Feasibility of composted green waste amended by vermiculite and earthworm casts as the growth media for three common ornamental plants.

This study demonstrated the effects of adding specific proportions of vermiculite (VMT: 0%, 10%, and 20%) and earthworm casts (EWCs: 0%, 10%, and 20%) on the physico-chemical properties of composted green waste (CGW), and the impacts of amended CGW as growth media on the growth of three common ornamental plants (Dahlia pinnata Cav. [dahlia], Centaurea cyanus L. [cornflower], and Consolida ajacis [L.] Schur [delphinium]). Compared with Treatment T1 (CK), the addition of 10% VMT and 20% EWCs greatly (p < 0.05) increased the total porosity, aeration porosity, water-holding porosity, total nitrogen, available phosphorus, available potassium, and organic matter of CGW by 9%, 35%, 4%, 18%, 27%, 13%, and 33%, respectively. In addition, this pattern increased (p < 0.05) the total fresh biomass, total chlorophyll content, and root length of dahlias by 9%, 19%, and 27%, respectively; those of cornflowers by 17%, 30%, and 29%, respectively (p < 0.05); and those of delphiniums by 23%, 14%, and 63%, respectively. Therefore, the amended CGW supplemented with 10% VMT and 20% EWCs was an ideal growth medium for the three plants.

A systematic review of research on sitting and working furniture ergonomic from 2012 to 2022: Analysis of assessment approaches.

This study analyses which aspects of sitting and working furniture ergonomics that may be influenced and how they are assessed. To gather information on the types and assessment techniques connected with influencing furniture ergonomics, a systematic review of the literature was conducted. The papers in the systematic review were published between 2012 and 2022. The articles applied the Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines to limit the 41 papers that were eventually included (N = 41) to those containing keywords like ergonomics, human factors, comfort, working furniture, Chair, assessment and evaluation. The research objective of this systematic review is to provide a comprehensive overview of sitting and working furniture and the main findings, obtaining common assessment techniques for this type of furniture and their suitability. According to the relevant studies, the publications were categorized by summarizing factors like region, gender, research methods, ergonomic assessment techniques and methods used, correlation between assessment techniques and methods, etc. Summaries of the data extracted from the included papers are provided and the applicability of some approaches are assessed. Only a small number of authors have evaluated the ergonomics of furniture used in homes. One of the research gaps is the paucity of research on gender segregation, secular trends, and cultural contexts. These studies heavily rely on quantitative research techniques, and the articles may lack credibility due to the homogeneity of the evaluation techniques. Finally, the authors offer some suggestions for the appropriate ergonomic analysis of furniture.

Non-ribosomal peptide synthetase (NRPS)-encoding products and their biosynthetic logics in Fusarium.

Fungal non-ribosomal peptide synthetase (NRPS)-encoding products play a paramount role in new drug discovery. Fusarium, one of the most common filamentous fungi, is well-known for its biosynthetic potential of NRPS-type compounds with diverse structural motifs and various biological properties. With the continuous improvement and extensive application of bioinformatic tools (e.g., anti-SMASH, NCBI, UniProt), more and more biosynthetic gene clusters (BGCs) of secondary metabolites (SMs) have been identified in Fusarium strains. However, the biosynthetic logics of these SMs have not yet been well investigated till now. With the aim to increase our knowledge of the biosynthetic logics of NPRS-encoding products in Fusarium, this review firstly provides an overview of research advances in elucidating their biosynthetic pathways.

Negative enthalpy alloys and local chemical ordering: a concept and route leading to synergy of strength and ductility.

Solid solutions are ubiquitous in metals and alloys. Local chemical ordering (LCO) is a fundamental sub-nano/nanoscale process that occurs in many solid solutions and can be used as a microstructure to optimize strength and ductility. However, the formation of LCO has not been fully elucidated, let alone how to provide efficient routes for designing LCO to achieve synergistic effects on both superb strength and ductility. Herein, we propose the formation and control of LCO in negative enthalpy alloys. With engineering negative enthalpy in solid solutions, genetic LCO components are formed in negative enthalpy refractory high-entropy alloys (RHEAs). In contrast to conventional 'trial-and-error' approaches, the control of LCO by using engineering negative enthalpy in RHEAs is instructive and results in superior strength (1160 MPa) and uniform ductility (24.5%) under tension at ambient temperature, which are among the best reported so far. LCO can promote dislocation cross-slip, enhancing the interaction between dislocations and their accumulation at large tensile strains; sustainable strain hardening can thereby be attained to ensure high ductility of the alloy. This work paves the way for new research fields on negative enthalpy solid solutions and alloys for the synergy of strength and ductility as well as new functions.

Validation of reliability, repeatability and consistency of three-dimensional choroidal vascular index.

This study aimed to investigate the reliability, repeatability and consistency of choroidal vascularity index (CVI) measurements provided by an artificial intelligence-based software in swept-source optical coherence tomography (SS-OCT) in normal subject, and to evaluate the influencing factors for 3D-CVI. Repeatability of 3D-CVI by SS-OCT was evaluated based on different scanning modes including Macular Cubes (3 mm × 3 mm, 6 mm × 6 mm, 9 mm × 9 mm) and Optic Nerve Head 6 mm × 6 mm. Intraclass Correlation Coefficient (ICC) was used to estimate the repeatability and reproducibility of five repeated measurement by SS-OCT. Consistency of CVI between SS-OCT and spectral-domain optical coherence tomography (SD-OCT) was measured and compared in a pilot study of ten eyes and agreement between SS-OCT and SD-OCT was evaluated by Bland-Altman analysis and Deming regression. The influencing factors for 3D-CVI including age, gender, axial length and spherical equivalent on CVI was further investigated in a prospective study of 125 eyes of 125 healthy subjects. ICC between different measurements by SS-OCT was 0.934 (95% CI 0.812-0.956) indicating good repeatability. Intraclass correlation coefficient between CVI measure by SS-OCT and SD-OCT was 0.887 (95% CI 0.796-0.938, P value < 0.001). The mean difference between 3D-CVI measured by SS-OCT and SD-OCT 0.133. CVI measured with SS-OCTA showed stronger correlations with axial length and age but not correlated with gender. There is good agreement between CVIs obtained from the built-in software that requires less timing in manual quantification. Studies investigating choroidal vascularity can be standardized by the AI-based CVI analyze software.

Actomyosin and CSI1/POM2 cooperate to deliver cellulose synthase from Golgi to cortical microtubules in Arabidopsis.

As one of the major components of plant cell walls, cellulose is crucial for plant growth and development. Cellulose is synthesized by cellulose synthase (CesA) complexes (CSCs), which are trafficked and delivered from the Golgi apparatus to the plasma membrane. How CesAs are released from Golgi remains largely unclear. In this study, we observed that STELLO (STL) family proteins localized at a group of small CesA-containing compartments called Small CesA compartments (SmaCCs) or microtubule-associated CesA compartments (MASCs). The STL-labeled SmaCCs/MASCs were directly derived from Golgi through a membrane-stretching process: membrane-patches of Golgi attached to cortical microtubules, which led to emergence of membrane-tails that finally ruptured to generate SmaCCs/MASCs associated with the cortical microtubules. While myosin propelled the movement of Golgi along actin filaments to stretch the tails, the CesA-microtubule linker protein, CSI1/POM2 was indispensable for the tight anchor of the membrane-tail ends at cortical microtubules. Together, our data reveal a non-canonical delivery route to the plasma membrane of a major enzyme complex in plant biology.

The correlation between tic disorders and allergic conditions in children: A systematic review and meta-analysis of observational studies.

Aim: To evaluate the correlation between tic disorders and allergies and to inform strategies for the treatment and prevention of tic disorders. Methods: We conducted online searches of the MEDLINE, Embase, Cochrane, CNKI, CBM, WanFang, and VIP Information databases. Case-control studies and cohort studies related to tic disorders and allergic conditions were searched. Two researchers screened the literature, extracted data, and evaluated quality in strict accordance with the predetermined retrieval strategy and inclusion criteria. Finally, RevMan 5.4 software was used to conduct a meta-analysis. We used the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach to rating the certainty of evidence about each allergy outcome as high, moderate, low, or very low. Results: We obtained seven eligible studies involving eight allergic conditions. The following allergic conditions were significantly associated with the presence of a tic disorder: asthma (OR = 1.90, 95% CI = 1.57-2.30, P < 0.001), allergic rhinitis (OR = 2.61, 95% CI = 1.90-3.57, P < 0.001), allergic conjunctivitis (OR = 3.65, 95% CI = 1.53-8,67, P = 0.003), eczema (OR = 3.87, 95% CI = 2.24-6.67, P < 0.001) and food allergy (OR = 2.79, 95% CI = 1.56-4.99, P < 0.001). There was no significant correlation between atopic dermatitis, urticaria, drug allergy, and tic disorder. Conclusion: The occurrence of tic disorders may be associated with the presence of certain allergic disorders. However, whether allergy is one of the causes of tic disorders remains unclear. Systematic review registration: The registration number for this systematic review is PROSPERO: CRD42021231658.

Impact of transcatheter tricuspid valve replacement for tricuspid regurgitation on hepatic, cardiac, and venous structure.

BACKGROUND: Patients with long-term tricuspid regurgitation (TR) are mostly accompanied by hepatic, cardiac, and venous remodeling. Transcatheter tricuspid valve replacement (TTVR) device has emerged as a promising alternative to open-heart surgery for TR patients. No study has assessed the impact of TTVR on hepatic, cardiac, and venous remodeling. METHODS: Twenty-two patients with TR enrolled in this study underwent TTVR between October 2020 and January 2021. Liver, heart, and veins were reconstructed by three-dimensional computed tomography reconstruction software at baseline and 6 months follow-up. RESULTS: Twenty-two patients were enrolled in this study. The mean age was 64.8 ± 8.2 years, and all patients had severe or greater TR with multiple comorbidities. The left hepatic lobe volume decreased from 518.8 ± 171.9 ml to 470.4 ± 179.6 ml at 6 months during follow-up (p = 0.049). Evidence of a decrease in three hepatic veins parameters and splenic vein parameters was noted from baseline to 6 months. And a significant decrease in right atrial volume (317.5 ml [interquartile range: 216.1 to 497.3 ml] vs. 266.7 ml [interquartile range: 178.7 to 480.7 ml]; p = 0.003) were observed in the study. CONCLUSIONS: Six-month outcomes show that TR elimination by LuX-Valve is associated with the reverse remodeling of liver, heart, and veins. Accordingly, LuX-Valve is a promising alternative for patients presenting with severe TR.

The fault detection of transmitting current encoded by m-sequence using triple-correlation function in helicopter-borne electromagnetic method.

An m-sequence is applied to the helicopter-borne electromagnetic method system for the first time, and there are many problems to be solved, one of which is the detection of the quality of the transmitting current waveform, which directly affects the resource survey results. In this research, we found that the triple-correlation function (TCF) can reveal the bit integrity characteristics of the m-sequence encoded transmitting current. On this basis, this paper proposes to extract the three-dimensional information of the normalized TCF plot by using a peak detection method and, then, proposes to use a dual-threshold method to clarify the detection results. The whole process realizes the fault detection of the transmitting current waveform. We propose a reasonable transmitting current modeling method and conduct 1200 random experiments in 12 groups. The statistics of the experimental results show that when the number of missing bits is 1, 2, 4, and 8, the fault detection accuracy can reach more than 83%. A comparative experiment using the Field Programmable Gate Array. in the laboratory validates the feasibility of the fault detection method. This method is beneficial to improve the quality of detection data and avoid economic losses caused by invalid detection flights.

Exercise Intervention Modulates Synaptic Plasticity by Inhibiting Excessive Microglial Activation via Exosomes.

Background: Exosomes can activate microglia to modulate neural activity and synaptic plasticity by phagocytosis of neural spines or synapses. Our previous research found that an early 4-week exercise intervention in middle cerebral artery occlusion (MCAO) rats can promote the release of exosomes and protect the brain. This study intended to further explore the intrinsic mechanism of neuroprotection by exosome release after exercise. Methods: Rats were randomly divided into four groups: the sham operation (SHAM), middle cerebral artery occlusion (MCAO) with sedentary intervention (SED-MCAO), MCAO with exercise intervention (EX-MCAO), and MCAO with exercise intervention and exosome injection (EX-MCAO-EXO). Modified neurological severity score (mNSS), cerebral infarction volume ratio, microglial activation, dendritic complexity, and expression of synaptophysin (Syn) and postsynaptic density protein 95 (PSD-95) were detected after 28 days of intervention. Results: (1) The exercise improved body weight and mNSS score, and the survival state of the rats after exosome infusion was better. (2) Compared with the SED-MCAO group, the EX-MCAO (P = 0.039) and EX-MCAO-EXO groups (P = 0.002) had significantly lower cerebral infarct volume ratios (P < 0.05), among which the EX-MCAO-EXO group had the lowest (P = 0.031). (3) Compared with the SED-MCAO group, the EX-MCAO and EX-MCAO-EXO groups had a significantly decreased number of microglia (P < 0.001) and significantly increased process length/cell (P < 0.01) and end point/cell (P < 0.01) values, with the EX-MCAO-EXO group having the lowest number of microglia (P = 0.036) and most significantly increased end point/cell value (P = 0.027). (4) Compared with the SED-MCAO group, the total number of intersections and branches of the apical and basal dendrites in the EX-MCAO and EX-MCAO-EXO groups was increased significantly (P < 0.05), and the increase was more significant in the EX-MCAO-EXO group (P < 0.05). (5) The expression levels of Syn and PSD-95 in the EX-MCAO (P Syn = 0.043, P PSD-95 = 0.047) and EX-MCAO-EXO groups were significantly higher than those in the SED-MCAO group (P < 0.05), and the expression levels in the EX-MCAO-EXO group were significantly higher than those in the EX-MCAO group (P < 0.05). Conclusion: Early exercise intervention after stroke can inhibit the excessive activation of microglia and regulate synaptic plasticity by exosome release.

Swim bladder as an alternative biomaterial for bioprosthetic valves.

Valvular structural deterioration and calcification are the main indications for secondary intervention after bioprosthetic valve replacement, promoting an urgent requirement for more durable cardiovascular biomaterials for clinical applications. The swim bladder of carp we introduced in this study has several advantages as a raw biomaterial when compared to the bovine pericardium. First, the results of in vitro assays demonstrated that the cross-linked carp swim bladder exhibited superior biocompatibility compared to the bovine pericardium, and the anti-calcification property was verified by subcutaneous implantation experiments in rats. Furthermore, the cross-linked swim bladder tissue was sutured on a cobalt-chromium alloy stent to fabricate a pulmonary bioprosthetic valve, and then the feasibility and durability of the bioprosthetic valve were proved by a fatigue test in vitro. Finally, a sheep pulmonary bioprosthetic valve replacement in situ experiment further confirmed the superior calcification resistance, immune-compatibility, endothelialization, and hemodynamic properties of the swim bladder, suggesting that it might be used as an alternative biomaterial for bioprosthetic valves.

Recognition and binding of FEZ-1 from Legionella with penicillin V and cefoxitin by fluorescence spectra in combination with molecular dynamics simulation.

The recognition and interaction of FEZ-1 from Legionella (FEZ-1) with penicillin V(PV) and cefoxitin(CFX) were investigated using fluorescence spectra in combination with molecular dynamics simulation (MD). The results revealed that the CFX bind with FEZ-1 in stronger interaction and induced larger conformational change than PV, despite all being forced by the electrostatic interaction and along with the changing in an environment of amino acid residues as well as the polypeptide skeleton inside the FEZ-1. Moreover, only the loop1, loop2, and N-terminal were observed locating near the binding pocket of FEZ-1, consisting of a flexible "gate-like" zone with better adaptability that controlled the entrance of antibiotic into the pocket by allowing the newly introduced antibiotic to match the pocket better through the conformational changes of these three substructures in the binding procedure. The current study may provide some valuable information on the antibiotic hydrolytic process by metallo-beta-lactamase and thus the references for the development of new antibiotics for super bacteria.

Beer lees and ceramsite amendments enhance the two-stage co-composting of green waste.

Composting is a major way to process green waste (GW), and amendments are important in GW composting. In this study of the two-stage co-composting of GW, beer lees (0, 25, 30%) and/or ceramsite (0, 10, 15%) were assessed as amendments. Changes in bulk density, porosity, temperature, pH, gaseous emissions, dissolved organic carbon (DOC) and nitrogen (DON), lignocellulose degradation, microbial abundances, and phytotoxicity were assessed during GW composting with the amendments. Treatments with a combination of beer lees and ceramsite had positive effects, and 25% beer lees and 15% ceramsite optimized all compost parameters. The optimal combination of amendments extended the thermophilic phase, enhanced the lignocellulose decomposition, and generated a stable and mature product in 20 days. Consequently, the best final compost was not phytotoxic (germination index: 164%), was mature (void space ratio: 48.48, pH: 7.20, and DOC/DON ratio: 0.51), and nutrient-rich (especially for N: 5.13%, P: 1.84%, and K: 0.68%).

Bifunctional single-labelled oligonucleotide probe for detection of trace Ag(I) and Pb(II) based on cytosine-Ag(I)-cytosine mismatches and G-quadruplex.

A novel bifunctional oligonucleotide (OND) probe with single fluorescent group HEX labelled at 5'-end was designed for detecting trace Ag(I) and Pb(II) in real samples. In the presence of Ag(I), the hairpin structure originating from Ag(I) induced cytosine-Ag(I)-cytosine mismatches causes the proximity of the HEX to the consecutive guanine bases (G)4 at 3'-terminal, resulting in the fluorescence quenching of the HEX. While in the presence of Pb(II), the G-quadruplex structure originating from two G-quartet planes by the intramolecular hydrogen bond with Pb(II) also causes the HEX approaching the (G)4 terminal and consequently the fluorescence quenching. The results showed the quantitative detection of trace Ag(I) and Pb(II) both in the linear response ranges of 1.0-20.0 × 10-9 mol L-1 with no visible interferences of other 11 metal ions observed. And the detection limits were 82 × 10-12 mol L-1 for Ag(I), 92 × 10-12 mol L-1 for Pb(II), respectively. The fluorescence quenching mechanism of the (G)4 to HEX was verified to be the photoinduced electron transfer in the aspect of thermodynamics. This method provided a feasible application for sensitive and selective detection of Pb(II) and Ag(I) in water and Chinese traditional herbs with convenient operation.

Clinical Outcome of Reoperation for Mechanical Prosthesis at Aortic Position.

AIM: Redo aortic valve surgery is usually associated with a high risk of mortality and complications. The aim of this study was to investigate the perioperative and long-term outcomes of reoperation after prior mechanical prosthesis implantation at the aortic position. METHOD: The clinical data of 146 consecutive patients who underwent reoperation at the aortic position between 2003 and 2019 were analysed. RESULTS: Mean age was 51.5±12.7 years and 69 (47.3%) were female. The median interval from prior surgery to redo aortic valve surgery was 6 years. The aetiologies were pannus formation with prosthetic aortic stenosis in 62 cases (42.5%), prosthetic valve endocarditis (PVE) in five (3.4%), PVE with perivalvular leakage (PVL) in 16 (11.0%), PVL in 45 (30.8%), thrombosis in seven (4.8%), and aortic disease in 11 (7.5%). As for surgical procedure, aortic valve replacement was performed in 81 cases (55.5%), Bentall in 34 (23.3%), PVL repair in six (4.1%), and pannus debridement in 25 (17.1%). Fourteen (14) (9.6%) patients expired perioperatively. Prolonged ventilation time and postoperative renal failure were proved to be significant independent predictors of mortality according to multivariate analysis. Overall survival was 87.8%±7.4% and 76.4%±15.1% at 5 and 10 years, respectively. Survival was 87.7%±13.7% and 84.2%±15.6% in the pannus group, and 84.5%±12.6% and 74.6%±19.4% in the non-pannus group at 5 and 10 years, respectively (p=0.951). Survival was 87.5%±14.2% and 75.8%±22.7% in the PVL group and 84.7%±11.9% and 81.6%±13.5% in the non-PVL group at 5 and 10 years, respectively (p=0.365). CONCLUSIONS: Pannus formation and PVL are two major indications for reoperation of mechanical prosthesis at the aortic position. Redo aortic valve surgery has a satisfactory outcome but with a high risk of complications. Long-term survival of patients seems not to be related to the aetiology. Final decision-making of redo aortic valve surgery should be based on aetiology.

Transcatheter tricuspid valve replacement in patients with severe tricuspid regurgitation.

OBJECTIVE: Tricuspid regurgitation (TR) is a common valvular heart disease with unsatisfactory medical therapeutics and high surgical mortality. The present study aims to evaluate the safety and effectiveness of transcatheter tricuspid valve replacement (TTVR) in high-risk patients with severe TR. METHODS: This was a compassionate multicentre study. Between September 2018 and November 2019, 46 patients with TR who were not suitable for surgery received compassionate TTVR under general anaesthesia and the guidance of trans-oesophageal echocardiography and fluoroscopy in four institutions. Access to the tricuspid valve was obtained via a minimally invasive thoracotomy and transatrial approach. Patients' data at baseline, before discharge, 30 days and 6 months after the procedure were collected. RESULTS: All patients had severe TR with vena contracta width of 12.6 (11.0, 14.5) mm. Procedural success (97.8%) was achieved in all but one case with right ventricle perforation. The procedural time was 150.0 (118.8, 180.0) min. Intensive care unit time was 2.0 (1.0, 4.0) days. 6-month mortality was 17.4%. Device migration occurred in one patient (2.4%) during follow-up. Transthoracic echocardiography at 6 months after operation showed TR was significantly reduced (none/trivial in 33, mild in 4 and moderate in 1) and the primary safety end point was achieved in 38 cases (82.6%). Patients suffered from peripheral oedema and ascites decreased from 100.0% and 47.8% at baseline to 2.6% and 0.0% at 6 months. CONCLUSIONS: The present study showed TTVR was feasible, safe and with low complication rates in patients with severe TR.

Effects of filtration-induced size change on the subsequent transport and fate of graphene oxide in saturated porous media.

A particle size change occurs ubiquitously during transport of nanoparticles in the subsurface and is likely to influence nanoparticle fate and transport behaviours. The effects of this size change on the subsequent transport of eluted graphene oxide (GO) in saturated media were therefore investigated under various ionic strength (IS) and filtration degree conditions. Aggregation kinetics revealed that size change after filtration only occurred at relatively high IS conditions. As the filtration column length increased from 15 cm to 30 cm, sizes of aggregates in filtrates for large-sized and small-sized GO populations decreased and increased, respectively, and both approached to their steady aggregate sizes. Aggregation, straining, sedimentation, bridging, DLVO interactions, or a combination of these mechanisms were involved in the size change process during filtration. After passing through the 30 cm filtration column, filtered GO, in comparison with original GO, exhibited stronger mobility than expected, suggesting neglecting size change will result in underestimation of the nanoparticle mobility in porous media.

miR-214 Attenuates Aortic Valve Calcification by Regulating Osteogenic Differentiation of Valvular Interstitial Cells.

Calcific aortic valve disease (CAVD) is a common heart valve disease in aging populations, and aberrant osteogenic differentiation of valvular interstitial cells (VICs) plays a critical role in the pathogenesis of ectopic ossification of the aortic valve. miR-214 has been validated to be involved in the osteogenesis process. Here, we aim to investigate the role and mechanism of miR-214 in CAVD progression. miR-214 expression was significantly downregulated in CAVD aortic valve leaflets, accompanied by upregulation of osteogenic markers. Overexpression of miR-214 suppressed osteogenic differentiation of VICs, while silencing the expression of miR-214 promoted this function. miR-214 directly targeted ATF4 and Sp7 to modulate osteoblastic differentiation of VICs, which was proved by dual luciferase reporter assay and rescue experiment. miR-214 knockout rats exhibited higher mean transvalvular velocity and gradient. The expression of osteogenic markers in aortic valve leaflets of miR-214 knockout rats was upregulated compared to that of the wild-type group. Taken together, our study showed that miR-214 inhibited aortic valve calcification via regulating osteogenic differentiation of VICs by directly targeting ATF4 and Sp7, indicating that miR-214 may act as a profound candidate of targeting therapy for CAVD.

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 ClinicalTrials.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.

Long-term outcomes of surgical procedures for Marfan syndrome: aortic dissection versus aneurysm.

BACKGROUND: Multiple of subsequent procedures may necessary in Marfan syndrome (MFS) patients after initial surgery. The aim of this study was to investigate the full spectrum of secondary distal vascular or valvular interventions encountered after initial surgery. METHODS: Retrospective analysis of 201 consecutive MFS patients between January 2000 and March 2019 who underwent 274 distal aortic reinterventions and 5 mitral valve replacements. RESULTS: Of the enrolled 201 MFS patients (73 female, mean age 37.0±12.8 years), the surgical indication for 93 patients was aortic root aneurysm, and for another 108 patients was dissection. The mean follow-up interval was 8.4±5.5 years. Total arch replacement (TAR) was performed in 68.5% of MFS patients presenting with type A aortic dissection (TAAD) and in 2.2% of patients with aneurysm. Secondary TAR became necessary for 3.4% of patients who failed to receive TAR at initial surgery in aneurysm group during follow-up, while for 33.3% of patients in dissection group (P<0.001). Freedom from distal aortic reoperation in dissection group were 65.4%±5.2%, 49.6%±6.4%, and 38.3%±7.7% and in aneurysm group were 90.5%±3.5%, 84.2%±4.8%, and 84.2%±4.8% at 5, 10, and 15 years, respectively (P<0.001). Survival in dissection group were 94.4%±2.4%, 83.4%±5.7%, 68.4%±10.8% and in aneurysm group were 100%, 97.7%±2.3%, 97.7%±2.3% at 5, 10, and 15 years, respectively (P=0.001). Freedom from mitral valve reoperation in dissection group were 98.8%±1.2%, 98.8%±1.2%, 88.9%±9.4% at 5, 10, and 15 years, respectively. Freedom from mitral valve reoperation in aneurysm group were 97.2%±1.9%, 94.6%±3.2%, 94.6%±3.2% at 5, 10, and 15 years, respectively (P=0.775). CONCLUSIONS: TAAD at initial surgery was an independent predictor of distal aortic reoperation. Limited repair was feasible for MFS patients presenting with aneurysm at initial surgery, extended repair might be better for TAAD for its higher risk of distal reintervention. Concomitant mitral valve procedures may depend on mitral regurgitation grades.