human
***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 To establish the efficacy of a multidrug oral treatment with the tricyclic antidepressant agent doxepin and the cyclooxygenase ( COX ) inhibitor piroxicam in patients with interstitial cystitis ( IC ) , who had failed st and ard therapy in an open , prospect i ve , nonr and omized study . METHODS A total of 37 patients diagnosed with IC received 75 mg doxepin and 40 mg piroxicam daily . The treatment was termed DOXCAM .  Effectiveness of therapy was assessed with frequency-volume charts , an IC symptom score and with cystometry prior to treatment , 8 weeks after the start and 4 weeks after termination of drug treatment . RESULTS Medication was not tolerated by five patients . Twenty-six of 32 patients have experienced virtual total remission of symptoms ( 81 % ) and six patients had significant relief ( 19 % ) . DOXCAM treatment result ed in a significant percent decrease in pain ( 65 % versus 21 % ) . Daytime frequency decreased from 17.6+/-5.7 to 11.3+/-3.6 voids while nocturia did not improve significantly . Twenty-three of the 26 patients who became symptom free and four of the six patients who showed significant improvement had a return of symptoms after cessation of therapy . CONCLUSION It is reasonable to consider oral treatment with DOXCAM in those patients who have failed first-line therapies PURPOSE In a previous retrospective analysis , cyclosporine A ( CyA ) was highly efficient in treating patients with interstitial cystitis . A prospect i ve r and omized study with this immunosuppressive agent was warranted . We compared CyA to pentosan polysulfate sodium ( PPS ) in patients with interstitial cystitis . MATERIAL S AND METHODS A total of 64 patients with interstitial cystitis meeting the National Institute of Diabetes and Digestive and Kidney Diseases criteria were enrolled in a r and omized prospect i ve study . Patients were r and omized in a 1:1 ratio to 1.5 mg/kg CyA twice daily ( 27 women , 5 men ) or 100 mg PPS 3 times daily ( 26 women , 6 men ) for a period of 6 months . The primary end point was daily micturition frequency , and secondary end points were mean and maximal voided volume , number of nocturia episodes , O'Leary-Sant symptom and problem indexes , visual analogue scale for pain , and subjective global response assessment . RESULTS CyA was superior to PPS in all clinical outcome parameters measured at 6 months . Micturition frequency in 24 hours was significantly reduced in the CyA arm compared to the PPS arm ( -6.7 + /- 4.7 vs -2.0 + /- 5.1 times ) . The clinical response rate ( according to global response assessment ) was 75 % for CyA compared to 19 % for PPS ( p < 0.001 ) . Although there were more adverse events in the CyA arm than in the PPS arm , 29 patients completed the 6-month followup in both groups . CONCLUSIONS CyA is more effective than PPS in interstitial cystitis Interstitial cystitis ( IC ) is a disorder of the urinary bladder characterized by urgency , frequency , nocturia and suprapubic pain . IC occurs primarily in women and symptoms are exacerbated by stress , ovulatory hormones and certain foods . IC pathogenesis is unknown , but the most consistent findings involve some dysfunction of the bladder glycosaminoglycan ( GAG ) protective layer and a high number of activated bladder mast cells . There is no effective therapy even through intravesical administration of dimethylsulfoxide ( DMSO ) or oral pentosanpolysulfate ( PPS ) have had variable success . A dietary supplement , CystoProtek ® , was formulated with the natural GAG components chondroitin sulfate and sodium hyaluronate to provide urothelial cytoprotection , together with the flavonoid quercetin that has anti-inflammatory properties and inhibits activation of mast cells . Thirty-seven female patients diagnosed by the NIDDK criteria who had failed all forms of therapy  took six softgel CystoProtek ® capsules per day for 6 months . Global assessment scale was reduced from 9.0 ± 2.9 to 4.3 ± 2.1 ( p < 0.05 ) ; moreover , the O'Leary/Sant Symptom Index decreased from 16.3 ± 3.1 to 6.9 ± 4.2 ( p < 0.05 ) and the Problem Index from 13.1 ± 3.7 to 5.4 ± 4.0 ( p < 0.05 ) . These results are very promising and warrant a larger study that may permit further analyses with respect to other , especially atopic , comorbid diseases PURPOSE Interstitial cystitis ( IC ) is a disorder of unknown etiology with few effective therapies . Oral bioflavonoid therapy utilizing quercetin recently proved to be clinical ly effective in men with chronic pelvic pain syndrome , a disorder with similarities to IC . We therefore tested in an open-label trial a quercetin-based supplement in patients with clinical ly proven IC . MATERIAL S AND METHODS Twenty-two patients ( 5 men and 17 women ; average age 53.1 years ) with classically documented IC received  one capsule of Cysta-Q complex ( equivalent to 500 mg of quercetin ) twice a day for 4 weeks . Symptoms were assessed before and after therapy by the IC problem and symptom indices as well as by global assessment of pain ( range 0 - 10 ) . RESULTS Two patients did not complete the study . In the remaining 20 patients , improvement was seen in all three parameters tested . After 4 weeks of treatment , the mean ( + /- SEM ) problem index improved from 11.3 + /- 0.6 to 5.1 + /- 0.7 ( p = .000001 ) , the mean symptom index improved from 11.9 + /- 0.9 to 4.5 + /- 0.5 ( p = .000001 ) , and the mean global assessment score improved from 8.2 + /- 0.4 to 3.5 + /- 0.4 ( p = .000001 ) . None of the patients experienced any negative side effects , and all but one patient had at least some improvement in every outcome measure . CONCLUSION Oral therapy with the quercetin supplement Cysta-Q was well tolerated and provided significant symptomatic improvement in patients with IC . Larger , r and omized , placebo-controlled trials appear warranted based on these preliminary open-label results ABSTRACT Objective : To evaluate the relationship between symptom reduction and satisfaction with pentosan polysulfate sodium ( PPS ) therapy in subjects with interstitial cystitis ( IC ) . Methods : A secondary analysis was conducted in 128 subjects treated with PPS 300 mg/day ( US Food and Drug Administration-approved dose ) from a 32-week multicenter , r and omized , double-blind study of 380 subjects with IC who were treated with PPS 300 mg/day , 600 mg/day , or 900 mg/day .  Self-rated outcome measures included the O'Leary-Sant Interstitial Cystitis Symptom Index ( ICSI ) and a treatment satisfaction question naire . Treatment responders were defined as subjects having ≥30 % reduction in ICSI from baseline to study end point . Results : A reduction in IC symptoms was associated with significantly higher satisfaction with PPS ( p < 0.05 ) . Compared with nonresponders , subjects achieving a ≥30 % reduction in ICSI were more likely to be pleased with PPS for IC symptoms , to have benefited from PPS for their IC symptoms , to recommend PPS for IC symptoms to others with the same condition , and to say that PPS provides better relief , based on prior experience with other IC treatments . Among all subjects at week 32 , 75 % said they would recommend PPS therapy for IC symptoms to others with the condition . Conclusion : Despite limitations ( lack of placebo control , use of a nonvali date d instrument ) , this analysis demonstrated significantly increased treatment satisfaction with PPS therapy among treatment responders versus nonresponders . There was a significant positive correlation between ICSI scores and response on the treatment satisfaction question naire . Treatment response and patient satisfaction with treatment are important clinical considerations in the management of patients with IC PURPOSE Cyclosporine is a widely used immunosuppressive drug in organ transplantation and recently it has been used in several autoimmune disorders with good results . Because interstitial cystitis may have an autoimmune etiology , we wished to determine whether cyclosporine has any effect on symptoms in patients with severe interstitial cystitis . MATERIAL S AND METHODS A total of 11 patients , who fulfilled the criteria for interstitial cystitis according to an international accrual form , received cyclosporine for 3 to 6 months at an initial dose of 2.5 to 5 mg./kg . daily and a maintenance dose of 1.5 to 3 mg./kg . daily .  Blood pressure , serum creatinine and cyclosporine concentrations were monitored regularly . The patients completed frequency-volume charts at 2-week intervals . RESULTS The frequency-volume charts showed favorable effects . Micturition frequency decreased ( p<0.01 ) , and mean and maximum voided volumes increased significantly ( p<0.001 and p<0.01 , respectively ) . Bladder pain decreased or disappeared in 10 patients , allowing for storage of large urine volumes . Serum creatinine did not change with the dosages used . Mild hypertension occurred in 2 patients and resolved after the cyclosporine dose was lowered . After cessation of treatment symptoms recurred in the majority of patients . CONCLUSIONS The findings revive the concept of interstitial cystitis as an autoimmune disease INTRODUCTION AND AIM We report the 2-year efficacy and tolerability of intravesical botulinum A toxin ( BoNT/A ) injections in patients with painful bladder syndrome ( PBS ) associated with increased urinary frequency refractory to conventional treatments . MATERIAL S AND METHODS Thirteen women were prospect ively included in the study . The preliminary assessment included voiding diary , urodynamics , urinary tract ultrasound and the visual analog scale ( VAS ) for pain quantification . All patients received multiple injections of 200 U commercially available BoNT/A diluted in 20 ml 0.9 % NaCl , under cystoscopic guidance .  Clinical evaluation , urodynamics , urinary tract ultrasound and VAS were repeated at least two times per year throughout the follow-up . RESULTS A total of 58 injections were administered with a mean of 4.8 + /- 0.8 injections per patient . The mean interval between two consecutive injections was 5.25 + /- 0.75 months . At 1 and 4 mo follow up ten patients reported a subjective improvement . Mean VAS scores , mean daytime and night-time urinary frequency decreased significantly . Nine patients at 1 month and seven at the 4-month check-up complained of dysuria . The three non-responders to the first intravesical treatment session underwent another three months later with satisfactory results . At 1 and 2 years follow up the beneficial effects persisted in all patients . We did not observe any systemic side effects during the observation time . CONCLUSIONS Intravesically injected BoNT/A is effective and safe in the medium-term management of patients with PBS . As the beneficial effect decreased progressively within a few months after treatment , repeat injections of the neurotoxin were needed over time OBJECTIVES To present clinical evidence with botulinum toxin A ( BTX-A ) suggesting an antinociceptive role in patients with interstitial cystitis ( IC ) . Intriguing evidence in a somatic pain model has suggested that BTX-A injection may have an antinociceptive effect on both acute and chronic ( inflammatory ) pain . METHODS Thirteen female patients ( 6 in the United States and 7 in Pol and ) with IC according to the criteria of the National Institute of Diabetes , Digestive and Kidney Disease were included . Under short general anesthesia or sedation , 100 to 200 U of Dysport ( Polish patients ) or Botox ( U.S. patients ) was injected through a cystoscope into 20 to 30 sites submucosally in the trigone and floor of the bladder . Patients were evaluated with the O'Leary-Sant vali date d IC question naire or with voiding charts and a visual analog pain scale 1 month postoperatively and at subsequent 3-month intervals . The Polish patients also underwent pretreatment and post-treatment urodynamic evaluations . RESULTS Overall , 9 ( 69 % ) of 13 patients noted subjective improvement after BTX-A treatment . The Interstitial Cystitis Symptom Index and Interstitial Cystitis Problem Index mean scores improved by 71 % and 69 % , respectively ( P < 0.05 ) . Daytime frequency , nocturia , and pain by visual analog scale decreased by 44 % , 45 % , and 79 % , respectively ( P < 0.01 ) . The first desire to void and maximal cystometric capacity increased by 58 % and 57 % , respectively ( P < 0.01 ) . CONCLUSIONS Our results suggest that BTX-A has an antinociceptive effect on bladder afferent pathways in patients with IC , producing both symptomatic and functional ( ie , urodynamic ) improvements PURPOSE This pilot study was design ed to evaluate the feasibility of a multicenter , r and om 
    Output:
    
agent
Meta- analysis of RCTs showed that only cyclosporine A provided a simultaneous great effect size of SMD on ICSI , pain , and frequency .
Amitriptyline at different dosages showed a great effect size of SMD on pain and urgency or on ICSI and frequency .
The results from the n RCTs showed that the most frequently adopted treatment is oral pentosan polysulfate and that the use of botulinum A toxin intradetrusorial injections in PBS/IC is increasing .
Limited evidence exists for the few treatments for PBS/IC .
The lack of definitive conclusions is due to the great heterogeneity in methodology , symptoms assessment , duration of treatment , and follow-up in both RCTs and n RCTs
***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 To establish the efficacy of a multidrug oral treatment with the tricyclic antidepressant agent doxepin and the cyclooxygenase ( COX ) inhibitor piroxicam in patients with interstitial cystitis ( IC ) , who had failed st and ard therapy in an open , prospect i ve , nonr and omized study . METHODS A total of 37 patients diagnosed with IC received 75 mg doxepin and 40 mg piroxicam daily . The treatment was termed DOXCAM .  Effectiveness of therapy was assessed with frequency-volume charts , an IC symptom score and with cystometry prior to treatment , 8 weeks after the start and 4 weeks after termination of drug treatment . RESULTS Medication was not tolerated by five patients . Twenty-six of 32 patients have experienced virtual total remission of symptoms ( 81 % ) and six patients had significant relief ( 19 % ) . DOXCAM treatment result ed in a significant percent decrease in pain ( 65 % versus 21 % ) . Daytime frequency decreased from 17.6+/-5.7 to 11.3+/-3.6 voids while nocturia did not improve significantly . Twenty-three of the 26 patients who became symptom free and four of the six patients who showed significant improvement had a return of symptoms after cessation of therapy . CONCLUSION It is reasonable to consider oral treatment with DOXCAM in those patients who have failed first-line therapies PURPOSE In a previous retrospective analysis , cyclosporine A ( CyA ) was highly efficient in treating patients with interstitial cystitis . A prospect i ve r and omized study with this immunosuppressive agent was warranted . We compared CyA to pentosan polysulfate sodium ( PPS ) in patients with interstitial cystitis . MATERIAL S AND METHODS A total of 64 patients with interstitial cystitis meeting the National Institute of Diabetes and Digestive and Kidney Diseases criteria were enrolled in a r and omized prospect i ve study . Patients were r and omized in a 1:1 ratio to 1.5 mg/kg CyA twice daily ( 27 women , 5 men ) or 100 mg PPS 3 times daily ( 26 women , 6 men ) for a period of 6 months . The primary end point was daily micturition frequency , and secondary end points were mean and maximal voided volume , number of nocturia episodes , O'Leary-Sant symptom and problem indexes , visual analogue scale for pain , and subjective global response assessment . RESULTS CyA was superior to PPS in all clinical outcome parameters measured at 6 months . Micturition frequency in 24 hours was significantly reduced in the CyA arm compared to the PPS arm ( -6.7 + /- 4.7 vs -2.0 + /- 5.1 times ) . The clinical response rate ( according to global response assessment ) was 75 % for CyA compared to 19 % for PPS ( p < 0.001 ) . Although there were more adverse events in the CyA arm than in the PPS arm , 29 patients completed the 6-month followup in both groups . CONCLUSIONS CyA is more effective than PPS in interstitial cystitis Interstitial cystitis ( IC ) is a disorder of the urinary bladder characterized by urgency , frequency , nocturia and suprapubic pain . IC occurs primarily in women and symptoms are exacerbated by stress , ovulatory hormones and certain foods . IC pathogenesis is unknown , but the most consistent findings involve some dysfunction of the bladder glycosaminoglycan ( GAG ) protective layer and a high number of activated bladder mast cells . There is no effective therapy even through intravesical administration of dimethylsulfoxide ( DMSO ) or oral pentosanpolysulfate ( PPS ) have had variable success . A dietary supplement , CystoProtek ® , was formulated with the natural GAG components chondroitin sulfate and sodium hyaluronate to provide urothelial cytoprotection , together with the flavonoid quercetin that has anti-inflammatory properties and inhibits activation of mast cells . Thirty-seven female patients diagnosed by the NIDDK criteria who had failed all forms of therapy  took six softgel CystoProtek ® capsules per day for 6 months . Global assessment scale was reduced from 9.0 ± 2.9 to 4.3 ± 2.1 ( p < 0.05 ) ; moreover , the O'Leary/Sant Symptom Index decreased from 16.3 ± 3.1 to 6.9 ± 4.2 ( p < 0.05 ) and the Problem Index from 13.1 ± 3.7 to 5.4 ± 4.0 ( p < 0.05 ) . These results are very promising and warrant a larger study that may permit further analyses with respect to other , especially atopic , comorbid diseases PURPOSE Interstitial cystitis ( IC ) is a disorder of unknown etiology with few effective therapies . Oral bioflavonoid therapy utilizing quercetin recently proved to be clinical ly effective in men with chronic pelvic pain syndrome , a disorder with similarities to IC . We therefore tested in an open-label trial a quercetin-based supplement in patients with clinical ly proven IC . MATERIAL S AND METHODS Twenty-two patients ( 5 men and 17 women ; average age 53.1 years ) with classically documented IC received  one capsule of Cysta-Q complex ( equivalent to 500 mg of quercetin ) twice a day for 4 weeks . Symptoms were assessed before and after therapy by the IC problem and symptom indices as well as by global assessment of pain ( range 0 - 10 ) . RESULTS Two patients did not complete the study . In the remaining 20 patients , improvement was seen in all three parameters tested . After 4 weeks of treatment , the mean ( + /- SEM ) problem index improved from 11.3 + /- 0.6 to 5.1 + /- 0.7 ( p = .000001 ) , the mean symptom index improved from 11.9 + /- 0.9 to 4.5 + /- 0.5 ( p = .000001 ) , and the mean global assessment score improved from 8.2 + /- 0.4 to 3.5 + /- 0.4 ( p = .000001 ) . None of the patients experienced any negative side effects , and all but one patient had at least some improvement in every outcome measure . CONCLUSION Oral therapy with the quercetin supplement Cysta-Q was well tolerated and provided significant symptomatic improvement in patients with IC . Larger , r and omized , placebo-controlled trials appear warranted based on these preliminary open-label results ABSTRACT Objective : To evaluate the relationship between symptom reduction and satisfaction with pentosan polysulfate sodium ( PPS ) therapy in subjects with interstitial cystitis ( IC ) . Methods : A secondary analysis was conducted in 128 subjects treated with PPS 300 mg/day ( US Food and Drug Administration-approved dose ) from a 32-week multicenter , r and omized , double-blind study of 380 subjects with IC who were treated with PPS 300 mg/day , 600 mg/day , or 900 mg/day .  Self-rated outcome measures included the O'Leary-Sant Interstitial Cystitis Symptom Index ( ICSI ) and a treatment satisfaction question naire . Treatment responders were defined as subjects having ≥30 % reduction in ICSI from baseline to study end point . Results : A reduction in IC symptoms was associated with significantly higher satisfaction with PPS ( p < 0.05 ) . Compared with nonresponders , subjects achieving a ≥30 % reduction in ICSI were more likely to be pleased with PPS for IC symptoms , to have benefited from PPS for their IC symptoms , to recommend PPS for IC symptoms to others with the same condition , and to say that PPS provides better relief , based on prior experience with other IC treatments . Among all subjects at week 32 , 75 % said they would recommend PPS therapy for IC symptoms to others with the condition . Conclusion : Despite limitations ( lack of placebo control , use of a nonvali date d instrument ) , this analysis demonstrated significantly increased treatment satisfaction with PPS therapy among treatment responders versus nonresponders . There was a significant positive correlation between ICSI scores and response on the treatment satisfaction question naire . Treatment response and patient satisfaction with treatment are important clinical considerations in the management of patients with IC PURPOSE Cyclosporine is a widely used immunosuppressive drug in organ transplantation and recently it has been used in several autoimmune disorders with good results . Because interstitial cystitis may have an autoimmune etiology , we wished to determine whether cyclosporine has any effect on symptoms in patients with severe interstitial cystitis . MATERIAL S AND METHODS A total of 11 patients , who fulfilled the criteria for interstitial cystitis according to an international accrual form , received cyclosporine for 3 to 6 months at an initial dose of 2.5 to 5 mg./kg . daily and a maintenance dose of 1.5 to 3 mg./kg . daily .  Blood pressure , serum creatinine and cyclosporine concentrations were monitored regularly . The patients completed frequency-volume charts at 2-week intervals . RESULTS The frequency-volume charts showed favorable effects . Micturition frequency decreased ( p<0.01 ) , and mean and maximum voided volumes increased significantly ( p<0.001 and p<0.01 , respectively ) . Bladder pain decreased or disappeared in 10 patients , allowing for storage of large urine volumes . Serum creatinine did not change with the dosages used . Mild hypertension occurred in 2 patients and resolved after the cyclosporine dose was lowered . After cessation of treatment symptoms recurred in the majority of patients . CONCLUSIONS The findings revive the concept of interstitial cystitis as an autoimmune disease INTRODUCTION AND AIM We report the 2-year efficacy and tolerability of intravesical botulinum A toxin ( BoNT/A ) injections in patients with painful bladder syndrome ( PBS ) associated with increased urinary frequency refractory to conventional treatments . MATERIAL S AND METHODS Thirteen women were prospect ively included in the study . The preliminary assessment included voiding diary , urodynamics , urinary tract ultrasound and the visual analog scale ( VAS ) for pain quantification . All patients received multiple injections of 200 U commercially available BoNT/A diluted in 20 ml 0.9 % NaCl , under cystoscopic guidance .  Clinical evaluation , urodynamics , urinary tract ultrasound and VAS were repeated at least two times per year throughout the follow-up . RESULTS A total of 58 injections were administered with a mean of 4.8 + /- 0.8 injections per patient . The mean interval between two consecutive injections was 5.25 + /- 0.75 months . At 1 and 4 mo follow up ten patients reported a subjective improvement . Mean VAS scores , mean daytime and night-time urinary frequency decreased significantly . Nine patients at 1 month and seven at the 4-month check-up complained of dysuria . The three non-responders to the first intravesical treatment session underwent another three months later with satisfactory results . At 1 and 2 years follow up the beneficial effects persisted in all patients . We did not observe any systemic side effects during the observation time . CONCLUSIONS Intravesically injected BoNT/A is effective and safe in the medium-term management of patients with PBS . As the beneficial effect decreased progressively within a few months after treatment , repeat injections of the neurotoxin were needed over time OBJECTIVES To present clinical evidence with botulinum toxin A ( BTX-A ) suggesting an antinociceptive role in patients with interstitial cystitis ( IC ) . Intriguing evidence in a somatic pain model has suggested that BTX-A injection may have an antinociceptive effect on both acute and chronic ( inflammatory ) pain . METHODS Thirteen female patients ( 6 in the United States and 7 in Pol and ) with IC according to the criteria of the National Institute of Diabetes , Digestive and Kidney Disease were included . Under short general anesthesia or sedation , 100 to 200 U of Dysport ( Polish patients ) or Botox ( U.S. patients ) was injected through a cystoscope into 20 to 30 sites submucosally in the trigone and floor of the bladder . Patients were evaluated with the O'Leary-Sant vali date d IC question naire or with voiding charts and a visual analog pain scale 1 month postoperatively and at subsequent 3-month intervals . The Polish patients also underwent pretreatment and post-treatment urodynamic evaluations . RESULTS Overall , 9 ( 69 % ) of 13 patients noted subjective improvement after BTX-A treatment . The Interstitial Cystitis Symptom Index and Interstitial Cystitis Problem Index mean scores improved by 71 % and 69 % , respectively ( P < 0.05 ) . Daytime frequency , nocturia , and pain by visual analog scale decreased by 44 % , 45 % , and 79 % , respectively ( P < 0.01 ) . The first desire to void and maximal cystometric capacity increased by 58 % and 57 % , respectively ( P < 0.01 ) . CONCLUSIONS Our results suggest that BTX-A has an antinociceptive effect on bladder afferent pathways in patients with IC , producing both symptomatic and functional ( ie , urodynamic ) improvements PURPOSE This pilot study was design ed to evaluate the feasibility of a multicenter , r and om 
    Output:
    