Summary table of different devices.
\r\n\t
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Sickle cell anemia is a
There are
According to WHO estimates, approximately 300–500,000 children are born each year with hemoglobinopathy; 80% of them are born in developing countries, particularly in Africa. The sickle cell anemia is a hemoglobin disorder most common in Africa, where every year about
\n
Sickle cell disease is particularly common among people from sub-Saharan Africa, India, Saudi Arabia, and Mediterranean countries. Migration has increased the frequency of the offending gene in the Americas. In parts of sub-Saharan Africa, sickle cell disease affects up to 2% of newborns. More broadly, the prevalence of sickle cell disease (healthy carriers that inherited the mutant gene from only one parent) in equatorial Africa is 10–40%, compared to only 1–2% on the coast of North Africa and less than 1% in South Africa. This distribution reflects the fact that the sickle cell trait confers an advantage in terms of survival against malaria and that the selection pressure due to malaria has made the mutant gene more frequent, especially in areas with high malaria transmission. In West African countries such as Ghana and Nigeria, the rate of trafficking is 15–30%, while in Uganda, where marked tribal variations are observed, it is 45% among the Bahamas of west of the country [2].
\nA country’s problem of access to health care depends on its ability to finance the required health systems. This presupposes that the country concerned can offer structures, viable infrastructures, and competent personnel. However, low-income countries are struggling to find adequate budget balances to effectively meet the ever-growing health needs of their populations [3], and this is the case of the DR Congo and many other countries in sub-Saharan Africa.
\nIndeed, the current sources of financing useful for universal health coverage are essentially public expenditure, donor funding, and compulsory contributions to social health insurance [4]. Since under current conditions household contributions to health care remain relatively low, with a few exceptions when community initiatives are organized [5] or when the state is effectively involved, only two sources are secure: public spending and donor funding.
\nWith regard to public expenditure, the state budget is low, often well below Abuja’s commitments (15%) [6]. In 2013, for example, the Congolese state allocated only 4.3% of its budget to health, while all projections for spending in 2020 are below 3%. Worse still, this state contribution has only decreased from 2013 to date.
\nIt just so happens that a large part of the financing of the health system relies heavily on donor funding. And in order to cover all needs, donors will theoretically have to continually increase their contribution in proportion to the decrease in the state budget.
\nBut is such a hypothesis sustainable? Logically, the answer is negative, since donors cannot set themselves up as substitutes for failing health systems. Indeed, the study of the financing mechanism supported by the World Bank Group shows that “the health sector in the DRC suffers from several ills: low budget allocation; excessive household expenditure; dependence on external financing; available resources are poorly spent; budget execution is weak; governance problems; and the decentralization process is partly theoretical.” [7] The same study shows that a decrease in external financing is observed from 2017, just as the projections predict that the deficit financing observed since 2019 will have to continue until 2030.
\nIn the specific case of the management of sickle cell disease, are there other ways of compensating for this financial situation?
\nThe first way already present in the field is that of the actions of charitable associations. The contribution of several nongovernmental organizations involved in the management of specific pathologies such as sickle cell disease is very significant and constitutes a major support, especially for the most deprived populations. The action is perceptible not only in the DR Congo but also in other countries of sub-Saharan Africa [8]. But these efforts remain insignificant compared to the magnitude of the disease, and a country’s health policy cannot be based on impulses that are difficult to predict.
\nThe second way is the frequent use of donated second-hand equipment to reduce the costs they (the equipment) represent in the health-care chain. This resource can make a great contribution if best practices for donors and donors’ applicants are rigorously observed [9]. Unfortunately, very often this is not the case. Many donations still arrive in Africa without observing the prerequisites, which very often makes them either ineffective or unusable. On the other hand, recourse to donations of second-hand equipment should remain ad hoc, without becoming structural.
\nThe third way is that of optimizing the use of the means available to approach the objectives set. At the international level, donors have understood the challenge of structured and well-executed health financing. This obliges the partners to accompany for decades the countries receiving aid through specific national programs in order to reduce deficits and achieve the objectives.
\nIn the DR Congo, it is through the national health development program that the government and its partners express their willingness to provide effective and realistic solutions to the health problems of the DR Congo’s populations. This is generally applied for a period of 5 years, iteratively after evaluation.
\nThe partners in the health field remain practically the same for African countries, and their health problems are very similar: the fight against epidemics, malnutrition, and hereditary diseases. This probably explains why almost all countries in sub-Saharan Africa each develop a national health development plan, with virtually the same content except for a few differences. Examples include the DR Congo, Mali, Côte d’Ivoire, Burkina Faso, Benin, and Kenya. Therefore the methods applied by the partners for health support to the different countries will be very similar.
\nIn the national health development plans drawn up in many sub-Saharan African countries since 2000 to date, the improvement of infrastructures and the strengthening of the capacities of the medical technical platforms, including the expression of needs, acquisition, and maintenance of the systems acquired, are among the issues addressed. These topics involve a lot of money that will have to be put to good use; otherwise they can be a source of conscious or unconscious waste of scarce resources.
\nIn the case of the DR Congo, a reflection carried out on the medical technical platform shows that the objectives assigned to medical infrastructure and equipment through national programs are never achieved and the situation is getting more complicated every year. And yet, after evaluation, the same programs continue with the same objectives and use practically the same methods [10]. In order to minimize procurement costs, the WHO proposes a strategic procurement approach to achieve universal health coverage [11]. The illustration below is more explicit.
\n\n
This diagram raises fundamental questions that need to be answered if we are to succeed in our efforts. Indeed, countries cannot simply spend their money on universal health coverage. They must master purchasing, define the relationships between suppliers and buyers, define a purchasing strategy on the basis of useful data before disbursement, and finally move from passive purchasing to strategic purchasing.
\nThe fourth path, a corollary to the third, consists of mobilizing and structuring human skills, each in its own sector, to boost the strategic purchasing process. Since the problem of strategic purchasing concerns all sectors, what can the biomedical engineer’s contribution be as far as it is concerned?
\nFrom this point of view, the biomedical engineer can play an important role as a technical interface between the hospital, suppliers, and industry to make the right choices, as he is considered responsible for the research and development, architecture, selection, management, and safe use of all types of medical devices including single-use, reusable, prosthetic, implantable, and bionic devices, among others [12].
\nFor several decades, a developed country like France has been efficiently involving biomedical engineers in the medical equipment procurement process [13]. It organizes hospital purchasing, where biomedical engineers play a leading role in the purchasing function that has developed in companies over the last 30 years or so [14]. Better still, it is developing a purchasing policy that, among other things, brings together the skills of biomedical engineers to offer end customer equipment negotiated at attractive prices through group purchasing [15].
\nBut in the Democratic Republic of the Congo in particular and in sub-Saharan Africa in general, the biomedical engineering component does not seem to be sufficiently integrated at its best in the administrative and technical response mechanisms for improving health care. This aspect of things can only lead to a waste of funds when the actors at this stage do not master the equipment.
\nIn the field there are currently different types of electrophoresis equipment. However, to date, it is difficult to determine their number, origins, and brands, given the country’s size, diverse supply methods, and ineffective control mechanisms. Nevertheless, some facilities stand out from the others in terms of their number, mainly for historical and geographical, economic, and commercial reasons.
\nHistorically and geographically, sickle cell disease was first discovered in black populations in Africa and in the Arabian Peninsula; to date it remains more frequent in these geographical areas. Initially, this disease, which later turned out to be hereditary, did not directly affect the Indo-European populations.
\nHowever, due to massive immigration, countries with well-organized prevention programs are now faced with the problems of uninformed couples of allochthonous origin, as well as variations in specific population characteristics, which is rare among indigenous populations [16].
\nIn the early 1970s, screening tests were launched in the United States, and the American population of African origin was indeed very affected. In 1981, an experimental neonatal screening program began in the French Antilles and metropolitan France. It is set up by the Association Française pour le Dépistage et la Prévention du Handicap (AFDPHE). It was only in 2000 that neonatal screening for sickle cell disease was, this time, extended in whole France [17].
\nAs a result of the above, electrophoresis systems are initially more equipped with routine programs dedicated to serum protein analysis; programs for the analysis of hemoglobinopathies will gradually come into operation. Indeed, the implementation of new programs involves significant costs that the manufacturer cannot incur without a guaranteed return on investment.
\nSince the greatest need for sickle cell disease management is in Africa, countries with strong historical ties to the continent will find it easier to sell their technologies to this potential market. Among them we will mention the most prominent firms such as HELENA, TITAN, BECKMAN SEBIA, and BIORAD.
\nIn financial terms, the choice of equipment for routine needs will focus more on technical solutions that offer good results at lower cost. From this point of view, for the analysis of hemoglobinopathies, there is an established correlation between agarose gel electrophoresis on the one hand and capillary electrophoresis on the other [18]. On the other hand, high-performance liquid chromatography (HPLC) and capillary techniques are complementary and can be used routinely, knowing that capillary diagrams are easier to read and interpret than those obtained in HPLC. Even better, the development of the capillary technique for the characterization of hemoglobin variants suggested that it would become the first method of choice for screening in many clinical laboratories [19].
\nThis trend is confirmed with regular innovations from certain manufacturers, and this is the case of SEBIA, which has added to its range for the screening of hemoglobinopathies [20]. In addition, the capillary technique is more sensitive than the HPLC technique for the detection of certain variants such as hemoglobin New York [21].
\nOn the commercial level, thanks to their historical links with Africa, the first companies are more easily organized and set up local representations of their firms to facilitate the sale of their products. Among the first to obtain country-level representation are HELENA and BECKMAN.
\nBut for almost two decades, we have been observing the rise of the SEBIA company, which offers different models of equipment according to the needs and which regularly innovates its products. Today, this firm, now a world leader in the field of electrophoresis, is among those with a large number of distributors in Africa.
\nApart from the abovementioned brands, it is worth noting a slow penetration of products of Asian origin in the field. However, while the financial offer is attractive, distribution is still struggling to be structured in terms of regularity, reliability, and operation.
\nIn the present case of the management of sickle cell disease and in order to make his contribution relevant and effective, the biomedical engineer must make an inventory of the existing situation in the field, evaluate the technologies in the state of the art, and propose material solutions that present a better compromise between technical and technological contributions and optimization of the financial aspect.
\nThe following theories are drawn mainly from the book
Electrophoresis has established itself over time as the method of choice for the qualification and quantification of different fractions in the management of hemoglobinopathy. It involves methods often embedded in laboratory materials. We review below the most common methods in electrophoresis of hemoglobin.
\nElectrophoresis is a physical method of separating molecules based on their difference in mobility, under the effect of an electric field. Zone electrophoresis, carried out on a solid support, is used to essentially separate the ionizable biological macromolecules, that is to say proteins, nucleic acids, and certain polyosides and proteoglycans.
\nLiquid vein electrophoresis, currently capillary electrophoresis, is also applied to small molecules, organic or mineral, and not necessarily ionizable. In the most common case, the movement of the molecule depends on several intrinsic (due to the molecule itself) and extrinsic parameters, in particular linked to migration buffers which play the role of solvent [22].
\nThis is the electrophoresis whose migration medium is stabilized by a real or sometimes virtual porous support as in the density gradient. In the case of a porous substrate, it is soaked with a buffer solution that both ensures conductivity and stabilizes the pH at the desired value. The molecules separate according to their different mobility in the system (they appear as migration zones) and will be visualized in a second time (“revelations”); we can even isolate them from the support for the preparatory purpose.
\nZone electrophoresis is mainly applied to the separation of macromolecules.
\nThese electrophoreses are often characterized by strong electroosmotic currents and sometimes intense Joule effect. The most common electroosmotic current is the electroendosmosis current, especially in polyosidic supports used at pH alkaline: the walls are negatively ionized as the macromolecules to be separated; positive buffer charges are attracted to the cathode and create a current that is in the opposite direction of electrophoretic migration.
\nAnother electroosmosis phenomenon is related to the structure of the support, which can be assimilated to a capillary network; the friction forces are greater on the edges of the support, and the center moves faster, distorting the migration band. Finally, the Joule effect heats the substrate and therefore evaporates the solvent; this is gradually replaced by the liquid of the vessels which rises in the support by capillary action, opposite both ends of the support, and annulling in the middle [23].
\nThe supports must be chemically inert (low adsorbent) and homogeneous (regular microporous structure), have good mechanical resistance (handling), and possibly allow densitometric reading [24].
\nPaper is a natural cellulose; it is no longer used much because it is not homogeneous. Paper electrophoresis provides a strong electroendosmosis current and is a source of parasitic adsorptions (added chromatography), resulting in poor resolution; the Joule effect is important with heating, evaporation, and even electrolysis of the buffer. At high pressure (1000–3000 V), paper electrophoresis is mainly used to separate peptides and amino acids.
\nCellulose acetate is much more homogeneous than paper; this support allows densitometric reading, but the electroendosmosis current remains high. The applications of cellulose acetate are mainly found in medical biology, allowing a quantitative densitometric reading of the protein fractions rather roughly separated (plasma and urinary proteins, lipoproteins, and hemoglobins), or finer (isoenzymes), applying the potential gradients of the order of 30 V cm−1. Resolution is poor, and reproducibility is average.
\nHowever, at alkaline pH (typically pH 8.6), Hb A2, Hb C, Hb E, and Hb O migrate to the same area, and Hb S, Hb D, and Hb G migrate at the same rate. In the case of suspicions of such hemoglobin abnormalities, an additional technique should therefore be considered [25].
\nStarch gel is a polyoside; electrophoresis on this gel allows the separation of complex or heterogeneous oligomeric protein associations. Starch gel is little used because it is opaque, fragile, and not very reproducible.
\nAgarose is desulfonated agar (purified agar); removal of sulfonates greatly limits the flow of electroendosmosis; agarose gels between 0.5 and 2% are not very viscous. They make it possible to carry out native electrophoresis as with the previous supports, that is, without denaturation of the macromolecules. Potential gradients up to 50 V cm−1 are usable for protein separation; agarose gel is gradually replacing cellulose acetate in most biomedical applications because agarose improves resolution and remains colorless, allowing a good densitometric reading. The agarose gel is also very homogeneous, thus ensuring good reproducibility, and is well adapted to zymographic reading [23].
\nThe distinction between the different variants Hb A2, Hb C, Hb E, and Hb O, as well as Hb S, Hb D, and Hb G, is most often made by electrophoresis on agarose gel at acidic pH (pH 6.0), which allows to separate Hb C, from Hb E and Hb O, as well as Hb S, from Hb D and Hb G. On the other hand, Hb E and Hb O, as well as Hb D and G, still cannot be differentiated by combining these two electrophoretic methods (cellulose acetate, agarose gel). In addition, these techniques have the disadvantage of consuming time and labor.
\nIn addition, they lack precision for the quantification of hemoglobin in low concentrations, such as Hb A2, and for the detection of fast-migrating variants, such as Hb H or Hb Bart’s. It is even now accepted that the quantification of variants by densitometry lacks precision and that these two electrophoresis techniques must be used for qualitative purposes. They are therefore most often used today in combination with another method, mainly high-performance liquid chromatography, which has a much higher accuracy.
\nA 1999 study by the College of American Pathologists showed a coefficient of variation (CV) of 33.6% for the quantification of Hb A2 at a concentration of 2.41% by densitometry from electrophoretic gels. By HPLC, the CV was 4.3% for Hb A2 at a concentration of 3.47%. Thus, the combination of these electrophoresis techniques with HPLC allows the identification and quantification of hemoglobin, the latter being performed by HPLC only [26].
\nIt is a polymer of acrylamide and N,N′-methylene-bisacrylamide (Bis), the acrylamide gel polymerization being obtained in the presence of a catalyst (ammonium persulfate) and a cross-linking agent (N,N,N′,N′-tetramethyl-ethylene-diamine [TEMED]). The porosity of gels can be very precise; it depends on the relative concentrations of acrylamide and Bis.
\nThe polymer obtained is very hydrophilic although insoluble in water and easy to mold even under small thicknesses (<1 mm); it is thermostable, not fragile, transparent, and inert chemically. There is almost no electroendosmosis flow and no macromolecules are absorbed. The resolutive power is generally superior to that of polyosidic gels using gradients of similar potential. The main disadvantage is that the acrylamide in solution is neurotoxic but also that the resulting porosities are very poorly adapted to very large molecules [27].
\nIt is made on paper, starch, cellulose acetate, agarose gel, and sometimes polyacrylamide whenever we do not want to touch the tertiary and quaternary structures of macromolecules, thus their biological activities. This method without denaturation is a priori applicable to all types of macromolecules, both in vertical and horizontal tanks [27].
\nIsoelectrofocusing, carried out on agarose gel or polyacrylamide gel, separates hemoglobin in a pH gradient according to their isoelectric point. To do this, ampholytes are introduced into the gel in order to create a continuous pH gradient under the effect of an electric field. The different hemoglobins contained in the sample to be analyzed will migrate to the region where the pH is equal to their isoelectric pH. At this position, the net load is zero, and the hemoglobin ceases to migrate and focuses into a narrow band.
\nThis technique, capable of separating hemoglobin variants with isoelectric points different from 0.02 pH units, has excellent resolution and is very useful for detecting abnormal hemoglobin in the newborn. In fact, it allows a good separation of hemoglobins F, A, and S. Moreover, the electrical isofocusing is perfectly adapted to the analysis of large series. On the other hand, the main limitations of this method are a long and complex implementation. Therefore, its use is almost reserved for neonatal screening of hemoglobinopathies [28, 29].
\nTypically, capillary electrophoresis is performed in a fused silica capillary coated with a polyamide layer of 20–200 μm of internal diameter and 20–200 cm of length. The capillary, placed in a thermostatization system, is filled with a buffer solution and plunges into two tanks containing the same solution. Each tank is connected to an electrode connected to a current generator. A large potential difference (several thousand volts) is applied to the terminals of each capillary to separate the molecules on the basis of their charge/mass ratio [30].
\nThe use of a capillary has a double advantage: increases the sensitivity of the detection since a reading window in the capillary allows an absorbance reading with a very small optical path and increases the resolution by applying the potential difference of more than 10,000 V since it is easy to regulate the capillary in temperature [31].
\nIn this method, the buffer solution in contact with the two tanks of the system constitutes the support. Since liquid has no specific form, the buffer uses the capillary as a solid support, contributing also to electroendosmosis current production.
\nThere are several methods used in capillary electrophoresis including capillary zone electrophoresis (CZE), capillary gel electrophoresis (CGE), and micellar electrokinetic chromatography (MECC) [32]. In this study, we will limit ourselves to capillary zone electrophoresis which is the most exploited for hemoglobinopathy.
\nThis method can be performed on a single-fused silica capillary in which an electroosmotic flux develops. It causes the negative molecules to the cathode where the detection is carried out, the injection being anodic.
\nThe electroosmotic flux depends on the temperature, the ionic force, and the concentration of organic solvent.
\nWe will limit ourselves here to the most common routine techniques for the analysis of hemoglobinopathies in the Democratic Republic of the Congo in particular and in sub-Saharan Africa in general. They are often affected by accessibility during acquisition, ease of commissioning, operation, maintenance and supply, and cost.
\nOn one side, our analysis is based globally on equipment meeting international standards such as ISO, FDA, and CE certification. Field experience shows that such equipment can operate for about 7 years, if the manufacturer’s operating recommendations are followed.
\nOn the other hand, high-performance liquid chromatography has been developed to allow both the detection and confirmation of hemoglobinopathy in newborns with high sensitivity and specificity. In fact, its good sensitivity to the major variants involved in pathology and its speed of completion (about 3 min per sample), allowing the analysis of a large number of samples, have made HPLC a particularly suitable method for screening for hemoglobin abnormalities [33].
\nHowever, we will not discuss this technique in this study because, since its performance is comparable to that of the HPLC method, capillary electrophoresis quickly became the method of choice, just like HPLC, for the study of hemoglobinopathy. In addition, it is of economic interest: although the material cost is comparable to that of the HPLC, the expenditures on reagents are much lower. Indeed, the price of a capillary is much lower than that of a chromatography column, and the volumes of buffer used are much lower, about 1000 times less [34].
\nManual systems for native electrophoresis (on cellulose acetate and agarose gel) or isoelectrofocusing offer the best acquisition possibility both in terms of cost and operational constraints. Their limits both in the separation and in the identification of hemoglobin variants will be used for the routine forms to be specified by the customer (identification of the electrophoretic profile, identification of specific variants).
\nThe coupling of these methods to the reading system (densitometers) makes it possible to quantify the separate variants. And from this point of view, agarose gel electrophoresis offers better performance than cellulose acetate. On the other hand, the reagents are in the form of combs which often require a minimum of seven samples. Such a constraint requires, for economic reasons, to launch the samples in series of seven, which requires a consequent sizing and proper holding wire.
\nFor native electrophoresis the system is usually composed of a current generator and a migration tank. For isoelectrofocusing, the system consists of a stabilized supply, an isoelectrofocusing, unit, and a circulating cryostat.
\nThe devices typically contain conventional electronic parts and boards, used in the manufacture of power generators. These components are often not complex, and do not require advanced technical repair. In addition, it has been found that when equipment actually meets ISO, FDA, or CE marking standards, it works well and lasts for a long time.
\nThese systems can be used in very small laboratories, without large volume flow of samples, for the screening of hemoglobinopathies, by planning a periodic operation. Indeed, the pre-analytical phase requires a lot of sample preparation time and immobilizes the staff for quite a long time. They can also be used in medium laboratories as a backup system.
\nThe isoelectrofocusing system will be more targeted for newborn screening because it allows for a good separation of the Hb F, Hb A, and Hb S fractions, which assumes that the system is usually installed near a maternity ward.
\nSemiautomatic systems for native electrophoresis on cellulose acetate or agarose gel offer the possibility of processing large series of samples. Although the cost of the system is still high for a large number of health facilities, the manual routine is clearly improved. Semiautomatic systems (on cellulose acetate or agarose gel) are embedded on compact systems generally comprising a migration and coloring modules, which considerably reduce user handling.
\nThe reading system, often equipped with advanced post-processing software, can be incorporated or remote. Nevertheless, the results obtained show the same limits as in the case of manual methods because the operating principles of the migration and coloring units taken separately are the same as those of the manual system.
\nThe semiautomatic system is generally composed of a compact unit comprising a thermoregulated migration module connected to a current generator and a fluidic module for coloring migrated gels. Technologically, an intelligent electronic unit manages the high voltage of the migration module, the fluidics of the coloring module, and the application programs for the two modules.
\nGenerally, devices typically contain conventional electronic parts and boards. The process control is often ensured by position and temperature sensors. As their complexity is not great, maintenance can be easily carried out by a duly trained biomedical technician.
\nThese systems can equip medium-sized laboratories by planning either periodic operation or continuous operation, depending on the flow of samples. They are fairly widespread in the private laboratories which can obtain them and some public hospital laboratories often on behalf of specific programs. User maintenance monitoring must be ensured to guarantee proper functioning, and periodic annual maintenance must be carried out, insured in accordance with the manufacturer’s recommendations.
\nAutomatic techniques (only capillary zone electrophoresis) are the best offer, both in terms of flexibility of use and technical performance. Prices are still very high for many customers in Africa. Nevertheless, a good expression of needs and an adequate exploitation planning can allow a return on investment in an acceptable time.
\nThese techniques are carried out on compact systems, generally comprising capillaries at the ends plunging into reservoirs of buffer solution, themselves connected to the current generator. The apparatus also includes a detection system, most often a UV–visible spectrophotometer, linked to the wavelength of specific absorption of hemoglobin at 415 nm.
\nMore sophisticated technology includes a capillary thermoregulation system, a control system comprising various sensors that manage optics, robotics, pneumatics, and detection, and a set of intelligent electronic cards capable of communicating with each other. Unlike previous methods, this method allows both to launch samples in an emergency without restriction and to process large series of samples.
\nIn view of the complexity of its technology, management requires competent personnel who are regularly trained by the manufacturer. Water quality and user maintenance of equipment are of paramount importance to ensure the quality of results. This assumes that the supplier provides user training for the best care.
\nThanks to their flexibility in the work organization, these automated systems can equip laboratories with small volumes of samples, as well as those which process large volumes. Indeed, there are small and large models of automata to cover all these needs. Because of their high prices, these automata are acquired in public hospitals on the basis of research projects and specific programs. Private clinics acquire them for routine because of their performance. However they do have a few requirements that must be observed: the operating environment must be less dusty, the quality of electricity flawless, the quality of pure water, and regular maintenance.
\nWe present in Table 1 a summary of different devices that we have reviewed.
\nMigration support | \nAdvantages | \nDisadvantages | \nSystems | \nMaterials | \nMaintenance level | \nConstraints | \nAverage cost (€) | \n
---|---|---|---|---|---|---|---|
Paper | \n- Native electrophoresis - Separation of amino acids and peptides | \n- High electroendosmosis current - Significant Joule effect - Bad resolution - Poor homogeneity - Parasite adsorptions | \nManual | \n- Current generator | \n- Low | \nGood grounding | \n\n |
- Migration tank | \n- Free | \nFree | \n7000 | \n||||
- Densitometer | \n- Low | \nFree | \n\n | ||||
Cellulose acetate | \n- Native electrophoresis - More homogeneous than paper - Separation of plasma and urine proteins, lipoproteins, hemoglobin, and isoenzymes | \n- High electroendosmosis currents - Poor resolution - Medium reproducibility - The hemoglobins A2, C, E, and O migrate in the same zone - The hemoglobins S, D, and G migrate at the same rate - Long implementation | \nManual | \n- Current generator | \n- Low | \nGood grounding | \n\n |
- Migration tank | \n- Free | \nFree | \n7000 | \n||||
- Densitometer | \n- Low | \nFree | \n\n | ||||
Semiautomatic | \n- Compact staining and migration module and densitometer (integrated or no) | \n- Medium - Medium | \n- Steady voltage - Good grounding - Air-conditioned room - Inverter | \n15,000 | \n|||
Agarose gel | \n-Native electrophoresis - Nonnative electrophoresis - Limited electroendosmosis flow - Improved resolution - Very homogeneous - Separation of Hb C from Hb E and Hb O - Separation of Hb S from Hb D and Hb G | \n- No separation between HB E and Hb O - No separation between Hb D and Hb G - Inaccurate for the quantification of hemoglobin with low concentration (Hb A2) and for the detection of variants with fast migration (Hb H and Hb Bart’s) - Long Implementation | \nManual | \n- Current generator | \n-Low | \nGood grounding | \n\n |
- Migration tank | \n-Free | \nFree | \n7000 | \n||||
- Densitometer | \n- Low | \nFree | \n\n | ||||
Semiautomatic | \n- Compact staining and migration module and densitometer (integrated or no) | \n- Medium - Medium | \n- Steady stable - Good grounding - Air-conditioned room - Inverter | \n15,000 | \n|||
\n | \n\n | \n\n | \nSemiautomatic | \n-Isoelectrofocusing module | \n- Medium | \n- Steady voltage - Good grounding - Air-conditioned room - Inverter | \n150,000 | \n
-Circulation cryostat | \n- Medium | \n- Steady voltage - Good grounding - Air-conditioned room - Inverter | \n\n | ||||
Liquid vein (capillaries) | \n- Fast - Precise quantification of hemoglobin fractions - Flexible (small and large series) | \n-High water quality -Demanding environment | \nAutomatic | \n- Compact migration and detection module | \n- High | \n- Steady voltage - Good grounding - Air-conditioned room - Inverter - Water quality | \n30,000 | \n
Summary table of different devices.
For better use of data in Table 1, it will be broken down below with two subsidiaries: Tables 2 and 3.
\nPerformances | \nMigration support | \n|||
---|---|---|---|---|
Paper | \nCellulose acetate | \nAgarose gel | \nLiquid vein | \n|
Nonnative electrophoresis | \n\n | \n | ✓ | \n✓ | \n
Native electrophoresis | \n✓ | \n✓ | \n✓ | \n✓ | \n
Separation of amino acids and peptides | \n✓ | \n✓ | \n✓ | \n✓ | \n
Homogeneity | \n✓ (poor) | \n✓ (medium) | \n✓ (good) | \n✓ | \n
Separation of plasma and urine proteins, lipoproteins, hemoglobin, and isoenzymes | \n— | \n✓ | \n✓ | \n✓ | \n
Resolution | \n✓ (bad) | \n✓ (poor) | \n✓ | \n✓ | \n
Separation of Hb A2 from Hb C, Hb E, and Hb O | \n— | \nx (migrate in the same area) | \n✓ | \n✓ | \n
Separation of Hb C from Hb E and Hb O | \n— | \nx | \n✓ | \n✓ | \n
Separation of Hb S and Hb from Hb D and G | \n— | \nx (migrate at the same rate) | \n✓ | \n✓ | \n
Separation of Hb S and Hb O | \n— | \nx | \nx | \n✓ | \n
Separation of Hb D and Hb G | \n— | \nx | \nx | \n✓ | \n
Rapidity | \nLow | \nGood | \nGood | \nFast | \n
Quantification of hemoglobin with low concentration (Hb A2) | \n— | \nx | \nx | \n✓ | \n
Detection of fast-migrating variants (Hb H, Hb Bart’s) | \n— | \nx | \nx | \n✓ | \n
Precise quantification of hemoglobin fractions | \n— | \nx | \nx | \n✓ | \n
Flexible (small and wide series) | \n— | \nx | \nx | \n✓ | \n
Electroendosmosis current | \nVery high | \nHigh | \nHigh | \nHigh | \n
Joule effect | \n✓ | \n— | \n— | \n— | \n
Pest adsorption | \n✓ | \nx | \nx | \nx | \n
Reproducibility | \n— | \n✓ (medium) | \n✓ | \n✓ | \n
Water quality | \nNormal | \nNormal | \nNormal | \nHigh | \n
Demanding environment | \nNormal | \nNormal | \nNormal | \nHigh | \n
Performance comparison based on migration support.
\n | Systems | \n||
---|---|---|---|
\n | Manual | \nSemiautomatic | \nAutomatic | \n
Migration support | \n-Paper -Cellulose acetate -Agarose gel | \nCellulose acetate -Agarose gel | \n-Vein liquid (capillaries) | \n
Equipment | \n-Power generator -Tank migration -Densitometer | \n-Module staining and migration -Densitometer (integrated or not) | \n-Module compact migration and detection | \n
Installation constraints | \n-Quality ground line -Quality voltage | \n-Quality ground line -Quality voltage -Quality air conditioning | \n-Quality ground line -Quality voltage -Quality air conditioning -Quality of water | \n
Execution time | \nTrès long | \nLong | \nCourt | \n
Acquisition cost (en €) | \n7000 | \n15,000 | \n3000 | \n
Maintenance level | \nBas | \nMoyen | \nHaut | \n
Comparison of systems in terms of hardware, installation constraints, acquisition cost, and maintenance level.
The information contained in Table 2 will highlight the performance of the equipment according to different migration or embedded media available, while those in Table 3 will compare the systems sold compared to hardware, installation constraints, execution time, and cost.
\nA cursory reading shows that the most efficient migration support remains one of the capillary methods (liquid vein): this support brings in itself the best return for the resolution, reproducibility, discrimination, and quantification, while the parasitic effects are almost nonexistent. But medical needs and health goals differ from one level to another and do not require in all cases the acquisition of such technology.
\nFor routine screening for sickle cell disease, for example, the performance of migration on cellulose acetate amply suffices needs. This assumes that the precise separation variants like Hb A2, Hb C, Hb E, and Hb O are not a need first. On the other hand, as part of the requirements to cover, the effective separation of Hb S and Hb C variant is needed, and migration on agarose gel will best meet this requirement.
\nIf, during treatment, abnormal forms of hemoglobin are associated, then the choice of medium will be directed towards agarose gel for a qualitative indication or the liquid vein for a quantitative indication of Hb A2. Indeed, abnormally low Hb A and abnormally high Hb A2 correlate with the presence of some abnormal forms of hemoglobin (alpha or beta thalassemia, etc.).
\nIf precise separation and precise quantification of the variants Hb A2, Hb C, Hb E, and Hb O are required, then the liquid vein (capillary) support should be readily chosen.
\nDepending on work previously defined criteria, this table can guide the choice of performance basis based migration media.
\nBut the only performance criteria are not sufficient to make a choice of appropriate materials. It will also take into account industrial supply in terms of existing systems, the materials that make up, their costs, and maintenance requirements. Below we provide a table that can guide us in assessing the choices to be made.
\nThe line “migration support” is added in order to link Tables 2 and 3.
\nThe analysis of the table shows that as the system moves from manual to fully automated, the necessary hardware is gradually being integrated into a compact module. From this point of view, this development provides an appreciable response to the ergonomic problems that are becoming very frequent in laboratories.
\nOn the other hand, we observe that the installation constraints are more demanding when the analysis module becomes more compact. Indeed, in addition to the quality of the electrical ground line and voltage which greatly affect the operation of systems provided, the environment requires better temperature control (air conditioning), for example, besides the requirements of the water quality.
\nThe time required to perform the analyses is a very important parameter in the choice of equipment. On the one hand, it allows better management of the patient queue, and on the other hand, it ensures the management of reagents and consumables with a limited life. When the volume of samples to be treated in a routine manner is small, manual systems are suitable for both patient satisfaction and reactive management. If the volume of samples to be processed requires more than 1 day of work, the semiautomated system should be considered to resolve the queue. Finally, if the volume of samples increases further, the fully automated system will better meet expectations.
\nThe management of reagents in the laboratory depends heavily on two important parameters that should be noted: this is the expiry date and the stability time after opening of the reagent. The expiry date indicated on the label is usually the date after which the manufacturer no longer guarantees the validity of the results, while the stability time after opening of the reagent indicates the period after which the manufacturer no longer guarantees its reliability after the first use.
\nSince the stability time is shorter than the expiry date itself, it will be necessary to ensure that each open reagent is consumed before that time. For example, the use of a reagent that has a stability time of 60 days and can analyze 1000 samples in a laboratory that receives only 10 samples per day is a waste. The use of this reagent before maturity requires an average daily rate of 20 samples, considering that the laboratory operates 6 days a week. Ten samples/day instead of 20 samples/day will theoretically cause the damage of half the reagent.
\nThe level of maintenance, and in turn cost, follows the same trend: more compact system is provided and the higher level of maintenance.
\nSince the cost of acquiring systems increases with the complexity of the technology, it is important to ask good questions, find good answers, and make good choices based on real needs, to achieve savings. As an example, is it necessary to acquire a semiautomatic agarose gel system when, taking into account the medical needs and the volume of samples to be treated, the manual system on agarose gel support gives us satisfaction? Affirmative answer incurs an additional a non-justified expenditure of 8000€. Worse still, such equipment oversizing compromises a substantial depreciation because it will be under-utilized.
\nThe management of any pathology implies the appropriate choice of techniques and technologies. Indeed, beyond the medical needs that are priority, a control equipment acquisition cost is one of the major parameters providing effective support to strategies put in place.
\nVery often in sub-Saharan countries, the aspect of the consequent acquisition of the necessary technology is not always thorough, and this can lead a poor quality of reported results, the inaccessible test cost for the poorest people, and the delicate operation of projects being implemented.
\nThe choice of equipment performed after an objective needs analysis enables to optimize the process of acquiring, to ensure the quality of reported results, and to provide more accessible costs to target populations generally poor.
\nAccording to WHO recommendations, technology assessment, device evaluation, needs planning, selection and acquisition, installation, commissioning, and finally monitoring should be part of a successful acquisition procedure [35].
\nSuch an approach should involve all stakeholders, namely, doctors, managers, biomedical engineers, and users.
\nIn the case of sickle cell anemia, the inventory of installed park shows that beside manual methods, diagnostic techniques most common in the Democratic Republic of the Congo and even in sub-Saharan Africa are phenotypic techniques. These include
The prices of the equipment listed in the table remain indicative. We have taken into account only good-quality equipment commonly used in the DR Congo and by extension in other countries of sub-Saharan Africa.
\nFor low-income countries, the costs of such facilities are still high overall. Indeed, the increase in health expenditure, which represents 10% of the world’s gross domestic product (GDP), is faster than the growth of the world economy. According to a new World Health Organization report on global health spending, it is increasing rapidly, particularly in low- and middle-income countries, where spending is increasing at an average of 6% per year, compared to 4% in high-income countries.
\nHealth expenditure is assumed by governments, by individuals who pay for their own care (out-of-pocket payments), and by other entities such as voluntary health insurance schemes, employer-sponsored schemes, and nongovernmental organizations. On average, 51% of a country’s health expenditure is assumed by general government and more than 35% by individuals in the form of direct expenditure. One of the consequences of this situation is that every year 100 million people are plunged into extreme poverty [36].
\nFor the countries concerned, the acquisition of these health technologies requires new upstream procurement strategies to meet acquisition and operating costs. And from this point of view, some developed countries such as France are now developing group procurement procedures in public hospitals.
\nAccording to a recent study conducted in the Democratic Republic of the Congo on an investment in capillary electrophoresis equipment for a project on sickle cell disease, this can contribute to improve quality and low cost of tests, if a complete analysis of needs is carried out upstream.
\nIn this study, for an equipment activity extending over a period of 7 years, the cost of acquisition and maintenance cost represent, respectively, 11.4% and 5.0% of the total life cycle cost.
\nBut when the activity of the same equipment is done over a period of 2 years, the cost of acquisition and maintenance cost represent, respectively, 31.0% and 3.9% of the total life cycle cost.
\nAdded to this, for the same annual rate, the minimum unit test cost is € 3.9 for a 7-year activity cycle, whereas it costs € 5 if the activity cycle is reduced to 2 years [37].
\nTherefore, it should be noted that when operating conditions remain the same, amortization of equipment carried on shorter lead times significantly increases the cost of the test at the expense of patients.
\nEven though this example only concerns electrophoresis capillary equipment, extrapolating conclusions on agarose gel equipment is possible for the following reasons: installation, operation, and maintenance are less demanding than for capillary technology.
\nWhile sub-Saharan Africa is the most affected region in the world for sickle cell disease, research and care are relatively slow.
\nAt its 60th session held in Malabo from 30 August to 3 September 2010, the WHO was already raising the option of a strategy for its African region. Nine years after the effects are hardly noticeable.
\nThe management improvement of this pathology solicits several challenges, including the one concerning the technical platform necessary for diagnosis. The costs of acquiring and operating equipment often require significant fundraising, which is often lacking. The missing financial means are often one of the first obstacles to the launching of the relevant programs.
\nThe study mentioned above proves that it is possible to optimize the available resources, however modest they may be, in order to obtain good and lasting results.
\nIn the case of biomedical equipment, it is sufficient to involve the right people to achieve the expected results. Policymakers in sub-Saharan African countries must therefore integrate the skills of biomedical engineers into the design and start-up of medical projects so that they, in turn, contribute effectively to improve the quality of medical care populations.
\n.
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His studies in robotics lead him not only to a PhD degree but also inspired him to co-found and build the International Journal of Advanced Robotic Systems - world's first Open Access journal in the field of robotics.",institutionString:null,institution:{name:"TU Wien",country:{name:"Austria"}}},{id:"441",title:"Ph.D.",name:"Jaekyu",middleName:null,surname:"Park",slug:"jaekyu-park",fullName:"Jaekyu Park",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/441/images/1881_n.jpg",biography:null,institutionString:null,institution:{name:"LG Corporation (South Korea)",country:{name:"Korea, South"}}},{id:"465",title:"Dr",name:"Christian",middleName:null,surname:"Martens",slug:"christian-martens",fullName:"Christian Martens",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"479",title:"Dr.",name:"Valentina",middleName:null,surname:"Colla",slug:"valentina-colla",fullName:"Valentina Colla",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/479/images/358_n.jpg",biography:null,institutionString:null,institution:{name:"Sant'Anna School of Advanced Studies",country:{name:"Italy"}}},{id:"494",title:"PhD",name:"Loris",middleName:null,surname:"Nanni",slug:"loris-nanni",fullName:"Loris Nanni",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/494/images/system/494.jpg",biography:"Loris Nanni received his Master Degree cum laude on June-2002 from the University of Bologna, and the April 26th 2006 he received his Ph.D. in Computer Engineering at DEIS, University of Bologna. On September, 29th 2006 he has won a post PhD fellowship from the university of Bologna (from October 2006 to October 2008), at the competitive examination he was ranked first in the industrial engineering area. He extensively served as referee for several international journals. He is author/coauthor of more than 100 research papers. He has been involved in some projects supported by MURST and European Community. His research interests include pattern recognition, bioinformatics, and biometric systems (fingerprint classification and recognition, signature verification, face recognition).",institutionString:null,institution:null},{id:"496",title:"Dr.",name:"Carlos",middleName:null,surname:"Leon",slug:"carlos-leon",fullName:"Carlos Leon",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Seville",country:{name:"Spain"}}},{id:"512",title:"Dr.",name:"Dayang",middleName:null,surname:"Jawawi",slug:"dayang-jawawi",fullName:"Dayang Jawawi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Technology Malaysia",country:{name:"Malaysia"}}},{id:"528",title:"Dr.",name:"Kresimir",middleName:null,surname:"Delac",slug:"kresimir-delac",fullName:"Kresimir Delac",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/528/images/system/528.jpg",biography:"K. Delac received his B.Sc.E.E. degree in 2003 and is currentlypursuing a Ph.D. degree at the University of Zagreb, Faculty of Electrical Engineering andComputing. His current research interests are digital image analysis, pattern recognition andbiometrics.",institutionString:null,institution:{name:"University of Zagreb",country:{name:"Croatia"}}},{id:"557",title:"Dr.",name:"Andon",middleName:"Venelinov",surname:"Topalov",slug:"andon-topalov",fullName:"Andon Topalov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/557/images/1927_n.jpg",biography:"Dr. Andon V. Topalov received the MSc degree in Control Engineering from the Faculty of Information Systems, Technologies, and Automation at Moscow State University of Civil Engineering (MGGU) in 1979. He then received his PhD degree in Control Engineering from the Department of Automation and Remote Control at Moscow State Mining University (MGSU), Moscow, in 1984. 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She obtained a BSc from the University of Derby, England, a master’s degree from Technische Universität München, Germany, and a Ph.D. from the University of Nottingham. She undertook a post-doctoral research fellowship in the School of Medicine before accepting tenure in Veterinary Medicine and Science. Dr. Rutland also obtained an MMedSci (Medical Education) and a Postgraduate Certificate in Higher Education (PGCHE). She is the author of more than sixty peer-reviewed journal articles, twelve books/book chapters, and more than 100 research abstracts in cardiovascular biology and oncology. She is a board member of the European Association of Veterinary Anatomists, Fellow of the Anatomical Society, and Senior Fellow of the Higher Education Academy. 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He studied \r\nchemistry at the Universidad Nacional de La Plata, Argentina, where received aPh.D. degree in chemistry (Biological Branch) in 1965. From\r\n1964 to 1974, he worked as Assistant in Biochemistry at the School of MedicineUniversidad Nacional de La Plata, Argentina. From 1974 to 1976, he was a Fellowof the National Institutes of Health (NIH) at the University of Connecticut, Health Center, USA. From 1985 to 2004, he served as a Full Professor oBiochemistry at the Universidad Nacional de La Plata, Argentina. He is Member ofthe National Research Council (CONICET), Argentina, and Argentine Society foBiochemistry and Molecular Biology (SAIB). His laboratory has been interested for manyears in the lipid peroxidation of biological membranes from various tissues and different species. Professor Catalá has directed twelve doctoral theses, publishedover 100 papers in peer reviewed journals, several chapters in books andtwelve edited books. 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Angel Catalá belongto the Editorial Board of Journal of lipids, International Review of Biophysical ChemistryFrontiers in Membrane Physiology and Biophysics, World Journal oExperimental Medicine and Biochemistry Research International, W orld Journal oBiological Chemistry, Oxidative Medicine and Cellular Longevity, Diabetes and thePancreas, International Journal of Chronic Diseases & Therapy, International Journal oNutrition, Co-Editor of The Open Biology Journal.",institutionString:null,institution:{name:"National University of La Plata",institutionURL:null,country:{name:"Argentina"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"186048",title:"Prof.",name:"Ines",middleName:null,surname:"Drenjančević",slug:"ines-drenjancevic",fullName:"Ines Drenjančević",profilePictureURL:"https://mts.intechopen.com/storage/users/186048/images/5818_n.jpg",institutionString:null,institution:{name:"University of Osijek",institutionURL:null,country:{name:"Croatia"}}},{id:"187859",title:"Prof.",name:"Kusal",middleName:"K.",surname:"Das",slug:"kusal-das",fullName:"Kusal Das",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSBDeQAO/Profile_Picture_1623411145568",institutionString:"BLDE (Deemed to be University), India",institution:null},{id:"79615",title:"Dr.",name:"Robson",middleName:null,surname:"Faria",slug:"robson-faria",fullName:"Robson Faria",profilePictureURL:"https://mts.intechopen.com/storage/users/79615/images/system/79615.png",institutionString:null,institution:{name:"Oswaldo Cruz Foundation",institutionURL:null,country:{name:"Brazil"}}},{id:"84459",title:"Prof.",name:"Valerie",middleName:null,surname:"Chappe",slug:"valerie-chappe",fullName:"Valerie Chappe",profilePictureURL:"https://mts.intechopen.com/storage/users/84459/images/system/84459.jpg",institutionString:null,institution:{name:"Dalhousie University",institutionURL:null,country:{name:"Canada"}}}]},{id:"12",title:"Human Physiology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/12.jpg",editor:{id:"195829",title:"Prof.",name:"Kunihiro",middleName:null,surname:"Sakuma",slug:"kunihiro-sakuma",fullName:"Kunihiro Sakuma",profilePictureURL:"https://mts.intechopen.com/storage/users/195829/images/system/195829.jpg",biography:"Professor Kunihiro Sakuma, Ph.D., currently works in the Institute for Liberal Arts at the Tokyo Institute of Technology. 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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. The interest of Javier's lab is the study of cell signaling with a special focus on Ca2+ signaling, and how Ca2+ transport modulates the cytoskeleton, migration, differentiation, cell death, etc. He is especially interested in the study of Ca2+ channels, and the role of STIM1 in the initiation of pathological events.",institutionString:null,institution:{name:"University of Extremadura",country:{name:"Spain"}}},{id:"217323",title:"Prof.",name:"Guang-Jer",middleName:null,surname:"Wu",slug:"guang-jer-wu",fullName:"Guang-Jer Wu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/217323/images/8027_n.jpg",biography:null,institutionString:null,institution:null},{id:"148546",title:"Dr.",name:"Norma Francenia",middleName:null,surname:"Santos-Sánchez",slug:"norma-francenia-santos-sanchez",fullName:"Norma Francenia Santos-Sánchez",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/148546/images/4640_n.jpg",biography:null,institutionString:null,institution:null},{id:"272889",title:"Dr.",name:"Narendra",middleName:null,surname:"Maddu",slug:"narendra-maddu",fullName:"Narendra Maddu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/272889/images/10758_n.jpg",biography:null,institutionString:null,institution:null},{id:"242491",title:"Prof.",name:"Angelica",middleName:null,surname:"Rueda",slug:"angelica-rueda",fullName:"Angelica Rueda",position:"Investigador Cinvestav 3B",profilePictureURL:"https://mts.intechopen.com/storage/users/242491/images/6765_n.jpg",biography:null,institutionString:null,institution:null},{id:"88631",title:"Dr.",name:"Ivan",middleName:null,surname:"Petyaev",slug:"ivan-petyaev",fullName:"Ivan Petyaev",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Lycotec (United Kingdom)",country:{name:"United Kingdom"}}},{id:"423869",title:"Ms.",name:"Smita",middleName:null,surname:"Rai",slug:"smita-rai",fullName:"Smita Rai",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Integral University",country:{name:"India"}}},{id:"424024",title:"Prof.",name:"Swati",middleName:null,surname:"Sharma",slug:"swati-sharma",fullName:"Swati Sharma",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Integral University",country:{name:"India"}}},{id:"439112",title:"MSc.",name:"Touseef",middleName:null,surname:"Fatima",slug:"touseef-fatima",fullName:"Touseef Fatima",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Integral University",country:{name:"India"}}},{id:"424836",title:"Dr.",name:"Orsolya",middleName:null,surname:"Borsai",slug:"orsolya-borsai",fullName:"Orsolya Borsai",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Agricultural Sciences and Veterinary Medicine of Cluj-Napoca",country:{name:"Romania"}}},{id:"422262",title:"Ph.D.",name:"Paola Andrea",middleName:null,surname:"Palmeros-Suárez",slug:"paola-andrea-palmeros-suarez",fullName:"Paola Andrea Palmeros-Suárez",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Guadalajara",country:{name:"Mexico"}}}]}},subseries:{item:{id:"8",type:"subseries",title:"Bioinspired Technology and Biomechanics",keywords:"Bioinspired Systems, Biomechanics, Assistive Technology, Rehabilitation",scope:'Bioinspired technologies take advantage of understanding the actual biological system to provide solutions to problems in several areas. Recently, bioinspired systems have been successfully employing biomechanics to develop and improve assistive technology and rehabilitation devices. The research topic "Bioinspired Technology and Biomechanics" welcomes studies reporting recent advances in bioinspired technologies that contribute to individuals\' health, inclusion, and rehabilitation. Possible contributions can address (but are not limited to) the following research topics: Bioinspired design and control of exoskeletons, orthoses, and prostheses; Experimental evaluation of the effect of assistive devices (e.g., influence on gait, balance, and neuromuscular system); Bioinspired technologies for rehabilitation, including clinical studies reporting evaluations; Application of neuromuscular and biomechanical models to the development of bioinspired technology.',coverUrl:"https://cdn.intechopen.com/series_topics/covers/8.jpg",hasOnlineFirst:!1,hasPublishedBooks:!0,annualVolume:11404,editor:{id:"144937",title:"Prof.",name:"Adriano",middleName:"De Oliveira",surname:"Andrade",slug:"adriano-andrade",fullName:"Adriano Andrade",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRC8QQAW/Profile_Picture_1625219101815",biography:"Dr. Adriano de Oliveira Andrade graduated in Electrical Engineering at the Federal University of Goiás (Brazil) in 1997. He received his MSc and PhD in Biomedical Engineering respectively from the Federal University of Uberlândia (UFU, Brazil) in 2000 and from the University of Reading (UK) in 2005. He completed a one-year Post-Doctoral Fellowship awarded by the DFAIT (Foreign Affairs and International Trade Canada) at the Institute of Biomedical Engineering of the University of New Brunswick (Canada) in 2010. Currently, he is Professor in the Faculty of Electrical Engineering (UFU). He has authored and co-authored more than 200 peer-reviewed publications in Biomedical Engineering. He has been a researcher of The National Council for Scientific and Technological Development (CNPq-Brazil) since 2009. He has served as an ad-hoc consultant for CNPq, CAPES (Coordination for the Improvement of Higher Education Personnel), FINEP (Brazilian Innovation Agency), and other funding bodies on several occasions. He was the Secretary of the Brazilian Society of Biomedical Engineering (SBEB) from 2015 to 2016, President of SBEB (2017-2018) and Vice-President of SBEB (2019-2020). He was the head of the undergraduate program in Biomedical Engineering of the Federal University of Uberlândia (2015 - June/2019) and the head of the Centre for Innovation and Technology Assessment in Health (NIATS/UFU) since 2010. He is the head of the Postgraduate Program in Biomedical Engineering (UFU, July/2019 - to date). He was the secretary of the Parkinson's Disease Association of Uberlândia (2018-2019). Dr. Andrade's primary area of research is focused towards getting information from the neuromuscular system to understand its strategies of organization, adaptation and controlling in the context of motor neuron diseases. His research interests include Biomedical Signal Processing and Modelling, Assistive Technology, Rehabilitation Engineering, Neuroengineering and Parkinson's Disease.",institutionString:null,institution:{name:"Federal University of Uberlândia",institutionURL:null,country:{name:"Brazil"}}},editorTwo:null,editorThree:null,series:{id:"7",title:"Biomedical Engineering",doi:"10.5772/intechopen.71985",issn:"2631-5343"},editorialBoard:[{id:"49517",title:"Prof.",name:"Hitoshi",middleName:null,surname:"Tsunashima",slug:"hitoshi-tsunashima",fullName:"Hitoshi Tsunashima",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYTP4QAO/Profile_Picture_1625819726528",institutionString:null,institution:{name:"Nihon University",institutionURL:null,country:{name:"Japan"}}},{id:"425354",title:"Dr.",name:"Marcus",middleName:"Fraga",surname:"Vieira",slug:"marcus-vieira",fullName:"Marcus Vieira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003BJSgIQAX/Profile_Picture_1627904687309",institutionString:null,institution:{name:"Universidade Federal de Goiás",institutionURL:null,country:{name:"Brazil"}}},{id:"196746",title:"Dr.",name:"Ramana",middleName:null,surname:"Vinjamuri",slug:"ramana-vinjamuri",fullName:"Ramana Vinjamuri",profilePictureURL:"https://mts.intechopen.com/storage/users/196746/images/system/196746.jpeg",institutionString:"University of Maryland, Baltimore County",institution:{name:"University of Maryland, Baltimore County",institutionURL:null,country:{name:"United States of America"}}}]},onlineFirstChapters:{paginationCount:0,paginationItems:[]},publishedBooks:{paginationCount:6,paginationItems:[{type:"book",id:"9008",title:"Vitamin K",subtitle:"Recent Topics on the Biology and Chemistry",coverURL:"https://cdn.intechopen.com/books/images_new/9008.jpg",slug:"vitamin-k-recent-topics-on-the-biology-and-chemistry",publishedDate:"March 23rd 2022",editedByType:"Edited by",bookSignature:"Hiroyuki Kagechika and Hitoshi Shirakawa",hash:"8b43add5389ba85743e0a9491e4b9943",volumeInSeries:27,fullTitle:"Vitamin K - Recent Topics on the Biology and Chemistry",editors:[{id:"180528",title:"Dr.",name:"Hiroyuki",middleName:null,surname:"Kagechika",slug:"hiroyuki-kagechika",fullName:"Hiroyuki Kagechika",profilePictureURL:"https://mts.intechopen.com/storage/users/180528/images/system/180528.jpg",institutionString:"Tokyo Medical and Dental University",institution:{name:"Tokyo Medical and Dental University",institutionURL:null,country:{name:"Japan"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{type:"book",id:"9759",title:"Vitamin E in Health and Disease",subtitle:"Interactions, Diseases and Health Aspects",coverURL:"https://cdn.intechopen.com/books/images_new/9759.jpg",slug:"vitamin-e-in-health-and-disease-interactions-diseases-and-health-aspects",publishedDate:"October 6th 2021",editedByType:"Edited by",bookSignature:"Pınar Erkekoglu and Júlia Scherer Santos",hash:"6c3ddcc13626110de289b57f2516ac8f",volumeInSeries:22,fullTitle:"Vitamin E in Health and Disease - Interactions, Diseases and Health Aspects",editors:[{id:"109978",title:"Prof.",name:"Pınar",middleName:null,surname:"Erkekoğlu",slug:"pinar-erkekoglu",fullName:"Pınar Erkekoğlu",profilePictureURL:"https://mts.intechopen.com/storage/users/109978/images/system/109978.jpg",institutionString:"Hacettepe University",institution:{name:"Hacettepe University",institutionURL:null,country:{name:"Turkey"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{type:"book",id:"7004",title:"Metabolomics",subtitle:"New Insights into Biology and Medicine",coverURL:"https://cdn.intechopen.com/books/images_new/7004.jpg",slug:"metabolomics-new-insights-into-biology-and-medicine",publishedDate:"July 1st 2020",editedByType:"Edited by",bookSignature:"Wael N. 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Behind these definitions are hidden all the aspects of normal and pathological functioning of all processes that the topic ‘Metabolism’ will cover within the Biochemistry Series. 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Thus proteomics, an area of research that detects all protein forms expressed in an organism, including splice isoforms and post-translational modifications, is more suitable than genomics for a comprehensive understanding of the biochemical processes that govern life. The most common proteomics applications are currently in the clinical field for the identification, in a variety of biological matrices, of biomarkers for diagnosis and therapeutic intervention of disorders. From the comparison of proteomic profiles of control and disease or different physiological states, which may emerge, changes in protein expression can provide new insights into the roles played by some proteins in human pathologies. Understanding how proteins function and interact with each other is another goal of proteomics that makes this approach even more intriguing. Specialized technology and expertise are required to assess the proteome of any biological sample. Currently, proteomics relies mainly on mass spectrometry (MS) combined with electrophoretic (1 or 2-DE-MS) and/or chromatographic techniques (LC-MS/MS). MS is an excellent tool that has gained popularity in proteomics because of its ability to gather a complex body of information such as cataloging protein expression, identifying protein modification sites, and defining protein interactions. 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