Remote-controlled ambidextrous robot hand actuated by pneumatic muscles: from feasibility study to design and control algorithms

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University LondonThis thesis relates to the development of the Ambidextrous Robot Hand engineered in Brunel University. Assigned to a robotic hand, the ambidextrous feature means that two different behaviours are accessible from a single robot hand, because of its fingers architecture which permits them to bend in both ways. On one hand, the robotic device can therefore behave as a right hand whereas, on another hand, it can behave as a left hand. The main contribution of this project is its ambidextrous feature, totally unique in robotics area. Moreover, the Ambidextrous Robot Hand is actuated by pneumatic artificial muscles (PAMs), which are not commonly used to drive robot hands. The type of the actuators consequently adds more originality to the project. The primary challenge is to reach an ambidextrous behaviour using PAMs designed to actuate non-ambidextrous robot hands. Thus, a feasibility study is carried out for this purpose. Investigating a number of mechanical possibilities, an ambidextrous design is reached with features almost identical for its right and left sides. A testbench is thereafter designed to investigate this possibility even further to design ambidextrous fingers using 3D printing and an asymmetrical tendons routing engineered to reduce the number of actuators. The Ambidextrous Robot Hand is connected to a remote control interface accessible from its website, which provides video streaming as feedback, to be eventually used as an online rehabilitation device. The secondary main challenge is to implement control algorithms on a robot hand with a range twice larger than others, with an asymmetrical tendons routing and actuated by nonlinear actuators. A number of control algorithms are therefore investigated to interact with the angular displacement of the fingers and the grasping abilities of the hand. Several solutions are found out, notably the implementations of a phasing plane switch control and a sliding-mode control, both specific to the architecture of the Ambidextrous Robot Hand. The implementation of these two algorithms on a robotic hand actuated by PAMs is almost as innovative as the ambidextrous design of the mechanical structure itself

Relationship of Serum Trimethylamine N-Oxide Levels With Carotid Intima-Media Thickness and Disease Activity in Psoriasis Patients

Introduction:  Psoriasis is an inflammatory disease that can cause cardiovascular comorbidities. Some recent studies have indicated that impaired gut microbiota and metabolites may be associated with inflammatory diseases. Objectives: In this study, the relationship between serum trimethylamine n-oxide (TMAO, a gut bacterial metabolite) level and carotid intima-media thickness (CIMT) and disease severity in psoriasis patients was investigated. Methods: Age- and gender-matched 73 patients and 72 healthy controls were included in the study. In both groups serum trimethylamine n-oxide(TMAO), oxidized low- density lipoprotein (ox-LDL), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglyceride, total cholesterol, high-sensitivity C-reactive protein (hs-CRP), creatinine, aspartate aminotransferase (AST) and alanine aminotransferase(ALT) levels were recorded and the carotid intima-media thickness (CIMT) was measured by B-mode ultrasonography by a cardiologist.   Results: TMAO, hs-CRP, oxidized-LDL, triglyceride and CIMT levels were statistically higher in the patient group. HDL levels were statistically higher in the control group. There was no significant difference between the two groups in terms of total cholesterol and LDL-C levels. In partial correlation analyzes in the patient group, positive correlations were observed between TMAO and CIMT, LDL-C and total cholesterol levels. Linear regression analysis showed that TMAO levels positively predicted CIMT levels. Conclusions: This study confirmed that psoriasis is a risk factor for the development of cardiovascular disease and that elevated serum TMAO levels in these patients indicate the presence of intestinal dysbiosis. Furthermore, TMAO levels were found to be a predictor of the risk of developing cardiovascular disease in psoriasis patients

Yeni başlangıçlı Tip 1 Diyabet ile Akut Hepatit B Muhtemel İlişkisi: Olgu Sunumu

Tip 1 diyabet gelişiminde esas faktör pankreasın beta hücrelerinin genetik ve çevresel nedenlerle tahribatıdır. Virüslerin tip 1 diyabetin tetiklenmesinde rol oynadığı bilinmektedir. Hepatit B virusu otoimmünite ile ilişkilidir. Bu yazıda Hepatit B virusünün tetiklediği tip 1 diyabet'li bir vaka sunulmuştur.Type 1 diabetes (T1D) results from the destruction of pancreatic beta cells, and genetic and environmental factors are believed to be the major components in the development of the disease. Viruses have long been suspected to contribute to the onset of T1D. Hepatitis B (HBV) is associated with the development of autoimmunity. We describe a case of type 1 diabetes that was triggered by HBV

with the Findings of Puberty to the Pediatric Endocrinology Clinic The Etiologic Distribution and Clinical Features of Cases Presenting

Amaç: Çalışmamızda ergenlik bulgularının başlaması şikayeti ile başvuran kız hastaların etiyolojik nedenlere göre değerlendirilmesi ve bulguların literatür eşliğinde tartışılması amaçlanmıştır.Gereç ve Yöntemler: Çocuk Endokrinolojisi polikliniğine başvuran 96 kız hasta çalışmaya dahil edildi. Hastaların antropometrik ölçümleri, puberte durumları değerlendirildi. Erken puberte şüphesi olan hastaların değerlendirilmesinde Folikül stimüle edici hormon (FSH), Lüteinize edici hormon (LH), estradiol (E2), dehidroepiandrosteron sülfat (DHEA-SO4), 17 hidroksiprogesteron (17OHP) değerleri, luteinize edici hormon releasing hormon (LHRH) uyarı testi sonuçları kullanıldı. Yapılan kemik yaşı değerlendirilmesi, pelvik ultrasonografi sonuçları kaydedildi.Bulgular: Hastaların yaş ortalaması 8.38 1.72 yıldı. Hastaların % 14.6'sında (n14) prematüre telarş,% 4.2'sinde (n4) prematüre pubarş, %3.1'inde (n3) prematüre menarş, %8.3'ünde (n8) erken puberte tespit edildi. Normalin varyantı pubertal gelişim hastaların %21.9'unu (n21) oluşturmaktaydı. Başvuran olguların %46.9'u (n45) normal pubertal gelişime,% 22.9'u (n22) sekiz yaşın üzerinde pubertal gelişimde hızlanmaya sahipti. %21.9 (n21) hastada pubertal gelişim atipik başlangıçlıydı.Sonuç: Günümüzde puberte bulgularının başlama yaşının düşmesiyle endokrinoloji kliniklerine başvuru artmıştır. Başvuruların çoğunu ise normal puberte varyantları oluşturmaktadır. Bu çalışma ile hastaların tanı aşamasında iyi değerlendirilmesini vurgulamak istedik.Objective: In our study we aimed to evaluate the findings of female patients presenting with a complaint of the onset of puberty according to the etiological factors and to discuss the findings in the literature.Material and Methods: Ninety-six girls presenting to the pediatric endocrinology clinic patients were enrolled in the study. Anthropometric measuremNecmettin Erbakan Üniversitesi, Meram Tıp Fakültesi, çocuk Sağlığı ve Hastalıkları Anabilim Dalı, Konya, Türkiyeents and pubertal status of the patients were evaluated. In the evaluation of patients with suspected early puberty, follicle stimulating hormone (FSH), Luteinising Hormone (LH), estradiol (E2), dehydroxyepiandrostenedione sulfate (DHEA-SO4), 17-hydroxyprogesterone (17OHP) levels, and luteinizing hormone releasing hormone (LHRH) stimulation test results were used. The bone age and pelvic ultrasound results were recorded.Results: The mean age of the patients was 8.38 ± 1.72 years. We found premature thelarche in 14.6% of the patients (n 14), premature pubarche in 4.2% (n 4), premature menarche in 3.1% (n 3), and precocious puberty in 8.3% (n 8) while 21.9% (n 21) were normal variants of pubertal development. 46.9% of admitted patients (n 45) had normal pubertal development, 22.9% (n 22) had an acceleration in pubertal development over eight years. 21.9% (n 21) of patients had atypic pubertal development.Conclusion: The decrease in the age of the onset of puberty has increased applications to the endocrine clinic. Most of the applications are normal variants of puberty. We wanted to highlight the good diagnostic evaluation of these patients in this study

Familial Testotoxicosis: A Case Report

Ailevi Testotoksikoz LH reseptöründe aktive edici mutasyon nedeniyle testislerin otoaktivasyon kazanması sonucu or- taya çıkan gonodotropin bağımlı olmayan yalancı erken puberte nedenidir. 2 yaş 3 aylık erkek hasta, kliniğimize genital bölgede kıllanma şikayetiyle başvurdu. Babada ve babanın erkek kuzenlerinde erken puberte öyküsü mevcuttu. Cilt ve sistem muayeneleri normal olan hastanın testis hacimleri bilateral 4 ml, gerilmiş penis boyu 4.5 cm, pubik kıllanması Tan- ner evre 2di. Testosteron seviyeleri pubertal düzeyde olmasına rağmen bazal ve uyarılmış LH seviyeleri prepubertaldi. Hasta aile öyküsü ile birlikte değerlendirildiğinde klinik ve biyokimyasal olarak ailevi testotoksikoz tanısı aldı. Olgu nadir görülmesi nedeni ile sunuldu.Testotoxicosis arises from testicular autoactivation due to LH receptor activating mutations and is a cause of false gonadotropin-independent precocious puberty. A male child aged 2 years and 3 months was admitted to our clinic with pubic hair in the genital area. He had a family history of precocious puberty in the father and the fathers male cousins. On physical examination skin and systemic findings were normal, bilateral testis volume was 4 ml, stretched penile length was 4.5 cm, and pubic hair was Tanner stage 2. Although the testosterone levels were pubertal, baseline and stimulated LH levels were prepubertal.The patient was diagnosed with testotoxicosis with the family history, and clinical and biochemical evaluation.The case was presented because of its rarity

Long Term Monitoring of Patients with Type 1 Diabetes Mellitus: A Single Center Experience

Amaç: Tip 1 diyabetes mellitus (DM) çocukluk yaş grubunda sık görülen, pankreasın beta hücrelerinin tahrip olması sonucu gelişen insülopeni ve hiperglisemi ile karakterize kronik metabolik bir hastalıktır. Çalışmada, Tip 1 DMli hastaların klinik ve laboratuvar bulgularının değerlendirilmesi ve bulguların literatür eşliğinde tartışılması amaçlanmıştır. Gereç ve Yöntemler: Bu çalışma 2010-2013 Ocak tarihleri arasında Pediatrik Endokrinoloji Kliniğinde takip edilen, Tip 1 DMli 162 hastanın değerlendirildiği tanımlayıcı kesitsel bir araştırmadır. Bulgular: Çalışmamıza 162 hasta dahil edildi (Yaş ortalaması 12.3 4.2 yıl). Olguların ortalama diyabet süresi 3.92.3 yıl, son 1 yıldaki ortalama Hba1c değerleri%9.74 2.5di. Tip 1 DMye ek olarak olguların % 6.7sinde (n11) çölyak hasta- lığı , %18.52inde (n30) de otoimmüntiroid hastalığı mevcuttu. Olguların %9.2sinde (n15) hipertansiyon, %7. 4ünde (n12) dislipidemi saptandı. Mikrovasküler komplikasyon olarak % 6.1inde (n10) 24 saatlik idrarda mikroalbüminüri, %15.4ünde (n25) EMGde sinir ileti hızında yavaşlama tespit edildi. Sonuç: Tip 1 DMli hastaların izleminde eşlik edebilecek otoimmün hastaların tespiti ve diyabete bağlı gelişebilecek komplikasyonların erken dönemde saptanması ve koruyucu önlemlerin alınması hastaların hayat kalitesinin arttırılması açısından önemlidir.Objective: Type 1 diabetes mellitus (DM) is a chronic metabolic disease of childhood characterized by insulin insufficiency and hyperglycemia due to the destruction of the beta cells of the pancreas. The aim of this study was to determine the laboratory and clinical characteristics of patients with type 1 diabetes mellitus and to compare the findings with the literature. Material and Methods: This is a descriptive study of 162 patients with type 1 diabetes mellitus followed by the Pediatric Endocrinology department between January 2010 and 2013. results: A total of 162 patients were included in this study (mean age, 12. 3 ±4. 2 years). The mean duration of diabetes was 3.89 ± 2.3 years and mean HbA1c was 2.5 ± 9.74%. In addition to Type 1 DM, 6.7% of cases (n 11) had celiac disease and 18.52% of the cases (n 30) had autoimmune thyroid disease. Hypertension was present in 9.2% of the cases (n 15) while 7.4% (n 12) had dyslipidemia. We found had 24-hour urine microalbuminuria in 6.1% of the cases (n 10) and decreased EMG nerve conduction velocity in 15.4% of the cases (n 25). conclusion: It is important to detect any concurrent autoimmune disorders and diabetes-related potential complications in the early stages and to take preventive measures to increase the quality of life during follow-up of patients with Type 1 DM

Parvovirus Infection in a Child Complicated with Diabetic Ketoacidosis and Acute Fulminant Hepatitis: A Case Report

Tip 1 diabetes mellitus (T1DM) pankreatik beta hücrelerinin harabiye- tiyle ortaya çıkmaktadır. Genetik ve çevresel faktörlerin hastalığın geli- şimindeki ana faktörler olduğu düşünülmektedir. Virüslerin hastalığın başlangıcında etkili olduğu düşünülmektedir. Bu olguda asemptomatik parvovirus B19 (PB19) enfeksiyonunu takiben ortaya çıkan diyabetik ke- toasidoz ve akut fulminan hepatit birlikteliğinin olduğu bir olgu sunul- muştur. Diyabetik ketoasidozda karaciğer enzimlerinin de yakın izlen- mesini ve kötüleşme olduğunda dikkat edilmesini önermekteyiz.Type 1 diabetes mellitus (T1DM) results from the destruction of pan- creatic beta cells. Genetic and environmental factors are believed to be the major component for the development of the disease. Viruses have been suspected to contribute to the onset of T1DM. In this case report, a patient who had diabetic ketoacidosis with acute fulminant hepatitis following asymptomatic infection with parvovirus B19 virus (PB19) is presented. To our knowledge this is the first report of diabetic ketoaci- dosis (DKA) and acute fulminant hepatitis due to PB19. We suggest close monitoring of the liver functions in DKA and taking care when the liver functions deteriorate

Evaluation of Periaortic Adiposity and Metabolic Disorders in Obese Children

Objective: To evaluate the relationship between periaortic fat thickness (PAFT) and parameters involved in the development of metabolic complications of the cardiovascular system in obese children and to assess the usefulness of echocardiographic measurements of PAFT in correlation with cardiovascular risk factors.Methods: The study was conducted with 263 obese and 100 healthy children and adolescents. PAFT was measured with echocardiography method which was recently performed in obese children and adolescents.Results: PAFT was significantly higher in the obese group (0.258±0.031 mm) than in the control group (0.137±0.032 mm) (p>0.001). In multivariable regression analysis, body mass index-standard deviation score and total body fat were predictors of PAFT. The area under the receiver operating characteristic curve was 0.989 and was quite significant at p>0.001. PAFT above 0.179 mm was determined as the cut-off value in obese children and adolescents (sensitivity1, specificity0.97). Conclusion: The measurement of PAFT in obese children and adolescents may be a good method to reveal the presence of early cardiovascular risk

Ambulatory Blood Pressure and Subclinical Cardiovascular Disease in Patients with Congenital Adrenal Hyperplasia: A Preliminary Report

Objective: There is an increased risk of cardiovascular morbidity in children and adolescents with classical congenital adrenal hyperplasia (CAH), presumably associated with obesity, hypertension, impaired glucose tolerance and dyslipidemia. This study was designed to evaluate the metabolic and cardiovascular profile of a group of children with classical CAH from the perspective of cardiovascular risk.Methods: Twenty-five CAH patients and 25 healthy controls were included in the study. Metabolic and anthropometric parameters were investigated and compared in these two groups. Results: Subjects in the CAH group were shorter than the controls (p0.001) and had higher body mass index values (p0.033). Diastolic blood pressure (DBP) (p0.027) and carotid intima-media thickness (CIMT) values (p0.006) were also higher in the patient group. In 24% (n6) of CAH patients, 24-h ambulatory BP monitoring showed arterial hypertension. CIMT was significantly higher in the hypertensive patients than in those with no hypertension (p0.013). Twenty percent (n5) of CAH patients had nocturnal hypertension. CIMT was significantly greater in the nocturnal hypertensive group (p0.02). Mean systolic BP (SBP) and DBP dipping were significantly different in the CAH patients (p>0.001). CIMT correlated negatively with DBP dipping (r-0632, p0.037) in these patients.Conclusion: These results provide additional evidence for the presence of subclinical cardiovascular disease in classical CAH patients and its relationship with hypertensio

Assessment of Cardiovascular Parameters in Obese Children and Adolescents with Non-Alcoholic Fatty Liver Disease

Objective: The aim of this study was to evaluate the periaortic fat thickness (PAFT) using conventional echocardiography in obese children and adolescents with non-alcoholic fatty liver disease (NAFLD).Methods: Two hundred and ninety-seven obese children and adolescents were included in the study. Anthropometric measurements were made in all subjects, and fasting venous blood samples were taken for determination of glucose, insulin, total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. Ultrasonography of the liver was used for assessment of NAFLD and the subjects were grouped as NAFLD and non-NAFLD. Echocardiography was performed in all subjects.Results: PAFT was higher in patients with NAFLD compared with the nonNAFLD group. In patients with NAFLD, PAFT was positively correlated with waist circumference and with total cholesterol levels. In multiple regression analysis, waist circumference (?0.28, p>0.001) was found to be the best predictor of PAFT.Conclusion: Conventional echocardiography may be used to determine increased PAFT at an early stage in obese children and adolescents with NAFLD for careful monitoring of cardiovascular ris