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: A r and omized controlled prospect i ve clinical trial has been undertaken to examine the efficacy of the technique of early postoperative feeding using a fine bore catheter jejunostomy .  Fifty patients undergoing surgery for gastrointestinal malignancy were r and omly allocated into treatment and control groups . A low residue liquidized diet ( IsocalR ) was administered to the patients in the treatment group . Control patients received routine intravenous therapy .  Nutritional parameters ( serum albumin , serum transferrin , serum prealbumin , weight , body fat and fat free mass ) were measured pre‐operatively and on the tenth postoperative day . Postoperative surgical complications were similar in both groups . There were 20 catheter complications and one death directly attributable to the jejunal catheter feeding . Postoperative stay was significantly longer ( P < 0.01 ) in the treatment group patients . Evaluation of the nutritional parameters showed no advantage for either the treatment group or a selected complication‐free , successful treatment , subgroup . It is concluded that no significant clinical or nutritional advantage for jejunal catheter feeding has been demonstrated and because of the related complications , its routine use can not be recommended Ninety-three cancer patients about to undergo radiotherapy were studied . These patients were affected by cancer of the head and neck , breast cancer , and abdominopelvic cancer . They were r and omly distributed into control and experimental groups . The patients from the control group were allowed to eat ad libitum , whereas those from the experimental group followed a strict nutritional protocol that covered their needs while satisfying their particular tastes and habits . Data were collected the day before radiotherapy commenced and the day treatment ended . Anthropometric , analytical , and clinical parameters were determined . The results showed the benefit of dietetic treatment in experimental patients with head and neck or abdominopelvic cancer In recent years , the concept of nutritional support as a part of a comprehensive cancer management program has gained increasing acceptability . However , little data is available in regard to the effect of nutritional support programs on the chronic disease state represented by recurrent or persistent cancer that characterizes patients undergoing systemic chemotherapy . In 1977 we undertook to study this problem in a r and omized prospect i ve study design ed to evaluate the effects of long-term ( 12 months ) enteral nutritional support in a group of ambulatory breast cancer patients undergoing a st and ard cytotoxic chemotherapy treatment program  , in an adjuvant or therapeutic setting . The results of this study suggest that patients with breast cancer are overweight as compared to the general population and that any significant change in initial body weight , either a gain or a loss , is associated with an increased risk of recurrent disease . Data are presented which show little or no correlation between st and ard parameters of nutritional assessment and risk of disease recurrence and /or response to chemotherapy . These data also suggest that until we better underst and the relationship between tumor and host in breast cancer patients , we offer nutritional support programs only in situations where there are specific clinical indications for such interventions 59 elderly patients ( mean age 82 ) with femoral neck fractures were r and omised into two groups . 27 patients received daily an oral nutrition supplement ( 250 ml , 20 g protein , 254 kcal ) for a mean of 32 days ; 32 patients acted as controls . On admission most patients had nutritional deficiencies . Despite being offered adequate quantities , nutritional requirements were not met during the hospital stay . Clinical outcome was significantly better in the supplemented group ( 56 % favourable course vs 13 % in controls ) during the stay in the convalescent hospital . The rates of complications and deaths were also significantly lower in supplemented patients ( 44 % vs 87 % ) . 6 months after the fracture the rates of complications and mortality were significantly lower in supplemented patients ( 40 % vs 74 % ) . The median duration of hospital stay was significantly shorter in the supplemented group ( 24 vs 40 days ) . Thus the clinical outcome of elderly patients with femoral neck fracture can be improved by once daily dietary oral supplementation A total of 744 elderly women with fractured neck of femur were classified into three groups according to anthropometric measurements on admission : group 1 , well nourished ; group 2 , thin ; group 3 , very thin . Group 1 ate well and had a low mortality and a short rehabilitation time . The thinner the patients the lower their voluntary food intake , the higher their mortality and the longer their rehabilitation time . A series of 122 patients from groups 2 and 3 were entered postoperatively into a r and omised controlled trial of overnight supplementary nasogastric tube feeding ( 4.2 MJ ( 1000 kcal ) , including 28 g protein ) in addition to their normal ward diet . This treatment was associated with improvements not only in anthropometric and plasma protein measurements but also in clinical outcome , especially in the very thin group 3 patients . Rehabilitation time and hospital stay were shortened . Mortality in group 3 was less in the tube fed patients ( 8 % ) than in the controls ( 22 % ) but this difference did not reach statistical significance . One in five patients could not tolerate the nasogastric tube , but in the remainder the treatment caused no side effects and did not seriously diminish voluntary oral food intake by day The value of early postoperative feeding with an elemental diet was assessed in 30 patients after major gastrointestinal operations . The patients were allocated at r and om to conventional treatment ( control group ) or feeding with the elemental diet ( ED group ) . The clinical and metabolic course of the 15 patients in the ED group was significantly better than that of the controls . Patients in the ED group lost less weight and had a shorter stay in hospital . Negative nitrogen balance was more pronounced in the control group throughout the seven postoperative days . Energy intake was higher in the ED group . Provided elemental feeding is used with caution , it may be given from the first postoperative day . Patients do better metabolically and require shorter stays in hospital Immune function , particularly cell-mediated immunity ( CMI ) , declines with age and it has been suggested that this may be secondary to the impaired nutritional status often found in the elderly . In the present study a balanced nutritional supplement consisting of several macro- and micro-nutrients was administered daily to 27 housebound elderly ( aged 70 - 85 years ) for 12 weeks . Thirty-one matched subjects served as a control group . Delayed cutaneous hypersensitivity ( DCH ) to seven recall antigens was measured using the Mérieux Multitest CMI device and total numbers of lymphocytes , B-cells , T-cells and T-cell sub- population s were determined using monoclonal antibodies . These tests and several indices of nutritional status were measured before and at the end of the 12-week study . Before supplementation 19 % of the entire group of subjects were anergic and another 19 % hypoergic , values greater than expected for healthy elderly subjects . A weak association ( P = 0.056 ) was shown between plasma zinc concentration and the number of positive skin test responses . Supplementation had minimal effect on DCH , result ing in a significant ( P < 0.05 ) increase only in the sum of positive in duration s. Pre- study numbers of total lymphocytes and lymphocyte sub- population s were as expected for healthy elderly subjects , but a correlation was found between plasma selenium concentrations ( mean 1.07 , range 0.64 - 1.66 mumol/l ) and the numbers of CD4 lymphocytes ( P < 0.01 ) . Supplementation did not result in a significant change in any of the lymphocyte population s. ( ABSTRACT TRUNCATED AT 250 WORDS The effects of early postoperative nasoduodenal feeding on nutrition and metabolic response were studied using 24 patients after biliary surgery . The patients were r and omly divided into two groups with 12 in each group . Group I was fed via a nasoduodenal tube from the first postoperative day but control group II was not fed until the fourth postoperative day . The hospital blenderized tube feeding diet provided the enteric nutrition ( 17 % protein , 33 % fat and 50 % carbohydrate ) . The nutritional status of the 2 groups was compared over a one week period . The changes in nitrogen balance were measured daily for 8 days . The group fed early had a significantly reduced negative nitrogen balance when compared to the group whose feeding was started later . ( -1.91 + /- 1.05 g/day vs -5.84 + /- 0.48 g/day ) . There was no difference in serum albumin and transferrin levels , but serum prealbumin levels in the group fed early were more desirable than those of the control group ( from 15.8 + /- 2.5 mg/dl to 28.9 + /- 3.8 mg/dl vs from 18.0 + /- 2.0 mg/dl to 25.9 + /- 3.9 mg/dl ) . Total lymphocyte count was also better in the group fed early than in the controls ( from 1,325 + /- 204 cells/mm3 to 2,655 + /- 584 cells/mm3 vs from 1,277 + /- 188 cells/mm3 to 1,877 + /- 440 cells/mm3 ) . All the patients in group I felt better than those in group II during the study course . These results indicated that those patients provided with early nasoduodenal feeding after a biliary operation displayed a better nitrogen balance , and a faster increase in short half life visceral protein and total lymphocyte count The present study was design ed to evaluate to the effect of dietary supplements on clinical outcome and nutritional status in a large group of geriatric patients ( n = 501 ) . The patients were r and omised into an experimental group which received nutritional supplementation ( 400 kcal ) as well as a st and ard hospital diet , and a control group on hospital diet alone . The nutritional state was measured on admission and after 8 and 26 weeks by anthropometry , serum protein analysis and a delayed hypersensitivity skin test . Protein energy malnutrition was defined as the presence of three or more abnormal parameters . 28.5 % of patients showed evidence of malnutrition on admission . Hospitalisation itself result ed in a gradual deterioration in nutritional status .  Nutritional supplementation generally improved nutritional state . Among those patients who were well nourished on admission , and subsequently receiving dietary supplementation , 8.3 % fulfilled malnutrition criteria after 26 weeks , while 21.1 % were considered malnourished in the control group ( p < 0.05 ) . The improvement observed in transport proteins was probably related to nutritional support and not just to the reversal of inflammation . In the initially well nourished group of more than 300 patients , the mortality rate was 8.6 % in those given nutritional support compared to 18.6 % in the control group ( p < 0.02 ) One hundred ninety-two patients with previously untreated metastatic cancer ( 102 non-small-cell lung cancer [ NSCLC ] ; 90 colorectal cancer ) were r and omized to receive either ad lib nutritional intake ( control group ) or specific nutritional intervention during a 12-week study period when chemotherapy was administered . Those patients r and omized to nutritional interventions were counselled to take oral nutrients with caloric intake equal to 1.7 to 1.95 times their basal energy expenditure , depending on their pretreatment nutritional status ( " st and ard " group ) . An augmented group was counselled to have a caloric intake equivalent to that of the st and ard group but with 25 % of calories provided as protein and additional supplements of zinc and magnesium . Counselling increased caloric intake in both tumor types but reduced weight loss in the short term only for lung cancer patients . Ninety-three NSCLC patients were evaluable for tumor response to vindesine and cisplatin . Overall , only 20.4 % of the patients responded , and there were no significant differences in response rates , median time to progression , or overall duration of survival between the nutrition intervention groups and the control group . The tumor response rate to time-sequenced 5-fluorouracil ( 5-FU ) and methotrexate in the 81 evaluable patients with colorectal cancer was only 14.8 % , and no significant differences in tumor response rates were noted between the three groups . Furthermore , the median time to progression and overall duration of survival were not different for the control , st and ard , and augmented groups . Nutritional interventions using dietary counselling had no impact on the percent of planned chemotherapy dose administered , the degree of toxicity experienced by patients , or the frequency of treatment delays . A multivariate prognostic factor analysis demonstrated that for lung cancer , the percent of weight loss , serum albumin concentration , and presence of liver metastases were significant ( P less than .05 ) and independent prognostic variables for survival duration . For colorectal cancer , serum albumin , alkaline phosphatase , lactic dehydrogenase ( LDH ) levels , and percent targeted caloric intake ( TCI ) were significant independent predictors of survival duration Thirty-two patients undergoing bowel resection were r and omized to receive either immediate postoperative nasojejunal feeding with full strength Osmolite solution for 56 hours ( n = 16 ) or routine postoperative hypocaloric fluids and gradual re introduction of diet  ( n = 16 ) . Body composition changes were measured at 14 days after operation with in vivo neutron activation analysis , the wound healing response by subcutaneous implantation of Gortex tubes , and muscle function by grip strength , maximum ventilatory volume , and stimulation of the ulnar nerve at the w 
    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: A r and omized controlled prospect i ve clinical trial has been undertaken to examine the efficacy of the technique of early postoperative feeding using a fine bore catheter jejunostomy .  Fifty patients undergoing surgery for gastrointestinal malignancy were r and omly allocated into treatment and control groups . A low residue liquidized diet ( IsocalR ) was administered to the patients in the treatment group . Control patients received routine intravenous therapy .  Nutritional parameters ( serum albumin , serum transferrin , serum prealbumin , weight , body fat and fat free mass ) were measured pre‐operatively and on the tenth postoperative day . Postoperative surgical complications were similar in both groups . There were 20 catheter complications and one death directly attributable to the jejunal catheter feeding . Postoperative stay was significantly longer ( P < 0.01 ) in the treatment group patients . Evaluation of the nutritional parameters showed no advantage for either the treatment group or a selected complication‐free , successful treatment , subgroup . It is concluded that no significant clinical or nutritional advantage for jejunal catheter feeding has been demonstrated and because of the related complications , its routine use can not be recommended Ninety-three cancer patients about to undergo radiotherapy were studied . These patients were affected by cancer of the head and neck , breast cancer , and abdominopelvic cancer . They were r and omly distributed into control and experimental groups . The patients from the control group were allowed to eat ad libitum , whereas those from the experimental group followed a strict nutritional protocol that covered their needs while satisfying their particular tastes and habits . Data were collected the day before radiotherapy commenced and the day treatment ended . Anthropometric , analytical , and clinical parameters were determined . The results showed the benefit of dietetic treatment in experimental patients with head and neck or abdominopelvic cancer In recent years , the concept of nutritional support as a part of a comprehensive cancer management program has gained increasing acceptability . However , little data is available in regard to the effect of nutritional support programs on the chronic disease state represented by recurrent or persistent cancer that characterizes patients undergoing systemic chemotherapy . In 1977 we undertook to study this problem in a r and omized prospect i ve study design ed to evaluate the effects of long-term ( 12 months ) enteral nutritional support in a group of ambulatory breast cancer patients undergoing a st and ard cytotoxic chemotherapy treatment program  , in an adjuvant or therapeutic setting . The results of this study suggest that patients with breast cancer are overweight as compared to the general population and that any significant change in initial body weight , either a gain or a loss , is associated with an increased risk of recurrent disease . Data are presented which show little or no correlation between st and ard parameters of nutritional assessment and risk of disease recurrence and /or response to chemotherapy . These data also suggest that until we better underst and the relationship between tumor and host in breast cancer patients , we offer nutritional support programs only in situations where there are specific clinical indications for such interventions 59 elderly patients ( mean age 82 ) with femoral neck fractures were r and omised into two groups . 27 patients received daily an oral nutrition supplement ( 250 ml , 20 g protein , 254 kcal ) for a mean of 32 days ; 32 patients acted as controls . On admission most patients had nutritional deficiencies . Despite being offered adequate quantities , nutritional requirements were not met during the hospital stay . Clinical outcome was significantly better in the supplemented group ( 56 % favourable course vs 13 % in controls ) during the stay in the convalescent hospital . The rates of complications and deaths were also significantly lower in supplemented patients ( 44 % vs 87 % ) . 6 months after the fracture the rates of complications and mortality were significantly lower in supplemented patients ( 40 % vs 74 % ) . The median duration of hospital stay was significantly shorter in the supplemented group ( 24 vs 40 days ) . Thus the clinical outcome of elderly patients with femoral neck fracture can be improved by once daily dietary oral supplementation A total of 744 elderly women with fractured neck of femur were classified into three groups according to anthropometric measurements on admission : group 1 , well nourished ; group 2 , thin ; group 3 , very thin . Group 1 ate well and had a low mortality and a short rehabilitation time . The thinner the patients the lower their voluntary food intake , the higher their mortality and the longer their rehabilitation time . A series of 122 patients from groups 2 and 3 were entered postoperatively into a r and omised controlled trial of overnight supplementary nasogastric tube feeding ( 4.2 MJ ( 1000 kcal ) , including 28 g protein ) in addition to their normal ward diet . This treatment was associated with improvements not only in anthropometric and plasma protein measurements but also in clinical outcome , especially in the very thin group 3 patients . Rehabilitation time and hospital stay were shortened . Mortality in group 3 was less in the tube fed patients ( 8 % ) than in the controls ( 22 % ) but this difference did not reach statistical significance . One in five patients could not tolerate the nasogastric tube , but in the remainder the treatment caused no side effects and did not seriously diminish voluntary oral food intake by day The value of early postoperative feeding with an elemental diet was assessed in 30 patients after major gastrointestinal operations . The patients were allocated at r and om to conventional treatment ( control group ) or feeding with the elemental diet ( ED group ) . The clinical and metabolic course of the 15 patients in the ED group was significantly better than that of the controls . Patients in the ED group lost less weight and had a shorter stay in hospital . Negative nitrogen balance was more pronounced in the control group throughout the seven postoperative days . Energy intake was higher in the ED group . Provided elemental feeding is used with caution , it may be given from the first postoperative day . Patients do better metabolically and require shorter stays in hospital Immune function , particularly cell-mediated immunity ( CMI ) , declines with age and it has been suggested that this may be secondary to the impaired nutritional status often found in the elderly . In the present study a balanced nutritional supplement consisting of several macro- and micro-nutrients was administered daily to 27 housebound elderly ( aged 70 - 85 years ) for 12 weeks . Thirty-one matched subjects served as a control group . Delayed cutaneous hypersensitivity ( DCH ) to seven recall antigens was measured using the Mérieux Multitest CMI device and total numbers of lymphocytes , B-cells , T-cells and T-cell sub- population s were determined using monoclonal antibodies . These tests and several indices of nutritional status were measured before and at the end of the 12-week study . Before supplementation 19 % of the entire group of subjects were anergic and another 19 % hypoergic , values greater than expected for healthy elderly subjects . A weak association ( P = 0.056 ) was shown between plasma zinc concentration and the number of positive skin test responses . Supplementation had minimal effect on DCH , result ing in a significant ( P < 0.05 ) increase only in the sum of positive in duration s. Pre- study numbers of total lymphocytes and lymphocyte sub- population s were as expected for healthy elderly subjects , but a correlation was found between plasma selenium concentrations ( mean 1.07 , range 0.64 - 1.66 mumol/l ) and the numbers of CD4 lymphocytes ( P < 0.01 ) . Supplementation did not result in a significant change in any of the lymphocyte population s. ( ABSTRACT TRUNCATED AT 250 WORDS The effects of early postoperative nasoduodenal feeding on nutrition and metabolic response were studied using 24 patients after biliary surgery . The patients were r and omly divided into two groups with 12 in each group . Group I was fed via a nasoduodenal tube from the first postoperative day but control group II was not fed until the fourth postoperative day . The hospital blenderized tube feeding diet provided the enteric nutrition ( 17 % protein , 33 % fat and 50 % carbohydrate ) . The nutritional status of the 2 groups was compared over a one week period . The changes in nitrogen balance were measured daily for 8 days . The group fed early had a significantly reduced negative nitrogen balance when compared to the group whose feeding was started later . ( -1.91 + /- 1.05 g/day vs -5.84 + /- 0.48 g/day ) . There was no difference in serum albumin and transferrin levels , but serum prealbumin levels in the group fed early were more desirable than those of the control group ( from 15.8 + /- 2.5 mg/dl to 28.9 + /- 3.8 mg/dl vs from 18.0 + /- 2.0 mg/dl to 25.9 + /- 3.9 mg/dl ) . Total lymphocyte count was also better in the group fed early than in the controls ( from 1,325 + /- 204 cells/mm3 to 2,655 + /- 584 cells/mm3 vs from 1,277 + /- 188 cells/mm3 to 1,877 + /- 440 cells/mm3 ) . All the patients in group I felt better than those in group II during the study course . These results indicated that those patients provided with early nasoduodenal feeding after a biliary operation displayed a better nitrogen balance , and a faster increase in short half life visceral protein and total lymphocyte count The present study was design ed to evaluate to the effect of dietary supplements on clinical outcome and nutritional status in a large group of geriatric patients ( n = 501 ) . The patients were r and omised into an experimental group which received nutritional supplementation ( 400 kcal ) as well as a st and ard hospital diet , and a control group on hospital diet alone . The nutritional state was measured on admission and after 8 and 26 weeks by anthropometry , serum protein analysis and a delayed hypersensitivity skin test . Protein energy malnutrition was defined as the presence of three or more abnormal parameters . 28.5 % of patients showed evidence of malnutrition on admission . Hospitalisation itself result ed in a gradual deterioration in nutritional status .  Nutritional supplementation generally improved nutritional state . Among those patients who were well nourished on admission , and subsequently receiving dietary supplementation , 8.3 % fulfilled malnutrition criteria after 26 weeks , while 21.1 % were considered malnourished in the control group ( p < 0.05 ) . The improvement observed in transport proteins was probably related to nutritional support and not just to the reversal of inflammation . In the initially well nourished group of more than 300 patients , the mortality rate was 8.6 % in those given nutritional support compared to 18.6 % in the control group ( p < 0.02 ) One hundred ninety-two patients with previously untreated metastatic cancer ( 102 non-small-cell lung cancer [ NSCLC ] ; 90 colorectal cancer ) were r and omized to receive either ad lib nutritional intake ( control group ) or specific nutritional intervention during a 12-week study period when chemotherapy was administered . Those patients r and omized to nutritional interventions were counselled to take oral nutrients with caloric intake equal to 1.7 to 1.95 times their basal energy expenditure , depending on their pretreatment nutritional status ( " st and ard " group ) . An augmented group was counselled to have a caloric intake equivalent to that of the st and ard group but with 25 % of calories provided as protein and additional supplements of zinc and magnesium . Counselling increased caloric intake in both tumor types but reduced weight loss in the short term only for lung cancer patients . Ninety-three NSCLC patients were evaluable for tumor response to vindesine and cisplatin . Overall , only 20.4 % of the patients responded , and there were no significant differences in response rates , median time to progression , or overall duration of survival between the nutrition intervention groups and the control group . The tumor response rate to time-sequenced 5-fluorouracil ( 5-FU ) and methotrexate in the 81 evaluable patients with colorectal cancer was only 14.8 % , and no significant differences in tumor response rates were noted between the three groups . Furthermore , the median time to progression and overall duration of survival were not different for the control , st and ard , and augmented groups . Nutritional interventions using dietary counselling had no impact on the percent of planned chemotherapy dose administered , the degree of toxicity experienced by patients , or the frequency of treatment delays . A multivariate prognostic factor analysis demonstrated that for lung cancer , the percent of weight loss , serum albumin concentration , and presence of liver metastases were significant ( P less than .05 ) and independent prognostic variables for survival duration . For colorectal cancer , serum albumin , alkaline phosphatase , lactic dehydrogenase ( LDH ) levels , and percent targeted caloric intake ( TCI ) were significant independent predictors of survival duration Thirty-two patients undergoing bowel resection were r and omized to receive either immediate postoperative nasojejunal feeding with full strength Osmolite solution for 56 hours ( n = 16 ) or routine postoperative hypocaloric fluids and gradual re introduction of diet  ( n = 16 ) . Body composition changes were measured at 14 days after operation with in vivo neutron activation analysis , the wound healing response by subcutaneous implantation of Gortex tubes , and muscle function by grip strength , maximum ventilatory volume , and stimulation of the ulnar nerve at the w 
    Output:
    