***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 
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    ***EXAMPLES*** 
    Input: BACKGROUND Remote ischaemic preconditioning attenuates cardiac injury at elective surgery and angioplasty . We tested the hypothesis that remote ischaemic conditioning during evolving ST-elevation myocardial infa rct ion , and done before primary percutaneous coronary intervention , increases myocardial salvage . METHODS 333 consecutive adult patients with a suspected first acute myocardial infa rct ion were r and omly assigned in a 1:1 ratio by computerised block r and omisation to receive  primary percutaneous coronary intervention with ( n=166 patients ) versus without ( n=167 ) remote conditioning ( intermittent arm ischaemia through four cycles of 5-min inflation and 5-min deflation of a blood-pressure cuff ) . Allocation was concealed with opaque sealed envelopes . Patients received remote conditioning during transport to hospital , and primary percutaneous coronary intervention in hospital . The primary endpoint was myocardial salvage index at 30 days after primary percutaneous coronary intervention , measured by myocardial perfusion imaging as the proportion of the area at risk salvaged by treatment ; analysis was per protocol . This study is registered with Clinical Trials.gov , number NCT00435266 . FINDINGS 82 patients were excluded on arrival at hospital because they did not meet inclusion criteria , 32 were lost to follow-up , and 77 did not complete the follow-up with data for salvage index . Median salvage index was 0.75 ( IQR 0.50 - 0.93 , n=73 ) in the remote conditioning group versus 0.55 ( 0.35 - 0.88 , n=69 ) in the control group , with median difference of 0.10 ( 95 % CI 0.01 - 0.22 ; p=0.0333 ) ; mean salvage index was 0.69 ( SD 0.27 ) versus 0.57 ( 0.26 ) , with mean difference of 0.12 ( 95 % CI 0.01 - 0.21 ; p=0.0333 ) . Major adverse coronary events were death ( n=3 per group ) , reinfa rct ion ( n=1 per group ) , and heart failure ( n=3 per group ) . INTERPRETATION Remote ischaemic conditioning before hospital admission increases myocardial salvage , and has a favourable safety profile . Our findings merit a larger trial to establish the effect of remote conditioning on clinical outcomes . FUNDING Fondation Leducq Background One or more brief episodes of coronary artery occlusion protect or “ precondition ” the myocardium perfused by that artery from a subsequent episode of sustained ischemia . We sought to determine whether ischemic preconditioning protects only those myocytes subjected to brief coronary occlusion or whether brief occlusions in one vascular bed also limit infa rct size and for attenuate contractile dysfunction in remote virgin myocardium subjected to subsequent sustained coronary occlusion . Methods and Results In the preliminary limb of the study , six anesthetized dogs underwent four episodes of 5-minute circumflex branch occlusion plus 5-minute reperfusion , followed by 1 hour of sustained left anterior descending coronary artery occlusion and 4.5 hours of reflow . Subendocardial blood flow during left anterior descending coronary artery occlusion ( measured by injection of radiolabeled microspheres ) was 0.07±0.03 mL. min-1 . g tissue-1 , similar to the value of 0.07±0.02 mL. min-1 . g-1 observed in a group of eight concurrent control dogs . However , infa rct size ( assessed by triphenyltetrazolium staining ) in the circumflex preconditioned group averaged 4±1 % of the myocardium at risk , significantly less ( p<0.05 ) than the value of 13 + 4 % observed in the concurrent controls . An additional 18 dogs were then r and omized to undergo either four episodes of circumflex branch occlusion ( n=8 ) or no intervention ( n=10 ) before 1 hour of left anterior descending coronary artery occlusion and 4.5 hours of reflow . Subendocardial blood flow averaged 0.08±0.02 versus 0.08±0.03 mL. min-1 . g-1 in the control versus circumflex preconditioned groups , yet infa rct size was significantly smaller in circumflex preconditioned dogs than in the controls ( 6±2 % versus 16±5 % of the risk region ; p<0.05 ) . At 4.5 hours following reperfusion , segment shortening in the left anterior descending coronary artery bed ( assessed by sonomicrometry ) averaged -21 + 19%o of baseline in control animals versus 13±12 % of baseline in the preconditioned group ( p = NS ) . Circumflex preconditioning did not , however , have an independent beneficial effect on contractile function : Regression analysis revealed that the trend toward improved function in circumflex preconditioned dogs reflected the smaller infa rct sizes in this group . Conclusions Brief episodes of ischemia in one vascular bed protect remote , virgin myocardium from subsequent sustained coronary artery occlusion in this canine model . These data imply that preconditioning may be mediated by factor(s ) activated , produced , or transported throughout the heart during brief ischemia/reperfusion Background — Myocardial and renal injury commonly contribute to perioperative morbidity and mortality after abdominal aortic aneurysm repair .  Remote ischemic preconditioning ( RIPC ) is a phenomenon whereby brief periods of ischemia followed by reperfusion in one organ provide systemic protection from prolonged ischemia . To investigate whether remote preconditioning reduces the incidence of myocardial and renal injury in patients undergoing elective open abdominal aortic aneurysm repair , we performed a r and omized trial . Method and Results — Eighty-two patients were r and omized to abdominal aortic aneurysm repair with RIPC or conventional abdominal aortic aneurysm repair ( control ) . Two cycles of intermittent crossclamping of the common iliac artery with 10 minutes ischemia followed by 10 minutes reperfusion served as the RIPC stimulus .  Myocardial injury was assessed by cardiac troponin I ( > 0.40 ng/mL ) , myocardial infa rct ion by the American College of Cardiology/American Heart Association definition and renal injury by serum creatinine ( > 177 & mgr;mol/L ) according to American Heart Association guidelines for risk stratification in major vascular surgery . The groups were well matched for baseline characteristics . RIPC reduced the incidence of myocardial injury by 27 % ( 39 % versus 12 % [ 95 % CI : 8.8 % to 45 % ] ; P=0.005 ) , myocardial infa rct ion by 22 % ( 27 % versus 5 % [ 95 % CI : 7.3 % to 38 % ] ; P=0.006 ) , and renal impairment by 23 % ( 30 % versus 7 % ; [ 95 % CI : 6.4 to 39 ] ; P=0.009 ) . Multivariable analysis revealed the protective effect of RIPC on myocardial injury ( OR : 0.22 , 95 % CI : 0.07 to 0.67 ; P=0.008 ) , myocardial infa rct ion ( OR : 0.18 , 95 % CI : 0.04 to 0.75 ; P=0.006 ) and renal impairment were independent of other covariables . Conclusions — In patients undergoing elective open abdominal aortic aneurysm repair , RIPC reduces the incidence of postoperative myocardial injury , myocardial infa rct ion , and renal impairment Background Novel treatment strategies are required to reduce the development of acute kidney injury ( AKI ) in patients undergoing cardiac surgery . In this respect , remote ischemic preconditioning ( RIPC ) , a phenomenon in which transient nonlethal ischemia applied to an organ or tissue protects another organ or tissue from subsequent lethal ischemic injury , is a potential renoprotective strategy . Study Design Secondary analysis of 2 r and omized trials . Setting & Participants 78 consenting selected nondiabetic patients in a university teaching hospital undergoing elective coronary artery bypass graft ( CABG ) surgery recruited to 2 previously reported r and omized studies . Intervention RIPC consisted of three 5-minute cycles of right forearm ischemia , induced by inflating a blood pressure cuff on the upper arm to 200 mm Hg , with an intervening 5 minutes of reperfusion , during which time the cuff was deflated . The control consisted of placing an uninflated cuff on the arm for 30 minutes . Outcomes AKI measured using Acute Kidney Injury Network ( AKIN ) criteria , duration of hospital stay , in-hospital and 30-day mortality . Results Numbers of participants with AKI stages 1 , 2 , and 3 were 1 ( 3 % ) , 3 ( 8 % ) , and 0 in the intervention group compared with 10 ( 25 % ) , 0 , and 0 in the control group , respectively ( P = 0.005 ) . The decrease in AKI was independent of the effect of concomitant aortic valve replacement and cross-clamp times , which were distributed unevenly between the 2 groups . Limitations Retrospective analysis of data . More patients in the RIPC group underwent concomitant aortic valve replacement with CABG ; although we have corrected statistically for this imbalance , it remains an important confounding variable . Conclusions RIPC induced using transient forearm ischemia decreased the incidence of AKI in nondiabetic patients undergoing elective CABG surgery in this retrospective analysis . A large prospect i ve clinical trial is required to study this effect and clinical outcomes in patients undergoing cardiac surgery Background Remote ischemic preconditioning ( RIPC ) may protect the spinal cord from ischemic injury . This r and omized clinical trial was design ed to assess whether a large clinical trial testing the effect of RIPC on neurologic outcome in patients undergoing spine surgery is warranted . This trial was registered with Clinical Trials.gov , number NCT00778323 . Methods Forty adult cervical spondylotic myelopathy patients undergoing elective decompression surgery were r and omly assigned to either the RIPC group ( n=20 ) or the control group ( n=20 ) . Limb RIPC consisted of three 5-minutes cycles of upper right limb ischemia with intervening 5-minute periods of reperfusion .  Neuron-specific enolase and S-100B levels were measured in serum at set time points . Median nerve somatosensory-evoked potentials ( SEPs ) were also recorded . Neurologic recovery rate was evaluated using a Japanese Orthopaedic Association scale . Results RIPC significantly reduced serum S-100B release at 6 hours and 1 day after surgery , and reduced neuron-specific enolase release at 6 hours , and then at 1 , 3 , and 5 days after surgery . No differences were observed in SEP measurements or the incidence of SEP changes during surgery between the control and RIPC groups . Recovery rate at 7 days , and at 1 and 3 months after surgery was higher in the RIPC group than in the control group ( P<0.05 ) . Conclusions Our results for markers of neuronal ischemic injury and rate of recovery suggest that a clinical trial with sufficient statistical power to detect an effect of RIPC on the incidence of neurologic complications ( paresis , palsy , etc ) due to spinal cord ischemia-reperfusion injury after spine surgery Background — We assessed whether remote ischemic preconditioning ( RIPC ) improves myocardial , renal , and lung protection  after on-pump coronary surgery . Methods and Results — This was a single-center , prospect i ve , r and omized ( 1:1 ) , placebo-controlled trial . Patients , investigators , anesthetists , surgeons , and critical care teams were blinded to group allocation . Subjects received RIPC ( or placebo ) stimuli ( ×3 upper limb ( or dummy arm ) , 5-minute cycles of 200 mm Hg cuff inflation/deflation ) before aortic clamping . Anesthesia , perfusion , cardioplegia , and surgical techniques were st and ardized . The primary end point was 48-hour area under the curve ( AUC ) troponin T ( cTnT ) release . Secondary end points were 6-hour and peak cTnT , ECG changes , cardiac index , inotrope and vasoconstrictor use , renal dysfunction , and lung injury . Hospital survival was 99.4 % . Comparing placebo and RIPC , median ( interquartile range ) AUC 48-hour cTnT ( ng/mL−1/48 h−1 ) ; 28 ( 19 , 39 ) versus 30 ( 22 , 38 ) , 6-hour cTnT ( ng/mL−1 ) ; 0.93(0.59 , 1.35 ) versus 1.01(0.72 , 1.43 ) , peak cTnT ( ng/mL−1 ) ; 1.02 ( 0.74 , 1.44 ) versus 1.04 ( 0.78 , 1.51 ) , de novo left bundle-branch block ( 4 % versus 0 % ) and Q waves ( 5.3 % versus 5. 
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Conclusion There is no evidence that remote ischemic conditioning  reduces mortality associated with ischemic events ; nor does it reduce major adverse cardiovascular events .
However , remote ischemic conditioning did reduce the incidence of peri-procedural myocardial infa rct ions , as well as the release of troponin