignancy Cancer and its treatment can induce subjective and objective evidence of diminished functional capacity encompassing physical fatigue and cognitive impairment . Dexmethylpheni date ( D-MPH ; the D-isomer of methylpheni date ) was evaluated for treatment of chemotherapy-related fatigue and cognitive impairment . A r and omized , double-blind , placebo-controlled , parallel-group study evaluated the potential therapeutic effect and safety of D-MPH in the treatment of patients with chemotherapy-related fatigue . Change from baseline in the Functional Assessment of Chronic Illness Therapy-Fatigue Subscale ( FACIT-F ) total score at Week 8 was the primary outcome measure . One hundred fifty-four patients ( predominantly with breast and ovarian cancers ) were r and omized and treated . Compared with placebo , D-MPH-treated subjects demonstrated a significant improvement in fatigue symptoms at Week 8 in the FACIT-F ( P=0.02 ) and the Clinical Global Impression-Severity scores ( P=0.02 ) , without clinical ly relevant changes in hemoglobin levels . Cognitive function was not significantly improved . There was a higher rate of study drug-related adverse events ( AEs ) ( 48 of 76 [ 63 % ] vs. 22 of 78 [ 28 % ] ) and a higher discontinuation rate because of AEs ( 8 of 76 [ 11 % ] vs. 1 of 78 [ 1.3 % ] ) in D-MPH-treated subjects compared with placebo-treated subjects . The most commonly reported AEs independent of study drug relationship in D-MPH-treated subjects were headache , nausea , and dry mouth , and in placebo-treated subjects were headache , diarrhea , and insomnia .  D-MPH produced significant improvement in fatigue in subjects previously treated with cytotoxic chemotherapy . Further studies with D-MPH or other agents to explore treatment response in chemotherapy-associated fatigue should be considered To determine the effect of dexamethasone when treating malignant bowel obstruction , 35 patients were r and omized to receive intravenous dexamethasone or a placebo , crossing over to the alternate treatment arm if there had been no resolution of obstruction by day 5 . This was done in two consecutive studies . Patients were stratified according to whether or not they had received specific anticancer therapy within 28 days of study . In trial 1 , 15 out of 22 patients ‘ responded ’ ( resolution of obstruction by day 5 ; 10 on dexamethasone , five on placebo ) . Eleven out of 15 patients were ‘ on treatment ’ . In trial 2 , six out of 13 responded ( three on dexamethasone , three on placebo ) ; three out of six were ‘ on treatment ’ . When both studies are combined , 60 % ( 21/35 ) patients responded ( 13 on dexamethasone , eight on placebo ) . Poor patient accrual terminated both studies . Numbers are too small to allow a combination of studies or formal statistical analysis . We are unable to make any conclusion as to the effectiveness of dexamethasone  in the palliation of malignant bowel disease Background Women who receive adjuvant chemotherapy for breast cancer develop fatigue , and a subset reports cognitive impairment . Methylpheni date is reported to improve fatigue and to decrease cognitive impairment in other population s. Material s and methods Women were r and omised early during their chemotherapy  to receive d-methylpheni date ( d-MPH ) , a form of methylpheni date , or an identical appearing placebo . All participants took placebo for one cycle to ensure compliance and then study medication until completion of chemotherapy . Subjects were assessed at baseline , end of chemotherapy and at ∼6 months follow-up with the High Sensitivity Cognitive Screen ( HSCS ) and the Hopkins Verbal Learning Test-Revised ( HVLT-R ) . They also completed the self-report Functional Assessment of Cancer Therapy-General ( FACT-G ) and FACT-F ( F = fatigue ) question naires , evaluating quality of life and fatigue . Results A total of 57 evaluable women were r and omised : 29 to d-MPH and 28 to placebo ; the study did not meet its accrual goal of 170 patients , mainly because women were reluctant to take additional medication in general and methylpheni date in particular . Groups were well matched for age ( median , 50 years ) and education . d-MPH and placebo were well tolerated . There were no significant differences between the r and omised groups in classification of cognitive function by HSCS or in summed FACT-F fatigue scores ( the primary endpoints of the study ) at any of the assessment s. There were also no differences in HLTV-R scores or quality of life . Conclusions This study is underpowered , but there are no trends to suggest that d-MPH , taken concurrently with adjuvant chemotherapy , improves quality of life or fatigue Purpose The purpose of the study was to determine the effectiveness of megestrol acetate ( MA ) and olanzapine ( OLN ) for the treatment of  cancer-related anorexia ( CRA ) .  Methods Eighty adult patients with advanced gastrointestinal cancer or lung cancer ( stages III and IV ) with CRA ( loss of appetite and greater than or equal to 5 % loss of preillness stable weight ) were r and omized to receive daily MA or MA plus OLN for a period of 8 weeks . Patients were assessed weekly using the M.D. And erson Symptom Inventory with specific measurement of weight , appetite , nausea , and quality of life ( QOL ) measures . Results For the 37 patients receiving MA , 15 patients had a greater than or equal to 5 % weight gain , 2 patients had an appetite improvement , 3 patients had an improvement in nausea , and 5 patients had an improvement in QOL at both 4 and 8 weeks . For the 39 patients receiving MA plus OLN , 33 patients had a greater than or equal to 5 % weight gain , 25 patients had an appetite improvement , 21 patients had an improvement in nausea , and 23 patients had an improvement in QOL at both 4 and 8 weeks , and there was an improvement in general activity , mood , work , walking , and enjoyment at 8 weeks . There were no grade III or IV treatment-related toxicities in patients receiving MA or the combination of MA plus OLN . Conclusions The combination of MA and OLN appears to be an effective intervention for patients with CRA CONTEXT Dyspnea is a disabling distressing symptom that is common in advanced disease affecting millions of people worldwide . Current palliative strategies are partially effective in managing this symptom ; facial cooling has been shown to reduce the sensation of breathlessness when induced in volunteers but has not been formally investigated in dyspnea associated with disease . OBJECTIVE The objective of this study was to investigate whether a h and held fan reduces the sensation of breathlessness in such patients , enhancing palliative approaches . METHODS The effectiveness of a h and held fan ( blowing air across the nose and mouth ) in reducing the sensation of breathlessness was assessed in patients with advanced disease . Fifty participants were r and omized to use a h and held fan for five minutes directed to their face or leg first and then crossed over to the other treatment . The primary outcome measure was a decrease of greater than 1 cm in breathlessness recorded on a 10 cm visual analog scale ( VAS ) . RESULTS There was a significant difference in the VAS scores between the two treatments , with a reduction in breathlessness when the fan was directed to the face ( P=0.003 ) . CONCLUSION This study supports the hypothesis that a h and held fan directed to the face reduces the sensation of breathlessness . The fan was acceptable to participants : it is inexpensive , portable , enhances self-efficacy , and available internationally . It should be recommended as part of a palliative management strategy for reducing breathlessness associated with advanced disease PURPOSE A phase III , r and omized study was carried out to establish the most effective and safest treatment to improve the primary endpoints of cancer cachexia-lean body mass ( LBM ) , resting energy expenditure ( REE ) , and fatigue- and relevant secondary endpoints : appetite , quality of life , grip strength , Glasgow Prognostic Score ( GPS ) and proinflammatory cytokines . PATIENTS AND METHODS Three hundred thirty-two assessable patients with cancer-related anorexia/cachexia syndrome were r and omly assigned to one of five treatment arms : arm 1 , medroxyprogesterone ( 500 mg/day ) or megestrol acetate ( 320 mg/day ) ; arm 2 , oral supplementation with eicosapentaenoic acid ; arm 3 , L-carnitine ( 4 g/day ) ; arm 4 , thalidomide ( 200 mg/day ) ; and arm 5 , a combination of the above . Treatment duration was 4 months . RESULTS Analysis of variance showed a significant difference between treatment arms . A post hoc analysis showed the superiority of arm 5 over the others for all primary endpoints . An analysis of changes from baseline showed that LBM ( by dual-energy X-ray absorptiometry and by L3 computed tomography ) significantly increased in arm 5 . REE decreased significantly and fatigue improved significantly in arm 5 . Appetite increased significantly in arm 5 ; interleukin (IL)-6 decreased significantly in arm 5 and arm 4 ; GPS and Eastern Cooperative Oncology Group performance status ( ECOG PS ) score decreased significantly in arm 5 , arm 4 , and arm 3 . Toxicity was quite negligible , and was comparable between arms . CONCLUSION The most effective treatment in terms of all three primary efficacy endpoints and the secondary endpoints appetite , IL-6 , GPS , and ECOG PS score was the combination regimen that included all selected agents Chronic nausea occurs in most patients with advanced cancer . This study was done to assess the antiemetic effects of dexamethasone in patients with chronic nausea refractory to metoclopramide .  Secondary outcomes included appetite , fatigue , and pain .  Fifty-one patients who had nausea ( > or = 3/10 on a 0 - 10 scale ) for > or = 2 weeks despite 48 hours of oral metoclopramide therapy ( 40 - 60 mg/day ) were enrolled . Patients received 20 mg/day dexamethasone ( DM ) orally ( n = 25 ) or placebo ( n = 26 ) for severe nausea in addition to metoclopramide ( 60 mg/day orally ) . At baseline the mean nausea intensity ratings in the DM and placebo groups were 8.0 and 7.4 . At Day 8 they were 2.1 
    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: Helium has a low density and the potential of reducing the work of breathing and improving alveolar ventilation when replacing nitrogen in air . A Phase II , double-blind , r and omised , prospect i ve , controlled trial was undertaken to assess whether Heliox28 ( 72 % He/28 % O2 ) compared with oxygen-enriched air ( 72 % N2/28 % O2 ) or medical air ( 78.9 % N2/21.1 % O2 ) could reduce dyspnoea and improve the exercise capability of patients with primary lung cancer and dyspnoea on exertion ( Borg > 3 ) . A total of 12 patients ( seven male , five female patients , age 53–78 ) breathed the test gases in r and omised order via a facemask and inspiratory dem and valve at rest and while performing 6-min walk  tests . Pulse oximetry ( SaO2 ) was recorded continuously . Respiratory rate and dyspnoea ratings ( Borg and VAS ) were taken before and immediately post-walk . Breathing Heliox28 at rest significantly increased SaO2 compared to oxygen-enriched air ( 96±2 cf . 94±2 , P<0.01 ) . When compared to medical air , breathing Heliox28 but not oxygen-enriched air gave a significant improvement in the exercise capability ( P<0.0001 ) , SaO2 ( P<0.05 ) and dyspnoea scores ( VAS , P<0.05 ) of lung cancer patients The usefulness of percutaneous endoscopic gastrostomy ( PEG ) for decompression in patients with unresolving intestinal obstruction by gynecological malignancy is examined . Between April 1993 and August 1995 , 34 consecutive patients with small-bowel obstruction by gynecological cancer , heavily pretreated with surgery and chemotherapy , were admitted to our prospect i ve study .  PEG was performed in 32/34 patients ( 94.1 % ) . Failure in the placing of the tube occurred in 2 patients ( 5.9 % ) . Twenty-seven patients ( 84.4 % ) experienced symptomatic relief after a few days from PEG and tolerated soft and liquid foods . All of these patients were discharged from the hospital and underwent parenteral nutrition at home . The median postoperative hospital stay was 7 days ( range 3 - 45 ) . No major complications due to PEG placement itself occurred in our patients . Only 4 patients ( 12.5 % ) had postprocedure nausea and vomiting that was unresponsive to the conventional therapy . The use of Octreotide ( 0.6 mg/24 hr ) obtained relief from symptoms until death . The gastrostomy remained in place for a median of 74 days ( range 5 - 210 ) . Relief from symptoms after PEG placement and total parenteral nutrition permitted continuation of palliative  chemotherapy  in 8 patients ( 25 % ) . We suggest percutaneous endoscopic drainage gastrostomy technique as the procedure of choice for long-term drainage of unresolving small bowel obstruction in patient with metastatic abdominal gynecologic malignancy Cancer and its treatment can induce subjective and objective evidence of diminished functional capacity encompassing physical fatigue and cognitive impairment . Dexmethylpheni date ( D-MPH ; the D-isomer of methylpheni date ) was evaluated for treatment of chemotherapy-related fatigue and cognitive impairment . A r and omized , double-blind , placebo-controlled , parallel-group study evaluated the potential therapeutic effect and safety of D-MPH in the treatment of patients with chemotherapy-related fatigue . Change from baseline in the Functional Assessment of Chronic Illness Therapy-Fatigue Subscale ( FACIT-F ) total score at Week 8 was the primary outcome measure . One hundred fifty-four patients ( predominantly with breast and ovarian cancers ) were r and omized and treated . Compared with placebo , D-MPH-treated subjects demonstrated a significant improvement in fatigue symptoms at Week 8 in the FACIT-F ( P=0.02 ) and the Clinical Global Impression-Severity scores ( P=0.02 ) , without clinical ly relevant changes in hemoglobin levels . Cognitive function was not significantly improved . There was a higher rate of study drug-related adverse events ( AEs ) ( 48 of 76 [ 63 % ] vs. 22 of 78 [ 28 % ] ) and a higher discontinuation rate because of AEs ( 8 of 76 [ 11 % ] vs. 1 of 78 [ 1.3 % ] ) in D-MPH-treated subjects compared with placebo-treated subjects . The most commonly reported AEs independent of study drug relationship in D-MPH-treated subjects were headache , nausea , and dry mouth , and in placebo-treated subjects were headache , diarrhea , and insomnia .  D-MPH produced significant improvement in fatigue in subjects previously treated with cytotoxic chemotherapy . Further studies with D-MPH or other agents to explore treatment response in chemotherapy-associated fatigue should be considered To determine the effect of dexamethasone when treating malignant bowel obstruction , 35 patients were r and omized to receive intravenous dexamethasone or a placebo , crossing over to the alternate treatment arm if there had been no resolution of obstruction by day 5 . This was done in two consecutive studies . Patients were stratified according to whether or not they had received specific anticancer therapy within 28 days of study . In trial 1 , 15 out of 22 patients ‘ responded ’ ( resolution of obstruction by day 5 ; 10 on dexamethasone , five on placebo ) . Eleven out of 15 patients were ‘ on treatment ’ . In trial 2 , six out of 13 responded ( three on dexamethasone , three on placebo ) ; three out of six were ‘ on treatment ’ . When both studies are combined , 60 % ( 21/35 ) patients responded ( 13 on dexamethasone , eight on placebo ) . Poor patient accrual terminated both studies . Numbers are too small to allow a combination of studies or formal statistical analysis . We are unable to make any conclusion as to the effectiveness of dexamethasone  in the palliation of malignant bowel disease Background Women who receive adjuvant chemotherapy for breast cancer develop fatigue , and a subset reports cognitive impairment . Methylpheni date is reported to improve fatigue and to decrease cognitive impairment in other population s. Material s and methods Women were r and omised early during their chemotherapy  to receive d-methylpheni date ( d-MPH ) , a form of methylpheni date , or an identical appearing placebo . All participants took placebo for one cycle to ensure compliance and then study medication until completion of chemotherapy . Subjects were assessed at baseline , end of chemotherapy and at ∼6 months follow-up with the High Sensitivity Cognitive Screen ( HSCS ) and the Hopkins Verbal Learning Test-Revised ( HVLT-R ) . They also completed the self-report Functional Assessment of Cancer Therapy-General ( FACT-G ) and FACT-F ( F = fatigue ) question naires , evaluating quality of life and fatigue . Results A total of 57 evaluable women were r and omised : 29 to d-MPH and 28 to placebo ; the study did not meet its accrual goal of 170 patients , mainly because women were reluctant to take additional medication in general and methylpheni date in particular . Groups were well matched for age ( median , 50 years ) and education . d-MPH and placebo were well tolerated . There were no significant differences between the r and omised groups in classification of cognitive function by HSCS or in summed FACT-F fatigue scores ( the primary endpoints of the study ) at any of the assessment s. There were also no differences in HLTV-R scores or quality of life . Conclusions This study is underpowered , but there are no trends to suggest that d-MPH , taken concurrently with adjuvant chemotherapy , improves quality of life or fatigue Purpose The purpose of the study was to determine the effectiveness of megestrol acetate ( MA ) and olanzapine ( OLN ) for the treatment of  cancer-related anorexia ( CRA ) .  Methods Eighty adult patients with advanced gastrointestinal cancer or lung cancer ( stages III and IV ) with CRA ( loss of appetite and greater than or equal to 5 % loss of preillness stable weight ) were r and omized to receive daily MA or MA plus OLN for a period of 8 weeks . Patients were assessed weekly using the M.D. And erson Symptom Inventory with specific measurement of weight , appetite , nausea , and quality of life ( QOL ) measures . Results For the 37 patients receiving MA , 15 patients had a greater than or equal to 5 % weight gain , 2 patients had an appetite improvement , 3 patients had an improvement in nausea , and 5 patients had an improvement in QOL at both 4 and 8 weeks . For the 39 patients receiving MA plus OLN , 33 patients had a greater than or equal to 5 % weight gain , 25 patients had an appetite improvement , 21 patients had an improvement in nausea , and 23 patients had an improvement in QOL at both 4 and 8 weeks , and there was an improvement in general activity , mood , work , walking , and enjoyment at 8 weeks . There were no grade III or IV treatment-related toxicities in patients receiving MA or the combination of MA plus OLN . Conclusions The combination of MA and OLN appears to be an effective intervention for patients with CRA CONTEXT Dyspnea is a disabling distressing symptom that is common in advanced disease affecting millions of people worldwide . Current palliative strategies are partially effective in managing this symptom ; facial cooling has been shown to reduce the sensation of breathlessness when induced in volunteers but has not been formally investigated in dyspnea associated with disease . OBJECTIVE The objective of this study was to investigate whether a h and held fan reduces the sensation of breathlessness in such patients , enhancing palliative approaches . METHODS The effectiveness of a h and held fan ( blowing air across the nose and mouth ) in reducing the sensation of breathlessness was assessed in patients with advanced disease . Fifty participants were r and omized to use a h and held fan for five minutes directed to their face or leg first and then crossed over to the other treatment . The primary outcome measure was a decrease of greater than 1 cm in breathlessness recorded on a 10 cm visual analog scale ( VAS ) . RESULTS There was a significant difference in the VAS scores between the two treatments , with a reduction in breathlessness when the fan was directed to the face ( P=0.003 ) . CONCLUSION This study supports the hypothesis that a h and held fan directed to the face reduces the sensation of breathlessness . The fan was acceptable to participants : it is inexpensive , portable , enhances self-efficacy , and available internationally . It should be recommended as part of a palliative management strategy for reducing breathlessness associated with advanced disease PURPOSE A phase III , r and omized study was carried out to establish the most effective and safest treatment to improve the primary endpoints of cancer cachexia-lean body mass ( LBM ) , resting energy expenditure ( REE ) , and fatigue- and relevant secondary endpoints : appetite , quality of life , grip strength , Glasgow Prognostic Score ( GPS ) and proinflammatory cytokines . PATIENTS AND METHODS Three hundred thirty-two assessable patients with cancer-related anorexia/cachexia syndrome were r and omly assigned to one of five treatment arms : arm 1 , medroxyprogesterone ( 500 mg/day ) or megestrol acetate ( 320 mg/day ) ; arm 2 , oral supplementation with eicosapentaenoic acid ; arm 3 , L-carnitine ( 4 g/day ) ; arm 4 , thalidomide ( 200 mg/day ) ; and arm 5 , a combination of the above . Treatment duration was 4 months . RESULTS Analysis of variance showed a significant difference between treatment arms . A post hoc analysis showed the superiority of arm 5 over the others for all primary endpoints . An analysis of changes from baseline showed that LBM ( by dual-energy X-ray absorptiometry and by L3 computed tomography ) significantly increased in arm 5 . REE decreased significantly and fatigue improved significantly in arm 5 . Appetite increased significantly in arm 5 ; interleukin (IL)-6 decreased significantly in arm 5 and arm 4 ; GPS and Eastern Cooperative Oncology Group performance status ( ECOG PS ) score decreased significantly in arm 5 , arm 4 , and arm 3 . Toxicity was quite negligible , and was comparable between arms . CONCLUSION The most effective treatment in terms of all three primary efficacy endpoints and the secondary endpoints appetite , IL-6 , GPS , and ECOG PS score was the combination regimen that included all selected agents Chronic nausea occurs in most patients with advanced cancer . This study was done to assess the antiemetic effects of dexamethasone in patients with chronic nausea refractory to metoclopramide .  Secondary outcomes included appetite , fatigue , and pain .  Fifty-one patients who had nausea ( > or = 3/10 on a 0 - 10 scale ) for > or = 2 weeks despite 48 hours of oral metoclopramide therapy ( 40 - 60 mg/day ) were enrolled . Patients received 20 mg/day dexamethasone ( DM ) orally ( n = 25 ) or placebo ( n = 26 ) for severe nausea in addition to metoclopramide ( 60 mg/day orally ) . At baseline the mean nausea intensity ratings in the DM and placebo groups were 8.0 and 7.4 . At Day 8 they were 2.1 
    Output:
    