***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 AND PURPOSE The purpose of this study was to prospect ively evaluate a protocol with hypertonic saline hydroxyethyl starch ( HS-HES ) and mannitol in stroke patients with increased intracranial pressure ( ICP ) .  METHODS We studied 30 episodes of ICP crisis in 9 patients . ICP crisis was defined as ( 1 ) a rise of ICP of more than 25 mm Hg ( n = 22 ) , or ( 2 ) pupillary abnormality ( n=3 ) , or ( 3 ) a combination of both ( n=5 ) . Baseline treatment was performed according to a st and ardized protocol . For initial treatment , the patients were r and omly assigned to either infusion of 100 mL HS-HES or 40 g mannitol over 15 minutes . For repeated treatments the 2 substances were alternated . ICP , blood pressure , and cerebral perfusion pressure ( CPP ) were monitored over 4 hours . Blood gases , hematocrit , blood osmolarity , and sodium were measured before and 15 and 60 minutes after the start of infusion . Treatment was regarded as effective if ICP decreased > 10 % below baseline value or if the pupillary reaction had normalized . RESULTS Treatment was effective in all 16 HS-HES-treated and in 10 of 14 mannitol-treated episodes . ICP decreased from baseline values in both groups , P < 0.01 . The maximum ICP decrease was 11.4 mm Hg ( after 25 minutes ) in the HS-HES-treated group and 6.4 mm Hg ( after 45 minutes ) in the mannitol-treated group . There was no constant effect on CPP in the HS-HES-treated group , whereas CPP rose significantly in the mannitol-treated group . Blood osmolarity rose by 6.2 mmol/L in the mannitol-treated group and by 10.5 mmol/L in the HS-HES-treated group ; sodium fell by 3.2 mmol/L in the mannitol and rose by 4.1 mmol/L in the HS-HES-treated group . CONCLUSIONS Infusion of 40 g mannitol and 100 mL HS-HES decreases increased ICP after stroke . The maximum effect occurs after the end of infusion and is visible over 4 hours . HS-HES seems to lower ICP more effectively but does not increase CPP as much as does mannitol In a prospect i ve study , we r and omly allocated 70 patients with acute ischemic stroke to two therapy groups . Up to interim analysis , 33 patients underwent bloodletting , with simultaneous infusion of an identical volume of hydroxyethyl starch ( 10 % , 200/0.5 ) . The target hematocrit was 35 % . A control group of 37 patients did not receive hemodilution . Apart from an unequal sex distribution , the two groups were comparable with regard to age , cardiovascular risk factors , and medical history . In the hemodilution group , the mean hematocrit fell from 44.4 % to 37.7 % . After 14 days , improvement on the neurological score scale was 3.3 points in the hemodilution group compared with 6.5 points in the control group ( p = 0.12 ) . Subgroups with early inclusion ( less than 12 hours ) or pronounced lowering of hematocrit ( greater than 15 % of initial hematocrit ) also did not profit from hemodilution . Clinical deterioration observed in eight hemodilution group patients ( p less than 0.01 ) led to discontinuation of the study for ethical reasons BACKGROUND In animal models of ischaemic stroke , 25 % albumin reduced brain infa rct ion and improved neurobehavioural outcome . In a pilot clinical trial , albumin doses as high as 2 g/kg were safely tolerated . We aim ed to assess whether albumin given within 5 h of the onset of acute ischaemic stroke increased the proportion of patients with a favourable outcome . METHODS We did a r and omised , double-blind , parallel-group , phase 3 , placebo-controlled trial between Feb 27 , 2009 , and Sept 10 , 2012 , at 69 sites in the USA , 13 sites in Canada , two sites in Finl and , and five sites in Israel . Patients aged 18 - 83 years with ischaemic ( ie , non-haemorrhagic ) stroke with a baseline National Institutes of Health stroke scale ( NIHSS ) score of 6 or more who could be treated within 5 h of onset were r and omly assigned ( 1:1 ) , via a central web-based r and omisation process with a biased coin minimisation approach , to receive 25 % albumin ( 2 g [ 8 mL ] per kg ; maximum dose 750 mL ) or the equivalent volume of isotonic saline . All study personnel and participants were masked to the identity of the study drug . The primary endpoint was favourable outcome , defined as either a modified Rankin scale score of 0 or 1 , or an NIHSS score of 0 or 1 , or both , at 90 days . Analysis was by intention to treat . Thrombolytic therapies were permitted . This trial is registered with Clinical Trials.gov , number NCT00235495 . FINDINGS 422 participants were r and omly assigned to receive albumin and 419 to receive saline . On Sept 12 , 2012 , the trial was stopped early for futility ( n=841 ) . The primary outcome did not differ between patients in the albumin group and those in the saline group ( 186 [ 44 % ] vs 185 [ 44 % ] ; risk ratio 0·96 , 95 % CI 0·84 - 1·10 , adjusted for baseline NIHSS score and thrombolysis stratum ) . Mild-to-moderate pulmonary oedema was more common in patients given albumin than in those given saline ( 54 [ 13 % ] of 412 vs 5 [ 1 % ] of 412 patients ) ; symptomatic intracranial haemorrhage within 24 h was also more common in patients in the albumin group than in the placebo group ( 17 [ 4 % ] of 415 vs 7 [ 2 % ] of 414 patients ) . Although the rate of favourable outcome in patients given albumin remained consistent at 44 - 45 % over the course of the trial , the cumulative rate of favourable outcome in patients given saline rose steadily from 31 % to 44 % . INTERPRETATION Our findings show no clinical benefit of 25 % albumin in patients with ischaemic stroke ; however , they should not discourage further efforts to identify effective strategies to protect the ischaemic brain , especially because of pre clinical literature showing convincing proof-of-principle for the possibility of this outcome . FUNDING National Institute of Neurological Disorders and Stroke , US National Institutes of Health ; and Baxter Healthcare Corporation In a multicenter trial , 183 patients with acute ischemic stroke of less than 48 hours ' duration and hematocrits of 38 - 50 % were r and omized to st and ardized hemodilution treatment ( venesection and dextran 40 administration ) and 190 to a control group .  We have previously reported that there were no beneficial effects of hemodilution in the total patient population . In this report , the case fatality rates and neurologic outcome in survivors ( 3 months ' follow-up ) in subsets of patients have been analyzed . The patients were subgrouped by sex , age , medical history , smoking habits , delay from the onset of symptoms to the start of treatment , hematocrit at entry , venesection volume , neurologic score at entry into the study , blood pressure changes in the acute phase , presence of atrial fibrillation , location of brain lesion by computed tomography , type of diagnostic procedures , and hospital setting . No subset in which hemodilution reduced mortality or improved neurologic outcome could be identified . Case fatality rate was apparently higher in hemodiluted patients with infa rct ion affecting deep brain structures than in control patients with such lesions . By simple clinical criteria , we have been unable to define subsets of stroke patients who benefit from the present st and ardized regimen of moderate hemodilution . The sample sizes are , however , too small to refute the possibility that a modest clinical effect of hemodilution may be present in some patients with stroke BACKGROUND AND PURPOSE Experimental studies suggest a beneficial effect of hemodilution on acute ischemic stroke . This was not proven by previous multicenter trials in the clinical setting . Various reasons have been suggested for the failure of these studies , which we attempted to consider in the Multicenter Austrian Hemodilution Stroke Trial ( MAHST ) . METHODS MAHST is a r and omized , double-blind , placebo-controlled study of hypervolemic hemodilution  ( HHD ) within 6 hours of a clinical ly first ischemic stroke localized in the middle cerebral artery territory . The treatment consisted of 10 % hydroxyethyl starch 200/0.5 ( HES ) and was tested against pure rehydration with Ringer 's lactate over a period of 5 days . Our primary outcome measure was clinical improvement within 7 days as measured by the Grade d Neurologic Scale ( GNS ) . We performed an adaptive interim analysis to reevaluate the study goal after entering half of the projected number of patients ( n = 200 ) . At least 600 patients per group would have been required for significant results , and therefore we decided to terminate the trial . RESULTS Ninety-eight patients received HHD and 102 patients placebo .  The baseline characteristics were comparable between both groups . In the HHD group the absolute reduction of the hematocrit was 2.5 % on day 2 with a maximum of 3.7 % on day 5 , which compares with a reduction in the placebo group of 1 % and 1.9 % , respectively . Intention-to-treat analysis showed no significant difference of the change of the GNS scores between HHD-treated ( median , -8.5 ; 95 % confidence interval , -14.2 to -4.0 ) and placebo-treated patients ( median , -6.0 ; 95 % confidence interval , -11.0 to 0.0 ) on day 7 , and GNS scores remained similar in both treatment groups throughout the trial . At 3 months , slightly more HHD patients showed complete independence on the Barthel Index ( 28 versus 24 ) , and fewer HHD than placebo patients had died ( 13 versus 17 ) , but these differences were not statistically significant . HHD treatment was not associated with any specific adverse event . CONCLUSIONS Mild HHD is safe but failed to demonstrate a significant beneficial effect over the pure rehydration regimen in patients with acute ischemic stroke In a r and om manner , 100 patients with acute cerebral infa rct ion due to thromboembolism were assigned to two groups . The patients in one group received continuous intravenous therapy with dextran 40 for three days ; the others received an equivalent volume of fluid without the dextran 40 . In the treated group , levels of dextran 40  remained greater than 1 % for three to five days after the infusion was stopped . The group treated with dextran 40 showed lower mortality and better quality of survival in terms of the neurological status . The improvement in the treated group was significantly better than in the untreated group ( OBJECTIVE To determine the effect of normovolaemic haemodilution in patients after a cerebrovascular accident . DESIGN Prospect i ve , r and omized clinical trial . SETTING St Lucas Hospital , Amsterdam . METHOD Normovolaemic haemodilution was achieved by means of bloodletting and administration of a 20 % solution of albumin plus crystalline infusion fluids under haemodynamic and rheological monitoring during the acute phase of the cerebral infa rct ion . All patients were subjected to general intensive care and monitoring with a pulmonary artery catheter . This custom-tailored fluid therapy was guided by a pulmonary wedge pressure of 12 mm Hg ( SD 3 ) and a haematocrit ( Ht ) of 0.32 l/l ( SD 0.02 ) . The control group only received individually dosed rehydration with crystalline infusion fluids . Endpoints of the study after 3 months were mortality and dependence/independence concerning everyday functioning . RESULTS The results in the total haemodilution group and the control group did not differ significantly . However , in the subgroup with normal Ht ( < 0.45 l/l ; n = 201 ) there was a significant reduction ( p < 0.05 ) of the mortality after 3 months ( 27 % and 16 % , respectively ) and an increase of independence at home ( 35 % and 48 % , respectively ) due to a reduction of the viscosity by means of haemodilution with albumin ( a specific viscosity effect in the normovolaemic group ) . In the control group with raised Ht ( dehydration ; Ht > or = 0.45 l/l ; n = 50 ) there was a significant decrease ( p < 0.005 ) of the mortality after 3 months ( 27 % and 8 % , respectively ) and an increase of independence at home ( 35 % and 59 % , respectively ) compared with the control group with normal Ht without signs of dehydration ( Ht < 0.045 l/l ; n = 102 ) , due to rehydration exclusively with crystalline infusion fluids ( a specific rehydration effect in the dehydrated group ) . CONCLUSION In cerebrovascular accident patients haemodilution should be adjusted individually ; in normovolaemic patients ha 
    Output:
    
The overall results of this review showed no clear evidence of benefit of haemodilution therapy for acute ischaemic stroke .
These results are compatible with no persuasive beneficial evidence of haemodilution therapy for acute ischaemic stroke .
This therapy has not been proven to improve survival or functional outcome