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Background: Frailty is recognized as a surrogate for physiological age and has been established as a valid and independent predictor of postoperative morbidity, mortality, and complications. Enhanced recovery after surgery (ERAS) can enhance surgical safety by minimizing stress responses in frail patients, enabling surgeons to discharge patients earlier. However, the question of whether and to what extent the frailty impacts the post-ERAS outcomes in older patients remains. Materials and methods: An evidence-based ERAS program was implemented in our center from January 2019. This is a prospective cohort study of patients aged =75 years who underwent open transforaminal lumbar interbody fusion (TLIF) for degenerative spine disease from April 2019 to October 2021. Frailty was assessed with the Fried frailty scale (FP scale), and patients were categorized as non/prefrail (FP 0-2) or frail (FP = 3). The preoperative variables, operative data, postoperative outcomes, and follow-up information were compared between the two groups. Univariate and multivariate logistic regression analyses were used to identify risk factors for 90-day major complications and prolonged length of hospital stay after surgery. Results: A total of 245 patients (age of 79.8 ± 3.4 year) who had a preoperative FP score recorded and underwent scheduled TLIF surgery were included in the final analysis. Comparisons between nonfrail and prefrail/frail patients revealed no significant difference in age, sex, and surgery-related variables. Even after adjusting for multiple comparisons, the association between Fried frailty and ADL-dependency, IADL-dependency, and malnutrition remained significant. Preoperative frailty was associated with increased rates of postoperative adverse events. A higher CCI grade was an independent predictor for 90-day major complications, while Fried frailty and MNA-SF scores <12 were predictive of poor postoperative recovery. Conclusion: Frail older patients had more adverse post-ERAS outcomes after TLIF compared to non/prefrail older patients. Continued research and multidisciplinary collaboration will be essential to refine and optimize protocols for surgical care in frail older adults. [ABSTRACT FROM AUTHOR]

Synthetic nitrogen fertilizers, such as urea, are instrumental in augmenting agricultural output and addressing the demands of a growing population. Nevertheless, conventional urea production heavily relies on energy‐intensive processes. In this study, an environmentally friendly photocatalytic method is proposed for directly and selectively synthesizing urea from nitrogen (N2) and methanol (CH3OH using a Pt cluster‐decorated TiO2 catalyst (Pt cluster/TiO2). Remarkably, the Pt cluster/TiO2 exhibits outstanding urea synthesis performance with a rate of 105.68 µmol g−1 h−1 and N‐selectivity of 97.29 ± 0.79%, representing the highest level of photocatalytic urea synthesis from N2. Further analysis with density functional theory (DFT) calculation reveals that the "σ–π*" donor–acceptor interaction occurred between Pt clusters and N2, efficiently reducing the N2 hydrogenation barrier. EPR experiments demonstrate that photogenerated electrons (e−) and hole (h+) are synchronously consumed through N2 reduction and CH3OH oxidation, thereby accelerating urea synthesis. The crucial step of C─N coupling is initiated by the reaction between *NH─NH and *CHO intermediate, facilitated by the low energy barrier on Pt cluster/TiO2. This work suggests an mild route of urea production and provides profound insights into the underlying chemistry of the C─N coupling reaction, which can guide the sustainable synthesis of essential indispensable chemicals. [ABSTRACT FROM AUTHOR]

The current paradigm considers the control of the MOF/polymer interface mostly for achieving a good compatibility between the two components to ensure the fabrication of continuous mixed-matrix metal-organic framework (MMMOF) membranes. Here, we unravel that the interfacial pore shape nanostructure plays a key role for an optimum molecular transport. The prototypical ultrasmall pore AlFFIVE-1-Ni MOF was assembled with the polymer PIM-1 to design a composite with gradually expanding pore from the MOF entrance to the MOF/polymer interfacial region. Concentration gradient-driven molecular dynamics simulations demonstrated that this pore nanostructuring enables an optimum guided path for the gas molecules at the MOF/polymer interface that decisively leads to an acceleration of the molecular transport all along the MMMOF membrane. This numerical prediction resulted in the successful fabrication of a [001]-oriented nanosheets AlFFIVE-1-Ni/PIM-1 MMMOF membrane exhibiting an excellent CO2 permeability, better than many MMMs, and ideally associated with a sufficiently high CO2/CH4 selectivity that makes this membrane very promising for natural gas/biogas purification. [ABSTRACT FROM AUTHOR]

Objective This study aims to investigate the feasibility and safety of Da Vinci robotic-assisted thoracoscopy for resecting mediastinal tumors in pediatric patients. Methods From November 2020 to June 2023, a total of 80 pediatric patients undergoing mediastinal tumor resection at Wuhan Children's Hospital were randomly assigned into two groups, with each group consisting of 40 participants. The control group underwent conventional thoracoscopy, while the observation group underwent Da Vinci robotic-assisted thoracoscopy. This study aimed to compare perioperative indicators between the two groups and establish learning curves based on surgical duration and intraoperative blood loss. Additionally, it assessed levels of pain mediators and stress response markers before surgery and at 24 hours post-surgery, as well as postoperative complications. Inflammatory marker levels were evaluated one month after surgery, and the children's quality of life was measured using the Pediatric Quality of Life Inventory(PedsQL) Generic Core Scales before surgery and one month post-surgery. Results The surgical duration for the observation group and the control group was(1.76 ± 0.33) hours and(2.82±0.62) hours, respectively, and the intraoperative blood loss was(49.83 ± 6.39) mL and(71.55 ± 8.19) mL, respectively. Furthermore, the post-operative drainage time, drainage volume, and hospital stay for the observation group were all lower than those for the control group(P < 0.05). After surgery, the levels of BK, 5-HT, NPY, and PGE2 in the observation group were(8.06 ± 1.06) mg/L, (170.20 ± 13.21) ng/L, (201.82 ± 13.52) mg/L, and(241.82 ± 15.32) ng/L, respectively, indicating lower levels of pain mediators, stress response markers, and inflammatory factors compared to the control group(P < 0.05). he overall incidence of complications was 2.50% in the observation group as opposed to 20.00% in the control group. Moreover, there was a statistically significant improvement in quality of life after surgery within the observation group when compared to that within the control group(P < 0.05). Conclusion Da Vinci robotic-assisted thoracoscopy demonstrates enhanced feasibility and safety in pediatric mediastinal tumor resection, thereby justifying its clinical promotion. [ABSTRACT FROM AUTHOR]

The opioid crisis in the United States is a significant public health issue, with a nearly threefold increase in opioid-related fatalities between 1999 and 2014. In response to this crisis, society has made numerous efforts to mitigate its impact. Recent advancements in understanding the structural intricacies of the κ opioid receptor (KOR) have improved our knowledge of how opioids interact with their receptors, triggering downstream signaling pathways that lead to pain relief. This review concentrates on the KOR, offering crucial structural insights into the binding mechanisms of both agonists and antagonists to the receptor. Through comparative analysis of the atomic details of the binding site, distinct interactions specific to agonists and antagonists have been identified. These insights not only enhance our understanding of ligand binding mechanisms but also shed light on potential pathways for developing new opioid analgesics with an improved risk-benefit profile. [ABSTRACT FROM AUTHOR]