***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: Methylprednisolone sodium succinate ( MPSS ) was given to 50 % of patients undergoing coronary artery bypass graft in a 50-patient double-blind clinical study to ascertain the beneficial effects of this glucocorticoid in decreasing ischemic injury to the heart . MPSS ( 1 gm ) was given intravenously at the start of cardiopulmonary bypass and another gram was given during the course of the open-heart procedure .  Steroid-treated patients demonstrated a favorable response compared to placebo-treated controls in a variety of physiologic variables : Bypass graft flow rates measured prior to operative closure were 51 - 62 % greater ; urine output in the first 24 postoperative hours was 67 % higher ; fewer abnormalities were found in both chest x-ray and microbiology results . Thus , methylprednisolone sodium succinate treated patients exhibited more favorable trends for all critical variables measured BACKGROUND Cardiopulmonary bypass ( CPB ) induces derangements in physiology characterized by activation of blood pathways that may contribute to multiorgan dysfunction . This trial addresses the efficacy of a biocompatible surface alone and in combination with steroids in inhibiting these changes . METHODS In a factorial design , patients undergoing coronary artery bypass grafting were r and omized ( four groups ; n = 17 per group ) to CPB utilizing control circuits or a circuit prepared with a surface modifying active copolymer ( SMA-CPB ) , with or without methylprednisolone ( MPSS , 1 g intravenous ) . Leukocyte and complement activation , cytokine release , and bradykinin generation were measured . Clinical outcomes ( blood loss , transfusion , arterial pressure response , and postoperative cardiac and pulmonary functions ) were also examined . RESULTS The SMA-CPB was associated with a significant inhibition of elastase release ( p = 0.026 ) and bradykinin generation ( p = 0.027 ) during CPB . Terminal complement complex ( TCC ) generation was inhibited as an effect of SMA-CPB ( p = 0.047 ) . There was an interaction of SMA-CPB and MPSS to decrease both TCC ( p = 0.042 ) and bradykinin generation ( p = 0.028 ) . There were strong effects of MPSS in inhibiting release of interleukin 6 ( IL-6 ) ( p = 0.007 ) and IL-8 ( p < 0.001 ) and tissue plasminogen activator over time ( p = 0.009 ) as well as decreasing peak day 1 creatine kinase ( CK , p = 0.015 ) levels . Clinical effects of MPSS included decreased atrial fibrillation ( p = 0.02 ) , improved cardiac index over time , increased pulmonary compliance , and increased insulin need . CONCLUSIONS This trial suggests a potential beneficial effect for combined strategies to minimize inflammation after CPB . The specific effect of MPSS in decreasing postoperative atrial fibrillation and CK warrants further investigation of its role as a potential myocardial protective agent The purpose of this study was to evaluate the acute cardioprotective effect of high-dose methylprednisolone ( 25 mg/kg ) in the controlled in vivo model of myocardial ischemia – reperfusion injury occurring during cardiopulmonary bypass . Forty nondiabetic male patients with three-vessel disease undergoing first-time bypass surgery were enrolled for this double-blind prospect i ve study . Patients were r and omized to be given 25 mg/kg methylprednisolone ( Group I ) and saline ( Group II ) 1 h before cardiopulmonary bypass . The levels of cardiac troponin-I ( cTnI ) were used as a marker of myocardial tissue damage in myocardial ischemia – reperfusion injury . The cTnI levels were measured before surgery , at the second hour after cardiopulmonary bypass , at the 6th and 24th hours , and 5th day postoperatively . There was no significant difference between the two groups in respect to the duration of ischemia and reperfusion . The preoperative cTnI levels were 0.22 ± 0.29 ng/ml in Group I and 0.23 ± 0.28 ng/ml in Group II . cTnI levels increased to 2.40 ± 1.0 ng/ml in Group I and 3.19 ± 0.88 ng/ml in Group II at the 2nd hour after cardiopulmonary bypass . When the differences between T1 and T0 level that showed the amount of troponin release occurring due to ischemia – repefusion injury was calculated and then compared , there was a significant difference between Groups I and II ( P = 0.024 ) . The cTnI levels measured at 6 h after CPB were 1.98 ± 0.63 ng/ml in Group I and 2.75 ± 1.15 ng/ml in Group II ( P = 0.049 ) . cTnI levels decreased to 0.22 ± 0.10 ng/ml in Group I and 0.49 ± 0.25 ng/ml in Group II on the postoperative day 5 ( P = 0.0001 ) . Univalent regression analysis showed that preoperative high-dose corticosteroid usage decreased the troponin release in about 12 % and this effect was statistically significant ( R2 = 0.12 , P < 0.05 ) . A single dose of intravenous methylpredisolone ( 25 mg/kg ) given 1 h before ischemia reduced myocardial ischemia – reperfusion injury . These results demonstrated that the acute cardioprotective effect of corticosteroids has much potential in the future for reducing ischemia – reperfusion injury occurring during cardiopulmonary bypass when it is inevitable OBJECTIVE The mechanism involved in the endotoxemia frequently recognized during cardiopulmonary bypass remains unclear . It has also been suggested that endotoxin levels were higher in steroid-pretreated patients undergoing cardiopulmonary bypass . METHODS Twenty patients undergoing cardiopulmonary bypass were r and omly pretreated with steroids ( methylprednisolone , 30 mg/kg ) or placebo .  Blood sample s for endotoxin measurement were drawn simultaneously from the superior and inferior venae cavae before heparin administration , 5 and 50 minutes after the onset of bypass , 5 minutes after aortic declamping , at the end of bypass , and 1 , 2 , and 20 hours after the end of cardiopulmonary bypass . RESULTS The perioperative variables in the two groups were similar . Blood endotoxin levels were higher in the inferior vena cava than in the superior vena cava immediately after the onset of bypass . Endotoxin levels in inferior vena cava blood were significantly lower in steroid-pretreated patients than those in patients not receiving steroids . CONCLUSIONS Endotoxin is released during cardiopulmonary bypass from the region drained by the inferior vena cava . Steroid pretreatment may actually reduce endotoxin release during bypass This study investigated whether the prophylactic administration of methylprednisolone sodium succinate ( MPSS ) could prevent an increase in plasma endotoxin levels during cardiac surgery with cardiopulmonary bypass .  MPSS ( 1 g/patient ) or saline was given intravenously with induction in the steroid ( n = 6 ) and control ( n = 7 ) groups , respectively . Blood sample s were collected preinduction and postinduction , during and after cardiopulmonary bypass , and 1 and 24 hours postoperatively . Plasma endotoxin was determined by a chromogenic Limulus amebocyte lysate assay . There was an intraoperative increase in the level of plasma endotoxin that occurred primarily after initiation of cardiopulmonary bypass and removal of the aortic cross-clamp . Endotoxin at 1 and 24 hours postoperatively was lower than the peak intraoperative levels and approached the preinduction level in both groups . The pump prime and other administered fluids contained low levels of endotoxin that were at or below the preinduction or postinduction level of the patients . MPSS did not prevent or attenuate the degree of endotoxemia during cardiopulmonary bypass . The loss of normal gut mucosal barrier function during cardiopulmonary bypass may result in endotoxemia and /or bacterial translocation , either of which could initiate or contribute to postoperative complications The use of  cardiopulmonary bypass ( CPB ) is associated with the development of a significant systemic inflammatory response syndrome ( SIRS ) which can affect patient outcomes . Multiple pathways are involved in initiating and maintaining SIRS . We studied whether a single dose of steroids ( dexamethasone ) after the induction of anesthesia could blunt the SIRS from CPB . A prospect i ve , r and omized , double-blinded , placebo control trial of 28 patients ( 13 study vs. 15 control ) . The study group received 100 mg of dexamethasone whereas the control group received sterile saline .  Inclusion criteria were the following : elective coronary artery bypass grafting , less than 80 years old , normal ejection fraction , no acute myocardial infa rct ion .  Serum levels of C3a , interleukin (IL)-6 , and plasma norepinephrine ( PNE ) were measured after intubation , 30 minutes after initiation of CPB , 24 and 72 hours after termination of bypass . The study group demonstrated significantly lower levels of IL-6 ( p = 0.0005 ) at 24 hours and PNE ( p = 0.05 ) at 72 hours post-CPB . There were no differences in the C3a levels between the groups . No infections occurred in either group . A single dose of dexamethasone reduces IL-6 and PNE levels associated with CPB . Despite the significant reductions in IL-6 and PNE , there was no effect on clinical outcomes . Additional studies are needed to demonstrate a clinical ly significant effect on patient outcomes Thirty-one patients who were undergoing cardiopulmonary bypass for elective aortic valve replacement were studied . The effects on some aspects of lung function of intravenous methyl prednisolone , administered immediately before bypass , were assessed by measuring alveolar-arterial oxygen differences and shunt fractions . No significant differences in pulmonary function were found between the treated and control groups . The use of methyl prednisolone in this context is not justified OBJECTIVE To compare the effects of low- and full-dose aprotinin to methylprednisolone ( MPS ) in reducing cardiopulmonary bypass (CPB)-induced interleukin-6 ( IL-6 ) release . DESIGN Prospect i ve , r and omized , blinded study . SETTING Cytokine Laboratory , pharmacology department , in a university teaching hospital . PARTICIPANTS Forty adult male human patients scheduled for myocardial revascularization were divided into four groups ( n = 10 ) : ( 1 ) control ; ( 2 ) MPS , 1 g IV before CPB ; ( 3 ) aprotinin-low-dose protocol ; and ( 4 ) aprotinin-full-dose protocol . MEASUREMENTS AND MAIN RESULTS Plasma levels of IL-6 were measured at baseline and 1 and 24 hours after CPB by enzyme-linked immunosorbent assay technique . Group 1 demonstrated a significant ( p < 0.05 ) increase in IL-6 at 1 and 24 hours post-CPB . Groups 2 and 4 demonstrated significant ( p < 0.05 ) reduction of IL-6 at 1 ( group 2 only ) and 24 ( groups 2 and 4 ) hours post-CPB when compared with group 1 at the same time periods . CONCLUSIONS These results demonstrate that MPS , 1 g before CPB , and full-dose aprotinin , but not half-dose aprotinin , achieve significant reduction in IL-6 release after CPB . These results further suggest that MPS and full-dose aprotinin may reduce reperfusion injury after CPB Background Intensive insulin therapy to maintain normoglycemia after cardiac surgery reduces morbidity and mortality . We investigated the magnitude and duration of hyperglycemia caused by dexamethasone administered after cardiopulmonary bypass . Methods A single-center before-after cohort study was performed . All consecutive patients undergoing coronary artery bypass grafting with cardiopulmonary bypass during a 6-month period were included . Insulin administration was guided by a sliding scale protocol . Halfway the observation period , the dexamethasone protocol was changed . The single dose ( 1D ) group received a pre-operative dose of dexamethasone of 1 mg/kg . The double dose group ( 2D ) received an additional dose of 0.5 mg/kg of dexamethasone post-operatively at ICU admission . Results We included 116 patients in the 1D group and 158 patients in the 2D group . There were no significant baseline differences between the groups .  Median Euroscore was 5 . In univariable analysis , the glucose level was different between groups 1D and 2D at 4 , 6 , 9 , 12 and 24 hours after ICU admission ( all p < 0.001 ) . Insulin infusion was higher in the 1D group . Corrected for insulin dose in multivariable linear analysis , the difference in glucose between the 1D and 2D groups was 1.5 mmol/L ( 95 % confidence interval 1.0–2.0 , p < 0 
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Steroid prophylaxis had no effect on postoperative mortality , mechanical ventilation duration , re-exploration for bleeding , and postoperative infection .
CONCLUSIONS A systematic review of RDB trials reveals that steroid prophylaxis may reduce morbidity after cardiac surgery and does not increase the risk of postoperative infections