***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: BACKGROUND : We proposed a new chest physiotherapy ( CPT ) secretion clearance method to treat respiratory syncytial virus bronchiolitis in infants . Our new CPT method consists of 15 prolonged slow expirations , then 5 provoked cough maneuvers . METHODS : We r and omized 20 infants ( mean age 4.2 months ) into 2 groups : 8 patients received 27 sessions of nebulization of hypertonic saline ; 12 patients received 31 sessions of nebulization of hypertonic saline followed by our new CPT method . We used the Wang clinical severity scoring system ( which assesses wheezing , respiratory rate , retractions , and general condition ) and measured SpO2 and heart rate before each CPT session ( T0 ) , immediately after the 30-min session ( T30 ) , and 120 min after the session ( T150 ) . RESULTS : Within the groups : in the first group , Wang score was significantly lower at T150 than at T0 : 4.6 vs 5.0 ( P = .008 ) . In the new- method -CPT group , Wang score was significantly lower at T30 ( 3.6 vs 4.3 , P = .001 ) and at T150 ( 3.7 vs 4.3 , P = .002 ) . Wheezing score was significantly lower at T150 than at T0 ( 1.1 vs 1.2 , P = .02 ) in the first group , and in the new- method -CPT group at T30 than at T0 ( 0.8 vs 1.3 , P = .001 ) and at T150 than at T0 ( 0.9 vs 1.3 , P = .001 ) . Between the groups : at T30 the improvement was significantly better in the new- method -CPT group for overall Wang score ( P = .02 ) , retractions ( P = .05 ) , respiratory rate ( P = .001 ) , and heart rate ( P < .001 ) . At T150 the Wang score was not significantly different between the groups . At T30 ( versus T0 ) the difference in percent gain between the groups was significant for Wang score ( P = .004 ) , wheezing ( P = .001 ) , and heart rate ( P = .02 ) . Over 5-hospital days , the daily baseline ( T0 ) Wang score decreased significantly in the new- method -CPT group ( P = .002 ) , whereas it did not in the first group . There were no adverse events . Average hospital stay was not significantly different between the groups . CONCLUSIONS : Our new CPT method showed short-term benefits to some respiratory symptoms of bronchial obstruction in infants with acute respiratory syncytial virus bronchiolitis OBJECTIVE In previously well infants hospitalized with acute viral bronchiolitis , the effectiveness of repeated nebulized therapy with epinephrine ( EPI ) was compared with treatment with albuterol ( ALB ) or saline placebo ( PLAC ) . STUDY DESIGN In this r and omized , double-blind , parallel-group , controlled trial , infants received study nebulizations every 1 to 6 hours and were assessed twice daily by the research team . The primary outcome was length of hospital stay ( LOS ) . Secondary outcomes included the time from admission until the infant had normal hydration , oxygenation , and minimal respiratory distress . RESULTS A total of 149 infants were r and omized ; 50 were allocated to receive racemic EPI , 51 were given ALB , and 48 received PLAC . Baseline characteristics and pre-enrollment symptoms , signs , and therapy were similar between groups . There were no group differences in the primary outcome measure , mean LOS (hours)(+/- SD ) : EPI = 59.8 ( 62 ) , ALB = 61.4 ( 54 ) , and PLAC = 63.3 ( 47 ) ; P = .95 by intent-to-treat analysis . Group differences were not statistically significant in any of the secondary outcomes . CONCLUSIONS There were no group differences in the effectiveness of therapy for infants hospitalized with bronchiolitis . Based on these results , we do not recommend routine use of either nebulized EPI or ALB in this patient group Objective To compare the length of hospital stay ( primary ) and improvement in clinical severity scores ( secondary ) among children with bronchiolitis nebulized with 3 % hypertonic saline or 0.9 % saline .  Design R and omized double blind controlled trial . Setting Tertiary care teaching hospital . Patients Hospitalized children ( 1–24 months ) with acute bronchiolitis of moderate severity . InterventionNebulization of 4 ml of 3 % hypertonic saline or 4 mL of 0.9 % saline , along with 2.5 mg salbutamol , at 4-hourly intervals till the patient was ready for discharge . Results Baseline characteristics were similar in two groups . Median clinical severity score at admission was 6 ( IQR-1 ) in both the groups . Clinical severity scores monitored afterwards 12-hourly till discharge ( 132 h ) did not show statistically significant differences in 3 % and 0.9 % saline groups . Mean length of hospital stay ( time to reach predefined clinical severity score<3 ) was 63.93 ± 22.43 h in 3 % saline group and 63.51 ± 21.27 h in 0.9 % saline group ( P=0.878 ) . No adverse events were reported by the parents , caregivers or treating medical attendants in both groups . Conclusion Nebulized 3 % saline is not superior to 0.9 % saline in infants with clinical ly diagnosed acute bronchiolitis OBJECTIVE To assess the efficacy and safety of inhaled nebulized hypertonic saline ( HS ) solution in infants with acute bronchiolitis . METHOD Totally 129 patients with acute bronchiolitis ( clinical severity score ≥ 4 , aged 2 - 18 months ) admitted to the Capital Institute of Pediatrics from November 2012 to January 2013 were enrolled . All the subjects were assigned to receive 1.5 ml compound ipratropium bromide solution for inhalation and 1 ml budesonide firstly , twice a day . Then , the subjects were r and omized to receive 2 ml doses of nebulized 5 % HS ( Group A ) , 3 % HS ( Group B ) or 0.9 % NS ( Group C ) , twice a day . The treatment lasted for 3 days . Clinical severity scores before treatment and 24 , 48 , 72 h after treatment were documented . Bronchospasm , nausea and emesis were recorded to assess safety . RESULT A total of 124 patients completed this research .Group A included 40 cases , Group B included 42 cases , Group C included 42 cases . Demographic characteristics , pre-treatment duration and clinical severity score before treatment were similar among the 3 group . Seventy-two hours after treatment , the clinical severity score of Group A , B , and C were 3.5 ( 1.0 ) , 4.0 ( 1.0 ) and 5.0 ( 0 ) . At 24 , 48 , and 72 h after treatment , the clinical severity score were significantly different among the three groups ( χ(2 ) = 36.000 , 51.200 , 50.800 , P < 0.05 ) .One patient in Group A got paroxysmal cough everytime as soon as he received 5 % HS ( 6 times).Other 3 patients in Group A got paroxysmal cough once . The incidence of adverse effect of Group A was 3.75 % ( 9/240 ) ; no adverse event occurred in other group . The incidence of adverse effect among this three group was significantly different ( χ(2 ) = 19.13 , P < 0.01 ) . CONCLUSION Inhalation of nebulized 5 % and 3 % hypertonic saline could decrease clinical symptoms of patient with acute bronchiolitis ; 5 % HS was superior to 3 % HS . But 2 ml dose of 5 % HS may induce paroxysmal cough Bronchiolitis is a common disorder in young children that often results in hospitalisation . Except for a possible effect of nebulised hypertonic saline ( sodium chloride ) , no evidence -based therapy is available . This study investigated the efficacy of nebulised 3 % and 6 % hypertonic saline compared with 0.9 % hypertonic saline in children hospitalised with viral bronchiolitis . In this multicentre , double-blind , r and omised , controlled trial , children hospitalised with acute viral bronchiolitis were r and omised to receive either nebulised 3 % , 6 % hypertonic saline or 0.9 % normal saline during their entire hospital stay . Salbutamol was added to counteract possible bronchial constriction . The primary endpoint was the length of hospital stay . Secondary outcomes were need for supplemental oxygen and tube feeding . From the 292 children included in the study ( median age 3.4 months ) , 247 completed the study . The median length of hospital stay did not differ between the groups : 69 h ( interquartile range 57 ) , 70 h ( IQR 69 ) and 53 h ( IQR 52 ) , for 3 % ( n=84 ) and 6 % ( n=83 ) hypertonic saline and 0.9 % ( n=80 ) normal saline , respectively , ( p=0.29 ) . The need for supplemental oxygen or tube feeding did not differ significantly . Adverse effects were similar in the three groups . Nebulisation with hypertonic saline ( 3 % or 6 % sodium chloride ) although safe , did not reduce the length of stay in hospital , duration of supplemental oxygen or tube feeding in children hospitalised with moderate-to-severe viral bronchiolitis . Hypertonic saline nebulisation did not reduce hospital stay for children with viral bronchiolitis Objective To examine the prevalence of outcome reporting bias — the selection for publication of a subset of the original recorded outcome variables on the basis of the results — and its impact on Cochrane review s. Design A nine point classification system for missing outcome data in r and omised trials was developed and applied to the trials assessed in a large , unselected cohort of Cochrane systematic review s. Research ers who conducted the trials were contacted and the reason sought for the non-reporting of data . A sensitivity analysis was undertaken to assess the impact of outcome reporting bias on review s that included a single meta- analysis of the review primary outcome . Results More than half ( 157/283 ( 55 % ) ) the review s did not include full data for the review primary outcome of interest from all eligible trials . The median amount of review outcome data missing for any reason was 10 % , whereas 50 % or more of the potential data were missing in 70 ( 25 % ) review s. It was clear from the publications for 155 ( 6 % ) of the 2486 assessable trials that the research ers had measured and analysed the review primary outcome but did not report or only partially reported the results . For reports that did not mention the review primary outcome , our classification regarding the presence of outcome reporting bias was shown to have a sensitivity of 88 % ( 95 % CI 65 % to 100 % ) and specificity of 80 % ( 95 % CI 69 % to 90 % ) on the basis of responses from 62 trialists . A third of Cochrane review s ( 96/283 ( 34 % ) ) contained at least one trial with high suspicion of outcome reporting bias for the review primary outcome . In a sensitivity analysis undertaken for 81 review s with a single meta- analysis of the primary outcome of interest , the treatment effect estimate was reduced by 20 % or more in 19 ( 23 % ) . Of the 42 meta-analyses with a statistically significant result only , eight ( 19 % ) became non-significant after adjustment for outcome reporting bias and 11 ( 26 % ) would have overestimated the treatment effect by 20 % or more . Conclusions Outcome reporting bias is an under-recognised problem that affects the conclusions in a substantial proportion of Cochrane review s. Individuals conducting systematic review s need to address explicitly the issue of missing outcome data for their review to be considered a reliable source of evidence . Extra care is required during data extraction , review ers should identify when a trial reports that an outcome was measured but no results were reported or events observed , and contact with trialists should be encouraged OBJECTIVE To determine the utility of inhaled hypertonic saline solution to treat ambulatory infants with viral bronchiolitis . DESIGN R and omized , double-blind , controlled trial . Sixty-five ambulatory infants ( mean + /- SD age , 12.5 + /- 6 months ) with viral bronchiolitis received either of the following : inhalation of 0.5 mL ( 5 mg ) terbutaline added to 2 mL of 0.9 % saline solution as a wet nebulized aerosol ( control ; group 1 ; n = 32 ) or 0.5 mL ( 5 mg ) terbutaline added to 2 mL of 3 % saline solution administered in the same manner as above ( treatment ; group 2 ; n = 33 ) . This therapy was repeated three times every day for 5 days . RESULTS The clinical severity ( CS ) scores at baseline on the first day of treatment were 6.4 + /- 1.8 in group 1 and 6.6 + /- 1.5 in group 2 ( not significant ) . After the first day , the CS score was significantly lower ( better ) in group 2 as compared to group 1 on each of the treatment days ( p < 0.005 ; Fig 1 ) . On the first day , the percentage decrease in the CS score after inhalation 
    Output:
    
Cl aims that HS achieves small reductions in LoS must be treated with scepticism .