Impact of prosthesis-patient mismatch on early and late outcomes after mitral valve replacement:a meta-analysis

Background Prognostic significance of prosthesis-patient mismatch(PPM)after mitral valve replacement(MVR)remains uncertain because of the limited studies reporting inconsistent or even contrary results.This meta-analysis pooled results of all available studies comparing early and late prognoses between patients with significant mitral PPM and those without.Methods Studies were identified by searching Pubmed,Excerpta Medica Database,Cochrane Central Register of Controlled Trials,and Clinical Trials.gov.Impact of PPM on postoperative hemodynamic results,thirty-day mortality,overall mortality,mortality of thirty-day survivors,and primary morbidity after MVR was evaluated via meta-analysis.Robustness of pooled estimates,source of heterogeneity,and publication bias were assessed via sensitivity analyses,meta-regression as well as subgroup analysis stratified according to methodological or clinical heterogeneity,or sequential omission method,and funnel plot or Begg's and Egger's tests,respectively.Results Nineteen cohort studies involving 9302 individuals(PPM group:n=5109,Control group:n=4193)were included for meta-analysis.Total PPM and severe PPM prevalence were 3.8%–85.9%and 1%–27%,with a mean value of 54.9%and 14.1%,respectively.As compared with control group,mitral PPM group demonstrated a poorer postoperative hemodynamic status of higher mean and peak residual transprosthetic pressure gradients(TPG),higher postoperative systolic pulmonary artery pressure(SPAP)and less reduction,higher postoperative pulmonary hypertension(PH)prevalence and less PH regression,smaller net atrioventricular compliance,less NYHA class decrease,higher postoperative functional tricuspid regurgitation prevalence and less regression.The PPM group also revealed a higher thirty-day mortality,long-term overall mortality,mortality of thirty-day survivors,and postoperative congestive heart failure prevalence,which were positively correlated with the severity of PPM if it was classified into tri-level subgroups.Left ventricular end-diastolic diameter,postoperative atrial fibrillation(AF)prevalence,and the AF regression were analogous between groups.Most pooled estimates were robust according to sensitivity analyses.Male patients and bioprosthesis implantation proportion were prominent source of between-study heterogeneity on thirty-day mortality.Publication bias was not significant in tests for all the outcomes,except for SPAP and TPG.Conclusions Mitral PPM would result in poorer postoperative hemodynamics and worse early and late prognosis.Severe PPM must be avoided since deleterious impact of mitral PPM was severity dependent.

Overview of the systematic reviews of premature ovarian insufficiency treated with acupuncture

Objective:To assess the reliability of the methodological quality and outcome measures of systematic reviews(SR)/meta-analysis of premature ovarian insufficiency(POI) treated with acupuncture.Methods:SR/meta-analysis of POI treated with acupuncture were searched on POI from the databases including PubMed,Web of Science,EMBase,the Cochran Library,Chinese biomedical literature database(SinoMed),China journal full-text database(CNKI),Wanfang data knowledge service platform(Wanfang)and VIP information Chinese periodical service platform(VIP),from inception to 1 st May 2021.Using A Measurement Tool to Assess Systematic Reviews 2(AMSTAR 2) scale and Grades of Recommendations Assessment,Development and Evaluation(GRADE) system,the methodological quality and outcome measures of the included studies were appraised.Results:Ten articles of SR/meta-analysis were included,published from 2015 to 2020.Using AMSTAR 2,5 articles of SR/meta-analysis were rated as critical low quality in methods,3 articles as low quality,and2 articles as moderate quality.The results of GRADE showed that among the 50 outcomes the quality of evidence of 22 outcomes was very low,that of 25 outcomes was low and that of 3 outcomes was moderate.Conclusion:The methodological quality and the reliability of outcome measures were not high in existing SR/meta-analysis on POI treated with acupuncture,which may affect the translation of the SR/metaanalysis findings into clinical practice.It is necessary to further strengthen the methodological quality and reporting standard of SR/meta-analysis,as well as the robustness of design and implementation of randomized controlled trials(RCTs),in order to generate high quality evidences for clinical decision-making and practice.

Sputtered MoN nanolayer as a multifunctional polysulfide catalyst for high-performance lithium–sulfur batteries

Two major obstacles for the practical application of lithium–sulfur batteries are sluggish redox kinetics and the shuttle effect of lithium polysulfides(LiPSs).Herein,MoN nanolayer-decorated multilayer graphene is fabricated via magnetron sputtering then serves as a multifunctional interlayer in Li–S batteries to suppress the shuttle effect and enhance redox kinetics.It is revealed that after the initial discharge process,the MoN layers break up into independent microreaction units consisting of MoN bodies and MoS_(2) edges,forming a heterogeneous composite catalyst in situ.The MoN bodies not only have high sulfur affinity to trap LiPSs but also enhance their redox kinetics.At the same time,the MoS_(2) edge weakens the mobility of LiPSs via the anchoring effect.As a result,Li–S cells using the interlayer present superior cycling stability under a high sulfur loading of 4.8 mg cm^(-2).This work may open a new avenue for developing high-performance Li–S batteries.