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Studying strong electron correlations has been an essential driving force for pushing the frontiers of condensed matter physics. In particular, in the vicinity of correlation-driven quantum phase transitions (QPTs), quantum critical fluctuations of multiple degrees of freedom facilitate exotic many-body states and quantum critical behaviours beyond Landau's framework1. Recently, moiré heterostructures of van der Waals materials have been demonstrated as highly tunable quantum platforms for exploring fascinating, strongly correlated quantum physics2-22. Here we report the observation of tunable quantum criticalities in an experimental simulator of the extended Hubbard model with spin-valley isospins arising in chiral-stacked twisted double bilayer graphene (cTDBG). Scaling analysis shows a quantum two-stage criticality manifesting two distinct quantum critical points as the generalized Wigner crystal transits to a Fermi liquid by varying the displacement field, suggesting the emergence of a critical intermediate phase. The quantum two-stage criticality evolves into a quantum pseudo criticality as a high parallel magnetic field is applied. In such a pseudo criticality, we find that the quantum critical scaling is only valid above a critical temperature, indicating a weak first-order QPT therein. Our results demonstrate a highly tunable solid-state simulator with intricate interplay of multiple degrees of freedom for exploring exotic quantum critical states and behaviours.
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Myocarditis has emerged as a rare but lethal immune checkpoint inhibitor (ICI)-associated toxicity. However, the exact mechanism and the specific therapeutic targets remain underexplored. In this study, we aim to characterise the transcriptomic profiles based on single-cell RNA sequencing from ICI-related myocarditis. Peripheral blood mononuclear cell (PBMC) samples were collected from four groups for single-cell RNA sequencing: (1) patients with newly diagnosed lung squamous cell carcinoma before treatment (Control Group); (2) patients with lung squamous cell carcinoma with PD-1 inhibitor therapy who did not develop myocarditis (PD-1 Group); (3) patients during fulminant ICI-related myocarditis onset (Myocarditis Group); and (4) Patients with fulminant ICI-related myocarditis during disease remission (Recovery Group). Subcluster determination, functional analysis, single-cell trajectory and cell-cell interaction analysis were performed after scRNA-seq. Bulk-RNA sequencing was performed for further validation. Our results revealed the diversity of cellular populations in ICI-related myocarditis, marked by their distinct transcriptional profiles and biological functions. Monocytes, NKs as well as B cells contribute to the regulation of innate immunity and inflammation in ICI-related myocarditis. With integrated analysis of scRNA-seq and bulk sequencing, we identified S100A protein family as a potential serum marker for ICI-related myocarditis. Our study has created a cell atlas of PBMC during ICI-related myocarditis, which would shed light on the pathophysiological mechanism and potential therapeutic targets of ICI-related myocarditis in continuous exploration.
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Inibidores de Checkpoint Imunológico , Imunidade Inata , Neoplasias Pulmonares , Miocardite , Análise de Célula Única , Humanos , Miocardite/imunologia , Miocardite/induzido quimicamente , Miocardite/genética , Inibidores de Checkpoint Imunológico/efeitos adversos , Inibidores de Checkpoint Imunológico/uso terapêutico , Masculino , Feminino , Pessoa de Meia-Idade , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/imunologia , Neoplasias Pulmonares/genética , Transcriptoma , Análise de Sequência de RNA , Leucócitos Mononucleares/imunologia , Leucócitos Mononucleares/metabolismo , Idoso , Carcinoma de Células Escamosas/imunologia , Carcinoma de Células Escamosas/tratamento farmacológico , Carcinoma de Células Escamosas/genética , Perfilação da Expressão GênicaRESUMO
This study aims to explore the potential mechanism of action in the intervention of acute lung injury(ALI) based on the blood entry components of Ganke Granules in rats and in conjunction with network pharmacology, molecular docking, and animal experimental validation. The blood entry components of Ganke Granules in rats were imported into the SwissTargetPrediction platform to predict drug targets, and ALI-related targets were collected from the disease database. Intersections were taken, and protein-protein interaction(PPI) networks were constructed to screen the core targets, followed by Gene Ontology(GO) functional and Kyoto encyclopedia of genes and gnomes(KEGG) pathway enrichment analyses. A "blood entry components-target-pathway-disease" network was constructed, and the core components for disease intervention based on their topological parameters were screened. Molecular docking was used to predict the binding ability of the core components to key targets. The key targets of Ganke Granules in the intervention of ALI were verified by the lipopolysaccharide(LPS)-induced ALI mouse model. Through PPI topological parameter analysis, the top six key targets of STAT3, SRC, HSP90AA1, MAPK3, HRAS, and MAPK1 related to ALI were obtained. GO functional analysis showed that it was mainly related to ERK1 and ERK2 cascade, inflammatory response, and response to LPS. KEGG analysis showed that the main enrichment pathways were MAPK, neutrophil extracellular trap(NET) formation, and so on. Six core components(schizantherin B, schisandrin, besigomsin, harpagoside, isotectorigenin, and trachelanthamine) were filtered out by the "blood entry components-target-pathway-disease" network based on the analysis of topological parameters. Molecular docking results showed that the six core components and Tectoridin with the highest content in the granules had a high affinity with the key targets of MAPK3, SRC, MAPK1, and STAT3. In vivo experiment results showed that compared with the model group, Ganke Granules could effectively alleviate LPS-induced histopathological injury in the lungs of mice and reduce the percentage of inflammatory infiltration. The total protein content, nitric oxide(NO) level, myeloperoxidase(MPO) content, tumor necrosis factor-α(TNF-α), gamma interferon(IFN-γ), interleukin-1ß(IL-1ß), interleukin-6(IL-6), vascular endothelial growth factor(VEGF), and chemokine(C-X-C motif) ligand 1(CXCL1) chemokines in bronchoalveolar lavage fluid(BALF) were decreased, and the expression levels of lymphocyte antigen 6G(Ly6G), citrullinated histones 3(Cit-H3), and phosphorylated proteins SRC, ERK1/2, and STAT3 in lung tissue were significantly down-regulated. In conclusion, Ganke Granules could effectively inhibit the inflammatory response of ALI induced by LPS, protect lung tissue, regulate the release of inflammatory factors, and inhibit neutrophil infiltration and NET formation, and the mechanism of action may be related to inhibiting the activation of SRC/ERK1/2/STAT3 signaling pathway.
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Lesão Pulmonar Aguda , Medicamentos de Ervas Chinesas , Simulação de Acoplamento Molecular , Farmacologia em Rede , Lesão Pulmonar Aguda/tratamento farmacológico , Lesão Pulmonar Aguda/metabolismo , Animais , Medicamentos de Ervas Chinesas/farmacologia , Medicamentos de Ervas Chinesas/química , Camundongos , Ratos , Masculino , Mapas de Interação de Proteínas , Fator de Transcrição STAT3/metabolismo , Fator de Transcrição STAT3/genética , Ratos Sprague-Dawley , HumanosRESUMO
There is a hot debate on the anomalous behavior of superfluid density ρ_{s} in overdoped La_{2-x}Sr_{x}CuO_{4} films in recent years. The linear drop of ρ_{s} at low temperatures implies the superconductors are clean, but the linear scaling between ρ_{s} (in the zero temperature limit) and the transition temperature T_{c} is a hallmark of the dirty limit in the Bardeen-Cooper-Schrieffer (BCS) framework [I. Bozovic et al., Nature (London) 536, 309 (2016)NATUAS0028-083610.1038/nature19061]. This dichotomy motivated exotic theories beyond the standard BCS theory. We show, however, that such a dichotomy can be reconciled naturally by the role of increasing anisotropic scattering caused by the apical oxygen vacancies. Furthermore, the anisotropic scattering also explains the "missing" Drude weight upon doping in the optical conductivity, as reported in the THz experiment [F. Mahmood et al., Phys. Rev. Lett. 122, 027003 (2019)PRLTAO0031-900710.1103/PhysRevLett.122.027003]. Therefore, the overdoped cuprates can actually be described consistently by the d-wave BCS theory with the unique anisotropic scattering.
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Hematopoiesis plays an important role(s) in maintenance and physiology of life. Hematopoiesis in vertebrates mainly includes self-renewal of the hematopoietic stem cells, proliferation and differentiation of the hematopoietic progenitor cells, and maturation of the blood cells. The regulation of hematogenesis involves a variety of transcription factors, membrane receptors, hematopoietic growth factors, and microRNAs, which interact with each other and form a variety of signaling pathways and signal networks. MicroRNAs are a class of non-coding RNAs widely distributed in eukaryotic cells and play important roles in the hematopoietic process. The expression of microRNAs is regulated by transcription factors involved in hematopoietic signaling pathways. In turn, their expression can inhibit or down-regulate those of transcription factors involved in hematopoietic related signaling pathways and other related regulatory factors, thereby affecting the signaling pathways related to hematopoiesis and ultimately the hematopoietic process. In this review, we introduce the hematopoiesis processes and related signal pathways in vertebrates, focusing on the relationships between microRNAs and hematopoietic transcription factors and signal pathways, and summarizing the recent research progress of microRNAs in hematopoiesis.
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MicroRNAs , Animais , MicroRNAs/metabolismo , Hematopoese/genética , Células-Tronco Hematopoéticas/metabolismo , Diferenciação Celular , Fatores de Transcrição/metabolismoRESUMO
The energy and spatial distributions of vortex bound state in superconductors carry important information about superconducting pairing and the electronic structure. Although discrete vortex states, and sometimes a zero energy mode, had been observed in several iron-based superconductors, their spatial properties are rarely explored. In this study, we used low-temperature scanning tunneling microscopy to measure the vortex state of (Li,Fe)OHFeSe with high spatial resolution. We found that the nonzero energy states display clear spatial oscillations with a period corresponding to bulk Fermi wavelength; while in contrast, the zero energy mode does not show such oscillation, which suggests its distinct electronic origin. Furthermore, the oscillations of positive and negative energy states near E_{F} are found to be clearly out of phase. Based on a two-band model calculation, we show that our observation is more consistent with an s_{++} wave pairing in the bulk of (Li, Fe)OHFeSe, and superconducting topological states on the surface.
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The inhibitor of apoptosis-stimulating protein of p53 (iASPP) acts as a key modulator of cellular protection against oxidative stress. In the present work, we assessed the role of iASPP in the regulation of cardiomyocyte injury induced by hypoxia/reoxygenation (H/R). We found that H/R-exposed cardiomyocytes expressed decreased levels of iASPP. The upregulation of iASPP repressed H/R-induced injury by decreasing levels of apoptosis and reactive oxygen species production. The upregulation of iASPP increased nuclear factor (erythroid-derived 2)-like 2 (Nrf2) nuclear translocation and enhanced Nrf2 activation. The overexpression of Kelch-like ECH-associated protein 1 reversed iASPP-mediated promotion of Nrf2 activation. Nrf2 inhibition abrogated iASPP-mediated cardioprotective effects in H/R-exposed cardiomyocytes. Our work demonstrates that the upregulation of iASPP ameliorates H/R-induced apoptosis and oxidative stress in cardiomyocytes via potentiating Nrf2 signaling via modulation of Keap1.
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Apoptose , Peptídeos e Proteínas de Sinalização Intracelular/biossíntese , Traumatismo por Reperfusão Miocárdica/metabolismo , Miócitos Cardíacos/metabolismo , Fator 2 Relacionado a NF-E2/metabolismo , Estresse Oxidativo , Proteínas Repressoras/biossíntese , Transdução de Sinais , Regulação para Cima , Animais , Linhagem Celular , Camundongos , Traumatismo por Reperfusão Miocárdica/patologia , Miócitos Cardíacos/patologiaRESUMO
Using low-temperature scanning tunneling microscopy (STM), we studied the vortex states of single-layer FeSe film on a SrTiO_{3} (100) substrate, and the local behaviors of superconductivity at sample boundaries. We clearly observed multiple discrete Caroli-de Gennes-Matricon states in the vortex core, and quantitative analysis shows their energies well follow the formula: E=µΔ^{2}/E_{F}, where µ is a half integer (±1/2,±3/2,±5/2 ) and Δ is the mean superconducting gap over the Fermi surface. Meanwhile, a fully gapped spectrum without states near zero bias is observed at the [110]_{Fe} oriented boundary of 1 and 2 ML FeSe films, and atomic step edge of 1 ML FeSe. Accompanied with theoretical calculations, our results indicate an s-wave pairing without sign change in the high-T_{C} FeSe/SrTiO_{3} superconductor.
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We show that a conical magnetic field H=(1,1,1)H can be used to tune the topological order and hence, anyon excitations of the Z_{2} quantum spin liquid in the isotropic antiferromagnetic Kitaev model. A novel topological order, featured with Chern number C=4 and Abelian anyon excitations, is induced in a narrow range of intermediate fields H_{c1}≤H≤H_{c2}. On the other hand, the C=1 Ising-topological order with non-Abelian anyon excitations, as previously known to be present at small fields, is found here to survive up to H_{c1}. The results are obtained by developing and applying a Z_{2} mean field theory that works at finite fields and is asymptotically exact in the zero field limit and the associated variational quantum Monte Carlo.
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MicroRNAs can act as tumour suppressors or oncogenes by regulating cellular differentiation, proliferation and apoptosis, and the dysregulation of miRNA is involved in the occurrence and development of NSCLC. Here, we provided evidence that miR-92b as an oncogene in NSCLC by targeting PTEN/AKT. We found that miR-92b was up-regulated in human NSCLC tissues and cell lines. MiR-92b knockdown suppressed the NSCLC cells proliferation and migration in both in vivo and in vitro models. Conversely, miR-92b overexpression induced an aggressive phenotype. Moreover, miR-92b-mediated regulation of NSCLC cell proliferation and migration depended on binding to PTEN mRNA, which then led to the degradation of PTEN and activation of the downstream AKT signalling pathway. Overall, this study revealed the oncogenic roles of miR-92b in NSCLC by targeting PTEN/AKT, and provided novel insights for future treatments of NSCLC patients. SIGNIFICANCE OF THE STUDY: MiR-92b was up-regulated in human NSCLC tissues and cell lines. Our study demonstrated that miR-92b as an oncogene in NSCLC by targeting PTEN/AKT in both in vivo and in vitro models and provided novel insights for future treatments of NSCLC patients.
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Carcinoma Pulmonar de Células não Pequenas/metabolismo , Neoplasias Pulmonares/metabolismo , MicroRNAs/metabolismo , Oncogenes , PTEN Fosfo-Hidrolase/metabolismo , Proteínas Proto-Oncogênicas c-akt/metabolismo , RNA Neoplásico/metabolismo , Células A549 , Carcinoma Pulmonar de Células não Pequenas/genética , Carcinoma Pulmonar de Células não Pequenas/patologia , Humanos , Neoplasias Pulmonares/genética , MicroRNAs/genética , PTEN Fosfo-Hidrolase/genética , Proteínas Proto-Oncogênicas c-akt/genética , RNA Neoplásico/genéticaRESUMO
BACKGROUD: Diabetes mellitus is a common chronic disease and a severe public health issue. The incidence trends for type 1 diabetes (TIDM) and type 2 diabetes (T2DM) have rarely been studied on a global scale. We aimed to determine the temporal and geographical trends of diabetes globally. METHODS: Data on diabetes mellitus, including incidence, prevalence from 1990 to 2017 were obtained from the 2017 Global Burden of Disease study. We calculated the estimated annual percentage changes (EAPCs) in age-standardized incidence rate (ASIR) of diabetes mellitus according to sex, region, and disease type. RESULTS: The worldwide incident cases of diabetes mellitus has increased by 102.9% from 11,303,084 cases in 1990 to 22,935,630 cases in 2017 worldwide, while the ASIR increased from 234 /100,000 persons (95% UI, 219-249) to 285/100,000 persons (95% UI, 262-310) in this period [EAPC = 0.87, 95% confidence interval (CI):0.79-0.96]. The global ASIRs of T1DM and T2DM both demonstrated significant increase during 1990-2017, with EAPCs of 0.34 (95% CI,0.30-0.39) and 0.89 (95% CI,0.80-0.97), respectively. The ASIR trends also varied considerably by regions and countries. The increase in ASIR was greatest in high sociodemographic index regions (EAPC = 1.05, 95% CI:0.92-1.17) and lowest in low-SDI regions (EAPC = 0.79, 95% CI:0.71-0.88). CONCLUSIONS: Both the number of incident cases and ASIR of diabetes mellitus increased significantly during 1990-2017 worldwide, but the temporal trends varied markedly across regions and countries.
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Diabetes Mellitus/epidemiologia , Carga Global da Doença/tendências , Adolescente , Adulto , Distribuição por Idade , Idoso , Criança , Pré-Escolar , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Prevalência , Análise Espaço-Temporal , Adulto JovemRESUMO
A "fingerprint" of Cooper pairing mediated by collective bosonic excitation mode is the reconstruction of the quasiparticle-density-of-states (DOS) spectrum with an additional "dip-hump" structure located outside the superconducting coherence peak. Here, we report an in situ scanning tunneling spectroscopy study of one-unit-cell (1-UC) FeSe film on a SrTiO3(001) substrate. In the quasiparticle-DOS spectrum, the bosonic excitation mode characterized by the dip-hump structure is detected outside the larger superconducting gap. Statistically, the excitation mode shows an anticorrelation with pairing strength in magnitude and yields an energy scale upper-bounded by twice the superconducting gap. The observation coincides with the characteristics of magnetic resonance in cuprates and iron-based superconductors. Furthermore, the local response of superconducting spectra to magnetically distinct Se defects all exhibits the induced in-gap quasiparticle bound states, indicating an unconventional sign-reversing pairing over the Fermi surface in 1-UC FeSe. These results clarify the magnetic nature of the bosonic excitation mode and reveal a signature of electron-magnetic-excitation coupling in 1-UC FeSe/SrTiO3(001) besides the previously established pairing channel of electron-phonon interaction.
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We use the functional renormalization group method to study a three-orbital model for superconducting Sr_{2}RuO_{4}. Although the pairing symmetry is found to be a chiral p wave, the atomic spin-orbit coupling induces near nodes for quasiparticle excitations. Our theory explains a major experimental puzzle between a d-wavelike feature observed in thermal experiments and the chiral p-wave triplet pairing revealed in nuclear-magnetic resonance and the Kerr effect.
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The absence of holelike Fermi pockets in the heavily electron-doped iron selenides (HEDISs) challenges the s_{±}-wave pairing originally proposed for iron pnictides, which consists of opposite signs of the gap function on electron and hole pockets. While the HEDIS compounds have been investigated extensively, a consistent description of the superconducting pairing therein is still lacking. Here, by in situ scanning tunneling spectroscopy and theoretical calculations, we study the effects of strong scatterings from nonmagnetic Pb adatoms on the epitaxially grown HEDIS, one-unit-cell FeSe/SrTiO_{3}(001). Systematic tunneling spectra measured on the Pb adatoms show comprehensive signals of quasiparticle bound states, which can be well explained theoretically within the sign-reversing pairing scenarios. The finding implies that, in addition to previously detected phonons, spin fluctuations play an important role in driving the Cooper pairing in FeSe/SrTiO_{3}(001). The sign reversal in the gap function we revealed here is a significant ingredient in a unified understanding of the high-temperature superconductivity in HEDISs.
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INTRODUCTION: Obesity is one of the important risk factors of coronary heart disease (CHD). Nonalcoholic fatty liver disease (NAFLD) is always accompanied by obesity. Therefore, this study was designed to elucidate the relationship between NAFLD and CHD in obese and nonobese populations. METHODS: We conducted a cross-sectional study of 454 Chinese patients diagnosed with CHD. Patients were grouped into non-NAFLD + nonobese, non-NAFLD + obese, NAFLD + nonobese, and NAFLD + obese based on the presence or absence of both NAFLD and obesity. RESULTS: The mean Gensini score was significantly higher in patients with fatty liver compared to those without. Logistic regression analysis found that fatty liver, uric acid, and blood glucose levels were risk factors for a high Gensini score. CONCLUSIONS: Irrespective of the presence of obesity, NAFLD is a risk factor for CHD, and the clinical effect of nonobese fatty liver (especially in women) should be carefully considered.
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Doença da Artéria Coronariana/complicações , Hepatopatia Gordurosa não Alcoólica/complicações , Obesidade/complicações , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de DoençaRESUMO
BACKGROUND Percutaneous transforaminal endoscopic discectomy (PTED) and micro-endoscopic discectomy (MED) are alternative minimally invasive, widely performed procedures for the treatment of lumbar disc herniation (LDH). This study compared the clinical outcomes of these 2 surgical techniques in treating LDH. MATERIAL AND METHODS A comprehensive literature search was performed in PubMed, MEDLINE, EMBASE, Cochrane, and Google Scholar to identify all relevant studies comparing PTED and MED in treating LDH. RESULTS Eight comparative studies assessing a total of 805 patients were included for the final analysis. The results indicated that PTED needs a shorter incision [-1.02 (-1.21 to -0.83), p<0.001], less time in bed [-2.14 (-3.34 to -0.94), p<0.001], and shorter hospital stay [-1.92 (-2.90 to -0.94), p<0.001], whereas MED is superior regarding intraoperative fluoroscopy [7.47 (2.78 to 12.17), p=0.002] and total cost [0.69 (0.38 to 1.00), p<0.001]. No significant differences were found on operation time, intraoperative blood loss, or complications. Significant lower back pain was found in the PTED group at 1 week postoperatively [-0.52 (-0.95 to -0.10), p=0.02] and 1 year postoperatively or the last follow-up [-0.41 (-0.76 to -0.06), p=0.02]; significant lower leg pain was also detected at 1 week postoperatively [-0.52 (-0.75 to -0.30), p<0.001]. Oswestry Disability Index (ODI) was significant better at 1 week postoperatively in the PTED group [-4.41 (-7.03 to -1.79), p=0.001]. No significant differences were detected at other time points regarding pain score and ODI. CONCLUSIONS Both PTED and MED are safe and effective techniques for treating LDH. However, taking all clinical outcomes together, PTED might be a preferable treatment modality for LDH.
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Discotomia/métodos , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Adulto , Discotomia Percutânea/métodos , Endoscopia/métodos , Feminino , Humanos , Degeneração do Disco Intervertebral , Dor Lombar , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Medição da Dor , Período Pós-Operatório , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Due to the nontrivial topological band structure in type II Weyl semi-metal tungsten ditelluride (WTe2), unconventional properties may emerge in its superconducting phase. While realizing intrinsic superconductivity has been challenging in the type II Weyl semi-metal WTe2, the proximity effect may open an avenue for the realization of superconductivity. Here, we report the observation of proximity-induced superconductivity with a long coherence length along the c axis in WTe2 thin flakes based on a WTe2/NbSe2 van der Waals heterostructure. Interestingly, we also observe anomalous oscillations of the differential resistance during the transition from the superconducting to the normal state. Theoretical calculations show excellent agreement with experimental results, revealing that such a subgap anomaly is the intrinsic property of WTe2 in superconducting state induced by the proximity effect. Our findings enrich the understanding of the superconducting phase of type II Weyl semi-metals and pave the way for their future applications in topological quantum computing.
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We study the momentum-integrated quasiparticle interference (QPI) in the FeSe-based superconductors. This method was recently proposed theoretically and has been applied to determine the pairing symmetry in these materials experimentally. Our findings suggest that, if the incipient bands and the superconducting (SC) pairing on them are taken into consideration, then the experimentally measured bound states and momentum-integrated QPI can be well fitted, even if the SC order parameter does not change sign on the Fermi surfaces. Therefore, we offer an alternative explanation to the experimental data, calling for more careful identification of the pairing symmetry that is important for the pairing mechanism.
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Severe postoperative complications can affect cardiac surgery patients. Levosimendan is a novel calcium sensitizer commonly administered after cardiac surgery. However, the patient benefits are controversial. PubMed, Embase, and the Cochrane library were systematically searched for randomized controlled trials comparing levosimendan with control in adult cardiac surgery patients. Twenty-five studies (3247 patients) were included. Pooled data indicated that levosimendan reduced mortality after cardiac surgery [odds ratio (OR) 0.63, 95% confidence interval (CI): 0.47-0.84, P = 0.001]. However, this reduction was restricted to patients with low (<50%) left ventricular ejection fraction (OR 0.49, 95% CI: 0.35-0.70, P = 0.0001). It significantly reduced the incidence of postoperative acute kidney injury (OR 0.55, 95% CI: 0.41-0.74, P < 0.0001) and renal replacement therapy use (OR 0.56, 95% CI: 0.39-0.80, P = 0.002). Moreover, levosimendan significantly shortened the duration of the intensive care unit stay (weighted mean differences -0.49 day, 95% CI: -0.75 to -0.24, P = 0.0002) and mechanical ventilation use (weighted mean differences -2.30 hours, 95% CI: -3.76 to -0.84, P = 0.002). In conclusion, levosimendan reduced the mortality in patients with low left ventricular ejection fraction and decreased the incidence of acute renal injury and renal replacement therapy use. In addition, it shortened the duration of the intensive care unit stay and mechanical ventilation use.