***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: Xerostomia is a common and usually irreversible side effects in patients receiving radiation therapy ( > 50 Gy ) for head and neck cancer . Of 38 patients with radiation-induced xerostomia , 20 in the experimental group were treated with classical acupuncture and 18 patients in the control group received superficial acupuncture as placebo . Within both groups the patients showed significantly increased salivary flow rates after the acupuncture treatment . In the experimental group 68 % and in the control group 50 % of the patients had increased salivary flow rates at the end of the observation period . Among those patients who had had all their salivary gl and s irradiated , 50 % in both groups showed increased salivary flow rates ( > 20 % ) by the end of the observation period of 1 year . The study indicates that among the patients who had increased salivary flow rates already after the first 12 acupuncture sessions , the majority had high probability of continual improvement after the completion of acupuncture treatment . The improved salivary flow rates usually persisted during the observation year . The changes observed in the control group were somewhat smaller and appeared after a longer latency phase . Significant differences for salivary flow rates could be observed only within each group , and there were no statistically significant differences between the groups . There were no differences in the improvement of salivary flow rates between those patients who were irradiated within a year before the acupuncture treatment and those who had received radiation therapy several years earlier . The results indicate that acupuncture might be a useful method for the treatment of radiation-induced xerostomia , and that superficial acupuncture should preferably not be used as placebo acupuncture Background Clinical studies suggest that acupuncture can stimulate  saliva production  and reduce xerostomia ( dry mouth ) . We were interested in exploring the neuronal substrates involved in such responses . Methods In a r and omized , sham acupuncture controlled , subject blinded trial , twenty healthy volunteers received true and sham acupuncture  in r and om order . Cortical regions that were activated or deactivated during the interventions were evaluated by functional magnetic resonance imaging ( fMRI ) . Saliva production was also measured . Results Unilateral manual acupuncture stimulation at LI-2 , a point commonly used in clinical practice to treat xerostomia , was associated with bilateral activation of the insula and adjacent operculum . Sham acupuncture at an adjacent site induced neither activation nor deactivation .  True acupuncture induced more saliva production than sham acupuncture . Conclusion Acupuncture at LI-2 was associated with neuronal activations absent during sham acupuncture stimulation . Neuroimaging signal changes appear correlated to saliva production Current evidence indicates that acupuncture-like transcutaneous electrical nerve stimulation ( ALTENS ) can provide sustained benefit for established radiation-induced xerostomia ( RIX ) symptoms . This is further being evaluated by comparing it with st and ard treatment ( pilocarpine ) in a r and omized controlled trial . This report studies the potential effectiveness of xerostomia prevention using ALTENS delivered concomitantly with radiotherapy administered to head and neck cancer patients . Sixty patients were r and omized to either the treatment group ( n = 30 ) that received ALTENS daily with radiotherapy or the control group ( n = 26 ) that had st and ard mouth care only .  Stimulated and basal unstimulated whole saliva production ( WSP ) plus RIX symptoms visual analogue score ( RIXVAS ) were assessed at specific time points . Generalized linear models and generalized estimating equations were used for analysis . RIXVAS at 3 months follow-up after therapy completion was used as the primary study endpoint . The mean RIXVAS for the ALTENS intervention at 3 months was 39.8 , which was not significantly different from the control arm value of 40.5 . There were no statistically significant differences between the two groups for their mean RIXVAS and WSP at all assessment time points . In conclusion , there was no significant difference in mean WSP and RIXVAS between the two groups , so ALTENS is not recommended as a prophylactic intervention Background A distressing complication of radiotherapy treatment for head and neck cancer is xerostomia ( chronic oral dryness ) . Xerostomia is difficult to treat conventionally but there are reports that acupuncture can help . We conducted a feasibility study to examine the acceptability of a st and ardised group acupuncture technique and adherence to group sessions , together with acceptability of the objective and subjective measurements of xerostomia . Methods 12 males with established radiation induced xerostomia were treated in three groups of four . Each received eight weekly sessions of acupuncture using four bilateral acupuncture points ( Salivary Gl and 2 ; Modified Point Zero ; Shen Men and one point in the distal radial aspect of each index finger ( LI1 ) ) . Sialometry and quality of life assessment s were performed at baseline and at the end of treatment . A semi-structured interview was conducted a week after completing the intervention . Results Adherence to and acceptability of the treatment and assessment s was 100 % . There were objective increases in the amounts of saliva produced for 6/12 patients post intervention and the majority also reported subjective improvements . Mean quality of life scores for domains related to salivation and xerostomia also showed improvement . At baseline 92 % ( 11/12 ) patients reported experiencing a dry mouth “ quite a bit/very much ” as compared to 42 % ( 5/12 ) after the treatment . Qualitative data revealed that the patients enjoyed the sessions . Conclusion The pilot study shows that a st and ardised group technique is deliverable and effective . The tools for objective and subjective assessment are appropriate and acceptable . Further examination in a r and omised trial is now warranted The aim of this study was to evaluate the effectiveness of  acupuncture  in minimizing the severity of radiation-induced xerostomia in patients with head and neck cancer . A total of 24 consecutive patients receiving > 5000 cGy radiotherapy ( RT ) involving the major salivary gl and s bilaterally were assigned to either the preventive acupuncture group ( PA , n = 12 ) , treated with acupuncture before and during RT , or the control group ( CT , n = 12 ) , treated with RT and not receiving acupuncture . After RT completion , clinical response was assessed in all patients by syalometry , measuring the resting ( RSFR ) and stimulated ( SSFR ) salivary flow rates , and by the visual analogue scale ( VAS ) regarding dry mouth-related symptoms . Statistical analyses were performed with repeated- measures using a mixed-effect modeling procedure and analysis of variance . An alpha level of 0.05 was accepted for statistical significance . Although all patients exhibited some degree of impairment in salivary gl and functioning after RT , significant differences were found between the groups . Patients in the PA group showed improved salivary flow rates ( RSFR , SSFR ; p < 0.001 ) and decreased xerostomia-related symptoms ( VAS , p < 0.05 ) compared with patients in the CT group . Although PA treatment did not prevent the oral sequelae of RT completely , it significantly minimized the severity of radiation-induced xerostomia . The results suggest that acupuncture focused in a preventive approach can be a useful therapy in the management of patients with head and neck cancer undergoing RT PURPOSE Radiotherapy-induced xerostomia seriously reduces the quality of life ( QOL ) for patients with head and neck cancer . This study aim ed to investigate the effects of manual acupuncture on objective and subjective assessment of symptom changes in patients with cancer who have with radiation-induced xerostomia . MATERIAL S AND METHODS Twelve ( 12 ) patients with radiation-induced xerostomia were r and omized into 2 groups ( real or sham acupuncture ) . Acupuncture was conducted twice weekly for 6 weeks in a single-blind setting . The effect was evaluated by measuring whole salivary flow rates ( stimulated and unstimulated ) and question naire-based assessment of subjective symptoms pre- and post-treatment ( 3 and 6 weeks after acupuncture treatment ) . RESULTS Both groups showed a slight increase in whole salivary flow rates , with no significant difference between them . However , real acupuncture markedly increased unstimulated salivary flow rates , and improved the score for dry mouth according to the xerostomia question naire , by 2.33 points versus 0.33 in the controls . CONCLUSIONS Our results showed the significantly meaningful amelioration of the subjective sensation of xerostomia closely associated with QOL in patients with head and neck cancer treated with irradiation BACKGROUND Radiation treatment of head and neck cancer can cause chronic xerostomia which impairs patients ' quality of life . The study reported here examined the efficacy of acupuncture in alleviating xerostomia symptoms especially dry mouth . PATIENTS AND METHODS A total of 145 patients with chronic radiation-induced xerostomia > 18 months after treatments were recruited from seven UK cancer centres . The study employed a r and omised crossover design with participants receiving two group sessions of oral care education and eight of acupuncture using st and ardised methods . Patient-reported outcome ( PROs ) measures were completed at baseline and weeks 5 , 9 , 13 , 17 , and 21 . The primary outcome was improvement in dry mouth . OBJECTIVE saliva measurements were also carried out . RESULTS Acupuncture compared with oral care , produced significant reductions in patient reports of severe dry mouth ( OR = 2.01 , P = 0.031 ) sticky saliva ( OR = 1.67 , P = 0.048 ) , needing to sip fluids to swallow food ( OR = 2.08 , P = 0.011 ) and in waking up at night to drink ( OR = 1.71 , P = 0.013 ) . There were no significant changes in either stimulated or unstimulated saliva measurements over time . CONCLUSION Eight sessions of weekly group acupuncture compared with group oral care education provide significantly better relief of symptoms in patients suffering from chronic radiation-induced xerostomia Twenty-one patients , 20 women and 1 man , participated in a controlled study . All patients were diagnosed with primary Sjögren 's syndrome ( primary SS ) according to the Copenhagen and San Diego criteria . The patients were r and omly assigned to either a group receiving acupuncture treatment or a control group with no active treatment . The patients in the control group received acupuncture after 10 weeks when the acupuncture treatment was completed in the first group . A majority of the patients subjectively reported some improvement after treatment , and a significant increase in paraffin-stimulated saliva secretion was found after treatment . No statistically significant differences between the acupuncture group and the control group were seen in unstimulated salivary secretion or most of the subjective variables . The study showed that acupuncture is of limited value for patients with primary SS Summary A multi-center double-blind study of an electro-stimulator deviceTrade name : Salitron System manufactured by Biosonics , Inc. , Ft . Washington , Pa. , USA was conducted to evaluate its ability to increase the production of saliva and reduce clinical symptomatology . A total of 77 Sjögren 's syndrome patients at three centers were assigned to active devices ( n=40 ) or to placebo devices ( n=37 ) . There were 2 male and 32 female patients assigned to active devices , and 1 male and 36 female patients assigned to placebo devices .  The age range with the greatest number of patients was 60–69 years making up more than 31 % of the study population . The selection criteria required the patients to have no greater than 0.2 g/min of whole salivary production ( approximately 19 % of normal salivary production ) . At the start of the study , the patients assigned the active device had a mean salivary production of 0.06 ml per min ( 6 % of normal ) and patients assigned placebo devices had a mean salivary production of 0.07 ml per min ( 7 % of normal ) . There were three scheduled visits , 2 weeks apart , over a treatment period of 4 weeks . At all visits , the patients using active devices showed a statistically greater ( P=0.005 to 0.02 ) increase in the production of saliva than placebo patients . The study also evaluated the reduction of patients symptoms associated with xerostomia . Patients showed significant improvement in ( 1 ) difficulty in swallowing and ( 2 ) burning tongue ( P=0.008 ) . Some patients on their initial visit had no response to the active device and did not show a significant response at subsequent visits . These results demonstrated that electrostimulation was effective in stimulating increased production of saliva and in reducing the symptoms of xerostomia in patients with xerostomia secondary to Sjögen 's syndrome The purpose of this study was to determine if using a Sonicare toothbrush was a beneficial treatment of  xerostomia . Sixty-one subjects with medication-induced xerostomia were r and omly assigned a Sonicare ( SC ) or manual toothbrush ( MTB ) . Subjects were followed for four visits ( one month apart ) ; after two months , the MTB group crossed over to using a SC . At each visit , saliva flow was measured by subjects expectorating for five minutes at four collection periods . For the first sample subjects were asked to spit while brushing for three minutes and for two minutes after brushing . Five-minute saliva collection s were taken at 15- , 30- and 45-minute intervals . Question naires were administered at the end of the study period and three years later . Paired analysis on the MTB group that crossed over to SC showed significant increase in salivary flow at all post-brushing collection s ( p < 0.01 ) . The end-of- study question naire showed that 96.4 % of subjects found the SC comfortable to use , 98.2 % had enhanced salivary flow , and 92.7 % would use it to increase salivary flow . After three years , subjects rated the cleaning effect of the 
    Output:
    
Acupuncture was associated with more adverse effects ( tiny bruises and tiredness which were mild and temporary ) .
A single study at high risk of bias , compared the stimulatory effect of powered versus manual toothbrushing and found no difference for the outcomes of UWS or SWS .
AUTHORS ' CONCLUSIONS There is low quality evidence that acupuncture is no different from placebo acupuncture with regard to dry mouth symptoms , which is the most important outcome .
There is insufficient evidence to determine the effects of electrostimulation devices on dry mouth symptoms .
There is some low quality evidence that acupuncture results in a small increase in saliva production in patients with dry mouth following radiotherapy .
There is insufficient evidence to determine the effects of electrostimulation devices on dry mouth symptoms or saliva production in patients with Sjögren 's Syndrome .
Reported adverse effects of acupuncture are mild and of short duration , and there were no reported adverse effects from electrostimulation