***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 examine whether intensive glycemic control could decrease the frequency or severity of diabetic microvascular complications , an 8-year prospect i ve study of Japanese patients with type 2 diabetes was performed . RESEARCH DESIGN AND METHODS A total of 110 patients with type 2 diabetes ( 55 with no retinopathy [ the primary prevention cohort ] and 55 with simple retinopathy [ the secondary intervention cohort ] ) were r and omly assigned to multiple insulin injection therapy ( MIT ) groups and administered three or more daily insulin injections or assigned to conventional insulin injection therapy ( CIT ) groups and administered one or two daily intermediate-acting insulin injections . Worsening of microvascular complications was regularly assessed during 8 years . Two or more steps up in the 19 stages of the modified Early Treatment of Diabetic Retinopathy Study classification in retinopathy and one or more stages up among three stages in nephropathy ( normoalbuminuria , microalbuminuria , and albuminuria ) were defined as worsening of complications . RESULTS In both primary prevention and secondary intervention cohorts , the cumulative percentages of worsening in retinopathy and nephropathy were significantly lower ( P < 0.05 ) in the MIT group than in the CIT group . In neurological tests after 8 years , the MIT group showed significant improvement ( P < 0.05 ) in the median nerve conduction velocities ( motor and sensory nerves ) , whereas the CIT group showed significant deterioration ( P < 0.05 ) in the nerve conduction velocities and vibration threshold . From this study , the glycemic threshold to prevent the onset and progression of diabetic microvascular complications was as follows : HbA1c < 6.5 % , fasting blood glucose concentration < 110 mg/dl , and 2-h postpr and ial blood glucose concentration < 180 mg/dl . CONCLUSIONS Intensive glycemic control can delay the onset and progression of the early stages of diabetic microvascular complications in Japanese patients with type 2 diabetes A linear analogue for rating  pain with 10 , 15 and 20 cm lines is significantly less variable than a 5 cm line ( mean error of 15 cm line is 0 - 19 % , 95 % confidence limits for the group + /- 2 % and an inood correlation between repeated ratins of a recalled pain distant in time . The variance of the rating is significantly less than the repeated rating of a r and om mark . The linear analogue rating of a constant pain stimulus is reproducible and changes in rating are likely to be real changes of opinion . Pethidine 150 mg intramuscularly had no significant effect , tested 30 minutes after the administration , on the accuracy or reproducibility of the analogue rating . A linear analogue seems a suitable method of recording the patient 's opion of a severe pain such as that of labour OBJECTIVE To determine whether clinical trials originating in certain countries always have positive results . DATA SOURCES Abstract s of trials from Medline ( January 1966-June 1995 ) . STUDY SELECTION Two separate studies were conducted . The first included trials in which the clinical outcome of a group of subjects receiving acupuncture  was compared to that of a group receiving placebo , no treatment , or a nonacupuncture intervention . In the second study , r and omized or controlled trials of interventions other than  acupuncture  that were published in China , Japan , Russia/USSR , or Taiwan were compared to those published in Engl and . DATA EXTRACTION Blinded review ers determined inclusion and outcome and separately classified each trial by country of origin . DATA SYNTHESIS In the study of acupuncture  trials , 252 of 1085 abstract s met the inclusion criteria . Research conducted in certain countries was uniformly favorable to acupuncture ; all trials originating in China , Japan , Hong Kong , and Taiwan were positive , as were 10 out of 11 of those published in Russia/USSR . In studies that examined interventions other than acupuncture , 405 of 1100 abstract s met the inclusion criteria . Of trials published in Engl and , 75 % gave the test treatment as superior to control . The results for China , Japan , Russia/USSR , and Taiwan were 99 % , 89 % , 97 % , and 95 % , respectively . No trial published in China or Russia/USSR found a test treatment to be ineffective . CONCLUSIONS Some countries publish unusually high proportions of positive results . Publication bias is a possible explanation . Research ers undertaking systematic review s should consider carefully how to manage data from these countries OBJECTIVE The aim of the current study was to determine the independent clinical risk factors for predicting morphological severity of distal diabetic sensorimotor polynecuropathy ( DSP ) as determined by fiber density ( FD ) on sural nerve biopsy . RESEARCH DESIGN AND METHODS A total of 89 patients with both type 1 and type 2 diabetes , ascertained from a large therapeutic r and omized clinical trial , were included in this observational cohort study . Morphological severity of DSP was expressed as the myelinated FD in the sural nerve biopsy General linear models were used to assess the relationship between the morphological severity of DSP and various clinical risk factors . RESULTS Glycated hemoglobin ( GHb ) was significantly related to FD in univariate and multivariate regression analyses . This relationship was present in models in which GHb was h and led either as a continuous variable or as a categorical variable with the highest significance level , with a GHb cutoff level of 9 % . After dividing patients into groups with optimal to moderate GHb < or = 9 % ) and suboptimal ( GHb > 9 % ) glycemic control , the difference in FD between the two groups ranged between 3,461 and 2,334 per mm2 . FD was also significantly related to duration of diabetes and age of the patient . CONCLUSIONS The severity of peripheral DSP expressed by morphological criteria was significantly related to glycemic control in type 1 and type 2 diabetic patients . Inconsistent with previously published electrophysiological data demonstrating a correlation between height and conduction velocity , increasing height is not associated with morphological severity . Based on the results of the present study , it might be hypothesized that improving glycemic control will lessen severity of DSP in terms of FD loss in subjects with diabetes OBJECTIVE The aim of the present study was to examine risk factors for the electrophysiologic severity of diabetic peripheral sensorimotor polyneuropathy ( DSP ) . RESEARCH DESIGN AND METHODS A total of 97 patients with type 1 diabetes ( 25 patients ) or type 2 diabetes ( 72 patients ) were included in this cross-sectional study . Nerve conduction studies ( NCS ) were performed on median motor and sensory nerves , peroneal motor nerve , and both sural nerves . The severity of DSP was expressed as the sum of nerve conduction velocities ( SNCV ) and the score of distal amplitudes ( SAMP ) of the above-mentioned nerves . General linear models were used to assess the relationship between overall severity of DSP , as well as the severity of lower extremity , upper extremity , motor nerve , or sensory nerve involvement and various risk factors . RESULTS GHb was significantly related to both SNCV and SAMP in univariate and multivariate regression analyses . This relationship was present in models where GHb was h and led either as a continuous variable or as a categorical variable with highest significance level , with a GHb cutoff level of 9 % . The difference in NCV for individual nerves in patients with good-to-moderate glycemic control ( GHb ≤9 % ) and those with poor glycemic control ( GHb ≥9 % ) ranged from 1.8 to 3.6 m/s . SAMP was also significantly lower in patients with poor control . SNCV was also significantly related in multivariate analysis to duration of diabetes and height , while SAMP was related to duration of diabetes , age , and male sex . CONCLUSIONS The severity of DSP expressed by electrophysiologic criteria was significantly related to glycemic control in a study including patients with type 1 or type 2 diabetes . Based on the results of the present study , it might be predicted that better diabetic control would decrease the severity of OBJECTIVE To identify risk factors for diabetic lower-extremity peripheral sensory neuropathy prospect ively in a cohort of U.S. veterans with diabetes . RESEARCH DESIGN AND METHODS General medicine clinic out patients with diabetes were followed prospect ively for the development of insensitivity to the 5.07 monofilament on the foot . RESULTS Of 775 subjects , 388 ( 50 % ) had neuropathy at baseline . Of the 387 subjects without neuropathy at baseline , 288 were followed up , and of these , 58 ( 20 % ) developed neuropathy . Multivariate logistic regression modeling of prevalent neuropathy controlling for sex and race revealed independent and significant associations with age , duration of diabetes , glycohemoglobin level , height , history of lower-extremity ulceration , callus , and edema ; an independent and inverse correlation was noted with ankle-arm index . Risk factors for incident neuropathy in multivariate logistic regression included age , baseline glycohemoglobin level , height , history of ulcer , and CAGE screening instrument alcohol score ; current smoking and albumin level were inversely associated with risk . CONCLUSIONS Poorer glycemic control increases the risk of neuropathy and is amenable to intervention . Height and age directly increase risk of neuropathy and may help identify patients at risk . A proportion of neuropathy in diabetic veterans is probably due to or worsened by alcohol ingestion . Neuropathy was less common in current smokers than subjects not currently smoking Many r and omised controlled trials have been conducted in China to evaluate the effectiveness of traditional Chinese medicine , but much of the information is inaccessible to Western doctors . We estimated the total number of r and omised controlled trials published in China and identified problems in applying such methodology to the evaluation of traditional Chinese medicine , which would serve as preparatory work for systematic review and dissemination of the r and omised evidence for such medicine . We r and omly selected 28 journals using stratified sampling from a total of 100 Chinese journals of traditional Chinese medicine ( 4 national , 10 university , 10 provincial or regional , and 4 specialist journals ) . After special training , eight fifth year medical students ( working in pairs ) h and search ed all the issues of the journals published before 1 January 1997 to identify r and omised controlled trials . Discrepancies were settled by one of the principal investigators ( S-YZ ) . Data on method ological quality of r and omised controlled trials were extracted from 414 full length articles R and omized , controlled trials ( RCTs ) of herbal interventions often inadequately describe important aspects of their methods ( 1 - 4 ) . Although the quality of reporting of these trials may be improving with time , many still lack important information , particularly about the composition of the herbal intervention ( 4 , 5 ) . Crude herbal drugs are natural products and their chemical composition varies depending on several factors , such as geographic source of the plant material , climate in which it was grown , and time of harvest . Commercially available herbal medicinal products also vary in their content and concentration of chemical constituents from batch to batch and when products containing the same herbal ingredient are compared among manufacturers ( 6 - 14 ) . Even when herbal products are st and ardized for content of known active or marker compounds to achieve more consistent pharmaceutical quality , there is variation in the concentrations of other constituents . These variations can result in differences in pharmacologic activity in vitro ( 15 ) and in bioavailability in humans ( 16 ) . Mindful of these issues , we elaborated on the 22-item checklist of the Consoli date d St and ards of Reporting Trials ( CONSORT ) statement ( 17 ) to help authors and editors improve reporting of RCTs of herbal interventions . Methods We developed these reporting recommendations in 3 phases that included premeeting item generation , a consensus meeting , and postmeeting feedback . The individuals who participated are listed in the Appendix . To generate items , 1 investigator conducted telephone interviews of 16 participants with expertise in the method and reporting of RCTs ( 5 participants ) , pharmacognosy ( 4 participants ) , herbal medicinal products ( 5 participants ) , medical statistics ( 1 participant ) , and herbal product manufacturing ( 1 participant ) . The investigator asked participants to suggest revisions to existing CONSORT checklist items and also to additional items required for reporting trials of herbal interventions . He asked participants to nominate revisions or new items on the basis of empirical evidence that not reporting the item would bias estimates of treatment effect . When no empirical evidence was available , commonsense reasoning was acceptable . After completing all telephone calls , the investigator thematically grouped items and circulated them by e-mail to each participant for review . Fourteen participants attended the consensus meeting . The meeting began with a review of the premeeting checklist item suggestions . We emphasized minimizing item elaborations and additions and basing elaborations on evidence whenever possible . Each item suggestion was presented and followed by debate for its inclusion , deletion , or modification . This process was repeated until all items were review ed and a consensus emerged . After the consensus meeting , we circulated a draft summary report to all participants to ensure that it accurately represented decisions made during the consensus meeting . We then circulated the report to the wider CONSORT Group for input and revised it on the basis of their suggestions . Ethical approval was obtained from The University of Toronto Health Sciences Ethics Review Committee on 23 January 2004 . Financial support for the consensus meeting was provided by the Canadian Institutes of Health Research . The funding body had no role in the design , conduct 
    Output:
    
Based on this systematic review , there is no evidence to support the objective effectiveness and safety of Chinese herbal medicines for diabetic peripheral neuropathy .