***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 — Treatment of  intracerebral hematoma ( ICH )  is controversial . An advantage of neurosurgical intervention over conservative treatment of ICH has not been established . Recent reports suggest a favorable effect of stereotactic blood clot removal after liquefaction by means of a plasminogen activator . The SICHPA trial was aim ed at investigating the efficacy of this treatment . Methods — A stereotactically placed catheter was used to instill urokinase to liquefy and drain the ICH in 6-hour intervals over 48 hours . From 1996 to 1999 , 13 centers entered 71 patients into the study . Patients were r and omized into a surgical group ( n=36 ) and a nonsurgical group ( n=35 ) . Admission criteria were the following : age > 45 years , spontaneous supratentorial ICH , Glasgow Eye Motor score ranging from 2 to 10 , ICH volume > 10 cm3 , and treatment within 72 hours . The primary end point was death at 6 months . As secondary end points , ICH volume reduction and overall outcome measured by the modified Rankin scale were chosen . The trial was prematurely stopped as a result of slow patient accrual . Results — Seventy patients were analyzed .  Overall mortality at day 180 after stroke was 57 % ; this included 20 of 36 patients ( 56 % ) in the surgical group and 20 of 34 patients ( 59 % ) in the nonsurgical group . A significant ICH volume reduction was achieved by the intervention ( 10 % to 20 % , P < 0.05 ) . Logistic regression analysis indicated the possibility of efficacy for surgical treatment ( odds ratio , 0.23 ; 95 % confidence interval , 0.05 to 1.20;P = 0.08 ) . The odds ratio of mortality combined with modified Rankin scale score 5 at 180 days was also not statistically significant ( odds ratio , 0.52 ; 95 % confidence interval , 1.2 to 2.3;P = 0.38 ) . Conclusions — Stereotactic aspiration can be performed safely and in a relatively uniform manner ; it leads to a modest reduction of 18 mL of hematoma reduction over 7 days when compared with control , which has a 7-mL reduction , and therefore may improve prognosis The purpose of this study was to judge the clinical value of minimally invasive stereotactic puncture and thrombolysis therapy ( MISPTT ) for acute intracerebral hemorrhage ( ICH ) . A r and omized control clinical trial was undertaken . According to the enrollment criteria , 122 acute ICH cases were analyzed , of which 64 cases received  MISPTT ( MISPTT  group , MG ) and 58 cases received conventional craniotomy ( CC group , CG ) . The Glasgow coma scale ( GCS ) scores , postoperative complications ( PC ) , and rebleeding incidences were compared . Moreover , 1 year postoperation , the long-term outcomes of patients with regard to hematoma volume ( HV ) < 50 mL and HV ≥50 mL were judged , respectively , by the Glasgow outcome scale ( GOS ) , Barthel index ( BI ) , modified Rankin Scale ( mRS ) , and case fatality ( CF ) . MG patients showed obvious amelioration in GCS score compared with that of CG patients . The total incidence of PC in MG decreased compared with that of CG . The incidences of rebleeding in MG and CG were 9.4 and 17.2 % , respectively ( P = 0.243 ) . There were no obvious differences between the CFs of MG and CG ( 17.2 and 25.9 % , respectively , P = 0.199 ) . The GOS , BI , and mRS representing long-term outcome for both HV < 50 mL and HV ≥50 mL in MG were ameliorated significantly greater than that in CG patients ( all P < 0.05 ) . These data suggest that there are advantages with MISPTT not only in trauma and safety , but the MISPTT group had fewer complications and a trend toward improved short-term and long-term outcomes Background Within the spectrum of spontaneous intracerebral haemorrhage there are some patients with large or space occupying haemorrhage who require surgery for neurological deterioration and others with small haematomas who should be managed conservatively . There is equipoise about the management of patients between these two extremes . In particular there is some evidence that patients with lobar haematomas and no intraventricular haemorrhage might benefit from haematoma evacuation . The STICH II study will establish whether a policy of earlier surgical evacuation of the haematoma in selected patients will improve outcome compared to a policy of initial conservative treatment . Methods / Design an international multicentre r and omised parallel group trial . Only patients for whom the treating neurosurgeon is in equipoise about the benefits of  early craniotomy compared to  initial conservative treatment are eligible . All patients must have a CT scan confirming spontaneous lobar intracerebral haemorrhage ( ≤1 cm from the cortex surface of the brain and 10 - 100 ml in volume ) . Any clotting or coagulation problems must be corrected and r and omisation must take place within 48 hours of ictus . With 600 patients , the study will be able to demonstrate a 12 % benefit from surgery ( 2p < 0.05 ) with 80 % power . Stratified r and omisation is undertaken using a central 24 hour r and omisation service accessed by telephone or web . Patients r and omised to early surgery should have the operation within 12 hours . Information about the status ( Glasgow Coma Score and focal signs ) of all patients through the first five days of their trial progress is also collected in addition to another CT scan at about five days ( + /- 2 days ) . Outcome is measured at six months via a postal question naire to the patient . Primary outcome is death or severe disability defined using a prognosis based 8 point Glasgow Outcome Scale . Secondary outcomes include : Mortality , Rankin , Barthel , EuroQol , and Survival . Trial Registration IS RCT N : IS RCT BACKGROUND Spontaneous supratentorial intracerebral haemorrhage accounts for 20 % of all stroke-related sudden neurological deficits , has the highest morbidity and mortality of all stroke , and the role of surgery remains controversial . We undertook a prospect i ve r and omised trial to compare early surgery with initial conservative treatment for patients with intracerebral haemorrhage .  METHODS A parallel-group trial design was used . Early surgery combined haematoma evacuation ( within 24 h of r and omisation ) with medical treatment . Initial conservative treatment used medical treatment , although later evacuation was allowed if necessary . We used the eight-point Glasgow outcome scale obtained by postal question naires sent directly to patients at 6 months follow-up as the primary outcome measure . We divided the patients into good and poor prognosis groups on the basis of their clinical status at r and omisation . For the good prognosis group , a favourable outcome was defined as good recovery or moderate disability on the Glasgow outcome scale . For the poor prognosis group , a favourable outcome also included the upper level of severe disability . Analysis was by intention to treat . FINDINGS 1033 patients from 83 centres in 27 countries were r and omised to early surgery ( 503 ) or initial conservative treatment  ( 530 ) . At 6 months , 51 patients were lost to follow-up , and 17 were alive with unknown status . Of 468 patients r and omised to early surgery , 122 ( 26 % ) had a favourable outcome compared with 118 ( 24 % ) of 496 r and omised to initial conservative treatment ( odds ratio 0.89 [ 95 % CI 0.66 - 1.19 ] , p=0.414 ) ; absolute benefit 2.3 % ( -3.2 to 7.7 ) , relative benefit 10 % ( -13 to 33 ) . INTERPRETATION Patients with spontaneous supratentorial intracerebral haemorrhage in neurosurgical units show no overall benefit from early surgery when compared with initial conservative treatment Objective : To perform a single-center pilot investigation of early hematoma removal in patients with intracerebral hemorrhage ( ICH ) . Background : Considerable debate remains regarding the utility of surgical clot evacuation for ICH . Methods : This was a prospect i ve trial of open craniotomy within 12 hours of ICH symptom onset versus best medical therapy .  Patients were eligible if they had a nontraumatic ICH > 9 mL with significant neurologic impairment and were prepared for surgery within 12 hours of symptom onset . The study included a prospect i ve registry of patients and a r and omized trial . Results : The registry group included 34 medical and seven surgical patients . The surgical group had larger hemorrhages ( median , 96 mL ) and a lower Glasgow Coma Scale ( GCS ) score ( median , 10 ) compared with the medical group ( 33 mL ; GCS score , 13 ) . Six-month mortality was less in the medical group ( 36 % ) compared with the surgical group ( 54 % ) . In the r and omized series , median ICH volumes were similar in the surgical group ( n = 17 ; 49 mL ) compared with the medical group ( n = 17 ; 44 mL ) . Median GCS score was also similar ( medical , 10 ; surgical , 11 ) . Mortality was lower in the surgical group ( 6 % ) compared with the medical group ( 24 % ) at 1 month , but similar at 6 months ( surgical group , 17 % ; medical group , 24 % ) . Conclusion : A trial of early surgery for ICH is feasible . This study represents the largest prospect i ve , r and omized series of surgery for ICH . A modest early mortality benefit for surgery is possible , but long-term benefit for surgery was not established in this single-center pilot investigation St and ards of scientific reporting have evolved from the very beginning of scientific reporting . Virtually all journals now publish instructions for authors and most medical journals adhere to certain st and ards of publication . Such st and ards have been promoted by international groups such as the International Committee of Medical Journal Editors ( ICMJE ) and Committee on Publication Ethics ( COPE ) . The ICMJE has published general st and ards for crafting scientific articles : the “ Uniform Requirements for Manuscripts Su bmi tted to Biomedical Journals : Writing and Editing for Biomedical Publication ” [ 7 ] . These guidelines include suggestions not only for manuscript preparation , but also guidelines for ethical issues related to publishing . COPE , however , focuses on ethical issues [ 1 ] . CORR adheres to these guidelines ; authors may find links to these guidelines in our online Instructions for Authors . Such guidelines , as important as they are , lack sufficient detail to ensure all important information is included . Therefore , in addition to these general guidelines for preparing a manuscript , numerous international groups have published guidelines to ensure various sorts of studies contain all essential information . These include the CONSORT ( Consoli date d St and ards of Reporting Trials ) guidelines for r and omized trials [ 2 , 3 , 8 ] , QUORUM ( Quality of Reporting of Meta-analyses ) [ 6 ] and MOOSE ( Meta- analysis Of Observational Studies in Epidemiology ) [ 13 ] for meta-analyses , and STROBE ( Strengthening the Reporting of Observational Studies in Epidemiology ) for various sorts of observational studies ( the majority of clinical studies in surgical disciplines ) [ 12 , 15 ] . In essence , these guidelines tell investigators and authors what information is required to ensure readers ( and review ers ) can properly evaluate the study . Despite these st and ards , most reports of clinical studies lack such critical information . I suspect this is less by intent than lack of awareness of what information is required . In addition , although many journals , including CORR require a Level of Evidence [ 5 , 10 , 16 ] for studies involving patients , most clinical articles published in surgical journals have a relatively low level ; prospect i ve , r and omized trials are uncommon ( and often impractical ) , and even sufficiently large retrospective cohort studies to control for confounding variables may be unachievable for many conditions or treatments in single institutions . In the absence of high levels of evidence , systematic review s [ 9 , 11 , 17 ] and meta-analyses [ 4 ] have become increasingly common . My search of PubMed for articles limited to meta- analysis yielded 276 articles from 1950–1989 , 2116 from 1990–1994 , 3736 from 1995–1999 , 7920 from 2000–2004 , and 9313 from 2005 to 2009 . Most of these analyses undoubtedly collected information from lower level studies , thereby incurring the limitations of the individual studies . Virtually all systematic and meta-analyses we have recently published noted missing and variably reported data . In contrast to medical disciplines , surgical disciplines do not have the advantage of being able to conduct tightly design ed prospect i ve , r and omized , blinded , controlled trials . ( A PubMed search limited to r and omized controlled trials suggested The Journal of Bone and Joint Surgery and CORR had together published 556 RCTs and although I did not individually check these for quality , they reflect a small fraction of the articles both journals publish . ) For the foreseeable future , most of our information will arise from observational studies rather than prospect i ve trials . In this setting , it is especially important that each article contain all relevant information for future systematic review s and meta-analyses . The STROBE guidelines [  
    Output:
    
There is evidence that surgery is of benefit if undertaken early before the patient deteriorates .