***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 
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    ***EXAMPLES*** 
    Input: Aim To investigate the association between dry eye symptoms and depression in an adult population . Methods In this population -based cross-sectional study , a r and om sample of 1957 subjects from the Beijing Eye Study was examined for dry eye disease ( DED ) in 2006 . All patients completed an interviewer-assisted question naire on dry eye symptoms and underwent measurement of tear break-up time ( TBUT ) , slit-lamp evaluation of corneal staining and meibomian gl and dysfunction ( MGD ) , and the Schirmer test .  In 2011 , 1456 subjects from this sample were evaluated for depression using a depression scale . The association between depression symptoms and dry eye clinical tests was evaluated . Results Definite depression was more prevalent in patients with DED than in subjects without DED ( 13.7±0.4 % vs 8.6±0.3 % , p=0.02 ) . The depression score was correlated with dry eye symptoms ( correlation coefficient r=0.07 ; p=0.013 ) but not with TBUT ( p=0.18 ) , the Schirmer test ( p=0.37 ) , corneal staining ( p=0.30 ) and MGD evaluation ( p=0.93 ) . In multivariate regression analysis , the risk of definite depression remained significantly associated with dry eye symptoms ( p=0.028 ) after adjusting for lower cognitive status ( p=0.01 ) , rural region of habitation ( p=0.023 ) and lower body weight ( p=0.05 ) . Conclusions In an older population from Beijing , depression was associated with DED and in particular with dry eye symptoms OBJECTIVE To investigate the significant determinants of health-related quality of life ( HRQOL ) and the association of the EULAR Sjögren 's syndrome patient reported index ( ESSPRI ) with clinical parameters including HRQOL in Korean patients with primary Sjögren 's syndrome ( pSS ) compared with non-SS sicca patients . METHODS We prospect ively analysed 104 pSS and 42 non-SS sicca patients . Clinical data including Short Form 36 ( SF-36 ) scores , self- assessment s for symptoms and ESSPRI  were cross-sectionally collected . RESULTS Although most self- assessment s and HRQOL statuses were comparable , different association patterns between HRQOL and symptoms were observed in pSS and non-SS sicca patients . pSS patients with low HRQOL had significantly higher ESSPRI scores [ P = 7.6 × 10(-6 ) for physical component summary ( PCS ) subgroups and P = 0.0015 for mental component summary ( MCS ) subgroups ] and ESSPRI scores showed a significant association with all SF-36 scales in pSS patients ( all P ≤ 0.0020 ) . Moreover , in multivariate linear regression analyses , ESSPRI ( P = 0.035 ) and depression ( P = 4.1 × 10(-14 ) ) were significantly correlated with the PCS and the MCS , respectively . However , in the non-SS sicca group , xerostomia inventory ( XI ) scores were higher in the low PCS subgroup ( P = 0.031 ) and this correlated with five SF-36 scales ( all P ≤ 0.046 ) . XI scores ( P = 0.0039 ) and anxiety ( P = 7.9 × 10(-10 ) ) were the main determinants of the PCS and MCS , respectively . CONCLUSION HRQOL levels were differentially associated with clinical facets in pSS and non-SS sicca patients , although the groups had similar clinical symptoms and HRQOL reduction . Because depression and ESSPRI are major determinants of HRQOL in Korean pSS patients , ESSPRI is suggested to be disease-specific for pSS Objective . Although multiple diseases associated with primary Sjögren ’s syndrome ( pSS ) have been reported , reliable data regarding the prevalence of specific medical comorbidities among patients with pSS remain sparse . We investigated the prevalence and risk for a broad spectrum of medical conditions among patients with pSS in Taiwan . Methods . A total of 1974 patients with pSS were eligible for inclusion in the study group . We r and omly selected 9870 enrollees matched with the study subjects , using the Taiwan National Health Insurance Research Data set for 2006 and 2007 , inclusive .  Conditional logistic regression analyses conditioned on sex , age , monthly income , and level of urbanization of the patient ’s community were used to calculate the odds ratios ( OR ) of various comorbid conditions . Results . Pearson chi-square tests revealed that patients with pSS had significantly higher prevalence of hyperlipidemia , cardiac arrhythmias , headaches , migraines , fibromyalgia ( FM ) , asthma , pulmonary circulation disorders , hypothyroidism , liver disease , peptic ulcers , hepatitis B , deficiency anemias , depression , and psychoses . Conditional regression analyses showed that , compared to patients without the condition , patients with pSS were more likely to have hyperlipidemia ( OR 1.42 ) , cardiac arrhythmias ( OR 1.32 ) , headaches ( OR 1.47 ) , migraines ( OR 1.86 ) , FM ( OR 1.71 ) , asthma ( OR 1.54 ) , pulmonary circulation disorders ( OR 1.42 ) , hypothyroidism ( OR 2.37 ) , liver disease ( OR 1.89 ) ,  peptic ulcers ( OR 1.88 ) , hepatitis B ( OR 2.34 ) , deficiency anemias ( OR 1.33 ) , depression ( OR 2.57 ) , and psychoses ( OR 2.15 ) . Conclusion . The prevalence of several comorbidities was increased among the patients with pSS . Our study provides epidemiological data for comorbidities among pSS patients in an ethnic Chinese population OBJECTIVE Corneal and ocular wavefront aberrations were recorded together with clinical examination results and patient-reported vision-related quality -of-life evaluation results to define the relevance of dynamic optical analysis of the eye in dry eye disease ( DED ) . DESIGN Prospect i ve and comparative clinical study . PARTICIPANTS Forty DED patients and 40 age- and gender-matched control subjects . METHODS Serial measurements of ocular and corneal higher-order aberrations ( HOAs ) after blink were performed for 10 seconds using the KR-1 aberrometer ( Topcon , Clichy , France ) . Vision-related health-targeted quality of life was evaluated using the Ocular Surface Disease Index ( OSDI ) question naire . The clinical examination included tear film assessment ( tear film break-up time and Schirmer I test ) , ocular surface damage assessment with the Oxford and van Bijsterveld indexes , and Meibomian dysfunction grading . Tear osmolarity also was measured . MAIN OUTCOME MEASURES The time course of HOAs and modulation transfer function ( MTF ) was compared between groups and was analyzed in comparison with the OSDI and clinical data in DED patients . RESULTS The root mean square of ocular and corneal total HOAs , particularly third-order aberrations , significantly increased over the 10-second period in DED patients , whereas no change occurred in controls . Analysis of MTF revealed progressive degradation of ocular optical quality result ing from loss of contrast at intermediate and high spatial frequencies in DED patients compared with controls . The progression index for corneal HOAs was correlated with the subjective index of patient-reported visual outcomes and with objective clinical findings of tear film and ocular surface damage . CONCLUSIONS Objective measurement of the time course of HOAs may constitute a new single instrument to evaluate and manage patients with DED because it reliably reflects the completeness of the disease PURPOSE A population -based cross-sectional study to investigate the association between depression and dry eye disease ( DED ) in a community-dwelling elderly population . METHODS The subjects were 657 Korean elders ≥ 65 years of age r and omly selected from an official household registration data base in Yongin , Korea . DED symptoms were assessed using the six-item Dry Eye Question naire . DED signs were evaluated using the Schirmer test , fluorescein stain score , tear film break-up time ( BUT ) . Depression was assessed using the Korean version of the Short Geriatric Depression Scale ( SGDS-K ) . The association between DED and depression was evaluated using logistic linear analyses . RESULTS The SGDS-K score correlated with the number of positive responses in the Dry Eye Question naire ( r = 0.229 , P < 0.001 ) , but not with tear film break-up time ( r = 0.041 , P = 0.139 ) or Schirmer test score ( r = 0.048 , P = 0.642 ) . In the binary logistic regression model , female sex ( P = 0.014 ) , residence in urban areas ( P < 0.001 ) , depression ( P < 0.001 ) , and Schirmer score of ≤ 5 mm ( P = 0.035 ) were associated with the risk of DED . Depression was associated with the risk of DED ( P < 0.001 ) in the patients with Schirmer score > 5 mm but not in those with Schirmer score ≤ 5 mm ( P = 0.290 ) . CONCLUSIONS Depression was associated with DED symptoms in subjects with normal or mildly reduced tear production OBJECTIVE To compare pain , fatigue , and sicca symptoms ; quality of life ; and psychological status between patients with primary Sjögren 's syndrome ( SS ) and those with sicca symptoms but no autoimmune features ( sicca asthenia polyalgia syndrome [ SAPS ] ) , and to determine whether a psychological pattern can be detected in patients with SAPS , which could suggest psychological distress as the cause . METHODS This cross-sectional , prospect i ve study included 111 patients with primary SS according to the American-European Consensus Group criteria and 65 SAPS patients with no focus on lip biopsy and no anti-SSA/SSB antibodies .  Pain , fatigue , and sicca symptoms were assessed using visual analog scales ; quality of life was assessed using the Short Form 36 ( SF-36 ) ; and psychological distress by the Symptom Checklist-90-Revised ( SCL-90-R ) question naire . RESULTS No difference was observed between primary SS and SAPS patients for pain , fatigue , sicca symptoms , quality of life , and psychological status . Fatigue and pain , but not dryness , were correlated with both quality of life and psychological distress in both groups . For primary SS patients , physical and mental composite scores on the SF-36 correlated well with global severity index ( GSI ) scores of the SCL-90-R ( r = -0.29 , P = 0.006 and r = -0.61 , P < 0.0001 , respectively ) . CONCLUSION Patients with primary SS and SAPS do not differ in quality of life or psychological status . Although both diseases probably have a different origin , they may require the same psychological support or psychiatric care . The strong correlation between the composite physical and mental scores of the SF-36 and the GSI scores of the SCL-90-R in primary SS patients emphasizes the importance of the psychological dimension in results of the SF-36 
    Output:
    
Subgroup analyses revealed that the prevalence and severity of depression are greatest in primary Sjogren ’s syndrome patients .
Conclusion Depression and anxiety are more prevalent in DED patients than in controls .
Among patients with DED , those suffering from primary Sjogren 's syndrome have higher prevalence and severity of depression