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: Background Anemia is a common complication among hemodialysis ( HD ) patients . Although intravenous iron and erythropoiesis-stimulating agents revolutionized anemia treatment , about 10 % of HD patients show suboptimal response to these agents . Systemic inflammation and increased serum hepcidin level may contribute to this hyporesponsiveness . Considering the anti-inflammatory properties of omega-3 fatty acids , this study aim ed to evaluate potential role of these fatty acids in improving anemia and inflammation of chronic HD patients . Methods In this r and omized , placebo-controlled trial , 54 adult patients with HD duration of at least 3 months were r and omized to ingest 1800 mg of either omega-3 fatty acids or matching placebo per day for 4 months . Anemia parameters including blood hemoglobin , serum iron , transferrin saturation ( TSAT ) , erythropoietin resistance index , and required dose of intravenous iron and erythropoietin , and serum concentrations of inflammatory/anti-inflammatory markers including interleukin (IL)-6 , tumor necrosis factor (TNF)-α , IL-10 , C-reactive protein ( CRP ) , hepcidin , ferritin , intact parathyroid hormone ( iPTH ) , and ratios of IL-10 to IL-6 and IL-10 to TNF-α were measured at baseline and after 4 months of the intervention . Results 45 subjects ( 25 in the omega-3 and 20 in the placebo group ) completed the study . No significant changes were observed in blood hemoglobin , serum iron , TSAT , and required dose of intravenous iron in either within or between group comparisons . Additionally , erythropoietin resistance index as well as required dose of intravenous erythropoietin showed no significant change in the omega-3 group compared to the placebo group . Although a relative alleviation in inflammatory state appeared in the omega-3 group , the mean differences of inflammatory and anti-inflammatory markers between the two groups did not reach statistically significant level except for IL-10-to-IL-6 ratio and serum ferritin level which showed significant changes in favor of omega-3 treatment ( P < 0.001 and P = 0.003 , respectively ) . Conclusion Omega-3 fatty acids relatively improved systemic inflammation of chronic HD patients without any prominent benefits on anemia . However , future well- design ed studies on larger number of patients may determine utility of omega-3 fatty acids in HD patients with respect to inflammation and anemia BACKGROUND Psychological distress ( PD ) and depressive symptoms are commonly observed during menopausal transition . Studies suggest that omega-3 ( n-3 ) fatty acids may help alleviate depression . OBJECTIVE The objective was to compare enriched ethyl-eicosapentaenoic acid ( E-EPA ) supplementation with placebo for the treatment of PD and depressive symptoms in middle-aged women . DESIGN Women with moderate-to-severe PD ( n = 120 ) were r and omly assigned to receive 1.05 g E-EPA/d plus 0.15 g ethyl-docosahexaenoic acid/d ( n = 59 ) or placebo ( n = 61 ) for 8 wk . The main outcomes were 8-wk changes in PD scores [ Psychological General Well-Being Schedule ( PGWB ) ] and depressive scales [ 20-item Hopkins Symptom Checklist Depression Scale ( HSCL-D-20 ) and the 21-item Hamilton Depression Rating Scale ( HAM-D-21 ) ] . RESULTS At baseline , women with PD were mildly to moderately depressed , and 24 % met the major depressive episode ( MDE ) criteria of the Diagnostic and Statistical Manual of Mental Disorders , 4th edition . After 8 wk , outcomes improved in both groups , but no significant differences were noted between them . Stratification analyses for MDE diagnosis at baseline indicated that differences in adjusted 8-wk changes between the E-EPA group without MDE ( n = 46 ) and the placebo group ( n = 45 ) were 8.0 ( 95 % CI : 0.6 , 15.3 ; P = 0.034 ) for the PGWB , -0.2 ( 95 % CI : -0.01 , -0.4 ; P = 0.040 ) for the HSCL-D-20 , and -2.7 ( 95 % CI : -0.3 , -5.1 ; P = 0.030 ) for the HAM-D-21 . Differences in adjusted 8-wk changes between the E-EPA group with MDE ( n = 13 ) and the placebo group ( n = 16 ) were not significant . CONCLUSIONS To our knowledge , this is the first trial of n-3 supplementation in the treatment of PD and depressive symptoms in middle-aged women . In women with PD without MDE at baseline , the 8-wk changes in PD and depressive scales improved significantly more with E-EPA than with placebo . This trial was registered at http://www.controlled-trials.com as IS RCT N69617477 The aim of this study was to determine if changes in omega-3 polyunsaturated fatty acid status following tuna oil supplementation correlated with changes in scores of depression . A total of 95 volunteers receiving treatment for major depression were r and omised to consume 8 × 1 g capsules per day of HiDHA ( 2 g DHA , 0.6 g EPA and 10 mg Vitamin E ) or olive oil ( placebo ) for 16 weeks , whilst undergoing weekly counseling sessions by trained clinical psychologists using a st and ard empirically vali date d psychotherapy . Depression status was assessed using the 17 item Hamilton rating scale for depression and the Beck Depression Inventory by a psychodiagnostician who was blind to the treatment . Blood was taken at baseline and 16 weeks ( n = 48 ) for measurement of erythrocyte fatty acids .  With HiDHA supplementation , erythrocyte DHA content rose from 4.1 ± 0.2 to 7.9 ± 0.4 % ( mean ± SEM , p < 0.001 ) of total fatty acids but did not change ( 4.0 ± 0.2 to 4.1 ± 0.2 % ) in the olive oil group . The mean changes in scores of depression did not differ significantly between the two groups ( −12.2 ± 2.1 for tuna oil and −14.4 ± 2.3 for olive oil ) . However , analysis of covariance showed that in the fish oil group there was a significant correlation ( r = −0.51 ) between the change in erythrocyte DHA and the change in scores of depression ( p < 0.05 ) . Further study of the relationship between DHA and depression is warranted Depression and health-related quality of life ( HRQoL ) are closely interrelated among hemodialysis ( HD ) patients and associated with negative impacts on patients ' clinical outcomes . Considering previous reports on clinical benefits of omega-3 fatty acids in major depression and HRQoL in other patient population s , this study examined effects of omega-3 fatty acids on depression and HRQoL in chronic HD patients . In this r and omized placebo-controlled trial , 40 adult patients with a Beck Depression Inventory ( BDI ) score of ≥16 and HD vintage of at least 3 months were r and omized to ingest 6 soft-gel capsules of either omega-3 fatty acids ( 180 mg eicosapentaenoic acid and 120 mg docosahexaenoic acid in each capsule ) or corresponding placebo , daily for 4 months . At baseline and after 4 months , 2 question naires of BDI and the Medical Outcome Study 36-Item Short-Form Health Survey were completed by each patient . Although baseline BDI score was comparable between the 2 groups , it was significantly lower in the omega-3 group compared with the placebo group at the end of the study ( P = 0.008 ) . Except for mental health , social functioning , and general health , other domains of HRQoL showed significant improvement in the omega-3 group compared with the placebo group at month 4 of the study ( P < 0.05 for all ) . Regression analysis revealed that ameliorated BDI score by omega-3 treatment had considerable role in the improvement of overall HRQoL score , physical and mental component dimensions , and score of physical functioning , role-physical , and bodily pain . Supplemental use of omega-3 fatty acids  in HD patients with  depressive symptoms seems to be efficacious in improving depressive symptoms and Patients with depression have been extensively reported to be associated with the abnormality of omega-3 polyunsaturated fatty acids ( PUFAs ) , including significantly low eicosapentaenoic acid and docosahexaenoic acid in cell tissue contents ( red blood cell membrane , plasma , etc . ) and dietary intake . However , more evidence is needed to support its relation . In this study , we conducted an 8-week , double-blind , placebo-controlled trial , comparing omega-3 PUFAs ( 6.6 g/day ) [ corrected ] with placebo , on the top of the usual treatment , in 28 patients with major depressive disorder . Patients in the omega-3 PUFA group had a significantly decreased score on the 21-item Hamilton Rating Scale for Depression than those in the placebo group ( P < 0.001 ) . From the preliminary findings in this study , omega-3 PUFAs could improve the short-term course of illness and were well tolerated in patients with major depressive disorder OBJECTIVE Treatment-resistant depression has recently emerged as a marker of increased risk for morbidity and mortality in patients with coronary heart disease ( CHD ) . Studies in depressed patients without CHD suggest that elevated markers of inflammation predict poor response to treatment . This may help to explain the increased risk of cardiac events associated with depression . We therefore studied the relationship between pretreatment markers of inflammation and treatment response in patients with CHD and major depression . METHODS This was a planned , secondary analysis of a clinical trial in which 122 patients with CHD and comorbid major depression were r and omly assigned to 50 mg of sertraline plus 2 g/day omega-3 fatty acids or to 50 mg of sertraline plus 2 g/day corn oil placebo capsules for ten weeks . Depressive symptoms were assessed with the Beck Depression Inventory-II ( BDI-II ) . Blood sample s were collected at baseline to determine levels of high-sensitivity C-reactive protein ( hs-CRP ) , interleukin-6 ( IL-6 ) , and tumor necrosis factor alpha ( TNF-α ) . The primary outcome was the post-treatment BDI-II depression score . RESULTS Baseline levels of hs-CRP , IL-6 , and TNF-α were not associated with the 10-week post-treatment depression score ( P=.89 , P=.88 , and P=.31 , respectively ) . Treatment responders ( > 50 % reduction from baseline BDI-II score ) did not differ from non-responders in either baseline hs-CRP , IL-6 , or TNF-α ( P=.83 , P=.93 , and P=.24 , respectively ) . Similarly , depression remitters ( BDI-II ≤8 at post-treatment ) did not differ from non-remitters on the three baseline inflammation markers . CONCLUSION These findings do not support the hypothesis that elevated baseline inflammatory markers predict poor response to sertraline in patients with CHD and major depression . The explanation for the increased risk of cardiac events associated with poor response to depression treatment remains unclear Background Eicosapentaenoic acid ( EPA ) may reduce increased risks for ( cardiovascular ) morbidity and mortality in patients with diabetes mellitus ( DM ) and comorbid major depressive depression ( MDD ) . Yet , effects of EPA-supplementation on biological risk factors for adverse outcomes have not been studied in DM- patients with MDD . Methods We performed a r and omized , double-blind trial ( n = 25 ) comparing add-on ethyl-EPA-supplementation to placebo on ( I ) oxidative stress , ( II ) inflammatory , ( III ) hypothalamic-pituitary-adrenal (HPA)-axis , ( IV ) one-carbon-cycle , ( V ) fatty acid metabolism and ( VI ) lipoprotein parameters during 12-weeks ' follow-up . Results Besides increases in supplemented α-tocopherol [ estimate ( 95 % CI ) ; 3.62 ( 1.14–6.11 ) µmol/l ; p = 0.006 ] and plasma and erythrocyte EPA , the intervention did not influence other oxidative stress , inflammatory or one-carbon-cycle parameters compared to placebo . HPA-axis reactivity significantly decreased in the EPA-group ( N = 12 ) [ AUCi : −121.93 ( −240.20–−3.47 ) min × nmol/l ; p = 0.045 ] , not in the placebo-group ( N = 12 ) . Furthermore , EPA-supplementation increased erythrocyte and plasma docosapentaenoic acid , and decreased plasma arachidonic acid ( AA ) concentrations [ −1.61 ( −3.10–−0.11 ) % ; p = 0.036 ] . Finally , EPA had a multivariate influence on lipoprotein concentrations ( p = 0.03 
    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: Background Anemia is a common complication among hemodialysis ( HD ) patients . Although intravenous iron and erythropoiesis-stimulating agents revolutionized anemia treatment , about 10 % of HD patients show suboptimal response to these agents . Systemic inflammation and increased serum hepcidin level may contribute to this hyporesponsiveness . Considering the anti-inflammatory properties of omega-3 fatty acids , this study aim ed to evaluate potential role of these fatty acids in improving anemia and inflammation of chronic HD patients . Methods In this r and omized , placebo-controlled trial , 54 adult patients with HD duration of at least 3 months were r and omized to ingest 1800 mg of either omega-3 fatty acids or matching placebo per day for 4 months . Anemia parameters including blood hemoglobin , serum iron , transferrin saturation ( TSAT ) , erythropoietin resistance index , and required dose of intravenous iron and erythropoietin , and serum concentrations of inflammatory/anti-inflammatory markers including interleukin (IL)-6 , tumor necrosis factor (TNF)-α , IL-10 , C-reactive protein ( CRP ) , hepcidin , ferritin , intact parathyroid hormone ( iPTH ) , and ratios of IL-10 to IL-6 and IL-10 to TNF-α were measured at baseline and after 4 months of the intervention . Results 45 subjects ( 25 in the omega-3 and 20 in the placebo group ) completed the study . No significant changes were observed in blood hemoglobin , serum iron , TSAT , and required dose of intravenous iron in either within or between group comparisons . Additionally , erythropoietin resistance index as well as required dose of intravenous erythropoietin showed no significant change in the omega-3 group compared to the placebo group . Although a relative alleviation in inflammatory state appeared in the omega-3 group , the mean differences of inflammatory and anti-inflammatory markers between the two groups did not reach statistically significant level except for IL-10-to-IL-6 ratio and serum ferritin level which showed significant changes in favor of omega-3 treatment ( P < 0.001 and P = 0.003 , respectively ) . Conclusion Omega-3 fatty acids relatively improved systemic inflammation of chronic HD patients without any prominent benefits on anemia . However , future well- design ed studies on larger number of patients may determine utility of omega-3 fatty acids in HD patients with respect to inflammation and anemia BACKGROUND Psychological distress ( PD ) and depressive symptoms are commonly observed during menopausal transition . Studies suggest that omega-3 ( n-3 ) fatty acids may help alleviate depression . OBJECTIVE The objective was to compare enriched ethyl-eicosapentaenoic acid ( E-EPA ) supplementation with placebo for the treatment of PD and depressive symptoms in middle-aged women . DESIGN Women with moderate-to-severe PD ( n = 120 ) were r and omly assigned to receive 1.05 g E-EPA/d plus 0.15 g ethyl-docosahexaenoic acid/d ( n = 59 ) or placebo ( n = 61 ) for 8 wk . The main outcomes were 8-wk changes in PD scores [ Psychological General Well-Being Schedule ( PGWB ) ] and depressive scales [ 20-item Hopkins Symptom Checklist Depression Scale ( HSCL-D-20 ) and the 21-item Hamilton Depression Rating Scale ( HAM-D-21 ) ] . RESULTS At baseline , women with PD were mildly to moderately depressed , and 24 % met the major depressive episode ( MDE ) criteria of the Diagnostic and Statistical Manual of Mental Disorders , 4th edition . After 8 wk , outcomes improved in both groups , but no significant differences were noted between them . Stratification analyses for MDE diagnosis at baseline indicated that differences in adjusted 8-wk changes between the E-EPA group without MDE ( n = 46 ) and the placebo group ( n = 45 ) were 8.0 ( 95 % CI : 0.6 , 15.3 ; P = 0.034 ) for the PGWB , -0.2 ( 95 % CI : -0.01 , -0.4 ; P = 0.040 ) for the HSCL-D-20 , and -2.7 ( 95 % CI : -0.3 , -5.1 ; P = 0.030 ) for the HAM-D-21 . Differences in adjusted 8-wk changes between the E-EPA group with MDE ( n = 13 ) and the placebo group ( n = 16 ) were not significant . CONCLUSIONS To our knowledge , this is the first trial of n-3 supplementation in the treatment of PD and depressive symptoms in middle-aged women . In women with PD without MDE at baseline , the 8-wk changes in PD and depressive scales improved significantly more with E-EPA than with placebo . This trial was registered at http://www.controlled-trials.com as IS RCT N69617477 The aim of this study was to determine if changes in omega-3 polyunsaturated fatty acid status following tuna oil supplementation correlated with changes in scores of depression . A total of 95 volunteers receiving treatment for major depression were r and omised to consume 8 × 1 g capsules per day of HiDHA ( 2 g DHA , 0.6 g EPA and 10 mg Vitamin E ) or olive oil ( placebo ) for 16 weeks , whilst undergoing weekly counseling sessions by trained clinical psychologists using a st and ard empirically vali date d psychotherapy . Depression status was assessed using the 17 item Hamilton rating scale for depression and the Beck Depression Inventory by a psychodiagnostician who was blind to the treatment . Blood was taken at baseline and 16 weeks ( n = 48 ) for measurement of erythrocyte fatty acids .  With HiDHA supplementation , erythrocyte DHA content rose from 4.1 ± 0.2 to 7.9 ± 0.4 % ( mean ± SEM , p < 0.001 ) of total fatty acids but did not change ( 4.0 ± 0.2 to 4.1 ± 0.2 % ) in the olive oil group . The mean changes in scores of depression did not differ significantly between the two groups ( −12.2 ± 2.1 for tuna oil and −14.4 ± 2.3 for olive oil ) . However , analysis of covariance showed that in the fish oil group there was a significant correlation ( r = −0.51 ) between the change in erythrocyte DHA and the change in scores of depression ( p < 0.05 ) . Further study of the relationship between DHA and depression is warranted Depression and health-related quality of life ( HRQoL ) are closely interrelated among hemodialysis ( HD ) patients and associated with negative impacts on patients ' clinical outcomes . Considering previous reports on clinical benefits of omega-3 fatty acids in major depression and HRQoL in other patient population s , this study examined effects of omega-3 fatty acids on depression and HRQoL in chronic HD patients . In this r and omized placebo-controlled trial , 40 adult patients with a Beck Depression Inventory ( BDI ) score of ≥16 and HD vintage of at least 3 months were r and omized to ingest 6 soft-gel capsules of either omega-3 fatty acids ( 180 mg eicosapentaenoic acid and 120 mg docosahexaenoic acid in each capsule ) or corresponding placebo , daily for 4 months . At baseline and after 4 months , 2 question naires of BDI and the Medical Outcome Study 36-Item Short-Form Health Survey were completed by each patient . Although baseline BDI score was comparable between the 2 groups , it was significantly lower in the omega-3 group compared with the placebo group at the end of the study ( P = 0.008 ) . Except for mental health , social functioning , and general health , other domains of HRQoL showed significant improvement in the omega-3 group compared with the placebo group at month 4 of the study ( P < 0.05 for all ) . Regression analysis revealed that ameliorated BDI score by omega-3 treatment had considerable role in the improvement of overall HRQoL score , physical and mental component dimensions , and score of physical functioning , role-physical , and bodily pain . Supplemental use of omega-3 fatty acids  in HD patients with  depressive symptoms seems to be efficacious in improving depressive symptoms and Patients with depression have been extensively reported to be associated with the abnormality of omega-3 polyunsaturated fatty acids ( PUFAs ) , including significantly low eicosapentaenoic acid and docosahexaenoic acid in cell tissue contents ( red blood cell membrane , plasma , etc . ) and dietary intake . However , more evidence is needed to support its relation . In this study , we conducted an 8-week , double-blind , placebo-controlled trial , comparing omega-3 PUFAs ( 6.6 g/day ) [ corrected ] with placebo , on the top of the usual treatment , in 28 patients with major depressive disorder . Patients in the omega-3 PUFA group had a significantly decreased score on the 21-item Hamilton Rating Scale for Depression than those in the placebo group ( P < 0.001 ) . From the preliminary findings in this study , omega-3 PUFAs could improve the short-term course of illness and were well tolerated in patients with major depressive disorder OBJECTIVE Treatment-resistant depression has recently emerged as a marker of increased risk for morbidity and mortality in patients with coronary heart disease ( CHD ) . Studies in depressed patients without CHD suggest that elevated markers of inflammation predict poor response to treatment . This may help to explain the increased risk of cardiac events associated with depression . We therefore studied the relationship between pretreatment markers of inflammation and treatment response in patients with CHD and major depression . METHODS This was a planned , secondary analysis of a clinical trial in which 122 patients with CHD and comorbid major depression were r and omly assigned to 50 mg of sertraline plus 2 g/day omega-3 fatty acids or to 50 mg of sertraline plus 2 g/day corn oil placebo capsules for ten weeks . Depressive symptoms were assessed with the Beck Depression Inventory-II ( BDI-II ) . Blood sample s were collected at baseline to determine levels of high-sensitivity C-reactive protein ( hs-CRP ) , interleukin-6 ( IL-6 ) , and tumor necrosis factor alpha ( TNF-α ) . The primary outcome was the post-treatment BDI-II depression score . RESULTS Baseline levels of hs-CRP , IL-6 , and TNF-α were not associated with the 10-week post-treatment depression score ( P=.89 , P=.88 , and P=.31 , respectively ) . Treatment responders ( > 50 % reduction from baseline BDI-II score ) did not differ from non-responders in either baseline hs-CRP , IL-6 , or TNF-α ( P=.83 , P=.93 , and P=.24 , respectively ) . Similarly , depression remitters ( BDI-II ≤8 at post-treatment ) did not differ from non-remitters on the three baseline inflammation markers . CONCLUSION These findings do not support the hypothesis that elevated baseline inflammatory markers predict poor response to sertraline in patients with CHD and major depression . The explanation for the increased risk of cardiac events associated with poor response to depression treatment remains unclear Background Eicosapentaenoic acid ( EPA ) may reduce increased risks for ( cardiovascular ) morbidity and mortality in patients with diabetes mellitus ( DM ) and comorbid major depressive depression ( MDD ) . Yet , effects of EPA-supplementation on biological risk factors for adverse outcomes have not been studied in DM- patients with MDD . Methods We performed a r and omized , double-blind trial ( n = 25 ) comparing add-on ethyl-EPA-supplementation to placebo on ( I ) oxidative stress , ( II ) inflammatory , ( III ) hypothalamic-pituitary-adrenal (HPA)-axis , ( IV ) one-carbon-cycle , ( V ) fatty acid metabolism and ( VI ) lipoprotein parameters during 12-weeks ' follow-up . Results Besides increases in supplemented α-tocopherol [ estimate ( 95 % CI ) ; 3.62 ( 1.14–6.11 ) µmol/l ; p = 0.006 ] and plasma and erythrocyte EPA , the intervention did not influence other oxidative stress , inflammatory or one-carbon-cycle parameters compared to placebo . HPA-axis reactivity significantly decreased in the EPA-group ( N = 12 ) [ AUCi : −121.93 ( −240.20–−3.47 ) min × nmol/l ; p = 0.045 ] , not in the placebo-group ( N = 12 ) . Furthermore , EPA-supplementation increased erythrocyte and plasma docosapentaenoic acid , and decreased plasma arachidonic acid ( AA ) concentrations [ −1.61 ( −3.10–−0.11 ) % ; p = 0.036 ] . Finally , EPA had a multivariate influence on lipoprotein concentrations ( p = 0.03 
    Output:
    