The laparoscopic stapler is a surgical instrument that automatically creates visceral anastomosis. Although the laparoscopic stapler is widely used, objective ergonomic assessments are lacking. The purpose of this study was to quantitatively assess the force and muscle activities involved during the use of a laparoscopic stapler. The mechanical force needed to create anastomosis in a cattle colon was measured using a tensile tester. Three different loads (150 N, 200 N, and 250 N) were applied individually to compare the anastomosis conditions. The force and muscle activities of the operators of the laparoscopic stapler were also examined. Eleven healthy female subjects (age, 27.4±10.7 years) participated in the study. Force and surface electromyography (EMG) of the flexor digitorum superficialis and flexor digitorum profundus muscles during the use of the laparoscopic stapler were measured and compared to each subjectʼ s maximum grip strength. Approximately 250 N was necessary to operate the laparoscopic stapler appropriately. Although the mean grip strength of the subjects was 27.1±6.8 kg, the mean force applied when they gripped the laparoscopic stapler was 15.1±4.1 kg. Integrated EMG showed no differences between operating the laparoscopic stapler and gripping the hand dynamometer. This study demonstrated that the current design of laparoscopic stapler requires too much force to operate for individuals with small hands and/or low grip strength. In addition, the EMG results indicated that the enormous upper extremity muscular effort is not transmitted efficiently into power to operate the laparoscopic stapler, because of its handle design. Therefore, reconsidering the mechanism of the laparoscopic stapler is crucial to improve the usability of the laparoscopic stapler.

Strict blood glucose (BG) control is proved to improve the outcome in patients with glucose intolerance both in acute and chronic phases, irrespective of whether the patient has diabetes mellitus. However, strict BG control by conventional methods is so complicated that it cannot be performed easily in normal clinical situations. Furthermore, it is sometimes inadequate. Therefore, a clinically applicable, reliable artificial pancreas (AP) has long been sought after for more than 40 years. Considering the present important situations concerning AP, a survey of recent progress in AP is highly desirable. In this review, recent progress in mechanical AP (MAP) and in MAP-related items is presented. MAP is composed of three major components: a BG control algorithm, a drug administration system, and a glucose sensor. Recent progress in development of these components is presented, followed by descriptions of representative MAPs. Although significant progress in the development of MAP has been made, its use in clinical situations is limited or for research purposes at present. The main limiting factor is the slow progress in the development of glucose sensors. However, more widespread clinical application of the MAP will occur in the near future, considering the number of reliable long-life intravenous glucose sensors under development. Another factor is the worldwide recognition of the importance of BG control in acutely ill patients, in whom the period of strict BG control is usually for several days to a few weeks.

The purpose of this study was to elucidate the relationship between strict control of blood glucose (BG) and mortality reduction with the use of an artificial pancreas (AP). Patients were evaluated in the (1) early phase (E phase: mean 3.3 ± 2.6 days after admission, n = 84) and in the (2) late phase (L phase: mean 9.9 ± 3.3 days, n = 88), and were classified into a (1) group with a higher daily mean BG level (BGm) (BGmXa: BGm above Xmg/dl) and a (2) group with a lower BGm (BGmXb: BGm below Xmg/dl). Each group was classified into a (1) subgroup with a higher daily standard deviation of the BG levels (BGsd) and a (2) subgroup with a lower BGsd. In the E phase, the (1) mortality of the BGm200a group was significantly higher than that of the BGm200b group (56 vs. 29%, p < 0.05), and (2) in the BGm200b group, the mortality of the subgroup with a BGsd above 14 mg/dl was significantly higher than that with a BGsd below 14 mg/dl (46 vs. 17%, p < 0.025). In the L phase, the mortality of the BGm175a group was significantly higher than that of the BGm175b group (50 vs. 28%, p < 0.05). In conclusion, (1) a higher BGm and (2) higher BGsd in the E phase were prognostic risk factors. Based on the findings, it was considered that the target for BG control should be set at (1) BGm below 200 mg/dl and BGsd below 14 mg/dl in the E phase, and (2) BGm below 175 mg/dl in the L phase.

IntroductionIn order to find out the frequency rates of domestic and wild animal bites as well as the evaluation of the prevalence rates of rabies disease in the human population in the Province of Kerman, a retrospective study was designed to analyze statistically the collected recorded data related to this project. Methods This study was conducted within the framework of MPVM student research projects by means of collaboration

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