***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: A restricted sequential design multicentre controlled trial of yttrium-90 against triamcinolone intra-articularly was undertaken in patients with rheumatoid arthritis with knee involvement . The trial had to be discontinued because of dwindling recruitment over time . The reasons for this and other features contributing to an inconclusive outcome are noted . This experience lends little encouragement to the idea that yttrium-90 therapy is more or less advantageous than triamcinolone hexacetonide The use of irradiation of the synovium in the treatment of rheumatoid arthritis is presented . A colloidal resin of radioactive yttrium ( 90Y ) or saline was injected intra-articularly into 44 knee joints under double blind conditions . Patients selected for treatment had chronic effusions which were resistant to all forms of therapy , other than surgical synovectomy . All patients were followed up for one year . There was a sustained improvement in joint range in 13 cases ( 57 per cent ) and of knee circumference in eight cases ( 35 per cent ) ( P < 0.005 and < 0.05 respectively ) compared with the control . In seven patients ( 30 per cent ) the joint effusion had completely resolved . Intra-articular yttrium had no advantage over saline for the prevention of radiological deterioration of the joint . Irradiation of the synovium produced a significant reduction in the acid phosphatase concentration of the synovial fluid . One-third of the patients developed general and local reactions to the 90Y injection Irradiation of the synovium for the treatment of  chronic knee effusions associated with rheumatoid arthritis and allied conditions is being increasingly used as an alternative to surgical synovectomy . Intraarticular injections of a colloidal solution of radioactive gold ( 19"8Au ) has been tried with some success ( Ansell , Crook , Mallard , and Bywaters , 1963 ; Virkkunen , Krusius , and Heiskanen , 1967 ; Makin and Robin , 1968 ; Grahame , Ramsey , and Scott , 1970 ) . However , as 198Au has a beta-particle maximum range in tissue of only 4 mm . and as the synovium in these chronic knee effusions can attain a thickness of greater than 1 cm . , a complete synovial ablation is not produced . A serious disadvantage of intraarticular 198Au is that there may be marked leakage from the joint to the regional lymph nodes , the liver , and spleen in as many as 36 per cent . of patients so treated ( Virkkunnen and others , 1967 ) . Moreover , radioactive gold possesses a significant gamma-ray component and this gives an unwanted whole body radiation to the patient . Because of these disadvantages it has been suggested that radioactive yttrium ( 90Y ) may be a more suitable agent ( Ansell and others , 1963 ; Grahame and others , 1970 ) . 90Y is a pure beta-emitter with a maximum range in tissue of 10 mm . It has a higher maximum energy than gold , 2 26 MeV compared with 0 9 MeV , and it has a half-life of 2 - 7 days . The whole body distribution of 90Y silicate and  90Y resin after intraarticular injections has been compared ( Prichard , Bridgman , and Bleehen , 1970 ) . It was found that silicate preparations were associated with an appreciable leakage from the joint , but that the resin remained localized . It has also been shown that the 90Y resin was taken up more or less evenly in both normal and inflamed rabbit synovia ( Webb , Lowe , and Bluestone , 1969 ) . We have therefore undertaken a controlled double-blind trial , using intra-articular 90Y resin in the treatment of  chronic knee effusions .  The preliminary results after assessment of all cases 6 months after the intra-articular injections are presented In 66 patients with rheumatoid knee joint synovitis and hydrops and with only slight radiological destruction , local treatment of the knee was r and omly performed either with osmic acid , radioactive yttrium or surgical synovectomy . After a one-year follow-up the clinical and radiological results were slightly better in patients who underwent surgical synovectomy than in other treatment groups . However , radiological osteoarthrosis had progressed more in synovectomized patients than in others . In 2 patients with radioactive yttrium a relapse requiring surgical synovectomy was seen . Because osmic acid is almost as effective as surgical synovectomy , is very cheap and easy to perform , it can be recommended as the first choice for local therapy in patients with corticosteroid-restant knee joint synovitis , in the early stage of the disease Most systematic review s rely substantially on the assessment of the method ological quality of the individual trials . The aim of this study was to obtain consensus among experts about a set of generic core items for quality assessment of r and omized clinical trials ( RCTs ) . The invited participants were experts in the field of quality assessment of RCTs . The initial item pool contained all items from existing criteria lists . Subsequently , we reduced the number of items by using the Delphi consensus technique . Each Delphi round comprised a question naire , an analysis , and a feedback report . The feedback report included staff team decisions made on the basis of the analysis and their justification . A total of 33 international experts agreed to participate , of whom 21 completed all question naires . The initial item pool of 206 items was reduced to 9 items in three Delphi rounds . The final criteria list ( the Delphi list ) was satisfactory to all participants . It is a starting point on the way to a minimum reference st and ard for RCTs on many different research topics . This list is not intended to replace , but rather to be used alongside , existing criteria lists In an open , controlled trial , radioactive 90Yttrium was injected in doses of 3 - 6 mCi into 40 joints with chronic effusions in patients suffering from rheumatoid arthritis and other rheumatoid diseases . The processing in a computer was carried out by the punch card method . Intra-articular administration of 90Y result ed in a significant improvement of five objective criteria . In our study we have paid particular attention to the clinical and statistical differentiation of the effects of systemic , and especially of basic therapy , from the effects of topical intra-articular therapy . At the time of the last check-up examination , 43 % of the patients were free of any effusion .  The treatment was well tolerated . Skin necrosis occurred in only one single case . Intra-articular treatment with radioactive 90Yttrium represents a valuable contribution to the therapeutic arsenal for the treatment of the chronic articular effusions when all other methods of treatment failed The effectiveness of osmic acid and yttrium-90 in the treatment of synovitis of the knee in rheumatoid arthritis is compared in 126 patients followed-up for 3 years . Ninety-one knees were injected with osmic acid and eighty-four knees with yttrium-90 . Osmic acid appeared to be more effective than yttrium-90 throughout the period of the follow-up but the difference only reached statistical significance ( p less than 0.05 ) at 3 years . Both therapies were well tolerated by patients and should be considered as an alternative to operative synovectomy 
    Output:
    
CONCLUSION From the point of view of evidence based medicine it should be seriously question ed whether yttrium synovectomy deserves a place in clinical practice