Platelet Counts, Acute Kidney Injury, and Mortality after Coronary Artery Bypass Grafting Surgery.

BACKGROUND: Cardiac surgery requiring cardiopulmonary bypass is associated with platelet activation. Because platelets are increasingly recognized as important effectors of ischemia and end-organ inflammatory injury, the authors explored whether postoperative nadir platelet counts are associated with acute kidney injury (AKI) and mortality after coronary artery bypass grafting (CABG) surgery. METHODS: The authors evaluated 4,217 adult patients who underwent CABG surgery. Postoperative nadir platelet counts were defined as the lowest in-hospital values and were used as a continuous predictor of postoperative AKI and mortality. Nadir values in the lowest 10th percentile were also used as a categorical predictor. Multivariable logistic regression and Cox proportional hazard models examined the association between postoperative platelet counts, postoperative AKI, and mortality. RESULTS: The median postoperative nadir platelet count was 121 × 10/l. The incidence of postoperative AKI was 54%, including 9.5% (215 patients) and 3.4% (76 patients) who experienced stages II and III AKI, respectively. For every 30 × 10/l decrease in platelet counts, the risk for postoperative AKI increased by 14% (adjusted odds ratio, 1.14; 95% CI, 1.09 to 1.20; P < 0.0001). Patients with platelet counts in the lowest 10th percentile were three times more likely to progress to a higher severity of postoperative AKI (adjusted proportional odds ratio, 3.04; 95% CI, 2.26 to 4.07; P < 0.0001) and had associated increased risk for mortality immediately after surgery (adjusted hazard ratio, 5.46; 95% CI, 3.79 to 7.89; P < 0.0001). CONCLUSION: The authors found a significant association between postoperative nadir platelet counts and AKI and short-term mortality after CABG surgery.

Properties of InAlN/GaN Heterostructures Prepared by Molecular Beam Epitaxy

InAlN thin films and InAlN/GaN heterostructures have been intensively studied over recent years due to their applications in a variety of devices, including high electron mobility transistors (HEMTs). However, the quality of InAlN remains relatively poor with basic material and structural characteristics remain unclear.

Molecular beam epitaxy (MBE) is used to synthesize the materials for this research, as MBE is a widely used tool for semiconductor growth but has rarely been explored for InAlN growth. X-ray photoelectron spectroscopy (XPS) is used to determine the electronic and chemical characteristics of InAlN surfaces. This tool is used for the first time in application to MBE-grown InAlN and heterostructures for the characterization of surface oxides, the bare surface barrier height (BSBH), and valence band offsets (VBOs).

The surface properties of InAlN are studied in relation to surface oxide characteristics and formation. First, the native oxide compositions are studied. Then, methods enabling the effective removal of the native oxides are found. Finally, annealing is explored for the reliable growth of surface thermal oxides.

The bulk properties of InAlN films are studied. The unintentional compositional grading in InAlN during MBE growth is discovered and found to be affected by strain and relaxation. The optical characterization of InAlN using spectroscopy ellipsometry (SE) is also developed and reveals that a two-phase InAlN model applies to MBE-grown InAlN due to its natural formation of a nanocolumnar microstructure. The insertion of an AlN interlayer is found to mitigate the formation of this microstructure and increases mobility of whole structure by fivefold.

Finally, the synthesis and characterization of InAlN/GaN HEMT device structures are explored. The density and energy distribution of surface states are studied with relationships to surface chemical composition and surface oxide. The determination of the VBOs of InAlN/GaN structures with different In compositions are discussed at last.

Lattice Engineering of III-Nitride Heterostructures and Their Applications

III-Nitride materials have recently become a promising candidate for superior applications over the current technologies. However, certain issues such as lack of native substrates, and high defect density have to be overcome for further development of III-Nitride technology. This work presents research on lattice engineering of III-Nitride materials, and the structural, optical, and electrical properties of its alloys, in order to approach the ideal material for various applications. We demonstrated the non-destructive and quantitative characterization of composition modulated nanostructure in InAlN thin films with X-ray diffraction. We found the development of the nanostructure depends on growth temperature, and the composition modulation has impacts on carrier recombination dynamics. We also showed that the controlled relaxation of a very thin AlN buffer (20 ~ 30 nm) or a graded composition InGaN buffer can significantly reduce the defect density of a subsequent epitaxial layer. Finally, we synthesized an InAlGaN thin films and a multi-quantum-well structure. Significant emission enhancement in the UVB range (280 – 320 nm) was observed compared to AlGaN thin films. The nature of the enhancement was investigated experimentally and numerically, suggesting carrier confinement in the In localization centers.

Changes in Brain Resting-state Functional Connectivity Associated with Peripheral Nerve Block: A Pilot Study.

BACKGROUND: Limited information exists on the effects of temporary functional deafferentation (TFD) on brain activity after peripheral nerve block (PNB) in healthy humans. Increasingly, resting-state functional connectivity (RSFC) is being used to study brain activity and organization. The purpose of this study was to test the hypothesis that TFD through PNB will influence changes in RSFC plasticity in central sensorimotor functional brain networks in healthy human participants. METHODS: The authors achieved TFD using a supraclavicular PNB model with 10 healthy human participants undergoing functional connectivity magnetic resonance imaging before PNB, during active PNB, and during PNB recovery. RSFC differences among study conditions were determined by multiple-comparison-corrected (false discovery rate-corrected P value less than 0.05) random-effects, between-condition, and seed-to-voxel analyses using the left and right manual motor regions. RESULTS: The results of this pilot study demonstrated disruption of interhemispheric left-to-right manual motor region RSFC (e.g., mean Fisher-transformed z [effect size] at pre-PNB 1.05 vs. 0.55 during PNB) but preservation of intrahemispheric RSFC of these regions during PNB. Additionally, there was increased RSFC between the left motor region of interest (PNB-affected area) and bilateral higher order visual cortex regions after clinical PNB resolution (e.g., Fisher z between left motor region of interest and right and left lingual gyrus regions during PNB, -0.1 and -0.6 vs. 0.22 and 0.18 after PNB resolution, respectively). CONCLUSIONS: This pilot study provides evidence that PNB has features consistent with other models of deafferentation, making it a potentially useful approach to investigate brain plasticity. The findings provide insight into RSFC of sensorimotor functional brain networks during PNB and PNB recovery and support modulation of the sensory-motor integration feedback loop as a mechanism for explaining the behavioral correlates of peripherally induced TFD through PNB.