Tunnel Release Research Articles

Carpal Tunnel Corticosteroid Injection Treatment of Nail Lichen Planus

Treatment for nail lichen planus (NLP) typically involves the use of intralesional or systemic corticosteroids. However, both modalities have distinct considerations. Systemic options are typically reserved for severe cases due to potential adverse effects while intralesional injections are limited due to patient discomfort. Here we present a case in which a corticosteroid injection for carpal tunnel syndrome led to incidental bilateral improvement in a patient’s nail lichen planus. Carpal tunnel injection may be an alternative to more traditional treatments and is a potential area for further research.

Suppressing the Dark Current Under Forward Bias for Dual‐Mode Organic Photodiodes

AbstractTremendous research efforts are developed to suppress the reverse dark current (Jd) and enhance the responsivity of organic photodiodes (OPDs). The functional layers of traditional OPDs usually follow the principle of energy level alignment to make unobstructed photo‐carriers transport under reverse bias, but this inevitably leads to a large forward Jd. Herein, a universal strategy is proposed to manipulate the carrier dynamics and effectively suppress the forward Jd of OPDs, that is, tuning the energy level and electron traps of the anode interface layers (AILs). The bandgap and electron traps of typical organometallic chelate AIL (PEIE‐Co) can be well controlled by adjusting the component ratio of PEIE and metal ions. The wide bandgap increases the carrier injection barrier under reverse and forward bias, endowing OPD with a much lower Jd; the electron traps induce hole tunneling injection by capturing photo‐generated electrons under forward bias, thereby enabling the photomultiplication effect. The obtained OPD exhibits photoconductive/photomultiplication working mode at reverse/forward bias and the specific detectivity approaches ≈1013/1012 Jones, showing promise for adaptively detecting faint and strong light. This study presents an intelligent strategy to achieve dual‐mode OPDs, paving the way for the multifunctional development of photodetectors.

Adopting Buffer Layer for Improving Signal‐to‐Noise Ratio of Broadband Photomultiplication Type Organic Photodetectors

AbstractThe photomultiplication type organic photodetectors (PM‐OPDs) are prepared with structure of ITO/PNDIT‐F3N/F8BT/Y6‐1O:P3HT (100:3, wt/wt)/Al, containing hole traps formed with P3HT surrounded by Y6‐1O in active layers. The PM‐OPDs exhibit external quantum efficiency (EQE)>100% in the spectral response range from 310 to 910 nm, resulting from electron tunneling injection assisted by trapped hole near ITO electrode. The incorporation of F8BT buffer layers can induce the markedly decreased dark current density (JD) due to the large electron injection barrier. The light current density (JL) of PM‐OPDs exhibits slightly decreased by inserting F8BT buffer layers due to the enhanced electron tunneling injection assisted by the more trapped holes near ITO electrode. The signal‐to‐noise ratio (SNR) of PM‐OPDs achieves over 40‐fold increment by inserting appropriate thickness of F8BT buffer layers, resulting from the markedly decreased JD and reasonably high JL. The optimal PM‐OPDs exhibit excellent photodetection capability with EQE of 4200% at 360 nm and 6600% at 850 nm, associated with the specific detectivity of 3.9 × 1011 Jones at 360 nm and 9.7 × 1011 Jones at 850 nm.

Boosting the UV-vis-NIR Photodetection Performance of MoS2 through the Cavity Enhancement Effect and Bulk Heterojunction Strategy.

Navigating more effective methods to enhance the photon utilization of photodetectors poses a significant challenge. This study initially investigates the impact of morphological alterations in 2H-MoS2 on photodetector (PD) performance. The results reveal that compared to layered MoS2 (MoS2 NLs), MoS2 nanotubes (MoS2 NTs) impart a cavity enhancement effect through multiple light reflections. This structural feature significantly enhances the photodetection performance of the MoS2-based PDs. We further employ the heterojunction strategy to construct Y-TiOPc NPs:MoS2 NTs, utilizing Y-TiOPc NPs (Y-type titanylphthalocyanine) as the vis-NIR photosensitizer and MoS2 NTs as the photon absorption enhancer. This approach not only addresses the weak absorption of MoS2 NTs in the near-infrared region but also enhances carrier generation, separation, and transport efficiency. Additionally, the band bending phenomenon induced by trapped-electrons at the interface between ITO and the photoactive layer significantly enhances the hole tunneling injection capability from the external circuit. By leveraging the synergistic effects of the aforementioned strategies, the PD based on Y-TiOPc NPs:MoS2 NTs (Y:MT-PD) exhibits superior photodetection performance in the wavelength range of 365-940 nm compared to MoS2 NLs-based PD and MoS2 NTs-based PD. Particularly noteworthy are the peak values of key metrics for Y:MT-PD, such as EQE, R, and D* that are 4947.6%, 20588 mA/W, and 1.94 × 1012 Jones, respectively. The multiperiod time-resolved photocurrent response curves of Y:MT-PD also surpass those of the other two PDs, displaying rapid, stable, and reproducible responses across all wavelengths. This study provides valuable insights for the further development of photoactive materials with a high photon utilization efficiency.

Boston carpal tunnel syndrome questionnaire clinical function assessment outcomes of carpal tunnel injection for carpal tunnel syndrome

Carpal tunnel syndrome is the most common compressive neuropathy. Risk factors include hereditary, obesity, pregnancy, hypothyroidism, rheumatoid arthritis, and work related. With treatment ranging from simple lifestyle changes, up until surgery. Studies have shown that local steroid injection improve symptoms by at least one month and up to one year after injection, which allows for the delay of surgical treatment. In this study, BCTQ was chosen as a measuring tool because it can objectively assess functional improvement in functional status and disease severity. An analytical study design with a quasi-experimental pretest post-test one group only design approach was used in this study. Primary data and secondary data were used to measure the symptom severity scale and functional status based on the BCTQ. The research subjects were taken from populations that fulfilled the inclusion and exclusion criteria. Based on the Friedman test analysis of differences in the severity scale of symptoms of clinical function assessment outcome data and functional status on the BCTQ from the action of carpal tunnel injection on carpal tunnel syndrome, the results of the BCTQ value show that there is a significant difference before and after injection at one month and three months assessment post injection with a P-value of 0.00 (p<0.05) on both. Carpal tunnel injection with Triamcinolone acetonide 20 mg can provide good clinical outcomes in cases of carpal tunnel syndrome and can reduce the severity of symptoms and provide a good functional status scale of the hand.

Ultrasound-Guided, Mid-Forearm Median Nerve Block for Relief of Carpal Tunnel Syndrome Pain in the Emergency Department: A Case Report.

Carpal tunnel syndrome (CTS) is a common complaint in the emergency department (ED) and accounts for approximately 90% of all peripheral neuropathies.6 Pain control from injection with corticosteroids into the carpal tunnel space is associated with multiple possible complications including atrophy, iatrogenic median nerve injury, and skin changes. Ultrasound (US)-guided mid-forearm median nerve block is an ED procedure that can be used to avoid direct injection into the carpal tunnel space. Here we present a case report proposing the use of US-guided mid-forearm block as a safe and effective adjunct to the management of acute pain caused by CTS. A previously healthy 44-year-old, right-hand dominant female presented to the ED with left wrist pain. Her clinical exam and US findings were consistent with CTS. Given her allergy to non-steroidal anti-inflammatory drugs, she was offered a median nerve block, which was performed in the ED. The patient reported continued pain relief 24 hours after discharge from the ED. There is limited data on the use of US-guided mid-forearm median nerve block as an acute pain management tool for CTS in the ED. The US-guided median nerve block done in the mid-forearm location can provide pain control for those with CTS while reducing the risk of complications associated with direct carpal tunnel injection.

Comparison of Comfort and Patient Preference of Common and a Novel Position for Ultrasound-Guided Carpal Tunnel Injections.

This study compared levels of discomfort among three positions for ultrasound-guided carpal tunnel injections (USCTI) to potentially facilitate and improve the procedure's tolerability in treating carpal tunnel syndrome (CTS). Ambulatory Veterans referred for electromyography (EMG) evaluation of CTS were eligible for the study; a total of 30 participants were evaluated. Participants were asked to hold three different positions: 1) Hypersupination, 2) Airplane, and 3) total supported abduction (TSA). Participants rated their pain level, ease of performing/holding each position, exacerbation of underlying symptoms, and position preference. Results were analyzed with two-way repeated measures ANOVA. Hypersupination was determined to be the least preferred and most painful position to hold, demonstrating a statistically significant increase in the Numeric Rating Scale score for pain during the procedure compared with Airplane and TSA, which were not significantly different from one another. Pre-procedure neck, shoulder, elbow, and wrist pain were not significantly associated with intra-procedure pain. When performing USCTI, patient comfort can be optimized by avoiding Hypersupination. Utilizing the Airplane or TSA positions may provide similar access for ulnar approach injections while inducing lower levels of discomfort. Clinical space, resources, patient mobility, and laterality of procedures may further guide one's selection among the positions.

Implementing high-performance near-infrared photomultiplication-type organic photodetectors by synergistic effects of energetic disorder and charge tunneling injection

A high efficiency near-infrared (NIR) photomultiplication-type organic photodetector (PM-OPD) has been achieved by combining the energetic disorder and trap-assisted charge tunneling injection. The performance of the prepared NIR PM-OPD with simple structure was significantly improved, and the external quantum efficiency and specific detectivity (D*) reached 5675% and 5.0 × 1011 Jones, respectively. Furthermore, the high-performance NIR PM-OPD also showed application in human heart rate detection.

High Stability of Broadband Photomultiplier Organic Photodetector with metal ion-chelated polymer as an electron tunneling injection dipole layer

Broadband photomultiplier organic photodetectors (PM-OPDs) have tremendous potential for use in a variety of photoimaging, physical health monitoring, and wearable applications. However, the interfacial mismatch between electrodes and organic semiconductors inhibits the long-term working stability and reliability of devices. Here, we devised high-performance and stability PM-OPDs by using Zn2+-chelated ethoxylated-polyethylenimine (denoted as PEIE-Zn) as an electron tunneling injection dipole layer between ITO and P3HT:PC71BM: Y6 (3:20:80) broadband photoactive layer. The specific detectivity of the PEIE-Zn-modified PM-OPDs was higher than 1012 Jones in the whole spectral response range (350–1000 nm) under 10V bias. The external quantum efficiency of the device exceeded 1000 % in the whole spectral response range under −20V bias. The transient photoresponse curve of the device has no obvious peaks and fluctuations, and the photocurrent density drops only 2.34 % and 0.25 % at 10 V and −20 V bias after illumination, respectively. The device exhibited very good stability over the course of a week, with its photocurrent density maintained at more than 98.94 % of the initial photocurrent density in the ambient environment without encapsulation. This work improves interface contact by modifying the ITO electrode with PEIE-Zn, providing a practical design solution for devices with high response and stability for broadband PM-OPDs.

Resonant tunneling injection of electrons through double stacked GaAs/InAs quantum dots with nanohole electrode

Resonant tunneling diodes containing closely double-stacked InAs quantum dots (QDs) were grown on GaAs substrates by MBE. After growing a thin GaAs capping layer on the double-stacked InAs QDs, nanoholes were selectively formed just above the larger second QDs by thermal annealing. The Au thin film was deposited directly on top surface of the larger second QDs through the nanoholes. The second QDs contacted with Au film served as conducting dots, which can locally inject electrons into the underlying first QDs. In current versus voltage (I–V) measurements, (dI/dV) peaks were clearly observed in the forward bias voltage region. It was due to the tunneling current through a non-doped GaAs thin layer between double-stacked QDs and n-GaAs conduction band. The (dI/dV) peaks shifted toward the lower forward voltage region with increasing temperature. It was explained by the temperature dependence of the electron energy distribution in the GaAs conduction band.

Rate equations description of the asymmetric double barrier electronic cooler

Recent experimental results showed that an electron gas in an asymmetrical double barrier heterostructure can be effectively cooled down under resonant tunneling condition, thus leading to the realization of an electronic cooler. The cooling process is a multi-parameters phenomenon and it is desirable to handle this problem through a reasonably simple approach, in order to understand the role of each parameter. To this end, we present a rate equation modeling of the electron cooling. We model the resonant tunnel injection of the electrons in the well and their thermionic emission assisted by Longitudinal Optical (LO) phonons absorption and emission. The influence of several parameters on the electronic temperature is discussed. This simple model compares rather well to the predictions of non-equilibrium Green function approach and to the experiments.

High‐Power AlGaN‐Based Ultrathin Tunneling Junction Deep Ultraviolet Light‐Emitting Diodes

AbstractTunnel junctions (TJs) offer a unique approach to utilizing nonequilibrium tunneling injection of holes and have demonstrated potential applications in ultraviolet (UV) emitters. However, high operating voltage caused by the wide bandgap of the III‐nitrides has impeded the further promotion of TJ. Here, 275 nm n+‐Al0.45Ga0.55N/p+‐Al0.5Ga0.5N ultrathin tunnel junction (UTJ) deep‐UV light‐emitting diodes (LEDs) are developed for minimizing the electrical losses and achieve, to the current knowledge, the lowest operating voltage (5.7 V) at 300 mA reported to date. This study discovers that Mg‐Si co‐doping occurs in the n+‐Al0.45Ga0.55N layer during the growth of n+‐Al0.45Ga0.55N/p+‐Al0.5Ga0.5N UTJ due to the memory and diffusion effect of Mg, which leads to the formation of Ohmic contact between high‐work‐function Ni/Au and Mg‐Si co‐doped n+‐ Al0.45Ga0.55N layer in UTJ. The Zener diode, fluorine resin, and optimally designed glass lens are incorporated into the chip encapsulation to enhance the reliability and optical performance of the device. Furthermore, a high‐efficiency sterilization deep‐UV light source is developed integrated with 120 UTJ deep‐UV LED chips. Complete surface inactivation at a long irradiation distance (20 cm) is achieved within only seconds using the high‐power sterilization deep‐UV light source. These results indicate that UTJ is promising in developing deep UV LEDs and their integrated light sources.

Effects of base and quantum wells widths variations on technical characteristics of tunneling injection transistor laser

Effects of base and quantum wells widths variations on technical characteristics of tunneling injection transistor laser

Revisiting Hole Injection in Quantum Dot Light‐Emitting Diodes

AbstractInjecting holes from the hole transport layer (HTL) into the quantum dot (QD) emitting layer in quantum dot light‐emitting diodes (QLEDs) is considered challenging due to the presence of a relatively high hole injection barrier at the HTL/QD interface. However, QLEDs with exceptional brightness and efficiency are achieved, prompting a reevaluation of the traditional hole injection mechanisms. This study examines the hole injection mechanism in QLEDs using a combination of experiments and simulations. The results demonstrate that the applied bias significantly reduces the barrier height between the highest occupied molecular orbital level of the HTL and the valence band (VB) of the QDs, facilitating hole injection. The bending of the lowest unoccupied molecular orbital energy level of the HTL at the HTL/QD interface confines electrons within the QD, effectively minimizing leakage current. Additionally, the triangle‐shaped potential barrier arising from the bending of the VB energy level of the QDs creates favorable conditions for hole–tunneling injection. Moreover, both simulations and experiments consistently demonstrate that the predominant pathway for hole injection from the HTL to the QDs in the QLED device involved thermally assisted tunneling. This study is important to understand the hole injection mechanism in QLEDs.

Investigations on the effect of separate confinement heterostructure width on the distortion performance of tunnel injection based transistor laser

Investigations on the effect of separate confinement heterostructure width on the distortion performance of tunnel injection based transistor laser

EXTRAORDINARY MAGNETORESISTANCE OF LASERANNEALED NANO BORON DEPOSITEDON OXIDIZED POROUS SILICON

This study explores the impact of laser annealing on the electrical and magnetic properties of nano boron deposited on oxidized porous silicon (n-B/PSiO2) and its potential for spintronic applications. The Nd: YAG laser was used at varying energies to anneal the n-B thin films. Increasing the laser energy increased grain size and more ordered grain structures. It also increased surface roughness due to forming new grain boundaries and secondary phases. The electrical properties of the material were also affected by the laser annealing, with an increase in forward and reverse current and an increase in electrical resistivity with increased annealing temperature. The study also found that the magnetoresistance of the material increased with increasing laser temperature, attributed to tunnel injection through the thin silicon dioxide layer, and could be up to 7 times higher than non-annealed n-B/PSiO2in a magnetic field. The study highlights the importance of controlling materials’ grain size and structure for their physical and electrical properties. In addition, it provides insights into the electronic properties of n-B/PSiO2and the behavior of charge carriers in a magnetic field.

The Incidence of Carpal Tunnel Syndrome Diagnosis Increases after Arthroscopic Shoulder Surgery

Arthroscopic shoulder surgery has been identified as a potential risk factor for carpal tunnel syndrome (CTS). The purposes of this study were as follows: to (1) examine the percentage of patients who underwent arthroscopic shoulder procedures and later developed ipsilateral CTS within 1 year of the procedure, (2) determine the percentage of those patients with CTS who subsequently underwent an injection or release, and (3) examine comorbidities associated with developing CTS after surgery. Patients who underwent arthroscopic rotator cuff repair (RCR), labral repair, or biceps tenodesis were retrospectively identified in a national database. Within 1 year, we compared the rates of ipsilateral CTS diagnoses versus the contralateral side. The rates of comorbidities between those who did and did not develop CTS were also compared. Within 1 year, arthroscopic RCR patients (1.47% vs 1.00%; odds ratio [OR], 1.48; P < .001) and arthroscopic labral repair patients (0.76% vs 0.52%; OR, 1.47; P < .001) had a significantly higher rate of ipsilateral carpal tunnel diagnosis versus contralateral side diagnosis. Arthroscopic RCR patients were also significantly more likely to have ipsilateral carpal tunnel injection (0.16% vs 0.11%; OR, 1.45; P < .001) and release (0.46% vs 0.37%; OR, 1.24; P < .001). Patients who had an ipsilateral carpal tunnel diagnosis following arthroscopic RCR and labral repair were both significantly older (both P < .001), a higher percentage of women (both P<.001), and more likely to have had a preoperative nerve block (both P < .05). Both cohorts had significantly higher mean Elixhauser comorbidity Index (P < .001) and more comorbidities. This study demonstrated a significantly higher incidence of operative side CTS within 1 year following arthroscopic RCR and labral repairs. Arthroscopic RCR was also demonstrated to result in significantly higher rates of injections and carpal tunnel release. The cohort that developed ipsilateral CTS was older, had higher percentage of women, and had more comorbidities. Prognostic III.

The safety and accuracy of various carpal tunnel injection techniques.

Carpal tunnel (CT) syndrome continues to be a commonly treated hand pathology. We aimed to evaluate several CT injection techniques for (1) spatial accuracy within the CT and (2) risk of median nerve (MN) injury. Our purpose was to evaluate for any significant differences in accuracy of needle placement within the carpal tunnel and final distance between the needle tip and the MN with each technique. Fifteen fresh frozen cadaveric arms were used for this study. Six different injection techniques for CT injection were performed on each specimen, including palmaris longus, ulnar to flexor carpi radialis, trans-flexor carpi radialis, volar radial, volar ulnar, and direct through the palm techniques. After needle placement, a standard open CT release was performed to assess for accuracy of placement within the CT and measure needle position in relation to the MN and other anatomic structures. Accurate intra-CT needle placement was seen in 91% of injections. While there was no significant difference between injection techniques for distance to nearest tendon (p = 0.1531), the trans-flexor carpi radialis (tFCR), volar radial (VR), and volar ulnar (VU) techniques consistently provided the greatest intra-CT distance from needle tip to median nerve (p = 0.0019). The least incidence of intraneural needle placement was found with the tFCR and VR approaches. All six injection techniques reliably enter the CT space. The lowest risk to the MN was found with tFCR and VR techniques, and we recommend these techniques for safe and effective needle placement to avoid iatrogenic intraneural injection. Level V: Cadaveric Study.

Defeating broken symmetry with doping: Symmetric resonant tunneling in noncentrosymetric heterostructures

Resonant tunneling transport in polar heterostructures is intimately connected to the polarization fields emerging from the geometric Berry-phase. In these structures, quantum confinement results not only in a discrete electronic spectrum, but also in built-in polarization charges exhibiting a broken inversion symmetry along the transport direction. Thus, electrons undergo highly asymmetric quantum interference effects with respect to the direction of current flow. By employing doping to counter the broken symmetry, we deterministically control the resonant transmission through GaN/AlN resonant tunneling diodes and experimentally demonstrate the recovery of symmetric resonant tunneling injection across the noncentrosymmetric double-barrier potential.

Publicly Disclosed Pricing for Common Upper-Extremity Procedures: An Analysis of Hospital Chargemasters.

American hospitals are required to provide price transparency data (known as a chargemaster) for medical services, which is intended to allow consumers to accurately estimate the cost of medical services. Our purpose was to identify hospital compliance in publishing chargemaster documents and to assess the price information published for common upper-extremity services and procedures. We performed a cross-sectional analysis of publicly available chargemaster data from 122 hospitals, which included the top-20-ranked Honor Roll hospitals from US News and World Report and 2 top-ranked hospitals from each state. Chargemaster files were accessed for each hospital, and price information was recorded for 10 common upper-extremity procedures including radiographs, injections, and surgeries. Mean procedural prices were compared between academic and nonacademic hospitals. Chargemaster files were able to be accessed for 107 (88%) of 122 institutions. Price estimates for imaging studies were more frequently reported (73%) than those of procedures (23%-41%). With 50 hospitals reporting a price estimate, carpal tunnel injection was the most frequently reported procedure, whereas trigger finger release was the least frequently reported (41% and 23%, respectively). Wide price ranges were noted, with mean charges for a total shoulder arthroplasty listed as US $51 723 (range, US $247-US $364 024). Mean prices between academic and nonacademic hospital systems were similar. While most (88%) of the included hospitals have been compliant with publishing their price transparency files, price estimates for common upper-extremity procedures and imaging studies are inconsistently reported and, when present, demonstrate high levels of price variability between and within hospital systems.