***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: Introduction Our objective was to compare the effectiveness and safety of traditional Chinese moxibustion to that of sham moxibustion in patients with chronic knee osteoarthritis ( KOA ) pain . Methods We conducted a r and omized placebo-controlled trial involving 110 patients with KOA who met the inclusion criteria . These patients r and omly received either active moxibustion ( n = 55 ) or sham moxibustion control ( n = 55 ) at acupoints Dubi ( ST 35 ) , extra-point Neixiyan ( EX-LE 4 ) , and an Ashi ( tender ) point three times a week for 6 weeks . Effects were evaluated with Western Ontario and McMaster Universities ’ Osteoarthritis Index ( WOMAC VA 3.1 ) criteria at the end of the course of treatment and 3 , 12 , and 24 weeks after the initial treatment . Results The WOMAC pain scores showed greater improvement in the active treatment group than in control at weeks 3 ( P = 0.012 ) , 6 ( P < 0.001 ) , 12 ( P = 0.002 ) , and 24 ( P = 0.002 ) as did WOMAC physical function scores of the active treatment group at week 3 ( P = 0.002 ) , 6 ( P = 0.015 ) , and 12 ( P < 0.001 ) but not 24 ( P = 0.058 ) . Patients and practitioners were blinded successfully , and no significant adverse effects were found during the trial . Conclusions A 6-week course of moxibustion seems to relieve pain effectively and improve function in patients with KOA for up to 18 weeks after the end of treatment . Moxibustion treatment appears to be safe , and the usefulness of the novel moxa device was vali date d . Trial registration Current controlled trial : IS RCT N68475405 . Registered 4 April 2014 Objective . To observe the effects of traditional Chinese moxibustion , compared with sham moxibustion , on the quality of life ( QOL ) in patients with chronic knee osteoarthritis ( KOA ) . Methods . This is a r and omized double-blinded , placebo-controlled trial . 150 patients with KOA were r and omly allocated to either a true moxibustion treatment ( n = 77 ) or a sham moxibustion treatment ( n = 73 ) three times a week for six weeks . The QOL of patients was evaluated with SF-36 at baseline and 3 , 6 , and 12 weeks after baseline . Results . 136 patients were available for analysis . Participants in the true moxibustion group experienced statistically significantly greater improvement in GH ( general health ) scores than the sham group at week 6 ( P = 0.015 ) and week 12 ( P = 0.029 ) . Participants in the true moxibustion group experienced statistically significantly greater improvement in VT ( vitality ) scores than the sham group at week 12 ( P = 0.042 ) . No significant adverse effects were found during the trial . Conclusion . A 6-week moxibustion treatment seems to improve general health and vitality , which are associated with physical and mental quality of life , in patients with KOA up to 12 weeks , relative to credible sham moxibustion . This trial is registered with Clinical trials.gov IS RCT N68475405 Introduction This study tested the effectiveness of moxibustion on pain and function in chronic knee osteoarthritis ( KOA ) and evaluated safety . Methods A multi-centre , non-blinded , parallel-group , r and omised controlled trial compared moxibustion with usual care ( UC ) in KOA . 212 South Korean patients aged 40–70 were recruited from 2011–12 , stratified by mild ( Kellgren/Lawrence scale grade s 0/1 ) and moderate-severe KOA ( grade s 2/3/4 ) , and r and omly allocated to moxibustion  or UC  for four weeks . Moxibustion involved burning mugwort devices over acupuncture and Ashi points in affected knee(s ) . UC was allowed . Korean Western Ontario and McMaster Universities Question naire ( K-WOMAC ) , Short Form 36 Health Survey ( SF-36v2 ) , Beck Depression Inventory ( BDI ) , physical performance test , pain numeric rating scale ( NRS ) and adverse events were evaluated at 5 and 13 weeks . K-WOMAC global score at 5 weeks was the primary outcome . Results 102 patients ( 73 mild , 29 moderate-severe ) were allocated to moxibustion , 110 ( 77 mild , 33 moderate-severe ) to UC . K-WOMAC global score ( moxibustion 25.42+/−SD 19.26 , UC 33.60+/−17.91 , p<0.01 , effect size = 0.0477 ) , NRS ( moxibustion 44.77+/−22.73 , UC 56.23+/−17.71 , p<0.01 , effect size = 0.0073 ) and timed-st and test  ( moxibustion 24.79+/−9.76 , UC 25.24+/−8.84 , p = 0.0486 , effect size = 0.0021 ) were improved by moxibustion at 5 weeks . The primary outcome improved for mild but not moderate-severe KOA . At 13 weeks , moxibustion significantly improved the K-WOMAC global score and NRS .  Moxibustion  improved SF-36 physical component summary ( p = 0.0299 ) , bodily pain ( p = 0.0003 ) , physical functioning ( p = 0.0025 ) and social functioning ( p = 0.0418 ) at 5 weeks , with no difference in mental component summary at 5 and 13 weeks . BDI showed no difference ( p = 0.34 ) at 5 weeks . After 1158 moxibustion treatments , 121 adverse events included first ( n = 6 ) and second degree ( n = 113 ) burns , pruritus and fatigue ( n = 2 ) . Conclusions Moxibustion may improve pain , function and quality of life in KOA patients , but adverse events are common . Limitations included no sham control or blinding . Trial Registration Clinical Research Information Service ( CRIS ) OBJECTIVE To observe the effect of Aconite cake-separated moxibustion on primary knee osteoarthritis of liver and kidney deficiency type . METHODS Fifty-six cases of such disease ( 80 knees ) were r and omly divided into a cake-separated moxibustion group ( 41 knees ) with Neixiyan ( EX-LE 5 ) , Dubi ( ST 35 ) , Yinlingquan ( SP 9 ) etc . selected , and a western medicine group ( 39 knees ) were treated with oral administration of Sodium Diclofenate Slow-released Tablet . RESULTS The cumulative score for symptoms and signs was ( 37.41 + /- 6.61 ) points before treatment and ( 9.37 + /- 8.15 ) points after treatment in the cake-separated moxibustion group and ( 37.64 - 6.00 ) points before treatment and ( 12.05 + /- 8.83 ) points after treatment in the western medicine group , with a very significant difference before and after treatment in the two groups ( P < 0.01 ) ; two months after treatment , it was ( 11.71 + /- 8.69 ) points in the cake-separated moxibustion group and ( 15.95 + /- 9.96 ) points in the western medicine group , the former being better than the latter ( P < 0.05 ) . After the end of treatment , there was no significant difference in the comprehensive therapeutic effect between the two groups ( P > 0.05 ) , the cured and markedly effective rate was 63.4 % in the cake-separated moxibustion group and 48.7 % in the western medicine group , but two months after treatment , the cured and markedly effective rate of 56.1 % in the cake-separated moxibustion group was better than 33.3 % in the western medicine group ( P < 0.05 ) . CONCLUSION Aconite cake-separated moxibustion has an ideal therapeutic effect on primary knee osteoarthritis of liver and kidney deficiency type , and the therapeutic effect at anaphase is better than that of Sodium Diclofenate Slow-released Tablet OBJECTIVE To investigate the role of adenosine tri-phosphate ( ATP ) purinergic signaling in mast cells ( MCs ) modulated by heat to further underst and the molecular mechanisms of moxibustion . METHODS Skin temperatures induced by  monkshood cake moxibustion  were evaluated by measuring the Neiguan acupoint ( PC 6 ) from 31 participants  with a digital thermocouple thermometer . Temperatures of 43 ° C and 52 ° C were applied to cultured human leukemia mast cell line HMC-1 in vitro . Calcium fluorescence was applied to detect intracellular Ca2 + ( [ Ca2 + ] ) . Extracellular ATP contents were measured by luciferin-luciferase assay . RESULTS Maximum skin temperatures mostly ranged from 40 - 45 ° C , but some reached up to 50 ° C . Both 43 ° C and 52 ° C induced MC degranulation , which was accompanied by an increase in [ Ca2 + ] and ATP release . Complexing extracellular Ca2 + with 5 mM ethylene glycol-bis ( β-aminoethyl ether)-N , N , N',N'-tetraacetic acid ( EGTA ) inhibited the noxious , heat-induced elevation of [Ca2+]i and prevented the enhanced ATP secretion by those . cells at 52 ° C , but not 43 ° C . CONCLUSION Monkshood cake moxibustion can generate heat sufficient to trigger cellular events of MCs , including degranulation , [Ca2+]i elevation , and ATP release , suggesting that purinergic signals originating from MCs are possibly the initiating response of acupoints to moxibustion OBJECTIVE To evaluate the clinical efficacy of warm-needling moxibustion for knee osteoarthritis ( KOA ) , and to explore its effects on isokinetic strength of lower limb muscle . METHODS Fifty cases of KOA were r and omly divided into an observation group ( 25 cases ) and a control group ( 21 cases ) , but 4 cases lost contact . The observation group was treated with warm-needling moxibustion at Dubi ( ST 35 ) , Neixiyan ( EX-LE 4 ) , Xuehai ( SP 10 ) , Liangqiu ( ST 34 ) , Yinlingquan ( SP 9 ) , Yanglingquan ( GB 34 ) , Weizhong ( BL 40 ) , Heyang ( BL 55 ) and Fengshi ( GB 31 ) for 40 min per treatment . The first 6 treatments were given once a day , and the last 6 treatments were given once every other day . 12 treatments were taken as one course , and totally 3-week treatment was given . No treatment was given in the control group for 3 weeks . The isokinetic strength of extensor muscle and flexor muscle , including the total work , absolute peak torque ( aPT ) and relative peak torque ( rPT ) , and Western Ontario and McMaster Universities Arthritis Index ( WOMAC ) , and comprehensive efficacy were observed and compared in the two groups . RESULTS Compared before treatment , the total work , aPT and rPT of the extensor and flexor muscle increased significantly after treatment in the observation group ( P<0.01 , P<0.05 ) , but the flextion/extention ratio was lowered ( P<0.05 ) . In the control group , aPT and rPT of flexor muscle were reduced after treatment ( P<0.05 , P<0.01 ) . The total work , aPT and rPT of the extensor muscle in the observation group were higher than those in the control group after treatment ( P<0.05 , P<0.01 ) , but the flextion/extention ratio was lowered ( P<0.05 ) . The item score and total score of WOMAC were reduced in the observation group after treatment ( all P<0.01 ) , but no significant change was observed in the control group ( all P>0.05 ) . The pain score , stiffness scores and total score of WOMAC in the observation group were lower than those in the control group ( P<0.01 , P<0.05 ) ; the score of daily function activities was declined in the observation group , but not significantly different from that in the control group ( P>0.05 ) . The total effective rate was 88.0 % ( 22/25 ) in the observation group . CONCLUSIONS Warm-needling moxibustion could relieve pain , improve function and muscle balance , strengthen extensor and flexor muscle power , especially extensor , which has superior clinical efficacy OBJECTIVE To investigate hip or knee symptoms in older persons from a longitudinal , population perspective , and to determine the impact of persistent hip or knee pain on general health status over time . METHODS A postal question naire was sent to a r and om sample of 5,500 individuals 
    Output:
    
Conclusion Moxibustion treatment for KOA is more effective than the positive control ( western medicine ) or negative control ( placebo moxibustion or no treatment or UC ) , and there were fewer adverse reactions to moxibustion .