human
***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: BACKGROUND Glucose-insulin-potassium ( GIK ) administration is advocated on the premise of preventing hyperglycaemia and hyperlipidaemia during reperfusion after cardiac interventions . Current research has focused on hyperglycaemia , largely ignoring lipids , or other substrates . The present study examines lipids and other substrates during and after on-pump coronary artery bypass grafting and how they are affected by a hyperinsulinaemic normoglycaemic clamp . METHODS Forty-four patients were r and omized to a control group ( n=21 ) or to a GIK group ( n=23 ) receiving a hyperinsulinaemic normoglycaemic clamp during 26 h.  Plasma levels of free fatty acid ( FFA ) , total and lipoprotein ( VLDL , HDL , and LDL)-triglycerides ( TG ) , ketone bodies , and lactate were determined . RESULTS In the control group , mean FFA peaked at 0.76 ( sem 0.05 ) mmol litre(-1 ) at early reperfusion and decreased to 0.3 - 0.5 mmol litre(-1 ) during the remaining part of the study . GIK decreased FFA levels to 0.38 ( 0.05 ) mmol litre(-1 ) at early reperfusion , and to low concentrations of 0.10 ( 0.01 ) mmol litre(-1 ) during the hyperinsulinaemic clamp . GIK reduced the area under the curve ( AUC ) for FFA by 75 % and for TG by 53 % . The reduction in total TG was reflected by a reduction in the VLDL ( -54 % AUC ) and HDL ( -42 % AUC ) fraction , but not in the LDL fraction . GIK prevented the increase in ketone bodies after reperfusion ( -44 to -47 % AUC ) , but was without effect on lactate levels . CONCLUSIONS Mild hyperlipidaemia was only observed during early reperfusion ( before heparin reversal ) and the hyperinsulinaemic normoglycaemic clamp actually result ed in hypolipidaemia during the largest part of reperfusion after cardiac surgery BACKGROUND This study was undertaken to determine whether glucose-insulin-potassium ( GIK ) would improve myocardial performance and limit morbidity after coronary artery bypass grafting in diabetic patients . METHODS Forty consecutive coronary artery bypass grafting patients with medically treated diabetes mellitus were prospect ively r and omly assigned to either a GIK group ( n = 20 ; 500 mL D5W + 80 U regular insulin + 40 mEq KCl 30 mL/hour ) or a no-GIK group ( n = 20 ; D5W at 30 mL/hour ) . The GIK was begun at anesthetic induction and continued for 12 hours postoperatively . RESULTS Patients treated with GIK had higher postoperative cardiac indices ( 2.88 + /- 0.50 versus 2.20 + /- 0.39 L/minute per square meter ; p < 0.0001 ) , lower inotrope scores ( 0.40 + /- 0.68 versus 1.25 + /- 1.44 ; p = 0.05 ) , less weight gain ( 5.80 + /- 3.76 versus 13.85 + /- 6.52 pounds ; p < 0.0001 ) , and had shorter times of ventilator support ( 8.35 + /- 2.60 versus 13.45 + /- 7.33 hours ; p = 0.0128 ) . They had a significantly lower prevalence of atrial fibrillation ( 15 % versus 60 % ; p = 0.003 ) , and shorter hospital stays ( 6.70 + /- 1.52 versus 10.15 + /- 6.62 days ; p = 0.02 ) . CONCLUSIONS Substrate enhancement with GIK in diabetic patients improved myocardial performance and result ed in faster recovery after coronary artery bypass grafting Purpose A safe and effective insulin infusion algorithm that achieves rigorous intraoperative glycemic control in noncardiac surgery has yet to be formally characterized and evaluated . We therefore report the validation of the DeLit Trial insulin infusion algorithm . Methods Patients scheduled for major noncardiac surgery were r and omized to a target intraoperative blood glucose concentration of 4.4 - 6.1 mmoL·L−1 ( 80 - 110 mg·dL−1 ) intensive group or 10 - 11.1 mmoL·L−1 ( 180 - 200 mg·dL−1 ) conventional group . Glucose was managed with a dynamic intravenous insulin infusion algorithm . We compared the r and omized groups on glucose time-weighted average ( TWA ) , proportion of time spent within target , number of severe ( < 2.2 mmoL·L−1 or < 40 mg·dL−1 ) or moderate ( < 2.8 mmoL·L−1or < 50 mg·dL−1 ) hypoglycemic episodes , and within-patient variability in glucose concentrations expressed as st and ard deviation from the patient mean . Results One hundred eighty-seven patients were assigned to intensive glucose control , and 177 patients were assigned to conventional glucose control .  Median ( lower quartile value [ Q1 ] , upper quartile value [ Q3 ] ) of intraoperative TWA for the intensive vs conventional groups was 6 [ 5.6 , 6.7 ] mmoL·L−1vs 7.7 [ 6.9 , 9.2 ] mmoL·L−1 , respectively ; P < 0.001 . The intensive group spent 49 % ( 29 , 71 ) of the time within target , substantially more time than the conventional group spent either within the intensive target or within its own target ( both P < 0.001 ) . The intensive group had slightly lower within-patient glucose variability than the conventional group ( 0.9 [ 0.7 , 1.3 ] mmoL·L−1vs 1.3 [ 0.8 , 1.8 ] mmoL·L−1 , respectively ; P < 0.001 ) . Three patients had moderate hypoglycemia ( intensive group ) , but none experienced severe episodes . Conclusion Tight intraoperative glucose control in noncardiac surgery can be maintained successfully without serious hypoglycemic episodes . ( Clinical Trials.gov number , NCT00433251).RésuméObjectifNous ne disposons pas encore d’un algorithme de perfusion d’insuline formellement caractérisé et évalué , qui soit à la fois sécuritaire et efficace , et qui permette de maintenir un contrôle glycémique peropératoire rigoureux en chirurgie non cardiaque . C’est pourquoi nous rapportons la validation de notre algorithme de perfusion de l’insuline . MéthodeDes patients devant subir une chirurgie non cardiaque majeure ont été r and omisés à une concentration glycémique peropératoire cible de 4,4 - 6,1 mmoL·L−1 ( 80 - 110 mg·dL−1 ) dans le groupe intensif ou à une concentration de 10 - 11,1 mmoL·L−1 ( 180 - 200 mg·dL−1 ) dans le groupe conventionnel . La glycémie a été contrôlée à l’aide d’un algorithme dynamique de perfusion intraveineuse d’insuline . Nous avons comparé les groupes r and omisés en matière de moyenne pondérée dans le temps , de la proportion de temps passé à la concentration cible , du nombre d’épisodes d’hypoglycémie grave ( < 2,2 mmoL·L−1 ou < 40 mg·dL−1 ) ou modérée ( < 2,8 mmoL·L−1 ou < 50 mg·dL−1 ) , ainsi que de la variabilité chez un même patient des concentrations glycémiques , exprimée en tant qu’écart type de la moyenne du patient . RésultatsCent quatre-vingt-sept patients ont été attribués au groupe contrôle glycémique intensif , et 177 au groupe contrôle glycémique conventionnel . La médiane ( valeur du quartile inférieur [ Q1 ] , valeur du quartile supérieur [ Q3 ] ) de la moyenne pondérée dans le temps pour les groupes intensif vs conventionnel était de 6 ( 5,6 , 6,7 ) mmoL·L−1vs 7,7 ( 6,9 , 9,2 ) , respectivement ; P < 0,001 . Le groupe intensif a passé 49 % ( 29 , 71 ) du temps dans la zone cible , soit considérablement plus de temps que le groupe conventionnel n’a passé dans la zone cible intensive ou dans sa propre zone cible ( tous deux P < 0,001 ) . Le groupe intensif a présenté une variabilité chez un même patient légèrement plus basse que le groupe conventionnel ( 0,9 [ 0,7 , 1,3 ] mmoL·L−1vs 1,3 [ 0,8 , 1,8 ] mmoL·L−1 , respectivement ; P < 0,001 ) . Trois patients ont présenté une hypoglycémie modérée ( groupe intensif ) , mais aucun patient n’a manifesté d’épisode grave . Conclusion Un contrôle glycémique peropératoire rigoureux peut être maintenu en chirurgie non cardiaque sans épisode hypoglycémique grave . ( Numéro de Clinical Trials.gov , NCT00433251 ) Background There is increasing evidence that tight blood glucose ( BG ) control improves outcomes in critically ill adults . Children show similar hyperglycaemic responses to surgery or critical illness . However it is not known whether tight control will benefit children given maturational differences and different disease spectrum . Methods / Design The study is an r and omised open trial with two parallel groups to assess whether , for children undergoing intensive care in the UK aged ≤ 16 years who are ventilated , have an arterial line in-situ and are receiving vasoactive support following injury , major surgery or in association with critical illness in whom it is anticipated such treatment will be required to continue for at least 12 hours , tight control will increase the numbers of days alive and free of mechanical ventilation at 30 days , and lead to improvement in a range of complications associated with intensive care treatment and be cost effective . Children in the tight control group will receive insulin by intravenous infusion titrated to maintain BG between 4 and 7.0 mmol/l . Children in the control group will be treated according to a st and ard current approach to BG management . Children will be followed up to determine vital status and healthcare re sources usage between discharge and 12 months post-r and omisation . Information regarding overall health status , global neurological outcome , attention and behavioural status will be sought from a subgroup with traumatic brain injury (TBI).A difference of 2 days in the number of ventilator-free days within the first 30 days post-r and omisation is considered clinical ly important . Conservatively assuming a st and ard deviation of a week across both trial arms , a type I error of 1 % ( 2-sided test ) , and allowing for non-compliance , a total sample size of 1000 patients would have 90 % power to detect this difference . To detect effect differences between cardiac and non-cardiac patients , a target sample size of 1500 is required . An economic evaluation will assess whether the costs of achieving tight BG control are justified by subsequent reductions in hospitalisation costs . Discussion The relevance of tight glycaemic control in this population needs to be assessed formally before being accepted into st and ard practice .Trial Registration Current Controlled Trials IS RCT Objective : This study sought to determine whether aggressive glycemic control ( 90–120 mg/dL ) would result in more optimal clinical outcomes and less morbidity than moderate glycemic control ( 120–180 mg/dL ) in diabetic patients undergoing coronary artery bypass graft ( CABG ) surgery . Summary of Background Data : Maintaining serum glucose levels between 120 and 180 mg/dL with continuous insulin infusions decreases morbidity in diabetic patients undergoing CABG surgery . Studies in surgical patients requiring prolonged ventilation suggest that aggressive glycemic control ( < 120 mg/dL ) may improve survival ; however , its effect in diabetic CABG patients is unknown . Methods : Eighty-two diabetic patients undergoing CABG were prospect ively r and omized to aggressive glycemic control ( 90–120 mg/dL ) or moderate glycemic control ( 120–180 mg/dL ) using continuous intravenous insulin solutions ( 100 units regular insulin in 100 mL : normal saline ) beginning at the induction of anesthesia and continuing for 18 hours after CABG . Primary end points were the incidence of major adverse events ( major adverse events = 30-day mortality , myocardial infa rct ion , neurologic events , deep sternal infections , and atrial fibrillation ) , the level of serum glucose , and the incidence of hypoglycemic events . Results : There were no differences in the incidence of major adverse events between the groups ( 17 moderate vs 15 aggressive ; P = 0.91 ) . Pat 
    Output:
    
agent
None of the trials examined the effects of the interventions in terms of costs .
AUTHORS ' CONCLUSIONS The included trials did not demonstrate significant differences for most of the outcomes when targeting intensive perioperative glycaemic control compared with conventional glycaemic control in patients with diabetes mellitus .
However , posthoc analysis indicated that intensive glycaemic control was associated with an increased number of patients experiencing hypoglycaemic episodes .
***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: BACKGROUND Glucose-insulin-potassium ( GIK ) administration is advocated on the premise of preventing hyperglycaemia and hyperlipidaemia during reperfusion after cardiac interventions . Current research has focused on hyperglycaemia , largely ignoring lipids , or other substrates . The present study examines lipids and other substrates during and after on-pump coronary artery bypass grafting and how they are affected by a hyperinsulinaemic normoglycaemic clamp . METHODS Forty-four patients were r and omized to a control group ( n=21 ) or to a GIK group ( n=23 ) receiving a hyperinsulinaemic normoglycaemic clamp during 26 h.  Plasma levels of free fatty acid ( FFA ) , total and lipoprotein ( VLDL , HDL , and LDL)-triglycerides ( TG ) , ketone bodies , and lactate were determined . RESULTS In the control group , mean FFA peaked at 0.76 ( sem 0.05 ) mmol litre(-1 ) at early reperfusion and decreased to 0.3 - 0.5 mmol litre(-1 ) during the remaining part of the study . GIK decreased FFA levels to 0.38 ( 0.05 ) mmol litre(-1 ) at early reperfusion , and to low concentrations of 0.10 ( 0.01 ) mmol litre(-1 ) during the hyperinsulinaemic clamp . GIK reduced the area under the curve ( AUC ) for FFA by 75 % and for TG by 53 % . The reduction in total TG was reflected by a reduction in the VLDL ( -54 % AUC ) and HDL ( -42 % AUC ) fraction , but not in the LDL fraction . GIK prevented the increase in ketone bodies after reperfusion ( -44 to -47 % AUC ) , but was without effect on lactate levels . CONCLUSIONS Mild hyperlipidaemia was only observed during early reperfusion ( before heparin reversal ) and the hyperinsulinaemic normoglycaemic clamp actually result ed in hypolipidaemia during the largest part of reperfusion after cardiac surgery BACKGROUND This study was undertaken to determine whether glucose-insulin-potassium ( GIK ) would improve myocardial performance and limit morbidity after coronary artery bypass grafting in diabetic patients . METHODS Forty consecutive coronary artery bypass grafting patients with medically treated diabetes mellitus were prospect ively r and omly assigned to either a GIK group ( n = 20 ; 500 mL D5W + 80 U regular insulin + 40 mEq KCl 30 mL/hour ) or a no-GIK group ( n = 20 ; D5W at 30 mL/hour ) . The GIK was begun at anesthetic induction and continued for 12 hours postoperatively . RESULTS Patients treated with GIK had higher postoperative cardiac indices ( 2.88 + /- 0.50 versus 2.20 + /- 0.39 L/minute per square meter ; p < 0.0001 ) , lower inotrope scores ( 0.40 + /- 0.68 versus 1.25 + /- 1.44 ; p = 0.05 ) , less weight gain ( 5.80 + /- 3.76 versus 13.85 + /- 6.52 pounds ; p < 0.0001 ) , and had shorter times of ventilator support ( 8.35 + /- 2.60 versus 13.45 + /- 7.33 hours ; p = 0.0128 ) . They had a significantly lower prevalence of atrial fibrillation ( 15 % versus 60 % ; p = 0.003 ) , and shorter hospital stays ( 6.70 + /- 1.52 versus 10.15 + /- 6.62 days ; p = 0.02 ) . CONCLUSIONS Substrate enhancement with GIK in diabetic patients improved myocardial performance and result ed in faster recovery after coronary artery bypass grafting Purpose A safe and effective insulin infusion algorithm that achieves rigorous intraoperative glycemic control in noncardiac surgery has yet to be formally characterized and evaluated . We therefore report the validation of the DeLit Trial insulin infusion algorithm . Methods Patients scheduled for major noncardiac surgery were r and omized to a target intraoperative blood glucose concentration of 4.4 - 6.1 mmoL·L−1 ( 80 - 110 mg·dL−1 ) intensive group or 10 - 11.1 mmoL·L−1 ( 180 - 200 mg·dL−1 ) conventional group . Glucose was managed with a dynamic intravenous insulin infusion algorithm . We compared the r and omized groups on glucose time-weighted average ( TWA ) , proportion of time spent within target , number of severe ( < 2.2 mmoL·L−1 or < 40 mg·dL−1 ) or moderate ( < 2.8 mmoL·L−1or < 50 mg·dL−1 ) hypoglycemic episodes , and within-patient variability in glucose concentrations expressed as st and ard deviation from the patient mean . Results One hundred eighty-seven patients were assigned to intensive glucose control , and 177 patients were assigned to conventional glucose control .  Median ( lower quartile value [ Q1 ] , upper quartile value [ Q3 ] ) of intraoperative TWA for the intensive vs conventional groups was 6 [ 5.6 , 6.7 ] mmoL·L−1vs 7.7 [ 6.9 , 9.2 ] mmoL·L−1 , respectively ; P < 0.001 . The intensive group spent 49 % ( 29 , 71 ) of the time within target , substantially more time than the conventional group spent either within the intensive target or within its own target ( both P < 0.001 ) . The intensive group had slightly lower within-patient glucose variability than the conventional group ( 0.9 [ 0.7 , 1.3 ] mmoL·L−1vs 1.3 [ 0.8 , 1.8 ] mmoL·L−1 , respectively ; P < 0.001 ) . Three patients had moderate hypoglycemia ( intensive group ) , but none experienced severe episodes . Conclusion Tight intraoperative glucose control in noncardiac surgery can be maintained successfully without serious hypoglycemic episodes . ( Clinical Trials.gov number , NCT00433251).RésuméObjectifNous ne disposons pas encore d’un algorithme de perfusion d’insuline formellement caractérisé et évalué , qui soit à la fois sécuritaire et efficace , et qui permette de maintenir un contrôle glycémique peropératoire rigoureux en chirurgie non cardiaque . C’est pourquoi nous rapportons la validation de notre algorithme de perfusion de l’insuline . MéthodeDes patients devant subir une chirurgie non cardiaque majeure ont été r and omisés à une concentration glycémique peropératoire cible de 4,4 - 6,1 mmoL·L−1 ( 80 - 110 mg·dL−1 ) dans le groupe intensif ou à une concentration de 10 - 11,1 mmoL·L−1 ( 180 - 200 mg·dL−1 ) dans le groupe conventionnel . La glycémie a été contrôlée à l’aide d’un algorithme dynamique de perfusion intraveineuse d’insuline . Nous avons comparé les groupes r and omisés en matière de moyenne pondérée dans le temps , de la proportion de temps passé à la concentration cible , du nombre d’épisodes d’hypoglycémie grave ( < 2,2 mmoL·L−1 ou < 40 mg·dL−1 ) ou modérée ( < 2,8 mmoL·L−1 ou < 50 mg·dL−1 ) , ainsi que de la variabilité chez un même patient des concentrations glycémiques , exprimée en tant qu’écart type de la moyenne du patient . RésultatsCent quatre-vingt-sept patients ont été attribués au groupe contrôle glycémique intensif , et 177 au groupe contrôle glycémique conventionnel . La médiane ( valeur du quartile inférieur [ Q1 ] , valeur du quartile supérieur [ Q3 ] ) de la moyenne pondérée dans le temps pour les groupes intensif vs conventionnel était de 6 ( 5,6 , 6,7 ) mmoL·L−1vs 7,7 ( 6,9 , 9,2 ) , respectivement ; P < 0,001 . Le groupe intensif a passé 49 % ( 29 , 71 ) du temps dans la zone cible , soit considérablement plus de temps que le groupe conventionnel n’a passé dans la zone cible intensive ou dans sa propre zone cible ( tous deux P < 0,001 ) . Le groupe intensif a présenté une variabilité chez un même patient légèrement plus basse que le groupe conventionnel ( 0,9 [ 0,7 , 1,3 ] mmoL·L−1vs 1,3 [ 0,8 , 1,8 ] mmoL·L−1 , respectivement ; P < 0,001 ) . Trois patients ont présenté une hypoglycémie modérée ( groupe intensif ) , mais aucun patient n’a manifesté d’épisode grave . Conclusion Un contrôle glycémique peropératoire rigoureux peut être maintenu en chirurgie non cardiaque sans épisode hypoglycémique grave . ( Numéro de Clinical Trials.gov , NCT00433251 ) Background There is increasing evidence that tight blood glucose ( BG ) control improves outcomes in critically ill adults . Children show similar hyperglycaemic responses to surgery or critical illness . However it is not known whether tight control will benefit children given maturational differences and different disease spectrum . Methods / Design The study is an r and omised open trial with two parallel groups to assess whether , for children undergoing intensive care in the UK aged ≤ 16 years who are ventilated , have an arterial line in-situ and are receiving vasoactive support following injury , major surgery or in association with critical illness in whom it is anticipated such treatment will be required to continue for at least 12 hours , tight control will increase the numbers of days alive and free of mechanical ventilation at 30 days , and lead to improvement in a range of complications associated with intensive care treatment and be cost effective . Children in the tight control group will receive insulin by intravenous infusion titrated to maintain BG between 4 and 7.0 mmol/l . Children in the control group will be treated according to a st and ard current approach to BG management . Children will be followed up to determine vital status and healthcare re sources usage between discharge and 12 months post-r and omisation . Information regarding overall health status , global neurological outcome , attention and behavioural status will be sought from a subgroup with traumatic brain injury (TBI).A difference of 2 days in the number of ventilator-free days within the first 30 days post-r and omisation is considered clinical ly important . Conservatively assuming a st and ard deviation of a week across both trial arms , a type I error of 1 % ( 2-sided test ) , and allowing for non-compliance , a total sample size of 1000 patients would have 90 % power to detect this difference . To detect effect differences between cardiac and non-cardiac patients , a target sample size of 1500 is required . An economic evaluation will assess whether the costs of achieving tight BG control are justified by subsequent reductions in hospitalisation costs . Discussion The relevance of tight glycaemic control in this population needs to be assessed formally before being accepted into st and ard practice .Trial Registration Current Controlled Trials IS RCT Objective : This study sought to determine whether aggressive glycemic control ( 90–120 mg/dL ) would result in more optimal clinical outcomes and less morbidity than moderate glycemic control ( 120–180 mg/dL ) in diabetic patients undergoing coronary artery bypass graft ( CABG ) surgery . Summary of Background Data : Maintaining serum glucose levels between 120 and 180 mg/dL with continuous insulin infusions decreases morbidity in diabetic patients undergoing CABG surgery . Studies in surgical patients requiring prolonged ventilation suggest that aggressive glycemic control ( < 120 mg/dL ) may improve survival ; however , its effect in diabetic CABG patients is unknown . Methods : Eighty-two diabetic patients undergoing CABG were prospect ively r and omized to aggressive glycemic control ( 90–120 mg/dL ) or moderate glycemic control ( 120–180 mg/dL ) using continuous intravenous insulin solutions ( 100 units regular insulin in 100 mL : normal saline ) beginning at the induction of anesthesia and continuing for 18 hours after CABG . Primary end points were the incidence of major adverse events ( major adverse events = 30-day mortality , myocardial infa rct ion , neurologic events , deep sternal infections , and atrial fibrillation ) , the level of serum glucose , and the incidence of hypoglycemic events . Results : There were no differences in the incidence of major adverse events between the groups ( 17 moderate vs 15 aggressive ; P = 0.91 ) . Pat 
    Output:
    