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.

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.

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.

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.

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.

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.

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.

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.

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.

miR-424-5p regulates apoptosis and cell proliferation via targeting Bcl2 in nucleus pulposus cells.

miRNAs play an important role in the pathogenesis of intervertebral disc degeneration (IDD). The role and the underlying mechanism of miR-424-5p in human nucleus pulposus (NP) are still unknown. We aimed to explore the role of miR-424-5p in IDD. Real-time PCR was used to detect the expression of miR-424-5p and Bcl2 in IDD tissues and idiopathic scoliosis tissues. Human NP cells were used in our study. MTT and Hoechst apoptosis assays were used to detect the proliferation and apoptosis of NP cells, respectively. Western blotting assays were used to detect the expression levels of Bcl-2, cleaved caspase-3, cleaved caspase-9, caspase-3 and caspase-9 in degenerative NP cells. A luciferase reporter assay was applied to confirm the relationship between miR-424-5p and Bcl2. Our results showed that the expression of miR-424-5p was increased and Bcl2 was decreased in degenerative NP cells. miR-425-5p expression was negatively correlated with Bcl2 expression in IDD tissues. Suppression of miR-424-5p using an inhibitor increased Bcl2 expression at both the mRNA and protein levels, and it promoted cell viability and inhibited apoptosis. Furthermore, the levels of cleaved caspase-3 and cleaved caspase-9 were downregulated in miR-424-5p-silenced NP cells. Interestingly, we found that silencing miR-424-5p increased p62 expression at both the mRNA and protein levels. Finally, a luciferase reporter assay verified the binding of the miR-424-5p and the 3'UTR of Bcl2. These results suggested that silencing miR-424-5p suppressed NP cell apoptosis by upregulating Bcl2. Therefore, miR-424-5p might be a novel target for IDD therapies.

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.

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 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.

Dynamically encircling an exceptional point in anti-parity-time symmetric systems: asymmetric mode switching for symmetry-broken modes.

Dynamically encircling an exceptional point (EP) in parity-time (PT) symmetric waveguide systems exhibits interesting chiral dynamics that can be applied to asymmetric mode switching for symmetric and anti-symmetric modes. The counterpart symmetry-broken modes (i.e., each eigenmode is localized in one waveguide only), which are more useful for applications such as on-chip optical signal processing, exhibit only non-chiral dynamics and therefore cannot be used for asymmetric mode switching. Here, we solve this problem by resorting to anti-parity-time (anti-PT) symmetric systems and utilizing their unique topological structure, which is very different from that of PT-symmetric systems. We find that the dynamical encircling of an EP in anti-PT-symmetric systems with the starting point in the PT-broken phase results in chiral dynamics. As a result, symmetry-broken modes can be used for asymmetric mode switching, which is a phenomenon and application unique to anti-PT-symmetric systems. We perform experiments to demonstrate the new wave-manipulation scheme, which may pave the way towards designing on-chip optical systems with novel functionalities.

Novel mutation in OCRL leading to a severe form of Lowe syndrome.

AIM: To investigate the phenotype and genotype of a family with X-linked recessive Lowe syndrome. METHODS: All the members in the Chinese pedigree underwent comprehensive ophthalmologic and systemic examinations. Genomic DNA was isolated from peripheral blood of the pedigree members and 100 unrelated healthy Chinese subjects. Direct sequencing was performed to screen the exons and intron boundaries of OCRL. RESULTS: The ophthalmological and systemic examinations suggested that the affected individual had Lowe syndrome. The phenotype in the pedigree is severe and consistent among all the affected individuals except for an individual who additionally suffered from congenital heart disease and laryngeal cartilage dysplasia. Directional Sanger sequencing identified a complex mutation c.(2368_2368delG; c.2370A>C) in the Rho-GTPase activating protein domain. This complex mutation causes termination of protein synthesis at amino acid 824 and result in a new peptide with 823 amino acids (p.Ala790ProfsX34). This mutation was not detected in 100 unrelated healthy Chinese subjects. CONCLUSION: Our findings expand the phenotypic and genotypic spectrum of Lowe syndrome.

Plasmonic-Assisted Graphene Oxide Artificial Muscles.

Muscles and joints make highly coordinated motion, which can be partly mimicked to drive robots or facilitate activities. However, most cases primarily employ actuators enabling simple deformations. Therefore, a mature artificial motor system requires many actuators assembled with jointed structures to accomplish complex motions, posing limitations and challenges to the fabrication, integration, and applicability of the system. Here, a holistic artificial muscle with integrated light-addressable nodes, using one-step laser printing from a bilayer structure of poly(methyl methacrylate) and graphene oxide compounded with gold nanorods (AuNRs), is reported. Utilizing the synergistic effect of the AuNRs with high plasmonic property and wavelength-selectivity as well as graphene with good flexibility and thermal conductivity, the artificial muscle can implement full-function motility without further integration, which is reconfigurable through wavelength-sensitive light activation. A biomimetic robot and artificial hand are demonstrated, showcasing functionalized control, which is desirable for various applications, from soft robotics to human assists.

Mechanically robust stretchable organic optoelectronic devices built using a simple and universal stencil-pattern transferring technology.

Stretchable electronic and optoelectronic devices based on controllable ordered buckling structures exhibit superior mechanical stability by retaining their buckling profile without distortion in repeated stretch-release cycles. However, a simple and universal technology to introduce ordered buckling structures into stretchable devices remains a real challenge. Here, a simple and general stencil-pattern transferring technology was applied to stretchable organic light-emitting devices (SOLEDs) and polymer solar cells (SPSCs) to realize an ordered buckling profile. To the best of our knowledge, both the SOLEDs and SPSCs with periodic buckles exhibited the highest mechanical robustness by operating with small performance variations after 20,000 and 12,000 stretch-release cycles between 0% and 20% tensile strain, respectively. Notably, in this work, periodic-buckled structures were introduced into SPSCs for the first time, with the number of stretch-release cycles for the SPSCs improved by two orders of magnitude compared to that for previously reported random-buckled stretchable organic solar cells. The simple method used in this work provides a universal solution for low-cost and high-performance stretchable electronic and optoelectronic devices and promotes the commercial development of stretchable devices in wearable electronics.

Surface plasmon-enhanced amplified spontaneous emission from organic single crystals by integrating graphene/copper nanoparticle hybrid nanostructures.

Organic single crystals have attracted great attention because of their advantages such as high carrier mobility and high thermal stability. Amplified spontaneous emission (ASE) is an important parameter for the optoelectronic applications of organic single crystals. Here, surface plasmon-enhanced ASE from the organic single crystals has been demonstrated by integrating graphene/copper nanoparticle (Cu NP) hybrid nanostructures. Graphene is fully accommodating to the topography of Cu NPs by the transfer-free as-grown method for the configuration of the hybrid nanostructures, which makes full electrical contact and strong interactions between graphene and the local electric field of surface plasmon resonances. The enhanced localized surface plasmon resonances induced by the hybrid nanostructures result in an enhanced intensity and lowered threshold of ASE from the organic single crystals. Moreover, the as-grown graphene sheets covering fully and uniformly on the Cu NPs act as a barrier against oxidation, and results in an enhanced stability of the fluorescence from the crystals.