***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: Summary The present study was partly a clinical pharmacological analysis of the action of imipramine in nocturnal enuresis and partly an attempt to select children who would benefit most from this treatment . 61 fairly severe cases of nocturnal enuresis were studied as out- patients , divided by the criteria primary / secondary enuresis and with/without associated behavioural disturbances . The patients received imipramine , imipramine-N-oxide , emepronium , and a placebo in r and om sequence in a double-blind cross-over trial . There was no difference in effect between placebo and emepronium ; after imipramine the frequency of enuresis fell to 58 % of the figure during placebo treatment , i.e. 31 % of the children became dry ; imipramine-N-oxide reduced the number of wet nights only to 78 % of the number on placebo , 18 % of the children became dry . When the patients were classified into groups imipramine and imipramine-N-oxide were found to have had the greatest effect in cases of presumed psychogenic aetiology , a 65 % reduction of the frequency of wet nights whilst taking the placebo . The most favourable results were in children with combined nocturnal and diurnal enuresis and in those with urinary frequency and imperative urgency . The effect was maintained during treatment for 3 months with the most suitable drug . The dose was 50 mg regardless of the body weight of the patient . There were no serious side effects . It was concluded that the psychopharmacological actions of imipramine and imipramine-N-oxide appear to be important in their effects on enuresis . Imipramine might have been the best drug because success may require the combination of antidepressant and anticholinergic activity . It was not possible to assess in detail its presumed effect on the level of sleep . Thus many children can be treated successfully and the final cure of enuresis may be hastened by breaking a vicious circle of psychological phenomena The study population consisted of 100 children with nocturnal enuresis ( NE ) aged between six and 14 years , who had been r and omly selected amongst the enuretic out patients at the Ankara S.S.K. Children 's Hospital . A placebo-controlled evaluation of piracetam , diphenylhydantoin and psychotherapy was carried out . At the end of the eighth week of the study , it was discovered that the therapeutic effects observed in the patients administered piracetam did not differ from those given the placebo . Therefore , we recommend that psychotherapy in association with a placebo be the first step in the treatment of NE children PURPOSE We prospect ively evaluated the efficacy of a combination of desmopressin and oxybutynin for treating children with nocturnal enuresis , compared to the single drugs imipramine and desmopressin . MATERIAL S AND METHODS We enrolled 158 patients from 2003 to 2004 . Children were r and omly assigned to 1 of 3 groups and treated with desmopressin , imipramine or a combination of desmopressin plus oxybutynin . Of these patients 145 ( 100 boys and 45 girls , mean age 7.8 + /- 2.5 years , range 5 to 15 ) were followed for more than 6 months .  Efficacy was measured at 1 , 3 and 6 months in terms of average enuretic frequency , 5-scale response based on change in nocturnal enuretic frequency after treatment and posttreatment enuretic frequency as a percentage of pretreatment baseline frequency . The latter efficacy was classified according to daytime voiding symptoms . Statistical evaluation was performed using chi-square tests and ANOVA . RESULTS Of the 145 children followed 48 received combination therapy , 49 received desmopressin and 48 received imipramine . A total of 68 patients ( 47 % ) had monosymptomatic enuresis and 77 ( 53 % ) had polysymptomatic enuresis . Combination therapy produced the best and most rapid results regardless of whether the children had monosymptomatic or polysymptomatic enuresis . CONCLUSIONS Combination therapy with desmopressin plus oxybutynin for the treatment of pediatric nocturnal enuresis was well tolerated , and gave significantly faster and more cost-effective results than single drug therapy using either desmopressin or imipramine PURPOSE We estimated the spectrum and risk factors for daytime urinary incontinence in school-age children . MATERIAL S AND METHODS A vali date d , reproducible , parent administered daytime incontinence question naire was distributed to r and omly selected school children . The question naire elicited information on demographic factors , prenatal and developmental factors , and bowel and urinary history . The spectrum of daytime urinary incontinence was measured by recording the frequency and amount of incontinence . RESULTS Parents of 2,856 children ( mean age 7.3 years ) completed the question naire . Overall 16.9 % reported any daytime urinary incontinence in the previous 6 months , with 64 % of cases being very mild , 14.8 % mild , 11.6 % moderate and 9.6 % severe . There was low agreement between frequency and amount of incontinence ( weighted kappa 0.03 ) but risk factors were similar . Independent risk factors were nocturnal enuresis ( OR 7.2 , 95 % CI 3.4 to 15.2 ) , female gender ( 5.4 , 2.6 to 11.1 ) , social concerns ( 3.4 , 1.4 to 8.3 ) , urinary tract infection ( 5.6 , 2.0 to 15.6 ) and encopresis ( 3.3 , 1.4 to 7.7 ) . Expressed as population attributable risk , 36 % of moderate to severe daytime incontinence can be attributed to encopresis , nocturnal enuresis , social concerns , female gender or urinary tract infection . Urinary tract infection was a risk factor for boys but not for girls ( interaction p < 0.01 ) . CONCLUSIONS Daytime urinary incontinence in children is a common but heterogeneous disorder . Episodes may be frequent or major or both but appear to share the same causal pathway . Given the risk factors identified , interventions should target endogenous/physiological and environmental factors BACKGROUND Meclofenoxate hydrochloride is a psychostimulant in the nootropic agent group available in capsule and tablet formulations approved for traumatic cataphora , alcoholic poisoning , anoxia neonatorum , and children 's enuresis in China . Although these 2 generic formulations are marketed in China , information regarding their pharmacokinetics and bioequivalence in humans has not been published . OBJECTIVE The aim of this study was to compare the pharmacokinetic properties and bioequivalence of the capsule ( test ) and tablet ( reference ) formulations of meclofenoxate hydrochloride 200 mg in healthy Chinese volunteers . METHODS This single-dose , r and omized-sequence , open-label , 2-period crossover study was performed at the Nanjing First Hospital of Nanjing Medical University , Nanjing , China . Eligible subjects were healthy male volunteers who were r and omly assigned at a 1:1 ratio to receive a single 200-mg dose of the test or reference formulation , followed by a 1-week washout period and administration of the alternate formulation . The study drugs were administered after a 12-hour overnight fast . As a prodrug , meclofenoxate is hydrolyzed into 4-chlorophenoxyacetic acid and is not detected in plasma . The active metabolite of meclofenoxate , chlorophenoxyacetic acid , was assayed using a high-performance liquid chromatography method . For analysis of pharmacokinetic properties , including Cmax , AUC0 - 24 , and AUC0-infinity , blood sample s were obtained at 0.33 , 0.67 , 1 , 1.5 , 2 , 2.5 , 3 , 4 , 6 , 8 , 10 , 14 , and 24 hours after administration . The formulations were considered bioequivalent if the log-transformed ratios of Cmax and AUC were within the predetermined equivalence range ( 80%-125 % ) as established by the US Food and Drug Administration ( FDA ) . Subjects were interviewed concerning the occurrence of adverse events including excitement , insomnia , lassitude , and headache . Tolerability was assessed at baseline ( before administration ) and at 1 , 2 , 6 , and 12 hours after administration by monitoring vital signs and laboratory tests ( hematology , blood biochemistry , hepatic function , and urinalysis ) . RESULTS Twenty-four Chinese male subjects ( mean [range]age,23.5[22 - 30]years;weight,63.3[56 - 68]kg ; height , 171 [ 165 - 184 ] cm ) were enrolled ; all completed the study . No period or sequence effect was observed . The 90 % CIs for the log-transformed ratios of chlorophenoxyacetic acid Cmax , AUC0 - 24 , and AUC0-infinity were 95.7 to 122.9 , 97.6 to 111.9 , and 97.8 to 111.7 , respectively ( all , P>0.05 ) . Similar results were found for the data without log-transformation . No adverse events were reported or observed during this single-dose study . CONCLUSIONS In this small study in healthy Chinese adult male volunteers , a single 200-mg dose of the capsule formulation was found to be bioequivalent to a single 200-mg dose of the tablet formulation based on the US FDA 's regulatory definition ( rate and extent of absorption ) . Both formulations were well tolerated Purpose : The treatment approach for enuresis is controversial due to the lack of consensus as to the exact causes of nocturnal enuresis . Despite various treatment modalities , pharmacotherapy still appears to be the common choice . The aim of this prospect i ve study was the evaluation of the efficacy of combination therapy ( imipramine and oxybutynin ) in patients with enuresis nocturna . Patients and Methods : This prospect i ve study was done with 77 monosymptomatic nocturnal enuretics between July 1996 and December 1998 . Results : Even though there is no statistically significant difference between combination therapy ( imipramine plus oxybutynin ) and monotherapy , clinical data showed that combination therapy is more effective . Conclusions : We conclude that combination of imipramine with oxybutynin is a safe and new choice in the treatment of nocturnal enuresis Various treatment modalities have been used in Primary Nocturnal Enuresis ( PNE ) and pharmacotherapy is widely accepted . Prostagl and ins increase detrusor pressure , decrease urethral pressure and lead to sodium excretion . They also antagonize hydro-osmotic effect of vasopressin by competing with this hormone . According to these functions of prostagl and ins it is suggested that inhibition of prostagl and in synthesis may have value in the management of PNE . We evaluated the efficacy or oral diclofenac sodium treatment in 78 patients . We conclude that diclofenac sodium , an inhibitor of prostagl and in synthesis , is a good alternative agent for nocturnal enuresis particularly as a supplementary treatment combined to Imipramine , with 60 % complete response and 13.3 % recurrence rate PURPOSE This r and omized blinded clinical study was design ed to compare the efficacy of tolterodine treatment combined with behavioral modification , behavioral modification alone and behavioral modification plus placebo in children with nonneurogenic , nonanatomical voiding dysfunction . MATERIAL S AND METHODS A total of 72 children meeting inclusion criteria were r and omly allocated to 1 of 3 groups . One group received tolterodine ( 1 mg twice daily ) along with behavioral modification , 1 received behavioral modification only and 1 received placebo with behavioral modification . A dysfunctional voiding scoring system question naire was completed for all patients at the beginning of the study , and at 1 and 3 months of treatment . RESULTS A total of 71 patients were evaluated . The groups did not differ with respect to age , gender and symptom score before study enrollment ( p > 0.05 ) . Repeated calculations of symptom scores at 1 month of the treatment revealed a significant decrease in symptoms in all 3 groups , with a significant decrease in patients receiving tolterodine . In addition , at month 3 the symptom score of the tolterodine group was significantly lower compared to month 1 , while scores remained steady in the behavioral modification and behavioral modification plus placebo groups . CONCLUSIONS Tolterodine combined with behavioral modification for voiding dysfunction in children without neurological or anatomical abnormality can be recommended as a first line treatment before invasive evaluation This exploratory r and omized , double-blind , double-dummy , placebo-controlled trial of 14 days duration conducted in 22 primary care practice s in the United States was used to compare the efficacy of ibuprofen and pseudoephedrine , administered alone or in combination , to placebo for the treatment of primary nocturnal enuresis ( PNE ) in children aged 6 to 11 years .  Ibuprofen ( IBU ) and pseudoephedrine ( PSE ) are not approved for the treatment of PNE . Three hundred eighteen children with PNE were enrolled . Eligible children had ≥ 8 wet nights during a 14-day baseline . Each child was r and omly assigned to 1 of 4 treatment 
    Output:
    
There was an overall paucity of data regarding outcomes after treatment was withdrawn .
For drugs versus placebo , when compared to placebo indomethacin  ( risk ratio [ RR ] 0.36 , 95 % CI 0.16 to 0.79 ) ,  diazepam  ( RR 0.22 , 95 % CI 0.11 to 0.46 ) , mestorelone ( RR 0.32 , 95 % CI 0.17 to 0.62 ) and atomoxetine ( RR 0.81 , 95 % CI 0.70 to 0.94 ) appeared to reduce the number of children failing to have 14 consecutive dry nights .
Although indomethacin and diclofenac were better than placebo during treatment , they were not as effective as desmopressin and there was a higher chance of adverse effects .
There was an overall paucity of data regarding outcomes after treatment was withdrawn .
There was not enough evidence to judge whether or not the included drugs cured bedwetting when used alone .
There was limited evidence to suggest that desmopressin , imipramine and enuresis alarms therapy were better than the included drugs to which they were compared .
In other review s , desmopressin , tricyclics and alarm interventions have been shown to be effective during treatment .