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: Objectives We examined the effect of changing treatment timing and the use of manual , electro acupuncture on the symptoms of  primary dysmenorrhea .  Methods A r and omised controlled trial was performed with four arms , low frequency manual acupuncture ( LF-MA ) , high frequency manual acupuncture ( HF-MA ) , low frequency electro acupuncture ( LF-EA ) and high frequency electro acupuncture ( HF-EA ) . A manualised trial protocol was used to allow differentiation and individualized treatment over three months . A total of 74 women were r and omly assigned to one of the four groups ( LF-MA n = 19 , HF-MA n = 18 , LF-EA n = 18 , HF-EA n = 19 ) . Twelve treatments were performed over three menstrual cycles , either once per week ( LF groups ) or three times in the week prior to menses ( HF groups ) . All groups received a treatment in the first 48 hours of menses . The primary outcome was the reduction in peak menstrual pain at 12 months from trial entry . Results During the treatment period and nine month follow-up all groups showed statistically significant ( p < .001 ) reductions in peak and average menstrual pain compared to baseline but there were no differences between groups ( p > 0.05 ) . Health related quality of life increased significantly in six domains in groups having high frequency of treatment compared to two domains in low frequency groups . Manual acupuncture groups required less analgesic medication than electro-acupuncture groups ( p = 0.02 ) . HF-MA was most effective in reducing secondary menstrual symptoms compared to both – EA groups ( p<0.05 ) . Conclusion Acupuncture treatment reduced menstrual pain intensity and duration after three months of treatment and this was sustained for up to one year after trial entry . The effect of changing mode of stimulation or frequency of treatment on menstrual pain was not significant . This may be due to a lack of power . The role of acupuncture stimulation on menstrual pain needs to be investigated in appropriately powered r and omised controlled trials OBJECTIVE To compare the difference in the clinical efficacy on depression with chronic pain between the simple medication of selective serotonin uptake inhibition antidepressants ( SSRIs ) and the combined therapy of acupuncture and SSRIs . METHODS Ninety cases of depression were r and omized into an acupuncture + medication group ( combined therapy of acupuncture and western medication ) and a medication group ( simple medication ) , 45 cases in each one . In the medication group , the western medicine was adopted . According to the condition of disease , SSRIs was prescribed such as fluoxetine and paroxetine . In the acupuncture + medication group , on the basic treatment of western medication , acupuncture was applied to Baihui ( GV 20 ) , Yintang ( GV 29 ) , Shenting ( BL 24 ) , Fengchi ( GB 20 ) , etc . HAMD scale , VAS and SERS were used to evaluate the clinical efficacy in terms of depression symptoms , pain and side reactions of antidepressants before treatment and in the 1st , 2nd and 4th weeks after treatment in the patients and the differences between the two groups . RESULTS The differences in HAMD and VAS scores were not apparent before treatment between the two groups ( P>0.05 ) . HAMD score and VAS score in the 1st , 2nd and 4th weeks of treatment in the acupuncture + medication group were lower apparently than those in the medication group ( all P<0.01 ) . SERS score in the 1st , 2nd and 4th weeks of treatment in the acupuncture + medication group was lower apparently than that in the medication group ( all P<0.01 ) . CONCLUSION Acupuncture enhances the clinical efficacy on depression with chronic pain treated with SSRI antidepressants and reduces the adverse reactions For clinical trials of acupuncture , it would be desirable to have a sham procedure that is indistinguishable from the real treatment , yet inactive . A sham needle has been design ed which telescopes instead of penetrating the skin . The Park Sham Device involves an improved method of supporting the sham needle and requires validation . The objective of these studies was to test whether the sham procedure using the new device was 1 ) indistinguishable from the same procedure using real needles in acupuncture naïve subjects , and 2 ) inactive , where the specific needle sensation ( de qi ) is taken as a surrogate measure of activity . The studies were design ed as subject and assessor blind , r and omised controlled trials . Study 1 ) included 58 patients enrolled in a clinical trial of acupuncture for acute stroke . Study 2 ) included 63 healthy , acupuncture naïve , adult volunteers . The interventions used were real or sham acupuncture using the Park Sham Device . Study 1 ) was set in a district general hospital , and study 2 ) in a university laboratory . The outcome measure in study 1 ) was the form of treatment that patients believed they had received . In study 2 ) the outcome measure was experience of de qi , as judged by three acupuncture experts . No patient in either group ( study 1 ) believed he or she had been treated with the sham needle . In 40 volunteers ( study 2 ) for whom experts achieved consensus , the relative risk of experiencing de qi with real acupuncture to that with sham acupuncture was 15.38 ( 95 % CI 2.26 to 104.86 ) . The inter-rater reliability of all 13 experts ( study 2 ) , calculated from their judgements on 10 subjects selected by r and omisation , was 0.52 ( 95 % CI 0.19 to 0.61 ) . In conclusion , the results suggest that the procedure using the new device is indistinguishable from the same procedure using real needles in acupuncture naïve subjects , and is inactive , where the specific needle sensation ( de qi ) is taken as a surrogate measure of activity . It is therefore a valid control for acupuncture trials . The findings also lend support to the existence of de qi , a major concept underlying traditional Chinese acupuncture In a r and omized controlled trial , Hugh MacPherson and colleagues investigate the effectiveness of acupuncture and counseling compared with usual care alone for the treatment of  depression symptoms  in primary care setting s. Please see later in the article for the Editors ' Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more The CONSORT ( Consoli date d St and ards of Reporting Trials ) statement is used worldwide to improve the reporting of r and omized , controlled trials . Schulz and colleagues describe the latest version , CONSORT 2010 , which up date s the reporting guideline based on new method ological evidence and accumulating experience . OBJECTIVE To evaluate the clinical therapeutic effect of depression treated by acupuncture and electroacupuncture combined with western medicine . METHODS Seventy-five patients were r and omly divided into 3 groups . In control group , 30 cases were treated by SSRI with oral administration ; in observation group 1 , 25 cases were treated by acupuncture therapy combined with SSRI , and Shenting ( GV 24 ) , Baihui ( GV 20 ) , Dazhui ( GV 14 ) , Shendao ( GV 11 ) and Zhiyang ( GV 9 ) etc . were selected with regulating qi needling method ; in observation group 2 , same acupoints were selected with routine needling method , and 20 cases were treated by electroacupuncture therapy combined with SSRI , Baihui ( GV 20 ) and Yintang ( EX-HN 3 ) etc . were treated by electroacupuncture . The clinical therapeutic effects and Hamilton Depression Scale scores were evaluated after 1 , 2 , 4 and 6 weeks treatment . RESULTS The total effective rates of observation group 1 and 2 were 100.0 % , superior to that of 73.3 % in control group ( both P < 0.05 ) . The total scores of HAMD on each time point dropped , and there were significant differences compard with those before treatment in 3 groups ( P < 0.01 , P < 0.05 ) ; the total scores of HAMD after 1 , 2 and 4 weeks improved more obviously than that in control group ( P < 0.01 , P < 0.05 ) , and there was no significant difference among groups after 6 weeks ( all P > 0.05 ) . After one week treatment , the comparison of total scores of HAMD in observation group l and 2 indicated significant differences ( P < 0.05 ) ; after 2 , 4 and 6 weeks treatment , there were no significant differences between groups ( all P > 0.05 ) . CONCLUSION The acupuncture therapy and electroacupuncture combined with western medicine for treating depression have better effects than medicine treatment ; and there is no obvious difference between acupuncture therapy and electroacupuncture therapy , however , the effect works fast by electroacupuncture Objective Recent functional MRI ( fMRI ) studies show that brain activity , including the default mode network ( DMN ) , can be modulated by acupuncture . Conventional means to enhance the neurophysiological ‘ dose ’ of acupuncture , including an increased number of needles and manual needle manipulation , are expected to enhance its physiological effects . The aim of this study was to compare the effects of both methods on brain activity . Methods 58 healthy volunteers were r and omly assigned into four groups that received single needle acupuncture ( SNA , n=15 ) or transcutaneous electrical nerve stimulation ( TENS , n=13 ) as active controls , or enhanced acupuncture by way of three needle acupuncture ( TNA , n=17 ) or SNA plus manual stimulation ( SNA+MS , n=13 ) . Treatment-associated sensations were evaluated using a visual analogue scale . Central responses were recorded before , during , and after treatment at LI4 on the left h and using resting state fMRI . Results TNA and SNA+MS induced DMN-insula activity and extensive DMN activity compared to SNA , despite comparable levels of de qi sensation . The TNA and SNA+MS groups exhibited a delayed and enhanced modulation of the DMN , which was not observed followed SNA and TENS . Furthermore , TNA increased precuneus activity and increased the DMN-related activity of the cuneus and left insula , while SNA+MS increased activity in the right insula . Conclusions The results showed that conventional methods to enhance the acupuncture dose induce different DMN modulatory effects . TNA induces the most extensive DMN modulation , compared with other methods . Conventional methods of enhancing the acupuncture dose could potentially be applied as a means of modulating brain activity Objective To observe the clinical efficacy and adverse reactions of Paroxetine combined with electro-acupuncture ( EA ) in treating depression . Methods Forty-two patients with depression were r and omly assigned to the observation group ( 22 patients ) treated with EA combined with Paroxetine , and the control group ( 20 patients ) treated with Paroxetine alone , and the therapeutic course for both groups was 6 weeks . The therapeutic efficacy and adverse reactions were evaluated with scores by Hamilton depression scale ( HAMD ) and treatment emergent symptoms scale ( TESS ) , respectively . Results HAMD scores determined at the end of the 1st , 2nd , 4th , and 6th week of the treatment course were significantly lower in the observation group than those in the control group ( P<0.05 ) . The significant improvement rate evaluated at the end of the 6-week treatment was remarkably higher in the observation group than that in the control group ( 72.7 % vs 40.0 % ) . No significant difference of TESS scores was found between the two groups . Conclusion EA combined with Paroxetine has better clinical efficacy than that of Paroxetine alone , with milder adverse reaction and quicker initiation of effect Background There is relatively limited knowledge about the practitioners who provide  acupuncture treatment  within the UK , what conditions patients consult for and the treatment provided . Objectives To characterise the conditions treated and by whom , to examine characteristics of the treatment and to explore trends over time . Method A cross-sectional survey of the UK acupuncture practitioners was conducted ; 800 practitioners were selected by computer-generated r and omisation sequences from the four major UK-based professional associations . Data collected on the practitioners included demographic details , association membership , statutorily regulated status , practice setting , style of acupuncture , diagnostic methods and needle response sought . Practitioners recorded details of their 10 most recent patients , including demographic details , primary reason for consulting and lifestyle advice provided . Results 330 practitioners responded comprising doctors ( 29 % ) physiotherapists ( 29 % ) , nurses ( 15 % ) and independent acupuncturists ( 27 % ) : 62 % were women with median age of 48 years . The majority ( 68 % ) practice d in independent setting s and 42 % practice d within the National Health Service . Patients most commonly consulted for low back , neck , shoulder and knee pain , as well as headaches and migraine . Treatment for infertility by independent acupuncturists was found to have increased fivefold in 10 years . Conclusion Acupuncture provides a substantial contribution to the healthcare of the UK , with an estimated 4 million sessions provided annually . The primary complaints for which patients consult reflect the growing evidence base on acupuncture for these conditions . These data provide a basis for decision-making regarding policy and practice BACKGROUND Quality acupuncture influences the outcomes of clinical research , and issues associated with effective administration of acupuncture in r and omized controlled trials need to be addressed when appraising studies 
    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: Objectives We examined the effect of changing treatment timing and the use of manual , electro acupuncture on the symptoms of  primary dysmenorrhea .  Methods A r and omised controlled trial was performed with four arms , low frequency manual acupuncture ( LF-MA ) , high frequency manual acupuncture ( HF-MA ) , low frequency electro acupuncture ( LF-EA ) and high frequency electro acupuncture ( HF-EA ) . A manualised trial protocol was used to allow differentiation and individualized treatment over three months . A total of 74 women were r and omly assigned to one of the four groups ( LF-MA n = 19 , HF-MA n = 18 , LF-EA n = 18 , HF-EA n = 19 ) . Twelve treatments were performed over three menstrual cycles , either once per week ( LF groups ) or three times in the week prior to menses ( HF groups ) . All groups received a treatment in the first 48 hours of menses . The primary outcome was the reduction in peak menstrual pain at 12 months from trial entry . Results During the treatment period and nine month follow-up all groups showed statistically significant ( p < .001 ) reductions in peak and average menstrual pain compared to baseline but there were no differences between groups ( p > 0.05 ) . Health related quality of life increased significantly in six domains in groups having high frequency of treatment compared to two domains in low frequency groups . Manual acupuncture groups required less analgesic medication than electro-acupuncture groups ( p = 0.02 ) . HF-MA was most effective in reducing secondary menstrual symptoms compared to both – EA groups ( p<0.05 ) . Conclusion Acupuncture treatment reduced menstrual pain intensity and duration after three months of treatment and this was sustained for up to one year after trial entry . The effect of changing mode of stimulation or frequency of treatment on menstrual pain was not significant . This may be due to a lack of power . The role of acupuncture stimulation on menstrual pain needs to be investigated in appropriately powered r and omised controlled trials OBJECTIVE To compare the difference in the clinical efficacy on depression with chronic pain between the simple medication of selective serotonin uptake inhibition antidepressants ( SSRIs ) and the combined therapy of acupuncture and SSRIs . METHODS Ninety cases of depression were r and omized into an acupuncture + medication group ( combined therapy of acupuncture and western medication ) and a medication group ( simple medication ) , 45 cases in each one . In the medication group , the western medicine was adopted . According to the condition of disease , SSRIs was prescribed such as fluoxetine and paroxetine . In the acupuncture + medication group , on the basic treatment of western medication , acupuncture was applied to Baihui ( GV 20 ) , Yintang ( GV 29 ) , Shenting ( BL 24 ) , Fengchi ( GB 20 ) , etc . HAMD scale , VAS and SERS were used to evaluate the clinical efficacy in terms of depression symptoms , pain and side reactions of antidepressants before treatment and in the 1st , 2nd and 4th weeks after treatment in the patients and the differences between the two groups . RESULTS The differences in HAMD and VAS scores were not apparent before treatment between the two groups ( P>0.05 ) . HAMD score and VAS score in the 1st , 2nd and 4th weeks of treatment in the acupuncture + medication group were lower apparently than those in the medication group ( all P<0.01 ) . SERS score in the 1st , 2nd and 4th weeks of treatment in the acupuncture + medication group was lower apparently than that in the medication group ( all P<0.01 ) . CONCLUSION Acupuncture enhances the clinical efficacy on depression with chronic pain treated with SSRI antidepressants and reduces the adverse reactions For clinical trials of acupuncture , it would be desirable to have a sham procedure that is indistinguishable from the real treatment , yet inactive . A sham needle has been design ed which telescopes instead of penetrating the skin . The Park Sham Device involves an improved method of supporting the sham needle and requires validation . The objective of these studies was to test whether the sham procedure using the new device was 1 ) indistinguishable from the same procedure using real needles in acupuncture naïve subjects , and 2 ) inactive , where the specific needle sensation ( de qi ) is taken as a surrogate measure of activity . The studies were design ed as subject and assessor blind , r and omised controlled trials . Study 1 ) included 58 patients enrolled in a clinical trial of acupuncture for acute stroke . Study 2 ) included 63 healthy , acupuncture naïve , adult volunteers . The interventions used were real or sham acupuncture using the Park Sham Device . Study 1 ) was set in a district general hospital , and study 2 ) in a university laboratory . The outcome measure in study 1 ) was the form of treatment that patients believed they had received . In study 2 ) the outcome measure was experience of de qi , as judged by three acupuncture experts . No patient in either group ( study 1 ) believed he or she had been treated with the sham needle . In 40 volunteers ( study 2 ) for whom experts achieved consensus , the relative risk of experiencing de qi with real acupuncture to that with sham acupuncture was 15.38 ( 95 % CI 2.26 to 104.86 ) . The inter-rater reliability of all 13 experts ( study 2 ) , calculated from their judgements on 10 subjects selected by r and omisation , was 0.52 ( 95 % CI 0.19 to 0.61 ) . In conclusion , the results suggest that the procedure using the new device is indistinguishable from the same procedure using real needles in acupuncture naïve subjects , and is inactive , where the specific needle sensation ( de qi ) is taken as a surrogate measure of activity . It is therefore a valid control for acupuncture trials . The findings also lend support to the existence of de qi , a major concept underlying traditional Chinese acupuncture In a r and omized controlled trial , Hugh MacPherson and colleagues investigate the effectiveness of acupuncture and counseling compared with usual care alone for the treatment of  depression symptoms  in primary care setting s. Please see later in the article for the Editors ' Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more The CONSORT ( Consoli date d St and ards of Reporting Trials ) statement is used worldwide to improve the reporting of r and omized , controlled trials . Schulz and colleagues describe the latest version , CONSORT 2010 , which up date s the reporting guideline based on new method ological evidence and accumulating experience . OBJECTIVE To evaluate the clinical therapeutic effect of depression treated by acupuncture and electroacupuncture combined with western medicine . METHODS Seventy-five patients were r and omly divided into 3 groups . In control group , 30 cases were treated by SSRI with oral administration ; in observation group 1 , 25 cases were treated by acupuncture therapy combined with SSRI , and Shenting ( GV 24 ) , Baihui ( GV 20 ) , Dazhui ( GV 14 ) , Shendao ( GV 11 ) and Zhiyang ( GV 9 ) etc . were selected with regulating qi needling method ; in observation group 2 , same acupoints were selected with routine needling method , and 20 cases were treated by electroacupuncture therapy combined with SSRI , Baihui ( GV 20 ) and Yintang ( EX-HN 3 ) etc . were treated by electroacupuncture . The clinical therapeutic effects and Hamilton Depression Scale scores were evaluated after 1 , 2 , 4 and 6 weeks treatment . RESULTS The total effective rates of observation group 1 and 2 were 100.0 % , superior to that of 73.3 % in control group ( both P < 0.05 ) . The total scores of HAMD on each time point dropped , and there were significant differences compard with those before treatment in 3 groups ( P < 0.01 , P < 0.05 ) ; the total scores of HAMD after 1 , 2 and 4 weeks improved more obviously than that in control group ( P < 0.01 , P < 0.05 ) , and there was no significant difference among groups after 6 weeks ( all P > 0.05 ) . After one week treatment , the comparison of total scores of HAMD in observation group l and 2 indicated significant differences ( P < 0.05 ) ; after 2 , 4 and 6 weeks treatment , there were no significant differences between groups ( all P > 0.05 ) . CONCLUSION The acupuncture therapy and electroacupuncture combined with western medicine for treating depression have better effects than medicine treatment ; and there is no obvious difference between acupuncture therapy and electroacupuncture therapy , however , the effect works fast by electroacupuncture Objective Recent functional MRI ( fMRI ) studies show that brain activity , including the default mode network ( DMN ) , can be modulated by acupuncture . Conventional means to enhance the neurophysiological ‘ dose ’ of acupuncture , including an increased number of needles and manual needle manipulation , are expected to enhance its physiological effects . The aim of this study was to compare the effects of both methods on brain activity . Methods 58 healthy volunteers were r and omly assigned into four groups that received single needle acupuncture ( SNA , n=15 ) or transcutaneous electrical nerve stimulation ( TENS , n=13 ) as active controls , or enhanced acupuncture by way of three needle acupuncture ( TNA , n=17 ) or SNA plus manual stimulation ( SNA+MS , n=13 ) . Treatment-associated sensations were evaluated using a visual analogue scale . Central responses were recorded before , during , and after treatment at LI4 on the left h and using resting state fMRI . Results TNA and SNA+MS induced DMN-insula activity and extensive DMN activity compared to SNA , despite comparable levels of de qi sensation . The TNA and SNA+MS groups exhibited a delayed and enhanced modulation of the DMN , which was not observed followed SNA and TENS . Furthermore , TNA increased precuneus activity and increased the DMN-related activity of the cuneus and left insula , while SNA+MS increased activity in the right insula . Conclusions The results showed that conventional methods to enhance the acupuncture dose induce different DMN modulatory effects . TNA induces the most extensive DMN modulation , compared with other methods . Conventional methods of enhancing the acupuncture dose could potentially be applied as a means of modulating brain activity Objective To observe the clinical efficacy and adverse reactions of Paroxetine combined with electro-acupuncture ( EA ) in treating depression . Methods Forty-two patients with depression were r and omly assigned to the observation group ( 22 patients ) treated with EA combined with Paroxetine , and the control group ( 20 patients ) treated with Paroxetine alone , and the therapeutic course for both groups was 6 weeks . The therapeutic efficacy and adverse reactions were evaluated with scores by Hamilton depression scale ( HAMD ) and treatment emergent symptoms scale ( TESS ) , respectively . Results HAMD scores determined at the end of the 1st , 2nd , 4th , and 6th week of the treatment course were significantly lower in the observation group than those in the control group ( P<0.05 ) . The significant improvement rate evaluated at the end of the 6-week treatment was remarkably higher in the observation group than that in the control group ( 72.7 % vs 40.0 % ) . No significant difference of TESS scores was found between the two groups . Conclusion EA combined with Paroxetine has better clinical efficacy than that of Paroxetine alone , with milder adverse reaction and quicker initiation of effect Background There is relatively limited knowledge about the practitioners who provide  acupuncture treatment  within the UK , what conditions patients consult for and the treatment provided . Objectives To characterise the conditions treated and by whom , to examine characteristics of the treatment and to explore trends over time . Method A cross-sectional survey of the UK acupuncture practitioners was conducted ; 800 practitioners were selected by computer-generated r and omisation sequences from the four major UK-based professional associations . Data collected on the practitioners included demographic details , association membership , statutorily regulated status , practice setting , style of acupuncture , diagnostic methods and needle response sought . Practitioners recorded details of their 10 most recent patients , including demographic details , primary reason for consulting and lifestyle advice provided . Results 330 practitioners responded comprising doctors ( 29 % ) physiotherapists ( 29 % ) , nurses ( 15 % ) and independent acupuncturists ( 27 % ) : 62 % were women with median age of 48 years . The majority ( 68 % ) practice d in independent setting s and 42 % practice d within the National Health Service . Patients most commonly consulted for low back , neck , shoulder and knee pain , as well as headaches and migraine . Treatment for infertility by independent acupuncturists was found to have increased fivefold in 10 years . Conclusion Acupuncture provides a substantial contribution to the healthcare of the UK , with an estimated 4 million sessions provided annually . The primary complaints for which patients consult reflect the growing evidence base on acupuncture for these conditions . These data provide a basis for decision-making regarding policy and practice BACKGROUND Quality acupuncture influences the outcomes of clinical research , and issues associated with effective administration of acupuncture in r and omized controlled trials need to be addressed when appraising studies 
    Output:
    