***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 
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    ***EXAMPLES*** 
    Input: To investigate the influence of alcohol on glucose counterregulation and recovery during acute insulin-induced hypoglycemia in type 2 diabetic subjects , 8 diet-treated type 2 diabetic subjects were examined twice after an overnight fast . A grade d hyperinsulinemic ( 1 mU/kg/min , 60 to 195 minutes ) euglycemic/hypoglycemic clamp was performed with concomitant infusion of 3-(3)H-glucose to assess glucose turnover . After a euglycemic baseline period ( 150 to 180 minutes ) , 200 mL of water was taken either alone or with alcohol ( 0.4 g/kg body weight ) . Hypoglycemia ( plasma glucose nadir , 2.8 mmol/L ) was subsequently induced , and the recovery period followed after discontinuation of insulin and the variable glucose infusion . On both study days , circulating concentrations of insulin and glucose were comparable . Alcohol intake markedly increased plasma lactate ( area under the curve [ AUC ] , recovery period ) ( 244 + /- 30 v 12 + /- 4 mmol/L x 240 minutes ; P = .00009 ) and suppressed plasma nonesterified fatty acids ( NEFA ) ( AUC , recovery period ) ( 95 + /- 13 v 161 + /- 18 mmol/L x 240 minutes ; P = .0008 ) . No differences were found in the counterregulatory response of catecholamines , cortisol , and growth hormone ( GH ) . However , alcohol intake decreased peak glucagon significantly ( 155 + /- 12 v 200 + /- 17 pg/mL ; P = .038 ) . In diet-treated , mild type 2 diabetic subjects , alcohol does not modify recovery from insulin-induced hypoglycemia Meta-analytic investigations sometimes use assessment s of research quality according to a formal protocol as a tool for improving research synthesis . We asked whether a particular  quality scoring system could have a direct use in adjusting the summary estimates of a treatment difference . In an empirical study of the relation of quality scores to treatment differences in published meta-analyses of 7 groups of controlled r and omized clinical trials comprising 107 primary studies , we found no relation between treatment difference and overall quality score . We also found no relation between quality score and variation in treatment difference . The level of quality scores has increased at a rate of 9 % per decade for three decades , averaging 0.51 on a scale of 0 to 1 for the 1980s , and leaving much room for improvement . Nevertheless , attention to quality of studies by editors , review ers , and authors may be raising both the level of research done and quality of the reports Dupuytren 's disease or palmar fibromatosis is a common disabling h and disorder , mainly confined to Caucasians of northwestern European origin . The prevalence of Dupuytren 's disease and possible risk factors related to the disease were evaluated in a r and om sample of 1297 males and 868 females , aged 46 to 74 years .  Blood sample s were collected and biochemical parameters were evaluated . The possible relation between the disease and clinical , social , and biochemical parameters were estimated with age-adjusted univariate logistic regression analysis . Altogether 19.2 % of the males and 4.4 % of the female participants had clinical signs of Dupuytren 's disease . The prevalence increased with age , from 7.2 % among males in the age group 45 - 49 years up to 39.5 % in those 70 - 74 years old . The more severe form of the disease , finger contractures , was found in 5.0 % of the men and 1.4 % had required operation , while this was rarely seen among women . In men elevated fasting blood glucose ( P < 0.04 ) , low body weight , and body mass index were significantly correlated with the presence of the disease ( P < 0.001 ) . Dupuytren 's disease was common among heavy smokers ( P = 0.02 ) and those having manual labor as occupation ( P = 0.018 ) . These results show that Dupuytren 's disease is common in the Icel and ic population and occupation and lifestyle seem to be related to the disease A comparative prospect i ve study of 120 adult diabetics ( 60 insulin dependent , 60 non-insulin dependent ) and 120 non-diabetic adults as controls showed significantly higher incidence of Dupuytren 's disease , limited joint motion , carpal tunnel syndrome , and flexor tenosynovitis in the diabetic population . Of the diabetic patients one third had a mild non-progressive form of Dupuytren 's disease  , which commonly involved the long and ring rays . Limited joint motion was noted in a third of diabetics , and carpal tunnel syndrome was observed in 15 - 25 % , and flexor tenosynovitis in about a fifth . Limited joint motion co-existed with Dupuytren 's disease in 57 % of insulin-dependent diabetics . Diabetic polyneuropathy was found in two thirds of insulin-dependent diabetics and in one third of non-insulin dependent diabetics . All these h and changes were more marked in insulin-dependent diabetics and they showed a positive correlation with increasing age of the patient , duration of the diabetes , and the presence of a microangiopathy This prospect i ve study was undertaken to assess the prevalence of  Dupuytren 's contracture ( DC )  and its relationship with possible causes , especially alcohol consumption and chronic liver disease . Four hundred thirty-two consecutively hospitalized patients were examined for evidence of DC . They were divided into five groups based on the following clinical , biologic , and histologic criteria : alcoholic cirrhosis ( 89 patients ) , noncirrhotic alcoholic liver disease ( 55 patients ) , chronic alcoholism without liver disease ( 46 patients ) , nonalcoholic chronic liver disease ( 68 patients ) , and a control group ( 174 patients ) . The prevalence of DC in these five groups of patients was 32.5 % , 22 % , 28 % , 6 % , and 12 % , respectively ; the prevalence of DC was higher in patients with cirrhotic or noncirrhotic alcoholic liver disease ( 25.5 % ) than it was in patients with nonalcoholic liver disease ( 6 % ) , but it was not significantly different in alcoholic patients with or without liver disease . The relationship between DC and age , sex , manual labor , previous h and injuries , diabetes mellitus , alcohol consumption , and cigarette smoking was assessed by univariate and logistic regression methods . Nine variables were significantly different in patients with or without DC : age , sex , manual labor , previous h and injuries , diabetes mellitus , daily alcohol consumption , duration of alcohol consumption , total alcohol consumption , and duration of cigarette smoking . In our patients , variables that could explain DC were , in decreasing order , age , total alcohol consumption , sex ( male ) , and previous h and injuries . In alcoholic patients , these variables were age and previous h and injuries ; in nonalcoholic patients , these variables were age and cigarette smoking . These results emphasize the high prevalence of DC in alcoholic patients and the absence of a correlation between DC and chronic liver disease . Age and alcohol consumption are the best explanatory variables of DC in hospitalized patients The musculoskeletal complications of diabetes mellitus ( DM ) , which are the most common endocrine arthropathy , have been generally ignored and poorly treated compared with other complications such as neuropathy , retinopathy and nephropathy . Like other quality of life issues , the musculoskeletal disability of DM has not been investigated effectively . The incidence of diabetic foot has decreased thanks to excellent foot care , but the h and is still an important target for diabetic complications . The aim of this study was to investigate early diabetic musculoskeletal complications on the basis of a collaborative multidisciplinary study design . For this purpose 78 patients ( mean age 57.8 ± 11.9 years , 55 women and 23 men ) who had type II DM for 15 years maximally and 37 non-diabetic controls ( mean age : 55.7 ± 11.5 , 27 women and 10 men ) were r and omly selected for inclusion in the study . All patients were evaluated by the Rheumatology , Orthopedic Rehabilitation and H and Rehabilitation Divisions . Dupuytren 's disease was present in 17 ( 21.8 % ) of 78 diabetic subjects as the most frequent and statistically significant complication of the musculoskeletal system . In correlation and logistic regression analysis , only retinopathy was significantly associated with duration of diabetes and diabetic foot . Long-term prospect i ve r and omised controlled trials on the effects  of exercise in preventing musculoskeletal complications and disability in diabetics are needed Sixty Type 1 ( insulin dependent ) and sixty Type 2 ( non insulin dependent ) diabetic patients attending a diabetology unit were examined in search of limited joint mobility , Dupuytren 's disease , flexor tenosynovitis and carpal tunnel syndrome , in comparison with two population s of 60 non diabetic controls matched for sex and age with the Type 1 and the Type 2 diabetic patients . Microangiopathic and neuropathic complications , glycaemic control , blood pressure and tobacco consumption were simultaneously assessed in 39 of the 60 type 1 and in all the type 2 diabetic patients . The prevalence of the various soft tissue h and lesions was higher in both diabetic population s ( respectively Type 1 and Type 2 ) than in their control population s : Limited joint mobility : 33.3 and 26.7 % vs 5.0 and 8.3 % ( both p < 0.01 ) ; Dupuytren 's disease : 35.0 and 30.0 % vs 6.7 and 10.0 % ( both p < 0.01 ) ; flexor tenosynovitis : 23.3 and 16.7 % vs 0.0 and 3.3 % ( p < 0.01 and p < 0.05 ) ; carpal tunnel syndrome : 26.7 and 15.0 % vs 3.3 and 5 % ( p < 0.01 and NS ) . The prevalence of limited joint mobility in Type 1 diabetes was independently associated with increasing age ( p < 0.05 ) and to lower extent with increasing duration of diabetes ( p = 0.05 ) , whereas the prevalence of Dupuytren 's disease only correlated with increasing age in both types of diabetes ( p < 0.05 ) . In Type 2 diabetes , the prevalence of flexor tenosynovitis also increased independently with age ( p < 0.05 ) , and the prevalence of limited joint mobility increased in the opposite way to the body mass index after adjustment on age , duration of diabetes and sex ( p < 0.05 ) . ( ABSTRACT TRUNCATED AT 250 WORDS Development of Dupuytren 's contractures , frozen shoulder , Ledderhose 's syndrome , Peyronie 's disease , fibromas , and general joint pain has been linked in retrospective studies and case reports to the use of antiepileptic drugs . We undertook a prospect i ve survey of the incidence of connective tissue disorders in 622 patients newly treated with carbamazepine , phenobarbital , phenytoin sodium , or primidone . Ten of the 406 patients who were treated for 6 months or more developed connective tissue disorders . All affected patients were taking a barbiturate ( primidone , 4 patients ; phenobarbital , 6 patients ) . Seven of the 10 problems occurred during the first year of treatment . These data are prospect i ve evidence of a statistically significant relationship between barbiturate use and the development of connective tissue disorders , and timing of appearance A study of 197 epileptic out patients consecutively observed by one Neurologist allowed a prospect i ve study of the side effects of antiepileptic drugs . This study shows essentially that a clinical improvement comparable to that generally reported can be obtained with side effects limited in their number and intensity . The main principle is the routine search of these effects which are not always spontaneously mentioned by the patients , especially intellectual slowness and loss of sexual activity . The detection of the side effects through history and physical examination is far more fruitful than are plasma concentrations of drugs which can be doubly misleading : some plasma concentrations lower than recognized therapeutical levels are efficient however while others are higher and nevertheless necessary and well tolerated . Among the side effects specific to certain antiepileptic drugs , shoulder-h and syndrome due to phenobarbital  was noted in 10 per cent of the cases . Furthermore , the frequency of scapulo-humeral periarthritis was significantly higher in the epileptic group than in the controls . Dupuytren 's disease was less frequent ( 8 per cent ) and the difference with the controls was not significant . Among the non-specific side effects , nystagmus is a somewhat useful sign in treatments by phenytoin but as with drugs dosages , it must be weighed within the whole clinical picture Prospect i ve study of 280 diabetic adults and 100 control show an association of  limited joint mobility ( LJM )  with Dupuytren 's contracture ( DC ) in 37 diabetic and no one of control case . In 80 diabetic with LJM , DC is found in 46.25 p. cent against 21 p. cent in 200 diabetic without LJM ( p less than 0.00003 ) . LJM and DC are significantly related to diabetic retinopath 
    Output:
    
Conclusions : These findings demonstrate an association between Dupuytren disease and diabetes mellitus , liver disease , and epilepsy .