***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: Introduction Nowadays , many patients undergo coronary artery bypass grafting ( CABG ) with a cardiopulmonary bypass ( CPB ) ;  while a number of therapeutic agents have been used to suppress its related inflammatory process . Magnesium sulfate ( MgSO4 ) solution has been used as an anti-inflammatory agent . Among the cardiac biomarkers , N-terminal pro brain natriuretic peptide ( NT Pro-BNP ) is one of the most widely recognized . We performed this study to assess the effect of MgSO4 solution on NT Pro-BNP levels in patients undergoing CABG with CPB .  Material s and methods In a double-blind clinical trial , after IRB approval for ethical considerations , during a 12-month period , 88 adult patients aged 40–70 years qualified for the study after inclusion and exclusion criteria were considered . After r and om allocation of the patients between the two groups , anesthesia , surgical procedure , cardiopulmonary bypass ( CPB ) methods , and postoperative care were made as similar as possible ; however , one group received a MgSO4 infusion ( 15 mg/kg/h ) and the other group saline ( placebo ) . Pre- and post-operative levels of NT Pro-BNP were assessed using an electrochemical luminescence immunoassay in an Elecsys 2010 ( Roche , Indianapolis , IN , USA ) . The results were compared using a Student ’s t-test . A P value less than 5 % was considered significant . Results The MgSO4 group had shorter postoperative mechanical ventilation , lower postoperative morphine requirements and lower postoperative pain scores . Also , 24 h postoperative NT Pro-BNP levels were significantly lower in the MgSO4 group . Conclusion Administration of MgSO4 in elective CABG with CPB can decrease the postoperative NT Pro-BNP levels ; also , it decreases their time of postoperative mechanical ventilation Background and Purpose — Neurocognitive decline occurs frequently after cardiac surgery and persists in a significant number of patients . Magnesium is thought to provide neuroprotection by preservation of cellular energy metabolism , blockade of the N-methyl-D-aspartate receptor , diminution of the inflammatory response , and inhibition of platelet activation . We therefore hypothesized that intraoperative magnesium administration would decrease postoperative cognitive impairment . Methods — After approval by the Duke University Health System Institutional Review Board , 389 patients undergoing cardiac surgery were enrolled in this prospect i ve , r and omized , double-blind , placebo-controlled clinical trial . Subjects were r and omized to receive magnesium as a 50 mg/kg bolus followed by another 50 mg/kg infusion for 3 hours or placebo bolus and infusion .  Cognitive function was assessed preoperatively and again at 6 weeks postoperatively using a st and ardized test battery . Mean CD11b fluorescence and percentage of platelets expressing CD62P , which are markers of leukocyte and platelet activation , respectively , were assessed by flow cytometry as a secondary outcome . The effect of magnesium on postoperative cognition was tested using multivariable regression modeling , adjusting for age , years of education , baseline cognition , sex , race , and weight . Results — Among the 389 allocated subjects ( magnesium : n=198 ; placebo : n=191 ) , the incidence of cognitive deficit in the magnesium group was 44.4 % compared with 44.9 % in the placebo group ( P=0.93 ) . The cognitive change score and platelet and leukocyte activation were also not different between the groups . Multivariable analysis revealed a marginal interaction between treatment group and weight such that heavier subjects receiving magnesium were less likely to have cognitive deficit ( P=0.06 ) . Conclusions — Magnesium administered intravenously during cardiac surgery does not reduce postoperative cognitive dysfunction . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT00041392 BACKGROUND The apparent benefit of magnesium in acute myocardial infa rct ion , and the persistently poor outcome after cardiac arrest , have led to use of magnesium in cardiopulmonary resuscitation . Because few data on its use in cardiac arrest were available , we undertook a r and omised placebo-controlled trial ( MAGIC trial ) . METHODS Patients treated for cardiac arrest by the Duke Hospital code team were r and omly assigned intravenous magnesium ( 2 g [ 8 mmoles ] bolus , followed by 8 g [ 32 mmoles ] over 24 h ; 76 patients ) or placebo ( 80 patients ) . Only patients in intensive care or general wards were eligible ; those whose cardiac arrest occurred in emergency , operating , or recovery rooms were excluded . The primary endpoint was return of spontaneous circulation , defined as attainment of any measurable blood pressure or palpable pulse for at least 1 h after cardiac arrest . The secondary endpoints were survival to 24 h , survival to hospital discharge , and neurological outcome . Analysis was by intention to treat . FINDINGS There were no significant differences between the magnesium and placebo groups in the proportion with return of spontaneous circulation ( 41 [ 54 % ] vs 48 [ 60 % ] , p = 0.44 ) , survival to 24 h ( 33 [ 43 % ] vs 40 [ 50 % ] , p = 0.41 ) , survival to hospital discharge ( 16 [ 21 % ] vs 17 [ 21 % ] , p = 0.98 ) , or Glasgow coma score ( median 15 in both ) . INTERPRETATION Empirical magnesium supplementation did not improve the rate of successful resuscitation , survival to 24 h , or survival to hospital discharge overall or in any sub population of patients with in-hospital cardiac arrest OBJECTIVE To determine if magnesium sulfate ( MgSO(4 ) ) improves outcome in cardiac arrest patients initially in ventricular fibrillation ( VF ) . METHODS R and omized , prospect i ve , double blind , placebo-controlled , multicenter prehospital trial using 2 g of MgSO(4 ) .  Eligible patients were non-traumatic cardiac arrest patients ( > or = 18 years of age ) presenting in VF . The protocol included those patients refractory to three electroshocks . Epinephrine and either 2 g of MgSO(4 ) or placebo ( normal saline ) were then administered . The primary outcome variable was return of spontaneous circulation ( ROSC ) in the field and a perfusing pulse on arrival at the ED . Secondary endpoints included admission to the hospital ( ADMT ) and hospital discharge ( DISC ) . IRB approval was obtained at all participating centers . RESULTS Total 116 patients ( 58 MgSO(4 ) , 58 placebo ) were enrolled during the period from 4/1992 to 10/96 with 109 available . There were no significant differences between the groups in baseline characteristics and times to cardio pulmonary resuscitation ( CPR ) , advanced life support ( ALS ) , and first defibrillation , except for time to study drug administration . There was no significant differences in ROSC  ( placebo , 18.5 % , and MgSO(4 ) , 25.5 % , P=0.38 ) , ADMT ( placebo rate=16.7 % , MgSO(4)=16.4 % , P=1.0 ) or DISC ( placebo rate=3.7 % , MgSO(4)=3.6 % , P=1.0 ) . CONCLUSIONS We failed to demonstrate that the administration of 2 g of MgSO(4 )  to prehospital cardiac arrest patients presenting in VF improves short or long term survival Increasing evidence suggests a neuroprotective potential of magnesium sulfate ( MgSO4 ) . Only limited information about the passage of MgSO4 to the cerebrospinal fluid ( CSF ) is available in neurosurgical patients . However , with regard to the clinical relevance of magnesium 's neuroprotective properties , quantitative data about its CSF passage are needed . The present study aims to assess the amount and the time course of magnesium 's CSF passage in neurosurgical patients . To this end , 20 patients undergoing general anesthesia for neurosurgery and needing CSF drainage were included . Patients received an i.v . bolus of 60 mg/kg MgSO4 . The increase in plasma and CSF magnesium concentration were measured 30 , 90 , and 240 min after the end of the MgSO4 infusion . These values were compared with the baseline levels taken before the start of the MgSO4 infusion . Thus , each patient served as his or her own control . Values are expressed as means + /- SD . The plasma magnesium levels were measured as follows : baseline , 0.74 + /- 0.12 mM ; at 30 min , 1.24 + /- 0.1 mM ( p < 0.01 ) ; at 90 min , 0.95 + /- 0.15 mM ( p < 0.01 ) , and at 240 min , 0.82 + /- 0.14 mM ( p < 0.05 ) . The CSF magnesium levels were measured as follows : baseline , 0.95 + /- 0.11 mM ; at 30 min , 1.00 + /- 0.15 mM ( NS ) ; at 90 min , 1.10 + /- 0.17 mM ( p < 0.01 ) ; and at 240 min , 1.13 + /- 0.19 mM ( p < 0.001 ) . We concluded that a bolus of 60 mg/kg of MgSO4 leads at least after 90 min to a significant increase in the CSF magnesium concentration . Moreover , the increase in plasma and CSF magnesium concentration is not parallel . Thus , plasma magnesium concentration can not be used to predict the changes in CSF concentrations OBJECTIVE We sought to evaluate magnesium as a neuroprotectant in patients undergoing cardiac surgery with cardiopulmonary bypass . METHODS From February 2002 to September 2003 , 350 patients undergoing elective coronary artery bypass grafting , valve surgery , or both were enrolled in a r and omized , blinded , placebo-controlled trial to receive either magnesium sulfate to increase plasma levels 1(1/2 ) to 2 times normal during cardiopulmonary bypass ( n = 174 ) or no intervention ( n = 176 ) . Neurologic function , neuropsychologic function , and depression were assessed preoperatively , at 24 and 96 hours after extubation ( neurologic ) and at 3 months ( neuropsychologic , depression ) . Neurologic scores were analyzed using ordinal longitudinal methods , and neuropsychologic and depression inventory data were summarized by principal component analysis , followed by linear regression analysis using component scores as response variables . RESULTS Seven ( 2 % ) patients had a postoperative stroke , 2 ( 1 % ) in the magnesium and 5 ( 3 % ) in the placebo group ( P = .4 ) . Neurologic score was worse postoperatively in both groups ( P < .0001 ) ; however , magnesium group patients performed better than placebo group patients ( P = .0001 ) , who had prolonged declines in short-term memory and reemergence of primitive reflexes . Three-month neuropsychologic performance and depression inventory score were generally better than preoperatively , with few differences between groups ( P > .6 ) ; however , older age ( P = .0006 ) , previous stroke ( P = .003 ) , and lower education level ( P = .0007 ) were associated with worse performance . CONCLUSIONS Magnesium administration is safe and improves short-term postoperative neurologic function after cardiac surgery , particularly in preserving short-term memory and cortical control over brainstem functions . However , by 3 months , other factors and not administration of magnesium influence neuropsychologic and depression inventory performance The prognosis of out of hospital cardiac arrest ( OHCA ) is dismal . Recent reports indicate that high dose magnesium may improve survival . A prospect i ve r and omized double blind placebo controlled trial was conducted at the emergency department ( ED ) of Royal Perth Hospital , a University teaching hospital . Patients with OHCA of cardiac origin received either 5 g MgSO4 or placebo as first line drug therapy . The remainder of their management was st and ard advanced cardiac life support ( ACLS ) . Study endpoints were : ( 1 ) ECG rhythm 2 min after the trial drug ; ( 2 ) return of spontaneous circulation ; ( 3 ) survival to leave the ED ; ( 4 ) survival to leave intensive care ; and ( 5 ) survival to hospital discharge . Of 67 patients enrolled , 31 received magnesium and 36 placebo . There were no significant differences between groups for all criteria , except that there were significantly more arrests witnessed after arrival of EMS personnel in the magnesium group ( 11 or 35 % vs 4 or 11 % ) . Return of spontaneous circulation occurred in seven ( 23 % ) patients receiving magnesium and eight ( 22 % ) placebo . Four patients in each group survived to leave the ED and one from the magnesium group survived to hospital discharge . There were no survivors in the placebo group . In this study , the use of high dose magnesium as first line drug therapy for OHCA was not associated with a significantly improved survival . Early defibrillation remains the single most important treatment for ventricular fibrillation ( VF ) . Further studies are required to 
    Output:
    
Conclusion Magnesium may improve functional neurological outcome in patients who suffer global cerebral ischemia associated with cardiac surgery and cardiac arrest .
Magnesium does not decrease neuropsychological decline .