Background: We prospectively investigated whether the wound-protective Alexis (Applied Medical, Rancho Santa Margarita, CA) wound retractor was effective in preventing surgical site infection (SSI). Methods: We examined the actual condition of SSI in a 12-month randomized, controlled trial consisting of 221 patients who had undergone nontraumatic gastrointestinal surgery. The patients were divided into a With Alexis retractor group (n = 111) and a Without Alexis retractor group (n = 110). We also analyzed SSI separately on the basis of surgical sites such as gastric surgery or colorectal surgery. Results: Overall estimation showed a significant decrease in wound infection (superficial incisional SSI) in the With Alexis retractor group. In the analysis based on surgical sites, a significant decrease in wound infection was noted in the With Alexis retractor group, the members of which had undergone colorectal surgery. There was no significant difference between the two groups in the occurrence of organ/space SSI, including anastomotic leak or intraperitoneal abscess. Conclusion: It was suggested that the use of the Alexis wound retractor would protect surgical wounds from contamination by bacteria and thus prevent infection.
In this paper, we report on a multi-layer casting process of a Nafion membrane to produce a monolithic thin film robot (MTFR). This robot is developed on the basis of the novel concept of a soft robot, which has both a body part and an actuator part and does not require a mechanical and electrical assembly process. A MTFR is made from only one thin film that has thicknesses gradient. The thick parts of the membrane act as bone structures, and the thin parts of the membrane function as actuators. This multi-function structure of the MTFR realizes an assemblyless manufacturing process. To fabricate the monolithic film with a distributed thickness, we propose a multilayer casting process. To demonstrate the potential of a MTFR for use in a biomimetic application, we manufactured anomalocaris-like MTFR and conducted self-sustaining driving experiment in water.
Ionic Polymer Metal Composites (IPMCs) have tremendous potential in the field of soft robotics, but their applications are currently limited by the restraints of the fabrication process. This paper introduces a fabrication method that produces thinner 3D structures, which is advantageous for use in micro soft robots. In this study, a honeycomb structured IPMC actuator was fabricated through 3D printing with dispersion liquid that utilizes water and propanol as a solvent. The frequency response of the prototype was measured to evaluate the fabricated microstructure and the results show that the proposed method to manufacture IPMC actuators with microstructures was successful.
Ionic polymer-metal composites (IPMC) actuators are popular because they can be driven at a low voltage, possess excellent responsiveness, and can perform soft motions similar to that of living creatures. Conventional IPMC soft robots are manufactured by cutting and assembling IPMC sheets. However, using this conventional process to stably manufacture three-dimensional (3D)-shaped soft robots is difficult. To mitigate this problem, we propose a new method for fabricating 3D IPMC actuators in which several surface electrodes are separately fabricated from a single ion-exchange membrane. We refer to our proposal as the simultaneous 3D forming and patterning (SFP) method. Unlike the conventional IPMC fabrication process, the SFP method requires only one step to fix the ion-exchange membrane to contact masks. First, we briefly describe IPMC actuators, before introducing the proposed SFP method in detail. Next, we describe our investigations of the patterning resolution for the surface electrode using the proposed method. We fabricated two soft robot prototypes using the proposed method. The first robot is a starfish-type soft robot. Its surface electrode can be patterned in a plane using the proposed method, and independent driving is possible by applying voltage individually to the divided electrodes. The second prototype is a sea anemone-type soft robot, wherein surface electrodes can be patterned on a 3D curved surface to form a 3D shape.
Angiosarcoma is a rare and unfavorable disease among breast tumors.A 70-year-old woman who had undergone bilateral breast augmentation with silicone gel bags 20 years ago, presented with discomfort itching, and redness in the left breast in May 2012.No tumor was observed on mammary ultrasonography.Initially, we administered antibiotics under the diagnosis of mastitis.After unsuccessful treatment of the mastitis, an oncology consultation was obtained.In October 2013, a breast mass was found unexpectedly, close to the nipple of the left breast, on abdominal magnetic resonance imaging (MRI) for follow-up of a hepatic tumor.The breast mass showed similar findings on breast contrast-enhanced MRI.Although incisional biopsy did not reveal a definitive diagnosis, angiosarcoma was suspected based on the pathological findings.Therefore, we performed left mastectomy with removal of the silicone gel bag.Finally, the tumor was confirmed as angiosarcoma.She is currently without evidence of disease recurrence.Key words：breast augmentation，angiosarcoma，breast
Mesenteric cysts are rare intra-abdominal lesions. We present a case of a mesenteric cyst that was discovered by abdominal computed tomography (CT) and excised by retroperitoneoscopic surgery. There have been 10 reports of excision of mesenteric cysts by laparoscopy in the literature, but retroperitoneoscopic resection of such cysts has not been reported. This case suggests that when a mesenteric cyst arises from the ascending or descending colon, the retroperitoneal approach has a lower risk of traumatizing the bowel than does the laparoscopic intra-abdominal approach, and it does not have to compress other intra-abdominal organs.
Ionic electroactive polymer (iEAP) actuators have attracted great attention in the fields of micro-electromechanical systems and biomedicine due to their remarkably large strain under low-voltage stimulation. As actuation performance is mainly dominated by the electrochemical and electromechanical processes, the electrode layer and its structure are increasingly crucial to the actuators. In this research, we introduced a nanoporous carbon nanotube film with superior conductivity (1000–2000 S cm−1) as a cost-effective alternative electrode in fabricating iEAP actuators. The actuators were assembled by hot-pressing a Nafion/EMImBF4 electrolyte layer between two electrode films under vacuum conditions. Based on the developed porous hierarchal structure and superior electrical and mechanical properties of the electrode film, the actuators showed highly improved electrochemical and electromechanical properties and can operate controllably and durably under various voltage amplitudes and waveforms with a wide frequency range. The generated strain and stress reach up to 1.26% and 5.27 MPa, respectively, which are greater than the performances of the actuators based on polymer-supporting nano carbon electrodes. Once the voltage increases by 1 V, the strain and stress will increase by 0.336% and 1.407 MPa, respectively. The actuators can perform more than 20 000 cycles with an initial drop less than 20% in the operation stroke, showing a relatively durable and controllable cycle life. The newly developed actuators can be promising candidates for artificial muscles in academic interest and industrial applications.
Tazobactam/ceftolozane, a novel antimicrobial therapy, is active against Pseudomonas aeruginosa and most extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae. We report the results of the efficacy and safety of tazobactam/ceftolozane in Japanese patients with complicated intra-abdominal infections (cIAI).A multicenter, open-label, noncomparative study (MK-7625A Protocol 013, ClinicalTrials.gov Identifier: NCT02739997) to investigate the efficacy and safety of tazobactam/ceftolozane used in combination with metronidazole in Japanese patients with cIAI was conducted. One hundred Japanese patients with cIAI received tazobactam/ceftolozane 1.5 g (tazobactam 0.5 g/ceftolozane 1 g) plus metronidazole 500 mg intravenously every 8 h for 60 min for 4–14 days. The clinical response rate at the Test-of-Cure visit (TOC; Day 28 ± 2 days) was 92.0% (81/88 subjects). By disease type, the clinical response rates were 92.3% (24/26) for cholecystitis, 100% (6/6) for liver abscess, 93.5% (58/62) for intra-abdominal abscess and 90.2% (55/61) for peritonitis. The per-subject microbiological response rate at the TOC was 90.2% (55/61). Per-pathogen microbiological response rates in the most common baseline pathogens were Escherichia coli 90.2% (37/41), Kebsiella pneumoniae 91.7% (11/12), Streptococcus anginosus 100% (11/11), Streptococcus constellatus 90.0% (9/10) and Bacteroides fragilis 95.2% (20/21). The most common drug-related AEs were aspartate aminotransferase increased (11.0%) and alanine aminotransferase increased (9.0%). No serious drug-related AE was reported during the study.The favorable effect of tazobactam/ceftolozane in the treatment of cIAI suggests that the agent will be useful in clinical practice in Japan.
