***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: UNLABELLED Pseudoephedrine is an over-the-counter drug to relieve nasal and sinus congestion . Although it has been suggested that pseudoephedrine could be a stimulant and ergogenic aid , pseudoephedrine was recently removed from the banned substance list by the International Olympic Committee and placed on the monitoring program ( from January 2004 ) . It was felt that evidence was lacking for an ergogenic effect , although few studies have investigated the effects of pseudoephedrine on exercise performance . This study , therefore , aim ed to investigate the effects of pseudoephedrine on 1500-m running performance . METHODS In a double-blind , r and omized crossover design , seven male athletes completed two 1500-m running trials on an outdoor track after having completed a familiarization trial . All trials were 7 d apart . After a 12-h overnight fast , subjects reported to the laboratory and received a st and ardized breakfast ( energy asymptotically equal to 500 kcal 50 % CHO ) . Subjects were given either 2.5 mg.kg(-1 ) bw pseudoephedrine or 2.5 mg.kg(-1 ) bw maltodextrins ( placebo ) in gelatin capsules 70 min before the start of the warm-up , which started 20 min before they ran 1500 m all-out . Pre- and postexercise blood sample s were collected and analyzed for lactate and glucose concentrations , partial pressure of oxygen ( PO2 ) and carbon dioxide ( PCO2 ) , and percent oxygen saturation . RESULTS Pseudoephedrine significantly decreased time to completion of 1500-m time trials in the present study by 2.1 % ( from 279.65 + /- 4.36 s with placebo to 273.86 + /- 4.36 s with pseudoephedrine ) with no reported side effects . No changes in the measured blood parameters were found , suggesting a central effect of pseudoephedrine rather than a metabolic effect . CONCLUSION The finding was that 2.5 mg.kg(-1 ) bw pseudoephedrine ingested 90 min preexercise improves 1500-m running performance The aim of the study was to assess the effect of maximal therapeutic dosing of sympathomimetic amines found in over-the-counter ( OTC ) decongestant preparations on endurance running . Following familiarisation and a grade d exercise test to determine maximal oxygen uptake ( VO2 max ) , trained male runners ( n = 8) completed four exercise sessions each separated by a minimum of one week . Each session was comprised of 20 min of sub-maximal treadmill running ( 70 % VO2 max ) followed by a 5,000-m time trial on the treadmill under drug , placebo or control conditions . Drugs were administered in their commercial format over the 36-hour period prior to testing in the manufacturer 's recommended maximal doses ( i. e. 25 mg of phenylpropanolamine and 60 mg of pseudoephedrine four times daily ) . During sub-maximal endurance running no statistical differences were observed in heart rate , VO2 , minute ventilation , respiratory exchange ratio , blood lactate , glucose or non-esterified fatty acids ( NEFA ) or ratings of perceived exertion with respect to the treatment administered . Similarly there were no statistical differences according to the condition during the 5,000-m running time trial , in terms of heart rate , ratings of perceived exertion , time of completion and pre and post exercise blood lactate , glucose or NEFA . The results indicate that in maximal , multiple therapeutic doses both pseudoephedrine or phenylpropanolamine as present in common OTC decongestant formulations do not affect , nor possess any ergogenic properties with regard to , endurance running OBJECTIVES The purpose of the present study was to examine a possible dose-response between pre-exercise pseudoephedrine intake and cycling time trial performance . DESIGN R and omised , double-blind , crossover trial . METHODS Ten trained male endurance cyclists ( 26.5 ± 6.2 years , 75.1 ± 5.9 kg , 70.6 ± 6.8 mL kg(-1)min(-1 ) ) undertook three cycling time trials in which a fixed amount of work ( 7 kJ kg(-1 ) body mass ) was completed in the shortest possible time . Sixty minutes before the start of exercise , subjects orally ingested either 2.3 mg kg(-1 ) or 2.8 mg kg(-1 ) body mass of pseudoephedrine or a placebo in a r and omised and double-blind manner .  Venous blood was sample d at baseline , pre- and post-warm up and post-exercise for the analysis of pH and lactate and glucose concentrations ; plasma catecholamine and pseudoephedrine concentrations were measured at all times except post-warm up . RESULTS Cycling time trial performance ( ∼ 30 min ) was not enhanced by pseudoephedrine ingestion . Plasma pseudoephedrine concentration increased from pre-warm up to post-exercise in both treatment conditions , with the 2.8 mg kg(-1 ) body mass dose producing the highest concentration at both time points ( 2.8 mg kg(-1)>2.3 mg kg(-1)>placebo ; p<0.001 ) . CONCLUSIONS There was large individual variation in plasma pseudoephedrine concentration between subjects following pseudoephedrine administration . A number of factors clearly influence the uptake and appearance of pseudoephedrine in the blood and these are not yet fully understood . Combined with subsequent differences in plasma pseudoephedrine between individuals , this may partially explain the present findings and also the inconsistencies in performance following pseudoephedrine administration in previous studies The ingestion of a combination of caffeine ( C ) and ephedrine ( E ) has been reported to prolong exercise time to exhaustion during cycle ergometry at 85 % VO2max . The present study was undertaken to investigate whether this enhancement would occur in a field setting and if drug ingestion on 1 d would affect performance 1 d later . Two hours after ingesting either a combination of 375 mg of C and 75 mg E ( C+E ) , or a placebo ( P ) , 9 healthy male recreational runners completed six balanced and double-blind trials of the Canadian Forces Warrior Test ( WT ) , a 3.2 km run wearing " fighting order " which weighed about 11 kg . The trials were performed in sets of two runs , i.e. , two runs were done 24 h apart , and these sets were separated by a minimum of 7 d. The sets were : C+E trial on day 1 ( D1 ) , placebo on day 2 ( P2 ) ; placebo first ( P1 ) , C+E second ( D2 ) ; and placebo first ( P3 ) , placebo second ( P4 ) . In addition , 1 wk before the treatment trials the subjects performed a control trial WT . During the WT , heart rates ( HR ) were recorded every minute . Plasma C and E levels immediately before the WT were similar for both C+E trials , but were undetectable for all P trials . Run times ( mean+/-SD ) were 15.3+/-0.6 , 15.4+/-0.9 , 15.5+/-1.2 , 15.4+/-0.9 , 15.4+/-0.9 , 14.8+/-0.7 , and 14.6+/-0.8 min for control , P1 , P2 , P3 , P4 , D1 , D2 trials , respectively . The two C+E trial run times were similar and both were significantly faster ( p < 0.05 ) than control and all placebo trials . HR during the WT was significantly higher ( p < 0.05 ) for the C+E trials compared with the other trials . WT performance was not impaired by C+E ingestion 24 h earlier . In conclusion , performance of the WT was improved by ingestion of Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Objective To investigate the effect of an acute oral administration of pseudoephedrine ( PSE ) on muscle function , fatigue , and anaerobic power output . Design and Material sHealthy males ( N = 10 ) and females ( N = 10 ) were allocated to receive both a placebo and PSE ( 120 mg ) using a r and omized , double-blind , crossover experimental design . Each subject had their maximal voluntary contraction strength and fatigability measured for both h and grip and ankle dorsi-flexion . Following the strength measurements , a 30-second maximal cycle test was performed to determine lower extremity anaerobic power and fatigue . Plasma lactate was measured before and after exercise . Results There were no significant differences in any of the outcome variables between the placebo and PSE trials . Conclusions These results demonstrated that a 120 mg dose of PSE did not enhance force production , time to fatigue , fatigue index , or power output in young men or women . Therefore , there does not appear to be an ergogenic benefit from the ingestion of 120 mg PSE in high-intensity exercise performance In the GRADE approach , r and omized trials start as high- quality evidence and observational studies as low- quality evidence , but both can be rated down if a body of evidence is associated with a high risk of publication bias . Even when individual studies included in best- evidence summaries have a low risk of bias , publication bias can result in substantial overestimates of effect . Authors should suspect publication bias when available evidence comes from a number of small studies , most of which have been commercially funded . A number of approaches based on examination of the pattern of data are available to help assess publication bias . The most popular of these is the funnel plot ; all , however , have substantial limitations . Publication bias is likely frequent , and caution in the face of early results , particularly with small sample size and number of events , is warranted This study was design ed to measure whether a single dose of 120 mg pseudoephedrine ingested 120 min before exercise influences performance during 1 h of high-intensity exercise . The effects of exercise on urinary excretion of the drug were also studied . Ten healthy male cyclists were tested on two occasions , separated by at least 7 days , by using a r and omly assigned , double-blind , placebo-controlled , crossover design . Exercise performance was tested during a 40-km trial on a laboratory cycle ergometer , and skeletal muscle function was measured during isometric contractions . On a third occasion , subjects ingested 120 mg pseudoephedrine but did not exercise [ control ( C ) ] . Pseudoephedrine did not influence either time trial performance [ drug ( D ) vs. placebo : 58.1 + /- 1.4 ( SE ) vs. 58.7 + /- 1.5 min ] or isometric muscle function . Urinary pseudoephedrine concentrations were significantly increased 1 h after exercise ( D vs. C : 114.3 + /- 27.2 vs. 35.4 + /- 13.1 micrograms/ml ; P < 0.05 ) . Peak plasma pseudoephedrine concentrations ( P < 0.05 ) but not time taken to reach peak plasma concentrations or the area under the plasma pseudoephedrine concentration vs. time curve was significantly increased in the total group with exercise ( D vs. C ) . In three subjects , plasma pseudoephedrine concentrations were not influenced by exercise . Only these subjects showed increased urinary pseudoephedrine excretion during exercise . We conclude that a single therapeutic dose of pseudoephedrine did not have a measurable ergogenic effect during high-intensity exercise of 1-h duration , but plasma drug concentrations and urinary excretion were altered by exercise . These findings have practical relevance to doping control regulations in international sporting competitions Objective To study the effects of over-the-counter dosages of the pure α1–agonists pseudoephedrine ( PSE ) and phenylpropanolamine ( PPA ) on selected parameters of exercise performance , and to establish a range of corresponding drug levels in the urine of the athletes who use these drugs . Design Placebo-controlled , r and omized , double-blinded , multiple-dose trial . Setting The National Institute of Fitness and Sport , the Department of Family Medicine , Indiana University , and the Sports Medicine Lab , Department of Pathology , Indiana University , Indianapolis , Indiana . Participants A convenience sample of 20 male cyclists , aged 18–35 , from the local cycling community . Inclusion criteria required cycling at least 50 miles a week , no chronic medical problems , and not taking any medications . Subjects were recruited by local ads and word of mouth . Intervention Patients were r and omized to one of two groups of 10 subjects . Each subject in both groups performed three separate bicycle ergometer tests after ingestion of varying dosages of α1–agonists . One group performed tests after receiving placebo , 0.33 mg/kg PPA , and 0.66 mg/kg PPA , whereas the other group received placebo , 1 mg/kg PSE , and 2 mg/kg PSE . A minimum 1-week washout period was required between tests . Urine for drug testing was collected 1 h before , immediately afterward , and the next morning after testing . Drug testing was performed by gas GC/MCD at a facility approved by the International Olympic Committee . Main outcome measures Maximum oxygen uptake ( VO2max ) , time to exhaustion , urine drug levels of PSE and PPA , peak blood pressures ( BPs ) , peak pulse , and Borg scale ( rating of perceived exertion or RPE ) . Main Results 
    Output:
    
Results Overall , the review showed that the ergogenic effect of pseudoephedrine  is dose-dependent .
It is evident that there is a correlation between the dose administered and its ergogenic effects , but it is also evident that the side effects of using above the therapeutic dose outweigh the possible benefits of using pseudoephedrine in sport .