Adherence to Self-care and Quality of Life of Patients with Diabetic Foot Ulcers Treated with Low-Level Laser Therapy: An Exploratory Study.

OBJECTIVE: To evaluate the quality of life (QoL) of patients with a diabetic foot ulcer undergoing treatment with low-level laser therapy (LLLT) at 904 nm and its association with self-care. METHODS: In this randomized, exploratory study, participants were divided into the following four groups: control group (CG) with LLLT placebo, LLLT group 1 (LG1) at 10 J/cm2, LLLT group 2 (LG2) at 8 J/cm2, and LLLT group 3 (LG3) at 4 J/cm2. Participants received light therapy (or placebo) twice a week, for a total of 20 sessions. Researchers assessed participants' QoL using the Short-Form 36 questionnaire. RESULTS: Sixty-two participants were included in the analysis (CG = 18, LG1 = 14, LG2 = 17, LG3 = 13). The LG1 group showed a higher proportion of healing, whereas the CG group showed a lower proportion than the other groups. The LG1 group showed a relationship between physical limitations and blood glucose monitoring, pain and foot care, and general health status (GHS) and foot care. The GL2 group showed a relationship between physical limitations and blood glucose monitoring, vitality and foot care, and GHS and diet. CONCLUSIONS: Low-level laser therapy had a positive impact on QoL as assessed by the Short-Form 36 questionnaire (functional capacity, vitality, and pain domains), and there was a positive association between QoL and self-care in the LLLT groups (physical limitations, pain, GHS, and vitality domains).

A soluble model for synchronized rhythmic activity in ant colonies.

Synchronization is one of the most striking instances of collective behavior, occurring in many natural phenomena. For example, in some ant species, ants are inactive within the nest most of the time, but their bursts of activity are highly synchronized and involve the entire nest population. Here we revisit a simulation model that generates this synchronized rhythmic activity through autocatalytic behavior, i.e., active ants can activate inactive ants, followed by a period of rest. We derive a set of delay differential equations that provide an accurate description of the simulations for large ant colonies. Analysis of the fixed-point solutions, complemented by numerical integration of the equations, indicates the existence of stable limit-cycle solutions when the rest period is greater than a threshold and the event of spontaneous activation of inactive ants is very unlikely, so that most of the arousal of ants is done by active ants. Furthermore, we argue that the persistent oscillations observed in the simulations for colonies of finite size are due to resonant amplification of demographic noise.

Impact of Different Mineral Reinforcements on HDPE Composites: Effects of Melt Flow Index and Particle Size on Physical and Mechanical Properties.

The use of mineral reinforcements in polymer matrix composites has emerged as an alternative for sustainable production, reducing waste and enhancing the physical and mechanical properties of these materials. This study investigated the impact of the melt flow index (MFI) of HDPE and the particle size of two mineral reinforcements, Bahia Beige (BB) and Rio Grande do Norte Limestone (CRN), on the composites. All composites were processed via extrusion, followed by injection, with the addition of 30 wt.% reinforcement. Chemical analyses revealed similar compositions with high CaO content for both minerals, while X-ray diffraction (XRD) identified predominantly calcite, dolomite, and quartz phases. Variations in the MFI, reinforcement type, and particle size showed a minimal influence on composite properties, supported by robust statistical analyses that found no significant differences between groups. Morphological analysis indicated that composites with lower MFI exhibited less porous structures, whereas larger particles of BB and CRN formed clusters, affecting impact resistance, which was attributed to poor interfacial adhesion.

Dose-response and efficacy of 904 nm photobiomodulation on diabetic foot ulcers healing: a randomized controlled trial.

PURPOSE: This study aimed to examine the impact of a 904 nm photobiomodulation (PBM) on diabetic ulcers using varying dosages. METHODS: The study was a randomized, double-blind, placebo-controlled clinical trial that compared treatments using PBM (GaAs 904 nm 30w) with three different energy densities (4 J/cm2; 8 J/cm2; 10 J/cm2) in the healing process of non-infected diabetic foot ulcers. Eighty volunteers (48.75% female; 58.5 ± 11.1 years) were randomized into three intervention groups treated with PBM and one control group (PBM placebo). Volunteers performed up 20 interventions with PBM, either placebo or actual, in conjunction with conventional therapy, which involved dressing the wound with Helianthus annuus vegetable oil. The primary variable was the ulcer size reduction rate. RESULTS: GaAs 904 nm PBM yielded a clinically and significant ulcer size rate reduction of diabetic foot ulcers, independently of energy density range (p < 0.05). However, 10 J/cm² had 60% of completely healed ulcers and the highest proportion of patients reaching 50% of ulcer reduction rate after 5 weeks of treatment. In addition, only 10 J/cm² showed a significant difference between control group after a 10-week follow-up (p < 0.05). CONCLUSION: GaAs 904 nm PBM was effective in treating diabetic foot ulcers in this study and a dosage of 10 J/cm², after a 10-week follow-up, proved to be the most effective compared to the other groups. CLINICAL TRIAL REGISTRATION NUMBER: NCT04246814.

Neuroleptic Malignant Syndrome: An Intensive Care Unit Case of Exceptionally High Creatinine Kinase and Myoglobin Levels.

Neuroleptic Malignant Syndrome (NMS) is a rare, life-threatening neurologic emergency known to be related to the administration or sudden withdrawal of dopaminergic medications. The clinical course, symptoms, and bloodwork are very heterogeneous, making this syndrome difficult to identify. Thus, NMS is a diagnosis of exclusion. We present a case of severe NMS with exceptionally high creatinine kinase (CK) and myoglobin levels with unclear etiology and a challenging differential diagnosis. Also, our case stands out because it was serious, unique, and had a favorable outcome, which could contribute to the management of future similar cases.

Babassu Coconut Fibers: Investigation of Chemical and Surface Properties (Attalea speciosa.).

To complement previous results, an analysis of the chemical and morphological properties of babassu fibers (Attalea speciosa Mart. ex Spreng.) was conducted in order to evaluate their potential as reinforcements in the production of composites with epoxy matrix. The diameter distribution was analyzed in a sample of one hundred fibers, allowing the verification of its variation. The determination of the chemical properties involved experimental analyses of the constituent index and X-ray diffraction. The diffractogram was used to calculate the crystallinity index and the microfibril angle, which are crucial parameters that indicate the consistency of the mechanical properties of babassu fibers and the feasibility of their use in composites. The results revealed that babassu fiber has a chemical composition, with contents of 28.53% lignin, 32.34% hemicellulose, and 37.97% cellulose. In addition, it showed a high crystallinity index of 81.06% and a microfibril angle of 7.67°. These characteristics, together with previous results, indicate that babassu fibers have favorable chemical and morphological properties to be used as reinforcements in composites, highlighting its potential as an important material for applications in technology areas.

Ballistic Performance, Thermal and Chemical Characterization of Ubim Fiber (Geonoma baculifera) Reinforced Epoxy Matrix Composites.

The search for unexplored natural materials as an alternative to synthetic components has driven the development of novel polymeric composites reinforced with environmentally-friendly materials. Natural lignocellulosic fibers (NLFs) have been highlighted as potential reinforcement in composite materials for engineering applications. In this work, a less known Amazonian fiber, the ubim fiber (Geonoma baculifera), is investigated as a possible reinforcement in epoxy composites and was, for the first time, thermally characterized by thermogravimetric analysis (TGA) and differential scanning calorimetry (DSC). Additionally, its chemical structure was elucidated by Fourier transform infrared spectroscopy (FTIR). Ballistic tests were also performed against the threat of a 7.62 mm high-speed lead projectile. The results were statistically analyzed by the Weibull statistical analysis method. FTIR analysis showed the functional groups normally found for NLFs highly rich in cellulose, hemicellulose, and lignin. The TGA/DTG results showed the onset of thermal degradation for the composites (325~335 °C), which represents better thermal stability than isolated ubim fiber (259 °C), but slightly lower than that of pure epoxy (352 °C). The DSC results of the composites indicate endothermic peaks between 54 and 56 °C, and for the ubim fibers, at 71 °C. Ballistic tests revealed higher energy absorption in composites with lower fiber content due to the more intense action of the brittle fracture mechanisms of the epoxy resin, which tended to dissipate more energy. These failure mechanisms revealed the presence of river marks, cracks, and broken fibers with a detachment interface. These results may contribute to the production of ubim fiber-reinforced composites in engineering applications, such as ballistic armors.

Characterization of Thermo-Mechanical and Chemical Properties of Polypropylene/Hemp Fiber Biocomposites: Impact of Maleic Anhydride Compatibilizer and Fiber Content.

This article presents a comprehensive study on the physical, mechanical, thermal, and chemical properties of polypropylene (PP) composites reinforced with hemp fibers (HF) and compatibilized with maleic anhydride (MAPP). The composites were processed using a twin-screw extruder, followed by hot compression at 190 °C. Subsequently, the composites were analyzed using Izod impact and Shore D hardness tests to evaluate their mechanical properties. Thermal properties were investigated through differential scanning calorimetry (DSC) and thermogravimetric analysis (TGA), while X-ray diffraction (XRD) and Fourier-transform infrared spectroscopy (FTIR) were employed to study their chemical properties. Additionally, a statistical analysis was conducted to compare the average results of the impact and hardness tests. XRD analysis revealed that the addition of HF and MAPP led to the disappearance of peaks corresponding to the beta phase in pure PP. Hemp fibers exhibited an impressive crystallinity of 82.10%, surpassing other natural fibers, and had a significant molecular orientation angle (MFA) of 6.06°, making them highly desirable for engineering applications. The crystallite size was observed to be relatively large, at 32.49 nm. FTIR analysis demonstrated strong interactions between the fiber, compatibilizing agent, and polymer matrix. TGA tests showed that the addition of 5 and 10 wt.% MAPP resulted in complete degradation of the composites, similar to pure PP. DSC analyses indicated a reduction in crystallinity (Xc) due to the incorporation of HF and MAPP. Shore D hardness tests revealed an increase in hardness with the addition of 5 wt.% MAPP, while a steep decline in this property was observed with 10 wt.% MAPP. In terms of impact resistance, fractions of 3 and 5 wt.% MAPP in the composites exhibited improved performance compared to the pure polymer. Analysis of variance (ANOVA) was employed to ensure the statistical reliability of the mechanical test results. This comprehensive study sheds light on the diverse properties of PP composites reinforced with hemp fibers and compatibilized with MAPP, emphasizing their potential as sustainable materials for engineering applications. The results contribute to the understanding of the structural and functional aspects of these composites, guiding future research and developments in the field.

Acute Cocaine Intoxication: An Approach to Severe Hepatic and Renal Dysfunctions.

Cocaine is a highly addictive substance. Its poisoning can lead to potentially fatal multi-organ dysfunction. We report a case of cocaine overdose with severe multi-organ dysfunction. A healthy 51-year-old man was admitted to the emergency room due to behaviour changes and seizure after inhaling crack. Multiple dysfunctions were developed, with emphasis on liver and kidney dysfunction, due to their severity. The patient had marked hepatic cytolysis with a peak on the third day with alanine aminotransferase (ALT) and aspartate aminotransferase (AST): 7941 and 4453 IU/L, respectively with mild coagulopathy and hyperbilirubinemia. Underwent empirical treatment with acetylcysteine ​​with good clinical response. Also developed anuric AKIN3 acute kidney injury secondary to rhabdomyolysis, requiring treatment with intermittent haemodialysis. The approach to a case with severe multiorgan dysfunction is described, with special emphasis on the use of acetylcysteine. The good evolution of the patient can corroborate the use of this drug as a potential modifier of prognosis.

Polymeric nanoparticles containing babassu oil: A proposed drug delivery system for controlled release of hydrophilic compounds.

Different drug delivery systems are prepared on the nanoscale to improve performance in drug formulations, such as nanoparticles or nanoemulsions. Polymeric nanoparticles have been used to encapsulate drugs for several applications because of some characteristics of these carriers to control drug delivery, transport molecules to a specific tissue, protect the drugs, and increase drug bioavailability. When using nanocapsules, an essential parameter for encapsulating different hydrophilic or lipophilic molecules is the characteristics of the core. Babassu oil (BBS) is a natural product from Brazil, composed majoritary of short-chain saturated fatty acids. BBS has an elevated hydrophilic-lipophilic balance (HLB), which may promote interaction of the oil with hydrophilic drugs. In this study, we developed and characterized particles containing babassu oil, solely or combined with sorbitan monostearate (Span® 60) or medium chain triglycerides (MCT) in the core to test different HLB and evaluated the encapsulation of a model hydrophilic molecule. Different techniques were used to characterize all formulations in terms of size and distribution, and in vitro drug release by dialysis technique was performed. The BBS was also characterized and presented 46,05 ± 1,11% and 15,38 ± 0,06% of lauric and myristic acid, respectively; saponification index of 248.87 ± 0.64 mg of KOH per gram of BBS, and no oxidation of the oil was indicated by means of peroxide index. Evaporation of solvent carried in the room or reduced pressure influenced the particles' size; nevertheless, all had a z-average smaller than 220 nm. Nanoparticles with a ratio among aqueous phase and organic phase of 2.8 were considered adequate to encapsulate diclofenac sodium. The particles size/zeta potential were 189.83 ± 7.86 nm / - 10.39 ± 2.52 mV, 156.80 ± 4.77 nm / - 9.27 ± 4.61 mV, and 168.87 ± 5.22 nm / - 12.98 ± 4.66 mV to nanoparticles prepared with BBS + MCT, BBS, and BBS + Span® 60, respectively. All formulations exhibited an amount of drug content close to the theoretical amount (1.0 mg mL-1), and no difference was observed in the release profile among the three nanoparticles. Formulation containing only babassu oil in the core displayed 66.78 ± 15.62% of encapsulation efficiency to diclofenac sodium, the highest value among all formulations tested. Results demonstrate that the innovative nanoparticles containing BBS promote the encapsulation of a model hydrophilic molecule, and other components can be evaluated to change the core's hydrophilicity and encapsulation of molecules.

Fabric Impregnation with Shear Thickening Fluid for Ballistic Armor Polymer Composites: An Updated Overview.

As destructive power of firearms raises over the years, ballistic armors are in continuous need of enhancement. For soft armors, this improvement is invariably related to the increase of stacked layers of high-strength fiber fabrics, which potentially restrains wearer mobility. A different solution was created in the early 2000s, when a research work proposed a new treatment of the ballistic panels with non-Newtonian colloidal shear thickening fluid (STF), in view of weight decreasing with strength reinforcement and cost-effective production. Since then, databases reveal a surge in publications generally pointing to acceptable features under ballistic impact by exploring different conditions of the materials adopted. As a result, several works have not been covered in recent reviews for a wider discussion of their methodologies and results, which could be a barrier to a deeper understanding of the behavior of STF-impregnated fabrics. Therefore, the present work aims to overview the unexplored state-of-art on the effectiveness of STF addition to high-strength fabrics for ballistic applications to compile achievements regarding the ballistic strength of this novel material through different parameters. From the screened papers, SiO2, Polyethylene glycol (PEG) 200 and 400, and Aramid are extensively being incorporated into the STF/Fabric composites. Besides, parameters such as initial and residual velocity, energy absorbed, ballistic limit, and back face signature are common metrics for a comprehensive analysis of the ballistic performance of the material. The overview also points to a promising application of natural fiber fabrics and auxetic fabrics with STF fluids, as well as the demand for the adoption of new materials and more homogeneous ballistic test parameters. Finally, the work emphasizes that the ballistic application for STF-impregnated fabric based on NIJ standards is feasible for several conditions.

Bio-Based Composites for Light Automotive Parts: Statistical Analysis of Mechanical Properties; Effect of Matrix and Alkali Treatment in Sisal Fibers.

Composites based on virgin and recycled polypropylene (PP and rPP) reinforced with 15 wt% sisal fibers, with and without alkali treatment, were prepared by compression molding in a mat composed of a three-layer sandwich structure. The sisal was characterized by Fourier-transform infrared spectroscopy (FTIR) and X-ray diffraction (XRD). The composites were characterized according to physical and mechanical properties. Additionally, a factorial experimental design was used to statistically evaluate the mechanical properties of the composite. The FTIR and XRD indicated the partial removal of amorphous materials from the surface of the sisal after alkali treatment. The composites' density results varied from 0.892 to 0.927 g·cm-3, which was in the desirable range for producing lightweight automotive components. A slight decrease in the hardness of the pure rPP and rPP composites in relation to the PP was observed. The water absorption was higher in rPP composites, regardless of the chemical treatment. Moreover, the impact resistance of PP and its composites was higher than the values for rPP. Statistical analysis showed that the alkali treatment was a significant factor for the hardness of the rPP and PP composites, and that the addition of the sisal layer was relevant to improve the impact resistance of the composites.

Dynamic Mechanical Analysis and Ballistic Performance of Kenaf Fiber-Reinforced Epoxy Composites.

Several industry sectors have sought to develop materials that combine lightness, strength and cost-effectiveness. Natural lignocellulosic natural fibers have demonstrated to be efficient in replacing synthetic fibers, owing to several advantages such as costs 50% lower than that of synthetic fibers and promising mechanical specific properties. Polymeric matrix composites that use kenaf fibers as reinforcement have shown strength increases of over 600%. This work aims to evaluate the performance of epoxy matrix composites reinforced with kenaf fibers, by means of dynamic-mechanical analysis (DMA) and ballistic test. Through DMA, it was possible to obtain the curves of storage modulus (E'), loss modulus (E″) and damping factor, Tan δ, of the composites. The variation of E' displayed an increase from 1540 MPa for the plain epoxy to 6550 MPa for the 30 vol.% kenaf fiber composites, which evidences the increase in viscoelastic stiffness of the composite. The increase in kenaf fiber content induced greater internal friction, resulting in superior E″. The Tan δ was considerably reduced with increasing reinforcement fraction, indicating better interfacial adhesion between the fiber and the matrix. Ballistic tests against 0.22 caliber ammunition revealed similar performance in terms of both residual and limit velocities for plain epoxy and 30 vol.% kenaf fiber composites. These results confirm the use of kenaf fiber as a promising reinforcement of polymer composites for automotive parts and encourage its possible application as a ballistic armor component.

Evaluation of the Change in Density with the Diameter and Thermal Analysis of the Seven-Islands-Sedge Fiber.

Basic properties of sedge fibers from the seven-islands-sedge plant (Cyperus malaccensis) were investigated with possible application in reinforcing composite materials. A dimensional distribution and the effect of fiber diameter on density were investigated using gas pycnometry. The Weibull method, used to statistically analyze the acquired data from the diameter intervals, indicated an inverse dependence, where the thinnest fibers had the highest density values. The morphology of the fibers was obtained through scanning electron microscopy (SEM), in which a lower presence of defects was revealed in the thinner fibers, corroborating the inverse density dependence. In addition, the sedge fiber was characterized by differential scanning calorimetry and thermogravimetric analysis, which indicate an initial thermal degradation at around 241 °C. These results revealed for the first time that thinner sedge fibers might be promising reinforcement for polymer composites with a limit in temperature application.

Curaua-Aramid Hybrid Laminated Composites for Impact Applications: Flexural, Charpy Impact and Elastic Properties.

Curaua, as a leaf-based natural fiber, appears to be a promising component with aramid fabric reinforcement of hybrid composites. This work deals with the investigation of flexural, impact and elastic properties of non-woven curaua-aramid fabric hybrid epoxy composites. Five configurations of hybrid composites in a curaua non-woven mat with an increasing quantity of layers, up to four layers, were laminated through the conventional hand lay-up method. The proposed configurations were idealized with at least 60 wt% reinforcement in the non-alternating configuration. As a result, it was observed that the flexural strength decreased by 33% and the flexural modulus by 56%. In addition, the energy absorbed in the Charpy impact also decreased in the same proportion as the replaced amount of aramid. Through the impulse excitation technique, it was possible observe that the replacement of the aramid layers with the curaua layers resulted in decreased elastic properties. However, reduction maps revealed proportional advantages in hybridizing the curaua with the aramid fiber. Moreover, the hybrid composite produced an almost continuous and homogeneous material, reducing the possibility of delamination and transverse deformation, which revealed an impact-resistant performance.

Mechanical Properties, Critical Length, and Interfacial Strength of Seven-Islands-Sedge Fibers (Cyperus malaccensis) for Possible Epoxy Matrix Reinforcement.

The growing concern about the limitation of non-renewable resources has brought a focus on the development of environmentally sustainable and biodegradable composite materials. In this context, a trend in the development of natural fibers used as a reinforcement in composites is ever-increasing. In this work, for the first-time, fibers extracted from the seven-islands-sedge plant (Cyperus malaccensis) have been characterized by X-ray diffraction (XRD) to calculate the crystallinity index and the microfibrillar angle (MFA). Also, an evaluation of the ultimate tensile strength by diameter intervals has been investigated and statistically analyzed by both the Weibull method and the analysis of variance (ANOVA). Moreover, the maximum deformation and tensile modulus have been found from the data acquired. Pullout tests have been conducted to investigate the critical length and interfacial strength when sedge fibers, are incorporated into epoxy resin matrix. Microstructure analysis by scanning electron microscopy (SEM) was performed to observe the mechanism responsible for causing rupture of the fiber as well as the effective fiber interfacial adhesion to the epoxy matrix.

Tensile Properties of Curaua-Aramid Hybrid Laminated Composites for Ballistic Helmet.

A typical ballistic protection helmet for ground military troops has an inside laminate polymer composite reinforced with 19 layers of the aramid, which are neither recyclable or biodegradable and are relatively expensive. The hybridization of synthetic aramid with a natural lignocellulosic fiber (NLF) can provide a lower cost and desirable sustainability to the helmet. In the present work, the curaua fiber, one of the strongest NLFs, is, for the first time, considered in non-woven mat layers to partially replace the aramid woven fabric layers. To investigate the possible advantage of this replacement, the tensile and impact properties of aramid/curaua hybrid laminated composites intended for ballistic helmets, in which up to four layers of curaua were substituted for the aramid, were evaluated. Tensile strength, toughness, and elastic modulus decreased with the replacement of the aramid while the deformation of rupture was improved for the replacement of nine aramid layers by two layers of curaua. Preliminary impact tests corroborate the decreasing tendency found in the tensile properties with the replacement of the aramid by curaua. Novel proposed Reduction Maps showed that, except for the replacement of four aramid layers by one layer of curaua, the decrease percentage of any tensile property value was lower than the corresponding volume percentage of replaced aramid, which revealed advantageous hybridization for the replacement of nine or more aramid layers.