Normal flow velocities and Resistance Index in orbital vessels [15, 31, 32].
\\n\\n
Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\\n\\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\\n"}]',published:!0,mainMedia:{caption:"Highly Cited",originalUrl:"/media/original/117"}},components:[{type:"htmlEditorComponent",content:'IntechOpen is proud to announce that 191 of our authors have made the Clarivate™ Highly Cited Researchers List for 2020, ranking them among the top 1% most-cited.
\n\nThroughout the years, the list has named a total of 261 IntechOpen authors as Highly Cited. Of those researchers, 69 have been featured on the list multiple times.
\n\n\n\nReleased this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\n\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\n'}],latestNews:[{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"},{slug:"introducing-intechopen-book-series-a-new-publishing-format-for-oa-books-20210915",title:"Introducing IntechOpen Book Series - A New Publishing Format for OA Books"}]},book:{item:{type:"book",id:"6389",leadTitle:null,fullTitle:"Entrepreneurship - Trends and Challenges",title:"Entrepreneurship",subtitle:"Trends and Challenges",reviewType:"peer-reviewed",abstract:"Entrepreneurship is a powerful attitude that, in such a way, in the last few years, has become a discipline increasingly transversal to different areas of knowledge. Many times, we think about the things we want such as a good house, a brand new car, a beautiful relationship, a good friendship, and a good way to be in the world. Is that possible that you convert into an entrepreneur? This book shows some examples of that possibility, from simple people to a big organization. In all cases, if you become an entrepreneur, it will be for your taste and pleasure, a means to survive and enjoy the uncertainty, and rejoice that you have all these in your hands and will. Can you find out the trends and overcome the challenges? We would say yes. It all depends on whether you want to develop and apply this attitude.",isbn:"978-953-51-3964-5",printIsbn:"978-953-51-3963-8",pdfIsbn:"978-953-51-4092-4",doi:"10.5772/intechopen.69977",price:119,priceEur:129,priceUsd:155,slug:"entrepreneurship-trends-and-challenges",numberOfPages:170,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"f30626e6cc598d69d90838d24db873b8",bookSignature:"Sílvio Manuel Brito",publishedDate:"April 4th 2018",coverURL:"https://cdn.intechopen.com/books/images_new/6389.jpg",numberOfDownloads:12965,numberOfWosCitations:12,numberOfCrossrefCitations:8,numberOfCrossrefCitationsByBook:1,numberOfDimensionsCitations:21,numberOfDimensionsCitationsByBook:1,hasAltmetrics:1,numberOfTotalCitations:41,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"March 16th 2017",dateEndSecondStepPublish:"April 6th 2017",dateEndThirdStepPublish:"July 3rd 2017",dateEndFourthStepPublish:"October 1st 2017",dateEndFifthStepPublish:"November 30th 2017",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"170935",title:"Ph.D.",name:"Sílvio Manuel",middleName:"Da Rocha",surname:"Brito",slug:"silvio-manuel-brito",fullName:"Sílvio Manuel Brito",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bS9HrQAK/Profile_Picture_2022-04-25T07:50:04.png",biography:"Silvio Brito holds a degree in human resources management and work psychology from ISLA, a master’s degree in management in the area of organizational behavior from the Lusíada University, and a Ph.D. degree in psychology from the University of Extremadura, Spain. He is an effective member of the Portuguese Society of Psychology, INFAD (Spain), and CITUR (Portugal), as well as an investigator of Psyche EX (Spain), a member of the chair of Entrepreneurs (Spain), and the founder and general secretary of AFIDE (Spain). He teaches Human Resources at the Polytechnic Institute of Tomar (Portugal) and a master’s course in Portugal and abroad. He is also a member of its jury commissions in Portugal and abroad, and an advisor on several scientific research papers. He has published several scientific, national, and international publications in the field of human resources, management, and psychology. He is an investigator member of the Human Talent Research Group of Organizational Behaviour and Human Resources.",institutionString:null,position:null,outsideEditionCount:null,totalCites:0,totalAuthoredChapters:"4",totalChapterViews:"0",totalEditedBooks:"3",institution:null}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"453",title:"Entrepreneurial Economics",slug:"entrepreneurial-economics"}],chapters:[{id:"59795",title:"Introductory Chapter: Entrepreneurship as a Trend and as a Challenge",doi:"10.5772/intechopen.75097",slug:"introductory-chapter-entrepreneurship-as-a-trend-and-as-a-challenge",totalDownloads:1280,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:0,abstract:null,signatures:"Sílvio Manuel da Rocha Brito Brito",downloadPdfUrl:"/chapter/pdf-download/59795",previewPdfUrl:"/chapter/pdf-preview/59795",authors:[{id:"170935",title:"Ph.D.",name:"Sílvio Manuel",surname:"Brito",slug:"silvio-manuel-brito",fullName:"Sílvio Manuel Brito"}],corrections:null},{id:"58034",title:"Arts and Entrepreneurship: Disentangling the Literature",doi:"10.5772/intechopen.72014",slug:"arts-and-entrepreneurship-disentangling-the-literature",totalDownloads:1843,totalCrossrefCites:1,totalDimensionsCites:4,hasAltmetrics:0,abstract:"Arts entrepreneurship is not a new area of investigation, but it is far from constituting a consolidated topic. Scholars coming from several fields rediscovered it only in recent years, after a period in which it has been slow to emerge. Since the early 2000s, they developed a heterogeneous literature, which is difficult to disentangle. The purpose of this study is to shed light on arts entrepreneurship literature, outlining the most significant issues emerged and their trajectories for future development. We attempted to achieve the purpose of this chapter through a qualitative analysis of the relevant literature on the topic. Results revealed the most relevant issues to which scholars are devoting their efforts. With respect to these, we tried to identify subthemes and we attempted to trace the trajectories for future research. The first main theme concerns the entrepreneur in the arts, focusing on aspects such as identity and characteristics, and examining training and entrepreneurial education. Another theme regards entrepreneurship and training, which is attracting increasing attention, thanks also to the emergence of specific curricula and arts incubators. Besides these themes, other collateral issues emerged. Ultimately, literature is complex and multifaceted, but it is possible to read it with greater clarity.",signatures:"Francesca Rivetti and Mirella Migliaccio",downloadPdfUrl:"/chapter/pdf-download/58034",previewPdfUrl:"/chapter/pdf-preview/58034",authors:[{id:"208613",title:"Ph.D.",name:"Francesca",surname:"Rivetti",slug:"francesca-rivetti",fullName:"Francesca Rivetti"},{id:"208617",title:"Prof.",name:"Mirella",surname:"Migliaccio",slug:"mirella-migliaccio",fullName:"Mirella Migliaccio"}],corrections:null},{id:"57880",title:"Entrepreneurial Orientation and Firm Performance",doi:"10.5772/intechopen.72009",slug:"entrepreneurial-orientation-and-firm-performance",totalDownloads:1683,totalCrossrefCites:0,totalDimensionsCites:2,hasAltmetrics:0,abstract:"This chapter assesses the important contribution of entrepreneurial orientation’s strategic determinant that influences export performance. Based on survey data from 247 Portuguese small- and medium-sized enterprises (SMEs), findings suggest that entrepreneurial orientation has a positive and significant influence on export performance. This study deepens our understanding and provides novel insights into entrepreneurship and strategic management literature, since it combines multiple factors and has obtained the importance of each construct in SMEs business growth. Moreover, this chapter presents further evidences of the strategies that small firm managers should pursue and policy makers should promote.",signatures:"Orlando Lima Rua, Alexandra França and Rubén Fernández Ortiz",downloadPdfUrl:"/chapter/pdf-download/57880",previewPdfUrl:"/chapter/pdf-preview/57880",authors:[{id:"207969",title:"Prof.",name:"Orlando Lima",surname:"Rua",slug:"orlando-lima-rua",fullName:"Orlando Lima Rua"},{id:"215881",title:"Dr.",name:"Alexandra",surname:"França",slug:"alexandra-franca",fullName:"Alexandra França"},{id:"215882",title:"Prof.",name:"Rubén",surname:"Fernández Ortiz",slug:"ruben-fernandez-ortiz",fullName:"Rubén Fernández Ortiz"}],corrections:null},{id:"60145",title:"The Digitalisation of Rural Entrepreneurship",doi:"10.5772/intechopen.75925",slug:"the-digitalisation-of-rural-entrepreneurship",totalDownloads:1730,totalCrossrefCites:5,totalDimensionsCites:6,hasAltmetrics:0,abstract:"The main primary purpose of this chapter is to present new established understanding and knowledge of the digitalization of rural entrepreneurship, how it can help entrepreneurial survival and growth in rural industries, and what are the theoretical and practical implications. The digitalization concept of businesses is the issue of interest in the world today; however, it is still of concern in the rural South African entrepreneurship sector. Collection of primary data was done from 501 owners/managers operating in rural of the KwaZulu-Natal (KZN) province. The mixed questionnaire of quantitative and qualitative was used as the survey instruments. The questionnaire was distributed at the entrepreneur’s business premises, and they were given 7 days to respond while researcher and research assistants were always available to assist where necessary. The findings of this survey revealed that the large number of participants are not using their digital technology for the business purpose, but rather they use it for other things such as private communications and social friendship. The survey was confined in one province of South Africa; therefore, the generalization of the results should be done with care. This study has indicated some recommendation and suggested further research which may include other provinces as well as other countries.",signatures:"Lawrence Mpele Lekhanya",downloadPdfUrl:"/chapter/pdf-download/60145",previewPdfUrl:"/chapter/pdf-preview/60145",authors:[{id:"208001",title:"Dr.",name:"Lawrence Mpele",surname:"Lekhanya",slug:"lawrence-mpele-lekhanya",fullName:"Lawrence Mpele Lekhanya"}],corrections:null},{id:"59850",title:"Micro-Finance: A Driver for Entrepreneurship",doi:"10.5772/intechopen.75031",slug:"micro-finance-a-driver-for-entrepreneurship",totalDownloads:1211,totalCrossrefCites:1,totalDimensionsCites:3,hasAltmetrics:0,abstract:"Micro-finance lending has long been the answer to many rural developments around the world. It has successfully led to women empowerment and helped in enhancing the socio-economic status of women globally. Development policies and programs have often ignored women as the integral source in alleviating the growth process. The study thus examines the impact of handicrafts on the socio-economic status of women in Pakistan. It also focuses on the role played by micro-finance institutions in enabling women’s micro-entrepreneurship. Women are successfully achieving a high social and economic status in countries like Pakistan through earnings from handicrafts’ industry. The data is analyzed quantitatively, using inferential statistics to support the descriptive analysis. Results of the findings showed that handicrafts prove to be improving the socio-economic status of women in Pakistan and micro-finance has been at its backbone.",signatures:"Asma Salman",downloadPdfUrl:"/chapter/pdf-download/59850",previewPdfUrl:"/chapter/pdf-preview/59850",authors:[{id:"206443",title:"Prof.",name:"Asma",surname:"Salman",slug:"asma-salman",fullName:"Asma Salman"}],corrections:null},{id:"58202",title:"A Practical and Theoretical Approach to Social Venturing Entrepreneurship",doi:"10.5772/intechopen.72011",slug:"a-practical-and-theoretical-approach-to-social-venturing-entrepreneurship",totalDownloads:1506,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Research in social venturing entrepreneurship promoted by Professor Gert Van Dijk is gaining ground. The concept of social venturing entrepreneurship is not new. It is rooted in entrepreneurship as described by classical authors like Von Mises, Kirzner, Schumpter Knight and social reformer like Raiffeisen. It is anchored in new institutional and behavioral economics and exit strategy theory. A social venturing entrepreneur is a creator of effective social change in the context of economic, social and political conditions. Social venturing entrepreneur masters the skills of networking and lobbying. A social venturing entrepreneur is recognized by the social venturing and co-operative entrepreneurship business model they employ to execute their teleology. Social venturing entrepreneurship has advantages above conventional entrepreneurship as it has reintroduced the concept as entrepreneurship as a calling. They aim to empower the stakeholders for whom they setup the social venture and exit when the stakeholders are able to self-manage the enterprise. This chapter explains the commonly used concepts, ontologies, the social venturing entrepreneur’s social venturing and co-operative business model, the economic theories and conceptual framework and practical application from appreciative inquiry point of view.",signatures:"Moulen Siame",downloadPdfUrl:"/chapter/pdf-download/58202",previewPdfUrl:"/chapter/pdf-preview/58202",authors:[{id:"207670",title:"Mr.",name:"Moulen",surname:"Siame",slug:"moulen-siame",fullName:"Moulen Siame"},{id:"215998",title:"Prof.",name:"Gert",surname:"Van Dijk",slug:"gert-van-dijk",fullName:"Gert Van Dijk"}],corrections:null},{id:"57036",title:"From Entrepreneurial Intentions to Behaviors: Wandering In- Between and Wondering about Challenges and Avenues",doi:"10.5772/intechopen.70836",slug:"from-entrepreneurial-intentions-to-behaviors-wandering-in-between-and-wondering-about-challenges-and",totalDownloads:1196,totalCrossrefCites:0,totalDimensionsCites:3,hasAltmetrics:1,abstract:"In order to wander and understand the chasm between intentions and actions/behaviors, this chapter presents and discusses the leading theories (such as theory of reasoned action and theory of planned behavior), alternative ones (such as implementation intention theory and theory of goal-directed behavior), potential concepts bridging the intention-behavior gap (entrepreneurial motivation and commitment) and empirical intention-based models and their applicability and predictive validity in entrepreneurship field. For that purpose, it is argued that a socio- and cognitive psychological approach is the most suitable to understand entrepreneurship and in particular the intention-behavior link. This chapter invites entrepreneurship scholars to wonder about challenges in entrepreneurship research and education field and about potential research avenues. At the end, the chapter re-launches the debate by pointing out certain questionings for future research on entrepreneurial intentions and behaviors to produce novel knowledge.",signatures:"Wassim J. Aloulou",downloadPdfUrl:"/chapter/pdf-download/57036",previewPdfUrl:"/chapter/pdf-preview/57036",authors:[{id:"207130",title:"Dr.",name:"Wassim",surname:"Aloulou",slug:"wassim-aloulou",fullName:"Wassim Aloulou"}],corrections:null},{id:"57901",title:"From Entrepreneurship to Social Activist: The Role of Indonesian Migrant Entrepreneurs in Taiwan and Socio- Economic Functions of Return-Migrant Entrepreneurship in Malang, East Java",doi:"10.5772/intechopen.72013",slug:"from-entrepreneurship-to-social-activist-the-role-of-indonesian-migrant-entrepreneurs-in-taiwan-and-",totalDownloads:1027,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"In the case of Taiwan, Indonesian migrant entrepreneurs’ active in social activities; they are linked strongly to the petty conditions of co-migrants. In various cases, entrepreneurs play the role of friends in need, acting as third-party resources, to co-migrants, who turn to the former for help and self-actualization. Their activities contribute to bridging the relations between the larger community and Indonesian migrants living as a minority and as marginal foreign newcomers in Taiwan. Meanwhile, the case study of Indonesian return-migrant entrepreneurship at the home village of Malang found that migration and returning home experiences increase socio-economic mobility and develop socio-economic activities at home villages. The migrants’ experiences and enterprise activities have emerged as a critical source of sustainable livelihoods, migration knowledge of production application, self-transformation, and the economic reintegration process for return migrants in their home villages, all of which can create a new life for returnees after migration. Practically and theoretically speaking, the manner in which migrant and return-migrant entrepreneurs perform economic adaptation or social adjustment, indicates that the socio-economic function, comprising valuable ties that cut across classes, can prevent the social and economic isolation of disadvantaged entrepreneurs, co-migrants, and return migrants in the community.",signatures:"Paulus Rudolf Yuniarto",downloadPdfUrl:"/chapter/pdf-download/57901",previewPdfUrl:"/chapter/pdf-preview/57901",authors:[{id:"208588",title:"Dr.",name:"Rudolf",surname:"Yuniarto",slug:"rudolf-yuniarto",fullName:"Rudolf Yuniarto"}],corrections:null},{id:"57358",title:"Social Entrepreneurship: Case Study in Unilever Food Solutions’ Trusted Hands Food Safety Online Training Program",doi:"10.5772/intechopen.70955",slug:"social-entrepreneurship-case-study-in-unilever-food-solutions-trusted-hands-food-safety-online-train",totalDownloads:1489,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:1,abstract:"The social entrepreneurship is important in meso (organizational) and macro (policy-making) levels. This paper focuses on a case study in Turkey. “Trusted Hands Food Safety Online Training Program” by Unilever Food Solutions is examined as an example of social entrepreneurship. It is aimed to support food safety awareness in the industry to create and certificate the chefs. Unilever Food Solutions has received the Food Security Special Award, a project developed and implemented by the Food Safety Association. In the first year, 5000 chefs in Turkey intended to complete the education of this field and to have a certificate. It started with the support of professional associations. The sustainability and private sector involvement plays an essential role in this case, which is such an important issue such as health and hygiene.",signatures:"Pınar Başar",downloadPdfUrl:"/chapter/pdf-download/57358",previewPdfUrl:"/chapter/pdf-preview/57358",authors:[{id:"208540",title:"Ph.D.",name:"Pınar",surname:"Başar",slug:"pinar-basar",fullName:"Pınar Başar"}],corrections:null}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},subseries:null,tags:null},relatedBooks:[{type:"book",id:"6935",title:"Toward Super-Creativity",subtitle:"Improving Creativity in Humans, Machines, and Human - Machine Collaborations",isOpenForSubmission:!1,hash:"98c0eed8bde901e69239d5217d9be28d",slug:"toward-super-creativity-improving-creativity-in-humans-machines-and-human-machine-collaborations",bookSignature:"Sílvio Manuel Brito",coverURL:"https://cdn.intechopen.com/books/images_new/6935.jpg",editedByType:"Edited 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It is also recognized as Horton, temporal, or granulomatous arteritis. It causes narrowing of the artery, leading (by wall thickening) to partial (stenosis) or complete obstruction (occlusion) of local arterial blood flow, its clinical manifestations being expressed by signs of local ischemia [1, 2, 3, 4, 5, 6].
\nGCA is the most common form of vasculitis that occurs in adults and in the elderly, being diagnosed over the age of 50’s. Women are two to three times more affected than men. It is well known that the disease can occur in every racial group but is most common in Caucasians, especially people of northern European descent, and others in northern latitudes. [1, 2, 3, 4, 5, 6].
\nAccording to Hunder [7], and Jennette [8] a complete diagnosis of GCA requires the presence of American College of Rheumatology (ACR) classification modified criteria:
age over 50 years at the onset of the disease;
moderate, bitemporal, recently installed headache;
scalp tenderness, abnormal temporal arteries on inspection and palpation (Figure 1), reduced pulse, jaw claudication (pain in the jaw while/after chewing);
blurred vision or permanent visual loss in one or both eyes (since permanent visual loss due to ischemia is frequent, GCA should be considered an ophthalmic emergency requiring immediate management);
systemic symptoms (fatigue, weight loss, fever, pain in the shoulders and hips: polymyalgia rheumatica);
increased inflammatory markers (erythrocyte sedimentation rate greater than 50 mm/h, C reactive protein greater than 1,5 mg/dl);
representative histologic findings in temporal artery biopsy (TAB): mononuclear cell infiltration or granulomatous inflammation of the vessel wall, usually accompanied with multinucleated giant cells (Figure 2).
Giant cell arteritis (GCA) of the left superficial temporal artery (TA) shows a prominent, tender and nodular artery, that is also hypo pulsating on palpation [
The histopathological examination of the left superficial temporal artery biopsy (TAB) noted [
Several imaging techniques may be suitable in the diagnosis of GCA. [9] Compared to other imaging techniques, US is considered to be the most suitable in the evaluation of GCA patients, therefor it can easily be performed by the clinician (immediately after the general examination of patient), and it is significantly shortening the waiting period until another investigation is performed. [9, 10, 11, 12, 13, 14, 15, 16].
\nUltrasonography (US) is a safe, noninvasive, without radiations, widespread accessible, fast, and low-cost bedside screening technique which has the unique capacity of studying real-time hemodynamics. It presents the ability to evaluate the anatomy of vessel’s wall, identifying equally parietal abnormalities (wall thickening, hypoechoic plaques, clotting, parietal hematoma, dissections) and the external diameter of the artery; it can rule out both stenosis and occlusion. Therefore, the use of US is widespread in neurological clinical practice, mainly in the evaluation of arterial atherosclerotic process but also for monitoring other diseases such as medium/large-vessel vasculitis. [17, 18, 19].
\nOlah noted that for US imaging of extracranial vessels different modes are being used:
\n
The strength of the echo is recorded as a bright dot, while the location of different gray dots corresponds to the depth of the target. [17]
\n
It associates a B-mode gray-scale image with pulse-wave (PW) Doppler flow velocities measurements.
The B-mode image represents the anatomical localization of the vessels, indicating the zone of interest where a Doppler sample volume should be placed and where the velocities are measured.
The Doppler angle can be measured correctly when the blood is parallel to the direction of the vessel. [17]
\n
Measure mean frequency shift in each sample volume.
It represents color–coded velocity information, which is superimposed as a color flow map on a B-mode image.
In each sample volume, the color reflects the blood flow velocity in a semi quantitative manner, as well as the flow direction relative to the transducer. Blood flowing toward or away from the transducer is shown by different colors (red and blue). Moreover, fast flow is indicated by a lighter hue and slow flow by a deeper one.
The color flow map indicates the position and orientation of the vessels, as well as the site of turbulent flow or stenosis. Since color flow mapping is based on flow velocity measured by PW technology, aliasing occurs if the frequency shift is higher than half of the pulse repetition frequency (PRF). [17]
\n
Uses the signal intensity of the returning Doppler signal instead of frequency shift.
Power (intensity) of the signal is displayed as a color map superimposed on a B-mode image. Since the Doppler power is determined mainly by the volume rather than the velocity of moving blood, power Doppler imaging is free from aliasing artifacts and much more sensitive to detect flow, especially in the low-flow regions. However, it does not contain information about the flow direction or flow velocity. [17]
The advantages of US over other imaging techniques in GCA are represented by its safety, accessibility, tolerability, fast (may take about 15-20 minutes, if it’s conducted by an experienced sonographer) and the more important, its high resolution (a high –frequency probe offers both an axial and a lateral resolution of 0.1 mm) [19, 20, 21, 22, 23, 24, 25, 26, 27]. The smaller the vessel diameter, the more difficult is to appreciate the vessel wall damages, so that, in this case, the most informative US data are based on Doppler spectral evaluation. This is also valid for the assessment of medium to small vessel inflammation such as intracranial vasculitis. Small vessel vasculitis (the ANCA-associated or the immune complex vasculitis) are not a domain of ultrasound. [19].
\nFurthermore, US has a higher sensitivity than TAB, the last one evaluating only a restricted anatomical region in a systemic disease. Using US, we can reveal pathological characteristics in GCA: non-compressible arteries (compression sign), the wall thickening (“halo” sign), stenosis and vessel occlusion. A normal intima-media complex (IMC) of an artery is represented by US as a homogeneous, hypoechoic or anechoic echo structure delineated by two parallel hyperechoic margins. [19, 20, 21, 22, 23, 24, 25, 26, 27].
\nThere is imperative to underline the importance of establishing the arteries that should be routinely examined in a patient suspected for GCA and these are: the TAs, and axillary arteries. If US of these arteries does not reveal suggestive lesions, in the presence of a clear patient history and of an obvious clinical examination, other arteries should be examined: other branches of the ECAs (the internal maxillary, the facial, the lingual, the occipital arteries), the vertebral, the subclavian, the common carotid arteries-CCAs, and the internal carotid arteries-ICAs. [9, 19, 21].
\nRegarding the adequate US equipment for the diagnosis of GCA, modern high-resolution linear probes providing Doppler mode should be used, especially for examination of TAs. We should take into consideration that tissue penetration increases with lower frequencies and the resolution of US increases with higher frequencies. Probes that provide frequencies >20 MHz allow the clearly visualization of the normal IMC of TAs probes with frequencies ≥15 MHz are usually used for detection of minor wall thickening. [19, 21].
\nIn 2012, during the Chapel Hill Consensus Conference [19, 28], large vascular vasculitis (LVV) was well-defined as a vasculitis involving the aorta and its major branches, although any size of artery may be affected. This definition does not state that LVV mainly affects large vessels because in many patients, the number of medium and small arteries affected is greater than the number of large arteries involvement. For example, in GCA, only few branches of the ECAs may be affected when there is involvement of numerous small branches extending into the eye and orbit (e.g., central retinal artery, posterior ciliary arteries). [29, 30] Less frequently, the CCA and the ICA are also affected (Figures 3 and 4). [9].
\nLarge vessels GCA; CT-angiography- occlusion of the left CCA, ECA, and ICA [
Large vessels GCA, color Doppler ultrasound in transverse view of the right CCA. Hypoechoic wall swelling with right CCA occlusion [
As Sturzenegger pointed up, angiography is not able to illustrate the vessel wall, so as to diagnose the inflammation of the large cervical and cervico-brachial vessels (aorta and its supra-aortic branches), the US can be very useful, since it can define alterations of the vessel wall with the use of B-mode imaging, while Doppler spectral flow velocity evaluation can help identify the stenosis or occlusion of the vessel. [19].
\nColor Doppler Duplex sonography (CDDS) is an excellent device used in screening the large vessels involvement. Agreeing with different authors, including Sturzenegger, there are two ultra-sonographic hallmarks of large vessels GCA:
Vessel wall thickening, that typically is homogeneous, circumferential and over long segments (Figures 4 and 5);
Stenosis, typically revealing slickly tapered luminal tightening (hour glass like) [19, 20, 21, 22, 23, 24, 25, 26, 27]
Large vessel GCA, color Doppler ultrasound in longitudinal view of the right CCA with hypoechoic wall swelling [
Remarkably in some cases [9], the common carotid and the internal carotid arteries are also involved (large-vessel GCA) (Figures 3, 4, and 5).
\nExtracranial Duplex sonography investigates almost completely the whole length of the common superficial TAs, including the frontal and parietal branches, and founds that inflammation is segmental (intermittent arterial involvement) [19, 20, 21, 22, 23, 24, 25, 26, 27]. The common superficial TA derives from the ECA. It divides into the frontal and parietal ramus in front of the ear. The distal common superficial TA and the rami are localized between the two layers of the temporal fascia, which is like a bright band at ultrasound examination. [19, 20, 21, 22, 23, 24, 25, 26, 27].
\nHigh-resolution color Doppler US can illustrate the vessel wall and the lumen of the TAs. One should use linear probes with a minimum gray scale frequency of 8 Mhz. Color frequency should be about 10 Mhz. [19, 20, 21, 22, 23, 24, 25, 26, 27].
\nThe pulse repetition frequency (PRF) should be about 2.5 kHz as maximum systolic velocities are rather high (20-100 cm/s). Steering of the color box and the Doppler beam should be maximal as the rami are parallel to the probe. It is important that the color covers the artery lumen exactly. [19, 20, 21, 22, 23, 24, 25, 26, 27].
\nThe sonographer should perform at least 50 Duplex ultrasound of the TAs of subjects without GCA to be sure about the appearance of normal TAs before starting to evaluate patients with GCA. [19, 20, 21, 22, 23, 24, 25, 26, 27].
\nThe investigation should begin with the TA, using the longitudinal scan. The probe should then be moved along the course of the TA to the parietal ramus. On the way back one should delineate the TA in transverse scans. Using the transverse scan, one can find the frontal ramus, which should then be delineated in both scans (longitudinal and transverse). If the color signal indicates localized aliasing and diastolic flow, one should use the pw-Doppler mode to confirm the presence of stenosis. [19, 20, 21, 22, 23, 24, 25, 26, 27].
\nIn 1997 Schmidt et al. proved that the most specific (almost 100% specificity) and sensitive (73% sensitivity) sign for GCA was a concentric hypo-echogenic mural thickening, dubbed “halo”, which the authors interpreted as “vessel wall edema”. [24].
\nOther positive findings for GCA are the presence of occlusion and stenosis. [19, 20, 21, 22, 23, 24, 25, 26, 27].
\nIn conclusion, there are three important items in the ultrasound diagnosis of temporal arteritis:
“dark halo” sign – a typically homogeneous, hypoechoic, circumferential wall thickening around the lumen of an inflamed TA - which represents vessel wall edema and a characteristic finding in temporal arteritis/GCA. It is well delineated toward the lumen (Figure 6).
stenosis are documented by blood-flow velocities, which are more than twice the rate recorded in the area of stenosis compared with the area before the stenosis, with wave forms demonstrating turbulence and reduced velocities behind the area of stenosis (Figure 7).
acute occlusions, in which the US image is comparable to that of acute embolism in other vessels, showing hypoechoic material in the former artery lumen with absence of color signals. [19, 20, 21, 22, 23, 24, 25, 26, 27]
Color Doppler ultrasonography (CDUS) of the right TA shows a hypoechoic halo around the lumen in transverse view (arrow). The “halo sign” corresponds to edema of the artery wall. [
Longitudinal view of the right TA by color Doppler ultrasonography (CDUS) shows a hypoechoic halo of the TA and the presence of turbulent and weak flow, suggesting the presence of stenosis. The PSV is 1 m/s, that is double compared to the segment without stenosis. [
Related ultrasound patterns can be found in other arteries: the facial, the internal maxillary, the lingual, the occipital, the distal subclavian and the axillary arteries.
\nThe best time to perform ultrasound investigation is before initiating the corticosteroid treatment, or in the first 7 days of treatment, since with corticosteroid therapy the” halo” revealed by TAs ultrasound disappears within 2-3 weeks. The wall inflammation, stenosis, or occlusions of the larger arteries (CCA, ICA) remain for months, despite corticosteroid treatment. However, the diagnosis process should not postpone the initiation of therapy. Ultrasound may also detect inflamed TAs in patients with clinically normal TAs. Some patients with the clinical image of polymyalgia rheumatica, but with hidden TAs may be diagnosed using ultrasonography. [9, 10, 11, 12, 13, 14, 15, 16, 19, 20, 21, 22, 23, 24, 25, 26, 27].
\nIn 2010, Arida et al. [26] evaluated a number of studies that examined the sensitivity and specificity of the “halo” sign confirmed by TA ultrasound (US) for GCA diagnosis versus the American College of Rheumatology (ACR) 1990 criteria for the classification of this vasculitis (used as a reference standard). Only 8 studies involving 575 patients, 204 of whom received the final diagnosis of GCA, achieved the technical quality criteria for US. This meta-analysis disclosed a sensitivity of 68% and a specificity of 91% for the unilateral “halo” sign, as well as 43% and 100%, respectively, for the bilateral “halo” sign in TA US for GCA diagnosis when the 1990 ACR criteria are used as the reference standard. The authors established that the halo sign in US is of great utility in diagnosing GCA. [19, 20, 21, 22, 23, 24, 25, 26, 27].
\nIn the case of consistent clinical and sonographic results, temporal arteries biopsy (TAB) does not appear to be useful and justified. [19, 27].
\nSturzenegger affirmed that differential diagnosis with arteriosclerosis is important in patients over 50 years, taking into consideration that GCA with large vessels disease disturbs almost exclusively this category of patients. There are some characteristic features of the arteriosclerotic wall: the thickening usually appears less homogeneous; there are calcified arteriosclerotic plaques ulcers; stenosis extends over shorter segments, they are not concentric, not tapering, and location of lesions differs (e.g., mainly bifurcations). [19].
\nBesides, agreeing to Sturzenegger, differential diagnosis with the other LVV, especially Takayasu arteritis, has to be reflected:
Takayasu arteritis usually affects women below the age of 40 years;
symptoms like tender scalp or polymyalgia syndrome are exceptional;
the involvement of CCA is more frequent in Takayasu arteritis, while the involvement of temporal artery in Takayasu arteritis is not known;
US image of wall thickening (“halo”) is brighter in TA than in GCA probably due to a larger mural edema in GCA which is a more acute disease than TA. Reflected. [19, 20, 21, 22, 23, 24, 25, 26, 27]
Approximately 25% of patients with temporal artery biopsy (TAB) - proven GCA have ophthalmologic complications: usually unilateral visual loss (due to the vasculitic involvement of orbital vessels:
of posterior ciliary arteries (PCAs) - represented by arteritic anterior ischemic optic neuropathies (A-AION), or
of central retinal artery (CRA) - represented by central retinal artery occlusion (CRAO). [31, 32, 33, 34, 35]
Schmidt compared the results of TAs-US examinations with the occurrence of visual ischemic complications (A-AION, CRAO, branch retinal artery occlusion, diplopia, or amaurosis fugax) in 222 consecutive patients with newly diagnosed, active GCA. [21, 22, 23, 24].
\nHowever, findings of TAs US did not correlate with eye complications. [21, 22, 23, 24].
\nThis is the reason why we always have to exam the orbital (retrobulbar) vessels in GCA patients or in patients with unilateral abrupt visual loss [9, 10, 11, 12, 13, 14, 15, 16] (Figure 8A,B).
\nColor Doppler imaging (CDI) of orbital (retro-bulbar) vessels: (A). central retinal artery (CRA); (B). posterior ciliary arteries (PCAs) [
The ophthalmic artery (OA) branches in several arteries, including (Table 1):
the central retinal artery (CRA) (Figure 8 A), and
the posterior ciliary arteries (nasal and temporal branches-nPCAs, tPCAs) [28, 31, 32] (Figure 8B), (Table 1). [15, 28, 31, 32]
Parameter | \nOA | \nCRA | \nPCA (temporal) | \nPCA (nasal) | \nSOV (superior ophthalmic vein) | \n
---|---|---|---|---|---|
45,3 ± 10,5 | \n10,2 ± 3,8 | \n||||
11,8 ± 4,3 | \n4,3 ± 2,4 | \n||||
0,74 ± 0,07 | \n\n |
OA finishes in the a. supra-trohlearis and
Standard neurovascular ultrasound machines equipped with linear-array transducers emitting 6-12 MHz (up to 15 MHz) are adequate for identifying (by Color Doppler sonography), and measuring (by spectral analysis pulsed Doppler sonography) the blood flow in the orbital vessels: the OA, the CRA and central retinal vein (CRV), PCAs, and the superior ophthalmic vein (SOV). [28, 31, 32].
\nThe CRA, a distal branch of the OA, enters the optic nerve (ON) approximately 1-1.5 cm distal from the bulbus coming from the dorsolateral direction. Parallel to this is the CRV.
\nThe PCAs are located near the optic nerve (ON) (the nasal-nPCA and the temporal-tPCA branches). [28, 31, 32].
\nIf the vessels are difficult to display, the power should be elevated for a short time if the clinical question is important. [28, 31, 32].
\nThe optic nerve head (ONH) consists of (from anterior to posterior):
the surface nerve fiber layer - mostly supplied by the retinal arterioles. The cilioretinal artery, when present, usually supplies the corresponding sector of the surface layer. [36, 37, 38, 39, 40]
the prelaminar region - situated anterior of the lamina cribrosa. It is supplied by centripetal branches from the peripapillary choroid. [36, 37, 38, 39, 40]
the lamina cribrosa region - supplied by centripetal branches from the posterior ciliary arteries (PCAs), either directly or by the so-called arterial circle of Zinn and Haller (when is present). [36, 37, 38, 39, 40]
the retrolaminar region - is the part of the ONH that lies immediately behind the lamina cribrosa. It is supplied by two vascular systems: the peripheral centripetal and the axial centrifugal systems. The previous represents the main source of stream for this part. It is formed by recurrent pial branches arising from the peripapillary choroid and the circle of Zinn and Haller (when present, or the PCAs instead). In addition, pial branches from the central retinal artery (CRA) also supply this part. The latter is not present in all eyes. When present, it is formed by inconstant branches arising from the intraneural part of the CRA.
From the description of the arterial supply of the ONH given above, it is obvious that the PCAs are the main source of blood supply to the ONH. [36, 37, 38, 39, 40].
\nThe blood flow in the ONH depends upon [36, 37, 38, 39, 40]:
resistance to blood flow - depends upon the condition and caliber of the vessels supplying the ONH, which in turn are influenced by: the efficiency of auto-regulation of the ONH blood flow, the vascular variations in the arteries feeding the ONH circulation, and the rheological properties of the blood.
arterial blood pressure (BP) - both arterial hypertension and hypotension can influence the ONH blood flow in several ways. In an ONH, a fall of blood pressure below a critical level of auto-regulation would decrease its blood flow. Decrease of BP in the ONH may be due to systemic (nocturnal arterial hypotension during sleep, intensive antihypertensive medication, etc.) or local hypotension.
intra-ocular pressure (IOP) - there is an opposite relationship between intra-ocular pressure and perfusion pressure in the ONH.
The blood flow in the ONH is calculated by using the following formula:
\nPerfusion pressure = Mean BP minus intraocular pressure (IOP).
\nMean BP = Diastolic BP + 1/3 (systolic - diastolic BP) [6, 13].
\nAION is the consequence of an acute ischemic disorder (a segmental infarction) of the ONH supplied by the PCAs. Blood supply interruption can occur with or without arterial inflammation. Therefore, AION is of two types: non-arteritic AION (NA-AION) and arteritic AION (A-AION). The prior is far more common than the last, and they are distinct entities etiologically, pathogenically, clinically and from the management point of view. [36, 37, 38, 39, 40].
\nA history of amaurosis fugax before an abrupt, painless, and severe loss of vision of the involved eye, with concomitant diffuse pale optic disc edema is extremely suggestive of A-AION. None of these symptoms are found in NA-AION patients. [36, 37, 38, 39, 40].
\nIn acute stage, blood flow cannot be detected in the PCAs in the clinically affected eye of any of the GCA patients with A-AION. Low end diastolic velocities (EDV) and high resistance index (RI) are identified in all other orbital vessels (including the PCAs in the opposite eye) of all A-AION patients. [9, 10, 11, 12, 13, 14, 41].
\nOver 7 days, Spectral Doppler analysis of the orbital vessels highlights blood flow alterations in all A-AION patients even with a high-dose corticosteroids therapy. Severely reduced blood flow velocities (especially EDV) in the PCAs of the affected eye (both nasal and temporal branches), compared to the unaffected eye, are observed. An increased RI in the PCAs is noted (the RI is higher on the clinically affected eye as compared to the unaffected eye). [9, 10, 11, 12, 13, 14, 41] (Figure 9A,B).
\nCDI of the PCAs in A-AION: (A). Decreased EDV in the nasal PCAs of the clinically affected right eye, and (B) of the clinically unaffected left eye.
Fewer abnormalities are detected in the CRAs: high RI are measured in both sides, with decreased peak systolic velocities (PSV) in the CRA of the clinically affected eye. [9, 10, 11, 12, 13, 14, 41].
\nSimilar abnormalities are noted in the OAs: high RI are measured in both sides. [9, 10, 11, 12, 13, 14, 41].
\nAt 1 month, after treatment with high-dose corticosteroids, CDI examinations of orbital blood vessels reveals that blood flow normalization is slow in all A-AION patients. [9, 10, 11, 12, 13, 14, 41].
\nIn conclusion, the Spectral Doppler Analysis of the orbital vessels in A-AION indicates (after several days of corticosteroid treatment) low blood velocities, especially EDV, and high RI in all orbital vessels, in both orbits. These signs represent characteristic signs of the CDI of the orbital vessels in A-AION. [9, 10, 11, 12, 13, 14, 41].
\nIn contrast, the patients with NA-AION present the following characteristics in acute stage, and at 1 week of evolution:
minor reduction of PSV in PCAs (nasal and temporal) in the affected eye, compared to the unaffected eye.
slight decrease of PSV in CRA of the affected eye, due to papillary edema. [9, 10, 11, 12, 13, 14, 41]:
in OAs, PSV are variable: normal to decreased, according to ipsilateral ICAs status.
Severe ICA stenosis (≥70% of vessel diameter) combined with an insufficient Willis polygon led to diminish PSV in ipsilateral OA. [9, 10, 11, 12, 13, 14, 41].
\nIn 1 month, CDI examinations of orbital blood vessels reveal that blood flow normalization is reached. The exceptions are the cases with severe ipsilateral ICA stenosis/occlusion. [9, 10, 11, 12, 13, 14, 41].
\nIn conclusion, in NA-AION, blood velocities and RI in PCAs are preserved. Similar results were obtained in other studies. [9, 10, 11, 12, 13, 14, 41].
\nFluorescein angiogram and CDI of the orbital vessels data support the histopathological evidence of involvement of the entire trunk of the PCAs in the A-AION (impaired optic disc and choroidal perfusion in the patients with A-AION). On the other hand, in the NA-AION, the impaired flow to the optic nerve head (ONH) is distal to the PCAs themselves, possibly at the level of the para-optic branches (only 1/3 of the flow of the PCAs). [36, 37, 38, 39, 40].
\nThese branches supply the ONH directly (impaired optic disc perfusion, with relatively conservation of the choroidal perfusion). [36, 37, 38, 39, 40].
\nExtremely delayed or absent filling of the choroid has been depicted as a fluorescein angiogram characteristic of arteritic AION and has been suggested as one useful factor by which A-AION can be differentiated from NA-AION. [36, 37, 38, 39, 40].
\nCRAO is the result of an abrupt diminuation of blood flow in CRA, severe enough to cause ischemia of the inner retina. Due to the fact that there are no functional anastomoses between choroidal (PCAs) and retinal circulation (CRA), CRAO determines severe and permanent loss of vision. Therefore, it is very important to identify the cause of CRAO, in order to protect the contralateral eye. Frequently, the site of the blockage is within the optic nerve substance and for this reason, it is generally not visible on the ophthalmoscopy. The majority of CRAO are caused by thrombus formation due to systemic diseases, including GCA. For this reason, all patients with CRAO should undergo a systemic evaluation. [42, 43, 44].
\nThe patients with an unilateral CRAO present at the Spectral Doppler analysis of the retrobulbar vessels the following aspects [9, 15, 16]:
an elevated RI in the CRAs (the RI is higher on the affected side, than it is on the unaffected side); with severe diminished blood flow velocities (especially EDV) in the CRA.
fewer abnormalities are observed in the PCAs, and in the OAs (Figure 10).
CDI of orbital vessels revealed severely diminished EDV and high RI in both CRAs (a, b) despite the fact that the left eye had the normal aspect at ophthalmoscopy. Fewer abnormalities were observed in the PCAs (c, d). [
Other imaging techniques, such as high-resolution magnetic resonance imaging (MRI), magnetic resonance-angiography (MR-A), computer tomography angiography (CT-A), positron emission tomography (PET) provide valuable information regarding the structure of large vessels, highlighting with much greater precision the thoracic aorta, compared with US. [45, 46, 47].
\nThere are few studies that compared US with other imaging techniques. Some of them indicated that there is a good correlation between US and PET, even though PET might have a little more sensitivity for vertebral arteries examination. [45, 46] 18F-fluorodeoxyglucose-positron emission tomography/ computed tomography (FDG-PET/CT) has a higher sensitivity for detection of large arteries and aortic involvement - analysis of the arterial wall. [45, 46] The diagnostic power of high-resolution MRI and color-coded duplex US of extra-cranial arteries in detecting GCA are equivalent [47].
\nThe disadvantages of this techniques are: they are more expensive, hardly accessible, some of them are limited by invasiveness, nephrotoxicity (angiography) and exposure to high radiations (CT,PET), this is why they might be unnecessary (excepting those patients with exclusively thoracic aorta involvement) and are not accepted as diagnostic methods in GCA. They should only be used when interventions are required [45, 46, 47].
\nAll these imaging techniques should always be performed by well-trained specialists, using suitable equipment and operational protocols. [45, 46, 47].
\nNevertheless, US is particularly useful in examining the orbital vessels. [9, 10, 11, 12, 13, 14, 15, 16, 28, 31, 32, 41].
\nThe diagnostic work-up of AION benefits from the combined used of fluorescein angiography and noninvasive multimodal imaging, including CDI of the orbital vessels and structural Optical Coherence Tomography (OCT) of the optic nerve head (ONH) and OCT angiography [10, 48]. They provide very detailed information regarding the structural (retinal nerve fiber layer-RNFL-thickness/optic disc edema) and vascular impairments (microvascular defects-vessel tortuosity, and vessel density reduction) of the ONH, respectively [10, 48].
\nUS should be used as a first-line diagnostic investigation for patients presenting with clinical and biological features suggestive for GCA, taking into consideration that it has a high sensitivity to detect vessel wall thickening (dark hallo sign) in the case of large/medium vessels. In a few cases of our studies, the CCAs and the ICAs were also involved.
\nIn consequence, in our department, CCDS has emerged as a safe and reliable alternative to TAB as a point of care diagnostic tool in the management of temporal arteritis.
\nThe eye involvement in GCA is frequent and consists in A-AIONs or CRAO, with abrupt, painless, and severe loss of vision of the involved eye.
\nBecause findings of TAs US do not correlate with eye complications in GCA, CDI of the orbital vessels is of critical importance, in order to quickly differentiate the mechanism of eye involvement (arteritic, versus non-arteritic). This US tehnique may be helpful to detect the blood flow in the orbital vessels, especially in cases of opacity of the medium, or when the clinical appearance of ophthalmologic complications in temporal arteritis is athypical.
\nThe Spectral Doppler Analysis of the orbital vessels in GCA with eye involvement reveals low blood velocities, especially EDV, and high RI in all orbital vessels, in both orbits, for all patients (especially on the affected side).
\nA huge advantage of CDI of orbital vessels is that it provides immediate information that can be used to inform treatment decisions, including a potential reduction in loss of sight and avoidance of unnecessary long-term steroid treatment by early exclusion of mimics.
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\n\nThe first step in obtaining funds for your Open Access publication begins with your institution or library. IntechOpen’s publishing standards align with most institutional funding programs. Our advice is to petition your institution for help in financing your Open Access publication.
\n\nHowever, as Open Access becomes a more commonly used publishing option for the dissemination of scientific and scholarly content, in addition to institutions, there are a growing number of funders who allow the use of grants for covering OA publication costs, or have established separate funds for the same purpose.
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After the healing process was completed, the healing efficiency was defined using the fracture energy values. In this study, the healing process was repeated two times with the acceptable healing efficiencies. It is concluded that the damaged reinforced adhesive can repair itself with a considerable healing efficiency.",book:{id:"5365",slug:"adhesives-applications-and-properties",title:"Adhesives",fullTitle:"Adhesives - Applications and Properties"},signatures:"Halil Özer and Engin Erbayrak",authors:[{id:"186177",title:"Prof.",name:"Halil",middleName:null,surname:"Ozer",slug:"halil-ozer",fullName:"Halil Ozer"},{id:"187497",title:"M.Sc.",name:"Engin",middleName:null,surname:"Erbayrak",slug:"engin-erbayrak",fullName:"Engin Erbayrak"}]},{id:"56158",title:"Natural Rubber and its Derivatives",slug:"natural-rubber-and-its-derivatives",totalDownloads:2883,totalCrossrefCites:3,totalDimensionsCites:5,abstract:"This chapter summarizes various types of chemical modification of natural rubber (NR). These chemically modified NRs are known as NR derivatives. Chemical modification reviewed includes chemical modification without introducing new atom such as cyclized natural rubber and deproteinized natural rubber (DPNR), modification by introducing a chemical group such as hydrogenated natural rubber (HNR), chlorinated natural rubber (CNR) and epoxidized natural rubber (ENR) and lastly modification by grafting on NR. Grafting can be carried out using DPNR latex to yield styrene‐grafted‐NR, methyl methacrylate‐grafted‐NR and styrene and methyl methacrylate‐grafted‐NR. 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He is a full professor of signal processing and pattern recognition and is head of the Signals and Communications Department at ULPGC, teaching from 2001 on subjects on signal processing and learning theory. His research lines are biometrics, biomedical signals and images, data mining, classification system, signal and image processing, machine learning, and environmental intelligence. He has researched in 52 international and Spanish research projects, some of them as head researcher. He is co-author of 4 books, co-editor of 27 proceedings books, guest editor for 8 JCR-ISI international journals, and up to 24 book chapters. He has over 450 papers published in international journals and conferences (81 of them indexed on JCR – ISI - Web of Science). He has published seven patents in the Spanish Patent and Trademark Office. He has been a supervisor on 8 Ph.D. theses (11 more are under supervision), and 130 master theses. 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He has been a member of the IASTED Technical Committee on Image Processing from 2007 and a member of the IASTED Technical Committee on Artificial Intelligence and Expert Systems from 2011. \n\nHe has held the general chair position for the following: ACM-APPIS (2020, 2021), IEEE-IWOBI (2019, 2020 and 2020), A PPIS (2018, 2019), IEEE-IWOBI (2014, 2015, 2017, 2018), InnoEducaTIC (2014, 2017), IEEE-INES (2013), NoLISP (2011), JRBP (2012), and IEEE-ICCST (2005)\n\nHe is an associate editor of the Computational Intelligence and Neuroscience Journal (Hindawi – Q2 JCR-ISI). He was vice dean from 2004 to 2010 in the Higher Technical School of Telecommunication Engineers at ULPGC and the vice dean of Graduate and Postgraduate Studies from March 2013 to November 2017. He won the “Catedra Telefonica” Awards in Modality of Knowledge Transfer, 2017, 2018, and 2019 editions, and awards in Modality of COVID Research in 2020.\n\nPublic References:\nResearcher ID http://www.researcherid.com/rid/N-5967-2014\nORCID https://orcid.org/0000-0002-4621-2768 \nScopus Author ID https://www.scopus.com/authid/detail.uri?authorId=6602376272\nScholar Google https://scholar.google.es/citations?user=G1ks9nIAAAAJ&hl=en \nResearchGate https://www.researchgate.net/profile/Carlos_Travieso",institutionString:null,institution:{name:"University of Las Palmas de Gran Canaria",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"23",title:"Computational Neuroscience",coverUrl:"https://cdn.intechopen.com/series_topics/covers/23.jpg",isOpenForSubmission:!0,editor:{id:"14004",title:"Dr.",name:"Magnus",middleName:null,surname:"Johnsson",slug:"magnus-johnsson",fullName:"Magnus Johnsson",profilePictureURL:"https://mts.intechopen.com/storage/users/14004/images/system/14004.png",biography:"Dr Magnus Johnsson is a cross-disciplinary scientist, lecturer, scientific editor and AI/machine learning consultant from Sweden. \n\nHe is currently at Malmö University in Sweden, but also held positions at Lund University in Sweden and at Moscow Engineering Physics Institute. \nHe holds editorial positions at several international scientific journals and has served as a scientific editor for books and special journal issues. \nHis research interests are wide and include, but are not limited to, autonomous systems, computer modeling, artificial neural networks, artificial intelligence, cognitive neuroscience, cognitive robotics, cognitive architectures, cognitive aids and the philosophy of mind. \n\nDr. Johnsson has experience from working in the industry and he has a keen interest in the application of neural networks and artificial intelligence to fields like industry, finance, and medicine. \n\nWeb page: www.magnusjohnsson.se",institutionString:null,institution:{name:"Malmö University",institutionURL:null,country:{name:"Sweden"}}},editorTwo:null,editorThree:null},{id:"24",title:"Computer Vision",coverUrl:"https://cdn.intechopen.com/series_topics/covers/24.jpg",isOpenForSubmission:!0,editor:{id:"294154",title:"Prof.",name:"George",middleName:null,surname:"Papakostas",slug:"george-papakostas",fullName:"George Papakostas",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002hYaGbQAK/Profile_Picture_1624519712088",biography:"George A. Papakostas has received a diploma in Electrical and Computer Engineering in 1999 and the M.Sc. and Ph.D. degrees in Electrical and Computer Engineering in 2002 and 2007, respectively, from the Democritus University of Thrace (DUTH), Greece. Dr. Papakostas serves as a Tenured Full Professor at the Department of Computer Science, International Hellenic University, Greece. Dr. Papakostas has 10 years of experience in large-scale systems design as a senior software engineer and technical manager, and 20 years of research experience in the field of Artificial Intelligence. Currently, he is the Head of the “Visual Computing” division of HUman-MAchines INteraction Laboratory (HUMAIN-Lab) and the Director of the MPhil program “Advanced Technologies in Informatics and Computers” hosted by the Department of Computer Science, International Hellenic University. He has (co)authored more than 150 publications in indexed journals, international conferences and book chapters, 1 book (in Greek), 3 edited books, and 5 journal special issues. His publications have more than 2100 citations with h-index 27 (GoogleScholar). His research interests include computer/machine vision, machine learning, pattern recognition, computational intelligence. \nDr. Papakostas served as a reviewer in numerous journals, as a program\ncommittee member in international conferences and he is a member of the IAENG, MIR Labs, EUCogIII, INSTICC and the Technical Chamber of Greece (TEE).",institutionString:null,institution:{name:"International Hellenic University",institutionURL:null,country:{name:"Greece"}}},editorTwo:null,editorThree:null},{id:"25",title:"Evolutionary Computation",coverUrl:"https://cdn.intechopen.com/series_topics/covers/25.jpg",isOpenForSubmission:!0,editor:{id:"136112",title:"Dr.",name:"Sebastian",middleName:null,surname:"Ventura Soto",slug:"sebastian-ventura-soto",fullName:"Sebastian Ventura Soto",profilePictureURL:"https://mts.intechopen.com/storage/users/136112/images/system/136112.png",biography:"Sebastian Ventura is a Spanish researcher, a full professor with the Department of Computer Science and Numerical Analysis, University of Córdoba. Dr Ventura also holds the positions of Affiliated Professor at Virginia Commonwealth University (Richmond, USA) and Distinguished Adjunct Professor at King Abdulaziz University (Jeddah, Saudi Arabia). Additionally, he is deputy director of the Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI) and heads the Knowledge Discovery and Intelligent Systems Research Laboratory. He has published more than ten books and over 300 articles in journals and scientific conferences. Currently, his work has received over 18,000 citations according to Google Scholar, including more than 2200 citations in 2020. In the last five years, he has published more than 60 papers in international journals indexed in the JCR (around 70% of them belonging to first quartile journals) and he has edited some Springer books “Supervised Descriptive Pattern Mining” (2018), “Multiple Instance Learning - Foundations and Algorithms” (2016), and “Pattern Mining with Evolutionary Algorithms” (2016). He has also been involved in more than 20 research projects supported by the Spanish and Andalusian governments and the European Union. He currently belongs to the editorial board of PeerJ Computer Science, Information Fusion and Engineering Applications of Artificial Intelligence journals, being also associate editor of Applied Computational Intelligence and Soft Computing and IEEE Transactions on Cybernetics. Finally, he is editor-in-chief of Progress in Artificial Intelligence. He is a Senior Member of the IEEE Computer, the IEEE Computational Intelligence, and the IEEE Systems, Man, and Cybernetics Societies, and the Association of Computing Machinery (ACM). Finally, his main research interests include data science, computational intelligence, and their applications.",institutionString:null,institution:{name:"University of Córdoba",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"26",title:"Machine Learning and Data Mining",coverUrl:"https://cdn.intechopen.com/series_topics/covers/26.jpg",isOpenForSubmission:!0,editor:{id:"24555",title:"Dr.",name:"Marco Antonio",middleName:null,surname:"Aceves Fernandez",slug:"marco-antonio-aceves-fernandez",fullName:"Marco Antonio Aceves Fernandez",profilePictureURL:"https://mts.intechopen.com/storage/users/24555/images/system/24555.jpg",biography:"Dr. Marco Antonio Aceves Fernandez obtained his B.Sc. (Eng.) in Telematics from the Universidad de Colima, Mexico. 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