***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 Fatigue is a major clinical problem in many patients with primary biliary cirrhosis ( PBC ) and primary sclerosing cholangitis ( PSC ) . An effective treatment has not been defined . Recently , a large proportion of patients with these diseases was found to have symptoms of depression . Because fatigue is a frequent symptom of depression and there is some evidence that treatment with an antidepressant improves fatigue in patients with fibromyalgia , we hypothesised that the antidepressant fluvoxamine might improve fatigue related to PBC and PSC . Methods Fatigued patients were r and omised to receive fluvoxamine ( 75 mg BID ) or placebo for a six-week period . Fatigue and quality of life were quantified using a visual analogue scale , the Fisk Fatigue Severity Scale , the Multidimensional Fatigue Inventory and the SF-36 . Results Seventeen and 16 patients were allocated to fluvoxamine and placebo , respectively . There was no statistically significant beneficial effect of fluvoxamine on fatigue or quality of life . The median VAS scores in the fluvoxamine and placebo groups were 7.40 and 7.45 at day 0 , 6.9 and 7.15 at day 14 , 7.45 and 7.65 at day 42 and 7.8 and 8.0 four weeks after treatment discontinuation . Conclusion We found no evidence for a beneficial effect of fluvoxamine on fatigue in these patients with cholestatic liver disease and severe chronic fatigue BACKGROUND / AIMS Former studies reported a high prevalence of depression in patients with primary biliary cirrhosis ( PBC ) and primary sclerosing cholangitis ( PSC ) . These studies hypothesized that the presence of depression could explain the fatigue experienced by these patients . METHODS Our aim was to study the prevalence of depression in a Dutch population with PBC and PSC . In addition , to investigating the effects of using an additional diagnostic structured psychiatric interview , after screening with the  Beck Depression Inventory ( BDI )  , a self-report severity scale instrument used in former studies . Patients with PBC and PSC ( n=92 ) completed the BDI .  Patients with scores of 10 or higher ( n=39 ) were interviewed using a structured psychiatric interview .  Patients with scores lower than 10 were at r and om ( 30/53 , 57 % ) also interviewed using a structured psychiatric interview . RESULTS Of the 92 patients that were included 42 % had depressive symptoms according to the BDI . However , of these patients only 3.7 % had a depressive syndrome according to the DSM-IV criteria as assessed with the structured psychiatric interview . CONCLUSIONS The prevalence of a depressive disorder in patients with PBC and PSC is not higher than in the general population . Fatigue in patients with PBC and PSC can not be explained by depression Little is known comparing and contrasting quality of life ( QoL ) in patients with hepatitis C , compared to patients with other liver diseases . We performed two independent prospect i ve cross-sectional studies including 511 and 284 patients with different forms of liver diseases .  SF-36 was used in both studies .  Fatigue Impact Score , WHO-BREF and Hospital Anxiety and Depression Scale ( HADS ) were used in either study only . In both studies , HCV-positive patients scored worse in the mental aspects of health-related QoL compared to other liver diseases , except for HBV in one study . Surprisingly , in both studies , quality of life was also significantly impaired in patients with viral clearance after interferon therapy but not after spontaneous clearance . Furthermore , patients with primary biliary cirrhosis showed significantly better mental health but significantly worse physical well-being . Liver diseases differ in their form of impaired QoL. In HCV , this impairment might not always return to normal after treatment-induced viral clearance . This may suggest that HCV either may not be involved in QoL impairment or may induce a process which persists after viral clearance in some patients BACKGROUND & AIMS There is no medical treatment of proven benefit for primary sclerosing cholangitis . This study aim ed at study ing the effect of a higher dose of ursodeoxycholic acid than previously used on survival , symptoms , biochemistry , and quality of life in this disease . METHODS A r and omized placebo-controlled study was performed in tertiary and secondary gastroenterology units . A total of 219 patients were r and omized to 17 to 23 mg/kg body weight per day of ursodeoxycholic acid ( n = 110 ) or placebo ( n = 109 ) for 5 years . Follow-up data are available from 97 patients r and omized to ursodeoxycholic acid  and for 101 r and omized to placebo .  Quality of life was assessed by using the Medical Outcomes Study 36-item Short-Form Health Survey . RESULTS The combined end point " death or liver transplantation " occurred in 7 of 97 ( 7.2 % ) patients in the ursodeoxycholic acid group vs 11 of 101 ( 10.9 % ) patients in the placebo group ( P = .368 ; 95 % confidence interval , -12.2 % to 4.7 % ) . The occurrence of liver transplantation as a single end point showed a similar positive trend for ursodeoxycholic acid treatment ( 5/97 [ 5.2 % ] vs 8/101 [ 7.9 % ] ; 95 % confidence interval , -10.4 % to 4.6 % ) . Three ursodeoxycholic acid and 4 placebo patients died from cholangiocarcinoma , and 1 placebo patient died from liver failure . Alkaline phosphatase and alanine aminotransferase tended to decrease during the first 6 months . There were no differences between the 2 groups in symptoms or quality of life . Analyses of serum ursodeoxycholic acid concentration gave no evidence that noncompliance may have influenced the results . CONCLUSIONS This study found no statistically significant beneficial effect of a higher dose of ursodeoxycholic acid than previously used on survival or prevention of cholangiocarcinoma in primary sclerosing cholangitis BACKGROUND & AIMS Little is known about nongenetic risk factors for primary sclerosing cholangitis ( PSC ) , except a possible protective effect of smoking . We investigated the relationship between environmental risk factors and susceptibility to PSC . METHODS A question naire was distributed to patients with PSC , recruited from Oslo University Hospital Rikshospitalet in Norway through 2011 , and r and omly chosen individuals from the Norwegian Bone Marrow Donor Registry ( control subjects ) . Data were analyzed from 240 patients with PSC and 245 control subjects , matched for gender and age . RESULTS A lower proportion of patients with PSC were daily coffee drinkers than control subjects , both currently ( 76 % vs 86 % ; odds ratio [ OR ] , 0.52 ; 95 % confidence interval [ CI ] , 0.32 - 0.82 ; P = .006 ) and at the age of 18 years ( 35 % vs 49 % ; OR , 0.58 ; 95 % CI , 0.40 - 0.83 ; P = .003 ) . The associations were mainly attributed to differences observed in men . Twenty percent of the patients were ever ( current or former ) daily smokers compared with 43 % of control subjects ( OR , 0.33 ; 95 % CI , 0.22 - 0.50 ; P < .001 ) . Ever daily smoking before PSC diagnosis was associated with older age at diagnosis ( 42 years vs 32 years ; P < .001 ) . Ever daily smoking ( P < .001 ) and being a coffee drinker at the age of 18 years ( P = .048 ) were independently and negatively associated with PSC . Fewer female patients with PSC than control subjects reported ever use of hormonal contraception ( 51 % vs 85 % ; P < .001 ) . Among female patients , there was a strong correlation between increasing number of children before the diagnosis of PSC and increasing age at diagnosis ( r = 0.63 ; P < .001 ) . CONCLUSIONS  Coffee consumption and smoking might protect against development of PSC . In women , the disease might be influenced by hormonal factors Liver transplantation has never been the subject of a r and omized controlled trial , and there remains uncertainty about the magnitude of benefit and cost-effectiveness for specific patient groups . This article reports the results of an economic evaluation of  adult liver transplantation in Engl and and Wales . Patients placed on the waiting list for a liver transplant were observed over 27 months . The costs and health benefits of a comparison group , representing experience in the absence of liver transplantation , were estimated using a combination of observed data from patients waiting for a transplant and published prognostic models . The analysis focuses on three disease groups , for each of which prognostic models were available : primary biliary cirrhosis ( PBC ) , alcoholic liver disease ( ALD ) , and primary sclerosing cholangitis ( PSC ) . A higher proportion of patients with ALD were assessed for a transplant but not placed on the waiting list . The estimated gain in quality -adjusted life-years from transplantation was positive for each of the disease groups . The mean incremental cost per quality -adjusted life-year ( 95 % bootstrap confidence intervals ) from time of listing to 27 months for patients with PBC , ALD , and PSC are pound 29,000 ( pounds 1,000 to pounds 59,000 ) , pounds 48,000 ( pounds 12,000 to pounds 83,000 ) and pounds 21,000 ( -pounds 23,000 to pounds 60,000 ) , respectively . In conclusion , liver transplantation increases the survival and health-related quality of life of patients with each of three end-stage liver diseases . However , the extent of this increase differs between different disease groups . Cost-effectiveness estimates were poorer for patients with ALD over the 27-month period than for patients with PBC or PSC . This in part reflects the costs of the higher number of ALD patients assessed for each transplant OBJECTIVE : There is no effective therapy for patients with primary sclerosing cholangitis ( PSC ) . Rats with experimental small bowel bacterial overgrowth develop hepatobiliary injury similar to PSC . The hepatobiliary injury results from peptidoglycan-polysaccharide – mediated activation of Kupffer cells , release of cytokines such as tumor necrosis factor ( TNF-α ) , and is prevented by pentoxifylline . Our aims were to assess the safety and effects of pentoxifylline on symptoms and biochemical liver tests in patients with PSC . METHODS : A total of 20 patients with clinical , cholangiographic , and histological features of PSC of varying severity were treated with pentoxifylline sustained release ( SR ) tablets ( 400 mg q.i.d . ) for ≤1 yr . Serum alkaline phosphatase , aspartate aminotransferase , and bilirubin were monitored every 3 months for 1 year ; serum TNF-α and TNF receptor subtypes I and II were assessed at baseline and 1 year . RESULTS : Of 20 patients , 16 tolerated pentoxifylline and completed the study . Two patients were withdrawn because of severe nausea , and two patients were noncompliant with medication and withdrew . Pentoxifylline did not significantly alter symptoms of fatigue or pruritus , serum liver tests , serum TNF-α or TNF receptor levels . CONCLUSIONS : In the current regimen , pentoxifylline alone does not significantly improve symptoms or liver tests in patients with PSC Background : Impairment of health‐related quality of life ( HRQoL ) is an important concern in inflammatory bowel disease ( IBD ; ulcerative colitis [ UC ] , Crohn 's disease [ CD ] ) . Between 2%–10 % of patients with IBD have primary sclerosing cholangitis ( PSC ) . There has been limited examination of the disease‐specific HRQoL in this population compared to non‐PSC IBD controls . Methods : This was a retrospective , case – control study performed at a tertiary referral center . Cases comprised 26 patients with a known diagnosis of PSC and IBD ( 17 UC , 9 CD ) . Three r and om controls were selected for each case after matching for IBD type , gender , age , and duration of disease . Disease‐specific HRQoL was measured using the Short Inflammatory Bowel Disease Question naire ( SIBDQ ) . Disease activity for CD was measured using the Harvey – Bradshaw index ( HB ) and using the UC activity index for UC . Independent predictors of HRQoL were identified . Results : There was no significant difference in the age , gender distribution , or disease duration between PSC‐IBD and controls . There was no difference in use of immunomodulators or biologics between the 2 groups . Mean SIBDQ score was comparable between PSC‐IBD patients ( 54.5 ) and controls ( 54.1 ) , both for UC and CD . Likewise , the disease activity scores were also similar ( 2.8 versus 3.1 , P = 0.35 ) . On multivariate analysis , higher disease activity score ( −1.33 , 95 % confidence interval [ CI ] 95 % CI −1.85 to −0.82 ) and shorter disease duration were predictive of lower HRQoL. Coexisting PSC did not influence IBD‐related HRQoL. There was a higher proportion of permanent work disability in PSC 
    Output:
    
The newly developed PSC PRO requires further validation in PSC patients with diverse demographics , comorbidities and at different stages of disease ; however this is a promising new measure with which to assess the impact of PSC on patient quality of life and symptoms