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: The efficacy of nortriptyline in the treatment of post-stroke depression was assessed by a double-blind study in thirty-four patients . Half of the patients had major depression .  There was a significantly greater improvement in depression in patients treated with  nortriptyline  than in a similar group of placebo-treated patients . Depression was measured by the Hamilton depression scale , Zung depression scale , present state examination , and an overall depression scale . Successfully treated patients had serum nortriptyline levels in the therapeutic range . Post-stroke depressions are common , severe , and longst and ing , and the demonstrated efficacy of nortriptyline provides an important addition to the treatments available for stroke patients BACKGROUND Adverse drug reactions are important determinants of non-adherence to antidepressant treatment , but their assessment is complicated by overlap with depressive symptoms and lack of reliable self-report measures . AIMS To evaluate a simple self-report measure and describe adverse reactions to antidepressants in a large sample . METHOD The newly developed self-report Antidepressant Side-Effect Checklist and the psychiatrist-rated UKU Side Effect Rating Scale were repeatedly administered to 811 adult participants with depression in a part-r and omised multicentre open-label study comparing escitalopram and nortriptyline .  RESULTS There was good agreement between self-report and psychiatrists ' ratings . Most complaints listed as adverse reactions in people with depression were more common when they were medication-free rather than during their treatment with antidepressants . Dry mouth ( 74 % ) , constipation ( 33 % ) and weight gain ( 15 % ) were associated with nortriptyline treatment . Diarrhoea ( 9 % ) , insomnia ( 36 % ) and yawning ( 16 % ) were more common during treatment with escitalopram .  Problems with urination and drowsiness predicted discontinuation of nortriptyline .  Diarrhoea and decreased appetite predicted discontinuation of escitalopram . CONCLUSIONS Adverse reactions to antidepressants can be reliably assessed by self-report . Attention to specific adverse reactions may improve adherence to antidepressant treatment The number of published systematic review s of studies of healthcare interventions has increased rapidly and these are used extensively for clinical and policy decisions . Systematic review s are subject to a range of biases and increasingly include non-r and omised studies of interventions . It is important that users can distinguish high quality review s. Many instruments have been design ed to evaluate different aspects of review s , but there are few comprehensive critical appraisal instruments . AMSTAR was developed to evaluate systematic review s of r and omised trials . In this paper , we report on the updating of AMSTAR and its adaptation to enable more detailed assessment of systematic review s that include r and omised or non-r and omised studies of healthcare interventions , or both . With moves to base more decisions on real world observational evidence we believe that AMSTAR 2 will assist decision makers in the identification of high quality systematic review s , including those based on non-r and omised studies of healthcare interventions BACKGROUND Antidepressants are commonly prescribed medications , but their effect on cardiovascular morbidity and mortality remains unclear . METHODS Prospect i ve cohort study of 136 293 community-dwelling postmenopausal women in the Women 's Health Initiative ( WHI ) . Women taking no antidepressants at study entry and who had at least 1 follow-up visit were included . Cardiovascular morbidity and all-cause mortality for women with new antidepressant use at follow-up ( n = 5496 ) were compared with those characteristics for women taking no antidepressants at follow-up ( mean follow-up , 5.9 years ) . RESULTS Antidepressant use was not associated with coronary heart disease ( CHD ) .  Selective serotonin reuptake inhibitor ( SSRI ) use was associated with increased stroke risk ( hazard ratio [HR],1.45 , [ 95 % CI , 1.08 - 1.97 ] ) and all-cause mortality ( HR,1.32 [ 95 % CI , 1.10 - 1.59 ] ) . Annualized rates per 1000 person-years of stroke with no antidepressant use and SSRI use were 2.99 and 4.16 , respectively , and death rates were 7.79 and 12.77 . Tricyclic antidepressant ( TCA ) use was associated with increased risk of all-cause mortality ( HR,1.67 [ 95 % CI , 1.33 - 2.09 ] ; annualized rate , 14.14 deaths per 1000 person-years ) . There were no significant differences between SSRI and TCA use in risk of any outcomes . In analyses by stroke type , SSRI use was associated with incident hemorrhagic stroke ( HR , 2.12 [ 95 % CI , 1.10 - 4.07 ] ) and fatal stroke ( HR , 2.10 [ 95 % CI , 1.15 - 3.81 ] ) . CONCLUSIONS In postmenopausal women , there were no significant differences between SSRI and TCA use in risk of CHD , stroke , or mortality . Antidepressants were not associated with risk of CHD .  Tricyclic antidepressants and SSRIs may be associated with increased risk of mortality , and SSRIs with increased risk of hemorrhagic and fatal stroke , although absolute event risks are low . These findings must be weighed against quality of life and established risks of cardiovascular disease and mortality associated with untreated depression Background Stroke is one of the most common causes of cognitive impairment . Up to 75 % of stroke survivors may be considered to have cognitive impairment , which severely limit individual autonomy for successful reintegration into family , work and social life . The clinical efficacy of acupuncture with Baihui ( DU20 ) and Shenting ( DU24 ) in stroke and post-stroke cognitive impairment has been previously demonstrated . Computer-assisted cognitive training is part of conventional cognitive rehabilitation and has also shown to be effective in improvement of cognitive function of affected patients . However , the cognitive impairment after stroke is so complexity that one single treatment can not resolve effectively . Besides , the effects of acupuncture and RehaCom cognitive training have not been systematic ally compared , nor has the possibility of a synergistic effect of combination of the two therapeutic modalities been evaluated . Our primary aim of this trial is to evaluate the synergistic effect of acupuncture and RehaCom cognitive training  on cognitive dysfunction after stroke . Method / Design A r and omized controlled trial of 2 × 2 factorial design will be conducted in the Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine . A total of 240 patients with cognitive dysfunction after stroke who meet the eligibility criteria will be recruited and r and omized into RehaCom training group , acupuncture group , a combination of both or control group in a 1:1:1:1 ratio . All patients will receive conventional treatment . The interventions will last for 12 weeks ( 30 min per day , Monday to Friday every week ) . Evaluations will be conducted by blinded assessors at baseline and again at 4 , 8 and 12 weeks . Outcome measurements include mini – mental state examination ( MMSE ) , Montreal cognitive assessment s ( MoCA ) , functional independence measure scale ( FIM ) and adverse events . Discussion The results of this trial are expected to clarify the synergistic effect of acupuncture and RehaCom cognitive training on cognitive dysfunction after stroke . Furthermore , to confirm whether combined or alone of acupuncture and RehaCom cognitive training , is more effective than conventional treatment in the management of post-stroke cognitive dysfunction . Trial registration Chinese Clinical Trial Registry : ChiCTR-TRC-13003704 . Registration date : 4 September , 2013 BACKGROUND Hemiplegia and hemiparesis are the most common deficits caused by stroke . A few small clinical trials suggest that fluoxetine enhances motor recovery but its clinical efficacy is unknown . We therefore aim ed to investigate whether fluoxetine would enhance motor recovery if given soon after an ischaemic stroke to patients who have motor deficits . METHODS In this double-blind , placebo-controlled trial , patients from nine stroke centres in France who had ischaemic stroke and hemiplegia or hemiparesis , had Fugl-Meyer motor scale ( FMMS ) scores of 55 or less , and were aged between 18 years and 85 years were eligible for inclusion . Patients were r and omly assigned , using a computer r and om-number generator , in a 1:1 ratio to fluoxetine ( 20 mg once per day , orally ) or placebo for 3 months starting 5 - 10 days after the onset of stroke . All patients had physiotherapy . The primary outcome measure was the change on the FMMS between day 0 and day 90 after the start of the study drug . Participants , carers , and physicians assessing the outcome were masked to group assignment . Analysis was of all patients for whom data were available ( full analysis set ) . This trial is registered with Clinical Trials.gov , number NCT00657163 . FINDINGS 118 patients were r and omly assigned to fluoxetine ( n=59 ) or placebo ( n=59 ) , and 113 were included in the analysis ( 57 in the fluoxetine group and 56 in the placebo group ) . Two patients died before day 90 and three withdrew from the study . FMMS improvement at day 90 was significantly greater in the fluoxetine group ( adjusted mean 34·0 points [ 95 % CI 29·7 - 38·4 ] ) than in the placebo group ( 24·3 points [ 19·9 - 28·7 ] ; p=0·003 ) . The main adverse events in the fluoxetine and placebo groups were hyponatraemia ( two [ 4 % ] vs two [ 4 % ] ) , transient digestive disorders including nausea , diarrhoea , and abdominal pain ( 14 [ 25 % ] vs six [ 11 % ] ) , hepatic enzyme disorders ( five [ 9 % ] vs ten [ 18 % ] ) , psychiatric disorders ( three [ 5 % ] vs four [ 7 % ] ) , insomnia ( 19 [ 33 % ] vs 20 [ 36 % ] ) , and partial seizure ( one [ < 1 % ] vs 0 ) . INTERPRETATION In patients with ischaemic stroke and moderate to severe motor deficit , the early prescription of fluoxetine with physiotherapy enhanced motor recovery after 3 months . Modulation of spontaneous brain plasticity by drugs is a promising pathway for treatment of patients with ischaemic stroke and moderate to severe motor deficit . FUNDING Public French National Programme for Clinical Research Objective : Post-stroke depression ( PSD ) is common and has a negative impact on recovery . Although many stroke patients in Taiwan have used acupuncture as a supplementary treatment for reducing stroke comorbidities , little research has been done on the use of acupuncture to prevent PSD . Accordingly , our goal is to investigate whether using acupuncture after a stroke can reduce the risk of PSD . Method : This population -based cohort study examined medical cl aims data from a r and om sample of 1 million insured people registered in Taiwan . Newly diagnosed stroke patients in the period 2000–2005 were recruited in our study . All patients were followed through to the end of 2007 to determine whether they had developed symptoms of depression . A Cox proportional hazard model was used to estimate the relative risk of depression in patients after being diagnosed as having had a stroke , with a focus on the differences in those with and without acupuncture treatment . Results : A total of 8487 newly-diagnosed stroke patients were included in our study ; of these , 1036 patients received acupuncture more than five times following their stroke , 1053 patients  received acupuncture 1–5 times following their stroke and 6398 did not receive acupuncture . After we controlled for potential confounders ( e.g. , age , sex , insurance premium , residential area , type of stroke , length of hospital stay , stroke severity index , rehabilitation and major illness – related depression ) , we found that acupuncture after stroke significantly reduced the risk of depression , with a hazard ratio ( HR ) of 0.475 ( 95 % CI , 0.389–0.580 ) in frequent acupuncture users and 0.718 ( 95 % CI , 0.612–0.842 ) in infrequent acupuncture users , indicating that acupuncture may lower the risk of PSD by an estimated 52.5 % in frequent users and 28.2 % in infrequent users . Conclusions : After we controlled for potential confounders , it appears that using acupuncture after a stroke lowers the risk of depression . Additional strictly- design ed r and omized controlled trials are needed to better underst and the specific mechanisms relating acupuncture to health outcomes Background and Purpose The aim of the study was to investigate the efficacy and safety of the selective serotonin reuptake inhibitor citalopram in treating poststroke depression , since available treatments are usually poorly tolerated . Methods A 6-week double-blind , placebo-controlled trial was undertaken . Diagnosis and outcome were determined using the Hamilton Depression Scale , and unwanted effects were measured using the UKU side effect rating scale .  Sixtysix consecutive depressed patients from an unselected population of 285 stroke patients aged 25 to 80 years entered the trial 2 to 52 weeks after stroke . They were assigned to equally sized treatment and placebo groups . The initial level of depression was comparable in the two groups ( mean baseline Hamilton Depression scores 
    Output:
    
agent
***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: The efficacy of nortriptyline in the treatment of post-stroke depression was assessed by a double-blind study in thirty-four patients . Half of the patients had major depression .  There was a significantly greater improvement in depression in patients treated with  nortriptyline  than in a similar group of placebo-treated patients . Depression was measured by the Hamilton depression scale , Zung depression scale , present state examination , and an overall depression scale . Successfully treated patients had serum nortriptyline levels in the therapeutic range . Post-stroke depressions are common , severe , and longst and ing , and the demonstrated efficacy of nortriptyline provides an important addition to the treatments available for stroke patients BACKGROUND Adverse drug reactions are important determinants of non-adherence to antidepressant treatment , but their assessment is complicated by overlap with depressive symptoms and lack of reliable self-report measures . AIMS To evaluate a simple self-report measure and describe adverse reactions to antidepressants in a large sample . METHOD The newly developed self-report Antidepressant Side-Effect Checklist and the psychiatrist-rated UKU Side Effect Rating Scale were repeatedly administered to 811 adult participants with depression in a part-r and omised multicentre open-label study comparing escitalopram and nortriptyline .  RESULTS There was good agreement between self-report and psychiatrists ' ratings . Most complaints listed as adverse reactions in people with depression were more common when they were medication-free rather than during their treatment with antidepressants . Dry mouth ( 74 % ) , constipation ( 33 % ) and weight gain ( 15 % ) were associated with nortriptyline treatment . Diarrhoea ( 9 % ) , insomnia ( 36 % ) and yawning ( 16 % ) were more common during treatment with escitalopram .  Problems with urination and drowsiness predicted discontinuation of nortriptyline .  Diarrhoea and decreased appetite predicted discontinuation of escitalopram . CONCLUSIONS Adverse reactions to antidepressants can be reliably assessed by self-report . Attention to specific adverse reactions may improve adherence to antidepressant treatment The number of published systematic review s of studies of healthcare interventions has increased rapidly and these are used extensively for clinical and policy decisions . Systematic review s are subject to a range of biases and increasingly include non-r and omised studies of interventions . It is important that users can distinguish high quality review s. Many instruments have been design ed to evaluate different aspects of review s , but there are few comprehensive critical appraisal instruments . AMSTAR was developed to evaluate systematic review s of r and omised trials . In this paper , we report on the updating of AMSTAR and its adaptation to enable more detailed assessment of systematic review s that include r and omised or non-r and omised studies of healthcare interventions , or both . With moves to base more decisions on real world observational evidence we believe that AMSTAR 2 will assist decision makers in the identification of high quality systematic review s , including those based on non-r and omised studies of healthcare interventions BACKGROUND Antidepressants are commonly prescribed medications , but their effect on cardiovascular morbidity and mortality remains unclear . METHODS Prospect i ve cohort study of 136 293 community-dwelling postmenopausal women in the Women 's Health Initiative ( WHI ) . Women taking no antidepressants at study entry and who had at least 1 follow-up visit were included . Cardiovascular morbidity and all-cause mortality for women with new antidepressant use at follow-up ( n = 5496 ) were compared with those characteristics for women taking no antidepressants at follow-up ( mean follow-up , 5.9 years ) . RESULTS Antidepressant use was not associated with coronary heart disease ( CHD ) .  Selective serotonin reuptake inhibitor ( SSRI ) use was associated with increased stroke risk ( hazard ratio [HR],1.45 , [ 95 % CI , 1.08 - 1.97 ] ) and all-cause mortality ( HR,1.32 [ 95 % CI , 1.10 - 1.59 ] ) . Annualized rates per 1000 person-years of stroke with no antidepressant use and SSRI use were 2.99 and 4.16 , respectively , and death rates were 7.79 and 12.77 . Tricyclic antidepressant ( TCA ) use was associated with increased risk of all-cause mortality ( HR,1.67 [ 95 % CI , 1.33 - 2.09 ] ; annualized rate , 14.14 deaths per 1000 person-years ) . There were no significant differences between SSRI and TCA use in risk of any outcomes . In analyses by stroke type , SSRI use was associated with incident hemorrhagic stroke ( HR , 2.12 [ 95 % CI , 1.10 - 4.07 ] ) and fatal stroke ( HR , 2.10 [ 95 % CI , 1.15 - 3.81 ] ) . CONCLUSIONS In postmenopausal women , there were no significant differences between SSRI and TCA use in risk of CHD , stroke , or mortality . Antidepressants were not associated with risk of CHD .  Tricyclic antidepressants and SSRIs may be associated with increased risk of mortality , and SSRIs with increased risk of hemorrhagic and fatal stroke , although absolute event risks are low . These findings must be weighed against quality of life and established risks of cardiovascular disease and mortality associated with untreated depression Background Stroke is one of the most common causes of cognitive impairment . Up to 75 % of stroke survivors may be considered to have cognitive impairment , which severely limit individual autonomy for successful reintegration into family , work and social life . The clinical efficacy of acupuncture with Baihui ( DU20 ) and Shenting ( DU24 ) in stroke and post-stroke cognitive impairment has been previously demonstrated . Computer-assisted cognitive training is part of conventional cognitive rehabilitation and has also shown to be effective in improvement of cognitive function of affected patients . However , the cognitive impairment after stroke is so complexity that one single treatment can not resolve effectively . Besides , the effects of acupuncture and RehaCom cognitive training have not been systematic ally compared , nor has the possibility of a synergistic effect of combination of the two therapeutic modalities been evaluated . Our primary aim of this trial is to evaluate the synergistic effect of acupuncture and RehaCom cognitive training  on cognitive dysfunction after stroke . Method / Design A r and omized controlled trial of 2 × 2 factorial design will be conducted in the Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine . A total of 240 patients with cognitive dysfunction after stroke who meet the eligibility criteria will be recruited and r and omized into RehaCom training group , acupuncture group , a combination of both or control group in a 1:1:1:1 ratio . All patients will receive conventional treatment . The interventions will last for 12 weeks ( 30 min per day , Monday to Friday every week ) . Evaluations will be conducted by blinded assessors at baseline and again at 4 , 8 and 12 weeks . Outcome measurements include mini – mental state examination ( MMSE ) , Montreal cognitive assessment s ( MoCA ) , functional independence measure scale ( FIM ) and adverse events . Discussion The results of this trial are expected to clarify the synergistic effect of acupuncture and RehaCom cognitive training on cognitive dysfunction after stroke . Furthermore , to confirm whether combined or alone of acupuncture and RehaCom cognitive training , is more effective than conventional treatment in the management of post-stroke cognitive dysfunction . Trial registration Chinese Clinical Trial Registry : ChiCTR-TRC-13003704 . Registration date : 4 September , 2013 BACKGROUND Hemiplegia and hemiparesis are the most common deficits caused by stroke . A few small clinical trials suggest that fluoxetine enhances motor recovery but its clinical efficacy is unknown . We therefore aim ed to investigate whether fluoxetine would enhance motor recovery if given soon after an ischaemic stroke to patients who have motor deficits . METHODS In this double-blind , placebo-controlled trial , patients from nine stroke centres in France who had ischaemic stroke and hemiplegia or hemiparesis , had Fugl-Meyer motor scale ( FMMS ) scores of 55 or less , and were aged between 18 years and 85 years were eligible for inclusion . Patients were r and omly assigned , using a computer r and om-number generator , in a 1:1 ratio to fluoxetine ( 20 mg once per day , orally ) or placebo for 3 months starting 5 - 10 days after the onset of stroke . All patients had physiotherapy . The primary outcome measure was the change on the FMMS between day 0 and day 90 after the start of the study drug . Participants , carers , and physicians assessing the outcome were masked to group assignment . Analysis was of all patients for whom data were available ( full analysis set ) . This trial is registered with Clinical Trials.gov , number NCT00657163 . FINDINGS 118 patients were r and omly assigned to fluoxetine ( n=59 ) or placebo ( n=59 ) , and 113 were included in the analysis ( 57 in the fluoxetine group and 56 in the placebo group ) . Two patients died before day 90 and three withdrew from the study . FMMS improvement at day 90 was significantly greater in the fluoxetine group ( adjusted mean 34·0 points [ 95 % CI 29·7 - 38·4 ] ) than in the placebo group ( 24·3 points [ 19·9 - 28·7 ] ; p=0·003 ) . The main adverse events in the fluoxetine and placebo groups were hyponatraemia ( two [ 4 % ] vs two [ 4 % ] ) , transient digestive disorders including nausea , diarrhoea , and abdominal pain ( 14 [ 25 % ] vs six [ 11 % ] ) , hepatic enzyme disorders ( five [ 9 % ] vs ten [ 18 % ] ) , psychiatric disorders ( three [ 5 % ] vs four [ 7 % ] ) , insomnia ( 19 [ 33 % ] vs 20 [ 36 % ] ) , and partial seizure ( one [ < 1 % ] vs 0 ) . INTERPRETATION In patients with ischaemic stroke and moderate to severe motor deficit , the early prescription of fluoxetine with physiotherapy enhanced motor recovery after 3 months . Modulation of spontaneous brain plasticity by drugs is a promising pathway for treatment of patients with ischaemic stroke and moderate to severe motor deficit . FUNDING Public French National Programme for Clinical Research Objective : Post-stroke depression ( PSD ) is common and has a negative impact on recovery . Although many stroke patients in Taiwan have used acupuncture as a supplementary treatment for reducing stroke comorbidities , little research has been done on the use of acupuncture to prevent PSD . Accordingly , our goal is to investigate whether using acupuncture after a stroke can reduce the risk of PSD . Method : This population -based cohort study examined medical cl aims data from a r and om sample of 1 million insured people registered in Taiwan . Newly diagnosed stroke patients in the period 2000–2005 were recruited in our study . All patients were followed through to the end of 2007 to determine whether they had developed symptoms of depression . A Cox proportional hazard model was used to estimate the relative risk of depression in patients after being diagnosed as having had a stroke , with a focus on the differences in those with and without acupuncture treatment . Results : A total of 8487 newly-diagnosed stroke patients were included in our study ; of these , 1036 patients received acupuncture more than five times following their stroke , 1053 patients  received acupuncture 1–5 times following their stroke and 6398 did not receive acupuncture . After we controlled for potential confounders ( e.g. , age , sex , insurance premium , residential area , type of stroke , length of hospital stay , stroke severity index , rehabilitation and major illness – related depression ) , we found that acupuncture after stroke significantly reduced the risk of depression , with a hazard ratio ( HR ) of 0.475 ( 95 % CI , 0.389–0.580 ) in frequent acupuncture users and 0.718 ( 95 % CI , 0.612–0.842 ) in infrequent acupuncture users , indicating that acupuncture may lower the risk of PSD by an estimated 52.5 % in frequent users and 28.2 % in infrequent users . Conclusions : After we controlled for potential confounders , it appears that using acupuncture after a stroke lowers the risk of depression . Additional strictly- design ed r and omized controlled trials are needed to better underst and the specific mechanisms relating acupuncture to health outcomes Background and Purpose The aim of the study was to investigate the efficacy and safety of the selective serotonin reuptake inhibitor citalopram in treating poststroke depression , since available treatments are usually poorly tolerated . Methods A 6-week double-blind , placebo-controlled trial was undertaken . Diagnosis and outcome were determined using the Hamilton Depression Scale , and unwanted effects were measured using the UKU side effect rating scale .  Sixtysix consecutive depressed patients from an unselected population of 285 stroke patients aged 25 to 80 years entered the trial 2 to 52 weeks after stroke . They were assigned to equally sized treatment and placebo groups . The initial level of depression was comparable in the two groups ( mean baseline Hamilton Depression scores 
    Output:
    