Simultaneous Tunneling Research Articles

Evaluating the Need for Simultaneous Carpal Tunnel Release With Forearm Fasciotomy

The need to include simultaneous carpal tunnel release (sCTR) with forearm fasciotomy for acute compartment syndrome (ACS) or after vascular repair is unclear. We hypothesized that sCTR is more common when: 1) fasciotomies are performed by orthopedic or plastic surgeons, rather than general or vascular surgeons; 2) ACS occurred because of crush, blunt trauma, or fractures rather than vascular/reperfusion injuries; 3) elevated compartment pressures were documented. We also sought to determine the incidence of delayed CTR when not performed simultaneously. Retrospective chart review identified patients who underwent forearm fasciotomy for ACS or vascular injury over a period of 10 years. Patient demographics, mechanism of ACS or indication for fasciotomy, surgeon subspecialty, compartment pressure measurements, inclusion of sCTR, complications, reoperations, and timing and method of definitive closure were analyzed. Logistic regression modeling was used to analyze predictors associated with delayed CTR. Fasciotomies were performed in 166 patients by orthopedic (63%), plastic (28%), and general/vascular (9%) surgeons. Orthopedic and plastic surgeons more frequently performed sCTR (67% and 63%, respectively). A total of 107 (65%) patients had sCTR. Fasciotomies for vascular/reperfusion injury were more likely to include sCTR (44%) compared with other mechanisms. If not performed simultaneously, 11 (19%) required delayed CTR at a median of 42 days. ACS secondary to fracture had the highest rate of delayed CTR (35%), and the necessity of late CTR for fractures was not supported by the logistic regression model. Residual hand paresthesias were less frequent in the sCTR group (6.5% vs 20%). Overall complication rates were similar in both groups (63% sCTR vs 70% without sCTR). When sCTR is excluded during forearm fasciotomy, 19% of patients required delayed CTR. This rate was higher (35%) when ACS was associated with fractures. Simultaneous CTR with forearm fasciotomy may decrease the incidence of residual hand paresthesias and the need for a delayed CTR. Prognosis IV.

Anomalous Behavior of the Tunneling Magnetoresistance in (CoFeB)x(LiNbO3)100 − x/Si Nanocomposite Film Structures Below the Percolation Threshold: Manifestations of the Cotunneling and Exchange Effects

A strongly nonmonotonic temperature dependence of the magnetoresistance in (CoFeB)x(LiNbOy)100 –xfilm nanocomposites (x≈ 40–48 at %) is observed in the temperature range of 3–250 K at the magnetic field up to 14 T near the percolation threshold on its insulating side. The magnetoresistance has a minimum at 40K and increases steeply on cooling. Such behavior of the magnetoresistance is attributed to the coexistence of superferromagnetic regions with exchange-coupled granules separated by regions with superparamagnetic granules in the nanocomposite. In this case, an increase in the negative magnetoresistance atT 40 K is due to the destruction of superferromagnetic ordering, whereas an increase in the magnetoresistance atT 40 K is related to the processes involving simultaneous elastic tunneling via the chains of granules. At the saturation of the magnetization, an additional negative contribution arises, which is probably due to the quantum interference effects. AtT 4 K, a double-well shape of the field dependence of the magnetoresistance is observed, which could be attributed to the effect of a positive contribution that competes with the negative magnetoresistance.

Simultaneous Tunnel Grafting and Anterior Cruciate Ligament Reconstructions Revision Using Double Suspensory Fixation: A Single-Stage Solution

The anterior cruciate ligament (ACL) is often vulnerable to sports-related injuries, leading to numerous ACL reconstructions (ACLRs) annually in the United States. Although largely successful, these procedures face the risk of recurrent instability due to graft failure. ACLR failures are typically attributed to technical errors and patient-related factors, with improper positioning of the tibial and femoral tunnels as the most common technical mistake. Current 2-stage revision techniques involve primary bone grafting followed by secondary tendon graft placement, resulting in increased costs and extended rehabilitation times. This article proposes a single-stage revision strategy involving simultaneous tunnel grafting and ACLR revision. The method employs double suspensory fixation by adjustable loop buttons, thereby eliminating the dependence on metaphyseal bone stock for stable graft fixation. This new procedure may offer a more efficient and cost-effective approach, reducing the need for a second surgery and potentially allowing patients to return to normal activities more quickly.

Safety and feasibility of percutaneous needle tunneling with platelet-rich plasma injections for Peyronie's disease in the outpatient setting: a pilot study.

The objective of this study is to evaluate the safety and feasibility of the combined simultaneous percutaneous needle tunneling coupled with injection of platelet-rich plasma in the outpatient department for the treatment of Peyronie's disease. This prospective, non-randomized, cohort and preliminary study included patients who underwent this procedure from November 2020 to July 2022. The main outcome was an improvement in penile curvature. Fifty-four patients were enrolled and underwent 6 sessions under local anesthesia followed by vacuum therapy for the treatment of Peyronie's disease in our outpatient unit. The amendment of the curvature angle was significant with a median correction percentage of -44.40% interquartile range (-66.70 to (-39.70)), [p-value = 0.001, 95% CI (-29.76 to (-18.02)), paired Student's t-test]. The median pre-treatment curvature angle was 45° (40-75), and the median post-treatment was 30° (20-40). The median score for pain during the procedure was 3 (0-4.25) according to a 10-point visual analogic scale. After two hours, 20.37% of patients still had pain but none required any pain medication. 50% of patients had a minor hematoma and 75.93% patients reported penile ecchymosis. A single patient reported an injection site skin infection. In our experience percutaneous needle tunneling with platelet-rich plasma injections for Peyronie's disease in the outpatient setting is a safe, effective, and feasible treatment of penile deformity for PD.

Delocalized states in three-terminal superconductor-semiconductor nanowire devices

We fabricate three-terminal hybrid devices consisting of a semiconductor nanowire segment proximitized by a grounded superconductor and having tunnel probe contacts on both sides. By performing simultaneous tunneling measurements, we identify delocalized states, which can be observed from both ends, and states localized near one of the tunnel barriers. The delocalized states can be traced from zero magnetic field to fields beyond 0.5 T. Within the regime that supports delocalized states, we search for correlated low-energy features consistent with the presence of Majorana zero modes. While both sides of the device exhibit ubiquitous low-energy features at high fields, no correlation is inferred. Simulations using a one-dimensional effective model suggest that the delocalized states, which extend throughout the whole system, have large characteristic wave vectors, while the lower momentum states expected to give rise to Majorana physics are localized by disorder. To avoid such localization and realize Majorana zero modes, disorder needs to be reduced significantly. We propose a method for estimating the disorder strength based on analyzing the level spacing between delocalized states.

What Factors Are Associated With Revision Cubital Tunnel Release Within 3 Years?

It has been shown that patient demographics such as age, payer factors such as insurance type, clinical characteristics such as preoperative opioid use, and disease grade but not surgical procedure are associated with revision surgery to treat cubital tunnel syndrome. However, prior studies evaluating factors associated with revision surgery after primary cubital tunnel release have been relatively small and have involved patients from a single institution or included only a single payer. (1) What percentage of patients who underwent cubital tunnel release underwent revision within 3 years? (2) What factors are associated with revision cubital tunnel release within 3 years of primary cubital tunnel release? We identified all adult patients who underwent primary cubital tunnel release from January 1, 2011, to December 31, 2017, in the New York Statewide Planning and Research Cooperative System database using Current Procedural Terminology codes. We chose this database because it includes all payers and nearly all facilities in a large geographic area where cubital tunnel release may be performed. We used Current Procedural Terminology modifier codes to determine the laterality of primary and revision procedures. The mean age of the cohort overall was 53 ± 14 years, 43% (8490 of 19,683) were women, and 73% (14,308 of 19,683) were non-Hispanic White. The Statewide Planning and Research Cooperative System database organization does not include a listing of all state residents and thus does not allow for censoring of patients who move out of state. All patients were followed for 3 years. We developed a multivariable hierarchical logistic regression model to model factors independently associated with revision cubital tunnel release within 3 years. Key explanatory variables included age, gender, race or ethnicity, insurance, patient residential location, medical comorbidities, concomitant procedures, whether the procedure was unilateral or bilateral, and year. The model also controlled for facility-level random effects to account for the clustering of observations among these entities. The risk of revision cubital tunnel release within 3 years of the primary procedure was 0.7% (141 of 19,683). The median time to revision cubital tunnel release was 448 days (interquartile range 210 to 861 days). After controlling for patient-level covariates and facility random effects, and compared with their respective counterparts, the odds of revision surgery were higher for patients with workers compensation insurance (odds ratio 2.14 [95% confidence interval 1.38 to 3.32]; p < 0.001), a simultaneous bilateral index procedure (OR 12.26 [95% CI 5.93 to 25.32]; p < 0.001), and those who underwent submuscular transposition of the ulnar nerve (OR 2.82 [95% CI 1.35 to 5.89]; p = 0.006). The odds of revision surgery were lower with increasing age (OR 0.79 per 10 years [95% CI 0.69 to 0.91]; p < 0.001) and a concomitant carpal tunnel release (OR 0.66 [95% CI 0.44 to 0.98]; p = 0.04). The risk of revision cubital tunnel release was low. Surgeons should be cautious when performing simultaneous bilateral cubital tunnel release and when performing submuscular transposition in the setting of primary cubital tunnel release. Patients with workers compensation insurance should be informed they are at increased odds for undergoing subsequent revision cubital tunnel release within 3 years. Future work may seek to better understand whether these same effects are seen in other populations. Future work might also evaluate how these and other factors such as disease severity could affect functional outcomes and the trajectory of recovery. Level III, therapeutic study.

Comparing entanglement and identity effects in tunnelling

The probability of simultaneous tunnelling of two particles is modified when the system is in a non-separable state, either entangled or symmetrised. We compare both effects in the rectangular potential barrier by evaluating the transmission rates in superposition states. For large momenta, their simultaneous presence greatly changes the form of the transmission rates. The joint effects are much larger than the superposition ones. Moreover, there are significant differences between bosons and fermions. We present an unified view of the combined effects as a quantum interference phenomenon. The analysis also illustrates a novel aspect of exclusion in entangled systems, the existence of superposition states one of whose terms is forbidden by Pauli's principle.

Simultaneous tunnel defects and lining thickness identification based on multi-tasks deep neural network from ground penetrating radar images

The overall assessment of tunnel lining, including shapes, categories, and depths of tunnel internal defects as well as the thickness of tunnel linings is vital to the safe operation of tunnels. We proposed a method comprising a multi-task deep neural network and curve fitting post-processing operation for simultaneously identifying the shapes, categories, and depths of tunnel defects as well as lining thicknesses from ground penetrating radar (GPR) images. The multi-task deep neural network, denoted as M-YOLACT, was designed to identify defects, lining profiles, and hyperbola shapes simultaneously. We introduced a curve-fitting post-processing operation to calculate the dielectric constant automatically based on the hyperbola shapes and evaluated the defect depths and lining thicknesses. The method was validated by numerical simulations, sandbox, and field tests. The method effectively identified the shapes and classes of tunnel defects as well as the thickness profiles from GPR B-Scan images.

Simultaneous Tunneling Control in Conformer-Specific Reactions.

We present here a new example of chemical reactivity governed by quantum tunneling, which also highlights the limitations of the classical theories. The syn and anti conformers of a triplet 2-formylphenylnitrene, generated in a nitrogen matrix, were found to spontaneously rearrange to the corresponding 2,1-benzisoxazole and imino-ketene, respectively. The kinetics of both transformations were measured at 10 and 20 K and found to be temperature-independent, providing clear evidence of concomitant tunneling reactions (heavy-atom and H-atom). Computations confirm the existence of these tunneling reaction pathways. Although the energy barrier between the nitrene conformers is lower than any of the observed reactions, no conformational interconversion was observed. These results demonstrate an unprecedented case of simultaneous tunneling control in conformer-specific reactions of the same chemical species. The product outcome is impossible to be rationalized by the conventional kinetic or thermodynamic control.

Is icodextrin use feasible in a peritoneal dialysis patient undergoing 18 F-FDG PET/CT scan?

18 F-FDG PET/CT scan is a useful diagnostic tool in patients with neoplasia or inflammatory diseases for further evaluation. Due to interference of glucose with the cellular uptake of the 18 F-FDG tracer via glucose transporter, withhold of any glucose source several hours before imaging is mandatory. This is also the case in peritoneal dialysis patients where glucose-containing peritoneal dialysis fluid cannot be used prior to 18 F-FDG PET/CT scan. Whether the same hold true for icodextrin is not known. We describe two patients with metastatic carcinomas while on peritoneal dialysis on an icodextrin-containing regimen, in whom icodextrin was not discontinued before 18 F-FDG PET/CT scan and where accurate diagnosis of metastatic lesions as well as in one case a simultaneous tunnel infection could be made. Our observation suggests that there is no significant interference of icodextrin with the metabolism of 18 F-FDG and so it is feasible to continue an established icodextrin-containing regimen in peritoneal dialysis patients in case of 18 F-FDG PET/CT scan.

The Primary Cost Drivers of Outpatient Distal Radius Fracture Fixation: A Cost-Minimalization Analysis of 15,379 Cases.

Background Distal radius fractures are the most common fracture of the upper extremity. While some distal radius fractures can be managed with closed reduction and immobilization, operative treatment is the standard of care, with open reduction internal fixation (ORIF) as a predominant operative method. Questions/Purpose To investigate how patient and surgical characteristics affect the overall costs of internal fixation of distal radius fractures in adults. Patients and Methods The 2014 State Ambulatory Surgery and Services Databases for six states were used to identify cases and surgical characteristics of distal radius fracture ORIF in adult patients. Results Surgical variables that significantly increased cost were postoperative admission within 30 days, regional anesthesia, simultaneous endoscopic carpal tunnel release, and increasing operating room time. Conclusion Substantial contributors to total cost are postoperative hospital admission within 30 days of surgery, use of regional anesthesia, simultaneous endoscopic carpal tunnel release, and longer operative time. Level of Evidence Level III, retrospective cohort study.

An efficient stiffness degradation model for layered composites with arbitrarily oriented tunneling and delamination cracks

A periodic 2D finite element model is proposed to identify the axial and transverse stiffness degradation for arbitrarily oriented parallel tunneling cracks. This is achieved with a recently developed off-axis framework taking the 3D deformation into account via a special kinematic formulation. The proposed model is successfully validated against a variety of cases from the literature. Not only is the model capable of accurately predicting what previously was only possible with expensive 3D models or complex analytical methods, but at the same time, it is achieved with remarkably small finite element models which only take seconds for each simulation. A parametric study, shows that by including frictionless contact between the crack surfaces, a significant effect on the stiffness degradation is present for carbon fiber composite materials for off-axis orientations below 40°. An effect not seen for the analyzed glass fiber composites. In addition, based on the axial and transverse stiffness degradation, a method is proposed from which the amount of simultaneous tunnel cracking and delamination can be predicted. A Fortran-based user subroutine and supplementary Python scripts for the commercial finite element code Abaqus are made available as a co-published data-repository reference.

Photon-pair blockade in a Josephson-photonics circuit with two nondegenerate microwave resonators

We propose to generate photon-pair blockade in a Josephson-photonics circuit that consists of a dc voltage-biased Josephson junction in series with a superconducting charge qubit and two nondegenerate microwave resonators. The two-level charge qubit is utilized to create anticorrelations of the charge transport; that is, the simultaneous Cooper pair tunneling events are inhibited. When the Josephson frequency matches the sum of resonance frequencies of the charge qubit and the two resonators, we demonstrate that the two resonators can release their energies in the form of antibunched pairs of two strongly correlated photons. The present work provides a practical way for producing a bright microwave source of antibunched photon pairs, with potential applications ranging from spectroscopy and metrology to quantum information processing.

Stability Evaluation of TBM Pilot Tunnels to Rear Blasting Using the Protection Shield

Recent studies have increasingly investigated construction methods for tunnel excavation because of growing underground space development. Although the New Austrian tunneling method (NATM)—a representative tunnel excavation method—can be applied to various ground conditions, as well as having good constructability and economic feasibility, it suffers from problems such as vibration and noise. By contrast, excavation using a tunnel boring machine (TBM)—a representative mechanized construction method—affords advantages such as stable excavation, minimized ground and environmental damage, noise, and vibration. However, it cannot be applied easily to various ground conditions, and it suffers from problems such as high construction costs and delays owing to equipment defects. Therefore, the simultaneous pilot tunnel excavation using the TBM—which affords advantages such as constructability, economic feasibility, and minimized noise and vibration—and rear enlargement blasting using NATM was investigated in this study. A protection shield was installed to minimize accidents occurring from equipment defects (a disadvantage of TBM) and analyze the decrease in the effect of NATM blasting, which depends on the use of the protection shield and the separation distance through 3D numerical analysis.

Morphometric Analysis of Experimental Chronic Limb Ischemia Before and after Laser Exposure

The work is performed on 34 sexually mature non-breeding dogs. The aschemized limb used the following methods: surveillance of dogs, morphometric. In EHIK there were intermittent lameness, a reliable decrease in the diameter of capillaries and a specific area of the surface of blood vessels in the muscles of the limb. Application of continuous radiation Nd:YAG-laser wavelength 1.06 microns, 15 watt capacity, duration of exposure of 6-8 seconds on muscles and bones with the aim of their simultaneous tunneling led to the disappearance of the alteration of lameness, a significant increase in the diameter of the capillaries and a specific area of the surface of the blood vessels in the muscles and shin.

Return to Activities After Simultaneous Bilateral Endoscopic Carpal Tunnel Release.

Approximately 56% of patients diagnosed with carpal tunnel syndrome present with bilateral symptoms; however, few studies have investigated bilateral simultaneous endoscopic carpal tunnel release (ECTR) and postoperative effect on return to activity. The purpose of this study was to evaluate the length of recovery in patients who received bilateral simultaneous ECTR, including pain medication requirements, return to activities of daily living, return to work, and return to recreational activities. A retrospective analysis was performed on patients who underwent bilateral ECTR by a single hand fellowship-trained surgeon from 2013 to 2019. Demographic, operative, and clinical outcomes were collected via chart review and a telephone interview. Student t tests and χ2 tests were conducted for analysis. Eighty patients were included in the study; 40 were successfully contacted for telephone interview follow-up. Patients reported an average of 2 days of use of postoperative narcotic pain medication and an average of 5, 7, and 19 days of return to activities of daily living, work, and recreational activities, respectively. Female patients reported more days of narcotic pain medications (1 day vs 3 days, P = .0483) and an average of longer return to work than men (9 days vs 5 days, P = .0477). Manual laborers reported longer return to work (9 days vs 5 days, P = .0500). Older patients (aged >65 years) reported longer return to recreational activities (39 days vs 11 days, P = .0189). Simultaneous bilateral ECTR is a successful procedure with shorter recovery times than reported previously. Female patients, manual laborers, and older patients experience a longer recovery and should be counseled appropriately.

Distributed Linear Heterogeneous Reconfiguration of Cubic Modular Robots via Simultaneous Tunneling and Permutation

Two types of reconfiguration—heterogeneous reconfiguration, in which all the modules are considered to be nonidentical, and homogeneous reconfiguration, in which they are considered to be identical—are widely studied in modular robotics research. Homogeneous reconfiguration can manage the transformation of the whole configuration of the robot structure, whereas heterogeneous reconfiguration can manage not only this transformation, but also the permutation process for navigating all modules to their exact target positions in the transformed configuration. However, the transformation process and time-consuming permutation process cannot always be executed simultaneously in heterogeneous reconfiguration. As a result, it takes much more time to reconfigure heterogeneous modular robots than it does to reconfigure homogeneous ones. In the previous research, linear homogeneous transformation algorithms for modular robots have been proposed. However, only quadratic permutation algorithms are available for heterogeneous lattice modular robots. This article studies a reconfiguration algorithm for heterogeneous lattice modular robots with linear operation time cost. The algorithm is based on simultaneous tunneling and permutation; a robot transforms its configuration via homogeneous tunneling motion, but permutation of each module's position is carried out simultaneously during the tunneling transformation. The approach also makes the time cost for the whole permutation process linear. To achieve this, the idea of a transparent meta-module is introduced, which allows the modules belonging to a meta-module to pass through the spaces occupied by other meta-modules. The algorithm is provided in both centralized and distributed form. We prove the correctness and completeness of the proposed algorithm. We also show some results of the reconfiguration simulation of heterogeneous modular robots with three-dimensional 2 × 2 × 2 cubic meta-modules by the proposed algorithm.

Bond-Level Imaging of the 3D Conformation of Adsorbed Organic Molecules Using Atomic Force Microscopy with Simultaneous Tunneling Feedback.

The chemical structure and orientation of molecules on surfaces can be visualized using low temperature atomic force microscopy with CO-functionalized tips. Conventionally, this is done in constant-height mode by measuring the frequency shift of the oscillating force sensor. However, this method is unsuitable for analyzing 3D objects. We are using the tunneling current to track the topography while simultaneously obtaining submolecular resolution from the frequency shift signal. Thereby, the conformation of 3D molecules and the adsorption sites on the atomic lattice can be reliably determined.

Model could improve promising C–H activation

Chemists recently found a C–H activation reaction that worked surprisingly well with relatively weak oxidants. Now their colleagues have made a theoretical model that can explain the reaction’s dynamics (J. Am. Chem. Soc. 2018, DOI: 10.1021/jacs.8b10461). The reaction uses intramolecular proton-coupled electron transfer (PCET), in which an oxidant extracts one electron from the C–H bond as a benzoate oxygen positioned nearby grabs the resulting proton, leaving a carbon radical where new substituents can bind. Yale University’s Sharon Hammes-Schiffer, whose group studies PCET reactions, found that the reaction happens by a simultaneous energy-releasing tunneling of the proton and electron between energy states, explaining why the oxidant has relatively little effect on the reaction’s speed. The Yale group also discovered that the H and O atoms start farther apart than thought, which means twisting them into position incurs an energy penalty. Redesigning the molecule to avoid that conformation change could ...

Correlated spin-flip tunneling in a Fermi lattice gas

We report the realization of correlated, density-dependent tunneling for fermionic 40K atoms trapped in an optical lattice. By appropriately tuning the frequency difference between a pair of Raman beams applied to a spin-polarized gas, simultaneous spin transitions and tunneling events are induced that depend on the relative occupations of neighboring lattice sites. Correlated spin-flip tunneling is spectroscopically resolved using gases prepared in opposite spin states, and the inferred Hubbard interaction energy is compared with a tight-binding prediction. We show that the laser-induced correlated tunneling process generates doublons via loss induced by light-assisted collisions. Furthermore, by controllably introducing vacancies to a spin-polarized gas, we demonstrate that correlated tunneling is suppressed when neighboring lattice sites are unoccupied.