Tunnel Type Research Articles

Evaluating Failure Rates of Primary Quadriceps Tendon Repairs Across Different Surgical Techniques.

Quadriceps tendon ruptures occur infrequently in the general population. Biomechanical data suggest advantages with the use of suture anchor fixation for major tendon repair. Clinical studies of quadriceps tendon repair have been limited to small case series. To evaluate clinical failure following primary quadriceps tendon repair with transosseous tunnel or suture anchor repair. Cohort study; Level of evidence, 3. The Military Health System Data Repository was queried to identify all adult patients who underwent primary quadriceps tendon repair in the Military Health System between 2014 and 2018. Patients were excluded if they had incomplete records, polytrauma, open injury, prior ipsilateral total knee arthroplasty did not undergo quadriceps tendon repair, or underwent revision repair. Follow-up was obtained by manual chart review of both orthopaedic and nonorthopaedic records, recording any evidence of ongoing knee issues. Univariate analysis was performed to determine associations between potential risk factors and repair failure. Multicollinearity was assessed between potential risk factors, and candidate variables were included in multivariate logistic regression models to determine independent risk factors for repair failure. Following application of inclusion/exclusion criteria, 245 knees in 234 patients were included. Mean age of the cohort was 52 years. Patients were predominantly male (223/234; 95%) and military retirees (143/234; 61%). Transosseous tunnel repair was the most frequently employed surgical technique (147/245; 60%), followed by suture anchor repair (78/245; 32%). Repair failure requiring revision surgery occurred in 11% of knees (27/245). Surgical-site infection following index surgery was associated with eventual rerupture (P = .02). There was no difference in failure rate between transosseous tunnel repair and suture anchor repair (12.2% vs 9.0%; P = .51). Among knees undergoing suture anchor repair, no difference in failure was found between knot-tying and knotless suture anchor fixation (P = .73). We observed no difference in failure of primary quadriceps tendon repair between transosseous tunnel and suture anchor repair types or between the 2 main suture anchor implant subtypes (knotless vs knot-tying anchors). A greater than previously reported rerupture rate was observed, indicating the need for continued investigation into optimal surgical techniques.

Doping of Sodium-Ion Cathodes for in-Situ Resource Utilization on the Moon and Mars

On-demand in-space and on-surface manufacturing of batteries is sought to deliver energy storage devices needed for sustained human presence on the Moon and Mars. In-situ resource utilization (ISRU) is a disruptive approach that reduces the dependence on launch payload weight and volume by utilizing the local available resources to maximize long-term sustainability of exploration where resupply may be infeasible or costly. In this study, candidate sodium-ion cathode compositions were designed within the elemental abundance limitations of the Moon and Mars, which support sodium-ion chemistry over lithium-ion due to the low abundance of lithium in regolith. Compositions were assessed for theoretical yield normalized capacity [mAh/kgfeedstock], which revealed that poly-anion type sodium-ion cathodes, which use elements such as P, V, Ni, and Co, are infeasible to attain from ISRU manufacturing. Manganese containing layered and tunnel-type cathode compositions and processing conditions were studied to explore the balance between specific energy density and cycling performance with elemental abundance, specifically searching for replacement of manganese. Study of tunnel-type cathodes found that a critical manganese content was required to stabilize the orthorhombic tunnel type structure with Pbam symmetry (Na0.44MnO2 type) over the NaTiFeO4 type Pnma symmetry, which showed degraded electrochemical performance. Tunnel-type cathodes exhibit higher theoretical yield at the expense of specific capacity and yield normalized capacity. Calculated differences in elemental abundance between the Moon and Mars revealed that compositions containing Ti are better suited for lunar ISRU due to the lower Ti abundance on Mars. Layered-type cathodes exhibit the highest specific capacity and yield normalized capacity, but require improvement in capacity retention. Modification of layered-type Na0.67Mn0.5Fe0.5O2 with the ISRU abundant dopants Al3+, Ti4+, and Mg2+ delivered phase pure Na0.67Mn0.5Fe0.44Al0.03Ti0.015Mg0.015O2 (NMFATM) after calcination. Modification with dopants significantly improved the specific capacity and capacity retention compared to the undoped material.

Research on the determination and influencing factors of topographic unsymmetrical-loaded tunnels based on the unsymmetrical coefficient

The accurate judgment of topographic bias tunnels is directly related to reasonable tunnel design and construction safety. In this study, numerical simulations were carried out to determine the unsymmetrical coefficient of topographic unsymmetrical-loaded tunnels, according to the critical thickness of the cover layer of the topographic bias tunnel proposed in the Chinese Code. The unsymmetrical coefficient was analyzed via control variable method and orthogonal test method. The results showed that it is appropriate to take 1.2 as the criterion for all types of topographic unsymmetrical-loaded tunnel in practical application. The influence of different topographic factors, mechanical properties of the surrounding rock, rock quality, construction methods and tunnel spans on the unsymmetrical coefficient were summarized by the control variable method. The results of multifactor analysis under an orthogonal design revealed that the influence of Uc is in the following order: slope angle, overburden thickness, construction method, surrounding rock quality, and height-to-span ratio.Article HighlightsThe Chinese code for topographic unsymmetrical-loaded tunnels presents a the determination of the corrected unsymmetry coefficient.Single-factor analysis determines the change pattern of the corrected unsymmetry coefficient under the influencing factors.Polar analysis based on orthogonal tests determines the strength of the factors influencing the corrected unsymmetry coefficient.

Design optimization of quasi-rectangular tunnels based on hyperstatic reaction method and ensemble learning

The quasi-rectangular tunnel represents a novel cross-section design, intended to supersede the traditional circular and rectangular tunnel formats. Due to the limited capacity of the tunnel vault to withstand vertical loads, an interior column is often installed at the center to enhance its load-bearing capacity. This study aims to develop a hyperstatic reaction method (HRM) for the analysis of deformation and structural integrity in this specific tunnel type. The computational model is validated through comparison with the corresponding finite element method (FEM) analysis. Following comprehensive validation, an ensemble machine learning (ML) model is proposed, using numerical benchmark data, to facilitate real-time design and optimization. Subsequently, three widely used ensemble models, i.e. random forest (RF), gradient boosting decision tree (GBDT), and extreme gradient boosting (XGBoost) are compared to identify the most efficient ML model for replacing the HRM model in the design optimization process. The performance metrics, such as the coefficient of determination R2 of about 0.999 and the mean absolute percentage error (MAPE) of about 1%, indicate that XGBoost outperforms the others, exhibiting excellent agreement with the HRM analysis. Additionally, the model demonstrates high computational efficiency, with prediction times measured in seconds. Finally, the HRM-XGBoost model is integrated with the well-known particle swarm optimization (PSO) for the real-time design optimization of quasi-rectangular tunnels, both with and without the interior column. A feature importance assessment is conducted to evaluate the sensitivity of design input features, enabling the selection of the most critical features for the optimization task.

Strain‐Induced Effects on Band‐to‐Band Tunneling and Trap‐Assisted Tunneling in Si Examined by Experiment and Theory

Strain is commonly used in metal–oxide–semiconductor technologies to boost on‐state performance. This booster has been in production for at least a decade. Despite this, a systematic study of the impact of strain on off‐state leakage current has been lacking. Herein, experimental data and ab initio calculations are used to refine existing models to account for the impact of strain on band‐to‐band tunneling and trap‐assisted tunneling in silicon. It is observed that the strain may dramatically increase the leakage current, depending on the type of tunneling involved. For band‐to‐band and trap‐assisted tunneling, low uniaxial strains of 0.1% (or 180 MPa) can increase the leakage current by 60% and 10% compared to the unstrained case, respectively. Using models, it is predicted that compressive strain on the order of 1% (or 2 GPa) can increase the leakage current by 150 times. Conversely, tensile strain may diminish or at most double the leakage current in all observed cases. Though detrimental in conventional inversion‐mode metal‐oxide‐semiconductor field‐effect‐transistor, these processes may be used to boost the performance of tunnel field‐effect transistors, where on‐state current is defined by band‐to‐band tunneling.

TBM Advanced Geological Prediction via Ellipsoidal Positioning Velocity Analysis

Traditional seismic wave-based tunnel advanced geological forecasting techniques are primarily designed for drill and blast method construction tunnels. However, given the fast excavation speed and limited prediction space in tunnel boring machine (TBM) construction tunnels, traditional methods have significant technical limitations. This study analyzes the characteristics of different types of TBM construction tunnels and, considering the practical construction conditions, identifies an effective observation system and data acquisition method. To address the challenges in advanced forecasting for TBM construction tunnels, a method of ellipsoid positioning velocity analysis, which takes into account the constraints of three-component data directions, is proposed. Based on the characteristics of the advanced forecasting observation system, this method compares the maximum values on the spatial isochronous ellipsoidal surface to determine the average velocity of the geological layer rays, thereby enabling accurate inversion of the spatial distribution ahead. Utilizing numerical simulation, a model for the advanced detection of typical unfavorable geological formations is established by obtaining the wave field response characteristics of seismic waves in three-dimensional space, and the velocity structure of the model is retrieved through this velocity analysis method. In the engineering example, the fracture property, water content, and weathering degree of the surrounding rock are predicted accurately.

Shaking table tests on transverse seismic performance of a new type of combined prefabricated utility tunnel

Due to the limitation of hoisting weight in the construction site, standard segments of prefabricated utility tunnels usually have only one or two cabins, making it difficult to carry out the multi-cabin prefabricated utility tunnel construction. To solve this problem, two rows of prefabricated utility tunnels are often combined side by side with foam board filled in between them in engineering practice, forming a new type of combined prefabricated utility tunnel. However, there is currently no study on the influence of the interaction between two rows of prefabricated utility tunnels on the seismic performance of combined tunnels. This paper conducted shaking table test of the new type of combined prefabricated utility tunnel under transverse excitation. For the purpose of comparison, shaking table test of single prefabricated utility tunnel was also conducted. To simplify the model making, the combined tunnel was combined by two rows of single-cabin tunnels. Standard segments of utility tunnels were made by microconcrete and assembled longitudinally by bolting. The soil acceleration, utility tunnel strain, and relative displacement between two cabins of the combined tunnel were measured during the tests. Numerical simulation of the test cases was conducted. The numerical results matched the test results well. The research results show that the seismic performance of the combined tunnel is superior to that of single tunnel, because the interaction between two cabins of the combined tunnel reduces the relative deformation between the top and bottom slabs of each cabin. The relative displacement between two cabins of the combined tunnel is much smaller than the initial spacing between the two cabins, and there will be no violent collision between two cabins of the combined tunnel. This study may be of a reference for seismic design of the new type of combined prefabricated utility tunnel.

Controlled single step synthesis, structural and electrode response of honeycomb layered Li3Co2SbO6

We report, for the first time, a single step synthesis process of Li3Co2SbO6 in air medium using the solid state reaction route. The structural analysis confirmed single phase layered crystal structure comprising 2D diffusion path along a-axis and b-axis. The Rietveld refinement of Li3Co2SbO6 yielded monoclinic crystal structure with C2/m space group having cell parameters, a = 5.216 A°, b = 8.989 A° and c = 5.171 A° with Li/Co mixed occupancy. The TEM analysis corroborated the layered structure which is consistent with x-ray analysis. Raman and FTIR analysis confirmed the presence of -CoO6 and -SbO6 octahedra in Li3Co2SbO6 with edge shared arrangement to form a layered stack comprising tunnel type pathway for Li+ ion transport. The estimated electrical conductivity of Li3Co2SbO6 is found to be ∼6.9 × 10−8 Scm−1 with a band gap ∼ 3.5 eV that suggests poor electronic transport for storage cells. This was observed in the electrochemical response of the Li || LiPF6(EC/EMC) || Li3Co2SbO6 cell. The 1st discharge capacity of Li3Co2SbO6 has been found to be a meagre 45 mAhg−1. Despite lower reversible capacity due to poor electrical transport, stable coulombic efficency observed up to 100 cycles suggest the feasibility of improvements in the electrical and charge transport properties.

Experimental Analysis of Noise Characteristics on Different Types of Pavements inside and outside Highway Tunnels

Aiming to reduce noise pollution and optimize the acoustic quality in highway tunnels, the noise characteristics on different types of pavements were analyzed and compared in this research, based on the on-site noise measurement in two tunnels with the free fields as a control group. Specifically, the noise characteristics include two aspects: various noise and noise time attenuation performance. Various noise includes on-board sound intensity (OBSI) noise and cabin noise. The noise time attenuation performance uses the indicator of reverberation time. Three types of pavements were measured, including dense-graded asphalt concrete (DAC) and single-layered and double-layered porous asphalt (PA) pavement. The results showed that, for the same type of pavement, compared with the free fields, the difference in OBSI noise in tunnels was within a range of less than 1 dBA; the cabin noise increased by 3.4 dBA~6.6 dBA. The noise level in tunnels was greater than that outside tunnels, and the longer tunnel exhibited higher traffic noise and worse noise time attenuation performances. For the same tunnel, PA pavement could reduce the cabin noise by 3.8 dBA~6.7 dBA. PA pavement also exhibited shorter reverberation time. The application of PA pavement could effectively improve the acoustic quality in the tunnel. This research contributes to noise pollution abatement and the improvement of the comfort and safety of drivers in tunnels.

Energy-exergy analysis of tunnel type glaze kiln used in porcelain firing

Energy-exergy analysis of tunnel type glaze kiln used in porcelain firing

Surface settlement induced by frictional force of epb shield tunneling in sandy gravels.

The excavation of Earth Pressure Balance (EPB) shield can be divided into two distinct stages, i.e. advancing and lining installation. The frictional force applied on surrounding soils reverses at these two stages, which is harmful to the settlement control. Based on Mindlin's method, a new model of surface settlement is derived to involve the reversed friction. A closed form formula is then obtained for the major type of metro tunnels. Main operational parameters are also used as input of the formula. Numerous operational data and measured settlements are collected from EPB tunnels of Chengdu Metro, Line 7. The proposed formula is validated against these field data in sandy gravels. It is shown that the new formula gives reasonable prediction of surface settlement along the tunnel sections. The accuracy of new formula is significantly higher than that of Peck's formula. This study provides a new vision in settlement control of EPB shield tunneling. The increase of chamber pressure will induce higher negative friction during the lining installation. Therefore, surface settlement of EPB tunneling cannot be controlled by just increasing chamber pressure. A balanced relationship between the chamber pressure and the thrust should be maintained instead.

Simulation of the Dynamic Impact of High-Speed Rolling Stock on Buried Structures of the Tunnel Type

Simulation of the Dynamic Impact of High-Speed Rolling Stock on Buried Structures of the Tunnel Type

Propagation Characteristics of Initial Compression Wave Induced by 400 km/h High-Speed Trains Passing through Very Long Tunnels

When high-speed trains enter tunnels, an initial compression wave is generated. As the compression wave propagates at the local speed of sound to the tunnel exit, it radiates into the surrounding environment, forming micro-pressure waves (MPWs). MPWs create sonic booms, resulting in significant environmental issues. The magnitude of the micro-pressure waves is directly proportional to the pressure gradient of the compression wave at the tunnel exit. The nonlinear effects of the initial compression wave during propagation lead to a significant increase in pressure gradient. Therefore, the propagation characteristics of the initial compression wave during the tunnel are the crucial factor affecting the amplitude of MPWs. Based on the one-dimensional compressible unsteady non-isentropic flow model and the improved generalized Riemann variable characteristic method, this paper researched the propagation and evolution characteristics of an initial compression wave generated when 400 km/h high-speed trains enter tunnels with three portal shapes: (no tunnel entrance hood (no hood), an oblique, enlarged tunnel entrance hood (type A), an enlarged equal-section non-uniform opening hole tunnel entrance hood (type B)). The results show that when the initial compression wave propagates inside very long tunnels, the pressure gradient of the compression wave exhibits a trend of initially increasing and then decreasing with the increase in propagation distance. When the pressure gradient of the compression wave reaches its maximum value, the corresponding propagation distance is the steepening critical distance. For no tunnel entrance hoods, type A tunnel entrance hoods, and type B tunnel entrance hoods, the steepening critical distances are 5 km, 6 km, and 16 km, respectively. The steepening critical distance shortens with increasing train speed. Steady friction and unsteady friction effects mainly affect the pressure amplitude and pressure gradient during compression wave propagation, respectively. At lower ambient temperatures, the nonlinear effects in compression wave propagation are significantly enhanced. The mitigation effects of type A tunnel entrance hoods and type B tunnel entrance hoods on pressure gradient reduction are mainly concentrated within 4 km and 12 km, respectively. It is necessary to determine the optimal matching relationship between the tunnel entrance hood and tunnel length based on the characteristics of compression wave propagation to ensure their mitigating performance is maximized.

Support mechanical response analysis and surrounding rock pressure calculation method for a shallow buried super large section tunnel in weak surrounding rock

At present, China's demand for high-speed railway construction is constantly increasing, and the construction of Multi line high-speed railway tunnels has been put on the agenda. The design and construction issues of super-large-sections tunnels urgently need to be addressed. The Xiabei mountain No. 1 and No. 2 tunnels in the Hangzhou-Taizhou Railway are typical shallow-buried super-large-section-tunnels in weak surrounding rock, and their design and construction issues are representative. Eleven monitoring sections were set up in the tunnel, including tunnel deformation, surrounding rock, shotcrete, steel frames, bolts and temporary support mechanical responses. Taking the monitoring data of the most typical cross-section as an example, the mechanical response of the support structure of a shallow-buried super-large-section tunnel was analyzed in detail. Based on previous research results, this paper discusses and summarizes the common construction problems of this type of tunnel, and puts forward corresponding suggestions. The existing formula for calculating surrounding rock pressure has poor applicability to super-large-section tunnels constructed by step excavation, resulting in conservative support parameters. Therefore, based on the monitoring values of surrounding rock pressure at 10 monitoring sections in Xiabei mountain No. 1 and No. 2 tunnels, empirical parameters reflecting the impact of step excavation were summarized. Based on the Wang formula and combined with the step excavation empirical parameters, an empirical formula for the surrounding rock pressure of shallow-buried super-large-section tunnels considering step excavation was constructed. The calculated results are in good agreement with the on-site monitoring data. This study can provide a good reference for similar projects.

The manipulation of photon blockade via Newtonian gravity

We theoretically investigate the model of a quadratically coupled optomechanical system with a Newtonian gravitational potential in the weak-driving regime, where the optical cavity is driven by an external laser. The steady state of the whole system is treated in the framework of a few-photon subspace. We find that the conventional single-photon blockade, nonstandard types of single-photon blockade, two-photon blockade, and photon-induced tunneling can be induced by gravity when the quadratic optomechanical coupling strength remains constant. Moreover, we find that gravitational potential energy can compensate for the lack of quadratic optomechanical coupling for observation photon blockade. In particular, the photon stream with super-Poissonian distribution can be converted into a sub-Poissonian, antibunching photon stream by changing the driving detuning when the gravitational potential energy is included. These results show that the gravity has potential for realizing the manipulation of photon blockade in a quadratically coupled optomechanical system.

The Fracture Evolution Mechanism of Tunnels with Different Cross-Sections under Biaxial Loading

Biaxial compression tests based on an elliptical tunnel were conducted to study the failure characteristics and the meso-crack evolution mechanism of tunnels with different cross-sections constructed in sandstone. The progressive crack propagation process around the elliptical tunnel was investigated using a real-time digital image correlation (DIC) system. Numerical simulations were performed on egg-shaped, U-shaped, and straight-walled arched tunnels based on the mesoscopic parameters of the elliptical tunnel and following the principle of an equal cross-sectional area. The meso-crack evolution and stress conditions of the four types of tunnels were compared. The results show that (1) fractures around an elliptical tunnel were mainly distributed at the end of the long axis and mainly induce slabbing failure, and the failure mode is similar to a V-shaped notch; (2) strain localization is an important characteristic of rock fracturing, which forebodes the initiation, propagation, and coalescence paths of macro-cracks; and (3) the peak loads of tunnels with egg-shaped, U-shaped, and straight-walled arched cross-sections are 98.76%, 97.56%, and 90.57% that of an elliptical cross-section. The elliptical cross-section shows the optimal bearing capacity.

Comparative Analysis of the Stability of Overlying Rock Mass for Two Types of Lined Rock Caverns Based on Rock Mass Classification

Lined rock caverns (LRCs) are becoming the preferred option for air storage at sites where there are no natural cavities, such as salt caverns, and this storage technology is being developed and utilized in markets around the world. The stability of the overlying rock mass is one of the key factors to ensure the successful operation of LRCs. In this paper, a stability assessment method is presented that first calculates the potential fracture surfaces of the surrounding rock based on the limiting stress field and the Mohr–Coulomb damage criterion, and then, based on these fracture surfaces, solves for the factor of safety defined on the basis of the concept of strength reserve. Using this method, this study evaluates the stability of two types of LRCs, tunnel- and silo-type, under three different geological conditions. The results of the analysis show that the silo-type LRCs are more economical for engineering purposes. Also, this paper provides some guidance for engineers in site selection and preliminary design.

Influence of Interior Column on the Behaviour of Quasi-Rectangular Tunnel

The growing population in major cities around the world requires significant development of transportation infrastructure, especially underground system. It requires the construction of more subway lines, and larger tunnel cross-sections. In underground construction, a cross-sectional shape which is a combination of circular and rectangular tunnels is an advanced trend. This shape incorporates the advantages of both forms. There are two terminologies used to classify these shapes, including sub-rectangular and quasi-rectangular tunnels. While the sub-rectangular tunnel lacks an interior column, the quasi-rectangular tunnel includes an interior column located at the center of tunnel. Recent studies focus on separately investigating the behavior of sub-rectangular and quasi-rectangular tunnels using various methods such as numerical methods, analytical methods, and experimental methods. The present study conducted a numerical comparison of these two types of tunnels. The results indicated that the presence of an interior column help to increase the stability of the lining structure. The internal forces within the quasi-rectangular tunnel with an interior column are smaller than those of the sub-rectangular tunnel and quasi-rectangular tunnel without an interior column.

Study on the Glare Phenomenon and Time-Varying Characteristics of Luminance in the Access Zone of the East–West Oriented Tunnel

In response to the special feature of the east–west oriented road tunnel entrance being easily exposed to direct sunlight, a study was conducted on the glare phenomenon at the access zone for this type of tunnel and on the time-varying characteristics of the L20(S) value outside the tunnel. First, the actual situation of luminance difference inside and outside the tunnel was considered. Field tests were carried out in a 20° field of view of the human eye within a stopping distance. Then, the environment paraments outside the tunnel were collected by combining the environment schematic method with the digital camera method. Finally, the differences and time-varying characteristics between the measured and recommended values of luminance outside the tunnel were analyzed. The PGSV daylight calculation model was used to analyze the glare effect in the 20° field of view of the human eye. The results indicate that the luminance L20(S) outside the tunnel towards the east (west) generally shows a trend of first increasing and then decreasing, and reaches its maximum value in the morning (afternoon). The difference in the contribution ratio of luminance inside and outside the tunnel for this type shows an overall trend of first increasing and then decreasing, and the maximum difference appears in the morning (afternoon), reaching about 97% and 96% respectively. The time-varying characteristics of glare in the access zone of an east (west) oriented road tunnel are roughly consistent with the variation trend of the luminance L20(S) outside the tunnel and exceed the intolerable glare limit. Due to direct sunlight, the luminance outside the tunnel is too high, resulting in an uncomfortable glare that the driver cannot tolerate, becoming more serious after rainfall, and which affects driving comfort and safety.

The effectiveness of wound cleansing using <i>Cocor Bebek</i> (<i>Kalanchoe pinnata</i>) leaves in healing diabetic foot ulcers

This study aimed to evaluate the effectiveness of Cocor Bebek (Kalanchoe pinnata) leaves in wound cleaning for diabetic foot ulcers (DFU) and compare it with the use of NaCl solution. Diabetes mellitus (DM) and its complications, such as DFU, pose a global health problem with increasing prevalence. Given the escalating occurrence of DFU, timely and effective treatment is crucial to prevent severe complications, including amputation. This research employed a quasi-experimental design with a pretest-posttest control group and was conducted at Rumah Luka Surabaya, Indonesia. The sample comprised 40 respondents with DFU, divided into an intervention group (using Cocor Bebek leaves) and a control group (using NaCl solution). Respondents' characteristics, including age, sex, occupation, duration of diabetes, and other factors, were assessed to understand their impact on the response to treatment. The results demonstrated a significant improvement in DFU wound healing in the intervention group after using Cocor Bebek leaves (p<0.05), along with reduced scores on Bates Jensen Wound Assessment Tool (BWAT) indicators such as wound edge, tunnel, and necrotic tissue type. Conversely, the control group using NaCl solution also exhibited significant improvement in wound healing (p<0.05), with decreased scores on indicators such as the amount of necrotic tissue and the quantity of exudate. This study underscores the potential of Cocor Bebek leaves in aiding wound healing in DFU, evident from clinical improvements and reduced BWAT scores. However, further research and clinical trials are needed to comprehensively support these findings and understand the mechanism of action, as well as the safety of using Cocor Bebek leaves in diabetic patients.