Please select the eligibility criteria that correspond to the clinical trial below.
Title: The Role of Inflammatory and Stress Response in the Pathogenesis of Cognitive Dysfunction After Cardiac Surgery
Brief Summary: Postoperative cognitive dysfunction (POCD) is the most common complication after cardiac surgery. This prospective study was conducted to investigate the mechanisms of development of POCD following cardiac surgery taking into account surgical technique (with use or no use of extracorporeal circulation). The investigators focused on the role of inflammatory and stress response to surgical procedure as potential factors involved in the pathogenesis of cognitive dysfunction. Systematic inflammatory response in patients undergoing on-pump or off-pump surgery was analyzed by measuring serum levels of C reactive protein (CRP) and occurrence of systemic inflammatory response syndrome (SIRS). Stress response to surgery was evaluated following cortisol levels and its daily variations. The degree of cognitive dysfunction was assessed based on serum levels of S100β. The effect of dexamethasone on the levels of stress and inflammatory response biomarkers, serum levels of S100β, as well as on the development of POCD was compared with control group that received normal saline.


Options:
A: Inclusion Criteria:

* Patients with coronary artery disease scheduled for elective CABG
* Patients willing and able to complete the requirements of this study
* Ejection Fraction \> 50%
* EuroSCORE ≤ 8
* men and women \>= 50 yrs
* women without childbearing potential
* ASA Score II-IV

Exclusion Criteria:

* Lack of informed consent
* EuroSCORE \< 8
* MMSE \< 24
* Age \< 50 years
* COPD GOLD \> II, increased need of oxygen
* Renal dysfunction
* Liver function disorders
* Acute coronary syndrome during the last 24 hours; hemodynamic instability
* Requirement of inotropic support
* Off-pump-surgery
* Disabling neuropsychiatric disorders
* History of stroke with residuals
* Hypersensitivity to the study anaesthetics
* Increased intracranial pressure
* Pregnancy and lactation period
* Women of childbearing potential
* Presumed uncooperativeness or legal incapacity
* Participation in a concomitant trial
B: Inclusion Criteria:

* Elective complex cardiac surgery (combined valve and coronary bypass grafting surgery, concomitant valve surgery, surgery of the ascending aorta and aortic arch, as well as re-operations of the same type)
* Age \> 18 years

Exclusion Criteria:

* Disagreement to participate in the study
* Age \< 18 years
* Pregnancy
* Emergency procedure
* Heart transplantation
* Implantation of LVAD (left ventricular assist device), RVAD (right ventricular assist device) or TAH (total artificial heart)
* Treatment with chemotherapy, immunosuppressive therapy
* Treatment with anti-leukocyte drugs or TNF-alfa blockers
* Immunocompromised patients (AIDS), leucopenia (\< 4,0x109 / L)
* Clinical and/or laboratory signs of infection (CRP \>2 mg/dl)
* Serum creatinine \>2 mg/dl
* Bilirubin \>2 mg/dl
* History of stroke
* Malnourished patients, BMI \< 18
C: Inclusion Criteria:

* Participants undergoing cardiac surgery: coronary artery bypass grafting, heart valve surgery or a combined procedure,
* Procedure must be elective

Exclusion Criteria:

* Symptomatic cerebrovascular disease,
* Cerebrovascular incident in last 3 years,
* Neurodegenerative disease,
* Psychiatric disease,
* Visual, hearing or motor impairment interfering with cognitive testing,
* Carotid artery stenosis ( ≥50%),
* Myocardial infarction within last 3 months,
* Left ventricular ejection fraction of ≤35%,
* Previous cardiac or carotid surgery,
* Uncontrolled systemic hypertension (blood pressure≥180/110 mmHg),
* Corticosteroid-dependent asthma,
* Chronic obstructive pulmonary disease (COPD),
* Malignancy, liver disease (aspartate transaminase (AST), alanine transaminase (ALT) or bilirubin ˃1.5x above reference range),
* Kidney disease (serum creatinine ˃1.7 mg/dl or blood urea nitrogen ˃50 mg/dL),
* Uncontrolled diabetes mellitus (postprandial glucose ˃200 mg/dL or hemoglobin A1c ˃9%),
* Endocrine and metabolic diseases, requiring steroid treatment longer than 7 days in the past year,
* Alcohol or controlled substance abuse,
* Individuals without primary school education,
* Preoperative C reactive protein ˃0.5 mg/dL,
* Preoperative white blood cell count \<3 x109/L or ˃11 x109/L,
* Preoperative Mini mental score \<26 points,
* Preoperative Beck's depression inventory score ˃ 19 points,
* Intraoperative plan change (conversion from "off-pump" to "on-pump" and vice versa),
* Need for deep hypothermic circulatory arrest,
* Additional corticosteroid treatment throughout the study period.
D: Inclusion Criteria:

* Patients at risks for acute tubular necrosis (patients with mechanical ventilation, patients with sepsis, in the post-operative state, with hemodynamic impairment or with previous chronic renal failure.
* Consent form signed

Exclusion Criteria:

* Patients with malignant hypertension
* Patients with systolic BP \> 150 mmHg at enrollment
* Patients with Hb level \> 120g/L
* Patients with acute coronaropathy
* Pregnancy
* Patients with urine output \< 600 ml/12 h

Answer: C