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Removing the bone flap is a compulsory step in open skull surgeries and is very cumbersome and time-consuming. Exerting large forces during the milling and cutting of the skull renders the surgeon exhausted and consequently increases probable errors in further task of manipulating the sensitive brain tissue. This paper aims to present the development of a robotic system capable of perforating and cutting the required bone flap without restraining the surgeon.

For the purpose of optimization, the target workspace is estimated by 3D modeling of the sample skull and bone flaps of targeted surgeries. The optimization considers kinematic performance matrices and the extracted workspace requirements by assigning scores to each possible design and finally selects the design with highest score.

The design utilizes a parallel remote center of motion mechanism. Coordinating the remote center of motion (RCM) of the mechanism with the center of a sphere which circumscribes the skull, the milling tool is always nearly perpendicular to the skull bone. The paper presents the concept design, optimization criteria and finally the optimal design of the robot and the fabricated prototype. Tests indicate that the prototype is able to sweep the target workspace and to exert the required forces for bone milling.

The workspace requirements of the craniotomy/craniectomy surgeries are investigated and converted into one quantitative target workspace. An optimized design for a surgical robot is developed which satisfies the workspace requirements of the targeted surgeries.

Diabetes is one of the most prevailed chronic diseases in the world. Pro-inflammatory cytokines play a key role in the type 2 diabetes mellitus. Pomegranate seed oil (PSO) has potential anti-inflammatory properties. The purpose of this study is to evaluate the antidiabetic effects of the use of PSO on the expression of peroxisome proliferator-activated receptor-gamma (PPAR-γ), pro-inflammatory biomarkers and lipid profile levels in obese type 2 diabetic patients.

In total, 52 patients were randomly assigned to the PSO (n = 26) and placebo (n = 26) groups. Subjects received daily PSO 3 g placebo (paraffin) in 1 g soft-gel capsules (along with breakfast, lunch and dinner meals) for eight weeks.

Serum levels of fasting blood sugar (FBS) decreased from 161.46 ± 34.44 to 143.50 ± 24.2 mg/dL (p = 0.008), IL-6 decreased from 5.17 ± 2.25 to 4.52 ± 1.90 (p = 0.049) and tumor necrosis factor alpha (TNF-α) significantly decreased from 9.17 ± 4.13 to 7.74 ± 2.44 pmol/mL in PSO group (p = 0.030). However, changes in the expression of PPAR-γ gene, serum levels of hs-CRP and lipid profile levels were not significant.

Lack of PSO concentration measurements and the short duration of the study were the key limitations. Future randomized clinical trials with a longer period of follow-up are needed to assess the potential anti-diabetic effects of PSO.

Administration of PSO in obese type 2 diabetic patients reduced the levels of FBS, interleukin 6 and TNF-α; nevertheless, changes in the insulin, lipid profiles and hs-CRP were not significant.