***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: Gynoid lipodystrophy , also known as cellulite , is a common multifactorial entity that affects millions of women around the world . There have been few scientific articles dealing with its physiology and treatment in the past few years , and vascular changes seem to play an important role in its pathophysiology . Skin microvascular alterations can be observed noninvasively with a new method called orthogonal polarization spectral imaging , which was used to evaluate the effectiveness of an anticellulite drug composed mainly of a 7 % caffeine solution . Microcirculatory parameters evaluated were functional capillary density ( FCD ; number of flowing capillaries per unit area ) , diameter of the dermic papilla ( DPD ) , and capillary diameter ( CD ) . The clinical parameters analyzed were centimetrical measurements of thighs and hips and the influence of tobacco , alcohol , and physical activities on the efficacy of the treatment . After 1 month of treatment , statistical application of chi-squared and Z approximation tests showed , in treated patients , statistically significant reduction of thigh circumferences in more than 80 % of the cases and reduction of hip circumference in 67.7 % . FCD , DPD , and CD did not change significantly after treatment . Smoking as well as alcohol consumption and regular physical activity were not significantly related to the centimetrical reduction observed in treated thighs and hips The aim of this study was to determine how worthwhile it would be to combine a newly developed topical slimming product with customized dietary habits not based on calorie restriction , so as to improve the cellulite appearance of the skin . At the beginning of the study , a nutritionist recorded the dietary habits of each participant and gave recommendations to each of them according to their food consumption . The chosen methodology was a right/left comparison , one thigh and hip being treated with the new topical slimming product  and the other one left untreated to serve as a r and om control . Objective evaluations were performed by blind assessors . Control of food intake improved the cellulite score after 4 weeks when compared with the base value , but this reduction was significantly greater and earlier on the treated side than on the untreated side , indicating an objective additional benefit derived from the new slimming cream . This result corroborated the slimming effect assessed by measurement in centimetres of the circumference of the upper thighs and the reconstructed volume of the thigh between two fixed horizontal slices . Furthermore , skin tonicity , a major component of cellulite visibility , was also significantly improved on the treated side after only 2 weeks CONTEXT The Consoli date d St and ards for Reporting of Trials ( CONSORT ) statement was developed to help improve the quality of reports of r and omized controlled trials ( RCTs ) . To date , a paucity of data exists regarding whether it has achieved this goal . OBJECTIVE To determine whether use of the CONSORT statement is associated with improvement in the quality of reports of RCTs . DESIGN AND SETTING Comparative before- and -after evaluation in which reports of RCTs published in 1994 ( pre-CONSORT ) were compared with RCT reports from the same journals published in 1998 ( post-CONSORT ) . We included 211 reports from BMJ , JAMA , and The Lancet ( journals that adopted CONSORT ) as well as The New Engl and Journal of Medicine ( a journal that did not adopt CONSORT and was used as a comparator ) . MAIN OUTCOME MEASURES Number of CONSORT items included in a report , frequency of unclear reporting of allocation concealment , and overall trial quality score based on the Jadad scale , a 5-point quality assessment instrument . RESULTS Compared with 1994 , the number of CONSORT checklist items in reports of RCTs increased in all 4 journals in 1998 , and this increase was statistically significant for the 3 adopter journals ( pre-CONSORT , 23.4 ; mean change , 3.7 ; 95 % confidence interval [ CI ] , 2.1 - 5.3 ) . The frequency of unclear reporting of allocation concealment decreased for each of the 4 journals , and this change was statistically significant for adopters ( pre-CONSORT , 61 % ; mean change , -22 % ; 95 % CI , -38 % to -6 % ) . Similarly , 3 of the 4 journals showed an improvement in the quality score for reports of RCTs , and this increase was statistically significant for adopter journals overall ( pre-CONSORT , 2.7 ; mean change , 0.4 ; 95 % CI , 0.1 - 0.8 ) . CONCLUSION Use of the CONSORT statement is associated with improvements in the quality of reports of RCTs Background CONSORT ( Consoli date d St and ards for Reporting Trials ) guidelines were constructed to ensure optimal reporting quality of r and omized controlled trials ( RCTs ) . Three studies were performed to investigate the mechanism of action and evaluate the efficacy of a topical cosmetic slimming product combining tetrahydroxypropyl ethylenediamine , caffeine , carnitine , forskolin and retinol . The Ex vivo study on skin explants showed that caffeine and forskolin both stimulated glycerol release and demonstrates for the first time that retinol and carnitine in combination synergistically stimulated keratinocyte proliferation , which leads to an increase epidermal thickness . The double-blind , r and omized , placebo-controlled clinical study associating circumference measurements on five selected parts of the body , cutaneous hydration measurements as well as blinded expert grading of skin aspect was conducted on 78 women who applied the product or placebo twice daily for 12 consecutive weeks . After 4 weeks of twice-daily application of the product , significant reductions in circumference of abdomen , hips-buttocks and waist were already observed . Improvements concerned all the measured body parts after 12 weeks . Orange peel and stubborn cellulite decreased significantly from 4 weeks of treatment and tonicity improved from 8 weeks , demonstrating that the product improved skin aspect . At the end of the study , eight parameters of the thirteen evaluated were significantly improved in the active group and compared with placebo INTRODUCTION Cellulite is the unsightly dimpling and nodularity found on the thighs and buttocks of many postadolescent women . Unfortunately , poor underst and ing of its pathophysiology coupled with very few scientifically based studies have left us with limited treatment options that are tolerable and effective . PURPOSE To review current concepts of the etiology and nature of cellulite and summarize available treatment options . To evaluate a novel , pathophysiologically based , topical agent for treatment . MATERIAL S AND METHODS A total of 40 women with a moderate degree of cellulite ( 20 from each of the two research centers ) entered a double-blinded , r and omized trial where an anticellulite cream was applied on a nightly basis to the affected sites for four continuous weeks . Each subject was r and omized to receive active cream on either the right or left leg , with the contralateral side serving as placebo control . Bioceramic-coated neoprene shorts were worn overnight to enhance penetration of the topical agents by occlusion . High- quality digital photography was taken before treatment and after 4 weeks , with tangential full-spectrum lighting . Five blinded , independent physician review ers assessed the photographs for improvement . Subject question naires were completed to assess tolerability and efficacy . RESULTS Of the 34 subjects who completed the study , 62 % ( 21/34 ) noticed an overall improvement in their cellulite , with 62 % ( 13/21 ) reporting greater improvement in the thigh that received active product . All 34 subjects found the shorts and creams easy and pleasant to use . Overall , the average measured decrease in thigh circumference was 1.9 cm ( range : 0.1 - 4.5 ) with active product , and 1.3 cm ( range : 0.1 - 3.0 ) with placebo . Upon review of the pre- and post study photographs , dermatologist evaluators found thighs treated with active product showed greater improvement than thighs treated with placebo in 68 % of subjects . CONCLUSIONS The active topical agent used in this study was found to be effective in reducing the appearance of cellulite . All subjects tolerated the formulation well with no adverse effects . The success of this research vali date s the pathophysiologic concepts used to formulate the topical compound . This study both increases our underst and ing of the nature of cellulite and establishes a tolerable , effective product to treat it Numerous manufacturers are marketing topical creams , cl aim ing that they improve or eliminate unwanted fat or cellulite in a short period of time . The active ingredient in most of these creams is theophylline , and cl aims have been made that it initiates lipolysis by binding to adipocyte beta-adrenergic receptors . The creams are applied with vigorous massage to facilitate absorption and apply mechanical stress to the fat cells . The efficacy of these creams is largely untested . This prospect i ve r and omized study was conducted to determine whether there is scientific evidence that application of these creams alone can eliminate unwanted fat or cellulite . Eleven women with normal body weight as defined by insurance tables applied either Skinny Dip(TM ) or a placebo to one thigh and one half of the abdomen for 8 weeks . Each subject was examined , photographed , weighed , and measured by a study monitor on a weekly basis . There were no statistically significant differences in appearance , abdominal circumference , thigh circumference , or skin fold measurements among subjects using the active agent ( Skinny Dip(TM ) ) or the placebo . This study failed to support the efficacy of topically applied lipolytic creams in eliminating unwanted fat manifesting as a localized bulge or cellulite presenting as a dimpling of the skin A double-blind , r and omized , placebo-controlled study was conducted with 46 healthy female volunteers in order to test an anti-cellulite product containing retinol , caffeine and ruscogenine . An evaluation of different parameters related to cellulite appearance , i.e. , the skin macrorelief , the dermal and hypodermal structures , the skin mechanical characteristics , and the cutaneous flowmetry was assessed using several non-invasive methods . This combination of different evaluation methods result ed in the demonstration of significant activity of the anti-cellulite product versus baseline and showed its superiority versus the placebo in skin macrorelief ( decrease of the " orange peel " effect ) and an increase in cutaneous microcirculation . By using a combination of methods , it was possible to detail the activity of an anti-cellulite product and to show superiority of the product in comparison with the placebo Cellulite is a common phenomenon that particularly affects the thighs and buttocks of women . Little scientific evidence exists to support any of the many advertised treatments for it . A total of 52 of 69 women , who were divided into three groups , completed a 12-week , r and omized , controlled trial in which the effectiveness of two different treatments for cellulite was assessed . The patients acted as their own controls . The treatments investigated were twice-daily application of aminophylline cream and twice-weekly treatment with Endermologie ES1 . Group 1 ( double blind ) received aminophylline to one thigh/buttock and a placebo cream to the other . Group 2 ( singly blind ) received Endermologie to one thigh/buttock . Group 3 received Endermologie to both sides and used the same cream regimen as group 1 . Results were assessed subjectively by the patient and by clinical examination and photographic assessment by the surgeon ( before and after the trial ) . Morphologic assessment included body mass index , thigh girth at two points , and thigh fat depth measurement by ultrasound . No statistical difference existed in measurements between legs for any of the treatment groups ( paired t test , p > 0.4 ) . The best subjective assessment , by the patients themselves , revealed that only 3 of 35 aminophylline-treated legs and 10 of 35 Endermologie-treated legs had their cellulite appearance improved . The authors do not believe that either of these two treatments is effective in improving the appearance of cellulite BACKGROUND The development of ultrasonography allowed for skin imaging used in dermatology and esthetic medicine . By means of classic and high-frequency ultrasonographies , changes within the dermis and subcutaneous tissue can be presented . OBJECTIVE The aim of this study was to show the possibilities of applying classic and high-frequency ultrasonographies in esthetic dermatology based on monitoring various types of anti-cellulite therapies . METHODS Sixty-one women with cellulite were assigned to two smaller groups . One group was using anti-cellulite cream and the second group was a placebo group . The ultrasound examination was carried out before the initiation and after the completion of the treatment and evaluated epidermal echoes , the thickness of the subcutaneous tissue and the dermis , dermis echogenicity , the length and surface area of the subcutaneous tissue fascicles growing into the dermis , and the presence or absence of edemas . RESULTS After the completion of the treatment , a statistically significant difference was observed . The most useful parameters were as follows : the thickness of the subcutaneous tissue , echogenicity , the surface area and length of the subcutaneous tissue , as well as the presence of edemas . The discussed changes were not observed in the placebo group . CONCLUSION Classic and high-frequency ultrasonographies are useful methods for monitoring anti-cellulite therapies BACKGROUND Excessive subcutaneous adipose tissue is typically treated by physically removing the fat through liposuction , but cost and accessibility have popularized alternative treatments for reducing adipose tissue thickness . OBJECTIVE The purpose of this study was to test the absolute and relative effectiveness of a liposome-encapsulated caffeine-based cream in modifying subcutaneous adipose tissue . METHODS Forty-one patients consented and completed the double-blind , single-center , placebo-controlled study . Caliper measurements , tape measurements , and photographs were taken over a 2-month period . RESULTS Both concentrations of the cream were found to significantly reduce the thickness of the adipose tissue in all areas of the body . In addition , 
    Output:
    
This article provides a systematic evaluation of the scientific evidence of the efficacy of cosmetic products in cellulite reduction and supports a moderate efficacy in thigh circumference reduction