***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: Oxerutins ( O-(beta-hydroxyethyl)rutosides , HR , Venoruton ) and horse chestnut extract ( HCE ) are active principles of first priority for the pharmacological treatment of chronic venous insufficiency ( CVI ) . The efficacies of both compounds were shown in numerous , double-blind , r and omized , placebo controlled clinical trials . Besides the direct comparison of the two compounds the aim of the study was to investigate the initial dose/maintenance dose concept for HR . 137 female , postmenopausal patients with CVI II finished the study according to protocol . Following one week placebo run-in the patients were treated either with 1000 mg/d HR , 600 mg/d HCE or 1000 mg/d for 4 weeks and than with 500 mg/d HR within the initial dose/maintainance dose concept for 12 weeks and observed for further 6 weeks . A main confirmative criterion was the volume reduction of the leg . Subjective criteria were descriptively evaluated . HR ( 1000 mg/d ) was proven to be equivalent or better , reducing the leg volume ( AUB0 - 18 ) by -5273 + /- 11418 ml.d compared to -3187 + /- 10842 ml.d under HR ( 1000 mg/d and 500 mg/d ) , and -3004 + /- 7429 ml.d under HCE-treatment . Both compounds exhibit a substantial carry-over effect . The maintenance posology of HR is able to stabilize the therapeutic obtained under initial dose conditions The aim of this study was to compare the efficacy of Venostasin ( horse chestnut seed extract ) and Pycnogenol ( French maritime pine bark extract ) in the treatment of chronic venous insufficiency ( CVI ) . In an open , controlled comparative study 40 patients with diagnosed CVI were treated either with 600 mg chestnut seed extract per day or 360 mg Pycnogenol per day over a period of 4 weeks . The following parameters were investigated before the start of treatment and after 2 and 4 weeks of treatment : circumference of the lower legs and rating of subjective symptoms ( scores ) of pain , cramps , night-time swelling , feeling of " heaviness " , and reddening of the skin . In addition , blood levels of cholesterol LDL and HDL were determined before and at the end of treatment . Pycnogenol significantly reduced the circumference of the lower limbs and significantly improved subjective symptoms . Furthermore , Pycnogenol significantly decreased cholesterol and LDL values in the blood , whereas HDL remained unaffected . Venostasin only moderately but not significantly , reduced the circumference of the lower limbs and marginally improved symptoms .  Venostasin had no influence on the determined lipid values . Both medications were equally well tolerated . In conclusion , Pycnogenol was found to be more efficacious than Venostasin for the treatment of CVI BACKGROUND Diseases of the venous system are widespread disorders sometimes associated with modern civilisation and are among the major concerns of social and occupational medicine . This study was carried out to compare the efficacy ( oedema reduction ) and safety of compression stockings class II and dried horse chestnut seed extract ( HCSE , 50 mg aescin , twice daily ) . METHODS Equivalence of both therapies was examined in a novel hierarchical statistical design in 240 patients with chronic venous insufficiency . Patients were treated over a period of 12 weeks in a r and omised , partially blinded , placebo-controlled , parallel study design . FINDINGS Lower leg volume of the more severely affected limb decreased on average by 43.8 mL ( n = 95 ) with HCSE and 46.7 mL ( n = 99 ) with compression therapy , while it increased by 9.8 mL with placebo ( n = 46 ) after 12 weeks therapy for the intention-to-treat group ( 95 % CI : HCSE : 21.1 - 66.4 ; compression : 30.4 - 63.0 ; placebo : 40.0 - 20.4 ) . Significant oedema reductions were achieved by HCSE ( p = 0.005 ) and compression ( p = 0.002 ) compared to placebo , and the two therapies were shown to be equivalent ( p = 0.001 ) ; in this design , however , compression could not be proven as st and ard with regard to oedema reduction in the statistical test procedure . Both HCSE and compression therapy were well tolerated and no serious treatment-related events were reported . INTERPRETATION These results indicate that compression stocking therapy and HCSE therapy are alternative therapies for the effective treatment of patients with oedema result ing from chronic venous insufficiency The efficacy of Essaven-capsules in  venous circulatory disorders of the leg was assessed under the conditions of everyday general practice in a double blind trial including 34 out- patients . During the 4 week-treatment Essaven proved to be significantly superior to a placebo of identical appearance as regards the parameter pain in the legs , skin lesions , circumference of the ankle , and diuretic performance . The dosage was 3 X 2 capsules per day In a retrospective survey , 487 research projects approved by the Central Oxford Research Ethics Committee between 1984 and 1987 , were studied for evidence of publication bias . As of May , 1990 , 285 of the studies had been analysed by the investigators , and 52 % of these had been published . Studies with statistically significant results were more likely to be published than those finding no difference between the study groups ( adjusted odds ratio [ OR ] 2.32 ; 95 % confidence interval [ Cl ] 1.25 - 4.28 ) . Studies with significant results were also more likely to lead to a greater number of publications and presentations and to be published in journals with a high citation impact factor . An increased likelihood of publication was also associated with a high rating by the investigator of the importance of the study results , and with increasing sample size . The tendency towards publication bias was greater with observational and laboratory-based experimental studies ( OR = 3.79 ; 95 % Cl = 1.47 - 9.76 ) than with r and omised clinical trials ( OR = 0.84 ; 95 % Cl = 0.34 - 2.09 ) . We have confirmed the presence of publication bias in a cohort of clinical research studies . These findings suggest that conclusions based only on a review of published data should be interpreted cautiously , especially for observational studies . Improved strategies are needed to identify the results of unpublished as well as published studies In a r and omized placebo controlled parallel double blind study on 40 patients suffering from venous edema in chronic deep vein incompetence , the edema-reducing effect of horse chestnut seed extract vs. placebo , being the main test variable , was demonstrated by hydroplethysmography to be statistically significant . In addition , measurements of leg volume under aggravated conditions ( edema provocation ) were conducted , which yielded the same results . Additional measurements of leg circumference tendentially confirm the demonstrated clinical efficacy of verum , as is true for phlebody-namometric measurements ( pressure at rest , minimum pressure , replenishment time ) as well . By measuring the leg volume before and after edema provocation , it could be shown that the clinical benefit for the patient is present in all everyday situations ( in movement as well as on sitting or st and ing ) . Treatment with an edema protective agent of the horse chestnut seed extract type is thus a useful adjunct to compression therapy . The tested preparation were well tolerated BACKGROUND Some r and omised controlled trials ( RCTs ) done in German-speaking Europe are published in international English- language journals and others in national German- language journals . We assessed whether authors are more likely to report trials with statistically significant results in English than in German . METHODS We studied pairs of RCT reports , matched for first author and time of publication , with one report published in German and the other in English . Pairs were identified from reports round in a manual search of five leading German- language journals and from reports published by the same authors in English found on Medline .  Quality of methods and reporting were assessed with two different scales by two investigators who were unaware of authors ' identities , affiliations , and other characteristics of trial reports . Main study endpoints were selected by two investigators who were unaware of trial results . Our main outcome was the number of pairs of studies in which the levels of significance ( shown by p values ) were discordant . FINDINGS 62 eligible pairs of reports were identified but 19 ( 31 % ) were excluded because they were duplicate publications . A further three pairs ( 5 % ) were excluded because no p values were given . The remaining 40 pairs were analysed . Design characteristics and quality features were similar for reports in both language s. Only 35 % of German- language articles , compared with 62 % of English- language articles , reported significant ( p < 0.05 ) differences in the main endpoint between study and control groups ( p = 0.002 by McNemar 's test ) . Logistic regression showed that the only characteristic that predicted publication in an English- language journal was a significant result . The odds ratio for publication of trials with significant results in English was 3.75 ( 95 % CI 1.25 - 11.3 ) . INTERPRETATION Authors were more likely to publish RCTs in an English- language journal if the results were statistically significant . English language bias may , therefore , be introduced in review s and meta-analyses if they include only trials reported in English . The effort of the Cochrane Collaboration to identify as many controlled trials as possible , through the manual search of many medical journals published in different language s will help to reduce such bias An open controlled study was performed over a period of 8 weeks to evaluate the effect of Essaven ultra capsules versus placebo in a total of 60 patients suffering from chronic venous insufficiency . Statistical analysis was performed on 29 patients on the active drug ( one dropout ) and on 25 patients on placebo ( 5 dropouts ) . Apart from patients ' statements circumference measurements taken of 3 leg segments were used to assess the results of the treatment . In the patients on the active drug there were significant reductions of circumference in the three leg segments ( ankle , calf and knee joint ) while , in part of the patients on placebo , leg circumference was significantly increased . In the group on active treatment subjective symptoms were also significantly improved in comparison with the controls . The test drug was very well tolerated To comprehend the results of a r and omised controlled trial ( RCT ) , readers must underst and its design , conduct , analysis , and interpretation . That goal can be achieved only through total transparency from authors . Despite several decades of educational efforts , the reporting of RCTs needs improvement . Investigators and editors developed the original CONSORT ( Consoli date d St and ards of Reporting Trials ) statement to help authors improve reporting by use of a checklist and flow diagram . The revised CONSORT statement presented here incorporates new evidence and addresses some criticisms of the original statement . The checklist items pertain to the content of the Title , Abstract , Introduction , Methods , Results , and Discussion . The revised checklist includes 22 items selected because empirical evidence indicates that not reporting this information is associated with biased estimates of treatment effect , or because the information is essential to judge the reliability or relevance of the findings . We intended the flow diagram to depict the passage of participants through an RCT . The revised flow diagram depicts information from four stages of a trial ( enrollment , intervention allocation , follow- up , and analysis ) . The diagram explicitly shows the number of participants , for each intervention group , included in the primary data analysis . Inclusion of these numbers allows the reader to judge whether the authors have done an intention- to-treat analysis . In sum , the CONSORT statement is intended to improve the reporting of an RCT , enabling readers to underst and a trial 's conduct and to assess the validity of its results 
    Output:
    
MAIN RESULTS Overall , there appeared to be an improvement in CVI related signs and symptoms with HCSE compared with placebo .
The evidence presented suggests that HCSE is an efficacious and safe short-term treatment for CVI .