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: The outcome of coronary artery bypass grafting ( CABG )  in diabetic patients has traditionally been worse than in non-diabetic patients . Recent studies have suggested an improvement in outcome in diabetic patients undergoing contemporary CABG .  However , the direct impact of diabetes on mortality and morbidities following CABG remains unclear . We retrospectively analyzed prospect ively collected data of 2725 CABG patients from January 1998 to December 2005 : one thous and and eighty-five ( 40 % ) diabetics and 1640 ( 60 % ) non-diabetics [ mean age 65+/-11 years , 1882 ( 69 % ) male ] . Subgroup analysis was performed for two study periods ( 1998 - 2002 vs. 2003 - 2005 ) . The overall hospital mortality was 1.8 % [ n=50 ; diabetics : 2.4 % , non-diabetics : 1.5 % ( P=0.07 ) ] . The mortality rate among diabetics decreased from 3.1 % in 1998 - 2002 to 1.0 % in 2003 - 2005 ( P=0.021 ) . Diabetes was not an independent predictor of hospital mortality but predicted the occurrence of deep sternal wound infection ( OR=3.77 ) . Diabetes significantly decreased long-term survival [ 1-year and 5-year survival 94.7+/-0.7 % and 81.9+/-1.4 % for diabetic vs. 95.4+/-0.5 % and 85.9+/-1.0 % for non-diabetic patients ( P=0.01 ) ] . Excellent results following contemporary CABG can be expected in diabetics with a similar mortality compared to non-diabetics . Therefore , our data suggest that diabetes may , in fact , not be a risk factor for adverse outcome following CABG . However , long-term survival in diabetics remains significantly inferior compared to non-diabetics To determine the risk of nephrotoxicity induced by the infusion of radiographic contrast material , we undertook a prospect i ve study of consecutive patients undergoing radiographic procedures with intravascular contrast material . There were three study groups : patients with diabetes mellitus and normal renal function ( n = 85 ) , patients with preexisting renal insufficiency ( serum creatinine level , greater than or equal to 150 mumol per liter ) without diabetes ( n = 101 ) , and patients with both diabetes and renal insufficiency ( n = 34 ) . The control group consisted of patients undergoing CT scanning or abdominal imaging procedures without the infusion of contrast material who had diabetes mellitus ( n = 59 ) , preexisting renal insufficiency ( n = 145 ) , or both ( n = 64 ) . Clinical ly important acute renal failure ( defined as an increase of greater than 50 percent in the serum creatinine level ) attributable to the contrast material did not occur in nondiabetic patients with preexisting renal insufficiency or in diabetics with normal renal function . The incidence of clinical ly important contrast-induced renal failure among the diabetic patients with preexisting renal insufficiency was 8.8 percent ( 95 percent confidence interval , 1.9 to 23.7 percent ) , as compared with 1.6 percent for the controls . The incidence of acute renal insufficiency , more broadly defined as an increase of greater than 25 percent in the serum creatinine level after the infusion of contrast material , was 11.8 percent among all patients with preexisting renal insufficiency . After the exclusion of patients whose acute renal insufficiency could be attributed to other causes , the incidence was 7.0 percent ( 95 percent confidence interval , 3.2 to 12.8 percent ) , as compared with 1.5 percent in the control group . The risk of acute renal insufficiency attributable to the contrast material was therefore 5.5 percent , and the relative risk associated with the infusion of contrast material was 4.7 . These rates were similar whether the osmolarity of the contrast material was high or low . We conclude that there is little risk of clinical ly important nephrotoxicity attributable to contrast material for patients with diabetes and normal renal function or for nondiabetic patients with preexisting renal insufficiency . The risk for those with both diabetes and preexisting renal insufficiency is about 9 percent , which is lower than previously reported BACKGROUND We prospect ively analyzed the postoperative morbidity , mortality rate , and risk factors in 605 patients who underwent thoracotomy for bronchogenic carcinoma . METHODS Patients were categorized by postsurgical tumor stage : I , 287 patients ( 47.4 % ) ; II , 49 patients ( 8.1 % ) ; IIIA , 154 patients ( 25.5 % ) ; IIIB , 80 patients ( 13.2 % ) ; IV , 16 patients ( 2.7 % ) ; unavailable , 19 patients ( 3.1 % ) . Two hundred ninety-four patients ( 48.6 % ) underwent lobectomy  , 172 ( 28.4 % )  pneumonectomy  , 20 ( 3.3 % ) bilobectomy , 29 ( 4.8 % ) segmentectomy , 27 ( 4.5 % ) wedge resection , and 63 ( 10.4 % ) exploratory thoracotomy . The importance of the factors that influence the morbidity and mortality rates was calculated from their relative risks . Univariate and multivariate methods for a logistic regression model were used for this analysis . RESULTS Postoperative complications developed in 196 patients ( 32.4 % ) ; there were 165 ( 27.3 % ) cases of operation-related complications and 152 ( 25.1 % ) cases of respiratory and cardiovascular complications . The morbidity rate was highest in patients with preexisting vascular disease ( 50.9 % ; odds ratio [ OR ] , 2.20 ) or insulin-dependent diabetes mellitus ( 52.4 % ; OR , 2.77 ) and in patients who underwent pneumonectomy ( 40.1 % ; OR , 1.82 ) . Forty patients ( 6.6 % ) died postoperatively , most commonly of respiratory failure ( 67.5 % ) . The mortality rate was highest in patients with postoperative morbidity ( OR , 31.9 ) or vascular disease ( 15.8 % ; OR , 2.83 ) and in patients who underwent pneumonectomy ( 13.4 % ; OR , 4.9 ) . CONCLUSIONS Postoperative complications are more likely to develop in patients with peripheral vascular disease or insulin-dependent diabetes mellitus , or both . Postoperative mortality was found to be significantly higher in patients with vascular disease and those who underwent pneumonectomy BACKGROUND This study sought to analyze the morbidity and mortality rates after  radical gastrectomy for carcinoma , since the operation has been criticized as too morbid for the benefits it may provide . STUDY DESIGN A prospect i ve study of 474 patients who underwent radical gastrectomy  was conducted . RESULTS The overall morbidity and mortality rates were 20.1 and 3.0 percent , respectively . The morbidity and mortality rates fell significantly from 27.0 to 15.7 percent ( p = 0.003 ) and 5.5 to 1.1 percent ( p < 0.001 ) , respectively , after the first 200 cases . By logistic regression analysis , it was found that male gender , combined organ(s ) resection , extended lymphadenectomy , respiratory system disease , and tumor location were significantly related to postoperative morbidity . In regard to the extent of lymphadenectomy , relative to R2 resection ( n = 102 ) , the odds ratio for morbidity after R3 resection ( n = 217 ) was 2.13 , and for R4 resection ( n = 155 ) it was 3.12 . Age older than 65 years , total gastrectomy , combined organ(s ) resection , and respiratory system disease were factors that negatively affected operative mortality . CONCLUSIONS These observations suggested that radical gastrectomy can be performed with an acceptable risk of morbidity and mortality in a general hospital OBJECTIVE To analyze the  morbidity and mortality after radical and palliative pancreatic cancer surgery in Norway , especially the risk factors . SUMMARY BACKGROUND DATA A prospect i ve multicenter study between 1984 - 1987 including only histologically or cytologically verified adenocarcinoma of the pancreas ( N = 442 ) or the papilla of Vater ( N = 30 ) ; 84 patients ( 19 % ) with pancreatic carcinoma and 24 patients ( 80 % ) with papilla carcinoma underwent radical operations .  A palliative procedure was performed in 252 patients ( 53 % ) . METHODS Clinical data , surgical procedures and the following morbidity and mortality were recorded on st and ardized forms . The risk factors were analyzed by a logistic multiple regression model . RESULTS The morbidity , reoperation , and mortality rates were 43 , 18 , and 11 % after radical surgery and 23 , 4 , and 14 % after palliative surgery .  Karnofsky 's index was the sole independent risk factor for death after radical surgery .  Splenectomy , age , and TNM stage influenced morbidity . Diabetes , Karnofsky 's index , and liver metastases were risk factors in palliative surgery . CONCLUSIONS The morbidity and mortality risks were comparable between total pancreatectomy and a Whipple 's procedure and between biliary and a double bypass . Preoperative biliary drainage had no impact on the risks and may be ab and oned . High age is a relative and a low Karnofsky 's index an absolute contraindication for radical surgery . Nonsurgical palliation of jaundice should be considered according to the presence of independent risk factors OBJECTIVE Although hyperglycemia is hypothesized to increase the short-term risk of infection , this hypothesis has not been well tested in a clinical setting . This study was design ed to assess the relationship of perioperative glycemic control to the subsequent risk of infectious complications . RESEARCH DESIGN AND METHODS A total of 411 adults with diabetes who underwent coronary artery surgery from 1990 to 1995 in the cardiac surgery service of an urban university hospital were included in a nonconcurrent prospect i ve cohort study based on chart review . Perioperative glycemic control was characterized by the mean of six capillary glucose measurements taken during the 36-h interval following surgery . The major outcomes studied were infections of leg and chest wounds , pneumonia , and urinary tract infections . RESULTS Mean postoperative glucose levels ranged from 121 to 352 mg/dl and were divided into quartiles : quartile 1 ( 121 - 206 mg/dl ) , quartile 2 ( 207 - 229 mg/dl ) , quartile 3 ( 230 - 252 mg/dl ) , and quartile 4 ( 253352 mg/dl ) . After simultaneous adjustment for age , sex , race , underlying comorbidity , acute severity of illness , and the length of the stay in the surgical intensive care unit , patients with higher mean capillary glucose readings were at increased risk of developing infections . Compared with people in the lowest quartile of postoperative glucose , those in quartiles 2 ( relative odds of infection [ 95 % CI ] = 1.17 [ 0.57 - 2.40 ] ) , 3 ( 1.86 [ 0.94 - 3.68 ] ) , and 4 ( 1.78 [ 0.86 - 3.47 ] ) were at progressively higher risk for infection ( P = 0.05 for trend ) . CONCLUSIONS In patients with diabetes who undergo coronary artery surgery , postoperative hyperglycemia is an independent predictor of short-term infectious complications . Physicians should consider a glucose concentration target of < or = 200 mg/dl to reduce the risk of infection Diabetes is associated with alterations in liver metabolism and immune response that may influence post-operative recovery and long-term survival after hepatectomy for cancer . Patients with type I or type II diabetes mellitus su bmi tted to a potentially curative hepatic resection for metastatic colorectal cancer were identified from the prospect i ve data base , and compared with patients with hepatic colorectal metastases su bmi tted to resection during the same time interval , but without diabetes mellitus . Data on operative morbidity and mortality and long-term survival were analyzed . Between December 1990 and July 1999 , a total of 727 patients underwent hepatic resection , 61 of whom ( 8.1 % ) had type I and type II diabetes mellitus .  Operative mortality in the diabetic patients was significantly greater than in nondiabetic patients ( 8 % vs. 2 % , P < 0.02 ) . Among patients with diabetes mellitus , four of the five perioperative deaths were due to liver failure after major hepatic resection ( lobectomy or greater ) . All four of these 
    Output:
    
agent
Compared with their nondiabetic counterparts , cancer patients with preexisting diabetes are ∼50 % more likely to die after surgery .
***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: The outcome of coronary artery bypass grafting ( CABG )  in diabetic patients has traditionally been worse than in non-diabetic patients . Recent studies have suggested an improvement in outcome in diabetic patients undergoing contemporary CABG .  However , the direct impact of diabetes on mortality and morbidities following CABG remains unclear . We retrospectively analyzed prospect ively collected data of 2725 CABG patients from January 1998 to December 2005 : one thous and and eighty-five ( 40 % ) diabetics and 1640 ( 60 % ) non-diabetics [ mean age 65+/-11 years , 1882 ( 69 % ) male ] . Subgroup analysis was performed for two study periods ( 1998 - 2002 vs. 2003 - 2005 ) . The overall hospital mortality was 1.8 % [ n=50 ; diabetics : 2.4 % , non-diabetics : 1.5 % ( P=0.07 ) ] . The mortality rate among diabetics decreased from 3.1 % in 1998 - 2002 to 1.0 % in 2003 - 2005 ( P=0.021 ) . Diabetes was not an independent predictor of hospital mortality but predicted the occurrence of deep sternal wound infection ( OR=3.77 ) . Diabetes significantly decreased long-term survival [ 1-year and 5-year survival 94.7+/-0.7 % and 81.9+/-1.4 % for diabetic vs. 95.4+/-0.5 % and 85.9+/-1.0 % for non-diabetic patients ( P=0.01 ) ] . Excellent results following contemporary CABG can be expected in diabetics with a similar mortality compared to non-diabetics . Therefore , our data suggest that diabetes may , in fact , not be a risk factor for adverse outcome following CABG . However , long-term survival in diabetics remains significantly inferior compared to non-diabetics To determine the risk of nephrotoxicity induced by the infusion of radiographic contrast material , we undertook a prospect i ve study of consecutive patients undergoing radiographic procedures with intravascular contrast material . There were three study groups : patients with diabetes mellitus and normal renal function ( n = 85 ) , patients with preexisting renal insufficiency ( serum creatinine level , greater than or equal to 150 mumol per liter ) without diabetes ( n = 101 ) , and patients with both diabetes and renal insufficiency ( n = 34 ) . The control group consisted of patients undergoing CT scanning or abdominal imaging procedures without the infusion of contrast material who had diabetes mellitus ( n = 59 ) , preexisting renal insufficiency ( n = 145 ) , or both ( n = 64 ) . Clinical ly important acute renal failure ( defined as an increase of greater than 50 percent in the serum creatinine level ) attributable to the contrast material did not occur in nondiabetic patients with preexisting renal insufficiency or in diabetics with normal renal function . The incidence of clinical ly important contrast-induced renal failure among the diabetic patients with preexisting renal insufficiency was 8.8 percent ( 95 percent confidence interval , 1.9 to 23.7 percent ) , as compared with 1.6 percent for the controls . The incidence of acute renal insufficiency , more broadly defined as an increase of greater than 25 percent in the serum creatinine level after the infusion of contrast material , was 11.8 percent among all patients with preexisting renal insufficiency . After the exclusion of patients whose acute renal insufficiency could be attributed to other causes , the incidence was 7.0 percent ( 95 percent confidence interval , 3.2 to 12.8 percent ) , as compared with 1.5 percent in the control group . The risk of acute renal insufficiency attributable to the contrast material was therefore 5.5 percent , and the relative risk associated with the infusion of contrast material was 4.7 . These rates were similar whether the osmolarity of the contrast material was high or low . We conclude that there is little risk of clinical ly important nephrotoxicity attributable to contrast material for patients with diabetes and normal renal function or for nondiabetic patients with preexisting renal insufficiency . The risk for those with both diabetes and preexisting renal insufficiency is about 9 percent , which is lower than previously reported BACKGROUND We prospect ively analyzed the postoperative morbidity , mortality rate , and risk factors in 605 patients who underwent thoracotomy for bronchogenic carcinoma . METHODS Patients were categorized by postsurgical tumor stage : I , 287 patients ( 47.4 % ) ; II , 49 patients ( 8.1 % ) ; IIIA , 154 patients ( 25.5 % ) ; IIIB , 80 patients ( 13.2 % ) ; IV , 16 patients ( 2.7 % ) ; unavailable , 19 patients ( 3.1 % ) . Two hundred ninety-four patients ( 48.6 % ) underwent lobectomy  , 172 ( 28.4 % )  pneumonectomy  , 20 ( 3.3 % ) bilobectomy , 29 ( 4.8 % ) segmentectomy , 27 ( 4.5 % ) wedge resection , and 63 ( 10.4 % ) exploratory thoracotomy . The importance of the factors that influence the morbidity and mortality rates was calculated from their relative risks . Univariate and multivariate methods for a logistic regression model were used for this analysis . RESULTS Postoperative complications developed in 196 patients ( 32.4 % ) ; there were 165 ( 27.3 % ) cases of operation-related complications and 152 ( 25.1 % ) cases of respiratory and cardiovascular complications . The morbidity rate was highest in patients with preexisting vascular disease ( 50.9 % ; odds ratio [ OR ] , 2.20 ) or insulin-dependent diabetes mellitus ( 52.4 % ; OR , 2.77 ) and in patients who underwent pneumonectomy ( 40.1 % ; OR , 1.82 ) . Forty patients ( 6.6 % ) died postoperatively , most commonly of respiratory failure ( 67.5 % ) . The mortality rate was highest in patients with postoperative morbidity ( OR , 31.9 ) or vascular disease ( 15.8 % ; OR , 2.83 ) and in patients who underwent pneumonectomy ( 13.4 % ; OR , 4.9 ) . CONCLUSIONS Postoperative complications are more likely to develop in patients with peripheral vascular disease or insulin-dependent diabetes mellitus , or both . Postoperative mortality was found to be significantly higher in patients with vascular disease and those who underwent pneumonectomy BACKGROUND This study sought to analyze the morbidity and mortality rates after  radical gastrectomy for carcinoma , since the operation has been criticized as too morbid for the benefits it may provide . STUDY DESIGN A prospect i ve study of 474 patients who underwent radical gastrectomy  was conducted . RESULTS The overall morbidity and mortality rates were 20.1 and 3.0 percent , respectively . The morbidity and mortality rates fell significantly from 27.0 to 15.7 percent ( p = 0.003 ) and 5.5 to 1.1 percent ( p < 0.001 ) , respectively , after the first 200 cases . By logistic regression analysis , it was found that male gender , combined organ(s ) resection , extended lymphadenectomy , respiratory system disease , and tumor location were significantly related to postoperative morbidity . In regard to the extent of lymphadenectomy , relative to R2 resection ( n = 102 ) , the odds ratio for morbidity after R3 resection ( n = 217 ) was 2.13 , and for R4 resection ( n = 155 ) it was 3.12 . Age older than 65 years , total gastrectomy , combined organ(s ) resection , and respiratory system disease were factors that negatively affected operative mortality . CONCLUSIONS These observations suggested that radical gastrectomy can be performed with an acceptable risk of morbidity and mortality in a general hospital OBJECTIVE To analyze the  morbidity and mortality after radical and palliative pancreatic cancer surgery in Norway , especially the risk factors . SUMMARY BACKGROUND DATA A prospect i ve multicenter study between 1984 - 1987 including only histologically or cytologically verified adenocarcinoma of the pancreas ( N = 442 ) or the papilla of Vater ( N = 30 ) ; 84 patients ( 19 % ) with pancreatic carcinoma and 24 patients ( 80 % ) with papilla carcinoma underwent radical operations .  A palliative procedure was performed in 252 patients ( 53 % ) . METHODS Clinical data , surgical procedures and the following morbidity and mortality were recorded on st and ardized forms . The risk factors were analyzed by a logistic multiple regression model . RESULTS The morbidity , reoperation , and mortality rates were 43 , 18 , and 11 % after radical surgery and 23 , 4 , and 14 % after palliative surgery .  Karnofsky 's index was the sole independent risk factor for death after radical surgery .  Splenectomy , age , and TNM stage influenced morbidity . Diabetes , Karnofsky 's index , and liver metastases were risk factors in palliative surgery . CONCLUSIONS The morbidity and mortality risks were comparable between total pancreatectomy and a Whipple 's procedure and between biliary and a double bypass . Preoperative biliary drainage had no impact on the risks and may be ab and oned . High age is a relative and a low Karnofsky 's index an absolute contraindication for radical surgery . Nonsurgical palliation of jaundice should be considered according to the presence of independent risk factors OBJECTIVE Although hyperglycemia is hypothesized to increase the short-term risk of infection , this hypothesis has not been well tested in a clinical setting . This study was design ed to assess the relationship of perioperative glycemic control to the subsequent risk of infectious complications . RESEARCH DESIGN AND METHODS A total of 411 adults with diabetes who underwent coronary artery surgery from 1990 to 1995 in the cardiac surgery service of an urban university hospital were included in a nonconcurrent prospect i ve cohort study based on chart review . Perioperative glycemic control was characterized by the mean of six capillary glucose measurements taken during the 36-h interval following surgery . The major outcomes studied were infections of leg and chest wounds , pneumonia , and urinary tract infections . RESULTS Mean postoperative glucose levels ranged from 121 to 352 mg/dl and were divided into quartiles : quartile 1 ( 121 - 206 mg/dl ) , quartile 2 ( 207 - 229 mg/dl ) , quartile 3 ( 230 - 252 mg/dl ) , and quartile 4 ( 253352 mg/dl ) . After simultaneous adjustment for age , sex , race , underlying comorbidity , acute severity of illness , and the length of the stay in the surgical intensive care unit , patients with higher mean capillary glucose readings were at increased risk of developing infections . Compared with people in the lowest quartile of postoperative glucose , those in quartiles 2 ( relative odds of infection [ 95 % CI ] = 1.17 [ 0.57 - 2.40 ] ) , 3 ( 1.86 [ 0.94 - 3.68 ] ) , and 4 ( 1.78 [ 0.86 - 3.47 ] ) were at progressively higher risk for infection ( P = 0.05 for trend ) . CONCLUSIONS In patients with diabetes who undergo coronary artery surgery , postoperative hyperglycemia is an independent predictor of short-term infectious complications . Physicians should consider a glucose concentration target of < or = 200 mg/dl to reduce the risk of infection Diabetes is associated with alterations in liver metabolism and immune response that may influence post-operative recovery and long-term survival after hepatectomy for cancer . Patients with type I or type II diabetes mellitus su bmi tted to a potentially curative hepatic resection for metastatic colorectal cancer were identified from the prospect i ve data base , and compared with patients with hepatic colorectal metastases su bmi tted to resection during the same time interval , but without diabetes mellitus . Data on operative morbidity and mortality and long-term survival were analyzed . Between December 1990 and July 1999 , a total of 727 patients underwent hepatic resection , 61 of whom ( 8.1 % ) had type I and type II diabetes mellitus .  Operative mortality in the diabetic patients was significantly greater than in nondiabetic patients ( 8 % vs. 2 % , P < 0.02 ) . Among patients with diabetes mellitus , four of the five perioperative deaths were due to liver failure after major hepatic resection ( lobectomy or greater ) . All four of these 
    Output:
    