Oxygen concentration titration guided by oxygen reserve index during pediatric laryngeal surgery with high-flow nasal cannula oxygen: a randomized controlled trial.

PURPOSE: The objective of this study was to evaluate whether adjusting the oxygen concentration guided by the Oxygen Reserve Index (ORI) during pediatric laryngeal surgery with High Flow Nasal Cannula Oxygen (HFNO) could achieve postoperative PaO2 close to physiological levels while ensuring adequate oxygenation in surgery. METHODS: Sixty pediatric patients undergoing laryngeal surgery or examination were randomly assigned to two groups. The ORI group received oxygen concentration adjustments every 5 min to maintain a target ORI value of 0.21, whereas the control group did not undergo any adjustments. Postoperative PaO2, time weighted average fraction of inspired oxygen (FiO2), and mean Peripheral Oxygen Saturation (SpO2) were compared between groups. Finally, some analyses were conducted to examine the relationship of ORI with PaO2. RESULTS: In general, the postoperative PaO2 was 164.9 ± 48.8 mmHg in ORI group and 323.0 ± 87.7 mmHg in control group (P < 0.01). The time weighted average FiO2 in the ORI group was 85.9 [81.8-92.7] %. There was no significant difference in mean SpO2 between the two groups (ORI vs. control: 98.4 [97.7-99.2] vs. 98.8 [97.7-99.5]; P = 0.36). According to the analyses, the optimal cut value for ORI was determined to be 0.195 when PaO2 was 150 mmHg. CONCLUSIONS: In pediatric laryngeal surgery with HFNO, reducing oxygen concentration guided by ORI helped achieve postoperative PaO2 levels closer to physiological norms without compromising intra-operative oxygenation.

Robustness of the modified multi-trench fiber design with two gaps.

We investigate the robustness of a modified multi-trench fiber (MTF) design with two gaps numerically. The excellent suppression of high-order modes is demonstrated over a wide range of the gap misalignment and the fundamental mode loss is barely affected even with the 5 dB/m scattering loss in gaps at the modified two-gap MTF for the first time. Therefore, the required fabrication accuracy decreases.

Airway management with Hi-flow nasal cannula oxygen in children with severe laryngeal obstruction.

BACKGROUND: The aim of this study was to report our initial experience in airway management in young children with severe laryngeal obstruction. Hi-flow nasal cannula oxygen (HFNO) with spontaneous respiration was used as a new airway management strategy in young children undergoing suspension laryngoscopic surgery. METHODS: Children aged between 1 day and 24 months scheduled for suspension laryngoscopy were retrospectively studied. The data collected included the patients' age, gender, American Society of Anaesthesiologists physical status classification, comorbidities, preoperative physiological status, methods of induction and maintenance of anesthesia, course of the disease and surgical options, lowest oxygen saturation recorded, transcutaneous CO2, duration of operation, and patients' need for rescue methods. RESULTS: A total of 38 patients successfully underwent suspension laryngoscopy under HFNO with spontaneous respiration. 19 patients were less than 1 year old (7 neonates), while the other half were less than or equal to 2 years old. The median [IQR (range)] lowest oxygen saturation recorded during the operation was 98 [93-99 (91-99)] %. The median [IQR (range)] duration of HFNO with spontaneous respiration was 65 [45-100 (30-200)] minutes. The median [IQR (range)] PCO2/PtcCO2 at the end of the spontaneous ventilation period was 54 [48-63 (39-70)] mmHg, which was the same as the preoperative PCO2 despite a long operation time. CONCLUSIONS: HFNO with spontaneous respiration emerged as a new airway management strategy in young children with severe laryngeal obstruction that was beneficial in maintaining oxygenation and was superior to transnasal humidified rapid insufflation ventilatory exchange (THRIVE) in terms of the rising rate of PCO2 in these patients, thereby prolonging the safety time of the operation.

Research on Simultaneous Measurement of Magnetic Field and Temperature Based on Petaloid Photonic Crystal Fiber Sensor.

In this paper, we propose and design a magnetic field and temperature sensor using a novel petaloid photonic crystal fiber filled with magnetic fluid. The PCF achieves a high birefringence of more than 1.43 × 10-2 at the wavelength of 1550 nm via the design of material parameters, air hole shape and the distribution of the photonic crystal fiber. Further, in order to significantly improve the sensitivity of the sensor, the magnetic-fluid-sensitive material is injected into the pores of the designed photonic crystal fiber. Finally, the sensor adopts a Mach-Zehnder interferometer structure combined with the ultra-high birefringence of the proposed petaloid photonic crystal fiber. Magnetic field and temperature can be simultaneously measured via observing the spectral response of the x-polarization state and y-polarization state. As indicated via simulation analysis, the sensor can realize sensitivities to magnetic fields and temperatures at -1.943 nm/mT and 0.0686 nm/°C in the x-polarization state and -1.421 nm/mT and 0.0914 nm/°C in the y-polarization state. The sensor can realize the measurement of multiple parameters including temperature and magnetic intensity and has the advantage of high sensitivity.

Comparison of the application of high-flow nasal oxygen with two different oxygen concentrations in infant and child laryngotracheal surgery.

Background: This study aimed to compare the use of the STRIVE Hi technique with 70 and 100% oxygen concentrations in children with 1st or 2nd degree laryngeal obstruction undergoing suspension laryngoscopic surgery. Methods: Children aged 1 month to 6 years scheduled for suspension laryngoscopic surgery with spontaneous respiration were randomly divided into the 70% oxygen concentration group (HFNO70% group) and the 100% oxygen concentration group (HFNO100% group). The data recorded for all the patients included age and sex, comorbidities, preoperative physiological status, methods of induction and maintenance of anesthesia, course of the disease and surgical options, and duration of operation. The primary endpoint was the lowest oxygen saturations during the surgery. The secondary endpoints included the partial pressure of oxygen PaO2, the arterial pressure of carbon dioxide PaCO2, the peak transcutaneous carbon dioxide PtcCO2, and the incidence of desaturation (defined as SpO2 < 90%) or hypercarbia (PtcCO2 > 65 mmHg). Results: A total of 80 children with 1st or 2nd degree laryngeal obstruction were included in the analysis. The median [IQR (range)] duration of spontaneous ventilation using STRIVE Hi was 52.5 [40-60 (30-170)]min and 62.5 [45-81 (20-200)]min in the HFNO 70% and HFNO 100% groups, respectively (p = 0.99); the lowest oxygen saturation recorded during the operation was 97.8 ± 2.1% and 96.8 ± 2.5%, respectively (p = 0.053); the mean PaO2 at the end of surgery was 184.6 ± 56.3 mmHg and 315.2 ± 101.3 mmHg, respectively (p < 0.001); and the peak transcutaneous CO2 was 58.0 ± 13.0 mmHg and 60.4 ± 10.9 mmHg, respectively (p = 0.373), despite a long operation time. Conclusion: STRIVE Hi had a positive effect on children undergoing tubeless laryngeal surgery with spontaneous ventilation, and for children with 1st or 2nd degree laryngeal obstruction, there was no significant difference in maintaining the intraoperative oxygenation between the 70 and 100% oxygen concentration groups. The 100% oxygen concentration group showed significant hyperoxia, which has been proven to be associated with multiple organ damage. Using a relatively lower oxygen concentration of 70% can effectively reduce the hazards associated with hyperoxia compared to 100% oxygen concentration. Clinical trial registration: [www.chictr.org.cn], identifier [CHICTR2200064500].

20 dB improvement utilizing custom-designed 3D-printed terahertz horn coupler.

Terahertz band is envisaged to provide substantially higher capacity and much lower latency for wireless communications in contrast to microwave frequencies. Moving to higher frequencies comes with its own unique challenges to be addressed, such as poor coupling efficiency from free space into and out of planar air-core waveguides. Here, we propose a framework for rapid design and low-cost fabrication of terahertz horn couplers. The horn couplers are first designed by maximizing the field overlap integral on apex and aperture interfaces, then fabricated exploiting 3D printing technique, and finally sputtered with a thin layer of gold. A 28~µm standard deviation of the surface roughness height of the 3D printed horn couplers is calculated. Experimental demonstrations show that the proposed horn coupler improves the transmittance of a hybrid photonic crystal waveguide by 20 dB in comparison with the previous pinhole-based coupling configuration. This work provides a fast, convenient and economical approach for design and fabrication of customized couplers for any waveguide size, with a cost of only 5% of commercially available counterparts, and could be integrated in 3D-printed terahertz devices during fabrication.

Compact terahertz birefringent gratings for dispersion compensation.

Terahertz radiation as an upcoming carrier frequency for next-generation wireless communication systems has great potential to enable ultra-high-capacity transmissions with several tens of gigahertz bandwidths. Nevertheless, dispersion is one of the main impairments in achieving a higher bit rate. Here, we experimentally demonstrate a compact terahertz dispersion compensator based on subwavelength gratings. The gratings are fabricated from the low-loss cyclic olefin copolymer exploiting micro-machining fabrication techniques. With the strong index modulation introduced in the subwavelength grating, the high negative group velocity dispersion of -188 (-88) ps/mm/THz is achieved at 0.15 THz for x-polarization (y-polarization), i.e., 7.5 times increase compared to the state-of-the-art reported to date for terahertz. Such high negative dispersion is realized in a grating of 43 mm length. The asymmetric cross-section and periodic-structural modulation along propagation direction lead to considerable birefringence that maintains and filters two orthogonal polarization states, respectively. These polymer-based birefringent gratings can be integrated into terahertz communication systems for dispersion compensation of both long-haul wireless links and waveguide-based interconnect links.

High-sensitivity refractive index and temperature sensor based on cascaded dual-wavelength fiber laser and SNHNS interferometer.

A novel differential intensity-measurement high-sensitivity refractive index (RI) sensor based on cascaded dual-wavelength fiber laser and single-mode-no-core-hollow-core-no-core-single-mode (SNHNS) structure is proposed and demonstrated. The sensing unit consists of one uniform fiber Bragg grating (FBG) and an SNHNS structure as all-fiber interferometer filter. The dual-wavelength fiber laser has a ring cavity composed of two FBGs with central wavelengths of 1550.10nm and 1553.61nm. Through monitoring the wavelength shift and the output power difference of the dual-wavelength fiber laser, the simultaneous measurement for RI and temperature is realized. In our experiment, the proposed fiber laser sensor exhibits high RI sensitivities of -193.1dB/RIU and 174.8dB/RIU in the range of 1.334-1.384. The relative variation of output power at the two FBG wavelengths shows a higher RI sensitivity of -367.9dB/RIU with better stability, which is greater than the traditional modal interferometer structure. Meanwhile, the temperature sensitivity of the proposed sensor is 8.53 × 10-3nm/°C, and the changes of laser output power caused by temperature are -0.223dB/°C and 0.215dB/°C.

Terahertz polarization-maintaining subwavelength filters.

Terahertz (THz) polarization-maintaining waveguides, which have been considered fundamental elements in polarization-sensitive THz systems, are promising platforms in developing functional THz devices. Here, we propose a THz grating based on a subwavelength rectangular polymer waveguide, which filters two polarization states simultaneously. The proposed gratings are characterized and discussed using numerical simulations. We observe two transmission dips with over a 20.9 dB extinction ratio (ER) and around a 21.1 GHz full-width half-maximum (FWHM), where the reflective frequencies of the two polarization waves and the separation between them can be harnessed with appropriate structure designs. Furthermore, we demonstrate that the grating can operate as a polarization-maintaining narrow bandpass filter (ER>12.3 dB and FWHM<1.7 GHz) by introducing a π-phase shift. This work has the potential to open a new avenue for steering polarized THz radiation using the waveguide-based filters, which could be integrated in THz polarization-sensitive imaging, sensing, and wireless communication systems.

Magnetic field sensor based on a dual-frequency optoelectronic oscillator using cascaded magnetostrictive alloy-fiber Bragg grating-Fabry Perot and fiber Bragg grating-Fabry Perot filters.

A magnetic field sensor using a dual-frequency optoelectronic oscillator (OEO) incorporating cascaded magnetostrictive alloy-fiber Bragg grating-Fabry Perot (MA-FBG-FP) and FBG-FP filters is proposed and demonstrated. In the OEO resonant cavity, two microwave signals are generated, whose oscillation frequencies are determined by the FBG-FP filter and MA-FBG-FP filter filters with two ultra-narrow notches and two laser sources. Due to the characteristics of MA and FBG, the two generated microwave signals show different magnetic field and temperature sensitivities. By monitoring the variations of two oscillating frequencies and the beat signal using a digital signal processor, the simultaneous measurement for the magnetic field and temperature can be realized. The proposed sensor has the advantages of high-speed and high-resolution measurement, which make it very attractive for practical magnetic field sensing applications. The sensitivities of the proposed OEO sensor for magnetic field and temperature are experimentally measured to be as high as -38.4MHz/Oe and -1.23 or -2.45 GHz/°C corresponding to the MA-FBG-FP filter and FBG-FP filter, respectively.

Vector mode conversion based on an asymmetric fiber Bragg grating in few-mode fibers.

We propose a vector mode conversion approach based on asymmetric fiber Bragg gratings (AFBGs) written in step-index fiber and vortex fiber, respectively. The mode coupling properties of AFBGs are numerically investigated. Compared to step-index fiber, the large mode separation in the vortex fiber is beneficial to extracting the desired vector mode at specific wavelengths. In addition, the polarization of incident light and the attenuation coefficient of index change distribution of the AFBG play critical roles in the mode coupling process. The proposed AFBG provides an efficient method to realize high-order vector mode conversion, and it shows great potential for orbital angular momentum multiplexing and fiber lasers with vortex beam output.

Bending effect characterization of individual higher-order modes in few-mode fibers.

We propose an approach to directly measure the bending effect on individual modes in few-mode fibers using a wavelength-scanning spatially and spectrally resolved imaging technique. By collecting a fiber output beam profile with a scanning wavelength at different bending diameters and analyzing the peaks of its Fourier transformation, we have distinguished higher-order modes (HOMs) of the fiber and investigated their group delay, beam profile, bend loss, and mode splitting individually. We have experimentally verified with a multilayer core fiber at 1-8 cm bending diameters that its HOMs experience more loss compared to lower-order modes, but delay at approximately the same speed as the bending diameter decreases. Mode splitting of the LP11 mode at a small bending diameter due to bending-induced birefringence is also observed and discussed. This method provides an efficient tool to study the bending effect on individual HOMs in fibers and could be extended to studying fiber stretching and twisting.

Linearly polarized orbital angular momentum mode purity measurement in optical fibers.

We presented a simple method for measuring the mode purity of linearly polarized orbital angular momentum (OAM) modes in optical fibers. The method is based on the analysis of OAM beam projections filtered by a polarizer. The amplitude spectrum and phase spectrum of a data ring derived from the beam pattern are obtained by Fourier transform. Then the coefficients of the mixed electric field expression can be determined and the mode purity can be obtained. The proposed method is validated and it is experimentally demonstrated in a two-mode fiber.

Guiding terahertz orbital angular momentum beams in multimode Kagome hollow-core fibers.

We explore terahertz (THz) orbital angular momentum (OAM) modes supported in multimode Kagome hollow-core fibers. Numerical models are adopted to characterize the effective indices and confinement losses of vector modes over 0.2-0.9 THz, where two low-loss transmission windows are observed. Linearly combining the vector modes, THz OAM states can be generated. Covering a broad bandwidth of 0.25 THz, the purity values of OAM modes are beyond 0.9. Using numerical simulations, the hollow-core THz fibers with one and two rings of Kagome structures are also comparably investigated. We reveal that the OAM purity is dependent upon the confinement performance of THz fiber.

Strong light confinement and gradient force in a hexagonal boron nitride slot waveguide.

In this Letter, we show that a hexagonal boron nitride (h-BN) slot waveguide can achieve strong field enhancement and light confinement in a slot region and a giant gradient force between h-BN slabs. Excellent agreement between simulations and results from an analytical model is observed. In a two-dimensional case, a field enhancement ratio near 60, a power confinement ratio of 80%, and a gradient force over -8.5 nN/µm×mW have been achieved, which are much higher than the slot waveguide based on artificial hyperbolic metamaterials. The gradient force and power confinement ratio in a three-dimensional slot waveguide structure are also studied. A gradient force of -1.2 nN/mW and a power confinement ratio of 50% have been obtained. The h-BN slot waveguide may have potential in particle manipulation.

Nanofocusing of hybrid plasmons-phonons-polaritons in a graphene-hexagonal boron nitride heterostructure.

In this Letter, we investigate the nanofocusing of hybrid plasmons-phonons-polaritons (SPP-HPhPs) in a graphene-hexagonal boron nitride (h-BN) heterostructure with a graphene coating on a tapered h-BN slab. Compared with the hyperbolic phonon polariton (HPhP) in h-BN, the hybrid SPP-HPhP in a heterostructure exhibits much smaller losses, which is validated through both analytical and numerical methods. Furthermore, the thickness dependent dispersions of a hybrid SPP-HPhP enable the tapered heterostructure to achieve a function of focusing electromagnetic waves. Compared with the tapered h-BN slab, the field enhancement in a tapered heterostructure is improved evidently with a maximum enhancement of the amplitude of normalized electric field over 60. This nanofocusing scheme may have potential in applications such as nonlinear optics.

Linearly polarized single TM mode terahertz waveguide.

We design a hollow-core terahertz (THz) waveguide guiding a single linearly polarized mode. This is achieved using a hybrid cladding, where we introduce a ring of subwavelength structures, including metal wires and air-holes. The wire-based cladding is extremely anisotropic, reflecting only transverse magnetic (TM) modes. The polarization of TM modes is further manipulated by replacing some wires with air-holes. Numerical simulations confirm the guidance of only an x-polarized TM2 mode over 0.36-0.46 THz in a wavelength-scale core (diameter of 1 mm). The propagation losses are of the order 0.25 dB/cm, with low bend losses <0.3 dB/cm at 0.4 THz for a bend radius of 5 cm.

Broadband orbital angular momentum transmission using a hollow-core photonic bandgap fiber.

We present the viability of exploiting a current hollow-core photonic bandgap fiber (HC-PBGF) to support orbital angular momentum (OAM) states. The photonic bandgap intrinsically provides a large refractive index spacing for guiding light, leading to OAM transmission with low crosstalk. From numerical simulations, a broad OAM±1 mode transmission window with satisfied effective index separations between vector modes (>10-4) and low confinement loss (<3 dB/km) covering 240 nm bandwidth is observed. The OAM purity (defined as normalized power weight for OAM mode) is found to be affected by the modal effective area. Simulation results also show HC-PBGF based OAM transmission is immune to fabrication inaccuracies near the hollow core. This work illustrates that HC-PBGF is a competitive candidate for high-capacity communication harnessing OAM multiplexing.

Bending losses of trench-assisted few-mode optical fibers.

A semianalytical method based on the perturbation theory is developed to calculate the bending losses of individual modes of few-mode fibers (FMFs); it is applicable for optical fibers with arbitrary circularly symmetric index profile, especially for trench-assisted fibers. The bending performance of trench-assisted step-index FMFs and parabolic-index FMFs are investigated with three key parameters (i.e., the refractive index difference of trench-cladding, the width of the trench, and the distance of the core-trench). Then, a performance index is defined to estimate the bending performance for FMFs. It is shown that changing the distance of the trench-core, for each order of mode, there is a minimum bending loss, which can be used for fiber optimization. This optimization position (core-trench distance) decreases as the mode order increases. It is found that the bending performance of parabolic-index FMFs is better than that of step-index FMFs with fixed core radius and cutoff wavelength. The conclusions are helpful for understanding the mechanism of bending loss for FMFs, and make contributions to designing and manufacturing of few-mode bend-insensitive fibers.

Stable single-polarization single-longitudinal-mode linear cavity erbium-doped fiber laser based on structured chirped fiber Bragg grating.

A novel linear cavity erbium-doped fiber (EDF) laser based on a structured chirped fiber Bragg grating (CFBG) filter is proposed for stable single-polarization (SP) single-longitudinal-mode (SLM) operation. For the first time, to the best of our knowledge, a structured CFBG filter with an ultranarrow transmission band which is generated by tapering directly on CFBG is used to select the laser longitudinal mode. The SLM operation is obtained by using the structured CFBG together with an unpumped EDF acting as a saturable absorber. The fluctuations of the laser peak power and center wavelength are less than 0.07 dB and 1 pm in 1 h, respectively. The stable SP operation is achieved by using the inline broadband polarizer. The measured 20 dB laser linewidth is about 27.7 kHz, which indicates the laser linewidth is approximately 1.39 kHz FWHM.