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 Docosahexaenoic acid ( DHA ) might help prevent or attenuate posttraumatic stress disorder ( PTSD ) symptoms . We examined the efficacy and safety of DHA for preventing PTSD ( DSM-IV ) after severe accidental injury . METHOD From December 2008 to August 2013 , we conducted a r and omized , double-blind , placebo-controlled trial of 110 accident-injured patients consecutively admitted to an intensive care unit of the National Disaster Medical Center in Tokyo , Japan . All patients were taught about their psychological reactions to accidental injury for 20 minutes and were r and omly assigned to receive 1,470 mg/d of DHA plus 147 mg/d of eicosapentaenoic acid ( EPA ; n = 53 ) or placebo ( n = 57 ) for 12 weeks . The primary outcome was total score on the Clinician-Administered PTSD Scale ( CAPS ) at 3-month follow-up . Secondary outcomes included PTSD diagnosis ( full-blown or partial PTSD ) . Adherence to the interventions was assessed by erythrocyte fatty acid composition . RESULTS At 3 months , the CAPS total score revealed no differences between the 2 groups ( 10.78 in the DHA group vs 9.22 in the placebo group ; n = 100 ; P = .572 ) . We found that 11.1 % of the DHA group and 5.5 % of the placebo group developed PTSD . The erythrocyte level of DHA and EPA in the DHA group was significantly elevated compared to the placebo group ( P < .01 ) . CONCLUSIONS Docosahexaenoic acid supplementation was not superior to placebo for the secondary prevention of PTSD symptoms at 3 months after severe accidental injury . The efficacy of a different ratio of DHA and EPA and higher doses of omega-3 fatty acids as secondary prevention of PTSD remains to be determined . TRIAL REGISTRATION Clinical Trials.gov Identifier : NCT00671099 OBJECTIVE Selective serotonin reuptake inhibitor ( SSRI ) medication does not appear to be effective in ill , malnourished anorexia nervosa ( AN ) patients . However , it may be effective in preventing relapse after weight restoration . The purpose of this study was to determine whether nutritional supplements could potentiate the effects of fluoxetine in underweight AN subjects . METHOD Twenty-six subjects with AN participated in a trial of fluoxetine . In a double-blind , placebo-controlled manner , subjects received either nutritional supplements or a nutritional placebo . The nutritional supplement included tryptophan ( the precursor of serotonin ) , vitamins , minerals , and essential fatty acids believed to influence serotonin pathway function . RESULTS There was no significant difference in weight gain between subjects treated with fluoxetine plus nutritional supplements versus fluoxetine plus a nutritional placebo . Moreover , there were no significant differences between groups on mean changes in anxiety or obsessive and compulsive symptoms . DISCUSSION The results of this study suggest that supplement strategies are not a substitute for adequate nutrition and are ineffective in increasing the efficacy of fluoxetine in underweight AN subjects This study investigated effects of PUFA and micronutrient supplementation on cognition in children with ADHD symptoms . In a r and omised controlled trial , 7 - 12-year-old children with symptoms 2 S.D. on Conners ' ADHD Index were given PUFA , PUFA+multivitamins/minerals ( MVM ) , or placebo for 15 weeks , and then all children were given PUFA+MVM for an additional 15 weeks . After 15 weeks there were improvements in a test of the ability to switch and control attention ( Creature Counting ) in the PUFA groups compared to placebo ( N=129 , p=0.002 ) . This improvement was also observed in the placebo group after taking PUFA from weeks 16 to 30 ( N=104 ) . There were no significant improvements in other cognitive measures , or with additional micronutrient supplementation . However , improvements in cognitive performance mediated previous parent-reported improvements in inattention , hyperactivity and impulsivity [ N. Sinn , J. Bryan , Effect of supplementation with polyunsaturated fatty acids and micronutrients on ADHD-related problems with attention and behaviour , J. Dev . Behav . Pediatr . 28 ( 2 ) ( 2007 ) 82 - 91 ] , suggestive of a common neurological mechanism for these symptoms BACKGROUND Epidemiological and clinical evidence suggests that an increased intake of long-chain n-3 fatty acids protects against mortality from coronary artery disease . We aim ed to test the hypothesis that long-term use of eicosapentaenoic acid ( EPA ) is effective for prevention of major coronary events in hypercholesterolaemic patients in Japan who consume a large amount of fish . METHODS 18 645 patients with a total cholesterol of 6.5 mmol/L or greater were recruited from local physicians throughout Japan between 1996 and 1999 . Patients were r and omly assigned to receive either 1800 mg of EPA daily with statin ( EPA group ; n=9326 ) or statin only ( controls ; n=9319 ) with a 5-year follow-up . The primary endpoint was any major coronary event , including sudden cardiac death , fatal and non-fatal myocardial infa rct ion , and other non-fatal events including unstable angina pectoris , angioplasty , stenting , or coronary artery bypass grafting . Analysis was by intention-to-treat . The study was registered at Clinical Trials.gov , number NCT00231738 . FINDINGS At mean follow-up of 4.6 years , we detected the primary endpoint in 262 ( 2.8 % ) patients in the EPA group and 324 ( 3.5 % ) in controls-a 19 % relative reduction in major coronary events ( p=0.011 ) . Post-treatment LDL cholesterol concentrations decreased 25 % , from 4.7 mmol/L in both groups . Serum LDL cholesterol was not a significant factor in a reduction of risk for major coronary events . Unstable angina and non-fatal coronary events were also significantly reduced in the EPA group . Sudden cardiac death and coronary death did not differ between groups . In patients with a history of coronary artery disease who were given EPA treatment , major coronary events were reduced by 19 % ( secondary prevention subgroup : 158 [ 8.7 % ] in the EPA group vs 197 [ 10.7 % ] in the control group ; p=0.048 ) . In patients with no history of coronary artery disease , EPA treatment reduced major coronary events by 18 % , but this finding was not significant ( 104 [ 1.4 % ] in the EPA group vs 127 [ 1.7 % ] in the control group ; p=0.132 ) . INTERPRETATION EPA is a promising treatment for prevention of major coronary events , and especially non-fatal coronary events , in Japanese hypercholesterolaemic patients OBJECTIVE The purpose of this study was to compare the efficacy of ethyl-eicosapentaenoic acid ( E-EPA ) and placebo in the treatment of female subjects with borderline personality disorder . METHOD The authors conducted an 8-week , placebo-controlled , double-blind study of E-EPA in 30 female subjects meeting Revised Diagnostic Interview for Borderlines and DSM-IV criteria for borderline personality disorder . RESULTS Twenty subjects were r and omly assigned to 1 g of E-EPA ; 10 subjects were given placebo . Ninety percent of those in both groups completed all 8 weeks of the trial . Analyses that used r and om-effects regression modeling and controlled for baseline severity showed E-EPA to be superior to placebo in diminishing aggression as well as the severity of depressive symptoms . CONCLUSIONS The results of this study suggest that E-EPA may be a safe and effective form of monotherapy for women with moderately severe borderline personality disorder Low dietary intakes of the n-3 long-chain PUFA ( LCPUFA ) EPA and DHA are thought to be associated with increased risk for a variety of adverse outcomes , including some psychiatric disorders . Evidence from observational and intervention studies for a role of n-3 LCPUFA in depression is mixed , with some support for a benefit of EPA and /or DHA in major depressive illness . The present study was a double-blind r and omised controlled trial that evaluated the effects of EPA+DHA supplementation ( 1.5 g/d ) on mood and cognitive function in mild to moderately depressed individuals . Of 218 participants who entered the trial , 190 completed the planned 12 weeks intervention . Compliance , confirmed by plasma fatty acid concentrations , was good , but there was no evidence of a difference between supplemented and placebo groups in the primary outcome - namely , the depression subscale of the Depression Anxiety and Stress Scales at 12 weeks . Mean depression score was 8.4 for the EPA+DHA group and 9.6 for the placebo group , with an adjusted difference of - 1.0 ( 95 % CI - 2.8 , 0.8 ; P = 0.27 ) . Other measures of mood , mental health and cognitive function , including Beck Depression Inventory score and attentional bias toward threat words , were similarly little affected by the intervention . In conclusion , substantially increasing  EPA+DHA  intake for 3 months was found not to have beneficial or harmful effects on mood in mild to moderate depression . Adding the present result to a meta- analysis of previous relevant r and omised controlled trial results confirmed an overall negligible benefit of n-3 LCPUFA supplementation for depressed mood Attention deficit/hyperactivity disorder ( ADHD ) is one of the most common child psychiatric disorders , and is often treated with stimulant medication . Nonpharmacological treatments include dietary supplementation with omega-3 fatty acids , although their effectiveness remains to be shown conclusively . In this study , we investigated the effects of dietary omega-3 fatty acid supplementation on ADHD symptoms and cognitive control in young boys with and without ADHD . A total of 40 boys with ADHD , aged 8–14 years , and 39 matched , typically developing controls participated in a 16-week double-blind r and omized placebo-controlled trial . Participants consumed 10 g of margarine daily , enriched with either 650 mg of eicosapentaenoic acid (EPA)/docosahexaenoic acid ( DHA ) each or placebo . Baseline and follow-up assessment s addressed ADHD symptoms , fMRI of cognitive control , urine homovanillic acid , and cheek cell phospholipid sampling . EPA/DHA supplementation improved parent-rated attention in both children with ADHD and typically developing children . Phospholipid DHA level at follow-up was higher for children receiving EPA/DHA supplements than placebo . There was no effect of EPA/DHA supplementation on cognitive control or on fMRI measures of brain activity . This study shows that dietary supplementation with omega-3 fatty acids  reduces symptoms of ADHD , both for individuals with ADHD and typically developing children . This effect does not appear to be mediated by cognitive control systems in the brain , as no effect of supplementation was found here . Nonetheless , this study offers support that omega-3 supplementation may be an effective augmentation for pharmacological treatments of ADHD ( NCT01554462 : The Effects of EPA/DHA Supplementation on Cognitive Control in Children with ADHD ; http:// clinical trials.gov/show/NCT01554462 ) Background and Objectives Some evidence of efficacy has been found for omega-3 fatty acids in patients with borderline personality disorder ( BPD ) . In a previous 12-week r and omized trial we assessed the efficacy of the combination of eicosapentaenoic acid ( EPA ) and docosahexaenoic acid ( DHA ) with valproic acid , in comparison with valproic acid monotherapy , in 43 BPD out patients . Combined therapy was superior to valproic acid monotherapy ( the control group ) in the treatment of some BPD symptoms : impulsive – behavioral dyscontrol , outbursts of anger , and self-harm . The present study is a 24-week follow-up aim ed at evaluating whether the differences in efficacy between the two subgroups were maintained after discontinuation of omega-3 fatty acids . Methods Thirty-four patients who completed the 12-week trial entered the follow-up study . Participants were evaluated at the beginning and at the end of the follow-up period using the rating scales that showed a significant difference between the groups after the 12-week trial with fatty acids supplementation : the Borderline Personality Disorder Severity Index ( BPDSI ) ( items ‘ impulsivity ’ and ‘ outbursts of anger ’ ) , Barratt Impulsiveness Scale – Version 11 ( BIS-11 ) , and Self Harm Inventory ( SHI ) . Statistical analysis was performed with analysis of variance ( ANOVA ) for repeated measures . Results At the end of the follow-up a significant difference within groups was maintained for all four variables examined , while a significant difference between groups was maintained for outbursts of anger . Concerning tolerability , no clinical ly significant adverse effects were registered during the follow-up period . Conclusions Combined therapy with omega-3 fatty acids showed long-lasting effects after discontinuation in terms of anger control . Trial registration The trial was registered in the Australian New Zeal and Clinical Trials 
    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: OBJECTIVE Docosahexaenoic acid ( DHA ) might help prevent or attenuate posttraumatic stress disorder ( PTSD ) symptoms . We examined the efficacy and safety of DHA for preventing PTSD ( DSM-IV ) after severe accidental injury . METHOD From December 2008 to August 2013 , we conducted a r and omized , double-blind , placebo-controlled trial of 110 accident-injured patients consecutively admitted to an intensive care unit of the National Disaster Medical Center in Tokyo , Japan . All patients were taught about their psychological reactions to accidental injury for 20 minutes and were r and omly assigned to receive 1,470 mg/d of DHA plus 147 mg/d of eicosapentaenoic acid ( EPA ; n = 53 ) or placebo ( n = 57 ) for 12 weeks . The primary outcome was total score on the Clinician-Administered PTSD Scale ( CAPS ) at 3-month follow-up . Secondary outcomes included PTSD diagnosis ( full-blown or partial PTSD ) . Adherence to the interventions was assessed by erythrocyte fatty acid composition . RESULTS At 3 months , the CAPS total score revealed no differences between the 2 groups ( 10.78 in the DHA group vs 9.22 in the placebo group ; n = 100 ; P = .572 ) . We found that 11.1 % of the DHA group and 5.5 % of the placebo group developed PTSD . The erythrocyte level of DHA and EPA in the DHA group was significantly elevated compared to the placebo group ( P < .01 ) . CONCLUSIONS Docosahexaenoic acid supplementation was not superior to placebo for the secondary prevention of PTSD symptoms at 3 months after severe accidental injury . The efficacy of a different ratio of DHA and EPA and higher doses of omega-3 fatty acids as secondary prevention of PTSD remains to be determined . TRIAL REGISTRATION Clinical Trials.gov Identifier : NCT00671099 OBJECTIVE Selective serotonin reuptake inhibitor ( SSRI ) medication does not appear to be effective in ill , malnourished anorexia nervosa ( AN ) patients . However , it may be effective in preventing relapse after weight restoration . The purpose of this study was to determine whether nutritional supplements could potentiate the effects of fluoxetine in underweight AN subjects . METHOD Twenty-six subjects with AN participated in a trial of fluoxetine . In a double-blind , placebo-controlled manner , subjects received either nutritional supplements or a nutritional placebo . The nutritional supplement included tryptophan ( the precursor of serotonin ) , vitamins , minerals , and essential fatty acids believed to influence serotonin pathway function . RESULTS There was no significant difference in weight gain between subjects treated with fluoxetine plus nutritional supplements versus fluoxetine plus a nutritional placebo . Moreover , there were no significant differences between groups on mean changes in anxiety or obsessive and compulsive symptoms . DISCUSSION The results of this study suggest that supplement strategies are not a substitute for adequate nutrition and are ineffective in increasing the efficacy of fluoxetine in underweight AN subjects This study investigated effects of PUFA and micronutrient supplementation on cognition in children with ADHD symptoms . In a r and omised controlled trial , 7 - 12-year-old children with symptoms 2 S.D. on Conners ' ADHD Index were given PUFA , PUFA+multivitamins/minerals ( MVM ) , or placebo for 15 weeks , and then all children were given PUFA+MVM for an additional 15 weeks . After 15 weeks there were improvements in a test of the ability to switch and control attention ( Creature Counting ) in the PUFA groups compared to placebo ( N=129 , p=0.002 ) . This improvement was also observed in the placebo group after taking PUFA from weeks 16 to 30 ( N=104 ) . There were no significant improvements in other cognitive measures , or with additional micronutrient supplementation . However , improvements in cognitive performance mediated previous parent-reported improvements in inattention , hyperactivity and impulsivity [ N. Sinn , J. Bryan , Effect of supplementation with polyunsaturated fatty acids and micronutrients on ADHD-related problems with attention and behaviour , J. Dev . Behav . Pediatr . 28 ( 2 ) ( 2007 ) 82 - 91 ] , suggestive of a common neurological mechanism for these symptoms BACKGROUND Epidemiological and clinical evidence suggests that an increased intake of long-chain n-3 fatty acids protects against mortality from coronary artery disease . We aim ed to test the hypothesis that long-term use of eicosapentaenoic acid ( EPA ) is effective for prevention of major coronary events in hypercholesterolaemic patients in Japan who consume a large amount of fish . METHODS 18 645 patients with a total cholesterol of 6.5 mmol/L or greater were recruited from local physicians throughout Japan between 1996 and 1999 . Patients were r and omly assigned to receive either 1800 mg of EPA daily with statin ( EPA group ; n=9326 ) or statin only ( controls ; n=9319 ) with a 5-year follow-up . The primary endpoint was any major coronary event , including sudden cardiac death , fatal and non-fatal myocardial infa rct ion , and other non-fatal events including unstable angina pectoris , angioplasty , stenting , or coronary artery bypass grafting . Analysis was by intention-to-treat . The study was registered at Clinical Trials.gov , number NCT00231738 . FINDINGS At mean follow-up of 4.6 years , we detected the primary endpoint in 262 ( 2.8 % ) patients in the EPA group and 324 ( 3.5 % ) in controls-a 19 % relative reduction in major coronary events ( p=0.011 ) . Post-treatment LDL cholesterol concentrations decreased 25 % , from 4.7 mmol/L in both groups . Serum LDL cholesterol was not a significant factor in a reduction of risk for major coronary events . Unstable angina and non-fatal coronary events were also significantly reduced in the EPA group . Sudden cardiac death and coronary death did not differ between groups . In patients with a history of coronary artery disease who were given EPA treatment , major coronary events were reduced by 19 % ( secondary prevention subgroup : 158 [ 8.7 % ] in the EPA group vs 197 [ 10.7 % ] in the control group ; p=0.048 ) . In patients with no history of coronary artery disease , EPA treatment reduced major coronary events by 18 % , but this finding was not significant ( 104 [ 1.4 % ] in the EPA group vs 127 [ 1.7 % ] in the control group ; p=0.132 ) . INTERPRETATION EPA is a promising treatment for prevention of major coronary events , and especially non-fatal coronary events , in Japanese hypercholesterolaemic patients OBJECTIVE The purpose of this study was to compare the efficacy of ethyl-eicosapentaenoic acid ( E-EPA ) and placebo in the treatment of female subjects with borderline personality disorder . METHOD The authors conducted an 8-week , placebo-controlled , double-blind study of E-EPA in 30 female subjects meeting Revised Diagnostic Interview for Borderlines and DSM-IV criteria for borderline personality disorder . RESULTS Twenty subjects were r and omly assigned to 1 g of E-EPA ; 10 subjects were given placebo . Ninety percent of those in both groups completed all 8 weeks of the trial . Analyses that used r and om-effects regression modeling and controlled for baseline severity showed E-EPA to be superior to placebo in diminishing aggression as well as the severity of depressive symptoms . CONCLUSIONS The results of this study suggest that E-EPA may be a safe and effective form of monotherapy for women with moderately severe borderline personality disorder Low dietary intakes of the n-3 long-chain PUFA ( LCPUFA ) EPA and DHA are thought to be associated with increased risk for a variety of adverse outcomes , including some psychiatric disorders . Evidence from observational and intervention studies for a role of n-3 LCPUFA in depression is mixed , with some support for a benefit of EPA and /or DHA in major depressive illness . The present study was a double-blind r and omised controlled trial that evaluated the effects of EPA+DHA supplementation ( 1.5 g/d ) on mood and cognitive function in mild to moderately depressed individuals . Of 218 participants who entered the trial , 190 completed the planned 12 weeks intervention . Compliance , confirmed by plasma fatty acid concentrations , was good , but there was no evidence of a difference between supplemented and placebo groups in the primary outcome - namely , the depression subscale of the Depression Anxiety and Stress Scales at 12 weeks . Mean depression score was 8.4 for the EPA+DHA group and 9.6 for the placebo group , with an adjusted difference of - 1.0 ( 95 % CI - 2.8 , 0.8 ; P = 0.27 ) . Other measures of mood , mental health and cognitive function , including Beck Depression Inventory score and attentional bias toward threat words , were similarly little affected by the intervention . In conclusion , substantially increasing  EPA+DHA  intake for 3 months was found not to have beneficial or harmful effects on mood in mild to moderate depression . Adding the present result to a meta- analysis of previous relevant r and omised controlled trial results confirmed an overall negligible benefit of n-3 LCPUFA supplementation for depressed mood Attention deficit/hyperactivity disorder ( ADHD ) is one of the most common child psychiatric disorders , and is often treated with stimulant medication . Nonpharmacological treatments include dietary supplementation with omega-3 fatty acids , although their effectiveness remains to be shown conclusively . In this study , we investigated the effects of dietary omega-3 fatty acid supplementation on ADHD symptoms and cognitive control in young boys with and without ADHD . A total of 40 boys with ADHD , aged 8–14 years , and 39 matched , typically developing controls participated in a 16-week double-blind r and omized placebo-controlled trial . Participants consumed 10 g of margarine daily , enriched with either 650 mg of eicosapentaenoic acid (EPA)/docosahexaenoic acid ( DHA ) each or placebo . Baseline and follow-up assessment s addressed ADHD symptoms , fMRI of cognitive control , urine homovanillic acid , and cheek cell phospholipid sampling . EPA/DHA supplementation improved parent-rated attention in both children with ADHD and typically developing children . Phospholipid DHA level at follow-up was higher for children receiving EPA/DHA supplements than placebo . There was no effect of EPA/DHA supplementation on cognitive control or on fMRI measures of brain activity . This study shows that dietary supplementation with omega-3 fatty acids  reduces symptoms of ADHD , both for individuals with ADHD and typically developing children . This effect does not appear to be mediated by cognitive control systems in the brain , as no effect of supplementation was found here . Nonetheless , this study offers support that omega-3 supplementation may be an effective augmentation for pharmacological treatments of ADHD ( NCT01554462 : The Effects of EPA/DHA Supplementation on Cognitive Control in Children with ADHD ; http:// clinical trials.gov/show/NCT01554462 ) Background and Objectives Some evidence of efficacy has been found for omega-3 fatty acids in patients with borderline personality disorder ( BPD ) . In a previous 12-week r and omized trial we assessed the efficacy of the combination of eicosapentaenoic acid ( EPA ) and docosahexaenoic acid ( DHA ) with valproic acid , in comparison with valproic acid monotherapy , in 43 BPD out patients . Combined therapy was superior to valproic acid monotherapy ( the control group ) in the treatment of some BPD symptoms : impulsive – behavioral dyscontrol , outbursts of anger , and self-harm . The present study is a 24-week follow-up aim ed at evaluating whether the differences in efficacy between the two subgroups were maintained after discontinuation of omega-3 fatty acids . Methods Thirty-four patients who completed the 12-week trial entered the follow-up study . Participants were evaluated at the beginning and at the end of the follow-up period using the rating scales that showed a significant difference between the groups after the 12-week trial with fatty acids supplementation : the Borderline Personality Disorder Severity Index ( BPDSI ) ( items ‘ impulsivity ’ and ‘ outbursts of anger ’ ) , Barratt Impulsiveness Scale – Version 11 ( BIS-11 ) , and Self Harm Inventory ( SHI ) . Statistical analysis was performed with analysis of variance ( ANOVA ) for repeated measures . Results At the end of the follow-up a significant difference within groups was maintained for all four variables examined , while a significant difference between groups was maintained for outbursts of anger . Concerning tolerability , no clinical ly significant adverse effects were registered during the follow-up period . Conclusions Combined therapy with omega-3 fatty acids showed long-lasting effects after discontinuation in terms of anger control . Trial registration The trial was registered in the Australian New Zeal and Clinical Trials 
    Output:
    