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: Chemotherapy and radiotherapy offer little benefit to patients with advanced pancreatic cancer .  Eicosapentaenoic acid ( EPA ) has anticancer effects both in vitro and in animal models . The dose of EPA that can be administered to cancer patients has previously been limited by the low purity of available preparations and the tolerability of large capsules . A high-purity preparation of EPA as a 20 % oil-in-water diester emulsion allowed a small study of the tolerance , incorporation , and effects of EPA in high doses in five patients with advanced pancreatic cancer . Patients underwent assessment at baseline and every 4 wk thereafter . All patients managed to tolerate a dose providing 18 g EPA per day , with doses between 9 and 27 g daily being taken for at least a month . Dosage was limited by a sensation of fullness , cramping abdominal pain , steatorrhea , and nausea . All such symptoms were controlled by dose reduction or pancreatic enzyme supplements . No other adverse effects attributable to the trial agent were observed . Plasma phospholipid EPA content increased from around 1 % at baseline to 10 % at 4 wk and 20 % at 8 wk . Incorporation of EPA into red blood cell phospholipids reached levels of around 10 % . The present study has shown that a novel , high-purity , EPA diester emulsion can be tolerated at a dose providing around 18 g EPA per day with side-effects being easily controlled . The acceptibility of large doses of oral EPA should allow larger controlled clinical studies into potential anticancer effects of EPA Metabolic dem and and altered supply of essential nutrients is poorly characterised in patients with advanced cancer . A possible imbalance or deficiency of essential fatty acids is suggested by reported beneficial effects of fish oil supplementation . To assess fatty acid status ( composition of plasma and neutrophil phospholipids ) in advanced cancer patients before and after 14 days of supplementation ( 12±1 g day−1 ) with fish ( eicosapentaenoic acid , and docosahexaenoic acid ) or placebo ( olive ) oil . Blood was drawn from cancer patients experiencing weight loss of > 5 % body weight ( n=23 ) . Fatty acid composition of plasma phospholipids and the major phospholipid classes of isolated neutrophils were determined using gas liquid chromatography . At baseline , patients with advanced cancer exhibited low levels ( < 30 % of normal values ) of plasma phospholipids and constituent fatty acids and elevated 20:4 n-6 content in neutrophil phospholipids . High n-6/n-3 fatty acid ratios in neutrophil and plasma phospholipids were inversely related to body mass index . Fish oil supplementation raised eicosapentaenoic acid and docosahexaenoic acid content in plasma but not neutrophil phospholipids . 20:4 n-6 content was reduced in neutrophil PI following supplementation with fish oil . Change in body weight during the supplementation period related directly to increases in eicosapentaenoic acid in plasma . Advanced cancer patients have alterations in lipid metabolism potentially due to nutritional status and /or chemotherapy . Potential obstacles in fatty acid utilisation must be addressed in future trials aim ing to improve outcomes using nutritional intervention with fish oils Aim : N-3 fatty acids , especially eicosapentaenoic acid ( EPA ) , may possess anticachectic properties . This trial compared a protein and energy dense supplement enriched with n-3 fatty acids and antioxidants ( experimental : E ) with an isocaloric isonitrogenous control supplement ( C ) for their effects on weight , lean body mass ( LBM ) , dietary intake , and quality of life in cachectic patients with advanced pancreatic cancer . Methods : A total of 200 patients ( 95 E ; 105 C ) were r and omised to consume two cans/day of the E or C supplement ( 480 ml , 620 kcal , 32 g protein ± 2.2 g EPA ) for eight weeks in a multicentre , r and omised , double blind trial . Results : At enrolment , patients ’ mean rate of weight loss was 3.3 kg/month . Intake of the supplements ( E or C ) was below the recommended dose ( 2 cans/day ) and averaged 1.4 cans/day . Over eight weeks , patients in both groups stopped losing weight ( Δ weight E : −0.25 kg/month versus C : −0.37 kg/month ; p = 0.74 ) and LBM ( Δ LBM E : + 0.27 kg/month versus C : + 0.12 kg/month ; p = 0.88 ) to an equal degree ( change from baseline E and C , p<0.001 ) . In view of evident non-compliance in both E and C groups , correlation analyses were undertaken to examine for potential dose-response relationships . E patients demonstrated significant correlations between their supplement intake and weight gain ( r = 0.50 , p<0.001 ) and increase in LBM ( r = 0.33 , p = 0.036 ) . Such correlations were not statistically significant in C patients . The relationship of supplement intake with change in LBM was significantly different between E and C patients ( p = 0.043 ) . Increased plasma EPA levels in the E group were associated with weight and LBM gain ( r = 0.50 , p<0.001 ; r = 0.51 , p = 0.001 ) . Weight gain was associated with improved quality of life ( p<0.01 ) only in the E group . Conclusion : Intention to treat group comparisons indicated that at the mean dose taken , enrichment with n-3 fatty acids did not provide a therapeutic advantage and that both supplements were equally effective in arresting weight loss . Post hoc dose-response analysis suggests that if taken in sufficient quantity , only the n-3 fatty acid enriched energy and protein dense supplement results in net gain of weight , lean tissue , and improved quality of life . Further trials are required to examine the potential role of n-3 enriched supplements in the treatment of cancer cachexia OBJECTIVE To evaluate the effect of early postoperative feeding with a nutritionally complete enteral diet supplemented with the nutrients arginine , ribonucleic acid ( RNA ) , and omega-3 fatty acids on the immune function in patients undergoing surgery for upper gastrointestinal ( GI ) malignancies . DESIGN Prospect i ve , r and omized , placebo-controlled , double-blind study . SETTING Surgical intensive care unit ( ICU ) in a German university hospital . PATIENTS Forty-two consecutive patients receiving an enteral diet via needle catheter jejunostomy after GI surgery for cancer . INTERVENTIONS Patients were r and omized to receive either the arginine , RNA , and omega-3 fatty acids supplemented diet or an isocaloric and isonitrogenous placebo diet . Early enteral nutrition was started on postoperative day 1 in the surgical ICU with 20 mL/hr and progressed to the optimal goal of 80 mL/hr by postoperative day 5 . MEASUREMENTS AND MAIN RESULTS Clinical examination and adverse GI symptoms were recorded on a daily basis . Body weight was determined twice weekly . Immunoglobulin concentrations were determined by laser nephelometry . Interferon-gamma concentrations were measured with a modified enzyme-linked immunosorbent assay method . Fluorescence-activated cell scan flow cytometry was performed to analyze B cells , T lymphocytes and their subsets . Clinical patient characteristics and mean caloric intake were similar between the two groups and both formulas were well tolerated . The number of T lymphocytes and their subsets , helper T cells ( CD4 ) and activated T cells ( CD3 , HLA-DR ) , were significantly higher in the supplemented diet group on postoperative days 10 and 16 ( p < .05 ) . Mean interferon-gamma concentration after phytohemagglutinin stimulation was higher in the supplemented diet group on postoperative day 16 . In the supplemented diet group , mean immunoglobulin M concentrations were significantly higher on postoperative day 10 and mean immunoglobulin G concentrations were higher on postoperative day 16 ( p < .05 ) compared with the results in the placebo group . B-lymphocyte indices were significantly higher in the supplemented vs. the placebo diet group on postoperative days 7 and 10 ( p < .05 ) . CONCLUSIONS Supplementation of enteral diet with arginine , RNA , and omega-3 fatty acids in the early postoperative time period improves postoperative immunologic responses and helps to overcome more rapidly the immunologic depression after surgical trauma OBJECTIVE To determine if early postoperative feeding of patients with upper gastrointestinal malignancy , using an enteral diet supplemented with arginine , dietary nucleotides , and omega-3 fatty acids ( IMPACT , S and oz Nutrition , Bern , Switzerl and ) results in an improved clinical outcome , i.e. , reduced infectious and wound complications and decreased treatment costs when compared with an isocaloric , isonitrogenous control diet . DESIGN A prospect i ve , r and omized , placebo-controlled , double-blind , multicenter trial of the clinical outcome and a retrospective cost-comparison analysis . SETTING Surgical intensive care units in three different German university hospitals . PATIENTS Of 164 patients enrolled in the study , 154 patients were eligible for analysis . They were admitted to the intensive care unit after upper gastrointestinal surgery for cancer and they received an enteral diet via needle catheter jejunostomy .  Infectious complications were defined as sepsis or systemic inflammatory response syndrome , pneumonia , urinary tract infection , central venous catheter sepsis , wound infection , and anastomotic leakage . The complication events were prospect ively divided into two groups : early ( postoperative days 1 to 5 ) and late ( after the fifth postoperative day ) postoperative complications . The treatment costs of each complication were analyzed and compared in both groups . INTERVENTIONS Patients were r and omized to receive either the immunonutritional diet ( n = 77 ) or an isocaloric and isonitrogenous placebo diet ( n = 77 ) . Enteral feeding was initiated 12 to 24 hrs after surgery , starting with 20 mL/hr and advanced to a target volume of 80 mL/hr by postoperative day 5 . MEASUREMENTS AND MAIN RESULTS Clinical examination and adverse gastrointestinal symptoms were recorded on a daily basis . Both groups tolerated early enteral feeding well , and the rate of tube feeding-related complications was low . Postoperative complications occurred in 17 patients in the immunonutrition group vs. 24 patients in the control group ( NS ) . Further , in the early phase ( postoperative day 1 to 5 ) , complications occurred to a similar extent in both groups ( 12 patients in the immunonutritional group vs. 11 patients in the control group ) . However , in the late phase ( after postoperative day 5 ) , considerably fewer patients in the experimental diet group experienced complications compared with the control group ( 5 vs. 13 , p < .05 ) . In addition , the frequency rate of complicating events were recorded in each group . In the experimental diet group , a total of 22 complicating events were recorded vs. a total of 32 events in the placebo diet group ( NS ) . However , the occurrence of late complicating events , i.e. , complicating events after the fifth postoperative day , was significantly reduced in the immunonutrition group when compared with the control group ( 8 vs. 17 events , p < .05 ) . The total costs for the treatment of the complications were 83,563 German marks in the experimental diet group vs. 122,430 German marks in the control group , result ing in a cost-reduction of 38,867 German marks . ( At the end of December 1995 , the conversion rate from German marks to U.S. dollars was 1.4365 German marks to $ 1.00 . ) CONCLUSIONS Early enteral feeding with an arginine , dietary nucleotides , and omega-3 fatty acids supplemented diet , as well as an isonitrogenous , isocaloric control diet ( placebo ) were well tolerated in patients who underwent upper gastrointestinal surgery . In patients who received the supplemented diet , a significant reduction in the frequency rate of late postoperative infectious and wound complications was observed . Thereby , the treatment costs were substantially reduced in the immunonutrition group as compared with the control group OBJECTIVES /HYPOTHESIS Malnutrition is a significant risk factor for postoperative infections in patients undergoing oncologic surgery . This study was undertaken to determine if perioperative nutritional supplementation with an immune-enhancing formula is superior to st and ard formula in the prevention of postoperative infectious complications . STUDY DESIGN This was a prospect i ve , r and omized , double-blind trial comparing perioperative nutritional supplementation with Impact and st and ard nutritional formulas . METHODS Following stratification , 136 patients undergoing oncologic head and neck surgery were r and omly assigned to one of four treatment groups : preoperative/postoperative Impact , postoperative Impact , preoperative/postoperative st and ard formula , and postoperative st and ard formula . Outcome measures included laboratory 
    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: Chemotherapy and radiotherapy offer little benefit to patients with advanced pancreatic cancer .  Eicosapentaenoic acid ( EPA ) has anticancer effects both in vitro and in animal models . The dose of EPA that can be administered to cancer patients has previously been limited by the low purity of available preparations and the tolerability of large capsules . A high-purity preparation of EPA as a 20 % oil-in-water diester emulsion allowed a small study of the tolerance , incorporation , and effects of EPA in high doses in five patients with advanced pancreatic cancer . Patients underwent assessment at baseline and every 4 wk thereafter . All patients managed to tolerate a dose providing 18 g EPA per day , with doses between 9 and 27 g daily being taken for at least a month . Dosage was limited by a sensation of fullness , cramping abdominal pain , steatorrhea , and nausea . All such symptoms were controlled by dose reduction or pancreatic enzyme supplements . No other adverse effects attributable to the trial agent were observed . Plasma phospholipid EPA content increased from around 1 % at baseline to 10 % at 4 wk and 20 % at 8 wk . Incorporation of EPA into red blood cell phospholipids reached levels of around 10 % . The present study has shown that a novel , high-purity , EPA diester emulsion can be tolerated at a dose providing around 18 g EPA per day with side-effects being easily controlled . The acceptibility of large doses of oral EPA should allow larger controlled clinical studies into potential anticancer effects of EPA Metabolic dem and and altered supply of essential nutrients is poorly characterised in patients with advanced cancer . A possible imbalance or deficiency of essential fatty acids is suggested by reported beneficial effects of fish oil supplementation . To assess fatty acid status ( composition of plasma and neutrophil phospholipids ) in advanced cancer patients before and after 14 days of supplementation ( 12±1 g day−1 ) with fish ( eicosapentaenoic acid , and docosahexaenoic acid ) or placebo ( olive ) oil . Blood was drawn from cancer patients experiencing weight loss of > 5 % body weight ( n=23 ) . Fatty acid composition of plasma phospholipids and the major phospholipid classes of isolated neutrophils were determined using gas liquid chromatography . At baseline , patients with advanced cancer exhibited low levels ( < 30 % of normal values ) of plasma phospholipids and constituent fatty acids and elevated 20:4 n-6 content in neutrophil phospholipids . High n-6/n-3 fatty acid ratios in neutrophil and plasma phospholipids were inversely related to body mass index . Fish oil supplementation raised eicosapentaenoic acid and docosahexaenoic acid content in plasma but not neutrophil phospholipids . 20:4 n-6 content was reduced in neutrophil PI following supplementation with fish oil . Change in body weight during the supplementation period related directly to increases in eicosapentaenoic acid in plasma . Advanced cancer patients have alterations in lipid metabolism potentially due to nutritional status and /or chemotherapy . Potential obstacles in fatty acid utilisation must be addressed in future trials aim ing to improve outcomes using nutritional intervention with fish oils Aim : N-3 fatty acids , especially eicosapentaenoic acid ( EPA ) , may possess anticachectic properties . This trial compared a protein and energy dense supplement enriched with n-3 fatty acids and antioxidants ( experimental : E ) with an isocaloric isonitrogenous control supplement ( C ) for their effects on weight , lean body mass ( LBM ) , dietary intake , and quality of life in cachectic patients with advanced pancreatic cancer . Methods : A total of 200 patients ( 95 E ; 105 C ) were r and omised to consume two cans/day of the E or C supplement ( 480 ml , 620 kcal , 32 g protein ± 2.2 g EPA ) for eight weeks in a multicentre , r and omised , double blind trial . Results : At enrolment , patients ’ mean rate of weight loss was 3.3 kg/month . Intake of the supplements ( E or C ) was below the recommended dose ( 2 cans/day ) and averaged 1.4 cans/day . Over eight weeks , patients in both groups stopped losing weight ( Δ weight E : −0.25 kg/month versus C : −0.37 kg/month ; p = 0.74 ) and LBM ( Δ LBM E : + 0.27 kg/month versus C : + 0.12 kg/month ; p = 0.88 ) to an equal degree ( change from baseline E and C , p<0.001 ) . In view of evident non-compliance in both E and C groups , correlation analyses were undertaken to examine for potential dose-response relationships . E patients demonstrated significant correlations between their supplement intake and weight gain ( r = 0.50 , p<0.001 ) and increase in LBM ( r = 0.33 , p = 0.036 ) . Such correlations were not statistically significant in C patients . The relationship of supplement intake with change in LBM was significantly different between E and C patients ( p = 0.043 ) . Increased plasma EPA levels in the E group were associated with weight and LBM gain ( r = 0.50 , p<0.001 ; r = 0.51 , p = 0.001 ) . Weight gain was associated with improved quality of life ( p<0.01 ) only in the E group . Conclusion : Intention to treat group comparisons indicated that at the mean dose taken , enrichment with n-3 fatty acids did not provide a therapeutic advantage and that both supplements were equally effective in arresting weight loss . Post hoc dose-response analysis suggests that if taken in sufficient quantity , only the n-3 fatty acid enriched energy and protein dense supplement results in net gain of weight , lean tissue , and improved quality of life . Further trials are required to examine the potential role of n-3 enriched supplements in the treatment of cancer cachexia OBJECTIVE To evaluate the effect of early postoperative feeding with a nutritionally complete enteral diet supplemented with the nutrients arginine , ribonucleic acid ( RNA ) , and omega-3 fatty acids on the immune function in patients undergoing surgery for upper gastrointestinal ( GI ) malignancies . DESIGN Prospect i ve , r and omized , placebo-controlled , double-blind study . SETTING Surgical intensive care unit ( ICU ) in a German university hospital . PATIENTS Forty-two consecutive patients receiving an enteral diet via needle catheter jejunostomy after GI surgery for cancer . INTERVENTIONS Patients were r and omized to receive either the arginine , RNA , and omega-3 fatty acids supplemented diet or an isocaloric and isonitrogenous placebo diet . Early enteral nutrition was started on postoperative day 1 in the surgical ICU with 20 mL/hr and progressed to the optimal goal of 80 mL/hr by postoperative day 5 . MEASUREMENTS AND MAIN RESULTS Clinical examination and adverse GI symptoms were recorded on a daily basis . Body weight was determined twice weekly . Immunoglobulin concentrations were determined by laser nephelometry . Interferon-gamma concentrations were measured with a modified enzyme-linked immunosorbent assay method . Fluorescence-activated cell scan flow cytometry was performed to analyze B cells , T lymphocytes and their subsets . Clinical patient characteristics and mean caloric intake were similar between the two groups and both formulas were well tolerated . The number of T lymphocytes and their subsets , helper T cells ( CD4 ) and activated T cells ( CD3 , HLA-DR ) , were significantly higher in the supplemented diet group on postoperative days 10 and 16 ( p < .05 ) . Mean interferon-gamma concentration after phytohemagglutinin stimulation was higher in the supplemented diet group on postoperative day 16 . In the supplemented diet group , mean immunoglobulin M concentrations were significantly higher on postoperative day 10 and mean immunoglobulin G concentrations were higher on postoperative day 16 ( p < .05 ) compared with the results in the placebo group . B-lymphocyte indices were significantly higher in the supplemented vs. the placebo diet group on postoperative days 7 and 10 ( p < .05 ) . CONCLUSIONS Supplementation of enteral diet with arginine , RNA , and omega-3 fatty acids in the early postoperative time period improves postoperative immunologic responses and helps to overcome more rapidly the immunologic depression after surgical trauma OBJECTIVE To determine if early postoperative feeding of patients with upper gastrointestinal malignancy , using an enteral diet supplemented with arginine , dietary nucleotides , and omega-3 fatty acids ( IMPACT , S and oz Nutrition , Bern , Switzerl and ) results in an improved clinical outcome , i.e. , reduced infectious and wound complications and decreased treatment costs when compared with an isocaloric , isonitrogenous control diet . DESIGN A prospect i ve , r and omized , placebo-controlled , double-blind , multicenter trial of the clinical outcome and a retrospective cost-comparison analysis . SETTING Surgical intensive care units in three different German university hospitals . PATIENTS Of 164 patients enrolled in the study , 154 patients were eligible for analysis . They were admitted to the intensive care unit after upper gastrointestinal surgery for cancer and they received an enteral diet via needle catheter jejunostomy .  Infectious complications were defined as sepsis or systemic inflammatory response syndrome , pneumonia , urinary tract infection , central venous catheter sepsis , wound infection , and anastomotic leakage . The complication events were prospect ively divided into two groups : early ( postoperative days 1 to 5 ) and late ( after the fifth postoperative day ) postoperative complications . The treatment costs of each complication were analyzed and compared in both groups . INTERVENTIONS Patients were r and omized to receive either the immunonutritional diet ( n = 77 ) or an isocaloric and isonitrogenous placebo diet ( n = 77 ) . Enteral feeding was initiated 12 to 24 hrs after surgery , starting with 20 mL/hr and advanced to a target volume of 80 mL/hr by postoperative day 5 . MEASUREMENTS AND MAIN RESULTS Clinical examination and adverse gastrointestinal symptoms were recorded on a daily basis . Both groups tolerated early enteral feeding well , and the rate of tube feeding-related complications was low . Postoperative complications occurred in 17 patients in the immunonutrition group vs. 24 patients in the control group ( NS ) . Further , in the early phase ( postoperative day 1 to 5 ) , complications occurred to a similar extent in both groups ( 12 patients in the immunonutritional group vs. 11 patients in the control group ) . However , in the late phase ( after postoperative day 5 ) , considerably fewer patients in the experimental diet group experienced complications compared with the control group ( 5 vs. 13 , p < .05 ) . In addition , the frequency rate of complicating events were recorded in each group . In the experimental diet group , a total of 22 complicating events were recorded vs. a total of 32 events in the placebo diet group ( NS ) . However , the occurrence of late complicating events , i.e. , complicating events after the fifth postoperative day , was significantly reduced in the immunonutrition group when compared with the control group ( 8 vs. 17 events , p < .05 ) . The total costs for the treatment of the complications were 83,563 German marks in the experimental diet group vs. 122,430 German marks in the control group , result ing in a cost-reduction of 38,867 German marks . ( At the end of December 1995 , the conversion rate from German marks to U.S. dollars was 1.4365 German marks to $ 1.00 . ) CONCLUSIONS Early enteral feeding with an arginine , dietary nucleotides , and omega-3 fatty acids supplemented diet , as well as an isonitrogenous , isocaloric control diet ( placebo ) were well tolerated in patients who underwent upper gastrointestinal surgery . In patients who received the supplemented diet , a significant reduction in the frequency rate of late postoperative infectious and wound complications was observed . Thereby , the treatment costs were substantially reduced in the immunonutrition group as compared with the control group OBJECTIVES /HYPOTHESIS Malnutrition is a significant risk factor for postoperative infections in patients undergoing oncologic surgery . This study was undertaken to determine if perioperative nutritional supplementation with an immune-enhancing formula is superior to st and ard formula in the prevention of postoperative infectious complications . STUDY DESIGN This was a prospect i ve , r and omized , double-blind trial comparing perioperative nutritional supplementation with Impact and st and ard nutritional formulas . METHODS Following stratification , 136 patients undergoing oncologic head and neck surgery were r and omly assigned to one of four treatment groups : preoperative/postoperative Impact , postoperative Impact , preoperative/postoperative st and ard formula , and postoperative st and ard formula . Outcome measures included laboratory 
    Output:
    