***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: This paper reports the results of a study to determine whether pulsed electromagnetic stimulation , applied over the mastoid bone , caused an improvement in the level of tinnitus in long-st and ing tinnitus sufferers . Fifty-eight patients from the Liverpool Tinnitus Association volunteered to take part in a double-blind placebo controlled trial . Active and placebo devices were r and omly allocated to these patients on their first visit . At the end of one week of treatment , each patient noted whether their tinnitus had completely disappeared , was improved , unchanged or made worse by the treatment Forty-five per cent of the patients who completed the trial were improved by the active device , but only 9 % by placebo ( P = 0.0013 , Mann-Whitney test ) . We suggest that electromagnetic stimulation may be an effective treatment in some tinnitus sufferers Background Tinnitus , the perception of sound and noise in absence of an auditory stimulus , has been shown to be associated with maladaptive neuronal reorganization and increased activity of the temporoparietal cortex . Transient modulation of tinnitus by repetitive transcranial magnetic stimulation ( rTMS ) indicated that these areas are critically involved in the pathophysiology of tinnitus and suggested new treatment strategies . However , the therapeutic efficacy of rTMS in tinnitus is still unclear , individual response is variable , and the optimal stimulation area disputable . Recently , continuous theta burst stimulation ( cTBS ) has been put forward as an effective rTMS protocol for the reduction of pathologically enhanced cortical excitability . Methods 48 patients with chronic subjective tinnitus will be included in this r and omized , placebo controlled , three-arm trial . The treatment consists of two trains of cTBS applied bilaterally to the secondary auditory cortex , the temporoparietal associaction cortex , or to the lower occiput ( sham condition ) every working day for four weeks . Primary outcome measure is the change of tinnitus distress as quantified by the Tinnitus Question naire ( TQ ) . Secondary outcome measures are tinnitus loudness and annoyance as well as tinnitus change during and after treatment . Audiologic and speech audiometric measurements will be performed to assess potential side effects . The aim of the present trail is to investigate effectiveness and safety of a four weeks cTBS treatment on chronic tinnitus and to compare two areas of stimulation . The results will contribute to clarify the therapeutic capacity of rTMS in tinnitus . Trial registration The trial was registered with the clinical trials register of http://www . clinical trials.gov ( NCT00518024 ) Background The heterogeneity statistic I2 , interpreted as the percentage of variability due to heterogeneity between studies rather than sampling error , depends on precision , that is , the size of the studies included . Methods Based on a real meta- analysis , we simulate artificially ' inflating ' the sample size under the r and om effects model . For a given inflation factor M = 1 , 2 , 3 , ... and for each trial i , we create a M-inflated trial by drawing a treatment effect estimate from the r and om effects model , using si2MathType@MTEF@5@5@+=feaagaart1ev2aaatCvAUfKttLearuWrP9MDH5MBPbIqV92AaeXatLxBI9gBaebbnrfifHhDYfgasaacPC6xNi = xH8viVGI8Gi = hEeeu0xXdbba9frFj0xb9qqpG0dXdb9aspeI8k8fiI+fsY = rqGqVepae9pg0db9vqaiVgFr0xfr = xfr = xc9adbaqaaeGaciGaaiaabeqaaeqabiWaaaGcbaGaem4Cam3aa0baaSqaaiabdMgaPbqaaiabikdaYaaaaaa@2FBE@/M as within-trial sampling variance . Results As precision increases , while estimates of the heterogeneity variance τ2 remain unchanged on average , estimates of I2 increase rapidly to nearly 100 % . A similar phenomenon is apparent in a sample of 157 meta-analyses . Conclusion When deciding whether or not to pool treatment estimates in a meta- analysis , the yard-stick should be the clinical relevance of any heterogeneity present . τ2 , rather than I2 , is the appropriate measure for this purpose Background Supporting 21st century health care and the practice of evidence -based medicine ( EBM ) requires ubiquitous access to clinical information and to knowledge-based re sources to answer clinical questions . Many questions go unanswered , however , due to lack of skills in formulating questions , crafting effective search strategies , and accessing data bases to identify best levels of evidence . Methods This r and omized trial was design ed as a pilot study to measure the relevancy of search results using three different interfaces for the PubMed search system . Two of the search interfaces utilized a specific framework called PICO , which was design ed to focus clinical questions and to prompt for publication type or type of question asked . The third interface was the st and ard PubMed interface readily available on the Web . Study subjects were recruited from interns and residents on an inpatient general medicine rotation at an academic medical center in the US . Thirty-one subjects were r and omized to one of the three interfaces , given 3 clinical questions , and asked to search PubMed for a set of relevant articles that would provide an answer for each question . The success of the search results was determined by a precision score , which compared the number of relevant or gold st and ard articles retrieved in a result set to the total number of articles retrieved in that set . Results Participants using the PICO templates ( Protocol A or Protocol B ) had higher precision scores for each question than the participants who used Protocol C , the st and ard PubMed Web interface . ( Question 1 : A = 35 % , B = 28 % , C = 20 % ; Question 2 : A = 5 % , B = 6 % , C = 4 % ; Question 3 : A = 1 % , B = 0 % , C = 0 % ) 95 % confidence intervals were calculated for the precision for each question using a lower boundary of zero . However , the 95 % confidence limits were overlapping , suggesting no statistical difference between the groups . Conclusion Due to the small number of search es for each arm , this pilot study could not demonstrate a statistically significant difference between the search protocol s. However there was a trend towards higher precision that needs to be investigated in a larger study to determine if PICO can improve the relevancy of search results Objective Pathophysiology of tinnitus known to accompany nearly all disorders in hearing system has not been fully understood , and therefore , there are some difficulties in evaluation and treatment thereof . The objective of the current study is to research the effectiveness of transcranial magnetic stimulation ( TMS ) application in treatment of tinnitus . Material s and Methods Sixty patients aged between 15 and 70 years who applied to a polyclinic of Ear-Nose-Throat Department , Cerrahpasa Medical Faculty , Istanbul University , because of the complaint of tinnitus between January 2009 and July 2009 were selected using simple r and om sampling method . The treatment group and the placebo group were separated r and omly as to include 30 patients . The tinnitus loudness , tinnitus frequency , tinnitus subjective score , and tinnitus h and icap inventory results were compared before application of TMS and after 1 month . Findings It was found that the difference of tinnitus h and icap inventory score within the TMS group ( before the treatment : mean , 52.76 ; SD , 15.8 ; after the treatment : mean , 44.4 ; SD , 13.57 ) was statistically significant ( P < 0.0001 ) and the difference of tinnitus h and icap inventory score within the placebo group ( before the treatment : mean , 51.46 ; SD , 15.41 ; after the treatment : mean , 51.13 ; SD , 16.86 ) was significantly insignificant ( P = 0.848 ) . When tinnitus severities determined at the beginning and end of the treatment were evaluated within each group , it was found that the difference of loudness within the group subjected to TMS was statistically significant ( P < 0.0001 ) but the difference of loudness within the placebo group was statistically insignificant ( P = 0.490 ) . When tinnitus subjective scores were evaluated within each group before and after the treatment , the difference of subjective score within the group subjected to transcranial magnetic stimulation was statistically significant ( P < 0.0001 ) , and the difference of subjective score within the placebo group was statistically significant ( P = 0.168 ) . Conclusions The studies showed that low-frequency repeating TMS is useful in the treatment of chronic tinnitus . In the current study performed on the patients with chronic tinnitus , it was shown that low-frequency repeating TMS has a statistically significant success when compared with the placebo group Objectives : Repetitive transcranial magnetic stimulation ( rTMS ) , a noninvasive method for altering cortical excitability , is becoming a therapeutic strategy in auditory research institutions worldwide . Application of inhibiting rTMS on these overactive cortical regions can result in effective tinnitus suppression . The aim of this study is to investigate the efficacy of theta-burst rTMS in patients with chronic tinnitus .  Study Design : Parallel r and omized control study . Setting : Tertiary referral center . Patients : We enrolled 2 female and 20 male patients in this study . The evaluative tools included tinnitus frequency- and loudness-matching , tinnitus question naires ( TQ ) , and the Tinnitus H and icap Inventory ( THI ) . Methods : The orthogonal projection of the auditory cortex on the scalp was focalized . A figure-eight coil was placed on the surface of the skull over the targeted region with the intensity setting at 80 % of the resting motor threshold . We delivered 900 pulses of theta-burst rTMS daily for 10 business days . Main Outcome Measures : Nine of twelve patients ( 75 % ) in the active-stimulation group reported tinnitus suppression following treatment with rTMS . The treatment led to reductions of 8.58 and 8.33 in the mean TQ global and THI scores , respectively . Tinnitus loudness also decreased significantly after delivering rTMS . Results : Descriptive analysis of the TQs revealed that patients experienced significant improvements in emotional distress levels and somatic symptoms . Conclusions : Our preliminary results demonstrate that theta-burst rTMS treatments offer a method of modulating tinnitus . Patients could benefit from emotional improvements , even more than auditory perceptive relief . Further studies are needed to establish a st and ard protocol and to clarify nervous propagation along the auditory and psychological projection following treatment with rTMS We used PET to examine the pattern and time course of changes produced by repetitive transcranial magnetic stimulation ( rTMS ) over the dorsal premotor cortex ( PMd ) in healthy subjects and in patients with primary focal dystonia . Subjects received 1800 stimuli of subthreshold 1 Hz rTMS or sham stimulation to the left PMd . Afterwards , we measured regional cerebral blood flow ( rCBF ) as a marker of synaptic activity at rest and during performance of freely selected r and om finger movement . In both groups of subjects , real rTMS caused widespread bilateral decreases in neuronal activity in prefrontal , premotor , primary motor cortex , and left putamen . Conversely , rCBF in the cerebellum increased . Effects were equivalent at rest and during movement , indicating that the pattern of movement-related activation did not change . rTMS-induced changes in neuronal activity lasted for at least 1 h except in the medial aspect of the left globus pallidus . Conditioning effects on neuronal activity were larger in the patients than in the healthy subjects : there was a greater decrease of rCBF in lateral and medial premotor areas , putamen , and thalamus , including the stimulated premotor cortex , and a larger increase in cerebellar rCBF . Our findings indicate that , in healthy subjects and patients with dystonia , a single session of rTMS can produce powerful and widespread changes in regional synaptic activity as indexed by rCBF . Since the greater effects of premotor rTMS were not related to any differences in task performance , increased responsiveness of the motor system to rTMS reveals a physiological trait that characterizes patients with focal arm dystonia Background Chronic tinnitus is a frequent condition , which can have enormous impact on patient 's life and which is very difficult to treat . Accumulating data indicate that chronic tinnitus is related to dysfunctional neuronal activity in the central nervous system . Repetitive transcranial magnetic stimulation ( rTMS ) is a non-invasive method which allows to focally modulate neuronal activity . An increasing amount of studies demonstrate reduction of tinnitus after repeated sessions of low-frequency rTMS and indicate that rTMS might represent a new promising approach for the treatment of tinnitus . However available studies have been mono-centric and are characterized by small sample sizes . Therefore , this multi-center trial will test the efficacy of rTMS treatment in a large sample of chronic tinnitus patients . Methods / Design This is a r and omized , placebo-controlled , double-blind multi-center trial of two weeks 1 Hz rTMS-treatment in chronic tinnitus patients . Eligible patients will be r and omized to either 2 weeks real or sham rTMS  treatment . Main eligibility criteria : male or female individuals aged 18–70 years with chronic tinnitus ( duration > 6 months ) , tinnitus-h and icap-inventory-score ≥ 38 , age-adjusted normal sensorineural hearing ( i.e. not more than 5 dB below the 10 % percentile of the appropriate age and gender group ( DIN EN ISO 7029 ) , conductive hearing loss ≤ 15dB. The primary endpoint is a change of tinnitus severity according to 
    Output:
    
These data underscore the clinical effect of rTMS in the treatment of tinnitus .