Objective:To access the benefits and harms of remote ischemic preconditioning(RIPC) in patients undergoing cardiac surgery with cardiopulmonary bypass.Methods:An electronic and manual search of literature published before Mar 2020 was conducted using Pubmed, EMBASE, Cochrane Library for randomized controlled trials(RCTs), CNKI, CBM, WanFang and VIP. 23 studies involving in 5 025 participants were included. Patients were randomly assigned to either remote ischemic preconditioning group(n=2 524) or control group(n=2 521). Remote ischemic preconditioning consisted of 3-4 cycles of lower limbs or upper limbs ischemia and reperfusion with an automated cuff inflator. Clinical data and the levels of injury biomarkers were collected. The main outcomes were the incidence of adverse events, mortality in the hospital, and the post-operative troponin concentration. The effective values of dichotomous variables or continuous variables were estimated by Relative risk( RR) or by mean differences( MD), standardized mean differences( SMD) with 95% confidence intervals( CI) respectively. Results:In general risk of bias varied from low to moderate risk of bias across included studies, and insufficient detail was provided to inform judgement in several cases. There were no significant differences between the two groups with regard to all-cause mortality in hospital( RR=1.27, 95% CI: 0.84-1.91, P=0.26), no-fatal myocardial infarction( RR=0.92, 95% CI: 0.79-1.07, P=0.27) , new stroke( RR=0.96, 95% CI: 0.61-1.50, P=0.84), new atrial fibrillation( RR=0.98, 95% CI: 0.83-1.15, P=0.77) and acute renal failure( RR=1.01, 95% CI: 0.90-1.14, P=0.83). Conclusion:There is no evidence that RIPC has a treatment effect on clinical outcomes(measured as all-cause mortality in hospital, no-fatal myocardial infarction, new stroke, new atrial fibrillation, and acute renal failure). More research should be designed to confirm the effect of RIPC on myocardial protection with cardiopulmonary bypass.

Nucleoside analogues and nucleotide analogues can not only achieve long-term viral suppression in the treatment of most CHB patients but also have a positive impact on other CHB therapeutic goals and an improved prognosis. A certain difference can be observed in the impact of nucleotide analogues such as TDF and TAF and nucleoside analogues such as ETV on the clinical outcomes of CHB. Studies on the mechanism of action indicate that apart from inhibiting the direct antiviral effects of HBV reverse transcriptase, these two categories of drugs exhibit distinct impacts on immune-related signaling pathways, gene expression, genome stability, and other non-antiviral mechanisms. This article reviews the evidence on the potential non-antiviral mechanism of action of nucleoside analogues and nucleotide analogues and proposes a preliminary explanation for the observation trend of nucleotide analogues having a comparative advantage in clinical outcomes in CHB patients based on the latest research advancement.

Tenofovir disoproxil fumarate (TDF) is a novel nucleotide reverse transcriptase inhibitor that is mainly used to treat human immunodeficiency virus (HIV) and hepatitis B virus (HBV) infections. In recent years, an increasing number of studies have demonstrated that TDF treatment can reduce blood lipid levels in patients with AIDS and chronic hepatitis B and has a close correlation with the severity of the disease and the occurrence of cardiovascular events. This article reviews the research progress on the effect of TDF on blood lipid profiles, with the aim of providing a basis for rational use of TDF.