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: OBJECTIVE Osseous changes in the temporom and ibular joint ( TMJ ) were evaluated using computed tomography ( CT ) examinations before and after TMJ injections of sodium hyaluronate or a corticosteroid in patients with osteoarthritis ( OA ) . STUDY DESIGN Forty patients were r and omly allocated into 2 groups for 2 intra-articular injections with either sodium hyaluronate or a corticosteroid . Bilateral TMJ examinations with high resolution CT were obtained in 36 patients before and 6 months after treatment . Treated and contralateral TMJs were evaluated for the presence of osteoarthritic osseous abnormalities by 2 review ers independently . RESULTS Progression , regression , and no changes of osseous abnormalities were demonstrated in 13 , 9 , and 14 TMJs , respectively , 6 months after treatment . There was no significant difference between the groups . CONCLUSIONS Progression/regression and no changes of osteoarthritic abnormalities were observed on CT examinations in both the treated and the contralateral TMJs after treatment with intra-articular injection with sodium hyaluronate or corticosteroid PURPOSE To show whether an intra-articular ( IA ) infiltration of 1 mL sodium hyaluronate ( SH ) into the temporom and ibular joint ( TMJ ) would significantly reduce pain and improve joint function in Wilkes stage II disease , compared with the oral administration of a combination of methocarbamol and paracetamol . PATIENTS AND METHODS Forty-one patients with Wilkes stage II disease were selected and r and omly assigned to 2 groups . The experimental group received 1 IA infiltration of SH with assessment s at days 14 , 28 , 56 , and 84 . The control group was given 2 tablets of a combination of methocarbamol 380 mg and paracetamol 300 mg every 6 hours for 4 weeks , with assessment s at days 14 and 28 . RESULTS Forty-one patients were r and omized into the study ( SH : 20 patients , control drug : 21 patients ) . A statistically significant difference ( P < . 05 ) was detected in favor of the SH group from day 56 onward for TMJ pain at rest , from day 14 onward for pain on jaw opening , and at days 28 and 56 for pain on mastication . The TMJ function was statistically significantly ( P < .05 ) better in the test group at all follow-up visits . The global evaluation of efficacy by both , the patients and investigators , was better for the test group . No adverse reactions were detected with SH . CONCLUSIONS An IA infiltration of SH showed better efficacy in reducing pain and improving joint function in Wilkes stage II disease , compared with the oral administration of methocarbamol-paracetamol tablets This study is an open-label trial on a sample of 76 consecutive patients with temporom and ibular joint ( TMJ ) osteoarthritis treated with a cycle of five weekly arthrocenteses plus hyaluronic acid injections . Patients had a diagnosis of osteoarthritis according to the Research Diagnostic Criteria for Temporom and ibular Disorders ( RDC/TMD Axis I Group IIIb ) . They underwent a cycle of five arthrocenteses with injections ( 1 per week ) of 1ml hyaluronic acid and four follow-up assessment s after the end of the treatment ( at 1 week , 1 month , 3 months , 6 months ) . At each appointment , several subjective and objective outcome variables were assessed to test the efficacy of the treatment protocol . Marked improvements were reported for all variables during the treatment phase . The improvements were maintained over the 6-month follow-up period . The p-value of the multivariate permutation test for the efficacy of the treatment over time ( with Tippett 's combination ) was 0.001 , and significant changes at the end of the follow-up period were detected for almost all the outcome variables . Data from this study lend further support to the usefulness of serial hyaluronic acid injections performed after arthrocentesis for the treatment of TMJ osteoarthritis and for the maintenance of improvements over a 6-month follow-up period The purpose of this study was to compare the efficacy and the complications of intra-articular temporom and ibular joint ( TMJ ) injections in 40 patients with osteoarthritis of the TMJ . The subjects were r and omly divided into two groups , and the patients received either two intra-articular injections with sodium hyaluronate or two intra-articular injections with corticosteroids , 14 days apart . The effect of the treatment was evaluated 14 days , 1 and 6 months after the initial injection and was based on the following measurements : pain intensity , pain localization , joint sounds , m and ibular function and complications . Both groups of patients had less pain intensity at the 6-month follow-up , and there was significantly less pain intensity in the group of patients receiving sodium hyaluronate compared with corticosteroids ( P = 0.001 ) . A decrease in crepitation was seen in both groups . In the 20 subjects receiving sodium hyaluronate both the m and ibular vertical opening and protrusion increased significantly ( P < 0.000 ) . Lateral movement from the affected side increased both in subjects injected with sodium hyaluronate ( P = 0.024 ) , and those injected with corticosteroids ( P = 0.042 ) . In conclusion , this study confirms that injections in the TMJ with sodium hyaluronate or corticosteroids may reduce pain and improve function in patients with osteoarthritis . The injections were more effective in patients with only TMJ pain compared with patients suffering from both TMJ and myofascial pain . Injection with sodium hyaluronate was significantly more effective in decreasing pain intensity than corticosteroids .  Temporary pain after injections may be observed OBJECTIVE To evaluate the effect of arthrocentesis and sodium hyaluronate ( SH ) injections on nitrite , nitrate , and thiobarbituric acid-reactive substance ( TBA-RS ) levels in temporom and ibular joint internal derangements . STUDY DESIGN Arthrocentesis was performed on 10 patients , and 15 patients received a supplemental injection of SH after arthrocentesis .  All these patients received an SH injection 15 days after the first intervention . The synovial fluid sample s were obtained before arthrocentesis on the first appointment and before the SH injection 15 days later . Nitrite and nitrate levels were measured with a highly sensitive and specific chemiluminescence detection method , and the concentration of lipid peroxidation products was assessed by means of the thiobarbituric acid reaction . RESULTS Symptomatic improvement was seen in both groups . Nitrite , nitrate , and TBA-RS levels only decreased significantly ( P < .05 ) with a supplemental SH injection after arthrocentesis . CONCLUSIONS Intra-articular injections of SH may reduce nitrite , nitrate , and TBA-RS levels that play a role in the pathogenesis of various temporom and ibular disorders PURPOSE This study was design ed to investigate the efficacy of arthrocentesis with and without injection of sodium hyaluronate ( SH ) into the upper joint space in the treatment of temporom and ibular joint ( TMJ ) internal derangements . PATIENTS AND METHODS Forty-one TMJs in 5 males and 26 females aged 14 to 53 years comprised the study material . The patients ' complaints were limited mouth opening , TMJ pain and tenderness , and joint noises during function . Patients were r and omly divided into 2 groups in which only arthrocentesis was performed in 1 group and arthrocentesis plus intra-articular injection of sodium hyaluronate was performed in the other group . Both groups contained patients with disc displacement with reduction and with closed lock . Clinical evaluation of the patients was done before the procedure , immediately after the procedure , on postoperative day 1 , and at 1 , 2 , 3 , 4 , 5 , 6 , 9 , 12 , 18 , and 24 months postoperatively . Intensity of TMJ pain , jaw function , and clicking sounds in the TMJ were assessed using visual analog scales . Maximal mouth opening and lateral jaw movements also were recorded at each follow-up visit . RESULTS Both techniques increased maximal mouth opening , lateral movements , and function , while reducing TMJ pain and noise . CONCLUSIONS Although patients benefitted from both techniques , arthrocentesis with injection of SH seemed to be superior to arthrocentesis alone Temporom and ibular dysfunction ( TMD ) has been established as a therapeutic challenge in the plastic and maxillofacial clinics . The current treatment recommendations for TMD include resting the jaw , soft diet , and pain medication with nonsteroidal analgesic agents . If conservative and noninvasive techniques do not work , more invasive techniques may be considered . The main goal of this study was to assess the safety and clinical utility of intraarticular injection of sodium hyaluronate for the treatment of symptoms associated with internal derangement of the temporom and ibular joint ( TMJ ) . In this prospect i ve study , 40 TMJs of 33 patients who have TMD were treated with intraarticular sodium hyaluronate injections at weekly intervals for 3 weeks . Pre- and postinjection pain intensity , the presence of joint sounds , and interincisial distance were documented . The follow-up period was 12 months . There was a statistically significant reduction of pain intensity ( P < 0.01 ) and joint sound ( P < 0.05 ) in all patients . This study shows that intraarticular hyaluronic acid injection for the treatment of reducing and nonreducing disc displacement of TMJ is an effective and safe management The long-term effect ( 2 years ) of occlusal treatment and intra-articular injections of a mixture of corticosteroid and local anaesthetic was investigated in two groups of patients with pain and dysfunction in the temporom and ibular joint ( TMJ ) . Fifteen patients were treated with injections and eighteen patients with occlusal adjustment . The TMJ was tender to palpation in all patients . The intra-articular injections were given once a week for three weeks . The occlusal treatment included splints , grinding on natural teeth and occlusal correction of complete dentures . The severity of the subjective symptoms and clinical signs was estimated before and after treatment . Both sorts of treatment reduced the subjective symptoms and the clinical signs significantly , but the reduction was significantly greater after the intra-articular injections . The effect of the injections was less efficient in patients with radiographic signs of remodelling of the TMJ and general joint symptoms .  It was concluded that both intra-articular injections of corticosteroid combined with local anaesthetic and occlusal treatment have a long palliative effect on  TMJ pain and dysfunction . The intraarticular treatment , however , had a greater effect on the clinical signs OBJECTIVE The present study presents a case series on the efficacy of arthrocentesis with hyaluronic acid injections for the treatment of temporom and ibular joint osteoarthritis by providing patient evaluations at a one-year follow-up . STUDY DESIGN Twenty-five patients with a diagnosis of osteoarthritis according to the Research Diagnostic Criteria for Temporom and ibular Disorders ( RDC/TMD axis I group IIIb ) underwent a cycle of 5 arthrocenteses with injections ( 1 per week ) of 1 mL hyaluronic acid . A number of clinical parameters ( pain at rest and mastication , masticatory efficiency , maximum nonassisted and assisted mouth openings , functional limitation , subjective efficacy , and tolerability of the treatment ) were assessed by the same blinded operator at the time of the diagnosis ( baseline ) , at each appointment during the treatment , and at 1-week , 1-month , 3-month , 6-month , and 1-year follow-up appointments . RESULTS Descriptive analysis showed improvements which were maintained over time for all the study parameters . Permutation tests evidence d the significance of changes which occurred in many clinical parameters within the first 2 injections . Differences with baseline levels remained significant at the end of the follow-up period , particularly for the masticatory efficiency and pain at mastication ( minimum and maximum ) parameters . CONCLUSIONS Data from the present investigation support findings from studies on other joints , which show the efficacy of serial injections of hyaluronic acid after arthrocentesis to reduce symptoms of osteoarthritis and to maintain improvements over time The long-term effect of intra-articular injections of sodium hyaluronate and corticosteroid ( betamethasone ) was compared in a sample of 24 patients who had pain and tenderness to palpation in the temporom and ibular joint ( TMJ arthritis ) of at least six months duration , and who had not responded to conservative treatment . The two drugs were r and omly allocated to the patients . The drugs , 0.5 ml , were injected twice into the superior joint compartment of the TMJ with a two-week interval between injections . The effect on subjective symptoms , clinical signs , and bite force was assessed . At the one and two-year follow-ups both the hyaluronate- and the corticosteroid-group had significantly reduced subjective symptoms as well as clinical signs , and the maximum voluntary bite force was significantly increased . The differences in effect between treatments were not statistically significant . It was concluded that both drugs have a significant long-term effect on chronic arthritis of the TMJ and that either of the drugs can be helpful ; however , sodium hyaluronate might be the best alternative due to the least risk for side effects The short-term effect of intra-articular injections of sodium hyaluronate and a corticosteroid ( betamethasone ) was compared in a sample of 33 patients who had pain and tenderness 
    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: OBJECTIVE Osseous changes in the temporom and ibular joint ( TMJ ) were evaluated using computed tomography ( CT ) examinations before and after TMJ injections of sodium hyaluronate or a corticosteroid in patients with osteoarthritis ( OA ) . STUDY DESIGN Forty patients were r and omly allocated into 2 groups for 2 intra-articular injections with either sodium hyaluronate or a corticosteroid . Bilateral TMJ examinations with high resolution CT were obtained in 36 patients before and 6 months after treatment . Treated and contralateral TMJs were evaluated for the presence of osteoarthritic osseous abnormalities by 2 review ers independently . RESULTS Progression , regression , and no changes of osseous abnormalities were demonstrated in 13 , 9 , and 14 TMJs , respectively , 6 months after treatment . There was no significant difference between the groups . CONCLUSIONS Progression/regression and no changes of osteoarthritic abnormalities were observed on CT examinations in both the treated and the contralateral TMJs after treatment with intra-articular injection with sodium hyaluronate or corticosteroid PURPOSE To show whether an intra-articular ( IA ) infiltration of 1 mL sodium hyaluronate ( SH ) into the temporom and ibular joint ( TMJ ) would significantly reduce pain and improve joint function in Wilkes stage II disease , compared with the oral administration of a combination of methocarbamol and paracetamol . PATIENTS AND METHODS Forty-one patients with Wilkes stage II disease were selected and r and omly assigned to 2 groups . The experimental group received 1 IA infiltration of SH with assessment s at days 14 , 28 , 56 , and 84 . The control group was given 2 tablets of a combination of methocarbamol 380 mg and paracetamol 300 mg every 6 hours for 4 weeks , with assessment s at days 14 and 28 . RESULTS Forty-one patients were r and omized into the study ( SH : 20 patients , control drug : 21 patients ) . A statistically significant difference ( P < . 05 ) was detected in favor of the SH group from day 56 onward for TMJ pain at rest , from day 14 onward for pain on jaw opening , and at days 28 and 56 for pain on mastication . The TMJ function was statistically significantly ( P < .05 ) better in the test group at all follow-up visits . The global evaluation of efficacy by both , the patients and investigators , was better for the test group . No adverse reactions were detected with SH . CONCLUSIONS An IA infiltration of SH showed better efficacy in reducing pain and improving joint function in Wilkes stage II disease , compared with the oral administration of methocarbamol-paracetamol tablets This study is an open-label trial on a sample of 76 consecutive patients with temporom and ibular joint ( TMJ ) osteoarthritis treated with a cycle of five weekly arthrocenteses plus hyaluronic acid injections . Patients had a diagnosis of osteoarthritis according to the Research Diagnostic Criteria for Temporom and ibular Disorders ( RDC/TMD Axis I Group IIIb ) . They underwent a cycle of five arthrocenteses with injections ( 1 per week ) of 1ml hyaluronic acid and four follow-up assessment s after the end of the treatment ( at 1 week , 1 month , 3 months , 6 months ) . At each appointment , several subjective and objective outcome variables were assessed to test the efficacy of the treatment protocol . Marked improvements were reported for all variables during the treatment phase . The improvements were maintained over the 6-month follow-up period . The p-value of the multivariate permutation test for the efficacy of the treatment over time ( with Tippett 's combination ) was 0.001 , and significant changes at the end of the follow-up period were detected for almost all the outcome variables . Data from this study lend further support to the usefulness of serial hyaluronic acid injections performed after arthrocentesis for the treatment of TMJ osteoarthritis and for the maintenance of improvements over a 6-month follow-up period The purpose of this study was to compare the efficacy and the complications of intra-articular temporom and ibular joint ( TMJ ) injections in 40 patients with osteoarthritis of the TMJ . The subjects were r and omly divided into two groups , and the patients received either two intra-articular injections with sodium hyaluronate or two intra-articular injections with corticosteroids , 14 days apart . The effect of the treatment was evaluated 14 days , 1 and 6 months after the initial injection and was based on the following measurements : pain intensity , pain localization , joint sounds , m and ibular function and complications . Both groups of patients had less pain intensity at the 6-month follow-up , and there was significantly less pain intensity in the group of patients receiving sodium hyaluronate compared with corticosteroids ( P = 0.001 ) . A decrease in crepitation was seen in both groups . In the 20 subjects receiving sodium hyaluronate both the m and ibular vertical opening and protrusion increased significantly ( P < 0.000 ) . Lateral movement from the affected side increased both in subjects injected with sodium hyaluronate ( P = 0.024 ) , and those injected with corticosteroids ( P = 0.042 ) . In conclusion , this study confirms that injections in the TMJ with sodium hyaluronate or corticosteroids may reduce pain and improve function in patients with osteoarthritis . The injections were more effective in patients with only TMJ pain compared with patients suffering from both TMJ and myofascial pain . Injection with sodium hyaluronate was significantly more effective in decreasing pain intensity than corticosteroids .  Temporary pain after injections may be observed OBJECTIVE To evaluate the effect of arthrocentesis and sodium hyaluronate ( SH ) injections on nitrite , nitrate , and thiobarbituric acid-reactive substance ( TBA-RS ) levels in temporom and ibular joint internal derangements . STUDY DESIGN Arthrocentesis was performed on 10 patients , and 15 patients received a supplemental injection of SH after arthrocentesis .  All these patients received an SH injection 15 days after the first intervention . The synovial fluid sample s were obtained before arthrocentesis on the first appointment and before the SH injection 15 days later . Nitrite and nitrate levels were measured with a highly sensitive and specific chemiluminescence detection method , and the concentration of lipid peroxidation products was assessed by means of the thiobarbituric acid reaction . RESULTS Symptomatic improvement was seen in both groups . Nitrite , nitrate , and TBA-RS levels only decreased significantly ( P < .05 ) with a supplemental SH injection after arthrocentesis . CONCLUSIONS Intra-articular injections of SH may reduce nitrite , nitrate , and TBA-RS levels that play a role in the pathogenesis of various temporom and ibular disorders PURPOSE This study was design ed to investigate the efficacy of arthrocentesis with and without injection of sodium hyaluronate ( SH ) into the upper joint space in the treatment of temporom and ibular joint ( TMJ ) internal derangements . PATIENTS AND METHODS Forty-one TMJs in 5 males and 26 females aged 14 to 53 years comprised the study material . The patients ' complaints were limited mouth opening , TMJ pain and tenderness , and joint noises during function . Patients were r and omly divided into 2 groups in which only arthrocentesis was performed in 1 group and arthrocentesis plus intra-articular injection of sodium hyaluronate was performed in the other group . Both groups contained patients with disc displacement with reduction and with closed lock . Clinical evaluation of the patients was done before the procedure , immediately after the procedure , on postoperative day 1 , and at 1 , 2 , 3 , 4 , 5 , 6 , 9 , 12 , 18 , and 24 months postoperatively . Intensity of TMJ pain , jaw function , and clicking sounds in the TMJ were assessed using visual analog scales . Maximal mouth opening and lateral jaw movements also were recorded at each follow-up visit . RESULTS Both techniques increased maximal mouth opening , lateral movements , and function , while reducing TMJ pain and noise . CONCLUSIONS Although patients benefitted from both techniques , arthrocentesis with injection of SH seemed to be superior to arthrocentesis alone Temporom and ibular dysfunction ( TMD ) has been established as a therapeutic challenge in the plastic and maxillofacial clinics . The current treatment recommendations for TMD include resting the jaw , soft diet , and pain medication with nonsteroidal analgesic agents . If conservative and noninvasive techniques do not work , more invasive techniques may be considered . The main goal of this study was to assess the safety and clinical utility of intraarticular injection of sodium hyaluronate for the treatment of symptoms associated with internal derangement of the temporom and ibular joint ( TMJ ) . In this prospect i ve study , 40 TMJs of 33 patients who have TMD were treated with intraarticular sodium hyaluronate injections at weekly intervals for 3 weeks . Pre- and postinjection pain intensity , the presence of joint sounds , and interincisial distance were documented . The follow-up period was 12 months . There was a statistically significant reduction of pain intensity ( P < 0.01 ) and joint sound ( P < 0.05 ) in all patients . This study shows that intraarticular hyaluronic acid injection for the treatment of reducing and nonreducing disc displacement of TMJ is an effective and safe management The long-term effect ( 2 years ) of occlusal treatment and intra-articular injections of a mixture of corticosteroid and local anaesthetic was investigated in two groups of patients with pain and dysfunction in the temporom and ibular joint ( TMJ ) . Fifteen patients were treated with injections and eighteen patients with occlusal adjustment . The TMJ was tender to palpation in all patients . The intra-articular injections were given once a week for three weeks . The occlusal treatment included splints , grinding on natural teeth and occlusal correction of complete dentures . The severity of the subjective symptoms and clinical signs was estimated before and after treatment . Both sorts of treatment reduced the subjective symptoms and the clinical signs significantly , but the reduction was significantly greater after the intra-articular injections . The effect of the injections was less efficient in patients with radiographic signs of remodelling of the TMJ and general joint symptoms .  It was concluded that both intra-articular injections of corticosteroid combined with local anaesthetic and occlusal treatment have a long palliative effect on  TMJ pain and dysfunction . The intraarticular treatment , however , had a greater effect on the clinical signs OBJECTIVE The present study presents a case series on the efficacy of arthrocentesis with hyaluronic acid injections for the treatment of temporom and ibular joint osteoarthritis by providing patient evaluations at a one-year follow-up . STUDY DESIGN Twenty-five patients with a diagnosis of osteoarthritis according to the Research Diagnostic Criteria for Temporom and ibular Disorders ( RDC/TMD axis I group IIIb ) underwent a cycle of 5 arthrocenteses with injections ( 1 per week ) of 1 mL hyaluronic acid . A number of clinical parameters ( pain at rest and mastication , masticatory efficiency , maximum nonassisted and assisted mouth openings , functional limitation , subjective efficacy , and tolerability of the treatment ) were assessed by the same blinded operator at the time of the diagnosis ( baseline ) , at each appointment during the treatment , and at 1-week , 1-month , 3-month , 6-month , and 1-year follow-up appointments . RESULTS Descriptive analysis showed improvements which were maintained over time for all the study parameters . Permutation tests evidence d the significance of changes which occurred in many clinical parameters within the first 2 injections . Differences with baseline levels remained significant at the end of the follow-up period , particularly for the masticatory efficiency and pain at mastication ( minimum and maximum ) parameters . CONCLUSIONS Data from the present investigation support findings from studies on other joints , which show the efficacy of serial injections of hyaluronic acid after arthrocentesis to reduce symptoms of osteoarthritis and to maintain improvements over time The long-term effect of intra-articular injections of sodium hyaluronate and corticosteroid ( betamethasone ) was compared in a sample of 24 patients who had pain and tenderness to palpation in the temporom and ibular joint ( TMJ arthritis ) of at least six months duration , and who had not responded to conservative treatment . The two drugs were r and omly allocated to the patients . The drugs , 0.5 ml , were injected twice into the superior joint compartment of the TMJ with a two-week interval between injections . The effect on subjective symptoms , clinical signs , and bite force was assessed . At the one and two-year follow-ups both the hyaluronate- and the corticosteroid-group had significantly reduced subjective symptoms as well as clinical signs , and the maximum voluntary bite force was significantly increased . The differences in effect between treatments were not statistically significant . It was concluded that both drugs have a significant long-term effect on chronic arthritis of the TMJ and that either of the drugs can be helpful ; however , sodium hyaluronate might be the best alternative due to the least risk for side effects The short-term effect of intra-articular injections of sodium hyaluronate and a corticosteroid ( betamethasone ) was compared in a sample of 33 patients who had pain and tenderness 
    Output:
    