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: 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 : Background Human leptin is a peptide hormone that is released from white adipocytes . The absence of leptin or its receptor leads to uncontrolled food intake , leading to obesity . In the present work , the effects of auricular acupressure combined with low-calorie diet on the leptin hormone level were investigated . Methods Volunteers ( n=86 ) with body mass indices ( BMI ) between 25 and 45 kg/m2 were r and omised into a case ( n=43 ) or a control ( n=43 ) group . Participants in each group received a low-calorie diet for 6 weeks . The case group was treated with auricular acupressure and the control group received a sham procedure .  Plasma leptin levels , body fat mass , body weight and BMI were measured before and after treatment . Results Participants who received auricular acupressure showed significant reductions in their plasma leptin levels ( 18.57 % , p<0.01 ) as well as in their body fat mass ( 4 % , p<0.05 ) . These changes were not observed in the control group . The reduction in leptin was significantly greater in the acupressure group than the controls . Conclusions Auricular acupressure combined with a low-calorie diet significantly reduced plasma levels of leptin . However , the mechanism of this reduction is not clear OBJECTIVE Visceral adipose tissue ( VAT ) and hepatic fat deposition are the most important risk factors for women 's health . Acupuncture , including electroacupuncture ( EA ) , is used to treat obesity throughout the world . The effect of EA is evaluated mainly by body mass index ( BMI ) and waist circumference ( WC ) . Few studies have assessed its effect in reducing VAT volume and hepatic fat fraction ( HFF ) based on an exact measurement method such as magnetic resonance imaging ( MRI ) . This study aim ed to resolve this issue . METHODS Thirty subjects were r and omly divided into two groups . The control group ( n = 15 ) did not receive any  intervention  and maintained a normal diet and their usual exercise habits . The treatment group ( n = 15 ) received EA three times a week for 3 months . BMI and WC were measured using different devices . VAT and HFF were measured by MRI and calculated by related software before and after the intervention . RESULTS A marked difference was evident in group that received EA treatment in the following tests . The differences in BMI ( U = 21.00 , p < 0.001 ) , WC ( U = 40.50 , p = 0.002 ) , VAT volume ( U = 13.00 , p < 0.001 ) , and mean HFF ( U = 0.00 , p < 0.001 ) before and after the intervention in the treatment group were distinct and significant compared with those of the control group . Three months later , the treatment group showed a lower BMI ( W = 91.00 , p = 0.001 ) , WC ( t = 4.755 , p < 0.001 ) , VAT volume ( t = 5.164 , p < 0.001 ) , and mean HFF ( W = 120.00 , p = 0.001 ) compared with pretreatment levels . Compared with the control group , the treatment group showed a lower VAT volume ( t = 60.00 , p = 0.029 ) after 3 months of treatment . After 3 months , the control group showed higher mean HFF ( t = -2.900 , p = 0.012 ) and VAT volume ( W = 11.50 , p = 0.006 ) compared with their initial levels . CONCLUSION Based on MRI evaluation , this r and omized controlled study proved that EA treatment reduces BMI and WC as well as VAT volume and HFF in women with abdominal obesity Chronic constipation affects approximately 16 % of the world 's population ( 1 ) , 17.1 % of persons in Europe ( 2 ) , 12 % to 19 % of those in North America ( 3 ) , and 10.8 % of those in Asia ( 1 ) . Patients with severe chronic constipation have complete spontaneous bowel movements ( CSBMs ) no more than twice per week , with hard stools , frequent straining , and the sensation of incomplete evacuation ( 4 ) . Most chronic constipation is functional and is associated with decreased quality of life ( 5 ) . Laxatives produce only temporary relief , and constipation tends to reoccur after discontinuing medication ( 6 , 7 ) . Nearly half of patients are dissatisfied with their traditional therapies , such as laxatives ( 8) . Other treatment options may include prokinetic agents . In a trial , 1 to 2 mg of prucalopride ( an agonist for 5-hydroxytryptamine receptor 4 ) per day was reported to normalize BMs in 37.9 % of patients with severe chronic constipation ( 9 ) . However , the adverse cardiac effects induced by some prokinetic agents can not be ignored ( 10 ) , and their long-term effects remain unknown . A systematic review supports the use of acupuncture for chronic constipation ( 11 ) , and our previous study indicates that electroacupuncture ( EA ) might have some sustained effects ( 12 ) . However , the evidence for the therapeutic effects of acupuncture is limited because many r and omized , controlled trials have had small sample sizes or other method ological limitations ( 11 ) . Our goal was to determine the efficacy of EA for the treatment of chronic severe functional constipation ( CSFC ) over an 8-week treatment period and evaluate the maintenance of effects throughout the 12-week follow-up . We hypothesized that EA would be superior to sham EA ( SA ) at both end points . Methods Design Overview We conducted a multicenter , r and omized , parallel , sham-controlled trial at 15 sites in China . The study duration per patient was 22 weeks : 2 weeks before r and omization ( baseline assessment ) ; 8 weeks of treatment ; and 12 weeks of follow-up without treatment . Research ers screened c and i date s for study participation , and experienced physicians at digestive or anorectal departments made diagnoses . Participants Participants were included if they met the diagnosis of functional constipation based on the Rome III diagnostic criteria for functional gastrointestinal disorders ( 13 ) , had CSFC with 2 or fewer mean weekly CSBMs for more than 3 months , were aged between 18 and 75 years , had not taken constipation medication for a minimum of 2 weeks before enrollment except for rescue medicine ( glycerol or sorbitol anal enema ) , had not received acupuncture for constipation , and had not participated in any other trial in the previous 3 months . The exclusion criteria were constipation caused by irritable bowel syndrome or drugs or that was secondary to endocrine , metabolic , neurologic , or postoperative diseases ; severe cardiovascular , hepatic , or renal diseases ; cognitive dysfunction , aphasia , mental disorders , or illness that could affect patient cooperation ; pregnant or lactating women ; abdominal aortic aneurysm or hepatosplenomegaly ; blood coagulation disorders or regular anticoagulant use , including warfarin or heparin ( an exception was antiplatelet treatment using aspirin or clopidogrel ) ; and cardiac pacemaker implantation . C and i date s signed informed consent . After the 2-week baseline assessment , eligible participants were r and omly assigned and received their first treatment on the same day . The study was performed according to common guidelines for clinical trials ( Declaration of Helsinki and International Conference on Harmonisation Good Clinical Practice E6 guidance ) . The study protocol ( 14 ) adhered to the St and ards for Reporting Interventions in Clinical Trials of Acupuncture guidelines and was approved by the ethics committees of each responsible site . R and omization and Blinding Participants were allocated to the EA or SA group using stratified block r and omization . The r and omization sequences were generated by using PROC PLAN in SAS , version 9.4 ( SAS Institute ) , with the study site as the stratification factor and the block length as 4 . Acupuncturists obtained each patient 's r and om number and assignment through the central r and omization system ( Institute of Basic Research in Clinical Medicine , China Academy of Chinese Medical Sciences ) . All participants were treated separately to prevent communication . Except for acupuncturists , all relevant parties were blinded to the intervention ( EA vs. SA ) groups . Participants were informed that they had an equal chance of allocation to the EA or SA group before study participation . To test the success of blinding , we r and omly selected 140 participants ( 70 from each group , with 9 to 10 participants at each site ) for the blinding assessment ; the acupuncturists asked them to guess whether they received EA or SA after treatments in weeks 4 and 8 . Intervention Study interventions were developed by the consensus of acupuncture experts and per the results of our pilot study ( Cai Y , Wu J , Liu Z. Electroacupuncture versus sham electroacupuncture for chronic  severe functional constipation : a r and omized controlled pilot study . 2012 . Unpublished data . ) . Fifteen acupuncturists with 2 to 3 years of experience at the 15 sites administered the EA and SA treatments . All acupuncturists had at least a 5-year undergraduate education and were registered practitioners of traditional Chinese medicine . All research assistants and acupuncturists received a 2-day training session before study initiation . Both treatments consisted of 28 sessions , each for 30 minutes , and were administered over 8 weeks ( 5 sessions in each of the first 2 weeks , and 3 sessions in each of the remaining 6 weeks ) . Disposable needles ( Huatuo ) and the SDZ-V EA apparatus ( Suzhou Medical Appliance ) were used . Participants in the EA group received EA at 
    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: 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 : Background Human leptin is a peptide hormone that is released from white adipocytes . The absence of leptin or its receptor leads to uncontrolled food intake , leading to obesity . In the present work , the effects of auricular acupressure combined with low-calorie diet on the leptin hormone level were investigated . Methods Volunteers ( n=86 ) with body mass indices ( BMI ) between 25 and 45 kg/m2 were r and omised into a case ( n=43 ) or a control ( n=43 ) group . Participants in each group received a low-calorie diet for 6 weeks . The case group was treated with auricular acupressure and the control group received a sham procedure .  Plasma leptin levels , body fat mass , body weight and BMI were measured before and after treatment . Results Participants who received auricular acupressure showed significant reductions in their plasma leptin levels ( 18.57 % , p<0.01 ) as well as in their body fat mass ( 4 % , p<0.05 ) . These changes were not observed in the control group . The reduction in leptin was significantly greater in the acupressure group than the controls . Conclusions Auricular acupressure combined with a low-calorie diet significantly reduced plasma levels of leptin . However , the mechanism of this reduction is not clear OBJECTIVE Visceral adipose tissue ( VAT ) and hepatic fat deposition are the most important risk factors for women 's health . Acupuncture , including electroacupuncture ( EA ) , is used to treat obesity throughout the world . The effect of EA is evaluated mainly by body mass index ( BMI ) and waist circumference ( WC ) . Few studies have assessed its effect in reducing VAT volume and hepatic fat fraction ( HFF ) based on an exact measurement method such as magnetic resonance imaging ( MRI ) . This study aim ed to resolve this issue . METHODS Thirty subjects were r and omly divided into two groups . The control group ( n = 15 ) did not receive any  intervention  and maintained a normal diet and their usual exercise habits . The treatment group ( n = 15 ) received EA three times a week for 3 months . BMI and WC were measured using different devices . VAT and HFF were measured by MRI and calculated by related software before and after the intervention . RESULTS A marked difference was evident in group that received EA treatment in the following tests . The differences in BMI ( U = 21.00 , p < 0.001 ) , WC ( U = 40.50 , p = 0.002 ) , VAT volume ( U = 13.00 , p < 0.001 ) , and mean HFF ( U = 0.00 , p < 0.001 ) before and after the intervention in the treatment group were distinct and significant compared with those of the control group . Three months later , the treatment group showed a lower BMI ( W = 91.00 , p = 0.001 ) , WC ( t = 4.755 , p < 0.001 ) , VAT volume ( t = 5.164 , p < 0.001 ) , and mean HFF ( W = 120.00 , p = 0.001 ) compared with pretreatment levels . Compared with the control group , the treatment group showed a lower VAT volume ( t = 60.00 , p = 0.029 ) after 3 months of treatment . After 3 months , the control group showed higher mean HFF ( t = -2.900 , p = 0.012 ) and VAT volume ( W = 11.50 , p = 0.006 ) compared with their initial levels . CONCLUSION Based on MRI evaluation , this r and omized controlled study proved that EA treatment reduces BMI and WC as well as VAT volume and HFF in women with abdominal obesity Chronic constipation affects approximately 16 % of the world 's population ( 1 ) , 17.1 % of persons in Europe ( 2 ) , 12 % to 19 % of those in North America ( 3 ) , and 10.8 % of those in Asia ( 1 ) . Patients with severe chronic constipation have complete spontaneous bowel movements ( CSBMs ) no more than twice per week , with hard stools , frequent straining , and the sensation of incomplete evacuation ( 4 ) . Most chronic constipation is functional and is associated with decreased quality of life ( 5 ) . Laxatives produce only temporary relief , and constipation tends to reoccur after discontinuing medication ( 6 , 7 ) . Nearly half of patients are dissatisfied with their traditional therapies , such as laxatives ( 8) . Other treatment options may include prokinetic agents . In a trial , 1 to 2 mg of prucalopride ( an agonist for 5-hydroxytryptamine receptor 4 ) per day was reported to normalize BMs in 37.9 % of patients with severe chronic constipation ( 9 ) . However , the adverse cardiac effects induced by some prokinetic agents can not be ignored ( 10 ) , and their long-term effects remain unknown . A systematic review supports the use of acupuncture for chronic constipation ( 11 ) , and our previous study indicates that electroacupuncture ( EA ) might have some sustained effects ( 12 ) . However , the evidence for the therapeutic effects of acupuncture is limited because many r and omized , controlled trials have had small sample sizes or other method ological limitations ( 11 ) . Our goal was to determine the efficacy of EA for the treatment of chronic severe functional constipation ( CSFC ) over an 8-week treatment period and evaluate the maintenance of effects throughout the 12-week follow-up . We hypothesized that EA would be superior to sham EA ( SA ) at both end points . Methods Design Overview We conducted a multicenter , r and omized , parallel , sham-controlled trial at 15 sites in China . The study duration per patient was 22 weeks : 2 weeks before r and omization ( baseline assessment ) ; 8 weeks of treatment ; and 12 weeks of follow-up without treatment . Research ers screened c and i date s for study participation , and experienced physicians at digestive or anorectal departments made diagnoses . Participants Participants were included if they met the diagnosis of functional constipation based on the Rome III diagnostic criteria for functional gastrointestinal disorders ( 13 ) , had CSFC with 2 or fewer mean weekly CSBMs for more than 3 months , were aged between 18 and 75 years , had not taken constipation medication for a minimum of 2 weeks before enrollment except for rescue medicine ( glycerol or sorbitol anal enema ) , had not received acupuncture for constipation , and had not participated in any other trial in the previous 3 months . The exclusion criteria were constipation caused by irritable bowel syndrome or drugs or that was secondary to endocrine , metabolic , neurologic , or postoperative diseases ; severe cardiovascular , hepatic , or renal diseases ; cognitive dysfunction , aphasia , mental disorders , or illness that could affect patient cooperation ; pregnant or lactating women ; abdominal aortic aneurysm or hepatosplenomegaly ; blood coagulation disorders or regular anticoagulant use , including warfarin or heparin ( an exception was antiplatelet treatment using aspirin or clopidogrel ) ; and cardiac pacemaker implantation . C and i date s signed informed consent . After the 2-week baseline assessment , eligible participants were r and omly assigned and received their first treatment on the same day . The study was performed according to common guidelines for clinical trials ( Declaration of Helsinki and International Conference on Harmonisation Good Clinical Practice E6 guidance ) . The study protocol ( 14 ) adhered to the St and ards for Reporting Interventions in Clinical Trials of Acupuncture guidelines and was approved by the ethics committees of each responsible site . R and omization and Blinding Participants were allocated to the EA or SA group using stratified block r and omization . The r and omization sequences were generated by using PROC PLAN in SAS , version 9.4 ( SAS Institute ) , with the study site as the stratification factor and the block length as 4 . Acupuncturists obtained each patient 's r and om number and assignment through the central r and omization system ( Institute of Basic Research in Clinical Medicine , China Academy of Chinese Medical Sciences ) . All participants were treated separately to prevent communication . Except for acupuncturists , all relevant parties were blinded to the intervention ( EA vs. SA ) groups . Participants were informed that they had an equal chance of allocation to the EA or SA group before study participation . To test the success of blinding , we r and omly selected 140 participants ( 70 from each group , with 9 to 10 participants at each site ) for the blinding assessment ; the acupuncturists asked them to guess whether they received EA or SA after treatments in weeks 4 and 8 . Intervention Study interventions were developed by the consensus of acupuncture experts and per the results of our pilot study ( Cai Y , Wu J , Liu Z. Electroacupuncture versus sham electroacupuncture for chronic  severe functional constipation : a r and omized controlled pilot study . 2012 . Unpublished data . ) . Fifteen acupuncturists with 2 to 3 years of experience at the 15 sites administered the EA and SA treatments . All acupuncturists had at least a 5-year undergraduate education and were registered practitioners of traditional Chinese medicine . All research assistants and acupuncturists received a 2-day training session before study initiation . Both treatments consisted of 28 sessions , each for 30 minutes , and were administered over 8 weeks ( 5 sessions in each of the first 2 weeks , and 3 sessions in each of the remaining 6 weeks ) . Disposable needles ( Huatuo ) and the SDZ-V EA apparatus ( Suzhou Medical Appliance ) were used . Participants in the EA group received EA at 
    Output:
    