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: Purpose To evaluate the effects of acupuncture compared to a control group using artificial tears . Methods Setting & design : multicenter r and omised controlled trial ( three local research hospitals of South Korea ) . Study Population : 150 patients with moderate to severe dry eye . Intervention : Participants were r and omly allocated into four weeks of acupuncture treatment ( bilateral BL2 , GB14 , TE 23 , Ex1 , ST1 , GB20 , LI4 , LI11 and single GV23 ) or to the artificial tears group ( sodium carboxymethylcellulose ) . Main Outcome Measure(s ) : The ocular surface disease index ( OSDI ) , tear film break-up time ( TFBUT ) , Schirmer Ι test , visual analogue scale ( VAS ) for self- assessment of ocular discomfort , general assessment ( by both acupuncture practitioners and participants ) and quality of life ( QOL ) through the Measure Yourself Medical Outcome Profile-2 ( MYMOP-2 ) . Results There was no statistically significant difference between two groups for the improvement of dry eye symptoms as measured by OSDI ( MD −16.11 , 95 % CI [ −20.91 , −11.32 ] with acupuncture and −15.37 , 95 % CI [ −19.57 , −11.16 ] with artificial tears ; P = 0.419 ) , VAS ( acupuncture : −23.84 [ −29.59 , −18.09 ] ; artificial tears : −22.2 [ −27.24 , −17.16 ] , P = 0.530 ) or quality of life ( acupuncture : −1.32 [ −1.65 , −0.99 ] ; artificial tears : −0.96 [ −1.32 , −0.6 ] , P = 0.42 ) immediately after treatment . However , compared with artificial tears group , the OSDI ( acupuncture : −16.15 [ −21.38 , −10.92 ] ; artificial tears : −10.76 [ −15.25 , −6.27 ] , P = 0.030 ) and VAS ( acupuncture : −23.88 [ −30.9 , −16.86 ] ; artificial tears : −14.71 [ −20.86 , −8.55 ] , P = 0.018 ) were significantly improved in the acupuncture group at 8 weeks after the end of acupuncture treatment . TFBUT measurements increased significantly in the acupuncture group after treatment . Conclusions Acupuncture may have benefits on the mid-term outcomes related to dry eye syndrome compared with artificial tears . Trial registration Clinical Trials.gov NCT01105221 Background The purpose of this study was to investigate whether acupuncture is effective at treating dry eye disease among postmenopausal women and to identify the possible mechanisms . Methods Twenty-eight postmenopausal women with dry eye disease were r and omly divided into two groups : an acupuncture plus artificial tears ( AC + AT ) group and an artificial tears ( AT ) only group . After baseline examination of clinical parameters and tear sample collection , each patient received the design ated modality of topical therapy for 2 months . Post-treatment documentation of clinical parameters was recorded , and tear sample s were collected . Tear sample s from the AC + AT group were subjected to two-dimensional nano-liquid chromatography coupled with t and em mass spectrometry ( 2D nano-LC-MS/MS ) . Western blot analysis was also performed on tear sample s from both groups . Results After treatment , the Ocular Surface Disease Index scores , symptom assessment scores , scores of sign assessment , and tear break-up time were significantly improved in both groups ( P=0.000 ) . Symptom assessment scores were significantly improved in the AC + AT group ( P=0.000 ) compared with the AT group . 2D nano-LC-MS/MS identified 2,411 proteins , among which 142 were downregulated and 169 were upregulated . After combined AC + AT treatment , the abundance of secreted proteins was increased , whereas that of cytoplasmic proteins decreased ( Pearson ’s χ2 test , P=0.000 , P=0.000 , respectively ) . Proteins involved in immunity and regulation were also more abundant ( Pearson ’s χ2 test , P=0.040 , P=0.016 , respectively ) , while components and proliferation-related proteins were downregulated ( Pearson ’s χ2 test , P=0.003 , P=0.011 , respectively ) . Conclusion AC + AT treatment increased protein synthesis and secretion , and improved clinical symptoms . These results indicate that acupuncture may be a complimentary therapy for treating postmenopausal dry eye disease 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 . OBJECTIVE The study objective was to achieve consensus on domains and items for inclusion in a rating scale to assess quality acupuncture administered in clinical research . STUDY DESIGN AND SUBJECTS An active group of Australian acupuncture research ers initially identified a pool of items assessing quality . The Delphi consensus process was then used to select and reduce the number of items , and an additional expert panel of 42 research ers were invited to participate . Participants initially ranked items along a five-point scale for the first Delphi round , and indicated an agree or disagree response during the second round . For an item to be retained into the second round , an item had to attain greater than 80 % agreement that the item described a dimension of quality acupuncture and related study design . RESULTS Thirty-two ( 32 ) experts agreed to participate in the study . After two rounds of the Delphi process , consensus was reached on 14 domains and 26 items relating to quality acupuncture . Domains , items , and minimum st and ards related to study design ; rationale of the intervention ; criteria relating to needling stimulation either manual or electrostimulation ; duration and frequency of treatment ; and practitioner training . CONCLUSIONS Items for inclusion in an instrument to assess quality  acupuncture in clinical research were identified . Further development of the instrument including relative weighting of items and reliability testing is under way OBJECTIVE To compare the efficacy of the patients of xerosis conjunctivitis with liver and kidney yin deficiency among the combined therapy of acupuncture and Shi 's manipulation , common acupuncture and artificial tears therapy . METHODS One hundred and eight patients were r and omized into an acupuncture group , a SHI 's manipulation group and an artificial tears group , 36 cases in each group . A total of 15 cases dropped out before the end of the study , including 4 cases in the acupuncture group , 6 cases in the SHI 's manipulation group , and 5 cases in the artificial tears group . In the acupuncture group , acupuncture was applied to Jingming ( BL 1 ) and Qiuhou ( EX-HN 7 ) on the affected side , and the bilateral Sanyinjiao ( SP 6 ) and Taixi ( KI 3 ) . The needles were retained for 20 min . In the SHI 's manipulation group , on the basis of the treatment as the acupuncture group , Shuigou ( GV26 ) was added and stimulated with SHI 's acupuncture manipulation . In these two groups , acupuncture was given 3 times a week totally for 3 weeks . In the artificial tears group , sodium hyaluronate eye drops were used , 5 times a day , for 3 weeks totally . Separately , before treatment , at the moment after the 1st treatment and 3 weeks after treatment , the subjective symptom score , Schirmer I test , breakup time ( BUT ) of tear film were observed in each group . RESULTS ( 1 ) Subjective symptom score : at the moment after the 1st treatment and 3 weeks after treatment , the scores in each group were all reduced significantly as compared with those before treatment ( all P < 0.05 ) . At the moment after the 1st treatment , the score in the SHI 's manipulation group and the artificial tears group was reduced apparently as compared with that in the acupuncture group ( both P < 0.05 ) . In 3 weeks of treatment , the score in the SHI 's manipulation group was reduced apparently as compared with the acupuncture group and the artificial tears group ( both P < 0.05 ) . ( 2 ) For Schirmer I test , at the moment of the 1st treatment , the result in the SHI 's manipulation group and the artificial tears group was improved significantly as compared with that before treatment ( both P < 0.05 ) . In 3 weeks of treatment , the result in the acupuncture group and the SHI 's manipulation group group was improved significantly as compared with that before treatment ( both P < 0.05 ) . At the moment of the 1st treatment , the result in the artificial tears group was improved significantly as compared with the acupuncture group and the SHI 's manipulation group ( both P < 0.05 ) . In 3 weeks of treatment , the result in the acupuncture group and the SHI 's manipulation group was better than that in the artifi-cial tears group separately ( both P < 0.05 ) . ( 3 ) For BUT , the result in the acupuncture group and the SHI 's manipulation group was prolonged significantly as compared with that before treatment and was prolonged apparently as compared with that in the artificial tears group ( both P < 0.05 ) in 3 weeks of treatment . CONCLUSION The intervention of SHI 's acupuncture manipulation relieves the subjective symptoms of xerosis conjunctivitis of liver and kidney yin deficiency and achieves the same efficacy as the common acupuncture and artificial tears treatment . It does not present the apparent advantages as the common acupuncture in the short term for promoting the tear secretion and tears film repair This study observes changes in symptoms of xerophthalmia pre- and post-acupuncture therapy and compares the results of the acupuncture therapy ( AT ) group and the artificial tear control ( ATC ) group . Parallel comparative studies were carried out on 44 patients with xerophthalmia , who were divided into the AT group ( n = 20 ) and the ATC group ( n = 24 ) . A 10-session acupuncture therapy program was performed for the AT group while Dextran 70 was used for the ATC group with each course of treatment lasting 21 day . Examinations were made on the day when a patient was chosen to join the study , 1 hour after completion of treatment , and 3 weeks after stopping treatment . There was no statistically significant difference in terms of the reduction of the symptoms and sign score ( SSS ) 1 hour after completion of treatment between the AT group and the ATC group . Three weeks after completion of treatment , the reduction of SSS for the AT group was larger than that of the ATC group , with the difference achieving statistical significance . Both acupuncture therapy and artificial tear therapy have an immediate positive effect on the symptoms of xerophthalmia , but acupuncture therapy has a longer continuous effect than that of artificial tears PURPOSE To investigate the prevalence of and risk factors associated with  dry eye syndrome ( DES ) in South Korea . DESIGN Cross-sectional study . METHODS In 2010 and 2011 , 11,666 subjects , ranging in age from 19 to 95 , were r and omly selected as nationally representative participants in the Korea National Health and Nutrition Examination Survey ( KNHANES ) . Subjects were divided into 2 groups : 1 with clinical ly  diagnosed DES and 1 with symptoms of dry eye . We determined the prevalence of and risk factors for dry eyes in a Korean population .  Health-related quality of life ( HRQoL ) , measured by the EuroQoL-5 dimension ( EQ-5D )  , was evaluated in patients with dry eyes . RESULTS The mean age was 49.9 years . The overall prevalence of diagnosed DES was 8.0 % ( 95 % confidence interval [ CI ] , 7.3 % to 8.7 % ) , and of dry eye symptoms the prevalence was 14.4 % ( 95 % CI , 13.1 to 15.7 ) . Age ( adjusted odds ratio [ aOR ] = 1.8 , 1.6 ) , female ( aOR = 2.8 , 1.9 ) ; history of eye surgery ( aOR = 2.6 , 2.2 ) ; stress ( aOR = 1.7 , 1.6 ) ; thyroid disease ( aOR = 1.7 , 1.5 ) ; and high education level ( aOR = 1.6 , 1.5 ) were common risk factors in the groups . Subjects who had undergone ptosis , cataract or refractive surgery were more likely to have dry eye than subjects with no history of eye surgery . Means of pain and anxiety dimensions in the EQ-5D and the Euro Quality of Life Visual Analog Scale ( EQ-VAS ) were significantly higher in the group with diagnosed DES than in the normal group . CONCLUSIONS The risk factors were mostly similar in both groups . It is thought there are more patients with DES who have not been diagnosed by doctors . Doctors should identify whether a patient has any risk factors for dry eye . Patients need to be educated about the modifiable factors of DES OBJECTIVES The objective of this study was to investigate whether typical acupuncture methods such as needle placement , needle stimulation , and treatment frequency were important factors in fibromyalgia symptom improvement . DESIGN / SETTING S/SUBJECTS : A single-site , single-blind , r and omized trial of 114 participants diagnosed with fibromyalgia for at least 1 year was performed . INTERVENTION Participants were r and omized to one of four treatment groups : ( 1 ) T/S needles placed in traditional sites with manual needle stimulation ( n = 29 ) : ( 
    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: Purpose To evaluate the effects of acupuncture compared to a control group using artificial tears . Methods Setting & design : multicenter r and omised controlled trial ( three local research hospitals of South Korea ) . Study Population : 150 patients with moderate to severe dry eye . Intervention : Participants were r and omly allocated into four weeks of acupuncture treatment ( bilateral BL2 , GB14 , TE 23 , Ex1 , ST1 , GB20 , LI4 , LI11 and single GV23 ) or to the artificial tears group ( sodium carboxymethylcellulose ) . Main Outcome Measure(s ) : The ocular surface disease index ( OSDI ) , tear film break-up time ( TFBUT ) , Schirmer Ι test , visual analogue scale ( VAS ) for self- assessment of ocular discomfort , general assessment ( by both acupuncture practitioners and participants ) and quality of life ( QOL ) through the Measure Yourself Medical Outcome Profile-2 ( MYMOP-2 ) . Results There was no statistically significant difference between two groups for the improvement of dry eye symptoms as measured by OSDI ( MD −16.11 , 95 % CI [ −20.91 , −11.32 ] with acupuncture and −15.37 , 95 % CI [ −19.57 , −11.16 ] with artificial tears ; P = 0.419 ) , VAS ( acupuncture : −23.84 [ −29.59 , −18.09 ] ; artificial tears : −22.2 [ −27.24 , −17.16 ] , P = 0.530 ) or quality of life ( acupuncture : −1.32 [ −1.65 , −0.99 ] ; artificial tears : −0.96 [ −1.32 , −0.6 ] , P = 0.42 ) immediately after treatment . However , compared with artificial tears group , the OSDI ( acupuncture : −16.15 [ −21.38 , −10.92 ] ; artificial tears : −10.76 [ −15.25 , −6.27 ] , P = 0.030 ) and VAS ( acupuncture : −23.88 [ −30.9 , −16.86 ] ; artificial tears : −14.71 [ −20.86 , −8.55 ] , P = 0.018 ) were significantly improved in the acupuncture group at 8 weeks after the end of acupuncture treatment . TFBUT measurements increased significantly in the acupuncture group after treatment . Conclusions Acupuncture may have benefits on the mid-term outcomes related to dry eye syndrome compared with artificial tears . Trial registration Clinical Trials.gov NCT01105221 Background The purpose of this study was to investigate whether acupuncture is effective at treating dry eye disease among postmenopausal women and to identify the possible mechanisms . Methods Twenty-eight postmenopausal women with dry eye disease were r and omly divided into two groups : an acupuncture plus artificial tears ( AC + AT ) group and an artificial tears ( AT ) only group . After baseline examination of clinical parameters and tear sample collection , each patient received the design ated modality of topical therapy for 2 months . Post-treatment documentation of clinical parameters was recorded , and tear sample s were collected . Tear sample s from the AC + AT group were subjected to two-dimensional nano-liquid chromatography coupled with t and em mass spectrometry ( 2D nano-LC-MS/MS ) . Western blot analysis was also performed on tear sample s from both groups . Results After treatment , the Ocular Surface Disease Index scores , symptom assessment scores , scores of sign assessment , and tear break-up time were significantly improved in both groups ( P=0.000 ) . Symptom assessment scores were significantly improved in the AC + AT group ( P=0.000 ) compared with the AT group . 2D nano-LC-MS/MS identified 2,411 proteins , among which 142 were downregulated and 169 were upregulated . After combined AC + AT treatment , the abundance of secreted proteins was increased , whereas that of cytoplasmic proteins decreased ( Pearson ’s χ2 test , P=0.000 , P=0.000 , respectively ) . Proteins involved in immunity and regulation were also more abundant ( Pearson ’s χ2 test , P=0.040 , P=0.016 , respectively ) , while components and proliferation-related proteins were downregulated ( Pearson ’s χ2 test , P=0.003 , P=0.011 , respectively ) . Conclusion AC + AT treatment increased protein synthesis and secretion , and improved clinical symptoms . These results indicate that acupuncture may be a complimentary therapy for treating postmenopausal dry eye disease 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 . OBJECTIVE The study objective was to achieve consensus on domains and items for inclusion in a rating scale to assess quality acupuncture administered in clinical research . STUDY DESIGN AND SUBJECTS An active group of Australian acupuncture research ers initially identified a pool of items assessing quality . The Delphi consensus process was then used to select and reduce the number of items , and an additional expert panel of 42 research ers were invited to participate . Participants initially ranked items along a five-point scale for the first Delphi round , and indicated an agree or disagree response during the second round . For an item to be retained into the second round , an item had to attain greater than 80 % agreement that the item described a dimension of quality acupuncture and related study design . RESULTS Thirty-two ( 32 ) experts agreed to participate in the study . After two rounds of the Delphi process , consensus was reached on 14 domains and 26 items relating to quality acupuncture . Domains , items , and minimum st and ards related to study design ; rationale of the intervention ; criteria relating to needling stimulation either manual or electrostimulation ; duration and frequency of treatment ; and practitioner training . CONCLUSIONS Items for inclusion in an instrument to assess quality  acupuncture in clinical research were identified . Further development of the instrument including relative weighting of items and reliability testing is under way OBJECTIVE To compare the efficacy of the patients of xerosis conjunctivitis with liver and kidney yin deficiency among the combined therapy of acupuncture and Shi 's manipulation , common acupuncture and artificial tears therapy . METHODS One hundred and eight patients were r and omized into an acupuncture group , a SHI 's manipulation group and an artificial tears group , 36 cases in each group . A total of 15 cases dropped out before the end of the study , including 4 cases in the acupuncture group , 6 cases in the SHI 's manipulation group , and 5 cases in the artificial tears group . In the acupuncture group , acupuncture was applied to Jingming ( BL 1 ) and Qiuhou ( EX-HN 7 ) on the affected side , and the bilateral Sanyinjiao ( SP 6 ) and Taixi ( KI 3 ) . The needles were retained for 20 min . In the SHI 's manipulation group , on the basis of the treatment as the acupuncture group , Shuigou ( GV26 ) was added and stimulated with SHI 's acupuncture manipulation . In these two groups , acupuncture was given 3 times a week totally for 3 weeks . In the artificial tears group , sodium hyaluronate eye drops were used , 5 times a day , for 3 weeks totally . Separately , before treatment , at the moment after the 1st treatment and 3 weeks after treatment , the subjective symptom score , Schirmer I test , breakup time ( BUT ) of tear film were observed in each group . RESULTS ( 1 ) Subjective symptom score : at the moment after the 1st treatment and 3 weeks after treatment , the scores in each group were all reduced significantly as compared with those before treatment ( all P < 0.05 ) . At the moment after the 1st treatment , the score in the SHI 's manipulation group and the artificial tears group was reduced apparently as compared with that in the acupuncture group ( both P < 0.05 ) . In 3 weeks of treatment , the score in the SHI 's manipulation group was reduced apparently as compared with the acupuncture group and the artificial tears group ( both P < 0.05 ) . ( 2 ) For Schirmer I test , at the moment of the 1st treatment , the result in the SHI 's manipulation group and the artificial tears group was improved significantly as compared with that before treatment ( both P < 0.05 ) . In 3 weeks of treatment , the result in the acupuncture group and the SHI 's manipulation group group was improved significantly as compared with that before treatment ( both P < 0.05 ) . At the moment of the 1st treatment , the result in the artificial tears group was improved significantly as compared with the acupuncture group and the SHI 's manipulation group ( both P < 0.05 ) . In 3 weeks of treatment , the result in the acupuncture group and the SHI 's manipulation group was better than that in the artifi-cial tears group separately ( both P < 0.05 ) . ( 3 ) For BUT , the result in the acupuncture group and the SHI 's manipulation group was prolonged significantly as compared with that before treatment and was prolonged apparently as compared with that in the artificial tears group ( both P < 0.05 ) in 3 weeks of treatment . CONCLUSION The intervention of SHI 's acupuncture manipulation relieves the subjective symptoms of xerosis conjunctivitis of liver and kidney yin deficiency and achieves the same efficacy as the common acupuncture and artificial tears treatment . It does not present the apparent advantages as the common acupuncture in the short term for promoting the tear secretion and tears film repair This study observes changes in symptoms of xerophthalmia pre- and post-acupuncture therapy and compares the results of the acupuncture therapy ( AT ) group and the artificial tear control ( ATC ) group . Parallel comparative studies were carried out on 44 patients with xerophthalmia , who were divided into the AT group ( n = 20 ) and the ATC group ( n = 24 ) . A 10-session acupuncture therapy program was performed for the AT group while Dextran 70 was used for the ATC group with each course of treatment lasting 21 day . Examinations were made on the day when a patient was chosen to join the study , 1 hour after completion of treatment , and 3 weeks after stopping treatment . There was no statistically significant difference in terms of the reduction of the symptoms and sign score ( SSS ) 1 hour after completion of treatment between the AT group and the ATC group . Three weeks after completion of treatment , the reduction of SSS for the AT group was larger than that of the ATC group , with the difference achieving statistical significance . Both acupuncture therapy and artificial tear therapy have an immediate positive effect on the symptoms of xerophthalmia , but acupuncture therapy has a longer continuous effect than that of artificial tears PURPOSE To investigate the prevalence of and risk factors associated with  dry eye syndrome ( DES ) in South Korea . DESIGN Cross-sectional study . METHODS In 2010 and 2011 , 11,666 subjects , ranging in age from 19 to 95 , were r and omly selected as nationally representative participants in the Korea National Health and Nutrition Examination Survey ( KNHANES ) . Subjects were divided into 2 groups : 1 with clinical ly  diagnosed DES and 1 with symptoms of dry eye . We determined the prevalence of and risk factors for dry eyes in a Korean population .  Health-related quality of life ( HRQoL ) , measured by the EuroQoL-5 dimension ( EQ-5D )  , was evaluated in patients with dry eyes . RESULTS The mean age was 49.9 years . The overall prevalence of diagnosed DES was 8.0 % ( 95 % confidence interval [ CI ] , 7.3 % to 8.7 % ) , and of dry eye symptoms the prevalence was 14.4 % ( 95 % CI , 13.1 to 15.7 ) . Age ( adjusted odds ratio [ aOR ] = 1.8 , 1.6 ) , female ( aOR = 2.8 , 1.9 ) ; history of eye surgery ( aOR = 2.6 , 2.2 ) ; stress ( aOR = 1.7 , 1.6 ) ; thyroid disease ( aOR = 1.7 , 1.5 ) ; and high education level ( aOR = 1.6 , 1.5 ) were common risk factors in the groups . Subjects who had undergone ptosis , cataract or refractive surgery were more likely to have dry eye than subjects with no history of eye surgery . Means of pain and anxiety dimensions in the EQ-5D and the Euro Quality of Life Visual Analog Scale ( EQ-VAS ) were significantly higher in the group with diagnosed DES than in the normal group . CONCLUSIONS The risk factors were mostly similar in both groups . It is thought there are more patients with DES who have not been diagnosed by doctors . Doctors should identify whether a patient has any risk factors for dry eye . Patients need to be educated about the modifiable factors of DES OBJECTIVES The objective of this study was to investigate whether typical acupuncture methods such as needle placement , needle stimulation , and treatment frequency were important factors in fibromyalgia symptom improvement . DESIGN / SETTING S/SUBJECTS : A single-site , single-blind , r and omized trial of 114 participants diagnosed with fibromyalgia for at least 1 year was performed . INTERVENTION Participants were r and omized to one of four treatment groups : ( 1 ) T/S needles placed in traditional sites with manual needle stimulation ( n = 29 ) : ( 
    Output:
    