***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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    ***EXAMPLES*** 
    Input: Background —Steroid administration during cardiopulmonary bypass is thought to improve cardiopulmonary function by modulating bypass-related inflammation . This study was design ed to compare preoperative and intraoperative methylprednisolone ( MP ) to intraoperative MP alone with respect to postbypass inflammation and clinical outcome . Methods and Results —Twenty-nine pediatric patients undergoing bypass procedures were r and omly assigned to receive preoperative and intraoperative MP ( 30 mg/kg 4 hours before bypass and in bypass prime , n=14 ) or intraoperative MP only ( 30 mg/kg , n=15 ) . Myocardial inflammatory mediator mRNA expression was determined in paired atrial biopsies ( before and after bypass ) by ribonuclease protection . Before and after bypass , serum IL-6 and IL-10 were measured by ELISA . Postoperative outcome was assessed by intubation time , CICU length of stay , fluid balance , arterio-venous O2 difference ( & Dgr;A−Vo2 ) , and inotrope requirements . Compared with intraoperative MP alone , combined preoperative and intraoperative MP was associated with reduced myocardial mRNA expression for IL-6 , MCP-1 , and ICAM-1 both before and after bypass ( P < 0.05 ) . Patients who received combined steroids had lower serum IL-6 and increased IL-10 at end-bypass ( P < 0.05 ) , although differences were negligible by 24 hours . Combined MP treatment was associated with reduced fluid requirements , lower body temperature , and lower & Dgr;A−Vo2 for the first 24 hours after surgery ( P < 0.05 ) , along with trends toward improvement in other clinical outcomes . Conclusions —Compared with intraoperative steroid treatment , combined preoperative and intraoperative steroid administration attenuates inflammatory mediator expression more effectively and is associated with improved indexes of O2 delivery in the first 24 hours after congenital heart surgery . These findings need to be confirmed in a larger multicenter trial BACKGROUND Corticosteroids are widely used in pediatric open-heart surgery to reduce systemic inflammatory response and to mediate possible cardioprotective effects . However , the optimal dosing of corticosteroids is unknown and their administration varies considerably between different institutions . METHODS Forty neonates undergoing open-heart surgery were r and omized in a double-blind fashion equally into 2 groups . After the induction of anesthesia , 1 group received 30 mg/kg intravenous methylprednisolone and the other a placebo . Concentrations in plasma of interleukin 6 ( IL-6 ) , IL-8 , IL-10 , free methylprednisolone and total methylprednisolone were obtained for the following : ( 1 ) at anesthesia induction before the study drug was administered ; ( 2 ) 30 minutes on cardiopulmonary bypass ; ( 3 ) 5 minutes after protamine administration ; and ( 4 ) 6 hours after weaning from cardiopulmonary bypass . Troponin T was measured at time points T1 , T3 , T4 , and also at 6:00 on the first postoperative morning . Physiological and clinical outcome parameters were also recorded . RESULTS Intravenous methylprednisolone result ed in high plasma drug concentrations that peaked at T2 . Methylprednisolone significantly lowered concentrations of proinflammatory cytokines IL-6 and IL-8 and raised levels of anti-inflammatory IL-10 . No significant differences in troponin T levels were detected . Blood glucose levels were significantly higher in the methylprednisolone group , and patients in this group received more often insulin therapy than controls . No significant differences were observed in other clinical or physiological outcome measurements . CONCLUSIONS Intravenous 30 mg/kg methylprednisolone administered before cardiopulmonary bypass result ed in high effective plasma drug concentrations and a decreased inflammatory response . However , no cardioprotective effect or better clinical outcome was noticed OBJECTIVE To determine the influence of methylprednisolone on the cytokine balance during cardiac surgery . DESIGN Prospect i ve , r and omized , nonblinded study . SETTING University hospital . PATIENTS Twenty-one patients on cardiopulmonary bypass undergoing aortocoronary bypass surgery .  INTERVENTIONS According to a r and omized sequence , the patients either received methylprednisolone ( 30 mg/kg ) [ corrected ] before cardiopulmonary bypass and before declamping of the aorta ( MPS group , n = 11 ) or received nothing ( control group , n = 10 ) . MEASUREMENTS AND MAIN RESULTS Serum proinflammatory cytokines ( interleukin [IL]-8 , IL-6 ) and anti-inflammatory cytokines ( IL-10 , IL-1ra ) were measured by enzyme-linked immunosorbent assays . Serum IL-6 and IL-8 concentrations in the control group ( 15.2 + /- 4.1 and 14.1 + /- 1.9 pg/mL , preoperatively ) increased to 242 + /- 70.1 and 97.3 + /- 18.3 pg/mL at 60 mins after declamping of the aorta ( p < .01 , p < .01 , respectively ) . The increases were greater than those from 2.5 + /- 0.6 and 2.5 + /- 0.5 pg/mL to 109.5 + /- 29.0 and 33 + /- 4.1 pg/mL in the MPS group for IL-6 and IL-8 , respectively . Serum IL-10 concentrations increased significantly 60 mins after declamping of the aorta compared with its preoperative value in the two groups ( the control group , from 1.0 + /- 0 to 537.9 + /- 61.7 pg/mL ; the MPS group , from 0.3 + /- 0.2 to 654.9 + /- 24 pg/mL [ p < .01 , p < .01 , respectively ] ) . No difference was found between the two groups . Similarly , serum IL-1ra concentrations in the two groups increased the preoperative value in the control group from 304 + /- 120 to 44,374 + /- 14,631 pg/mL and in the MPS group from 616.5 + /- 109.6 to 35,598 + /- 9,074 pg/mL at 60 mins after declamping of the aorta ( p < .01 , p < .01 , respectively ) . There was no difference between the two groups . CONCLUSIONS Methylprednisolone reduces the production of IL-6 and IL-8 but not that of IL-10 and IL-1ra . These results suggest that one of the mechanisms of the cytoprotective effect of methylprednisolone may be to make changes in the proinflammatory and anti-inflammatory cytokine balance Introduction Extracorporeal circulation induces hemostatic alterations that lead to inflammatory response ( IR ) and postoperative bleeding .  Tranexamic acid ( TA ) reduces fibrinolysis and blood loss after cardiopulmonary bypass ( CPB ) . However , its effects on IR and vasoplegic shock ( VS ) are not well known and elucidating these effects was the main objective of this study . Methods A case control study was carried out to determine factors associated with IR after CPB . Patients undergoing elective CPB surgery were r and omly assigned to receive 2 g of TA or placebo ( 0.9 % saline ) before and after intervention . We performed an intention-to-treat analysis , comparing the incidence of IR and VS . We also analyzed several biological parameters related to inflammation , coagulation , and fibrinolysis systems . We used SPSS version 12.2 for statistical purpose s. Results In the case control study , 165 patients were studied , 20.6 % fulfilled IR criteria , and the use of TA proved to be an independent protective variable ( odds ratio 0.38 , 95 % confidence interval 0.18 to 0.81 ; P < 0.01 ) . The clinical trial was interrupted . Fifty patients were r and omly assigned to receive TA ( 24 ) or placebo ( 26 ) . Incidence of IR was 17 % in the TA group versus 42 % in the placebo group ( P = 0.047 ) . In the TA group , we observed a significant reduction in the incidence of VS ( P = 0.003 ) , the use of norepinephrine ( P = 0.029 ) , and time on mechanical ventilation ( P = 0.018 ) . These patients showed significantly lower D-dimer , plasminogen activator inhibitor 1 , and creatine-kinase levels and a trend toward lower levels of soluble tumor necrosis factor receptor and interleukin-6 within the first 24 hours after CPB . Conclusion The use of TA attenuates the development of IR and VS after CPB.Trial registration numberIS RCT N05718824 BACKGROUND Anti-inflammatory treatment with glucocorticoids during cardiopulmonary bypass can reduce inflammatory mediator release , but the effects of glucocorticoid on outcome are controversial . METHODS We studied the effects of dexamethasone on clinical course , C-reactive protein , von Willebr and factor antigen ( vWf : Ag ) and S100B in a r and omized masked study of children after open cardiac surgery . Twenty children weighing > 10 kg received dexamethasone ( 1 mg kg(-1 ) )  and 20 controls received saline after induction of anaesthesia . We measured vWf : Ag as a marker of endothelial activation , S100B as a marker of cerebral protein release and C-reactive protein as a marker of inflammatory activity . Oxygenation , body temperature , fluid balance , leucocyte and platelet counts , days in the intensive care unit ( ICU ) and days on mechanical ventilation were noted . RESULTS Dexamethasone decreased C-reactive protein concentration on the first postoperative day ( P<0.05 ) , but did not affect the release of vWf : Ag or S100B . There was no significant difference in oxygenation , body temperature , fluid balance , leucocyte and platelet counts , days in the ICU or days on mechanical ventilation between the placebo and dexamethasone-treated groups . CONCLUSION Administration of dexamethasone before cardiopulmonary bypass for paediatric cardiac surgery decreased the inflammatory response , but did not affect the immediate features after surgery or changes in vWf : Ag or S100B OBJECTIVE A heightened inflammatory response occurs after cardiac surgery . The perioperative use of glucocorticoids has been advocated as a method to improve postoperative outcomes . R and omized prospect i ve studies to quantify the effect of methylprednisolone on perioperative outcomes in neonatal cardiac surgery have not been performed . We sought to determine whether preoperative methylprednisolone would improve postoperative recovery in neonates requiring cardiac surgery . METHODS Neonates scheduled for cardiac surgery were r and omly assigned to receive either 2-dose ( 8 hours preoperatively and operatively , n = 39 ) or single-dose ( operatively , n = 37 )  methylprednisolone ( 30 mg/kg per dose ) in a prospect i ve double-blind trial . The primary outcome was the incidence of low cardiac output syndrome ( st and ardized score ) or death 36 hours postoperatively . Secondary outcomes were death at 30 days , interleukin-6 levels , inotropic score , fluid balance , serum creatinine , and intensive care unit and hospital stay . RESULTS Preoperative plasma levels of the inflammatory cytokine interleukin-6 were reduced by 2-fold ( P < .001 ) in the 2-dose methylprednisolone group , consistent with the anti-inflammatory effects of methylprednisolone . However , the incidence of low cardiac output syndrome was 46 % ( 17/37 ) in the single-dose and 38 % ( 15/39 ) in the 2-dose methylprednisolone groups ( P = .51 ) . Two-dose methylprednisolone was associated with a higher serum creatinine ( 0.61 ± 0.18 mg/dL vs 0.53 ± 0.12 mg/dL , P = .03 ) and poorer postoperative diuresis ( -96 ± 49 mL , P = .05 ) . Inotropic requirement , duration of mechanical ventilation , intensive care unit , and hospital stay did not differ between the 2 groups . CONCLUSIONS Combined preoperative and intraoperative use of glucocorticoids in neonatal cardiac surgery does not favorably affect early clinical outcomes and may exacerbate perioperative renal dysfunction Cardiopulmonary bypass ( CPB ) is associated with a systemic inflammatory response . Pre-bypass steroid administration may modulate the inflammatory response , result ing in improved postoperative recovery . We performed a prospect i ve study in the departments of cardiovascular surgery and pediatric intensive care medicine of two university hospitals that included 50 infants who underwent heart surgery . Patients received either prednisolone ( 30 mg/kg ) added to the 
    Output:
    
Despite a demonstrated attenuation of cardiopulmonary bypass-induced inflammatory response by steroid administration , a systematic review of r and omized controlled trials performed so far reveals that steroid administration has potential clinical advantages ( lower mortality and significant reduction of renal function deterioration ) .