***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 purpose of the study was to investigate the efficacy and safety of Cerebrolysin in patients with hemorrhagic stroke . The primary objective of this trial was to assess the clinical efficacy and safety of a 10–days course of therapy with a daily administration of Cerebrolysin ( 50 mL Ⅳ per day ) . The trial had to demonstrate that Cerebrolysin treatment is safe in hemorrhagic stroke . Methods : The study was performed as a prospect i ve , r and omized , double blind , placebo – controlled , parallel group study with 2 treatment groups . Efficacy measures were the Unified Neurological Stroke Scale , Barthel Index , and Syndrome Short Test . The duration of the trial was of 21 days for each patient . Out of 100 r and omized patients , a total of 96 ( 96 % ) completed the study . Results : Overall , no statistically significant group effects were observed based on single average comparisons at the individual visits . It could be shown that the treatment of hemorrhagic stroke with Cerebrolysin  is safe and well tolerated . Conclusion : In the changes of UNSS , BI and SST from baseline to day 21 , the group differences are not statistically significant ; however , the use of Cerebrolysin in hemorrhagic stroke is safe and well tolerated and studies with a larger sample size may provide statistical evidence of Cerebrolysin 's efficacy in patients with hemorrhagic stroke Summary . Background and purpose . Cerebrolysin is a compound with neurotrophic and neuroprotective activity . It is produced by enzymatic breakdown of purified brain proteins and consists of low molecular weight peptides and amino acids . Cellular and animal models of cerebral ischaemia have shown that it is a potent neuroprotective agent . We explored the safety and preliminary outcome of Cerebrolysin treatment in patients with acute stroke . Methods . R and omised , placebo-controlled , parallel group trial . Patients with acute stroke were r and omised within 24 h of stroke onset to IV therapy with placebo or Cerebrolysin 50 mL/day for 21 days . Both groups received concomitant treatment with ASA 250 mg/day PO and pentoxifylline 300 mg/day IV . Clinical examinations were performed on days 1 , 3 , 7 , 21 and 90 post baseline . Outcome measures were the Canadian Neurological Scale , the Barthel Index , the Clinical Global Impressions , the Mini-Mental State Examination , and the Syndrome Short Test . Treatment emergent adverse events , lab tests , and vital signs were recorded to assess the safety of Cerebrolysin . Results . 146 patients were enrolled in two groups : 78 Cerebrolysin and 68 placebo .  At baseline , no significant group differences were observed . Patients in the Cerebrolysin group had no significant improvement in the CNS score , the Barthel Index and the Clinical Global Impressions when compared to the placebo group . A significant improvement of cognitive function of the patients on Cerebrolysin was observed in the Syndrome Short Test when compared to the placebo group . Cerebrolysin was well tolerated and safe . Adverse events occurred with a similar frequency in both groups . Conclusion . The results demonstrate that neurotrophic treatment with Cerebrolysin is safe and well tolerated by patients with acute stroke . The findings , despite the small sample size , also indicate a potential treatment effect of Cerebrolysin in acute stroke . Larger studies , however , are needed to confirm and extend these findings Background and Purpose — The aim of this trial was to investigate whether stroke patients who receive Cerebrolysin  show improved motor function in the upper extremities at day 90 compared with patients who receive a placebo . Methods — This study was a prospect i ve , r and omized , double-blind , placebo-controlled , multicenter , parallel-group study . Patients were treated with Cerebrolysin ( 30 mL/d ) or a placebo ( saline ) once daily for 21 days , beginning at 24 to 72 hours after stroke onset . The patients also participated in a st and ardized rehabilitation program for 21 days that was initiated within 72 hours after stroke onset . The primary end point was the Action Research Arm Test score on day 90 . Results — The nonparametric effect size on the Action Research Arm Test score on day 90 indicated a large superiority of Cerebrolysin compared with the placebo ( Mann – Whitney estimator , 0.71 ; 95 % confidence interval , 0.63–0.79 ; P<0.0001 ) . The multivariate effect size on global status , as assessed using 12 different outcome scales , indicated a small-to-medium superiority of Cerebrolysin ( Mann – Whitney estimator , 0.62 ; 95 % confidence interval , 0.58–0.65 ; P<0.0001 ) . The rate of premature discontinuation was < 5 % ( 3.8 % ) . Cerebrolysin was safe and well tolerated . Conclusions — Cerebrolysin had a beneficial effect on function and global outcome in early rehabilitation patients after stroke . Its safety was comparable with that of the placebo , suggesting a favorable benefit/risk ratio . Because this study was exploratory and had a relatively small sample size , the results should be confirmed in a large-scale , r and omized clinical trial . Clinical Trial Registration — URL : http://www . clinical trialsregister.eu . Unique identifier : 2007 - 000870 - 21 Background The neurotrophic drug Cerebrolysin accelerated recovery and prevented acute neuronal damage in pre clinical models of ischaemia . Previous clinical trials support therapeutic effects in stroke patients . The study investigated whether the combination with alteplase and Cerebrolysin is safe and can further reduce disability after acute ischaemic stroke . Methods This placebo-controlled , double-blind trial involved 119 patients with acute ischaemic hemispheric stroke , r and omly assigned to a combined treatment with alteplase plus Cerebrolysin or placebo ( administered 1 h after thrombolytic treatment ) starting within three-hours after onset of symptoms . A daily i.v . infusion of 30 ml Cerebrolysin or placebo was given for 10 consecutive days . Primary outcome was the modified Rankin Scale at day 90 . A sequential design with interim analyses was applied . Results The third interim analysis did not show a benefit in the modified Rankin Scale for Cerebrolysin on day 90 compared to placebo and the study was stopped . The National Institutes of Health Stroke Scale responder analysis ( secondary outcome measure ) showed significantly more patients with an improvement of 6 or more points ( or a total score of 0 or 1 ) after two- , five- , 10 , and 30 days in the Cerebrolysin group . Similar trends were observed for the modified Rankin Scale responder analysis without achieving statistical significance . There was no difference between treatment groups regarding adverse events . Conclusions The combination of Cerebrolysin with recombinant tissue-Plasminogen Activator is safe for treatment of acute ischaemic stroke but did not improve outcome at day 90 . During the treatment period with Cerebrolysin ( 10 days ) , significantly more patients had a favourable response in neurological outcome measures ( National Institutes of Health Stroke Scale ) as compared to the placebo group Background Cerebrolysin , a brain-derived neuropeptide , has been shown to improve the neurological outcomes of stroke , but no study has demonstrated its effect on cerebral blood flow . This study aim ed to determine the cerebrolysin impact on the neurological outcomes and cerebral blood flow . Methods In a r and omized , double-blinded , placebo-controlled trial , 46 patients who had acute focal ischemic stroke were r and omly assigned into two groups to receive intravenously either 30 mL of cerebrolysin diluted in normal saline daily for 10 days ( n=23 ) or normal saline alone ( n=23 ) adjunct to 100 mg of aspirin daily . All patients were examined using the National Institutes of Health Stroke Scale and transcranial Doppler to measure the mean flow velocity and pulsatility index ( PI ) of their cerebral arteries at baseline as well as on days 30 , 60 , and 90 . Results The patients ’ mean age was 60±9.7 years , and 51.2 % of patients were male . The National Institutes of Health Stroke Scale was significantly lower in the cerebrolysin group compared with the placebo group on day 60 ( median 10 , interquartile range 9–11 , P=0.008 ) and day 90 ( median 11 , interquartile range 10–13.5 , P=0.001 ) . The median of PI in the right middle cerebral artery was significantly lower in the cerebrolysin group compared with the placebo group on days 30 , 60 , and 90 ( P<0.05 ) . One patient in the cerebrolysin group and two patients in the placebo group died before day 30 ( 4.3 % versus 8.7 % ) . Conclusion Cerebrolysin can be useful to improve the neurological outcomes and the PI of middle cerebral artery in patients with acute focal ischemic stroke Cerebrolysin has exhibited neuroprotective as well as neurotrophic properties in various animal models of cerebral ischaemia and has shown clinical efficacy and good safety in several small controlled clinical studies in ischaemic stroke . Therefore , a large double-blind placebo-controlled r and omized clinical trial was launched in Asia to prove the validity of this treatment strategy . In the more than 50 participating centres patients with acute ischemic hemispheric stroke are r and omized within 12 hours of symptoms onset to treatment ( 30 ml Cerebrolysin diluted in physiologic saline ) or placebo ( saline ) given as intravenous infusion once daily added to st and ard care for 10 days . The patients are followed with regular visits for 90 days . Efficacy is evaluated on day 90 by three outcome scales – modified Rankin Scale , Barthel Index and NIH Stroke Scale – combined to single global directional test . Additionally , adverse events are documented to prove safety . In this study a total of 1060 patients will be included and analysis of data will be completed in 2010 . If positive , this trial will add an effective strategy to the treatment of acute ischaemic stroke Background and Purpose Approved use of intravenous alteplase for ischemic stroke offers net benefit . Pooled r and omized controlled trial analysis suggests additional patients could benefit but others be harmed with treatment initiated beyond 4·5 h after stroke onset . We proposed prognostic scoring methods to identify a strategy for patient selection . Methods We selected 500 patients treated by intravenous alteplase and 500 controls from Virtual International Stroke Trials Archive , matching modified Rankin score outcomes to those from pooled r and omized controlled trial 4·5–6 h data . We ranked patients by prognostic score . We chose limits to optimize our sample for a net treatment benefit significant at P = 0·01 by Cochran – Mantel – Haenszel test and by ordinal regression . For validation , we had these applied to the pooled r and omized controlled trial data for 4·5–6 h , testing for net benefit by Cochran – Mantel – Haenszel test , ordinal regression , and also by dichotomized outcomes : modified Rankin score 0–1 , mortality and parenchymal hemorrhage type 2 bleeds . All analyses were adjusted for age and National Institutes of Health Stroke Scale . Results In the training data set , limits of 56–95 on a prognostic score retained 714 patients in whom there was net benefit significant at P = 0·01 . When applied to the 1120 patients in the pooled r and omized controlled trial 4·5–6 h data set , score limits of 56–95 retained 711 patients and gave odds ratio for improved modified Rankin score distribution of 1·13 , 95 % confidence interval 0·87–1·47 , Cochran – Mantel – Haenszel P = 0·89 . More patients achieved modified Rankin score 0–1 ( odds ratio 1·44 , 1·02–2·05 , P = 0·04 ) but mortality and parenchymal hemorrhage type 2 bleeds were increased : odds ratio 1·56 , 1·01–2·40 , P = 0·04 ; odds ratio 15·6 , 3·7–65·8 , P = 0·0002 , respectively . Conclusion Selection of patients between 4·5 and 6 h based on simple clinical measures failed to deliver a population in whom the alteplase effect would be safe and effective Background and Purpose — Cerebrolysin showed neuroprotective and neurotrophic properties in various pre clinical models of ischemia and small clinical trials . The aim of this large double-blind , placebo-controlled r and omized clinical trial was to test its efficacy and safety in patients with acute ischemic stroke . Methods — Patients with acute ischemic hemispheric stroke were r and omized within 12 hours of symptoms onset to active treatment ( 30 mL Cerebrolysin daily ) or placebo ( saline solution ) given as intravenous infusion for 10 days in addition to aspirin ( 100 mg daily ) . The patients were followed up to 90 days . The primary end point was the result of a combined global directional test of modified Rankin Scale , Barthel Index , and National Institutes of Health Stroke Scale . Adverse events were documented to assess safety . Results — A total of 1070 patients were enrolled in this study . Five hundred twenty-nine patients were assigned to Cerebro 
    Output:
    
The findings of this Cochrane Review do not demonstrate clinical benefits of cerebrolysin for treating acute ischaemic stroke .
We found moderate- quality evidence of an increase in non-fatal SAEs with cerebrolysin use but not in total SAEs