Randomized controlled trial of the effect of hyperinsulinemic normoglycemia during liver resection on postoperative hepatic function and surgical site infection
Bibliographic record
Abstract
Background: While avoidance of preoperative fasting followed by hyperinsulinemic-normoglycemic clamp (HNC) reduced postoperative hepatic dysfunction and surgical site infection (SSI), the effect of HNC restricted to the intraoperative period is unknown. This study examined whether HNC restricted to the intraoperative period has similar effects in patients undergoing elective liver resections. Methods: This study is a post hoc exploratory analysis of a randomized-controlled trial in patients undergoing hepatobiliary surgery and receiving the HNC as a potential preventative intervention to reduce infectious morbidity postoperatively. Patients (>18 years old) undergoing elective transabdominal resection of liver malignancy were enrolled. We implemented the random allocation by labelling cards. Consenting patients were randomly assigned to receive the HNC during surgery or standard metabolic care. The HNC was initiated by insulin (2 mU/kg/min) followed by 20% dextrose infusion titrated to keep blood glucose between 4.0 and 6.0 mmol/L until the end of surgery. In the control group, glycemia >10.0 mmol/L prompted insulin treatment according to a standardized sliding scale. The primary outcome was hepatic function on postoperative day (POD) one, assessed by Schindl score. Secondary outcome was the incidence of SSIs within 30 days after surgery. The Schindl score was analyzed by Mann-Whitney U test and the incidence of SSIs was analyzed by Fisher's exact test. Two-sided P values <0.05 were considered statistically significant. Results: 31%, P=0.01). Conclusions: The HNC restricted to the intraoperative period did not improve postoperative hepatic function but reduced SSIs. Preoperative carbohydrate loading may contribute to the preservation of hepatic function. Trial Registration: ClinicalTrials.gov NCT01528189.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.008 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.006 | 0.003 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.008 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".