***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: Objectives . Studies have shown decreases in N30 somatosensory evoked potential ( SEP ) peak amplitudes following spinal manipulation ( SM ) of dysfunctional segments in sub clinical pain ( SCP ) population s. This study sought to verify these findings and to investigate underlying brain sources that may be responsible for such changes . Methods . Nineteen SCP volunteers attended two experimental sessions , SM and control in r and om order .  SEPs from 62-channel EEG cap were recorded following median nerve stimulation ( 1000 stimuli at 2.3 Hz ) before and after either intervention . Peak-to-peak amplitude and latency analysis was completed for different SEPs peak . Dipolar models of underlying brain sources were built by using the brain electrical source analysis . Two-way repeated measures ANOVA was used to assessed differences in N30 amplitudes , dipole locations , and dipole strengths . Results . SM decreased the N30 amplitude by 16.9 ± 31.3 % ( P = 0.02 ) , while no differences were seen following the control intervention ( P = 0.4 ) . Brain source modeling revealed a 4- source model but only the prefrontal source showed reduced activity by 20.2 ± 12.2 % ( P = 0.03 ) following SM . Conclusion . A single session of spinal manipulation of dysfunctional segments in sub clinical pain patients alters somatosensory processing at the cortical level , particularly within the prefrontal cortex OBJECTIVE The purpose of this study was to determine if high-velocity , low-amplitude spinal manipulation ( SM ) altered the effects of corticospinal excitability on motoneuron activity innervating the paraspinal muscles . In a previous study using transcranial magnetic stimulation ( TMS ) , augmentation of motor-evoked potentials ( MEPs ) from the gastrocnemius muscle after lumbar SM was reported . To date , there is no known report of the effect of SM on paraspinal muscle excitability . METHODS The experimental design was a prospect i ve physiologic evaluation of the effects of SM on corticospinal excitability in asymptomatic subjects . The TMS-induced MEPs  were recorded from relaxed lumbar erector spinae muscles of 72 asymptomatic subjects . The MEP amplitudes were evaluated pre-SM and post-SM or conditions involving prethrust positioning and joint loading or control . RESULTS There was a transient increase in MEP amplitudes from the paraspinal muscles as a consequence of lumbar SM ( F([6,414 ] ) = 8.49 ; P < .05 ) without concomitant changes after prethrust positioning and joint loading or in control subjects ( P > .05 ) . These data findings were substantiated by a significant condition x time interaction term ( F([12,414 ] ) = 2.28 ; P < .05 ) . CONCLUSIONS These data suggest that there is a postsynaptic facilitation of alpha motoneurons and /or corticomotoneurons innervating paraspinal muscles as a consequence of SM . It appears that SM may offer unique sensory input to the excitability of the motor system as compared to prethrust positioning and joint loading and control conditions Purpose The primary purpose of this study was to investigate whether a single session of spinal manipulation ( SM ) increases strength and cortical drive in the lower limb ( soleus muscle ) of elite Taekwondo athletes . Methods Soleus-evoked V-waves , H-reflex and maximum voluntary contraction ( MVC ) of the plantar flexors were recorded from 11 elite Taekwondo athletes using a r and omized controlled crossover design . Interventions were either SM or passive movement control . Outcomes were assessed at pre-intervention and at three post-intervention time periods ( immediate post , post 30 min and post 60 min ) . A multifactorial repeated measures ANOVA was conducted to assess within and between group differences . Time and session were used as factors . A post hoc analysis was carried out , when an interactive effect was present . Significance was set at p ≤ 0.05 . Results SM increased MVC force [ F(3,30 ) = 5.95 , p < 0.01 ] , and V-waves [ F(3,30 ) = 4.25 , p = 0.01 ] over time compared to the control intervention . Between group differences were significant for all time periods ( p < 0.05 ) except for the post60 force measurements ( p = 0.07 ) . Conclusion A single session of SM  increased muscle strength and corticospinal excitability to ankle plantar flexor muscles in elite Taekwondo athletes . The increased MVC force lasted for 30 min and the corticospinal excitability increase persisted for at least 60 min Significance Functional MRI ( fMRI ) is 25 years old , yet surprisingly its most common statistical methods have not been vali date d using real data . Here , we used  resting-state fMRI data from 499 healthy controls to conduct 3 million task group analyses . Using this null data with different experimental design s , we estimate the incidence of significant results . In theory , we should find 5 % false positives ( for a significance threshold of 5 % ) , but instead we found that the most common software packages for fMRI analysis ( SPM , FSL , AFNI ) can result in false-positive rates of up to 70 % . These results question the validity of a number of fMRI studies and may have a large impact on the interpretation of weakly significant neuroimaging results . The most widely used task functional magnetic resonance imaging ( fMRI ) analyses use parametric statistical methods that depend on a variety of assumptions . In this work , we use real resting-state data and a total of 3 million r and om task group analyses to compute empirical familywise error rates for the fMRI software packages SPM , FSL , and AFNI , as well as a nonparametric permutation method . For a nominal familywise error rate of 5 % , the parametric statistical methods are shown to be conservative for voxelwise inference and invalid for clusterwise inference . Our results suggest that the principal cause of the invalid cluster inferences is spatial autocorrelation functions that do not follow the assumed Gaussian shape . By comparison , the nonparametric permutation test is found to produce nominal results for voxelwise as well as clusterwise inference . These findings speak to the need of validating the statistical methods being used in the field of neuroimaging Overwhelming evidence shows the quality of reporting of r and omised controlled trials ( RCTs ) is not optimal . Without transparent reporting , readers can not judge the reliability and validity of trial findings nor extract information for systematic review s. Recent method ological analyses indicate that inadequate reporting and design are associated with biased estimates of treatment effects . Such systematic error is seriously damaging to RCTs , which are considered the gold st and ard for evaluating interventions because of their ability to minimise or avoid bias . A group of scientists and editors developed the CONSORT ( Consoli date d St and ards of Reporting Trials ) statement to improve the quality of reporting of RCTs . It was first published in 1996 and up date d in 2001 . The statement consists of a checklist and flow diagram that authors can use for reporting an RCT . Many leading medical journals and major international editorial groups have endorsed the CONSORT statement . The statement facilitates critical appraisal and interpretation of RCTs . During the 2001 CONSORT revision , it became clear that explanation and elaboration of the principles underlying the CONSORT statement would help investigators and others to write or appraise trial reports . A CONSORT explanation and elaboration article was published in 2001 alongside the 2001 version of the CONSORT statement . After an expert meeting in January 2007 , the CONSORT statement has been further revised and is published as the CONSORT 2010 Statement . This up date improves the wording and clarity of the previous checklist and incorporates recommendations related to topics that have only recently received recognition , such as selective outcome reporting bias . This explanatory and elaboration document-intended to enhance the use , underst and ing , and dissemination of the CONSORT statement-has also been extensively revised . It presents the meaning and rationale for each new and up date d checklist item providing examples of good reporting and , where possible , references to relevant empirical studies . Several examples of flow diagrams are included . The CONSORT 2010 Statement , this revised explanatory and elaboration document , and the associated website ( www.consort-statement.org ) should be helpful re sources to improve reporting of r and omised trials Background This systematic review up date d and extended the " UK evidence report " by Bronfort et al. ( Chiropr Osteopath 18:3 , 2010 ) with respect to conditions/ interventions that received an ' inconclusive ’ or ' negative ’ evidence rating or were not covered in the report . Methods A literature search of more than 10 general medical and specialised data bases was conducted in August 2011 and up date d in March 2013 . Systematic review s , primary comparative studies and qualitative studies of patients with musculoskeletal or non-musculoskeletal conditions treated with manual therapy and reporting clinical outcomes were included . Study quality was assessed using st and ardised instruments , studies were summarised , and the results were compared against the evidence ratings of Bronfort . These were either confirmed , up date d , or new categories not assessed by Bronfort were added . Results 25,539 records were found ; 178 new and additional studies were identified , of which 72 were systematic review s , 96 were r and omised controlled trials , and 10 were non-r and omised primary studies . Most ' inconclusive ’ or ' moderate ’ evidence ratings of the UK evidence report were confirmed . Evidence ratings changed in a positive direction from inconclusive to moderate evidence ratings in only three cases ( manipulation/mobilisation [ with exercise ] for rotator cuff disorder ; spinal mobilisation for cervicogenic headache ; and mobilisation for miscellaneous headache ) . In addition , evidence was identified on a large number of non-musculoskeletal conditions not previously considered ; most of this evidence was rated as inconclusive . Conclusions Overall , there was limited high quality evidence for the effectiveness of manual therapy . Most review ed evidence was of low to moderate quality and inconsistent due to substantial method ological and clinical diversity . Areas requiring further research are highlighted Background In r and omised trials , rather than comparing r and omised groups directly some research ers carry out a significance test comparing a baseline with a final measurement separately in each group . Methods We give several examples where this has been done . We use simulation to demonstrate that the procedure is invalid and also show this algebraically . Results This approach is biased and invalid , producing conclusions which are , potentially , highly misleading . The actual alpha level of this procedure can be as high as 0.50 for two groups and 0.75 for three . Conclusions R and omised groups should be compared directly by two- sample methods and separate tests against baseline are highly misleading OBJECTIVE The aim of the study was to examine the effects of a high-velocity , low-amplitude ( HVLA ) manipulation to the lumbosacral joint on corticospinal excitability , as measured by motor evoked potentials ( MEPs ) using transcranial magnetic stimulation , and spinal reflex excitability , as measured by the Hoffman reflex ( H-reflex ) . METHODS In a r and omized , controlled , crossover design , 14 asymptomatic volunteers ( mean age , 23 ± 5.4 years ; 10 men ; 4 women ) were measured for MEPs and H-reflexes immediately before and after a r and omly allocated intervention . The interventions consisted of HVLA applied bilaterally to the lumbosacral joint and a control intervention . Participants returned a week later , and the same procedures were performed using the other intervention . Data for H-reflex and MEP amplitudes were normalized to the M-wave maximum amplitude and analyzed using 2-way analysis of variance with repeated measures . RESULTS A significant interaction of treatment by time was found for MEP ( F(1,13 ) = 4.87 , P = .04 ) , and post hoc analyses showed that the MEP/M-wave maximum ratio decreased significantly in the HVLA treatment ( P = .02 ; effect size , 0.68 ) . For H-reflex , there was a significant effect of time ( F(1,13 ) = 8.186 , P = .01 ) and treatment and time interaction ( F(1,13 ) = 9.05 , P = .01 ) , with post hoc analyses showing that H-reflexes were significantly reduced after the HVLA manipulation ( P = .004 ; effect size , 0.94 ) . There were no significant changes in MEP latency or silent period duration . CONCLUSION An HVLA manipulation applied to the lumbosacral joint produced a significant decrease in corticospinal and spinal reflex excitability , and no significant change occurred after the control intervention . The changes in H-reflexes were larger than those in MEPs , suggesting a greater degree of inhibition at the level of the spinal cord BACKGROUND The physiologic mechanism by which spinal manipulation may reduce  pain and muscular spasm  is not fully understood . One such mechanistic theory proposed is that spinal manipulation may intervene in the cycle of pain and spasm by affecting the resting excitability of the motoneuron pool in the spinal cord . Previous data from our laboratory indicate that spinal manipulation leads to attenuation of the excitability of the motor neuron pool when assessed by means of peripheral nerve Ia-afferent stimulation ( Hoffmann reflex ) . OBJECTIVE The purpose of this study was to determine the effects of lumbar spinal manipulation on the excitability of the motor neuron pool as assessed by means of transcranial magnetic stimulation . METHODS Motor-evoked potentials were recorded subsequent to transcranial magnetic stimulation . The motor-evoked potential peak-to-peak amplitudes in the right gastrocnemius muscle of healthy volunteers ( n = 24 ) were measured before and after homolateral L5-S1 spinal manipulation ( experimental group ) or side-posture positioning with no manipulative thrust applied ( control group ) . 
    Output:
    
Conclusion The available evidence suggests that changes occur in ‘ brain function ’ in response to spinal manipulation but are inconsistent across and - sometimes - within studies .
Conclusion La littérature scientifique suggère que des changements neurophysiologiques surviennent au niveau du cerveau en réponse à la manipulation vertébrale mais , de façon inconsistante .
Ainsi , il est prématuré d’attribuer à la manipulation vertébrale des bénéfices cliniques via un effet sur le cerveau