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 Anemia in patients with solid tumors is a common problem that is associated with impaired exercise capacity , increased fatigue , and lower quality of life ( QoL ) . Erythropoiesis-stimulating agents ( ESAs ) have been shown to improve these outcomes ; however , it is unknown if additional benefits can be achieved with aerobic exercise training . METHODS We conducted a single-center , prospect i ve , r and omized , controlled trial in 55 mild-to-moderately anemic patients with solid tumors . Patients were r and omized to either darbepoetin alfa alone ( DAL , n = 29 ) or darbepoetin alfa plus aerobic exercise training ( DEX ; n = 26 ) . The DEX group performed aerobic exercise training three times per week at 60%-100 % of baseline exercise capacity for 12 weeks . The primary endpoint was QoL assessed by the Functional Assessment of Cancer Therapy-Anemia scale . Secondary endpoints were fatigue , cardiorespiratory fitness ( VO(2peak ) ) , hemoglobin ( Hb ) response , and darbepoetin alfa dosing . RESULTS Intention-to-treat analyses indicated significant improvements in QoL and fatigue in both groups over time but there were no between-group differences . The DEX group had a significantly greater VO(2peak ) than the DAL group ( mean group difference , + 3.0 ml/kg per minute ; 95 % confidence interval , 1.2 - 4.7 ; p = .001 ) and there were borderline significant differences in favor of the DEX group for Hb response and darbepoetin alfa dosing . CONCLUSIONS Aerobic exercise training did not improve QoL or fatigue beyond the established benefits of DAL but it did result in favorable improvements in exercise capacity and a more rapid Hb response with lower dosing requirements . Our results may be useful to clinicians despite the more recent restrictions on the indications for ESAs The aim of this study was to evaluate a low-dose regimen of megestrol acetate ( MA ; 320 mg/day ) on appetite in advanced cancer patients . Out- patients with far-advanced non-hormone responsive tumours and loss of appetite were r and omised in a phase III trial , with two consecutive phases : a 14-day double-blind placebo controlled phase ( phase A ) and a 76-day open phase ( phase B ) . During phase A , patients were treated with MA , two 160 mg tablets/day , or placebo . In phase B , the MA dose was titrated to clinical response in both groups . Appetite , food intake , body weight , performance status , mood and quality of life were evaluated with st and ardised measures ; patients ' global judgement about treatment efficacy was also requested . Of 42 patients entering the study , 33 ( 17 MA and 16 placebo ) were evaluable for efficacy . The appetite score improved significantly with MA after 7 days ( P = 0.0023 ) , and this effect was still significant at 14 days ( P = 0.0064 ) . Patients judged the treatment with MA effective in 88.2 % of cases ( 14th day ) , whilst placebo was considered effective by 25 % ( P = 0.0003 ) . None of the other measures showed significant changes during treatment . The remarkable effect on appetite evident after 7 days , without serious side-effects , shows that MA can produce significant subjective effects at a low-dose even in patients with far-advanced disease The effectiveness of an 8-week , 125 mg/day intravenous course of methylprednisolone sodium succinate ( MPSS ) for improving quality of life in patients with preterminal cancer was investigated in a double-blind , placebo-controlled , multicenter study . Quality of life was assessed using the Nurses ' Observational Scale for Inpatient Evaluation ( NOSIE ) , the Linear Analog Self- Assessment Scale ( LASA ) , and the Physicians ' Global Evaluation . A total of 403 patients were enrolled : 207 were treated with MPSS and 196 were treated with placebo . MPSS was significantly more effective than placebo in improving quality of life as judged by the changes from baseline in the NOSIE and LASA total scores . ( P less than 0.05 ) and by the Physicians ' Global Evaluation ( P less than 0.001 ) . The mortality rate was similar between  MPSS-treated males ( 40.2 % ) ,  placebo-treated  males ( 35.5 % ) , and  MPSS-treated  females ( 40.0 % ) . However , the mortality rate of 27.7 % for female placebo-treated females was significantly lower than for their MPSS-treated counterparts . The reason for lower mortality among placebo-treated females is unknown and warrants further study Patients with breast cancer treated with MPA often report an improvement in appetite . Similar appetite stimulation is seen in patients treated with some corticosteroids , but MPA has a potential advantage over these drugs in that it does not exert a catabolic effect . MPA ( 100 mg tds orally ) has therefore been compared with placebo in 60 patients with advanced malignant disease . Twenty-one patients in the MPA group and 20 in the placebo group were receiving chemotherapy .  Patients were treated for 6 weeks and were assessed at weeks 0 , 3 and 6 for appetite , energy , mood and pain using visual analogue scales . Nutritional status was assessed by the measurement of serum proteins and anthropometrics . Karnofsky score was recorded as a measure of performance status . There was a significant improvement in appetite in the MPA group between weeks 0 ( pre- study ) and 3 ( P = 0.0002 ) and 0 and 6 ( P = 0.015 ) . There was no significant improvement in appetite in the placebo group . Supporting this finding was the significant increase in serum thyroid binding pre-albumin and retinol binding protein in the MPA group between weeks 0 and 3 and 0 and 6 ( P = 0.023 and P = 0.039 respectively ) . These two parameters showed no significant change in the placebo group . There was no change in anthropometric measurements , weight , performance status , energy , mood or pain in either group . These data indicate that there was a significant increase in appetite in anorexic patients with advanced cancer treated with MPA which was reflected in increases in rapid turnover proteins reported to reflect nutritional status . However , this apparent increase in appetite did not result in improved weight , performance status , energy levels , mood or relief of pain . Further studies to investigate the effect of higher doses of  MPA  are indicated A total of 173 female terminal cancer patients were r and omized to treatment with daily 125 mg infusions of methylprednisolone sodium succinate or a matching placebo for a period of 8 consecutive weeks . Data were collected relative to quality of life , investigator assessment of efficacy and cause and time of death within the 8-week treatment period . Significant improvement in quality of life was reported across the 8-week follow-up period in the steroid group . Investigator global assessment of efficacy significantly favored the steroid-treatment patients . There were no significant differences between treatment groups with regard to overall mortality rates or time to death . The total number of reported adverse events did not differ significantly between treatment groups . However , significantly more steroid patients reported gastrointestinal and cardiovascular events . The severity and outcome of these events did not differ from the placebo patients . The results of this study confirm previous reports of steroid efficacy in improving quality of life in terminal cancer patients . The absence of any untoward effect on mortality and the favorable safety profile support the use of methylprednisolone as palliative therapy for terminal cancer patients BACKGROUND Extracellular adenosine 5'-triphosphate ( ATP ) is involved in the regulation of a variety of biologic processes , including neurotransmission , muscle contraction , and liver glucose metabolism , via purinergic receptors . In nonr and omized studies involving patients with different tumor types including non-small-cell lung cancer ( NSCLC ) , ATP infusion appeared to inhibit loss of weight and deterioration of quality of life ( QOL ) and performance status . We conducted a r and omized clinical trial to evaluate the effects of ATP in patients with advanced NSCLC ( stage IIIB or IV ) . METHODS Fifty-eight patients were r and omly assigned to receive either 10 intravenous 30-hour ATP infusions , with the infusions given at 2- to 4-week intervals , or no ATP . Outcome parameters were assessed every 4 weeks until 28 weeks . Between-group differences were tested for statistical significance by use of repeated- measures analysis , and reported P values are two-sided . RESULTS Twenty-eight patients were allocated to receive ATP treatment and 30 received no ATP .  Mean weight changes per 4-week period were -1.0 kg ( 95 % confidence interval [ CI ] = -1.5 to -0.5 ) in the control group and 0.2 kg ( 95 % CI = -0.2 to + 0.6 ) in the ATP group ( P = .002 ) . Serum albumin concentration declined by -1.2 g/L ( 95 % CI= -2.0 to -0.4 ) per 4 weeks in the control group but remained stable ( 0.0 g/L ; 95 % CI = -0.3 to + 0.3 ) in the ATP group ( P = .006 ) . Elbow flexor muscle strength declined by -5.5 % ( 95 % CI = -9.6 % to -1 . 4 % ) per 4 weeks in the control group but remained stable ( 0.0 % ; 95 % CI= -1.4 % to + 1.4 % ) in the ATP group ( P = .01 ) . A similar pattern was observed for knee extensor muscles ( P = .02 ) . The effects of  ATP  on body weight , muscle strength , and albumin concentration were especially marked in cachectic patients ( P = .0002 , P = .0001 , and P = . 0001 , respectively , for ATP versus no ATP ) . QOL score changes per 4-week period in the ATP group showed overall less deterioration than in the control group-physical scores ( -0.2 % versus -2.4 % ; P = . 0002 ) ; functional scores ( + 0.4 % versus -5.5 % ; P = .02 ) ; psychologic scores ( -0.7 % versus -2.4 % ; P = .11 ) ; overall QOL score ( + 0.1 % versus -3.5 % ; P = .0001 ) . CONCLUSIONS This r and omized trial demonstrates that ATP has beneficial effects on weight , muscle strength , and QOL in patients with advanced NSCLC BACKGROUND Fatigue is a commonly encountered symptom of human immunodeficiency virus ( HIV ) disease , associated with significant psychological and functional morbidity and poor quality of life . Preliminary studies on the treatment of fatigue from the cancer and multiple sclerosis literature suggest that psychostimulants may be effective in reducing fatigue . OBJECTIVE To compare the efficacy of 2 psychostimulant medications , methylpheni date hydrochloride ( Ritalin ) and pemoline ( Cylert ) , with a placebo intervention for the treatment of fatigue in patients with HIV disease . METHODS In this double-blind trial , 144 ambulatory patients with HIV disease and persistent and severe fatigue were r and omized to treatment with methylpheni date , pemoline , or placebo . Medications were titrated up to a maximum dose of 60 mg of methlypheni date hydrochloride , 150 mg of pemoline , or 8 capsules of placebo daily . Fatigue was measured using 2 self-reported rating scales , the Piper Fatigue Scale ( PFS ) and the Visual Analogue Scale for Fatigue ( VAS-F ) . We also used the timed isometric unilateral straight leg-raising task , a measure of muscular endurance . Quality -of-life and psychological well-being measures included the Beck Depression Inventory , the Brief Symptom Inventory , and the 36-Item Short-Form Medical Outcomes Study Health Status Survey . Side effects were monitored using the Systematic Assessment for Treatment Emergent Events and the Extra-pyramidal Symptom Rating Scale . All measures were rated weekly . RESULTS One hundred nine subjects completed the 6-week trial ; 15 patients ( 41 % ) receiving methylpheni date and 12 patients ( 36 % ) receiving pemoline demonstrated clinical ly significant improvement compared with 6 patients ( 15 % ) receiving placebo . Patients receiving methylpheni date or pemoline demonstrated significantly more improvement in fatigue on several self-reported rating scales ( PFS total score , P=.04 ; affective subscale , P=.008 ; sensory subscale , P=.04 ; and VAS-F energy subscale , P=.02 ) . Analysis of the regression slopes by means of hierarchical linear modeling demonstrated a significantly greater rate of improvement in PFS total scores among patients receiving psychostimulants compared with the placebo group ( P=.02 ) . There were no significant differences in the efficacy between methlypheni date and pemoline on any outcome measure studied . Improvement in fatigue was also significantly correlated with improvement in measures of depression , psychological distress , and overall quality of life . Severe side effects were relatively uncommon among this sample , and only hyperactivity or jitteriness occurred significantly more often among subjects receiving active medication . CONCLUSIONS Many patients with HIV- and acquired immunodeficiency syndrome-unrelated fatigue respond favorably to treatment with methylpheni date or pemoline . Both psychostimulants appear to be equally effective and significantly superior to placebo in decreasing fatigue severity with minimal side effects . Moreover , improvement of fatigue was significantly associated with improved quality of life and decreased levels of depression and psychological distress Summary Anaemia commonly occurs in 
    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: BACKGROUND Anemia in patients with solid tumors is a common problem that is associated with impaired exercise capacity , increased fatigue , and lower quality of life ( QoL ) . Erythropoiesis-stimulating agents ( ESAs ) have been shown to improve these outcomes ; however , it is unknown if additional benefits can be achieved with aerobic exercise training . METHODS We conducted a single-center , prospect i ve , r and omized , controlled trial in 55 mild-to-moderately anemic patients with solid tumors . Patients were r and omized to either darbepoetin alfa alone ( DAL , n = 29 ) or darbepoetin alfa plus aerobic exercise training ( DEX ; n = 26 ) . The DEX group performed aerobic exercise training three times per week at 60%-100 % of baseline exercise capacity for 12 weeks . The primary endpoint was QoL assessed by the Functional Assessment of Cancer Therapy-Anemia scale . Secondary endpoints were fatigue , cardiorespiratory fitness ( VO(2peak ) ) , hemoglobin ( Hb ) response , and darbepoetin alfa dosing . RESULTS Intention-to-treat analyses indicated significant improvements in QoL and fatigue in both groups over time but there were no between-group differences . The DEX group had a significantly greater VO(2peak ) than the DAL group ( mean group difference , + 3.0 ml/kg per minute ; 95 % confidence interval , 1.2 - 4.7 ; p = .001 ) and there were borderline significant differences in favor of the DEX group for Hb response and darbepoetin alfa dosing . CONCLUSIONS Aerobic exercise training did not improve QoL or fatigue beyond the established benefits of DAL but it did result in favorable improvements in exercise capacity and a more rapid Hb response with lower dosing requirements . Our results may be useful to clinicians despite the more recent restrictions on the indications for ESAs The aim of this study was to evaluate a low-dose regimen of megestrol acetate ( MA ; 320 mg/day ) on appetite in advanced cancer patients . Out- patients with far-advanced non-hormone responsive tumours and loss of appetite were r and omised in a phase III trial , with two consecutive phases : a 14-day double-blind placebo controlled phase ( phase A ) and a 76-day open phase ( phase B ) . During phase A , patients were treated with MA , two 160 mg tablets/day , or placebo . In phase B , the MA dose was titrated to clinical response in both groups . Appetite , food intake , body weight , performance status , mood and quality of life were evaluated with st and ardised measures ; patients ' global judgement about treatment efficacy was also requested . Of 42 patients entering the study , 33 ( 17 MA and 16 placebo ) were evaluable for efficacy . The appetite score improved significantly with MA after 7 days ( P = 0.0023 ) , and this effect was still significant at 14 days ( P = 0.0064 ) . Patients judged the treatment with MA effective in 88.2 % of cases ( 14th day ) , whilst placebo was considered effective by 25 % ( P = 0.0003 ) . None of the other measures showed significant changes during treatment . The remarkable effect on appetite evident after 7 days , without serious side-effects , shows that MA can produce significant subjective effects at a low-dose even in patients with far-advanced disease The effectiveness of an 8-week , 125 mg/day intravenous course of methylprednisolone sodium succinate ( MPSS ) for improving quality of life in patients with preterminal cancer was investigated in a double-blind , placebo-controlled , multicenter study . Quality of life was assessed using the Nurses ' Observational Scale for Inpatient Evaluation ( NOSIE ) , the Linear Analog Self- Assessment Scale ( LASA ) , and the Physicians ' Global Evaluation . A total of 403 patients were enrolled : 207 were treated with MPSS and 196 were treated with placebo . MPSS was significantly more effective than placebo in improving quality of life as judged by the changes from baseline in the NOSIE and LASA total scores . ( P less than 0.05 ) and by the Physicians ' Global Evaluation ( P less than 0.001 ) . The mortality rate was similar between  MPSS-treated males ( 40.2 % ) ,  placebo-treated  males ( 35.5 % ) , and  MPSS-treated  females ( 40.0 % ) . However , the mortality rate of 27.7 % for female placebo-treated females was significantly lower than for their MPSS-treated counterparts . The reason for lower mortality among placebo-treated females is unknown and warrants further study Patients with breast cancer treated with MPA often report an improvement in appetite . Similar appetite stimulation is seen in patients treated with some corticosteroids , but MPA has a potential advantage over these drugs in that it does not exert a catabolic effect . MPA ( 100 mg tds orally ) has therefore been compared with placebo in 60 patients with advanced malignant disease . Twenty-one patients in the MPA group and 20 in the placebo group were receiving chemotherapy .  Patients were treated for 6 weeks and were assessed at weeks 0 , 3 and 6 for appetite , energy , mood and pain using visual analogue scales . Nutritional status was assessed by the measurement of serum proteins and anthropometrics . Karnofsky score was recorded as a measure of performance status . There was a significant improvement in appetite in the MPA group between weeks 0 ( pre- study ) and 3 ( P = 0.0002 ) and 0 and 6 ( P = 0.015 ) . There was no significant improvement in appetite in the placebo group . Supporting this finding was the significant increase in serum thyroid binding pre-albumin and retinol binding protein in the MPA group between weeks 0 and 3 and 0 and 6 ( P = 0.023 and P = 0.039 respectively ) . These two parameters showed no significant change in the placebo group . There was no change in anthropometric measurements , weight , performance status , energy , mood or pain in either group . These data indicate that there was a significant increase in appetite in anorexic patients with advanced cancer treated with MPA which was reflected in increases in rapid turnover proteins reported to reflect nutritional status . However , this apparent increase in appetite did not result in improved weight , performance status , energy levels , mood or relief of pain . Further studies to investigate the effect of higher doses of  MPA  are indicated A total of 173 female terminal cancer patients were r and omized to treatment with daily 125 mg infusions of methylprednisolone sodium succinate or a matching placebo for a period of 8 consecutive weeks . Data were collected relative to quality of life , investigator assessment of efficacy and cause and time of death within the 8-week treatment period . Significant improvement in quality of life was reported across the 8-week follow-up period in the steroid group . Investigator global assessment of efficacy significantly favored the steroid-treatment patients . There were no significant differences between treatment groups with regard to overall mortality rates or time to death . The total number of reported adverse events did not differ significantly between treatment groups . However , significantly more steroid patients reported gastrointestinal and cardiovascular events . The severity and outcome of these events did not differ from the placebo patients . The results of this study confirm previous reports of steroid efficacy in improving quality of life in terminal cancer patients . The absence of any untoward effect on mortality and the favorable safety profile support the use of methylprednisolone as palliative therapy for terminal cancer patients BACKGROUND Extracellular adenosine 5'-triphosphate ( ATP ) is involved in the regulation of a variety of biologic processes , including neurotransmission , muscle contraction , and liver glucose metabolism , via purinergic receptors . In nonr and omized studies involving patients with different tumor types including non-small-cell lung cancer ( NSCLC ) , ATP infusion appeared to inhibit loss of weight and deterioration of quality of life ( QOL ) and performance status . We conducted a r and omized clinical trial to evaluate the effects of ATP in patients with advanced NSCLC ( stage IIIB or IV ) . METHODS Fifty-eight patients were r and omly assigned to receive either 10 intravenous 30-hour ATP infusions , with the infusions given at 2- to 4-week intervals , or no ATP . Outcome parameters were assessed every 4 weeks until 28 weeks . Between-group differences were tested for statistical significance by use of repeated- measures analysis , and reported P values are two-sided . RESULTS Twenty-eight patients were allocated to receive ATP treatment and 30 received no ATP .  Mean weight changes per 4-week period were -1.0 kg ( 95 % confidence interval [ CI ] = -1.5 to -0.5 ) in the control group and 0.2 kg ( 95 % CI = -0.2 to + 0.6 ) in the ATP group ( P = .002 ) . Serum albumin concentration declined by -1.2 g/L ( 95 % CI= -2.0 to -0.4 ) per 4 weeks in the control group but remained stable ( 0.0 g/L ; 95 % CI = -0.3 to + 0.3 ) in the ATP group ( P = .006 ) . Elbow flexor muscle strength declined by -5.5 % ( 95 % CI = -9.6 % to -1 . 4 % ) per 4 weeks in the control group but remained stable ( 0.0 % ; 95 % CI= -1.4 % to + 1.4 % ) in the ATP group ( P = .01 ) . A similar pattern was observed for knee extensor muscles ( P = .02 ) . The effects of  ATP  on body weight , muscle strength , and albumin concentration were especially marked in cachectic patients ( P = .0002 , P = .0001 , and P = . 0001 , respectively , for ATP versus no ATP ) . QOL score changes per 4-week period in the ATP group showed overall less deterioration than in the control group-physical scores ( -0.2 % versus -2.4 % ; P = . 0002 ) ; functional scores ( + 0.4 % versus -5.5 % ; P = .02 ) ; psychologic scores ( -0.7 % versus -2.4 % ; P = .11 ) ; overall QOL score ( + 0.1 % versus -3.5 % ; P = .0001 ) . CONCLUSIONS This r and omized trial demonstrates that ATP has beneficial effects on weight , muscle strength , and QOL in patients with advanced NSCLC BACKGROUND Fatigue is a commonly encountered symptom of human immunodeficiency virus ( HIV ) disease , associated with significant psychological and functional morbidity and poor quality of life . Preliminary studies on the treatment of fatigue from the cancer and multiple sclerosis literature suggest that psychostimulants may be effective in reducing fatigue . OBJECTIVE To compare the efficacy of 2 psychostimulant medications , methylpheni date hydrochloride ( Ritalin ) and pemoline ( Cylert ) , with a placebo intervention for the treatment of fatigue in patients with HIV disease . METHODS In this double-blind trial , 144 ambulatory patients with HIV disease and persistent and severe fatigue were r and omized to treatment with methylpheni date , pemoline , or placebo . Medications were titrated up to a maximum dose of 60 mg of methlypheni date hydrochloride , 150 mg of pemoline , or 8 capsules of placebo daily . Fatigue was measured using 2 self-reported rating scales , the Piper Fatigue Scale ( PFS ) and the Visual Analogue Scale for Fatigue ( VAS-F ) . We also used the timed isometric unilateral straight leg-raising task , a measure of muscular endurance . Quality -of-life and psychological well-being measures included the Beck Depression Inventory , the Brief Symptom Inventory , and the 36-Item Short-Form Medical Outcomes Study Health Status Survey . Side effects were monitored using the Systematic Assessment for Treatment Emergent Events and the Extra-pyramidal Symptom Rating Scale . All measures were rated weekly . RESULTS One hundred nine subjects completed the 6-week trial ; 15 patients ( 41 % ) receiving methylpheni date and 12 patients ( 36 % ) receiving pemoline demonstrated clinical ly significant improvement compared with 6 patients ( 15 % ) receiving placebo . Patients receiving methylpheni date or pemoline demonstrated significantly more improvement in fatigue on several self-reported rating scales ( PFS total score , P=.04 ; affective subscale , P=.008 ; sensory subscale , P=.04 ; and VAS-F energy subscale , P=.02 ) . Analysis of the regression slopes by means of hierarchical linear modeling demonstrated a significantly greater rate of improvement in PFS total scores among patients receiving psychostimulants compared with the placebo group ( P=.02 ) . There were no significant differences in the efficacy between methlypheni date and pemoline on any outcome measure studied . Improvement in fatigue was also significantly correlated with improvement in measures of depression , psychological distress , and overall quality of life . Severe side effects were relatively uncommon among this sample , and only hyperactivity or jitteriness occurred significantly more often among subjects receiving active medication . CONCLUSIONS Many patients with HIV- and acquired immunodeficiency syndrome-unrelated fatigue respond favorably to treatment with methylpheni date or pemoline . Both psychostimulants appear to be equally effective and significantly superior to placebo in decreasing fatigue severity with minimal side effects . Moreover , improvement of fatigue was significantly associated with improved quality of life and decreased levels of depression and psychological distress Summary Anaemia commonly occurs in 
    Output:
    