***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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    ***EXAMPLES*** 
    Input: Objective In 1990 , large-dose steroid administration was advocated in spine-injured patients to lessen neurologic deficits . The authors undertook both prospect i ve and retrospective studies to evaluate the response of such profound pharmacologic intervention . Summary Background Data Of all sources of nonfatal injury , spinal cord trauma remains the most devastating in both cost and impact on the quality of the patient 's life . One study found that routine large-dose steroid administration after injury lessened the extent of neurologic injury . After uncommonly promp‡ and broad lay press publicity , this practice was widely accepted . Biased by knowledge of the known immunosuppressive effects of steroids , the authors suspected that pneumonia was both more frequent and severe in steroid-treated patients . Methods Thirty-two patients with cervical or upper thoracic spinal injuries ( C3–6 , 20 patients ; C6–7 , 6 patients ; and T1–6 6 patients ) were studied at an urban level I trauma center from January 1987 to February 1993 . Complete spinal cord injury was present in 22 of 32 patients ; 14 patients received steroids postinjury . There was no difference in mean age , cord level , age-adjusted injury severity score , or the percent of injury severity score caused by the spinal injury . Results The length of hospital stay was longer in  steroid-treated patients ( S ) than in nonsteroid ( NS ) patients , that is , 44.4 days versus 27.7 days , respectively ( p = 0.065 ) . Seventy-nine per cent of S patients had pneumonia compared with 50 % of NS patients ( p = 0.614 ) . There was no statistical difference in the episodes of pneumonia per patient between the two groups ( p > 0.05 ) . Prospect ively , the authors evaluated sequentially several parameters known to be important in human immune responses to bacterial challenges in nine S and five NS patients . In S patients , both the per cent and density of monocyte class II antigen expression and T-helper/ suppressor cell ratios were lower than in NS patients . However , S patients did have an initially higher , earlier boost in some host defense parameters that rapidly declined , and their subsequent response was both blunted and delayed . These differences became even clearer when stratified according to cord level and incomplete versus complete cord status . Not surprisingly , infected patients , whether S or NS , had lower levels of monocyte antigen expression , CR3 , and helper/ suppressor ratios . Conclusions These data do not permit a judgment to be made whether neurologic status was improved by S administration . It is known that vital immune responses were adversely affected , that pneumonia was somewhat more prevalent , and that hospitalization was prolonged and costs therefore increased by an average of $ 51,504 per admission . Further clinical studies will be needed to determine to what extent these observations offset the putative benefits of large-dose steroids in the treatment of spinal trauma Using data from the Second National Acute Spinal Cord Injury Study ( NASCIS II ) , the authors sought to characterize the role of surgery in the management of traumatic spinal cord injury and to examine the interaction between pharmacological treatment and surgery .  Patients who did not undergo surgery  had more severe spinal cord injuries initially than those who had surgery .  However , no differences in neurological improvement at 1-year follow-up were found between those who underwent surgery and those who did not . The results suggest that either early surgery ( < or = 25 hours after injury ) or late surgery ( > 200 hours ) may be associated with increased neurological recovery , particularly motor function , but these results are equivocal . Surgery was not shown to interact with pharmacological treatments , indicating that the effect of drug treatment in NASCIS II , reported elsewhere , is not influenced by surgery . Other independent variables that best predicted improvement in motor score were age of 25 years or younger , incomplete injury , and lower baseline emergency department neurological scores . This study does not provide clinical ly relevant evidence concerning the efficacy of timing or the value of surgery in treating patients with spinal cord injuries . A r and omized study on the timing and efficacy of spinal cord surgery is needed to obtain valid comparisons of the efficacy of surgical treatments Beginning 30 minutes after compression trauma of the upper lumbar ( L-2 ) spinal cord , cats were treated with either a high-dose regimen of methylprednisolone ( MP ) administered as the sodium salt of the 21-succinate ester ( Solu-Medrol sterile powder ) or the MP vehicle . Animals were r and omly assigned to either treatment group ( 10 cats per group ) , and all personnel were blind as to which animals received vehicle or drug . The intensive 48-hour dosing regimen was design ed to maintain therapeutic tissue levels of MP and consisted of an initial 30 mg/kg intravenous bolus of MP ; 2 and 6 hours later additional 15 mg/kg MP doses were administered by intravenous bolus . Immediately following the bolus given at 6 hours , a continuous MP infusion of 2.5 mg/kg/hr was started . The infusion was stopped abruptly at 48 hours with no dose tapering . Animals in the vehicle group received an equivalent volume of MP vehicle . The total MP dose administered over 48 hours was 165 mg/kg . Animals were evaluated weekly for neurological recovery based upon a 12-point functional scale which assessed general mobility , running , and stair-climbing . Mean recovery scores at 1 month after injury ( + /- st and ard error of the mean ) were : vehicle group ( seven cats ) 3.7 + /- 0.9 , and MP group ( 10 cats ) 8.7 + /- 0.2 ; ( p less than 0.001 ) . Histological evaluation of the spinal cords revealed a strong negative correlation between neurological recovery and size of the spinal cord cavity at 1 month ( r = -0.88 ) . Three of 10 animals in the vehicle group became ill and had to be dropped from the study , whereas all of the 10 MP-treated animals survived in excellent health . The results demonstrate the therapeutic effectiveness and low incidence of side effects associated with an intensive MP dose regimen for treatment of experimental spinal cord injury A study is presented of a prospect i ve analysis of survival rates in 157 patients with spinal cord injury consecutively admitted to the Pellegrin Hospital ( University Hospital , Bordeaux , France ) . There was a 20 % death rate , occurring in the first three months after injury . Three independent predictors of survival in patients with spinal cord injuries ( age , initial conscious level and respiratory assistance ) were found by analysis of the course of the disorder In 1990 , the Second National Acute Spinal Cord Injury Study reported that high-dosage methylprednisolone improves neurologic recovery in spinal-injured humans . The study showed that patients who received the drug within 8 hr after injury improved , whereas those who received the drug later did not . The drug significantly increased recovery even in severely injured patients who were admitted with no motor or sensory function below the lesion , contradicting a long-held dogma that such patients would not recover . Some research ers , however , have question ed the stratification of the patient population , the use of summed neurologic change scores , and the absence of functional assessment s. The stratification by injury severity and treatment time was planned a priori and based on objective criteria . Detailed analyses revealed no differences between groups attributable to stratification or r and omization . While multivariate analyses of the summed neurologic scores were used , the conclusions were corroborated by other analytical approaches that did not rely on summed scores . For example , treatment with methylprednisolone more than doubled the probability that patients would convert from quadriplegia or paraplegia to quadriparesis or paraparesis , analgesia to hypalgesia , and anesthesia to hypesthesia . The treatment also significantly improved neurologic scores in lumbosacral segments , indicating that beneficial effects were not limited to segments close to the lesion site . The treatment did not significantly affect mortality or morbidity . The study strongly suggests that methylprednisolone has significant beneficial effects in human spinal cord injury , that these effects occur only when the drug is given within 8 hr , and that it helps even in patients with severe spinal cord injuries . These conclusions have important implication s for spinal cord injury care and research A multi-center double-blind r and omized clinical trial was conducted by the National Acute Spinal Cord Injury Study Group to examine the efficacy of high-dose methylprednisolone ( 1000-mg bolus and 1000 mg daily thereafter for 10 days ) compared with that of a st and ard dose ( 100-mg bolus and 100 mg daily for 10 days ) . No significant difference was observed in neurological recovery of motor function , pinprick response , or touch sensation 1 year after injury between the two treatment groups , after adjustment for other potentially confounding factors . Analyses that specifically took into account the patients ' total steroid dose and relative weight confirmed the lack of a steroid treatment effect . The case fatality rate was 10.7 % during the 1st year after injury , and this was not associated with the steroid treatment protocol or the patient 's gender . Deaths did occur significantly more frequently among patients who were completely ( 15.3 % ) and partially ( 8.6 % ) plegic than among those who were paretic ( 2.5 % , p = 0.0005 ) , and among patients aged 50 years or older ( 38.6 % , p = 0.0001 ) Steroids are commonly used in the treatment of acute spinal cord injury patients although a review of the literature fails to define a consistent regimen for administration with regard to optimal preparation or dosage or schedule . This study was design ed to evaluate the effect of exogenous steroids on the outcome of experimental spinal cord injury and the effect of experimental spinal cord injury on endogenous cortisol production . Thirty female rhesus monkeys received a 660 gm cm lesion to the T10 spinal cord . They were r and omly placed into one of six groups of five animals each . Two groups were controls used to assess the endogenous cortisol response to spinal cord injury . These animals received no steroids . The other four groups received one of two commonly used steroid preparations . All animals were evaluated serially for neurological status using motor testing and for general physical status . Serial cortisol determinations were obtained for an eight-week post injury period . The steroid groups showed some benefit from treatment when compared to the untreated controls . There were no significant differences in physical condition between treated and control groups . Of special interest was the response of endogenous cortisol production to spinal cord injury . Early cortisol elevation following injury peaked by eight hours and then precipitously dropped to baseline levels before 24 hours following injury THE R AND OMIZED controlled trial ( RCT ) , more than any other methodology , can have a powerful and immediate impact on patient care . Ideally , the report of such an evaluation needs to convey to the reader relevant information concerning the design , conduct , analysis , and generalizability of the trial . This information should provide the reader with the ability to make informed judgments regarding the internal and external validity of the trial . Accurate and complete reporting also benefits editors and review ers in their deliberations regarding su bmi tted manuscripts . For RCTs to ultimately benefit patients , the published report should be of the highest possible st and ard OBJECTIVE Since the results of the Second National Acute Spinal Cord Injury Study were published in 1990 , methylprednisolone has become a mainstay in the treatment of nonpenetrating spinal cord injury . Although potential significant relationships between the prompt administration of high-dose methylprednisolone after blunt spinal cord injury and outcome have recently been addressed , the relationship between the prompt administration of high-dose methylprednisolone after penetrating spinal cord injury and outcome remain unanswered . METHODS To explore this relationship , we performed a retrospective nonr and omized study on a series of 252 patients with penetrating missile injuries to the spine who presented to our institution from March 1980 to July 1993 . One hundred eighty-one patients ( 71 % ) were treated conventionally without adjunctive steroid therapy  before 1990 . Sixteen patients followed up during the 13-year study period received steroid protocol s that were not consistent with the Second National Acute Spinal Cord Injury Study protocol and were excluded from the study . Since 1990 , 55 patients ( 21 % ) were treated with intravenous methylprednisolone according to the Second National Acute Spinal Cord Injury Study protocol . All patients were subsequently transferred for rehabilitative care , and prospect i ve evaluations of their neurological status were performed at admission and discharge . RESULTS The study included 236 men and 16 women ( mean age , 25.6 yr ) . The mean duration of stay for initial hospitalization was 94.6 days , and the mean duration of stay in rehabilitation was 78.6 days . Frankel scores were used to assess outcome ( P < 0.05 ) and were assessed at admission and at the time of definitive discharge from the Spinal Cord Injury Care System . The hypothesis that methylprednisolone therapy significantly improves functional outcomes in patients with gunshot wound injuries to the spine was rejected . Only the total number of days in rehabilitation and the degree of neurological injury at admission contributed significantly to explaining outcome at discharge . CONCLUSION The administration of methylprednisolone did not significantly improve functional outcomes in patients with gunshot wound injuries to the spine or increase the number of complications experienced by patients during their hospitalizations Previous analyses of the National Acute Spinal Cord Injury Study ( NASCIS ) have not distinguished recovery of segmental function at the injury level from recovery of the long spinal tracts . Recovery at the injury level could be of considerable clinical significance , but long-tract recovery is the ultimate therapeutic goal . This analysis demonstrates that the greatest proportion of all neurological recovery and of recovery due to treatment with very high doses of methylpred 
    Output:
    
The evidence they provide supports ` the recommendation that the manoeuvre ( high dose methylpredisolone ) be excluded from consideration as an intervention for the condition ' ( acute spinal cord injury ) .
The weight of evidence lay with those studies demonstrating no definite effect of MPSS on functional outcome .
In cat experiments with higher level cord damage , deaths in the MPSS treated groups were notable .
Conclusion : The evidence produced by this systematic review does not support the use of high dose methylprednisolone in acute spinal cord injury to improve neurological recovery .
A deleterious effect on early mortality and morbidity can not be excluded by this evidence .