Return to flight duty (RTFD) after posterior lumbar spine surgery for symptomatic lumbar disc herniation (LDH) and lumbar isthmic spondylolisthesis (LIS) in Chinese military pilots.

BACKGROUND: Symptomatic lumbar disc herniation (LDH) and lumbar isthmic spondylolisthesis (LIS) present significant challenges for military pilots, which may result in grounding if not effectively managed. Surgical treatment for LDH and LIS may offer a pathway to return to flight duty (RTFD), but recent data on this crucial topic is lacking. This study seeks to address this gap by investigating the RTFD outcomes among Chinese military pilots who have undergone lumbar spine surgery for symptomatic LDH and LIS. METHODS: A retrospective review was conducted on active-duty military pilots who underwent isolated decompressive or fusion procedures at an authorized military medical center from March 1, 2007, to March 1, 2023. The analysis utilized descriptive statistics to examine demographic, occupational, surgical, and outcome data, with a particular focus on preoperative flight status, recommended clearance by spine surgeons, and actual RTFD outcomes and time. RESULTS: Among the identified cases of active-duty military pilots with LDH or LIS treated by lumbar surgery (n = 24), 70.8% (17 of 24) consistently maintained RTFD status without encountering surgical complications or medical issues during the follow-up period. Of the seven pilots who did not RTFD, one retired within a year of surgery, two had anterior cruciate ligament injuries, three had residual radicular symptoms, and one had chronic low back pain. Excluding pilots who retired and did not RTFD for reasons unrelated to their lumbar conditions, the RTFD rate stood at 81.0% (17 of 21). The median time for recommended clearance by spine surgeons was 143.0 days (inter-quartile range, 116.5-196.0), while the median duration for actual RTFD attainment was 221.0 days (inter-quartile range, 182.0-300.0). The median follow-up post-lumbar surgery was 1.7 years (inter-quartile range, 0.4-2.9). CONCLUSION: Most military pilots diagnosed with symptomatic LDH and LIS can continue their careers and regain active-duty flight status following lumbar spine surgery, as reflected by the high RTFD rate. Lumbar spine surgery can successfully alleviate the physical constraints associated with spinal conditions, facilitating the return of military pilots to their demanding profession.

Recycling Valuable Alkylbenzenes from Polystyrene through Methanol-Assisted Depolymerization.

The vast bulk of polystyrene (PS), a major type of plastic polymers, ends up in landfills, which takes up to thousands of years to decompose in nature. Chemical recycling promises to enable lower-energy pathways and minimal environmental impacts compared with traditional incineration and mechanical recycling. Herein, we demonstrated that methanol as a hydrogen supplier assisted the depolymerization of PS (denoted as PS-MAD) into alkylbenzenes over a heterogeneous catalyst composed of Ru nanoparticles on SiO2. PS-MAD achieved a high yield of liquid products which accounted for 93.2 wt % of virgin PS at 280 °C for 6 h with the production rate of 118.1 mmolcarbon gcatal. -1 h-1. The major components were valuable alkylbenzenes (monocyclic aromatics and diphenyl alkanes), the sum of which occupied 84.3 wt % of liquid products. According to mechanistic studies, methanol decomposition dominates the hydrogen supply during PS-MAD, thereby restraining PS aromatization which generates by-products of fused polycyclic arenes and polyphenylenes.

3D Printed Graphene-Based Metamaterials: Guesting Multi-Functionality in One Gain.

Advanced functional materials with fascinating properties and extended structural design have greatly broadened their applications. Metamaterials, exhibiting unprecedented physical properties (mechanical, electromagnetic, acoustic, etc.), are considered frontiers of physics, material science, and engineering. With the emerging 3D printing technology, the manufacturing of metamaterials becomes much more convenient. Graphene, due to its superior properties such as large surface area, superior electrical/thermal conductivity, and outstanding mechanical properties, shows promising applications to add multi-functionality into existing metamaterials for various applications. In this review, the aim is to outline the latest developments and applications of 3D printed graphene-based metamaterials. The structure design of different types of metamaterials and the fabrication strategies for 3D printed graphene-based materials are first reviewed. Then the representative explorations of 3D printed graphene-based metamaterials and multi-functionality that can be introduced with such a combination are further discussed. Subsequently, challenges and opportunities are provided, seeking to point out future directions of 3D printed graphene-based metamaterials.

Transcription factor Sp2 promotes TGFB-mediated interstitial cell osteogenic differentiation in bicuspid aortic valves through a SMAD-dependent pathway.

Calcification of the bicuspid aortic valve (BAV) involves differential expression of various RNA genes, which is achieved through complex regulatory networks that are controlled in part by transcription factors and microRNAs. We previously found that miR-195-5p regulates the osteogenic differentiation of valvular interstitial cells (VICs) by targeting the TGF-ß pathway. However, the transcriptional regulation of miR-195-5p in calcified BAV patients is not yet clear. In this study, stenotic aortic valve tissues from patients with BAVs and tricuspid aortic valves (TAVs) were collected. Candidate transcription factors of miR-195-5p were predicted by bioinformatics analysis and tested in diseased valves and in male porcine VICs. SP2 gene expression and the corresponding protein levels in BAV were significantly lower than those in TAV, and a low SP2 expression level environment in VICs resulted in remarkable increases in RNA expression levels of RUNX2, BMP2, collagen 1, MMP2, and MMP9 and the corresponding proteins. ChIP assays revealed that SP2 directly bound to the transcription promoter region of miR-195-5p. Cotransfection of SP2 shRNA and a miR-195-5p mimic in porcine VICs demonstrated that SP2 repressed SMAD7 expression via miR-195-5p, while knockdown of SP2 increased the mRNA expression of SMAD7 and the corresponding protein and attenuated Smad 2/3 expression. Immunofluorescence staining of diseased valves confirmed that the functional proteins of osteogenesis differentiation, including RUNX2, BMP2, collagen 1, and osteocalcin, were overexpressed in BAVs. In Conclusion, the transcription factor Sp2 is expressed at low levels in VICs from BAV patients, which has a negative impact on miR-195-5p expression by binding its promoter region and partially promotes calcification through a SMAD-dependent pathway.

Intrawound vancomycin powder in orthopaedic surgery as surgical site wound infection prophylaxis: A meta-analysis.

A meta-analysis research was executed to appraise the consequence of intrawound vancomycin powder (IWVP) in orthopaedic surgery (OPS) as surgical site wound infection (SSWI) prophylaxis. Inclusive literature research till March 2023 was carried out and 2756 interconnected researches were revised. Of the 18 picked researches enclosed 13 214 persons with OPS were in the used researches' starting point, 5798 of them were utilising IWVP, and 7416 were control. Odds ratio (OR) in addition to 95% confidence intervals (CIs) were used to appraise the consequence of the IWVP in OPS as SSWI prophylaxis by the dichotomous approaches and a fixed or random model. IWVP had significantly lower SSWIs (OR, 0.61; 95% CI, 0.50-0.74, P < .001), deep SSWIs (OR, 0.57; 95% CI, 0.36-0.91, P = .02), and superficial SSWIs (OR, 0.67; 95% CI, 0.46-0.98, P = .04) compared with control in persons with OPS. IWVP had significantly lower SSWIs, deep SSWIs, and superficial SSWIs compared with control in persons with OPS. However, when interacting with its values, caution must be taken and more research is needed to confirm this finding.

Nitrogen-Embedded Quintuple [7]Helicene: A Helicene-Azacorannulene Hybrid with Strong Near-Infrared Fluorescence.

Herein, a nitrogen-embedded quintuple [7]helicene (N-Q7H) with an azapentabenzocorannulene core, which can be considered to be a helicene/azacorannulene hybrid π-system, was synthesized from azapentabenzocorannulene in a three-step process. N-Q7H is the first example of a multiple helicene with an azabuckybowl core. Single-crystal X-ray diffractometry unambiguously confirmed the structure of the propeller-shaped hybrid π-system. Owing to nitrogen-atom doping in the multiple helicenes and effective hybridization between the helicene and azacorannulene, N-Q7H exhibits considerably redshifted absorption and emission (yellow-to-green color change and green-to-near-infrared fluorescence change) relative to the azapentabenzocorannulene core. The broad absorption from the ultraviolet-visible to the NIR region is ascribable to the allowed transition between the highest occupied molecular orbital and the lowest unoccupied molecular orbital after symmetry breaking, as revealed by density functional theory calculations. Compared to previous propeller-shaped multiple helicenes with corannulene or hexabenzocoronene (etc.) as cores, N-Q7H demonstrates a significantly higher NIR fluorescence quantum efficiency of 28%. Additionally, the chiral-resolution and redox properties of N-Q7H were investigated. The excellent photophysical and inherent chiral properties of N-Q7H suggest that azapentabenzocorannulene can be used as an outstanding nitrogen-embedded core to construct novel multiple helicenes with wide application potential, including as NIR fluorescent bio-probes.

Symmetry-Breaking Sites for Activating Linear Carbon Dioxide Molecules.

ConspectusCO2 is not only a greenhouse gas but also a pivotal carbon source as a promising supplement to fossil fuels. Both the environment and energy crises have compelled the researchers to explore how to efficiently transform CO2 into liquid fuels and value-added chemicals. As the industrialized approach nowadays, heterogeneous CO2 hydrogenation driven by thermal energy represents a potential strategy to help mitigate the greenhouse effect and reduce the reliance on fossil fuels. However, as the prerequisite for CO2 hydrogenation, CO2 activation is difficult due to the thermodynamic stability and chemical inertness of CO2 molecules. It is not proper to activate CO2 by directly increasing the reaction temperature, because CO2 hydrogenation into liquid products is an exothermic process where elevating the temperature decreases both the balanced conversion of CO2 and the balanced selectivity for target products. Therefore, the key scientific issue for CO2 hydrogenation lies in how to design catalysts which enable efficient activation of CO2. Up to date, a vast variety of active sites have been constructed for effective activation of CO2. These active sites including step sites, alloys, interface, substitution, vacancies, etc. are generally symmetry-breaking rather than perfect flat surfaces.Herein, we propose a catalyst design principle of constructing symmetry-breaking sites to activate nonpolar CO2 molecules. From the perspective of electronic properties, there is a prominent charge density gradient in a symmetry-breaking center, resulting in perturbing electronic structures of nonpolar CO2 and polarizing the adsorbed species. From the perspective of adsorption configuration, a symmetry-breaking site gives a local torque which enables more effective overlapping of atomic orbitals and thus more facilely bending of linear CO2 molecules, compared with symmetric sites. In this Account, we categorize the modes of CO2 activation and put forward the design principle of constructing symmetry-breaking sites. Moreover, we illustrate how to construct symmetry-breaking sites from the perspectives of local and global structures. Strategies to break the symmetry of local structures include surface substitution, surface adatom, and surface vacancy. Strategies to break the symmetry of global structures comprise surface modification with ligands, high-index surface, and phase reconstruction. In the future, further improvements, such as quantified descriptors, function for C-C coupling, and applicability to other nonpolar molecules, are necessary.

High-resolution on-chip Fourier transform spectrometer based on cascaded optical switches.

Chip-level spectrometers provide a stable and cost-effective solution for spectral analysis in various applications. Here we present a silicon on-chip digital Fourier transform spectrometer consisting of eight cascaded optical switches connected by delay waveguides. By configuring the states of the optical switches, this chip can realize 127 Mach-Zehnder interferometers with linearly increased optical path differences. A machine-learning regularization method is utilized to reconstruct the spectrum. Experimental results show that our chip can retrieve both sparse and broadband optical spectra with negligible reconstruction errors. The spectral resolution can be further improved by cascading more stages of optical switches. Our method has the advantages of compact size, high scalability, and high signal-to-noise ratio, making it a promising candidate for realizing miniaturized spectrometers.

The training effects of a continuing education program on nurses' knowledge and attitudes to palliative care: a cross sectional study.

BACKGROUND: Most nurses in China have not been trained to take care of end-of-life patients appropriately due to lack of educational resources and insufficient training. A palliative care program was launched by the Jiangsu Nursing Association (JNA training program) and to identify gaps in palliative care training. The main aim of this study was to evaluate the training effects of the JNA training program on nurses' knowledge and attitudes to palliative care. METHODS: A cross-sectional study was conducted with 10 048 registered nurses in all regions of Jiangsu. All participants completed an online questionnaire using the Chinese version of The Palliative Care Quiz for Nursing (PCQN-C) and the Frommelt Attitude Toward Care of the Dying scale (FATCOD-B-C). A propensity score matched analysis was performed between the nurses who had attended the JNA training program and whose who hadn't. RESULTS: The average score of PCQN-C among all nurses was 8.79, while the mean score of the FATCOD-B-C was 103.62. Those participants who attended the JNA training program had significantly better scores than those who did not. Propensity score matching analysis showed that the palliative care training program failed to improve nurses' knowledge in psychosocial and spiritual care or their attitudes towards the necessity of family support although there was positive impact on other aspects of palliative care. CONCLUSIONS: Knowledge of palliative care among Chinese nurses remains low. Training programs may improve general knowledge and attitudes to palliative care. However, important aspects of knowledge such as communication skills, family support, and psychosocial aspects of care, are missing. These gaps should be filled in future palliative care training programs targeting nurses with oriental culture background.

Understanding online self-directed learning using point of care information systems (POCIS): A plot study using a capability approach perspective.

PURPOSE OF THE STUDY: Understanding self-directed learning (SDL) when using point of care information systems (POCIS) can inform educational providers of the usefulness of the system for continuing medical education (CME). Sen's capability approach can offer a unique perspective to understand SDL, which considers the extent to which individual valued learning needs can be achieved. The aim of the study was to pilot the use of a questionnaire informed by the capability approach for understanding SDL when using POCIS in the context of CME. METHODS: A semi-structured questionnaire aligned to the capability approach (Capability Approach for SDL with POCIS Questionnaire - CA-SPQ) in the context of CME was developed and implemented with 200 users of a POCIS (BMJ Best Practice). RESULTS: The response rate was 92 and 78% of users considered that their valued outcomes were achieved and that they could apply their new learning to practice. The questionnaire had high content, face, and construct validity. CONCLUSION: The CA-SPQ can offer a practical instrument to provide data and useful information for understanding SDL, when using POCIS in the context of CME. It also has the potential for adaptation to other areas of medical education.

Sulfur-Doped Quintuple [9]Helicene with Azacorannulene as Core.

Herein, a hetero(S,N)-quintuple [9]helicene (SNQ9H) molecule with an azacorannulene core was synthesized, currently representing the highest hetero-helicene reported in the field of multiple [n]helicenes. X-ray crystallography indicated that SNQ9H includes not only a propeller-shaped conformer SNQ9H-1, but also an unforeseen quasi-propeller-shaped conformer SNQ9H-2. Different conformers were observed for the first time in multiple [n≥9]helicenes, likely owing to the doping of heteroatomic sulfurs in the helical skeletons. Remarkably, the ratio of SNQ9H-1 to SNQ9H-2 can be regulated in situ by the reaction temperature. Experimental studies on the photophysical and redox properties of SNQ9H and theoretical calculations clearly demonstrated that the electronic structures of SNQ9H depend on their molecular conformations. The strategy of introducing heteroatomic sulfurs into the helical skeleton may be useful in constructing various conformers of higher multiple [n]helicenes in the future.

Integrative transcriptomic analysis of developing hematopoietic stem cells in human and mouse at single-cell resolution.

Current understanding of hematopoietic stem cell (HSC) development comes from mouse models is considered to be evolutionarily conserved in human. However, the cross-species comparison of the transcriptomic profiles of developmental HSCs at single-cell level is still lacking. Here, we performed integrative transcriptomic analysis of a series of key cell populations during HSC development in human and mouse, including HSC-primed hemogenic endothelial cells and pre-HSCs in mid-gestational aorta-gonad-mesonephros (AGM) region, and mature HSCs in fetal liver and adult bone marrow. We demonstrated the general similarity of transcriptomic characteristics between corresponding cell populations of the two species. Of note, one of the previously transcriptomically defined hematopoietic stem progenitor cell (HSPC) populations with certain arterial characteristics in AGM region of human embryos showed close transcriptomic similarity to pre-HSCs in mouse embryos. On the other hand, the other two HSPC populations in human AGM region displayed molecular similarity with fetal liver HSPCs, suggesting the maturation in AGM before HSCs colonizing the fetal liver in human, which was different to that in mouse. Finally, we re-clustered cells based on the integrated dataset and illustrated the evolutionarily conserved molecular signatures of major cell populations. Our results revealed transcriptomic conservation of critical cell populations and molecular characteristics during HSC development between human and mouse, providing a resource and theoretic basis for future studies on mammalian HSC development and regeneration by using mouse models.

Quantitative study of conservative gradient force and non-conservative scattering force exerted on a spherical particle in optical tweezers.

We rigorously calculate the conservative gradient force (GF) and the non-conservative scattering force (SF) associated with the optical tweezers (the single beam optical trap). A wide range of parameters are considered, with particle size ranging from the Rayleigh to Mie regime (radius ∼3 µm), dielectric constant ranging from metallic (large and negative) to high dielectrics (large and positive), numerical aperture (NA) ranging from 0.5 to 1.33, and different polarizations. The trap depth associated with GF can reach 123 and 168 kBT per mW for a 0.5 µm-radius polystyrene particle illuminated by a 1064 nm Gaussian beam with NA = 0.9 and 1.3, respectively. This indicates that unless at a low beam power or with a small NA, the Brownian fluctuations do not play a role in the stability. The transverse GF orthogonal to beam propagation always dominates over the transverse SF. While the longitudinal SF can be larger than the longitudinal GF when the scattering is strong, the NA is small, or when absorption is present, optical trapping under these conditions is difficult. Generally speaking, absorption reduces GF and enhances SF, while increasing a dielectric constant enhances GF slightly but boosts SF significantly owing to stronger scattering. These results verify previous experimental observations and explain why optical tweezers are so robust across such a wide range of conditions. Our quantitative calculations will also provide a guide to future studies.

Retroreflection from a single layer of electromagnetic Helmholtz cavities based on magnetic symmetric dipole modes.

We demonstrate a new electromagnetic mode which is formed by the dynamic interaction between a magnetic quadrupole mode and an electric monopole mode in a two-dimensional electromagnetic Helmholtz cavity. It is termed a magnetic symmetric dipole mode since it shares similarity with a magnetic dipole mode in the sense that their radiation is both overwhelmingly dominant in the forward and backward directions with respect to the incident wave. However, the phase distribution in the two radiation directions is symmetric, in stark contrast to the antisymmetry of magnetic dipole modes. When the Helmholtz cavities are arranged in a line, the incident wave will be reflected back to the source, in other words, retroreflection occurs because of the peculiar properties of magnetic symmetric dipole modes. We show that the retroreflection is quite robust against the disorder of the orientation angle of Helmholtz cavities and there exists a wide tolerance for wavelength and the outer radius of the cavity. With low fabrication demands, this might offer a feasible solution for the design of ultrathin retroreflectors towards device miniaturization and the realization of multiplexing holography.

Graphene oxide enters the rice roots and disturbs the endophytic bacterial communities.

The environmental release of graphene oxide (GO) will certainly induce the GO exposure to plants. To date, the influence of GO on the intracellular structures and the endophytic bacterial ecology of plants have been rarely reported. In the present study, the rice seedlings were exposed to GO (5 mg/L) under hydroponic condition for fifteen days with periodic stir. The cellular structures damage, GO deposition and oxidative stress were found in rice root after GO exposure. A Illumina analysis based on the bacterial 16 S rRNA gene showed that the richness, evenness and diversity of endophytic bacterial communities of rice root decreased due to GO exposure. The relative abundance of beneficial endophytic bacterial populations decreased after GO exposure. Out of potential phenotypes predicted by BugBase, the relative abundance of Gram negative, stress-tolerant and biofilm-forming phenotypes, presented an increase trend after GO exposure.

Inducible cardiac-specific overexpression of cyclooxygenase-2 (COX-2) confers resistance to ischemia/reperfusion injury.

The role of cyclooxygenase-2 (COX-2) in cardiovascular biology remains controversial. Although COX-2 has been reported to mediate the protective actions of late preconditioning, other studies show that it is also an important mediator of inflammation, toxic shock, and apoptosis, resulting in significant dysfunction and injury in several tissues. To determine whether increased myocardial COX-2, in itself, is protective, cardiac-specific, inducible (Tet-off) COX-2 transgenic (iCOX-2 TG) mice were generated by crossbreeding α-MyHC-tTA transgenic mice (tetracycline transactivator [tTA]) with CMV/TRE-COX-2 transgenic mice. Three months after COX-2 induction, mice were subjected to a 30-min coronary occlusion and 24 h of reperfusion. Three different lines (L5, L7, and L8) of iCOX-2 TG mice were studied; in all three lines, infarct size was markedly reduced compared with WT mice: L5 TG/TG 23.4 ± 5.8 vs. WT/WT 48.5 ± 6.1% of risk region; L7 TG/TG 23.2 ± 6.2 vs. WT/WT 53.3 ± 3.6%; and L8 TG/TG 23.5 ± 2.8 vs. WT/WT 52.7 ± 4.6% (P < 0.05 for each). COX-2 inhibition with NS-398 completely abolished the cardioprotection provided by COX-2 overexpression. This study for the first time utilizes an inducible cardiac-specific COX-2 overexpression system to examine the role of this enzyme in ischemia/reperfusion injury in vivo. We demonstrate that induced cardiac-specific overexpression of COX-2 exerts a potent cardioprotective effect against myocardial infarction in mice, and that chronic COX-2 overexpression is not associated with any apparent deleterious effects. We also show that PGE2 levels are upregulated in COX-2 overexpressing cardiac tissue, confirming increased enzyme activity. Finally, we have developed a valuable genetic tool to further our understanding of the role of COX-2 in ischemia/reperfusion injury and other settings. The concept that COX-2 is chronically protective has important therapeutic implications for studies of long-term gene therapy aimed at increasing myocardial COX-2 content as well as other COX-2- based strategies.

Intramolecular Copper-Containing Hyperbranched Polytriazole Assemblies for Label-Free Cellular Bioimaging and Redox-Triggered Copper Complex Delivery.

Intramolecular Cu-containing amphiphilic hyperbranched polytriazoles are purposefully designed and synthesized via a Cu(I)-catalyzed azide-alkyne cycloaddition (CuAAC) reaction, and are self-assembled into spherical assemblies. Based on the metal coordination ability of triazole groups, the copper catalyst can be intramolecularly coordinated with triazole groups in the CuAAC, producing the copper-triazole coordination polyprodrugs. Unexpectedly, the amphiphilic hyperbranched polytriaozle assemblies can also be applied as fluorescent nanoprobes with aggregation-induced emission enhancement. The cellular uptake verifies their functional application for cellular bioimaging. Furthermore, the results of cell viability indicate that the mPEG-hb-S-S-PTAs assemblies are effective copper delivery systems for cancer therapy by releasing the anticancer copper-triazole coordination complexes. Therefore, the amphiphilic hyperbranched polytriazoles may have very promising applications in complex copper delivery and label-free cellular bioimaging.

Calcification of the intervertebral disc and ossification of posterior longitudinal ligament in children.

BACKGROUND: IDC in children, first reported by Baron in 1924, is very rare. OPLL of the cervical spine mainly affect people ages 50-70 years. The coexistence of IDC and OPLL in children is very rare, only six cases with 3 to 24 months' follow-up were reported to date. CASE PRESENTATION: A 6-year-old boy presented with complains of neck pain at July 2007. The boy was treated by conservative treatment and observed up for 9 years. Neck pain greatly improved after a one-month conservative treatment and never recur. Laboratory tests revealed elevated ESR and CRP at admission and found nothing abnormal at 19-month and 9-year follow-up. Computed tomography and magnetic resonance imaging revealed IDC at C2/3, C3/4 and OPLL at C3/4 at admission and found minor calcification at C2/3 remained but calcification at C3/4 and OPLL at C3/4 completely disappeared at 19-month and 9-year follow-up. Nineteen months after initial diagnosis, restoration of T2-weighted signal intensity of C2/3 and C3/4 discs was observed through MRI. Loss of T2-weighted signal intensity of C2/3 disc and decrease of T2-weighted signal intensity of C3/4 disc was observed at 9-year follow-up. CONCLUSIONS: IDC with OPLL in children is very rare. Conservative treatments are recommended with affirmative short-term and long-term clinical effects. More intensive observation with long-term follow-ups may be needed to warrant the clinical effects.

Downregulated MicroRNA-195 in the Bicuspid Aortic Valve Promotes Calcification of Valve Interstitial Cells via Targeting SMAD7.

BACKGROUND/AIMS: Aortic stenosis caused by leaflet calcification in the bicuspid aortic valve (BAV) is more accelerative than that in the tricuspid aortic valve (TAV). MicroRNA-195 (miR-195) is downregulated more in stenotic than in insufficient BAVs, but its expression in BAVs compared with TAVs is unclear. We aimed to investigate the roles of miR-195 and its calcification-related target SMAD7 in stenotic BAVs compared with those in TAVs. METHODS: Twenty-one stenotic BAV and 29 TAV samples were collected from surgical patients and examined for the expression of miR-195 and SMAD7 by RT-PCR. The samples were also assessed by western blotting and immunohistochemistry for the functional protein alteration associated with calcification. Dual-luciferase assay was performed to determine the putative target of miR-195 before the effects of miR-195 expression on osteogenic progression was demonstrated in cultured porcine valve interstitial cells (VICs). RESULTS: Compared with TAV, the expression of miR-195 was remarkably lower in the BAV leaflet with higher expression of SMAD7, which was then validated as a direct target of miR-195. Their negative correlation was then confirmed in cultured VICs. Under an osteogenic environment, the cellular calcification was promoted in miR-195-repressed VICs expressing higher BMP-2 and Runx2 and higher activity of MMP-2 compared with the controls. Finally, higher MMP-2 and MMP-9 expression and more collagen distribution were observed in BAV than TAV samples. CONCLUSIONS: miR-195 is downregulated more in stenotic BAV than TAV in this study. The downregulation of miR-195 is associated with valvular calcification via targeting SMAD7, which promotes the remodeling of the extracellular matrix.

The NHLBI-sponsored Consortium for preclinicAl assESsment of cARdioprotective therapies (CAESAR): a new paradigm for rigorous, accurate, and reproducible evaluation of putative infarct-sparing interventions in mice, rabbits, and pigs.

RATIONALE: Despite 4 decades of intense effort and substantial financial investment, the cardioprotection field has failed to deliver a single drug that effectively reduces myocardial infarct size in patients. A major reason is insufficient rigor and reproducibility in preclinical studies. OBJECTIVE: To develop a multicenter, randomized, controlled, clinical trial-like infrastructure to conduct rigorous and reproducible preclinical evaluation of cardioprotective therapies. METHODS AND RESULTS: With support from the National Heart, Lung, and Blood Institute, we established the Consortium for preclinicAl assESsment of cARdioprotective therapies (CAESAR), based on the principles of randomization, investigator blinding, a priori sample size determination and exclusion criteria, appropriate statistical analyses, and assessment of reproducibility. To validate CAESAR, we tested the ability of ischemic preconditioning to reduce infarct size in 3 species (at 2 sites/species): mice (n=22-25 per group), rabbits (n=11-12 per group), and pigs (n=13 per group). During this validation phase, (1) we established protocols that gave similar results between centers and confirmed that ischemic preconditioning significantly reduced infarct size in all species and (2) we successfully established a multicenter structure to support CAESAR's operations, including 2 surgical centers for each species, a Pathology Core (to assess infarct size), a Biomarker Core (to measure plasma cardiac troponin levels), and a Data Coordinating Center-all with the oversight of an external Protocol Review and Monitoring Committee. CONCLUSIONS: CAESAR is operational, generates reproducible results, can detect cardioprotection, and provides a mechanism for assessing potential infarct-sparing therapies with a level of rigor analogous to multicenter, randomized, controlled clinical trials. This is a revolutionary new approach to cardioprotection. Importantly, we provide state-of-the-art, detailed protocols ("CAESAR protocols") for measuring infarct size in mice, rabbits, and pigs in a manner that is rigorous, accurate, and reproducible.