human
***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: BACKGROUND Dyslipidemia is common in women with polycystic ovary syndrome ( PCOS ) but its prevalence in different PCOS phenotypes is still largely unknown . METHODS We measured  plasma lipids and lipoproteins  in 35 anovulatory PCOS ( age : 25 + /- 6 years , BMI : 28 + /- 6 kg/m(2 ) ) , 15 ovulatory PCOS ( age : 30 + /- 6 years , BMI : 25 + /- 3 kg/m(2 ) ) and 27 healthy women ( controls ) age- and BMI -matched with ovulatory PCOS . PCOS was diagnosed by the presence of clinical or biologic hyper and rogenism associated with chronic anovulation and /or polycystic ovaries at ultrasound . In women with normal menses chronic anovulation was indicated by low serum progesterone levels ( < 9.54 nmol/l ) during midluteal phase ( days 21 - 24 ) in two consecutive menstrual cycles . RESULTS Total cholesterol , triglycerides and low-density lipoprotein (LDL)-cholesterol levels increased and high-density lipoprotein (HDL)-cholesterol decreased from controls to ovulatory and then to anovulatory PCOS ( all P < 0.05 ) . Levels of lipoprotein(a ) ( Lp(a ) ) and small , dense LDL increased ( P < 0.0001 for both ) and LDL size reduced ( P < 0.005 ) between groups . Insulin resistance ( by HOMA ) showed a positive correlation with triglycerides and small , dense LDL and an inverse correlation with HDL-cholesterol and LDL size ( P < 0.05 for all ) in both PCOS phenotypes . No significant correlations were found with testosterone levels . At multivariate analysis , insulin resistance was independently associated with HDL-cholesterol and small , dense LDL in both PCOS phenotypes and with triglyceride concentrations in ovulatory PCOS only . CONCLUSIONS Women with ovulatory PCOS showed milder forms of atherogenic dyslipidemia than anovulatory PCOS and this seemed to be related to the extent of insulin resistance . Future prospect i ve studies are needed to assess the relative contribution of such alterations on cardiovascular risk We prospect ively estimated the prevalence of the polycystic ovary syndrome ( PCOS ) , as defined by the NIH/NICHHD 1990 endocrine criteria , in a population of 154 Caucasian women of reproductive age reporting spontaneously for blood donation .  Anthropometric data ; the presence of hirsutism , acne , and and rogenic alopecia ; and the menstrual history were recorded by a single investigator . In 145 women , blood sample s were also obtained for measurement of serum and rogen levels .  PCOS was defined by the presence of 1 ) oligomenorrhea , 2 ) clinical and /or biochemical hyper and rogenism , and 3 ) exclusion of hyperprolactinemia , thyroid disorders , and nonclassic 21-hydroxylase deficiency . Hirsutism was defined by a modified Ferriman-Gallwey score of 8 or more , acne was considered as a sign of hyper and rogenism when persistent after the second decade of life , and hyper and rogenemia was defined by an increase in circulating testosterone or dehydroepi and rosterone sulfate or an increase in the free and rogen index above the 95th percentile of the control values derived from the nonhirsute , nonacneic women having regular menses who were not receiving hormonal therapy . PCOS was present in 10(6.5 % ) , hirsutism was present in 11 ( 7.1 % ) , and acne was present in 19 ( 12.3 % ) of the 154 women . Our results demonstrate a 6.5 % prevalence of PCOS , as defined , in a minimally biased population of Caucasian women from Spain . The polycystic ovary syndrome , hirsutism , and acne are common endocrine disorders in women We performed this study to access the changes in glucose tolerance over time in a group of women with polycystic ovary syndrome ( PCOS ) ( n = 71 ) and control women ( n = 23 ) with regular menstrual cycles and baseline normal glucose tolerance . Mean follow-up was between 2 and 3 yr for both groups ( PCOS 2.5 + /- 1.7 yr ; controls 2.9 + /- 2.1 yr ) . Based on World Health Organization glucose tolerance categories , there was no significant difference in the prevalence of glucose intolerance at follow-up in the PCOS group . In the PCOS group , 25 ( 37 % ) had impaired glucose tolerance ( IGT ) and seven ( 10 % ) had type 2 diabetes mellitus at baseline , compared with 30 ( 45 % ) and 10 ( 15 % ) , respectively , at follow-up . There were also no differences within groups ( PCOS or control ) or between groups ( PCOS vs. control ) in the oral glucose tolerance test-derived measure of insulin sensitivity , but in the women with PCOS who converted to either IGT or type 2 diabetes mellitus , there was a significant decrease ( P < 0.0001 ) . At the follow-up visit , the mean glycohemoglobin level was 6.1 + /- 0.9 % in women with PCOS vs. 5.3 + /- 0.7 % in the control women ( P < 0.001 ) . Women with PCOS and baseline IGT had a low conversion risk of 6 % to type 2 diabetes over approximately 3 yr , or 2 % per year . The effect of PCOS , given normal glucose tolerance ( NGT ) at baseline , is more pronounced with 16 % conversion to IGT per year . Our study supports that women with PCOS ( especially with NGT ) should be periodically rescreened for diabetes due to worsening glucose intolerance over time , but this interval may be over several years and not annually BACKGROUND Cross-sectional studies have shown a high frequency of impaired glucose tolerance ( IGT ) and non-insulin dependent diabetes mellitus ( NIDDM ) in women with polycystic ovarian syndrome ( PCOS ) . However , little is known about the change in glucose tolerance that occurs over a period of several years in women with PCOS . METHODS Sixty-seven women with PCOS received a 75 g glucose tolerance test and measurement of lipids at baseline and at follow-up after an average time of 6.2 years . All women followed prospect ively had normal glucose tolerance ( n = 54 ) or IGT ( n = 13 ) at the start of the study . RESULTS Change in glycaemic control from baseline was frequent , with 5/54 ( 9 % ) of normoglycaemic women at baseline developing IGT and a further 4/54 ( 8 % ) moving directly from normoglycaemic to NIDDM . For women with IGT at baseline , 7/13 ( 54 % ) had NIDDM at follow-up . Body mass index ( BMI ) at baseline was an independent significant predictor of adverse change in glycaemic control . CONCLUSIONS Women with PCOS , particularly those with a high BMI , should be review ed regularly with respect to IGT or NIDDM , as the frequency of impaired glycaemic control is high , and that the rate of conversion from normal glucose tolerance to IGT or NIDDM , or from IGT to NIDDM is substantial CONTEXT Polycystic ovary syndrome ( PCOS ) presents in adolescence , and obesity is a common finding . The benefits and risks of alternate approaches to the management of PCOS in obese adolescent women are not clear . OBJECTIVE We investigated the effects of metformin , oral contraceptives ( OCs ) , and /or lifestyle modification in obese adolescent women with PCOS . DESIGN Two small , r and omized , placebo-controlled clinical trials were performed . PATIENTS AND PARTICIPANTS A total of 79 obese adolescent women with PCOS participated . INTERVENTIONS In the single treatment trial , subjects were r and omized to metformin , placebo , a lifestyle modification program , or OC . In the combined treatment trial , all subjects received lifestyle modification and OC and were r and omized to metformin or placebo . MAIN OUTCOME MEASURES Serum concentrations of and rogens and lipids were measured . RESULTS Lifestyle modification alone result ed in a 59 % reduction in free and rogen index with a 122 % increase in SHBG . OC result ed in a significant decrease in total testosterone ( 44 % ) and free and rogen index ( 86 % ) but also result ed in an increase in C-reactive protein ( 39.7 % ) and cholesterol ( 14 % ) . The combination of lifestyle modification , OC , and metformin result ed in a 55 % decrease in total testosterone , as compared to 33 % with combined treatment and placebo , a 4 % reduction in waist circumference , and a significant increase in HDL ( 46 % ) . CONCLUSIONS In these preliminary trials , both lifestyle modification and OCs significantly reduce and rogens and increase SHBG in obese adolescents with PCOS . Metformin , in combination with lifestyle modification and OC , reduces central adiposity , reduces total testosterone , and increases HDL , but does not enhance overall weight reduction BACKGROUND Our aim was to assess the effects of metformin on menstrual frequency , fasting plasma glucose ( FPG ) , insulin resistance assessed as HOMA-index , weight , waist/hip ratio , blood pressure ( BP ) , serum lipids , and testosterone levels in women with polycystic ovary syndrome ( PCOS ) METHODS : In a r and omized , controlled , double-blinded setup , 56 women aged 18 - 45 with PCOS were treated with either metformin 850 mg or placebo twice daily for 6 months . After a wash-out period of 3 months participants received the alternate treatment for 6 months . The changes in the measured parameters were analysed by intention-to-treat and per protocol . RESULTS There were no changes in menstrual frequency . In the intention-to-treat analysis , weight and systolic BP were reduced on metformin treatment ( p=0.009 and 0.047 , respectively ) , while high-density lipoprotein ( HDL ) increased ( p=0.001 ) . On placebo , weight and FPG increased ( p<0.05 ) . Post-hoc subgrouping according to BMI revealed reductions in testosterone ( p=0.013 ) , FPG ( p=0.018 ) , insulin ( p=0.045 ) and HOMA-index ( p=0.022 ) in obese women . Per protocol analysis showed the following differences between the changes on placebo and metformin ( mean ( 5 - 95 % percentiles ) : weight ( -4.2 ( -7.0 , -1.9 ) kg , p<0.001 ) , FPG ( -0.23 ( -0.44 , -0.01 ) mmol/l , p=0.041 ) , insulin ( -4.17 ( -8.10 , -0.23 ) mIU/l , p=0.039 ) and HOMA index ( -1.50 ( -2.53 , -0.47 ) mIU/l*mmol/l , p=0.006 ) . Weight , FPG and HOMA index were lower after metformin than after placebo . CONCLUSIONS Metformin treatment lowered weight and systolic blood pressure and increased HDL in women with PCOS . In post-hoc analysis it increased insulin sensitivity and lowered testosterone in obese women . Non-obese women did not benefit from metformin PURPOSE Polycystic ovary syndrome ( PCOS ) is an extremely prevalent disorder in which elevated blood markers of cardiovascular risk and altered endothelial function have been found . This study was design ed to determine if abnormal carotid intima-media thickness ( IMT ) and brachial flow-mediated dilation ( FMD ) in young women with PCOS may be explained by insulin resistance and elevated adipocytokines . METHODS A prospect i ve study in 50 young women with PCOS ( age : 25.2 + /- 1 years ; body mass index [ BMI ] : 28.7 + /- 0.8 ) and 50 matched ovulatory controls ( age : 25.1 + /- 0.7 years ; BMI : 28.5 + /- 0.5 ) was performed . Carotid IMT , brachial FMD , and blood for fasting glucose , insulin , leptin , adiponectin and resistin  were measured . RESULTS PCOS , IMT was increased ( P < .01 ) , FMD was decreased ( P < .01 ) , fasting insulin was increased ( P < .01 ) , QUICKI ( a marker of insulin resistance ) was decreased ( P < .01 ) , and adiponectin was lower ( P < .05 ) , whereas leptin and resistin were not different compared with matched controls . Whereas BMI or waist/hip ratios did not correlate with IMT or FMD , insulin and QUICKI correlated positively and negatively with IMT ( P < .01 ) . There was a significant negative 
    Output:
    
agent
***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: BACKGROUND Dyslipidemia is common in women with polycystic ovary syndrome ( PCOS ) but its prevalence in different PCOS phenotypes is still largely unknown . METHODS We measured  plasma lipids and lipoproteins  in 35 anovulatory PCOS ( age : 25 + /- 6 years , BMI : 28 + /- 6 kg/m(2 ) ) , 15 ovulatory PCOS ( age : 30 + /- 6 years , BMI : 25 + /- 3 kg/m(2 ) ) and 27 healthy women ( controls ) age- and BMI -matched with ovulatory PCOS . PCOS was diagnosed by the presence of clinical or biologic hyper and rogenism associated with chronic anovulation and /or polycystic ovaries at ultrasound . In women with normal menses chronic anovulation was indicated by low serum progesterone levels ( < 9.54 nmol/l ) during midluteal phase ( days 21 - 24 ) in two consecutive menstrual cycles . RESULTS Total cholesterol , triglycerides and low-density lipoprotein (LDL)-cholesterol levels increased and high-density lipoprotein (HDL)-cholesterol decreased from controls to ovulatory and then to anovulatory PCOS ( all P < 0.05 ) . Levels of lipoprotein(a ) ( Lp(a ) ) and small , dense LDL increased ( P < 0.0001 for both ) and LDL size reduced ( P < 0.005 ) between groups . Insulin resistance ( by HOMA ) showed a positive correlation with triglycerides and small , dense LDL and an inverse correlation with HDL-cholesterol and LDL size ( P < 0.05 for all ) in both PCOS phenotypes . No significant correlations were found with testosterone levels . At multivariate analysis , insulin resistance was independently associated with HDL-cholesterol and small , dense LDL in both PCOS phenotypes and with triglyceride concentrations in ovulatory PCOS only . CONCLUSIONS Women with ovulatory PCOS showed milder forms of atherogenic dyslipidemia than anovulatory PCOS and this seemed to be related to the extent of insulin resistance . Future prospect i ve studies are needed to assess the relative contribution of such alterations on cardiovascular risk We prospect ively estimated the prevalence of the polycystic ovary syndrome ( PCOS ) , as defined by the NIH/NICHHD 1990 endocrine criteria , in a population of 154 Caucasian women of reproductive age reporting spontaneously for blood donation .  Anthropometric data ; the presence of hirsutism , acne , and and rogenic alopecia ; and the menstrual history were recorded by a single investigator . In 145 women , blood sample s were also obtained for measurement of serum and rogen levels .  PCOS was defined by the presence of 1 ) oligomenorrhea , 2 ) clinical and /or biochemical hyper and rogenism , and 3 ) exclusion of hyperprolactinemia , thyroid disorders , and nonclassic 21-hydroxylase deficiency . Hirsutism was defined by a modified Ferriman-Gallwey score of 8 or more , acne was considered as a sign of hyper and rogenism when persistent after the second decade of life , and hyper and rogenemia was defined by an increase in circulating testosterone or dehydroepi and rosterone sulfate or an increase in the free and rogen index above the 95th percentile of the control values derived from the nonhirsute , nonacneic women having regular menses who were not receiving hormonal therapy . PCOS was present in 10(6.5 % ) , hirsutism was present in 11 ( 7.1 % ) , and acne was present in 19 ( 12.3 % ) of the 154 women . Our results demonstrate a 6.5 % prevalence of PCOS , as defined , in a minimally biased population of Caucasian women from Spain . The polycystic ovary syndrome , hirsutism , and acne are common endocrine disorders in women We performed this study to access the changes in glucose tolerance over time in a group of women with polycystic ovary syndrome ( PCOS ) ( n = 71 ) and control women ( n = 23 ) with regular menstrual cycles and baseline normal glucose tolerance . Mean follow-up was between 2 and 3 yr for both groups ( PCOS 2.5 + /- 1.7 yr ; controls 2.9 + /- 2.1 yr ) . Based on World Health Organization glucose tolerance categories , there was no significant difference in the prevalence of glucose intolerance at follow-up in the PCOS group . In the PCOS group , 25 ( 37 % ) had impaired glucose tolerance ( IGT ) and seven ( 10 % ) had type 2 diabetes mellitus at baseline , compared with 30 ( 45 % ) and 10 ( 15 % ) , respectively , at follow-up . There were also no differences within groups ( PCOS or control ) or between groups ( PCOS vs. control ) in the oral glucose tolerance test-derived measure of insulin sensitivity , but in the women with PCOS who converted to either IGT or type 2 diabetes mellitus , there was a significant decrease ( P < 0.0001 ) . At the follow-up visit , the mean glycohemoglobin level was 6.1 + /- 0.9 % in women with PCOS vs. 5.3 + /- 0.7 % in the control women ( P < 0.001 ) . Women with PCOS and baseline IGT had a low conversion risk of 6 % to type 2 diabetes over approximately 3 yr , or 2 % per year . The effect of PCOS , given normal glucose tolerance ( NGT ) at baseline , is more pronounced with 16 % conversion to IGT per year . Our study supports that women with PCOS ( especially with NGT ) should be periodically rescreened for diabetes due to worsening glucose intolerance over time , but this interval may be over several years and not annually BACKGROUND Cross-sectional studies have shown a high frequency of impaired glucose tolerance ( IGT ) and non-insulin dependent diabetes mellitus ( NIDDM ) in women with polycystic ovarian syndrome ( PCOS ) . However , little is known about the change in glucose tolerance that occurs over a period of several years in women with PCOS . METHODS Sixty-seven women with PCOS received a 75 g glucose tolerance test and measurement of lipids at baseline and at follow-up after an average time of 6.2 years . All women followed prospect ively had normal glucose tolerance ( n = 54 ) or IGT ( n = 13 ) at the start of the study . RESULTS Change in glycaemic control from baseline was frequent , with 5/54 ( 9 % ) of normoglycaemic women at baseline developing IGT and a further 4/54 ( 8 % ) moving directly from normoglycaemic to NIDDM . For women with IGT at baseline , 7/13 ( 54 % ) had NIDDM at follow-up . Body mass index ( BMI ) at baseline was an independent significant predictor of adverse change in glycaemic control . CONCLUSIONS Women with PCOS , particularly those with a high BMI , should be review ed regularly with respect to IGT or NIDDM , as the frequency of impaired glycaemic control is high , and that the rate of conversion from normal glucose tolerance to IGT or NIDDM , or from IGT to NIDDM is substantial CONTEXT Polycystic ovary syndrome ( PCOS ) presents in adolescence , and obesity is a common finding . The benefits and risks of alternate approaches to the management of PCOS in obese adolescent women are not clear . OBJECTIVE We investigated the effects of metformin , oral contraceptives ( OCs ) , and /or lifestyle modification in obese adolescent women with PCOS . DESIGN Two small , r and omized , placebo-controlled clinical trials were performed . PATIENTS AND PARTICIPANTS A total of 79 obese adolescent women with PCOS participated . INTERVENTIONS In the single treatment trial , subjects were r and omized to metformin , placebo , a lifestyle modification program , or OC . In the combined treatment trial , all subjects received lifestyle modification and OC and were r and omized to metformin or placebo . MAIN OUTCOME MEASURES Serum concentrations of and rogens and lipids were measured . RESULTS Lifestyle modification alone result ed in a 59 % reduction in free and rogen index with a 122 % increase in SHBG . OC result ed in a significant decrease in total testosterone ( 44 % ) and free and rogen index ( 86 % ) but also result ed in an increase in C-reactive protein ( 39.7 % ) and cholesterol ( 14 % ) . The combination of lifestyle modification , OC , and metformin result ed in a 55 % decrease in total testosterone , as compared to 33 % with combined treatment and placebo , a 4 % reduction in waist circumference , and a significant increase in HDL ( 46 % ) . CONCLUSIONS In these preliminary trials , both lifestyle modification and OCs significantly reduce and rogens and increase SHBG in obese adolescents with PCOS . Metformin , in combination with lifestyle modification and OC , reduces central adiposity , reduces total testosterone , and increases HDL , but does not enhance overall weight reduction BACKGROUND Our aim was to assess the effects of metformin on menstrual frequency , fasting plasma glucose ( FPG ) , insulin resistance assessed as HOMA-index , weight , waist/hip ratio , blood pressure ( BP ) , serum lipids , and testosterone levels in women with polycystic ovary syndrome ( PCOS ) METHODS : In a r and omized , controlled , double-blinded setup , 56 women aged 18 - 45 with PCOS were treated with either metformin 850 mg or placebo twice daily for 6 months . After a wash-out period of 3 months participants received the alternate treatment for 6 months . The changes in the measured parameters were analysed by intention-to-treat and per protocol . RESULTS There were no changes in menstrual frequency . In the intention-to-treat analysis , weight and systolic BP were reduced on metformin treatment ( p=0.009 and 0.047 , respectively ) , while high-density lipoprotein ( HDL ) increased ( p=0.001 ) . On placebo , weight and FPG increased ( p<0.05 ) . Post-hoc subgrouping according to BMI revealed reductions in testosterone ( p=0.013 ) , FPG ( p=0.018 ) , insulin ( p=0.045 ) and HOMA-index ( p=0.022 ) in obese women . Per protocol analysis showed the following differences between the changes on placebo and metformin ( mean ( 5 - 95 % percentiles ) : weight ( -4.2 ( -7.0 , -1.9 ) kg , p<0.001 ) , FPG ( -0.23 ( -0.44 , -0.01 ) mmol/l , p=0.041 ) , insulin ( -4.17 ( -8.10 , -0.23 ) mIU/l , p=0.039 ) and HOMA index ( -1.50 ( -2.53 , -0.47 ) mIU/l*mmol/l , p=0.006 ) . Weight , FPG and HOMA index were lower after metformin than after placebo . CONCLUSIONS Metformin treatment lowered weight and systolic blood pressure and increased HDL in women with PCOS . In post-hoc analysis it increased insulin sensitivity and lowered testosterone in obese women . Non-obese women did not benefit from metformin PURPOSE Polycystic ovary syndrome ( PCOS ) is an extremely prevalent disorder in which elevated blood markers of cardiovascular risk and altered endothelial function have been found . This study was design ed to determine if abnormal carotid intima-media thickness ( IMT ) and brachial flow-mediated dilation ( FMD ) in young women with PCOS may be explained by insulin resistance and elevated adipocytokines . METHODS A prospect i ve study in 50 young women with PCOS ( age : 25.2 + /- 1 years ; body mass index [ BMI ] : 28.7 + /- 0.8 ) and 50 matched ovulatory controls ( age : 25.1 + /- 0.7 years ; BMI : 28.5 + /- 0.5 ) was performed . Carotid IMT , brachial FMD , and blood for fasting glucose , insulin , leptin , adiponectin and resistin  were measured . RESULTS PCOS , IMT was increased ( P < .01 ) , FMD was decreased ( P < .01 ) , fasting insulin was increased ( P < .01 ) , QUICKI ( a marker of insulin resistance ) was decreased ( P < .01 ) , and adiponectin was lower ( P < .05 ) , whereas leptin and resistin were not different compared with matched controls . Whereas BMI or waist/hip ratios did not correlate with IMT or FMD , insulin and QUICKI correlated positively and negatively with IMT ( P < .01 ) . There was a significant negative 
    Output:
    