Summary of studies investigating canine forelimb and/or elbow joint kinematics.
\r\n\tSynthetic zeolites can be formed from different raw materials and among these many wastes represent some interesting sources due to their chemical and mineralogical composition. Today, a large number of different types of waste resulting from many human activities are produced in the world (e.g. industrial, municipal, agricultural waste) and most of them are deposed of in landfills thus determining a great environmental problem.
\r\n\r\n\tThis book intends to provide the reader with a comprehensive overview of the current state-of-the-art on the possibility to transform the different types of waste materials into useful products, zeolites, through conventional processes and innovative methods. The aim is to demonstrate that waste can be a problem or a resource depending on how it is managed.
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Lawrie",coverURL:"https://cdn.intechopen.com/books/images_new/1830.jpg",editedByType:"Edited by",editors:[{id:"103158",title:"Dr.",name:"Charles",surname:"Lawrie",slug:"charles-lawrie",fullName:"Charles Lawrie"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},onlineFirst:{chapter:{type:"chapter",id:"78503",title:"Biomechanics of the Canine Elbow Joint",doi:"10.5772/intechopen.99569",slug:"biomechanics-of-the-canine-elbow-joint",body:'The canine elbow joint is a complex joint, whose musculoskeletal anatomy is well investigated. However, the in vivo function of the elbow joint, the individual movement of the humerus, radius and ulna relative to each other and the load distribution within the joint is still subject of present and future research. Especially pathophysiological motion of the elbow joint, leading to a mechanical overload of certain joint compartments, is not well understood and an interesting field of present veterinary research. Canine developmental elbow disease (DED), in particular medial coronoid disease (MCD), is one of the most common reasons for forelimb lameness in the dog and therefore this topic has not only academic, but also clinical relevance.
The canine elbow joint is composed of the humerus proximally and the radius and ulna distally, and can be divided into three joint compartments: the humero-ulnar, humero-radial and proximal radio-ulnar joint [1, 2]. The humero-ulnar joint is formed by the humeral trochlea and intercondylar region of the condyle and the ulnar trochlear notch, which extends from the anconeal process to the radial incisure, and continues to the medial coronoid process of the ulna. The humero-radial joint is formed by the capitulum of the humeral condyle and the radial head. The radial incisure and the medial aspect of the radial head form the proximal radio-ulnar joint. Altogether the elbow joint acts as a hinge joint (ginglymus) with extension and flexion being the main motion pattern and some amount of pronation and supination, mainly taken over by the radio-ulnar joint [1].
In healthy canine elbows the radio-ulnar joint shows a congruent shape without any step formation between the ulnar and radial joint surface, at least under static conditions. However, the humero-ulnar joint is not perfectly congruent even in healthy dogs [3, 4, 5, 6]. The radii of curvature of the humeral condyle and ulnar trochlear notch show different values along their curvilinear course, resulting in reduced contact in the central notch region [3, 4, 5, 6, 7]. The trochlear notch shows a slightly elliptical shape, so that the anconeal process and distal aspect of the notch as well as the coronoid process are in contact with the humeral condyle. This kind of physiological humero-ulnar incongruence was first described in humans and could be detected in the canine elbow joint, too [4, 5, 6, 8, 9].
The maximum range of motion (ROM) varies between 110 to 150 degrees, with breed-specific maximum flexion of 25 to 49 degrees and maximum extension of 155 to 175 degrees [10, 11, 12, 13, 14]. The main extensor muscle of the elbow joint is the triceps brachii muscle [1]. Further this muscle prevents flexion of the elbow during the stance phase. The anconeal and tensor fasciae antebrachii muscles are additional extensors of the elbow joint. Flexion is performed by the biceps brachii and brachial muscles. The extensor carpi radialis muscle contributes to flexor function to some amount. The canine antebrachium can be pronated 17 to 50 degrees and supinated 31 to 70 degrees [10, 15]. The supinator and brachioradial muscles are responsible for supination of the antebrachium. The latter contributes only minimal to supination and is missing in some individuals [16]. The pronator teres and pronator quadratus muscles are responsible for pronation and the pronator teres muscle is supposed to contribute to elbow joint flexion as well [1, 2].
Four ligaments support the elbow joint: the medial and lateral collateral ligament, the annular ligament and interosseous ligament/interosseous membrane [1, 2]. The medial and lateral collateral ligaments origin from the medial and lateral humeral epicondyle. The medial collateral divides into two crura. The cranial one is weaker and attaches at the radius, while the stronger caudal one attaches mainly at the ulna and to some amount at the radius. The lateral collateral ligament consists of two crura as well. The cranial part attaches to the radius, and the caudal part attaches to the ulna and colligates with the annular ligament, which can contain a sesamoid bone [2]. The annular ligament runs transversely around the radial head spanning from the lateral to the medial aspect of the radial incisure of the ulna. It runs underneath the medial and lateral collateral ligaments. The radius and ulna are further attached to each other by the interosseous ligament and interosseous membrane, which spans the interosseous space. Distally the radius and ulna are connected to each other by the radioulnar ligament.
Kinematics describe the motion of body segments without measuring the forces acting onto that segments. Kinematic analysis allows evaluation of the range of motion, angular velocities, segmental velocities of each portion of the limb, stride frequency and stride length [17]. Depending on the technique used for the kinematic analysis, motion of bones and joints can be measured with a submillimeter accuracy [18, 19, 20].
Generally two forms of kinematic analysis can be differentiated: the video-kinematography, based on a video motion capture system, and the radiostereometric kinematic analysis (RSA), based on a radiographic system, coupled with high speed video cameras. Video motion capture kinematic systems use skin markers, attached to specific body areas, which are tracked in the generated videos of the moving animal and allow for calculation of the aforementioned parameters. Radiostereometric analysis can be marker based or performed without bone markers [21, 22, 23, 24, 25, 26, 27, 28, 29, 30]. Furthermore, both kinematic analysis systems can be used to evaluate motion in the two or three dimensional (2D, 3D) space, depending on the technical setup [17].
The most commonly used technique is a video motion capture system based analysis. This technique is non-invasive and allows for evaluation of overall limb, limb segment or body segment motion. However, skin mounted markers do not match exactly the movement of the underlying bones. Movement of the soft tissues results in skin motion artifacts [21, 28, 31, 32, 33, 34, 35], with a difference of 0.4 to 1.2 cm between the skin marker and respective underlying bony landmark in small animals [33]. Especially in the proximal joints of the forelimb skin marker based data differ significantly from fluoroscopically gained kinematic data [28]. Comparison of biplanar fluoroscopy and video-kinematography in hindlimb kinematics revealed significant differences between both techniques, too [21]. Skin marker based data tend to project different trajectories and smaller amplitudes compared to fluoroscopic kinematography with particularly contradictory results, especially in proximal joints, where increased soft tissues can be found [21].
Radiostereometric analysis, also called fluoroscopic kinematography, allows for the most accurate kinematic data acquisition [19, 21, 22, 23, 24, 28, 30]. One or two fluoroscopic units, coupled with high speed video cameras, take x-ray movies of the moving object. Based on these x-ray movies bone movement can be calculated and transferred onto 3D bone models generated from CT scans of the individual animal. Bone motion analysis can be performed using implanted bone markers, which are tracked in one (uniplanar, 2D evaluation) or both (biplanar, 3D evaluation) x-ray movies and 3D coordinates of each marker are then transferred onto the 3D bone models. Alternatively, scientific rotoscoping or autoscoping techniques can be used to track bone movement and transfer this in vivo bone motion from the fluoroscopic images onto 3D bone models [18, 20, 36]. These techniques do not rely on bone markers, rather the shape and edges of each bone are used to project digitally reconstructed radiographs (DRR), generated from the CT scans of each bone, onto the respective bone in the fluoroscopic image. By that the 3D bone model is aligned and animated along the x-ray movies. Scientific rotoscoping is performed manually, while autoscoping is a completely computerized process. Both techniques can be described as morphology based methods of motion analysis. Marker based tacking is the gold standard of kinematic analysis with an accuracy of 0.1 mm and 0.1 degrees [20]. However, scientific rotoscoping and autoscoping show a high accuracy as well, with values ranging from 0.16 to 0.66 mm in translation and 0.43 to 2.78 degrees rotation for scientific rotoscoping and 0.07 to 1.13 mm translation and 0.01 to 3.0 degrees rotation for autoscoping [18, 37, 38, 39, 40, 41, 42]. Therefore, both techniques result in a highly precise evaluation of bone and joint motion with a substantially reduced invasiveness compared to a bone marker based analysis.
Multiple studies have investigated elbow joint kinematics in healthy dogs and dogs with different joint pathologies. Results have to be interpreted cautiously due to varying breeds, different technical setups and varying gaits and gait velocities, e.g. the walk or the trot, all of which influencing the kinematic pattern. Table 1 gives an overview of previous studies on canine forelimb and elbow joint kinematics.
Study | Technique | Breed | Number of dogs | Gait/Speed |
---|---|---|---|---|
DeCamp et al. [43] | 3D marker based video-kinematography, 2D evaluation (sagittal motion) | Greyhound | 8 | trot, 1.8–2.3 m/s (walkway) |
Allen et al. [44] | 3D marker based video-kinematography, 2D evaluation (sagittal motion) | Mixed breed dogs | 14 | trot, 1.8–2.3 m/s (overground) |
Hottinger et al. [45] | 3D marker based video-kinematography, 2D evaluation (sagittal motion) | Different large breed dogs | 15 | walk, 0.9–1.1. m/s (overground) |
Gillette and Zebas [46] | Uniplanar marker based video-kinematography, 2D evaluation (sagittal motion) | Labrador Retriever | 16 | trot, 2.8 m/s |
Nielsen et al. [47] | 3D marker based video-kinematography, 2D evaluation (sagittal motion), stance phase only | Mixed breed dogs | 6 | walk, 0.8–1.0 m/s (overground) |
Owen et al. [48] | Uniplanar marker based video-kinematography, 2D evaluation (sagittal motion) | Greyhound | 11 | trot, 2.2–2.4 m/s (treadmill) |
Clements et al. [49] | Uniplanar marker based video-kinematography, 2D evaluation (sagittal motion) | Labrador Retriever | 10 | trot, 2.0 m/s (treadmill) |
Feeney et al. [50] | Uniplanar marker based video-kinematography, 2D evaluation (sagittal motion) | Labrador Retriever | 10 | walk, velocity not documented (overground) |
Burton et al. [51] | 3D marker based video-kinematography, 2D evaluation (sagittal motion) | Different mid to large breed dogs | 7 (unilateral elbow disease) | trot, velocity not documented (treadmill) |
Holler et al. [52] | 3D marker based video-kinematography, 2D evaluation (sagittal motion) | Different mid to large breed dogs | 8 | walk, 0.89–1.1 m/s (treadmill, normal, uphill, downhill, obstacle) |
Agostinho et al. [53] | 3D marker based video-kinematography, 2D evaluation (sagittal motion) | Labrador Retriever Rottweiler | 20 (10 each) | trot, 2.1–2.2. m/s (treadmill) |
Guillou et al. [54] | 3D marker based fluoroscopic kinematography | Fox hound | 4 | walk & trot, velocity not documented |
Angle et al. [55] | Uniplanar marker based video-kinematography, 2D evaluation (sagittal motion) | Greyhound | 7 | Movement initiation up to 3.52 m/s (overground) |
Jarvis et al. [56] | 3D marker based video-kinematography, 2D evaluation (sagittal motion), stance phase only | Different breeds | 40 (24 healthy, 16 front limb amputee dogs) | trot, 2.2–2.6 m/s (walkway) |
Brady et al. [57] | 3D marker based video-kinematography, 2D evaluation (sagittal motion) | Different breeds | 16 | trot, 1.8 m/s & 2.5 m/s (walkway) |
Miqueleto et al. [58] | 3D marker based video-kinematography, 2D evaluation (sagittal motion) | German Shepherd | 20 (10 hip dysplasia, 10 healthy dogs) | trot, 2.1–2.2. m/s (treadmill) |
Galindo-Zamora et al. [59] | 3D marker based video-kinematography, 2D evaluation (sagittal motion) | Different mid to large breed dogs | 20 (unilateral elbow disease) | walk, 0.65–1.1 m/s (treadmill) |
Caron et al. [60] | 3D marker based video-kinematography, 3D evaluation | Labrador Retriever | 26 (13 healthy, 13 dogs with coronoid disease) | walk, 0.7 m/s (treadmill) |
Fischer & Lilje, [61] | 3D marker based video- & fluoroscopic kinematography, 2D evaluation (sagittal motion) | 32 different breeds | 327 | walk & trot, 0.54–5.56 m/s (treadmill) |
Catavitello et al. [62] | Uniplanar marker based video-kinematography, 2D evaluation (sagittal motion) | Labrador Retriever Golden Retriever | 6 (3 each breed) | walk, 2 m/s, trot, 4 m/s & running, 9.5 m/s (overground) |
Duerr et al. [63] | Uniplanar marker based video-kinematography, 2D evaluation (sagittal motion) and inertial measurements unit | Different mid to large breed dogs | 16 | trot, 2.4–2.5 m/s (overground) |
Andrada et al. [28] | 3D marker based video- & fluoroscopic kinematography (scientific rotoscoping), 3D evaluation | Beagle | 5 | walk, 0.98 m/s & trot, 2.2 m/s (treadmill) |
Lorke et al. [64] | 3D marker based video-kinematography, 2D evaluation (sagittal motion) | Beagle | 10 | trot, 1.7–1.8 m/s (treadmill) |
Rohwedder et al. [22] | 3D marker based fluoroscopic kinematography (first third of stance phase only) | Different mid to large breed dogs | 11 (5 healthy, 6 dogs with coronoid disease) | walk, 0.6–0.9 m/s (treadmill) |
Kopec et al. [65] | Uniplanar marker based video-kinematography, 2D evaluation (sagittal motion) | Different mid to large breed dogs | 8 | walk, 1.01–1.45 m/s (overground & stair exercise) |
Rohwedder et al. [23] | 3D marker based fluoroscopic kinematography (first third of stance phase only) | Different mid to large breed dogs | 11 (5 healthy, 6 dogs with coronoid disease) | walk, 0.6–0.9 m/s (treadmill) |
Rohwedder et al. [24] | 3D marker based fluoroscopic kinematography & joint contact pattern evaluation | Labrador Retriever | 1 (before and after DPUO*) | walk, 0.6–0.9 m/s (treadmill) |
Humphries et al. [66] | 3D marker based video-kinematography, 2D evaluation (sagittal motion) | Labrador Retriever German Shepherd | 24 (12 each breed) | trot, 2.19–2.45 m/s (walkway) |
De Souza et al. [67] | 3D marker based video-kinematography, 2D evaluation (sagittal motion) | American Pit Bull Terrier | 11 | walk, 1.17 ± 0.17 m/s trot, 2.04 ± 0.33 m/s (overground) |
Summary of studies investigating canine forelimb and/or elbow joint kinematics.
DPUO: dynamic proximal ulnar osteotomy.
Most studies on elbow joint kinematics are based on video-kinematographic analysis and have investigated the motion of the elbow only in the sagittal plane [43, 44, 45, 47, 48, 49, 50, 51, 52, 53, 55, 56, 57, 58, 59, 62, 63, 65, 68, 69]. Caron et al. were the first to describe the real 3D kinematics of the canine forelimb of healthy Labrador retrievers and dogs with medial coronoid disease using video-kinematographic analysis [60]. Another study evaluated the 3D motion of orthopedic healthy canine forelimbs using video-kinematography and compared that data to fluoroscopically gained motion analysis, which was additionally calculated in one of the dogs [28].
One complete gait cycle consists of the swing and the stance phase. The swing phase starts when the paw breaks contact with the ground and ends with first ground contact of the paw. The time between initial ground contact and paw lift is defined as the stance phase. The ratio between swing and stance phase depends from the gait pattern and the dog’s velocity [28, 29, 70, 71]. At the walk the swing phase of the forelimb accounts for 39 to 43% of the whole gait cycle [60] and increases to approximately 50% to two thirds of the whole gait cycle during the trot, depending from the trotting speed [28, 43, 45, 58, 62, 64, 66]. During running the swing phase is further prolonged and accounts for approximately 75% of the gait cycle [62]. Conversely, with increasing speed the stance phase decreases [45, 70, 71].
The sagittal plane range of motion of the elbow joint (flexion-extension) is between 48.1 degrees and 70 degrees during one complete gait cycle when the dog is moving on a flat surface (Table 2), with the majority of motion occurring during the swing phase [28, 43, 44, 45, 47, 48, 49, 50, 52, 53, 56, 57, 58, 59, 60, 61, 63, 64, 65, 66, 67]. Range of motion is influenced by different parameters like breed, limb and body segment length, gait, velocity, exercise, age, contralateral limb amputation and concurrent orthopedic disease. With increasing speed of the gait the range of motion of joints increases [29, 45, 57, 62, 66, 68, 69]. Obese dogs show an increased range of motion as well, especially during the stance phase [57]. However, increasing age leads to an decrease in total range of motion, even in orthopedic healthy dogs [64]. Further, different exercises like descending stairs, uphill and downhill walking influence the range of motion, with descending stairs, obstacle exercises and uphill walking increasing the range of motion, while downhill walking decreases the amount of sagittal motion in the elbow [52, 65].
Study | Breed | Range of motion (°) | Flexion/Extension (°) | Gait/Speed |
---|---|---|---|---|
DeCamp et al. [43] | Greyhound | 53.7 | 86.8/140.5 | trot, 1.8–2.3 m/s (walkway) |
Allen et al. [44] | Mixed breed dogs | 55.8 | 93.7/149.5 | trot, 1.8–2.3 m/s (overground) |
Hottinger et al. [45] | Different large breed dogs | 48.1 | — | walk, 0.9–1.1. m/s (walkway) |
Gillette and Zebas [46] | Labrador Retriever | right: 69.1 left: 66.1 | — | trot, 2.8 m/s |
Nielsen et al. [47] | Mixed breed dogs | — | 111.7 ± 12/136.3 ± 10.4 (stance phase only) | walk, 0.8–1.0 m/s (overground) |
Owen et al. [48] | Greyhound | 49.35–49.59 | 100.98–102.7/150.57–152.05 | trot, 2.2–2.4 m/s (treadmill) |
Clements et al. [49] | Labrador Retriever | 59.3 (SD 5.5) | — | trot, 2.0 m/s (treadmill) |
Feeney et al. [50] | Labrador Retriever | 54.8 ± 17.9 | 91.4/146.3 | walk, velocity not documented(overground) |
Holler et a. [52] | Different mid to large breed dogs | normal: 52.9 ± 7.0 uphill: 54.2 ± 7.4 downhill: 43.1 ± 5.8 obstacle: 57.0 ± 6.9 | — | walk, 0.89–1.1 m/s (treadmill, normal, uphill, downhill, obstacle) |
Agostinho et al. [53] | Labrador Retriever Rottweiler | 63.77 ± 4.83 54.86 ± 5.16 | 90.52 ± 11.66/154.28 ± 9.64 93.99 ± 10.19/148.85 ± 9.15 | trot, 2.1–2.2. m/s (treadmill) |
Jarvis et al. [56] | Different breeds | stance phase only: control: 33.3 ± 8.6 amputee: 39.7 ± 10.4 | control: 123.0 ± 12.9/ 156.4 ± 12.2 amputee: 119.2 ± 12.8/ 158.9 ± 12.5 | trot, 2.2–2.6 m/s (walkway) |
Brady et al. [57] | Different breeds | lean: 52.5 (1.8 m/s) obese: 65.0 (1.8 m/s) lean: 54.0 (2.5 m/s) obese: 62.0 (2.5 m/s) | lean: 95 ± 7/147 ± 17 obese: 90 ± 11/155 ± 9 lean: 93 ± 8/147 ± 9 obese: 88 ± 14/150 ± 18 | trot, 1.8 m/s & 2.5 m/s (walkway) |
Miqueleto et al. [58] | German Shepherd | healthy: 68.15 ± 7.19 hip dysplasia: 63.54 ± 13.53 | healthy: 61.99/131.77 ± 7.60 hip dysplasia: 69.09/133.68 ± 11.37 | trot, 2.1–2.2. m/s (treadmill) |
Galindo-Zamora et al. [59] | Different mid to large breed dogs | healthy: 54.18 ± 8.62 MCD: 51.45 ± 7.27 | healthy: 82.36 ± 6.02/136.54 ± 9.16 MCD: 87.1 ± 10.8/138.55 ± 13.03 | walk, 0.65–1.1 m/s (treadmill) |
Duerr et al. [63] | Different mid to large breed dogs | 63.4 ± 7.7 | 82.1 ± 8.6/145.5 ± 10.8 | trot, 2.4–2.5 m/s (overground) |
Lorke et al. [64] | Beagle | young: 68.8 ± 2.7 old: 62.9 ± 5.1 | young: 83.2/152.0 ± 10.5 old: 76.8/139.6 ± 12.4 | trot, 1.7–1.8 m/s (treadmill) |
Kopec et al. [65] | Different mid to large breed dogs | flat: 65.81 desc. Stair: 80.43 desc. Ramp: 67.95 | 66.23/132.03 34.36/114.79 46.0/113.95 | walk, 1.01–1.45 m/s (overground & stair exercise) |
Humphries et al. [66] | Labrador Retriever German Shepherd | left: 70.63 right: 67.13 left: 67.13 right: 67.94 | 77.21/147.84 77.21/144.34 75.45/142.58 74.37/142.31 | trot, 2.19–2.45 m/s (walkway) |
De Souza et al. [67] | American Pit Bull Terrier | walk: 45.22 trot: 52.39 | walk: 111.25/167.65 trot: 110.14/163.00 | walk, 1.17 ± 0.17 m/s trot, 2.04 ± 0.33 m/s (overground) |
Summary of the values for range of motion in sagittal plane and flexion and extension angles of the canine elbow joint from different kinematic studies. All values are expressed in degrees and were calculated, if necessary, based on data of each study to allow comparison between studies. 180 degrees represent maximum extension and 0 degrees maximum flexion.
The stance phase is mainly characterized by continuous extension of the elbow joint until lifting of the paw from the ground. Some studies have shown flexion of the elbow joint just after weight bearing [43, 45, 47, 53, 58, 60, 64], resulting in two peaks of extension during the gait cycle. The first peak of extension occurs during the late swing phase and the initiation of ground contact and a second peak occurs at the end of the stance phase. The amount of this flexion differs between studies by several degrees. Further, this movement has not been described using fluoroscopic kinematography, what represents the gold standard of kinematic gait analysis [28]. This might be due to breed and inter-individual differences in the gait, due to the different techniques used for kinematic analysis or due to a soft tissue artifact, which occurs with skin mounted markers, and does not represent the in vivo motion of the bony cubital joint, but the movement pattern of the complete limb including the soft tissues [28, 32, 33]. Maximum extension of the elbow joint is reached at the end of the stance phase and is followed by continuous flexion during the swing phase. The peak flexion of the elbow joint is reached at approximately the middle of the swing phase and is followed by continuous extension of the elbow joint as a preparation for paw strike [53, 60, 64].
Besides flexion and extension, which represent the main motion pattern of the elbow joint, supination and pronation of the antebrachium and abduction and adduction of the humerus and antebrachium occur during the regular locomotion. In healthy Labrador retrievers the antebrachium is positioned in mild supination at the initial stance phase and shows minimal pronation during the remainder stance phase with a mean supination of the antebrachium of 3 ± 9 degrees [60]. In healthy Beagle the forelimb is placed onto the ground in mild pronation and is kept in this position during two thirds of the stance phase and then externally rotated during the last third of stance [28]. During the initial swing phase the antebrachium is supinated and maximum supination (mean 19 ± 9 degrees) occurs at the middle of the swing phase, together with maximum flexion of the elbow joint, in healthy Labrador retrievers [60]. In orthopedic sound Beagle a similar motion pattern is present during the swing phase, with supination of the antebrachium occurring during the first third of the swing phase [28]. Prior to foot strike rapid pronation of the antebrachium occurs and the limb is placed on the ground in a slightly supinated position in Labrador retrievers and slight pronation in Beagle [28, 60].
Three dimensional micromotion of the humerus, radius and ulna relative to each other was measured in different studies using marker based fluoroscopic kinematographic analysis [22, 23, 24, 54, 72]. Results of these studies show that the bones of the antebrachium have a complex motion pattern and radius and ulna cannot be seen as one single object. At the walk and the trot an axial movement between radius and ulna occurs in healthy and MCD affected elbows [22, 54]. In healthy canine elbow joints the radius shows an mean axial movement of 0.7 (SD 0.31) mm to 0.8 mm in relation to the ulna. This axial motion was detected in different mid to large breed dogs, like Fox hounds, Australian shepherd, Labrador retriever, Eurasian, German shepherd, Bernese mountain dog and mixed breeds [22, 54]. After the initiation of ground contact the radius moves proximally and remains in a slightly elevated position relative to the ulna, resulting in a dynamic negative radio-ulnar incongruence (RUI) [22, 72]. These results correspond with data from an in vitro study, which investigated the effects of limb loading and flexion and extension onto the radio-ulnar joint conformation and intra articular contact areas and which showed, that elbow extension leads to a relative lowering of the ulna in relation to the radius [73]. Extension is the main motion of the elbow during the weight bearing phase and therefore the induction of a dynamic negative RUI might be seen as a adaption to joint loading [72]. Further, internal and external rotation between the radius and ulna occurs during the walk. Prior to foot strike the radius is in an externally rotated position relative to the ulna und shows internal rotation during the first third of the stance phase. Mean range of motion of the in vivo internal-external radial rotation is 11.4 (SD 2.0) degrees during the initial weight bearing phase [74]. No data exist investigating the in vivo radio-ulnar movement during the later stance phase and the swing. Therefore, the in vivo motion of the antebrachial bones and the dynamic changes within the radio-ulnar joint during the complete gait cycle are still unknown.
The in vivo humero-ulnar micromotion has only been investigated in one study so far [23]. Movement between the humerus and the ulna is characterized by flexion and extension, but rotational movement of the humerus relative to the ulna takes also place during locomotion [23]. At the walk the humerus shows an relative external rotation of 2.9 (SD 1.1) degrees during the first third of the stance phase in healthy humero-ulnar joints [23, 28]. These data imply that the elbow joint is not completely restricted to sagittal motion only. One study, investigating the 3D kinematics of the whole canine forelimb showed, that at the moment of ground contact the humerus is in an internally rotated position, which is slightly less at the trot compared to the walk (mean segment angle, walk: −34 degrees; trot: −25 degrees) [28]. During the walk the humerus shows internal and external rotation and only external rotation during the trot throughout the complete stance and swing phase, with a net external rotational movement during the stance phase [28]. This external rotational motion of the humerus is contrary to the internal rotation (pronation) of the antebrachium, which occurs prior to paw strike and is maintained during the stance [28, 60].
When kinematics of the diseased canine elbow joint are evaluated two different types of changes in the kinematic pattern have to be differentiated. First, changes attributed to pain and lameness, i.e. altered kinematics as a result of the disease. Second, changes in elbow joint kinematics, which represent a causative factor of the disease process.
Due to pain, caused by different joint pathologies in the elbow with DED, multiple adaptive mechanisms occur in the affected forelimb. Decreases in stance time, angular displacement and net joint moments can all be seen in the diseased elbow joint [51].
A reduced range of motion in the sagittal plane (flexion-extension) is present in dogs with MCD [51, 59, 60]. In particular flexion of the joint is decreased and the elbow kept in a more extended position during the gait. In Labrador retrievers with MCD a faster extension of the cubital joint occurs during late swing phase and the elbow is more extended by 9 degrees (mean) during initial ground contact and the early stance phase compared to orthopedically healthy elbows [60]. This more extended gait is a compensating mechanism and aims to reduce pressure at the medial joint compartment [7, 73, 75]. At the end of the stance and beginning of swing phase the elbow joint is more rapidly flexed in affected dogs. However, no active push off occurs at the end of the stance phase indicating that the affected limb is pulled off the ground by the proximal musculature [51]. Reduction in active push off aims to reduce the pressure acting on the joint surface. The elbow is held 16 degrees more externally rotated during the end of swing and initial stance phase and the antebrachium is in average 2 degrees more abducted throughout the gait cycle and 9 degrees more supinated during the paw strike and early stance phase [60]. These changes have to be assumed as compensating mechanisms as well. Supination leads to caudal displacement of the peak pressure at the medial ulnar joint surface and by that to a release of pressure and potentially pain at the diseased medial coronoid process. Besides the Labrador retriever a more extended elbow joint is present in other breeds with MCD, e.g. Rottweiler, Staffordshire Bullterrier, Airdale terrier, Golden retriever, Polish Lowland sheepdog, German wirehaired pointer, Belgian malinois, Irish setter and mixed breed dogs [51, 59, 60]. Therefore, these changes in the kinematic pattern represent a general secondary adaption to intra articular pathologies and the corresponding pain in canine elbow joints with MCD.
Primary changes in the kinematics of the radius, ulna and humerus are assumed to play an role in the pathogenesis of MCD. Altered kinematics in the proximal radio-ulnar joint, were suggested by different researchers to be one potential factor influencing the development of MCD [76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90]. One proposed mechanism was an increased axial translation of the radius relative to the ulna leading to an dynamic radio-ulnar incongruence. Translational movement between the radius and ulna occurs in elbows with and without MCD in vivo [22, 54], with no significant difference in the total amount of movement between both groups [22]. Therefore, increased axial movement between the radius and ulna and induction of a dynamic RUI under weight bearing conditions could be excluded as an primary factor. However, the direction of radial motion is different between normal and diseased joints, with a negative RUI being induced during the initial stance phase in healthy elbows and no significant change in the radio-ulnar joint conformation in MCD affected joints [72]. Based on the results of that study dogs with a static RUI are not able to compensate the radio-ulnar step formation by radio-ulnar translation and dogs with MCD, but without a static RUI, do not show the same amount of negative dynamic RUI as measured in healthy canine elbow joints [72]. The induction of a negative radio-ulnar step during weight bearing might be a protective mechanism in healthy canine elbow joints. Lowering of the ulna or elevation of the radius during extension of the elbow joint was previously described in vitro and leads to a decrease of intra articular pressure at the medial joint compartment [73]. The inability of the diseased canine elbow joint to adjust the radio-ulnar joint conformation during loading might be one potential biomechanical factor in the pathogenesis of MCD. Especially in dogs without a measurable static incongruence, which account for 40% of all patients with MCD [76], the insufficient adaption to intra articular joint loads can lead to mechanical overload at one distinct joint compartment. Increased radio-ulnar rotation was proposed as another potential cause of mechanical overload along the radial incisure of the medial coronoid process and subsequent cartilage and bone damage [82, 87, 88, 89, 90]. The only study comparing in vivo radio-ulnar rotational movement in healthy joints to joints with MCD showed no significant difference in the total amount of radial rotation and in the motion pattern of the radius [74]. The radius starts in an externally rotated position during the late swing phase just before paw strike and rotates internally in relation to the ulna during the early weight bearing phase. At approximately 30 to 40% of the stance phase the radius shows an external rotation again. Values of total rotational movement and internal/external movement of the radius show no significant difference between normal and affected elbow (internal radial rotation, healthy: 5.7 [SD 2.1] degrees; MCD: 5.3 [SD 2.6] degrees; p = 0.1727; external radial rotation, healthy: - 5.8 [SD: 1.3] degrees; MCD: - 4.5 [1.7] degrees; p = 0.7705; total rotation, healthy: 11.4 [SD: 2.0] degrees; MCD: 9.8 [SD: 3.2]; p = 0.2904) [74]. Absence of increased radio-ulnar rotational motion does not exclude an biomechanical overload along the lateral aspect of the medial coronoid process of the ulna caused by interaction with the radial head. An abaxial attachment of the tendon of the biceps brachii muscle at the ulna was detected in dogs with MCD [90]. The pull of the biceps brachii muscle on the ulna could potentially lead to increased pressure between the medial coronoid and the radial head without altering the kinematics. However, no studies have investigated the forces acting between radius and ulna and compared these data between healthy and MCD affected dogs.
Another significant difference can be seen in the humero-ulnar rotational movement between healthy and MCD affected joints. Increased external rotation of the humeral condyle in relation to the ulna occurs at the first third of the stance phase in cubital joints with MCD (humeral rotation, healthy: 2.9 [SD 1.1] degrees; MCD: 5.3 [SD 2.0] degrees; p = 0.0229) [23]. This rotation of the humeral condyle leads to compression of the joint space between the medial coronoid process and the humeral trochlea, and might potentially lead to mechanical overload at the coronoid process and consequently to cartilage and subchondral bone damage (Figure 1). Therefore, increased humero-ulnar rotation has to be considered as one dynamic factor in the pathogenesis of MCD. If this increased humero-ulnar rotational movement is caused by soft tissue laxity, like in the dysplastic hip joint, altered muscle function or due to bony differences altering the joint function has not been investigated so far. The influence of a static positive radio-ulnar incongruence onto the contact areas and pressure distribution within the humero-ulnar joint is known [91, 92, 93]. However, the literature is lacking kinematic analysis investigating the influence of a static RUI on elbow joint motion, particular the humero-radio-ulnar micromotion. In the cited study on humero-ulnar kinematics the MCD group consisted of dogs with and without a static positive RUI [23]. Due to the small sample size no correlation could be found between the presence of static RUI and the amount of humeral rotational motion. Therefore, the influence of this significant bony deformity on the kinematics of the elbow joint remains unknown.
Image sequence of the in vivo humero-ulnar joint motion during the late swing phase (f0), at the moment of weight bearing (f30) and the first third of the stance phase (f60 – f150). (A) Healthy joint; (B) MCD affected joint; relative external rotation of the humerus occurs just after ground contact, when the joint gets loaded. External rotation of the condyle leads to a craniolateral shift of the trochlea, impinging on the lateral aspect of the medial coronoid process [
The mean body weight distribution between fore- and hindlimbs is approximately 60% : 40% in dogs [56, 94]. A large study investigating 123 different breeds found that the grand mean proportion of mass was 60.4% on the forelimbs (range: 47.6 to 74.4%) [94]. Only sex was shown to be a significant factor altering that ratio, with females being below the mean value throughout different breeds [94]. Another study comparing kinematic and kinetic data of orthopedic healthy Labrador retrievers and German shepherds reported that Labrador retrievers carry a higher percentage of the weight on their forelimbs compared to the German shepherd (69% vs. 62%, p < 0.001) [66]. If this breed specific mechanical overload plays a role in the pathogenesis of DED and contributes to the high rate of Labrador retrievers with developmental elbow disease, in particular MCD, is not known.
Within the elbow joint load and forces are not homogenously distributed throughout the whole joint surface. It was believed that the radial joint surface is the main weight bearing surface of the radio-ulnar joint. However, more recent studies have shown, that the radius takes 51 to 52% of load [73, 75, 91]. Therefore the ulna plays a more important role in weight bearing than previously assumed. Despite an overall equal load and force distribution between the radius and the ulna, not every part of the joint surface represents an active joint contact area. Within the combined radio-ulnar joint surface three distinct contact areas can be found: the craniolateral aspect of anconeal process, the joint surface of the radial head, and the medial coronoid process [7, 24, 73]. There is no particular contact at the medial aspect of the anconeal process and the center of the trochlear notch (Figure 2). The latter one might be explained by the slight physiological humero-ulnar incongruence leading to a bicentrical contact pattern [6, 7, 9, 73, 95]. When the elbow joint is loaded the force applied by the humeral condyle is distributed along the anconeal process and the coronoid region. With increasing load the concave ulnar notch is stretched and these pressure forces are partially transformed to traction forces [8, 95, 96, 97]. Therefore this physiological incongruence leads to a more even stress distribution within the humero-ulnar joint. In human elbow joints the proximal and distal contact area confluent when high loads are acting onto the ulnar joint surface [98]. This load dependent change in contact pattern has not been described in canine elbows so far [7].
Colored animation of the in vivo humero-ulnar joint contact pattern at the ulnar joint surface at the beginning of weight bearing in a healthy canine elbow joint (red: Humero-ulnar contact). Joint contact is present along the medial coronoid process and the lateral and proximal aspect of the trochlear notch. The radius is not shown in this animation.
The presence of these three contact areas within the elbow joint is further supported by increased subchondral bone density measurements at these anatomic areas [95, 99]. Bone is a dynamic tissue which has the ability to remodel in response to mechanical load (Wolff’s law) [100]. Therefore, increased bone density can be found in areas with increased load. Increased subchondral bone densities are present at the disto-medial and cranial aspect of the humeral trochlea and in the olecranon fossa, the anconeal and medial coronoid processes of the ulna and the cranio-medial region of the joint surface of the radius [95]. The same study showed a significant age-dependent increase in the subchondral bone density of the joint surfaces of all three bones, representing continuous adaption of the bone to mechanical stress with increasing age [95].
Though increased loading of the ulnar joint surface does not result in confluence of the bicentric contact pattern, other factors can influence the joint contact patterns of the humero-ulnar and humero-radial joint surfaces. An in vitro study investigated the influence of positive radio-ulnar incongruence (short radius) on joint contact patterns. Presence of a positive RUI leads to a shift of the contact area at the medial coronoid process towards the cranio-lateral aspect of the coronoid process and reduction of the anconeal contact area [93]. Other in vitro studies show similar results. After induction of a 1.9 mm positive RUI medial compartment contact area decreases significantly while the lateral contact area increases. Likewise the mean contact pressure and peak contact pressure increase within the medial compartment and decrease in the lateral part [91, 92]. Therefore, presence of a static positive RUI has to be assumed as an important factor in the disease process of developmental elbow disease and a correlation between the severity of cartilage damage and static RUI has been shown in affected elbows [76, 77, 101]. In vivo evaluation of the ulnar joint contact pattern during the walk in a dog with positive static RUI before and after bi-oblique dynamic proximal ulnar osteotomy (DPUO) confirmed the results of different in vitro studies [24]. Following DPUO positive static RUI decreased, leading to a significant increase of the contact area at the medial coronoid process and to a shift of the contact area from the cranio-lateral aspect (tip and radial incisure) towards the medial aspect and the base of the medial coronoid process (Figure 3) [24]. This positive effect of different forms of ulnar and humeral osteotomies onto humero-radio-ulnar contact and force distribution has previously been shown in vitro [75, 91, 92]. Whether a static RUI changes the kinematic pattern of humero-radial, humero-ulnar or radio-ulnar motion and by that the intra articular contact areas and pressure distribution or has a purely mechanical influence without dynamic changes has not been investigated so far.
Humero-ulnar joint contact pattern at the ulnar joint surface at the beginning of weight bearing in a canine elbow joint with MCD (red: Contact area). (A) Contact pattern before bi-oblique DPUO; focal concentration of joint contact at the medial coronoid process (MCP) and slight contact at the medial and lateral aspect of the anconeal process is present. (B) Contact pattern 12 weeks postoperative; joint contact is more homogenously distributed throughout the ulnar joint surface and the craniolateral aspect of the MCP is even not in contact with the corresponding humeral trochlea [
Further, joint contact areas change during the regular locomotion. Pronation leads to reduction of the contact area in the medial and to a lesser amount in the lateral compartment of the radio-ulnar joint surface. The effect of pronation is further influenced by the elbow joint angle, with significant reduction of the medial contact area by 23% at 135 degree of flexion, what represents the average flexion angle during the stance phase [73]. A reduced contact area will result in increased pressure when the same load is applied to the joint. Further, pronation of the antebrachium leads to a shift of the peak contact pressure towards the apex of the medial coronoid process. Otherwise supination of the antebrachium leads to caudal displacement of the peak contact pressure on the medial coronoid process [73, 75]. This might explain that dogs with medial coronoid disease show a more supinated stance to release pressure from the apex of the medial coronoid [60]. Moreover, flexion and extension, the main motion pattern during the normal locomotion, influence the intra articular pressure distribution. Flexion increases peak pressure at the medial radio-ulnar joint compartment and extension decreases pressure [73]. It is assumed that this change is due to dynamic changes within the radio-ulnar joint surface in healthy canine elbows [72, 73]. In a cadaveric study extension of the elbow joint induced lowering of the radius and ulna, however more pronounced in the ulna (3.8 mm) compared to the radius (1.9 mm). This corresponds to findings of the in vivo investigation of the radio-ulnar joint cup conformation in healthy elbow joints during the walk, where a negative RUI (short ulna) was induced during weight bearing [72]. This lowering of the ulna relative to the radius might protect the medial coronoid process from mechanical overload during locomotion in healthy canine elbows. In contrast, altered radio-ulnar kinematics preventing elevation of the radius might lead to continuous excessive mechanical overload and subsequent joint pathologies.
Considering the changes of intra articular contact areas and pressure distribution as a function of limb position might explain the typical clinical signs in dogs with developmental elbow disease. Affected dogs stand with the elbow slightly abducted and the antebrachium in slight external rotation (supination) [102]. Furthermore, the elbow joint is more rapidly extended during the swing phase and kept in a more extended position during weight bearing [60]. This motion pattern aims to reduce the contact and pressure at the medial coronoid process, where most commonly lesions attributed to developmental elbow disease occur [90, 103].
Canine elbow joint kinematics are more complex than flexion and extension of the joint and influenced by multiple factors like breed, limb length, gait, exercise and joint pathologies. The precise interaction of the three joint forming bones is essential for physiologic joint contact and intra articular force and pressure distribution. Based on the current literature an significantly increased humero-ulnar rotational movement as well as an reduced adjustment of the radio-ulnar joint during the regular locomotion of the dog seem to be two essential pathological factors influencing the development of MCD. This kind of movement is only measurable using laborious techniques like 3D fluoroscopic based kinematography. Nevertheless, further studies are needed to evaluate the complex kinematics of the healthy and the diseased canine elbow joint and to understand the effect of different kinematics onto kinetics.
The author declares no conflict of interest.
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Saxena",hash:"d92a4085627bab25ddc7942fbf44cf05",volumeInSeries:2,fullTitle:"Current Perspectives in Human Papillomavirus",editors:[{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRET3QAO/Profile_Picture_2022-05-10T10:10:26.jpeg",institutionString:"King George's Medical University",institution:{name:"King George's Medical University",institutionURL:null,country:{name:"India"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null}]},subseriesFiltersForPublishedBooks:[{group:"subseries",caption:"Bacterial Infectious Diseases",value:3,count:2},{group:"subseries",caption:"Parasitic Infectious Diseases",value:5,count:4},{group:"subseries",caption:"Viral Infectious Diseases",value:6,count:7}],publicationYearFilters:[{group:"publicationYear",caption:"2022",value:2022,count:2},{group:"publicationYear",caption:"2021",value:2021,count:4},{group:"publicationYear",caption:"2020",value:2020,count:3},{group:"publicationYear",caption:"2019",value:2019,count:3},{group:"publicationYear",caption:"2018",value:2018,count:1}],authors:{paginationCount:250,paginationItems:[{id:"274452",title:"Dr.",name:"Yousif",middleName:"Mohamed",surname:"Abdallah",slug:"yousif-abdallah",fullName:"Yousif Abdallah",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/274452/images/8324_n.jpg",biography:"I certainly enjoyed my experience in Radiotherapy and Nuclear Medicine, particularly it has been in different institutions and hospitals with different Medical Cultures and allocated resources. Radiotherapy and Nuclear Medicine Technology has always been my aspiration and my life. As years passed I accumulated a tremendous amount of skills and knowledge in Radiotherapy and Nuclear Medicine, Conventional Radiology, Radiation Protection, Bioinformatics Technology, PACS, Image processing, clinically and lecturing that will enable me to provide a valuable service to the community as a Researcher and Consultant in this field. My method of translating this into day to day in clinical practice is non-exhaustible and my habit of exchanging knowledge and expertise with others in those fields is the code and secret of success.",institutionString:null,institution:{name:"Majmaah University",country:{name:"Saudi Arabia"}}},{id:"313277",title:"Dr.",name:"Bartłomiej",middleName:null,surname:"Płaczek",slug:"bartlomiej-placzek",fullName:"Bartłomiej Płaczek",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/313277/images/system/313277.jpg",biography:"Bartłomiej Płaczek, MSc (2002), Ph.D. (2005), Habilitation (2016), is a professor at the University of Silesia, Institute of Computer Science, Poland, and an expert from the National Centre for Research and Development. His research interests include sensor networks, smart sensors, intelligent systems, and image processing with applications in healthcare and medicine. He is the author or co-author of more than seventy papers in peer-reviewed journals and conferences as well as the co-author of several books. He serves as a reviewer for many scientific journals, international conferences, and research foundations. Since 2010, Dr. Placzek has been a reviewer of grants and projects (including EU projects) in the field of information technologies.",institutionString:"University of Silesia",institution:{name:"University of Silesia",country:{name:"Poland"}}},{id:"35000",title:"Prof.",name:"Ulrich H.P",middleName:"H.P.",surname:"Fischer",slug:"ulrich-h.p-fischer",fullName:"Ulrich H.P Fischer",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/35000/images/3052_n.jpg",biography:"Academic and Professional Background\nUlrich H. P. has Diploma and PhD degrees in Physics from the Free University Berlin, Germany. He has been working on research positions in the Heinrich-Hertz-Institute in Germany. Several international research projects has been performed with European partners from France, Netherlands, Norway and the UK. He is currently Professor of Communications Systems at the Harz University of Applied Sciences, Germany.\n\nPublications and Publishing\nHe has edited one book, a special interest book about ‘Optoelectronic Packaging’ (VDE, Berlin, Germany), and has published over 100 papers and is owner of several international patents for WDM over POF key elements.\n\nKey Research and Consulting Interests\nUlrich’s research activity has always been related to Spectroscopy and Optical Communications Technology. Specific current interests include the validation of complex instruments, and the application of VR technology to the development and testing of measurement systems. He has been reviewer for several publications of the Optical Society of America\\'s including Photonics Technology Letters and Applied Optics.\n\nPersonal Interests\nThese include motor cycling in a very relaxed manner and performing martial arts.",institutionString:null,institution:{name:"Charité",country:{name:"Germany"}}},{id:"341622",title:"Ph.D.",name:"Eduardo",middleName:null,surname:"Rojas Alvarez",slug:"eduardo-rojas-alvarez",fullName:"Eduardo Rojas Alvarez",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/341622/images/15892_n.jpg",biography:null,institutionString:null,institution:{name:"University of Cuenca",country:{name:"Ecuador"}}},{id:"215610",title:"Prof.",name:"Muhammad",middleName:null,surname:"Sarfraz",slug:"muhammad-sarfraz",fullName:"Muhammad Sarfraz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/215610/images/system/215610.jpeg",biography:"Muhammad Sarfraz is a professor in the Department of Information Science, Kuwait University. His research interests include computer graphics, computer vision, image processing, machine learning, pattern recognition, soft computing, data science, intelligent systems, information technology, and information systems. Prof. Sarfraz has been a keynote/invited speaker on various platforms around the globe. He has advised various students for their MSc and Ph.D. theses. He has published more than 400 publications as books, journal articles, and conference papers. He is a member of various professional societies and a chair and member of the International Advisory Committees and Organizing Committees of various international conferences. Prof. Sarfraz is also an editor-in-chief and editor of various international journals.",institutionString:"Kuwait University",institution:{name:"Kuwait University",country:{name:"Kuwait"}}},{id:"32650",title:"Prof.",name:"Lukas",middleName:"Willem",surname:"Snyman",slug:"lukas-snyman",fullName:"Lukas Snyman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/32650/images/4136_n.jpg",biography:"Lukas Willem Snyman received his basic education at primary and high schools in South Africa, Eastern Cape. He enrolled at today's Nelson Metropolitan University and graduated from this university with a BSc in Physics and Mathematics, B.Sc Honors in Physics, MSc in Semiconductor Physics, and a Ph.D. in Semiconductor Physics in 1987. After his studies, he chose an academic career and devoted his energy to the teaching of physics to first, second, and third-year students. After positions as a lecturer at the University of Port Elizabeth, he accepted a position as Associate Professor at the University of Pretoria, South Africa.\r\n\r\nIn 1992, he motivates the concept of 'television and computer-based education” as means to reach large student numbers with only the best of teaching expertise and publishes an article on the concept in the SA Journal of Higher Education of 1993 (and later in 2003). The University of Pretoria subsequently approved a series of test projects on the concept with outreach to Mamelodi and Eerste Rust in 1993. In 1994, the University established a 'Unit for Telematic Education ' as a support section for multiple faculties at the University of Pretoria. In subsequent years, the concept of 'telematic education” subsequently becomes well established in academic circles in South Africa, grew in popularity, and is adopted by many universities and colleges throughout South Africa as a medium of enhancing education and training, as a method to reaching out to far out communities, and as a means to enhance study from the home environment.\r\n\r\nProfessor Snyman in subsequent years pursued research in semiconductor physics, semiconductor devices, microelectronics, and optoelectronics.\r\n\r\nIn 2000 he joined the TUT as a full professor. Here served for a period as head of the Department of Electronic Engineering. Here he makes contributions to solar energy development, microwave and optoelectronic device development, silicon photonics, as well as contributions to new mobile telecommunication systems and network planning in SA.\r\n\r\nCurrently, he teaches electronics and telecommunications at the TUT to audiences ranging from first-year students to Ph.D. level.\r\n\r\nFor his research in the field of 'Silicon Photonics” since 1990, he has published (as author and co-author) about thirty internationally reviewed articles in scientific journals, contributed to more than forty international conferences, about 25 South African provisional patents (as inventor and co-inventor), 8 PCT international patent applications until now. Of these, two USA patents applications, two European Patents, two Korean patents, and ten SA patents have been granted. A further 4 USA patents, 5 European patents, 3 Korean patents, 3 Chinese patents, and 3 Japanese patents are currently under consideration.\r\n\r\nRecently he has also published an extensive scholarly chapter in an internet open access book on 'Integrating Microphotonic Systems and MOEMS into standard Silicon CMOS Integrated circuitry”.\r\n\r\nFurthermore, Professor Snyman recently steered a new initiative at the TUT by introducing a 'Laboratory for Innovative Electronic Systems ' at the Department of Electrical Engineering. The model of this laboratory or center is to primarily combine outputs as achieved by high-level research with lower-level system development and entrepreneurship in a technical university environment. Students are allocated to projects at different levels with PhDs and Master students allocated to the generation of new knowledge and new technologies, while students at the diploma and Baccalaureus level are allocated to electronic systems development with a direct and a near application for application in industry or the commercial and public sectors in South Africa.\r\n\r\nProfessor Snyman received the WIRSAM Award of 1983 and the WIRSAM Award in 1985 in South Africa for best research papers by a young scientist at two international conferences on electron microscopy in South Africa. He subsequently received the SA Microelectronics Award for the best dissertation emanating from studies executed at a South African university in the field of Physics and Microelectronics in South Africa in 1987. In October of 2011, Professor Snyman received the prestigious Institutional Award for 'Innovator of the Year” for 2010 at the Tshwane University of Technology, South Africa. This award was based on the number of patents recognized and granted by local and international institutions as well as for his contributions concerning innovation at the TUT.",institutionString:null,institution:{name:"University of South Africa",country:{name:"South Africa"}}},{id:"317279",title:"Mr.",name:"Ali",middleName:"Usama",surname:"Syed",slug:"ali-syed",fullName:"Ali Syed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/317279/images/16024_n.png",biography:"A creative, talented, and innovative young professional who is dedicated, well organized, and capable research fellow with two years of experience in graduate-level research, published in engineering journals and book, with related expertise in Bio-robotics, equally passionate about the aesthetics of the mechanical and electronic system, obtained expertise in the use of MS Office, MATLAB, SolidWorks, LabVIEW, Proteus, Fusion 360, having a grasp on python, C++ and assembly language, possess proven ability in acquiring research grants, previous appointments with social and educational societies with experience in administration, current affiliations with IEEE and Web of Science, a confident presenter at conferences and teacher in classrooms, able to explain complex information to audiences of all levels.",institutionString:null,institution:{name:"Air University",country:{name:"Pakistan"}}},{id:"75526",title:"Ph.D.",name:"Zihni Onur",middleName:null,surname:"Uygun",slug:"zihni-onur-uygun",fullName:"Zihni Onur Uygun",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/75526/images/12_n.jpg",biography:"My undergraduate education and my Master of Science educations at Ege University and at Çanakkale Onsekiz Mart University have given me a firm foundation in Biochemistry, Analytical Chemistry, Biosensors, Bioelectronics, Physical Chemistry and Medicine. After obtaining my degree as a MSc in analytical chemistry, I started working as a research assistant in Ege University Medical Faculty in 2014. In parallel, I enrolled to the MSc program at the Department of Medical Biochemistry at Ege University to gain deeper knowledge on medical and biochemical sciences as well as clinical chemistry in 2014. In my PhD I deeply researched on biosensors and bioelectronics and finished in 2020. Now I have eleven SCI-Expanded Index published papers, 6 international book chapters, referee assignments for different SCIE journals, one international patent pending, several international awards, projects and bursaries. In parallel to my research assistant position at Ege University Medical Faculty, Department of Medical Biochemistry, in April 2016, I also founded a Start-Up Company (Denosens Biotechnology LTD) by the support of The Scientific and Technological Research Council of Turkey. Currently, I am also working as a CEO in Denosens Biotechnology. The main purposes of the company, which carries out R&D as a research center, are to develop new generation biosensors and sensors for both point-of-care diagnostics; such as glucose, lactate, cholesterol and cancer biomarker detections. My specific experimental and instrumental skills are Biochemistry, Biosensor, Analytical Chemistry, Electrochemistry, Mobile phone based point-of-care diagnostic device, POCTs and Patient interface designs, HPLC, Tandem Mass Spectrometry, Spectrophotometry, ELISA.",institutionString:null,institution:{name:"Ege University",country:{name:"Turkey"}}},{id:"267434",title:"Dr.",name:"Rohit",middleName:null,surname:"Raja",slug:"rohit-raja",fullName:"Rohit Raja",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/267434/images/system/267434.jpg",biography:"Dr. Rohit Raja received Ph.D. in Computer Science and Engineering from Dr. CVRAMAN University in 2016. His main research interest includes Face recognition and Identification, Digital Image Processing, Signal Processing, and Networking. Presently he is working as Associate Professor in IT Department, Guru Ghasidas Vishwavidyalaya (A Central University), Bilaspur (CG), India. He has authored several Journal and Conference Papers. He has good Academics & Research experience in various areas of CSE and IT. He has filed and successfully published 27 Patents. He has received many time invitations to be a Guest at IEEE Conferences. He has published 100 research papers in various International/National Journals (including IEEE, Springer, etc.) and Proceedings of the reputed International/ National Conferences (including Springer and IEEE). He has been nominated to the board of editors/reviewers of many peer-reviewed and refereed Journals (including IEEE, Springer).",institutionString:"Guru Ghasidas Vishwavidyalaya",institution:{name:"Guru Ghasidas Vishwavidyalaya",country:{name:"India"}}},{id:"246502",title:"Dr.",name:"Jaya T.",middleName:"T",surname:"Varkey",slug:"jaya-t.-varkey",fullName:"Jaya T. Varkey",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/246502/images/11160_n.jpg",biography:"Jaya T. Varkey, PhD, graduated with a degree in Chemistry from Cochin University of Science and Technology, Kerala, India. She obtained a PhD in Chemistry from the School of Chemical Sciences, Mahatma Gandhi University, Kerala, India, and completed a post-doctoral fellowship at the University of Minnesota, USA. She is a research guide at Mahatma Gandhi University and Associate Professor in Chemistry, St. Teresa’s College, Kochi, Kerala, India.\nDr. Varkey received a National Young Scientist award from the Indian Science Congress (1995), a UGC Research award (2016–2018), an Indian National Science Academy (INSA) Visiting Scientist award (2018–2019), and a Best Innovative Faculty award from the All India Association for Christian Higher Education (AIACHE) (2019). She Hashas received the Sr. Mary Cecil prize for best research paper three times. She was also awarded a start-up to develop a tea bag water filter. \nDr. Varkey has published two international books and twenty-seven international journal publications. She is an editorial board member for five international journals.",institutionString:"St. Teresa’s College",institution:null},{id:"250668",title:"Dr.",name:"Ali",middleName:null,surname:"Nabipour Chakoli",slug:"ali-nabipour-chakoli",fullName:"Ali Nabipour Chakoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/250668/images/system/250668.jpg",biography:"Academic Qualification:\r\n•\tPhD in Materials Physics and Chemistry, From: Sep. 2006, to: Sep. 2010, School of Materials Science and Engineering, Harbin Institute of Technology, Thesis: Structure and Shape Memory Effect of Functionalized MWCNTs/poly (L-lactide-co-ε-caprolactone) Nanocomposites. Supervisor: Prof. Wei Cai,\r\n•\tM.Sc in Applied Physics, From: 1996, to: 1998, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Determination of Boron in Micro alloy Steels with solid state nuclear track detectors by neutron induced auto radiography, Supervisors: Dr. M. Hosseini Ashrafi and Dr. A. Hosseini.\r\n•\tB.Sc. in Applied Physics, From: 1991, to: 1996, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Design of shielding for Am-Be neutron sources for In Vivo neutron activation analysis, Supervisor: Dr. M. Hosseini Ashrafi.\r\n\r\nResearch Experiences:\r\n1.\tNanomaterials, Carbon Nanotubes, Graphene: Synthesis, Functionalization and Characterization,\r\n2.\tMWCNTs/Polymer Composites: Fabrication and Characterization, \r\n3.\tShape Memory Polymers, Biodegradable Polymers, ORC, Collagen,\r\n4.\tMaterials Analysis and Characterizations: TEM, SEM, XPS, FT-IR, Raman, DSC, DMA, TGA, XRD, GPC, Fluoroscopy, \r\n5.\tInteraction of Radiation with Mater, Nuclear Safety and Security, NDT(RT),\r\n6.\tRadiation Detectors, Calibration (SSDL),\r\n7.\tCompleted IAEA e-learning Courses:\r\nNuclear Security (15 Modules),\r\nNuclear Safety:\r\nTSA 2: Regulatory Protection in Occupational Exposure,\r\nTips & Tricks: Radiation Protection in Radiography,\r\nSafety and Quality in Radiotherapy,\r\nCourse on Sealed Radioactive Sources,\r\nCourse on Fundamentals of Environmental Remediation,\r\nCourse on Planning for Environmental Remediation,\r\nKnowledge Management Orientation Course,\r\nFood Irradiation - Technology, Applications and Good Practices,\r\nEmployment:\r\nFrom 2010 to now: Academic staff, Nuclear Science and Technology Research Institute, Kargar Shomali, Tehran, Iran, P.O. Box: 14395-836.\r\nFrom 1997 to 2006: Expert of Materials Analysis and Characterization. Research Center of Agriculture and Medicine. Rajaeeshahr, Karaj, Iran, P. O. Box: 31585-498.",institutionString:"Atomic Energy Organization of Iran",institution:{name:"Atomic Energy Organization of Iran",country:{name:"Iran"}}},{id:"248279",title:"Dr.",name:"Monika",middleName:"Elzbieta",surname:"Machoy",slug:"monika-machoy",fullName:"Monika Machoy",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/248279/images/system/248279.jpeg",biography:"Monika Elżbieta Machoy, MD, graduated with distinction from the Faculty of Medicine and Dentistry at the Pomeranian Medical University in 2009, defended her PhD thesis with summa cum laude in 2016 and is currently employed as a researcher at the Department of Orthodontics of the Pomeranian Medical University. She expanded her professional knowledge during a one-year scholarship program at the Ernst Moritz Arndt University in Greifswald, Germany and during a three-year internship at the Technical University in Dresden, Germany. She has been a speaker at numerous orthodontic conferences, among others, American Association of Orthodontics, European Orthodontic Symposium and numerous conferences of the Polish Orthodontic Society. She conducts research focusing on the effect of orthodontic treatment on dental and periodontal tissues and the causes of pain in orthodontic patients.",institutionString:"Pomeranian Medical University",institution:{name:"Pomeranian Medical University",country:{name:"Poland"}}},{id:"252743",title:"Prof.",name:"Aswini",middleName:"Kumar",surname:"Kar",slug:"aswini-kar",fullName:"Aswini Kar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252743/images/10381_n.jpg",biography:"uploaded in cv",institutionString:null,institution:{name:"KIIT University",country:{name:"India"}}},{id:"204256",title:"Dr.",name:"Anil",middleName:"Kumar",surname:"Kumar Sahu",slug:"anil-kumar-sahu",fullName:"Anil Kumar Sahu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204256/images/14201_n.jpg",biography:"I have nearly 11 years of research and teaching experience. I have done my master degree from University Institute of Pharmacy, Pt. Ravi Shankar Shukla University, Raipur, Chhattisgarh India. I have published 16 review and research articles in international and national journals and published 4 chapters in IntechOpen, the world’s leading publisher of Open access books. I have presented many papers at national and international conferences. I have received research award from Indian Drug Manufacturers Association in year 2015. My research interest extends from novel lymphatic drug delivery systems, oral delivery system for herbal bioactive to formulation optimization.",institutionString:null,institution:{name:"Chhattisgarh Swami Vivekanand Technical University",country:{name:"India"}}},{id:"253468",title:"Dr.",name:"Mariusz",middleName:null,surname:"Marzec",slug:"mariusz-marzec",fullName:"Mariusz Marzec",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/253468/images/system/253468.png",biography:"An assistant professor at Department of Biomedical Computer Systems, at Institute of Computer Science, Silesian University in Katowice. Scientific interests: computer analysis and processing of images, biomedical images, databases and programming languages. He is an author and co-author of scientific publications covering analysis and processing of biomedical images and development of database systems.",institutionString:"University of Silesia",institution:{name:"University of Silesia",country:{name:"Poland"}}},{id:"212432",title:"Prof.",name:"Hadi",middleName:null,surname:"Mohammadi",slug:"hadi-mohammadi",fullName:"Hadi Mohammadi",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/212432/images/system/212432.jpeg",biography:"Dr. Hadi Mohammadi is a biomedical engineer with hands-on experience in the design and development of many engineering structures and medical devices through various projects that he has been involved in over the past twenty years. Dr. Mohammadi received his BSc. and MSc. degrees in Mechanical Engineering from Sharif University of Technology, Tehran, Iran, and his PhD. degree in Biomedical Engineering (biomaterials) from the University of Western Ontario. He was a postdoctoral trainee for almost four years at University of Calgary and Harvard Medical School. He is an industry innovator having created the technology to produce lifelike synthetic platforms that can be used for the simulation of almost all cardiovascular reconstructive surgeries. He’s been heavily involved in the design and development of cardiovascular devices and technology for the past 10 years. He is currently an Assistant Professor with the University of British Colombia, Canada.",institutionString:"University of British Columbia",institution:{name:"University of British Columbia",country:{name:"Canada"}}},{id:"254463",title:"Prof.",name:"Haisheng",middleName:null,surname:"Yang",slug:"haisheng-yang",fullName:"Haisheng Yang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/254463/images/system/254463.jpeg",biography:"Haisheng Yang, Ph.D., Professor and Director of the Department of Biomedical Engineering, College of Life Science and Bioengineering, Beijing University of Technology. He received his Ph.D. degree in Mechanics/Biomechanics from Harbin Institute of Technology (jointly with University of California, Berkeley). Afterwards, he worked as a Postdoctoral Research Associate in the Purdue Musculoskeletal Biology and Mechanics Lab at the Department of Basic Medical Sciences, Purdue University, USA. He also conducted research in the Research Centre of Shriners Hospitals for Children-Canada at McGill University, Canada. Dr. Yang has over 10 years research experience in orthopaedic biomechanics and mechanobiology of bone adaptation and regeneration. He earned an award from Beijing Overseas Talents Aggregation program in 2017 and serves as Beijing Distinguished Professor.",institutionString:null,institution:{name:"Beijing University of Technology",country:{name:"China"}}},{id:"89721",title:"Dr.",name:"Mehmet",middleName:"Cuneyt",surname:"Ozmen",slug:"mehmet-ozmen",fullName:"Mehmet Ozmen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/89721/images/7289_n.jpg",biography:null,institutionString:null,institution:{name:"Gazi University",country:{name:"Turkey"}}},{id:"265335",title:"Mr.",name:"Stefan",middleName:"Radnev",surname:"Stefanov",slug:"stefan-stefanov",fullName:"Stefan Stefanov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/265335/images/7562_n.jpg",biography:null,institutionString:null,institution:{name:"Medical University Plovdiv",country:{name:"Bulgaria"}}},{id:"242893",title:"Ph.D. Student",name:"Joaquim",middleName:null,surname:"De Moura",slug:"joaquim-de-moura",fullName:"Joaquim De Moura",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/242893/images/7133_n.jpg",biography:"Joaquim de Moura received his degree in Computer Engineering in 2014 from the University of A Coruña (Spain). In 2016, he received his M.Sc degree in Computer Engineering from the same university. He is currently pursuing his Ph.D degree in Computer Science in a collaborative project between ophthalmology centers in Galicia and the University of A Coruña. His research interests include computer vision, machine learning algorithms and analysis and medical imaging processing of various kinds.",institutionString:null,institution:{name:"University of A Coruña",country:{name:"Spain"}}},{id:"294334",title:"B.Sc.",name:"Marc",middleName:null,surname:"Bruggeman",slug:"marc-bruggeman",fullName:"Marc Bruggeman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/294334/images/8242_n.jpg",biography:"Chemical engineer graduate, with a passion for material science and specific interest in polymers - their near infinite applications intrigue me. \n\nI plan to continue my scientific career in the field of polymeric biomaterials as I am fascinated by intelligent, bioactive and biomimetic materials for use in both consumer and medical applications.",institutionString:null,institution:null},{id:"255757",title:"Dr.",name:"Igor",middleName:"Victorovich",surname:"Lakhno",slug:"igor-lakhno",fullName:"Igor Lakhno",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255757/images/system/255757.jpg",biography:"Igor Victorovich Lakhno was born in 1971 in Kharkiv (Ukraine). \nMD – 1994, Kharkiv National Medical Univesity.\nOb&Gyn; – 1997, master courses in Kharkiv Medical Academy of Postgraduate Education.\nPh.D. – 1999, Kharkiv National Medical Univesity.\nDSC – 2019, PL Shupik National Academy of Postgraduate Education \nProfessor – 2021, Department of Obstetrics and Gynecology of VN Karazin Kharkiv National University\nHead of Department – 2021, Department of Perinatology, Obstetrics and gynecology of Kharkiv Medical Academy of Postgraduate Education\nIgor Lakhno has been graduated from international training courses on reproductive medicine and family planning held at Debrecen University (Hungary) in 1997. Since 1998 Lakhno Igor has worked as an associate professor in the department of obstetrics and gynecology of VN Karazin National University and an associate professor of the perinatology, obstetrics, and gynecology department of Kharkiv Medical Academy of Postgraduate Education. Since June 2019 he’s been a professor in the department of obstetrics and gynecology of VN Karazin National University and a professor of the perinatology, obstetrics, and gynecology department. He’s affiliated with Kharkiv Medical Academy of Postgraduate Education as a Head of Department from November 2021. Igor Lakhno has participated in several international projects on fetal non-invasive electrocardiography (with Dr. J. A. Behar (Technion), Prof. D. Hoyer (Jena University), and José Alejandro Díaz Méndez (National Institute of Astrophysics, Optics, and Electronics, Mexico). He’s an author of about 200 printed works and there are 31 of them in Scopus or Web of Science databases. Igor Lakhno is a member of the Editorial Board of Reproductive Health of Woman, Emergency Medicine, and Technology Transfer Innovative Solutions in Medicine (Estonia). He is a medical Editor of “Z turbotoyu pro zhinku”. Igor Lakhno is a reviewer of the Journal of Obstetrics and Gynaecology (Taylor and Francis), British Journal of Obstetrics and Gynecology (Wiley), Informatics in Medicine Unlocked (Elsevier), The Journal of Obstetrics and Gynecology Research (Wiley), Endocrine, Metabolic & Immune Disorders-Drug Targets (Bentham Open), The Open Biomedical Engineering Journal (Bentham Open), etc. He’s defended a dissertation for a DSc degree “Pre-eclampsia: prediction, prevention, and treatment”. Three years ago Igor Lakhno has participated in a training course on innovative technologies in medical education at Lublin Medical University (Poland). Lakhno Igor has participated as a speaker in several international conferences and congresses (International Conference on Biological Oscillations April 10th-14th 2016, Lancaster, UK, The 9th conference of the European Study Group on Cardiovascular Oscillations). His main scientific interests: are obstetrics, women’s health, fetal medicine, and cardiovascular medicine. \nIgor Lakhno is a consultant at Kharkiv municipal perinatal center. He’s graduated from training courses on endoscopy in gynecology. He has 28 years of practical experience in the field.",institutionString:null,institution:null},{id:"244950",title:"Dr.",name:"Salvatore",middleName:null,surname:"Di Lauro",slug:"salvatore-di-lauro",fullName:"Salvatore Di Lauro",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0030O00002bSF1HQAW/ProfilePicture%202021-12-20%2014%3A54%3A14.482",biography:"Name:\n\tSALVATORE DI LAURO\nAddress:\n\tHospital Clínico Universitario Valladolid\nAvda Ramón y Cajal 3\n47005, Valladolid\nSpain\nPhone number: \nFax\nE-mail:\n\t+34 983420000 ext 292\n+34 983420084\nsadilauro@live.it\nDate and place of Birth:\nID Number\nMedical Licence \nLanguages\t09-05-1985. Villaricca (Italy)\n\nY1281863H\n474707061\nItalian (native language)\nSpanish (read, written, spoken)\nEnglish (read, written, spoken)\nPortuguese (read, spoken)\nFrench (read)\n\t\t\nCurrent position (title and company)\tDate (Year)\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. Private practise.\t2017-today\n\n2019-today\n\t\n\t\nEducation (High school, university and postgraduate training > 3 months)\tDate (Year)\nDegree in Medicine and Surgery. University of Neaples 'Federico II”\nResident in Opthalmology. Hospital Clinico Universitario Valladolid\nMaster in Vitreo-Retina. IOBA. University of Valladolid\nFellow of the European Board of Ophthalmology. Paris\nMaster in Research in Ophthalmology. University of Valladolid\t2003-2009\n2012-2016\n2016-2017\n2016\n2012-2013\n\t\nEmployments (company and positions)\tDate (Year)\nResident in Ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl.\nFellow in Vitreo-Retina. IOBA. University of Valladolid\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. \n\t2012-2016\n2016-2017\n2017-today\n\n2019-Today\n\n\n\t\nClinical Research Experience (tasks and role)\tDate (Year)\nAssociated investigator\n\n' FIS PI20/00740: DESARROLLO DE UNA CALCULADORA DE RIESGO DE\nAPARICION DE RETINOPATIA DIABETICA BASADA EN TECNICAS DE IMAGEN MULTIMODAL EN PACIENTES DIABETICOS TIPO 1. Grant by: Ministerio de Ciencia e Innovacion \n\n' (BIO/VA23/14) Estudio clínico multicéntrico y prospectivo para validar dos\nbiomarcadores ubicados en los genes p53 y MDM2 en la predicción de los resultados funcionales de la cirugía del desprendimiento de retina regmatógeno. Grant by: Gerencia Regional de Salud de la Junta de Castilla y León.\n' Estudio multicéntrico, aleatorizado, con enmascaramiento doble, en 2 grupos\nparalelos y de 52 semanas de duración para comparar la eficacia, seguridad e inmunogenicidad de SOK583A1 respecto a Eylea® en pacientes con degeneración macular neovascular asociada a la edad' (CSOK583A12301; N.EUDRA: 2019-004838-41; FASE III). Grant by Hexal AG\n\n' Estudio de fase III, aleatorizado, doble ciego, con grupos paralelos, multicéntrico para comparar la eficacia y la seguridad de QL1205 frente a Lucentis® en pacientes con degeneración macular neovascular asociada a la edad. (EUDRACT: 2018-004486-13). Grant by Qilu Pharmaceutical Co\n\n' Estudio NEUTON: Ensayo clinico en fase IV para evaluar la eficacia de aflibercept en pacientes Naive con Edema MacUlar secundario a Oclusion de Vena CenTral de la Retina (OVCR) en regimen de tratamientO iNdividualizado Treat and Extend (TAE)”, (2014-000975-21). Grant by Fundacion Retinaplus\n\n' Evaluación de la seguridad y bioactividad de anillos de tensión capsular en conejo. Proyecto Procusens. Grant by AJL, S.A.\n\n'Estudio epidemiológico, prospectivo, multicéntrico y abierto\\npara valorar la frecuencia de la conjuntivitis adenovírica diagnosticada mediante el test AdenoPlus®\\nTest en pacientes enfermos de conjuntivitis aguda”\\n. National, multicenter study. Grant by: NICOX.\n\nEuropean multicentric trial: 'Evaluation of clinical outcomes following the use of Systane Hydration in patients with dry eye”. Study Phase 4. Grant by: Alcon Labs'\n\nVLPs Injection and Activation in a Rabbit Model of Uveal Melanoma. Grant by Aura Bioscience\n\nUpdating and characterization of a rabbit model of uveal melanoma. Grant by Aura Bioscience\n\nEnsayo clínico en fase IV para evaluar las variantes genéticas de la vía del VEGF como biomarcadores de eficacia del tratamiento con aflibercept en pacientes con degeneración macular asociada a la edad (DMAE) neovascular. Estudio BIOIMAGE. IMO-AFLI-2013-01\n\nEstudio In-Eye:Ensayo clínico en fase IV, abierto, aleatorizado, de 2 brazos,\nmulticçentrico y de 12 meses de duración, para evaluar la eficacia y seguridad de un régimen de PRN flexible individualizado de 'esperar y extender' versus un régimen PRN según criterios de estabilización mediante evaluaciones mensuales de inyecciones intravítreas de ranibizumab 0,5 mg en pacientes naive con neovascularización coriodea secunaria a la degeneración macular relacionada con la edad. CP: CRFB002AES03T\n\nTREND: Estudio Fase IIIb multicéntrico, randomizado, de 12 meses de\nseguimiento con evaluador de la agudeza visual enmascarado, para evaluar la eficacia y la seguridad de ranibizumab 0.5mg en un régimen de tratar y extender comparado con un régimen mensual, en pacientes con degeneración macular neovascular asociada a la edad. CP: CRFB002A2411 Código Eudra CT:\n2013-002626-23\n\n\n\nPublications\t\n\n2021\n\n\n\n\n2015\n\n\n\n\n2021\n\n\n\n\n\n2021\n\n\n\n\n2015\n\n\n\n\n2015\n\n\n2014\n\n\n\n\n2015-16\n\n\n\n2015\n\n\n2014\n\n\n2014\n\n\n\n\n2014\n\n\n\n\n\n\n\n2014\n\nJose Carlos Pastor; Jimena Rojas; Salvador Pastor-Idoate; Salvatore Di Lauro; Lucia Gonzalez-Buendia; Santiago Delgado-Tirado. Proliferative vitreoretinopathy: A new concept of disease pathogenesis and practical\nconsequences. Progress in Retinal and Eye Research. 51, pp. 125 - 155. 03/2016. DOI: 10.1016/j.preteyeres.2015.07.005\n\n\nLabrador-Velandia S; Alonso-Alonso ML; Di Lauro S; García-Gutierrez MT; Srivastava GK; Pastor JC; Fernandez-Bueno I. Mesenchymal stem cells provide paracrine neuroprotective resources that delay degeneration of co-cultured organotypic neuroretinal cultures.Experimental Eye Research. 185, 17/05/2019. DOI: 10.1016/j.exer.2019.05.011\n\nSalvatore Di Lauro; Maria Teresa Garcia Gutierrez; Ivan Fernandez Bueno. Quantification of pigment epithelium-derived factor (PEDF) in an ex vivo coculture of retinal pigment epithelium cells and neuroretina.\nJournal of Allbiosolution. 2019. ISSN 2605-3535\n\nSonia Labrador Velandia; Salvatore Di Lauro; Alonso-Alonso ML; Tabera Bartolomé S; Srivastava GK; Pastor JC; Fernandez-Bueno I. Biocompatibility of intravitreal injection of human mesenchymal stem cells in immunocompetent rabbits. Graefe's archive for clinical and experimental ophthalmology. 256 - 1, pp. 125 - 134. 01/2018. DOI: 10.1007/s00417-017-3842-3\n\n\nSalvatore Di Lauro, David Rodriguez-Crespo, Manuel J Gayoso, Maria T Garcia-Gutierrez, J Carlos Pastor, Girish K Srivastava, Ivan Fernandez-Bueno. A novel coculture model of porcine central neuroretina explants and retinal pigment epithelium cells. Molecular Vision. 2016 - 22, pp. 243 - 253. 01/2016.\n\nSalvatore Di Lauro. Classifications for Proliferative Vitreoretinopathy ({PVR}): An Analysis of Their Use in Publications over the Last 15 Years. Journal of Ophthalmology. 2016, pp. 1 - 6. 01/2016. DOI: 10.1155/2016/7807596\n\nSalvatore Di Lauro; Rosa Maria Coco; Rosa Maria Sanabria; Enrique Rodriguez de la Rua; Jose Carlos Pastor. Loss of Visual Acuity after Successful Surgery for Macula-On Rhegmatogenous Retinal Detachment in a Prospective Multicentre Study. Journal of Ophthalmology. 2015:821864, 2015. DOI: 10.1155/2015/821864\n\nIvan Fernandez-Bueno; Salvatore Di Lauro; Ivan Alvarez; Jose Carlos Lopez; Maria Teresa Garcia-Gutierrez; Itziar Fernandez; Eva Larra; Jose Carlos Pastor. Safety and Biocompatibility of a New High-Density Polyethylene-Based\nSpherical Integrated Porous Orbital Implant: An Experimental Study in Rabbits. Journal of Ophthalmology. 2015:904096, 2015. DOI: 10.1155/2015/904096\n\nPastor JC; Pastor-Idoate S; Rodríguez-Hernandez I; Rojas J; Fernandez I; Gonzalez-Buendia L; Di Lauro S; Gonzalez-Sarmiento R. Genetics of PVR and RD. Ophthalmologica. 232 - Suppl 1, pp. 28 - 29. 2014\n\nRodriguez-Crespo D; Di Lauro S; Singh AK; Garcia-Gutierrez MT; Garrosa M; Pastor JC; Fernandez-Bueno I; Srivastava GK. Triple-layered mixed co-culture model of RPE cells with neuroretina for evaluating the neuroprotective effects of adipose-MSCs. Cell Tissue Res. 358 - 3, pp. 705 - 716. 2014.\nDOI: 10.1007/s00441-014-1987-5\n\nCarlo De Werra; Salvatore Condurro; Salvatore Tramontano; Mario Perone; Ivana Donzelli; Salvatore Di Lauro; Massimo Di Giuseppe; Rosa Di Micco; Annalisa Pascariello; Antonio Pastore; Giorgio Diamantis; Giuseppe Galloro. Hydatid disease of the liver: thirty years of surgical experience.Chirurgia italiana. 59 - 5, pp. 611 - 636.\n(Italia): 2007. ISSN 0009-4773\n\nChapters in books\n\t\n' Salvador Pastor Idoate; Salvatore Di Lauro; Jose Carlos Pastor Jimeno. PVR: Pathogenesis, Histopathology and Classification. Proliferative Vitreoretinopathy with Small Gauge Vitrectomy. Springer, 2018. ISBN 978-3-319-78445-8\nDOI: 10.1007/978-3-319-78446-5_2. \n\n' Salvatore Di Lauro; Maria Isabel Lopez Galvez. Quistes vítreos en una mujer joven. Problemas diagnósticos en patología retinocoroidea. Sociedad Española de Retina-Vitreo. 2018.\n\n' Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor Jimeno. iOCT in PVR management. OCT Applications in Opthalmology. pp. 1 - 8. INTECH, 2018. DOI: 10.5772/intechopen.78774.\n\n' Rosa Coco Martin; Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor. amponadores, manipuladores y tinciones en la cirugía del traumatismo ocular.Trauma Ocular. Ponencia de la SEO 2018..\n\n' LOPEZ GALVEZ; DI LAURO; CRESPO. OCT angiografia y complicaciones retinianas de la diabetes. PONENCIA SEO 2021, CAPITULO 20. (España): 2021.\n\n' Múltiples desprendimientos neurosensoriales bilaterales en paciente joven. Enfermedades Degenerativas De Retina Y Coroides. SERV 04/2016. \n' González-Buendía L; Di Lauro S; Pastor-Idoate S; Pastor Jimeno JC. Vitreorretinopatía proliferante (VRP) e inflamación: LA INFLAMACIÓN in «INMUNOMODULADORES Y ANTIINFLAMATORIOS: MÁS ALLÁ DE LOS CORTICOIDES. RELACION DE PONENCIAS DE LA SOCIEDAD ESPAÑOLA DE OFTALMOLOGIA. 10/2014.",institutionString:null,institution:null},{id:"243698",title:"Dr.",name:"Xiaogang",middleName:null,surname:"Wang",slug:"xiaogang-wang",fullName:"Xiaogang Wang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/243698/images/system/243698.png",biography:"Dr. Xiaogang Wang, a faculty member of Shanxi Eye Hospital specializing in the treatment of cataract and retinal disease and a tutor for postgraduate students of Shanxi Medical University, worked in the COOL Lab as an international visiting scholar under the supervision of Dr. David Huang and Yali Jia from October 2012 through November 2013. Dr. Wang earned an MD from Shanxi Medical University and a Ph.D. from Shanghai Jiao Tong University. Dr. Wang was awarded two research project grants focused on multimodal optical coherence tomography imaging and deep learning in cataract and retinal disease, from the National Natural Science Foundation of China. He has published around 30 peer-reviewed journal papers and four book chapters and co-edited one book.",institutionString:null,institution:null},{id:"7227",title:"Dr.",name:"Hiroaki",middleName:null,surname:"Matsui",slug:"hiroaki-matsui",fullName:"Hiroaki Matsui",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Tokyo",country:{name:"Japan"}}},{id:"312999",title:"Dr.",name:"Bernard O.",middleName:null,surname:"Asimeng",slug:"bernard-o.-asimeng",fullName:"Bernard O. Asimeng",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Ghana",country:{name:"Ghana"}}},{id:"318905",title:"Prof.",name:"Elvis",middleName:"Kwason",surname:"Tiburu",slug:"elvis-tiburu",fullName:"Elvis Tiburu",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Ghana",country:{name:"Ghana"}}},{id:"336193",title:"Dr.",name:"Abdullah",middleName:null,surname:"Alamoudi",slug:"abdullah-alamoudi",fullName:"Abdullah Alamoudi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Majmaah University",country:{name:"Saudi Arabia"}}},{id:"318657",title:"MSc.",name:"Isabell",middleName:null,surname:"Steuding",slug:"isabell-steuding",fullName:"Isabell Steuding",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Harz University of Applied Sciences",country:{name:"Germany"}}},{id:"318656",title:"BSc.",name:"Peter",middleName:null,surname:"Kußmann",slug:"peter-kussmann",fullName:"Peter Kußmann",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Harz University of Applied Sciences",country:{name:"Germany"}}}]}},subseries:{item:{id:"3",type:"subseries",title:"Bacterial Infectious Diseases",keywords:"Antibiotics, Biofilm, Antibiotic Resistance, Host-microbiota Relationship, Treatment, Diagnostic Tools",scope:"