Stable Radicals in Dihydrophenazine Derivatives-Doped Epoxy Resin for High Photothermal Conversion.

Organic radicals exhibit great potential in photothermal applications, however, their innate high reactivity with oxygen renders the preparation of stable organic radicals highly challenging. In this work, a series of co-doped radical polymers ares prepared by doping dihydrophenazine derivatives (DPPs) into the epoxy resin matrix. DPPs can form radical species through the electron transfer process, which are further stabilized by the complex 3D network structure of epoxy resin. Experimental results show that the photothermal conversion efficiency is as high as 79.9%, and the temperature can quickly rise to ≈130 °C within 60 s. Due to the excellent visible light transmittance and mechanical properties of co-doped systems, this study further demonstrates their practical applications in energy-saving solar windows and thermoelectric power generation.

Prism[2]dihydrophenazines: Synthesis, Configurational Analysis, and Supramolecular Tessellation through Exo-Wall Interactions.

Macrocyclic arenes have gained considerable attention for their structural diversity and widespread applications. In this research, a new kind of macrocyclic arenes, namely prism[2]dihydrophenazines (anti-P2P20, syn-P2P20, and P2P22), composed of two dihydrophenazine derivatives subunits bridged by methylene groups, were conveniently synthesized by AlCl3-catalyzed one-pot condensation in 1,2-dichloroethane. Both anti-P2P20 and its isomer syn-P2P20 exhibited flexible and convertible conformation with narrow cavity, while P2P22 possessed rigid and rhombic-like skeleton due to the more steric hindrance on subunits. In addition, the selection of electron-deficient guest was found to influence the outside binding behavior of syn-P2P20. Fantastic regular supramolecular tessellation was fabricated by tiling of syn-P2P20 with tetrafluoro-1,4-benzoquinone (TFB) through the exo-wall interactions. Using 1,5-difluoro-2,4-dinitrobenzene (DFN) as a linker, only the regular 2D network superstructure with periodic units in a plane was obtained through cocrystallization. This work not only reports the construction of supramolecular tessellations by using prism[2]dihydrophenazines as building blocks, but also provides a new perspective for the design of macrocyclic arenes and fabrication of 2D supramolecular materials.

Risk factors for bacteremia and mortality due to multidrug-resistant Acinetobacter baumannii: a retrospective study.

This research aimed to determine the relationships between the risk factors for nosocomial multidrug-resistant Acinetobacter baumannii (MDRAB) bacteremia and associated mortality. We analyzed 144 patients treated for A. baumannii bacteremia, including 120 patients with MDRAB bacteremia, from March 2015 to March 2020, in this retrospective study. The overall bacteremia-related mortality rate was 48.6%. The mortality rates were 25.0% and 53.3% for non-MDRAB and MDRAB bacteremia, respectively. Risk factors for the development of MDRAB bacteremia were prior use of cephalosporins [odds ratio (OR): 8.62; P < .001], carbapenems (OR: 15.04; P < .001), or quinolones (OR: 5.02; P = .040); indwelling urinary catheters (OR: 21.38; P < .001); and respiratory tract as the source of bacteremia (OR: 75.33; P < .001). Patients with elective surgeries were inclined to develop non-MDRAB bacteremia (OR: 0.45; P = .029). High scores in the Acute Physiology and Chronic Health Evaluation II (OR: 1.321; P < .001) and Sequential Organ Failure Assessment (OR: 1.326; P < .001) were risk factors for mortality from MDRAB infection. In summary, higher mortality rates occur in patients with MDRAB bacteremia, and risk factors include prior use of cephalosporins, carbapenems, or quinolones. Urinary catheters and the respiratory tract as sources of the infection increase the risk of MDRAB bacteremia.

Exploring the Depth-Dependent Microviscosity inside a Micelle Using Butterfly-Motion-Based Fluorescent Probes.

The viscosity distribution of micellar interiors from the very center to the outer surface is dramatically varied, which has been distinguished in theoretical models, yet it remains highly challenging to quantify this issue experimentally. Herein, a series of fluorophore-substituted surfactants DPAC-Fn (n = 3, 5, 7, 9, 11, 13, and 15) are developed by functionalizing the different alkyl-trimethylammonium bromides with the butterfly motion-based viscosity sensor, N,N'-diphenyl-dihydrodibenzo[a,c]phenazine (DPAC). The immersion depth of DPAC units of DPAC-Fn in cetrimonium bromide (C16TAB) micelles depends on the alkyl chain lengths n. From deep (n = 15) to shallow (n = 3), DPAC-Fn in C16TAB micelles exhibits efficient viscosity-sensitive dynamic multicolor emissions. With external standards for quantification, the viscosity distribution inside a C16TAB micelle with the size of ∼4 nm is changed seriously from high viscosity (∼190 Pa s) in the core center to low viscosity (∼1 Pa s) near the outer surface. This work provides a tailored approach for powerful micelle tools to explore the depth-dependent microviscosity of micellar interiors.

Dual Ratio and Ultraprecision Quantification of Mitochondrial Viscosity in Ferroptosis Enabled by a Vibration-Based Triple-Emission Fluorescent Probe.

Ferroptosis is a new mode of cell death with major morphological changes in mitochondria, including structural shrinkage and increased membrane density, indicating the mitochondrial abnormality during this process. Viscosity, as one of the crucial microenvironmental parameters for characterizing the mitochondrial state, is thought to be highly involved in the ferroptosis. Herein, we present a single fluorescent probe (PPAC-C4) for the dual ratio and ultrahigh-accuracy quantification of mitochondrial viscosity. This probe is constructed by linking a mitochondria-targeting cation fragment on a vibration-based fluorescent scaffold whose fluorescence exhibits the rare triple emission (480, 533, and 628 nm) depending on the viscosity. The intensity ratios of 480 nm/628 nm and 533 nm/628 nm can be used to monitor the viscosity changes in a double self-calibration manner and finally afford an average viscosity value with improved precision. By virtue of this pattern, we reveal that the mitochondrial viscosity will increase from 43.58 to 152.05 cP in A549 cells during the ferroptosis. This dual-ratio probe with triemission not only shows great potential in the study of ferroptosis and ferroptosis-related diseases but also proposes a new concept for ultraprecision quantitative analysis.

Sequential Multistep Excited-State Structural Transformations in N,N'-Diphenyl-dihydrodibenzo[a,c]phenazine Fluorophores.

We demonstrate that a single polycyclic π-scaffold can undergo sequential multistep excited-state structural evolution along the bent, planar, and twisted conformers, which coexist to produce intrinsic multiple fluorescence emissions in room-temperature solution. By installing a methyl or trifluoromethyl group on the ortho-site of N,N'-diphenyl-dihydrodibenzo[a,c]phenazine (DPAC), the enhanced steric effects change the fluorescence emission of DPAC from a dominant red band to well-resolved triple bands. The ultra-broadband triple emissions of ortho-substituted DPACs range from ≈350 to ≈850 nm, which is unprecedented for small fluorophores with molecular weight of <500. Ultrafast spectroscopy and theoretical calculations clearly reveal that the above dramatic changes originate from the influence of steric hindrance on the shape of excited state potential energy surface (S1 PES). Compared to the steep S1 PES of parental DPAC, the introduction of ortho-substituent is shown to make the path of structural evolution in S1 wider and flatter, so the ortho-substituted derivatives exhibit slower structural transformations from bent to planar and then to twisted forms, yielding intrinsic triple emission. The results provide the proof of concept that the bent, planar, and twisted emissive states can coexist in the same S1 PES, which greatly expand the fundamental understanding of the excited-state structural relaxation.

Interplay of Steric Effects and Aromaticity Reversals to Expand the Structural/Electronic Responses of Dihydrophenazines.

To gain insights into the coupling of conformational and electronic variables, we exploited steric hindrance to modulate a polycyclic skeleton with a bent conformation in the S0 state and a twisted conformation in the S1 state under the guidance of photoexcited aromaticity reversals. Polycyclic 5,10-dihydrophenazine (DHP) adopted a bent structure in S0 but involved a bent-to-planar transformation in S1 due to the excited-state aromaticity of the 8π-electron central ring. The N,N'-locations and 1,4,6,9-sites of the DHP skeleton provided a versatile chemical handle for fine-tuning intramolecular steric hindrance. Specifically, N,N'-diphenyl-5,10-dihydrophenazine (DPP-00) and its derivatives DPP-10-DPP-22 were synthesized with different numbers of methyl groups on the 1,4,6,9-sites. X-ray crystal analyses suggested that the DHP skeletons of DPP-00-DPP-22 had more bending configurations along the N···N axis with an increase in the number of methyl groups. Following the bending-promoted interruption of π-conjugation, the absorption spectra of DPP-00-DPP-22 significantly blue-shifted from 416 to 324 nm. By contrast, the emission bands exhibited a reverse shift to longer wavelengths from 459 to 584 nm as the number of methyl substituents increased. Theoretical calculations revealed that introducing methyl groups caused the planar DHP skeleton in S1 to further twist along the N···N axis, resulting in a twisted high-strain conformation. The greater Stokes shift of the more steric-hindered structure can be attributed to the release of larger strain and aromatic stabilization energy. This research highlighted the potential promise associated with the interplay of steric effects and aromaticity reversals in a single fluorophore.

Photoconductance from the Bent-to-Planar Photocycle between Ground and Excited States in Single-Molecule Junctions.

Single-molecule conductance measurements for 9,14-diphenyl-9,14-dihydrodibenzo[a,c]phenazine (DPAC) may offer unique insight into the bent-to-planar photocycle between the ground and excited states. Herein, we employ DPAC derivative DPAC-SMe as the molecular prototype to fabricate single-molecule junctions using the scanning tunneling microscope break junction technique and explore photoconductance dependence on the excited-state structural/electronic changes. We find up to ∼200% conductance enhancement of DPAC-SMe under continuous 340 nm light irradiation than that without irradiation, while photoconductance disappears in the case where structural evolution of the DPAC-SMe is halted through macrocyclization. The in situ conductance modulation as pulsed 340 nm light irradiation is monitored in the DPAC-SMe-based junctions alone, suggesting that the photoconductance of DPAC-SMe stems from photoinduced intramolecular planarization. Theoretical calculations reveal that the photoinduced structural evolution brings about a significant redistribution of the electron cloud density, which leads to the appearance of Fano resonance, resulting in enhanced conductance through the DPAC-SMe-fabricated junctions. This work provides evidence of bent-to-planar photocycle-induced conductance differences at the single-molecule level, offering a tailored approach for tuning the charge transport characteristics of organic photoelectronic devices.

Diversified Excited-State Relaxation Pathways of Donor-Linker-Acceptor Dyads Controlled by a Bent-to-Planar Motion of the Donor.

Herein, we introduce the cyclic 8π-electron (C8π) molecule N,N'-diaryl-dihydrodibenzo[a,c]phenazine (DPAC) as a dual-functional donor to establish a series of new donor-linker-acceptor (D-L-A) dyads DLA1-DLA5. The excited-state bent-to-planar dynamics of DPAC regulate the energy gap of the donor, while the acceptors A1-A5 are endowed with different energy gaps and HOMO/LUMO levels. As a result, the rate and efficiency of the excited-state electron transfer vs. energy transfer can be finely harnessed, which is verified via steady-state spectroscopy and time-resolved emission measurements. This comprehensive approach demonstrates, for the first time, the manifold of excited-state properties governed by bifunctional donor-based D-L-A dyads, including bent-to-planar, photoinduced electron transfer (PET) from excited donor to acceptor (oxidative-PET), fluorescence resonance energy transfer (FRET), bent-to-planar followed by electron transfer (PFET), and PET from donor to excited acceptor (reductive-PET).

Extracellular vesicles from human umbilical cord mesenchymal stem cells improve nerve regeneration after sciatic nerve transection in rats.

Peripheral nerve injury results in limited nerve regeneration and severe functional impairment. Mesenchymal stem cells (MSCs) are a remarkable tool for peripheral nerve regeneration. The involvement of human umbilical cord MSC-derived extracellular vesicles (hUCMSC-EVs) in peripheral nerve regeneration, however, remains unknown. In this study, we evaluated functional recovery and nerve regeneration in rats that received hUCMSC-EV treatment after nerve transection. We observed that hUCMSC-EV treatment promoted the recovery of motor function and the regeneration of axons; increased the sciatic functional index; resulted in the generation of numerous axons and of several Schwann cells that surrounded individual axons; and attenuated the atrophy of the gastrocnemius muscle. hUCMSC-EVs aggregated to rat nerve defects, down-regulated interleukin (IL)-6 and IL-1ß, up-regulated IL-10 and modulated inflammation in the injured nerve. These effects likely contributed to the promotion of nerve regeneration. Our findings indicate that hUCMSC-EVs can improve functional recovery and nerve regeneration by providing a favourable microenvironment for nerve regeneration. Thus, hUCMSC-EVs have considerable potential for application in the treatment of peripheral nerve injury.

Molecular Cursor Caliper: A Fluorescent Sensor for Dicarboxylate Dianions.

We report here the fluorescent sensing of both aromatic and linear saturated dicarboxylate anions (DC2-) (as their tetrabutylammonium salts) with different lengths and shapes in acetonitrile using a single fluorescent probe, i.e., the bis-calix[4]pyrrole-appended 9,14-diphenyl-9,14-dihydrodibenzo[a,c]phenazine (DPAC-bisC4P) incorporating a vibration-induced emission (VIE) phenazine core. Fluorescence titration studies revealed that treating DPAC-bisC4P with dicarboxylate guests capable of forming pseudomacrocyclic host-guest complexes via multiple hydrogen-bonding interactions between the dicarboxylates and calix[4]pyrrole moieties led to a blue-shift in the emission of the phenazine core. The binding-based fluorescence-tuning features of DPAC-bisC4P allow the underlying binding events and inferred structural changes to be monitored in the form of different chromaticity outputs. The analyte-induced differences in the fluorescence response to DC2- cover a wide range within the chromaticity diagram and can be visualized readily. The present system thus functions as a rudimentary dicarboxylate anion sensor. It highlights the potential benefits associated with combining a tunable VIE core with noncovalent binding interactions and thus sets the stage for the development of new fluorescent chemosensors where a single chemical entity responds to different analytes with a high level of tunability.

Mono-Heteroatom Substitution for Harnessing Excited-State Structural Planarization of Dihydrodibenzo[a,c]phenazines.

With the aim of generalizing the structure-properties relationship of bending heterocyclic molecules that undergo prominent photoinduced structural planarization (PISP), a series of new dihydrodibenzo[ac]phenazine derivatives in which one nitrogen atom is replaced by oxygen (PNO), sulfur (PNS), selenium (PNSe), or dimethylmethanediyl (PNC) was strategically designed and synthesized. Compounds PNO, PNS, and PNSe have significantly nonplanar geometries in the ground state, which undergo PISP to give a planarlike conformer and hence a large emission Stokes shift. A combination of femtosecond early relaxation dynamics and computational approaches established an R*→I* (intermediate)→P* sequential kinetic pattern for PNS and PNSe, whereas PNO undergoes R*→P* one-step kinetics. The polarization ability of the substituted heteroatoms, which is in the order O

Phenothiazine Scope: Steric Strain Induced Planarization and Excimer Formation.

Phenothiazine derivatives based on the 10-phenyl-10H-phenothiazine (NAS) chromophore, namely 7-phenyl-7H-benzo[c]phenothiazine (NAS-1) and 12-phenyl-12H-benzo[a]phenothiazine (NAS-2), were designed and synthesized. NAS-1 and NAS-2 are constitutional isomers with different steric strains imposed on the phenothiazine core moiety. In solution, the more-strained NAS-2 possesses a bent structure and undergoes photoinduced structural planarization (PISP). In the crystal, despite the absence of PISP, bent NAS-2 exhibits prominent excimer emission as well as emission mechanochromism, which is not observed in the planar-like NAS and NAS-1. This unconventional observation results from the bent core structure facilitating π-π stacking of the peripheral naphthalene moieties. Two-photon-coupled depth-dependent emission shows spectral differences between the surface and kernel of the NAS-2 crystal, and is believed to be a general phenomenon, at least in part, for materials exhibiting emission mechanochromism.

Gremlin Regulates Podocyte Apoptosis via Transforming Growth Factor-ß (TGF-ß) Pathway in Diabetic Nephropathy.

BACKGROUND Gremlin has been reported to be up-regulated in glomerular mesangial cells in diabetic nephropathy (DN). However, the regulation of gremlin in podocytes is still rarely reported. This study aimed to investigate the underlying mechanisms by which gremlin mediates the pathogenesis of DN via transforming growth factor-ß (TGF-ß) signaling pathways. MATERIAL AND METHODS Lentiviral and RNAi transfection were performed to increase and decrease gremlin expression in high-glucose conditions. Expression at the mRNA and protein level was detected by RT-qPCR and Western blotting. RESULTS The expression of gremlin was significantly higher in high-glucose (HG, 30mM) than normal-glucose (NG, 5.5 mM) conditions. The gremlin overexpression significantly suppressed the expression of nephrin and synaptopodin. The phosphorylation of canonical TGF-b signaling pathway components, including Smad2/3 and MKK, was increased in the gremlin-overexpressing group. In addition, the expression levels of Bax and cleaved caspase-3 were also higher in the gremlin-overexpressing group. TGF-ß pathway inhibitor (SB505124) significantly inhibited TGF-ß pathway activity and enhanced the expression of nephrin and synaptopodin. CONCLUSIONS These results indicate that gremlin can aggravate podocyte lesions through the TGF-ß signaling pathway, providing a novel therapeutic target for DN.

The Importance of Excited-State Energy Alignment for Efficient Exciplex Systems Based on a Study of Phenylpyridinato Boron Derivatives.

Understanding excited-state dynamics is critical for improving the photoluminescence (PL) efficiency of exciplexes. A series of exciplexes based on conventional hole-transporting materials as donor and newly developed phenylpyridinato boron derivatives as acceptor were investigated. High PL efficiencies were achieved in only some combinations, and a large difference in performance among combinations provided insight into nonradiative processes in exciplex systems. Furthermore, the triplet local excited states (3 LE) of each donor and acceptor were found play an important role in triplet exciplex harvesting. Significant contributions from triplets were clearly observed when the charge-transfer excited states (1 CT and 3 CT) and 3 LE were ideally aligned. We also demonstrated fine control of relative energy alignment via the concentration to improve the PL efficiency.

Tuning the Conformation and Color of Conjugated Polyheterocyclic Skeletons by Installing ortho-Methyl Groups.

ortho-Methyl effects are exploited to tune steric hindrance between side-chain N,N'-diaryls and polycyclic dihydrodibenzo[a,c]phenazine, and in turn control the conformations of N,N'-diphenyl-dihydrodibenzo[a,c]phenazine (DPAC) and its ortho-methyl derivatives Mx-My (x=0, 1 or 2, y=1 or 2, x and y correlate with the number of methyl groups in the ortho-positiond of N,N'-diphenyl). The magnitude of steric hindrance increases as x and y increase, and the V-shaped dihydrodibenzo[a,c]phenazine skeleton is gradually tuned from a bent (DPAC) to planar (M2-M2) structure in the ground state. As a result, the relaxation of the excited-state structure of DPAC and its numerous analogues could be mimicked by model structures Mx-My, demonstrating for the first time the the conformation change from bent-to-planar and hence a large range of energy-gap tuning of polycyclic conjugated structures controlled by the steric hindrance.

Snapshotting the Excited-State Planarization of Chemically Locked N,N'-Disubstituted Dihydrodibenzo[a,c]phenazines.

For deeper understanding of the coupling of electronic processes with conformational motions, we exploit a tailored strategy to harness the excited-state planarization of N,N'-disubstituted dihydrodibenzo[a,c]phenazines by halting the structural evolution via a macrocyclization process. In this new approach, 9,14-diphenyl-9,14-dihydrodibenzo[a,c]phenazine (DPAC) is used as a prototype, in which the para sites of 9,14-diphenyl are systematically enclosed by a dialkoxybenzene-alkyl-ester or -ether linkage with different chain lengths, imposing various degrees of constraint to impede the structural deformation. Accordingly, a series of DPAC-n (n = 1-8) derivatives were synthesized, in which n correlates with the alkyl length, such that the strength of the spatial constraint decreases as n increases. The structures of DPAC-1, DPAC-3, DPAC-4, and DPAC-8 were identified by the X-ray crystal analysis. As a result, despite nearly identical absorption spectra (onset ∼400 nm) for DPAC-1-8, drastic chain-length dependent emission is observed, spanning from blue (n = 1, 2, ∼400 nm) and blue-green (n = 3-5, 500-550 nm) to green-orange (n = 6) and red (n = 7, 8, ∼610 nm) in various regular solvents. Comprehensive spectroscopic and dynamic studies, together with a computational approach, rationalized the associated excited-state structure responding to emission origin. Severing the linkage for DPAC-5 via lipase treatment releases the structural freedom and hence results in drastic changes of emission from blue-green (490 nm) to red (625 nm), showing the brightening prospect of these chemically locked DPAC-n in both fundamental studies and applications.

Ratiometric Hg2+ /Ag+ Probes with Orange Red-White-Blue Fluorescence Response Constructed by Integrating Vibration-Induced Emission with an Aggregation-Induced Emission Motif.

Two novel ratiometric fluorometric probes 6 a and 6 b have been designed and synthesized for the detection of Hg2+ and Ag+ , respectively. Each of these probes is comprised of a 9,14-diphenyl-9,14-dihydrodibenzo[a,c]phenazine (DPAC) skeleton, a tetraphenylethylene (TPE) unit, and two thymine/adenine groups. In this proof-of-concept work, the DPAC unit featuring vibration-induced emission (VIE) characteristics serves as a dual-emission chromogen, whereas the TPE moiety, which is noted for its aggregation-induced emission (AIE) properties, functions mainly as a signal amplifier. The coordination between the thymine/adenine groups and Hg2+ /Ag+ leads to the formation of aggregates, which restricts the intramolecular vibrations of DPAC and the intramolecular rotations of TPE, activating the AIE effect of TPE and resulting in the bent form of DPAC. Accordingly, the overall fluorescence changed from moderate orange-red (Iorange-red ) to intense blue light (Iblue ) passing through the white-light region, concurrently with an enhancement of fluorescence at 475 nm and a dramatic increase in the ratio of Iblue /Iorange-red . Furthermore, the superb sensitivity of 6 a/6 b towards Hg2+ /Ag+ has been demonstrated by the detection limit, which is as low as 6.1 nm and 0.1 µm, respectively. Both of these values are below the maximum concentration in drinking water permitted by the U.S. Environmental Protection Agency, demonstrating their great potential to be applied for real-world metal-ion sensing.

Vibration-Induced-Emission (VIE) for imaging amyloid ß fibrils.

This paper discusses the use of N,N'-disubstituted-dihydrodibenzo[a,c]phenazines with typical Vibration-Induced-Emission (VIE) properties for imaging amyloid ß (Aß) fibrils, which are a signature of neurological disorders such as Alzheimer's disease. A water-soluble VIEgen with a red fluorescence emission shows a pronounced, blue-shifted emission with Aß peptide monomers and fibrils. The enhancement in blue fluorescence can be ascribed to the restriction of the molecular vibration by selectively binding to Aß. We determine an increasing blue-to-red emission ratio of the VIEgen with both the concentration and fibrogenesis time of Aß, thereby enabling a ratiometric detection of Aß in its different morphological forms. Importantly, the VIEgen was proven to be suitable for the fluorescence imaging of small Aß plaques in the hippocampus of a transgenic mouse brain (five months old), with the blue and red emissions well overlapped on the Aß. This research offers a new rationale to design molecular VIE probes for biological applications.

Seven-day intensive preoperative rehabilitation for elderly patients with lung cancer: a randomized controlled trial.

BACKGROUND: As a newly developed treatment, preoperative pulmonary rehabilitation (PR) has been studied in depth. However, few studies have assessed the relationship between advanced age and a shorter term intensive pattern of preoperative PR in patients with lung cancer (LC) and especially those patients waiting for therapeutic LC surgeries. This study investigated short-term preoperative PR combined with inspiratory muscle training (IMT) and aerobic endurance training in elderly patients scheduled to undergo LC lobectomy. METHODS: A prospective randomized controlled trial with a total of 60 subjects aged ≥70 y was conducted. The intervention group (PR group) was treated for 1 wk with systematic and highly intensive preoperative PR training before lobectomy, and the control group (NPR group) was treated with conventional preoperative respiratory management. We analyzed the 6-min walking distance (6-MWD), the peak expiratory flow (PEF), and quality-of-life scores before and after the rehabilitation regimen as well as the incidence of postoperative pulmonary complications (PPCs). RESULTS: In total, 30 patients (PR group) completely executed the 7-d intensive preoperative PR, and 30 patients (NPR group) served as the control group. The two groups were comparable at baseline. During the preoperative PR, a significantly longer 6-MWD (increase: 28.6 ± 18.2 versus 9.4 ± 27.0 m; between-groups difference: 19.2 m, P = 0.029) and an increased PEF (increase: 26.2 ± 22.5 versus 8.2 ± 10.3 L/min; between-groups difference: 18.0 L/min, P < 0.001) were noted in the PR group compared with the NPR group. After LC surgery, the mean postoperative length of stay (6.9 ± 4.4 versus 10.7 ± 6.4 d, P = 0.010) and total hospital stay (16.0 ± 4.5 versus 19.7 ± 6.5 d, P = 0.012) were significantly reduced in the PR group. Thirty-day PPCs were noted in four (13.3%) patients in the PR group and 11 (36.7%) patients in the NPR group, with a significant difference between the two groups (P = 0.037). CONCLUSIONS: For elderly LC patients scheduled to undergo surgery in China, a 7-d intensive pattern of preoperative PR combined with IMT and aerobic endurance training may be a feasible rehabilitation strategy with positive physical and psychological effects.