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In this study, we prepared 4 assistive devices (A-D) for Miriopen ® to improve the "ease of holding" and "ease of pushing" and compared their usability with that of a device provided by the pharmaceutical company (S). Fifty-five healthy volunteers in their 20s performed the self-injection maneuver using all 5 assistive devices and ranked them regarding 3 items, i.e., the "ease of holding", "ease of pushing", and "overall ease of administration". In all evaluation items, C was ranked first by the largest number of subjects, and the ranking by the subjects was shown by Kendall's coefficient of concordance to be consistent. In addition, comparison of the distance scale calculated from the ordinal scale showed significantly higher ranks of C and D compared with A, B, and S in all evaluation items. No significant difference was noted between C and D. Since C and D had shapes with concavities and convexities that fit the index, middle, and ring fingers (2nd-4th fingers), the fingers are considered to be better stabilized during the injection maneuver with consequent high ratings. Moreover, the 4 assistive devices prepared in this study were rated to be equal to or higher than S.

Background: Injection force requirements for four insulin pen-type injection devices were evaluated using the AGS-IkNG Autograph force measurement device (Shimadzu Corp., Kyoto, Japan)., Results: Compared with the Humulin Pen (the Japanese brand name is Humacart kit; the same device as the Humalog Pen; Eli Lilly, Indianapolis, IN), HumaPen Ergo (Eli Lilly), and NovoPen 3 (Novo Nordisk A/S, Bagsvaerd, Denmark), the InnoLet(Novo Nordisk) required the lowest injection force to both initiate piston movement and commence insulin delivery and required the lowest overall force throughout delivery. InnoLet and NovoPen 3 showed the most even load-displacement curves, suggesting a smoother delivery of insulin during injection. In contrast, the Humulin Pen and HumaPen Ergo demonstrated marked fluctuations in the force required to complete injection., Conclusions: These performance characteristics appeared consistent with mechanical features of these insulin delivery devices, and the results highlight the potential importance of careful pen selection for patients with neuromuscular weakness or impaired manual coordination.

Twenty-three of 86 strains of lactic acid bacteria transformed linoleic acid into hydroxy FA. Two distinct conversion pathways were in operation. Two strains of Lactobacillus acidophilus and a strain of Pediococcus pentosaceus produced 13(S)-hydroxy-9-octadecenoic acid 113(S)-OH 18:11 and 10,13dihydroxyoctadecanoic acid (10,13-OH 18:0) as main and minor products, respectively, whereas 13 strains, including L. casei subsp. casei, L. paracasei subsp. paracasei, L. rhamnosus, L. lactis subsp. cremoris, and Streptococcus salivarius subsp. thermophilus produced 10-hydroxy-12-octadecenoic acid (10-OH 18:1). Seven strains of L. plantarum converted linoleic acid to 10-hydroxyoctadecanoic acid (10-OH 18:0) through 10-OH 18:1. Linoleic acid at 2 g/L was converted by L. acidophilus IFO13951T to 1.3 g of 13(S)-OH 18:1 and 0.09 g of 10,13-OH 18:0 in 7 d. Lactobacillus paracasei subsp. paracasei JCM 1111 produced 10-OH 18:1 in 91% yield, and L. plantarum JCM 8341, 10-OH 18:0 in 59% yield from linoleic acid (2 g/L) under optimal conditions. To our knowledge, this is the first report on the production of 13(S)-OH 18:1 by lactic acid bacteria other than ruminal bacteria, and of 10,13-OH 18:0 by any bacteria.

Dissolution of cholesterol gallstones by direct instillation of an agent into the biliary tract has been considered an alternate to surgical procedures. We developed an excellent direct solubilizer by combining d-limonene and medium-chain monoglyceride. This mixture enhances the advantages of each individual solvent and minimizes the disadvantages. In vitro experiments were done to determine the viscosities and the cholesterol dissolving rates of various combinations, and in vivo experiments were conducted to study their irritation effects on tissues. The optimal combination was a 3:2 mixture of d-limonene and medium-chain monoglyceride. It could quickly dissolve cholesterol gallstones with minimal or no observable side effect.

Retained gallstones in the bile ducts account for 60-70% of all the cases of postcholecystectomy syndromes. A solvent d-limonene preparation was injected directly to the biliary system of 200 patients to dissolve or disintegrate the retained gallstones. The outcomes were: retained stones completely disappeared in 96 cases (48%); partial dissolution in 29 (14.5%); chelating agent was also used with partial dissolution in 16 (8%); ineffective in 59 (24.5%). To make this method more effective, several guidelines should be observed including an in vitro trial dissolution test. Cautious observation for possible side effects and frequent hepatic and pancreatic function tests during the treatment with this preparation also should be performed.