Intraoperative suggestions to prevent postoperative delirium in patients undergoing transaortic valvular replacement: a randomized placebo-controlled trial.

BACKGROUND: Postoperative delirium (POD) is a serious complication following anaesthesia and surgery and significantly influences postoperative outcome especially in the elderly population. Intraoperative music and positive suggestions influence postoperative outcomes by attenuating analgesic demand and increasing patient satisfaction. AIMS: Here, we examined the effect of intraoperative music and positive suggestions on the development of POD in aged patients undergoing transcatheter aortic valve replacement (TAVR) procedure under general anaesthesia. METHODS: For this randomized placebo-controlled study, eligible patients without cognitive deficit, indicated by a MMSE < 10 points, were anesthetized using remifentanil and sevoflurane. Anaesthetic depth was guide with bispectral index. An audiotape with positive suggestions was applied from a MP3 player via headphones. POD, pain and PONV was assessed. CAM-ICU and Nu-DESC were done twice daily for the first 5 days. RESULTS: Of 140 patients 118 patients could be analysed (57 male, 80.6 ± 5.1 years). POD was diagnosed in 16 patients (12.7%). POD was significantly more often observed in male (12, 21.1%) than in female (4, 6.6%, p = 0.02) and in patients with a low MMSE (23.6 ± 4.5 vs. 26.8 ± 2.8, p = 0.001). Anaesthetic depth did not influence the incidence of POD. Intraoperative music and suggestions did not affect the rate of POD, pain, analgesic requirement or PONV. DISCUSSION: In patients undergoing TAVR male sex and low MMSE scoring are associated with an increase in POD. CONCLUSIONS: Intraoperative music and positive suggestions do not influence the incidence of POD in this patient group. STUDY REGISTRATION: DRKS: 00024444, start of registration: 4.02.202, final registration: 17.09.2021.

Real-time Observation of Structural Dynamics Triggering Excimer Formation in a Perylene Bisimide Folda-dimer by Ultrafast Time-Domain Raman Spectroscopy.

In π-conjugated organic photovoltaic materials, an excimer state has been generally regarded as a trap state which hinders efficient excitation energy transport. But despite wide investigations of the excimer for overcoming the undesirable energy loss, the understanding of the relationship between the structure of the excimer in stacked organic compounds and its properties remains elusive. Here, we present the landscape of structural dynamics from the excimer formation to its relaxation in a co-facially stacked archetypical perylene bisimide folda-dimer using ultrafast time-domain Raman spectroscopy. We directly captured vibrational snapshots illustrating the ultrafast structural evolution triggering the excimer formation along the interchromophore coordinate on the complex excited-state potential surfaces and following evolution into a relaxed excimer state. Not only does this work showcase the ultrafast structural dynamics necessary for the excimer formation and control of excimer characteristics but also provides important criteria for designing the π-conjugated organic molecules.

3D gait analysis, haemophilia joint health score, leg muscle laterality and biomarkers of joint damage: A cross-sectional comparative assessment of haemophilic arthropathy.

INTRODUCTION: 3D gait analysis has been proposed as a reproducible and valid method to assess abnormal gait patterns and to monitor disease progression in patients with haemophilia (PWH). AIM: This study aimed at comparing Gait Deviation Index (GDI) between adult PWH and healthy controls, and at assessing the agreement between outcome measures of haemophilic arthropathy. METHODS: Male PWH aged 18-49 years (prespecified subgroups: 18-25 vs 26-49 years) on prophylactic replacement therapy, and male healthy age-matched controls passed through a cross-sectional assessment panel. Besides the 3D gait analysis derived GDI, secondary outcomes included kinematic, kinetic and spatio-temporal gait parameters, the Haemophilia Joint Health Score (HJHS), electric impedance derived leg muscle laterality and inflammatory biomarkers. RESULTS: Patients with haemophilia (n = 18) walked slower, in shorter steps and accordingly with less functional range of motion in the hips and ankles, as compared to healthy controls (n = 24). Overall, PWH did not differ significantly in GDI and specific gait parameters. PWH had a higher mean HJHS (18.8 vs 2.6, P = .000) and leg muscle laterality (4.3% vs 1.5%, P = .004). A subgroup analysis revealed progressed gait pathology in PWH aged 26-49 years (not statistically significant). Leg muscle laterality was strongly correlated with HJHS (r = .76, P = .000), whereas GDI just moderately (r = -.39, P = .110). PWH had higher levels of the inflammatory markers CRP and IL-6. CONCLUSION: Progressed gait pathology was found in PWH, mainly those aged 26-49 years. Leg muscle laterality correlated strongly with HJHS and was identified as a promising tool for detecting progression and physiological consequences of haemophilic joint arthropathy.

Efficient Multiexciton State Generation in Charge-Transfer-Coupled Perylene Bisimide Dimers via Structural Control.

The singlet fission (SF) process is generally defined as the conversion of one singlet exciton (S1) into two triplet excitons (2·T1), which has the potential to overcome thermalization losses in the field of photovoltaic devices. Among the applicable compounds for SF-based photovoltaic devices, perylene bisimide (PBI) is one of the best candidates because of its electronic tunability and photostability. However, the strategy for efficient SF in PBIs remains ambiguous because of numerous competing relaxation pathways in PBI-based molecular materials. In this regard, for the first time, we observed the SF mechanism in PBI dimers by controlling the intrinsic factor (exciton coupling) and the external environment (solvent polarity and viscosity). Time-resolved spectroscopic measurements and quantum chemical simulations reveal that efficient SF occurs through the charge-transfer-assisted mechanism, entailing a large structural fluctuation. Our findings not only highlight the SF mechanism in PBI dimers but also suggest the factors responsible for an efficient SF process, which are important considerations in the design of molecular materials for photovoltaic devices.

Ultrafast coherent exciton dynamics in size-controlled perylene bisimide aggregates.

For H-aggregates of perylene bisimide (PBI), it has been reported that upon photoexcitation, an initially delocalized Frenkel exciton is localized by excimer formation. However, in recent studies, the beforehand exciton dynamics preceding the excimer formation was suggested in larger aggregates consisting of at least more than 10-PBI subunits, which was not observed in small aggregates comprising less than four-PBI subunits. This feature implies that the size of molecular aggregates plays a crucial role in the initial exciton dynamics. In this regard, we have tried to unveil the initial exciton dynamics in PBI H-aggregates by tracking down the transient reorientations of electronic transition dipoles formed by interactions between the PBI subunits in systematically size-controlled PBI H-aggregates. The ultrafast coherent exciton dynamics depending on the molecular aggregate sizes can be distinguished using polarization-dependent femtosecond-transient absorption anisotropy spectroscopic measurements with a time resolution of ∼40 fs. The ultrafast decay profiles of the anisotropy values are unaffected by vibrational relaxation and rotational diffusion processes; hence, the coherent exciton dynamics of the PBI H-aggregates prior to the excimer formation can be directly revealed as the energy migration processes along the PBI H-aggregates.

Discrete π-Stacks of Perylene Bisimide Dyes within Folda-Dimers: Insight into Long- and Short-Range Exciton Coupling.

Four well-defined π-stacks of perylene bisimide (PBI) dyes were obtained in solution by covalent linkage of two chromophores with spacer units of different length and sterical demand. Structural elucidation of the folda-dimers by in-depth nuclear magnetic resonance studies and geometry optimization at the level of density functional theory suggest different, but highly defined molecular arrangements of the two chromophores in the folded state enforced by the various spacer moieties. Remarkably, the dye stacks exhibit considerably different optical properties as investigated by UV/vis absorption and fluorescence spectroscopy, despite only slightly different chromophore arrangements. The distinct absorption properties can be rationalized by an interplay of long- and short-range exciton coupling resulting in optical signatures ranging from conventional H-type to monomer like absorption features with low and appreciably high fluorescence quantum yields, respectively. To the best of our knowledge, we present the first experimental proof of a PBI-based "null-aggregate", in which long- and short-range exciton coupling fully compensate each other, giving rise to monomer-like absorption features for a stack of two PBI chromophores. Hence, our insights pinpoint the importance of charge-transfer mediated short-range coupling that can significantly influence the optical properties of PBI π-stacks.

Ultrafast Exciton Delocalization, Localization, and Excimer Formation Dynamics in a Highly Defined Perylene Bisimide Quadruple π-Stack.

An adequately designed, bay-tethered perylene bisimide (PBI) dimer Bis-PBI was synthesized by Pd/Cu-catalyzed Glaser-type oxidative homocoupling of the respective PBI building block. This newly synthesized PBI dimer self-assembles exclusively and with high binding constants of up to 106 M-1 into a discrete π-stack of four chromophores. Steady-state absorption and emission spectra show the signatures of H-type excitonic coupling among the dye units. Broadband fluorescence upconversion spectroscopy (FLUPS) reveals an ultrafast dynamics in the optically excited state. An initially coherent Frenkel exciton state that is delocalized over the whole quadruple stack rapidly (τ = ∼200 fs) loses its coherence and relaxes into an excimer state. Comparison with Frenkel exciton dynamics in PBI dimeric and oligomeric H-aggregates demonstrates that in the quadruple stack coherent exciton propagation is absent due to its short length of aggregates, thereby it has only one relaxation pathway to the excimer state. Furthermore, the absence of pump-power dependence in transient absorption experiments suggests that multiexciton cannot be generated in the quadruple stack, which is in line with time-resolved fluorescence measurements.

Stepwise versus pseudo-concerted two-electron-transfer in a triarylamine-iridium dipyrrin-naphthalene diimide triad.

A triad based on triarylamine donors, an iridium dipyrrin sensitiser and a naphthalene diimide acceptor is investigated using fs-pump-probe spectroscopy at two different pump wavelengths. Excitation of the naphthalene diimide induces a stepwise electron transfer process that yields within ca. 100 ps a charge separated state with 50-60% quantum yield in which one triarylamine is oxidised and the imide is reduced. Although being in the Marcus normal region, this state has a lifetime of 580 ns in MeCN. Excitation at the dipyrrin ligand centred absorption directly produces the charge separated state within ca. 1 ns however without formation of an intermediate. This pseudo-concerted two-electron transfer step was analysed with the help of a model dyad and a modified triad and is interpreted to be caused by inverted electron transfer rates. Although being much slower the latter process has a quantum yield of practically 100%.