***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: The effect of torasemide and furosemide therapy was compared in 50 patients who had chronic heart failure and symptoms [ NYHA class II-III ] despite long-term therapy with both low-dose furosemide and angiotensin-converting enzyme inhibitors .  In this r and omized 6-month , open-label trial , baseline and follow-up echocardiograms and neurohumoral assays were obtained in 25 group F patients  ( continued same dose of oral furosemide at 20 - 40 mg/day ) and in 25 group T patients  ( received torasemide at 4 - 8 mg/day in place of furosemide ) . At 6 months , parameters were unchanged in group F whereas the group T patients had a lower left ventricular end-diastolic diameter ( p<0.005 ) and left ventricular mass index ( p<0.005 ) with improved Doppler filling parameters , decreased plasma B-type natriuretic concentration ( p<0.001 ) and increased plasma concentrations of active renin ( p<0.005 ) and aldosterone ( p<0.001 ) . The magnitude of these changes appeared dose dependent and it is suggested these favorable effects of switching from furosemide to torasemide may be related to aldosterone receptor blockade Plasma pharmacokinetics of oral furosemide have been shown to be influenced by degree of decompensation in patients with congestive heart failure ( CHF ) . This open-label , sequential comparison trial was conducted to determine whether CHF decompensation also alters the pharmacokinetics and pharmacodynamics of torsemide . Twelve patients with CHF , defined by either hemodynamic parameters or clinical signs and symptoms , were enrolled . On admission for treatment of their CHF , the patients were given 100 mg oral torsemide ( phase A ) . A second dose of oral torsemide 100 mg was administered after hemodynamic parameters and clinical signs and symptoms of decompensated CHF resolved ( phase B ) . Plasma and urine sample s were collected over a 24-hour period for determination of torsemide concentrations and urine sodium . Hemodynamic measurements and physical signs and symptoms also were evaluated . During phase A , patients had significantly greater urine output and fractional sodium excretion compared with phase B. A significant increase in the area under the plasma concentration-time curve ( AUC ) was observed during phase B compared with phase A. However , no significant differences in maximal excretion rate of torsemide were noted between phase A and phase B. Heart failure status slightly affects the plasma pharmacokinetics of torsemide ; however , this does not significantly alter the maximal urinary excretion rate of torsemide The effect of potassium supplements was studied in 28 patients taking long term frusemide ( 40 - 80 mg daily ) .  Plasma potassium fell when supplements were stopped , and rose towards prior values on the potassium/frusemide combination , Diumide K. In a crossover study in 14 of these patients comparing equivalent doses of frusemide , Diumide K ( frusemide 40 mg , potassium 8 mmol ) , bumetanide , and Burinex K ( bumetanide 0.5 mg , potassium 7.7 mmol ) plasma potassium was lower on frusemide than on bumetanide . On Diumide K and Burinex K  plasma potassium rose significantly but did not reach the levels on prior therapy . Small doses of potassium in combined formulations seem to be effective in countering the mild hypokalaemia caused by loop diuretics PURPOSE Because the bioavailability of oral furosemide is erratic and often incomplete , we tested the hypothesis that patients with heart failure who were treated with torsemide , a predictably absorbed diuretic , would have more favorable clinical outcomes than would those treated with furosemide . PATIENTS AND METHODS We conducted an open-label trial of 234 patients with chronic heart failure ( mean [ + /- SD ] age , 64 + /- 11 years ) from an urban public health care system . Patients received oral torsemide ( n = 113 ) or furosemide ( n = 121 ) for 1 year . The primary endpoint was readmission to the hospital for heart failure . Secondary endpoints included readmission for all cardiovascular causes and for all causes , numbers of hospital days , and health-related quality of life . RESULTS Compared with furosemide-treated patients , torsemide-treated patients were less likely to need readmission for heart failure ( 39 [ 32 % ] vs. 19 [ 17 % ] , P < 0.01 ) or for all cardiovascular causes ( 71 [ 59 % ] vs. 50 [ 44 % ] , P = 0.03 ) . There was no difference in the rate of admissions for all causes ( 92 [ 76 % ] vs. 80 [ 71 % ] , P = 0.36 ) . Patients treated with torsemide had significantly fewer hospital days for heart failure ( 106 vs. 296 days , P = 0.02 ) . Improvements in dyspnea and fatigue scores from baseline were greater among patients treated with torsemide , but the differences were statistically significant only for fatigue scores at months 2 , 8 , and 12 . CONCLUSIONS Compared with furosemide-treated patients , torsemide-treated patients were less likely to be readmitted for heart failure and for all cardiovascular causes , and were less fatigued . If our results are confirmed by blinded trials , torsemide may be the preferred loop diuretic for patients with chronic heart failure The ulcer crater disappeared completely in 81 % of the cases after six weeks and in 92 % after 12 weeks of carbenoxolone . The dose used in the trial was 100 mg . thrice daily for the first week and 50 mg . thrice daily for the second and subsequent weeks . Treatment should be continued until the ulcer has been shown radiologically to have healed . After complete healing a maintenance dose should be prescribed to prevent recurrence . Attention is also drawn to the drug 's side-effects , which occurred in 35 % of patients , and of which salt- and -water retention is the most important . The side-effects led to the introduction of a fiveor six-day regime in which carbenoxolone was omitted on one or both days at the week-end in those at risk . Since the introduction of this regime side-effects have been much less marked and less frequent . Carbenoxolone has a specific effect , facilitating the healing of gastric ulcer , and is not merely yet another symptomatic measure Summary The effects of slow-release furosemide and bendroflumethiazide in the ambulatory treatment of mild to moderate congestive heart failure were compared in a controlled multicentre study using a r and omized , double-blind procedure . In the first trial , slow-release furosemide 60 mg daily was compared with 2.5 mg bendroflumethiazide ; in the second trial the daily doses were 30 mg and 2.5 mg , respectively . There were 47 patients in Trial I and 39 in Trial II . The r and omised allocation to the treatment regimen was made after a four-week period on bendroflumethiazide 2.5 mg daily , and treatment was continued for 12 weeks . Clinical and laboratory data were recorded before , during and at the end of the trial . Adverse effects were few and minor in both medication groups , and there were no significant intergroup differences . It was concluded slow-release furosemide 30 mg or 60 mg daily was as effective as bendroflumethiazide 2.5 mg daily for maintenance treatment in mild to moderate congestive heart failure OBJECTIVES We sought to determine whether non-potassium-sparing diuretics ( PSDs ) in the absence of a PSD may result in  progressive heart failure ( HF ) . BACKGROUND Angiotensin-converting enzyme ( ACE ) inhibitors incompletely suppress ACE activity in HF patients . Furthermore , non-PSDs are activators of aldosterone secretion . We reasoned that non-PSDs , in the absence of a PSD , might result in progressive HF . METHODS In the 6,797 patients in the Studies Of Left Ventricular Dysfunction ( SOLVD ) , we compared the risk of hospitalization for , or death from , HF between those taking a PSD  and those who were not , adjusting for known covariates . RESULTS The risk of hospitalization from worsening HF in those taking a PSD relative to those taking only a non-PSD was 0.74 ( 95 % confidence interval [ CI ] 0.55 to 0.99 ; p = 0.047 ) . The relative risk for cardiovascular death was 0.74 ( 95 % CI 0.59 to 0.93 ; p = 0.011 ) , for death from all causes 0.73 ( 95 % CI 0.59 to 0.90 ; p = 0.004 ) , and for hospitalization for , or death from , HF 0.75 ( 95 % CI 0.58 to 0.97 ; p = 0.030 ) . Compared with patients not taking any diuretic , the risk of hospitalization or death due to worsening HF in patients  taking non-PSDs alone was significantly increased ( risk ratio [ RR ] = 1.31 , 95 % CI 1.09 to 1.57 ; p = 0.0004 ) ; this was not observed in patients  taking PSDs with or without a non-PSD ( RR = 0.99 , 95 % CI 0.76 to 1.30 ; p = 0.95 ) . CONCLUSIONS The use of  PSDs in HF patients is associated with a reduced risk of death from , or hospitalization for , progressive HF or all-cause or cardiovascular death , compared with patients taking only a non-PSD Systematic review s have become very popular . A recent estimate suggests that 22 new systematic review s are published daily [ 1 ] . One reason for this interest is that they serve many purpose s. For example , the influential Institute of Medicine has indicated that a systematic review is an essential component when developing clinical practice guidelines within the USA [ 2 ] . Some granting agencies are now advocating for the use of systematic review s as an evidence -based rationale for the conduct of a proposed r and omized trial [ 3 ] . And journals are now dem and ing the use of systematic review s to provide readers with context of the results of a clinical trial [ 4 ] . For systematic review s to be useful , they need to be reported in the highest possible quality thus facilitating their accurate use across a wide spectrum of stakeholders , including patients . Unfortunately , surveys of the published literature indicate that the quality of reporting is not optimal . For example , there is evidence indicating that reporting biases , particularly selective outcome reporting , is prevalent . An early example of differences between outcomes reported in protocol s and the paired completed review was an examination of 47 Cochrane review s in which 43 ( 91 % ) contained a major change , such as the addition or deletion of outcomes  , between the protocol and the full publication [ 5 ] . More recently , in an examination of 485 Cochrane protocol - review pairs , 38 % ( 95 % CI 23 to 54 % ) were found to have discrepant outcomes ( i.e. , added , omitted , or changed the priority ) between the protocol and completed review [ 6 ] . The vast majority of these discrepancies were without attribution with more significant outcomes being up grade d or added . Whether or not , and to what extent , these examples reflect reporting biases is not clear . However , they represent inconsistencies that should be avoided by authors . The gold st and ard for identifying reporting biases is a comparison of the completed review with its paired protocol . Such an examination is difficult with systematic review s as too few of them report working from a protocol , although a growing number of funders are now requiring them . Perhaps , systematic review ers do not report or use protocol s because there has been little guidance on how to report them until recently . To help facilitate the use of reporting systematic review protocol s , the three of us and several colleagues developed Preferred Reporting Items for Systematic Review and Meta- Analysis Protocol s ( PRISMA -P ) [ 7 ] . This is a reporting guideline consisting of a 17-item checklist , to help prospect i ve authors in the preparation and reporting of a scientifically rigorous systematic review protocol . We also prepared a pedagogical explanation and elaboration document to facilitate its use [ 8 ] . Readers appear interested in the guidance . Since its publication a little more than a year ago , it has been downloaded about 45,000 times and cited ( Google scholar ) nearly 100 times . This journal and others have endorsed PRISMA -P. Here , we describe how the journal intends to implement it . All protocol su bmi ssions to the journal should use continuous line numbering in their manuscript . Authors should also include a completed PRISMA -P checklist indicating whether or not the requested item information is reported ( by completing the check mark ) . If the item is checked , authors should then specify the line number ( or range of line numbers ) where this information is described . Manuscripts accepted for publication will have the completed PRIMSA-P checklist ( on su bmi ssion ) included as an Appendix to their publication , which must be referenced within the main text ( Additional file 1 ) . Prospect i ve authors can download a Word version of the PRISMA -P checklist , which includes the two added columns , from the journal ’s website ( URL to be added)or the PRISMA website ( ttp://www . prisma -statement.org/Extensions/ Protocol s.aspx ) . If PRISMA -P was used to help report the protocol , it should be cited or the PRISMA - 
    Output:
    
NMA demonstrated no significant differences between loop diuretics with respect to all-cause mortality , cardiovascular mortality or hypokalaemia .
In contrast , torasemide ranked best in terms of HF hospitalisation , and there was a trend towards benefits with torasemide with regard to occurrence of acute renal failure .
We found no significant superiority of either loop diuretic with respect to mortality and safety endpoints .
However , clinicians may prefer torasemide , as it was associated with fewer HF-related hospitalisations