***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: OBJECTIVE : Timolol maleate 0.5 % gel is a safe and effective medication for treating superficial infantile hemangiomas ( IHs ) in infants with a median age of 9 weeks . METHODS : Forty-one infants who had superficial IHs without ulceration and not near mucosal surfaces were recruited and r and omly assigned to placebo and treatment ( timolol maleate 0.5 % gel ) groups . Efficacy was assessed by performing blinded volume measurements at weeks 0 , 1 , 2 , 3 , 4 , 8 , 12 , 16 , 20 , and 24 and blinded investigator photograph scoring at weeks 0 , 12 , and 24 . Safety was assessed by measuring heart rate and systolic and diastolic blood pressure at weeks 0 , 1 , 2 , 3 , 4 , 8 , 12 , 16 , 20 , and 24 . RESULTS : Fifteen of the 19 infants receiving treatment and 17 of the 22 infants receiving placebo completed the study . Significant color change on the blinded photographic scores was noted at week 24 of the study ( P = .003 ) . There was a significantly higher proportion of treated IHs that reduced in size by > 5 % at weeks 20 and 24 ( P < .02 ) . The predicted proportion of IH volume change was also significantly less for treated IHs from week 16 onward when compared with placebo ( P < .05 ) . There was no significant variation in blood pressure and heart rate between the groups . CONCLUSIONS : Topical timolol maleate 0.5 % gel with a maximum dose of 0.5 mg per day is a safe and effective option for small superficial IHs that have not ulcerated and are not on mucosal surfaces Background and Objectives Childhood hemangioma is the most common soft tissue tumor of infancy , occurring in 10 % of children younger than 1 year old . Ten percent of these infantile hemangiomas involute yearly without intervention . Treatment with the pulsed dye laser ( PDL ) is the criterion st and ard for treating vascular lesions . It is well established as the most effective , safest treatment for port‐wine stains . Previous studies of the use of PDL treatment in superficial hemangioma showed inconsistent results . Main objectives were to compare the efficacy and adverse effects of PDL treatment with those of observation in the treatment of superficial hemangiomas . Parental quality of life was also assessed . Material s and Methods This was a prospect i ve , r and omized , controlled trial in which we enrolled 22 infants aged 1.5 to 5 months old with early hemangiomas with a maximum diameter of 5 cm . We assigned the infants to PDL treatment ( n = 11 ) or observation ( n = 11 ) , and followed up until the age of 1 year . Patients in the intervention group were treated using a 595‐nm PDL ( VBEAM , C and ela Corp. , Wayl and , MA ) with a 7‐mm spot diameter , 30/10 to 40/10‐ms epidermal cooling , a 7‐ to 15‐J/cm2 fluence range , and a pulse duration of 0.45 to 40.0 ms . During follow‐up , color measurements were made ( Colori meter ; Minolta , Tokyo , Japan ) , and surface area and echo depth of the hemangioma were determined . Results No significant differences were seen between the groups at time of inclusion or at the age of 1 year in echo depth ( p = .66 ) or surface area ( p = .62 ) . Results were significant for color difference ( p = .03 ) between PDL treatment and observation . Cosmetic outcome judged by an independent panel consisting of a dermatologist , physician assistant , dermatology resident , dermatology nurse , and plastic surgery resident was significantly better in the PDL treatment group ( 46 % ) than in the observation group ( 18 % ) ( p = .006 ) . Conclusions Pulsed dye laser is only to be considered as an alternative treatment up to the age of 6 months , at which time parents and physicians consider cosmetic outcome to be a relevant factor , but laser therapy plays a major role in the treatment of residual lesions at older ages BACKGROUND Renin-angiotensin system components have been demonstrated in the biology of infantile hemangioma ( IH ) .  Captopril , an angiotensin-converting enzyme inhibitor , is proposed as a therapeutic alternative to oral propranolol . OBJECTIVES We sought to compare the benefit of propranolol and captopril in the treatment of IH , and to assess angiotensin-converting enzyme gene polymorphism in patients with IH and in control subjects . METHODS Thirty patients with IH and 35 healthy control subjects were enrolled in this study . Patients were r and omly assigned to treatment with either propranolol or captopril . Assessment was done clinical ly and by measurement of serum vascular endothelial growth factor and angiotensin II in patients and control subjects . Angiotensin-converting enzyme gene polymorphism was also studied . RESULTS Clinical improvement was significantly better and faster in the patients treated with propranolol . Both groups showed reduced vascular endothelial growth factor and angiotensin II levels posttreatment , with a significantly higher percentage reduction in the propranolol-treated group . Cardiac side effects were reported only in the captopril-treated group . Baseline vascular endothelial growth factor level was significantly higher , and baseline angiotensin II level was significantly lower , in patients than control subjects . LIMITATIONS We studied a relatively small number of patients and control subjects . CONCLUSION Propranolol shows greater benefit than captopril in the treatment of IH Purpose : The combination treatment for mix infantile hemangiomas ( IHs ) using oral propranolol with topical timolol maleate was not well documented in the literature . The aim of this study was to evaluate the therapeutic effects and safety of oral propranolol along with topical timolol maleate or oral propranolol alone for treating mixed IHs in the oral and maxillofacial regions . Methods : Between March 2013 and June 2014 , a total of 31 patients with mixed IHs in the oral and maxillofacial regions were recruited to the study and r and omly divided into experimental and control groups . Fourteen patients in the experimental group ( A ) were treated with oral proranolol in combination with topical timolol maleate , and 17 patients in the control group ( B ) underwent orally proranolol treatment alone . The maximal treatment duration was planned for 8 months . Ultrasonography and serial photographs based on Visual Analogue Scale ( VAS ) were used to assess the effects of treatment before and after treatment , as well as adverse effects after medication were evaluated and managed accordingly . Results : All patients completed treatment . Among the most patients , there was obvious fading of color or decrease in size of the IHs when compared with pretreatment . There was significant reduction of color fading in A ( mean VAS score : 8.36 ± 1.39 ) than that in B ( 7.18 ± 1.71 ) ( P = 0.043 ) after the end of treatment , whereas the reduction of sizes in A ( 8.00 ± 1.75 ) had no significant difference than that in B ( 7.59 ± 1.80 ) ( P = .51 ) . The treatment duration of A ( 5.64 ± 1.45 ) was shorter than that of B ( 6.71 ± 1.10 ) ( P = .037 ) . No major collateral effects were observed in both the groups throughout the course of treatment . Conclusions : Oral proranolol combined with topical timolol maleate was well tolerated and effective treatment , mild side effects , and especially gave rise to better clinical response in the treatment of mixed IHs than oral propranolol alone UNLABELLED Oral propranolol has become the treatment of choice of infantile hemangiomas (IH)s . However , the safety of systemic propranolol is question ed . Topical therapy with 1 % propranolol has been reported to be safe and effective . Intralesional ( IL ) administration may possibly allow safe delivery of higher drug dosages . AIM To assess the efficacy and safety of two locally administered routes of propranolol ( topical and IL ) , in comparison with its systemic oral use in the treatment of IHs . PATIENTS AND METHODS 45 patients with IHs were r and omly divided into 3 groups , A , B and C ( n = 15 in each ) , receiving oral propranolol , 2 mg/kg/day , topical propranolol 1 % ointment twice daily , IL propranolol , 1 mg of propranolol hydrochloride in 1 ml of injection once weekly , respectively . Follow up was done for 6 months after treatment was stopped . RESULTS Excellent response was achieved in 9 patients in group A ( 60 % ) , 3 in group B ( 20 % ) and 2 in group C ( 13.3 % ) , ( P value : 0.04 ) . As regards safety , all 3 modalities proved safe with no major side effects apart from 1 patient in group A and 3 in group C who dropped out due to pain or inconvenience of therapy . CONCLUSIONS Further work is needed to establish clear guidelines and reach best formulations . Nevertheless , in properly selected patients with IHs , we recommend the usage of oral propranolol . Topically administered propranolol could be considered in patients at risk of potential side effects from oral administration . As IL application did not offer any more benefits , it could not be recommended Our aim was to compare in a prospect i ve study the clinical effects and safety of propranolol given orally , timolol maleate applied locally , and the combination of the two , in the management of superficial infantile haemangiomas . Thirty-nine patients with superficial infantile haemangiomas were r and omised into three equal groups of 13 each : the first given timolol maleate applied topically together with propranolol given orally , the second given only propranolol orally , and the third given only timolol maleate topically . Photographs were taken before , and periodically after , starting treatment . A minimum of 50 % improvement was considered to be effective . The maximum duration of treatment was planned for 6 months , and the patients were followed up for 3 - 12 months . The overall rate of clinical effectiveness for the three groups was 11/13 , 9/13 , and 8/13 , respectively . The two drugs together had a shorter effective response time than when they were given separately . There were no serious adverse effects . We therefore conclude that timolol maleate given topically together with propranolol given orally is safe and effective in the treatment of superficial infantile haemangiomas . Compared with simple medication , this method is more rapid , has an appreciable effect , takes a shorter time , and has fewer adverse reactions . It could be used as a first-line treatment , particularly if the lesion is potentially disfiguring or functionally threatening such as large periocular superficial haemangiomas OBJECTIVES . Oral systemic corticosteroids are the mainstay of treatment for problematic hemangiomas ; however , current information is based on anecdotal experience and retrospective studies . We aim ed to determine whether systemic steroids are efficacious in proliferating hemangioma and to compare the efficacy and safety of 2 corticosteroid treatment modalities . PATIENTS AND METHODS . Twenty patients with problematic hemangiomas of infancy were r and omly assigned to either daily oral prednisolone or monthly intravenous pulses of methylprednisolone . Their clinical outcomes ( improvement using a visual analog score ) and adverse events were compared at 3 months from baseline and 1 year of age . Data on possible surrogate markers of angiogenesis were available for the first 3 months . RESULTS . At 3 months , orally treated patients had a median visual analog score of 70 compared with 12 in the intravenous group . This response pattern was similar at the patients ' first birthday : 50.0 vs −1.5 . Additional treatment beyond 3 months was needed for 65 % of the patients ( 7 in the intravenous and 6 in the oral group ) . Six of 8 patients with impaired vision at enrollment had an improved function at 1 year ( 4 patients in the intravenous group and 3 patients in the oral group ) . Of the 4 surrogate markers of angiogenesis measured ( plasma basic fibroblast growth factor , vascular endothelial growth factor , vascular cellular adhesion molecule 1 , endoglin , and urine basic fibroblast growth factor ) , the only 2 that decreased over time were vascular cellular adhesion molecule 1 and endoglin . Patients in the oral group had a higher rate of adverse effects , such as hypertension ( 18.6 % vs 13.1 % ) , abnormal cortisol ( 78 % vs 60 % ) , and growth retardation . CONCLUSIONS . Systemic corticosteroids are efficacious in stopping the proliferation of hemangiomas . The oral corticosteroids offered more clinical and biological benefit than the pulse steroids with higher risk of adverse effects INTRODUCTION The role of pulsed dye lasers ( PDL ) in the treatment of childhood haemangiomas is controversial . Our aim was to compare treatment with PDL with a wait- and -see policy . METHODS We did a prospect i ve , r and omised controlled trial in which we enrolled 121 infants aged 1 - 14 weeks with early haemangiomas . We assigned infants to PDL treatment ( n=60 ) or observation ( n=61 ) , and followed them up to age 1 year . 
    Output:
    
Our key results indicate that oral propranolol and topical timolol maleate are more beneficial than placebo in terms of clearance or other measures of resolution , or both , without an increase in harm