A quantitative comparison between the mHand Adapt passive adjustable hand prosthesis and its predecessor, the Delft Self-Grasping Hand

INTRODUCTION

The Delft Self-Grasping Hand (SGH) is an adjustable passive hand prosthesis that relies on wrist flexion to adjust the aperture of its grasp. The mechanism requires engagement of the contralateral hand meaning that hand is not available for other tasks. A commercialised version of this prosthesis, known as the mHand Adapt, includes a new release mechanism, which avoids the need to press a release button, and changes to the hand shape. This study is the first of its kind to compare two passive adjustable hand prostheses on the basis of quantitative scoring and contralateral hand involvement.

METHODS

10 anatomically intact participants were asked to perform the Southampton Hand Assessment Procedure (SHAP) with the mHand. Functionality and contralateral hand involvement were recorded and compared against SGH data originating from a previous trial involving a nearly identical testing regime.

RESULTS

mHand exhibited higher functionality scores and less contralateral hand interaction time, especially during release-aiding interactions. Additionally, a wider range of tasks could be completed using the mHand than the SGH.

DISCUSSION

Geometric changes make the mHand more capable of manipulating smaller objects. The altered locking mechanism means some tasks can be performed without any contralateral hand involvement and a higher number of tasks do not require contralateral involvement when releasing. Some participants struggled with achieving a good initial grip due to the inability to tighten the grasp once already formed.

CONCLUSION

The mHand offers the user higher functionality scores with less contralateral hand interaction time and the ability to perform a wider range of tasks. However, there are some design trade-offs which may make it slightly harder to learn to use.

3D-printing allows for fluid-controlled linear actuators with unconventional shapes

Background

Pneumatic actuators are widely used in applications like (medical) robots, or prostheses. Pneumatic actuators require a complex manufacturing process and are produced in standardized dimensions to reduce costs. Over the last decade 3D-printing has emerged as a cost-effective and efficient production method in medical applications. 3D-printing can also function as a cost-efficient alternative production method for pneumatic actuators.

Objective

The goal of this research is to study the possibility of creating a pneumatic linear actuator with 3D-printing. Furthermore, the aim is to use the advantage of 3D-printing to create pneumatic actuators with non-circular cross-sections.

Methodology

To evaluate the performance of a 3D-printed pneumatic actuator, a test setup was designed and built to measure the leakage and sliding friction force. Furthermore, two pneumatic actuators with a non-conventional cross-sectional shape were designed and their performance was tested and compared with a 3D-printed cylindrical pneumatic actuator, since these tests only ran once, the results are more a guideline. During the manufacturing of the cylinders, no post-processing techniques were used.

Results

The functioning of a 3D-printed circular pneumatic actuator was proven with low static leakage rates of 2.5%, low dynamic leakage rates of approximately 1%, and a maximum friction force of Image 1. Furthermore, the results show that it is possible to print functioning pneumatic cylinders with a non-cylindrical concave cross-section. The non-conventional cylinders were tested up to Image 2 with maximum dynamic leakage of Image 3.

Conclusion

This study demonstrates a method to create functional pneumatic linear actuators with 3D-printing. It was possible to create 3D-printed actuators with a conventional shape, e.g. circular and unconventional shapes e.g. stadium/oval shape and a kidney shape. The leak rates for conventional and unconventional shapes were in the same range. This opens up the world for more design freedom in pneumatic actuators.

Design and evaluation of the pneumatic leg prosthesis ERiK to assist elderly amputees with sit-down and stand-up movements

Standing up using one leg is a challenging task for those with a transfemoral amputation, particularly for elderly users with a low activity level. Active prostheses are generally not accessible to this group and available passive prostheses do not support standing up. This article presents the design and evaluation of the "Energy Restoring Intelligent Knee" (ERiK), which stores energy during sit-down in a pneumatic cylinder and returns it during stand-up. We hypothesized that the system would reduce the time needed to perform transitions and also enable higher load sharing by the prosthetic leg. However, the results of an experimental study with seven participants with transfemoral amputation contradict these hypotheses: the participants could neither move faster nor make more use of the prosthetic leg to share their body weight during transitions. We observed that a major obstacle to the useful functionality of the leg was the absence of ankle dorsiflexion - the foot tended to slip during stand-up initiation, such that only low pre-pressures and therefore support levels could be set. The rather binary action of the pneumatics also complicated movement initiation. The lessons learned from this study may be helpful to those seeking to create better designs in the future.

State of the art of prosthesis simulators for the upper limb: A narrative review

BACKGROUND

Research into prosthesis training and design puts a burden on the small population of people with upper-limb absence who can participate in these studies. One solution is to use a prosthetic hand simulator, which allows for attaching a hand prosthesis to an intact limb. However, whether the results of prosthesis simulator studies can be translated to people with upper-limb absence using a hand prosthesis is unclear.

OBJECTIVE

To review the literature on prosthetic hand simulators, provide an overview of current designs, and highlight the differences and similarities between prosthesis simulators and traditional prostheses.

METHODS

A Boolean combination of keywords was used to search 3 electronic databases: PubMed, Scopus and Web of Science. Relevant articles in English were selected.

RESULTS

In total, 52 papers were included in the review, and an overview of the state of the art was presented. We identified the key differences between prosthesis simulators and traditional prostheses as the position of the terminal device and the available degrees of freedom of the arm and (prosthetic) wrist.

CONCLUSIONS

This paper provides an overview of prosthesis simulator designs over the past 27 years and an overview of the similarities and differences between prosthesis simulators and prostheses. The literature does not provide enough evidence to establish whether the results obtained from simulator studies could be translated to prostheses. A recommendation for future simulator design is to constrain pro- and supination of the forearm of anatomically intact participants and add a prosthetic wrist that can pro- and supinate. Additional research is required to find the ideal terminal device position for a prosthesis simulator with respect to the person's hand.

Stabilizing interventional instruments in the cardiovascular system: A classification of mechanisms

Positioning and stabilizing a catheter at the required location inside a vessel or the heart is a complicated task in interventional cardiology. In this review we provide a structured classification of catheter stabilization mechanisms to systematically assess their challenges during cardiac interventions. Commercially available, patented, and experimental prototypes of catheters were classified with respect to their stabilizing mechanisms. Subsequently, the classification was used to define requirements for future cardiac catheters and persisting challenges in catheter stabilization. The classification showed that there are two main stabilization mechanisms: surface-based and volume-based. Surface-based mechanisms apply attachment through surface anchoring, while volume-based mechanisms make use of locking through shape or force against the vessel or cardiac wall. The classification provides insight into existing catheter stabilization mechanisms and can possibly be used as a tool for future design of catheter stabilization mechanisms to keep the catheter at a specific location during an intervention. Additionally, insight into the requirements and challenges for catheter stabilization inside the heart and vasculature can lead to the development of more dedicated systems in the future, allowing for intervention- and patient-specific instrument manipulation.

Mechanical evaluation of the "Hüfner hand" prosthesis

BACKGROUND

Current body-powered hands have very low acceptance rates. They also require high activation forces. In the past, a high acceptance rate was reported for the then-available Hüfner hand, a hand which could be controlled by relatively low activation forces.

OBJECTIVE

The aim of this study was to measure and quantify the mechanical performance of the Hüfner hand.

STUDY DESIGN

Mechanical evaluation.

METHODS

Two versions of the Hüfner hand were tested using a mechanical test bench. Forces and displacements were measured under four different glove conditions (no glove, leather, polyvinyl chloride (PVC), silicone). The measured results were compared to data from currently available voluntary-closing hands.

RESULTS

The Hüfner hand required 132-170 Nmm of work and 78-104 N cable force to pinch 15 N. The overall mechanical performance of the Hüfner hands is better than currently available body-powered hands.

CONCLUSION

The mechanical performance of the Hüfner hand was measured and quantified. Mechanical testing results show that the Hüfner hand has better mechanical performance than current body-powered hands. This may have contributed to its reported high acceptance rates. The design of the Hüfner hand, combined with data presented in this study, can serve as guidelines for the design of a new generation of body-powered hands.

Remote Actuation Systems for Fully Wearable Assistive Devices: Requirements, Selection, and Optimization for Out-of-the-Lab Application of a Hand Exoskeleton

Wearable robots assist individuals with sensorimotor impairment in daily life, or support industrial workers in physically demanding tasks. In such scenarios, low mass and compact design are crucial factors for device acceptance. Remote actuation systems (RAS) have emerged as a popular approach in wearable robots to reduce perceived weight and increase usability. Different RAS have been presented in the literature to accommodate for a wide range of applications and related design requirements. The push toward use of wearable robotics in out-of-the-lab applications in clinics, home environments, or industry created a shift in requirements for RAS. In this context, high durability, ergonomics, and simple maintenance gain in importance. However, these are only rarely considered and evaluated in research publications, despite being drivers for device abandonment by end-users. In this paper, we summarize existing approaches of RAS for wearable assistive technology in a literature review and compare advantages and disadvantages, focusing on specific evaluation criteria for out-of-the-lab applications to provide guidelines for the selection of RAS. Based on the gained insights, we present the development, optimization, and evaluation of a cable-based RAS for out-of-the-lab applications in a wearable assistive soft hand exoskeleton. The presented RAS features full wearability, high durability, high efficiency, and appealing design while fulfilling ergonomic criteria such as low mass and high wearing comfort. This work aims to support the transfer of RAS for wearable robotics from controlled lab environments to out-of-the-lab applications.

Design of a 3D-printed hand prosthesis featuring articulated bio-inspired fingers

Various upper-limb prostheses have been designed for 3D printing but only a few of them are based on bio-inspired design principles and many anatomical details are not typically incorporated even though 3D printing offers advantages that facilitate the application of such design principles. We therefore aimed to apply a bio-inspired approach to the design and fabrication of articulated fingers for a new type of 3D printed hand prosthesis that is body-powered and complies with basic user requirements. We first studied the biological structure of human fingers and their movement control mechanisms in order to devise the transmission and actuation system. A number of working principles were established and various simplifications were made to fabricate the hand prosthesis using a fused deposition modelling (FDM) 3D printer with dual material extrusion. We then evaluated the mechanical performance of the prosthetic device by measuring its ability to exert pinch forces and the energy dissipated during each operational cycle. We fabricated our prototypes using three polymeric materials including PLA, TPU, and Nylon. The total weight of the prosthesis was 92 g with a total material cost of 12 US dollars. The energy dissipated during each cycle was 0.380 Nm with a pinch force of ≈16 N corresponding to an input force of 100 N. The hand is actuated by a conventional pulling cable used in BP prostheses. It is connected to a shoulder strap at one end and to the coupling of the whiffle tree mechanism at the other end. The whiffle tree mechanism distributes the force to the four tendons, which bend all fingers simultaneously when pulled. The design described in this manuscript demonstrates several bio-inspired design features and is capable of performing different grasping patterns due to the adaptive grasping provided by the articulated fingers. The pinch force obtained is superior to other fully 3D printed body-powered hand prostheses, but still below that of conventional body powered hand prostheses. We present a 3D printed bio-inspired prosthetic hand that is body-powered and includes all of the following characteristics: adaptive grasping, articulated fingers, and minimized post-printing assembly. Additionally, the low cost and low weight make this prosthetic hand a worthy option mainly in locations where state-of-the-art prosthetic workshops are absent.

Mechanical Follow-the-Leader motion of a hyper-redundant surgical instrument: Proof-of-concept prototype and first tests

One of the most prominent drivers in the development of surgical procedures is the will to reduce their invasiveness, attested by minimally invasive surgery being the gold standards in many surgical procedures and natural orifices transluminal endoscopic surgery gaining acceptance. A logical next step in this pursuit is the introduction of hyper-redundant instruments that can insert themselves along multi-curved paths referred to as Follow-the-Leader motion. In the current state of the art, two different types of Follow-the-Leader instruments can be distinguished. One type of instrument is robotized; the movements of the shaft are controlled from outside the patient by actuators, for example, electric motors, and a controller storing a virtual track of the desired path. The other type of instrument is more mechanical; the movements of the shaft are controlled from inside the patient by a physical track that guides the shaft along the desired path. While in the robotized approach all degrees of freedom of the shaft require an individual actuator, the mechanical approach makes the number of degrees of freedom independent from the number of actuators. A desirable feature as an increasing number of actuators will inevitably drive up costs and increase the footprint of an instrument. Building the physical track inside the body does, however, impede miniaturization of the shaft’s diameter. This article introduces a new fully mechanical approach for Follow-the-Leader motion using a pre-determined physical track that is placed outside the body. This new approach was validated with a prototype called MemoFlex, which supports a Ø5 mm shaft (standard size in minimally invasive surgery) that contains 28-degrees-of-freedom and utilizes a simple steel rod as its physical track. Even though the performance of the MemoFlex leaves room for improvement, especially when following multiple curves, it does validate the proposed concept for Follow-the-Leader motion in three-dimensional space.

Functional evaluation of a non-assembly 3D-printed hand prosthesis

In developing countries, the access of amputees to prosthetic devices is very limited. In a way to increase accessibility of prosthetic hands, we have recently developed a new approach for the design and 3D printing of non-assembly active hand prostheses using inexpensive 3D printers working on the basis of material extrusion technology. This article describes the design of our novel 3D-printed hand prosthesis and also shows the mechanical and functional evaluation in view of its future use in developing countries. We have fabricated a hand prosthesis using 3D printing technology and a non-assembly design approach that reaches certain level of functionality. The mechanical resistance of critical parts, the mechanical performance, and the functionality of a non-assembly 3D-printed hand prosthesis were assessed. The mechanical configuration used in the hand prosthesis is able to withstand typical actuation forces delivered by prosthetic users. Moreover, the activation forces and the energy required for a closing cycle are considerably lower as compared to other body-powered prostheses. The non-assembly design achieved a comparable level of functionality with respect to other body-powered alternatives. We consider this prosthetic hand a valuable option for people with arm defects in developing countries.

Ten guidelines for the design of non-assembly mechanisms: The case of 3D-printed prosthetic hands

In developing countries, prosthetic workshops are limited, difficult to reach, or even non-existent. Especially, fabrication of active, multi-articulated, and personalized hand prosthetic devices is often seen as a time-consuming and demanding process. An active prosthetic hand made through the fused deposition modelling technology and fully assembled right after the end of the 3D printing process will increase accessibility of prosthetic devices by reducing or bypassing the current manufacturing and post-processing steps. In this study, an approach for producing active hand prosthesis that could be fabricated fully assembled by fused deposition modelling technology is developed. By presenting a successful case of non-assembly 3D printing, this article defines a list of design considerations that should be followed in order to achieve fully functional non-assembly devices. Ten design considerations for additive manufacturing of non-assembly mechanisms have been proposed and a design case has been successfully addressed resulting in a fully functional prosthetic hand. The hand prosthesis can be 3D printed with an inexpensive fused deposition modelling machine and is capable of performing different types of grasping. The activation force required to start a pinch grasp, the energy required for closing, and the overall mass are significantly lower than body-powered commercial prosthetic hands. The results suggest that this non-assembly design may be a good alternative for amputees in developing countries.

Design of a Novel Three-Dimensional-Printed Two Degrees-of-Freedom Steerable Electrosurgical Grasper for Minimally Invasive Surgery

In current bipolar electrosurgical instruments, a high frequency electrical sinusoidal wave is passed through the patient's body from an active electrode to the return electrode to cut, coagulate, or desiccate tissues. Even though current bipolar electrosurgical instruments have proven effective in minimizing blood loss, advancement is needed to allow for improved dexterity and adaptability. With current advances in three-dimensional (3D)-print processes and its integration in the medical field, it has become possible to manufacture patient-and operation-specific instruments. In this study, we introduce the first 3D-printed steerable bipolar grasper (◻ 5 mm) for use in minimal invasive surgery. The grasper significantly improves dexterity by the addition of two planar joints allowing for ±65 deg for sideways and ±85 deg for up- and downward movement. The joints enable a significantly higher bending stiffness, 4.0 N/mm for joint 1 and 4.4 N/mm for joint 2, than that of currently available steerable instruments. The tip consists of two metallic movable jaws that can be opened and closed with angles up to 170 deg and allows for grasping and coagulating of tissues; reaching tissue temperatures of over 75 °C for an activation time of ∼5 s, respectively. In order to actuate the joint, tip, and electrosurgical system, as well as to tension the steering cables, a ring handle was designed. In summary, the 3D-printed steerable bipolar grasper provides the surgeon with electrosurgical capabilities, improved dexterity, improved stiffness, and the versatility that is needed to provide patient- and operation-specific care.

Passive prosthetic hands and tools: A literature review

BACKGROUND

The group of passive prostheses consists of prosthetic hands and prosthetic tools. These can either be static or adjustable. Limited research and development on passive prostheses has been performed although many people use these prosthesis types. Although some publications describe passive prostheses, no recent review of the peer-reviewed literature on passive prostheses is available.

OBJECTIVE

Review the peer-reviewed literature on passive prostheses for replacement of the hand.

STUDY DESIGN

Literature review.

METHODS

Four electronic databases were searched using a Boolean combination of relevant keywords. English-language articles relevant to the objective were selected.

RESULTS

In all, 38 papers were included in the review. Publications on passive prosthetic hands describe their users, usage, functionality, and problems in activities of daily living. Publications on prosthetic tools mostly focus on sport, recreation, and vehicle driving.

CONCLUSION

Passive hand prostheses receive little attention in prosthetic research and literature. Yet one out of three people with a limb deficiency uses this type of prosthesis. Literature indicates that passive prostheses can be improved on pulling and grasping functions. In the literature, ambiguous names are used for different types of passive prostheses. This causes confusion. We present a new and clear classification of passive prostheses. Clinical relevance This review provides information on the users of passive prosthetic hands and tools, their usage and the functionality. Passive prostheses receive very little attention and low appreciation in literature. Passive prosthetic hands and tools show to be useful to many unilateral amputees and should receive more attention and higher acceptance.

The Memo Slide: An explorative study into a novel mechanical follow-the-leader mechanism

Follow-the-leader propagation allows for the insertion of flexible surgical instruments along curved paths, reducing the access required for natural orifice transluminal endoscopic surgery. Currently, the most promising follow-the-leader instruments use the alternating memory method containing two mechanical memory-banks for controlling the motion of the flexible shaft, which reduces the number of actuators to a minimum. These instruments do, however, require concentric structures inside the shaft, limiting its miniaturization. The goal of this research was, therefore, to develop a mechanism conforming the principles of the alternating memory method that could be located at the controller-side instead of inside the shaft of the instrument, which is positioned outside the patient and is therefore less restricted in size. First, the three-dimensional motion of the shaft was decoupled into movement in a horizontal and vertical plane, which allowed for a relatively simple planar alternating memory mechanism design for controlling planar follow-the-leader motion. Next, the planar movement of the alternating memory mechanism was discretized, increasing its resilience to errors. The resulting alternating memory mechanism was incorporated and tested in a proof-of-concept prototype called the MemoSlide. This prototype does not include a flexible shaft, but was fully focused on proving the function of the alternating memory mechanism. Evaluation of the MemoSlide shows the mechanism to work very well, being able to transfer any planar path that lays within its physical boundaries along the body of the mechanism without accumulating errors.

A passive wrist with switchable stiffness for a body-powered hydraulically actuated hand prosthesis

State of art upper limb prostheses lack several degrees of freedom (DoF) and force the individuals to compensate for them by changing the motions of their arms and body. Such movements often yield to articulation injuries, nonetheless these could be prevented by adding DoFs, for instance, an articulated passive wrist. Available stiff or compliant wrists with passive flexion/extension and/or radial/ulnar deviation are sub-optimal solutions. Indeed, stiff wrists induce the individuals wearing them to perform exaggerated compensatory movements during the reaching phase while compliant wrists proved to be unpractical while manipulating heavy objects. Here we present a wrist capable of combining the benefits of stiff and compliant wrists. It is provided with two switchable levels of passive compliance that are automatically selected. The prototype was integrated in a body-powered hydraulic hand prosthesis and actuated using the same hydraulic circuit of the hand. Detailed analysis of the parameters that affect the compliance, the critical load and the performance of the prosthesis are presented.

Assessment of body-powered upper limb prostheses by able-bodied subjects, using the Box and Blocks Test and the Nine-Hole Peg Test

BACKGROUND

The functional performance of currently available body-powered prostheses is unknown.

OBJECTIVE

The goal of this study was to objectively assess and compare the functional performance of three commonly used body-powered upper limb terminal devices.

STUDY DESIGN

Experimental trial.

METHODS

A total of 21 able-bodied subjects (n = 21, age = 22 ± 2) tested three different terminal devices: TRS voluntary closing Hook Grip 2S, Otto Bock voluntary opening hand and Hosmer Model 5XA hook, using a prosthesis simulator. All subjects used each terminal device nine times in two functional tests: the Nine-Hole Peg Test and the Box and Blocks Test.

RESULTS

Significant differences were found between the different terminal devices and their scores on the Nine-Hole Peg Test and the Box and Blocks Test. The Hosmer hook scored best in both tests. The TRS Hook Grip 2S scored second best. The Otto Bock hand showed the lowest scores.

CONCLUSION

This study is a first step in the comparison of functional performances of body-powered prostheses. The data can be used as a reference value, to assess the performance of a terminal device or an amputee.

CLINICAL RELEVANCE

The measured scores enable the comparison of the performance of a prosthesis user and his or her terminal device relative to standard scores.

The lightweight Delft Cylinder Hand: first multi-articulating hand that meets the basic user requirements

Rejection rates of upper limb prostheses are high (23%-45%). Amputees indicate that the highest design priority should be reduction of the mass of the prosthetic device. Despite all efforts, the mass of the new prosthetic hands is 35%-73% higher than that of older hands. Furthermore, current hands are thicker than a human hand, they operate slower and do not provide proprioceptive force and position feedback. This study presents the Delft Cylinder Hand, a body powered prosthetic hand which mass is 55%-68% lower than that of the lightest current prosthetic hands, operates faster, has an anthropomorphic shape, and provides proprioceptive force and position feedback. The hand has articulating fingers, actuated by miniature hydraulic cylinders. The articulating fingers adapt to the shape of the grasped object. Its functional scores are similar to that of current prosthetic devices. The hand has a higher mechanical performance than current body-powered hands. It requires 49%-162% less energy from the user and it can deliver a higher maximum pinch force (30-60 N).

A mechanism to compensate undesired stiffness in joints of prosthetic hands

BACKGROUND

Cosmetic gloves that cover a prosthetic hand have a parasitic positive stiffness that counteracts the flexion of a finger joint.

OBJECTIVES

Reducing the required input torque to move a finger of a prosthetic hand by compensating the parasitic stiffness of the cosmetic glove.

STUDY DESIGN

Experimental, test bench.

METHODS

The parasitic positive stiffness and the required input torques of a polyvinyl chloride glove and a silicone glove were measured when flexing a metacarpophalangeal finger joint for 90°. To compensate this positive stiffness, an adjustable compensation mechanism with a negative stiffness was designed and built. A MATLAB model was created to predict the optimal settings of the mechanism, based on the measured stiffness, in order to minimize the required input torque of the total system. The mechanism was tested in its optimal setting with an applied glove.

RESULTS

The mechanism reduced the required input torque by 58% for the polyvinyl chloride glove and by 52% for the silicone glove. The total energy dissipation of the joint did not change significantly.

CONCLUSIONS

This study shows that the undesired positive stiffness in the joint can be compensated with a relatively simple negative stiffness mechanism, which fits inside a finger of a standard cosmetic glove. Clinical relevance This study presents a mechanism that compensates the undesired stiffness of cosmetic gloves on prosthetic hands. As a result, it requires less input force, torque and energy to move the fingers. Application of this mechanism in body-powered hands will reduce the control effort of the user.

Design and evaluation of two different finger concepts for body-powered prosthetic hand

The goal of this study was to find an efficient method of energy transmission for application in an anthropomorphic underactuated body-powered (BP) prosthetic hand. A pulley-cable finger and a hydraulic cylinder finger were designed and tested to compare the pulley-cable transmission principle with the hydraulic cylinder transmission principle. Both fingers had identical dimensions and a low mass. The only thing that differed between the fingers was the transmission principle. The input energy was measured for a number of tasks. The pulley-cable finger required more input energy than the hydraulic cylinder finger to perform the tasks. This was especially the case in tasks that required high pinch forces. The hydraulic cylinder transmission is therefore the more efficient transmission for application in BP prosthetic fingers.

Bioinspired Spring-Loaded Biopsy Harvester—Experimental Prototype Design and Feasibility Tests

Current minimally invasive laparoscopic tissue–harvesting techniques for pathological purposes involve taking multiple imprecise and inaccurate biopsies, usually using a laparoscopic forceps or other assistive devices. Potential hazards, e.g., cancer spread when dealing with tumorous tissue, call for a more reliable alternative in the form of a single laparoscopic instrument capable of repeatedly taking a precise biopsy at a desired location. Therefore, the aim of this project was to design a disposable laparoscopic instrument tip, incorporating a centrally positioned glass fiber for tissue diagnostics; a cutting device for fast, accurate, and reliable biopsy of a precisely defined volume; and a container suitable for sample storage. Inspired by the sea urchin's chewing organ, Aristotle's lantern, and its capability of rapid and simultaneous tissue incision and enclosure by axial translation, we designed a crown-shaped collapsible cutter operating on a similar basis. Based on a series of in vitro experiments indicating that tissue deformation decreases with increasing penetration speed leading to a more precise biopsy, we decided on the cutter's forward propulsion via a spring. Apart from the embedded spring-loaded cutter, the biopsy harvester comprises a smart mechanism for cutter preloading, locking, and actuation, as well as a sample container. A real-sized biopsy harvester prototype was developed and tested in a universal tensile testing machine at TU Delft. In terms of mechanical functionality, the preloading, locking, and actuation mechanism as well as the cutter's rapid incising and collapsing capabilities proved to work successfully in vitro. Further division of the tip into a permanent and a disposable segment will enable taking of multiple biopsies, mutually separated in individual containers. We believe the envisioned laparoscopic optomechanical biopsy device will be a solution ameliorating time-demanding, inaccurate, and potentially unsafe laparoscopic biopsy procedures.

Efficiency of voluntary opening hand and hook prosthetic devices: 24 years of development?

Quantitative data on the mechanical performance of upper-limb prostheses are very important in prostheses development and selection. The primary goal of this study was to objectively evaluate the mechanical performance of adult-size voluntary opening (VO) prosthetic terminal devices and select the best tested device. A second goal was to see whether VO devices have improved in the last two decades. Nine devices (four hooks and five hands) were quantitatively tested (Hosmer model 5XA hook, Hosmer Sierra 2 Load VO hook, RSL Steeper Carbon Gripper, Otto Bock model 10A60 hook, Becker Imperial hand, Hosmer Sierra VO hand, Hosmer Soft VO hand, RSL Steeper VO hand, Otto Bock VO hand). We measured the pinch forces, activation forces, cable displacements, mass, and opening span and calculated the work and hysteresis. We compared the results with data from 1987. Hooks required lower activation forces and delivered higher pinch forces than hands. The activation forces of several devices were very high. The pinch forces of all tested hands were too low. The Hosmer model 5XA hook with three bands was the best tested hook. The Hosmer Sierra VO hand was the best tested hand. We found no improvements in VO devices compared with the data from 1987.

Stiffness Compensation Mechanism for Body Powered Hand Prostheses with Cosmetic Covering

Body powered hand prostheses require high physical user effort. This is caused by the stiffness of the cosmetic covering, or cosmetic glove. This paper aims to present a new concept of a mechanism for the compensation of the nonlinear stiffness of body powered hand prostheses by using static balancers with a nonlinear behavior. This concept is based on a cooperative action of snap-through behavior in multiple bi-stable spring mechanisms to create the nonlinear balancing force. To demonstrate the efficiency of the concept, an optimized design for a case study of a child-size hand prosthesis is also presented. A pattern search method was applied for the optimization. As a result, the calculated stiffness and thereby the operating effort was reduced by 96%. It can be concluded from the conceptual and numerical results that the presented concept provides a highly efficient solution to the discussed problem.

Efficiency of voluntary closing hand and hook prostheses

The Delft Institute of Prosthetics and Orthotics has started a research program to develop an improved voluntary closing, body-powered hand prosthesis. Five commercially available voluntary closing terminal devices were mechanically tested: three hands [Hosmer APRL VC hand, Hosmer Soft VC Male hand, Otto Bock 8K24] and two hooks [Hosmer APRL VC hook, TRS Grip 2S]. The test results serve as a design guideline for future prostheses. A test bench was used to measure activation cable forces and displacements, and the produced pinch forces. The measurements show that the hands require higher activation forces than the hooks and 1.5-8 times more mechanical work. The TRS hook requires the smallest activation force (33 N for a 15 N pinch force) and has the lowest energy dissipation (52 Nmm). The Hosmer Soft hand requires the largest activation force (131 N for a 15 N pinch force) and has the highest energy dissipation (1409 Nmm). The main recommendations for future prostheses are the following: (1) Required activation forces should be below the critical muscle force (∼18% of maximum), to enable continuous activation without muscle fatigue; and (2) hysteresis of mechanism and glove should be lowered, to increase efficiency and controllability.

Stiffness Compensation in Hand Prostheses With Cosmetic Coverings Using Statically Balanced Mechanisms

Although hand prostheses with a cosmetic covering are commercially available for disabled people, the operating effort due to the stiffness of the mechanism is high. This results in high power requirements. This paper aims to present a new concept of mechanisms for the compensation of the nonlinear stiffness of hand prostheses by using statically balanced mechanisms with a nonlinear behavior. This concept was based on a combination of stability phases of snap-through buckling in bistable spring mechanisms to create the nonlinear balancing force. To demonstrate the efficiency of the concept, an optimized design for a case study of a child-sized hand prosthesis is also presented. A pattern search method was applied for the optimization. As a result, the calculated stiffness and, thereby, the operating effort was reduced by 96%. It can be concluded from the conceptual and numerical results that the presented concept provides a highly efficient solution to the discussed problem.

Growth stimulation of Brevibacterium sp. by siderophores

AIMS

To assess which types of siderophores are typically produced by Brevibacterium and how siderophore production and utilization traits are distributed within this genus.

METHODS AND RESULTS

During co-cultivation experiments it was found that growth of B. linens Br5 was stimulated by B. linens NIZO B1410 by two orders of magnitude. The stimulation was caused by the production of hydroxamate siderophores by B. linens NIZO B1410 that enabled the siderophore-auxotrophic strain Br5 to grow faster under the applied iron-limited growth conditions. Different patterns of siderophore production and utilization were observed within the genus Brevibacterium. These patterns did not reflect the phylogenetic relations within the group as determined by partial 16S rDNA sequencing. Most Brevibacterium strains were found to utilize hydroxamate siderophores.

CONCLUSIONS

Brevibacteria can produce and utilize siderophores although certain strains within this genus are siderophore-auxotrophic.

SIGNIFICANCE AND IMPACT OF THE STUDY

It is reported for the first time that brevibacteria produce and utilize siderophores. This knowledge can be utilized to stimulate growth of auxotrophic strains under certain conditions. Enhancing the growth rate of Brevibacterium is of importance for the application of this species, for example, for cheese manufacturing or for industrial production of enzymes or metabolites.

Radial head fractures: effectiveness of conservative treatment versus surgical intervention. A systematic review

INTRODUCTION

Radial head fractures are common elbow fractures. The Mason classification is used to describe the fracture. As of yet, there is no consensus on optimal treatment strategy for Mason II-IV fractures. The aim of this study was to compare the results of conservative treatment with different surgical strategies for radial head fractures.

MATERIALS AND METHODS

Electronic databases from 1966 to 2004 were screened. Based on our inclusion criteria, 24 studies, describing 825 patients, were included.

RESULTS

For Mason type II fractures, residual pain was present in 42% of the conservatively treated of the patients compared to 32% of the surgically treated patients. Good/excellent results for Broberg score were 52 and 88%, respectively. For Mason type III and IV fractures, no conservatively treated patients were described.

CONCLUSIONS

There is insufficient evidence to be able to draw definitive conclusions on optimal treatment of type II-IV radial head fractures. Evidence is currently limited to a maximum level II evidence. There is great need for sufficiently powered randomized controlled trials.

Radon in the spas of Croatia

Radon concentrations in air and geothermal water of the spa pools in Croatia were measured and the average values of 40.3 and 4.5 kBq/m3 were obtained, respectively. Great difference between radon concentrations in pool and spring water was considered as a result of mixing normal and geothermal water in the pool as well as the radon decay. Estimation of an effective dose, received by the personnel in the Bizovac spa, gave the value of 0.27 mSv/y. At the location Stubica, the transfer factor of the radon for air and thermal water in the pool was calculated, and the value of 4.9+/-0.7 x 10(-3) was obtained.

Development of a high throughput screening method to test flavour-forming capabilities of anaerobic micro-organisms

AIM

Development of a fast, automated and reliable screening method for screening of large collections of bacterial strains with minimal handling time.

METHODS AND RESULTS

The method is based on the injection of a small headspace sample (100 microl) from culture vials (2 ml) in 96-well format directly into the mass spectrometry (MS). A special sample tray has been developed for liquid media, and anaerobically grown cultures. In principle, all volatile components can be measured, but a representative mass fragment has to be obtained in the MS. Representative masses for 3-methylbutanal, 2-methylpropanal and benzaldehyde are 58, 72 and 105, respectively. In 1 day over 1500 samples could be analysed and the coefficient of variation for the response was <5%.

CONCLUSION

Screening of 72 strains belonging to the genus Lactococcus in quadruple on the production of the key-flavour compound 3-methylbutanal illustrated the effectiveness of the method. Furthermore, knowledge of the biochemistry and physiology of 3-methylbutanal formation was used to optimize the composition of the growth medium to enhance 3-methylbutanal production, and thereby improve the screening.

SIGNIFICANCE AND IMPACT OF THE STUDY

A commonly used method to control flavour formation in fermented food products is the selection of bacterial strains, which are able to produce the desired flavour compounds. As large collections of strains are available for such screenings, studying biodiversity of micro-organisms on the level of metabolic routes is strongly facilitated by highly automated high throughput screening methods for measuring enzyme activities or production of metabolites. Therefore, this method will be a useful tool for selecting flavour-producing strains and for enhancing starter culture development.

Diversity of L-leucine catabolism in various microorganisms involved in dairy fermentations, and identification of the rate-controlling step in the formation of the potent flavour component 3-methylbutanal

Various microorganisms, belonging to the genera Lactococcus, Lactobacillus, Streptococcus, Leuconostoc, Bifidobacterium, Propionibacterium, Brevibacterium, Corynebacterium and Arthrobacter, used in dairy fermentations such as cheese making, were analysed for their potential to convert leucine into flavour components, most notably 3-methylbutanal. A large variation between and within species was observed for various enzyme activities involved in the conversion pathway, e.g. transaminases, alpha-hydroxy acid dehydrogenase and alpha-keto acid decarboxylase. In particular, alpha-keto acid decarboxylase activity-leading to 3-methylbutanal-was found to be present in only two of the strains tested. It is proposed that this activity is rate-controlling in the conversion pathway leading to the flavour compound 3-methylbutanal.

Corneal decompensation in a boy with Kearns-Sayre syndrome

This paper describes the clinical history of a young boy with Kearns-Sayre syndrome. The first presenting symptom of Kearns-Sayre syndrome in this boy was corneal edema with photophobia and tearing.

Butterfly eyespot patterns: evidence for specification by a morphogen diffusion gradient

In this paper we describe a test for Nijhout's (1978, 1980a) hypothesis that the eyespot patterns on butterfly wings are the result of a threshold reaction of the epidermal cells to a concentration gradient of a diffusing degradable morphogen produced by focal cells at the centre of the future eyespot. The wings of the nymphalid butterfly, Bicyclus anynana, have a series of eyespots. each composed of a white pupil, a black disc and a gold outer ring. In earlier extirpation and transplantation experiments (Nijhout 1980a; French and Brakefield, 1995) it has been established that these eyespots are indeed organised around groups of signalling cells active during the first hours of pupal development. If these cells were to supply the positional information for eyespot formation in accordance with Nijhout's diffusion-degradation gradient model, then, when two foci are close together. the signals should sum, and this effect should be apparent in the detailed shape of the resulting pigment pattern. We give an equation for the form of the contours that would be obtained in this manner. We use this to test the morphogen gradient hypothesis on measurements of the outlines of fused eyespots obtained either by grafting focal cells close together, or by using a mutation (Spotty) that produces adjacent fused eyespots. The contours of the fused patterns were found to satisfy our equation, thus corroborating Nijhout's hypothesis to the extent possible with this particular type of experiment.

Enhanced flavour formation by combination of selected lactococci from industrial and artisanal origin with focus on completion of a metabolic pathway

Combinations of lactococcal strains from various origins with divers properties were developed as new starters for new dairy products. Flavour formation by such tailor-made cultures was studied. In some cases, a strongly enhanced flavour was observed. For instance, the combination of B1157 and SK110 strains in milk resulted in a very strong chocolate-like flavour. B1157 produces only a moderate chocolate-like flavour, whereas SK110 alone fails to produce this flavour. Headspace gas chromatography results corroborate the organoleptic evaluations. High levels of branched-chain aldehydes were found when B1157 and SK110 were grown together. The enzyme activities involved in this pathway were studied; both strains contain transaminase activity. Although B1157 had a very high amino acid decarboxylating activity, its release of amino acids from milk protein was limited. SK110 was strongly limited in decarboxylating activity, although this strain is very active in proteolysis. By combining these strains, the substrates released by SK110 can directly be used by the other strain, resulting in the completion of the whole flavour-formation pathway. This opens new avenues for the preparation of tailor-made cultures.

Lysis of Lactococcus lactis subsp. cremoris SK110 and its nisin-immune transconjugant in relation to flavor development in cheese

To develop a nisin-producing cheese starter, Lactococcus lactis subsp. cremoris SK110 was conjugated with transposon Tn5276-NI, which codes for nisin immunity but not for nisin production. Cheese made with transconjugant SK110::Tn5276-NI as the starter was bitter. The muropeptide of the transconjugant contained a significantly greater amount of tetrapeptides than the muropeptide of strain SK110, which could have decreased the susceptibility of the cells to lysis and thereby the release of intracellular debittering enzymes.

Uridine, a cell division factor in pea roots

Nodulation (root nodule formation) in legume roots is initiated by the induction of cell divisions and formation of root nodule primordia in the plant root cortex, usually in front of the protoxylem ridges of the central root cylinder. We isolated a factor from the central cylinder (stele) of pea roots which enhances hormone-induced cell proliferation in root cortex explants at positions similar to those of nodule primordia. The factor was identified as uridine. Uridine may act as a morphogen in plant roots at picomolar concentrations.

Isolation and partial purification of mannose-specific agglutinin from brewer's yeast involved in flocculation

Yeast cell-agglutinating activity, designated agglutinin (possible lectin), was isolated from cell walls of both non-flocculent and flocculent brewer's yeast cells. Agglutinin-mediated aggregation of yeast cells in a manner similar to flocculation with respect to specific mannose-sensitivity, pH-dependence and calcium-dependence. Agglutinating activity was found to be heat-stable and protease-insensitive. Furthermore, addition of agglutinin to flocculent cells strongly stimulated the flocculation ability of the cells, whereas addition to non-flocculent cells rendered these cells weakly flocculent. Agglutinin was found to be released from flocculent cells during the course of a flocculation assay, but not from non-flocculent cells. Presence of mannose during the assay inhibited release of agglutinin. Our results suggest that (i) mannose-specific agglutinin is continuously synthesized during growth of brewer's yeast cells, (ii) agglutinin is present in cell walls of non-flocculent cells but is unable to bind its ligand on other cells, and (iii) the ability of yeast cells to flocculate in a flocculation assay depends, among other factors, on release of agglutinin from the cells. A 10-kDa polypeptide might represent one form of agglutinin.

Purification and partial characterization of a flocculin from brewer's yeast

Analysis of a shear supernatant from flocculent, "fimbriated" Saccharomyces cerevisiae brewer's yeast cells revealed the presence of a protein involved in flocculation of the yeast cells and therefore designated a flocculin. The molecular mass of the flocculin was estimated to be over 300 kDa, as judged from sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Gel permeation chromatography of the flocculin yielded an aggregate with an apparent molecular weight of > 2,000. The flocculin was found to be protease sensitive, and the sequence of its 16 N-terminal amino acids revealed at least 69% identity with the predicted N terminus of the putative protein encoded by the flocculation gene FLO1. The flocculin was isolated from flocculent S. cerevisiae cells, whereas only a low amount of flocculin, if any, could be isolated from nonflocculent cells. The flocculin was found to stimulate the flocculation ability of flocculent yeast cells without displaying lectinlike activity (that is, the ability to agglutinate yeast cells).

Rhicadhesin-mediated attachment and virulence of an Agrobacterium tumefaciens chvB mutant can be restored by growth in a highly osmotic medium

Cyclic beta-1,2-glucan is considered to play a role in osmoadaptation of members of the family Rhizobiaceae in hypotonic media. Agrobacterium tumefaciens chvB mutants, lacking beta-1,2-glucan, exhibit a pleiotropic phenotype, including nonmotility, attachment deficiency, and avirulence. Here we report that by growth of chvB mutant cells in tryptone-yeast extract medium supplemented with 7 mM CaCl2 and 100 mM NaCl, the mutant cells become motile, attach to pea root hair tips, and are virulent on Kalanchoë leaves. Moreover, whereas chvB mutants grown in tryptone-yeast extract medium containing 7 mM CaCl2 do not produce active rhicadhesin, addition of 100 mM NaCl to this medium resulted in restoration of rhicadhesin activity. The presence of CaCl2 appeared to be required for attachment, virulence, and activity of rhicadhesin. The results support a role for cyclic beta-1,2-glucan in osmoadaptation and strengthen the notion that rhicadhesin is required for attachment and virulence of A. tumefaciens.

Purification and partial characterization of a glycoprotein from pea (Pisum sativum) with receptor activity for rhicadhesin, an attachment protein of Rhizobiaceae

Attachment of Rhizobium and Agrobacterium bacteria to cells of their host plants is a two-step process. The first step, direct attachment of bacteria to the plant cell wall, is mediated by the bacterial protein rhicadhesin. A putative plant receptor molecule for rhicadhesin was purified from cell walls of pea roots using a bioassay based on suppression of rhicadhesin activity. This molecule appeared to be sensitive to treatments with pronase or glycosidase. Its isoelectric point is 6.4, and its apparent molecular mass was estimated to be 32 kDa before and 29 kDa after glycosidase treatment, as determined by sodium dodecyl sulphate-polyacrylamide gel electrophoresis and ultrafiltration. The sequence of the first 29 N-terminal amino acids was determined: A-D-A-D-A-L-Q-D-L-C(?)-V-A-D-Y-A-S-V-I-L- V-N-G-F-A-S-K(Q)-(P/Q)-(L)-(I). No homology with known proteins was found. In the course of this research project the extracellular matrix protein vitronectin was reported to inhibit attachment of A. tumefaciens to carrot cells [29]. A variety of adhesive proteins, including vitronectin, contain a common cell attachment determinant with the sequence R-G-D. Since we could not detect other cell wall components able to suppress rhicadhesin activity, and since an R-G-D containing hexapeptide was also active as a receptor, we speculate that the plant receptor for rhicadhesin is a glycoprotein containing an R-G-D attachment site.

Restoration of attachment, virulence and nodulation of Agrobacterium tumefaciens chvB mutants by rhicadhesin

In contrast to wild-type Agrobacterium tumefaciens strains, beta-1,2-glucan-deficient chvB mutants were found to be unable to attach to pea root hair tips. The mutants appeared to produce rhicadhesin, the protein that mediates the first step in attachment of Rhizobiaceae cells to plant root hairs, but the protein was inactive. Both attachment to root hairs and virulence of the chvB mutants could be restored by treatment of the plants with active rhicadhesin, whereas treatment of plants with beta-1,2-glucan had no effect on attachment or virulence. Moreover, nodulation ability of a chvB mutant carrying a Sym plasmid could be restored by pretreatment of the host plant with rhicadhesin. Apparently the attachment-minus and avirulence phenotype of chvB mutants is caused by lack of active rhicadhesin, rather than directly being caused by a deficiency in beta-1,2-glucan synthesis. The results strongly suggest that rhicadhesin is essential for attachment and virulence of A. tumefaciens cells. They also indicate that the mechanisms of binding of Agrobacterium and Rhizobium bacteria to plant target cells are similar, despite differences between these target cells.

Cause and control of flocculation in yeast

Flocculation is an important characteristic of microorganisms which can be problematical, but may also be exploited in fermentation processes. The molecular mechanism of flocculation is still poorly understood although, recently, cell-surface hydrophobicity of brewer's yeast has been shown to play a key role. Regulation of this factor could enable control of flocculation during fermentation.

Determinants of flocculence of brewer's yeast during fermentation in wort

Ability of Saccharomyces cerevisiae MPY3 cells to flocculate during fermentation in wort was found to be triggered after growth limitation by oxygen shortage and to coincide with a sharp increase in cell surface hydrophobicity of the cells. Presence of oxygen in the pitching wort influenced final cell number, flocculence of the cells and cell surface hydrophobicity. Flocculation ability of cells grown in air-depleted pitching wort was hampered, concomitant with a decrease in final cell number and in final cell surface hydrophobicity. Addition of ergosterol and Tween 80 to air-depleted wort restored normal growth of the cells as well as flocculation ability and the increase in cell surface hydrophobicity. The same parameters increased in value after addition of ergosterol and Tween 80 to a fermentation with air-saturated pitching wort. Hydrophobicity of a non-flocculent mutant of S. cerevisiae strain MPY3, fermenting in air-saturated pitching wort, did not increase at cell division arrest. These results support the hypothesis that cell surface hydrophobicity is a major determinant for yeast cells to become flocculent, and suggest that shortage of sterols and unsaturated fatty acids precedes flocculence under brewing conditions.

Flocculence of Saccharomyces cerevisiae cells is induced by nutrient limitation, with cell surface hydrophobicity as a major determinant

Initiation of flocculation ability of Saccharomyces cerevisiae MPY1 cells was observed at the moment the cells stop dividing because of nitrogen limitation. A shift in concentration of the limiting nutrient resulted in a corresponding shift in cell division and initiation of flocculence. Other limitations also led to initiation of flocculence, with magnesium limitation as the exception. Magnesium-limited S. cerevisiae cells did not flocculate at any stage of growth. Cell surface hydrophobicity was found to be strongly correlated with the ability of the yeast cells to flocculate. Hydrophobicity sharply increased at the end of the logarithmic growth phase, shortly before initiation of flocculation ability. Treatments of cells which resulted in a decrease in hydrophobicity also yielded a decrease in flocculation ability. Similarly, the presence of polycations increased both hydrophobicity and the ability to flocculate. Magnesium-limited cells were found to be strongly affected in cell surface hydrophobicity. A proteinaceous cell surface factor(s) was identified as a flocculin. This heat-stable component had a strong emulsifying activity, and appears to be involved in both cell surface hydrophobicity and in flocculation ability of the yeast cells.