BACKGROUND: Surgical reconstruction is a crucial stage in various surgeries, including pancreaticoduodenectomy, as it can significantly affect the surgical results. The objective was to design a suture force feedback (SFF) device that can precisely measure the suture force during surgical closures. Afterward, the device was used to train junior surgeons in surgical closure techniques.
METHODS: The SFF was used to capture the suture force data of experienced surgeons. This data was utilized to train and assess junior surgeons. The SFF device had 2 tactile-based force sensors that measured the applied force. Whenever the applied force was not within the optimal force range, the device provided feedback to the surgeon. A workshop was conducted to train junior surgeons in surgical closure techniques to improve their suturing skills.
RESULTS: Thirty-seven junior surgeons were enrolled in this training, of whom only 24 completed the 30-day training program. The pre-assessment results revealed that the force exerted by junior surgeons during suture knot-tying was uneven compared with that of the experienced surgeons, with a significant difference in the force exerted per knot throw (P = 0.005. Before the training program, junior surgeons applied a force of 3.89 ± 0.43 N, which was more than twice the force applied by experienced surgeons (1.75 ± 0.12 N). However, after completing the 30-day training program, their force improved to 2.35 ± 0.13 N.
CONCLUSIONS: The SFF device was shown to be an encouraging training tool for improving the surgical closure dexterity and technique of the participating junior surgeons.

Background: The geometry of a laryngoscope\'s blade determines the forces acting on the pharyngeal structures to a relevant degree. Knowledge about the force distribution along the blade may prospectively allow for the development of less traumatic blades. Therefore, we examined the forces along the blades experienced during laryngoscopy with the C-MAC D-BLADE and blades of the Macintosh style. We hypothesised that lower peak forces are applied to the patient\'s pharyngeal tissue during videolaryngoscopy with a C-MAC D-BLADE compared to videolaryngoscopy with a C-MAC Macintosh-style blade and direct laryngoscopy with a Macintosh-style blade. Beyond that, we assumed that the distribution of forces along the blade differs depending on the respective blade\'s geometry. Methods: After ethical approval, videolaryngoscopy with the D-BLADE or the Macintosh blade, or direct laryngoscopy with the Macintosh blade (all KARL STORZ, Tuttlingen, Germany), was performed on 164 randomly assigned patients. Forces were measured at six positions along each blade and compared with regard to mean force, peak force and spatial distribution. Furthermore, the duration of the laryngoscopy was measured. Results: Mean forces (all p < 0.011) and peak forces at each sensor position (all p < 0.019) were the lowest with the D-BLADE, whereas there were no differences between videolaryngoscopy and direct laryngoscopy with the Macintosh blades (all p > 0.128). With the D-BLADE, the forces were highest at the blade\'s tip. In contrast, the forces were more evenly distributed along the Macintosh blades. Videolaryngoscopy took the longest with the D-BLADE (p = 0.007). Conclusions: Laryngoscopy with the D-BLADE resulted in significantly lower forces acting on pharyngeal and laryngeal tissue compared to Macintosh-style blades. Interestingly, with the Macintosh blades, we found no advantage for videolaryngoscopy in terms of force application.

UNASSIGNED: The significance of atraumatic electrode array (EA) insertion in cochlear implant (CI) surgery is widely acknowledged, with consensus that forces due to EA insertion are directly correlated with insertion trauma. Unfortunately, the manual perception of these forces through haptic feedback is inherently limited, and techniques for in vivo force measurements to monitor the insertion are not yet available. Addressing this gap, we developed of a force-sensitive insertion tool capable of capturing real-time insertion forces during standard CI surgery.
UNASSIGNED: This paper describes the tool and its pioneering application in a clinical setting and reports initial findings from an ongoing clinical study. Data and experiences from five patients have been evaluated so far, including force profiles of four patients.
UNASSIGNED: The initial intraoperative experiences are promising, with successful integration into the conventional workflow. Feasibility of in vivo insertion force measurement and practicability of the tool\'s intraoperative use could be demonstrated. The recorded in vivo insertion forces show the expected rise with increasing insertion depth. Forces at the end of insertion range from 17.2 mN to 43.6 mN, while maximal peak forces were observed in the range from 44.8 mN to 102.4 mN.
UNASSIGNED: We hypothesize that this novel method holds the potential to assist surgeons in monitoring the insertion forces and, thus, minimizing insertion trauma and ensuring better preservation of residual hearing. Future data recording with this tool can form the basis of ongoing research into the causes of insertion trauma, paving the way for new and improved prevention strategies.

UNASSIGNED: Weakness and atrophy in trunk muscles have been associated with chronic low back pain (CLBP).
UNASSIGNED: This study aimed to identify isometric exercises resulting the highest trunk muscle activity for individuals with and without CLBP.
UNASSIGNED: Fourteen males with CLBP and 15 healthy age-matched healthy subjects were recruited for this study. Muscle activity during maximal voluntary isometric contraction (MVIC) was measured for a comparative reference with surface electromyography (sEMG) from six trunk muscles. Thereafter maximum EMG amplitude values were measured during eleven trunk stability exercises. The maximal EMG activity in each exercise relative to the MVICs was analyzed using generalizing estimating equations (GEE) models with the unstructured correlation structure.
UNASSIGNED: The GEE models showed statistically significant differences in muscle activity between exercises within both groups (p< 0.001), with no significant differences between groups (p> 0.05). The highest muscle activity was achieved with the hip flexion machine for multifidus, side pull with a resistance band for lumbar extensors, side and single-arm cable pull exercises for thoracic extensors, rotary plank and the hip flexion machine for abdominal.
UNASSIGNED: This study found five isometric trunk exercises that exhibited highest muscle activity depending on muscle tested, with no significant difference between individuals with and without CLBP.

The presence and progression of a neuromuscular pathology can impact on the contractile force production of a muscle. Hence, measurements of force production can be an important tool for the evaluation of disease progression. In this chapter, we describe how to perform in situ function testing on the tibialis anterior muscle using a murine model. Performing neuromuscular in situ function testing allows force measurements to be recorded in a physiologically relevant environment.

BACKGROUND: Lateral/radial forces and the mechanical properties of Woven EndoBridge (WEB) devices have significant importance for therapeutic success. In other words, adequate apposition of the lateral wall of a cerebral aneurysm is critical for preventing recurrence or re-rupture risk.
OBJECTIVE: This study aimed to investigate the pressure values applied by different WEB devices to the lateral walls of aneurysms and the relationships between these pressure measurements and the diameters of WEB devices.
METHODS: By placing four WEB devices of different sizes and types between two rigid metal plates, the lateral forces applied by these WEB devices to plates of different apertures were measured quantitatively. We tested a single device of each size over multiple periods. The total number of examined WEB devices is four.
RESULTS: There was a significant negative relationship between plate distances and pressure values (correlation coefficient:-0.956, p = 0.000). The lateral wall apposition pressure of a 4- or 5-mm aperture size was higher than a 6-mm aperture size for SL-type WEB devices with a 7-mm diameter. Similarly, the lateral wall apposition pressure detected for a 3- or 3.5-mm aperture size was higher than a 4-mm aperture size for W5-4.5-3 and W5-5-3.6. It was observed that maximum lateral wall pressure was detected in plate measurements of SLS-type devices compared to SL-type devices. The diameter and height values of 3 of the 4 unconstrained WEB devices analyzed differed from the catalog values.
CONCLUSIONS: It seems that SLS-type devices apply more pressure on the aneurysm\'s lateral borders than SL-type devices.

To understand force generation under a wide range of loads, the stepping of single kinesin molecules was measured at loads from -20 to 42 pN by optical tweezers with high temporal resolution. The optical trap has been improved to halve positional noise and increase bandwidth by using 200-nm beads. The step size of the forward and backward steps was 8.2 nm even over a wide range of loads. Histograms of the dwell times of backward steps and detachment fit well to two independent exponential equations with fast (~0.4 ms) and slow (>3 ms) time constants, indicating the existence of a fast step in addition to the conventional slow step. The dwell times of the fast steps were almost independent of the load and ATP concentration, while those of the slow backward steps and detachment depended on those. We constructed the kinetic model to explain the fast and slow steps under a wide range of loads.

Fruits and vegetables are essential horticultural crops for humans. The quality of fruits and vegetables is critical in determining their nutritional value and edibility, which are decisive to their commercial value. Besides, it is also important to understand the changes in key substances involved in the preservation and processing of fruits and vegetables. Atomic force microscopy (AFM), a powerful technique for investigating biological surfaces, has been widely used to characterize the quality of fruits and vegetables and the substances involved in their preservation and processing from the perspective of nanoscale structure and mechanics. This review summarizes the applications of AFM to investigate the texture, appearance, and nutrients of fruits and vegetables based on structural imaging and force measurements. Additionally, the review highlights the application of AFM in characterizing the morphological and mechanical properties of nanomaterials involved in preserving and processing fruits and vegetables, including films and coatings for preservation, bioactive compounds for processing purposes, nanofiltration membrane for concentration, and nanoencapsulation for delivery of bioactive compounds. Furthermore, the strengths and weaknesses of AFM for characterizing the quality of fruits and vegetables and the substances involved in their preservation and processing are examined, followed by a discussion on the prospects of AFM in this field.

Spinal manipulative therapy (SMT) is commonly used to treat musculoskeletal conditions, including thoracic spine pain. Applying patient-specific force-time characteristics are believed to be important to improve SMT\'s effectiveness. Investigating SMT as part of a multimodal approach is fundamental to account for the complexity of chiropractic clinical practice. Therefore, pragmatic investigations balancing minimal disruptions to the clinical encounter at the same time as ensuring a robust data quality with rigorous protocols are needed. Consequently, preliminary studies are required to assess the study protocol, quality of data recorded and the sustainability of such investigation. Therefore, this study examined the feasibility of investigating SMT force-time characteristics and clinical outcome measures in a clinical setting.
In this mixed-methods study, providers recorded thoracic SMT force-time characteristics delivered to patients with thoracic spinal pain during regular clinical encounters. Self-reported clinical outcomes of pain, stiffness, comfort during the SMT (using an electronic visual analogue scale), and global rating of change scale were measured before and after each SMT application. Feasibility was quantitatively assessed for participant recruitment, data collection and data quality. Qualitative data assessed participants\' perceptions on the impact of data collection on patient management and clinical flow.
Twelve providers (58% female, 27.3 ± 5.0 years old) and twelve patients (58% female, 37.2 ± 14.0 years old) participated in the study. Enrolment rate was greater than 40%, data collection rate was 49% and erroneous data was less than 5%. Participant acceptance was good with both providers and patients reporting positive experience with the study.
Recording SMT force-time characteristics and self-reported clinical outcome measures during a clinical encounter may be feasible with specific modification to the current protocol. The study protocol did not negatively impact patient management. Specific strategies to optimize the data collection protocol for the development of a large clinical database are being developed.

Medical ultrasound is of increasing importance in medical diagnosis and intraoperative assistance and possesses great potential advantages when integrated with robotics. However, some concerns, including the operation efficiency, operation safety, image quality, and comfort of patients, remain after introducing robotics into medical ultrasound. In this paper, an ultrasound robot integrating a force control mechanism, force/torque measurement mechanism, and online adjustment method, is proposed to overcome the current limitations. The ultrasound robot can measure operating forces and torques, provide adjustable constant operating forces, eliminate great operating forces introduced by accidental operations, and achieve various scanning depths based on clinical requirements. The proposed ultrasound robot would potentially facilitate sonographers to find the targets quickly, improve operation safety and efficiency, and decrease patients\' discomfort. Simulations and experiments were carried out to evaluate the performance of the ultrasound robot. Experimental results show that the proposed ultrasound robot is able to detect operating force in the z-direction and torques around the x- and y- directions with errors of 3.53% F.S., 6.68% F.S., and 6.11% F.S., respectively, maintain the constant operating force with errors of less than 0.57N, and achieve various scanning depths for target searching and imaging. This proposed ultrasound robot has good performance and would potentially be used in medical ultrasound.