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 Avascular necrosis of femoral head ( ANFH ) is a progressive disease that often leads to hip joint dysfunction and even disability in young patients . Although the st and ard treatment , which is core decompression , has the advantage of minimal invasion , the efficacy is variable . Recent studies have shown that implantation of bone marrow containing osteogenic precursors into necrotic lesion of ANFH may be promising for the treatment of ANFH . Methods A prospect i ve , double-blinded , r and omized controlled trial was conducted to examine the effect of bone-marrow buffy coat ( BBC ) grafting combined with core decompression for the treatment of ANFH . Forty-five patients ( 53 hips ) with Ficat stage I to III ANFH were recruited . The hips were allocated to the control group ( core decompression + autologous bone graft ) or treatment group ( core decompression + autologous bone graft with BBC ) . Both patients and assessors were blinded to the treatment options . The clinical symptoms and disease progression were assessed as the primary and secondary outcomes . Results At the final follow-up ( 24 months ) , there was a significant relief in pain ( P < 0.05 ) and clinical joint symptoms as measured by the Lequesne index ( P < 0.05 ) and Western Ontario and McMaster Universities Arthritis Index ( P < 0.05 ) in the treatment group . In addition , 33.3 % of the hips in the control group have deteriorated to the next stage after 24 months post-procedure , whereas only 8 % in the treatment group had further deterioration ( P < 0.05 ) . More importantly , the non-progression rates for stage I/II hips were 100 % in the treatment group and 66.7 % in the control group . Conclusion Implantation of the autologous BBC grafting combined with core decompression is effective to prevent further progression for the early stages of ANFH.Trial registration Clinical Trials.gov identifier NCT01613612 . Registered 13 December 2011 Introduction This study tested the effectiveness of moxibustion on pain and function in chronic knee osteoarthritis ( KOA ) and evaluated safety . Methods A multi-centre , non-blinded , parallel-group , r and omised controlled trial compared moxibustion with usual care ( UC ) in KOA . 212 South Korean patients aged 40–70 were recruited from 2011–12 , stratified by mild ( Kellgren/Lawrence scale grade s 0/1 ) and moderate-severe KOA ( grade s 2/3/4 ) , and r and omly allocated to moxibustion  or UC  for four weeks . Moxibustion involved burning mugwort devices over acupuncture and Ashi points in affected knee(s ) . UC was allowed . Korean Western Ontario and McMaster Universities Question naire ( K-WOMAC ) , Short Form 36 Health Survey ( SF-36v2 ) , Beck Depression Inventory ( BDI ) , physical performance test , pain numeric rating scale ( NRS ) and adverse events were evaluated at 5 and 13 weeks . K-WOMAC global score at 5 weeks was the primary outcome . Results 102 patients ( 73 mild , 29 moderate-severe ) were allocated to moxibustion , 110 ( 77 mild , 33 moderate-severe ) to UC . K-WOMAC global score ( moxibustion 25.42+/−SD 19.26 , UC 33.60+/−17.91 , p<0.01 , effect size = 0.0477 ) , NRS ( moxibustion 44.77+/−22.73 , UC 56.23+/−17.71 , p<0.01 , effect size = 0.0073 ) and timed-st and test  ( moxibustion 24.79+/−9.76 , UC 25.24+/−8.84 , p = 0.0486 , effect size = 0.0021 ) were improved by moxibustion at 5 weeks . The primary outcome improved for mild but not moderate-severe KOA . At 13 weeks , moxibustion significantly improved the K-WOMAC global score and NRS .  Moxibustion  improved SF-36 physical component summary ( p = 0.0299 ) , bodily pain ( p = 0.0003 ) , physical functioning ( p = 0.0025 ) and social functioning ( p = 0.0418 ) at 5 weeks , with no difference in mental component summary at 5 and 13 weeks . BDI showed no difference ( p = 0.34 ) at 5 weeks . After 1158 moxibustion treatments , 121 adverse events included first ( n = 6 ) and second degree ( n = 113 ) burns , pruritus and fatigue ( n = 2 ) . Conclusions Moxibustion may improve pain , function and quality of life in KOA patients , but adverse events are common . Limitations included no sham control or blinding . Trial Registration Clinical Research Information Service ( CRIS ) The management of early-stage osteonecrosis of the femoral head ( ONFH ) remains challenging . This study aim ed to evaluate the effects of core decompression and concentrated bone marrow implantation on ONFH . The study recruited 28 hips with early ONFH r and omly assigned into two groups of core decompression with ( group A ) and without ( group B ) bone marrow injection . Patients were evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) question naire , Visual Analogue Scale ( VAS ) pain index , and MRI . The mean WOMAC and VAS scores in all patients improved significantly ( P<0.001 ) . MRI showed a significant improvement in group A ( P=0.046 ) and significant worsening in group B ( P<0.001 ) . Bone marrow stem cell injection with core decompression can be effective in early ONFH The aim of this study was to investigate the safety of injection of bone marrow aspirate concentrate during core decompression and to study its clinical ( visual analogue scale ; Harris-Hip-score ) and radiological outcomes ( magnetic resonance imaging ) . In this prospect i ve and r and omized clinical trial we evaluated 24 consecutive patients with non-traumatic femoral head necrosis ( FHN ) during a period of two years after intervention . In vitro analysis of mesenchymal stem cells was performed by evaluating the fibroblast colony forming units ( CFU-Fs ) . Postoperatively , significant decrease in pain associated with a functional benefit lasting was observed . However , there was no difference in the clinical outcome between the two study groups . Over the period of two years there was no significant difference between the head survival rate between both groups . In contrast to that , we could not perceive any significant change in the volume of FHN in both treatment groups related to the longitudinal course after treating . The number of CFU showed a significant increase after centrifugation . This trial could not detect a benefit from the additional injection of bone marrow concentrate with regard to bone regeneration and clinical outcome in the short term Fifty-one osteonecrotic hips in 40 patients were r and omly divided into 2 treatment groups . Patients in group A ( 25 hips ) were treated with core decompression , and those in group B ( 26 hips ) received autologous bone marrow mononuclear cell instillation into the core tract after core decompression . Outcome between the 2 groups were compared clinical ly ( Harris Hip score ) , radiographically ( x-ray and magnetic resonance imaging ) , and by Kaplan-Meier hip survival analysis after 12 and 24 months of surgical intervention . The clinical score and mean hip survival were significantly better in group B than in group A ( P < .05 ) . Patients with adverse prognostic features at initial presentation , that is , poor Harris Hip score , x-ray changes , edema , and /or effusion on magnetic resonance imaging had significantly better clinical outcome and hip survival in group B than in group BACKGROUND The prognosis for a patient with osteonecrosis of the hip is generally considered to be worse if a large volume of the femoral head is involved , the patient is symptomatic , and the stage of the lesion is advanced . In 1990 , we began a prospect i ve study to detect collapse in asymptomatic hips with a very small stage-I osteonecrotic lesion in the femoral head . We hypothesized that such patients would have a favorable prognosis . These hips were followed for a minimum of ten years after the diagnosis . METHODS A small asymptomatic stage-I osteonecrotic lesion ( not seen on plain radiographs ) was diagnosed with magnetic resonance imaging in forty patients ( forty hips ) contralateral to a hip with symptomatic osteonecrosis . The criterion for inclusion in the study was a lesion with a volume of < 5 cm(3 ) involving < 10 % of the volume of the femoral head . Plain radiographs were made annually in six different projections for all patients . At the most recent follow-up evaluation ( average , eleven years ) , patients with a symptomatic hip but without evidence of collapse on plain radiographs underwent a computerized tomography scan . RESULTS Thirty-five ( 88 % ) of the forty hips became symptomatic , and twenty-nine ( 73 % ) demonstrated collapse . The mean interval between the diagnosis and the first symptoms was eighty months . Symptoms always preceded collapse by at least six months . The mean interval between the diagnosis and the collapse was ninety-two months ( range , seventy-two to 140 months ) . The diagnosis of collapse could be made on only one or two of the six radiographic views obtained for each patient at each evaluation . The diagnosis of collapse for two patients was made only on a computerized tomography scan at the most recent follow-up evaluation . At the time of final follow-up , the twenty-nine hips with collapse had symptoms of intractable pain and required surgery . CONCLUSIONS This study confirms that the diagnosis of collapse is difficult in hips with a very small stage-I osteonecrotic lesion . Multiple radiographic views and computerized tomography scans may be required to demonstrate small areas of collapse . Clinical and radiographic signs of progression of the disease in asymptomatic hips with a very small asymptomatic lesion progress more slowly than do those signs in hips with a large symptomatic stage-II lesion . Because hips with a small area of osteonecrosis do collapse in a large percentage of patients , such patients should be followed carefully over a long period of time . LEVEL OF EVIDENCE Prognostic study , Level I-1 ( prospect i ve study ) . See Instructions to Authors for a complete description of levels of evidence OBJECTIVE To evaluate the clinical efficacy and safety of the treatment of osteonecrosis of the femoral head by percutaneous decompression and autologous bone marrow mononuclear cell ( BMC s ) infusion . METHODS 44 hips in 28 patients with avascular necrosis at early stage were treated by percutaneous multiple holes decompression followed by autologous BMC s infusion . Autologous BMC s were concentrated from bone marrow that was taken from the posterior iliac crest of the patient . Patients were followed up at least 2 years . The results were determined by the changes in the Harris hip score and the progression in the radiograghic stages . RESULTS No complications were observed after the operation . Before operation , there were stage I of femoral head necrosis in 8 hips , stage II in 15 hips , stage III in 14 hips , stage IV in 7 hips , and the postoperative stages at the most recent follow-up were stage O in 1 hip , stage I in 6 hips , stage II in 13 hips , stage III in 13 hips , stage IV in 7 hips , stage V in 4 hips . The mean preoperative Harris hip score was 58 ( 46 - 89 ) , and improved to 86 ( 70 - 94 ) postoperatively . All the femoral head collapsed preoperatively showed that the necrotic size was at least more than 30 % . CONCLUSIONS Percutaneous multiple holes decompression combined with autologous BMC s is a new way to treat avascular necrosis of the femoral head . The earlier the stage , the better the result . A r and omized prospect i ve study needed to compare with routine core decompression in the future Core decompression with bone graft is used frequently in the treatment of osteonecrosis of the femoral head . Many different techniques have been described . In the current series , grafting was done with autologous bone marrow obtained from the iliac crest of patients operated on for osteonecrosis of the hip . The results of a prospect i ve study of 189 hips in 116 patients treated with core decompression and autologous bone marrow grafting are reported . Patients were followed up from 5 to 10 years . The outcome was determined by the changes in the Harris hip score , by progression in radiographic stages , and by the need for hip replacement . The bone marrow was harvested with the patient under general anesthesia . The usual sites were the anterior iliac crests . The aspirated marrow was reduced in volume by concentration and injected into the femoral head after core decompression with a small trocar . When patients were operated on before collapse ( Stage I and Stage II ) , hip replacement was done in nine of the 145 hips . Total hip replacement was necessary in 25 hips among the 44 hips operated on after collapse ( Stage III and Stage IV ) . To measure the number of progenitor cells transplanted , the fibroblast colony forming unit was used as an indicator of the stroma cell activity . Patients who had the greater number of progenitor cells transplanted in their hips had better outcomes OBJECTIVE To compare the clinical outcomes of the core decompression 
    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 Avascular necrosis of femoral head ( ANFH ) is a progressive disease that often leads to hip joint dysfunction and even disability in young patients . Although the st and ard treatment , which is core decompression , has the advantage of minimal invasion , the efficacy is variable . Recent studies have shown that implantation of bone marrow containing osteogenic precursors into necrotic lesion of ANFH may be promising for the treatment of ANFH . Methods A prospect i ve , double-blinded , r and omized controlled trial was conducted to examine the effect of bone-marrow buffy coat ( BBC ) grafting combined with core decompression for the treatment of ANFH . Forty-five patients ( 53 hips ) with Ficat stage I to III ANFH were recruited . The hips were allocated to the control group ( core decompression + autologous bone graft ) or treatment group ( core decompression + autologous bone graft with BBC ) . Both patients and assessors were blinded to the treatment options . The clinical symptoms and disease progression were assessed as the primary and secondary outcomes . Results At the final follow-up ( 24 months ) , there was a significant relief in pain ( P < 0.05 ) and clinical joint symptoms as measured by the Lequesne index ( P < 0.05 ) and Western Ontario and McMaster Universities Arthritis Index ( P < 0.05 ) in the treatment group . In addition , 33.3 % of the hips in the control group have deteriorated to the next stage after 24 months post-procedure , whereas only 8 % in the treatment group had further deterioration ( P < 0.05 ) . More importantly , the non-progression rates for stage I/II hips were 100 % in the treatment group and 66.7 % in the control group . Conclusion Implantation of the autologous BBC grafting combined with core decompression is effective to prevent further progression for the early stages of ANFH.Trial registration Clinical Trials.gov identifier NCT01613612 . Registered 13 December 2011 Introduction This study tested the effectiveness of moxibustion on pain and function in chronic knee osteoarthritis ( KOA ) and evaluated safety . Methods A multi-centre , non-blinded , parallel-group , r and omised controlled trial compared moxibustion with usual care ( UC ) in KOA . 212 South Korean patients aged 40–70 were recruited from 2011–12 , stratified by mild ( Kellgren/Lawrence scale grade s 0/1 ) and moderate-severe KOA ( grade s 2/3/4 ) , and r and omly allocated to moxibustion  or UC  for four weeks . Moxibustion involved burning mugwort devices over acupuncture and Ashi points in affected knee(s ) . UC was allowed . Korean Western Ontario and McMaster Universities Question naire ( K-WOMAC ) , Short Form 36 Health Survey ( SF-36v2 ) , Beck Depression Inventory ( BDI ) , physical performance test , pain numeric rating scale ( NRS ) and adverse events were evaluated at 5 and 13 weeks . K-WOMAC global score at 5 weeks was the primary outcome . Results 102 patients ( 73 mild , 29 moderate-severe ) were allocated to moxibustion , 110 ( 77 mild , 33 moderate-severe ) to UC . K-WOMAC global score ( moxibustion 25.42+/−SD 19.26 , UC 33.60+/−17.91 , p<0.01 , effect size = 0.0477 ) , NRS ( moxibustion 44.77+/−22.73 , UC 56.23+/−17.71 , p<0.01 , effect size = 0.0073 ) and timed-st and test  ( moxibustion 24.79+/−9.76 , UC 25.24+/−8.84 , p = 0.0486 , effect size = 0.0021 ) were improved by moxibustion at 5 weeks . The primary outcome improved for mild but not moderate-severe KOA . At 13 weeks , moxibustion significantly improved the K-WOMAC global score and NRS .  Moxibustion  improved SF-36 physical component summary ( p = 0.0299 ) , bodily pain ( p = 0.0003 ) , physical functioning ( p = 0.0025 ) and social functioning ( p = 0.0418 ) at 5 weeks , with no difference in mental component summary at 5 and 13 weeks . BDI showed no difference ( p = 0.34 ) at 5 weeks . After 1158 moxibustion treatments , 121 adverse events included first ( n = 6 ) and second degree ( n = 113 ) burns , pruritus and fatigue ( n = 2 ) . Conclusions Moxibustion may improve pain , function and quality of life in KOA patients , but adverse events are common . Limitations included no sham control or blinding . Trial Registration Clinical Research Information Service ( CRIS ) The management of early-stage osteonecrosis of the femoral head ( ONFH ) remains challenging . This study aim ed to evaluate the effects of core decompression and concentrated bone marrow implantation on ONFH . The study recruited 28 hips with early ONFH r and omly assigned into two groups of core decompression with ( group A ) and without ( group B ) bone marrow injection . Patients were evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) question naire , Visual Analogue Scale ( VAS ) pain index , and MRI . The mean WOMAC and VAS scores in all patients improved significantly ( P<0.001 ) . MRI showed a significant improvement in group A ( P=0.046 ) and significant worsening in group B ( P<0.001 ) . Bone marrow stem cell injection with core decompression can be effective in early ONFH The aim of this study was to investigate the safety of injection of bone marrow aspirate concentrate during core decompression and to study its clinical ( visual analogue scale ; Harris-Hip-score ) and radiological outcomes ( magnetic resonance imaging ) . In this prospect i ve and r and omized clinical trial we evaluated 24 consecutive patients with non-traumatic femoral head necrosis ( FHN ) during a period of two years after intervention . In vitro analysis of mesenchymal stem cells was performed by evaluating the fibroblast colony forming units ( CFU-Fs ) . Postoperatively , significant decrease in pain associated with a functional benefit lasting was observed . However , there was no difference in the clinical outcome between the two study groups . Over the period of two years there was no significant difference between the head survival rate between both groups . In contrast to that , we could not perceive any significant change in the volume of FHN in both treatment groups related to the longitudinal course after treating . The number of CFU showed a significant increase after centrifugation . This trial could not detect a benefit from the additional injection of bone marrow concentrate with regard to bone regeneration and clinical outcome in the short term Fifty-one osteonecrotic hips in 40 patients were r and omly divided into 2 treatment groups . Patients in group A ( 25 hips ) were treated with core decompression , and those in group B ( 26 hips ) received autologous bone marrow mononuclear cell instillation into the core tract after core decompression . Outcome between the 2 groups were compared clinical ly ( Harris Hip score ) , radiographically ( x-ray and magnetic resonance imaging ) , and by Kaplan-Meier hip survival analysis after 12 and 24 months of surgical intervention . The clinical score and mean hip survival were significantly better in group B than in group A ( P < .05 ) . Patients with adverse prognostic features at initial presentation , that is , poor Harris Hip score , x-ray changes , edema , and /or effusion on magnetic resonance imaging had significantly better clinical outcome and hip survival in group B than in group BACKGROUND The prognosis for a patient with osteonecrosis of the hip is generally considered to be worse if a large volume of the femoral head is involved , the patient is symptomatic , and the stage of the lesion is advanced . In 1990 , we began a prospect i ve study to detect collapse in asymptomatic hips with a very small stage-I osteonecrotic lesion in the femoral head . We hypothesized that such patients would have a favorable prognosis . These hips were followed for a minimum of ten years after the diagnosis . METHODS A small asymptomatic stage-I osteonecrotic lesion ( not seen on plain radiographs ) was diagnosed with magnetic resonance imaging in forty patients ( forty hips ) contralateral to a hip with symptomatic osteonecrosis . The criterion for inclusion in the study was a lesion with a volume of < 5 cm(3 ) involving < 10 % of the volume of the femoral head . Plain radiographs were made annually in six different projections for all patients . At the most recent follow-up evaluation ( average , eleven years ) , patients with a symptomatic hip but without evidence of collapse on plain radiographs underwent a computerized tomography scan . RESULTS Thirty-five ( 88 % ) of the forty hips became symptomatic , and twenty-nine ( 73 % ) demonstrated collapse . The mean interval between the diagnosis and the first symptoms was eighty months . Symptoms always preceded collapse by at least six months . The mean interval between the diagnosis and the collapse was ninety-two months ( range , seventy-two to 140 months ) . The diagnosis of collapse could be made on only one or two of the six radiographic views obtained for each patient at each evaluation . The diagnosis of collapse for two patients was made only on a computerized tomography scan at the most recent follow-up evaluation . At the time of final follow-up , the twenty-nine hips with collapse had symptoms of intractable pain and required surgery . CONCLUSIONS This study confirms that the diagnosis of collapse is difficult in hips with a very small stage-I osteonecrotic lesion . Multiple radiographic views and computerized tomography scans may be required to demonstrate small areas of collapse . Clinical and radiographic signs of progression of the disease in asymptomatic hips with a very small asymptomatic lesion progress more slowly than do those signs in hips with a large symptomatic stage-II lesion . Because hips with a small area of osteonecrosis do collapse in a large percentage of patients , such patients should be followed carefully over a long period of time . LEVEL OF EVIDENCE Prognostic study , Level I-1 ( prospect i ve study ) . See Instructions to Authors for a complete description of levels of evidence OBJECTIVE To evaluate the clinical efficacy and safety of the treatment of osteonecrosis of the femoral head by percutaneous decompression and autologous bone marrow mononuclear cell ( BMC s ) infusion . METHODS 44 hips in 28 patients with avascular necrosis at early stage were treated by percutaneous multiple holes decompression followed by autologous BMC s infusion . Autologous BMC s were concentrated from bone marrow that was taken from the posterior iliac crest of the patient . Patients were followed up at least 2 years . The results were determined by the changes in the Harris hip score and the progression in the radiograghic stages . RESULTS No complications were observed after the operation . Before operation , there were stage I of femoral head necrosis in 8 hips , stage II in 15 hips , stage III in 14 hips , stage IV in 7 hips , and the postoperative stages at the most recent follow-up were stage O in 1 hip , stage I in 6 hips , stage II in 13 hips , stage III in 13 hips , stage IV in 7 hips , stage V in 4 hips . The mean preoperative Harris hip score was 58 ( 46 - 89 ) , and improved to 86 ( 70 - 94 ) postoperatively . All the femoral head collapsed preoperatively showed that the necrotic size was at least more than 30 % . CONCLUSIONS Percutaneous multiple holes decompression combined with autologous BMC s is a new way to treat avascular necrosis of the femoral head . The earlier the stage , the better the result . A r and omized prospect i ve study needed to compare with routine core decompression in the future Core decompression with bone graft is used frequently in the treatment of osteonecrosis of the femoral head . Many different techniques have been described . In the current series , grafting was done with autologous bone marrow obtained from the iliac crest of patients operated on for osteonecrosis of the hip . The results of a prospect i ve study of 189 hips in 116 patients treated with core decompression and autologous bone marrow grafting are reported . Patients were followed up from 5 to 10 years . The outcome was determined by the changes in the Harris hip score , by progression in radiographic stages , and by the need for hip replacement . The bone marrow was harvested with the patient under general anesthesia . The usual sites were the anterior iliac crests . The aspirated marrow was reduced in volume by concentration and injected into the femoral head after core decompression with a small trocar . When patients were operated on before collapse ( Stage I and Stage II ) , hip replacement was done in nine of the 145 hips . Total hip replacement was necessary in 25 hips among the 44 hips operated on after collapse ( Stage III and Stage IV ) . To measure the number of progenitor cells transplanted , the fibroblast colony forming unit was used as an indicator of the stroma cell activity . Patients who had the greater number of progenitor cells transplanted in their hips had better outcomes OBJECTIVE To compare the clinical outcomes of the core decompression 
    Output:
    