Early biomarkers to predict grade of encephalopathy following hypoxic ischaemic injury

The standard early markers for identifying and grading HIE severity, are not sufficient to ensure all children who would benefit from treatment are identified in a timely fashion. The aim of this thesis was to explore potential early biomarkers of HIE. Methods: To achieve this a cohort of infants with perinatal depression was prospectively recruited. All infants had cord blood samples drawn and biobanked, and were assessed with standardised neurological examination, and early continuous multi-channel EEG. Cord samples from a control cohort of healthy infants were used for comparison. Biomarkers studied included; multiple inflammatory proteins using multiplex assay; the metabolomics profile using LC/MS; and the miRNA profile using microarray. Results: Eighty five infants with perinatal depression were recruited. Analysis of inflammatory proteins consisted of exploratory analysis of 37 analytes conducted in a sub-population, followed by validation of all significantly altered analytes in the remaining population. IL-6 and IL-6 differed significantly in infants with a moderate/severely abnormal vs. a normal-mildly abnormal EEG in both cohorts (Exploratory: p=0.016, p=0.005: Validation: p=0.024, p=0.039; respectively). Metabolomic analysis demonstrated a perturbation in 29 metabolites. A Cross- validated Partial Least Square Discriminant Analysis model was developed, which accurately predicted HIE with an AUC of 0.92 (95% CI: 0.84-0.97). Analysis of the miRNA profile found 70 miRNA significantly altered between moderate/severely encephalopathic infants and controls. miRNA target prediction databases identified potential targets for the altered miRNA in pathways involved in cellular metabolism, cell cycle and apoptosis, cell signaling, and the inflammatory cascade. Conclusion: This thesis has demonstrated that the recruitment of a large cohortof asphyxiated infants, with cord blood carefully biobanked, and detailed early neurophysiological and clinical assessment recorded, is feasible. Additionally the results described, provide potential alternate and novel blood based biomarkers for the identification and assessment of HIE.

A completely kinematostatically decoupled XY compliant parallel manipulator through new topology structure

This paper deals with a completely kinematostaticaly decoupled XY compliant parallel manipulator (CPM) composed of exactly-constrained compliant modules. A new 4-PP XY translational parallel mechanism (TPM) with a new topology structure is firstly proposed where each two P (P: prismatic) joints on the base in two non-adjacent legs are rigidly connected. A novel 4-PP XY CPM is then obtained by replacing each traditional P join on the base in the 4-PP XY TPM with a compound basic parallelogram module (CBPM) and replacing each traditional P joint on the motion stage with a basic parallelogram module (BPM). Approximate analytical model is derived with comparison to the FEA (finite element analysis) model and experiment for a case study. The proposed novel XY CPM has a compact configuration with good dynamics, and is able to well constrain the parasitic rotation and the cross-axis coupling of the motion stage. The cross-axis motion of the input stage can be completely eliminated, and the lost motion between the input stage and the motion stage is significantly reduced.