Effect of Remimazolam on Emergence Delirium in Children Undergoing Laparoscopic Surgery: A Double-Blinded Randomized Trial.

BACKGROUND: Preventing emergence delirium is a clinical goal for pediatric anesthesia, yet there is no consensus on its prevention. This study investigated the hypothesis that a continuous infusion or a single bolus of remimazolam can reduce the incidence of emergence delirium in children. METHODS: A hundred and twenty children aged 1-6 years old were randomly and equally allocated into three groups: group RC, which received a continuous infusion of remimazolam at 1 mg kg -1 h -1; group RB, which received a single bolus of remimazolam at 0.2 mg kg -1 at the beginning of wound closure; and group C, which received a continuous infusion of saline at 1 mL kg -1 h -1 and single bolus of saline at 0.2 mL kg -1 at the beginning of sutures. The primary outcome was the incidence of emergence delirium assessed by pediatric anesthesia emergence delirium (PAED) scale. Secondary outcomes included the number of rescues propofol administrations in the post-anesthesia care unit (PACU), recovery time, end-tidal sevoflurane concentration when maintaining BIS within the range of 40-60, and adverse events. RESULTS: The incidence of emergence delirium in group RC (5%, vs. group C, risk ratio, 0.14; 95% CI, 0.04 to 0.59; P=0.001) and group RB (7.7%, vs. group C, risk ratio, 0.22; 95% CI, 0.07 to 0.71; P=0.003) was significantly lower compared with group C (32.5%). Propofol was given to 2 patients in each of groups RC and RB to treat delirium and to 10 patients in group C (group RC vs. group C, risk ratio, 0.20; 95% CI, 0.05 to 0.86; P=0.012; group RB vs. group C, risk ratio, 0.21; 95% CI, 0.05 to 0.88; P=0.014). No differences in the recovery time and adverse effects were detected. CONCLUSIONS: Both continuous infusion and single bolus administration of remimazolam can effectively reduce the occurrence of emergence delirium in children.

Three-dimensional on-chip mode converter.

The implementation of transverse mode, polarization, frequency, and other degrees of freedom (d.o.f.s) of photons is an important way to improve the capability of photonic circuits. Here, a three-dimensional (3D) linear polarized (LP) LP11 mode converter was designed and fabricated using a femtosecond laser direct writing (FsLDW) technique. The converter included multi-mode waveguides, symmetric Y splitters, and phase delaying waveguides, which were constructed as different numbers and arrangements of circular cross section waveguides. Finally, the modes (LP11a and LP11b) were generated on-chip with a relatively low insertion loss (IL). The mode converter lays a foundation for on-chip high-order mode generation and conversion between different modes, and will play a significant role in mode coding and decoding of 3D photonic circuits.

Extremely sensitive multi-order mode refractive index sensor using TiO2 nanograss film and weakly bounded waveguide modes.

An extremely sensitive multi-order mode refractive index (RI) sensor was fabricated by coupling titanium dioxide nanograss film coated FTO conductive glass with Kretschmann prism. Both calculation and experimental studies were carried out. Theoretical analysis by employing resonant waveguide modes indicated that the maximum sensitivity could be achieved when the mode worked at the weakly-bounded condition. The experimental results showed that for p-polarized and s-polarized light, the sensor exhibited a maximum RI sensitivity of 2938.21 nm/RI unit (RIU) and 1484.39 nm/RIU in the 1st order mode, respectively. Its maximum figure of merit was as high as 77.77. The proposed sensor is promising to be applied in environmental monitoring, immune analysis, nucleic acid test, etc.

Omnidirectional light absorption enhancement of perovskite solar cells by an antireflection film with holographic lithography microstructures.

We report an omnidirectional light absorption enhancement of a perovskite solar cell (PSC) using antireflection (AR) film with soft imprinted microstructures from master molds via holographic lithography technology, which has high throughput and repeatability. The PSC's omnidirectional power conversion efficiency (PCE) enhancement is achieved by reducing Fresnel surface reflections and enhancing the optical path length. The maximum PCE of PSCs with AR film is up to 20.27%, corresponding to an absolute increase of 0.93% compared to 19.34% of control devices. Significantly, the enhancements of PCE increase with incident angle enlargement, which attributes to more effective Fresnel surface reflection suppression. Moreover, AR films exhibit water and dust repellent properties due to hydrophobicity, which is beneficial for PSC's long-term stability and light harvesting.

General Rules Governing the Dynamical Encircling of an Arbitrary Number of Exceptional Points.

Dynamically encircling an exceptional point in non-Hermitian systems has drawn great attention recently, since a nonadiabatic transition process can occur and lead to intriguing phenomena and applications such as the asymmetric switching of modes. While all previous experiments have been restricted to two-state systems, the dynamics in multistate systems where more complex topology can be formed by exceptional points, is still unknown and associated experiments remain elusive. Here, we propose an on-chip photonic system in which an arbitrary number of exceptional points can be encircled dynamically. We reveal in experiment a robust state-switching rule for multistate systems, and extend it to an infinite-period system in which an exceptional line is encircled with outcomes being located at the Brillouin-zone boundary. The proposed versatile platform is expected to reveal more physics related to multiple exceptional points and exceptional lines, and give rise to applications in multistate non-Hermitian systems.

Design of a non-Hermitian on-chip mode converter using phase change materials.

The introduction of non-Hermiticity into photonics has enabled new design principles for photonic devices. Here we propose the design of a tunable non-Hermitian on-chip mode converter working at telecommunication wavelengths. The key component of the converter is a phase change material, and switching its working state can enable a topological change in the energy surface of the system. The conversion functionality can be realized by dynamically encircling an exceptional point in the parameter space of the device. The device based on this non-Hermitian principle is robust to perturbations of structural parameters and works in broadband. The non-Hermitian principle can be applied for the design of more complex on-chip photonic devices.

Enhanced efficiency of organic light-emitting devices by using a directly imprinted nanopillared ultrathin metallic electrode.

An ultrathin metal film with high transmittance and conductivity has been demonstrated to be a promising transparent electrode for organic light-emitting devices (OLEDs). However, mediocre surface morphology and continuity of evaporated metal films and the surface plasmon-polaritons (SPPs) energy loss between the metal electrode and organic layer still limit the external quantum efficiency (EQE) of OLEDs. Here, nanoimprint lithography has been directly applied on the ultrathin Au film with underlying uncured photopolymer to fabricate the nanopillared anode. Both the conductivity and transmittance of the nanopillared ultrathin Au film have been improved due to the improvement of continuity and surface smoothness. As we expected, the SPPs mode has been coupled into photons and further extracted from OLEDs by using the nanopillared Au film anode. Finally, 19.2% and 70.1% enhancement of current efficiency were achieved compared to the planar device with ultrathin Au anode and ITO anode, respectively.

Improved light extraction in all-inorganic perovskite light-emitting devices with periodic nanostructures by nanoimprinting lithography.

We report an improved light extraction in all-inorganic perovskite light-emitting devices (PeLEDs) by integrating a periodic corrugated nanostructure at the metallic cathode/organic interface. Nanoimprinting lithography was used to introduce the nanostructures onto the surface of the electron transport layer directly to avoid influencing the morphology and crystallinity of the perovskite film underneath. The trapped energy at the metallic electrode has been successfully outcoupled by the excitation of the surface plasma polariton (SPP) modes induced by the periodic corrugations. The luminance and current efficiency of the periodically corrugated PeLED exhibit enhancements of 42% and 28%, respectively, compared to those of the planar PeLED. The finite-difference time-domain simulation was used to confirm the efficient outcoupling of the SPP modes.

Hamiltonian Hopping for Efficient Chiral Mode Switching in Encircling Exceptional Points.

Dynamically encircling exceptional points (EPs) can lead to chiral mode switching as the system parameters are varied along a path that encircles EP. However, conventional encircling protocols result in low transmittance due to path-dependent losses. Here, we present a paradigm to encircle EPs that includes fast Hamiltonian variations on the parameter boundaries, termed Hamiltonian hopping, enabling ultrahigh-efficiency chiral mode switching. This protocol avoids path-dependent loss and allows us to experimentally demonstrate nearly 90% efficiency at 1550 nm in the clockwise direction, overcoming a long-standing challenge of non-Hermitian optical systems and powering up new opportunities for EP physics.

Enhanced efficiency of all-inorganic perovskite light-emitting diodes by using F4-TCNQ-doped PTAA as a hole-transport layer.

We demonstrate an enhanced efficiency of all-inorganic perovskite light-emitting diodes (PeLEDs) by doping an electron acceptor of 2,3,5,6-tetrafluoro-7,7,8,8-tetracyanoquinodimethane (F4-TCNQ) as a p-type dopant into the hole-transport layer (HTL) of poly-triarylamine (PTAA). The conductivity of the PTAA was improved by the formation of the CT complex through the electron transfer from the PTAA to F4TCNQ. Moreover, the hydrophobic surface of the PTAA leads to an improved surface morphology of the perovskite films compared to that on the conventionally used HTL of PEDOT:PSS. As a result, the maximum luminance and efficiency for the doped PTAA-based PeLEDs are 28020 cd/m2 and 13.5 cd/A, respectively, corresponding to 32.7% and 48% improvement in the efficiency compared to those of the pure PTAA or PEDOT:PSS-based PeLEDs.

An Ultrasensitive Long-Period Fiber Grating-Based Refractive Index Sensor with Long Wavelengths.

The response of a novel long-period fiber grating (LPFG) with a period of 180 µm to a surrounding refractive index (RI) was investigated. The results displayed that, with the increase in RI of the surrounding media of cladding glass in the grating region, the resonant peak located at 1336.4 nm in the transmission spectrum gradually shifts towards a shorter wavelength, while the resonant peak located at 1618 nm gradually shifted towards a longer wavelength. Moreover, the resonant peak at 1618 nm is much more sensitive to the surrounding RI than that of the one at 1336.4 nm. Compared with the conventional LPFG and other types of wavelength-interrogated RI sensors, such as ring resonators, surface plasmon resonance sensors, and Fabry-Perot interferometric sensors, this novel LPFG possesses a higher sensitivity, which achieved 10,792.45 nm/RIU (RI unit) over a RI range of 1.4436-1.4489.

Chemical Profiles and Protective Effect of Hedyotis diffusa Willd in Lipopolysaccharide-Induced Renal Inflammation Mice.

Protective effect of Hedyotis diffusa (H. diffusa) Willd against lipopolysaccharide (LPS)-induced renal inflammation was evaluated by the productions of cytokines and chemokine, and the bioactive constituents of H. diffusa were detected by the ultra-fast liquid chromatography-diode array detector-quadrupole-time of flight mass spectrometry (UFLC-DAD-Q-TOF-MS/MS) method. As the results showed, water extract of H. diffusa (equal to 5.0 g/kg body weight) obviously protected renal tissues, significantly suppressed the productions of tumor necrosis factor-α (TNF-α), interleukin (IL)-1ß, IL-6, and monocyte chemoattractant protein (MCP)-1, as well as significantly promoted the production of IL-10 in serum and renal tissues. According the chemical profiles of H. diffusa, flavonoids, iridoid glycosides and anthraquinones were greatly detected in serum from H. diffusa extract treatment mice. Two main chemotypes, including eight flavonoids and four iridoid glycosides were found in renal tissues from H. diffusa extract treatment mice. The results demonstrated that water extract of H. diffusa had protective effect on renal inflammation, which possibly resulted from the bioactive constituents consisting of flavonoids, iridoids and anthraquinones.

Spectral engineering by flexible tunings of optical Tamm states and Fabry-Perot cavity resonance.

We present a design for spectral engineering in a metal dual distributed Bragg reflector (DBR)-based structure. Optical Tamm states and Fabry-Perot cavity mode, dual windows for light-matter interaction enhancement, can be excited simultaneously and tuned flexibly, including their respective bandwidth and resonant wavelength, due to the variable reflection phase from the outer DBR's internal surface. The design can find applications in solar cells for light trappings. Via calculations of overall absorptivity, the proposed simpler dual-states-based scheme is demonstrated to be almost as effective as the coherent-light-trapping scheme, owing to the dual-states-induced broader-band absorption enhancement.

In Situ Encapsulated Moiré Perovskite for Stable Photodetectors with Ultrahigh Polarization Sensitivity.

Nanostructures provide a simple, effective, and low-cost route to enhance the light-trapping capability of optoelectronic devices. In recent years, nano-optical structures have been widely used in perovskite optoelectronic devices to greatly enhance the device performance. However, the inherent instability of perovskite materials hinders the practical application of these nanostructured optoelectronic devices. Here, in situ encapsulated moiré lattice perovskite photodetectors (PDs) by two nanograting-structured soft templates with relative rotation angles is fabricated. The confinement growth of the two nanograting templates leads to crystal growth with moiré lattice structure, which improves the light-harvesting ability of the perovskite crystal, thereby improving the device performance. The PD exhibits responsivity to 1026.5 A W-1 . The Moiré lattice-perovskite-based PD maintained 95% of the initial performance after 223 days. After being continuously sprayed with water moist for 180 min, the performance is maintained at 95.7% of its initial level. The nanograting structure endows the device with high polarization sensitivity of Imax /Imin as high as 9.1.

The safety and efficacy of remimazolam tosylate for induction and maintenance of general anesthesia in pediatric patients undergoing elective surgery: Study protocol for a multicenter, randomized, single-blind, positive-controlled clinical trial.

Introduction: Remimazolam is an ultra-short-acting benzodiazepine sedative agent commonly used in general anesthesia, procedural sedation, and intensive care unit (ICU) sedation. This study aimed to explore the efficacy and safety of remimazolam versus propofol for the induction and maintenance of general anesthesia in preschool-age children undergoing elective surgery. Methods and analysis: In this multicenter, randomized, single-blind, positive-controlled non-inferior clinical trial, one hundred ninety-two children aged 3-6 years will be randomly allocated as a 3:1 ratio into two groups: Group R with an intravenous dose of remimazolam 0.3 mg/kg for the induction of anesthesia followed by a constant infusion rate of remimazolam 1-3 mg/kg/h to maintain anesthesia, and Group P with an intravenous dose of propofol 2.5 mg/kg for the induction of anesthesia followed by a constant infusion rate of propofol 4-12 mg/kg/h to maintain anesthesia. The primary outcome will be the rate of the successful induction and maintenance of anesthesia. The secondary outcomes will include the time to LoC, the Bispectral Index (BIS) value, awakening time, extubation time, post-anesthesia care unit (PACU) discharge time, usage of additional sedative drugs during the induction period, usage of remedial drugs in PACU, emergence delirium, pain in PACU, behavior scores at day 3 after surgery, parental and anesthesiologists' satisfaction, and adverse events. Ethics and dissemination: This study has been approved by the ethics review boards at all participating hospitals. The Ethics Committee of the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University (Reference No. LCKY 2020-380, November 13, 2020) is the central ethics committee.

Nanoporous TiO2/polyion thin-film-coated long-period grating sensors for the direct measurement of low-molecular-weight analytes.

We present novel nanoporous TiO(2)/polyion thin-film-coated long-period fiber grating (LPFG) sensors for the direct measurement of low-molecular-weight chemicals by monitoring the resonance wavelength shift. The hybrid overlay films are prepared by a simple layer-by-layer deposition approach, which is mainly based on the electrostatic interaction of TiO(2) nanoparticles and polyions. By the alternate immersion of LPFG into dispersions of TiO(2) nanoparticles and polyions, respectively, the so-formed TiO(2)/polyion thin film exhibits a unique nanoporous internal structure and has a relative higher refractive index than LPFG cladding. In particular, the porosity of the thin film reduces the diffusion coefficient and enhances the permeability retention of low-molecular-weight analytes within the porous film. The increases in the refractive index of the LPFG overlay results in a distinguished modulation of the resonance wavelength. Therefore, the detection sensitivity of LPFG sensors has been greatly improved, according to theoretical simulation. After the structure of the TiO(2)/polyion thin film was optimized, glucose solutions as an example with a low concentration of 10(-7) M was easily detected and monitored at room temperature.

Exceptional point protected robust on-chip optical logic gates.

Optical logic gates are crucial components for information processing and communication using photons. Current optical logic gates typically rely on the light interference principle which requires an accurate manipulation of the dynamical phase of light, making the device quite sensitive to system disturbances such as fabrication errors. Here we introduce non-Hermitian principles into the design of optical logic gates that work in the signal transmission process. We propose an exclusive-or gate for silicon-on-insulator platform by employing the physics in the exceptional point (EP) encirclement process. The EP induced mode switching behavior is applied to manipulate the phase of light which is topologically protected by the energy surface around the EP. As a result, the performance of the device is found to be extremely robust to structural parameter disturbances. The proposed non-Hermitian principle is expected to find applications for other on-chip photonic devices toward high robust performance.

A SERS-active microfluidic device with tunable surface plasmon resonances.

A surface-enhanced Raman scattering (SERS)-active microfluidic device with tunable surface plasmon resonances is presented here. It is constructed by silver grating substrates prepared by two-beam laser interference of photoresists and subsequent metal evaporation coating, as well as PDMS microchannel derived from soft lithography. By varying the period of gratings from 200 to 550 nm, surface plasmon resonances (SPRs) from the metal gratings could be tuned in a certain range. When the SPRs match with the Raman excitation line, the highest enhancement factor of 2×10(7) is achieved in the SERS detection. The SERS-active microchannel with tunable SPRs exhibits both high enhancement factor and reproducibility of SERS signals, and thus holds great promise for applications of on-chip SERS detection.

Grating amplitude effect on electroluminescence enhancement of corrugated organic light-emitting devices.

We report grating amplitude dependence of electroluminescence (EL) in organic light-emitting devices with one-dimensional corrugated structure. Our proposed devices can emit light from both the top silver and bottom quartz side, and both exhibit amplitude-dependence EL enhancement. The effect of grating amplitude on the EL intensity has been studied experimentally and numerically to find out the optimal grating amplitude for the greatest EL enhancement. We deduce from the numerical simulations and experimental results that surface plasmon-polariton modes and waveguide modes are coupled out of the corrugated devices efficiently at the optimal amplitude; therefore, higher efficiency of light extraction could be realized.

Recent progress in post treatment of silver nanowire electrodes for optoelectronic device applications.

Owing to the economical and practical solution synthesis and coating strategies, silver nanowires (AgNWs) have been considered as one of the most suitable alternative materials to replace commercial indium tin oxide (ITO) transparent electrodes. The primitive AgNW electrode cannot meet the requirements for preparing high performance optoelectronic devices due to its high contact resistance, large surface roughness and poor stability. Thus, various post-treatments for AgNW film optimization are needed before its actual applications, such as welding treatment to decrease contact resistance and passivation to increase film stability. This review investigates recent progress on the preparation and optimization of AgNWs. Moreover, some unique fabrication strategies to produce highly oriented AgNW films with unique anisotropic properties have also been carried out with detailed analysis. The representative devices based on the AgNW electrode have been summarized and discussed at the end of this review.