***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: Introduction Hypothalamic-pituitary-adrenal ( HPA ) deregulation is commonly observed in cancer patients , but its clinical significance is not well understood . We prospect ively examined the association between HPA activity , tumor-associated inflammation , and survival in ovarian cancer patients prior to treatment . Material s and Methods Participants were 113 women with ovarian cancer who provided salivary cortisol for three days prior to treatment for calculation of cortisol slope , variability  , and  night cortisol . Cox proportional hazard regression analyses were used to examine associations between cortisol and survival in models adjusting for disease stage , tumor grade , cytoreduction and age . On a sub sample of 41 patients with advanced disease ascites fluid was assayed for levels of interleukin-6 ( IL-6 ) and correlated with cortisol variables . Results Each cortisol measure was associated with decreased survival time , adjusting for covariates ( all p<.041 ) . A one st and ard deviation increase in night cortisol was associated with a 46 % greater likelihood of death . Patients in the high night cortisol group survived an estimated average of 3.3 years compared to 7.3 years for those in the low night cortisol group . Elevated ascites IL-6 was associated with each cortisol measure ( all r > .36 , all p<.017 ) . Discussion Abnormal cortisol rhythms assessed prior to treatment are associated with decreased survival in ovarian cancer and increased inflammation in the vicinity of the tumor . HPA abnormalities may reflect poor endogenous control of inflammation , dysregulation caused by tumor-associated inflammation , broad circadian disruption , or some combination of these factors . Nocturnal cortisol may have utility as a non-invasive measure of HPA function and /or disease severity CONTEXT Changes in and rogen levels across the adult female life span and the effects of natural menopause and oophorectomy have not been clearly established . OBJECTIVE The objective of this study was to document the effects of age on and rogen levels in healthy women and to explore the effects of natural and surgical menopause . DESIGN , SETTING , AND PARTICIPANTS A cross-sectional study was conducted of 1423 non-healthcare-seeking women , aged 18 - 75 yr , r and omly recruited from the community over 15 months . MAIN OUTCOME MEASURES Serum levels by age of total testosterone ( T ) , calculated free T , dehydroepi and rosterone sulfate , and and rostenedione in a reference group of women free of confounding factors . Women in the reference group had no usage of exogenous steroid therapy ; no history of tubal ligation , hysterectomy , or bilateral oophorectomy ; and no hyperprolactinemia or polycystic ovarian syndrome . The effects of natural and surgical menopause on sex steroid levels were also examined . RESULTS In the reference population ( n = 595 ) , total T , calculated free T , dehydroepi and rosterone sulfate , and and rostenedione declined steeply with age ( P < 0.001 ) , with the decline of each being greater in the earlier than the later decades . Examination of serum and rogen levels by year in women aged 45 - 54 yr showed no independent effect of menopausal status on and rogen levels . In women aged 55 yr or older , those who reported bilateral oophorectomy and were not on exogenous steroids had significantly lower total T and free T levels than women 55 yr or older in the reference group . CONCLUSIONS We report that serum and rogen levels decline steeply in the early reproductive years and do not vary because a consequence of natural menopause and that the postmenopausal ovary appears to be an ongoing site of testosterone production . These significant variations in and rogens with age must be taken into account when normal ranges are reported and in studies of the role of and rogens in women Background Current reporting guidelines do not call for st and ardised declaration of follow-up completeness , although study validity depends on the representativeness of measured outcomes . The Follow-Up Index ( FUI ) describes follow-up completeness at a given study end date as ratio between the investigated and the potential follow-up period . The association between FUI and the accuracy of survival-estimates was investigated . Methods FUI and Kaplan-Meier estimates were calculated twice for 1207 consecutive patients undergoing aortic repair during an 11-year period : in a scenario A the population ’s clinical routine follow-up data ( available from a prospect i ve registry ) was analysed conventionally . For the control scenario B , an independent survey was completed at the predefined study end . To determine the relation between FUI and the accuracy of study findings , discrepancies between scenarios regarding FUI , follow-up duration and cumulative survival-estimates were evaluated using multivariate analyses . Results Scenario A noted 89 deaths ( 7.4 % ) during a mean considered follow-up of 30±28months . Scenario B , although analysing the same study period , detected 304 deaths ( 25.2 % , P<0.001 ) as it scrutinized the complete follow-up period ( 49±32months ) . FUI ( 0.57±0.35 versus 1.00±0 , P<0.001 ) and cumulative survival estimates ( 78.7 % versus 50.7 % , P<0.001 ) differed significantly between scenarios , suggesting that incomplete follow-up information led to underestimation of mortality . Degree of follow-up completeness ( i.e. FUI-quartiles and FUI-intervals ) correlated directly with accuracy of study findings : underestimation of long-term mortality increased almost linearly by 30 % with every 0.1 drop in FUI ( adjusted HR 1.30 ; 95%-CI 1.24;1.36 , P<0.001 ) . Conclusion Follow-up completeness is a pre-requisite for reliable outcome assessment and should be declared systematic ally . FUI represents a simple measure suited as reporting st and ard . Evidence lacking such information must be challenged as potentially flawed by selection bias Background Esophageal adenocarcinoma ( EA ) is characterized by a strong male predominance . Sex steroid hormones have been hypothesized to underlie this sex disparity , but no population -based study to date has examined this potential association . Methods Using mass spectrometry and ELISA , we quantitated sex steroid hormones and sex hormone binding globulin , respectively , in plasma from males– 172 EA cases and 185 controls – within the Factors Influencing the Barrett/Adenocarcinoma Relationship ( FINBAR ) Study , a case-control investigation conducted in Northern Irel and and Irel and . Multivariable adjusted logistic regression was used to calculate odds ratios ( ORs ) and 95 % confidence intervals ( CIs ) for associations between circulating hormones and EA . Results Higher and rogen : estrogen ratio metrics were associated with increased odds of EA ( e.g. , testosterone : estradiol ratio ORQ4 v. Q1 = 2.58 , 95%CI = 1.23–5.43 ; Ptrend = 0.009 ) . All estrogens and and rogens were associated with significant decreased odds of EA . When restricted to individuals with minimal to no decrease in body mass index , the size of association for the and rogen : estrogen ratio was not greatly altered . Conclusions This first study of sex steroid hormones and EA provides tentative evidence that and rogen : estrogen balance may be a factor related to EA . Replication of these findings in prospect i ve studies is needed to enhance confidence in the causality of this effect Background Synthesis of multiple r and omized controlled trials ( RCTs ) in a systematic review can summarize the effects of individual outcomes and provide numerical answers about the effectiveness of interventions . Filtering of search es is time consuming , and no single method fulfills the principal requirements of speed with accuracy . Automation of systematic review s is driven by a necessity to expedite the availability of current best evidence for policy and clinical decision-making . We developed Rayyan ( http://rayyan.qcri.org ) , a free web and mobile app , that helps expedite the initial screening of abstract s and titles using a process of semi-automation while incorporating a high level of usability . For the beta testing phase , we used two published Cochrane review s in which included studies had been selected manually . Their search es , with 1030 records and 273 records , were uploaded to Rayyan . Different features of Rayyan were tested using these two review s. We also conducted a survey of Rayyan ’s users and collected feedback through a built-in feature . Results Pilot testing of Rayyan focused on usability , accuracy against manual methods , and the added value of the prediction feature . The “ taster ” review ( 273 records ) allowed a quick overview of Rayyan for early comments on usability . The second review ( 1030 records ) required several iterations to identify the previously identified 11 trials . The “ suggestions ” and “ hints , ” based on the “ prediction model , ” appeared as testing progressed beyond five included studies . Post rollout user experiences and a reflexive response by the developers enabled real-time modifications and improvements . The survey respondents reported 40 % average time savings when using Rayyan compared to others tools , with 34 % of the respondents reporting more than 50 % time savings . In addition , around 75 % of the respondents mentioned that screening and labeling studies as well as collaborating on review s to be the two most important features of Rayyan . As of November 2016 , Rayyan users exceed 2000 from over 60 countries conducting hundreds of review s totaling more than 1.6 M citations . Feedback from users , obtained mostly through the app web site and a recent survey , has highlighted the ease in exploration of search es , the time saved , and simplicity in sharing and comparing include-exclude decisions . The strongest features of the app , identified and reported in user feedback , were its ability to help in screening and collaboration as well as the time savings it affords to users . Conclusions Rayyan is responsive and intuitive in use with significant potential to lighten the load of review ers BACKGROUND Contrasting etiologic hypotheses about the role of endogenous sex steroids in breast cancer development among premenopausal women implicate ovarian and rogen excess and progesterone deficiency , estrogen excess , estrogen and progesterone excess , and both an excess or lack of adrenal and rogens ( dehydroepi and rosterone [ DHEA ] or its sulfate [ DHEAS ] ) as risk factors . We conducted a case-control study nested within the European Prospect i ve Investigation into Cancer and Nutrition cohort to examine associations among premenopausal serum concentrations of sex steroids and subsequent breast cancer risk . METHODS  Levels of DHEAS , ( Delta4- ) and rostenedione , testosterone , and sex hormone binding globulin ( SHBG )  were measured in single prediagnostic serum sample  s from 370 premenopausal women who subsequently developed breast cancer ( case patients ) and from 726 matched cancer-free control subjects .  Levels of progesterone , estrone , and estradiol  were also measured for the 285 case patients and 555 matched control subjects who had provided information about the day of menstrual cycle at blood donation . Conditional logistic regression models were used to estimate relative risks of breast cancer by quartiles of hormone concentrations . All statistical tests were two-sided . RESULTS Increased risks of breast cancer were associated with elevated serum concentrations of testosterone ( odds ratio [ OR ] for highest versus lowest quartile = 1.73 , 95 % confidence interval [ CI ] = 1.16 to 2.57 ; P(trend ) = .01 ) , and rostenedione ( OR for highest versus lowest quartile = 1.56 , 95 % CI = 1.05 to 2.32 ; P(trend ) = .01 ) , and DHEAS ( OR for highest versus lowest quartile = 1.48 , 95 % CI = 1.02 to 2.14 ; P(trend ) = .10 ) but not SHBG . Elevated serum progesterone concentrations were associated with a statistically significant reduction in breast cancer risk ( OR for highest versus lowest quartile = 0.61 , 95 % CI = 0.38 to 0.98 ; P(trend ) = .06 ) . The absolute risk of breast cancer for women younger than 40 followed up for 10 years was estimated at 2.6 % for those in the highest quartile of serum testosterone versus 1.5 % for those in the lowest quartile ; for the highest and lowest quartiles of progesterone , these estimates were 1.7 % and 2.6 % , respectively . Breast cancer risk was not statistically significantly associated with serum levels of the other hormones . CONCLUSIONS Our results support the hypothesis that elevated blood concentrations of and rogens are associated with an increased risk of breast cancer in premenopausal women OBJECTIVE To evaluate the effect of finasteride on serum and rost-4-ene-3,17-dione ( and rostenedione ) and its association with prostate cancer risk among subjects who participated in the Prostate Cancer Prevention Trial . METHODS We analyzed serum and rostenedione levels in 317 prostate cancer cases and 353 controls , nested in the Prostate Cancer Prevention Trial , a r and omized  placebo-controlled trial that found finasteride decreased prostate cancer risk . And rostenedione is the second most important circulating and rogen in men besides testosterone and also a substrate for 5α-reductase enzyme . RESULTS We observed a 22 % increase in and rostenedione levels compared with the baseline values in subjects who were treated with finasteride for 3 years . This significant increase did not vary by 
    Output:
    
Most studies focused on cancer risk prediction , followed by diagnosis , prognosis , and therapy monitoring .
Prostate cancer was the most frequently studied cancer .
Estradiol , dehydroepi and rosterone , and cortisol were mostly reported and altered in at least four types of cancer .
Estrogen and estrogen metabolites were highly reported to associate with women-related cancers .
Pathway enrichment analysis revealed that steroidogenesis ; and rogen and estrogen metabolism ; and and rostenedione metabolism were significantly altered in cancers .
Our findings indicated that estradiol , dehydroepi and rosterone , cortisol , and estrogen metabolites , among others , could be considered oncosteroids .