***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 There is conflicting evidence regarding the benefit of intravenous insulin therapy on mortality following acute myocardial infa rct ion ( AMI ) . The goal of the current study was to determine whether improved glycemic control , achieved through an insulin/dextrose infusion with a variable rate of insulin , reduces mortality among hyperglycemic patients with AMI . RESEARCH DESIGN AND METHODS Subjects suffering AMI with either known diabetes or without diabetes but blood glucose level ( BGL ) > or = 7.8 mmol/l were r and omized to receive  insulin/dextrose infusion therapy  for at least 24 h to maintain a BGL < 10 mmol/l or conventional therapy . RESULTS A total of 240 subjects were recruited .  Insulin/dextrose infusion did not reduce mortality at the inpatient stage ( 4.8 vs. conventional 3.5 % , P = 0.75 ) , 3 months ( 7.1 vs 4.4 % , P = 0.42 ) , or 6 months ( 7.9 vs. 6.1 % , P = 0.62 ) . There was , however , a lower incidence of cardiac failure ( 12.7 vs. 22.8 % , P = 0.04 ) and reinfa rct ion within 3 months ( 2.4 vs. 6.1 % , P = 0.05 ) . When analyzed by mean BGL achieved during the first 24 h , mortality was lower among subjects with a mean BGL < or = 8 mmol/l , compared with subjects with a mean BGL > 8 mmol/l ( 2 vs. 11 % at 6 months , P = 0.02 ) . CONCLUSIONS We did not find a reduction in mortality among patients who received insulin/dextrose infusion therapy . However , it remains possible that tight glycemic control with insulin therapy following AMI improves outcomes BACKGROUND AND PURPOSE Hyperglycemia at the time of ischemic stroke is associated with increased mortality and morbidity . Animal studies suggest that infa rct expansion may be responsible . The influence of persisting hyperglycemia after stroke has not previously been examined . We measured the blood glucose profile after acute ischemic stroke and correlated it with infa rct volume changes using T2- and diffusion-weighted MRI . METHODS We recruited 25 subjects within 24 hours of ischemic stroke symptoms .  Continuous glucose monitoring was performed with a glucose monitoring device ( CGMS ) , and 4-hour capillary glucose levels ( BGL ) were measured for 72 hours after admission .  MRI and clinical assessment s were performed at acute ( median , 15 hours ) , subacute ( median , 5 days ) , and outcome ( median , 85 days ) time points . RESULTS Mean CGMS glucose and mean BGL glucose correlated with infa rct volume change between acute and subacute diffusion-weighted MRI ( r > or=0.60 , P<0.01 ) , acute and outcome MRI ( r=0.56 , P=0.01 ) , outcome National Institutes of Health Stroke Scale ( NIHSS ; r > or=0.53 , P<0.02 ) , and outcome modified Rankin Scale ( mRS ; r > or=0.53 , P=0.02 ) . Acute and final infa rct volume change and outcome NIHSS and mRS were significantly higher in patients with mean CGMS or mean BGL glucose > or=7 mmol/L. Multiple regression analysis indicated that both mean CGMS and BGL glucose levels > or=7 mmol/L were independently associated with increased final infa rct volume change . CONCLUSIONS Persistent hyperglycemia on serial glucose monitoring is an independent determinant of infa rct expansion and is associated with worse functional outcome . There is an urgent need to study normalization of blood glucose after stroke Background and Purpose — Hyperglycemia is common after subarachnoid hemorrhage ( SAH ) . The extent to which prolonged hyperglycemia contributes to in-hospital complications and poor outcome after SAH is unknown . Methods — We studied an inception cohort of 281 SAH patients with an initial serum glucose level obtained within 3 days of SAH onset and who had at least 7 daily glucose measurements between SAH days 0 and 10 . We defined mean glucose burden ( GB ) as the average peak daily glucose level > 5.8 mmol/L ( 105 mg/dL ) . Hospital complications were recorded prospect ively , and 3-month outcome was assessed with the modified Rankin scale . Results — The median GB was 1.8 mmol/L ( 33 mg/dL ) . Predictors of high-GB included age ≥54 years , Hunt and Hess grade III – V , poor Acute Physiology and Chronic Health Evaluation (APACHE)-2 physiological subscores , and a history of diabetes mellitus ( all P≤0.001 ) . In a multivariate analysis , GB was associated with increased intensive care unit length of stay ( P=0.003 ) and the following complications : congestive heart failure , respiratory failure , pneumonia , and brain stem compression from herniation ( all P<0.05 ) . After adjusting for Hunt-Hess grade , aneurysm size , and age , GB was an independent predictor of death ( odds ratio , 1.10 per mmol/L ; 95 % CI , 1.01 to 1.21 ; P=0.027 ) and death or severe disability ( modified Rankin scale score of 4 to 6 ; odds ratio , 1.17 per mmol/L ; 95 % CI 1.07 to 1.28 , P<0.001 ) . Conclusions — Hyperglycemia after SAH is associated with serious hospital complications , increased intensive care unit length of stay , and an increased risk of death or severe disability OBJECTIVES We tested how insulin-glucose infusion followed by multidose insulin treatment in diabetic patients with acute myocardial infa rct ion affected mortality during the subsequent 12 months of follow-up . BACKGROUND Despite significant improvements in acute coronary care , diabetic patients with acute myocardial infa rct ion still have a high mortality rate . METHODS A total of 620 patients were studied : 306 r and omized to treatment with insulin-glucose infusion followed by multidose subcutaneous insulin for > or = 3 months and 314 to conventional therapy .  RESULTS The two groups were well matched for baseline characteristics . Blood glucose decreased from 15.4 + /- 4.1 to 9.6 + /- 3.3 mmol/liter ( mean + /- SD ) in the infusion group during the 1st 24 h , and from 15.7 + /- 4.2 to 11.7 + /- 4.1 among control patients ( p < 0.0001 ) . After 1 year 57 subjects ( 18.6 % ) in the infusion group and 82 ( 26.1 % ) in the control group had died ( relative mortality reduction 29 % , p = 0.027 ) . The mortality reduction was particularly evident in patients who had a low cardiovascular risk profile and no previous insulin treatment ( 3-month mortality rate 6.5 % in the infusion group vs. 13.5 % in the control group [ relative reduction 52 % , p = 0.046 ] ; 1-year mortality rate 8.6 % in the infusion group vs. 18.0 % in the control group [ relative reduction 52 % , p = 0.020 ] ) . CONCLUSIONS Insulin-glucose infusion followed by a multidose insulin regimen improved long-term prognosis in diabetic patients with acute myocardial infa rct ion Objective To determine the effect that acute physiologic derangements have on outcome after subarachnoid hemorrhage ( SAH ) and to design a composite score summarizing these abnormalities . Design Prospect i ve observational study . Setting Neuroscience intensive care unit in a tertiary care academic center . Patients Consecutive cohort of 413 patients with SAH admitted within 3 days of SAH onset with 3-month modified Rankin Scale scores . Interventions None . Results Among 20 physiologic variables assessed within 24 hrs of admission , four were independently associated with death or severe disability ( modified Rankin Scale score , 4–6 ) at 3 months in a multivariate analysis : arterio-alveolar gradient of > 125 mm Hg ( odds ratio [ OR ] , 4.5 ; 95 % confidence interval [ CI ] , 2.7–7.6 ) , serum bicarbonate of < 20 mmol/L ( OR , 2.9 ; 95 % CI , 1.6–5.6 ) , serum glucose of > 180 mg/dL ( OR , 2.8 ; 95 % CI , 1.6–4.8 ) , and mean arterial pressure of < 70 or > 130 mm Hg ( OR , 1.7 ; 95 % CI , 1.0–2.9 ) . Based on their proportional contribution to outcome , we constructed the SAH Physiologic Derangement Score  ( SAH-PDS ; range , 0–8 ) by assigning the following weights for abnormal findings : arterio-alveolar gradient , 3 points ; bicarbonate , 2 points ; glucose , 2 points ; and mean arterial pressure , 1 point . After controlling for known predictors of death or severe disability ( age , admission neurologic status , loss of consciousness , aneurysm size , intraventricular hemorrhage , and rebleeding ) , the SAH Physiologic Derangement Score was independently associated with poor outcome ( OR , 1.3 for each point increase ; 95 % CI , 1.1–1.6 ) . By contrast , the systemic inflammatory response syndrome score and the Acute Physiology and Chronic Health Evaluation II physiologic subscore did not add predictive value to the model . Conclusion Acute interventions specifically targeting hypoxemia , metabolic acidosis , hyperglycemia , and cardiovascular instability may improve the outcome of SAH patients . The SAH Physiologic Derangement Score may prove useful for rapidly quantifying the severity of important physiologic derangements in acute SAH Background —This study sought to determine whether tight glycemic control with a modified glucose-insulin-potassium ( GIK ) solution in diabetic coronary artery bypass graft ( CABG ) patients would improve perioperative outcomes . Methods and Results —One hundred forty-one diabetic patients undergoing CABG were prospect ively r and omized to tight glycemic control ( serum glucose , 125 to 200 mg/dL ) with GIK or st and ard therapy ( serum glucose < 250 mg/dL ) using intermittent subcutaneous insulin beginning before anesthesia and continuing for 12 hours after surgery . GIK patients had lower serum glucose levels ( 138±4 versus 260±6 mg/dL ; P < 0.0001 ) , a lower incidence of atrial fibrillation ( 16.6 % versus 42 % ; P = 0.0017 ) , and a shorter postoperative length of stay ( 6.5±0.1 versus 9.2±0.3 days ; P = 0.003 ) . GIK patients also showed a survival advantage over the initial 2 years after surgery ( P = 0.04 ) and decreased episodes of recurrent ischemia ( 5 % versus 19 % ; P = 0.01 ) and developed fewer recurrent wound infections ( 1 % versus 10 % , P = 0.03 ) . Conclusions —Tight glycemic control with GIK  in diabetic CABG patients  improves perioperative outcomes , enhances survival , and decreases the incidence of ischemic events and wound complications Background : Hyperglycaemia has been related to poor outcome and delayed cerebral ischaemia ( DCI )  after aneurysmal subarachnoid haemorrhage ( aSAH ) . Objective : This study aim ed to assess whether in patients with aSAH , levels of mean fasting glucose within the first week predict poor outcome and DCI better than single admission glucose levels alone . Methods : Data on non-diabetic patients admitted within 48 h after aSAH with at least two fasting glucose assessment s in the first week were retrieved from a prospect i ve data base ( n = 265 ) . The association of admission glucose or mean fasting glucose , dichotomised at the median levels , with outcome was assessed using logistic regression , and for DCI using Cox regression . To explore whether the association between glucose levels and outcome was mediated by DCI , we adjusted for DCI . Results : The crude and multivariable adjusted odds ratios and 95 % confidence intervals for poor outcome were 1.9 ( 1.1 to 3.2 ) and 1.6 ( 0.9 to 2.7 ) for high admission glucose and 3.5 ( 2.0 to 6.1 ) and 2.5 ( 1.4 to 4.6 ) for high mean fasting glucose . The crude and adjusted hazard ratios for DCI were 1.7 ( 1.1 to 2.5 ) and 1.4 ( 0.9 to 2.1 ) for high admission glucose and 2.0 ( 1.3 to 3.0 ) and 1.7 ( 1.1 to 2.7 ) for 
    Output:
    
CONCLUSIONS After aneurysmal subarachnoid hemorrhage , admission glucose levels are often high and hyperglycemia is associated with an increased risk of poor clinical outcome .