Methods of screening and its detection rate.
\r\n\tApplied and basic studies - Field studies and lab assays of fungicides can be discussed. We also look for examples of application methods, which may include timing of application, tools for application, fungicide compatibility, phytotoxicity, etc. Field trials have to have at least two years of data;
\r\n\tAdaptation of Integrated Plant Disease Management - How the IPM practice has been adapted in the field. Application of disease risk models, or use of fungicide application aids, which can be hardware or software. The introduction of a new tool for growers can also be included;
\r\n\tNovel fungicides - In addition to the traditional chemical approach, alternative materials (enzymes, oils, extracts, etc.), biological control agents, or plant defense activators can be discussed;
\r\n\tAdaptation of new technologies - Examples will be the use of unmanned vehicles, sensor technologies, advanced sprayers, or disease forecast systems for precision agriculture;
\r\n\tFungicide resistance - Unfortunately, we cannot ignore the fact that fungicide-resistant strains are widespread. Documentation of fungicide-resistant strains, the introduction of new technologies and methods can be discussed.
Aneuploidies are Trisomy21 (“Down syndrome”, T21), Trisomy18 (Edward syndrome, T18), trisomy13 (Patau syndrome, T13), monosomy (turner syndrome, monosomy) and triploidy. “Down syndrome” is more focused than other aneuploidy due to Trisomy 13 and 18 are lethal, do not have very long-term consequences, and almost all cases have major structural abnormalities and can be identified on the basis of these features. Where as in T21 the ultrasound and laboratory findings are subtle and nonspecific. Special effort has to be made to identify these nonspecific features and analyse their importance. Identification of T21 is based on these subtle abnormal structures i.e., ultrasound markers and abnormal biochemistry (low PAPP-A and raised β-HCG). The abortion rate in monosomy X is 98% and Edwards is 86% whereas “Down syndrome” is only 30%. Not only this Downs is the commonest congenital cause of mental disability with long life span and need life-long family support. The incidence is 1in 800 pregnancies. Downs can lead to considerable ill health, although some individual may have only mild problems and can lead relatively normal lives. Having baby with “Down syndrome” is likely to have significant impact on family life. There is currently no known cure. A significant number of parents would opt for terminating such a pregnancy or if they want to continue prior information would benefit for preparing for such a baby. Downs occur due to non-disjunction type (Errors in meiosis). Translocation type and mosaic type which is rare.
In 1862 & 1887 Langdon Down noted that common characteristics of patients with trisomy 21 are skin deficient in elasticity, giving the impression of being too large for the body, and face is flat, broad and destitute of prominence. The cheeks are roundish and extended laterally. The eyes are obliquely placed, and internal canthi more than normally distanced from one another. The palpebral fissure is very narrow. The tongue is long, thick and much roughened. The nose is small. In 1987 B Benacerraf [1], told that this loose skin can be seen in mid trimester scan at 20 weeks as a thickening of skin at the back of neck in axial view of skull in trans cerebellar plane which was defined as nuchal fold. After 5 years it was realized that the excess skin of individuals with Down’s syndrome can be visualized by ultrasonography as increased nuchal translucency in the third month of intrauterine life [2]. About 75% of trisomy 21 fetuses have increased nuchal translucency (NT) and 60–70% have absent nasal bone.
Aneuploidy increases with advancing maternal age. So, increasing the maternal age increases the risk. in the early 1970s, the screening was based only on the association with advanced maternal age. In late 1980s not only maternal age but also found that the concentration of various fetoplacental products in the maternal circulation has taken into account for screening. At 16 weeks of gestation the median maternal serum concentrations of alpha-fetoprotein (AFP), un-conjugated estriol (μE3), human chorionic gonadotropin (HCG) (free- β and total
Aneuploidy screening Approach: observed Detection rates.
“Down syndrome” can be diagnosed during pregnancy. Diagnostic tests are invasive and have an inherent miscarriage rate, however, small they are also expensive. Screening tests can identify a large number of patients who would benefit from diagnostic testing thus reducing risks and costs. Screening tests by definition, cannot identify all accepted pregnancies. First trimester screening is far more effective than later screening. Aneuploidy screening should be offered to all the pregnant women.
Screening tests that are performed in the first and second trimesters include integrated, sequential and contingent screening. The basic types are 1) first trimester combined screening the components in this are Nuchal translucency (NT), PAPP-A and β-HCG. The detection rate is 85–95%. If you add nasal bone and other ultrasound features to this the detection rate increases 93–96%. 2) Triple test the components are β-HCG, MS-AFP and unconjugated Estriol. The detection rate is only 60–65%. 3) Quadruple test β-HCG, MS-AFP, unconjugated Estriol and inhibin A. the detection rate is 70–75%. 4) Penta screen includes hyper glycosylated HCG in addition to quadruple test. If patient come for screening in first trimester, first trimester combined screening is advised, if she comes at 14-20 weeks quadruple test, if she comes at both first and second trimester integrated test is best for screening (Table 1).
Methods of screening | Detection rate | False-positive rate |
---|---|---|
Maternal age(MA) | 30% | 5% |
MA+ fetal nuchal translucency(NT) | 75–80% | 5% |
MA+ serum free β-hCG and PAPP-A | 60–70% | 5% |
MA + NT + free β-hCG and PAPP-A (combined Test) | 85–95% | 5% |
Combined Test+ nasal bone or tricuspid flow or ductus venosus flow | 93–96% | 2.5% |
MA + serum AFP,hCG, μE3(triple test) | 60–65% | 5% |
MA + serum AFP,free β-hCG, μE3, inhibin A(Quadruple test) | 70–75% | 5% |
MA + NT + PAPP-A(11-13 weeks) + quadruple test | 90–94% | 5% |
Nicolaides KH. Screening for fetal aneuplodies at 11t013weeks.Prenat Diagn 2011;31:7–15. |
Methods of screening and its detection rate.
Integrated test:-Integrate the First trimester PAPP-A, Free β-HCG and NT analyte screening followed by a second trimmester Quad screen and receives a single screen test result. The detection rate of this test is 90–94%. Limitations includes the withholding of first trimester screening test results until the second trimester which delay the management option.
Sequential screening: - these are two types one is stepwise another one is contingent model. These methods were developed to maintain a high detection rate. in step wise sequential model it can be achieved by using the combined first and second trimester screening approach while also reporting the patients first trimester screening test risk, which allows for earlier management options. If first trimester test result is higher than lab derived positive screening cutoff, we can offer them the diagnostic test or NIPT, and the screening protocol is discontinued. If the patient has a lower risk can counseled and proceed to quad screening in the second trimester. Sequential screening has a detection rate of 91–93% with a positive screening test result rate of 4–5% [5, 6, 7].
Contingent model classifies aneuploidy risk as high, intermediate or low on the basis of first trimester screening test results. High risk patients are offered cell free DNA screening or diagnostic testing with CVS and for low risk women further screening or testing is not recommended. Only those with intermediate risk are offered second trimester screening.
Every woman has a risk that her fetus has a chromosomal abnormality.
to calculate the individual risk, the clinical information which is necessary to take into account the background or a priori risk, depends on maternal age, weight the ethnicity (in terms of south Asian, east Asian, south east Asian black or Caucasian), IVF, number of fetuses diabetes and smoking. This information should be combined with ultrasound information and biochemistry. Which is based on crown rump length, NT, PAPP-A, free β-HCG. Then make calculation by a series of factors or likelihood ratios, which depend on the results of a series of screening tests carried out during the course of the pregnancy to determine the patient-specific risk. A priori risk established by maternal age has been adjusted successfully by NT screening. This has been one of the most important elements of aneuploidy screening as it resulted in a significant reduction in unnecessary invasive testing on pregnant women with advanced maternal age. If you add rest of the ultrasound features like nasal bone, ductus venosus and tricuspid regurgitation which can increase the rate of detection.
Genetic sonogram has been used to screen for Aneuploidy by using specific findings. In this approach seeks major structural abnormalities and minor ultrasonographic soft markers. These Soft markers are minor ultrasound abnormalities, considered as variants of normal, they do not constitute a structural defect. Presence of Soft markers are indicative of an increased age adjusted risk of an underlying fetal aneuploidy or some non- chromosomal abnormalities. So, these are also a priori risk. Detection of soft markers increase the risk for aneuploidy by constant proportion (likelihood ratio LR). Absence of these markers lower the risk (Negative predictive value NPV). These were decided after a meta-analysis study of second trimester markers for trisomy21 [8], (Table 2).
Marker | LR+(95%CI) | LR-(95%CI) | LR isolated marker* |
---|---|---|---|
Intra cardiac echogenic focus | 5.83(5.02–6.77) | 0.80(0.75–0.86) | 0.95 |
Ventriculomegaly | 27.52(13.61–55.68) | 0.94(0.91–0.98) | 3.81 |
Increased nuchal fold | 23.30(14.35–37.83) | 0.80(0.74–0.85) | 3.79 |
Echogenic bowel | 11.44(9.05–14.47) | 0.90(0.86–0.94) | 1.65 |
Mild Hydronephrosis | 7.63(6.11–9.51) | 0.92(0.89–0.96) | 1.08 |
Short humerus | 4.81(3.49–6.62) | 0.74(0.63-o.88) | 0.78 |
Short femur | 3.72(2.79–4.97) | 0.80(0.73–0.88) | 0.61 |
ARSA | 21.48(11.48–40.19) | 0.71(0.57–0.88) | 3.94 |
Absent or hypoplastic nasal bone | 23.27(14.23–38.06) | 0.46(0.36–0.58) | 6.58 |
Meta-analysis of 2nd trimester markers for trisomy21-M. Agathokleous et al.
Every time a test is carried out the
If a systematic second- trimester ultrasound examination demonstrates the absence of all major defects and markers, there is a 7.7fold reduction in risk for trisomy 21. Detection of any one of the markers during the scan should stimulate the sonographer to look for all other markers or defects. Post-test odds for trisomy 21 is derived by multiplying the pre-test odds by the positive LR for each detected marker and the negative LR for each marker demonstrated to be absent.
In Sequenitial screening first do the first trimester combined screening test identify the risk based on this risk if it is high risk do the invasive procedure (CVS) or NIPT. If there is false positive and false negetive results then you need to combine with quadraple test and sequentially calcuate the risk as the false positive rate is very very low.
First trimester markers are pregnancy associated plasma protein A (PAPP-A), Free β Human chorianic gonadotropin (β-HCG) where as second trimester markers are Alpha fetoprotein (AFP) Unconjugated oestriol (μE3), Total human chorianic gonadotropin (HCG) and inhibin-A.
The PAPP-A level is low in T21 which is about half of euploid pregnancies. β-HCG levels are double that of unaffected pregnancies. The concentrations of these markers vary with gestational age. In first trimester PAPP-A increases and free β-HCG decreases. In second trimester AFP and μE3 increase HCG and inhibin-A will decreases before 17 weeks after that it may increas. The measurements of these markers may vary between laboratories. In account of this variation the concentration of each marker is expressed as multiple of median for unaffected pregnancies of the same gestational age (MoM).
provision of a high-quality first trimester screening service significantly enhances the autonomy of pregnant women [10].
The gestation should be 11–13 + 6 weeks and the fetal crown–rump length should be 45–84 mm. Criteria for the Standardized Measurement of the Nuchal translucency at 11–13 + 6 weeks are- fetus must be in the midsagittal plane. The image must be magnified so, that it is filled by the fetal head, neck and upper thorax, the magnification should be as large as possible and each slight movement of the callipers should produce only a 0.1 mm change in the measurement. The fetal neck must be in neutral position, it should not be flexed, and not hyperextended. Amnion must be seen separate from NT line. The margins of NT edges must be clear enough for proper placement of the callipers (Figure 2). The + callipers on the ultrasound must be used to perform the NT measurement. Electronic callipers must be placed on the inner borders of the nuchal line space with none of the horizontal crossbar itself protruding into the space and the callipers must be placed perpendicular to the fetal long axis. Measurement must be obtained at the widest space of the NT. Cord round the neck may be present in 5–10% of cases which may produce a falsely increased NT. In such cases, the measurements of NT above and below the cord are different so, the average of these two measurements should be appropriate for calculating risk. One of the studies involving 96,127 pregnancies, at a crown rump length of 45 mm the median and 95th centile was 1.2 and 2.1 mm and the crown rump length of 84 mm were 1.9 and 2.7 mm [11]. The average NT in aneuploidy is about 2.5 mm above the normal median for crown-rump length. In Turner syndrome, the median NT is about 8 mm above the normal median.
Normal NT and nasal bone.
It may be present, absent or hypoplastic. In the normal fetus between the 11th and early 12th week of gestation, the nasal bone may appear poorly ossified or absent [12]. In such cases, it is recommended to repeat the measurement one week later [12]. Nasal bone hypoplasia is calculated as BPD/NBL ratio if >11 than hypoplasia. Several studies have demonstrated a high association between absent nasal bone at 11–13 + 6 weeks and trisomy 21, as well as other chromosomal abnormalities [13]. Criteria for the Standardized Measurement of the Nasal Bone at 11–13 + 6 weeks are mid sagittal view of face with the magnification of the image should be such that the fetal head and thorax occupy the whole screen. Mid sagittal face is defined by the presence of the echogenic tip of the nose and rectangular shape of the palate anteriorly, the translucent diencephalon in the center, and the nuchal membrane posteriorly. Minor deviations may cause non-visualization of the tip of the nose and visibility of the zygomatic process of the maxilla. The ultrasound transducer should be parallel to the direction of the nose and it should be gently tilted from side to side to ensure that the Nasal bone is seen separate from the skin (Figure 2). The echogenicity of NB should be greater than the overlying skin. Three distinct lines are noted in nasal bone demonstration: the first two lines are horizontal and parallel to each other where the top line represents the skin and bottom line is the NB. Third one represents the tip of the nose. When the NB line appears as a thin and less echogenic than the overlying skin, which suggests that the NB is not yet ossified, and it is classified as being absent (Figure 5) [12].
Normal ductus venosus.
Normal tricuspid valve.
Criteria for the Standardized Measurement of DV at 11–13 + 6 weeks are the magnification of the image should be such that the fetal head and thorax should occupy the whole screen. Right ventral mid sagittal view of fetal trunk should be obtained. Color flow mapping of umbilical vein DV and fetal heart should be demonstrated. Pulse doppler sample volume should be small (0.5–1.0 mm) and it should be placed in the yellowish aliasing area. Insonation angle should be less than 30degrees [12]. The filter should be set at a low frequency (50-70 Hz). Sweep speed should be high (2-3 cm/s) so that the waveforms are spread allowing better assessment of the A wave (Figure 3). Ductus venosus shows biphasic wave form with low pulsatility and antegrade flow in the diastolic components (a wave) throughout cardiac cycle. Normal ductus venosus Doppler waveforms show a positive a-wave, whereas the presence of an absent or reversed a-wave defines abnormal ductus venosus waveforms. The presence of high pulsatility or reverse flow of the a-wave in the first trimester increases the risk for chromosomal anomalies, cardiac defects, and the occurrence of twin-twin transfusion syndrome in monochorianic twins. Abnormal flow in the ductus venosus in about 80% of trisomy 21 fetuses and in about 5% of chromosomally normal fetuses [13].
Color and pulsed Doppler examination across the tricuspid valve is commonly used in the first trimester to assess for the presence of tricuspid valve regurgitation (TR). The presence of TR in the first trimester has been associated with chromosomal abnormalities [14, 15]. In the first trimester, TR is found in less than 5% of chromosomally normal fetuses, in more than 65% of fetuses with trisomy 21, and in more than 30% of fetuses with trisomy 18 [14]. Interrogation of other cardiac valves with color or pulsed Doppler is reserved for fetuses at risk for valve obstruction or when a cardiac malformation is suspected. Criteria for tricuspid valve evaluation at 11–13 + 6 weeks are- image should be such that the fetal thorax occupies most of the image (Figure 4). heart should be in apical position. Sample volume should be 2-3 mm should be positioned across the tricuspid valve with an angle should be less than 30 degrees from the direction of the interventricular septum. Significant TR is defined when regurgitation is more than half of the systole with velocity of >60 cm/s. The sweep speed should be 2-3 cm/s so that the wave forms are widely spread for better assessment. The tricuspid valve could be in sufficient in one or more of its three cusps, so, therefore the sample volume should be placed across the valve at least three times in an attempt to interrogate the complete valve [12].
Absent nasal bone.
It has been reported that high peak velocities in the hepatic artery are present in the first trimester in fetuses at risk for trisomy 21.
They are absent nasal bone, Aberrant subclavian artery, ventriculomegaly, increased Nuchal fold, Echogenic bowel loops, mild hydronephrosis, echogenic intra cardiac foci, short femur short humerus, choroid plexus cysts, single umbilical artery.
Major or minor abnormalities are found in about 75% of fetuses with trisomy 21 and in 10–15% of chromosomally normal fetuses. The Genetic sonogram is a targeted ultrasound looking for major abnormalities as well as minor markers for aneuploidy. Over the years these minor markers are being looked into and things like widened pelvic angle sandal gap deformity is going out of favour and is getting replaced by ARSA, pre nasal thickness and FMF angle. Absence of these markers decreases the risk of downs by around 70–80% but does not completely rule out Downs and hence Absence gives additional reassurance to the patient.
In first step when a soft marker is identified thoroughly search for other soft markers and structural abnormalities. In second step calculate the risk of aneuploidy based on likelihood ratios. This risk is calculated against background risk based maternal age alone or in combination with First trimester combined screening or second trimester quadruple test.
In second and third trimesters of pregnancy, abnormal accumulation of fluid behind the fetal neck can be known as nuchal cystic hygroma or nuchal edema. In about 75% of fetuses with cystic hygroma, there is a chromosomal abnormality and, in about 95% of cases, the abnormality is Turner syndrome. Chromosomal abnormalities are found in about one-third of the fetuses of nuchal edema and, in about 75% of cases, the abnormality is trisomy 21 or 18. Edema is also associated with fetal cardiovascular and pulmonary defects, skeletal dysplasia, congenital infections and metabolic and haematological disorders; The positive LR is 23.3 and negative LR is 0.8. Nuchal index is considered by some, because this is associated with gestational age. Nuchal index is (mean nuchal fold/mean BPD) x100 where the value of 11 or greater has a sensitivity of 50% and specificity of 96% (Figure 6).
Nuchal oedema.
occurs in 0.5to 1.4%. four vessels arise from the aortic arch where the right subclavian artery arises from distal part of the aortic arch and courses behind the oesophagus and trachea to the right upper arm (Figure 7). ARSA is present in 1% of euploid fetuses and 24% of trisomy 21. ARSA is associated with other conotruncal anomalies increases the risk of microdeletion 22Q11 and other syndromes. The positive LR is 21.5 and negative LR is 0.71. when it is isolated LR is 3.9 times.
ARSA.
This may be due to Swallowed blood, Cystic fibrosis or maternal infections. It may be also associated with congenital malformations of the bowel more so of upper GI lesions. And other perinatal complications, including fetal growth restriction. We have to also look for Ascites and bowel dilatation. Diagnosis of echogenic bowel should be confirmed by low frequency transducer, reduced Gain and without use of harmonics. Echogenicity should be equal to or more than bone (Figure 8). Grade 2 similar to bone echogenicity Grade 3 is more than bone. The positive LR of this is 11.4 and negative LR is 0.9.
Echogenic bowel loops.
Short Femur and humerus is when the measurement is below 5th percentile for gestational age or measured/expected ratio < 0.9. The positive LR is 3.72 and negative LR is 0.8. regarding short humerus is the humerus measuring <2.5% or measured/expected ratio < 0.89. The Positive LR is 4.81 and negative LR is 0.74.
usually noted at region of papillary muscle 88% in Lt ventricle, 5%in rt. ventricle and 7% in biventricular. The echogenicity should be comparable to bone. Grading of EICF - Grade 2 similar echogenicity of bone and grade 3 more denser than bone (Figure 9). EICF in RV, biventricular, multiple and bright EICF are more associated with aneuploidy, when compared to solitary LV EICF. The positive LR is 5.83 and negative LR is 0.8.
EICF.
Normal ventricular measurements are <10 mm. If it is defined as mild ventriculomegaly when measurement is between 10 and 15 mm. (Figure 10). The overall prevalence of chromosomal defects in fetal ventriculomegaly is about 10% and the commonest chromosomal defects are trisomies 21, 18, 13 and triploidy. The positive LR is 27.52and negative LR is0.94.
Mild ventriculomegaly.
pelvic AP diameter measuring >4 mm and it should be measured in transverse section in 12 clock or 6 clock position. The positive LR is 7.6 and negative LR is 0.92 (Figure 11).
Pyelectasis.
There are other soft markers also those doesn’t have any likely hood ratio but they are important and common in our practise but they are not a part of screening protocol. They are the choroid plexus cysts and single umbilical artery, sandal gap toes, short ears, clinodactyly, increased iliac angle. Not only this Duodenal atresia and small membranous VSD (Figure 12) is also be associated with aneuploidy [16].
Small membranous VSD.
they may be round or oval. May be unilateral or bilateral. They may be large or small. Commonly seen between 16 and 21 weeks by 23 week start undergoing regression. After 25–26 weeks uncommon to see. More commonly associated with trisomy 18. LR for trisomy 18 when isolated is 1.1–1.5.
No strong association with aneuploidy. Usually associated with fetal cardiac, renal anomalies and oesophageal atresia (Figure 13).
Single umbilical artery.
In normal fetuses, the pre nasal thickness is small and the nasal bone is relatively long, resulting in a ratio of approximately 0.6 [17]. In trisomy 21 fetuses in the first trimester, the prenasal thickness increases, whereas the nasal bone length decreases, resulting in a ratio > 0.8 [17].
Other names for NIPT are NIPS- non-invasive prenatal screening, cfDNA- cell free DNA. The test is based upon the presence of fetal cell-free DNA in the maternal circulation. Placental cell apoptosis releases into the maternal circulation as small DNA fragments (150-200 bp) that can be detected from >7 weeks of gestation [18]. It is estimated that about 2–20% of circulating cfDNA in the maternal circulation is fetal in origin [18]. So, about 1 in 103–107nucleated cells in maternal blood are fetal which can be enriched to about 1in 10–100 by techniques such as magnetic cell sorting (MACS) or fluorescence activated cell sorting (FACS) after attachment of magnetically labelled or fluorescent antibodies on to specific fetal cell surface markers. However, with the use of fluorescent
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Factors that is associated with an increased risk of “Down syndrome” are higher maternal age, a parental translocation involving chromosome 21, previous child with T21, significant ultrasound findings and a positive screening test result. In pregnancies with T21 fetuses, the maternal serum concentration of free β-HCG is about twice (about 2MoM) as high and PAPP-A is reduced to half (about 0.5 MoM) compared to euploid pregnancies. Although NT measurement alone identifies about 75–80% of T21 fetuses, the combination of NT with maternal biomarkers in the first trimester increases the T21 detection rate to 85–95%, while keeping the false-positive rate at 5%. AFP is decreased in T21.
In addition to NT, other sensitive first trimester ultrasound markers of T21 include absence or hypoplasia of the nasal bone (60–70%), increased impedance to flow in the ductus venosus (about 80%), tricuspid regurgitation, cardiac malformations (atrioventricular septal defect) with or without generalized edema, aberrant right subclavian artery and echogenic intracardiac focus. Increased fronto maxillary fascial angle (short maxilla in 25%), renal pylectasis and echogenic bowel loops are also soft markers for “Down syndrome” (Table 3) (Figures 14–18).
Trisomy21 | Trisomy18 | Trisomy13 | Triploidy | Turner | |
---|---|---|---|---|---|
Ventriculomegaly | + | + | + | + | |
Holoprocencephaly | + | ||||
Choroid plexus cyst | + | ||||
Dandy walker complex | + | + | |||
Fascial cleft | + | + | |||
micrognathia | + | + | |||
Nasal hypoplasia | + | ||||
Nuchal edema | + | + | + | ||
Cystic hygroma | + | ||||
Diaphragmatic hernia | + | + | |||
Cardiac defect | + | + | + | + | + |
Exomphalos | + | + | |||
Duodenal atresia | + | ||||
Esophageal atresia | + | + | |||
Renal defects | + | + | + | + | + |
Short limbs | + | + | + | + | |
Clinodactyly | + | ||||
Overlapping fingers | + | ||||
polydactyly | + | ||||
syndactyly | + | ||||
Talipes | + | + | + | ||
Fetal growth restriction | + | + | + |
In second trimester scan the soft markers in Trisomy 21 are nasal hypoplasia, increased nuchal fold thickness, intracardiac echogenic foci, echogenic bowel, hydronephrosis, shortening of the femur and more so of the humerus. It may also be associate with cardiac defects, duodenal atresia, sandal gap and clinodactyly or mid-phalanx hypoplasia of the fifth finger. Trisomy 21 is found in about 40% of cases of duodenal atresia.
T21 Fetus of 12 weeks 3 days showing normal NT with AFNB and Tricuspid regurgitation.
T21 fetus of 13 weeks 5 days showing increased NT with Omphalocele.
T21 fetus showing Increased NT with dilated posterior fossa and reverse flow in ductus venosus.
T21 with Atrioventricular septal defect with duodenal atresia(double bubble sign) and cleft lip with palate.
T21 with Absent nasal bone with EIC, ARSA and club foot.
Thickened NT is a common first trimester findings in Aneuploidy. In T18 and T13, NT median values were shown to be 5.5 and 4.0 mm, respectively [16, 27]. Reduced PAPP-A value in both trisomies noted with a median value of 0.2 MoM for T18 and 0.3 MoM for T13. Free β-HCG values are decreased whereas it is increased in T21. In T18 and T13 median values of free β-HCG 0.2 MoM and 0.5 MoM, respectively. T18 or T13 is often first suspected by the presence of typical ultrasound features, rather than by biochemical screening (Figures 19–25). single umbilical artery is found 80% fetuses with T18 and in about 3% of chromosomally normal fetuses [28]. There is 7fold increased risk of T18 associated with single umbilical artery noted. Presence of megacystis After taking into account maternal age and fetal NT the increases the likelihood for trisomy 13 or 18 by a factor of 6.7.
T18 12 weeks 1 day showing increased NT, absent nasal bone, cleft lip and palate and Congenital talipes equinovarus.
T18 fetus of 15 weeks gestational age with Holoprocencephaly and radial ray abnormality.
T18 fetus showing normal NT with dilated posterior fossa and single umbilical artery at 13 weeks 2 days followup 3D at 16 weeks 4 days with vermian rotation and incread Brainstem vermian angle.
Fetus of T18 showing Diaphragmatic hernia, choroid plexus cysts and bilateral rocker bottom foot at 21 weeks 5 days gestation.
15 weeks 5 days fetus of T13 showing holoprocencephaly, club hands and aborted fetus showing midline cleft with proboscis anophthalmia and bilateral club hands.
Megacystits with increased NT of 12 weeks 1 day T13 fetus.
15 weeks 3 days fetus showing micrognathia with polydactyly and syndactyly. In another fetus of 14 weeks 2 days 3D showing increased NT with posterior fossa dilatation and micrognathia in T13 cases.
Presence of exomphalos in association with T18 in first trimester is 60% compared about 30% at mid gestation and 15% in neonates. Trisomy 13 and Turner syndrome are associated with tachycardia, whereas in trisomy 18 and triploidy there is fetal bradycardia [29]. pulsatile flow in the umbilical vein is noted in 90% of fetuses in T18 and T13 where as 25% of chromosomally normal fetuses. The prevalence of chromosomal defects in Dandy walker -complex is about 40%, mainly in trisomies 18, 13 and triploidy.
20% 0f diaphragmatic hernia is associated with chromosomal defects mainly withTrisomy18. Heart abnormalities are found in more than 90% of fetuses with trisomy 18 or 13 and 40% of those with trisomy 21 or Turner syndrome. 30% and 15% cases of Exomphalos at mid gestation and in neonates are associated with Chromosomal defects, mainly trisomies 18 and 13. The prevalence of chromosomal defects is four-times higher when the exomphalos sac contains only bowel than in cases where the liver is included. Prenatally 20% of oesophageal atresia cases are associated with chromosomal defects, mainly trisomy 18. Polydactyly is associated with trisomy 13, overlapping fingers, Talipes and rocker bottom feet are associated with trisomy 18. Usually, Trisomy 18 and triploidy are associated with moderately severe growth restriction whereas trisomy 13, Turner syndrome with mild growth restriction and in trisomy 21 growth is essentially normal [30]. In second trimester scan Trisomy 18 is associated with strawberry-shaped head, choroid plexus cysts, absent corpus callosum, enlarged cisterna magna, facial cleft, micrognathia, nuchal edema, heart defects, esophageal atresia, diaphragmatic hernia and usually exomphalos with bowel only in the sac. The other associated findings are single umbilical artery, renal abnormalities, echogenic bowel, myelomeningocele, growth restriction and shortening of the limbs, radial aplasia, overlapping fingers and talipes or rocker bottom feet.
Trisomy 13 is associated with microcephaly, holoprosencephaly, facial abnormalities, cardiac abnormalities, exomphalos, enlarged and echogenic kidneys and post axial polydactyly.
NT has a median value of 7.8 mm [16] and has often been described as a cystic hygroma (Figure 26). The occurrence of monosomy X is not related to maternal age. Typically, lymphatic disturbances in turner syndrome are not limited to the neck region but involve the whole body including the presence of skin edema, hydrothorax and ascites. Generally Normal Nasal bone is present in fetuses with monosomy X [31]. Normal maternal serum-free β-HCG (1.1 MoM) and low PAPP-A is noted (0.49 MoM) [32]. Typical sonographic features in monosomy X includes large nuchal cystic hygromas, generalised edema, mild pleural effusions and ascites, cardiac abnormalities like left ventricular outflow tract obstruction, fetal tachycardia and renal anomalies such as the presence of horseshoe kidneys.
2 different cases of turners syndrome with generalised edema and cystic hygroma.
In triploidy, there is a complete additional haploid set of chromosomes resulting in 69 chromosomes in each cell instead of 46 chromosomes. The additional haploid set can be of paternal or maternal origin. The “paternal” type is called diandric triploidy and the “maternal” type is called digynic triploidy. These two types show different features, which can be often differentiated on ultrasound. The typical pattern of diandric triploidy includes the presence of a normally grown fetus with molar placenta, whereas in digynic triploidy, severe growth restriction is noted with a small but not molar placenta. Profile of biochemistry is different in both types due to these placental differences. Diandric triploidy is associated with increased maternal serum-free β-HCG and mildly decreased PAPP-A and in digynic triploidy which is associated with markedly decreased maternal serum free β-HCG and PAPP-A. Significantly short CRL with marked difference in size between the abdominal and head circumference, typically of more than 2 weeks of gestational age [33] which is a pathognomonic sign of digynic triploidy (Figure 27). In second trimester scan Triploidy where the extra set of chromosomes is paternally derived is associated with a molar placenta and the pregnancy rarely persists beyond 20 weeks. When there is a double maternal chromosome contribution, the pregnancy may persist into the third trimester (Figure 27). Commonly there is mild ventriculomegaly, micrognathia, cardiac abnormalities, myelomeningocele, syndactyly, and ‘hitch-hiker’ toe deformity (Figure 28).
Two fetuses of Digynic Triploidy showing short CRL with size difference in abdominal head circumference.
Live fetus at 22 weeks 4 days with Molar changes in placenta in a diandric triploidy.
The risk for trisomies in women who have had a previous fetus or child with a trisomy is higher than the one expected on the basis of their age alone.
when we have only CRL, NT, maternal age without biochemical markers there are calculators where we can enter these measurements, we get the risk assessment for downs at the time of birth- Pregnancy calculators- EDD. We can do same thing with only 2nd trimester markers without biochemical or first trimester screen results for this we will take the LR+ value of each marker present and LR- values of all absent markers and multiple all of these to get the LR for combination [8].
Instead if we find any soft markers we enter the same into the excel sheet provided by [8] M. Agathokleous et al. Excel sheet for downs.
Meta- analysis of second-trimester markers for trisomy21 [8] M. Agathokleous et al., ultrasound obstet Gynecol 2013;41:247–261.
For example:-.
when we get the measurements, we apply the same into the calculators and get the risk assessment for downs at the time of birth. It is given as in 1 in -------.
>1in 19(high risk): offer invasive testing.
>1in 50(high risk): offer NIPT/Invasive testing.
<1in 1000(Low risk): Back to routine second trimester genetic sonogram.
1in 50-1in 999(intermediate risk): Assess NB, DV, TR and recalculate risk+/-NIPT.
New cut-of risk for downs as 1:250, borderline between 251 and 1000, and less risk if <1:1001.
First trimester between 11 and 13 weeks 6 days scan evaluate NT, nasal bone along with Tricuspid valve regurgitation, a wave in Ductus Venosus and other major structural defects. Not only this detail cardiac evaluation should be done. If there is no abnormality repeat scan at 18–22 weeks may be recommended. In the second trimester scan look for soft markers, if there is any marker or abnormality detailed anatomy scan and echocardiography. In case of most isolated markers including intra cardiac echogenic focus, echogenic Bowel, mild hydronephrosis and short femur, there is only a small effect on modifying the pre-test odds.
All these are only screening protocols they are not diagnostic so, fetal karyotyping option is aways open to either risk groups.
Previous affected Pregnancy.
In women who had a previous pregnancy with trisomy 21, the risk of recurrence in the subsequent pregnancy is 0.75% higher than the maternal and gestational age-related risk for trisomy 21 at the time of testing. Recurrence is chromosome specific. If a previous pregnancy is T21 the result will be classified as screen positive regardless of level of screening markers. Risk is calculated which takes account of a women’s age at the time of her previous pregnancy with “Down syndrome” for the risk calculation.
“Down syndrome” may be non-disjunction type (95%) where there is a recurrence rate of 1% where as in translocation type like (21–21) if either parent is carrying same type of translocation then there is 100% rate of recurrence.
If there is h/o prior affected downs child screening test is not reassuring her so, better to go for direct invasive testing if she comes at first trimester go for CVS.
In Twin gestation.
Dichorionic twin- Free β-HCG and PAPP-A levels are nearly twice as high as singleton. Calculate the risk for each fetus based on maternal age and fetal NT. If one fetus the NT is increased look for other markers. Detection rate is 75–80%.
In monozygotic twins’ risk is same as singleton pregnancies.
In monochorionic twin pregnancies raised NT is an early manifestation of TTTS. So, false positive rate will be increased. Free beta HCG and PAPP-A levels are lower than dichorionic twin to twin transfusion syndrome as well as for chromosomal abnormality.
Calculate the risk of each fetus based on NT, serum biochemistry and then the average risk between the two fetuses is considered as whole.
No method is accurate for screening of fetal aneuploidy as it is in singleton pregnancy.
Appropriate Models for aneuploidy detection:
Age (not recommended).
CRL & NIPT (Ideal for first trimester, misses advantages of first trimester scan and expensive)
Age, CRL & NT (skill)
Age & Biochemistry (poor detection rate)
Age + CRL + Maternal factors +NT + PAPP-A + HCG (combined test)
Age + Maternal factors + CRL + NT + Additional markers + Biochemistry (enhanced sensitivity and low FPR but need time and skill)
First trimester combined test + second trimester Quad (sequential or integrated)
First trimester Quad: Age + historical factors + PAPP-A + βHCG + PIGF +AFP (risk for pre-eclampsia and NTD)
First trimester Penta: Combined test + Nasal bone + AFP + DIA + PIGF (high detection rate and low FPR).
In the economically privileged patient first trimester screening should include an 11–14 weeks complete assessment with first trimester combined screen, PIGF and NIPT. For population screening is by combined screening. Woman with positive screen test result should be counselled and offered the option of diagnostic testing. Those who have a negative test results should be counselled regarding their lower adjusted risk. Even if a woman has low risk results, she may choose diagnostic testing later in pregnancy whenever there is fetal anomalies or markers on follow-up sonography.
The authors wish to express thanks to all parentages involved for giving permission to collect the presented data. The authors also wish to express their thanks to Dr. Ashok Khurana, Dr. TLN Praveen and Dr. Krishna Gopal for the source of information.
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When a robot works in a structured environment, its automation is easier than in a non-structured environment in which case its modeling is quite difficult and presents a high computational effort. To overcome this difficulty, series elastic actuator (SEA) has been applied in compliant robotic grasping. Unlike rigid actuators, a SEA contains an elastic element in series with the mechanical energy source. Such an elastic element gives SEAs tolerance to impact loads, low mechanical output impedance, passive mechanical energy storage, and increased peak power output. The spring has to be able to support the loads, but it cannot be too stiff; otherwise, system impedance will be high. This chapter describes a comparison between two types of SEA, an electric series elastic actuator (ESEA) and a hydraulic series elastic actuator (HSEA), for four-legged dynamic robot application. 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The results indicate that HSEA is a better actuator than ESEA for a weight carrying four-legged dynamic robot because of its higher power density and dynamic ratio with desirable output impedance, time response, and bandwidth.",book:{id:"5245",slug:"recent-advances-in-robotic-systems",title:"Recent Advances in Robotic Systems",fullTitle:"Recent Advances in Robotic Systems"},signatures:"Arnaldo Gomes Leal Junior, Rafhael Milanezi de Andrade and\nAntônio Bento Filho",authors:[{id:"182082",title:"Dr.",name:"Rafhael",middleName:"Milanezi De",surname:"Andrade",slug:"rafhael-andrade",fullName:"Rafhael Andrade"},{id:"185372",title:"Dr.",name:"Antônio",middleName:null,surname:"Bento Filho",slug:"antonio-bento-filho",fullName:"Antônio Bento Filho"},{id:"185373",title:"MSc.",name:"Arnaldo",middleName:null,surname:"Gomes Leal Junior",slug:"arnaldo-gomes-leal-junior",fullName:"Arnaldo Gomes Leal Junior"}]},{id:"51357",doi:"10.5772/63746",title:"Muscle‐Like Compliance in Knee Articulations Improves Biped Robot Walkings",slug:"muscle-like-compliance-in-knee-articulations-improves-biped-robot-walkings",totalDownloads:1648,totalCrossrefCites:3,totalDimensionsCites:3,abstract:"This chapter focuses on the compliance effect of dynamic humanoid robot walking. This compliance is generated with an articular muscle emulator system, which is designed using two neural networks (NNs). One NN models a muscle and a second learns to tune the proportional integral derivative (PID) of the articulation DC motor, allowing it to behave analogously to the muscle model. Muscle emulators are implemented in the knees of a three‐dimensional (3D) simulated biped robot. The simulation results show that the muscle emulator creates compliance in articulations and that the dynamic walk, even in walk‐halt‐stop transitions, improves. If an external thrust unbalances the biped during the walk, the muscle emulator improves the control and prevents the robot from falling. The total power consumption is significantly reduced, and the articular trajectories approach human trajectories.",book:{id:"5245",slug:"recent-advances-in-robotic-systems",title:"Recent Advances in Robotic Systems",fullTitle:"Recent Advances in Robotic Systems"},signatures:"Hayssan Serhan and Patrick Henaff",authors:[{id:"184415",title:"Dr.",name:"Patrick",middleName:null,surname:"Henaff",slug:"patrick-henaff",fullName:"Patrick Henaff"},{id:"185026",title:"Dr.",name:"Hayssam",middleName:null,surname:"Serhan",slug:"hayssam-serhan",fullName:"Hayssam Serhan"}]},{id:"51618",doi:"10.5772/63575",title:"Validation and Experimental Testing of Observers for Robust GNSS-Aided Inertial Navigation",slug:"validation-and-experimental-testing-of-observers-for-robust-gnss-aided-inertial-navigation",totalDownloads:1677,totalCrossrefCites:2,totalDimensionsCites:3,abstract:"This chapter is the study of state estimators for robust navigation. Navigation of vehicles is a vast field with multiple decades of research. The main aim is to estimate position, linear velocity, and attitude (PVA) under all dynamics, motions, and conditions via data fusion. The state estimation problem will be considered from two different perspectives using the same kinematic model. First, the extended Kalman filter (EKF) will be reviewed, as an example of a stochastic approach; second, a recent nonlinear observer will be considered as a deterministic case. A comparative study of strapdown inertial navigation methods for estimating PVA of aerial vehicles fusing inertial sensors with global navigation satellite system (GNSS)-based positioning will be presented. The focus will be on the loosely coupled integration methods and performance analysis to compare these methods in terms of their stability, robustness to vibrations, and disturbances in measurements.",book:{id:"5245",slug:"recent-advances-in-robotic-systems",title:"Recent Advances in Robotic Systems",fullTitle:"Recent Advances in Robotic Systems"},signatures:"Jakob M. Hansen, Jan Roháč, Martin Šipoš, Tor A. Johansen and\nThor I. Fossen",authors:[{id:"132264",title:"Prof.",name:"Tor Arne",middleName:null,surname:"Johansen",slug:"tor-arne-johansen",fullName:"Tor Arne Johansen"},{id:"179630",title:"Prof.",name:"Thor",middleName:"I",surname:"Fossen",slug:"thor-fossen",fullName:"Thor Fossen"},{id:"179647",title:"Dr.",name:"Martin",middleName:null,surname:"Šipoš",slug:"martin-sipos",fullName:"Martin Šipoš"},{id:"179649",title:"Associate Prof.",name:"Jan",middleName:null,surname:"Rohac",slug:"jan-rohac",fullName:"Jan Rohac"},{id:"181258",title:"Mr.",name:"Jakob Mahler",middleName:null,surname:"Hansen",slug:"jakob-mahler-hansen",fullName:"Jakob Mahler Hansen"}]},{id:"50884",doi:"10.5772/63568",title:"Autonomous Quadrocopter for Search, Count and Localization of Objects",slug:"autonomous-quadrocopter-for-search-count-and-localization-of-objects",totalDownloads:1702,totalCrossrefCites:1,totalDimensionsCites:2,abstract:"This chapter describes and evaluates the design and implementation of a new fully autonomous quadrocopter, which is capable of self‐reliant search, count and localization of a predefined object on the ground inside a room.",book:{id:"5245",slug:"recent-advances-in-robotic-systems",title:"Recent Advances in Robotic Systems",fullTitle:"Recent Advances in Robotic Systems"},signatures:"Nils Gageik, Christian Reul and Sergio Montenegro",authors:[{id:"168230",title:"Ph.D. Student",name:"Nils",middleName:null,surname:"Gageik",slug:"nils-gageik",fullName:"Nils Gageik"},{id:"168231",title:"Prof.",name:"Sergio",middleName:null,surname:"Montenegro",slug:"sergio-montenegro",fullName:"Sergio Montenegro"},{id:"181110",title:"MSc.",name:"Christian",middleName:null,surname:"Reul",slug:"christian-reul",fullName:"Christian Reul"}]},{id:"51486",doi:"10.5772/64305",title:"Design, Implementation and Modeling of Flooding Disaster-Oriented USV",slug:"design-implementation-and-modeling-of-flooding-disaster-oriented-usv",totalDownloads:1884,totalCrossrefCites:2,totalDimensionsCites:2,abstract:"Although there exist some unmanned surface platforms, and parts of them have been applied in flooding disaster relief, the autonomy of these platforms is still so weak that most of them can only work under the control of operators. The primary reason is the difficulty of obtaining a dynamical model that is sufficient rich for model-based control and sufficient simple for model parameters identification. This makes them difficult to be used to achieve some high-performance autonomous control, such as robust control with respect to disturbances and unknown dynamics and trajectory tracking control in complicated and dynamical surroundings. In this chapter, a flooding disaster-oriented unmanned surface vehicle (USV) designed and implemented by Shenyang Institute of Automation, Chinese Academy of Sciences (SIA, CAS) is introduced first, including the hardware and software structures. Then, we propose a quasi-linear parameter varying (qLPV) model to approach the dynamics of the USV system. We first apply this to solve a structured modeling problem and then introduce model error to solve an unstructured modeling problem. Subsequently, the qLPV model identification results are analyzed and the superiority compared to two linear models is demonstrated. At last, extensive application experiments, including rescuing rope throwing using an automatic pneumatic and water sampling in a 2.5 m radius circle, are described in detail to show the performance of course keeping control and GPS point tracking control based on the proposed model.",book:{id:"5245",slug:"recent-advances-in-robotic-systems",title:"Recent Advances in Robotic Systems",fullTitle:"Recent Advances in Robotic Systems"},signatures:"Junfeng Xiong, Feng Gu, Decai Li, Yuqing He and Jianda Han",authors:[{id:"9884",title:"Dr.",name:"Yuqing",middleName:null,surname:"He",slug:"yuqing-he",fullName:"Yuqing He"},{id:"9921",title:"Prof.",name:"Jianda",middleName:null,surname:"Han",slug:"jianda-han",fullName:"Jianda Han"},{id:"185358",title:"Dr.",name:"Junfeng",middleName:null,surname:"Xiong",slug:"junfeng-xiong",fullName:"Junfeng Xiong"},{id:"185359",title:"Dr.",name:"Feng",middleName:null,surname:"Gu",slug:"feng-gu",fullName:"Feng Gu"},{id:"185360",title:"Dr.",name:"Decai",middleName:null,surname:"Li",slug:"decai-li",fullName:"Decai Li"}]}],mostDownloadedChaptersLast30Days:[{id:"51224",title:"Series Elastic Actuator: Design, Analysis and Comparison",slug:"series-elastic-actuator-design-analysis-and-comparison",totalDownloads:3415,totalCrossrefCites:4,totalDimensionsCites:10,abstract:"In general, actuators are built to be as stiff as possible to increase the bandwidth. When a robot works in a structured environment, its automation is easier than in a non-structured environment in which case its modeling is quite difficult and presents a high computational effort. To overcome this difficulty, series elastic actuator (SEA) has been applied in compliant robotic grasping. Unlike rigid actuators, a SEA contains an elastic element in series with the mechanical energy source. Such an elastic element gives SEAs tolerance to impact loads, low mechanical output impedance, passive mechanical energy storage, and increased peak power output. The spring has to be able to support the loads, but it cannot be too stiff; otherwise, system impedance will be high. This chapter describes a comparison between two types of SEA, an electric series elastic actuator (ESEA) and a hydraulic series elastic actuator (HSEA), for four-legged dynamic robot application. The parameters employed in the comparison are bandwidth, output impedance, time response, power density, and dynamic range. The results indicate that HSEA is a better actuator than ESEA for a weight carrying four-legged dynamic robot because of its higher power density and dynamic ratio with desirable output impedance, time response, and bandwidth.",book:{id:"5245",slug:"recent-advances-in-robotic-systems",title:"Recent Advances in Robotic Systems",fullTitle:"Recent Advances in Robotic Systems"},signatures:"Arnaldo Gomes Leal Junior, Rafhael Milanezi de Andrade and\nAntônio Bento Filho",authors:[{id:"182082",title:"Dr.",name:"Rafhael",middleName:"Milanezi De",surname:"Andrade",slug:"rafhael-andrade",fullName:"Rafhael Andrade"},{id:"185372",title:"Dr.",name:"Antônio",middleName:null,surname:"Bento Filho",slug:"antonio-bento-filho",fullName:"Antônio Bento Filho"},{id:"185373",title:"MSc.",name:"Arnaldo",middleName:null,surname:"Gomes Leal Junior",slug:"arnaldo-gomes-leal-junior",fullName:"Arnaldo Gomes Leal Junior"}]},{id:"50884",title:"Autonomous Quadrocopter for Search, Count and Localization of Objects",slug:"autonomous-quadrocopter-for-search-count-and-localization-of-objects",totalDownloads:1702,totalCrossrefCites:1,totalDimensionsCites:2,abstract:"This chapter describes and evaluates the design and implementation of a new fully autonomous quadrocopter, which is capable of self‐reliant search, count and localization of a predefined object on the ground inside a room.",book:{id:"5245",slug:"recent-advances-in-robotic-systems",title:"Recent Advances in Robotic Systems",fullTitle:"Recent Advances in Robotic Systems"},signatures:"Nils Gageik, Christian Reul and Sergio Montenegro",authors:[{id:"168230",title:"Ph.D. Student",name:"Nils",middleName:null,surname:"Gageik",slug:"nils-gageik",fullName:"Nils Gageik"},{id:"168231",title:"Prof.",name:"Sergio",middleName:null,surname:"Montenegro",slug:"sergio-montenegro",fullName:"Sergio Montenegro"},{id:"181110",title:"MSc.",name:"Christian",middleName:null,surname:"Reul",slug:"christian-reul",fullName:"Christian Reul"}]},{id:"51432",title:"CODA Algorithm: An Immune Algorithm for Reinforcement Learning Tasks",slug:"coda-algorithm-an-immune-algorithm-for-reinforcement-learning-tasks",totalDownloads:1540,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"This document presents the design of an algorithm that takes on its basis: reinforcement learning, learning from demonstration and most importantly Artificial Immune Systems. The main advantage of this algorithm named CODA (Cognition from Data). Is; it can learn from limited data samples- that is given a single example and the algorithm will create its own knowledge. The algorithm imitates from the Natural Immune System the clonal procedure for obtaining a repertoire of antibodies from a single antigen. It also uses the self-organised memory in order to reduce searching time in the whole action-state space by searching in specific clusters. CODA algorithm is presented and explained in detail in order to understand how these three principles are used. The algorithm is explained with pseudocode, flowcharts and block diagrams. The clonal/mutation results are presented with a simple example. It can be seen graphically how new data that has a completely new probability distribution. Finally, the first application where CODA is used, a humanoid hand is presented. In this application the algorithm created affordable grasping postures from limited examples, creates its own knowledge and stores data in memory data in memory in order to recognise whether it has been on a similar situation.",book:{id:"5245",slug:"recent-advances-in-robotic-systems",title:"Recent Advances in Robotic Systems",fullTitle:"Recent Advances in Robotic Systems"},signatures:"Daniel R. Ramirez Rebollo, Pedro Ponce Cruz and Arturo Molina",authors:[{id:"181021",title:"Ph.D. Student",name:"Daniel",middleName:"Rodrigo",surname:"Ramirez Rebollo",slug:"daniel-ramirez-rebollo",fullName:"Daniel Ramirez Rebollo"},{id:"181149",title:"Dr.",name:"Pedro",middleName:null,surname:"Ponce",slug:"pedro-ponce",fullName:"Pedro Ponce"},{id:"181151",title:"Dr.",name:"Arturo",middleName:null,surname:"Molina",slug:"arturo-molina",fullName:"Arturo Molina"}]},{id:"51357",title:"Muscle‐Like Compliance in Knee Articulations Improves Biped Robot Walkings",slug:"muscle-like-compliance-in-knee-articulations-improves-biped-robot-walkings",totalDownloads:1648,totalCrossrefCites:3,totalDimensionsCites:3,abstract:"This chapter focuses on the compliance effect of dynamic humanoid robot walking. This compliance is generated with an articular muscle emulator system, which is designed using two neural networks (NNs). One NN models a muscle and a second learns to tune the proportional integral derivative (PID) of the articulation DC motor, allowing it to behave analogously to the muscle model. Muscle emulators are implemented in the knees of a three‐dimensional (3D) simulated biped robot. The simulation results show that the muscle emulator creates compliance in articulations and that the dynamic walk, even in walk‐halt‐stop transitions, improves. If an external thrust unbalances the biped during the walk, the muscle emulator improves the control and prevents the robot from falling. The total power consumption is significantly reduced, and the articular trajectories approach human trajectories.",book:{id:"5245",slug:"recent-advances-in-robotic-systems",title:"Recent Advances in Robotic Systems",fullTitle:"Recent Advances in Robotic Systems"},signatures:"Hayssan Serhan and Patrick Henaff",authors:[{id:"184415",title:"Dr.",name:"Patrick",middleName:null,surname:"Henaff",slug:"patrick-henaff",fullName:"Patrick Henaff"},{id:"185026",title:"Dr.",name:"Hayssam",middleName:null,surname:"Serhan",slug:"hayssam-serhan",fullName:"Hayssam Serhan"}]},{id:"51053",title:"Recent Developments in Monocular SLAM within the HRI Framework",slug:"recent-developments-in-monocular-slam-within-the-hri-framework",totalDownloads:1869,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"This chapter describes an approach to improve the feature initialization process in the delayed inverse-depth feature initialization monocular Simultaneous Localisation and Mapping (SLAM), using data provided by a robot’s camera plus an additional monocular sensor deployed in the headwear of the human component in a human-robot collaborative exploratory team. The robot and the human deploy a set of sensors that once combined provides the data required to localize the secondary camera worn by the human. The approach and its implementation are described along with experimental results demonstrating its performance. A discussion on the usual sensors within the robotics field, especially in SLAM, provides background to the advantages and capabilities of the system implemented in this research.",book:{id:"5245",slug:"recent-advances-in-robotic-systems",title:"Recent Advances in Robotic Systems",fullTitle:"Recent Advances in Robotic Systems"},signatures:"Edmundo Guerra, Yolanda Bolea, Rodrigo Munguia and Antoni\nGrau",authors:[{id:"13038",title:"Prof.",name:"Antoni",middleName:null,surname:"Grau",slug:"antoni-grau",fullName:"Antoni Grau"},{id:"18024",title:"Dr.",name:"Yolanda",middleName:null,surname:"Bolea",slug:"yolanda-bolea",fullName:"Yolanda Bolea"},{id:"163432",title:"Dr.",name:"Rodrigo",middleName:null,surname:"Munguia",slug:"rodrigo-munguia",fullName:"Rodrigo Munguia"},{id:"165970",title:"Ph.D. Student",name:"Edmundo",middleName:null,surname:"Guerra",slug:"edmundo-guerra",fullName:"Edmundo Guerra"}]}],onlineFirstChaptersFilter:{topicId:"1291",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:0,limit:8,total:null},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:87,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:99,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:27,numberOfPublishedChapters:288,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:9,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:139,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:129,numberOfOpenTopics:0,numberOfUpcomingTopics:2,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!1},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:107,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:104,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:12,numberOfOpenTopics:2,numberOfUpcomingTopics:1,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:0,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!1},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:11,numberOfOpenTopics:4,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. 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In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. He is currently the Editor in Chief of the journal Travel Medicine and Infectious Diseases. 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Silva, Eliete A. Alvin, Lais S. de Jesus, Caio C.L. de França, Marílya P.G. da Silva, Samaysa L. Lins, Diógenes Meneses, Marcela R. Lemes, Rhanoica O. Guerra, Marcos V. da Silva, Carlo J.F. de Oliveira, Virmondes Rodrigues Junior, Renata M. Etchebehere, Fabiane C. de Abreu, Bruno G. Lucca, Sanívia A.L. Pereira, Rodrigo C. Rosa and Noelio O. 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His research interest focuses on computational chemistry and molecular modeling of diverse systems of pharmacological, food, and alternative energy interests by resorting to DFT and Conceptual DFT. He has authored a coauthored more than 255 peer-reviewed papers, 32 book chapters, and 2 edited books. He has delivered speeches at many international and domestic conferences. He serves as a reviewer for more than eighty international journals, books, and research proposals as well as an editor for special issues of renowned scientific journals.",institutionString:"Centro de Investigación en Materiales Avanzados",institution:{name:"Centro de Investigación en Materiales Avanzados",country:{name:"Mexico"}}},{id:"76477",title:"Prof.",name:"Mirza",middleName:null,surname:"Hasanuzzaman",slug:"mirza-hasanuzzaman",fullName:"Mirza Hasanuzzaman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/76477/images/system/76477.png",biography:"Dr. Mirza Hasanuzzaman is a Professor of Agronomy at Sher-e-Bangla Agricultural University, Bangladesh. He received his Ph.D. in Plant Stress Physiology and Antioxidant Metabolism from Ehime University, Japan, with a scholarship from the Japanese Government (MEXT). Later, he completed his postdoctoral research at the Center of Molecular Biosciences, University of the Ryukyus, Japan, as a recipient of the Japan Society for the Promotion of Science (JSPS) postdoctoral fellowship. He was also the recipient of the Australian Government Endeavour Research Fellowship for postdoctoral research as an adjunct senior researcher at the University of Tasmania, Australia. Dr. Hasanuzzaman’s current work is focused on the physiological and molecular mechanisms of environmental stress tolerance. Dr. Hasanuzzaman has published more than 150 articles in peer-reviewed journals. He has edited ten books and written more than forty book chapters on important aspects of plant physiology, plant stress tolerance, and crop production. According to Scopus, Dr. Hasanuzzaman’s publications have received more than 10,500 citations with an h-index of 53. He has been named a Highly Cited Researcher by Clarivate. He is an editor and reviewer for more than fifty peer-reviewed international journals and was a recipient of the “Publons Peer Review Award” in 2017, 2018, and 2019. He has been honored by different authorities for his outstanding performance in various fields like research and education, and he has received the World Academy of Science Young Scientist Award (2014) and the University Grants Commission (UGC) Award 2018. He is a fellow of the Bangladesh Academy of Sciences (BAS) and the Royal Society of Biology.",institutionString:"Sher-e-Bangla Agricultural University",institution:{name:"Sher-e-Bangla Agricultural University",country:{name:"Bangladesh"}}},{id:"187859",title:"Prof.",name:"Kusal",middleName:"K.",surname:"Das",slug:"kusal-das",fullName:"Kusal Das",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSBDeQAO/Profile_Picture_1623411145568",biography:"Kusal K. Das is a Distinguished Chair Professor of Physiology, Shri B. M. Patil Medical College and Director, Centre for Advanced Medical Research (CAMR), BLDE (Deemed to be University), Vijayapur, Karnataka, India. Dr. Das did his M.S. and Ph.D. in Human Physiology from the University of Calcutta, Kolkata. His area of research is focused on understanding of molecular mechanisms of heavy metal activated low oxygen sensing pathways in vascular pathophysiology. He has invented a new method of estimation of serum vitamin E. His expertise in critical experimental protocols on vascular functions in experimental animals was well documented by his quality of publications. He was a Visiting Professor of Medicine at University of Leeds, United Kingdom (2014-2016) and Tulane University, New Orleans, USA (2017). For his immense contribution in medical research Ministry of Science and Technology, Government of India conferred him 'G.P. Chatterjee Memorial Research Prize-2019” and he is also the recipient of 'Dr.Raja Ramanna State Scientist Award 2015” by Government of Karnataka. He is a Fellow of the Royal Society of Biology (FRSB), London and Honorary Fellow of Karnataka Science and Technology Academy, Department of Science and Technology, Government of Karnataka.",institutionString:"BLDE (Deemed to be University), India",institution:null},{id:"243660",title:"Dr.",name:"Mallanagouda Shivanagouda",middleName:null,surname:"Biradar",slug:"mallanagouda-shivanagouda-biradar",fullName:"Mallanagouda Shivanagouda Biradar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/243660/images/system/243660.jpeg",biography:"M. S. Biradar is Vice Chancellor and Professor of Medicine of\nBLDE (Deemed to be University), Vijayapura, Karnataka, India.\nHe obtained his MD with a gold medal in General Medicine and\nhas devoted himself to medical teaching, research, and administrations. He has also immensely contributed to medical research\non vascular medicine, which is reflected by his numerous publications including books and book chapters. Professor Biradar was\nalso Visiting Professor at Tulane University School of Medicine, New Orleans, USA.",institutionString:"BLDE (Deemed to be University)",institution:{name:"BLDE University",country:{name:"India"}}},{id:"289796",title:"Dr.",name:"Swastika",middleName:null,surname:"Das",slug:"swastika-das",fullName:"Swastika Das",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/289796/images/system/289796.jpeg",biography:"Swastika N. Das is Professor of Chemistry at the V. P. Dr. P. G.\nHalakatti College of Engineering and Technology, BLDE (Deemed\nto be University), Vijayapura, Karnataka, India. She obtained an\nMSc, MPhil, and PhD in Chemistry from Sambalpur University,\nOdisha, India. Her areas of research interest are medicinal chemistry, chemical kinetics, and free radical chemistry. She is a member\nof the investigators who invented a new modified method of estimation of serum vitamin E. She has authored numerous publications including book\nchapters and is a mentor of doctoral curriculum at her university.",institutionString:"BLDEA’s V.P.Dr.P.G.Halakatti College of Engineering & Technology",institution:{name:"BLDE University",country:{name:"India"}}},{id:"248459",title:"Dr.",name:"Akikazu",middleName:null,surname:"Takada",slug:"akikazu-takada",fullName:"Akikazu Takada",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/248459/images/system/248459.png",biography:"Akikazu Takada was born in Japan, 1935. After graduation from\nKeio University School of Medicine and finishing his post-graduate studies, he worked at Roswell Park Memorial Institute NY,\nUSA. He then took a professorship at Hamamatsu University\nSchool of Medicine. In thrombosis studies, he found the SK\npotentiator that enhances plasminogen activation by streptokinase. He is very much interested in simultaneous measurements\nof fatty acids, amino acids, and tryptophan degradation products. By using fatty\nacid analyses, he indicated that plasma levels of trans-fatty acids of old men were\nfar higher in the US than Japanese men. . He also showed that eicosapentaenoic acid\n(EPA) and docosahexaenoic acid (DHA) levels are higher, and arachidonic acid\nlevels are lower in Japanese than US people. By using simultaneous LC/MS analyses\nof plasma levels of tryptophan metabolites, he recently found that plasma levels of\nserotonin, kynurenine, or 5-HIAA were higher in patients of mono- and bipolar\ndepression, which are significantly different from observations reported before. In\nview of recent reports that plasma tryptophan metabolites are mainly produced by\nmicrobiota. He is now working on the relationships between microbiota and depression or autism.",institutionString:"Hamamatsu University School of Medicine",institution:{name:"Hamamatsu University School of Medicine",country:{name:"Japan"}}},{id:"137240",title:"Prof.",name:"Mohammed",middleName:null,surname:"Khalid",slug:"mohammed-khalid",fullName:"Mohammed Khalid",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/137240/images/system/137240.png",biography:"Mohammed Khalid received his B.S. degree in chemistry in 2000 and Ph.D. degree in physical chemistry in 2007 from the University of Khartoum, Sudan. He moved to School of Chemistry, Faculty of Science, University of Sydney, Australia in 2009 and joined Dr. Ron Clarke as a postdoctoral fellow where he worked on the interaction of ATP with the phosphoenzyme of the Na+/K+-ATPase and dual mechanisms of allosteric acceleration of the Na+/K+-ATPase by ATP; then he went back to Department of Chemistry, University of Khartoum as an assistant professor, and in 2014 he was promoted as an associate professor. In 2011, he joined the staff of Department of Chemistry at Taif University, Saudi Arabia, where he is currently an assistant professor. His research interests include the following: P-Type ATPase enzyme kinetics and mechanisms, kinetics and mechanisms of redox reactions, autocatalytic reactions, computational enzyme kinetics, allosteric acceleration of P-type ATPases by ATP, exploring of allosteric sites of ATPases, and interaction of ATP with ATPases located in cell membranes.",institutionString:"Taif University",institution:{name:"Taif University",country:{name:"Saudi Arabia"}}},{id:"63810",title:"Prof.",name:"Jorge",middleName:null,surname:"Morales-Montor",slug:"jorge-morales-montor",fullName:"Jorge Morales-Montor",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/63810/images/system/63810.png",biography:"Dr. Jorge Morales-Montor was recognized with the Lola and Igo Flisser PUIS Award for best graduate thesis at the national level in the field of parasitology. He received a fellowship from the Fogarty Foundation to perform postdoctoral research stay at the University of Georgia. He has 153 journal articles to his credit. He has also edited several books and published more than fifty-five book chapters. He is a member of the Mexican Academy of Sciences, Latin American Academy of Sciences, and the National Academy of Medicine. He has received more than thirty-five awards and has supervised numerous bachelor’s, master’s, and Ph.D. students. Dr. Morales-Montor is the past president of the Mexican Society of Parasitology.",institutionString:"National Autonomous University of Mexico",institution:{name:"National Autonomous University of Mexico",country:{name:"Mexico"}}},{id:"217215",title:"Dr.",name:"Palash",middleName:null,surname:"Mandal",slug:"palash-mandal",fullName:"Palash Mandal",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/217215/images/system/217215.jpeg",biography:null,institutionString:"Charusat University",institution:null},{id:"49739",title:"Dr.",name:"Leszek",middleName:null,surname:"Szablewski",slug:"leszek-szablewski",fullName:"Leszek Szablewski",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/49739/images/system/49739.jpg",biography:"Leszek Szablewski is a professor of medical sciences. He received his M.S. in the Faculty of Biology from the University of Warsaw and his PhD degree from the Institute of Experimental Biology Polish Academy of Sciences. He habilitated in the Medical University of Warsaw, and he obtained his degree of Professor from the President of Poland. Professor Szablewski is the Head of Chair and Department of General Biology and Parasitology, Medical University of Warsaw. Professor Szablewski has published over 80 peer-reviewed papers in journals such as Journal of Alzheimer’s Disease, Biochim. Biophys. Acta Reviews of Cancer, Biol. Chem., J. Biomed. Sci., and Diabetes/Metabol. Res. Rev, Endocrine. He is the author of two books and four book chapters. He has edited four books, written 15 scripts for students, is the ad hoc reviewer of over 30 peer-reviewed journals, and editorial member of peer-reviewed journals. Prof. Szablewski’s research focuses on cell physiology, genetics, and pathophysiology. He works on the damage caused by lack of glucose homeostasis and changes in the expression and/or function of glucose transporters due to various diseases. He has given lectures, seminars, and exercises for students at the Medical University.",institutionString:"Medical University of Warsaw",institution:{name:"Medical University of Warsaw",country:{name:"Poland"}}},{id:"173123",title:"Dr.",name:"Maitham",middleName:null,surname:"Khajah",slug:"maitham-khajah",fullName:"Maitham Khajah",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/173123/images/system/173123.jpeg",biography:"Dr. Maitham A. Khajah received his degree in Pharmacy from Faculty of Pharmacy, Kuwait University, in 2003 and obtained his PhD degree in December 2009 from the University of Calgary, Canada (Gastrointestinal Science and Immunology). Since January 2010 he has been assistant professor in Kuwait University, Faculty of Pharmacy, Department of Pharmacology and Therapeutics. His research interest are molecular targets for the treatment of inflammatory bowel disease (IBD) and the mechanisms responsible for immune cell chemotaxis. He cosupervised many students for the MSc Molecular Biology Program, College of Graduate Studies, Kuwait University. Ever since joining Kuwait University in 2010, he got various grants as PI and Co-I. He was awarded the Best Young Researcher Award by Kuwait University, Research Sector, for the Year 2013–2014. He was a member in the organizing committee for three conferences organized by Kuwait University, Faculty of Pharmacy, as cochair and a member in the scientific committee (the 3rd, 4th, and 5th Kuwait International Pharmacy Conference).",institutionString:"Kuwait University",institution:{name:"Kuwait University",country:{name:"Kuwait"}}},{id:"195136",title:"Dr.",name:"Aya",middleName:null,surname:"Adel",slug:"aya-adel",fullName:"Aya Adel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/195136/images/system/195136.jpg",biography:"Dr. Adel works as an Assistant Lecturer in the unit of Phoniatrics, Department of Otolaryngology, Ain Shams University in Cairo, Egypt. Dr. Adel is especially interested in joint attention and its impairment in autism spectrum disorder",institutionString:"Ain Shams University",institution:{name:"Ain Shams University",country:{name:"Egypt"}}},{id:"94911",title:"Dr.",name:"Boulenouar",middleName:null,surname:"Mesraoua",slug:"boulenouar-mesraoua",fullName:"Boulenouar Mesraoua",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94911/images/system/94911.png",biography:"Dr Boulenouar Mesraoua is the Associate Professor of Clinical Neurology at Weill Cornell Medical College-Qatar and a Consultant Neurologist at Hamad Medical Corporation at the Neuroscience Department; He graduated as a Medical Doctor from the University of Oran, Algeria; he then moved to Belgium, the City of Liege, for a Residency in Internal Medicine and Neurology at Liege University; after getting the Belgian Board of Neurology (with high marks), he went to the National Hospital for Nervous Diseases, Queen Square, London, United Kingdom for a fellowship in Clinical Neurophysiology, under Pr Willison ; Dr Mesraoua had also further training in Epilepsy and Continuous EEG Monitoring for two years (from 2001-2003) in the Neurophysiology department of Zurich University, Switzerland, under late Pr Hans Gregor Wieser ,an internationally known epileptologist expert. \n\nDr B. Mesraoua is the Director of the Neurology Fellowship Program at the Neurology Section and an active member of the newly created Comprehensive Epilepsy Program at Hamad General Hospital, Doha, Qatar; he is also Assistant Director of the Residency Program at the Qatar Medical School. \nDr B. Mesraoua's main interests are Epilepsy, Multiple Sclerosis, and Clinical Neurology; He is the Chairman and the Organizer of the well known Qatar Epilepsy Symposium, he is running yearly for the past 14 years and which is considered a landmark in the Gulf region; He has also started last year , together with other epileptologists from Qatar, the region and elsewhere, a yearly International Epilepsy School Course, which was attended by many neurologists from the Area.\n\nInternationally, Dr Mesraoua is an active and elected member of the Commission on Eastern Mediterranean Region (EMR ) , a regional branch of the International League Against Epilepsy (ILAE), where he represents the Middle East and North Africa(MENA ) and where he holds the position of chief of the Epilepsy Epidemiology Section; Dr Mesraoua is a member of the American Academy of Neurology, the Europeen Academy of Neurology and the American Epilepsy Society.\n\nDr Mesraoua's main objectives are to encourage frequent gathering of the epileptologists/neurologists from the MENA region and the rest of the world, promote Epilepsy Teaching in the MENA Region, and encourage multicenter studies involving neurologists and epileptologists in the MENA region, particularly epilepsy epidemiological studies. \n\nDr. Mesraoua is the recipient of two research Grants, as the Lead Principal Investigator (750.000 USD and 250.000 USD) from the Qatar National Research Fund (QNRF) and the Hamad Hospital Internal Research Grant (IRGC), on the following topics : “Continuous EEG Monitoring in the ICU “ and on “Alpha-lactoalbumin , proof of concept in the treatment of epilepsy” .Dr Mesraoua is a reviewer for the journal \"seizures\" (Europeen Epilepsy Journal ) as well as dove journals ; Dr Mesraoua is the author and co-author of many peer reviewed publications and four book chapters in the field of Epilepsy and Clinical Neurology",institutionString:"Weill Cornell Medical College in Qatar",institution:{name:"Weill Cornell Medical College in Qatar",country:{name:"Qatar"}}},{id:"282429",title:"Prof.",name:"Covanis",middleName:null,surname:"Athanasios",slug:"covanis-athanasios",fullName:"Covanis Athanasios",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/282429/images/system/282429.jpg",biography:null,institutionString:"Neurology-Neurophysiology Department of the Children Hospital Agia Sophia",institution:null},{id:"190980",title:"Prof.",name:"Marwa",middleName:null,surname:"Mahmoud Saleh",slug:"marwa-mahmoud-saleh",fullName:"Marwa Mahmoud Saleh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/190980/images/system/190980.jpg",biography:"Professor Marwa Mahmoud Saleh is a doctor of medicine and currently works in the unit of Phoniatrics, Department of Otolaryngology, Ain Shams University in Cairo, Egypt. She got her doctoral degree in 1991 and her doctoral thesis was accomplished in the University of Iowa, United States. Her publications covered a multitude of topics as videokymography, cochlear implants, stuttering, and dysphagia. She has lectured Egyptian phonology for many years. Her recent research interest is joint attention in autism.",institutionString:"Ain Shams University",institution:{name:"Ain Shams University",country:{name:"Egypt"}}},{id:"259190",title:"Dr.",name:"Syed Ali Raza",middleName:null,surname:"Naqvi",slug:"syed-ali-raza-naqvi",fullName:"Syed Ali Raza Naqvi",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259190/images/system/259190.png",biography:"Dr. Naqvi is a radioanalytical chemist and is working as an associate professor of analytical chemistry in the Department of Chemistry, Government College University, Faisalabad, Pakistan. Advance separation techniques, nuclear analytical techniques and radiopharmaceutical analysis are the main courses that he is teaching to graduate and post-graduate students. In the research area, he is focusing on the development of organic- and biomolecule-based radiopharmaceuticals for diagnosis and therapy of infectious and cancerous diseases. Under the supervision of Dr. Naqvi, three students have completed their Ph.D. degrees and 41 students have completed their MS degrees. He has completed three research projects and is currently working on 2 projects entitled “Radiolabeling of fluoroquinolone derivatives for the diagnosis of deep-seated bacterial infections” and “Radiolabeled minigastrin peptides for diagnosis and therapy of NETs”. He has published about 100 research articles in international reputed journals and 7 book chapters. Pakistan Institute of Nuclear Science & Technology (PINSTECH) Islamabad, Punjab Institute of Nuclear Medicine (PINM), Faisalabad and Institute of Nuclear Medicine and Radiology (INOR) Abbottabad are the main collaborating institutes.",institutionString:"Government College University",institution:{name:"Government College University, Faisalabad",country:{name:"Pakistan"}}},{id:"58390",title:"Dr.",name:"Gyula",middleName:null,surname:"Mozsik",slug:"gyula-mozsik",fullName:"Gyula Mozsik",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/58390/images/system/58390.png",biography:"Gyula Mózsik MD, Ph.D., ScD (med), is an emeritus professor of Medicine at the First Department of Medicine, Univesity of Pécs, Hungary. He was head of this department from 1993 to 2003. His specializations are medicine, gastroenterology, clinical pharmacology, clinical nutrition, and dietetics. His research fields are biochemical pharmacological examinations in the human gastrointestinal (GI) mucosa, mechanisms of retinoids, drugs, capsaicin-sensitive afferent nerves, and innovative pharmacological, pharmaceutical, and nutritional (dietary) research in humans. He has published about 360 peer-reviewed papers, 197 book chapters, 692 abstracts, 19 monographs, and has edited 37 books. He has given about 1120 regular and review lectures. He has organized thirty-eight national and international congresses and symposia. He is the founder of the International Conference on Ulcer Research (ICUR); International Union of Pharmacology, Gastrointestinal Section (IUPHAR-GI); Brain-Gut Society symposiums, and gastrointestinal cytoprotective symposiums. He received the Andre Robert Award from IUPHAR-GI in 2014. Fifteen of his students have been appointed as full professors in Egypt, Cuba, and Hungary.",institutionString:"University of Pécs",institution:{name:"University of Pecs",country:{name:"Hungary"}}},{id:"277367",title:"M.Sc.",name:"Daniel",middleName:"Martin",surname:"Márquez López",slug:"daniel-marquez-lopez",fullName:"Daniel Márquez López",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/277367/images/7909_n.jpg",biography:"Msc Daniel Martin Márquez López has a bachelor degree in Industrial Chemical Engineering, a Master of science degree in the same área and he is a PhD candidate for the Instituto Politécnico Nacional. His Works are realted to the Green chemistry field, biolubricants, biodiesel, transesterification reactions for biodiesel production and the manipulation of oils for therapeutic purposes.",institutionString:null,institution:{name:"Instituto Politécnico Nacional",country:{name:"Mexico"}}},{id:"196544",title:"Prof.",name:"Angel",middleName:null,surname:"Catala",slug:"angel-catala",fullName:"Angel Catala",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/196544/images/system/196544.jpg",biography:"Angel Catalá studied chemistry at Universidad Nacional de La Plata, Argentina, where he received a Ph.D. in Chemistry (Biological Branch) in 1965. From 1964 to 1974, he worked as an Assistant in Biochemistry at the School of Medicine at the same university. From 1974 to 1976, he was a fellow of the National Institutes of Health (NIH) at the University of Connecticut, Health Center, USA. From 1985 to 2004, he served as a Full Professor of Biochemistry at the Universidad Nacional de La Plata. He is a member of the National Research Council (CONICET), Argentina, and the Argentine Society for Biochemistry and Molecular Biology (SAIB). His laboratory has been interested for many years in the lipid peroxidation of biological membranes from various tissues and different species. Dr. Catalá has directed twelve doctoral theses, published more than 100 papers in peer-reviewed journals, several chapters in books, and edited twelve books. He received awards at the 40th International Conference Biochemistry of Lipids 1999 in Dijon, France. He is the winner of the Bimbo Pan-American Nutrition, Food Science and Technology Award 2006 and 2012, South America, Human Nutrition, Professional Category. In 2006, he won the Bernardo Houssay award in pharmacology, in recognition of his meritorious works of research. Dr. Catalá belongs to the editorial board of several journals including Journal of Lipids; International Review of Biophysical Chemistry; Frontiers in Membrane Physiology and Biophysics; World Journal of Experimental Medicine and Biochemistry Research International; World Journal of Biological Chemistry, Diabetes, and the Pancreas; International Journal of Chronic Diseases & Therapy; and International Journal of Nutrition. He is the co-editor of The Open Biology Journal and associate editor for Oxidative Medicine and Cellular Longevity.",institutionString:"Universidad Nacional de La Plata",institution:{name:"National University of La Plata",country:{name:"Argentina"}}},{id:"186585",title:"Dr.",name:"Francisco Javier",middleName:null,surname:"Martin-Romero",slug:"francisco-javier-martin-romero",fullName:"Francisco Javier Martin-Romero",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSB3HQAW/Profile_Picture_1631258137641",biography:"Francisco Javier Martín-Romero (Javier) is a Professor of Biochemistry and Molecular Biology at the University of Extremadura, Spain. He is also a group leader at the Biomarkers Institute of Molecular Pathology. Javier received his Ph.D. in 1998 in Biochemistry and Biophysics. At the National Cancer Institute (National Institute of Health, Bethesda, MD) he worked as a research associate on the molecular biology of selenium and its role in health and disease. After postdoctoral collaborations with Carlos Gutierrez-Merino (University of Extremadura, Spain) and Dario Alessi (University of Dundee, UK), he established his own laboratory in 2008. 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