***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 
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    Input: A double-blind , r and omized trial was performed with 51 patients suffering from focal ischemic lesions in the territory of the middle cerebral artery .  Intravenous infusions of 10 % glycerol in 0.9 % NaCI - 5 % glucose solutions were administered twice daily for 6 days to 26 patients , and the same amount of NaCI - glucose solutions to 25 controls . Glycerol did not reduce mortality ( 9 deaths in each group ) . The functional recovery was assessed by repeated neurological examinations during the 4 month trial . Glycerol significantly improved global performances and motor and sensory functions in patients with moderate disability , but its effect on global performances was transient . The patients with severe disability were not improved at all Abstract A double-blind evaluation of the effects of glycerol administration intravenously for 4 or 6 days in patients with acute stroke was completed in a stroke centre . Fifty-four patients with acute cerebral infa rct ion and eight patients with spontaneous intracerebral haemorrhage were admitted to the study . The neurological status was evaluated by use of a neurological scoring system . Patients with cerebral infa rct ion treated with glycerol showed significant improvement in neurological status compared to the patients treated with placebo ( The effects of intravenous glycerol and intravenous dextrose were compared using a double-blind trial in twenty-seven patients with acute stroke . Administration continued for up to 6 days . A st and ard scoring system was used for neurological evaluation . There was no difference in mortality or in improvement in neurological score between the two groups The results of clinical trials investigating various therapies in acute ischemic stroke have been inconsistent . The effect of glycerol therapy and a combination therapy of glycerol and dextran was evaluated in a double-blind , placebo-controlled study . Repeated neurologic examinations ( Day 0 , Weeks 1 , 6 , 12 , and 24 ) according to a modified Mathew score were performed on 62 patients . Statistical analysis showed no superiority of either treatment compared with placebo in acute ischemic stroke . A retrospective estimation of the Type II error of the study yielded approximately p = 0.25 . A major side effect was hemolysis in 98 % of patients treated with glycerol 1 . In patients with acute strokes entering a large ongoing r and omised double-blind controlled trial of intravenous glycerol therapy , the extent and pathogenesis of any ensuing haemolysis were evaluated using st and ard clinical investigations and in vitro techniques . 2 . Twenty patients received 10 %  glycerol in saline ( 500 ml over 4 h on 6 consecutive days ) and 15 received  corresponding control treatment with saline . 3 . Intravascular haemolysis was evident after the first infusion ; compared with the controls the glycerol group had i ) a greater mean reduction in serum haptoglobin concentration ( P less than .05 ) , and ii ) a greater proportion exhibiting haemoglobinaemia ( P = 0.03 ) . 4 . After 6 days of glycerol treatment , the mean reduction in haemoglobin concentration was only 0.8 g more than in controls ; this difference being neither clinical ly nor statistically significant . 5 . Glycerol therapy was not associated with haemoglobinuria , renal insufficiency or disseminated intravascular coagulation . 6 . Exposure of red blood cells to 1 - 10 % glycerol in vitro did not induce haemolysis per se ; on re-exposure to lower concentrations lysis ensued provided a minimum osmotic gradient was present . 7 . Whilst taking st and ard dosage regimes of glycerol , the stroke patients we studied manifested a degree of intravascular haemolysis but its consequences were not clinical ly significant ; lysis probably ensued after venous blood acquiring high glycerol concentrations mixed with blood containing little or no glycerol Background and Purpose This clinical trial investigates the effectiveness of intravenous glycerol therapy in patients with acute cortical infa rct ion in whom intracerebral hemorrhage was rigorously excluded . Methods Within 48 hours of symptoms from their first ischemic stroke , 113 hospital in patients were r and omized into the trial , provided that hemorrhage was excluded by computed tomography and informed consent was obtained . Patients were stratified into alert , semicoma , and coma groups using the Glasgow Coma Scale . Treatment was allocated according to a double-blind , r and omized protocol ; 56 patients received 500 mL of 10 % glycerol in saline over 4 hours on 6 consecutive days , and 57 patients received corresponding placebo treatment with saline . Using a variety of objective scoring systems , patient follow-up was up to 6 months . Results Corresponding measures of outcome in the glycerol and placebo groups were similar . At 6 months , respective mortality rates were 17 of 56 and 16 of 57 , and mean ±SD improvements in scores were 9.98±14.40 vs 10.51±12.68 ( long-term ) , 1.12±7.20 vs 1.57±6.30 ( prognostic ) , −1.94±5.53 vs −2.06±5.34 ( Glasgow Coma Scale ) , and 21.72±23.40 vs 11.94± 18.10 ( Barthel Index rating in survivors ) . Hemolysis ( generally sub clinical ) was the only adverse effect . Conclusions There was no clinical ly or statistically significant difference in outcome between the groups ; a trend toward greater functional recovery among survivors was evident after treatment with glycerol A prospect i ve study of 93 acute stroke patients r and omly selected by type of antiedema treatment given ( hypertonic glicerol infusion plus dexamethasone versus dexamethasone alone )  failed to elicit any statistically significant difference between the two treatments on survival rates and quality of survival 7 and 30 days after the stroke Intravenous administration of glycerol has been used in an effort to improve the prognosis for patients with acute cerebral infa rct ion . Fifty patients were treated actively and 56 served as a control group . The neurological status before , during and after treatment for six days was assessed by a score system . The patients were grouped according to the initial score . Those with the highest and lowest scores did not improve from glycerol infusion . However , the treated patients with intermediate scores , where the prognosis is known to be dubious , showed a significant improvement compared to the controls . The mortality was not influenced . No undesirable side-effects from glycerol were registered Background and Purpose Hitherto , treatment of acute cerebral hemorrhage with intravenous glycerol has not been evaluated in rigorous clinical studies with sufficient patient numbers . Methods We undertook a double-blind , stratified and r and omized , placebo-controlled clinical trial . Only patients with a first stroke admitted to the hospital within 24 hours after onset of symptoms were recruited , provided computed tomography confirmed hemorrhage and informed consent was obtained . After stratification into alert , semicoma , and coma subgroups using the Glasgow Coma Scale , 107 patients received active treatment ( 500 ml of 10 % glycerol in saline by intravenous infusion over 4 hours on 6 consecutive days ) and 109 were given corresponding saline treatment .  Using a variety of objective scoring systems , patients were followed up for up to 6 months . Results At follow-up , all measures of outcome in the treated and control groups were very similar . At 6 months , respective mortality rates were 37 of 107 and 33 of 109 . Corresponding mean±SD improvements in Sc and inavian Stroke Study Group scores were 8.35±16.9 versus 11.55±15.6 ( long-term ) and 0.64±7.3 versus 2.40±6.9 ( prognostic ) , and improvements in the Barthel Index ratings were 10.72±24.7 versus 13.95±23.3 , respectively . Glasgow Coma Scale score improvements in the survivors were 0.81±1.5 and 1.16±1.7 in the treated and control groups , respectively . Hemolysis ( generally sub clinical ) was the only adverse effect of glycerol noted . Conclusions In the absence of any clinical ly or statistically significant difference in outcome between the treated and control groups , this trial provides no justification for glycerol therapy following acute cerebral The effects of intravenous glycerol in elderly patients with recent onset of acute ischaemic stroke were evaluated in a double-blind r and omised controlled trial . 173 patients received either 500 ml of a 10 % solution of glycerol in physiological saline or 500 ml of physiological saline  administered intravenously over 4 h daily for 6 consecutive days . The number of deaths within the first week was 10 ( 12 % ) in the glycerol group versus 26 ( 30 % ) in the controls . Subsequent mortality up to 12 months was similar in the two groups and a survival analysis confirmed a beneficial effect of treatment ( p less than 0.02 ) . The neurological and functional recovery of survivors , their length of hospital stay , and the proportion able to return to live in their own home were similar in the two groups . The improvement in survival time with glycerol was achieved without serious adverse effects and without an increase in the proportion of survivors with severe residual disability 10 percent glycerol was given for 6 days to 30 patients who had had acute ischaemic cerebral infa rct ion , and the results were compared with those obtained after treating 31 similar patients with  dexamethasone  ( 16 mg . per 24 hours for 6 days ) . 1 patient treated with glycerol  died of haemoglobinuria and acute renal failure . 6 patients treated with dexamethasone  died--3 from cerebral oedema and 3 from non-neurological complications ( pulmonary embolism , myocardial infa rct ion , and aspiration pneumonia ) . Improvement was significantly greater in the glycerol group after 8 and 15 days . No improvement was noted using either glycerol or dexamethasone in 7 patients with spontaneous intracerebral haemorrhage Long-term beta blockade for perhaps a year or so following discharge after an MI is now of proven value , and for many such patients mortality reductions of about 25 % can be achieved . No important differences are clearly apparent among the benefits of different beta blockers , although some are more convenient than others ( or have slightly fewer side effects ) , and it appears that those with appreciable intrinsic sympathomimetic activity may confer less benefit . If monitored , the side effects of long-term therapy are not a major problem , as when they occur they are easily reversible by changing the beta blocker or by discontinuation of treatment . By contrast , although very early IV short-term beta blockade can definitely limit infa rct size , more reliable information about the effects of such treatment on mortality will not be available until a large trial ( ISIS ) reports later this year , with data on some thous and s of patients entered within less than 4 hours of the onset of pain . Our aim has been not only to review the 65-odd r and omized beta blocker trials but also to demonstrate that when many r and omized trials have all applied one general approach to treatment , it is often not appropriate to base inference on individual trial results . Although there will usually be important differences from one trial to another ( in eligibility , treatment , end-point assessment , and so on ) , physicians who wish to decide whether to adopt a particular treatment policy should try to make their decision in the light of an overview of all these related r and omized trials and not just a few particular trial results . Although most trials are too small to be individually reliable , this defect of size may be rectified by an overview of many trials , as long as appropriate statistical methods are used . Fortunately , robust statistical methods exist -- based on direct , unweighted summation of one O-E value from each trial -- that are simple for physicians to use and underst and yet provide full statistical sensitivity . These methods allow combination of information from different trials while avoiding the unjustified direct comparison of patients in one trial with patients in another . ( Moreover , they can be extended of such data that there is no real need for the introduction of any more complex statistical methods that might be more difficult for physicians to trust . ) Their robustness , sensitivity , and avoidance of unnecessary complexity make these particular methods an important tool in trial overviews In a prospect i ve , community-based study of 675 consecutive patients with a first-ever stroke , of whom over 90 % had computed tomography ( CT ) and /or necropsy examinations , 129 deaths occurred within 30 days of the onset of symptoms , a case fatality rate ( CFR ) of 19 % . The 30 day CFR for patients with cerebral infa rct ion was 10 % ( 57 of 545 , for primary intracerebral haemorrhage 52 % ( 34 of 66 ) , for subarachnoid haemorrhage 45 % ( 15 of 33 ) and for those of uncertain pathological type 74 % ( 23 of 31 ) . The CFR for patients who had been functionally dependent pre-stroke was 33 % compared with 17 % for those who had been independent pre-stroke . The age-adjusted relative risk of death for patients who had been functionally dependent pre-stroke was not significantly greater ( 1.8 , 95 % confidence interval 0 to 4.3 ) . There was a significant trend for CFR to increase with age ( Chi square for trend = 4.0 , p less than 0.05 ) . This relationship was found in those patients who had been function 
    Output:
    
The lack of evidence of benefit in long term survival does not support the routine or selective use of glycerol treatment in patients with acute stroke