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: Background After menopause , 10–20 % of all women have nearly intolerable hot flushes . Long term use of hormone replacement therapy involves a health risk , and many women seek alternative strategies to relieve climacteric complaints . Acupuncture is one of the most frequently used complementary therapies in Norway . We design ed a study to evaluate whether Traditional Chinese Medicine acupuncture-care together with self-care is more effective than self-care alone to relieve climacteric complaints . Methods / Design The study is a multi-centre pragmatic r and omised controlled trial with two parallel arms . Participants are postmenopausal women who document ≥7 flushes/24 hours and who are not using hormone replacement therapy or other medication that may influence flushes . According to power calculations 200 women are needed to detect a 50 % reduction in flushes , and altogether 286 women will be recruited to allow for a 30 % dropout rate . The treatment group receives 10 sessions of Traditional Chinese Medicine acupuncture-care and self-care ; the control group will engage in self-care only . A team of experienced Traditional Chinese Medicine acupuncturists give acupuncture treatments . Discussion The study tests acupuncture as a complete treatment package including the therapeutic relationship and expectation . The intervention period lasts for 12 weeks , with follow up at 6 and 12 months . Primary endpoint is change in daily hot flush frequency in the two groups from baseline to 12 weeks ; secondary endpoint is health related quality of life , assessed by the Women 's Health Question naire . We also collect data on Traditional Chinese Medicine diagnoses , and we examine treatment experiences using a qualitative approach . Finally we measure biological variables , to examine potential mechanisms for the effect of acupuncture . The study is funded by The Research Council of Norway PURPOSE To determine the immediate and long-term effects of true acupuncture versus sham acupuncture on hot flash frequency in women with breast cancer . PATIENTS AND METHODS Seventy-two women with breast cancer experiencing three or more hot flashes per day were r and omly assigned to receive either true or sham acupuncture . Interventions were given twice weekly for 4 consecutive weeks . Hot flash frequency was evaluated at baseline , at 6 weeks , and at 6 months after initiation of treatment . Patients initially r and omly assigned to the sham group were crossed over to true acupuncture starting at week 7 . RESULTS The mean number of hot flashes per day was reduced from 8.7 ( st and ard deviation [ SD ] , 3.9 ) to 6.2 ( SD , 4.2 ) in the true acupuncture group and from 10.0 ( SD , 6.1 ) to 7.6 ( SD , 5.7 ) in the sham group . True acupuncture was associated with 0.8 fewer hot flashes per day than sham at 6 weeks , but the difference did not reach statistical significance ( 95 % CI , -0.7 to 2.4 ; P = .3 ) . When participants in the sham acupuncture group were crossed over to true acupuncture , a further reduction in the frequency of hot flashes was seen . This reduction in hot flash frequency persisted for up to 6 months after the completion of treatment . CONCLUSION Hot flash frequency in breast cancer patients was reduced following acupuncture . However , when compared with sham acupuncture , the reduction by the acupuncture regimen as provided in the current study did not reach statistical significance . We can not exclude the possibility that a longer and more intense acupuncture intervention could produce a larger reduction of these symptoms Background Clinical studies suggest that acupuncture can stimulate  saliva production  and reduce xerostomia ( dry mouth ) . We were interested in exploring the neuronal substrates involved in such responses . Methods In a r and omized , sham acupuncture controlled , subject blinded trial , twenty healthy volunteers received true and sham acupuncture  in r and om order . Cortical regions that were activated or deactivated during the interventions were evaluated by functional magnetic resonance imaging ( fMRI ) . Saliva production was also measured . Results Unilateral manual acupuncture stimulation at LI-2 , a point commonly used in clinical practice to treat xerostomia , was associated with bilateral activation of the insula and adjacent operculum . Sham acupuncture at an adjacent site induced neither activation nor deactivation .  True acupuncture induced more saliva production than sham acupuncture . Conclusion Acupuncture at LI-2 was associated with neuronal activations absent during sham acupuncture stimulation . Neuroimaging signal changes appear correlated to saliva production PURPOSE The purpose is to investigate an additional antiemetic effect to ondansetron with needle acupuncture at P6 compared with nonskin-penetrating placebo acupuncture in patients undergoing high-dose chemotherapy and autologous peripheral blood stem cell transplantation . EXPERIMENTAL DESIGN Eighty patients who were admitted to hospital for high-dose chemotherapy and autologous peripheral blood stem cell transplantation were included into a r and omized placebo-controlled single-blind trial . The patients were r and omized to receive acupuncture ( n = 41 ) or noninvasive placebo acupuncture ( n = 39 ) at the acupuncture point P6 30 min before first application of high-dose chemotherapy and the day after . All patients received 8 mg ondansetron/day i.v . as basic antiemetic prophylaxis . The main outcome measure was the rate of patients who either had at least one episode of vomiting or required any additional antiemetic drugs on the first 2 days of chemotherapy . RESULTS The main outcome measure showed no significant difference ( P = 0.82 ) : 61 % failure in the acupuncture group and 64 % in the placebo acupuncture group ( 95 % confidence interval of 3 % difference : -18.1 and 24.3 % ) . Comparing nausea , episodes of vomiting or retching and number of additionally required antiemetic drugs did not provide any discrepancy with the main result . CONCLUSIONS This study suggests that in combination with ondansetron i.v . , invasive needle acupuncture at P6 compared with nonskin-penetrating placebo acupuncture has no additional effect for the prevention of acute nausea and vomiting in high-dose chemotherapy The aim of this study was to evaluate the effectiveness of  acupuncture  in minimizing the severity of radiation-induced xerostomia in patients with head and neck cancer . A total of 24 consecutive patients receiving > 5000 cGy radiotherapy ( RT ) involving the major salivary gl and s bilaterally were assigned to either the preventive acupuncture group ( PA , n = 12 ) , treated with acupuncture before and during RT , or the control group ( CT , n = 12 ) , treated with RT and not receiving acupuncture . After RT completion , clinical response was assessed in all patients by syalometry , measuring the resting ( RSFR ) and stimulated ( SSFR ) salivary flow rates , and by the visual analogue scale ( VAS ) regarding dry mouth-related symptoms . Statistical analyses were performed with repeated- measures using a mixed-effect modeling procedure and analysis of variance . An alpha level of 0.05 was accepted for statistical significance . Although all patients exhibited some degree of impairment in salivary gl and functioning after RT , significant differences were found between the groups . Patients in the PA group showed improved salivary flow rates ( RSFR , SSFR ; p < 0.001 ) and decreased xerostomia-related symptoms ( VAS , p < 0.05 ) compared with patients in the CT group . Although PA treatment did not prevent the oral sequelae of RT completely , it significantly minimized the severity of radiation-induced xerostomia . The results suggest that acupuncture focused in a preventive approach can be a useful therapy in the management of patients with head and neck cancer undergoing RT Background It is not known whether or not delivering acupuncture triggers mechanisms cited as placebo and if acupuncture or sham reduces radiotherapy-induced emesis more than st and ard care . Methodology /Principal Findings Cancer patients receiving radiotherapy over abdominal/pelvic regions were r and omized to  verum ( penetrating ) acupuncture ( n = 109 ; 99 provided data ) in the alleged antiemetic acupuncture point PC6 or sham acupuncture  ( n = 106 ; 101 provided data ) performed with a telescopic non-penetrating needle at a sham point 2–3 times/week during the whole radiotherapy period . The acupuncture cohort was compared to a reference  cohort receiving st and ard care ( n = 62 ; 62 provided data ) . The occurrence of emesis in each group was compared after a mean dose of 27 Gray . Nausea and vomiting were experienced during the preceding week by 37 and 8 % in the verum acupuncture group , 38 and 7 % in the sham acupuncture group and 63 and 15 % in the st and ard care group , respectively . The lower occurrence of nausea in the acupuncture cohort ( verum and sham ) compared to patients receiving st and ard care ( 37 % versus 63 % , relative risk ( RR ) 0.6 , 95 % confidence interval ( CI ) 0.5–0.8 ) was also true after adjustment for potential confounding factors for nausea ( RR 0.8 , CI 0.6 to 0.9 ) . Nausea intensity was lower in the acupuncture cohort ( 78 % no nausea , 13 % a little , 8 % moderate , 1 % much ) compared to the st and ard care cohort ( 52 % no nausea , 32 % a little , 15 % moderate , 2 % much ) ( p = 0.002 ) . The acupuncture cohort expected antiemetic effects from their treatment ( 95 % ) . Patients who expected nausea had increased risk for nausea compared to patients who expected low risk for nausea ( RR 1.6 ; Cl 1.2–2.4 ) . Conclusions / Significance Patients treated with verum or sham acupuncture experienced less nausea and vomiting compared to patients receiving st and ard care , possibly through a general care effect or due to the high level of patient expectancy . Trial Registration Clinical Trials.gov BACKGROUND Nausea , and to a lesser extend vomiting , remain significant clinical problems after the administration of chemotherapy , with up to 60 % of patients reporting nausea despite use of antiemetics . Combining antiemetics with other non-pharmacological treatments may prove more effective in decreasing nausea than antiemetics alone . Hence , the aim of the current study was to evaluate the effectiveness of using acupressure in Pericardium 6 ( Neiguan ) acu-point in managing chemotherapy-induced nausea and vomiting . METHODS This was a r and omised controlled trial . Acupressure was applied using wristb and s ( Sea-B and ) which patients in the experimental group had to wear for the 5 days following the chemotherapy administration . Assessment s of nausea , retching and vomiting were obtained from all patients daily for 5 days . Thirty-six patients completed the study from two centres in the UK , with 19 patients allocated to the control arm and 17 to the experimental arm . RESULTS It was found that nausea and retching experience , and nausea , vomiting and retching occurrence and distress were all significantly lower in the experimental group compared to the control group ( P<0.05 ) . The only exception was with the vomiting experience , which was close to significance ( P=0.06 ) . DISCUSSION Results highlight the important role of safe and convenient non-pharmacological complementary therapies , such as acupressure , in the management of the complex symptoms of chemotherapy-related nausea and vomiting BACKGROUND It is not known if verum ( real ) acupuncture is effective for nausea and vomiting ( emesis ) during radiotherapy . PATIENTS AND METHODS We r and omly treated 215 blinded cancer patients with verum : penetrating ' deqi ' creating acupuncture ( n = 109 ) or non-penetrating sham needles ( n = 106 ) two to three times per week . The patients documented emesis daily during the radiotherapy period . Primary end point was the number of patients with at least one episode of nausea . RESULTS In the verum and the sham acupuncture group , 70 % and 62 % experienced nausea at least once during the radiotherapy period ( relative risk 1.1 , 95 % CI 0.9 - 1.4 ) for a mean number of 10.1 and 8.7 days . Twenty five percent and 28 % vomited , and 42 % and 37 % used  antiemetic drugs  at least once , respectively . Ninety-five percent in the verum acupuncture group and 96 % in the sham acupuncture group believed that the treatment had been effective against nausea . In both groups , 67 % experienced positive effects on relaxation , mood , sleep or pain reduction and 89 % wished to receive the treatment again . CONCLUSION Acupuncture creating deqi is not more effective than sham in radiotherapy-induced nausea , but in this study , nearly all patients in both groups experienced that the treatment was effective for nausea PURPOSE Women with breast cancer ( BC ) treated with aromatase inhibitors ( AIs ) may experience joint symptoms that can lead to discontinuation of effective therapy . We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC . METHODS We conducted a r and omized , controlled , blinded study comparing true acupuncture ( TA ) versus sham acupuncture ( SA ) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs .  T 
    Output:
    
agent
***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: Background After menopause , 10–20 % of all women have nearly intolerable hot flushes . Long term use of hormone replacement therapy involves a health risk , and many women seek alternative strategies to relieve climacteric complaints . Acupuncture is one of the most frequently used complementary therapies in Norway . We design ed a study to evaluate whether Traditional Chinese Medicine acupuncture-care together with self-care is more effective than self-care alone to relieve climacteric complaints . Methods / Design The study is a multi-centre pragmatic r and omised controlled trial with two parallel arms . Participants are postmenopausal women who document ≥7 flushes/24 hours and who are not using hormone replacement therapy or other medication that may influence flushes . According to power calculations 200 women are needed to detect a 50 % reduction in flushes , and altogether 286 women will be recruited to allow for a 30 % dropout rate . The treatment group receives 10 sessions of Traditional Chinese Medicine acupuncture-care and self-care ; the control group will engage in self-care only . A team of experienced Traditional Chinese Medicine acupuncturists give acupuncture treatments . Discussion The study tests acupuncture as a complete treatment package including the therapeutic relationship and expectation . The intervention period lasts for 12 weeks , with follow up at 6 and 12 months . Primary endpoint is change in daily hot flush frequency in the two groups from baseline to 12 weeks ; secondary endpoint is health related quality of life , assessed by the Women 's Health Question naire . We also collect data on Traditional Chinese Medicine diagnoses , and we examine treatment experiences using a qualitative approach . Finally we measure biological variables , to examine potential mechanisms for the effect of acupuncture . The study is funded by The Research Council of Norway PURPOSE To determine the immediate and long-term effects of true acupuncture versus sham acupuncture on hot flash frequency in women with breast cancer . PATIENTS AND METHODS Seventy-two women with breast cancer experiencing three or more hot flashes per day were r and omly assigned to receive either true or sham acupuncture . Interventions were given twice weekly for 4 consecutive weeks . Hot flash frequency was evaluated at baseline , at 6 weeks , and at 6 months after initiation of treatment . Patients initially r and omly assigned to the sham group were crossed over to true acupuncture starting at week 7 . RESULTS The mean number of hot flashes per day was reduced from 8.7 ( st and ard deviation [ SD ] , 3.9 ) to 6.2 ( SD , 4.2 ) in the true acupuncture group and from 10.0 ( SD , 6.1 ) to 7.6 ( SD , 5.7 ) in the sham group . True acupuncture was associated with 0.8 fewer hot flashes per day than sham at 6 weeks , but the difference did not reach statistical significance ( 95 % CI , -0.7 to 2.4 ; P = .3 ) . When participants in the sham acupuncture group were crossed over to true acupuncture , a further reduction in the frequency of hot flashes was seen . This reduction in hot flash frequency persisted for up to 6 months after the completion of treatment . CONCLUSION Hot flash frequency in breast cancer patients was reduced following acupuncture . However , when compared with sham acupuncture , the reduction by the acupuncture regimen as provided in the current study did not reach statistical significance . We can not exclude the possibility that a longer and more intense acupuncture intervention could produce a larger reduction of these symptoms Background Clinical studies suggest that acupuncture can stimulate  saliva production  and reduce xerostomia ( dry mouth ) . We were interested in exploring the neuronal substrates involved in such responses . Methods In a r and omized , sham acupuncture controlled , subject blinded trial , twenty healthy volunteers received true and sham acupuncture  in r and om order . Cortical regions that were activated or deactivated during the interventions were evaluated by functional magnetic resonance imaging ( fMRI ) . Saliva production was also measured . Results Unilateral manual acupuncture stimulation at LI-2 , a point commonly used in clinical practice to treat xerostomia , was associated with bilateral activation of the insula and adjacent operculum . Sham acupuncture at an adjacent site induced neither activation nor deactivation .  True acupuncture induced more saliva production than sham acupuncture . Conclusion Acupuncture at LI-2 was associated with neuronal activations absent during sham acupuncture stimulation . Neuroimaging signal changes appear correlated to saliva production PURPOSE The purpose is to investigate an additional antiemetic effect to ondansetron with needle acupuncture at P6 compared with nonskin-penetrating placebo acupuncture in patients undergoing high-dose chemotherapy and autologous peripheral blood stem cell transplantation . EXPERIMENTAL DESIGN Eighty patients who were admitted to hospital for high-dose chemotherapy and autologous peripheral blood stem cell transplantation were included into a r and omized placebo-controlled single-blind trial . The patients were r and omized to receive acupuncture ( n = 41 ) or noninvasive placebo acupuncture ( n = 39 ) at the acupuncture point P6 30 min before first application of high-dose chemotherapy and the day after . All patients received 8 mg ondansetron/day i.v . as basic antiemetic prophylaxis . The main outcome measure was the rate of patients who either had at least one episode of vomiting or required any additional antiemetic drugs on the first 2 days of chemotherapy . RESULTS The main outcome measure showed no significant difference ( P = 0.82 ) : 61 % failure in the acupuncture group and 64 % in the placebo acupuncture group ( 95 % confidence interval of 3 % difference : -18.1 and 24.3 % ) . Comparing nausea , episodes of vomiting or retching and number of additionally required antiemetic drugs did not provide any discrepancy with the main result . CONCLUSIONS This study suggests that in combination with ondansetron i.v . , invasive needle acupuncture at P6 compared with nonskin-penetrating placebo acupuncture has no additional effect for the prevention of acute nausea and vomiting in high-dose chemotherapy The aim of this study was to evaluate the effectiveness of  acupuncture  in minimizing the severity of radiation-induced xerostomia in patients with head and neck cancer . A total of 24 consecutive patients receiving > 5000 cGy radiotherapy ( RT ) involving the major salivary gl and s bilaterally were assigned to either the preventive acupuncture group ( PA , n = 12 ) , treated with acupuncture before and during RT , or the control group ( CT , n = 12 ) , treated with RT and not receiving acupuncture . After RT completion , clinical response was assessed in all patients by syalometry , measuring the resting ( RSFR ) and stimulated ( SSFR ) salivary flow rates , and by the visual analogue scale ( VAS ) regarding dry mouth-related symptoms . Statistical analyses were performed with repeated- measures using a mixed-effect modeling procedure and analysis of variance . An alpha level of 0.05 was accepted for statistical significance . Although all patients exhibited some degree of impairment in salivary gl and functioning after RT , significant differences were found between the groups . Patients in the PA group showed improved salivary flow rates ( RSFR , SSFR ; p < 0.001 ) and decreased xerostomia-related symptoms ( VAS , p < 0.05 ) compared with patients in the CT group . Although PA treatment did not prevent the oral sequelae of RT completely , it significantly minimized the severity of radiation-induced xerostomia . The results suggest that acupuncture focused in a preventive approach can be a useful therapy in the management of patients with head and neck cancer undergoing RT Background It is not known whether or not delivering acupuncture triggers mechanisms cited as placebo and if acupuncture or sham reduces radiotherapy-induced emesis more than st and ard care . Methodology /Principal Findings Cancer patients receiving radiotherapy over abdominal/pelvic regions were r and omized to  verum ( penetrating ) acupuncture ( n = 109 ; 99 provided data ) in the alleged antiemetic acupuncture point PC6 or sham acupuncture  ( n = 106 ; 101 provided data ) performed with a telescopic non-penetrating needle at a sham point 2–3 times/week during the whole radiotherapy period . The acupuncture cohort was compared to a reference  cohort receiving st and ard care ( n = 62 ; 62 provided data ) . The occurrence of emesis in each group was compared after a mean dose of 27 Gray . Nausea and vomiting were experienced during the preceding week by 37 and 8 % in the verum acupuncture group , 38 and 7 % in the sham acupuncture group and 63 and 15 % in the st and ard care group , respectively . The lower occurrence of nausea in the acupuncture cohort ( verum and sham ) compared to patients receiving st and ard care ( 37 % versus 63 % , relative risk ( RR ) 0.6 , 95 % confidence interval ( CI ) 0.5–0.8 ) was also true after adjustment for potential confounding factors for nausea ( RR 0.8 , CI 0.6 to 0.9 ) . Nausea intensity was lower in the acupuncture cohort ( 78 % no nausea , 13 % a little , 8 % moderate , 1 % much ) compared to the st and ard care cohort ( 52 % no nausea , 32 % a little , 15 % moderate , 2 % much ) ( p = 0.002 ) . The acupuncture cohort expected antiemetic effects from their treatment ( 95 % ) . Patients who expected nausea had increased risk for nausea compared to patients who expected low risk for nausea ( RR 1.6 ; Cl 1.2–2.4 ) . Conclusions / Significance Patients treated with verum or sham acupuncture experienced less nausea and vomiting compared to patients receiving st and ard care , possibly through a general care effect or due to the high level of patient expectancy . Trial Registration Clinical Trials.gov BACKGROUND Nausea , and to a lesser extend vomiting , remain significant clinical problems after the administration of chemotherapy , with up to 60 % of patients reporting nausea despite use of antiemetics . Combining antiemetics with other non-pharmacological treatments may prove more effective in decreasing nausea than antiemetics alone . Hence , the aim of the current study was to evaluate the effectiveness of using acupressure in Pericardium 6 ( Neiguan ) acu-point in managing chemotherapy-induced nausea and vomiting . METHODS This was a r and omised controlled trial . Acupressure was applied using wristb and s ( Sea-B and ) which patients in the experimental group had to wear for the 5 days following the chemotherapy administration . Assessment s of nausea , retching and vomiting were obtained from all patients daily for 5 days . Thirty-six patients completed the study from two centres in the UK , with 19 patients allocated to the control arm and 17 to the experimental arm . RESULTS It was found that nausea and retching experience , and nausea , vomiting and retching occurrence and distress were all significantly lower in the experimental group compared to the control group ( P<0.05 ) . The only exception was with the vomiting experience , which was close to significance ( P=0.06 ) . DISCUSSION Results highlight the important role of safe and convenient non-pharmacological complementary therapies , such as acupressure , in the management of the complex symptoms of chemotherapy-related nausea and vomiting BACKGROUND It is not known if verum ( real ) acupuncture is effective for nausea and vomiting ( emesis ) during radiotherapy . PATIENTS AND METHODS We r and omly treated 215 blinded cancer patients with verum : penetrating ' deqi ' creating acupuncture ( n = 109 ) or non-penetrating sham needles ( n = 106 ) two to three times per week . The patients documented emesis daily during the radiotherapy period . Primary end point was the number of patients with at least one episode of nausea . RESULTS In the verum and the sham acupuncture group , 70 % and 62 % experienced nausea at least once during the radiotherapy period ( relative risk 1.1 , 95 % CI 0.9 - 1.4 ) for a mean number of 10.1 and 8.7 days . Twenty five percent and 28 % vomited , and 42 % and 37 % used  antiemetic drugs  at least once , respectively . Ninety-five percent in the verum acupuncture group and 96 % in the sham acupuncture group believed that the treatment had been effective against nausea . In both groups , 67 % experienced positive effects on relaxation , mood , sleep or pain reduction and 89 % wished to receive the treatment again . CONCLUSION Acupuncture creating deqi is not more effective than sham in radiotherapy-induced nausea , but in this study , nearly all patients in both groups experienced that the treatment was effective for nausea PURPOSE Women with breast cancer ( BC ) treated with aromatase inhibitors ( AIs ) may experience joint symptoms that can lead to discontinuation of effective therapy . We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC . METHODS We conducted a r and omized , controlled , blinded study comparing true acupuncture ( TA ) versus sham acupuncture ( SA ) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs .  T 
    Output:
    