ObjectiveStudies have shown that remote ischemic conditioning (RIC) can effectively attenuate ischemic-reperfusion injury in the heart and brain, but the effect on ischemic-reperfusion injury in patients with kidney transplantation or partial nephrectomy remains controversial. The main objective of this systematic review and meta-analysis was to investigate whether RIC provides renal protection after renal ischemia-reperfusion injury in patients undergoing kidney transplantation or partial nephrectomy.MethodsA computer-based search was conducted to retrieve relevant publications from the PubMed database, Embase database, Cochrane Library and Web of Science database. We then conducted a systematic review and meta-analysis of randomized controlled trials that met our study inclusion criteria.ResultsEleven eligible studies included a total of 1,145 patients with kidney transplantation or partial nephrectomy for systematic review and meta-analysis, among whom 576 patients were randomly assigned to the RIC group and the remaining 569 to the control group. The 3-month estimated glomerular filtration rate (eGFR) was improved in the RIC group, which was statistically significant between the two groups on kidney transplantation [P < 0.001; mean difference (MD) = 2.74, confidence interval (CI): 1.41 to 4.06; I2 = 14%], and the 1- and 2-day postoperative Scr levels in the RIC group decreased, which was statistically significant between the two groups on kidney transplantation (1-day postoperative: P < 0.001; MD = 0.10, CI: 0.05 to 0.15, I2 = 0; 2-day postoperative: P = 0.006; MD = 0.41, CI: 0.12 to 0.70, I2 = 0), but at other times, there was no significant difference between the two groups in Scr levels. The incidence of delayed graft function (DGF) decreased, but there was no significant difference (P = 0.60; 95% CI: 0.67 to 1.26). There was no significant difference between the two groups in terms of cross-clamp time, cold ischemia time, warm ischemic time, acute rejection (AR), graft loss or length of hospital stay.ConclusionOur meta-analysis showed that the effect of remote ischemia conditioning on reducing serum creatinine (Scr) and improving estimate glomerular filtration rate (eGFR) seemed to be very weak, and we did not observe a significant protective effect of RIC on renal ischemic-reperfusion. Due to small sample sizes, more studies using stricter inclusion criteria are needed to elucidate the nephroprotective effect of RIC in renal surgery in the future.

Background: Serratus anterior plane block (SAPB) was first proposed in 2013 as a new method for regional nerve block, while erector spinae plane block (ESPB) was first proposed in 2016. Both regional nerve block techniques can be used for analgesia in thoracic and breast surgery, but the debate about their actual effects continues. The purpose of this systematic review was to compare the analgesic effects of these two nerve block techniques after thoracic and breast surgery. Methods: We systematically searched the PubMed, Embase, Web of Science and Cochrane Library databases up to August 2022. We performed a meta-analysis of clinical randomized controlled trials (RCTs) comparing the effects of SAPB and ESPB on postoperative analgesia in patients undergoing thoracic and breast surgery. Results: A total of 11 RCTs were included. Meta-analysis revealed that compared with the SAPB group, patients in the ESPB group had significantly reduced 24-hour postoperative opioid consumption (standardized mean difference [SMD]: -0.76; 95% confidence interval [CI]: -1.29 to -0.24; P < 0.01; I2=88%). Rest or movement pain scores were significantly lower at various time points postoperatively. In addition, ESPB-group patients had significantly reduced intraoperative opioid consumption (SMD: -0.43; 95% CI: -0.64 to -0.23; P<0.001; I2=35%). In terms of time to first use of analgesics, ESPB significantly prolonged the time to first analgesic use (SMD: 3.53; 95% CI: 1.62 to 5.44; P < 0.001; I2 = 97%). Conclusions: Compared with SAPB, ESPB is more effective in analgesia after thoracic and breast surgery, especially in thoracic surgery.

Objective: lung ischemia-reperfusion injury has always been a research hotspot in the field of lung transplantation. The purpose of this study is tantamount to explore the molecular mechanism, key genes and related signal pathways of ischemia-reperfusion in lung transplantation through bioinformatics analysis. Methods: data numbered GSE172222 were downloaded from the Gene Expression Omnibus (GEO). The expression data of pulmonary micro vascular endothelial cells at 6 hours of cold ischemia and 6 hours of cold ischemia + 2 hours of reperfusion were obtained, and the differences were analyzed by gene ontology (GO), Kyoto gene and genome encyclopedia (KEGG) and disease ontology (DO). The protein interaction network of differential genes was constructed by the STRING database (https://www.string-db.org/) and visualized by Cytoscape Software (http://www.cytoscape.org/). Key genes were screened by cytoHubba plug-ins and key modules were screened by MCODE plug-ins. Gene set enrichment analysis (GSEA) was utilized to further understand the function of differential genes. Results: a total of 189 differential genes were generated. These differential genes were mainly enriched in myeloid cell differentiation. DNA binding transcriptional activator activity, and MAPK signal pathway. Six key modules were screened by MCODE plug-in, and five key genes of FOS,EGR1,JUNB,ATF3,CEBPB were screened based on NCC algorithm in cytoHubba. GSEA enrichment analysis showed that the expression of differential genes was up-regulated in osteoclast differentiation pathway and down-regulated in fatty acid degradation. Conclusion: in this study, differential genes and related pathways in pulmonary micro vascular endothelial cells were screened by bioinformatics to help understand the molecular mechanism of pulmonary ischemia-reperfusion injury and provide ideas for the prevention and treatment of pulmonary ischemia-reperfusion injury.

Background One-lung ventilation (OLV) is often used during lobectomy anesthesia. Inflammation and oxidative stress during OLV can aggravate lung tissue injury, which is an important factor causing postoperative acute lung injury. Studies have confirmed that remote ischemic preconditioning (RIPC) can initiate endogenous protective mechanisms and alleviate injury to target organs. However, whether RIPC has a lung protective effect in patients undergoing lung resection remains unknown. Therefore, this randomized controlled clinical study investigated whether RIPC could reduce OLV-related lung injury, improve intraoperative oxygenation parameters, and induce lung protection in patients with thoracoscopic lobectomy. Methods We adopted a single-center, randomized, single-blind clinical controlled trial method and selected 54 patients who underwent inferior lobectomy with OLV and were randomly divided into a preconditioning group (RIPC group) and a blank control group (NC group). The preconditioning group received lower limb RIPC before OLV, while the blank NC group did not receive RIPC. RIPC was used to perform 5 cycles of 5 min ischemia /5 min reperfusion on the opposite lower limb via a limb ischemia preadaptor. Four time points after anesthesia induction (T0), 30 min after single-lung ventilation (T1), 90 min after single-lung ventilation (T2), and 30 min after double-lung ventilation restoration (T3) were used as the data-recording and blood-collection points. The main outcome measure was the oxygenation index (OI), while the secondary outcome measures included Clara cell secreted protein CC16, inflammatory cytokines (IL-6), serum malondialdehyde (MDA), lung-related variables, and length of hospital stay. Results There was no significant difference in the OI in the RIPC group compared with the NC group at each time point of T0-T3 (P > 0.05), but in general, the OI value of of the RIPC group at the T1-T3 time points showed an increasing trend compared with that of the NC group. There were significant differences in plasma CC16 levels between T1-T3 (P < 0.05), and the plasma CC16 level in the RIPC group was significantly decreased. IL-6 and MDA levels at T1-T3 were lower than those in the NC group (P < 0.05). However, there were no significant differences in blood pH and pulmonary-related variables (respiratory index (RI), alveolar-arterial oxygen partial pressure (A-aDO2), and arterial-alveolar oxygen partial pressure (a/A ratio)) (P > 0.05), and the length of hospital stay was not significantly different (P > 0.05). Conclusions Remote limb ischemic preconditioning can reduce lung injury during lobectomy and can protect lung tissue mainly by reducing the inflammatory and oxidative-stress responses.