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: Introduction While de qi , the acupuncture needling sensation , has been considered as an important component of acupuncture , little is known of the acupuncture patient 's experience and beliefs about de qi in clinical setting s. The aim of this study was to describe Chinese acupuncture patients ’ perceived sensations of , and beliefs about , acupuncture needling . Methods We developed a question naire and conducted a survey study at two time periods among 200 subjects at six outpatient acupuncture clinics in Beijing , China . Results Respondents were 55 % female and had a mean age of 41 years . The most common types of needling sensations reported by subjects were the terms ‘ distended’(94 % ) , ‘ sore’(81 % ) , ‘ electric’(81 % ) and ‘ numb ’ ( 78 % ) . Eighty-nine percent of subjects reported that the needling sensation travelled away from the puncturing points or travelled among the needling points . Eighty-two percent of subjects believed that the needling sensation was very important for acupuncture treatment , and 68 % further indicated that the stronger the needling sensation , the more effective the therapy . Eighty-one percent of subjects found the acupuncture process to be very comfortable and relaxing . Conclusion Chinese acupuncture patients described the common characteristics of de qi and its migratory nature . The sensations were believed to be important in producing clinical efficacy by most patients . Measuring the sensations described as de qi in future prospect i ve studies will help us underst and the degree to which this phenomenon has an effect on the physiological outcome and clinical response to acupuncture . There appears to be a limit to the number of sensations that can be discriminated by each individual patient , and further development of the question naire is planned Summary This multifactorial mixed‐ methods r and omized controlled trial quantified the specific and nonspecific factors of acupuncture , and found that the practitioner , not the treatment , has the strongest effect on outcome . Abstract The nonspecific effects of acupuncture are well documented ; we wished to quantify these factors in osteoarthritic ( OA ) pain , examining needling , the consultation , and the practitioner . In a prospect i ve r and omised , single‐blind , placebo‐controlled , multifactorial , mixed‐ methods trial , 221 patients with OA awaiting joint replacement surgery were recruited . Interventions were acupuncture , Streitberger placebo acupuncture , and mock electrical stimulation , each with empathic or nonempathic consultations . Interventions involved eight 30‐minute treatments over 4 weeks . The primary outcome was pain ( VAS ) at 1 week posttreatment . Face‐to‐face qualitative interviews were conducted ( purposive sample , 27 participants ) . Improvements occurred from baseline for all interventions with no significant differences between real and placebo acupuncture ( mean difference −2.7 mm , 95 % confidence intervals −9.0 to 3.6 ; P = .40 ) or mock stimulation ( −3.9 , −10.4 to 2.7 ; P = .25 ) . Empathic consultations did not affect pain ( 3.0 mm , −2.2 to 8.2 ; P = .26 ) but practitioner 3 achieved greater analgesia than practitioner 2 ( 10.9 , 3.9 to 18.0 ; P = .002 ) . Qualitative analysis indicated that patients ’ beliefs about treatment veracity and confidence in outcomes were reciprocally linked . The supportive nature of the trial attenuated differences between the different consultation styles . Improvements occurred from baseline , but acupuncture has no specific efficacy over either placebo . The individual practitioner and the patient ’s belief had a significant effect on outcome . The 2 placebos  were equally as effective and credible as acupuncture . Needle and nonneedle placebos are equivalent . An unknown characteristic of the treating practitioner predicts outcome , as does the patient ’s belief ( independently ) . Beliefs about treatment veracity shape how patients self‐report outcome , complicating and confounding study interpretation BACKGROUND To our knowledge , verum acupuncture has never been directly compared with sham acupuncture and guideline -based conventional therapy in patients with chronic low back pain . METHODS A patient- and observer-blinded r and omized controlled trial conducted in Germany involving 340 outpatient practice s , including 1162 patients aged 18 to 86 years ( mean + /- SD age , 50 + /- 15 years ) with a history of chronic low back pain for a mean of 8 years . Patients underwent ten 30-minute sessions , generally 2 sessions per week , of verum acupuncture ( n = 387 ) according to principles of traditional Chinese medicine ; sham acupuncture ( n = 387 ) consisting of superficial needling at nonacupuncture points ; or conventional therapy , a combination of drugs , physical therapy , and exercise ( n = 388 ) . Five additional sessions were offered to patients who had a partial response to treatment ( 10%-50 % reduction in pain intensity ) . Primary outcome was response after 6 months , defined as 33 % improvement or better on 3 pain-related items on the Von Korff Chronic Pain Grade Scale question naire or 12 % improvement or better on the back-specific Hanover Functional Ability Question naire . Patients who were unblinded or had recourse to other than permitted concomitant therapies during follow-up were classified as nonresponders regardless of symptom improvement . RESULTS At 6 months , response rate was 47.6 % in the verum acupuncture group , 44.2 % in the sham acupuncture group , and 27.4 % in the conventional therapy group . Differences among groups were as follows : verum vs sham , 3.4 % ( 95 % confidence interval , -3.7 % to 10.3 % ; P = .39 ) ; verum vs conventional therapy , 20.2 % ( 95 % confidence interval , 13.4 % to 26.7 % ; P < .001 ) ; and sham vs conventional therapy , 16.8 % ( 95 % confidence interval , 10.1 % to 23.4 % ; P < .001 . CONCLUSIONS Low back pain improved after acupuncture treatment for at least 6 months . Effectiveness of acupuncture , either verum or sham , was almost twice that of conventional therapy During acupuncture treatments , acupuncture needles are manipulated to elicit the characteristic " de qi " reaction widely viewed as essential to acupuncture 's therapeutic effect . De qi has a biomechanical component , " needle grasp , " which we have quantified by measuring the force necessary to pull an acupuncture needle out of the skin ( pullout force ) in 60 human subjects . We hypothesized that pullout force is greater with both bidirectional needle rotation ( BI ) and unidirectional rotation ( UNI ) than no rotation ( NO ) . Acupuncture needles were inserted , manipulated , and pulled out by using a computer-controlled acupuncture needling instrument at eight acupuncture points and eight control points . We found 167 and 52 % increases in mean pullout force with UNI and BI , respectively , compared with NO ( repeated- measures ANOVA , P < 0.001 ) . Pullout force was on average 18 % greater at acupuncture points than at control points ( P < 0.001 ) . Needle grasp is therefore a measurable biomechanical phenomenon associated with acupuncture needle manipulation UNLABELLED A control treatment in acupuncture research must be credible , regardless if the needling is performed by one or by several therapists . OBJECTIVE To investigate if individuals could identify whether needling had been given with an acupuncture needle or a sham needle and if the therapist influenced this ability . DESIGN Eighty individuals were r and omized to one single needling given by one of four physiotherapists using either an invasive needle or a non-penetrating telescopic sham needle . RESULTS An equal proportion of individuals , 27 ( 68 % ) , in the acupuncture group and the sham group answered incorrectly or was not sure at all regarding needling type but the proportion varied between the therapists from 55 to 80 % ( ns ) . Bang 's blinding index was 0.20 ( 95 % CI 0.03 - 0.36 ) in the acupuncture group and 0.10 ( 95 % CI 0.09 - 0.29 ) in the sham group ( interpretation : 20 and 10 % identified needling type beyond statistical chance ) . Acupuncture was on a four- grade scale rated as median " mildly painful " and sham as " not painful " ( ns ) . Pain ratings varied from median " not " to " mildly painful " in the therapists ( p = 0.01 ) . CONCLUSIONS Two thirds of individuals needled by acupuncture as well as sham could not identify needling type and only 10 - 20 % of the individuals were unblinded beyond chance . The therapists , not the needling type , influenced how painful the needling was perceived . IMPLICATION S To achieve blinding success in acupuncture efficacy studies using the sham needle , the needling procedure must be strictly st and ardized in order to minimize differences between the therapists Background Deqi is defined in relation to acupuncture needling as a sensory perception of varying character . In a recently published sham laser validation study , we found that subjects in the verum and the sham laser group experienced deqi sensations . Therefore , we aim to further analyze whether the perceptions reported in the two study arms were distinguishable and whether expectancy effects exhibited considerable impact on our results . Methods A detailed re- analysis focusing on deqi sensations was performed from data collected in a previously published placebo-controlled , double-blind , clinical cross-over trial for a sham laser evaluation . Thirty-four healthy volunteers ( 28 ± 10.7 years ; 16 women , 18 men ) received two laser acupuncture treatments at three acupuncture points LI4 ( hégu ) , LU7 ( liéque ) , and LR3 ( táichong ) ; once by verum laser and once using a sham device containing an inactive laser in r and omized order . Outcome measures were frequency , intensity ( evaluated by visual analogue scale ; VAS ) , and quality of the subjects ' sensations perceived during treatments ( assessed with the " acupuncture sensation scale " ) . Results Both , verum and the sham laser acupuncture result in similar deqi sensations with regard to frequency ( p-value = 0.67 ) , intensity ( p-value = 0.71 ) and quality ( p-values between 0.15 - 0.98 ) . In both groups the most frequently used adjectives to describe these perceptions were " spreading " , " radiating " , " tingling " , " tugging " , " pulsing " , " warm " , " dull " , and " electric " . Sensations reported were consistent with the perception of deqi as previously defined in literature . Subjects ' conviction regarding the effectiveness of laser acupuncture or the history of having received acupuncture treatments before did not correlate with the frequency or intensity of sensations reported . Conclusions Since deqi sensations , described as sensory perceptions , were elicited without any cutaneous sensory input , we assume that they are a product of non-specific effects from the overall treatment procedure . Expectancy-effects due to previous acupuncture experience and belief in laser acupuncture do not seem to play a major role in elicitation of deqi sensations . Our results give hints that deqi might be a central phenomenon of awareness and consciousness , and that its relevance should be taken into account , even in clinical trials . However , further research is required to underst and mechanisms underlying deqi Background Accumulating neuroimaging studies in humans have shown that acupuncture can modulate a widely distributed brain network , large portions of which are overlapped with the pain-related areas . Recently , a striking feature of acupuncture-induced analgesia is found to be associated with its long-last effect , which has a delayed onset and gradually reaches a peak even after acupuncture needling being terminated . Identifying temporal neural responses in these areas that occur at particular time -- both acute and sustained effects during acupuncture processes -- may therefore shed lights on how such peripheral inputs are conducted and mediated through the CNS . In the present study , we adopted a non-repeated event-related ( NRER ) fMRI paradigm and control theory based approach namely change-point analysis in order to capture the detailed temporal profile of neural responses induced by acupuncture . Results Our findings demonstrated that neural activities at the different stages of acupuncture presented distinct temporal patterns , in which consistently positive neural responses were found during the period of acupuncture needling while much more complex and dynamic activities found during a post-acupuncture period . These brain responses had a significant time-dependent effect which showed different onset time and duration of neural activities . The amygdala and perigenual anterior cingulate cortex ( pACC ) , exhibited increased activities during the needling phase while decreased gradually to reach a peak below the baseline . The periaqueductal gray ( PAG ) and hypothalamus presented saliently intermittent activations across the whole fMRI session . Apart from the time-dependent responses , relatively persistent activities were also identified in the anterior insula and prefrontal cortices . The overall findings indicate that acupuncture may engage differential temporal neural responses as a function of time in a wide range of brain networks . Conclusions Our study has provided evidence supporting a view that acupuncture intervention involves complex modulations of temporal neural response , and its effect can gradually resolve as a function of time . The functional specificity of acupuncture at ST36 may involve multiple levels of differential activities of a wide range of brain networks , which are gradually enhanced even after acupuncture needle being terminated BACKGROUND Acupuncture is widely used by patients with low back pain , although its effectiveness is unclear . We investigated the efficacy of acupuncture compared with minimal acup 
    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: Introduction While de qi , the acupuncture needling sensation , has been considered as an important component of acupuncture , little is known of the acupuncture patient 's experience and beliefs about de qi in clinical setting s. The aim of this study was to describe Chinese acupuncture patients ’ perceived sensations of , and beliefs about , acupuncture needling . Methods We developed a question naire and conducted a survey study at two time periods among 200 subjects at six outpatient acupuncture clinics in Beijing , China . Results Respondents were 55 % female and had a mean age of 41 years . The most common types of needling sensations reported by subjects were the terms ‘ distended’(94 % ) , ‘ sore’(81 % ) , ‘ electric’(81 % ) and ‘ numb ’ ( 78 % ) . Eighty-nine percent of subjects reported that the needling sensation travelled away from the puncturing points or travelled among the needling points . Eighty-two percent of subjects believed that the needling sensation was very important for acupuncture treatment , and 68 % further indicated that the stronger the needling sensation , the more effective the therapy . Eighty-one percent of subjects found the acupuncture process to be very comfortable and relaxing . Conclusion Chinese acupuncture patients described the common characteristics of de qi and its migratory nature . The sensations were believed to be important in producing clinical efficacy by most patients . Measuring the sensations described as de qi in future prospect i ve studies will help us underst and the degree to which this phenomenon has an effect on the physiological outcome and clinical response to acupuncture . There appears to be a limit to the number of sensations that can be discriminated by each individual patient , and further development of the question naire is planned Summary This multifactorial mixed‐ methods r and omized controlled trial quantified the specific and nonspecific factors of acupuncture , and found that the practitioner , not the treatment , has the strongest effect on outcome . Abstract The nonspecific effects of acupuncture are well documented ; we wished to quantify these factors in osteoarthritic ( OA ) pain , examining needling , the consultation , and the practitioner . In a prospect i ve r and omised , single‐blind , placebo‐controlled , multifactorial , mixed‐ methods trial , 221 patients with OA awaiting joint replacement surgery were recruited . Interventions were acupuncture , Streitberger placebo acupuncture , and mock electrical stimulation , each with empathic or nonempathic consultations . Interventions involved eight 30‐minute treatments over 4 weeks . The primary outcome was pain ( VAS ) at 1 week posttreatment . Face‐to‐face qualitative interviews were conducted ( purposive sample , 27 participants ) . Improvements occurred from baseline for all interventions with no significant differences between real and placebo acupuncture ( mean difference −2.7 mm , 95 % confidence intervals −9.0 to 3.6 ; P = .40 ) or mock stimulation ( −3.9 , −10.4 to 2.7 ; P = .25 ) . Empathic consultations did not affect pain ( 3.0 mm , −2.2 to 8.2 ; P = .26 ) but practitioner 3 achieved greater analgesia than practitioner 2 ( 10.9 , 3.9 to 18.0 ; P = .002 ) . Qualitative analysis indicated that patients ’ beliefs about treatment veracity and confidence in outcomes were reciprocally linked . The supportive nature of the trial attenuated differences between the different consultation styles . Improvements occurred from baseline , but acupuncture has no specific efficacy over either placebo . The individual practitioner and the patient ’s belief had a significant effect on outcome . The 2 placebos  were equally as effective and credible as acupuncture . Needle and nonneedle placebos are equivalent . An unknown characteristic of the treating practitioner predicts outcome , as does the patient ’s belief ( independently ) . Beliefs about treatment veracity shape how patients self‐report outcome , complicating and confounding study interpretation BACKGROUND To our knowledge , verum acupuncture has never been directly compared with sham acupuncture and guideline -based conventional therapy in patients with chronic low back pain . METHODS A patient- and observer-blinded r and omized controlled trial conducted in Germany involving 340 outpatient practice s , including 1162 patients aged 18 to 86 years ( mean + /- SD age , 50 + /- 15 years ) with a history of chronic low back pain for a mean of 8 years . Patients underwent ten 30-minute sessions , generally 2 sessions per week , of verum acupuncture ( n = 387 ) according to principles of traditional Chinese medicine ; sham acupuncture ( n = 387 ) consisting of superficial needling at nonacupuncture points ; or conventional therapy , a combination of drugs , physical therapy , and exercise ( n = 388 ) . Five additional sessions were offered to patients who had a partial response to treatment ( 10%-50 % reduction in pain intensity ) . Primary outcome was response after 6 months , defined as 33 % improvement or better on 3 pain-related items on the Von Korff Chronic Pain Grade Scale question naire or 12 % improvement or better on the back-specific Hanover Functional Ability Question naire . Patients who were unblinded or had recourse to other than permitted concomitant therapies during follow-up were classified as nonresponders regardless of symptom improvement . RESULTS At 6 months , response rate was 47.6 % in the verum acupuncture group , 44.2 % in the sham acupuncture group , and 27.4 % in the conventional therapy group . Differences among groups were as follows : verum vs sham , 3.4 % ( 95 % confidence interval , -3.7 % to 10.3 % ; P = .39 ) ; verum vs conventional therapy , 20.2 % ( 95 % confidence interval , 13.4 % to 26.7 % ; P < .001 ) ; and sham vs conventional therapy , 16.8 % ( 95 % confidence interval , 10.1 % to 23.4 % ; P < .001 . CONCLUSIONS Low back pain improved after acupuncture treatment for at least 6 months . Effectiveness of acupuncture , either verum or sham , was almost twice that of conventional therapy During acupuncture treatments , acupuncture needles are manipulated to elicit the characteristic " de qi " reaction widely viewed as essential to acupuncture 's therapeutic effect . De qi has a biomechanical component , " needle grasp , " which we have quantified by measuring the force necessary to pull an acupuncture needle out of the skin ( pullout force ) in 60 human subjects . We hypothesized that pullout force is greater with both bidirectional needle rotation ( BI ) and unidirectional rotation ( UNI ) than no rotation ( NO ) . Acupuncture needles were inserted , manipulated , and pulled out by using a computer-controlled acupuncture needling instrument at eight acupuncture points and eight control points . We found 167 and 52 % increases in mean pullout force with UNI and BI , respectively , compared with NO ( repeated- measures ANOVA , P < 0.001 ) . Pullout force was on average 18 % greater at acupuncture points than at control points ( P < 0.001 ) . Needle grasp is therefore a measurable biomechanical phenomenon associated with acupuncture needle manipulation UNLABELLED A control treatment in acupuncture research must be credible , regardless if the needling is performed by one or by several therapists . OBJECTIVE To investigate if individuals could identify whether needling had been given with an acupuncture needle or a sham needle and if the therapist influenced this ability . DESIGN Eighty individuals were r and omized to one single needling given by one of four physiotherapists using either an invasive needle or a non-penetrating telescopic sham needle . RESULTS An equal proportion of individuals , 27 ( 68 % ) , in the acupuncture group and the sham group answered incorrectly or was not sure at all regarding needling type but the proportion varied between the therapists from 55 to 80 % ( ns ) . Bang 's blinding index was 0.20 ( 95 % CI 0.03 - 0.36 ) in the acupuncture group and 0.10 ( 95 % CI 0.09 - 0.29 ) in the sham group ( interpretation : 20 and 10 % identified needling type beyond statistical chance ) . Acupuncture was on a four- grade scale rated as median " mildly painful " and sham as " not painful " ( ns ) . Pain ratings varied from median " not " to " mildly painful " in the therapists ( p = 0.01 ) . CONCLUSIONS Two thirds of individuals needled by acupuncture as well as sham could not identify needling type and only 10 - 20 % of the individuals were unblinded beyond chance . The therapists , not the needling type , influenced how painful the needling was perceived . IMPLICATION S To achieve blinding success in acupuncture efficacy studies using the sham needle , the needling procedure must be strictly st and ardized in order to minimize differences between the therapists Background Deqi is defined in relation to acupuncture needling as a sensory perception of varying character . In a recently published sham laser validation study , we found that subjects in the verum and the sham laser group experienced deqi sensations . Therefore , we aim to further analyze whether the perceptions reported in the two study arms were distinguishable and whether expectancy effects exhibited considerable impact on our results . Methods A detailed re- analysis focusing on deqi sensations was performed from data collected in a previously published placebo-controlled , double-blind , clinical cross-over trial for a sham laser evaluation . Thirty-four healthy volunteers ( 28 ± 10.7 years ; 16 women , 18 men ) received two laser acupuncture treatments at three acupuncture points LI4 ( hégu ) , LU7 ( liéque ) , and LR3 ( táichong ) ; once by verum laser and once using a sham device containing an inactive laser in r and omized order . Outcome measures were frequency , intensity ( evaluated by visual analogue scale ; VAS ) , and quality of the subjects ' sensations perceived during treatments ( assessed with the " acupuncture sensation scale " ) . Results Both , verum and the sham laser acupuncture result in similar deqi sensations with regard to frequency ( p-value = 0.67 ) , intensity ( p-value = 0.71 ) and quality ( p-values between 0.15 - 0.98 ) . In both groups the most frequently used adjectives to describe these perceptions were " spreading " , " radiating " , " tingling " , " tugging " , " pulsing " , " warm " , " dull " , and " electric " . Sensations reported were consistent with the perception of deqi as previously defined in literature . Subjects ' conviction regarding the effectiveness of laser acupuncture or the history of having received acupuncture treatments before did not correlate with the frequency or intensity of sensations reported . Conclusions Since deqi sensations , described as sensory perceptions , were elicited without any cutaneous sensory input , we assume that they are a product of non-specific effects from the overall treatment procedure . Expectancy-effects due to previous acupuncture experience and belief in laser acupuncture do not seem to play a major role in elicitation of deqi sensations . Our results give hints that deqi might be a central phenomenon of awareness and consciousness , and that its relevance should be taken into account , even in clinical trials . However , further research is required to underst and mechanisms underlying deqi Background Accumulating neuroimaging studies in humans have shown that acupuncture can modulate a widely distributed brain network , large portions of which are overlapped with the pain-related areas . Recently , a striking feature of acupuncture-induced analgesia is found to be associated with its long-last effect , which has a delayed onset and gradually reaches a peak even after acupuncture needling being terminated . Identifying temporal neural responses in these areas that occur at particular time -- both acute and sustained effects during acupuncture processes -- may therefore shed lights on how such peripheral inputs are conducted and mediated through the CNS . In the present study , we adopted a non-repeated event-related ( NRER ) fMRI paradigm and control theory based approach namely change-point analysis in order to capture the detailed temporal profile of neural responses induced by acupuncture . Results Our findings demonstrated that neural activities at the different stages of acupuncture presented distinct temporal patterns , in which consistently positive neural responses were found during the period of acupuncture needling while much more complex and dynamic activities found during a post-acupuncture period . These brain responses had a significant time-dependent effect which showed different onset time and duration of neural activities . The amygdala and perigenual anterior cingulate cortex ( pACC ) , exhibited increased activities during the needling phase while decreased gradually to reach a peak below the baseline . The periaqueductal gray ( PAG ) and hypothalamus presented saliently intermittent activations across the whole fMRI session . Apart from the time-dependent responses , relatively persistent activities were also identified in the anterior insula and prefrontal cortices . The overall findings indicate that acupuncture may engage differential temporal neural responses as a function of time in a wide range of brain networks . Conclusions Our study has provided evidence supporting a view that acupuncture intervention involves complex modulations of temporal neural response , and its effect can gradually resolve as a function of time . The functional specificity of acupuncture at ST36 may involve multiple levels of differential activities of a wide range of brain networks , which are gradually enhanced even after acupuncture needle being terminated BACKGROUND Acupuncture is widely used by patients with low back pain , although its effectiveness is unclear . We investigated the efficacy of acupuncture compared with minimal acup 
    Output:
    