***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: CONTEXT The Consoli date d St and ards for Reporting of Trials ( CONSORT ) statement was developed to help improve the quality of reports of r and omized controlled trials ( RCTs ) . To date , a paucity of data exists regarding whether it has achieved this goal . OBJECTIVE To determine whether use of the CONSORT statement is associated with improvement in the quality of reports of RCTs . DESIGN AND SETTING Comparative before- and -after evaluation in which reports of RCTs published in 1994 ( pre-CONSORT ) were compared with RCT reports from the same journals published in 1998 ( post-CONSORT ) . We included 211 reports from BMJ , JAMA , and The Lancet ( journals that adopted CONSORT ) as well as The New Engl and Journal of Medicine ( a journal that did not adopt CONSORT and was used as a comparator ) . MAIN OUTCOME MEASURES Number of CONSORT items included in a report , frequency of unclear reporting of allocation concealment , and overall trial quality score based on the Jadad scale , a 5-point quality assessment instrument . RESULTS Compared with 1994 , the number of CONSORT checklist items in reports of RCTs increased in all 4 journals in 1998 , and this increase was statistically significant for the 3 adopter journals ( pre-CONSORT , 23.4 ; mean change , 3.7 ; 95 % confidence interval [ CI ] , 2.1 - 5.3 ) . The frequency of unclear reporting of allocation concealment decreased for each of the 4 journals , and this change was statistically significant for adopters ( pre-CONSORT , 61 % ; mean change , -22 % ; 95 % CI , -38 % to -6 % ) . Similarly , 3 of the 4 journals showed an improvement in the quality score for reports of RCTs , and this increase was statistically significant for adopter journals overall ( pre-CONSORT , 2.7 ; mean change , 0.4 ; 95 % CI , 0.1 - 0.8 ) . CONCLUSION Use of the CONSORT statement is associated with improvements in the quality of reports of RCTs PURPOSE Among patients with Wilkes stage III and IV disease undergoing arthroscopic lysis and lavage  , does the use of an intra-articular injection of sodium hyaluronate ( SH ) , when compared with Ringer lavage , result in better postoperative pain control and temporom and ibular joint ( TMJ ) function ? PATIENTS AND METHODS We design ed and implemented a r and omized , double-blind , pilot controlled clinical trial . The study sample was composed of patients with middle Wilkes stage ( late stage III and early stage IV ) disease . Subjects were r and omized to 1 of 2 treatment limbs . The treatment group received Ringer lactate plus an injection of 1 mL of SH after arthroscopy , whereas the control group was given Ringer lactate during arthroscopy . The primary outcome variables were pain and TMJ function measured by use of visual analog scales . Appropriate descriptive and bivariate statistics were computed . A P value less than .05 was considered statistically significant . RESULTS The study sample was composed of 40 patients with 20 subjects enrolled in both treatment groups . There were no statistically significant differences between the 2 groups in terms of demographics and preoperative variables . Postoperative analgesia was statistically significant in the treatment group with respect to the control group on the visits on days 14 and 84 . No statistically significant differences were observed between the 2 groups in the maximum interincisal opening and tolerance . CONCLUSIONS An intra-articular injection of SH after arthroscopic lysis and lavage is effective in reducing pain in patients with TMJ dysfunction , enhancing postsurgical recovery . The analgesic effect of treatment with SH is maintained in the long term The aim of this study was to investigate if the 5-HT3 antagonist granisetron reduces temporom and ibular joint ( TMJ ) pain in patients with systemic inflammatory joint disorders . Sixteen patients with systemic inflammatory joint disease with pain localized over the TMJ region and tenderness to digital palpation of the TMJ were included . The current resting pain ( VASRest ) and the pain during maximum mouth opening ( VAS(MVM ) ) of the TMJs were assessed with a 100 mm visual analogue scale . An electronic pressure algometer was used to estimate the pressure pain threshold ( PPT ) over the lateral aspect of the TMJ . Venous blood was collected for measurement of the plasma and serum levels of 5-HT , erythrocyte sedimentation rate , rheumatoid factor and C-reactive protein . The selective 5-HT3 receptor antagonist granisetron or saline were injected into the posterior part of the upper TMJ compartment in a r and omized double-blind manner . The patients in the granisetron group had lower VASRest than the patients in the saline group after 10 min . In the granisetron group , VASRest was decreased after 10 min , while VAS(MVM ) was decreased and PPT increased after 20 min . In the saline group , VAS(MVM ) was decreased after 20 min . In conclusion , granisetron has an immediate , short-lasting and specific pain reducing effect in TMJ inflammatory arthritis . The 5-HT3 receptor may therefore be involved in the mediation of TMJ pain in systemic inflammatory joint disorders PURPOSE This study was design ed to investigate the efficacy of arthrocentesis with and without injection of sodium hyaluronate ( SH ) into the upper joint space in the treatment of temporom and ibular joint ( TMJ ) internal derangements . PATIENTS AND METHODS Forty-one TMJs in 5 males and 26 females aged 14 to 53 years comprised the study material . The patients ' complaints were limited mouth opening , TMJ pain and tenderness , and joint noises during function . Patients were r and omly divided into 2 groups in which only arthrocentesis was performed in 1 group and arthrocentesis plus intra-articular injection of sodium hyaluronate was performed in the other group . Both groups contained patients with disc displacement with reduction and with closed lock . Clinical evaluation of the patients was done before the procedure , immediately after the procedure , on postoperative day 1 , and at 1 , 2 , 3 , 4 , 5 , 6 , 9 , 12 , 18 , and 24 months postoperatively . Intensity of TMJ pain , jaw function , and clicking sounds in the TMJ were assessed using visual analog scales . Maximal mouth opening and lateral jaw movements also were recorded at each follow-up visit . RESULTS Both techniques increased maximal mouth opening , lateral movements , and function , while reducing TMJ pain and noise . CONCLUSIONS Although patients benefitted from both techniques , arthrocentesis with injection of SH seemed to be superior to arthrocentesis alone OBJECTIVE To evaluate the clinical efficacy of intra-articular injection with 2 % chitosan as a treatment for irreducible anterior disc displacement of the TMJ . METHODS Total 30 patients with irreducible anterior disc displacement were divided into two groups according to quasi-r and omizaion . The patients in test group received intra-articular injection with 1.0 ml of 2 % chitosan into upper cavities of the suffered joints , in control group with 12.5 mg of prednisolone . The patients were followed up at the 1st day and 14th day after injection and the maximal mouth opening was measured . RESULTS The maximal mouth opening at 14th day was ( 36.73 + /- 4.69 ) mm in test group , with 11.73 mm increase from baseline ; and ( 28.53 + /- 5.81 ) mm in control group , with 3.86 mm increase , respectively . The increase of maximal mouth opening in test group was significantly higher than that of control group ( P < 0.05 ) . CONCLUSION Chitosan is an effective bio material in curing irreducible anterior disc displacement of TMJs The short-term effect ( 4 weeks ) of intra-articular injections of sodium hyaluronate , glucocorticoid , and saline was studied in three groups comprising 41 patients with rheumatoid arthritis of the temporom and ibular joint .  Sodium hyaluronate and glucocorticoid treatments had a significant positive effect according to the patients ' subjective evaluation . A comprehensive clinical dysfunction score was reduced significantly in all groups , while the number of tender muscle regions was significantly reduced and the maximum voluntary mouth opening significantly increased in the glucocorticoid and sodium hyaluronate groups only OBJECTIVE To analyze the treatment outcome of the two methods of intra-capsular injection of temporom and ibular joints , the upper capsule alone and both the upper and lower capsules , for different subtypes of temporom and ibular disorders . METHODS A retrospective cohort study was design ed , based on the out patients and the data which were obtained from West China Stomatological Hospital , Sichuan University . SPSS10.0 software was used to analyze the data , which were collected before the operation and one week after the operation . RESULTS 294 patients were followed up . The group of double capsules injection gained better prospect , not only on the mouth-opening but also the pain-cured , especially in two subgroups such as the anterior dislocation of disc without reduction and the osteoarthritis of TMJ . CONCLUSION It seems that the double capsules injection of sodium hyaluronate for TMD can gain better outcome than the upper capsule injection , but a clinical r and omized controlled test and a long-term follow-up study of the two methods are needed to verify this finding The short-term effect of intra-articular injections of sodium hyaluronate and a corticosteroid ( betamethasone ) was compared in a sample of 33 patients who had pain and tenderness to palpation in the temporom and ibular joint of at least six months duration that had not responded to previous conservative treatment . The two drugs were r and omly allocated to the patients . A volume of 0.5 ml of the drug was injected twice into the superior joint compartment of the TMJ with a two-week interval between injections . The effect on subjective symptoms , clinical signs , and bite force was assessed . Both drugs reduced the symptoms and signs significantly , and no statistically significant difference in effect could be found between drugs in this regard . The results indicate that the difference between the drugs in terms of short-term therapeutic effects is small , and that sodium hyaluronate could be used as an alternative to corticosteroid for patients who have signs of TMJ inflammation , especially for those who have symptomatic osteoarthrosis PURPOSE To compare the outcome of inferior and superior joint space injection of sodium hyaluronate in patients with disc displacement without reduction of the temporom and ibular joint ( TMJ ) . MATERIAL S AND METHODS One hundred twenty patients with disc displacement without reduction of TMJ were r and omized into 2 experimental groups . One group of patients received superior joint space injections of sodium hyaluronate and the other group was treated with inferior joint space injections . Patient 's TMJ status and clinical symptoms were evaluated at the 3 and 6 month follow-up appointments . The clinical parameters recorded were maximal mouth opening ( MMO ) , pain intensity on a visual analog scale ( VAS ) , and modified Helkimo 's clinical dysfunction index and analyzed with ANCOVA . RESULTS Fifty of the superior and 54 of the inferior joint space injection therapy group returned for the 3 and 6 month evaluations ; 86.67 % of the patients were retained in the follow-up . MMO , VAS , and Helkimo 's index of both groups improved at the 3 and 6 month follow-ups . The results of MMO changes and TMJ function were almost the same in both groups at 3 month follow-up . However , there was a significant reduction in TMJ pain in the inferior joint injection group at 3 month follow-up compared with the superior joint injection group ( P < .001 ) . There were also significant differences between the inferior joint injection group and superior joint injection group in MMO ( P < .005 ) , VAS ( P < .001 ) , and Helkimo 's index ( P < .001 ) at 6 month follow-up . CONCLUSION This study showed that inferior joint space injection with sodium hyaluronate is a valid method of treating disc displacement without reduction of TMJ and a long-term study will be needed to assess the effect of inferior joint injection on the morphologic changes of the TMJ 
    Output:
    
Meta- analysis showed that inferior or double spaces injection technique could significantly increase 2.88 mm more maximal mouth opening ( P = .0001 ) and alleviate pain intensity in the temporom and ibular area on average by 9.01 mm visual analog scale scores ( P = .0001 ) compared with superior space injection technique , but could not markedly change synthesized clinical index ( P = .05 ) in the short term ; nevertheless , they showed more beneficial maximal mouth opening ( P = .002 ) , pain relief ( P < .0001 ) , and synthesized clinical variable ( P < .0001 ) in the long term than superior space injection .
Inferior or double temporom and ibular joint spaces drug injection technique shows better effect than superior space injection technique , and their safety is affirmative .