human
***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: OBJECTIVE The objective of this study was to compare immediate effect of acupuncture at SP6 on uterine arterial blood flow in primary dysmenorrhea with that of GB39 . DESIGN This was a prospect i ve , r and omized clinical trial . SETTING Sixty-six ( 66 ) patients with primary dysmenorrhea from the Affiliated Hospital of Shangdong University of Traditional Chinese Medicine were recruited . INTERVENTIONS The SP6 group ( n = 32 ) was treated with manual acupuncture at bilateral SP6 for 5 minutes after obtaining needling sensation ( de qi ) during the period of menstrual pain , whereas the control group ( n = 34 ) was needled at GB39 of both sides for 5 minutes when they suffered menstrual pain . MAIN OUTCOME MEASURES Differences in pulsatility index ( PI ) , resistance index ( RI ) , and ratio of systolic peak and diastolic peak ( A/B ) in uterine arteries were the main outcome measures . RESULTS Highly significant reductions were observed in the SP6 treatment group 5 minutes after treatment in menstrual pain scores ( 8.17 ± 1.90 versus 11.20 ± 2.66 ; p < 0.001 ) , values of PI ( 1.75 ± 0.48 versus 2.32 ± 0.70 ; p < 0.001 ) , RI ( 0.72 ± 0.11 versus 0.78 ± 0.07 ; p < 0.001 ) , and A/B ( 4.33 ± 1.37 versus 5.23 ± 1.67 ; p < 0.001 ) . Compared with the GB39 control group , patients in the SP6 treatment group showed significant reductions in 5 minutes after treatment in the changes of menstrual pain scores ( 3.03 ± 2.36 versus 0.00 ± 0.29 ; p < 0.001 ) , values of PI ( 0.57 ± 0.42 versus -0.10 ± 0.58 ; p < 0.001 ) , RI ( 0.06 ± 0.08 versus -0.03 ± 0.15 ; p < 0.01 ) , and A/B ( 0.90 ± 0.87 versus 0.23 ± 1.02 ; p < 0.01 ) . There were no significant changes in menstrual pain scores , values of PI , RI , or A/B before and after treatment in the GB39 control group ( p > 0.05 ) . No adverse events from treatment were reported . CONCLUSIONS This study suggests that needling at SP6 can immediately improve uterine arterial blood flow of patients with primary dysmenorrhea , while GB39 does not have these effects Background Though moxibustion is frequently used to treat primary dysmenorrhea in China , relevant evidence supporting its effectiveness is still scanty . Methods This study was a pragmatic r and omized , conventional drug controlled , open-labeled clinical trial . After initial screen , 152 eligible participants were averagely r and omized to receive two different treatment strategies : Moxibustion and conventional drugs . Participants and practitioners were not blinded in this study . The duration of each treatment was 3 months . The primary outcome was pain relief measured by the Visual Analogue Scale . The menstrual pain severity was recorded in a menstrual pain diary . Results 152 eligible patients were included but only 133 of them eventually completed the whole treatment course . The results showed that the menstrual pain intensity in experimental group and control group was reduced from 6.38±1.28 and 6.41±1.29 , respectively , at baseline , to 2.54±1.41 and 2.47±1.29 after treatment . The pain reduction was not significantly different between these two groups ( P = 0.76 ) , however ; the pain intensity was significantly reduced relative to baseline for each group ( P<0.01 ) . Three months after treatment , the effectiveness of moxibustion sustained and started to be superior to the drug ’s effect ( -0.87 , 95%CI -1.32 to -0.42 , P<0.01 ) . Secondary outcome analyses showed that moxibustion  was as effective as drugs in alleviating menstrual pain-related symptoms . The serum levels of pain mediators , such as PGF2α , OT , vWF , β-EP , PGE2 , were significantly improved after treatment in both groups ( P<0.05 ) . No adverse events were reported in this trial . Conclusions Both moxibustion and conventional drug showed desirable merits in managing menstrual pain , given their treatment effects and economic costs . This study as a pragmatic trial only demonstrates the effectiveness , not the efficacy , of moxibustion for menstrual pain . It ca n’t rule out the effect of psychological factors during treatment process , because no blind procedure or sham control was used due to availability . In clinical practice , moxibustion should be used at the discretion of patients and their physicians . Trial registration ClinialTrials.gov Background The heterogeneity statistic I2 , interpreted as the percentage of variability due to heterogeneity between studies rather than sampling error , depends on precision , that is , the size of the studies included . Methods Based on a real meta- analysis , we simulate artificially ' inflating ' the sample size under the r and om effects model . For a given inflation factor M = 1 , 2 , 3 , ... and for each trial i , we create a M-inflated trial by drawing a treatment effect estimate from the r and om effects model , using si2MathType@MTEF@5@5@+=feaagaart1ev2aaatCvAUfKttLearuWrP9MDH5MBPbIqV92AaeXatLxBI9gBaebbnrfifHhDYfgasaacPC6xNi = xH8viVGI8Gi = hEeeu0xXdbba9frFj0xb9qqpG0dXdb9aspeI8k8fiI+fsY = rqGqVepae9pg0db9vqaiVgFr0xfr = xfr = xc9adbaqaaeGaciGaaiaabeqaaeqabiWaaaGcbaGaem4Cam3aa0baaSqaaiabdMgaPbqaaiabikdaYaaaaaa@2FBE@/M as within-trial sampling variance . Results As precision increases , while estimates of the heterogeneity variance τ2 remain unchanged on average , estimates of I2 increase rapidly to nearly 100 % . A similar phenomenon is apparent in a sample of 157 meta-analyses . Conclusion When deciding whether or not to pool treatment estimates in a meta- analysis , the yard-stick should be the clinical relevance of any heterogeneity present . τ2 , rather than I2 , is the appropriate measure for this purpose Importance Acupuncture is used to induce ovulation in some women with polycystic ovary syndrome , without supporting clinical evidence . Objective To assess whether active acupuncture , either alone or combined with clomiphene , increases the likelihood of live births among women with polycystic ovary syndrome . Design , Setting , and Participants A double-blind ( clomiphene vs placebo ) , single-blind ( active vs control acupuncture ) factorial trial was conducted at 21 sites ( 27 hospitals ) in mainl and China between July 6 , 2012 , and November 18 , 2014 , with 10 months of pregnancy follow-up until October 7 , 2015 . Chinese women with polycystic ovary syndrome were r and omized in a 1:1:1:1 ratio to 4 groups . Interventions Active or control acupuncture administered twice a week for 30 minutes per treatment and clomiphene or placebo administered for 5 days per cycle , for up to 4 cycles . The active acupuncture group received deep needle insertion with combined manual and low-frequency electrical stimulation ; the control acupuncture group received superficial needle insertion , no manual stimulation , and mock electricity . Main Outcomes and Measures The primary outcome was live birth . Secondary outcomes included adverse events . Results Among the 1000 r and omized women ( mean [ SD ] age , 27.9 [ 3.3 ] years ; mean [ SD ] body mass index , 24.2 [ 4.3 ] ) , 250 were r and omized to each group ; a total of 926 women ( 92.6 % ) completed the trial .  Live births occurred in 69 of 235 women ( 29.4 % ) in the active acupuncture plus clomiphene group , 66 of 236 ( 28.0 % ) in the control acupuncture plus clomiphene group , 31 of 223 ( 13.9 % ) in the active acupuncture plus placebo group , and 39 of 232 ( 16.8 % ) in the control acupuncture plus placebo group . There was no significant interaction between active acupuncture and clomiphene ( P = .39 ) , so main effects were evaluated . The live birth rate was significantly higher in the women treated with clomiphene than with placebo ( 135 of 471 [ 28.7 % ] vs 70 of 455 [ 15.4 % ] , respectively ; difference , 13.3 % ; 95 % CI , 8.0 % to 18.5 % ) and not significantly different between women treated with active vs control acupuncture ( 100 of 458 [ 21.8 % ] vs 105 of 468 [ 22.4 % ] , respectively ; difference , −0.6 % ; 95 % CI , −5.9 % to 4.7 % ) . Diarrhea and bruising were more common in patients receiving active acupuncture than control acupuncture ( diarrhea : 25 of 500 [ 5.0 % ] vs 8 of 500 [ 1.6 % ] , respectively ; difference , 3.4 % ; 95 % CI , 1.2 % to 5.6 % ; bruising : 37 of 500 [ 7.4 % ] vs 9 of 500 [ 1.8 % ] , respectively ; difference , 5.6 % ; 95 % CI , 3.0 % to 8.2 % ) . Conclusions and Relevance Among Chinese women with polycystic ovary syndrome , the use of acupuncture with or without clomiphene , compared with control acupuncture and placebo , did not increase live births . This finding does not support acupuncture as an infertility treatment in such women . Trial Registration clinical trials.gov Identifier : OBJECTIVE To observe the clinical therapeutic effects of acupuncture at single point Shiqizhui ( EX-B8 ) and multi-points in time-varying treatment for primary dysmenorrhea . METHODS 600 patients with primary dysmenorrhea were r and omly assigned to the single point group ( n=200 ) including group A ( treating before the menstruation , n=100 ) and group B ( immediately treating as soon as pain occurrence , n=100 ) , the multi-points group ( n=200 ) including group C ( treating before the menstruation , n=100 ) and group D ( immediately treating as soon as pain occurrence , n=100 ) , or the control group , group E ( n=200 , no treatment ) . The therapeutic effects were analyzed after treatment for three menstrual cycles and interviewed for three follow-up periods . RESULTS Acupuncture could effectively relieve menstrual pain for primary dysmenorrhea compared with the control group ( P<0.05 , P<0.01 ) . Immediate pain relief occurred following acupuncture within 5 min in group B ( P<0.01 ) and group D ( P<0.01 ) , and the two groups obviously relieved menstrual pain for VAS scores . Both group A and group C obviously relieved menstrual pain ( P<0.01 ) , and group C was better than group A ( P<0.05 ) . Compared with group D , Group C was much better for CMSS scores in cycle 1 . CONCLUSION Treating before the menstruation is better than immediately treating as soon as pain occurrence at the improvement in symptoms of dysmenorrheal at multi-points . And single point is better than multi-points when immediately treating as soon as pain occurrence . The present trial suggest Shiqizhui ( EX-B8 ) should be chosen as a convenient point BACKGROUND Acupuncture is often used for primary dysmenorrhea . But there is no convincing evidence due to low method ological quality . We aim to assess immediate effect of acupuncture at specific acupoint compared with unrelated acupoint and nonacupoint on primary dysmenorrhea . METHODS The Acupuncture Analgesia Effect in Primary Dysmenorrhoea-II is a multicenter controlled trial conducted in six large hospitals of China . Patients who met inclusion criteria were r and omly assigned to classic acupoint ( N = 167 ) , unrelated acupoint ( N = 167 ) , or non-acupoint ( N = 167 ) group on a 1:1:1 basis . They received three sessions with electro-acupuncture at a classic acupoint ( Sanyinjiao , SP6 ) , or an unrelated acupoint ( Xuanzhong , GB39 ) , or nonacupoint location , respectively . The primary outcome was subjective pain as measured by a 100-mm visual analog scale ( VAS ) . Measurements were obtained at 0 , 5 , 10 , 30 , and 60 minutes following the first intervention . In addition , patients scored changes of general complaints using Cox 
    Output:
    
agent
EA was superior to pharmacological treatment when the treatment duration lasted for three menstrual cycles , evidence d by significantly higher curative rate .
No statistically significant differences between EA at SP6 and control groups were found regarding the VRS , RSS-COX1 , and RSS-COX2 .
The findings of our study suggested that EA can provide considerable immediate analgesia effect for PD .
***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: OBJECTIVE The objective of this study was to compare immediate effect of acupuncture at SP6 on uterine arterial blood flow in primary dysmenorrhea with that of GB39 . DESIGN This was a prospect i ve , r and omized clinical trial . SETTING Sixty-six ( 66 ) patients with primary dysmenorrhea from the Affiliated Hospital of Shangdong University of Traditional Chinese Medicine were recruited . INTERVENTIONS The SP6 group ( n = 32 ) was treated with manual acupuncture at bilateral SP6 for 5 minutes after obtaining needling sensation ( de qi ) during the period of menstrual pain , whereas the control group ( n = 34 ) was needled at GB39 of both sides for 5 minutes when they suffered menstrual pain . MAIN OUTCOME MEASURES Differences in pulsatility index ( PI ) , resistance index ( RI ) , and ratio of systolic peak and diastolic peak ( A/B ) in uterine arteries were the main outcome measures . RESULTS Highly significant reductions were observed in the SP6 treatment group 5 minutes after treatment in menstrual pain scores ( 8.17 ± 1.90 versus 11.20 ± 2.66 ; p < 0.001 ) , values of PI ( 1.75 ± 0.48 versus 2.32 ± 0.70 ; p < 0.001 ) , RI ( 0.72 ± 0.11 versus 0.78 ± 0.07 ; p < 0.001 ) , and A/B ( 4.33 ± 1.37 versus 5.23 ± 1.67 ; p < 0.001 ) . Compared with the GB39 control group , patients in the SP6 treatment group showed significant reductions in 5 minutes after treatment in the changes of menstrual pain scores ( 3.03 ± 2.36 versus 0.00 ± 0.29 ; p < 0.001 ) , values of PI ( 0.57 ± 0.42 versus -0.10 ± 0.58 ; p < 0.001 ) , RI ( 0.06 ± 0.08 versus -0.03 ± 0.15 ; p < 0.01 ) , and A/B ( 0.90 ± 0.87 versus 0.23 ± 1.02 ; p < 0.01 ) . There were no significant changes in menstrual pain scores , values of PI , RI , or A/B before and after treatment in the GB39 control group ( p > 0.05 ) . No adverse events from treatment were reported . CONCLUSIONS This study suggests that needling at SP6 can immediately improve uterine arterial blood flow of patients with primary dysmenorrhea , while GB39 does not have these effects Background Though moxibustion is frequently used to treat primary dysmenorrhea in China , relevant evidence supporting its effectiveness is still scanty . Methods This study was a pragmatic r and omized , conventional drug controlled , open-labeled clinical trial . After initial screen , 152 eligible participants were averagely r and omized to receive two different treatment strategies : Moxibustion and conventional drugs . Participants and practitioners were not blinded in this study . The duration of each treatment was 3 months . The primary outcome was pain relief measured by the Visual Analogue Scale . The menstrual pain severity was recorded in a menstrual pain diary . Results 152 eligible patients were included but only 133 of them eventually completed the whole treatment course . The results showed that the menstrual pain intensity in experimental group and control group was reduced from 6.38±1.28 and 6.41±1.29 , respectively , at baseline , to 2.54±1.41 and 2.47±1.29 after treatment . The pain reduction was not significantly different between these two groups ( P = 0.76 ) , however ; the pain intensity was significantly reduced relative to baseline for each group ( P<0.01 ) . Three months after treatment , the effectiveness of moxibustion sustained and started to be superior to the drug ’s effect ( -0.87 , 95%CI -1.32 to -0.42 , P<0.01 ) . Secondary outcome analyses showed that moxibustion  was as effective as drugs in alleviating menstrual pain-related symptoms . The serum levels of pain mediators , such as PGF2α , OT , vWF , β-EP , PGE2 , were significantly improved after treatment in both groups ( P<0.05 ) . No adverse events were reported in this trial . Conclusions Both moxibustion and conventional drug showed desirable merits in managing menstrual pain , given their treatment effects and economic costs . This study as a pragmatic trial only demonstrates the effectiveness , not the efficacy , of moxibustion for menstrual pain . It ca n’t rule out the effect of psychological factors during treatment process , because no blind procedure or sham control was used due to availability . In clinical practice , moxibustion should be used at the discretion of patients and their physicians . Trial registration ClinialTrials.gov Background The heterogeneity statistic I2 , interpreted as the percentage of variability due to heterogeneity between studies rather than sampling error , depends on precision , that is , the size of the studies included . Methods Based on a real meta- analysis , we simulate artificially ' inflating ' the sample size under the r and om effects model . For a given inflation factor M = 1 , 2 , 3 , ... and for each trial i , we create a M-inflated trial by drawing a treatment effect estimate from the r and om effects model , using si2MathType@MTEF@5@5@+=feaagaart1ev2aaatCvAUfKttLearuWrP9MDH5MBPbIqV92AaeXatLxBI9gBaebbnrfifHhDYfgasaacPC6xNi = xH8viVGI8Gi = hEeeu0xXdbba9frFj0xb9qqpG0dXdb9aspeI8k8fiI+fsY = rqGqVepae9pg0db9vqaiVgFr0xfr = xfr = xc9adbaqaaeGaciGaaiaabeqaaeqabiWaaaGcbaGaem4Cam3aa0baaSqaaiabdMgaPbqaaiabikdaYaaaaaa@2FBE@/M as within-trial sampling variance . Results As precision increases , while estimates of the heterogeneity variance τ2 remain unchanged on average , estimates of I2 increase rapidly to nearly 100 % . A similar phenomenon is apparent in a sample of 157 meta-analyses . Conclusion When deciding whether or not to pool treatment estimates in a meta- analysis , the yard-stick should be the clinical relevance of any heterogeneity present . τ2 , rather than I2 , is the appropriate measure for this purpose Importance Acupuncture is used to induce ovulation in some women with polycystic ovary syndrome , without supporting clinical evidence . Objective To assess whether active acupuncture , either alone or combined with clomiphene , increases the likelihood of live births among women with polycystic ovary syndrome . Design , Setting , and Participants A double-blind ( clomiphene vs placebo ) , single-blind ( active vs control acupuncture ) factorial trial was conducted at 21 sites ( 27 hospitals ) in mainl and China between July 6 , 2012 , and November 18 , 2014 , with 10 months of pregnancy follow-up until October 7 , 2015 . Chinese women with polycystic ovary syndrome were r and omized in a 1:1:1:1 ratio to 4 groups . Interventions Active or control acupuncture administered twice a week for 30 minutes per treatment and clomiphene or placebo administered for 5 days per cycle , for up to 4 cycles . The active acupuncture group received deep needle insertion with combined manual and low-frequency electrical stimulation ; the control acupuncture group received superficial needle insertion , no manual stimulation , and mock electricity . Main Outcomes and Measures The primary outcome was live birth . Secondary outcomes included adverse events . Results Among the 1000 r and omized women ( mean [ SD ] age , 27.9 [ 3.3 ] years ; mean [ SD ] body mass index , 24.2 [ 4.3 ] ) , 250 were r and omized to each group ; a total of 926 women ( 92.6 % ) completed the trial .  Live births occurred in 69 of 235 women ( 29.4 % ) in the active acupuncture plus clomiphene group , 66 of 236 ( 28.0 % ) in the control acupuncture plus clomiphene group , 31 of 223 ( 13.9 % ) in the active acupuncture plus placebo group , and 39 of 232 ( 16.8 % ) in the control acupuncture plus placebo group . There was no significant interaction between active acupuncture and clomiphene ( P = .39 ) , so main effects were evaluated . The live birth rate was significantly higher in the women treated with clomiphene than with placebo ( 135 of 471 [ 28.7 % ] vs 70 of 455 [ 15.4 % ] , respectively ; difference , 13.3 % ; 95 % CI , 8.0 % to 18.5 % ) and not significantly different between women treated with active vs control acupuncture ( 100 of 458 [ 21.8 % ] vs 105 of 468 [ 22.4 % ] , respectively ; difference , −0.6 % ; 95 % CI , −5.9 % to 4.7 % ) . Diarrhea and bruising were more common in patients receiving active acupuncture than control acupuncture ( diarrhea : 25 of 500 [ 5.0 % ] vs 8 of 500 [ 1.6 % ] , respectively ; difference , 3.4 % ; 95 % CI , 1.2 % to 5.6 % ; bruising : 37 of 500 [ 7.4 % ] vs 9 of 500 [ 1.8 % ] , respectively ; difference , 5.6 % ; 95 % CI , 3.0 % to 8.2 % ) . Conclusions and Relevance Among Chinese women with polycystic ovary syndrome , the use of acupuncture with or without clomiphene , compared with control acupuncture and placebo , did not increase live births . This finding does not support acupuncture as an infertility treatment in such women . Trial Registration clinical trials.gov Identifier : OBJECTIVE To observe the clinical therapeutic effects of acupuncture at single point Shiqizhui ( EX-B8 ) and multi-points in time-varying treatment for primary dysmenorrhea . METHODS 600 patients with primary dysmenorrhea were r and omly assigned to the single point group ( n=200 ) including group A ( treating before the menstruation , n=100 ) and group B ( immediately treating as soon as pain occurrence , n=100 ) , the multi-points group ( n=200 ) including group C ( treating before the menstruation , n=100 ) and group D ( immediately treating as soon as pain occurrence , n=100 ) , or the control group , group E ( n=200 , no treatment ) . The therapeutic effects were analyzed after treatment for three menstrual cycles and interviewed for three follow-up periods . RESULTS Acupuncture could effectively relieve menstrual pain for primary dysmenorrhea compared with the control group ( P<0.05 , P<0.01 ) . Immediate pain relief occurred following acupuncture within 5 min in group B ( P<0.01 ) and group D ( P<0.01 ) , and the two groups obviously relieved menstrual pain for VAS scores . Both group A and group C obviously relieved menstrual pain ( P<0.01 ) , and group C was better than group A ( P<0.05 ) . Compared with group D , Group C was much better for CMSS scores in cycle 1 . CONCLUSION Treating before the menstruation is better than immediately treating as soon as pain occurrence at the improvement in symptoms of dysmenorrheal at multi-points . And single point is better than multi-points when immediately treating as soon as pain occurrence . The present trial suggest Shiqizhui ( EX-B8 ) should be chosen as a convenient point BACKGROUND Acupuncture is often used for primary dysmenorrhea . But there is no convincing evidence due to low method ological quality . We aim to assess immediate effect of acupuncture at specific acupoint compared with unrelated acupoint and nonacupoint on primary dysmenorrhea . METHODS The Acupuncture Analgesia Effect in Primary Dysmenorrhoea-II is a multicenter controlled trial conducted in six large hospitals of China . Patients who met inclusion criteria were r and omly assigned to classic acupoint ( N = 167 ) , unrelated acupoint ( N = 167 ) , or non-acupoint ( N = 167 ) group on a 1:1:1 basis . They received three sessions with electro-acupuncture at a classic acupoint ( Sanyinjiao , SP6 ) , or an unrelated acupoint ( Xuanzhong , GB39 ) , or nonacupoint location , respectively . The primary outcome was subjective pain as measured by a 100-mm visual analog scale ( VAS ) . Measurements were obtained at 0 , 5 , 10 , 30 , and 60 minutes following the first intervention . In addition , patients scored changes of general complaints using Cox 
    Output:
    