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 I SHALL discuss the combination of estimates of relative prevalence or incidence , commonly referred to as relative risk , obtained from retrospective 2 X 2 tables . Barnet Woolf ' described the method in 1954 and J. B. S. Haldane2 introduced some modifications shortly afterward in the Annals of Human Genetics . Figure 1 shows how  retrospective case and control data  may be classified . There are usually some background classes based on age , sex , race , occupation , and the like . Within each such class , individuals are further classified into a 2 X 2 table according to the presence or absence of the disease being studied and the presence or absence of a defined characteristic of focal interest . For any single 2 X 2 table , Cornfield3 has shown a simple way to estimate the risk of disease among those wvith the characteristic , relative to the risk of disease among those without the characteristic . This is done , as illustrated below Figure 1 , by taking the ratio of diagonal products of the cell frequencies . This is a maximum likelihood estimate of the relative risk of disease in the parent population , provided that it is assumed that the cases and controls have been selected at r and om and that cases comprise a negligible portion of the population . It is also possible to obtain a combined , unconditioned , maximum likelihood estimate of relative risk based on all of the 2 X 2 tables . However , the method is time-consuming , involving the iterative solution of sets of quadratic equations . Unless such a method is programed for the computer , I feel that the less tedious procedure to be described is adequate for most practical purpose s. Strictly speaking , the maximum likelihood estimate just described has infinite bias and it is positively skewed . To help remedy these defects , the number , 1/2 , is added to each cell frequency before obtaining the ratio of diagonal products ; furthermore , the natural logarithm of this ratio is taken . The result ing value is an estimate of natural log relative risk . Woolf pointed out that the logarithmic transformation tends to remove skew and Haldane showed that of all possible numbers which might be added to or subtracted from the cell frequencies , 1/2 is the number which reduces the bias of the estimate to a minimum . This estimate of log relative risk is shown in the first column of Figure 2 . The estimated The present paper is to study the effects of electroacupuncture ( EA ) on acute ischemic stroke patient and acute cerebral ischemic rat . In clinic , 42 acute ischemic stroke patients were r and omly divided into 2 therapeutic groups : drug group and EA+ drug group . Neurological deficits of patients were evaluated before and after the treatment by Chinese Stroke Scale . The results showed that the acute ischemic stroke patients treated by drug or EA+ drug were all partially recovered , but the clinical functional recovery in EA+ drug group was significantly better than in the drug group ( P < 0.01 ) . In laboratory , the model of reversible middle cerebral artery occlusion ( MCAO ) was used in rats . The somatosensory evoked potential ( SEP ) was recorded before and after MCAO . EA was applied one hour after cerebral ischemia and once a day after reperfusion for 7 days in EA+ MCAO group . It was shown that the amplitude of P1-N1 wave of SEP before MCAO was 100 % . After MCAO 30 min the P1-N1 wave of SEP on the ipsilateral side of MCAO was decreased to 2.2 + /- 3 % ( MCAO group ) , 1.9 + /- 2 % ( MCAO+ EA group ) ; and then recovered to 25.5 + /- 14.1 % ( MCAO group ) , 58.6 + /- 27.2 % ( MCAO+ EA group ) after 7 days of reperfusion following MCAO 2 hours . The above results indicated that EA could promote the recovery of neurological function in acute ischemic stroke patients and SEP on MCAO rats Background The approximately 1100 medical journals now active in China are publishing a rapidly increasing number of research reports , including many studies identified by their authors as r and omized controlled trials . It has been noticed that these reports mostly present positive results , and their quality and authenticity have consequently been called into question . We investigated the adequacy of r and omization  of clinical trials published in recent years in China to determine how many of them met acceptable st and ards for allocating participants to treatment groups . Methods The China National Knowledge Infrastructure electronic data base was search ed for reports of r and omized controlled trials on 20 common diseases published from January 1994 to June 2005 . From this sample , a subset of trials that appeared to have used r and omization methods was selected . Twenty-one investigators trained in the relevant knowledge , communication skills and quality control issues interviewed the original authors of these trials about the participant r and omization methods and related quality -control features of their trials . Results From an initial sample of 37,313 articles identified in the China National Knowledge Infrastructure data base , we found 3137 apparent r and omized controlled trials . Of these , 1452 were studies of conventional medicine ( published in 411 journals ) and 1685 were studies of traditional Chinese medicine ( published in 352 journals ) . Interviews with the authors of 2235 of these reports revealed that only 207 studies adhered to accepted methodology for r and omization and could on those grounds be deemed authentic r and omized controlled trials ( 6.8 % , 95 % confidence interval 5.9–7.7 ) . There was no statistically significant difference in the rate of authenticity between r and omized controlled trials of traditional interventions and those of conventional interventions . R and omized controlled trials conducted at hospitals affiliated to medical universities were more likely to be authentic than trials conducted at level 3 and level 2 hospitals ( relative risk 1.58 , 95 % confidence interval 1.18–2.13 , and relative risk 14.42 , 95 % confidence interval 9.40–22.10 , respectively ) . The likelihood of authenticity was higher in level 3 hospitals than in level 2 hospitals ( relative risk 9.32 , 95 % confidence interval 5.83–14.89 ) . All r and omized controlled trials of pre-market drug clinical trial were authentic by our criteria . Of the trials conducted at university-affiliated hospitals , 56.3 % were authentic ( 95 % confidence interval 32.0–81.0 ) . Conclusion Most reports of r and omized controlled trials published in some Chinese journals lacked an adequate description of r and omization . Similarly , most so called ' r and omized controlled trials ' were not real r and omized controlled trials owing toa lack of adequate underst and ing on the part of the authors of rigorous clinical trial design . All r and omized controlled trials of pre-market drug clinical trial included in this research were authentic . R and omized controlled trials conducted by authors in high level hospitals , especially in hospitals affiliated to medical universities had a higher rate of authenticity . That so many non-r and omized controlled trials were published as r and omized controlled trials reflected the fact that peer review needs to be improved and a good practice guide for peer review including how to identify the authenticity of the study urgently needs to be developed Background and Purpose — In small trials with control groups that receive no intervention , acupuncture has been reported to improve functional outcome after stroke . We studied effects of acupuncture and transcutaneous electrical nerve stimulation on functional outcome and quality of life after stroke versus a control group that received subliminal electrostimulation . Methods — In a multicenter r and omized controlled trial involving 7 university and district hospitals in Sweden , 150 patients with moderate or severe functional impairment were included . At days 5 to 10 after acute stroke , patients were r and omized to 1 of 3 intervention groups : ( a ) acupuncture , including electroacupuncture ; ( b ) sensory stimulation with high-intensity , low-frequency transcutaneous electrical nerve stimulation that induces muscle contractions ; and ( c ) low-intensity ( subliminal ) high-frequency electrostimulation ( control group ) . A total of 20 treatment sessions were performed over a 10-week period . Outcome variables included motor function , activities of daily living function , walking ability , social activities , and life satisfaction at 3-month and 1-year follow-up . Results — At baseline , patients in each group were closely similar in all important prognostic variables . At 3-month and 1-year follow-ups , no clinical ly important or statistically significant differences were observed between groups for any of the outcome variables . The 3 treatment modalities were all conducted without major adverse effects . Conclusions — When compared with a control group that received subliminal electrostimulation , treatment during the subacute phase of stroke with acupuncture or transcutaneous electrical nerve stimulation with muscle contractions had no beneficial effects on functional outcome or life satisfaction This pilot study obtained preliminary data on the effects of acupuncture treatment combined with a st and ard inpatient stroke rehabilitation program on poststroke motor recovery and physical function .  Thirty-two patients with acute stroke were recruited and r and omized to 1 of 2 treatment arms : st and ard rehabilitation ( control group ) or a combination of acupuncture and st and ard rehabilitation ( acupuncture group ) . Baseline and discharge assessment s were obtained on motor recovery as measured by the Fugl-Meyer ( FM ) Assessment and on physical function as measured by the Functional Independence Measure ( FIM ) . Comparisons were made between the acupuncture and control group in total FM and FIM as well as for each subscale of the FM and FIM . No differences between treatment groups were found in the total FM or the total FIM . However , statistically significant benefit due to acupuncture was observed for the FM lower extremity motor function subscale ( P = 0.01 ) and the tub/shower transfer mobility subscale of the FIM ( P = 0.03 ) . Marginally significant benefit due to acupuncture was noted for the toilet transfer mobility subscale of the FIM ( P = 0.09 ) . The effectiveness of acupuncture as an adjunct to st and ard poststroke rehabilitation programs may be demonstrated when more specific measures of stroke motor recovery and physical function are used BACKGROUND AND PURPOSE A number of studies have indicated that acupuncture might improve the functional recovery of stroke patients . These studies vary in inclusion criteria , sample size , and evaluation methods . The present study was design ed to investigate whether electroacupuncture treatment favorably affects stroke patients ' ability to perform daily life activities , their health-related quality of life , and their use of health care and social services . METHODS One hundred four consecutive patients > 40 years of age admitted to hospital because of an acute stroke were r and omized to 3 groups : deep , superficial , and no acupuncture treatment . The acupuncture treatment given by 4 physiotherapists started 4 to 10 days after r and omization and was given twice a week for 10 weeks . All patients underwent conventional stroke rehabilitation as well . Two occupational therapists , blinded regarding the patients ' allocation , evaluated the treatment effects . The assessment s were performed 4 times during the first year after r and omization by means of interviews and observations . RESULTS There were no differences between the groups with reference to changes in the neurological score and the Barthel and Sunnaas activities of daily living index scores after 3 and 12 months . Regarding the Nottingham Health Profile , the no acupuncture group had somewhat fewer mobility problems . No differences in health care and social services were found between the groups . CONCLUSIONS The present study does not give support to the previous studies , which indicates that acupuncture treatment may have a beneficial effect on acute stroke patients ' ability to perform daily life activities , their health-related quality of life , and their use of health care and social services Background and Purpose — A significant number of patients remain severely disabled after stroke despite rehabilitation with st and ard treatment modalities . Acupuncture has been reported as an alternative modality . This study aims to examine whether acupuncture has additional value to st and ard 
    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 I SHALL discuss the combination of estimates of relative prevalence or incidence , commonly referred to as relative risk , obtained from retrospective 2 X 2 tables . Barnet Woolf ' described the method in 1954 and J. B. S. Haldane2 introduced some modifications shortly afterward in the Annals of Human Genetics . Figure 1 shows how  retrospective case and control data  may be classified . There are usually some background classes based on age , sex , race , occupation , and the like . Within each such class , individuals are further classified into a 2 X 2 table according to the presence or absence of the disease being studied and the presence or absence of a defined characteristic of focal interest . For any single 2 X 2 table , Cornfield3 has shown a simple way to estimate the risk of disease among those wvith the characteristic , relative to the risk of disease among those without the characteristic . This is done , as illustrated below Figure 1 , by taking the ratio of diagonal products of the cell frequencies . This is a maximum likelihood estimate of the relative risk of disease in the parent population , provided that it is assumed that the cases and controls have been selected at r and om and that cases comprise a negligible portion of the population . It is also possible to obtain a combined , unconditioned , maximum likelihood estimate of relative risk based on all of the 2 X 2 tables . However , the method is time-consuming , involving the iterative solution of sets of quadratic equations . Unless such a method is programed for the computer , I feel that the less tedious procedure to be described is adequate for most practical purpose s. Strictly speaking , the maximum likelihood estimate just described has infinite bias and it is positively skewed . To help remedy these defects , the number , 1/2 , is added to each cell frequency before obtaining the ratio of diagonal products ; furthermore , the natural logarithm of this ratio is taken . The result ing value is an estimate of natural log relative risk . Woolf pointed out that the logarithmic transformation tends to remove skew and Haldane showed that of all possible numbers which might be added to or subtracted from the cell frequencies , 1/2 is the number which reduces the bias of the estimate to a minimum . This estimate of log relative risk is shown in the first column of Figure 2 . The estimated The present paper is to study the effects of electroacupuncture ( EA ) on acute ischemic stroke patient and acute cerebral ischemic rat . In clinic , 42 acute ischemic stroke patients were r and omly divided into 2 therapeutic groups : drug group and EA+ drug group . Neurological deficits of patients were evaluated before and after the treatment by Chinese Stroke Scale . The results showed that the acute ischemic stroke patients treated by drug or EA+ drug were all partially recovered , but the clinical functional recovery in EA+ drug group was significantly better than in the drug group ( P < 0.01 ) . In laboratory , the model of reversible middle cerebral artery occlusion ( MCAO ) was used in rats . The somatosensory evoked potential ( SEP ) was recorded before and after MCAO . EA was applied one hour after cerebral ischemia and once a day after reperfusion for 7 days in EA+ MCAO group . It was shown that the amplitude of P1-N1 wave of SEP before MCAO was 100 % . After MCAO 30 min the P1-N1 wave of SEP on the ipsilateral side of MCAO was decreased to 2.2 + /- 3 % ( MCAO group ) , 1.9 + /- 2 % ( MCAO+ EA group ) ; and then recovered to 25.5 + /- 14.1 % ( MCAO group ) , 58.6 + /- 27.2 % ( MCAO+ EA group ) after 7 days of reperfusion following MCAO 2 hours . The above results indicated that EA could promote the recovery of neurological function in acute ischemic stroke patients and SEP on MCAO rats Background The approximately 1100 medical journals now active in China are publishing a rapidly increasing number of research reports , including many studies identified by their authors as r and omized controlled trials . It has been noticed that these reports mostly present positive results , and their quality and authenticity have consequently been called into question . We investigated the adequacy of r and omization  of clinical trials published in recent years in China to determine how many of them met acceptable st and ards for allocating participants to treatment groups . Methods The China National Knowledge Infrastructure electronic data base was search ed for reports of r and omized controlled trials on 20 common diseases published from January 1994 to June 2005 . From this sample , a subset of trials that appeared to have used r and omization methods was selected . Twenty-one investigators trained in the relevant knowledge , communication skills and quality control issues interviewed the original authors of these trials about the participant r and omization methods and related quality -control features of their trials . Results From an initial sample of 37,313 articles identified in the China National Knowledge Infrastructure data base , we found 3137 apparent r and omized controlled trials . Of these , 1452 were studies of conventional medicine ( published in 411 journals ) and 1685 were studies of traditional Chinese medicine ( published in 352 journals ) . Interviews with the authors of 2235 of these reports revealed that only 207 studies adhered to accepted methodology for r and omization and could on those grounds be deemed authentic r and omized controlled trials ( 6.8 % , 95 % confidence interval 5.9–7.7 ) . There was no statistically significant difference in the rate of authenticity between r and omized controlled trials of traditional interventions and those of conventional interventions . R and omized controlled trials conducted at hospitals affiliated to medical universities were more likely to be authentic than trials conducted at level 3 and level 2 hospitals ( relative risk 1.58 , 95 % confidence interval 1.18–2.13 , and relative risk 14.42 , 95 % confidence interval 9.40–22.10 , respectively ) . The likelihood of authenticity was higher in level 3 hospitals than in level 2 hospitals ( relative risk 9.32 , 95 % confidence interval 5.83–14.89 ) . All r and omized controlled trials of pre-market drug clinical trial were authentic by our criteria . Of the trials conducted at university-affiliated hospitals , 56.3 % were authentic ( 95 % confidence interval 32.0–81.0 ) . Conclusion Most reports of r and omized controlled trials published in some Chinese journals lacked an adequate description of r and omization . Similarly , most so called ' r and omized controlled trials ' were not real r and omized controlled trials owing toa lack of adequate underst and ing on the part of the authors of rigorous clinical trial design . All r and omized controlled trials of pre-market drug clinical trial included in this research were authentic . R and omized controlled trials conducted by authors in high level hospitals , especially in hospitals affiliated to medical universities had a higher rate of authenticity . That so many non-r and omized controlled trials were published as r and omized controlled trials reflected the fact that peer review needs to be improved and a good practice guide for peer review including how to identify the authenticity of the study urgently needs to be developed Background and Purpose — In small trials with control groups that receive no intervention , acupuncture has been reported to improve functional outcome after stroke . We studied effects of acupuncture and transcutaneous electrical nerve stimulation on functional outcome and quality of life after stroke versus a control group that received subliminal electrostimulation . Methods — In a multicenter r and omized controlled trial involving 7 university and district hospitals in Sweden , 150 patients with moderate or severe functional impairment were included . At days 5 to 10 after acute stroke , patients were r and omized to 1 of 3 intervention groups : ( a ) acupuncture , including electroacupuncture ; ( b ) sensory stimulation with high-intensity , low-frequency transcutaneous electrical nerve stimulation that induces muscle contractions ; and ( c ) low-intensity ( subliminal ) high-frequency electrostimulation ( control group ) . A total of 20 treatment sessions were performed over a 10-week period . Outcome variables included motor function , activities of daily living function , walking ability , social activities , and life satisfaction at 3-month and 1-year follow-up . Results — At baseline , patients in each group were closely similar in all important prognostic variables . At 3-month and 1-year follow-ups , no clinical ly important or statistically significant differences were observed between groups for any of the outcome variables . The 3 treatment modalities were all conducted without major adverse effects . Conclusions — When compared with a control group that received subliminal electrostimulation , treatment during the subacute phase of stroke with acupuncture or transcutaneous electrical nerve stimulation with muscle contractions had no beneficial effects on functional outcome or life satisfaction This pilot study obtained preliminary data on the effects of acupuncture treatment combined with a st and ard inpatient stroke rehabilitation program on poststroke motor recovery and physical function .  Thirty-two patients with acute stroke were recruited and r and omized to 1 of 2 treatment arms : st and ard rehabilitation ( control group ) or a combination of acupuncture and st and ard rehabilitation ( acupuncture group ) . Baseline and discharge assessment s were obtained on motor recovery as measured by the Fugl-Meyer ( FM ) Assessment and on physical function as measured by the Functional Independence Measure ( FIM ) . Comparisons were made between the acupuncture and control group in total FM and FIM as well as for each subscale of the FM and FIM . No differences between treatment groups were found in the total FM or the total FIM . However , statistically significant benefit due to acupuncture was observed for the FM lower extremity motor function subscale ( P = 0.01 ) and the tub/shower transfer mobility subscale of the FIM ( P = 0.03 ) . Marginally significant benefit due to acupuncture was noted for the toilet transfer mobility subscale of the FIM ( P = 0.09 ) . The effectiveness of acupuncture as an adjunct to st and ard poststroke rehabilitation programs may be demonstrated when more specific measures of stroke motor recovery and physical function are used BACKGROUND AND PURPOSE A number of studies have indicated that acupuncture might improve the functional recovery of stroke patients . These studies vary in inclusion criteria , sample size , and evaluation methods . The present study was design ed to investigate whether electroacupuncture treatment favorably affects stroke patients ' ability to perform daily life activities , their health-related quality of life , and their use of health care and social services . METHODS One hundred four consecutive patients > 40 years of age admitted to hospital because of an acute stroke were r and omized to 3 groups : deep , superficial , and no acupuncture treatment . The acupuncture treatment given by 4 physiotherapists started 4 to 10 days after r and omization and was given twice a week for 10 weeks . All patients underwent conventional stroke rehabilitation as well . Two occupational therapists , blinded regarding the patients ' allocation , evaluated the treatment effects . The assessment s were performed 4 times during the first year after r and omization by means of interviews and observations . RESULTS There were no differences between the groups with reference to changes in the neurological score and the Barthel and Sunnaas activities of daily living index scores after 3 and 12 months . Regarding the Nottingham Health Profile , the no acupuncture group had somewhat fewer mobility problems . No differences in health care and social services were found between the groups . CONCLUSIONS The present study does not give support to the previous studies , which indicates that acupuncture treatment may have a beneficial effect on acute stroke patients ' ability to perform daily life activities , their health-related quality of life , and their use of health care and social services Background and Purpose — A significant number of patients remain severely disabled after stroke despite rehabilitation with st and ard treatment modalities . Acupuncture has been reported as an alternative modality . This study aims to examine whether acupuncture has additional value to st and ard 
    Output:
    