***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: 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 In order to determine the impact of extremely large doses of methylpredniso-lone , naloxone , or of spinal cord injury itself , on liver enzymes , we examined the results of SGOT , SGPT , alkaline phosphatase and total bilirubin tests obtained 24 hours , 3 and 10 days after the end of the study drug infusions in spinal cord injured patients entered in the National Acute Spinal Cord Injury Study .1 The mean values of four liver enzymes , the amount of change between 24 hours and 3 and 10 days post infusion , and the proportion of liver enzyme levels considered to be abnormal did not appear to be affected by either drug protocol . Even when controlling for drug protocol and severity of injury ( complete vs incomplete ) , variation in enzyme levels appeared to be the result of the spinal cord injury , not study drugs . Spinal cord injury is routinely treated with the NASCIS dose of methylprednisolone in many countries . It is reassuring to find no evidence of compromised liver function from this steroid protocol The 1-year follow-up data of a multicenter r and omized controlled trial of methylprednisolone ( 30 mg/kg bolus and 5.4 mg/kg/hr for 23 hours ) or naloxone ( 5.4 mg/kg bolus and 4.0 mg/kg/hr for 23 hours ) treatment for acute spinal cord injury are reported and compared with placebo results . In patients treated with  methylprednisolone  within 8 hours of injury , increased recovery of neurological function was seen at 6 weeks and at 6 months and continued to be observed 1 year after injury . For motor function , this difference was statistically significant ( p = 0.030 ) , and was found in patients with total sensory and motor loss  in the emergency room ( p = 0.019 ) and in those with some preservation of motor and sensory function ( p = 0.024 ) . Naloxone-treated patients did not show significantly greater recovery . Patients treated after 8 hours of injury recovered less motor function if receiving methylprednisolone ( p = 0.08 ) or naloxone ( p = 0.10 ) as compared with those given placebo .  Complication and mortality rates were similar in either group of treated patients as compared with the placebo group . The authors conclude that treatment with the study dose of methylprednisolone is indicated for acute spinal cord trauma , but only if it can be started within 8 hours of injury A multicenter double-blind r and omized trial was conducted to examine the efficacy of a high dose of methylprednisolone ( 1,000-mg bolus and daily thereafter for ten days ) compared with a st and ard dose ( 100-mg bolus and daily thereafter for ten days ) in 330 patients with acute spinal cord injury . No difference in neurological recovery of motor function or pinprick and light touch sensation was observed between the two treatment groups six weeks and six months after injury . The lack of a treatment effect was independent of the severity of the initial lesion or the time from injury to starting treatment . Although not statistically significant , early case fatality was greater in the high-dose protocol ( relative risk of 3.1 and 1.9 , less than or equal to 14 and 15 to 28 days after injury , respectively ) but not from 29 to 210 days after injury . Wound infections of both trauma and operative sites were more prevalent in the high-dose regimen ( relative risk of 3.6 ) OBJECT A r and omized double-blind clinical trial was conducted to compare neurological and functional recovery and morbidity and mortality rates 1 year after acute spinal cord injury in patients who had received a st and ard 24-hour methylprednisolone regimen ( 24MP ) with those in whom an identical MP regimen had been delivered for 48 hours ( 48MP ) or those who had received a 48-hour tirilazad mesylate ( 48TM ) regimen . METHODS Patients for whom treatment was initiated within 3 hours of injury showed equal neurological and functional recovery in all three treatment groups . Patients for whom treatment was delayed more than 3 hours experienced diminished motor function recovery in the 24MP group , but those in the 48MP group showed greater 1-year motor recovery ( recovery scores of 13.7 and 19 , respectively , p=0.053 ) . A greater percentage of patients improving three or more neurological grade s was also observed in the 48MP group ( p=0.073 ) . In general , patients treated with 48TM recovered equally when compared with those who received 24MP treatments . A corresponding recovery in self care and sphincter control was seen but was not statistically significant . Mortality and morbidity rates at 1 year were similar in all groups . CONCLUSIONS For patients in whom MP therapy is initiated within 3 hours of injury , 24-hour maintenance is appropriate . Patients starting therapy 3 to 8 hours after injury should be maintained on the regimen for 48 hours unless there are complicating medical factors Sixty-one individuals admitted for rehabilitation with a diagnosis of complete tetraplegia due to traumatic spinal cord injury underwent prospect i ve examinations for motor and sensory recovery . The amount of motor , light touch and sharp/dull ( pin prick ) sensory recovery was independent of the initial neurologic level of injury between C4 and C8 . In the interval between one month and one year following injury , the American Spinal Injury Association Motor Score increased an average of 8.6 + /- 4.7 . However , the rate of motor recovery rapidly declined in the first six months and then approached plateau . Ninety-seven percent of muscles with Grade 1/5 ( " Trace " ) or 2/5 ( " Poor " ) strength one month after injury recovered to > or = 3/5 ( " Fair " ) strength by the time of first annual follow-up . Muscles with 0/5 strength one month after injury and located one neurological level below the most caudal level having motor function regained > or = 3/5 strength in only 27 percent of cases at one year follow-up and at two levels below in only 1 % of cases We conducted a prospect i ve cohort study to determine whether administration of large doses of the corticosteroid methylprednisolone following spinal cord injury as recommended in the National Acute Spinal Cord Injury Study -2 ( NASCIS-2 ) protocol results in an increased incidence of avascular necrosis ( AVN ) of the femoral or humeral head . All subjects were patients treated by a spinal cord injury physician in an Acute Spinal Cord Injury Unit between 1989 and 1996 where some received the megadose steroids while others did not . Patients younger than 15 years and older than 75 years were excluded , as were those with any hip or shoulder disease , with pelvic fracture , or with a history of predisposition to AVN by hip dislocation , excessive alcohol consumption , previous high dose steroid use , or systemic lupus erythematosus . Screening for AVN of the femoral and humeral heads was performed at a minimum of 6 months following injury , using magnetic resonance imaging ( MRI ) . The films were read by a radiologist blinded to the treatment protocol received by the individual subject . Among the 59 spinal cord injured patients who received steroids ( age 15–64 years ( mean 32 years ) ) , five were female . Among the 32 spinal cord injured subjects who did not receive steroids ( age 16 to 65 years ( mean 34 years ) ) , seven were female . There was no case of AVN found in either group . Using binomial distribution , we conclude that the true incidence of AVN among the methylprednisolone treated group is less than 5 % ( α<0.05 ) and therefore continue to recommend short term ( 24 h ) methylprednisolone therapy The multicenter , double-blind , r and omized second National Acute Spinal Cord Injury Study ( NASCIS 2 ) was conducted to assess the effectiveness of methylprednisolone in improving neurological function  after acute spinal cord injury . At 6 weeks , patients treated within 8 hours of injury with methylprednisolone , given as an initial bolus of 30 mg/kg followed by infusion of 5.4 mg/kg/h over 23 hours , demonstrated significantly greater improvement in motor function and touch sensation than did those receiving either naloxone or placebo . Improvement in pinprick sensation was also greater in the  methylprednisolone group . These differences were maintained at 6 months and 1 year after injury . The recovery of motor and sensory function in methylprednisolone-treated  patients was found to be due primarily to reductions in the severity of the lesion in the spinal cord itself rather than to improvements in the level of injury or root function . A new trial , NASCIS 3 , is evaluating a 48-hour course of methylprednisolone infusion as well as treatment with tirilazad mesylate , an inhibitor of lipid peroxidation without glucocorticoid activity OBJECTIVES To evaluate the effect on neurologic outcome and the safety of nimodipine ( N ) , methylprednisolone ( M ) , or both ( MN ) versus no medical treatment ( P ) in spinal cord injury at the acute phase . STUDY DESIGN Prospect i ve , r and omized clinical trial . PATIENTS One hundred and six patients with a spinal trauma , including 48 with paraplegia and 58 with tetraplegia . METHOD After eligibility , patients were r and omly allocated in one of the following groups : M = methylprednisolone 30 mg.kg-1 over 1 hour , followed by 5.4 mg.kg-1.h-1 for 23 hours , N = nimodipine 0.015 mg.kg-1.h-1 over 2 hours followed by 0.03 mg.kg-1.h-1 for 7 days , MN or P. Neurologic assessment ( ASIA score ) was performed by a senior neurologist before treatment and at the 1-year follow-up . Early spinal decompression and stabilization was performed as soon as possible after injury . RESULTS One hundred patients were reassessed at the 1-year follow-up . Neurologic improvement was seen in each group ( P < 0.0001 ) , however no neurologic benefit from treatment was observed . Infectious complications occurred more often in patients treated with M. Early surgery ( 49 patients ) , within the first 8 hours did not influence the neurologic outcome . The only predictor of the latter was the extent of the spinal injury ( complete or incomplete lesion ) . CONCLUSION Currently , no evidence of the benefit of medical treatment in this indication is existing . Because of the lack of clinical studies proving efficacy of pharmacological treatment in this specific pathology , a systematic use of medications can not be recommended The frequency and degree of gastrointestinal ( GI ) bleeding were examined in 131 patients with spinal cord injuries . All patients were r and omly assigned to either high- or low-dose steroid regimens 
    Output:
    
There is insufficient evidence to support the use of high-dose methylprednisolone within eight hours following an acute closed spinal cord injury as a treatment st and ard or as a guideline for treatment .
Methylprednisolone , prescribed as a bolus intravenous infusion of 30 mg per kilogram of body weight over fifteen minutes within eight hours of closed spinal cord injury , followed 45 minutes later by an infusion of 5.4 mg per kilogram of body weight per hour for 23 hours , is only a treatment option for which there is weak clinical evidence ( Level I- to II-1 ) .
There is insufficient evidence to support extending methylprednisolone infusion beyond 23 hours if chosen as a treatment option