***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 Hyperglycemia at the time of ischemic stroke is associated with increased mortality and morbidity . Animal studies suggest that infa rct expansion may be responsible . The influence of persisting hyperglycemia after stroke has not previously been examined . We measured the blood glucose profile after acute ischemic stroke and correlated it with infa rct volume changes using T2- and diffusion-weighted MRI . METHODS We recruited 25 subjects within 24 hours of ischemic stroke symptoms .  Continuous glucose monitoring was performed with a glucose monitoring device ( CGMS ) , and 4-hour capillary glucose levels ( BGL ) were measured for 72 hours after admission .  MRI and clinical assessment s were performed at acute ( median , 15 hours ) , subacute ( median , 5 days ) , and outcome ( median , 85 days ) time points . RESULTS Mean CGMS glucose and mean BGL glucose correlated with infa rct volume change between acute and subacute diffusion-weighted MRI ( r > or=0.60 , P<0.01 ) , acute and outcome MRI ( r=0.56 , P=0.01 ) , outcome National Institutes of Health Stroke Scale ( NIHSS ; r > or=0.53 , P<0.02 ) , and outcome modified Rankin Scale ( mRS ; r > or=0.53 , P=0.02 ) . Acute and final infa rct volume change and outcome NIHSS and mRS were significantly higher in patients with mean CGMS or mean BGL glucose > or=7 mmol/L. Multiple regression analysis indicated that both mean CGMS and BGL glucose levels > or=7 mmol/L were independently associated with increased final infa rct volume change . CONCLUSIONS Persistent hyperglycemia on serial glucose monitoring is an independent determinant of infa rct expansion and is associated with worse functional outcome . There is an urgent need to study normalization of blood glucose after stroke Background and Purpose — We aim ed to analyze the frequency of  persistent hyperglycemia ( PH ) , its implication s for outcome , and to document the inpatient management of hyperglycemia . Methods — Post hoc analysis of the GLIAS ( Glycemia in Acute Stroke ) study , a multicenter , prospect i ve , and observational cohort study of 476 acute ischemic stroke patients . Capillary finger-prick glucose was determined on admission and during the first 48 hours . We defined PH was defined as at least 2 values ≥155 mg/dL. Outcome ( modified Rankin Scale ) was evaluated at 3 months . Results —  PH  developed in 117 patients ( 24.7 % ) .  PH was associated with poorer outcome ( modified Rankin Scale score > 2 : 56.2 % vs 28.1 % ; P<0.01 ) and higher mortality ( 26.7 % vs 5.9 % ; P<0.01 ) than those with glycemia < 155 mg/dL. PH ≥155 mg/dL was associated with a 4-fold increase in the odds of poor outcome at 3 months ( odds ratio , 4.7 ; 95 % confidence interval , 2.2–10.2 ) after adjustment for age , gender , hypertension , diabetes , stroke severity , admission glycemia , and infa rct volume . Only 20 % of patients with hyperglycemia ≥155 mg/dL received insulin on admission , with a progressive increase in the use  of insulin  during the following 48 hours . However , 114 ( 39.1 % ) out of 291 patients who received corrective treatment for hyperglycemia still had levels ≥155 mg/dL. Conclusions — PH ≥155 mg/dL is a common observation in acute ischemic stroke patients that is associated with poorer outcome and higher mortality . Almost 40 % of patients maintained levels ≥155 mg/dL despite corrective treatment Objective : To analyze the frequency , clinical characteristics , and predictors of symptomatic intracerebral hemorrhage ( ICH ) after intraarterial ( IA ) thrombolysis with recombinant pro-urokinase ( r-proUK ) in acute ischemic stroke . Method : The authors conducted an exploratory analysis of  symptomatic ICH  from a r and omized , controlled clinical trial of IA thrombolysis with r-proUK for patients with angiographically documented occlusion of the middle cerebral artery within 6 hours from stroke onset . Patients ( n = 180 ) were r and omized in a ratio of 2:1 to either 9 mg IA r-proUK over 120 minutes plus IV fixed-dose heparin or IV fixed-dose heparin alone . As opposed to intention to treat , this analysis was based on “ treatment received ” and includes 110 patients given r-proUK and 64 who did not receive any thrombolytic agent .  The remaining six patients received out-of- protocol urokinase and were excluded from analysis . The authors analyzed central ly adjudicated ICH with associated neurologic deterioration ( increase in NIH Stroke Scale [ NIHSS ] score of ≥4 points ) within 36 hours of treatment initiation . Results : Symptomatic ICH occurred in 12 of 110 patients ( 10.9 % ) treated with r-proUK and in two of 64 ( 3.1 % ) receiving heparin alone . ICH symptoms in r-proUK – treated patients occurred at a mean of 10.2 ± 7.4 hours after the start of treatment . Mortality after symptomatic ICH was 83 % ( 10/12 patients ) . Only blood glucose was significantly associated with symptomatic ICH  in r-proUK – treated patients based on univariate analyses of 24 variables : patients with baseline glucose > 200 mg/dL experienced a 36 % risk of symptomatic ICH compared with 9 % for those with ≤200 mg/dL ( p = 0.022 ; relative risk , 4.2 ; 95 % CI , 1.04 to 11.7 ) . Conclusions : Symptomatic ICH after IA thrombolysis with r-proUK for acute ischemic stroke occurs early after treatment and has high mortality . The risk of symptomatic ICH may be increased in patients with a blood glucose > 200 mg/dL at stroke onset Background and Purpose — Evidence is accumulating regarding the prognostic influence of hyperglycemia in patients with acute ischemic stroke . However , the level associated with poor outcome is unknown . Our objectives were to establish the capillary glucose threshold with the highest predictive accuracy of poor outcome and to evaluate its hypothetical value in influencing functional outcome by adjusting for other well-known prognostic factors in acute stroke . Methods — The authors conducted a multicenter , prospect i ve , and observational cohort study of 476 patients with ischemic stroke within less than 24 hours from stroke onset .  Capillary finger-prick glucose and stroke severity  were determined on admission and 3 times a day during the first 48 hours . Poor outcome ( modified Rankin Scale > 2 ) was evaluated at 3 months . Results — The receiver operating characteristic curves showed the predictive value of maximum capillary glucose at any time within the first 48 hours with an area under the curve of 0.656 ( 95 % CI , 0.592 to 0.720 ; P<0.01 ) and pointed to 155 mg/dL as the optimal cutoff level for poor outcome at 3 months ( 53 % sensitivity ; 73 % specificity ) . This point was associated with a 2.7-fold increase ( 95 % CI , 1.42 to 5.24 ) in the odds of poor outcome after adjustment for age , diabetes , capillary glucose on admission , infa rct volume , and baseline stroke severity and with a 3-fold increase in the risk of death at 3 months ( hazard ratio , 3.80 ; 95 % CI , 1.79 to 8.10 ) . Conclusions — Hyperglycemia ≥155 mg/dL at any time within the first 48 hours from stroke onset , and not only the isolated value of admission glycemia , is associated with poor outcome independently of stroke severity , infa rct volume , diabetes , or age Background : In patients with acute ischaemic stroke , hyperglycaemia has been retrospectively associated with negative outcome . There is an ongoing discussion as to which treatment algorithm , if any , provides the most effective prospect i ve intervention . Here we test the safety and feasibility of an intravenous insulin-only infusion protocol design ed for pragmatic routine clinical use . Methods : 40 ischaemic stroke patients with onset < 24 h ago , admitted to our stroke unit , were r and omized either to the study regimen ( 50 IU insulin in 50 ml 0.9 % saline solution applied intravenously via a perfusor pump ) , with the aim of reaching and maintaining blood glucose levels between 4.44 mmol/l ( 80 mg/dl ) and 6.11 mmol/l ( 110 mg/dl ) , or were treated with insulin subcutaneously if concentrations were above 11.10 mmol/l ( 200 mg/dl ) . Treatment was continued for 5 days . Primary outcome was the number of hypoglycaemic ( < 3.33 mmol/l ; < 60 mg/dl ) and severe hyperglycaemic ( > 16.65 mmol/l ; > 300 mg/dl ) events . Results : Hypoglycaemic events were significantly more common in patients treated intensively ( total n = 25 ; incidence rate ratio , IRR = 5.3 ; 95 % CI = 1.2–22.4 ; p < 0.05 ) . Symptomatic events were rare ( total n = 5 ) . Severe hyperglycaemia was associated with conventional treatment ( IRR = 4.9 ; 95 % CI = 1.5–15.9 ; p < 0.05 ) . Though those treated intensively attained near-normoglycaemic levels quicker and had significantly lower blood glucose levels over the study period ( 6.49 ± 2.19 mmol/l vs. 8.01 ± 3.06 mmol/l ; 95 % CI = –1.78 to –1.28 , p < 0.0005 ) , treatment imposes considerable strain on both patients and caregivers . Conclusions : The intensive intravenous insulin infusion protocol  effectively lowers blood glucose levels with an increased risk of manageable hypoglycaemic events . However , a highly motivated and trained staff seems essential , limiting feasibility outside of specialty care setting BACKGROUND diabetes mellitus not only increases the risk of ischaemic stroke two- to four-fold but also adversely inXuences prognosis . The prevalence of recognised diabetes mellitus in acute stroke patients is between 8 and 20 % , but between 6 and 42 % of patients may have undiagnosed diabetes mellitus before presentation . Post-stroke hyperglycaemia is frequent and of limited diagnostic value and the oral glucose tolerance test assumes that the patient is clinical ly stable and eating normally . There is a need for a simple and reliable method to predict new diabetes mellitus in acute stroke patients . OBJECTIVES to determine the prevalence of unrecognised diabetes mellitus and impaired glucose tolerance on hospital admission and 12 weeks later in acute stroke patients with post-stroke hyperglycaemia > or = 6.1 mmol/l . To measure the accuracy of hyperglycaemia and elevated glycosylated haemoglobin concentration in predicting the presence of unrecognised diabetes mellitus at 12 weeks . DESIGN acute ( < 24 hours ) stroke patients ( cerebral infa rct ion and primary intracerebral haemorrhage ) with admission hyperglycaemia between 6.0 and 17 mmol/l and without a previous history of insulin-treated diabetes mellitus who were r and omised into the Glucose Insulin in Stroke Trial between October 1997 and May 1999 were studied . The Glucose Insulin in Stroke Trial is a r and omised controlled trial investigating the benefits of maintaining euglycaemia in acute stroke patients with mild to moderate hyperglycaemia . At 12 weeks , survivors underwent a 75 g oral glucose tolerance test . The positive predictive value and negative predictive value of admission plasma glucose > or = 6.1 mmol/l and elevated glycosylated haemoglobin concentration in predicting the presence of diabetes mellitus were used to estimate the prevalence of unrecognised diabetes mellitus in a consecutive series of 582 acute stroke admissions . RESULTS 582 consecutive acute stroke patients were assessed for eligibility for the Glucose Insulin Stroke Trial , of whom 83 ( 14 % ) had recognised diabetes mellitus . One hundred and forty-two patients were r and omised and 62 underwent a 3-month oral glucose tolerance test , of whom 26 ( 42 % ) had normal glucose tolerance , 23 ( 37 % ) had impaired glucose tolerance and 13 ( 21 % ) had diabetes mellitus . Admission plasma glucose > or = 6.1 mmol/l and glycosylated haemoglobin > or = 6.2 % predicted the presence of previously unrecognised di 
    Output:
    
The patterns that emerged were persisting normoglycaemia , transient hyperglycaemia , persisting hyperglycaemia and delayed hyperglycaemia .