***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: Quality of life may be considerably reduced in patients who are suffering from chronic lower limb venous insufficiency , although existing generic quality of life instruments ( NHP , SF-36 or SIP ) can not completely identify their specific complaints . The Chronic Venous Insufficiency Question naire ( CIVIQ ) has been developed by iterative process . First , a pilot group of 20 patients was used to identify a number of important features of quality of life affected by venous insufficiency , other than physical symptoms of discomfort . A second study involving 2,001 subjects was used to reduce the number of items . Subjects were asked to score both the severity of their problems and the importance they attributed to each problem on a 5-point Likert scale . The importance items found in patients with venous insufficiency were subjected to factorial analyses ( PCA , PAF ) . The final version is a 20-item self-administered question naire which explores four dimensions : psychological , physical and social functioning and pain . Internal consistency of the question naire was vali date d for each dimension ( Cronbach 's alpha > 0.820 for three out of four factors ) . Reproducibility was confirmed in a 60 patient test-retest study . Pearson 's correlation coefficients for both the four dimension subscales and for the global score at 2-week intervals were greater than 0.940 . Finally , the question naire was tested in a r and omized clinical trial of 934 patients in order to assess responsiveness and the convergent validity of the instrument , together with the patient 's own quality of life . This study demonstrated that convergence was valid : Pearson 's correlation coefficients between clinical score differences and quality of life score differences were small ( from 0.199–0.564 ) but were statistically different from 0 ( p<0.001 ) . St and ardized response mean ( SRM ) and effect size ( ES ) were calculated to assess sensitivity to change . SRM and ES both demonstrated considerble responsiveness to change ( > 0.80 ) . Reliability , face , content , construct validity and responsiveness were also determined for this specific quality of life question naire relating to venous insufficiency . Results suggest that this question naire may be used with confidence to assess quality of life in clinical trials on chronic venous insufficiency STUDY OBJECTIVE : To determine the prevalence of varicose veins and chronic venous insufficiency ( CVI ) in the general population . DESIGN : Cross sectional survey . SETTING : City of Edinburgh . PARTICIPANTS : Men and women aged 18 - 64 years selected r and omly from age-sex registers of 12 general practice s. MAIN RESULTS : In 1566 subjects examined , the age adjusted prevalence of trunk varices was 40 % in men and 32 % in women ( p < or = 0.01 ) . This sex difference was mostly a result of higher prevalence of mild trunk varices in men . More than 80 % of all subjects had mild hyphenweb and reticular varices . The age adjusted prevalence of CVI was 9 % in men and 7 % in women ( p < or = 0.05 ) . The prevalence of all categories of varices and of CVI increased with age ( p < or = 0.001 ) . No relation was found with social class . CONCLUSIONS : Approximately one third of men and women aged 18 - 64 years had trunk varices . In contrast with the findings in most previous studies , mainly conducted in the 1960s and 1970s , chronic venous insufficiency and mild varicose veins were more common in men than women . No evidence of bias in the study was found to account for this sex difference . Changes in lifestyle or other factors might be contributing to an alteration in the epidemiology of venous disease AIM Epidemiological data show that st and ard compression therapy for leg ulceration in chronic venous insufficiency ( CVI ) often fails to effectively improve patients ' condition . This study assesses the contribution of Daflon 500 mg added to conventional therapy in the healing of hypostatic ulcers of CVI patients . METHODS Patients of about 65 years were included , with ulcers > or = 2 and > or = 10 cm diameter on 1 or 2 limbs , Doppler ankle/arm pressure index > 0.9 , and no recent history of skin graft . Controls ( n=68 ) remained on compression alone while the tested group ( n=82 ) also received Daflon 500 mg 2 tablets/day during 6 months . Treatment could be stopped as soon as the reference ulcer appeared fully healed . Primary endpoints were the rate of healed ulcers and the time to complete healing assessed by planimetry/photography and clinical examination . Variations of the ulcer surface , appearance of the skin , and clinical symptoms of CVI were the secondary criteria . RESULTS Only 7 % of Daflon 500 mg patients necessitated the full 6 month therapy . Whatever the lesion size , from W8 significantly more healed ulcers were observed under Daflon 500 mg ( p=0.004 ) , and the ulcer surface was more reduced ( p=0.012 ) . For large ulcers , the rate of healing was approximately 2-fold higher with Daflon 500 mg , and the percentage of ulcers healed before W24 was significantly higher ( p=0.008 ) . Heavy leg sensation was significantly improved by Daflon 500 mg from W4 ( p < 0.05 ) . No treatment-related side effects were reported and the acceptability was considered excellent by 85 % of Daflon 500 mg patients . CONCLUSION Six months of Daflon 500 mg in addition to compression significantly improve some clinical symptoms and accelerate the healing process in patients with ulcerous complications of CVI , with a good acceptability AIM The Vein Consult Program is an international , observational , prospect i ve survey aim ing to collect global epidemiological data on chronic venous disorders ( CVD ) based on the CEAP classification , and to identify CVD management worldwide . The survey was organized within the framework of ordinary consultations , with general practitioners ( GPs ) properly trained on the use of the CEAP classification . METHODS Screening for CVD was to be performed by enrolling in the survey  all consecutive out patients > 18 years whatever the reason for consultation , to record patient 's data and classify them according to the CEAP , from the stage C0s to C6 . The program enrolled 6232 GPs 91545 subjects were analysed . Their mean age was 50.6±16.9 years , younger patients being in the Middle East and older ones in Europe , and the proportion of women was higher than that of men . RESULTS The worldwide prevalence of CVD was 83.6 % : 63.9 % of the subjects ranging C1 to C6 , and 19.7 % being C0s subjects . C0s patients were more frequently men whatever the age and the geographical zone . C1-C3 appeared to be more frequent among women whatever the country but the rate of severe stages ( C4-C6 ) did not differ between men and women . GPs consider CVD subjects as patients eligible to specialist referral beginning from C2 but some geographical disparities were observed . CONCLUSION The VCP survey provides reliable results on CVD global epidemiology and shows that CVD affects a significant part of the population s worldwide , underlining the importance of adequate screening for CVD and training of both GPs and specialist physicians The objective of this study was to evaluate the efficacy of Daflon ® 500 mg ( Dios ) * in venous ulcers . A multicenter , double-blind , r and omized , controlled versus placebo ( Plac ) trial was conducted , with stratification according to the size of ulcer ( ≤ 10 cm and > 10 cm ) . The protocol called for a two-month treatment with Dios ( one tablet = 450 mg micronized purified Diosmin ) or a placebo , two tablets/day , in addition to compression therapy . Evaluations were performed every fifteen days , from DO to D60 . The primary endpoint , in accordance with Alex and er House group requirements were : percentage of patients with complete ulcer healing , ie , comparison between Dios and Plac group at D60 , and comparison of survival curves in each group between DO and D60 ( log rank test ) . Secondary endpoints included ulcer surface area assessed by computerized plani metric measurements , qualitative evaluation of ulcers , and symptoms .  The patients were 105 men and women ranging in age from eighteen to eighty-five years , with st and ard compression stocking , who were undergoing st and ardized local care of ulcer and had no significant arterial disease ( ankle/arm systolic pressure index > 0.8 ) . Fifty-three patients received Dios  , and 52 received Plac  . The 2 groups were well matched for age ( m ±1 SD = seventy-one ±eleven years ) , gender , ulcer size , and associated disorders . Among patients with ulcer size ≤ 10 cm ( Dios = 44 , Plac = 47 ) a significantly larger number of patients had a complete ulcer healing at two months in the Dios group ( n = 14 ) in comparison with the Plac group ( n = 6 ) ( 32 % vs 13 % , P = 0.028 ) with a signifi cantly shorter time duration of healing ( P = 0.037 ) . No difference was shown for the secondary criteria , except for sensation of heavy legs ( P = 0.039 ) and a less atonic aspect of ulcer ( P = 0.030 ) in favor of Dios . Among the 14 patients with ulcer size > 10 cm ( Dios = 9 , Plac = 5 ) , subjected to a descriptive analysis only , no ulcer healed . This study showed that a two-month course of Daflon 500 mg at a daily dose of two tablets , in addition to conventional treatment , is of benefit in patients with venous ulcer ≤ 10 cm by accelerating complete healing OBJECTIVE to evaluate the efficacy of a micronised purified flavonoid fraction ( MPFF ) in the treatment of chronic venous disease ( CVD ) . DESIGN prospect i ve double blind , r and omised , control study . PATIENTS AND METHODS one hundred and one patients with symptomatic CVD were r and omly allocated to treatment for 60 days with either MPFF ( 51 patients ) or placebo ( 50 patients ) 500 mg twice daily . There were 28 men and 73 women , aged 22 - 65 years ( mean age 48 years ) . No difference regarding age , gender , clinical class or duration of symptoms was recorded between the treatment and placebo groups . A global score for evaluation of symptoms was used . Patients were investigated with  plethysmography  ( foot-volumetry ) and duplex-ultrasonography before and after the treatment period . For statistical comparison Cochran-Mantel-Haenszel test , two-sided Student t-test and covariance analysis were used and p<0.05 was regarded significant . RESULTS improvement of the global score of symptoms was reported by 21 patients in the MPFF group and by 16 in the placebo group ( N.S. ) . For the whole groups , no significant differences were recorded before and after treatment regarding foot-volumetric or ultrasonographic parameters . On the other h and , in patients with edema ( 20 in the MPFF group , 23 in the placebo group ) ultrasonographic reflux time was significantly reduced for those in the treatment group ( p=0.03 ) . This finding did not correlate to clinical symptoms . CONCLUSION in this study , MPFF did not change the symptoms of CVD , except night cramps . A secondary finding was reduced reflux times in patients with oedema , although no ultrasonographic or foot-volumetric parameters changed significantly for the whole group . The role of MPFF in treatment of patients with CVD needs to be further analysed in a large population Chronic venous insufficiency ( CVI ) of the lower limbs is a complex and fluctuating disease by its pathogenic mechanisms and its clinical symptoms . Although symptoms are subjective , they affect the quality of life and socio-professional activity of many patients . This is why convincing demonstration of therapeutic activity of a venotropic drug should be carried out according to strict methodology . Only r and omized double-blind controlled trials versus placebo ( no reference drugs being available ) could demonstrate the activity on condition that they are set up in a protocol , the statistical design of which , is adapted and defined " a priori " . Inclusion , non inclusion and judgement criteria must be rigorous , taking into account many exogenous and endogenous factors which could have influence on the severity or the change in CVI and on the comparability of groups at the beginning and at the end of the study . Thus , the main risk factors of CVI ( heredity , obesity , obstetrical and gynecological history , estroprogestogen treatment , profession , environment , etc . ) and the season when the patient is recruited should be taken into account . With respect to all these restraints on methodology , the venotrotopic activity of a flavonoid Daflon 500 mg ( 2 tablets daily ) was demonstrated in 200 patients ( 174 women , 26 men ) with organic CVI ( n = 83 ) or functional CVI ( n = 117 ) treated for two months in two double-blind r and omized trials versus placebo . The venotropic activity of Daflon 500 mg , was shown by a significant reduction of CVI signs and symptoms , whether organic or functional , and a significant improvement in venous hemodynamics according to plethysmographic parameters . Good acceptability was observed after medium and long term trials OBJECTIVE To assess the efficacy of a micronized purified flavonoid fraction ( Daflon 500 mg = Dios ) in venous leg ulcer healing , in addition to compression therapy and st and ardized local care . DESIGN Double-blind , multicentre , r and omized , parallel groups , controlled versus placebo trial ; strat 
    Output:
    
Conclusion In summary , the general level of evidence supports the recommendation that the use of medical therapy with Micronized Purified Flavonoid Fraction has beneficial outcomes without serious adverse events .
In the United States , diosmiplex is the only available prescription formulation of Micronized Purified Flavonoid Fraction .