***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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    Input: OBJECTIVES This study sought to evaluate whether remote ischemic post-conditioning ( RIPC ) could reduce enzymatic infa rct size in patients with anterior ST-segment elevation myocardial infa rct ion undergoing primary percutaneous coronary intervention ( pPCI ) . BACKGROUND Myocardial reperfusion injury may attenuate the benefit of pPCI . In animal models , RIPC mitigates myocardial reperfusion injury . METHODS One hundred patients with anterior ST-segment elevation myocardial infa rct ion and occluded left anterior descending artery were r and omized to pPCI + RIPC  ( n = 50 ) or conventional pPCI ( n = 50 ) . RIPC consisted of 3 cycles of 5 min/5 min ischemia/reperfusion by cuff inflation/deflation of the lower limb . The primary endpoint was infa rct size assessed by the area under the curve of creatinine kinase-myocardial b and release ( CK-MB ) . Secondary endpoints included the following : infa rct size assessed by cardiac magnetic resonance delayed enhancement volume ; T2-weighted edema volume ; ST-segment resolution > 50 % ; TIMI ( Thrombolysis In Myocardial Infa rct ion ) frame count ; and myocardial blush grading . RESULTS Four patients ( 2 RIPC , 2 controls ) were excluded due to missing sample s of CK-MB . A total of 96 patients were analyzed ; median area under the curve CK-MB was 8,814 ( interquartile range [ IQR ] : 5,567 to 11,325 ) arbitrary units in the RIPC group and 10,065 ( IQR : 7,465 to 14,004 ) arbitrary units in control subjects ( relative reduction : 20 % , 95 % confidence interval : 0.2 % to 28.7 % ; p = 0.043 ) . Seventy-seven patients underwent a cardiac magnetic resonance scan 3 to 5 days after r and omization , and 66 patients repeated a second scan after 4 months . T2-weighted edema volume was 37 ± 16 cc in RIPC patients and 47 ± 22 cc in control subjects ( p = 0.049 ) . ST-segment resolution > 50 % was 66 % in RIPC and 37 % in control subjects ( p = 0.015 ) . We observed no significant differences in TIMI frame count , myocardial blush grading , and delayed enhancement volume . CONCLUSIONS In patients with anterior ST-segment elevation myocardial infa rct ion , RIPC at the time of pPCI reduced enzymatic infa rct size and was also associated with an improvement of T2-weighted edema volume and ST-segment resolution > 50 % . ( Remote Postconditioning in Patients With Acute Myocardial Infa rct ion Treated by Primary Percutaneous Coronary Intervention [ PCI ] [ RemPostCon ] ; NCT00865722 ) 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 : Two preconditioning stimuli should induce a more consistent overall cell protection . We hypothesized that remote ischemic preconditioning ( RIPC , second preconditioning stimulus ) applied during isoflurane inhalation ( first preconditioning stimulus ) would provide more protection to the myocardium of patients undergoing on-pump coronary artery bypass grafting . Methods : In this placebo-controlled r and omized controlled study , patients in the RIPC group received four 5-min cycles of 300 mmHg cuff inflation/deflation of the leg before aortic cross-clamping . Anesthesia consisted of opioids and propofol for induction and isoflurane for maintenance . The primary outcome was high-sensitivity cardiac troponin T release . Secondary endpoints were plasma levels of N-terminal pro-brain natriuretic peptide , high-sensitivity C-reactive protein , S100 protein , and short- and long-term clinical outcomes . Gene expression profiles were obtained from atrial tissue using microarrays . Results : RIPC ( n = 27 ) did not reduce high-sensitivity cardiac troponin T release when compared with placebo ( n = 28 ) . Likewise , N-terminal pro-brain natriuretic peptide , a marker of myocardial dysfunction ; high-sensitivity C-reactive protein , a marker of perioperative inflammatory response ; and S100 , a marker of cerebral injury , were not different between the groups . The incidence for the perioperative composite endpoint combining new arrhythmias and myocardial infa rct ions was higher in the RIPC group than the placebo group ( 14/27 vs. 6/28 , P = 0.036 ) . However , there was no difference in the 6-month cardiovascular outcome . N-terminal pro-brain natriuretic peptide release correlated with isoflurane-induced transcriptional changes in fatty-acid metabolism ( P = 0.001 ) and DNA-damage signaling ( P < 0.001 ) , but not with RIPC-induced changes in gene expression . Conclusions : RIPC applied during isoflurane inhalation provides no benefit to the myocardium of patients undergoing on-pump coronary artery bypass grafting Objectives To test the inter-rater reliability of the RoB tool applied to Physical Therapy ( PT ) trials by comparing ratings from Cochrane review authors with those of blinded external review ers . Methods R and omized controlled trials ( RCTs ) in PT were identified by search ing the Cochrane Data base of Systematic Review s for meta- analysis of PT interventions .  RoB assessment s were conducted independently by 2 review ers blinded to the RoB ratings reported in the Cochrane review s. Data on RoB assessment s from Cochrane review s and other characteristics of review s and trials were extracted . Consensus assessment s between the two review ers were then compared with the RoB ratings from the Cochrane review s. Agreement between Cochrane and blinded external review ers was assessed using weighted kappa ( κ ) . Results In total , 109 trials included in 17 Cochrane review s were assessed . Inter-rater reliability on the overall RoB assessment between Cochrane review authors and blinded external review ers was poor ( κ = 0.02 , 95%CI : −0.06 , 0.06 ] ) . Inter-rater reliability on individual domains of the RoB tool was poor ( median κ = 0.19 ) , ranging from κ = −0.04 ( “ Other bias ” ) to κ = 0.62 ( “ Sequence generation ” ) . There was also no agreement ( κ = −0.29 , 95%CI : −0.81 , 0.35 ] ) in the overall RoB assessment at the meta- analysis level . Conclusions Risk of bias assessment s of RCTs using the RoB tool are not consistent across different research groups . Poor agreement was not only demonstrated at the trial level but also at the meta- analysis level . Results have implication s for decision making since different recommendations can be reached depending on the group analyzing the evidence . Improved guidelines to consistently apply the RoB tool and revisions to the tool for different health areas are needed BACKGROUND Experimental evidence suggests that cyclosporine , which inhibits the opening of mitochondrial permeability-transition pores , attenuates lethal myocardial injury that occurs at the time of reperfusion . In this pilot trial , we sought to determine whether the administration of cyclosporine at the time of percutaneous coronary intervention ( PCI ) would limit the size of the infa rct during acute myocardial infa rct ion . METHODS We r and omly assigned 58 patients who presented with acute ST-elevation myocardial infa rct ion to receive either an intravenous bolus of 2.5 mg of cyclosporine per kilogram of body weight ( cyclosporine group ) or normal saline ( control group ) immediately before undergoing PCI .  Infa rct size was assessed in all patients by measuring the release of creatine kinase and troponin I and in a subgroup of 27 patients by performing magnetic resonance imaging ( MRI ) on day 5 after infa rct ion . RESULTS The cyclosporine and control groups were similar with respect to ischemia time , the size of the area at risk , and the ejection fraction before PCI . The release of creatine kinase was significantly reduced in the cyclosporine group as compared with the control group ( P=0.04 ) . The release of troponin I was not significantly reduced ( P=0.15 ) . On day 5 , the absolute mass of the area of hyperenhancement ( i.e. , infa rct ed tissue ) on MRI was significantly reduced in the cyclosporine group as compared with the control group , with a median of 37 g ( interquartile range , 21 to 51 ) versus 46 g ( interquartile range , 20 to 65 ; P=0.04 ) . No adverse effects of cyclosporine administration were detected . CONCLUSIONS In our small , pilot trial , administration of cyclosporine at the time of reperfusion was associated with a smaller infa rct by some measures than that seen with placebo . These data are preliminary and require confirmation in a larger clinical trial 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 
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The same reduction was observed with creatine kinase MB ( CK-MB ) AUC and peak .
We observed no difference regarding repeat revascularization .
RIC appears to be an effective method for reducing ischemia/reperfusion myocardial injury , and our findings suggest that it may reduce long-term clinical events