***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: The anxiolytic effect of Silexan , a patented active substance with an essential oil produced from Lav and ula angustifolia flowers , was investigated in patients with anxiety-related restlessness and disturbed sleep . 170 out- patients with a diagnosis of restlessness ( ICD-10 R45.1 ) , a Hamilton Anxiety Scale ( HAMA ) total score ≥18 points and ≥2 points for HAMA items ' Tension ' and ' Insomnia ' participated in this r and omized , double-blind trial and received 80 mg Silexan or placebo once daily for 10 weeks . Patients with clinical ly important other psychiatric or neurological disorders potentially interfering with the assessment of treatment efficacy were excluded . Outcome variables were the HAMA as well as the Pittsburgh Sleep Quality Index ( PSQI ) , the Zung Self-rating Anxiety Scale , a State Check inventory and the Clinical Global Impressions question naire . In the Silexan  group the HAMA total score decreased from an average of 25.5±6.0 points at baseline to 13.7±7.0 points at treatment end , compared to a decrease from 26.5±6.1 to 16.9±9.8 for placebo , corresponding to decreases of 12.0 and 9.3 points ( marginal means ) , respectively ( group difference : p=0.03 , ANCOVA with factor treatment and baseline value as covariate ) . In all outcome measures the treatment effect of Silexan was more pronounced than with placebo . According to the HAMA , 48.8 % and 33.3 % of the patients were responders ( Silexan , placebo ; reduction ≥50 % ; p=0.04 ) and 31.4 % and 22.6 % achieved remission ( HAMA<10 ; p=0.20 ) . 33.7 % ( Silexan ) and 35.7 % ( placebo ) of the participants reported adverse events . The study confirms the calming and anxiolytic efficacy of Silexan Mixed anxiety and depressive disorder ( MADD ; ICD-10 F41.2 ) is a condition characterized by subsyndromal symptoms of anxiety and depression , neither of which are clearly predominant . Silexan has been demonstrated to be efficacious in subsyndromal and syndromal anxiety disorders and co-morbid depressive symptoms . In this study 318 adult out- patients with MADD according to ICD-10 criteria , a total score ≥18 points on the Hamilton Anxiety Rating Scale ( HAMA ) , and at least moderately severe anxious and depressed mood were r and omized and received 1 × 80 mg Silexan or placebo in double-blind fashion for a scheduled period of 70 days . Primary outcome measures were the HAMA and Montgomery Åsberg Depression Rating Scale ( MADRS ) total score changes between baseline and treatment end . The HAMA total score decreased by 10.8±9.6 points for Silexan and by 8.4±8.9 points for placebo ( treatment group difference : p<0.01 , one-sided ; ANCOVA with factors for treatment and centre and the baseline value as covariate ) , and total score decreases of 9.2±9.9 and 6.1±7.6 points , respectively , were observed for the MADRS ( p<0.001 ) . Compared to placebo , the patients treated with Silexan had a better over-all clinical outcome and showed more pronounced improvements of impaired daily living skills and health related quality of life . Eructation was the only adverse event with a substantially higher incidence under Silexan . The study thus demonstrates that Silexan is efficacious and safe in the treatment of MADD Background : Open heart surgery can cause high levels of anxiety in patients . Nowadays , lavender essential oil is widely used in medical research . This study was conducted with an aim to investigate the effects of lavender essential oil to reduce the anxiety of patients after coronary artery bypass surgery . Material s and Methods : This research is double-blinded r and omized controlled trial on 60 patients who had undergone coronary artery bypass surgery in a 2-day intervention targeting reduction of anxiety . This study was conducted in Ekbatan Therapeutic and Educational Center , Hamadan city , Iran , in 2013 . The patients in the inhalation aromatherapy group inhaled two drops of 2 % lavender essential oil and those in the control group inhaled two drops of distilled water as placebo for 20 min on the 2nd and 3rd days after surgery . The level of anxiety was evaluated by Spielberger 's State Anxiety question naire before and after intervention and the vital signs were documented as well . Data were analyzed using Stata 11 ( Stata Corp. , College Station , TX , USA ) by independent t-test for continuous variables and Chi-square test for categorical variables . Results : The mean score of anxiety in the aromatherapy group was 48.73 ± 5.08 and in the control group was 48 ± 6.98 before the intervention ( P = 0.64 ) , which reduced after the intervention to 42.6 ± 5.44 and 42.73 ± 7.30 , respectively . On the 3rd day after surgery , the mean score of anxiety in the aromatherapy group was 46.76 ± 4.07 and in the control group was 46.53 ± 7.05 before the intervention , which reduced to 41.33 ± 3.65 and 41.56 ± 6.18 , respectively , after the intervention . However , there was no statistically significant difference in the mean scores of anxiety between the aromatherapy and control groups . Conclusions : Lavender essential oil has no significant effect on anxiety in patients after coronary artery bypass surgery , although it decreased the level of anxiety in the patients BACKGROUND Anxiety and pain are recognized as major problems of burn patients ; because pharmaceutical treatments for controlling anxiety and pain symptoms lead to complications and an increase in health costs , nonpharmacological nursing interventions were considered for this group of patients . This led to the present study aim ed at comparing the effect of aromatherapy massage with inhalation aromatherapy for anxiety and pain in burn patients . METHODS This single-blind clinical trial was carried out on 90 patients with burns < 20 % . Patients were r and omly assigned to one of three groups , namely aromatherapy massage , inhalation aromatherapy , and control group . The patients assigned to the aromatherapy massage group received a massage for half an hour using a blend of lavender and almond oils , while a blend of rose and lavender aroma was used for the inhalation aromatherapy group . Spielberger State Anxiety Inventory was used for measuring anxiety and the visual analog scale ( VAS ) scale was used for measuring pain . RESULTS The results showed that three groups were equal in terms of demographics , disease characteristics , and scores of anxiety and pain at the baseline . The mean decreases of anxiety scores were -0.04±5.08 , 6.33±12.55 , and 6.43±10.60 in the control group , aromatherapy massage group , and inhalation group , respectively ( p=0.007 ) . The mean decrease of pain scores were -0.10±0.96 , 1.70±1.84 , and 0.97±1.56 in the control group , aromatherapy massage group , and inhalation group , respectively ( p<0.001 ) . CONCLUSION The study results showed the positive effect of aromatherapy massage and inhalation aromatherapy compared with the control group in reducing both anxiety and pain of burn patients . Therefore , both interventions , which are inexpensive , and noninvasive nursing tasks can be proposed for alleviating anxiety and pain of burn patients Background : Recently , Silexan , a patented active substance comprised of an essential oil produced from Lav and ula angustifolia flowers , has been authorized in Germany as a medicinal product for the treatment of states of restlessness related to anxious mood . Its efficacy has been shown in several forms of anxiety disorders . Findings from pre clinical and clinical studies attribute a major role to the serotonin-1A receptor in the pathogenesis and treatment of anxiety . Methods : To eluci date the effect of Silexan on serotonin-1A receptor binding , 17 healthy men underwent 2 positron emission tomography measurements using the radiolig and [carbonyl-11C]WAY-100635 following the daily intake of 160 mg Silexan or placebo for a minimum of 8 weeks ( r and omized , double-blind , cross-over design ) . Additionally , structural magnetic resonance imaging and voxel-based morphometry analysis was performed to determine potential effects on gray matter microstructure . Results : Serotonin-1A receptor binding potential was shown to be significantly reduced following the intake of Silexan compared with placebo in 2 large clusters encompassing the temporal gyrus , the fusiform gyrus and the hippocampus on one h and as well as the insula and anterior cingulate cortex on the other h and . No effects of Silexan on gray matter volume could be detected in this investigation . Conclusion : This positron emission tomography study proposes an involvement of the serotonin-1A receptor in the anxiolytic effects of Silexan . The study was registered in the International St and ard R and omized Controlled Trial Number Register as IS RCT N30885829 ( http://www.controlled-trials.com/is rct n/ ) Background : Surgery , as a treatment , is a stressful experience . The anxiety is more severe in open-heart surgery patients due to its risk and complications . The present study aim ed to determine the effect of lavender essence on the levels of anxiety and blood cortisol in c and i date s for open-heart surgery . Material s and Methods : This was a single-blind clinical trial , a r and om allocation study with a control group conducted on 90 c and i date s for open-heart surgery in two groups of study and control . The study and control groups inhaled two drops of lavender and distilled water for 20 min , respectively . Spielberger question naire was filled by the patients . A 2 ml blood sample was taken to measure the cortisol level and patients ′ vital signs were recorded before and after intervention . Data were analyzed by chi-square in the form of mean , SD , and frequency distribution , independent t-test , paired t-test , and analysis of covariance ( ANCOVA ) , with a significance level of P = 0.05 to modify the pre-test scores . Results : Results showed a significant reduction in mean anxiety score from 56.73 ( 5.67 ) to 54.73 ( 5.42 ) after intervention in the study group , compared to the control group [ 1.11 ( 1.17 ) ] ( P < 0.001 ) . There was also a higher difference in cortisol level in the study group compared to the control group [ 1.88 ( 0.56 ) vs. 0.42 ( 0.45 ) ] . ANCOVA test showed that the 10.8 % variance in anxiety score and 69.6 % decrease in blood cortisol result ed from inhalation of lavender . Conclusions : Results showed the positive effect of lavender essence on anxiety and blood cortisol level among the patients . Aromatherapy with lavender is suggested to be considered as a nursing intervention in clinical setting Research suggests that patients with cancer , particularly in the palliative care setting , are increasingly using aromatherapy and massage . There is good evidence that these therapies may be helpful for anxiety reduction for short periods , but few studies have looked at the longer term effects . This study was design ed to compare the effects of four-week courses of aromatherapy massage and massage alone on physical and psychological symptoms in patients with advanced cancer . Forty-two patients were r and omly allocated to receive weekly massages with lavender essential oil and an inert carrier oil ( aromatherapy group ) , an inert carrier oil only ( massage group ) or no intervention . Outcome measures included a Visual Analogue Scale ( VAS ) of pain intensity , the Verran and Snyder-Halpern ( VSH ) sleep scale , the Hospital Anxiety and Depression ( HAD ) scale and the Rotterdam Symptom Checklist ( RSCL ) . We were unable to demonstrate any significant long-term benefits of aromatherapy or massage in terms of improving pain control , anxiety or quality of life . However , sleep scores improved significantly in both the massage and the combined massage ( aromatherapy and massage ) groups . There were also statistically significant reductions in depression scores in the massage group . In this study of patients with advanced cancer , the addition of lavender essential oil did not appear to increase the beneficial effects of massage . Our results do suggest , however , that patients with high levels of psychological distress  respond best to these therapies Background : Anxiety is an important mental health problem in patients with cardiac disease . Anxiety reduces patients ’ quality of life and increases the risk of different cardiac complications . Objectives : The aim of this study was to investigate the effects of inhalation aromatherapy on anxiety in patients with myocardial infa rct ion . Patients and Methods : This was a r and omized clinical trial conduced on 68 patients with myocardial infa rct ion hospitalized in coronary care units of a large-scale teaching hospital affiliated to Kashan University of Medical Sciences , Kashan , Iran in 2013 . By using the block r and omization technique , patients were r and omly assigned to experimental ( 33 patients receiving inhalation aromatherapy with lavender aroma twice a day for two subsequent days ) and control ( 35 patients receiving routine care of study setting including no aromatherapy ) groups . At the beginning 
    Output:
    
Overall , silexan 160 mg was noticed to be a more efficient treatment giving significant decline in HAMA score across other comparators .