New technologies for high-risk tunnel construction in GuiyangGuangzhou high-speed railway

Based on the construction of high risk tunnels in Guiguang-Guangzhou high-speed railway, several new technologies were developed for high-risk tunnel con- struction. First, an integrated advanced geological predic- tion was developed for tunneling in karst area. Then, a new system of ventilation by involving the dedusting technol- ogy was proposed and used in the field, which received a good air quality. Finally, a method to minimize the dis- tance between the working face and the invert installation was proposed by optimizing the invert installation and adopting the micro bench method. Applying the method to the project obtained an excellent result. The achievement obtained for this study would be able to provide a valuable reference to similar projects in the future.

Analysis of the interaction between bolt-reinforced rock and surface support in tunnels based on convergence-confinement method

To investigate the interaction of the bolt-reinforced rock and the surface support,an analytical model of the convergence-confinement type is proposed,considering the sequential installation of the fully grouted rockbolts and the surface support.The rock mass is assumed to be elastic-brittle-plastic material,obeying the linear Mohr-Coulomb criterion or the non-linear Hoek-Brown criterion.According to the strain states of the tunnel wall at bolt and surface support installation and the relative magnitude between the bolt length and the plastic depth during the whole process,six cases are categorized upon solving the problem.Each case is divided into three stages due to the different effects of the active rockbolts and the passive surface support.The fictitious pressure is introduced to quantify the threedimensional(3D)effect of the tunnel face,and thus,the actual physical location along the tunnel axis of the analytical section can be considered.By using the bolt-rock strain compatibility and the rocksurface support displacement compatibility conditions,the solutions of longitudinal tunnel displacement and the reaction pressure of surface support along the tunnel axis are obtained.The proposed analytical solutions are validated by a series of 3D numerical simulations.Extensive parametric studies are conducted to examine the effect of the typical parameters of rockbolts and surface support on the tunnel displacement and the reaction pressure of the surface support under different rock conditions.The results show that the rockbolts are more effective in controlling the tunnel displacement than the surface support,which should be installed as soon as possible with a suitable length.For tunnels excavated in weak rocks or with restricted displacement control requirements,the surface support should also be installed or closed timely with a certain stiffness.The proposed method provides a convenient alternative approach for the optimization of rockbolts and surface support at the preliminary stage of tunnel design.

Mechanism of high-preload support based on the NPR anchor cable in layered soft rock tunnels

The control of large deformation problems in layered soft rock tunnels needs to solve urgently.The roof problem is particularly severe among the deformation issues in tunnels.This study first analyzes the asymmetric deformation modes in layered soft rock tunnels with large deformations.Subsequently,we construct a mechanical model under ideal conditions for controlling the roof of layered soft rock tunnels through high preload with the support of NPR anchor cables.The prominent roles of long and short NPR anchor cables in the support system are also analyzed.The results indicate the significance of high preload in controlling the roof of layered soft rock tunnels.The short NPR anchor cables effectively improve the integrity of the stratified soft rock layers,while the long NPR anchor cables effectively mobilize the self-bearing capacity of deep-stable rock layers.Finally,the high-preload support method with NPR anchor cables is validated to have a good effect on controlling large deformations in layered soft rock tunnels through field monitoring data.

FibroScan-aspartate transaminase:A superior non-invasive model for diagnosing high-risk metabolic dysfunction-associated steatohepatitis

BACKGROUND Non-alcoholic fatty liver disease(NAFLD)with hepatic histological NAFLD activity score≥4 and fibrosis stage F≥2 is regarded as“at risk”non-alcoholic steatohepatitis(NASH).Based on an international consensus,NAFLD and NASH were renamed as metabolic dysfunction-associated steatotic liver disease(MASLD)and metabolic dysfunction-associated steatohepatitis(MASH),respectively;hence,we introduced the term“high-risk MASH”.Diagnostic values of seven non-invasive models,including FibroScan-aspartate transaminase(FAST),fibrosis-4(FIB-4),aspartate transaminase to platelet ratio index(APRI),etc.for high-risk MASH have rarely been studied and compared in MASLD.AIM To assess the clinical value of seven non-invasive models as alternatives to liver biopsy for diagnosing high-risk MASH.METHODS A retrospective analysis was conducted on 309 patients diagnosed with NAFLD via liver biopsy at Beijing Ditan Hospital,between January 2012 and December 2020.After screening for MASLD and the exclusion criteria,279 patients wereincluded and categorized into high-risk and non-high-risk MASH groups.Utilizing threshold values of each model,sensitivity,specificity,positive predictive value(PPV),and negative predictive values(NPV),were calculated.Receiver operating characteristic curves were constructed to evaluate their diagnostic efficacy based on the area under the curve(AUROC).RESULTS MASLD diagnostic criteria were met by 99.4%patients with NAFLD.The MASLD population was analyzed in two cohorts:Overall population(279 patients)and the subgroup(117 patients)who underwent liver transient elastography(FibroScan).In the overall population,FIB-4 showed better diagnostic efficacy and higher PPV,with sensitivity,specificity,PPV,NPV,and AUROC of 26.9%,95.2%,73.5%,72.2%,and 0.75.APRI,Forns index,and aspartate transaminase to alanine transaminase ratio(ARR)showed moderate diagnostic efficacy,whereas S index and gamma-glutamyl transpeptidase to platelet ratio(GPR)were relatively weaker.In the subgroup,FAST had the highest diagnostic efficacy,its sensitivity,specificity,PPV,NPV,and AUROC were 44.2%,92.3%,82.1%,67.4%,and 0.82.The FIB-4 AUROC was 0.76.S index and GPR exhibited almost no diagnostic value for high-risk MASH.CONCLUSION FAST and FIB-4 could replace liver biopsy as more effectively diagnostic methods for high-risk MASH compared to APRI,Forns index,ARR,S index,and GPR;FAST is superior to FIB-4.

Probabilistic analysis of tunnel face seismic stability in layered rock masses using Polynomial Chaos Kriging metamodel

Face stability is an essential issue in tunnel design and construction.Layered rock masses are typical and ubiquitous;uncertainties in rock properties always exist.In view of this,a comprehensive method,which combines the Upper bound Limit analysis of Tunnel face stability,the Polynomial Chaos Kriging,the Monte-Carlo Simulation and Analysis of Covariance method(ULT-PCK-MA),is proposed to investigate the seismic stability of tunnel faces.A two-dimensional analytical model of ULT is developed to evaluate the virtual support force based on the upper bound limit analysis.An efficient probabilistic analysis method PCK-MA based on the adaptive Polynomial Chaos Kriging metamodel is then implemented to investigate the parameter uncertainty effects.Ten input parameters,including geological strength indices,uniaxial compressive strengths and constants for three rock formations,and the horizontal seismic coefficients,are treated as random variables.The effects of these parameter uncertainties on the failure probability and sensitivity indices are discussed.In addition,the effects of weak layer position,the middle layer thickness and quality,the tunnel diameter,the parameters correlation,and the seismic loadings are investigated,respectively.The results show that the layer distributions significantly influence the tunnel face probabilistic stability,particularly when the weak rock is present in the bottom layer.The efficiency of the proposed ULT-PCK-MA is validated,which is expected to facilitate the engineering design and construction.

A methodology for damage evaluation of underground tunnels subjected to static loading using numerical modeling

We have proposed a methodology to assess the robustness of underground tunnels against potential failure.This involves developing vulnerability functions for various qualities of rock mass and static loading intensities.To account for these variations,we utilized a Monte Carlo Simulation(MCS)technique coupled with the finite difference code FLAC^(3D),to conduct two thousand seven hundred numerical simulations of a horseshoe tunnel located within a rock mass with different geological strength index system(GSIs)and subjected to different states of static loading.To quantify the severity of damage within the rock mass,we selected one stress-based(brittle shear ratio(BSR))and one strain-based failure criterion(plastic damage index(PDI)).Based on these criteria,we then developed fragility curves.Additionally,we used mathematical approximation techniques to produce vulnerability functions that relate the probabilities of various damage states to loading intensities for different quality classes of blocky rock mass.The results indicated that the fragility curves we obtained could accurately depict the evolution of the inner and outer shell damage around the tunnel.Therefore,we have provided engineers with a tool that can predict levels of damages associated with different failure mechanisms based on variations in rock mass quality and in situ stress state.Our method is a numerically developed,multi-variate approach that can aid engineers in making informed decisions about the robustness of underground tunnels.

Rock mass quality prediction on tunnel faces with incomplete multi-source dataset via tree-augmented naive Bayesian network

Rock mass quality serves as a vital index for predicting the stability and safety status of rock tunnel faces.In tunneling practice,the rock mass quality is often assessed via a combination of qualitative and quantitative parameters.However,due to the harsh on-site construction conditions,it is rather difficult to obtain some of the evaluation parameters which are essential for the rock mass quality prediction.In this study,a novel improved Swin Transformer is proposed to detect,segment,and quantify rock mass characteristic parameters such as water leakage,fractures,weak interlayers.The site experiment results demonstrate that the improved Swin Transformer achieves optimal segmentation results and achieving accuracies of 92%,81%,and 86%for water leakage,fractures,and weak interlayers,respectively.A multisource rock tunnel face characteristic(RTFC)dataset includes 11 parameters for predicting rock mass quality is established.Considering the limitations in predictive performance of incomplete evaluation parameters exist in this dataset,a novel tree-augmented naive Bayesian network(BN)is proposed to address the challenge of the incomplete dataset and achieved a prediction accuracy of 88%.In comparison with other commonly used Machine Learning models the proposed BN-based approach proved an improved performance on predicting the rock mass quality with the incomplete dataset.By utilizing the established BN,a further sensitivity analysis is conducted to quantitatively evaluate the importance of the various parameters,results indicate that the rock strength and fractures parameter exert the most significant influence on rock mass quality.

Prediction of subsurface settlement induced by shield tunnelling in sandy cobble stratum

This study focuses on the analytical prediction of subsurface settlement induced by shield tunnelling in sandy cobble stratum considering the volumetric deformation modes of the soil above the tunnel crown.A series of numerical analyses is performed to examine the effects of cover depth ratio(C/D),tunnel volume loss rate(h t)and volumetric block proportion(VBP)on the characteristics of subsurface settle-ment trough and soil volume loss.Considering the ground loss variation with depth,three modes are deduced from the volumetric deformation responses of the soil above the tunnel crown.Then,analytical solutions to predict subsurface settlement for each mode are presented using stochastic medium theory.The influences of C/D,h t and VBP on the key parameters(i.e.B and N)in the analytical expressions are discussed to determine the fitting formulae of B and N.Finally,the proposed analytical solutions are validated by the comparisons with the results of model test and numerical simulation.Results show that the fitting formulae provide a convenient and reliable way to evaluate the key parameters.Besides,the analytical solutions are reasonable and available in predicting the subsurface settlement induced by shield tunnelling in sandy cobble stratum.

Numerical analysis of moving train induced vibrations on tunnel,surrounding ground and structure

This study is focused on the effect of vibration induced by moving trains in tunnels on the surrounding ground and structures.A three-dimensional finite element model is established for a one-track railway tunnel and an adjacent twelve-storey building frame by using commercial software Midas GTS-NX(2019)and Midas Gen.This study considered the moving load effect of a complete train,which varies with space as well as with time.The effect of factors such as train speed,overburden pressure on the tunnel and variation in soil properties are studied in the time domain.As a result,the variations in horizontal and vertical acceleration for two different sites,i.e.,the free ground surface(without structure)and the area containing the structure,are compared.Also,the displacement pattern of the raft foundation is plotted for different train velocities.At lower speeds,the heaving phenomenon is negligible,but as the speed increases,both the heaving and differential settlement increase in the foundation.This study demonstrates that the effect of moving train vibrations should be considered in the design of new nearby structures and proper ground improvement should be considered for existing structures.

Application of excavation compensation method for enhancing stability and efficiency in shallow large-span rock tunnels

Engineering shallow,large-span rock tunnels challenges deformation control and escalates construction costs.This study investigates the excavation compensation method(ECM)and its associated technologies to address these issues.Utilizing five key technologies,the ECM effectively modulates radial stress post-excavation,redistributes stress in the surrounding rock,and eliminates tensile stress at the excavation face.Pre-tensioning measures further enhance the rock’s residual strength,establishing a new stability equilibrium.Field tests corroborate the method’s effectiveness,demonstrating a crown settlement reduction of 3–8 mm,a nearly 50%decrease compared to conventional construction approaches.Additionally,material consumption and construction duration were reduced by approximately 30%–35%and 1.75 months per 100 m,respectively.Thus,the ECM represents a significant innovation in enhancing the stability and construction efficiency of large-span rock tunnels,marking a novel contribution to the engineering field.

3D DEM simulation of hard rock fracture in deep tunnel excavation induced by changes in principal stress magnitude and orientation

To achieve the loading of the stress path of hard rock,the spherical discrete element model(DEM)and the new flexible membrane technology were utilized to realize the transient loading of three principal stresses with arbitrary magnitudes and orientations.Furthermore,based on the deep tunnel of China Jinping Underground Laboratory II(CJPL-II),the deformation and fracture evolution characteristics of deep hard rock induced by excavation stress path were analyzed,and the mechanisms of transient loading-unloading and stress rotation-induced fractures were revealed from a mesoscopic perspective.The results indicated that the stressestrain curve exhibits different trends and degrees of sudden changes when subjected to transient changes in principal stress,accompanied by sudden changes in strain rate.Stress rotation induces spatially directional deformation,resulting in fractures of different degrees and orientations,and increasing the degree of deformation anisotropy.The correlation between the degree of induced fracture and the unloading magnitude of minimum principal stress,as well as its initial level is significant and positive.The process of mechanical response during transient unloading exhibits clear nonlinearity and directivity.After transient unloading,both the minimum principal stress and minimum principal strain rate decrease sharply and then tend to stabilize.This occurs from the edge to the interior and from the direction of the minimum principal stress to the direction of the maximum principal stress on theε1-ε3 plane.Transient unloading will induce a tensile stress wave.The ability to induce fractures due to changes in principal stress magnitude,orientation and rotation paths gradually increases.The analysis indicates a positive correlation between the abrupt change amplitude of strain rate and the maximum unloading magnitude,which is determined by the magnitude and rotation of principal stress.A high tensile strain rate is more likely to induce fractures under low minimum principal stress.

Stability analysis of tunnel face reinforced with face bolts

Face bolting has been widely utilized to enhance the stability of tunnel face,particularly in soft soil tunnels.However,the influence of bolt reinforcement and its layout on tunnel face stability has not been systematically studied.Based on the theory of linear elastic mechanics,this study delved into the specific mechanisms of bolt reinforcement on the tunnel face in both horizontal and vertical dimensions.It also identified the primary failure types of bolts.Additionally,a design approach for tunnel face bolts that incorporates spatial layout was established using the limit equilibrium method to enhance the conventional wedge-prism model.The proposed model was subsequently validated through various means,and the specific influence of relevant bolt design parameters on tunnel face stability was analyzed.Furthermore,design principles for tunnel face bolts under different geological conditions were presented.The findings indicate that bolt failure can be categorized into three stages:tensile failure,pullout failure,and comprehensive failure.Increasing cohesion,internal friction angle,bolt density,and overlap length can effectively enhance tunnel face stability.Due to significant variations in stratum conditions,tailored design approaches based on specific failure stages are necessary for bolt design.

Ground settlement and tunnel response due to twin-curved shield tunnelling in soft ground with small clear distance

Twin curved tunnels are often encountered in shield tunnelling,where significant complexities in densely exploited underground space are observed.In this study,the ground settlement and tunnel deformation due to twin-curved shield tunnelling in soft ground were investigated using numerical simulation and field monitoring.Different curvature radii of twin curved tunnels and subsequent effects of tunnel construction were considered to reveal the tunnelling effect on ground surface settlement and tunnel deformation.The results show that the settlement trough yields one offset towards inside of curved shield tunnelling.The location of settlement trough and maximum settlement were affected by curvature radius but except for the shape and width of settlement trough.Adjacent parallel twin-curved shield tunnelling could increase the offset of existing settlement trough and maximum settlement.Then,an empirical prediction of surface settlement trough due to twin-curved shield tunnelling with same tunnel diameters in soft clay was proposed,which was applicable to curvature radius less than 800 m.Finally,a minimum radius of 600 m of curvature tunnel was proposed in terms of allowable convergence deformation of tunnel.The result could provide guidance on safety evaluation for twin curved shield tunnelling construction.

Efficacy of mycophenolate mofetil combined with topical 0.05%tacrolimus in high-risk keratoplasty:1-year cohort study

AIM:To investigate the efficacy of systemic mycophenolate mofetil(MMF)as an adjunct in combination with topical tacrolimus(FK506)and corticosteroid eyedrops for preventing corneal graft rejection after high-risk keratoplasty(HRK).METHODS:In this cohort study,55 consecutive patients(55 eyes)from an eye center who met the criteria of HRK were included.The definition for HRK includes large grafts of no less than 9 mm diameter,vascularized cornea of two or more quadrants,regrafting,or eccentric grafts.After penetrating keratoplasty,25 patients treated with systemic MMF in combination with 0.05%FK506 and tapering corticosteroid eyedrops were enrolled in Group 1 from October 2019.Thirty patients receiving postoperative treatment with 0.05%FK506 and tapering corticosteroid eyedrops alone were enrolled in Group 2 from January 2018 to September 2019.All participants were closely monitored after surgery,and episodes of graft rejection and relevant clinical data were collected and assessed over a one-year follow-up period.RESULTS:After a follow-up of 9.6±3.2mo,graft rejection episodes occurred in 4 cases(16%)in Group 1 and 18 cases(60%)in Group 2.One reversible and 3 irreversible graft rejections occurred in Group 1,while 3 reversible and 15 irreversible rejections occurred in Group 2.Kaplan-Meier analysis revealed that 82.5%of grafts in Group 1 and 37.1%in Group 2 did not experience corneal graft rejection(P<0.01,log-rank test).The clear graft survival rate was 83.6%in Group 1 and 36.7%in Group 2(P<0.01,log-rank test)within one year of follow-up.No severe systemic side effects were observed in either group during the follow-up period.CONCLUSION:The triple treatment regimen consisting of MMF,topical FK506,and corticosteroid eyedrops represents a promising strategy for effectively preventing graft rejection and improving graft survival in patients with HRK.

An improved analytical solution for solving the shield tunnel uplift problem

The problem of shield tunnel uplift is a common issue in tunnel construction.Due to the decrease in shear stiffness at the joints between the rings,uplift is typically observed as bending and dislocation deformation at these joints.Existing modeling methods typically rely on the Euler-Bernoulli beam theory,only considering the bending effect while disregarding shear deformation.Furthermore,the constraints on the shield tail are often neglected in existing models.In this study,an improved theoretical model of tunnel floating is proposed.The constraint effect of the shield machine shell on the tunnel structure is considered using the structural forms of two finite long beams and one semi-infinite long beam.Furthermore,the Timoshenko beam theory is adopted,providing a more accurate description of tunnel deformation,including both the bending effect and shear deformation,than existing models.Meanwhile,the buoyancy force and stratum resistance are calculated in a nonlinear manner.A reliable method for calculating the shear stiffness correction factor is proposed to better determination of the calculation parameters.The proposed theoretical model is validated through five cases using sitemonitored data.Its applicability and effectiveness are demonstrated.Furthermore,the influences of soil type,buried depth,and buoyancy force on the three key indicators of tunnel floating(i.e.the maximum uplift magnitude,the ring position with the fastest uplift race,and the ring position with the maximum uplift magnitude)are analyzed.The results indicate that the proposed model can provide a better understanding of the floating characteristics of the tunnel structure during construction.

Effect of burial depth of a new tunnel on the seismic response of an existing tunnel

Burial depth is a crucial factor affecting the forces and deformation of tunnels during earthquakes.One key issue is a lack of understanding of the effect of a change in the buried depth of a single-side tunnel on the seismic response of a double-tunnel system.In this study,shaking table tests were designed and performed based on a tunnel under construction in Dalian,China.Numerical models were established using the equivalent linear method combined with ABAQUS finite element software to analyze the seismic response of the interacting system.The results showed that the amplification coefficient of the soil acceleration did not change evidently with the burial depth of the new tunnel but decreased as the seismic amplitude increased.In addition,the existing tunnel acceleration,earth pressure,and internal force were hardly affected by the change in the burial depth;for the new tunnel,the acceleration and internal force decreased as the burial depth increased,while the earth pressure increased.This shows that the earth pressure distribution in a double-tunnel system is relatively complex and mainly concentrated on the arch spandrel and arch springing of the relative area.Overall,when the horizontal clearance between the center of the two tunnels was more than twice the sum of the radius of the outer edges of the two tunnels,the change in the burial depth of the new tunnel had little effect on the existing one,and the tunnel structure was deemed safe.These results provide a preliminary understanding and reference for the seismic performance of a double-tunnel system.

Intravitreal conbercept injection with panretinal photocoagulation for high-risk proliferative diabetic retinopathy with vitreous hemorrhage

AIM:To assess the clinical efficacy and safety of combining panretinal photocoagulation(PRP)with intravitreal conbercept(IVC)injections for patients with high-risk proliferative diabetic retinopathy(HR-PDR)complicated by mild or moderate vitreous hemorrhage(VH),with or without diabetic macular edema(DME).METHODS:Patients diagnosed with VH with/without DME secondary to HR-PDR and received PRP combined with IVC injections were recruited in this retrospective study.Upon establishing the patient’s diagnosis,an initial IVC was performed,followed by prompt administration of PRP.In cases who significant bleeding persisted and impeded the laser operation,IVC was sustained before supplementing with PRP.Following the completion of PRP,patients were meticulously monitored for a minimum of six months.Laser therapy and IVC injections were judiciously adjusted based on fundus fluorescein angiography(FFA)results.Therapeutic effect and the incidence of adverse events were observed.RESULTS:Out of 42 patients(74 eyes),29 were male and 13 were female,with a mean age of 59.17±12.74y(33-84y).The diabetic history was between 1wk and 26y,and the interval between the onset of visual symptoms and diagnosis of HR-PDR was 1wk-1y.The affected eye received 2.59±1.87(1-10)IVC injections and underwent 5.5±1.02(4-8)sessions of PRP.Of these,68 eyes received PRP following 1 IVC injection,5 eyes after 2 IVC injections,and 1 eye after 3 IVC injections.Complete absorption of VH was observed in all 74 eyes 5-50wk after initial treatment,with resolution of DME in 51 eyes 3-48wk after initial treatment.A newly developed epiretinal membrane was noted in one eye.Visual acuity significantly improved in 25 eyes.No complications such as glaucoma,retinal detachment,or endophthalmitis were reported.CONCLUSION:The study suggests that the combination of PRP with IVC injections is an effective and safe modality for treating diabetic VH in patients with HR-PDR.

Magnetic Switching Dynamics and Tunnel Magnetoresistance Effect Based on Spin-Splitting Noncollinear Antiferromagnet Mn_(3)Pt

In comparison to ferromagnets,antiferromagnets are believed to have superior advantages for applications in next-generation magnetic storage devices,including fast spin dynamics,vanishing stray fields and robust against external magnetic field,etc.However,unlike ferromagnetic orders,which could be detected through tunneling magnetoresistance effect in magnetic tunnel junctions,the antiferromagnetic order(i.e.,Néel vector)cannot be effectively detected by the similar mechanism due to the spin degeneracy of conventional antiferromagnets.Recently discovered spin-splitting noncollinear antiferromagnets,such as Mn_(3)Pt with momentum-dependent spin polarization due to their special magnetic space group,make it possible to achieve remarkable tunneling magnetoresistance effects in noncollinear antiferromagnetic tunnel junctions.Through first-principles calculations,we demonstrate that the tunneling magnetoresistance ratio can reach more than 800% in Mn_(3)Pt/perovskite oxides/Mn_(3)Pt antiferromagnetic tunnel junctions.We also reveal the switching dynamics of Mn_(3)Pt thin film under magnetic fields using atomistic spin dynamic simulation.Our study provides a reliable method for detecting Néel vector of noncollinear antiferromagnets through the tunnel magnetoresistance effect and may pave its way for potential applications in antiferromagnetic memory devices.

Tunneling Barrier Thickness Dependence of Spin Polarization of Ferromagnet in Magnetic Tunnel Junctions

For designing low-impedance magnetic tunnel junctions(MTJs),it has been found that tunneling magnetoresistance strongly correlates with the insulating barrier thickness,imposing a fundamental problem about the relationship between spin polarization of ferromagnet and the insulating barrier thickness in MTJs.Here,we investigate the influence of alumina barrier thickness on tunneling spin polarization(TSP)through a combination of theoretical calculations and experimental verification.Our simulating results reveal a significant impact of barrier thickness on TSP,exhibiting an oscillating decay of TSP with the barrier layer thinning.Experimental verification is realized on FeNi/AlO_(x)/Al superconducting tunnel junctions to directly probe the spin polarization of FeNi ferromagnet using Zeeman-split tunneling spectroscopy technique.These findings provide valuable insights for designs of high-performance spintronic devices,particularly in applications such as magnetic random access memories,where precise control over the insulating barrier layer is crucial.

Carpal Tunnel Syndrome: A Marker for Amyloidosis

Introduction: Amyloidosis are systemic conditions and carpal tunnel syndrome (CTS) precedes the principal systemic complications and can be used as an early marker. Our objective was to determine the frequency of amyloid deposition in idiopathic CTS and its systemic impact. Methods: We retrospectively evaluated patients with CTS between September 2019 to January 2020. Samples from the anterior carpal ligament were pathologically evaluated and amyloid deposition was confirmed by apple-green birefringence on polarized light using Congo red stain. When amyloid was detected we performed genetic testing for transthyretin variants (ATTRv), immunofixation electrophoresis in serum and urine for light chains and multidisciplinary evaluation. Results: Thirty consecutive patients were included, 19 women, 11 men, mean age 70 years old (range 42 - 89 years). We identified 3 patients (10%) with amyloid deposits (mean age: 78.6 years, 2 men, 1 woman). Genetic testing for ATTRv and light chains studies were negative. During follow-up: The first patient required aortic valve replacement. The second patient developed progressive cardiac failure with syncopal episodes, atrioventricular block and atrial fibrillation and required a pacemaker and anticoagulation. The third patient had unexplained chronic edemas. The cardiac evaluation in all 3 patients revealed left ventricular hypertrophy and myocardial uptake (Perugini Score > 2) in their nuclear bone scintigraphies with technetium pyrophosphate. Two patients were treated with tafamidis and one patient died due to refractory cardiac insufficiency. Discussion: Our findings underline the importance of investigating amyloidosis in idiopathic CTS. The identification of deposits allows early diagnosis of cardiac amyloidosis leading to timely intervention and treatment.