The effect of perioperative insulin therapy on patients undergoing major liver resections
Bibliographic record
Abstract
Tissue injury related to liver surgery stimulates the release of stress hormones and proinflammatory cytokines to produce the necessary elements needed for healing. An exaggerated stress response compounded by preoperative fasting limits the liver's capacity to regenerate by depleting its energy stores. This change in metabolism leads to an insulin resistant state in the patient and associated hyperglycaemia. Dextrose supplementation coupled with intravenous insulin given perioperatively affords superior surgical outcomes through preservation of liver glycogen and strict glycaemia control.The goal of this research was to investigate the benefits of a metabolic support protocol involving carbohydrate loading and insulin infusion provided by a hyperinsulinemic normoglycaemic clamp (HNC), for patients undergoing hepatic resection. Studies were performed in the context of a randomized-controlled clinical trial registered at clinicaltrial.gov NCT00774098. Initially, 5 patients including 1 with diabetes mellitus were given the HNC protocol while undergoing a major hepatectomy. This feasibility study helped fine-tune the protocol towards improving its safety and reproducibility, and prompted expansion and randomization of the trial to include sixty patients. The goal of the expanded trial was to study the benefits of the protocol in augmenting liver glycogen and reducing postoperative complications. The patients were randomly assigned to either intervention or control groups. Intervention patients received a 24-hour oral carbohydrate-load, followed by an IV dextrose infusion (2 mg/kg/min) in the 24 hours leading to surgery, followed by insulin therapy given intra- and postoperatively. Controls adhered to routine management. Blood and tissue samples were taken at various time points for monitoring liver glycogen content and function. In the final stage of the project a subset of patients was selected for genetic expression testing. Blood and liver tissue samples were analyzed to identify specific inflammatory, metabolic and cell cycles pathways stimulated by the protocol.Carbohydrate loading combined with intra- and postoperative use of the HNC protocol augmented liver glycogen and reduced postoperative complications. Diabetic and nondiabetic patients alike benefited from this therapy.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.002 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
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 teacher head, 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".