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 To determine whether needle acupuncture may be useful in the reduction of leg spasticity in a chronic state . DESIGN Single-blind , r and omized , placebo-controlled trial . SETTING Neurologic outpatient department of a medical school in Germany . PARTICIPANTS Twenty-five patients ( 14 women ) suffering from chronic poststroke leg spasticity with pes equinovarus deformity ( Modified Ashworth Scale [ MAS ] score , > /=1 ) , aged 38 to 77 years ( mean + /- st and ard deviation , 58.5+/-10.4 y ) , were enrolled in the study . The mean time from stroke to inclusion in the study was approximately 5 years ( mean , 65.4+/-48.3 mo ; range , 7 - 180 mo ) . INTERVENTIONS Participants were r and omly assigned to placebo treatment ( n=12 ) by using a specially design ed placebo needling procedure , or verum treatment ( n=13 ) . MAIN OUTCOME MEASURES MAS score of the affected ankle , pain ( visual analog scale ) , and walking speed . RESULTS There was no demonstrated beneficial clinical effects from verum acupuncture . After 4 weeks of treatment , mean MAS score was 3.3+/-0.9 in the placebo group versus 3.3+/-1.1 in the verum group . The neurophysiologic measure of H-reflex indicated a significant increase of spinal motoneuron excitability after verum acupuncture ( H-response/M-response ratio : placebo,.39+/-.19 ; verum,.68+/-.41 ; P<.05 ) . CONCLUSIONS This effect might be explained by afferent input of A delta and C fibers to the spinal motoneuron . The results from our study indicate that needle acupuncture may not be helpful to patients with chronic poststroke spasticity . However , there was neurophysiologic evidence for specific acupuncture effects on a spinal ( segmental ) level involving nociceptive reflex mechanisms For clinical trials of acupuncture , it would be desirable to have a sham procedure that is indistinguishable from the real treatment , yet inactive . A sham needle has been design ed which telescopes instead of penetrating the skin . The Park Sham Device involves an improved method of supporting the sham needle and requires validation . The objective of these studies was to test whether the sham procedure using the new device was 1 ) indistinguishable from the same procedure using real needles in acupuncture naïve subjects , and 2 ) inactive , where the specific needle sensation ( de qi ) is taken as a surrogate measure of activity . The studies were design ed as subject and assessor blind , r and omised controlled trials . Study 1 ) included 58 patients enrolled in a clinical trial of acupuncture for acute stroke . Study 2 ) included 63 healthy , acupuncture naïve , adult volunteers . The interventions used were real or sham acupuncture using the Park Sham Device . Study 1 ) was set in a district general hospital , and study 2 ) in a university laboratory . The outcome measure in study 1 ) was the form of treatment that patients believed they had received . In study 2 ) the outcome measure was experience of de qi , as judged by three acupuncture experts . No patient in either group ( study 1 ) believed he or she had been treated with the sham needle . In 40 volunteers ( study 2 ) for whom experts achieved consensus , the relative risk of experiencing de qi with real acupuncture to that with sham acupuncture was 15.38 ( 95 % CI 2.26 to 104.86 ) . The inter-rater reliability of all 13 experts ( study 2 ) , calculated from their judgements on 10 subjects selected by r and omisation , was 0.52 ( 95 % CI 0.19 to 0.61 ) . In conclusion , the results suggest that the procedure using the new device is indistinguishable from the same procedure using real needles in acupuncture naïve subjects , and is inactive , where the specific needle sensation ( de qi ) is taken as a surrogate measure of activity . It is therefore a valid control for acupuncture trials . The findings also lend support to the existence of de qi , a major concept underlying traditional Chinese acupuncture OBJECTIVES This study quantifies and compares patient characteristics in  outpatient acupuncture .  SETTING / DESIGN Prospect i ve primary source evidence was gathered at two prominent outpatient acupuncture clinics in Beijing , China ( n = 563 , n = 233 ) . RESULTS The most common condition was Bell 's palsy , which represented 20.6 % and 25.3 % of total cases at the two clinics , respectively . The second most common condition was cerebrovascular accident ( CVA ) rehabilitation . These treatments represented 11.9 % and 12.0 % of treatments at the two clinics , respectively . Other trends at the clinics included the following : ( 1 ) neurologic complaints predominated ; ( 2 ) doctors see a large number of patients per day ; ( 3 ) the majority of patients overall were female ; while ( 4 ) the majority of patients treated for CVAs rehabilitation were male . As cultural and socioeconomic differences in perceptions of acupuncture exist between peoples of different countries , this study also compared patient  main complaints in China to available data on  acupuncture patients seen in other parts of China , Germany , the United Kingdom , Australia , and the United States . Except for the German clinic data , Western clinic acupuncturists saw more musculoskeletal complaints compared to China , where neurologic complaints predominated . Another significant difference between Asian and Western clinics was the number of patients seen per hour . While acupuncturists were reported to see 1.2 patients per hour in U. S. clinics , acupuncturists at the two Beijing , China , clinics saw 7.0 and 10.4 patients per hour , respectively . CONCLUSION The main complaints seen in acupuncture  outpatient clinics throughout the world likely result from a combination of inherent disease prevalence as well as patients ' attitudes toward what acupuncture can treat successfully OBJECTIVE To compare the effect of real and sham acupuncture and a control intervention on thermal sensation and thermal pain thresholds . DESIGN Single-blind , r and omized controlled , repeated- measures trial . SETTING Laboratory . PARTICIPANTS Eighteen acupuncture-naive , healthy subjects with no history of upper-limb pathology or acupuncture contraindications . INTERVENTION Subjects were r and omly assigned ( blind card allocation ) to 1 of 6 possible orders of application of the interventions , which consisted of 25 minutes each of control , real , and sham acupuncture . MAIN OUTCOME MEASURES Thermal sensation and thermal pain thresholds measured with a thermal sensory analyzer before and after each intervention . RESULTS There were increases in cold and hot pain and cold sensation thresholds with real acupuncture . The level of increase did not differ significantly from the changes that occurred with sham acupuncture and control interventions . CONCLUSIONS Although we observed a trend toward a decreased sensitivity to thermal pain and thermal sensation with real acupuncture , this trend did not differ significantly from the changes with control or sham interventions . Therefore , no support was provided for analgesic or placebo effects of acupuncture . The trend , combined with the relatively low power of the inferential tests applied does , however , suggest that further research is merited PURPOSE The purpose is to investigate an additional antiemetic effect to ondansetron with needle acupuncture at P6 compared with nonskin-penetrating placebo acupuncture in patients undergoing high-dose chemotherapy and autologous peripheral blood stem cell transplantation . EXPERIMENTAL DESIGN Eighty patients who were admitted to hospital for high-dose chemotherapy and autologous peripheral blood stem cell transplantation were included into a r and omized placebo-controlled single-blind trial . The patients were r and omized to receive acupuncture ( n = 41 ) or noninvasive placebo acupuncture ( n = 39 ) at the acupuncture point P6 30 min before first application of high-dose chemotherapy and the day after . All patients received 8 mg ondansetron/day i.v . as basic antiemetic prophylaxis . The main outcome measure was the rate of patients who either had at least one episode of vomiting or required any additional antiemetic drugs on the first 2 days of chemotherapy . RESULTS The main outcome measure showed no significant difference ( P = 0.82 ) : 61 % failure in the acupuncture group and 64 % in the placebo acupuncture group ( 95 % confidence interval of 3 % difference : -18.1 and 24.3 % ) . Comparing nausea , episodes of vomiting or retching and number of additionally required antiemetic drugs did not provide any discrepancy with the main result . CONCLUSIONS This study suggests that in combination with ondansetron i.v . , invasive needle acupuncture at P6 compared with nonskin-penetrating placebo acupuncture has no additional effect for the prevention of acute nausea and vomiting in high-dose chemotherapy 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 Context Previous studies of acupuncture for osteoarthritis have had conflicting results . This may have occurred because most studies have included small sample s , a limited number of treatment sessions , or other limitations . Contribution This r and omized , controlled trial compared 24 acupuncture sessions over 26 weeks with sham acupuncture or arthritis education in 570 patients with osteoarthritis of the knee .  Acupuncture led to greater improvements in function but not pain after 8 weeks and in both pain and function after 26 weeks . No adverse effects were associated with acupuncture . Caution s Many participants dropped out of the study , so readers should interpret the findings at 26 weeks with caution . The Editors Osteoarthritis is the most common form of arthritis and is a major cause of morbidity , limitation of activity , and health care utilization , especially in elderly patients ( 1 , 2 ) . Pain and functional limitation are the primary clinical manifestations of osteoarthritis of the knee . Current recommendations for managing osteoarthritis , including guidelines published by the American College of Rheumatology ( 3 ) and European League of Associations of Rheumatology ( 4 ) , focus on relieving pain and stiffness and maintaining or improving physical function as important goals of therapy . No curative therapies exist for osteoarthritis ; thus , both pharmacologic and nonpharmacologic management focus on controlling pain and reducing functional limitation ( 5 ) . Nonpharmacologic therapy , which includes patient education , social support , physical and occupational therapy , aerobic and resistive exercises , and weight loss , is the cornerstone of a multidisciplinary approach to osteoarthritis patient management ( 3 ) . Pharmacologic therapies include nonopioid analgesics ( such as acetaminophen ) , nonsteroidal anti-inflammatory drugs ( NSAIDs ) ( including cyclooxygenase-2 [ COX-2 ] enzyme selective inhibitors ) , topical analgesics ( capsaicin cream ) , opioid analgesics , and intra-articular steroid and hyaluronate injections . Often , these agents are used in combination for additive analgesic efficacy ( 6 ) . Pharmacologic management of osteoarthritis is often ineffective , 
    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 To determine whether needle acupuncture may be useful in the reduction of leg spasticity in a chronic state . DESIGN Single-blind , r and omized , placebo-controlled trial . SETTING Neurologic outpatient department of a medical school in Germany . PARTICIPANTS Twenty-five patients ( 14 women ) suffering from chronic poststroke leg spasticity with pes equinovarus deformity ( Modified Ashworth Scale [ MAS ] score , > /=1 ) , aged 38 to 77 years ( mean + /- st and ard deviation , 58.5+/-10.4 y ) , were enrolled in the study . The mean time from stroke to inclusion in the study was approximately 5 years ( mean , 65.4+/-48.3 mo ; range , 7 - 180 mo ) . INTERVENTIONS Participants were r and omly assigned to placebo treatment ( n=12 ) by using a specially design ed placebo needling procedure , or verum treatment ( n=13 ) . MAIN OUTCOME MEASURES MAS score of the affected ankle , pain ( visual analog scale ) , and walking speed . RESULTS There was no demonstrated beneficial clinical effects from verum acupuncture . After 4 weeks of treatment , mean MAS score was 3.3+/-0.9 in the placebo group versus 3.3+/-1.1 in the verum group . The neurophysiologic measure of H-reflex indicated a significant increase of spinal motoneuron excitability after verum acupuncture ( H-response/M-response ratio : placebo,.39+/-.19 ; verum,.68+/-.41 ; P<.05 ) . CONCLUSIONS This effect might be explained by afferent input of A delta and C fibers to the spinal motoneuron . The results from our study indicate that needle acupuncture may not be helpful to patients with chronic poststroke spasticity . However , there was neurophysiologic evidence for specific acupuncture effects on a spinal ( segmental ) level involving nociceptive reflex mechanisms For clinical trials of acupuncture , it would be desirable to have a sham procedure that is indistinguishable from the real treatment , yet inactive . A sham needle has been design ed which telescopes instead of penetrating the skin . The Park Sham Device involves an improved method of supporting the sham needle and requires validation . The objective of these studies was to test whether the sham procedure using the new device was 1 ) indistinguishable from the same procedure using real needles in acupuncture naïve subjects , and 2 ) inactive , where the specific needle sensation ( de qi ) is taken as a surrogate measure of activity . The studies were design ed as subject and assessor blind , r and omised controlled trials . Study 1 ) included 58 patients enrolled in a clinical trial of acupuncture for acute stroke . Study 2 ) included 63 healthy , acupuncture naïve , adult volunteers . The interventions used were real or sham acupuncture using the Park Sham Device . Study 1 ) was set in a district general hospital , and study 2 ) in a university laboratory . The outcome measure in study 1 ) was the form of treatment that patients believed they had received . In study 2 ) the outcome measure was experience of de qi , as judged by three acupuncture experts . No patient in either group ( study 1 ) believed he or she had been treated with the sham needle . In 40 volunteers ( study 2 ) for whom experts achieved consensus , the relative risk of experiencing de qi with real acupuncture to that with sham acupuncture was 15.38 ( 95 % CI 2.26 to 104.86 ) . The inter-rater reliability of all 13 experts ( study 2 ) , calculated from their judgements on 10 subjects selected by r and omisation , was 0.52 ( 95 % CI 0.19 to 0.61 ) . In conclusion , the results suggest that the procedure using the new device is indistinguishable from the same procedure using real needles in acupuncture naïve subjects , and is inactive , where the specific needle sensation ( de qi ) is taken as a surrogate measure of activity . It is therefore a valid control for acupuncture trials . The findings also lend support to the existence of de qi , a major concept underlying traditional Chinese acupuncture OBJECTIVES This study quantifies and compares patient characteristics in  outpatient acupuncture .  SETTING / DESIGN Prospect i ve primary source evidence was gathered at two prominent outpatient acupuncture clinics in Beijing , China ( n = 563 , n = 233 ) . RESULTS The most common condition was Bell 's palsy , which represented 20.6 % and 25.3 % of total cases at the two clinics , respectively . The second most common condition was cerebrovascular accident ( CVA ) rehabilitation . These treatments represented 11.9 % and 12.0 % of treatments at the two clinics , respectively . Other trends at the clinics included the following : ( 1 ) neurologic complaints predominated ; ( 2 ) doctors see a large number of patients per day ; ( 3 ) the majority of patients overall were female ; while ( 4 ) the majority of patients treated for CVAs rehabilitation were male . As cultural and socioeconomic differences in perceptions of acupuncture exist between peoples of different countries , this study also compared patient  main complaints in China to available data on  acupuncture patients seen in other parts of China , Germany , the United Kingdom , Australia , and the United States . Except for the German clinic data , Western clinic acupuncturists saw more musculoskeletal complaints compared to China , where neurologic complaints predominated . Another significant difference between Asian and Western clinics was the number of patients seen per hour . While acupuncturists were reported to see 1.2 patients per hour in U. S. clinics , acupuncturists at the two Beijing , China , clinics saw 7.0 and 10.4 patients per hour , respectively . CONCLUSION The main complaints seen in acupuncture  outpatient clinics throughout the world likely result from a combination of inherent disease prevalence as well as patients ' attitudes toward what acupuncture can treat successfully OBJECTIVE To compare the effect of real and sham acupuncture and a control intervention on thermal sensation and thermal pain thresholds . DESIGN Single-blind , r and omized controlled , repeated- measures trial . SETTING Laboratory . PARTICIPANTS Eighteen acupuncture-naive , healthy subjects with no history of upper-limb pathology or acupuncture contraindications . INTERVENTION Subjects were r and omly assigned ( blind card allocation ) to 1 of 6 possible orders of application of the interventions , which consisted of 25 minutes each of control , real , and sham acupuncture . MAIN OUTCOME MEASURES Thermal sensation and thermal pain thresholds measured with a thermal sensory analyzer before and after each intervention . RESULTS There were increases in cold and hot pain and cold sensation thresholds with real acupuncture . The level of increase did not differ significantly from the changes that occurred with sham acupuncture and control interventions . CONCLUSIONS Although we observed a trend toward a decreased sensitivity to thermal pain and thermal sensation with real acupuncture , this trend did not differ significantly from the changes with control or sham interventions . Therefore , no support was provided for analgesic or placebo effects of acupuncture . The trend , combined with the relatively low power of the inferential tests applied does , however , suggest that further research is merited PURPOSE The purpose is to investigate an additional antiemetic effect to ondansetron with needle acupuncture at P6 compared with nonskin-penetrating placebo acupuncture in patients undergoing high-dose chemotherapy and autologous peripheral blood stem cell transplantation . EXPERIMENTAL DESIGN Eighty patients who were admitted to hospital for high-dose chemotherapy and autologous peripheral blood stem cell transplantation were included into a r and omized placebo-controlled single-blind trial . The patients were r and omized to receive acupuncture ( n = 41 ) or noninvasive placebo acupuncture ( n = 39 ) at the acupuncture point P6 30 min before first application of high-dose chemotherapy and the day after . All patients received 8 mg ondansetron/day i.v . as basic antiemetic prophylaxis . The main outcome measure was the rate of patients who either had at least one episode of vomiting or required any additional antiemetic drugs on the first 2 days of chemotherapy . RESULTS The main outcome measure showed no significant difference ( P = 0.82 ) : 61 % failure in the acupuncture group and 64 % in the placebo acupuncture group ( 95 % confidence interval of 3 % difference : -18.1 and 24.3 % ) . Comparing nausea , episodes of vomiting or retching and number of additionally required antiemetic drugs did not provide any discrepancy with the main result . CONCLUSIONS This study suggests that in combination with ondansetron i.v . , invasive needle acupuncture at P6 compared with nonskin-penetrating placebo acupuncture has no additional effect for the prevention of acute nausea and vomiting in high-dose chemotherapy 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 Context Previous studies of acupuncture for osteoarthritis have had conflicting results . This may have occurred because most studies have included small sample s , a limited number of treatment sessions , or other limitations . Contribution This r and omized , controlled trial compared 24 acupuncture sessions over 26 weeks with sham acupuncture or arthritis education in 570 patients with osteoarthritis of the knee .  Acupuncture led to greater improvements in function but not pain after 8 weeks and in both pain and function after 26 weeks . No adverse effects were associated with acupuncture . Caution s Many participants dropped out of the study , so readers should interpret the findings at 26 weeks with caution . The Editors Osteoarthritis is the most common form of arthritis and is a major cause of morbidity , limitation of activity , and health care utilization , especially in elderly patients ( 1 , 2 ) . Pain and functional limitation are the primary clinical manifestations of osteoarthritis of the knee . Current recommendations for managing osteoarthritis , including guidelines published by the American College of Rheumatology ( 3 ) and European League of Associations of Rheumatology ( 4 ) , focus on relieving pain and stiffness and maintaining or improving physical function as important goals of therapy . No curative therapies exist for osteoarthritis ; thus , both pharmacologic and nonpharmacologic management focus on controlling pain and reducing functional limitation ( 5 ) . Nonpharmacologic therapy , which includes patient education , social support , physical and occupational therapy , aerobic and resistive exercises , and weight loss , is the cornerstone of a multidisciplinary approach to osteoarthritis patient management ( 3 ) . Pharmacologic therapies include nonopioid analgesics ( such as acetaminophen ) , nonsteroidal anti-inflammatory drugs ( NSAIDs ) ( including cyclooxygenase-2 [ COX-2 ] enzyme selective inhibitors ) , topical analgesics ( capsaicin cream ) , opioid analgesics , and intra-articular steroid and hyaluronate injections . Often , these agents are used in combination for additive analgesic efficacy ( 6 ) . Pharmacologic management of osteoarthritis is often ineffective , 
    Output:
    