***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: This follow-up study presents the effects of DES on the genital tract of male and female offspring of mothers who were part of a double-blind , placebo-controlled investigation during 1951 and 1952 aim ed at determining the effect of DES on pregnancy . Epididymal cysts , hypotrophic testes , and capsular in duration were the more common genital lesions found in 25 % of 163 DES-exposed males as compared to 6 % in 168 control males .  Semen analysis data on 39 subjects of the DES-exposed group and 25 subjects of the control group showed that 26 % of the DES-exposed group produced an ejaculate volume under 1.5 ml ; no such cases were observed in the control group . The average values for sperm density and total motile spermatozoa per ejaculate , although in the normal range , were more than two times lower in the DES-exposed group as compared to the controls . A quality score of > 10 ( “ severely pathologic semen ” ) was found in 28 % of the DES-exposed group as compared to 0 in the control group . An association of pathologic semen quality with physical abnormalities was found only in the DES-exposed group . Two cases of azoospermia , one without genital abnormalities on physical examination and one with bilateral hypotrophic testes were observed so far in the DES-exposed group . Eighteen percent of 229 DES-exposed female patients had irregular menstrual cycles ( oligomenorrhea ) as compared to 10 % of 136 controls . The history of pregnancy revealed a lower incidence of pregnancy in the DES-exposed group ( 18 % ) than in the control group ( 33 % ) . Circumferential ridges of the vagina and cervix were seen in 40 % of 229 DES-exposed females but in none of 136 controls . Colposcopic findings in the vagina revealed adenosis in 66.8 % of the DES-exposed females and in 3.6 % of the control group . Dysplastic lesions were more prevalent in the vagina and cervix of the DES-exposed subjects . No cases of cancer were observed in either the male or female offspring Increasing rates of cryptorchidism and hypospadias in human population s may be caused by exogenous environmental agents . We conducted a case – control study of serum levels of p , p′-dichlorodiphenyltrichloroethane ( DDT ) and its major metabolite , p , p′-dichlorodiphenyldichloroethylene ( DDE ) , and cryptorchidism and hypospadias in the Child Health and Development Study , a longitudinal cohort of pregnancies that occurred between 1959 and 1967 , a period when DDT was produced and used in the United States . Serum was available from the mothers of 75 male children born with cryptorchidism , 66 with hypospadias , and 4 with both conditions . We r and omly selected 283 controls from the cohort of women whose male babies were born without either of these conditions . Overall , we observed no statistically significant relationships or trends between outcomes and serum measures . After adjusting for maternal race , triglyceride level , and cholesterol level , compared with boys whose mothers had serum DDE levels < 27.0 ng/mL , boys whose mothers had serum DDE levels ≥61.0 ng/mL had odds ratios of 1.34 [ 95 % confidence interval ( CI ) , 0.51–3.48 ] for cryptorchidism and 1.18 ( 95 % CI , 0.46–3.02 ) for hypospadias . For DDT , compared with boys whose mothers had serum DDT levels < 10.0 ng/mL , boys whose mothers had serum DDT levels ≥20.0 ng/mL had adjusted odds ratios of 1.01 ( 95 % CI , 0.44–2.28 ) for cryptorchidism and 0.79 ( 95 % CI , 0.33–1.89 ) for hypospadias . This study does not support an association of DDT or DDE and hypospadias or cryptorchidism The 27-year follow-up is reported of 136 children whose mothers were involved in a r and omised trial of high doses of stilboestrol and ethisterone therapy during pregnancy . The children were not contacted directly . Information about them was obtained from hospitals , general practitioners , and other official sources ; and the persons who responded to our inquiries were unaware of who had been exposed to hormones in utero and whose mothers had received an inactive tablet . All children were traced .  Urogenital anomalies were reported more frequently in the hormone-exposed than the unexposed children ( 14 % and 9 % respectively ) . The earlier in pregnancy the therapy began , the higher the prevalence rate of abnormalities ( X2 for trend , p less than 0.02 ) . No malignant tumours were reported . For males , the proportion reported to be married or living as married was lower in the exposed than in the unexposed group ( 32 % and 62 % respectively ) . The proportion was lower the earlier in pregnancy hormonal exposure occurred and the higher the total hormone dose to which they were exposed ( X2 for trend , p less than 0.02 ) . These findings suggest that some interference with sexual function may not be uncommon in males exposed to high doses of stilboestrol and ethisterone  while in utero Synthetic hormone-disrupting chemicals may play a role in the increased frequency of cryptorchidism observed in some studies . We used a spatial ecological design to search for variations in orchidopexy rates in the province of Granada in Spain and to search for relationships between these differences and geographical variations in exposure to pesticides . Orchidopexy rates were estimated for the period from 1980 to 1991 in all municipalities and health care districts served by the University of Granada Hospital . A r and om sample of males of the same age ( 1 - 16 years ) admitted for any reason during the same period was used to estimate inpatient control rates . Each municipality was assigned to one of four levels of pesticide use . We used Poisson homogeneity tests to detect significant differences in rates of orchidopexy between districts and between levels of pesticide use . Poisson and logistic regression models were also used to estimate the strength of association between orchidopexy and level of pesticide use . Orchidopexy rates tended to be higher in districts near the Mediterranean coast where intensive farming is widespread . The city of Granada , where the reference hospital is located , also had higher figures both for orchidopexy and inpatient control rates . Regression models showed that the strength of association between orchidopexy and level of pesticide use tended to increase with higher levels of use , with the exception of level 0 ( mainly in the city of Granada ) . Our results are compatible with a hypothetical association between exposure to hormone-disruptive chemicals and the induction of cryptorchidism . Several method ological limitations in the design make it necessary to evaluate the results with caution . ImagesFigure 1.Figure 2.Figure 3 Epididymal cysts and /or hypoplastic testes have been found in 31.5 per cent of 308 men exposed to diethylstilbestrol in utero , compared to 7.8 per cent of 307 placebo-exposed controls . Analyses of the spermatozoa have revealed severe pathological changes ( Eliasson score greater than 10 ) in 134 diethylstilbestrol-exposed men ( 18 per cent ) and 87 placebo-exposed men ( 8 per cent ) . Further investigation of the 26 diethylstilbestrol-exposed men with testicular hypoplasia has revealed that 65 per cent had a history of cryptorchidism . Only 1 of the 6 placebo-exposed  controls with testicular hypoplasia had a history of testicular maldescent . Although none of our Diekmann 's lying-in study group has had carcinoma to date one must keep in mind the reported increased risk of testicular carcinoma in testes that are or were cryptorchid . A 25-year-old man who was not part of the study group was treated recently by us for a testicular carcinoma ( mixed anaplastic seminoma plus embryonal cell carcinoma ) and he had a history of diethylstilbestrol exposure in utero and cryptorchidism BACKGROUND Several investigators have shown striking differences in semen quality and testicular cancer rate between Denmark and Finl and . Since maldescent of the testis is a shared risk factor for these conditions we undertook a joint prospect i ve study for the prevalence of congenital cryptorchidism . METHODS 1068 Danish ( 1997 - 2001 ) and 1494 Finnish boys ( 1997 - 99 ) were consecutively recruited prenatally . We also established prevalence data for all newborns at Turku University Central Hospital , Finl and ( 1997 - 99 , n=5798 ) .  Testicular position was assessed by a st and ardised technique . All subtypes of congenital cryptorchidism were included , but retractile testes were considered normal . FINDINGS Prevalence of cryptorchidism at birth was 9.0 % ( 95 % CI 7.3 - 10.8 ) in Denmark and 2.4 % ( 1.7 - 3.3 ) in Finl and . At 3 months of age , prevalence rates were 1.9 % ( 1.2 - 3.0 ) and 1.0 % ( 0.5 - 1.7 ) , respectively . Significant geographic differences were still present after adjustment for confounding factors ( birthweight , gestational age , being small for gestational age , maternal age , parity , mode of delivery ) ; odds ratio ( Denmark vs Finl and ) was 4.4 ( 2.9 - 6.7 , p<0.0001 ) at birth and 2.2 ( 1.0 - 4.5 , p=0.039 ) at three months . The rate in Denmark was significantly higher than that reported 40 years ago . INTERPRETATION Our findings of increasing and much higher prevalence of congenital cryptorchidism in Denmark than in Finl and contribute evidence to the pattern of high frequency of reproductive problems such as testicular cancer and impaired semen quality in Danish men . Although genetic factors could account for the geographic difference , the increase in reproductive health problems in Denmark is more likely explained by environmental factors , including endocrine disrupters and lifestyle Summary . In the early 1950s , a r and omized , double‐blind , controlled trial of the value of prophylactic stilboestrol therapy given antenatally to reduce the incidence of late pregnancy toxaemia and to improve perinatal mortality was conducted at University College Hospital , London . Women expecting their first baby were allocated to one or other of two groups . Those in the stilboestrol group started treatment at the 12th week of pregnancy on average and received a mean dose of about 11.5 g of the drug while those in the control group received placebo tablets . In spite of the fact that the original trial documentation was lost , it was possible to be fairly certain which was the treated group and follow‐up data from 650 mothers and 660 offspring were obtained from death certificates , cancer registration s and question naires sent to general practitioners . We found no indication of any harmful long‐term effect of stilboestrol exposure during pregnancy on the mothers — in particular 10 out of 331 women in the untreated group and 9 out of 319 women in the treated group were found to have developed breast cancer . Amongst the daughters , those in the treated group suffered an excess of minor benign lesions of the cervix uteri and an excess ( not statistically significant ) of unfavourable pregnancy outcomes . None of the daughters had developed clear cell adenocarcinoma of the vagina or cervix uteri . Amongst the sons , we discovered no evidence of any significant excess of genital tract disorders or of impaired reproductive performance in the treated group but one son developed a ( fatal ) teratoma of the testis . Unexpectedly , psychiatric disease ( especially depression and anxiety ) was reported by general practitioners about twice as often in the treated group offspring ( sons and daughters ) as in the untreated group . This result can not be due to bias , and is unlikely to be due to confounding or chance , and may thus represent an adverse effect of exposure to stilboestrol in utero BACKGROUND An association between prenatal  diethylstilbestrol ( DES ) exposure and cancer in men , especially testicular cancer , has been suspected , but findings from case-control studies have been inconsistent . This study was conducted to investigate the association between prenatal DES exposure and cancer risk in men via prospect i ve follow-up . METHODS A total of 3613 men whose prenatal DES exposure status was known were followed from 1978 through 1994 . The overall and site-specific cancer incidence rates among the DES-exposed men were compared with those of the unexposed men in the study and with population -based rates . The relative rate ( RR ) was used to assess the strength of the association between prenatal DES exposure and cancer development . All statistical tests were two-sided . RESULTS Overall cancer rates among DES-exposed men were similar to those among unexposed men ( RR = 1.07 ; 95 % confidence interval [ CI ] = 0.58 to 1.96 ) and to national rates ( RR = 0.99 ; 95 % CI = 0.65 to 1.44 ) . Testicular cancer may be elevated among DES-exposed men , since the RRs for testicular cancer were 3.05 ( 95 % CI = 0.65 to 22.0 ) times those of unexposed men in the study and 2.04 
    Output:
    
Conclusions The doubling of the risk ratios for all three end points investigated after DES exposure is consistent with a shared etiology and the TDS hypothesis but does not constitute evidence of an estrogenic mode of action .