***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 total of 132 infants and children with grade s III and IV primary vesicoureteral reflux was entered into a prospect i ve trial comparing medical to surgical management .  Inclusion criteria were an age not exceeding 10 years and a glomerular filtration rate of at least 70 ml . per minute per 1.73 m.2 . Children with significant urinary tract malformations and clinical signs/symptoms of dysfunctional voiding were not accepted into the trial .  Medical therapy consisted of continuous low dose antibiotic prophylaxis until vesicoureteral reflux resolved . The type of surgical procedure used for the correction of reflux was left to the discretion of the surgeon . Outcome variables included the appearance or progression of renal lesions , rate of renal growth , recurrence rate of urinary tract infection or pyelonephritis , changes in total kidney glomerular filtration rate , development of hypertension and resolution rate of vesicoureteral reflux . Followup at 6 , 18 , 36 and 54 months after entry included , in addition to history and physical examination , voiding cystourethrography , excretory urography and a urine culture . Of the patients 68 were allocated to the medical group and 64 to the surgical group . They were stratified for age , sex and preexisting renal scarring . Of the patients 10 % were boys , 47 % were between 2 and 6 years old at entry , 93 % had a history of pyelonephritis , 67 % had either scarring or thinning of the parenchyma at entry , 87 % had grade IV vesicoureteral reflux in at least 1 unit and 56 % had bilateral reflux . There were no significant differences in the frequency distribution of entry characteristics between the patients allocated to either group . New renal scarring developed in 22 % of medical and 31 % of surgical patients ( p < 0.4 ) . Growth of kidneys with grade IV vesicoureteral reflux was slightly less than normal in the medical ( -0.67 + /- 0.15 st and ard deviation ) and surgical ( -0.42 + /- 0.11 st and ard deviation ) groups ( p < 0.7 ) . Pyelonephritis occurred in 15 medical patients versus 5 surgical patients ( p < 0.05 ) . There was no significant change in glomerular filtration rate within each treatment group and no difference in glomerular filtration rate between groups . No patient had hypertension during the followup period . The disappearance rate of vesicoureteral reflux in patients with grade IV reflux was approximately 8 % per year . Of the medical patients 75 % still had vesicoureteral reflux after 3 years of observation . ( ABSTRACT TRUNCATED AT 400 WORDS Background Several recent review s have evaluated evidence on the efficacy of Mindfulness-Based Stress Reduction ( MBSR ) among fibromyalgia sufferers , and concluded that more research should test effects on both psychological and physiological functioning . Purpose We conducted a r and omized prospect i ve trial of MBSR among female fibromyalgia patients . Methods Effects on perceived stress , pain , sleep quality , fatigue , symptom severity , and salivary cortisol were tested in  treatment ( n = 51 ) versus wait-list control participants ( n = 40 ) using data at baseline , post-program , and 2-month follow-up . Results Analyses revealed that MBSR significantly reduced perceived stress , sleep disturbance , and symptom severity , with gains maintained at follow-up . Greater home practice at follow-up was associated with reduced symptom severity .  MBSR did not significantly alter pain , physical functioning , or cortisol profiles . Conclusion MBSR ameliorated some of the major symptoms of fibromyalgia and reduced subjective illness burden . Further exploration of MBSR effects on physiological stress responses is warranted . These results support use of MBSR as a complementary treatment for women with fibromyalgia ( IS RCT N : 34628811 ) Abstract Introduction Fibromyalgia ( FM ) is characterized by chronic pain . Impaired growth hormone responses and reduced serum insulin-like growth factor 1 ( IGF-1 ) are common in FM . The aim was to examine changes in serum IGF-1 , cerebrospinal fluid ( CSF ) , neuropeptides , and cytokines during aerobic exercise in FM patients . Methods In total , 49 patients ( median age , 52 years ) with FM were included in the study . They were r and omized to either the  moderate- to high-intensity Nordic Walking ( NW ) program  ( n = 26 ) or the  supervised low-intensity walking ( LIW ) program  ( n = 23 ) . Patients participated in blood tests before and after 15 weeks of aerobic exercise .  Changes in serum levels of free IGF-1 , pain rating on a 0- to 100-mm scale , pain threshold , and 6-minute walk test ( 6MWT ) were examined . CSF , neuropeptides , matrix metalloproteinase 3 ( MMP-3 ) , and inflammatory cytokines were determined . Nonparametric tests were used for group comparisons and correlation analyses . Results Serum free IGF-1 levels did not change during 15 weeks of exercise between the two groups , although the 6MWT significantly improved in the NW group ( p = 0.033 ) when compared with LIW . Pain did not significantly change in any of the groups , but tended to decrease ( p = 0.052 ) over time in the total group . A tendency toward a correlation was noted between baseline IGF-1 and a decrease of pain in response to exercise ( r = 0.278 ; p = 0.059 ) . When adjusted for age , this tendency disappeared . The change in serum free IGF-1 correlated positively with an alteration in CSF substance P ( SP ) levels ( rs= 0.495 ; p = 0.072 ) , neuropeptide Y ( NPY ) ( rs = 0.802 ; p = 0.001 ) , and pain threshold ( rs = 0.276 ; p = 0.058 ) . Differing CSF SP levels correlated positively to a change in pain threshold ( rs= 0.600 ; p = 0.023 ) , whereas the shift in CSF MMP-3 inversely correlated with an altered pain threshold ( rs= -0.569 ; p = 0.034 ) . Conclusions The baseline level of serum free IGF-1 did not change during high or low intensity of aerobic exercise . Changes in IGF-1 correlated positively with a variation in CSF SP , NPY , and pain threshold . These data indicate a beneficial role of IGF-1 during exercise in FM.Trial registration : Clinical Trials.gov NCT00643006 OBJECTIVE To determine the prevalence and characteristics of fibromyalgia in the general population . METHODS A r and om sample of 3,006 persons in Wichita , KS , were characterized according to the presence of no pain , non-widespread pain , and widespread pain . A sub sample of 391 persons , including 193 with widespread pain , were examined and interviewed in detail . RESULTS The prevalence of fibromyalgia was 2.0 % ( 95 % confidence interval [ 95 % CI ] 1.4 , 2.7 ) for both sexes , 3.4 % ( 95 % CI 2.3 , 4.6 ) for women , and 0.5 % ( 95 % CI 0.0 , 1.0 ) for men . The prevalence of the syndrome increased with age , with highest values attained between 60 and 79 years ( > 7.0 % in women ) . Demographic , psychological , dolorimetry , and symptom factors were associated with fibromyalgia . CONCLUSION Fibromyalgia is common in the population , and occurs often in older persons . Characteristic features of fibromyalgia -- pain threshold and symptoms -- are similar in community and clinic population s , but overall severity , pain , and functional disability are more severe in the clinic population Objective In this prospect i ve longitudinal clinical study , we evaluated the role of proinflammatory cytokine IL-8 and its clinical relevance in patients with fibromyalgia ( FM ) who fulfilled clearly defined inclusion and exclusion criteria and underwent a 3-week in patients multidisciplinary pain therapy .  Methods  IL-8  in sera was measured in 20 patients with FM and 80 healthy participants at 4 fixed time points : at the beginning of the study , at 10 days , 21 days , and 6 months , respectively . Pain intensity , back function , depression , nicotine/alcohol consumption , and medication were assessed in the patient group and correlated with IL-8 levels . Results Before and during the inpatient therapy , the serum level of IL-8 was significantly higher in patients with FM compared with controls ( P<0.001 ) , but did not correlated with pain intensity and medication . Already at T1 there was a significant reduction of IL-8 serum level ( P=0.023 ) in patient group . Six months after multidisciplinary pain therapy , IL-8 serum level in FM patients was still significantly higher than controls ( P=0.044 ) but reduced approximately to normal range and correlated significantly negatively with pain intensity ( r=−0.782 , P=0.001 ) . Patients with FM had significantly less pain ( P<0.001 ) and better back function ( P<0.001 ) at day 2 than at day 0 . In addition , in patients with FM , IL-8 serum level correlated with nicotine consumption ( r=0.471 , P=0.042 ) . Conclusions Our results suggest that IL-8 level contributes in patients with FM whose pain intensity and back function can be improved under influence of multidisciplinary pain therapy without need of an anti-IL-8 therapy Introduction Severe fatigue is a major health problem in fibromyalgia ( FM ) . Obesity is common in FM , but the influence of adipokines and growth factors is not clear . The aim was to examine effects of exercise on fatigue , in lean , overweight and obese FM patients . Methods In a longitudinal study , 48 FM patients ( median 52 years ) exercised for 15 weeks .  Nine patients were lean ( body mass index , BMI 18.5 to 24.9 ) , 26 overweight ( BMI 25 to 29.9 ) and 13 obese .  Fatigue was rated on a 0 to 100 mm scale ( fibromyalgia impact question naire [ FIQ ] fatigue ) and multidimensional fatigue inventory ( MFI-20 ) general fatigue ( MFIGF ) . Higher levels in FIQ fatigue and MFIGF indicate greater degree of fatigue . Free and total IGF-1 , neuropeptides , adipokines were determined in serum and cerebrospinal fluid ( CSF ) . Results Baseline FIQ fatigue correlated negatively with serum leptin ( r = -0.345 ; P = 0.016 ) and nerve growth factor ( NGF ; r = -0.412 ; P = 0.037 ) . In lean patients , baseline MFIGF associated negatively with serum resistin ( r = -0.694 ; P = 0.038 ) . FIQ Fatigue associated negatively with CSF resistin ( r = -0.365 ; P = 0.073 ) . Similarly , FIQ fatigue ( r = -0.444 ; P = 0.026 ) and MFIGF correlated negatively with CSF adiponectin ( r = -0.508 ; P = 0.01 ) . In lean patients , FIQ fatigue ( P = 0.046 ) decreased after 15 weeks . After 30 weeks , MFIGF decreased significantly in lean ( MFIGF : P = 0.017 ) , overweight ( MFIGF : P = 0.001 ) , and obese patients ( MFIGF : P = 0.016 ) . After 15 weeks , total IGF-1 increased in lean ( P = 0.043 ) patients . ∆Total IGF-1 differed significantly between lean and obese patients ( P = 0.010 ) . ∆Total IGF-1 related negatively with ∆MFIGF after 15 weeks ( r = -0.329 ; P = 0.050 ) . After 30 weeks , ∆FIQ fatigue negatively correlated with ∆NGF ( r = -0.463 ; P = 0.034 ) and positively with ∆neuropeptide Y ( NPY ) ( r = 0.469 ; P = 0.032 ) . Resistin increased after 30 weeks ( P = 0.034 ) . ∆MFIGF correlated negatively with ∆resistin ( r = -0.346 ; P = 0.031 ) , being strongest in obese patients ( r = -0.815 ; P = 0.007 ) . In obese patients , ∆FIQ fatigue after 30 weeks correlated negatively with ∆free IGF-1 ( r = -0.711 ; P = 0.032 ) . Conclusions Exercise  reduced fatigue  in all FM patients , this effect was achieved earlier in lean patients . Baseline levels of resistin in both serum and CSF associated negatively with fatigue . Resistin was increased after the exercise period which correlated with decreased fatigue . Changes in IGF-1 indicate similar long-term effects in obese patients . This study shows reduced fatigue  after moderate exercise in FM and indicates the involvement of IGF-1 and resistin in these beneficial effects . Trial registration Clinical Trials.gov : The purpose of this study was to investigate the clinical effects of balneotherapy in 
    Output:
    
After exercise , multidisciplinary , or dietary interventions in FM patients , interleukin ( IL ) expression appeared reduced , specifically serum IL-8 and IL-6 ( spontaneous , lipopolysaccharide (LPS)-induced , or serum ) .
Furthermore , the changes to insulin-like growth factor 1 ( IGF-1 ) levels might indicate a beneficial role for fatigue in obese FM patients .
In contrast , evidence of changes in neuropeptide and CRP levels seemed inconsistent .
Conclusion Despite minimal evidence , our findings indicate that exercise interventions might act as an anti-inflammatory treatment in FM patients and ameliorate inflammatory status , especially for pro-inflammatory cytokines .