Effects of Intra-operative Cardiopulmonary Variability On Post-operative Pulmonary Complications in Major Non-cardiac Surgery: A Retrospective Cohort Study.

Intraoperative cardiopulmonary variables are well-known predictors of postoperative pulmonary complications (PPC), traditionally quantified by median values over the duration of surgery. However, it is unknown whether cardiopulmonary instability, or wider intra-operative variability of the same metrics, is distinctly associated with PPC risk and severity. We leveraged a retrospective cohort of adults (n = 1202) undergoing major non-cardiothoracic surgery. We used multivariable logistic regression to evaluate the association of two outcomes (1)moderate-or-severe PPC and (2)any PPC with two sets of exposure variables- (a)variability of cardiopulmonary metrics (inter-quartile range, IQR) and (b)median intraoperative cardiopulmonary metrics. We compared predictive ability (receiver operating curve analysis, ROC) and parsimony (information criteria) of three models evaluating different aspects of the intra-operative cardiopulmonary metrics: Median-based: Median cardiopulmonary metrics alone, Variability-based: IQR of cardiopulmonary metrics alone, and Combined: Medians and IQR. Models controlled for peri-operative/surgical factors, demographics, and comorbidities. PPC occurred in 400(33%) of patients, and 91(8%) experienced moderate-or-severe PPC. Variability in multiple intra-operative cardiopulmonary metrics was independently associated with risk of moderate-or-severe, but not any, PPC. For moderate-or-severe PPC, the best-fit predictive model was the Variability-based model by both information criteria and ROC analysis (area under the curve, AUCVariability-based = 0.74 vs AUCMedian-based = 0.65, p = 0.0015; AUCVariability-based = 0.74 vs AUCCombined = 0.68, p = 0.012). For any PPC, the Median-based model yielded the best fit by information criteria. Predictive accuracy was marginally but not significantly higher for the Combined model (AUCCombined = 0.661) than for the Median-based (AUCMedian-based = 0.657, p = 0.60) or Variability-based (AUCVariability-based = 0.649, p = 0.29) models. Variability of cardiopulmonary metrics, distinct from median intra-operative values, is an important predictor of moderate-or-severe PPC.

Mechanistic Basis of Conductivity in Carbon Dioxide-Expanded Electrolytes: A Joint Experimental-Theoretical Study.

Electrolyte conductivity contributes to the efficiency of devices for electrochemical conversion of carbon dioxide (CO2) into useful chemicals, but the effect of the dissolution of CO2 gas on conductivity has received little attention. Here, we report a joint experimental-theoretical study of the properties of acetonitrile-based CO2-expanded electrolytes (CXEs) that contain high concentrations of CO2 (up to 12 M), achieved by CO2 pressurization. Cyclic voltammetry data and paired simulations show that high concentrations of dissolved CO2 do not impede the kinetics of outer-sphere electron transfer but decrease the solution conductivity at higher pressures. In contrast with conventional behaviors, Jones reactor-based measurements of conductivity show a nonmonotonic dependence on CO2 pressure: a plateau region of constant conductivity up to ca. 4 M CO2 and a region showing reduced conductivity at higher [CO2]. Molecular dynamics simulations reveal that while the intrinsic ionic strength decreases as [CO2] increases, there is a concomitant increase in ionic mobility upon CO2 addition that contributes to stable solution conductivities up to 4 M CO2. Taken together, these results shed light on the mechanisms underpinning electrolyte conductivity in the presence of CO2 and reveal that the dissolution of CO2, although nonpolar by nature, can be leveraged to improve mass transport rates, a result of fundamental and practical significance that could impact the design of next-generation systems for CO2 conversion. Additionally, these results show that conditions in which ample CO2 is available at the electrode surface are achievable without sacrificing the conductivity needed to reach high electrocatalytic currents.

Correlation between Lignin-Carbohydrate Complex Content in Grass Lignins and Phenolic Aldehyde Production by Rapid Spray Ozonolysis.

We provide strong evidence that the amounts of phenolic aldehydes (vanillin and p-hydroxybenzaldehyde, pHB) selectively released during rapid ozonolysis of grass lignins are correlated with the unsubstituted aryl carbons of lignin-carbohydrate complexes present in these lignins. In the case of acetosolv lignin from corn stover, we observed a steady yield of vanillin and pHB (cumulatively ∼5 wt % of the initial lignin). We demonstrate the continuous ozonolysis of the lignin in a spray reactor at ambient temperature and pressure. In sharp contrast, similar ozonolysis of acetosolv lignin from corn cobs resulted in a twofold increase in the combined yield (∼10 wt %) of vanillin and pHB. Structural analysis with 1H-13C heteronuclear single quantum coherence (HSQC) nuclear magnetic resonance revealed that signals assigned to unsubstituted aryl carbons of lignin-carbohydrate complexes are quantitatively correlated to phenolic aldehyde production from spray ozonolysis. The ratios of the integrated peak volumes corresponding to coumarates and ferulates in the HSQC spectra of cob and corn stover lignins (SLs) are 2.4 and 2.0, respectively. These ratios are nearly identical to the observed 2.3-fold increase in pHB and 1.8-fold increase in vanillin production rates from corn cob lignin compared to corn SL. Considering that the annual U.S. lignin capacity from these grass lignin sources is ∼60 million MT, the value creation potential from these flavoring agents is conservatively ∼$50 million annually from just 10% of the lignin. These new insights into structure/product correlation and spray reactor characteristics provide rational guidance for developing viable technologies to valorize grass lignins.

Distinguishing the mechanism of electrochemical carboxylation in CO2 eXpanded Electrolytes.

We shed light on the mechanism and rate-determining steps of the electrochemical carboxylation of acetophenone as a function of CO2 concentration by using a robust finite element analysis model that incorporates each reaction step. Specifically, we show that the first electrochemical reduction of acetophenone is followed by the homogeneous chemical addition of CO2. The electrochemical reduction of the acetophenone-CO2 adduct is more facile than that of acetophenone, resulting in an Electrochemical-Chemical-Electrochemical (ECE) reaction pathway that appears as a single voltammetric wave. These modeling results provide new fundamental insights into the complex microenvironment in CO2-rich media that produces an optimum electrochemical carboxylation rate as a function of CO2 pressure.

Facile Ozonation of Light Alkanes to Oxygenates with High Atom Economy in Tunable Condensed Phase at Ambient Temperature.

We have demonstrated the oxidation of mixed alkanes (propane, n-butane, and isobutane) by ozone in a condensed phase at ambient temperature and mild pressures (up to 1.3 MPa). Oxygenated products such as alcohols and ketones are formed with a combined molar selectivity of >90%. The ozone and dioxygen partial pressures are controlled such that the gas phase is always outside the flammability envelope. Because the alkane-ozone reaction predominantly occurs in the condensed phase, we are able to harness the unique tunability of ozone concentrations in hydrocarbon-rich liquid phases for facile activation of the light alkanes while also avoiding over-oxidation of the products. Further, adding isobutane and water to the mixed alkane feed significantly enhances ozone utilization and the oxygenate yields. The ability to tune the composition of the condensed media by incorporating liquid additives to direct selectivity is a key to achieving high carbon atom economy, which cannot be achieved in gas-phase ozonations. Even in the liquid phase, without added isobutane and water, combustion products dominate during neat propane ozonation, with CO2 selectivity being >60%. In contrast, ozonation of a propane+isobutane+water mixture suppresses CO2 formation to 15% and nearly doubles the yield of isopropanol. A kinetic model based on the formation of a hydrotrioxide intermediate can adequately explain the yields of the observed isobutane ozonation products. Estimated rate constants for the formation of oxygenates suggest that the demonstrated concept has promise for facile and atom-economic conversion of natural gas liquids to valuable oxygenates and broader applications associated with C-H functionalization.

Reirradiation and re-reirradiation in head-and-neck cancers: Learnings based on a case irradiated six times.

Second primary cancers and locoregional recurrences in head and neck cancers are common. Management is challenging owing to the effects of previous treatment. Locoregional therapy, whenever feasible, offers possibility of cure. We have managed a patient who has over a period of 15 years been treated seven times. Treatment included surgical resection four times, flap reconstruction thrice, postoperative radiation thrice, radiation therapy alone thrice. Brachytherapy has been used in two instances, intraoperative brachytherapy once and surface mould application once. Patient has maintained a good quality of life during these fifteen years but suffers from xerostomia and nasogastric tube dependence at present. The management of this patient teaches us important lessons in terms of using modern surgery and advances in radiation therapy for achieving good patient benefit.

Facile Production of 2,5-Furandicarboxylic Acid via Oxidation of Industrially Sourced Crude 5-Hydroxymethylfurfural.

The oxidation of 5-hydroxymethylfurfural (HMF) produces value-added chemicals such as 2,5-diformylfuran (DFF) and 2,5-furandicarboxylic acid (FDCA). In this work, FDCA production was achieved by oxidation of crude HMF solution containing around 45 % HMF and unwanted byproducts such as 5,5'-[oxy-bis(methylene)]bis-2-furfural (HMF dimer) and polymers. At optimized reaction conditions similar to the Mid-Century process, homogeneous oxidation of the crude HMF (up to 20 wt% in the feed) by Co/Mn/Br catalyst in acetic acid solution produced FDCA at >95 % yield. The solid FDCA product contained <4000 ppm 5-formyl-2-furancarboxylic acid (FFCA). Such high yields were observed because the impurities in crude HMF were also converted to FDCA, as confirmed by the facile oxidation of HMF dimer to FDCA under reaction conditions. The successful demonstration of crude HMF as feed, obviating the need for HMF purification, suggests potential for cost-effectively producing FDCA in existing terephthalic plants.

Selective ozone activation of phenanthrene in liquid CO2.

We demonstrate liquid CO2 (8 °C, 4.4 MPa) as a benign medium to perform safe ozonolysis of phenanthrene at near-ambient temperatures. The ozonolysis products consist of several monomeric oxidation products such as diphenaldehyde, diphenic acid and phenanthrenequinone as well as polymeric structures up to 1130 Da. The observed chemical shifts (1H-6.03 ppm, 13C-104.38 ppm) in 2D-NMR spectra of the products confirm the formation of secondary ozonide. Based on the range of observed products, a Criegee-type mechanism is proposed. The ability to deconstruct phenanthrene and produce oxygenated precursors via this technique is particularly of interest in creating new materials from aromatic moieties.

Enhancing Molecular Electrocatalysis of CO2 Reduction with Pressure-Tunable CO2 -Expanded Electrolytes.

Electrochemical studies of CO2 conversion by molecular catalysts are typically carried out in a narrow range of near-ambient CO2 pressures wherein low CO2 solubilities in the liquid phase can limit the rate of CO2 reduction. In this study, five-fold rate enhancements are enabled by pairing CO2 -expanded electrolytes (CXEs), a class of media that accommodate multimolar concentrations of CO2 in organic solvents at modest pressures, with a homogeneous molecular electrocatalyst, [Re(CO)3 (bpy)Cl] (1, bpy=2,2'-bipyridyl). Analysis of cyclic voltammetry data reveals pressure-tunable rate behavior, with first-order kinetics at moderate CO2 pressures giving way to zero-order kinetics at higher pressures. The significant enhancement in the space-time yield of CO demonstrates that CXEs offer a simple yet powerful strategy for unlocking the intrinsic potential of molecular catalysts by mitigating CO2 solubility limitations commonly encountered in conventional liquid electrolytes. Moreover, our findings reveal that 1, a workhorse molecular catalyst, performs with intrinsic kinetic behavior, which is competitive with fast enzymes under optimal conditions in CXEs.

Intensified Electrocatalytic CO2 Conversion in Pressure-Tunable CO2 -Expanded Electrolytes.

Multimolar CO2 concentrations are achieved in acetonitrile solutions containing supporting electrolyte at relatively mild CO2 pressures (<5 MPa) and ambient temperature. Such CO2 -rich, electrolyte-containing solutions are termed as CO2 -eXpanded Electrolytes (CXEs) because significant volumetric expansion of the liquid phase accompanies CO2 dissolution. Cathodic polarization of a model polycrystalline gold electrode-catalyst in CXE media enhances CO2 to CO conversion rates by up to an order of magnitude compared with those attainable at near-ambient pressures, without loss of selectivity. The observed catalytic process intensification stems primarily from markedly increased CO2 availability. However, a non-monotonic correlation between the dissolved CO2 concentration and catalytic activity is observed, with an optimum occurring at approximately 5 m CO2 concentration. At the highest applied CO2 pressures, catalysis is significantly attenuated despite higher CO2 concentrations and improved mass-transport characteristics, attributed in part to increased solution resistance. These results reveal that pressure-tunable CXE media can significantly intensify CO2 reduction rates over known electrocatalysts by alleviating substrate starvation, with CO2 pressure as a crucial variable for optimizing the efficiency of electrocatalytic CO2 conversion.

Nanostructured Metal Catalysts for Selective Hydrogenation and Oxidation of Cellulosic Biomass to Chemicals.

Conversion of biomass to chemicals provides essential products to human society from renewable resources. In this context, achieving atom-economical and energy-efficient conversion with high selectivity towards target products remains a key challenge. Recent developments in nanostructured catalysts address this challenge reporting remarkable performances in shape and morphology dependent catalysis by metals on nano scale in energy and environmental applications. In this review, most recent advances in synthesis of heterogeneous nanomaterials, surface characterization and catalytic performances for hydrogenation and oxidation for biorenewables with plausible mechanism have been discussed. The perspectives obtained from this review paper will provide insights into rational design of active, selective and stable catalytic materials for sustainable production of value-added chemicals from biomass resources.

Scalable novel PVDF based nanocomposite foam for direct blood contact and cardiac patch applications.

Scalable novel beta phase polyvinylidene fluoride-poly(methyl methacrylate) (PVDF-PMMA) polymer blend based nanocomposite foam with hydroxyapatite (HAp) and titanium dioxide (TiO2) as nanofillers (ß-PVDF-PMMA/HAp/TiO2) (ß-PPHT-f), was prepared by using salt etching assisted solution casting method. The prepared ß-PPHT-f nanocomposite material was characterized using XRD, FT-IR, SEM-EDS. The XRD and FTIR results confirmed the formation of ß phase of ß-PPHT-f. The SEM and EDS results confirmed the formation of high porous structured closed cell type morphology of ß-PPHT-f. It also, confirmed the uniform distribution of Ti, Ca, P, N and O, in ß-PPHT-f. Contact angle measurements performed using sessile drop method with water and EDTA treated blood (EDTA blood) as probe liquids revealed that ß-PPHT-f is hydrophilic with contact angle of 48.2° as well as hemophilic with contact angle of 13.7°. Porosity, fluid absorption and retention investigation by gravimetric analysis revealed that ß-PPHT-f was 89.2% porous and can absorb and retain 139.15% and 87.05% of water and blood, respectively. The hemolysis assay performed as per ASTM F756 procedure revealed that ß-PPHT-f is non hemolytic. Also, the Leishman stained blood smears prepared from whole blood incubated with ß-PPHT-f for 3, 4, 5 and 6 h at 37 °C revealed that the blood cells were not affected by ß-PPHT-f, its surface morphology and elemental composition. H9c2 cell line studies on a transparent film prepared using ß-PPHT-f revealed that the elemental composition of the nanocomposite favored H9c2 cell adhesion and differentiation. All the characterization results indicate that the newly developed scalable novel ß-PPHT-f is hemocompatible and cardiomyocyte compatible, suggesting it as a useful material for direct blood contact and cardiac patch applications.

Erratum: Ramanathan, A.; et al. Metal-Incorporated Mesoporous Silicates: Tunable Catalytic Properties and Applications. Molecules 2018, 23, 263.

The authors wish to make the following change to their paper [1].[...].

Metal-Incorporated Mesoporous Silicates: Tunable Catalytic Properties and Applications.

A relatively new class of three-dimensional ordered mesoporous silicates, KIT-6, incorporated with Earth-abundant metals such as Zr, Nb, and W (termed as M-KIT-6), show remarkable tunability of acidity and metal dispersion depending on the metal content, type, and synthetic method. The metal-incorporation is carried out using one-pot synthesis procedures that are amenable to easy scale-up. By such tuning, M-KIT-6 catalysts are shown to provide remarkable activity and selectivity in industrially-significant reactions, such as alcohol dehydration, ethylene epoxidation, and metathesis of 2-butene and ethylene. We review how the catalytic properties of M-KIT-6 materials may be tailored depending on the application to optimize performance.

Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery: A Multicenter Study by the Perioperative Research Network Investigators.

Importance: Postoperative pulmonary complications (PPCs), a leading cause of poor surgical outcomes, are heterogeneous in their pathophysiology, severity, and reporting accuracy. Objective: To prospectively study clinical and radiological PPCs and respiratory insufficiency therapies in a high-risk surgical population. Design, Setting, and Participants: We performed a multicenter prospective observational study in 7 US academic institutions. American Society of Anesthesiologists physical status 3 patients who presented for noncardiothoracic surgery requiring 2 hours or more of general anesthesia with mechanical ventilation from May to November 2014 were included in the study. We hypothesized that PPCs, even mild, would be associated with early postoperative mortality and use of hospital resources. We analyzed their association with modifiable perioperative variables. Exposure: Noncardiothoracic surgery. Main Outcomes and Measures: Predefined PPCs occurring within the first 7 postoperative days were prospectively identified. We used bivariable and logistic regression analyses to study the association of PPCs with ventilatory and other perioperative variables. Results: This study included 1202 patients who underwent predominantly abdominal, orthopedic, and neurological procedures. The mean (SD) age of patients was 62.1 (13.8) years, and 636 (52.9%) were men. At least 1 PPC occurred in 401 patients (33.4%), mainly the need for prolonged oxygen therapy by nasal cannula (n = 235; 19.6%) and atelectasis (n = 206; 17.1%). Patients with 1 or more PPCs, even mild, had significantly increased early postoperative mortality, intensive care unit (ICU) admission, and ICU/hospital length of stay. Significant PPC risk factors included nonmodifiable (emergency [yes vs no]: odds ratio [OR], 4.47, 95% CI, 1.59-12.56; surgical site [abdominal/pelvic vs nonabdominal/pelvic]: OR, 2.54, 95% CI, 1.67-3.89; and age [in years]: OR, 1.03, 95% CI, 1.02-1.05) and potentially modifiable (colloid administration [yes vs no]: OR, 1.75, 95% CI, 1.03-2.97; preoperative oxygenation: OR, 0.86, 95% CI, 0.80-0.93; blood loss [in milliliters]: OR, 1.17, 95% CI, 1.05-1.30; anesthesia duration [in minutes]: OR, 1.14, 95% CI, 1.05-1.24; and tidal volume [in milliliters per kilogram of predicted body weight]: OR, 1.12, 95% CI, 1.01-1.24) factors. Conclusions and Relevance: Postoperative pulmonary complications are common in patients with American Society of Anesthesiologists physical status 3, despite current protective ventilation practices. Even mild PPCs are associated with increased early postoperative mortality, ICU admission, and length of stay (ICU and hospital). Mild frequent PPCs (eg, atelectasis and prolonged oxygen therapy need) deserve increased attention and intervention for improving perioperative outcomes.

Barrierless tautomerization of Criegee intermediates via acid catalysis.

The tautomerization of Criegee intermediates via a 1,4 ß-hydrogen atom transfer to yield a vinyl hydroperoxide has been examined in the absence and presence of carboxylic acids. Electronic structure calculations indicate that the organic acids catalyze the tautomerization reaction to such an extent that it becomes a barrierless process. In contrast, water produces only a nominal catalytic effect. Since organic acids are present in parts-per-billion concentrations in the troposphere, the present results suggest that the acid-catalyzed tautomerization, which can also result in formation of hydroxyl radicals, may be a significant pathway for Criegee intermediates.

Role of tunable acid catalysis in decomposition of α-hydroxyalkyl hydroperoxides and mechanistic implications for tropospheric chemistry.

Electronic structure calculations have been used to investigate possible gas-phase decomposition pathways of α-hydroxyalkyl hydroperoxides (HHPs), an important source of tropospheric hydrogen peroxide and carbonyl compounds. The uncatalyzed as well as water- and acid-catalyzed decomposition of multiple HHPs have been examined at the M06-2X/aug-cc-pVTZ level of theory. The calculations indicate that, compared to an uncatalyzed or water-catalyzed reaction, the free-energy barrier of an acid-catalyzed decomposition leading to an aldehyde or ketone and hydrogen peroxide is dramatically lowered. The calculations also find a direct correlation between the catalytic effect of an acid and the distance separating its hydrogen acceptor and donor sites. Interestingly, the catalytic effect of an acid on the HHP decomposition resulting in the formation of carboxylic acid and water is relatively much smaller. Moreover, since the free-energy barrier of the acid-catalyzed aldehyde- or ketone-forming decomposition is ∼ 25% lower than that required to break the O-OH linkage of the HHP leading to the formation of hydroxyl radical, these results suggest that HHP decomposition is likely not an important source of tropospheric hydroxyl radical. Finally, transition state theory estimates indicate that the effective rate constants for the acid-catalyzed aldehyde- or ketone-forming HHP decomposition pathways are 2-3 orders of magnitude faster than those for the water-catalyzed reaction, indicating that an acid-catalyzed HHP decomposition is kinetically favored as well.

Organic acids tunably catalyze carbonic acid decomposition.

Density functional theory calculations predict that the gas-phase decomposition of carbonic acid, a high-energy, 1,3-hydrogen atom transfer reaction, can be catalyzed by a monocarboxylic acid or a dicarboxylic acid, including carbonic acid itself. Carboxylic acids are found to be more effective catalysts than water. Among the carboxylic acids, the monocarboxylic acids outperform the dicarboxylic ones wherein the presence of an intramolecular hydrogen bond hampers the hydrogen transfer. Further, the calculations reveal a direct correlation between the catalytic activity of a monocarboxylic acid and its pKa, in contrast to prior assumptions about carboxylic-acid-catalyzed hydrogen-transfer reactions. The catalytic efficacy of a dicarboxylic acid, on the other hand, is significantly affected by the strength of an intramolecular hydrogen bond. Transition-state theory estimates indicate that effective rate constants for the acid-catalyzed decomposition are four orders-of-magnitude larger than those for the water-catalyzed reaction. These results offer new insights into the determinants of general acid catalysis with potentially broad implications.

Criegee intermediate reaction with CO: mechanism, barriers, conformer-dependence, and implications for ozonolysis chemistry.

Density functional theory and transition state theory rate constant calculations have been performed to gain insight into the bimolecular reaction of the Criegee intermediate (CI) with carbon monoxide (CO) that is proposed to be important in both atmospheric and industrial chemistry. A new mechanism is suggested in which the CI acts as an oxidant by transferring an oxygen atom to the CO, resulting in the formation of a carbonyl compound (aldehyde or ketone depending upon the CI) and carbon dioxide. Fourteen different CIs, including ones resulting from biogenic ozonolysis, are considered. Consistent with previous reports for other CI bimolecular reactions, the anti conformers are found to react faster than the syn conformers. However, this can be attributed to steric effects and not hyperconjugation as generally invoked. The oxidation reaction is slow, with barrier heights between 6.3 and 14.7 kcal/mol and estimated reaction rate constants 6-12 orders-of-magnitude smaller than previously reported literature estimates. The reaction is thus expected to be unimportant in the context of tropospheric oxidation chemistry. However, the reaction mechanism suggests that CO could be exploited in ozonolysis to selectively obtain industrially important carbonyl compounds.