***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: Objective : The aim of this prospect i ve study was to investigate the relationships between inflammation , cerebral vasoregulation , and cognitive decline in type 2 diabetes mellitus ( T2DM ) over a 2-year span . Methods : Sixty-five participants ( aged 66 ± 9.2 years , 35 with T2DM , 33 women ) were enrolled for this 2-year prospect i ve study . Continuous arterial spin labeling at 3-tesla MRI was used to measure global and regional cerebral perfusion and vasoreactivity . Neuropsychological measures were evaluated at the beginning and completion of the study . The associations between serum inflammatory markers , regional cerebral vasoreactivity , and cognitive functions were examined using least squares models . Results : After 2 years of follow-up , participants with T2DM had diminished global and regional cerebral vasoreactivity and a decline in multiple cognitive tasks compared with baseline ( p < 0.0001–0.012 ) . In the T2DM group , lower cerebral vasoreactivity was associated with a greater decrease in daily living activities score ( r2adj = 0.35 , p = 0.04 ) , and lower global vasodilation was associated with a greater decline in executive function ( r2adj = 0.6 , p = 0.047 ) . Higher serum soluble intercellular and vascular adhesion molecules , higher cortisol , and higher C-reactive protein levels at baseline were associated with greater decreases in cerebral vasoreactivity and vasodilation only in the T2DM group ( r2adj = 0.16–0.53 , p = 0.007–0.048 ) , independent of diabetes control and 24-hour blood pressure . Higher glycated hemoglobin A1c levels were associated with a greater increase in vasoconstriction in the T2DM group . Conclusions : Inflammation may further impair cerebral vasoregulation , which consequently accelerates decline in executive function and daily activities performance in older people with T2DM Context Stress response induced by surgery is proposed to play an important role in the pathogenesis of postoperative cognitive dysfunction . Objective To investigate the association between postoperative serum cortisol level and occurrence of cognitive dysfunction early after coronary artery bypass graft surgery .  Design Prospect i ve cohort study . Setting Two teaching hospitals . Patients One hundred and sixth-six adult patients who were referred to elective coronary artery bypass graft surgery from March 2008 to December 2009 . Intervention None . Main Outcome Measures  Neuropsychological tests  were completed one day before and seven days after surgery . Cognitive dysfunction was defined using the same definition as used in the ISPOCD1- study . Blood sample s were obtained in the first postoperative morning for measurement of serum cortisol concentration . Multivariate Logistic regression analyses were performed to assess the relationship between serum cortisol level and occurrence of postoperative cognitive dysfunction . Results Cognitive dysfunction occurred in 39.8 % ( 66 of 166 ) of patients seven days after surgery . Multivariate Logistic regression analysis showed that high serum cortisol level was significantly associated with the occurrence of postoperative cognitive dysfunction ( odds ratio [ OR ] 2.603 , 95 % confidence interval [ CI ] 1.371 - 4.944 , P = 0.003 ) . Other independent predictors of early postoperative cognitive dysfunction included high preoperative New York Heart Association functional class ( OR 0.402 , 95 % CI 0.207 - 0.782 , P = 0.007 ) , poor preoperative Grooved Pegboard test score of nondominant h and ( OR 1.022 , 95 % CI 1.003 - 1.040 , P = 0.020 ) , use of penehyclidine as premedication ( OR 2.565 , 95 % CI 1.109 - 5.933 , P = 0.028 ) , and occurrence of complications within seven days after surgery ( OR 2.677 , 95 % CI 1.201 - 5.963 , P = 0.016 ) . Conclusions High serum cortisol level in the first postoperative morning was associated with increased risk of cognitive dysfunction seven days after coronary artery bypass graft surgery Objective : Pulsatile flow , generated by a pump during cardiopulmonary bypass , has been accepted as more physiological in coronary artery bypass grafting surgery ( CABG ) . Therefore , we aim ed to investigate the effects of pulsatile and nonpulsatile flow on postoperative cognitive function and to review relationship with the biomarkers S100β and neuron-specific enolase ( NSE ) . Methods : Patients who underwent isolated CABG were included this prospect i ve , r and omized , double-blind study , which was performed between March 2010 and December 2010 . Patients were divided into two groups : pulsatile ( Group I , n=20 ) and nonpulsatile ( Group II , n=20 ) flow . Blood sample s were collected 1 day before surgery and in the sixth postoperative hour for the analysis of S100β and NSE . In addition , Mini-Mental State Examination ( MMSE ) was performed during preoperative period and on third postoperative day . Outcomes were determination of effects of pump flow type on cognitive function and relationships with concentrations of S100β and NSE . Results : Forty patients were included . No differences were observed between the groups with respect to complications , mortality , S100β ( Group I : 1.9±0.2 µ/L ; Group II : 2.0±0.2 µ/L ) , NSE ( Group I : 12.5±0.8 µ/L ; Group II : 12.4±0.7 µ/L ) , MMSE scores [ Group I : 25 ( 23–27 ) ; Group II : 25 ( 23–27 ) ] , and postoperative cognitive dysfunction ( POCD ) ( p>0.05 ) . No correlation was observed between MMSE scores and concentrations of S100β ( r=–0.032 ) and NSE ( r=–0.423 ) ( p>0.05 ) . Conclusion : There was no difference between types of pump flow for POCD and no relationship between cognitive dysfunction and S100β and NSE concentrations . Pump flow type does not affect NSE concentrations BACKGROUND Previous uncontrolled studies have suggested that there is late cognitive decline after coronary artery bypass grafting that may be attributable to use of the cardiopulmonary bypass pump . METHODS In this prospect i ve , nonr and omized , longitudinal study , we compared cognitive outcomes after  on-pump coronary artery bypass surgery ( n = 152 ) with off-pump bypass surgery patients ( n = 75 ) ; nonsurgical cardiac comparison subjects ( n = 99 ) ; and 69 heart-healthy comparison ( HHC ) subjects . The primary outcome measure was change from baseline to 72 months in the following cognitive domains : verbal memory , visual memory , visuoconstruction , language , motor speed , psychomotor speed , attention , executive function , and a composite global score . RESULTS There were no consistent differences in 72-month cognitive outcomes among the three groups with coronary artery disease ( CAD ) . The CAD groups had lower baseline performance , and a greater degree of decline compared with HHC . The degree of change was small , with none of the groups having more than 0.5 SD decline . None of the groups was substantially worse at 72 months compared with baseline . CONCLUSIONS Compared with subjects with no vascular disease risk factors , the CAD patients had lower baseline cognitive performance and greater degrees of decline over 72 months , suggesting that in these patients , vascular disease may have an impact on cognitive performance . We found no significant differences in the long-term cognitive outcomes among patients with various CAD therapies , indicating that management strategy for CAD is not an important determinant of long-term cognitive outcomes BACKGROUND Hypothermic and normothermic cardiopulmonary bypass ( CPB ) have result ed in apparently contradictionary cardiac and neurologic outcome . Cerebrovascular risk and cognitive dysfunction associated with normothermic CPB still remain uncertain . MATERIAL S AND METHODS In a prospect i ve r and omized study , we measured the effects of  mildly hypothermic ( 32 degrees C , n=72 ) vs. normothermic ( 37 degrees C , n=72 ) CPB  on cognitive brain function .  All patients received elective coronary artery bypass grafting ( mean age 62.1+/-6.3 years , mean ejection fraction 60.4+/-13 % ) .  Cognitive brain function was objective ly measured by cognitive P300 auditory-evoked potentials before surgery , 1 week and 4 months after surgery , respectively . Additionally , st and ard psychometric tests ( ' trailmaking test A ' , ' mini-mental state ' ) were performed and clinical outcome was monitored . RESULTS Patients , operated with mild hypothermia  , showed a marked impairment of cognitive brain function . As compared with before surgery ( 370+/-45 ms ) , P300 evoked potentials were prolonged at 1 week ( 385+/-37 ms ; P<0.001 ) and even at 4 months ( 378+/-34 ms , P<0.001 ) after surgery , respectively . In contrast , patients operated with normothermic CPB  , did not show an impairment of P300 peak latencies ( before surgery 369+/-36 ms , 1 week after surgery 376+/-38 ms , n.s . ; 4 months after surgery 371+/-32 ms , n.s . ) . Group comparison revealed a trend towards prolonged P300 peak latencies in the patient group undergoing mildly hypothermic CPB ( P=0.0634 ) 1 week after surgery . Four months postoperatively , no difference between the two groups could be shown ( P = n.s . ) Trailmaking test A and mini mental state test failed to discriminate any difference . Five patients died ( mild hypothermia n=3 , normothermia n=2 ) postoperatively ( cardiac related n=3 , sepsis n=2 ) . None of the patients experienced major adverse cerebrovascular events . CONCLUSIONS Objective cognitive P300 auditory evoked potential measurements indicate , that sub clinical impairment of cognitive brain function is more pronounced in patients undergoing mildly hypothermic CPB  as compared with normothermic CPB  for CABG Objective : Postoperative cognitive dysfunction is an important complication of cardiac surgery with poor outcomes . Serum glial cell line – derived neurotrophic factor levels are decreased in patients with Alzheimer 's disease , but the association between glial cell line – derived neurotrophic factor levels and postoperative cognitive dysfunction is poorly understood . The present study aim ed to investigate the prognostic value of postoperative serum glial cell line – derived neurotrophic factor levels to predict postoperative cognitive dysfunction in patients with rheumatic heart disease undergoing heart valve replacement . Methods : This was a prospect i ve observational study of 80 patients undergoing elective heart valve replacement surgery from June 2015 to June 2016 at the Affiliated Hospital of Southeast Medical University .  Cognitive functions were assessed 1 day before and 7 days after surgery . Serum glial cell line – derived neurotrophic factor levels were measured by an enzyme‐linked immunosorbent assay before ( T1 ) and 1 ( T2 ) , 2 ( T3 ) , and 7 ( T4 ) days after surgery . Perioperative parameters were evaluated to assess the relationship between glial cell line – derived neurotrophic factors and postoperative cognitive dysfunction . Results : Postoperative cognitive dysfunction was identified in 38 patients ( 47.5 % ) 7 days after surgery . Average glial cell line – derived neurotrophic factor levels at 2 and 7 days after surgery in the postoperative cognitive dysfunction group were lower than in the nonpostoperative cognitive dysfunction group at the same time points ( P < .001 ) . & Dgr;Glial cell line – derived neurotrophic factor ( T1‐T3 ) and & Dgr;glial cell line – derived neurotrophic factor ( T1‐T4 ) were identified as good predictors of postoperative cognitive dysfunction with threshold for postoperative cognitive dysfunction detection of 49.10 and 60.90 , respectively . Conclusions : The perioperative glial cell line – derived neurotrophic factor levels in patients with postoperative cognitive dysfunction were lower than in patients without postoperative cognitive dysfunction . Glial cell line – derived neurotrophic factor could be an effective predictor for the occurrence of postoperative cognitive dysfunction . The results reveal a potentially important role of decreased glial cell line – derived neurotrophic factor levels in postoperative cognitive dysfunction , with possible treatment targets Background A recent study reported that patients with higher cortisol levels on the 1st postoperative morning after cardiac surgery exhibited an increased risk of early postoperative cognitive decline ( POCD ) . Therefore , we conducted the current study to gain further insight into the stress response to a surgical procedure as a potential risk factor for early POCD after cardiac surgery . Material / Methods This prospect i ve cohort study enrolled 125 patients undergoing elective cardiac surgery with or without cardiopulmonary bypass ( CPB ) .  Patient serum cortisol levels were determined 1 day before surgery ( at 08 : 00 ) and on the 1st ( at 
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Furthermore , we revealed that defining POCD is a very controversial matter and that the inflammatory response plays an important role in the mutually overlapping processes included in POCD development .