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: This study aims to examine electro-acupuncture stimulation ( EA ) assisted therapy with analysis of heart rate variability to underst and autonomic nervous activity variability ( ANAV ) and to track the changes in female patients with constipation . The average ages were 42 ± 12 years old . The participants were divided by a single-blind and r and omized trial into two groups : the electro-acupuncture-point group , and the non-electro-acupuncture-point group . Both of the groups had eight treatments , once a week . For the electro-acupuncture ( EA ) group , needles were inserted into their Zusunli ( ST36 ) , Shangiuxu ( ST37 ) , Tiensu ( ST25 ) , Shueidao ( ST28 ) , Guanyuan ( CV4 ) and Qihai ( CV6 ) points . For the sham electro-acupuncture ( SA ) group , needles were inserted into acu-points that were not the ones mentioned for the EA group . While inserting needles , needles were inserted lightly into the participants ' skin and removed quickly ( mock Transcutaneous Electrical Nerve Stimulation , TENTS ) . After an eight-week treatment period , the autonomic nervous system activities of the SA group did not show significant differences in their heart rate variability . However , the autonomic nervous system activities of the EA group had continuously increased after each session . The normalized high frequency powers ( nHFP ) of their autonomic nervous system activities were 26.79 in the first week , and they increased to 32.28 in the fourth week . In the eighth week , their nHFP had increased to 37.60 ( p < 0.05 ) . The normalized low frequency power ( nLFP ) was 30.81 in the first week . However , it decreased to 25.98 after three weeks of treatment . After the eight-week treatment period , the nLFP decreased to 24.84 ( p < 0.05 ) . After the eight-week treatment , the control group did not appear to undergo any physiological change , while the constipation had been improved for the experimental group . It was found that the activation of parasympathetic nervous system in the experimental group increased after the eight-week treatment . The effects of such a result on the enhancement of the activation of parasympathetic nervous system and the improvement of constipation should be further discussed Background Using an open r and omised controlled study , we examined the effectiveness of manual and electroacupuncture on symptom relief for patients with osteoarthritis of the knee . Methods Patients with symptomatic osteoarthritis of the knee were r and omised to one of three treatment groups . Group A had acupuncture alone , group B had acupuncture but continued on their symptomatic medication , and group C used their symptomatic medication for the first five weeks and then had a course of acupuncture added . Patients receiving acupuncture were treated twice weekly over five weeks . Needles were inserted ( with manual and electrical stimulation ) in acupuncture points for pain and stiffness , selected according to traditional acupuncture theory for treating Bi syndrome . Patients were assessed by a blinded observer before treatment , after five weeks ’ treatment and at one month follow up , using a visual analogue pain scale ( VAS ) and the Western Ontario McMaster ( WOMAC ) question naire for osteoarthritis of the knee . Results The 30 patients in our study were well matched for age , body mass index , disease duration , baseline VAS pain score and baseline WOMAC scores . Repeated measure analyses gave a highly significant improvement in pain ( VAS ) after the courses of acupuncture in groups A ( P=0.012 ) and B ( P=0.001 ) ; there was no change in group C until after the course of acupuncture , when the improvement was significant ( P=0.001 ) . Similarly significant changes were seen with the WOMAC pain and stiffness scores . These benefits were maintained during the one month after the course of acupuncture . Patients ’ rating of global assessment was higher than that of the acupuncturist . Conclusion We conclude that manual and electroacupuncture causes a significant improvement in the symptoms of osteoarthritis  of the knee , either on its own or as an adjunct therapy , with no loss of benefit after one month PURPOSE Data on the association between body mass index ( BMI ) and risk of knee osteoarthritis ( KOA ) are sparse for Asian population s who are leaner than Western population s. We evaluated the association between BMI and risk of  total knee replacement ( TKR ) due to severe KOA among Chinese in Singapore . METHODS We used data from the Singapore Chinese Health Study ( SCHS ) , a population -based prospect i ve cohort of 63,257 Chinese men and women , aged 45 - 74 years at enrollment from 1993 to 1998 . Information on  height , weight , diet and lifestyle factors  were obtained via in-person interviews . TKR cases for severe KOA were identified via linkage with the nationwide hospital discharge data base through 2011 . Cox regression and weighted least squares regression were used in the analysis . RESULTS The mean BMI among cohort participants was 23.1 kg/m(2 ) , and more than two-thirds had BMI below 25 kg/m(2 ) . A total of 1649 had TKR attributable to severe KOA . Risk of TKR increased in a strong dose-dependent manner with increasing BMI throughout the 15 - 32 kg/m(2 ) range and became less clear at BMI > 32 kg/m(2 ) . In the BMI range 16 - 27 kg/m(2 ) , there was a 27 % increase in TKR risk for each unit increase in BMI ( P for trend < 0.001 ) . Compared to BMI 19 - 20 kg/m(2 ) , the risk estimates of TKR were all statistically significant with increasing unit of BMI ≥21 kg/m(2 ) . Results were similar for men and women . CONCLUSION Our results provided evidence for a constant mechanical mechanism underlying BMI and KOA initiation and /or progression BACKGROUND Acupuncture is widely used by patients with chronic pain although there is little evidence of its effectiveness . We investigated the efficacy of acupuncture compared with minimal acupuncture and with no acupuncture in patients with osteoarthritis of the knee . METHODS Patients with chronic osteoarthritis of the knee ( Kellgren grade < or = 2 ) were r and omly assigned to acupuncture ( n=150 ) , minimal acupuncture ( superficial needling at non-acupuncture points ; n=76 ) , or a waiting list control ( n=74 ) . Specialised physicians , in 28 outpatient centres , administered acupuncture and minimal acupuncture in 12 sessions over 8 weeks . Patients completed st and ard question naires at baseline and after 8 weeks , 26 weeks , and 52 weeks . The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis ( WOMAC ) index at the end of week 8 ( adjusted for baseline score ) . All main analyses were by intention to treat . RESULTS 294 patients were enrolled from March 6 , 2002 , to January 17 , 2003 ; eight patients were lost to follow-up after r and omisation , but were included in the final analysis . The mean baseline-adjusted WOMAC index at week 8 was 26.9 ( SE 1.4 ) in the acupuncture group , 35.8 ( 1.9 ) in the minimal acupuncture group , and 49.6 ( 2.0 ) in the waiting list group ( treatment difference acupuncture vs minimal acupuncture -8.8 , [ 95 % CI -13.5 to -4.2 ] , p=0.0002 ; acupuncture vs waiting list -22.7 [ -27.5 to -17.9 ] , p<0.0001 ) . After 52 weeks the difference between the acupuncture and minimal acupuncture groups was no longer significant ( p=0.08 ) . INTERPRETATION After 8 weeks of treatment , pain and joint function are improved more with acupuncture than with minimal acupuncture or no acupuncture in patients with osteoarthritis of the knee . However , this benefit decreases over time Objective . To observe the effects of traditional Chinese moxibustion , compared with sham moxibustion , on the quality of life ( QOL ) in patients with chronic knee osteoarthritis ( KOA ) . Methods . This is a r and omized double-blinded , placebo-controlled trial . 150 patients with KOA were r and omly allocated to either a true moxibustion treatment ( n = 77 ) or a sham moxibustion treatment ( n = 73 ) three times a week for six weeks . The QOL of patients was evaluated with SF-36 at baseline and 3 , 6 , and 12 weeks after baseline . Results . 136 patients were available for analysis . Participants in the true moxibustion group experienced statistically significantly greater improvement in GH ( general health ) scores than the sham group at week 6 ( P = 0.015 ) and week 12 ( P = 0.029 ) . Participants in the true moxibustion group experienced statistically significantly greater improvement in VT ( vitality ) scores than the sham group at week 12 ( P = 0.042 ) . No significant adverse effects were found during the trial . Conclusion . A 6-week moxibustion treatment seems to improve general health and vitality , which are associated with physical and mental quality of life , in patients with KOA up to 12 weeks , relative to credible sham moxibustion . This trial is registered with Clinical trials.gov IS RCT N68475405 Background Previous studies have shown that electroacupuncture ( EA ) has a significant effect on acute pain , but it has not solved the clinical problem of the chronification of acute pain . Diffuse noxious inhibitory controls ( DNIC ) function as a reliable indicator to predict the risk of chronic pain events . DNIC function in knee osteoarthritis ( KOA ) patients has been demonstrated to gradually decrease during the development of chronic pain . The purpose of this study is to conduct a r and omized , controlled clinical trial to determine if EA can repair impaired DNIC function and thus prevent chronification of the acute pain of KOA . Methods / Design This is a multicenter , single blind , r and omized , controlled , three-arm , large-scale clinical trial . A total of 450 KOA patients will be r and omly assigned to three groups . The strong EA group will receive EA with high-intensity current ( 2 mA < current < 5 mA ) at the ipsilateral ‘ Neixiyan ’ ( EX-LE5 ) , ‘ Dubi’(ST35 ) , ‘ Liangqiu’(ST34 ) and ‘ Xuehai ’ ( SP10 ) . The weak EA group will receive EA with low-intensity current ( 0 mA < current < 0.5 mA ) on the same acupoints . The sham EA group will receive EA with low-intensity current ( 0 mA < current < 0.5 mA ) with fine needles inserted superficially into the sites 2 cm lateral to the above acupoints . The patients will be treated with EA once a day , 30 minutes per session , in 5 sessions per week , for 2 weeks . In order to determine the best stage of KOA for effective EA intervention , patients within the treatment groups also will be divided into four stages . The primary outcomes are Visual Analog Scale ( VAS ) , DNIC function and the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) . Clinical assessment s will be evaluated at baseline ( before treatment ) and after 5 to 10 sessions of treatment . Discussion This trial will be helpful in identifying whether strong EA is more effective than weak EA in reversing chronification of acute pain through repairing the impaired DNIC function and in screening for the best stage of KOA for effective EA intervention . Trial registration Chinese Clinical Trial Registry Number : ChiCTR-ICR-14005411 . The date of registration is 31 October 2014 IMPORTANCE There is debate about benefits of acupuncture for  knee pain . OBJECTIVE To determine the efficacy of laser and needle acupuncture for  chronic knee pain . DESIGN , SETTING , AND PARTICIPANTS Zelen- design clinical trial ( r and omization occurred before informed consent ) , in Victoria , Australia ( February 2010-December 2012 ) . Community volunteers ( 282 patients aged ≥50 years with chronic knee pain ) were treated by family physician acupuncturists . INTERVENTIONS No acupuncture ( control group , n = 71 ) and needle ( n = 70 ) , laser ( n = 71 ) , and sham laser ( n = 70 ) acupuncture . Treatments were delivered for 12 weeks . Participants and acupuncturists were blinded to laser and sham laser acupuncture . Control participants were unaware of the trial . MAIN OUTCOMES AND MEASURES Primary outcomes were average knee pain ( numeric rating scale , 0 [ no pain ] to 10 [ worst pain possible ] ; minimal clinical ly important difference [ MCID ] , 1.8 units ) and physical function ( Western Ontario and McMaster Universities Osteoarthritis Index , 0 [ no difficulty ] to 68 [ extreme difficulty ] ; MCID , 6 units ) at 12 weeks . Secondary outcomes included other pain and function measures , quality of life , global change , and 1-year follow-up . Analyses were by intention-to-treat using multiple imputation for missing outcome data . RESULTS At 12 weeks and 1 year 
    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: This study aims to examine electro-acupuncture stimulation ( EA ) assisted therapy with analysis of heart rate variability to underst and autonomic nervous activity variability ( ANAV ) and to track the changes in female patients with constipation . The average ages were 42 ± 12 years old . The participants were divided by a single-blind and r and omized trial into two groups : the electro-acupuncture-point group , and the non-electro-acupuncture-point group . Both of the groups had eight treatments , once a week . For the electro-acupuncture ( EA ) group , needles were inserted into their Zusunli ( ST36 ) , Shangiuxu ( ST37 ) , Tiensu ( ST25 ) , Shueidao ( ST28 ) , Guanyuan ( CV4 ) and Qihai ( CV6 ) points . For the sham electro-acupuncture ( SA ) group , needles were inserted into acu-points that were not the ones mentioned for the EA group . While inserting needles , needles were inserted lightly into the participants ' skin and removed quickly ( mock Transcutaneous Electrical Nerve Stimulation , TENTS ) . After an eight-week treatment period , the autonomic nervous system activities of the SA group did not show significant differences in their heart rate variability . However , the autonomic nervous system activities of the EA group had continuously increased after each session . The normalized high frequency powers ( nHFP ) of their autonomic nervous system activities were 26.79 in the first week , and they increased to 32.28 in the fourth week . In the eighth week , their nHFP had increased to 37.60 ( p < 0.05 ) . The normalized low frequency power ( nLFP ) was 30.81 in the first week . However , it decreased to 25.98 after three weeks of treatment . After the eight-week treatment period , the nLFP decreased to 24.84 ( p < 0.05 ) . After the eight-week treatment , the control group did not appear to undergo any physiological change , while the constipation had been improved for the experimental group . It was found that the activation of parasympathetic nervous system in the experimental group increased after the eight-week treatment . The effects of such a result on the enhancement of the activation of parasympathetic nervous system and the improvement of constipation should be further discussed Background Using an open r and omised controlled study , we examined the effectiveness of manual and electroacupuncture on symptom relief for patients with osteoarthritis of the knee . Methods Patients with symptomatic osteoarthritis of the knee were r and omised to one of three treatment groups . Group A had acupuncture alone , group B had acupuncture but continued on their symptomatic medication , and group C used their symptomatic medication for the first five weeks and then had a course of acupuncture added . Patients receiving acupuncture were treated twice weekly over five weeks . Needles were inserted ( with manual and electrical stimulation ) in acupuncture points for pain and stiffness , selected according to traditional acupuncture theory for treating Bi syndrome . Patients were assessed by a blinded observer before treatment , after five weeks ’ treatment and at one month follow up , using a visual analogue pain scale ( VAS ) and the Western Ontario McMaster ( WOMAC ) question naire for osteoarthritis of the knee . Results The 30 patients in our study were well matched for age , body mass index , disease duration , baseline VAS pain score and baseline WOMAC scores . Repeated measure analyses gave a highly significant improvement in pain ( VAS ) after the courses of acupuncture in groups A ( P=0.012 ) and B ( P=0.001 ) ; there was no change in group C until after the course of acupuncture , when the improvement was significant ( P=0.001 ) . Similarly significant changes were seen with the WOMAC pain and stiffness scores . These benefits were maintained during the one month after the course of acupuncture . Patients ’ rating of global assessment was higher than that of the acupuncturist . Conclusion We conclude that manual and electroacupuncture causes a significant improvement in the symptoms of osteoarthritis  of the knee , either on its own or as an adjunct therapy , with no loss of benefit after one month PURPOSE Data on the association between body mass index ( BMI ) and risk of knee osteoarthritis ( KOA ) are sparse for Asian population s who are leaner than Western population s. We evaluated the association between BMI and risk of  total knee replacement ( TKR ) due to severe KOA among Chinese in Singapore . METHODS We used data from the Singapore Chinese Health Study ( SCHS ) , a population -based prospect i ve cohort of 63,257 Chinese men and women , aged 45 - 74 years at enrollment from 1993 to 1998 . Information on  height , weight , diet and lifestyle factors  were obtained via in-person interviews . TKR cases for severe KOA were identified via linkage with the nationwide hospital discharge data base through 2011 . Cox regression and weighted least squares regression were used in the analysis . RESULTS The mean BMI among cohort participants was 23.1 kg/m(2 ) , and more than two-thirds had BMI below 25 kg/m(2 ) . A total of 1649 had TKR attributable to severe KOA . Risk of TKR increased in a strong dose-dependent manner with increasing BMI throughout the 15 - 32 kg/m(2 ) range and became less clear at BMI > 32 kg/m(2 ) . In the BMI range 16 - 27 kg/m(2 ) , there was a 27 % increase in TKR risk for each unit increase in BMI ( P for trend < 0.001 ) . Compared to BMI 19 - 20 kg/m(2 ) , the risk estimates of TKR were all statistically significant with increasing unit of BMI ≥21 kg/m(2 ) . Results were similar for men and women . CONCLUSION Our results provided evidence for a constant mechanical mechanism underlying BMI and KOA initiation and /or progression BACKGROUND Acupuncture is widely used by patients with chronic pain although there is little evidence of its effectiveness . We investigated the efficacy of acupuncture compared with minimal acupuncture and with no acupuncture in patients with osteoarthritis of the knee . METHODS Patients with chronic osteoarthritis of the knee ( Kellgren grade < or = 2 ) were r and omly assigned to acupuncture ( n=150 ) , minimal acupuncture ( superficial needling at non-acupuncture points ; n=76 ) , or a waiting list control ( n=74 ) . Specialised physicians , in 28 outpatient centres , administered acupuncture and minimal acupuncture in 12 sessions over 8 weeks . Patients completed st and ard question naires at baseline and after 8 weeks , 26 weeks , and 52 weeks . The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis ( WOMAC ) index at the end of week 8 ( adjusted for baseline score ) . All main analyses were by intention to treat . RESULTS 294 patients were enrolled from March 6 , 2002 , to January 17 , 2003 ; eight patients were lost to follow-up after r and omisation , but were included in the final analysis . The mean baseline-adjusted WOMAC index at week 8 was 26.9 ( SE 1.4 ) in the acupuncture group , 35.8 ( 1.9 ) in the minimal acupuncture group , and 49.6 ( 2.0 ) in the waiting list group ( treatment difference acupuncture vs minimal acupuncture -8.8 , [ 95 % CI -13.5 to -4.2 ] , p=0.0002 ; acupuncture vs waiting list -22.7 [ -27.5 to -17.9 ] , p<0.0001 ) . After 52 weeks the difference between the acupuncture and minimal acupuncture groups was no longer significant ( p=0.08 ) . INTERPRETATION After 8 weeks of treatment , pain and joint function are improved more with acupuncture than with minimal acupuncture or no acupuncture in patients with osteoarthritis of the knee . However , this benefit decreases over time Objective . To observe the effects of traditional Chinese moxibustion , compared with sham moxibustion , on the quality of life ( QOL ) in patients with chronic knee osteoarthritis ( KOA ) . Methods . This is a r and omized double-blinded , placebo-controlled trial . 150 patients with KOA were r and omly allocated to either a true moxibustion treatment ( n = 77 ) or a sham moxibustion treatment ( n = 73 ) three times a week for six weeks . The QOL of patients was evaluated with SF-36 at baseline and 3 , 6 , and 12 weeks after baseline . Results . 136 patients were available for analysis . Participants in the true moxibustion group experienced statistically significantly greater improvement in GH ( general health ) scores than the sham group at week 6 ( P = 0.015 ) and week 12 ( P = 0.029 ) . Participants in the true moxibustion group experienced statistically significantly greater improvement in VT ( vitality ) scores than the sham group at week 12 ( P = 0.042 ) . No significant adverse effects were found during the trial . Conclusion . A 6-week moxibustion treatment seems to improve general health and vitality , which are associated with physical and mental quality of life , in patients with KOA up to 12 weeks , relative to credible sham moxibustion . This trial is registered with Clinical trials.gov IS RCT N68475405 Background Previous studies have shown that electroacupuncture ( EA ) has a significant effect on acute pain , but it has not solved the clinical problem of the chronification of acute pain . Diffuse noxious inhibitory controls ( DNIC ) function as a reliable indicator to predict the risk of chronic pain events . DNIC function in knee osteoarthritis ( KOA ) patients has been demonstrated to gradually decrease during the development of chronic pain . The purpose of this study is to conduct a r and omized , controlled clinical trial to determine if EA can repair impaired DNIC function and thus prevent chronification of the acute pain of KOA . Methods / Design This is a multicenter , single blind , r and omized , controlled , three-arm , large-scale clinical trial . A total of 450 KOA patients will be r and omly assigned to three groups . The strong EA group will receive EA with high-intensity current ( 2 mA < current < 5 mA ) at the ipsilateral ‘ Neixiyan ’ ( EX-LE5 ) , ‘ Dubi’(ST35 ) , ‘ Liangqiu’(ST34 ) and ‘ Xuehai ’ ( SP10 ) . The weak EA group will receive EA with low-intensity current ( 0 mA < current < 0.5 mA ) on the same acupoints . The sham EA group will receive EA with low-intensity current ( 0 mA < current < 0.5 mA ) with fine needles inserted superficially into the sites 2 cm lateral to the above acupoints . The patients will be treated with EA once a day , 30 minutes per session , in 5 sessions per week , for 2 weeks . In order to determine the best stage of KOA for effective EA intervention , patients within the treatment groups also will be divided into four stages . The primary outcomes are Visual Analog Scale ( VAS ) , DNIC function and the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) . Clinical assessment s will be evaluated at baseline ( before treatment ) and after 5 to 10 sessions of treatment . Discussion This trial will be helpful in identifying whether strong EA is more effective than weak EA in reversing chronification of acute pain through repairing the impaired DNIC function and in screening for the best stage of KOA for effective EA intervention . Trial registration Chinese Clinical Trial Registry Number : ChiCTR-ICR-14005411 . The date of registration is 31 October 2014 IMPORTANCE There is debate about benefits of acupuncture for  knee pain . OBJECTIVE To determine the efficacy of laser and needle acupuncture for  chronic knee pain . DESIGN , SETTING , AND PARTICIPANTS Zelen- design clinical trial ( r and omization occurred before informed consent ) , in Victoria , Australia ( February 2010-December 2012 ) . Community volunteers ( 282 patients aged ≥50 years with chronic knee pain ) were treated by family physician acupuncturists . INTERVENTIONS No acupuncture ( control group , n = 71 ) and needle ( n = 70 ) , laser ( n = 71 ) , and sham laser ( n = 70 ) acupuncture . Treatments were delivered for 12 weeks . Participants and acupuncturists were blinded to laser and sham laser acupuncture . Control participants were unaware of the trial . MAIN OUTCOMES AND MEASURES Primary outcomes were average knee pain ( numeric rating scale , 0 [ no pain ] to 10 [ worst pain possible ] ; minimal clinical ly important difference [ MCID ] , 1.8 units ) and physical function ( Western Ontario and McMaster Universities Osteoarthritis Index , 0 [ no difficulty ] to 68 [ extreme difficulty ] ; MCID , 6 units ) at 12 weeks . Secondary outcomes included other pain and function measures , quality of life , global change , and 1-year follow-up . Analyses were by intention-to-treat using multiple imputation for missing outcome data . RESULTS At 12 weeks and 1 year 
    Output:
    