Primary and secondary sonographic features of acute appendicitis.
\\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:"3301",leadTitle:null,fullTitle:"Diagnosis and Treatment of Myocarditis",title:"Diagnosis and Treatment of Myocarditis",subtitle:null,reviewType:"peer-reviewed",abstract:"Myocarditis is a clinical syndrome, most frequently of infectious etiology, that occurs with a broad range of relatively non-specific symptoms, and consists of an inflammatory process of the heart with necrosis and degeneration of the myocardium by inflammatory infiltration of immune cells. 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\r\n\r\n\tThis book will entail design, development, and industrial applications of new and novel dyes and pigments from wide areas of organic and inorganic chemistry along with biological sciences. Besides, this book will comprise recent design and development on organic molecules and their metal-complexes towards the detection of biologically and environmentally concerned cations, anions, neutral molecules via chromogenic, fluorometric, and electrochemical signaling responses using UV/vis, emission, and electrochemical techniques. Further, the advancements in the bio-chromophores for detection of biologically vital as well as harmful ions and molecules using colorimetric changes via UV/vis technique, fluorimetric signaling through emission technique, and electrochemical changes by cyclic voltammetry (CV), LSV, etc. will also be included in this book.
",isbn:null,printIsbn:"979-953-307-X-X",pdfIsbn:null,doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!1,isSalesforceBook:!1,hash:"4aca0af0356d8d31fa8621859a68db8f",bookSignature:"Dr. Rampal Pandey",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/10572.jpg",keywords:"Organic Probes, Metal-Complex Probes, Nano-Probes, Fluorometric Readout, Electrochemical Response, Environmentally Concerned Analytes, Bio-Chromophores, Biomolecular Detection, Multichannel Signaling Response, Absorption, Emission, Electrochemical",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"November 17th 2020",dateEndSecondStepPublish:"December 15th 2020",dateEndThirdStepPublish:"February 13th 2021",dateEndFourthStepPublish:"May 4th 2021",dateEndFifthStepPublish:"July 3rd 2021",remainingDaysToSecondStep:"a year",secondStepPassed:!0,currentStepOfPublishingProcess:5,editedByType:null,kuFlag:!1,biosketch:"A leading young researcher in the chromophore, MOF, and soft material research, Appointed Associate Dean at NIT Uttarakhand, received Presidents Inspire Teacher Award, published quality international papers, registred patents, developed MOOC and e-PG Pathshala contents.",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"338234",title:"Assistant Prof.",name:"Rampal",middleName:null,surname:"Pandey",slug:"rampal-pandey",fullName:"Rampal Pandey",profilePictureURL:"https://mts.intechopen.com/storage/users/338234/images/system/338234.jpg",biography:"Dr. Rampal Pandey currently works as Senior Assistant Professor and Associate Dean (Faculty Welfare) at the Department of Chemistry, NIT Uttarakhand. He is an active researcher in the field of Supramolecular Chemistry, Porous functional materials, Inorganic and Organometalic Chemistry. He has been recognized as the President's Inspired Teacher, International Outstanding Scientist, and DST-INSPIRE Faculty. He is a member of the American Chemical Society (ACS), Royal Society of Chemistry (RSC), Chemical Research Society of India (CRSI), Society of Material Chemistry of India (SMC), Solar Energy Society of India (SESI), and Indian Society of Chemists & Biologists (ISCB). Dr. Pandey has over 45 internationally reputed publications, 2 Patents in chemical sensing, and over 10 invited talks in person. 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Currently used drugs are mostly sourced from traditional medical products such aspirin, which has been developed as a painkiller from quinine and cocaine has been prescribed in modern medicine for a long time.
Traditional medicine is living harmonized with cultural components where any disease information is passed through the generations. Not only in developing countries, but also in developed countries, traditional practitioners or physicians using traditional methods continue to give primary health services.
World Health Organization defined traditional medicine as the skills and practices based on health practices, approaches, knowledge and beliefs from various cultures, whether explicable or not, incorporating plant, animal- and mineral-derived medicines, spiritual therapies, manual techniques and exercises, applied singularly or in combination in the maintenance of health and well-being to prevent, diagnose, improve or treat physical and mental illness [1].
The therapeutic outcome is very much related with expectancy, which is created mostly by belief and attitude and results as a placebo, or “meaning response,” effect both in modern and traditional medicine.
From our experience, the most common reasons for using traditional medicine are:
Economic considerations (it is more affordable).
The healers know better the sociocultural background of the patients and they are closer to the patient’s ideology.
More concern about the adverse effects of chemical (synthetic) medicines.
Desire for more personalized health care.
Greater public access to health information.
The distances to be covered in some countries.
The strength of traditional beliefs.
The shortage of health professionals, particularly in rural areas.
Low incidence of harmful incidents.
Perception of traditional and complementary medicine as natural and safe.
Traditional and complementary medicine is considered natural, safe and non-toxic.
From our experience, in the use of traditional and complementary medicine, there are problems such as:
the difficulty in setting the limits
little knowledge about drug-herbal interactions
the indeterminant ethical point of view
the secrecy of healing methods
the absence of written records
incorrect diagnosis
improper dosage
low hygiene standards
the lack of a complete code of conduct
missing scientific and correct instructions, documentation and data base
insufficient control in labeling and sales
non-formal structure or organization to train tradi-practitioners
abuse of traditional medicinal products
weak labeling
inefficient control in the market for consumption
no national nor international convention nor treaty about traditional and complementary medicine
There are many different systems of traditional medicine, because the philosophy and practices of each are influenced by the prevailing conditions, environment and geographic area [2].
Traditional Chinese medicine (TCM), which is still used in present day health care conserving the holistic approach, is rooted to the ancient philosophy of Taoism and accumulates ancient knowledge dating back more than 2500 years. In this understanding, the human body is considered as a miniature version of the surrounding universe.
TCM encompasses many different practices:
moxibustion (burning an herb above the skin to apply heat to acupuncture points),
Chinese herbal medicine,
tui na (Chinese therapeutic massage),
dietary therapy and
acupuncture.
Tai chi: Gentle, dance-like body specific movements or postures, coordinated by breathing, relaxation and mental focus. Tai chi practice improves balance and stability in patients with Parkinson’s disease; reduces pain from knee osteoarthritis and fibromyalgia; and increases the quality of life and mood in patients with heart failure.
Harmony between two opposite forces,
The modalities of CAM vary from culture to culture, and from country to country.
Traditional systems of medicine that exist in other East and South Asian countries, are mostly influenced by TCM and each one has developed distinctive features of its own. For example, Kampo, the system of traditional herbal medicine in Japan, is even covered by the national health insurance plan and is practiced by many licensed medical doctors.
Ayurveda is practiced in India at the national level within the Federal Health System [4].
In Africa up to 90% and in India 70% of the population use traditional medicine for their health care needs [5].
In the United States, under the Dietary Supplement Health and Education Act (DSHEA) of 1994, any herb, botanical and natural concentrate, metabolite and constituent of extract, is classified as a dietary supplement and no additional toxicity studies are required, if the herb has been on the market prior to 1994 [6].
EU has standardized the information and guidelines related to herbal medicines by producing necessary materials, such as monographs on herbs and preparations, guidelines for the collection of materials of herbal origin, the standardization of applications, the identification and quantitative determination of herbal preparations and their complex compositions [7].
More and more people use the traditional medicines even in developed countries because of the positive perception of patients for the use of herbal medicines and satisfaction with therapeutic outcomes coupled with the disappointment with conventional allopathic or orthodox medicine in terms of effectiveness and/or safety [8].
Since herbal extracts may be contaminated or adulterated, their quality control has a direct impact on their safety and efficacy [9].
To isolate each active ingredient from any herb would be time-consuming at a high cost [10].
Plants, herbs and ethnobotanicals are the oldest known health care products and vary depending on the ethnological, medical and historical background of each country. Plants and natural sources form the basis of today’s modern medicine and pharmacological industry commercially manufacturing drug preparations for health promotion and treatment of disease. About 25% of the drugs prescribed worldwide are derived from plants.
In July 1996, WHO gathered 100 scientific experts from different countries and they made a list of 28 medicinal plants originally prepared by the WHO Collaborating Centre for Traditional Medicine in Chicago, Illinois, United States of America with 28 monographs.
Over the past 100 years, the development and mass production of chemically synthesized drugs have revolutionized health care. For example, three of the top-selling botanical products, namely
Currently, herbs are applied for the treatment of chronic and acute conditions and various ailments and problems such as cardiovascular disease, prostate problems, depression and inflammation. In Africa, for example, a traditional herbal medicine, the Africa flower, has been used for decades to treat wasting symptoms associated with HIV [5].
About 960 plant species are used by the Indian herbal industry [11].
Overall international trade in medicinal plants and their products was US$ 60 billion in 2010 and is expected to reach US$ 5 trillion by 2050.
The pharmaceutical industry has come to consider traditional medicine as a source for identification of bio-active agents that can be used in the preparation of synthetic medicine. Some of the medicinal plants have been already phyto-chemically screened and characterized and their antimicrobial, anti-inflammatory, anti-oxidant, anticancer and anti-diabetic activities are being tested by biochemists, toxicologists and pharmacologists, in animal models (in vivo), cell lines, pathogen (bacteria, fungi and viruses), parasites (malaria Plasmodium, sleeping sickness (Trypanosome)) and many others. Such clinical research trials have resulted in safety, efficacy and good pharmacokinetics and pharmacodynamics parameters for potential drugs [12].
About 200 years ago, the first pharmacologically active pure compound, morphine, was produced from opium extracted from seeds pods of the poppy
The expanding herbal product market threatens biodiversity due to the overharvesting of plants. Bad collection and cultivation can lead to the extinction of certain plant species and the destruction of natural resources. It is expected that 15,000 of 50,000–70,000 medicinal plant species are threatened with extinction. The herb-herb and herb-drug interactions challenge the identification of the active compounds in the plants and require research-based evidence, increased awareness and study, as polypharmacy and polyherbacy.
The “traditional” ways of identification and preparation of herbs need to be replaced with more accurate and reproducible methods to ensure the quality, safety and consistency of the product. Given the market value, potential toxicity and increasing consumer demand, particularly in the sick and elderly members, regulation of production and marketing of herbal supplements and medicines bring two main areas of concern such as the international diversity and national policies regarding the regulation of the production and use of herbs (and other complementary medicines) and their quality, safety and scientific evidence in relation to health claims.
In many countries, the herbal medicine market is not adequately regulated, herbal medicines and related products are introduced into the market without any mandatory safety or toxicological evaluation and the products are therefore not registered and controlled by regulatory bodies. There is no effective regulation for manufacturing practices and quality standards. The establishment of regulation and registration procedures is still a problem in both developed and developing countries.
Lack of any documentation system for information, conventions, treaties and decree on medicinal plants led to abuse the uses and sale of products without any instruction or any scientific studies on the active principles and safety and poor labeling.
Some herbal products on the market may be of low quality and suspecting efficacy, but sold without prescription and the potential hazards of such an inferior product may not be recognized. Although herbs may also have undesirable side effects, no set “doses” and herb-drug or herb-herb interactions are possible. There is a belief that herbs, as natural products, are inherently safe without side effects and their efficacy can be obtained over a wide range of doses. The general perception is that herbal remedies or drugs are very safe and devoid of adverse effects. But, herbs have been shown to produce undesirable or adverse reactions causing serious injuries, life-threatening conditions and even death.
In many countries, CAM practice is provided outside the national health care systems and practiced by non-regulated personnel. Therefore, it is usually not monitored by the safety mechanisms and reporting systems of the main-stream regulatory and legislative frameworks.
Generally, health professionals are not trained about the use and the effect of herbal medicines [14].
Analysis of adverse events related to the use of herbal products is more complex than the conventional pharmaceuticals. The evaluation of safety is complicated by factors such as the geographical origin of plant material, different processing techniques, route of administration and compatibility with other medicines. Furthermore, there is a lack of knowledge on taxonomic botany and documentation by most manufacturers of herbal medicines during identification and collection of medicinal plants used for herbal remedies.
There are different ways to define medicinal plants or herbs. As a result, different approaches have been adopted with regard to licensing, dispensing, manufacturing and trading in order to ensure the safety, quality and efficacy of medicinal plant preparations.
By definition, a dietary supplement is a product ingested to supplement the diet. The dietary ingredients in these products may include vitamins, minerals, herbs or other botanicals.
To eliminate the confusion of common names, the mostly used binomial names (including their binomial synonyms) should be accepted for medicinal plants. For example,
In this book, we have planned to bring together a scientific approach to the development of traditional and complementary medicine, the current use especially in Africa where one of the oldest traditional medical use still exists. The theoretical explanation, which combines with energy and information medicine, explains the bio-field approach as an individualized and holistic therapeutic approach. The interrelation with the modern pharmaceutical industry and the conflicts with the modern medicine are emphasized by the oxidative theory which is quite popular in modern medicine to explain the deviation from homeostasis.
Non-traumatic acute gastrointestinal (GI) disorders are common causes of presentation in the pediatric emergency department. Children have wide range of potential diagnosis, different from adults including congenital and acquired lesions. The causes of acute abdomen vary according to ages of the children. Since children are unable to give reliable history, have atypical presentations and accompanying extra-abdominal manifestations; evaluation and establishing the correct diagnosis is challenging.
Traditionally, pediatric abdominal ultrasound (US) examination focuses exclusively on parenchymal organs, putting less interest on the gastrointestinal tract [1]. However, recent US technologies and new transducers are able to perform a detailed examination with great contrast resolution of each section of the digestive system in pediatric age because of their smaller body size and less impaired by gas content and adipose tissues. The other well-known advantages of US, particularly its lack of ionizing radiation, easy access, low-cost and without need of patient preparation, makes this imaging modality an ideal one for the evaluation of pediatric population in the emergency settings. Currently in many places, US is the first line of imaging over computed tomography (CT) and radiography for patients with acute abdominal pain. The main role of diagnostic imaging with US and color Doppler in the emergency is to determine whether the acute abdomen is due to a surgically or medically treatable disease, even though the exact pathology has not been diagnosed.
This chapter presents the basic aspects of US for evaluating the pediatric GI tract, including techniques, equipment, patient preparation and the anatomy. Then indications and sonographic findings of frequently encountered acute non-traumatic GI diseases in neonates, infants and children are highlighted with some exemplary cases. Acute traumatic GI tract injuries, oncologic emergencies, acute abdomen due to hepatobiliary or urogenital diseases are beyond the scope of this chapter.
New generation ultrasound equipment including the wide spectrum frequency probes provides high quality images of the gastrointestinal system, adjacent mesentery and related structures. Children’s small body habitus and the presence of less fat tissue in the abdominal wall enable examination with high frequency transducers. Therefore US is increasingly used as the initial and follow-up study for investigating gastrointestinal tract pathologies in children and it is sufficient for the radiological diagnosis in majority of cases.
The contrast resolution of an US probe is dependent on the frequency, the velocity of sound in tissue and the number of cycles in the US pulse [2]. Depending on the age and size of the patient, a large convex-array (1–5 MHz) or smaller convex-array transducer (5–8 MHz) is a good option for beginning the examination for overview of the entire abdomen [3]. Following initial overview, a detailed analysis of the bowel wall and adjacent structures should be evaluated with a high frequency (10–18 MHz) linear-array transducer [1]. Tissue harmonic imaging is newly developed imaging software to increase resolution of the superficial parts of the field-of-view. It should be used to improve the delineation of bowel wall layers [2]. While evaluating anxious children in the acute setting, dynamic range should be lowered and the number of foci should be reduced to increase frame rate [4]. To demonstrate peristalsis, normal or abnormal motility, and motion of air bubbles in perforation or necrotizing enterocolitis; extended field-of-view can be helpful and cine clips should be recorded [5].
Doppler US evaluation is essential in GI system imaging, especially when looking at inflammatory diseases or neoplastic conditions. Doppler should be performed with a low wall filter and pulse repetition frequency should be adjusted as low as possible to prevent aliasing [6]. Power Doppler is a good method to overcome motion artifact in uncooperative children. As there are modern equipment and software, newer vascular imaging techniques, such as B-flow and superb microvascular imaging are brought into use by different vendors which are able to assess smaller vessels in the bowel wall [4].
US elastography is an emerging US technique to assess the stiffness of a tissue [5]. There are some studies in the literature regarding the usage of elastography for GI tract diseases, particularly in inflammatory conditions [7, 8]. The bowel is a hollow viscus with a lumen containing gas and fecal contents. The anatomy of the bowel is not ideal for US elastography as solid organs (e.g. liver or kidney). However, bowel wall thickening due to inflammation or tumor often reduces motility and luminal contents that enable to perform US elastography more reliable [2]. Some studies suggest using US elastography in inflammatory bowel disease to differentiate inflammatory and fibrotic stenosis [9, 10].
Contrast enhanced US (CEUS) can be used to evaluate bowel wall vascularity and perfusion in real time [5]. It is performed after the intravenous injection of microbubbles that resonate and give rise to more intensely reflected signals [2]. Enhancement pattern, contrast quantification at peak intensity and dynamic contrast enhancement can be analyzed with CEUS [11, 12]. Enhancement pattern following bolus injection is used as a qualitative parameter. For example, patients with absent bowel wall enhancement can be separated from those with detected enhancement [2]. It can also be used in patients with complicated GI disorders when trying to differentiate a phlegmon from an abscess [13].
US examination of GI system must involve a systematic approach. While evaluating large bowel, the transducer is applied to the right iliac fossa to identify the cecum. Afterwards, colon can be followed through the ascending colon, transverse colon, descending colon, sigmoid colon and finally the rectum. Since the rectum is visualized behind the bladder, filled bladder is better to evaluate rectum and sigmoid colon. Longitudinal placement of the transducer is often better to identify the haustrations of colon segments [2]. The examination of the small intestine begins with the identification of ileocecal valve and the terminal ileum at the right iliac fossa. The examiner should identify the appendix, often inferior to the terminal ileum and follow the ileum as far as possible. Tracking the whole small bowel is generally not possible, therefore the abdomen should be scanned cranially and caudally parallel scans covering the whole abdominal area. The scanning approach may differ according to clinical scenario. For surgical disorders or trauma, a faster and a targeted approach are preferred, whereas for general and nonspecific complaints, more detailed examination can be performed.
Graded compression is a simple, essential and effective technique to push away gas filled bowel segments or intraabdominal fat [3, 4]. It decreases the distance between the transducer and target organ and enables to reach deeper with high frequency transducers. Although it was introduced for the diagnosis of acute appendicitis by Puylaert [14], now it has been performed for detection of bowel thickening and compressibility, and for specific diseases such as diverticulitis and colonic polyps [15, 16].
As a general principle, no preparation of the patient is required to perform gastrointestinal US, particularly in the emergency setting. However, to decrease the amount of food and gas in the gut, and to examine the gallbladder and biliary tree, a fasting period of 3 hours in newborn and 5 hours in children is recommended [1]. Physical activity also reduces the splanchnic flow, therefore patients should avoid from extensive activity before the examination [2]. Since the cold gel is one of the major complaints of children, gel warmer to warm the coupling gel can be used. If the infants or neonates are anxious and reluctant to be scanned; examiner can sit them on their mother’s lap, get her lie down on the couch along with the child.
For stomach and pyloric examination, oral fluid intake or fluid ingestion via nasogastric tube is useful [4]. The distention of colon with anechoic fluid (water) ingestion, or with oral administration of hyperosmotic solutions allows the detailed examination of the haustration of colonic wall and adjacent structure [2]. The scanning of small intestine following the ingestion of iso-osmolar polyethylene glycol (PEG) solution is called US enterography or small intestine contrast US (SICUS). Since the PEG solution is non-absorbable in the small bowel, retained fluid distends the intestine and induces the wall contractility. The PEG solution moves distally and distends whole loops of the entire small bowel. Following PEG ingestion, small bowel lumen diameter > 30 mm and wall thickness > 3 mm is abnormal [17].
Before beginning a US examination, examiner should be familiar with the abdominal symptoms, clinical presentations and laboratory findings of acute GI diseases. The most common presentations are pain, vomiting, diarrhea, fever, hematochezia and melena. Although some diseases have peculiar clinical findings, majority of cases have non-specific symptoms and clinical appearances [3]. US is generally suggested as the first line imaging modality in children with acute abdomen. Most common indications for gastrointestinal US in children are acute appendicitis, intussusception, hernia, hypertrophic pyloric stenosis, inflammatory bowel disease, and volvulus. Further indications involve necrotizing enterocolitis, duplication cysts, malrotation of the bowel [4]. Also US is widely performed for the disease of other intraabdominal structures such as mesenteric lymphadenitis, lymphoid hyperplasia of the appendix, infectious enterocolitis, omental infarct, epiploic appendagitis, specific inflammations such as tuberculosis, colitis with hemolytic uraemic syndrome and Henoch-Schönlein purpura [4]. The recent COVID-19 pandemic associated multisystem inflammatory syndrome in children (MIS-C) can also manifest with gastrointestinal system dysfunction which has been also a novel US indication since 2020 [18].
Major challenges of US is based on its operator-dependency and reproducibility [5]. The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) suggests to set standards of training and education curriculum for GI system US to provide high quality performance in clinical practice [2]. According to EFSUMB recommendations; the operator should be able to recognize the normal anatomy of small intestine and large bowel initially. Following recognizing normal appearance of normal GI tract, the investigator should be able to perform a complete scanning of the gut; evaluation for focal or diffuse diseases, the presence of diverticular disease and its complications (perforation and obstruction), the peritoneal cavity, the mesentery, and the omentum for the inflammatory, infectious or malignant diseases [2].
There are other challenging factors related to the patient such as noncollaboration, obesity and interposition of large amount of gas [5]. Particularly retroperitoneal, paraaortic and retroduodenal areas are often danger zones that are not well delineated on US. If the graded compression technique is ineffective to eliminate gas interposition and US findings are unremarkable; intravenous contrast enhanced CT should be performed in patients with acute abdominal pain, especially if there is suspicion of gut perforation.
While examining normal anatomy of GI structures; position, size, wall thickness and stratification should be evaluated. Many GI disorders appear as bowel wall thickening but normal bowel wall thickness may vary depending on peristalsis and the degree of distention [3]. Recent studies with high frequency transducers suggest that both normal small and large bowel wall thickness should be <2 mm when distended [19]. The exceptions are the pylor/duodenal bulbus and rectum wall which should be < 3 mm and < 4 mm respectively [20]. If the measurements were made from collapsed bowel wall, it should be reported since the wall of collapsed bowel is shown as thicker [2].
When examined with high frequency transducers, five sonographic layers of the bowel wall can be seen. When imaging the anterior wall (closer to transducer); the innermost echogenic layer is called as the mucosa-lumen interface which is not a part of actual GI wall. The second hypoechoic layer correspond to the deep mucosa, the third hyperechoic layer is submucosa which is most prominent in the colon [3]. The muscularis propria is the hypoechoic fourth layer which is most pronounced in the stomach. The outermost hyperechoic layer is the interface between muscularis and serosa. As the interface are hyperechoic and located distal to the real tissue, correspondence of histology and US layers are slightly different in the dorsal wall [2]. Therefore, evaluation of the layers should be made from the anterior bowel wall in diffuse inflammatory diseases. Bowel wall thickness measurement should be made perpendicular to the wall from innermost to the outermost echogenic layers [2].
The small intestine has three segments. The duodenum passes into the jejunum at the ligament of Treitz located in the left upper quadrant. The jejunum is often located in the left upper quadrant and usually collapsed with prominent folds, also known as valvula conniventes. They decrease and shorten from jejunum to ileum and best demonstrated at the fluid filled loops [2]. The ileum is located at the right lower quadrant and frequently involves fluid in normal patients. Sometimes cecum may be located intraperitoneal in variable positions even at the left lower quadrant of abdomen. The cecum and ileocecal valve is important landmarks to identify appendix which is usually below to the ileocecal valve. Although appendix is typically seen over the iliopsoas muscle medial to the cecum, lateral elevation or retrocecal course are not infrequent [2]. The normal appendix can be visualized in about 70% of healthy children with graded compression and it may increase depending on the experience of examiner and the resolution of transducer [21].
Acute appendicitis accounts for 80% of all abdominal surgical emergencies in pediatric population [22]. It is most frequently seen in second decade and is rare in children under two years of age, probably due to the funnel shape of appendix in infancy, which reduces the possibility of obstruction [23, 24]. Possible predisposing factors include lymphoid hyperplasia (due to past viral infection), dehydration, and low dietary intake of fiber [24]. Although the typical clinical presentation is acute onset of abdominal pain that may occur in the periumbilical area, radiating to the right lower quadrant, one-third of children have atypical clinical findings and symptoms, especially younger ones [23]. Other clinical signs are; fever, elevated acute phase reactants, nausea, vomiting and leg pain. Diarrhea is not present unless there is perforation and peritonitis, more frequently occurs in young children and confused with gastroenteritis [24]. Following clinical assessment and laboratory findings, imaging is the third component while evaluating the patients with suspected appendicitis. The routine US examination in suspected appendicitis reduces the negative appendectomies 50% and decreases the surgical complications and costs [25].
In patients with localized pain, transducer is applied to the point of maximum tenderness or pain. Self-localization facilitates the scanning, especially in patients with an aberrantly located appendix, and reduces the time of examination. If the patient cannot localize the pain or uncooperative; systematic evaluation starts in transvers plane to identify ascending colon. Lowermost part of the ascending colon is the cecal pole and medial to the cecum ileocecal valve can be demonstrated. The most common origin of the appendix is 2–3 cm below to the ileocecal valve [26]. Pressure is gradually increased to displace gas and fecal materials in the cecal lumen to adduct appendix to the transducer. In obese children, a left oblique body position or an upward graded compression technique may be useful to displace the fat tissue of the abdominal wall [27]. Anatomical variations require a systematic approach to evaluate appendix and experience plays an important role in examination. There are several US features to distinguish between normal and inflamed appendix which are valid for both children and adults (Table 1) [25, 26, 28, 29].
Primary US findings of acute appendicitis | Secondary US findings of acute appendicitis (adjacent structures) |
---|---|
Maximum outer diameter > 6 (6–8 mm indicates borderzone) | Hyperechoic periappendiceal fat tissue |
Maximum tenderness over the thickened appendix | Complex fluid collection (pericecal abscess) |
Incompressibility of the inflamed appendix | Mesenteric / pericecal lymphadenopathy |
Appendicolith (fecalith) within the appendix lumen | Periappendiceal reactive fluid |
Hypervascularity in color Doppler in uncomplicated cases | |
Loss of stratification and normal appearance of appendix wall in gangrenous appendicitis |
Primary and secondary sonographic features of acute appendicitis.
The inflamed appendix is shown as a fluid-filled non-compressible distended aperistaltic tubular structure with a blind end (Figure 1). In the axial plane, it has a target appearance with thickened echogenic mucosal interface and hypoechoic muscular wall. Appearance of an appendicolith, which is an echogenic focus with a posterior acoustic shadowing, is supportive finding for the diagnosis (Figure 1C) [23]. However, intraluminal air is also echogenic and can mimic appendicolith (Figure 1D). A heterogeneous mass around appendix representing phlegmon, and a walled-off fluid collection representing abscess are often the signs of complicated appendicitis and perforation [23]. Complicated appendicitis can occur either as a gangrenous appendicitis (focal or diffuse necrosis of the wall) or as a perforation. There is continuous transition from phlegmonous uncomplicated to gangrenous appendicitis during the disease course. The most important indicator of gangrenous appendicitis is the loss of normal hyperechoic mucosa-lumen interface [30]. Other ancillary finding is the lack of vascularity on color Doppler. The rate of perforation following acute appendicitis is around 60% for a 3-year-old child, 50% for a 5-year-old child, and this incidence reduces with increasing age, because of limited ability to communicate and define complaints in little ones [31]. Moreover, small children are more prone to peritonitis and abscess formation, rather than phlegmon, following perforation due to underdeveloped omentum which confines purulent material [24].
Three different cases with acute appendicitis. Ultrasound images of an 8-year-old boy demonstrate longitudinal (A) and transverse (B) section of inflamed appendix (arrow) with a diameter of 8.7 mm, and hyperechoic inflamed periappendiceal fat tissue. Ultrasound image of a 9-year-old boy (C) shows appendicolith (dashed arrow) within the appendix lumen, fluid level (asterisk) and dilatation distal to the obstruction. Ultrasound image of a 5-year-old girl (D) demonstrates inflamed appendix with a diameter of 8.6 mm and periappendiceal reactive fluid. Despite the inflammation, lumen is filled with air seen as echogenicity with dirty posterior shadow (thin arrows).
Non-visualization of the appendix is an important problem while evaluating appendicitis. The major reason for false-negative scanning is inexperience examiner in GI US. Other challenging situations are retrocecal or pelvic position of appendix, thick abdominal fat tissue in very obese patients, or focal appendicitis confined to distal tip that account for 5% of cases [25]. Thus, the entire appendix should be delineated clearly [32]. In perforated appendicitis, an abscess may be misinterpreted as a gas-containing bowel loop. In these cases, indirect signs of appendicitis should be scrutinized around cecum [33].
Recent publications confirm the mild forms of appendicitis which is spontaneously resolved under antibiotic therapy without need for surgery [34]. Unfortunately, there are not any reliable criteria to differentiate mild courses on US that probably not require surgery [25]. Other pitfalls that lead to a false-positive diagnosis of acute appendicitis are; incorrect identification of the terminal ileum as inflamed appendix, Meckel’s diverticulitis, cecal diverticulitis, dilated Fallopian tube or gonadal vein thrombosis [25]. Contrarily, appendiceal thickening can occur by other conditions such as Crohn’s disease, infectious enterocolitis, peritonitis, ascites and appendiceal tumors such as mucocele, cystadenoma or carcinoid [25].
Over the last decades, the sensitivity of US for the diagnosis of appendicitis has reached to 95%, with specificity above 90% [23, 35, 36]. The accuracy of US is currently equivalent to CT and magnetic resonance imaging (MRI), even more accurate particularly in small children with less intraabdominal fat tissue. Point-of-care ultrasonography (POCUS) is increasingly done by emergency physicians for the diagnosis of appendicitis, but US is a highly operator dependent tool that requires experience and sufficient equipment. Consequently, adequate equipment, structured training program and quality control should be provided before clinical application. Consistent preoperative use of US for right lower quadrant pain can decrease the additional CT/MRI examinations to a low fraction [35, 37]. When initial US is inconclusive, second US following an observation period, or an additional MRI or CT examination can be considered. In children, MRI should be performed if possible to support the ALARA (radiation as low as reasonably achievable) principle. Some guidelines recommend several scoring systems for US to diagnose acute appendicitis [38]. Since these scoring systems roughly estimate the likelihood and do not prove appendicitis, they are not obligatory to use in routine practice [25].
Hypertrophic pyloric stenosis (HPS) is the most common cause of surgery in vomiting infants due to the failure of relaxation of the pyloric sphincter of stomach [39]. The disease usually appears between 2nd and 12th week of life and commonly affects white males [2, 39]. The typical complaint is non-bilious, projecting vomiting by a previously healthy infant after feeding. HPS is not an actual emergency unless severe dehydration or excessive electrolyte loss occur. HPS can be palpated as a pyloric mass in the epigastrium on physical examination (olive sign) [22]. Preoperative US is the gold standard radiologic modality for the diagnosis of HPS with sensitivity, specificity and accuracy of approximately 100% if adequate equipment is provided [40].
The US scanning begins with placing the baby in a supine or right lateral decubitus position. A high-frequency (10–18 MHz), linear-array transducer should be applied from sub-xiphoid area to the right paramedian area to search for pylorus [1]. If adequate fluid is not present in the stomach, breast feeding or oral sugar contained water can be given in order to displace the air in the stomach and to see the passage of the fluid [41]. Normal position of the pylorus can be demonstrated between the liver and the head of the pancreas, medial to the gallbladder. If abundant air present in the gastric antrum, the patient should be moved into the right lateral decubitus position, to displace air into the fundus and to move pylorus anteriorly [3]. To confirm the HPS, pyloric canal length and thickness of the pyloric muscle should be measured [1]. Pyloric muscle thickness > 3 mm, canal length > 17 mm, and antero-posterior diameter of pylorus >12 mm confirm the diagnosis of HPS with high accuracy (Figure 2) [1, 3, 22]. By the way, pylorus is a dynamic structure and muscle thickness may change due to peristalsis during a real-time US examination. Therefore, imaging for a sufficient time is needed to exclude pylorospasm from HPS, which is a transient phenomenon [41]. Other ancillary findings to diagnose HPS are the prolapsed mucosa into the gastric antrum (antral nipple or cervix sign) and trapped fluid within the crevices of mucosa. The main reason of false-negative result is the overdistention of stomach that moves antra-pyloric canal posteriorly [3]. To overcome this issue, gastric content can be aspirated via nasogastric or orogastric tube.
(A) Normal appearance of pylor in a 25-day-old baby and (B) hypertrophic pyloric stenosis in a 30-day-old boy. Hypertrophic pylor (arrows) is thicker and longer than normal (dashed arrows) that does not permit the passage of gastric content into the duodenum.
Intussusception is the penetration of the bowel segment, either the small intestine or colon, into the distal lumen and propulsion as luminal content. It is the most common etiology of small bowel obstruction in infants, with a reported incidence of 56 cases per 100,000 hospitalizations per year in the United States [24]. More than 90% of cases present in the first two years after birth and peak age between 3 and 9 months [1, 3, 22]. Depending on the localization, there are two subtypes; ileo-cecal (or ileocolic) comprises 90% of cases and ileo-ileal occurs in about 10% [42]. The most common symptoms are recurrent abdominal pain, vomiting and currant jelly stool. Additionally, previous episodes of infection in the upper respiratory tract or gastroenteritis may occur in the patient’s clinical history. Most common localization of ileocecal intussusception is the subhepatic region, followed by upper abdominal midline and left upper quadrant [3]. It consists of three bowel segments; the inner prolapsing and returning limbs of the bowel are terminal ileum (called as intussusceptum) and attached mesentery and lymph nodes is dragged between these limbs [3, 39]. Outermost bowel receiving intussusceptum is the colon (called as intussuscipiens). Due to the compromised vascular supply, the thickest ileal segment is the returning limb of the ileum [3].
The diagnostic accuracy of US have verified with the several studies with a sensitivity of 97–100% and a specificity of 88–100% [24]. Thus, US has become as the primary modality of choice, replacing the contrast enema, in patients with suspected intussusception. Transverse section of intussusception appears as an oval or round mass with concentric rings and hypoechoic rim, described as ‘doughnut’ or ‘target’ configuration on US [1]. The crescentic shaped, hyperechoic, mesenteric fat can be seen in the center of the mass (called as ‘the crescent in doughnut sign’) (Figure 3A and B). The longitudinal appearance of intussusception is called as ‘pseudo-kidney’ or ‘sandwich’ sign (Figure 3C). On color Doppler US, double rings sign between the layers can be seen (Figure 3B) and absence of blood flow may indicate ischemia or irreducibility [22]. US can also be performed safely and accurately to monitor the hydrostatic reduction. Successful hydrostatic reduction rates are approximately 80% with a very few complication rates (2.7%to 4.26%) [24]. Some findings on US are useful to predict the success of enema or hydrostatic reduction such as; reduced vascular flow, thickened outer wall (>10 mm), trapped fluid and/or large (>1 cm short axis) lymph nodes within the intussusceptum [1, 3]. The appearance of intramural or subserosal air, manifested as echogenic foci, indicates the risk of necrosis and perforation, for those enema/hydrostatic reduction is contraindicated [1].
A 5-month-old boy with intussusception. (A) Transverse section demonstrates “target sign” composed of intussusceptum (thin arrow), intussuscipiens (thick arrow) and a lymph node (dashed arrow) within the trapped mesenteric fat tissue. (B) Doppler shows swirling of arteries and veins within intussusception. (C) Longitudinal section shows typical “sandwich” or “pseudokidney” sign (arrows).
The US can identify pathologic lead points in approximately two third of cases, particularly in older age group [43]. Similarly pathologic lead points may occur in younger than expected age group as < 3 months of age [24]. Common lead points are; Meckel’s diverticulum, duplication cyst, lymphoma or polyp. Cystic fibrosis, Henoch-Schonlein purpura, or polyposis syndrome may cause recurrent intussusceptions. Lead points or underlying disease should be searched elaborately in a patient with unusual age, abnormal localization of intussusception, recurrent disease and long duration of symptoms [3].
Small bowel intussusception comprises 10% of cases and is usually transient and asymptomatic. Common locations are the periumbilical area, left upper or lower quadrant of the abdomen. Most cases are due to small bowel hyperperistalsis. They are usually smaller than ileocecal intussusception (<1 cm diameter) and involve shorter bowel segment. If small bowel intussusception is persistent and symptomatic or involving longer segment (>3.5 cm), the patient should be scrutinized carefully to identify pathological lead point [3].
Intestinal malrotaton is not an infrequent phenomenon with a prevalence of 0,2–0,5% of live births. While the most patients are asymptomatic, 3–8% of malrotated bowel is symptomatic in the first year of life with bilious vomiting, pain and malabsorption [1]. The normal midgut rotates 2700 counterclockwise in utero around the axis of superior mesenteric artery (SMA). Incomplete rotation of bowel during fetal period results in short mesenteric root, abnormal positioning of duodeno-jejunal junction and ileocecal valve and close proximity of duodenum and cecum [3]. Twisting of malrotated small bowel around its mesentery may cause obstruction and volvulus, an emergent situation that requires prompt surgical intervention [44].
The well-known sonographic finding of intestinal malrotation is the inversion of the SMA and superior mesenteric vein (SMV). Patients should be lay supine while US evaluation and transducer applied at the upper midline to recognize SMA at its point of origin on the abdominal aorta [1]. SMV can also be identified tracing from the main portal vein to the midline after giving branch of splenic vein. Normally, the SMV is found on the right side or anterior to the SMA. If SMV located ventrally or left to the SMA, it is an abnormal location, which raises suspicion but do not always indicate malrotation [3]. For evaluating duodenum and to see the passage or beak sign of acute volvulus, oral water instillation may be useful. In suspected malrotation patients, when US findings are abnormal or inconclusive, an upper GI study should be performed, as a gold standard, to confirm the diagnosis [45].
Midgut volvulus is a fatal complication of malrotation, and 90% of cases occur in the first year of life, even %75 of cases occur in the first month. The typical sonographic feature of volvulus is the ‘whirlpool sign’, which is the swirling of SMV and its tributaries around the SMA in clockwise direction, best appreciated on color Doppler. Associated US findings of malrotation are proximal duodenal dilatation with distal tapering, duodenal wall thickening (> 2 mm), fixed midline bowel, intraabdominal free fluid, dilatation of the distal SMV and increased resistive index on SMA [3, 39].
Off-midline scanning due to inappropriate position of the transducer may demonstrate SMV and SMA as an abnormal relation which is the most common cause of the false-positive diagnosis of malrotation. Another reason for false-positive diagnosis is the ‘whirlpool’ sign occurs due to normal counterclockwise rotation. False-negative diagnosis may also be observed due to severe abdominal distension, abdominal guarding, abundant bowel gas, and/or an inexperienced operator. If there is strong clinical suspicion, an emergency upper GI study should be performed to clarify the diagnosis [3].
Necrotizing enterocolitis (NEC) is one of the most common and lethal gastrointestinal emergencies of neonates, usually affecting the terminal ileum and ascending colon [22]. Although it affects primarily preterm babies, NEC can also be seen in term infants. The clinical presentation ranges from feeding intolerance, abdominal distention, emesis, diarrhea, rectal bleeding to more severe systemic findings including respiratory failure and fulminant shock [41]. Bowel necrosis occurs in NEC without any precise cause, which compromises the mucosal integrity [6]. Pathogenic organisms become dominant in the gut flora, leading to the pneumatosis intestinalis, which subsequently leads to portal venous gas and consequently leads to perforation and pneumoperitoneum. While the disease progresses, both early and late clinical signs and laboratory tests are often non-specific for diagnosis of NEC, therefore imaging plays crucial role for accurate diagnosis.
Radiographs are still primary modality of choice for evaluation of neonates suspected of having NEC [46]. Plain abdominal radiographs demonstrate pneumatosis, increased thickness of bowel wall, free intraperitoneal air and portal venous air [22, 46]. The role of US has been increasingly appreciated, owing to its higher sensitivity than plain films in the detection of early changes such as wall thickening, intestinal pneumatosis, portal venous air and disturbed bowel wall perfusion on color Doppler [5, 46]. Recent publications stated that diagnostic performance of US for detecting NEC is accurate with sensitivity of 100% and specificity of 90%. However, role of US in the follow-up of NEC is uncertain [6].
In the early phase of the disease, US can show the bowel wall thickening due to inflammation. Whereas, bowel wall thinning (<1 mm) may occur as it becomes necrotic and progresses toward perforation [47]. Similarly, Color Doppler may display hyperemia in the early stages due to inflammation, and avascular wall in the advanced disease with bowel wall necrosis [6]. Pneumatosis intestinalis is seen as punctate or granular echogenic foci with ‘dirty’ posterior acoustic shadowing or linear echogenic ring within the bowel wall. The gas bubbles create twinkling artifact on color Doppler which is useful in equivocal cases. To differentiate intramural gas from intraluminal air, nondependent bowel wall should be evaluated. Moreover, true pneumatosis would not change with the motion of the patient, whereas intraluminal air is freely mobile. Placing the patient in multiple positions may be useful to observe movement of the air. For the detection of pneumatosis, US is more sensitive than plain radiography [48].
Portal venous gas manifests on US as the presence of curvilinear or punctate mobile echogenic foci within the portal venous system. It is commonly seen in the neonates after umbilical catheterization, and may occur in different neonatal diseases. Therefore, in the absence of pneumatosis intestinalis, other etiologies should be considered rather than NEC. In the case of NEC, fluid-filled dilated bowel, complex hyperechoic intraperitoneal free fluid, focal fluid collections are suggestive of perforation and have been correlated with a poor clinical outcome [47, 49]. Evaluation of bowel peristalsis by real-time examination is an important component of US in infants with suspected NEC, because necrotic or inflamed bowel segments have decreased or absent motility [6]. US may also be considered in the follow-up to decide the appropriate time to restore oral feeding and to evaluate post-enterocolitis stenosis [5].
Inflammatory bowel disease (IBD) is a general term that covers a series of acute and non-acute diseases which do not require surgical treatment, ranging from self-limiting focal disorders to the debilitating and/or chronic diseases [1]. Diagnosis can be challenging due to nonspecific or atypical clinical presentation with extra-intestinal manifestations. US is useful in the diagnosis of IBD, especially in children by assessing bowel wall, peristalsis and surrounding mesentery with high-frequency transducers. Moreover, color Doppler increases the diagnostic accuracy and estimates the disease activity by showing vascularity. Presence of extra-intestinal complications such as abscess, fistula can also be evaluated with US.
While evaluating IBD, the thickening of the bowel wall can be divided into two categories according to US appearance [1]. ‘Layered thickening’ is shown as hyperechoic and organized wall thickening corresponds to mucosal inflammation with indirect involvement of submucosa. Whereas ‘non-layered thickening’ characterized by the loss of normal structure seen as a diffuse hypoechoic thickening without any reflective echoes. Based on the thickening type and localization, possible diagnoses are presented in Table 2.
Ileum involvement | Colon involvement | |
---|---|---|
Layered thickening | Infectious ileitis (Campylobacter or salmonella) | Infectious colitis (E.Coli, salmonella, shigella) |
Early Crohn disease | Chronic intestinal infectious disease (CIID) | |
Non-layered thickening | Henoch-Schönlein Purpura | Ischemic colitis prodromal of hemolytic uremic syndrome (HUS) |
Tuberculosis ileitis | Advanced IBD (ulcerative colitis or Crohn disease) | |
Protein-losing enteropathy, Celiac disease | Pseudomembranous colitis | |
Advanced Crohn disease | Neutropenic colitis |
Sonographic pattern and location of common inflammatory bowel diseases.
Crohn disease is the most common IBD that requires frequent imaging because of its extensive involvement of GI tract, and phases of exacerbations and remissions [1, 6]. It is characterized as a chronic transmural inflammation of an unknown cause and can affect any part of GI tract. In 20% of cases, the disease first becomes symptomatic during childhood [39]. Although, the role in the diagnostic algorithm is emerging, bowel US in its current form cannot replace with CT or MRI but can provide complementary information in the evaluation of disease. The diagnostic performance of US for identifying lesions of Crohn disease has sensitivity of 75–94% and specificity of 67–100% [6]. The primary imaging features of Crohn disease are bowel wall thickening and loss of stratification. Affected segments are non-compressible, hypoperistaltic and have hypoechoic wall with a minimal thickness of >3 mm [6, 39]. The hallmark of active disease is increased vascularity of thickened bowel wall segments (> 5 mm) with 88% specificity and 95% positive predictive value [49]. Moreover, SMA flow volume is higher but resistive index is lower with active disease [6]. Remarkable extramural manifestations that can be seen on US include thickened, hyperechoic mesentery (‘creeping fat’ sign) and enlarged mesenteric lymph nodes (Figure 4). Strictures, fistula, phlegmon and abscess are common complications of Crohn disease that can be depicted on US but requires further evaluation with CT or MRI. On US strictures are identified in 70–79% of cases as a narrowed bowel segment accompanying dilatation and hyperperistalsis at the proximal part [6]. Fistulas are less common in children than adults, and US is not a reliable modality to depict fistulas with the sensitivity of 31–87% in different publications [50]. An abscess can be delineated with US as an irregular thick-walled aperistaltic fluid collection including internal echoes and sometimes air. The sensitivity of US for the diagnosis of abscessranges from 83–91% [51]. An abscess may mimic a bowel loop, but bowel segments are thin-walled and peristalsis of bowel can be seen on real-time imaging.
An active Crohn’s disease in an 11-year-old girl. Longitudinal (A) and transverse (B) section of inflamed bowel segments demonstrates layered wall thickening, increased echogenicity and prominent thickening of mesenteric fat tissue.
Henoch-Schönlein Purpura (HSP) is the most common pediatric vasculitis that frequently involve GI tract [3, 39]. The pathogenesis of the disease originated from the thrombosis of small vessels, which in turn can cause ischemia of the small bowel [39]. Bowel wall thickening and edema can be seen on US in 50–60% of cases [52]. Although typical skin lesions are the hallmark of the disease, bowel wall thickening in duodenum and proximal small bowel may occur before the appearance of skin lesions. However, HSP can affect any segment of the bowel. The most common US feature is diffuse circumferential bowel wall thickening (Figure 5). Focal intramural hemorrhage can be revealed as a hyperechoic lesion in the mucosa or submucosa. With intramural hematoma, bowel wall thickening may increase up to 9–10 mm and multiple skip lesions can be demonstrated [3]. In HSP patients with obstructive symptoms such as vomiting or hemorrhagic stool, one or more intussusception can be seen with intramural hematoma as a lead point [53]. In the active stage of the disease, hypervascularity on color Doppler imaging may present. Other less common vasculitides involving the bowel may also occur with a variable presentation but similar findings on US.
An 8 year-old-girl with Henoch-Schönlein Purpura. (A) Ultrasound shows diffuse thickening of the intestinal wall (arrow). (B) Color Doppler demonstrates increased vascularity. Gray scale ultrasound from another part of abdomen (C) reveals hyperechoic mesenteric fat tissue (dashed arrows).
Bacterial enterocolitis can occur by a wide variety of pathogens, including
Neutropenic colitis, also known as typhilitis, is a necrotizing inflammatory process of cecum and terminal ileum usually seen in severe neutropenic and immunocompromised patients [39]. The typical US features are asymmetric, prominent wall thickening, with decreased echogenicity and loss of layering due to transmural inflammation. Echogenic foci can be seen in the bowel wall caused by circumscriptive hemorrhages or intramural air suggestive of anaerobic infection [55]. In thyphilitis, increased wall thickness may have correlation with a worse prognosis of the disease [41].
Pseudomembranous colitis is caused by the superinfection with
Mesenteric lymphadenitis is a benign, self-limiting inflammatory condition that affects the mesenteric lymph nodes, more frequently pericecal ones. It may either occur as a primary inflammatory disease or may arise secondarily due to an abdominal disease. Clinically, this condition is commonly mistaken for appendicitis, since the symptoms are quite similar [22]. As the lymph node enlargement is the only finding on US, the diagnosis is made by excluding other possible etiologies of abdominal pain.
Various nomograms for normal ranges of mesenteric lymph node size have been reported and short axis of > 5 mm for lymph nodes are very common in healthy children [3]. Simanovsky et al. [56] suggested that, in the setting of normal appendix, cluster of > 3 lymph nodes with short axis of > 10 mm should be diagnosed as mesenteric lymphadenopathy. Enlarged lymph nodes are often oval and perinodal fat tissue may appear hyperechoic (Figure 6). A preserved fatty hilum is seen as a hyperechoic area at the center with vascular pedicle on color Doppler imaging. If the shape of enlarged lymph nodes is round rather than being oval, cortex is eccentrically thickened and there is loss of fatty hilum, neoplastic process should be suspected [3].
Ultrasound (A,B) and color Doppler ultrasound (C) of the right lower quadrant of a 5-year-old girl diagnosed as mesenteric lymphadenitis. There are enlarged lymph nodes anterior to the iliac vessels. Color Doppler (C) demonstrates vascular supply from hilum of the lymph node.
Epiploic appendagitis is the inflammation of epiploic appendages arise from the serosal surface of the large bowel. Torsion of the appendages results in venous occlusion, ischemia and inflammation [39]. Although predominantly encountered in adults, it is also described in children and should be kept in mind in the differential diagnosis of acute appendicitis because the treatment is supportive rather than surgery. Characteristic US feature is hyperechoic, fixed non-compressible oval mass-like lesion at the anti-mesenteric side of the bowel. CT is generally needed to confirm the exact diagnosis [57].
Omental infarction is a rare cause of acute abdomen in children, even though 15% of all omental infarct cases occur in the pediatric population [3]. As the patients are commonly present with right-sided abdominal pain, it mimics appendicitis. However, associated nausea and vomiting is less frequent than appendicitis [24]. Predisposing factors include obesity, strenuous activity, coagulopathy and history of trauma to the affected region. The characteristic US feature is an ovoid or triangular hyperechoic mass located between the abdominal wall and the bowel, frequently in the right upper quadrant (Figure 7) [3]. In some cases, avascular hypoechoic tubular structure can be seen corresponds to a twisted vein. Although, some centers recommend conservative treatment, others prefer surgery to remove the necrotic tissue [24].
Ultrasound image (A) of an 11-year-old boy demonstrates thickened hyperechoic mass (asterisk) with indistinct border beneath the anterior abdominal wall. Intravenous contrast enhanced axial CT (B) and sagittal reconstructed image (C) shows hyperdense omentum (white circles), hyperdense dot at the center of lesion (arrows). The dot can be followed on the contiguous images as a linear tortuous hyperdense structure consistent with twisted vein. Surgical removal of necrotic tissue confirmed the diagnosis of omental infarct.
In the setting of a groin mass or swelling, possible diagnoses are hernia, fluid collection, enlarged lymph nodes, and cryptorchidism, and for those US can be performed to differentiate. The most common type of inguinal hernia in children is the indirect inguinal hernia in which hernia sac protrude into the inguinal canal [41]. Inguinal hernia is more common in preterm neonates and more frequently occurs on the right side because the right processus vaginalis closes later than the left. One-third of all infants with hernias become symptomatic before 6 months after birth, and males are affected more than females with a ratio of 6:1 [58]. Hernia sac frequently includes fluid in the processus vaginalis with or without bowel loops and other abdominal structures such as omentum, testes, ovaries, bladder and fallopian tubes. If hernia sac contains intestine and other abdominal structures; possibility of spontaneous regression reduces and incarceration risk increases. Hence, early diagnosis and surgery is very important in order to prevent complications and possible damage to the ipsilateral testis [6, 58].
The diagnostic accuracy of US to detect inguinal hernia is 97% in surgically confirmed cases with the sensitivity of 92.7% and the specificity of 92.7% [6]. Internal inguinal canal diameter > 4 mm is 95% diagnostic for indirect inguinal hernia. Real-time imaging on US is the biggest advantage among other modalities, with the patient performing a Valsalva maneuver (or provoke to cry in infants or babies) in both supine and upright views that enlarge the hernia sac and protrude through the inguinal canal with increased intraabdominal pressure. US can also be able to reveal peristalsis of herniated bowel segment with dynamic scan. Large inguinal hernias may lead to testicular ischemia by compressing the gonadal vessels within the inguinal canal [59]. Therefore, ipsilateral testis should be evaluated with US and color Doppler to assess intratesticular blood flow in the setting of inguinal hernia. While, evaluating a patient with an inguinal hernia, US should be performed to both inguinal canals because a clinically occult contralateral hernia can be found in 88% of cases [58].
Incarceration is a remarkable complication of indirect inguinal hernia and occurs with a frequency of 31% in children [58]. The most common incarcerated contents of hernia sac are the bowel, ovaries, and fallopian tubes. An incarcerated inguinal hernia may gradually progress to a strangulation, in which vascular supply is compromised and the necrosis of incarcerated contents occur. On US, incarcerated bowel shows circumferential thickening of the wall, aperistalsis, fluid level in the herniated loop, free fluid in the hernia sac and intraabdominal bowel dilatation (Figure 8). Incarcerated or strangulated hernias may not demonstrate clear continuity with abdominal bowel loops. Color Doppler may demonstrate absent vascularity in the hernia sac as a late finding of strangulation [41]. The presence of peristaltic activity in the herniated bowel loop is strong evidence against strangulation.
Ultrasound of an indirect inguinal hernia of an 8-week-old baby (A,B,C). Along with bowel, blind ending appendix (arrow) is herniated into the inguinal canal, called as Amyand hernia. (B) There is some fluid (dashed arrow) within the hernia sac and (C) transverse section of distal appendix is seen at the same level with penile shaft (asterisk).
Coins are the most common foreign material ingested, and most of them are not able to reach intraabdominal GI tract [41]. Two-third of those is located at the level of cricopharyngeus muscle that requires urgent endoscopic removal. In the radiologic evaluation of the ingested foreign body, plain radiographs are frequently the modality of choice. Nevertheless, all foreign bodies are not visible on plain films, depending on composition of the material and location within the body. US may provide additional information about the foreign bodies trapped in the intraabdominal GI tract [60]. However, diagnostic performance of US to detect intraabdominal foreign body is not known to date. Most of the foreign bodies in bowel appear as fixed, hyperechoic structure that often demonstrate posterior acoustic shadowing with a cleaner shadow than bowel gas [6]. Linear, high frequency transducers should be used with graded compression to evaluate intraluminal contents. Administration of 200–300 mL of oral water before the examination may facilitate the detection of foreign bodies within the stomach [41].
A bezoar consists of ingested foreign objects that cluster within the GI tract. The most common types are trichobezoars (composed of hair) and phytobezoars (composed of greengrocer fibers) and they usually accumulate in the stomach [39]. Sometimes enlarged bezoars reach to the small bowel and cause obstruction. Prior history of gastric surgery is an important predisposing factor to develop bezoar due to delayed gastric emptying [41]. On US, regardless of the originated fiber, bezoar is shown as an intraluminal mass with hyperechoic arc-like (curved or “inverted U” shape) anterior surface and prominent acoustic shadowing (Figure 9). Color Doppler can be used as a supportive modality which demonstrates ‘twinkling artifact’ behind the hyperechoic surface [39]. Bowel obstruction and proximal dilatation may be revealed as associated features.
A 12-year-old girl with a history of compulsive trichophagia disorder. Upper abdomen sonography with convex-array transducer (A) and linear-array transducer (B), demonstrates curvilinear echogenicities beneath the anterior wall of the stomach (arrow) and duodenum (dashed arrow) with clear, marked black posterior shadow. On endoscopy (C), trichobezoar was removed from her stomach and proximal duodenum.
While evaluating the etiology of acute abdominal pain in pediatric patients, US should be the initial imaging modality, as US is sufficient to diagnose several diseases that cause abdominal pain, far beyond only appendicitis and intussusception. Even if the underlying cause has not been identified, US will show indirect signs that indicate the need for a surgical exploration or provide supplemental information for CT and MRI. Therefore, it is crucial to be aware of the full potential of targeted bowel US with proper selection of the transducers, optimal positioning and the application of graded compression technique. Good quality examination requires experience, training, time and attention to perform a detailed evaluation of as many bowel loops as possible, minding their morphological features and their functional characteristics. Radiologists should be familiar with the sonographic appearance of both the normal and abnormal GI tract in order to provide the optimal treatment options for pediatric patients with acute abdominal diseases.
I thank Dr. Fatma Demirbas (Diyarbakır Children’s Hospital) for providing endoscopic image of the trichobezoar case.
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Luna-Muñoz and M.A.\nMeraz-Ríos",authors:[{id:"42225",title:"Dr.",name:"Jose",middleName:null,surname:"Luna-Muñoz",slug:"jose-luna-munoz",fullName:"Jose Luna-Muñoz"},{id:"114746",title:"Dr.",name:"Marco",middleName:null,surname:"Meraz-Ríos",slug:"marco-meraz-rios",fullName:"Marco Meraz-Ríos"},{id:"169616",title:"Dr.",name:"Maria del Carmen",middleName:null,surname:"Cardenas-Aguayo",slug:"maria-del-carmen-cardenas-aguayo",fullName:"Maria del Carmen Cardenas-Aguayo"},{id:"169857",title:"Dr.",name:"Maria del Carmen",middleName:null,surname:"Silva-Lucero",slug:"maria-del-carmen-silva-lucero",fullName:"Maria del Carmen Silva-Lucero"},{id:"169858",title:"Dr.",name:"Maribel",middleName:null,surname:"Cortes-Ortiz",slug:"maribel-cortes-ortiz",fullName:"Maribel Cortes-Ortiz"},{id:"169859",title:"Dr.",name:"Berenice",middleName:null,surname:"Jimenez-Ramos",slug:"berenice-jimenez-ramos",fullName:"Berenice Jimenez-Ramos"},{id:"169860",title:"Dr.",name:"Laura",middleName:null,surname:"Gomez-Virgilio",slug:"laura-gomez-virgilio",fullName:"Laura Gomez-Virgilio"},{id:"169861",title:"Dr.",name:"Gerardo",middleName:null,surname:"Ramirez-Rodriguez",slug:"gerardo-ramirez-rodriguez",fullName:"Gerardo Ramirez-Rodriguez"},{id:"169862",title:"Dr.",name:"Eduardo",middleName:null,surname:"Vera-Arroyo",slug:"eduardo-vera-arroyo",fullName:"Eduardo Vera-Arroyo"},{id:"169863",title:"Dr.",name:"Rosana Sofia",middleName:null,surname:"Fiorentino-Perez",slug:"rosana-sofia-fiorentino-perez",fullName:"Rosana Sofia Fiorentino-Perez"},{id:"169864",title:"Dr.",name:"Ubaldo",middleName:null,surname:"Garcia",slug:"ubaldo-garcia",fullName:"Ubaldo Garcia"}]},{id:"58070",doi:"10.5772/intechopen.72427",title:"MRI Medical Image Denoising by Fundamental Filters",slug:"mri-medical-image-denoising-by-fundamental-filters",totalDownloads:2564,totalCrossrefCites:17,totalDimensionsCites:30,abstract:"Nowadays Medical imaging technique Magnetic Resonance Imaging (MRI) plays an important role in medical setting to form high standard images contained in the human brain. MRI is commonly used once treating brain, prostate cancers, ankle and foot. The Magnetic Resonance Imaging (MRI) images are usually liable to suffer from noises such as Gaussian noise, salt and pepper noise and speckle noise. So getting of brain image with accuracy is very extremely task. An accurate brain image is very necessary for further diagnosis process. During this chapter, a median filter algorithm will be modified. Gaussian noise and Salt and pepper noise will be added to MRI image. A proposed Median filter (MF), Adaptive Median filter (AMF) and Adaptive Wiener filter (AWF) will be implemented. The filters will be used to remove the additive noises present in the MRI images. The noise density will be added gradually to MRI image to compare performance of the filters evaluation. The performance of these filters will be compared exploitation the applied mathematics parameter Peak Signal-to-Noise Ratio (PSNR).",book:{id:"6144",slug:"high-resolution-neuroimaging-basic-physical-principles-and-clinical-applications",title:"High-Resolution Neuroimaging",fullTitle:"High-Resolution Neuroimaging - Basic Physical Principles and Clinical Applications"},signatures:"Hanafy M. Ali",authors:[{id:"213318",title:"Dr.",name:"Hanafy",middleName:"M.",surname:"Ali",slug:"hanafy-ali",fullName:"Hanafy Ali"}]},{id:"41589",doi:"10.5772/50323",title:"The Role of the Amygdala in Anxiety Disorders",slug:"the-role-of-the-amygdala-in-anxiety-disorders",totalDownloads:9671,totalCrossrefCites:4,totalDimensionsCites:28,abstract:null,book:{id:"2599",slug:"the-amygdala-a-discrete-multitasking-manager",title:"The Amygdala",fullTitle:"The Amygdala - A Discrete Multitasking Manager"},signatures:"Gina L. Forster, Andrew M. Novick, Jamie L. Scholl and Michael J. Watt",authors:[{id:"145620",title:"Dr.",name:"Gina",middleName:null,surname:"Forster",slug:"gina-forster",fullName:"Gina Forster"},{id:"146553",title:"BSc.",name:"Andrew",middleName:null,surname:"Novick",slug:"andrew-novick",fullName:"Andrew Novick"},{id:"146554",title:"MSc.",name:"Jamie",middleName:null,surname:"Scholl",slug:"jamie-scholl",fullName:"Jamie Scholl"},{id:"146555",title:"Dr.",name:"Michael",middleName:null,surname:"Watt",slug:"michael-watt",fullName:"Michael Watt"}]},{id:"26258",doi:"10.5772/28300",title:"Excitotoxicity and Oxidative Stress in Acute Ischemic Stroke",slug:"excitotoxicity-and-oxidative-stress-in-acute-ischemic-stroke",totalDownloads:7157,totalCrossrefCites:6,totalDimensionsCites:25,abstract:null,book:{id:"931",slug:"acute-ischemic-stroke",title:"Acute Ischemic Stroke",fullTitle:"Acute Ischemic Stroke"},signatures:"Ramón Rama Bretón and Julio César García Rodríguez",authors:[{id:"73430",title:"Prof.",name:"Ramon",middleName:null,surname:"Rama",slug:"ramon-rama",fullName:"Ramon Rama"},{id:"124643",title:"Prof.",name:"Julio Cesar",middleName:null,surname:"García",slug:"julio-cesar-garcia",fullName:"Julio Cesar García"}]},{id:"62072",doi:"10.5772/intechopen.78695",title:"Brain-Computer Interface and Motor Imagery Training: The Role of Visual Feedback and Embodiment",slug:"brain-computer-interface-and-motor-imagery-training-the-role-of-visual-feedback-and-embodiment",totalDownloads:1439,totalCrossrefCites:13,totalDimensionsCites:23,abstract:"Controlling a brain-computer interface (BCI) is a difficult task that requires extensive training. Particularly in the case of motor imagery BCIs, users may need several training sessions before they learn how to generate desired brain activity and reach an acceptable performance. A typical training protocol for such BCIs includes execution of a motor imagery task by the user, followed by presentation of an extending bar or a moving object on a computer screen. In this chapter, we discuss the importance of a visual feedback that resembles human actions, the effect of human factors such as confidence and motivation, and the role of embodiment in the learning process of a motor imagery task. Our results from a series of experiments in which users BCI-operated a humanlike android robot confirm that realistic visual feedback can induce a sense of embodiment, which promotes a significant learning of the motor imagery task in a short amount of time. We review the impact of humanlike visual feedback in optimized modulation of brain activity by the BCI users.",book:{id:"6610",slug:"evolving-bci-therapy-engaging-brain-state-dynamics",title:"Evolving BCI Therapy",fullTitle:"Evolving BCI Therapy - Engaging Brain State Dynamics"},signatures:"Maryam Alimardani, Shuichi Nishio and Hiroshi Ishiguro",authors:[{id:"11981",title:"Prof.",name:"Hiroshi",middleName:null,surname:"Ishiguro",slug:"hiroshi-ishiguro",fullName:"Hiroshi Ishiguro"},{id:"231131",title:"Dr.",name:"Maryam",middleName:null,surname:"Alimardani",slug:"maryam-alimardani",fullName:"Maryam Alimardani"},{id:"231134",title:"Dr.",name:"Shuichi",middleName:null,surname:"Nishio",slug:"shuichi-nishio",fullName:"Shuichi Nishio"}]}],mostDownloadedChaptersLast30Days:[{id:"29764",title:"Underlying Causes of Paresthesia",slug:"underlying-causes-of-paresthesia",totalDownloads:192588,totalCrossrefCites:3,totalDimensionsCites:7,abstract:null,book:{id:"1069",slug:"paresthesia",title:"Paresthesia",fullTitle:"Paresthesia"},signatures:"Mahdi Sharif-Alhoseini, Vafa Rahimi-Movaghar and Alexander R. Vaccaro",authors:[{id:"91165",title:"Prof.",name:"Vafa",middleName:null,surname:"Rahimi-Movaghar",slug:"vafa-rahimi-movaghar",fullName:"Vafa Rahimi-Movaghar"}]},{id:"63258",title:"Anatomy and Function of the Hypothalamus",slug:"anatomy-and-function-of-the-hypothalamus",totalDownloads:4546,totalCrossrefCites:6,totalDimensionsCites:12,abstract:"The hypothalamus is a small but important area of the brain formed by various nucleus and nervous fibers. Through its neuronal connections, it is involved in many complex functions of the organism such as vegetative system control, homeostasis of the organism, thermoregulation, and also in adjusting the emotional behavior. The hypothalamus is involved in different daily activities like eating or drinking, in the control of the body’s temperature and energy maintenance, and in the process of memorizing. It also modulates the endocrine system through its connections with the pituitary gland. Precise anatomical description along with a correct characterization of the component structures is essential for understanding its functions.",book:{id:"6331",slug:"hypothalamus-in-health-and-diseases",title:"Hypothalamus in Health and Diseases",fullTitle:"Hypothalamus in Health and Diseases"},signatures:"Miana Gabriela Pop, Carmen Crivii and Iulian Opincariu",authors:null},{id:"57103",title:"GABA and Glutamate: Their Transmitter Role in the CNS and Pancreatic Islets",slug:"gaba-and-glutamate-their-transmitter-role-in-the-cns-and-pancreatic-islets",totalDownloads:3471,totalCrossrefCites:3,totalDimensionsCites:9,abstract:"Glutamate and gamma-aminobutyric acid (GABA) are the major neurotransmitters in the mammalian brain. Inhibitory GABA and excitatory glutamate work together to control many processes, including the brain’s overall level of excitation. The contributions of GABA and glutamate in extra-neuronal signaling are by far less widely recognized. In this chapter, we first discuss the role of both neurotransmitters during development, emphasizing the importance of the shift from excitatory to inhibitory GABAergic neurotransmission. The second part summarizes the biosynthesis and role of GABA and glutamate in neurotransmission in the mature brain, and major neurological disorders associated with glutamate and GABA receptors and GABA release mechanisms. The final part focuses on extra-neuronal glutamatergic and GABAergic signaling in pancreatic islets of Langerhans, and possible associations with type 1 diabetes mellitus.",book:{id:"6237",slug:"gaba-and-glutamate-new-developments-in-neurotransmission-research",title:"GABA And Glutamate",fullTitle:"GABA And Glutamate - New Developments In Neurotransmission Research"},signatures:"Christiane S. Hampe, Hiroshi Mitoma and Mario Manto",authors:[{id:"210220",title:"Prof.",name:"Christiane",middleName:null,surname:"Hampe",slug:"christiane-hampe",fullName:"Christiane Hampe"},{id:"210485",title:"Prof.",name:"Mario",middleName:null,surname:"Manto",slug:"mario-manto",fullName:"Mario Manto"},{id:"210486",title:"Prof.",name:"Hiroshi",middleName:null,surname:"Mitoma",slug:"hiroshi-mitoma",fullName:"Hiroshi Mitoma"}]},{id:"35802",title:"Cross-Cultural/Linguistic Differences in the Prevalence of Developmental Dyslexia and the Hypothesis of Granularity and Transparency",slug:"cross-cultural-linguistic-differences-in-the-prevalence-of-developmental-dyslexia-and-the-hypothesis",totalDownloads:3597,totalCrossrefCites:2,totalDimensionsCites:7,abstract:null,book:{id:"673",slug:"dyslexia-a-comprehensive-and-international-approach",title:"Dyslexia",fullTitle:"Dyslexia - A Comprehensive and International Approach"},signatures:"Taeko N. Wydell",authors:[{id:"87489",title:"Prof.",name:"Taeko",middleName:"N.",surname:"Wydell",slug:"taeko-wydell",fullName:"Taeko Wydell"}]},{id:"58597",title:"Testosterone and Erectile Function: A Review of Evidence from Basic Research",slug:"testosterone-and-erectile-function-a-review-of-evidence-from-basic-research",totalDownloads:1330,totalCrossrefCites:2,totalDimensionsCites:2,abstract:"Androgens are essential for male physical activity and normal erectile function. Hence, age-related testosterone deficiency, known as late-onset hypogonadism (LOH), is considered a risk factor for erectile dysfunction (ED). This chapter summarizes relevant basic research reports examining the effects of testosterone on erectile function. Testosterone affects several organs and is especially active on the erectile tissue. The mechanism of testosterone deficiency effects on erectile function and the results of testosterone replacement therapy (TRT) have been well studied. Testosterone affects nitric oxide (NO) production and phosphodiesterase type 5 (PDE-5) expression in the corpus cavernosum through molecular pathways, preserves smooth muscle contractility by regulating both contraction and relaxation, and maintains the structure of the corpus cavernosum. Interestingly, testosterone deficiency has relationship to neurological diseases, which leads to ED. Testosterone replacement therapy is widely used to treat patients with testosterone deficiency; however, this treatment might also induce some problems. Basic research suggests that PDE-5 inhibitors, L-citrulline, and/or resveratrol therapy might be effective therapeutic options for testosterone deficiency-induced ED. Future research should confirm these findings through more specific experiments using molecular tools and may shed more light on endocrine-related ED and its possible treatments.",book:{id:"5994",slug:"sex-hormones-in-neurodegenerative-processes-and-diseases",title:"Sex Hormones in Neurodegenerative Processes and Diseases",fullTitle:"Sex Hormones in Neurodegenerative Processes and Diseases"},signatures:"Tomoya Kataoka and Kazunori Kimura",authors:[{id:"219042",title:"Ph.D.",name:"Tomoya",middleName:null,surname:"Kataoka",slug:"tomoya-kataoka",fullName:"Tomoya Kataoka"},{id:"229066",title:"Prof.",name:"Kazunori",middleName:null,surname:"Kimura",slug:"kazunori-kimura",fullName:"Kazunori Kimura"}]}],onlineFirstChaptersFilter:{topicId:"18",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"81646",title:"Cortical Plasticity under Ketamine: From Synapse to Map",slug:"cortical-plasticity-under-ketamine-from-synapse-to-map",totalDownloads:14,totalDimensionsCites:0,doi:"10.5772/intechopen.104787",abstract:"Sensory systems need to process signals in a highly dynamic way to efficiently respond to variations in the animal’s environment. For instance, several studies showed that the visual system is subject to neuroplasticity since the neurons’ firing changes according to stimulus properties. This dynamic information processing might be supported by a network reorganization. Since antidepressants influence neurotransmission, they can be used to explore synaptic plasticity sustaining cortical map reorganization. To this goal, we investigated in the primary visual cortex (V1 of mouse and cat), the impact of ketamine on neuroplasticity through changes in neuronal orientation selectivity and the functional connectivity between V1 cells, using cross correlation analyses. We found that ketamine affects cortical orientation selectivity and alters the functional connectivity within an assembly. These data clearly highlight the role of the antidepressant drugs in inducing or modeling short-term plasticity in V1 which suggests that cortical processing is optimized and adapted to the properties of the stimulus.",book:{id:"11374",title:"Sensory Nervous System - Computational Neuroimaging Investigations of Topographical Organization in Human Sensory Cortex",coverURL:"https://cdn.intechopen.com/books/images_new/11374.jpg"},signatures:"Ouelhazi Afef, Rudy Lussiez and Molotchnikoff Stephane"},{id:"81582",title:"The Role of Cognitive Reserve in Executive Functioning and Its Relationship to Cognitive Decline and Dementia",slug:"the-role-of-cognitive-reserve-in-executive-functioning-and-its-relationship-to-cognitive-decline-and",totalDownloads:22,totalDimensionsCites:0,doi:"10.5772/intechopen.104646",abstract:"In this chapter, we explore how cognitive reserve is implicated in coping with the negative consequences of brain pathology and age-related cognitive decline. Individual differences in cognitive performance are based on different brain mechanisms (neural reserve and neural compensation), and reflect, among others, the effect of education, occupational attainment, leisure activities, and social involvement. These cognitive reserve proxies have been extensively associated with efficient executive functioning. We discuss and focus particularly on the compensation mechanisms related to the frontal lobe and its protective role, in maintaining cognitive performance in old age or even mitigating the clinical expression of dementia.",book:{id:"11742",title:"Neurophysiology",coverURL:"https://cdn.intechopen.com/books/images_new/11742.jpg"},signatures:"Gabriela Álvares-Pereira, Carolina Maruta and Maria Vânia Silva-Nunes"},{id:"81093",title:"Prehospital and Emergency Room Airway Management in Traumatic Brain Injury",slug:"prehospital-and-emergency-room-airway-management-in-traumatic-brain-injury",totalDownloads:49,totalDimensionsCites:0,doi:"10.5772/intechopen.104173",abstract:"Airway management in trauma is critical and may impact patient outcomes. Particularly in traumatic brain injury (TBI), depressed level of consciousness may be associated with compromised protective airway reflexes or apnea, which can increase the risk of aspiration or result in hypoxemia and worsen the secondary brain damage. Therefore, patients with TBI and Glasgow Coma Scale (GCS) ≤ 8 have been traditionally managed by prehospital or emergency room (ER) endotracheal intubation. However, recent evidence challenged this practice and even suggested that routine intubation may be harmful. This chapter will address the indications and optimal method of securing the airway, prehospital and in the ER, in patients with traumatic brain injury.",book:{id:"11367",title:"Traumatic Brain Injury",coverURL:"https://cdn.intechopen.com/books/images_new/11367.jpg"},signatures:"Dominik A. Jakob, Jean-Cyrille Pitteloud and Demetrios Demetriades"},{id:"81011",title:"Amino Acids as Neurotransmitters. The Balance between Excitation and Inhibition as a Background for Future Clinical Applications",slug:"amino-acids-as-neurotransmitters-the-balance-between-excitation-and-inhibition-as-a-background-for-f",totalDownloads:19,totalDimensionsCites:0,doi:"10.5772/intechopen.103760",abstract:"For more than 30 years, amino acids have been well-known (and essential) participants in neurotransmission. They act as both neuromediators and metabolites in nervous tissue. Glycine and glutamic acid (glutamate) are prominent examples. These amino acids are agonists of inhibitory and excitatory membrane receptors, respectively. Moreover, they play essential roles in metabolic pathways and energy transformation in neurons and astrocytes. Despite their obvious effects on the brain, their potential role in therapeutic methods remains uncertain in clinical practice. In the current chapter, a comparison of the crosstalk between these two systems, which are responsible for excitation and inhibition in neurons, is presented. The interactions are discussed at the metabolic, receptor, and transport levels. Reaction-diffusion and a convectional flow into the interstitial fluid create a balanced distribution of glycine and glutamate. Indeed, the neurons’ final physiological state is a result of a balance between the excitatory and inhibitory influences. However, changes to the glycine and/or glutamate pools under pathological conditions can alter the state of nervous tissue. Thus, new therapies for various diseases may be developed on the basis of amino acid medication.",book:{id:"10890",title:"Recent Advances in Neurochemistry",coverURL:"https://cdn.intechopen.com/books/images_new/10890.jpg"},signatures:"Yaroslav R. Nartsissov"},{id:"80821",title:"Neuroimmunology and Neurological Manifestations of COVID-19",slug:"neuroimmunology-and-neurological-manifestations-of-covid-19",totalDownloads:41,totalDimensionsCites:0,doi:"10.5772/intechopen.103026",abstract:"Infection with SARS-CoV-2 is causing coronavirus disease in 2019 (COVID-19). Besides respiratory symptoms due to an attack on the broncho-alveolar system, COVID-19, among others, can be accompanied by neurological symptoms because of the affection of the nervous system. These can be caused by intrusion by SARS-CoV-2 of the central nervous system (CNS) and peripheral nervous system (PNS) and direct infection of local cells. In addition, neurological deterioration mediated by molecular mimicry to virus antigens or bystander activation in the context of immunological anti-virus defense can lead to tissue damage in the CNS and PNS. In addition, cytokine storm caused by SARS-CoV-2 infection in COVID-19 can lead to nervous system related symptoms. Endotheliitis of CNS vessels can lead to vessel occlusion and stroke. COVID-19 can also result in cerebral hemorrhage and sinus thrombosis possibly related to changes in clotting behavior. Vaccination is most important to prevent COVID-19 in the nervous system. There are symptomatic or/and curative therapeutic approaches to combat COVID-19 related nervous system damage that are partly still under study.",book:{id:"10890",title:"Recent Advances in Neurochemistry",coverURL:"https://cdn.intechopen.com/books/images_new/10890.jpg"},signatures:"Robert Weissert"},{id:"80391",title:"COVID-19 and Seizures",slug:"covid-19-and-seizures",totalDownloads:43,totalDimensionsCites:0,doi:"10.5772/intechopen.102540",abstract:"The past two years were deeply marked by the emergence of a global pandemic caused by the worldwide spread of the virus severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection. The plethora of repercussions on the health of those affected is extensive, ranging from asymptomatic individuals, mild flu-like disease, and severe respiratory failure, eventually leading to death. Despite this predilection for the respiratory system, the virus is responsible for multisystemic manifestations and soon became clear that neurological involvement was a frequent issue of coronavirus disease 2019 (COVID-19). Much have been pointed out about the neurotropic nature of the virus, the ways by which it invades and targets specific structures of the central nervous system, and the physiopathology behind the neurologic manifestations associated with it (namely encephalomyelitis, Guillain-Barré syndrome, lacunar infarcts, and vascular dysfunction, just to list a few). This chapter aims to raise light about the association between COVID-19 and the mechanisms of acute symptomatic seizures, through neurotropism and neuroinvasion features of SARS-CoV-2, and to review the variety of clinical presentations reported so far.",book:{id:"10890",title:"Recent Advances in Neurochemistry",coverURL:"https://cdn.intechopen.com/books/images_new/10890.jpg"},signatures:"Rafael Jesus, Carolina Azoia, Paulo Coelho and Pedro Guimarães"}],onlineFirstChaptersTotal:9},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:0,limit:8,total:null},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:87,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:98,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:27,numberOfPublishedChapters:287,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:9,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:139,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:129,numberOfOpenTopics:0,numberOfUpcomingTopics:2,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!1},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:107,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:10,numberOfPublishedChapters:103,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:12,numberOfOpenTopics:2,numberOfUpcomingTopics:1,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:0,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!1},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:11,numberOfOpenTopics:4,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}}]},series:{item:{id:"10",title:"Physiology",doi:"10.5772/intechopen.72796",issn:"2631-8261",scope:"Modern physiology requires a comprehensive understanding of the integration of tissues and organs throughout the mammalian body, including the cooperation between structure and function at the cellular and molecular levels governed by gene and protein expression. While a daunting task, learning is facilitated by identifying common and effective signaling pathways mediated by a variety of factors employed by nature to preserve and sustain homeostatic life. \r\nAs a leading example, the cellular interaction between intracellular concentration of Ca+2 increases, and changes in plasma membrane potential is integral for coordinating blood flow, governing the exocytosis of neurotransmitters, and modulating gene expression and cell effector secretory functions. Furthermore, in this manner, understanding the systemic interaction between the cardiovascular and nervous systems has become more important than ever as human populations' life prolongation, aging and mechanisms of cellular oxidative signaling are utilised for sustaining life. \r\nAltogether, physiological research enables our identification of distinct and precise points of transition from health to the development of multimorbidity throughout the inevitable aging disorders (e.g., diabetes, hypertension, chronic kidney disease, heart failure, peptic ulcer, inflammatory bowel disease, age-related macular degeneration, cancer). 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His primary area of interest is physiology and pathophysiology of the gastrointestinal (GI) tract, with the major focus on the mechanism of GI mucosal defense, protection, and ulcer healing. He was a postdoctoral NIH fellow at the University of California and the Gastroenterology VA Medical Center, Irvine, Long Beach, CA, USA, and at the Gastroenterology Clinics Erlangen-Nuremberg and Munster in Germany. 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Saxena",hash:"d92a4085627bab25ddc7942fbf44cf05",volumeInSeries:2,fullTitle:"Current Perspectives in Human Papillomavirus",editors:[{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRET3QAO/Profile_Picture_2022-05-10T10:10:26.jpeg",institutionString:"King George's Medical University",institution:{name:"King George's Medical University",institutionURL:null,country:{name:"India"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null}]},subseriesFiltersForPublishedBooks:[{group:"subseries",caption:"Bacterial Infectious Diseases",value:3,count:2},{group:"subseries",caption:"Parasitic Infectious Diseases",value:5,count:4},{group:"subseries",caption:"Viral Infectious Diseases",value:6,count:7}],publicationYearFilters:[{group:"publicationYear",caption:"2022",value:2022,count:2},{group:"publicationYear",caption:"2021",value:2021,count:4},{group:"publicationYear",caption:"2020",value:2020,count:3},{group:"publicationYear",caption:"2019",value:2019,count:3},{group:"publicationYear",caption:"2018",value:2018,count:1}],authors:{paginationCount:249,paginationItems:[{id:"274452",title:"Dr.",name:"Yousif",middleName:"Mohamed",surname:"Abdallah",slug:"yousif-abdallah",fullName:"Yousif Abdallah",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/274452/images/8324_n.jpg",biography:"I certainly enjoyed my experience in Radiotherapy and Nuclear Medicine, particularly it has been in different institutions and hospitals with different Medical Cultures and allocated resources. Radiotherapy and Nuclear Medicine Technology has always been my aspiration and my life. As years passed I accumulated a tremendous amount of skills and knowledge in Radiotherapy and Nuclear Medicine, Conventional Radiology, Radiation Protection, Bioinformatics Technology, PACS, Image processing, clinically and lecturing that will enable me to provide a valuable service to the community as a Researcher and Consultant in this field. My method of translating this into day to day in clinical practice is non-exhaustible and my habit of exchanging knowledge and expertise with others in those fields is the code and secret of success.",institutionString:null,institution:{name:"Majmaah University",country:{name:"Saudi Arabia"}}},{id:"313277",title:"Dr.",name:"Bartłomiej",middleName:null,surname:"Płaczek",slug:"bartlomiej-placzek",fullName:"Bartłomiej Płaczek",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/313277/images/system/313277.jpg",biography:"Bartłomiej Płaczek, MSc (2002), Ph.D. (2005), Habilitation (2016), is a professor at the University of Silesia, Institute of Computer Science, Poland, and an expert from the National Centre for Research and Development. His research interests include sensor networks, smart sensors, intelligent systems, and image processing with applications in healthcare and medicine. He is the author or co-author of more than seventy papers in peer-reviewed journals and conferences as well as the co-author of several books. He serves as a reviewer for many scientific journals, international conferences, and research foundations. Since 2010, Dr. Placzek has been a reviewer of grants and projects (including EU projects) in the field of information technologies.",institutionString:"University of Silesia",institution:{name:"University of Silesia",country:{name:"Poland"}}},{id:"35000",title:"Prof.",name:"Ulrich H.P",middleName:"H.P.",surname:"Fischer",slug:"ulrich-h.p-fischer",fullName:"Ulrich H.P Fischer",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/35000/images/3052_n.jpg",biography:"Academic and Professional Background\nUlrich H. P. has Diploma and PhD degrees in Physics from the Free University Berlin, Germany. He has been working on research positions in the Heinrich-Hertz-Institute in Germany. Several international research projects has been performed with European partners from France, Netherlands, Norway and the UK. He is currently Professor of Communications Systems at the Harz University of Applied Sciences, Germany.\n\nPublications and Publishing\nHe has edited one book, a special interest book about ‘Optoelectronic Packaging’ (VDE, Berlin, Germany), and has published over 100 papers and is owner of several international patents for WDM over POF key elements.\n\nKey Research and Consulting Interests\nUlrich’s research activity has always been related to Spectroscopy and Optical Communications Technology. Specific current interests include the validation of complex instruments, and the application of VR technology to the development and testing of measurement systems. He has been reviewer for several publications of the Optical Society of America\\'s including Photonics Technology Letters and Applied Optics.\n\nPersonal Interests\nThese include motor cycling in a very relaxed manner and performing martial arts.",institutionString:null,institution:{name:"Charité",country:{name:"Germany"}}},{id:"341622",title:"Ph.D.",name:"Eduardo",middleName:null,surname:"Rojas Alvarez",slug:"eduardo-rojas-alvarez",fullName:"Eduardo Rojas Alvarez",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/341622/images/15892_n.jpg",biography:null,institutionString:null,institution:{name:"University of Cuenca",country:{name:"Ecuador"}}},{id:"215610",title:"Prof.",name:"Muhammad",middleName:null,surname:"Sarfraz",slug:"muhammad-sarfraz",fullName:"Muhammad Sarfraz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/215610/images/system/215610.jpeg",biography:"Muhammad Sarfraz is a professor in the Department of Information Science, Kuwait University, Kuwait. His research interests include optimization, computer graphics, computer vision, image processing, machine learning, pattern recognition, soft computing, data science, and intelligent systems. Prof. Sarfraz has been a keynote/invited speaker at various platforms around the globe. He has advised/supervised more than 110 students for their MSc and Ph.D. theses. He has published more than 400 publications as books, journal articles, and conference papers. He has authored and/or edited around seventy books. Prof. Sarfraz is a member of various professional societies. He is a chair and member of international advisory committees and organizing committees of numerous international conferences. He is also an editor and editor in chief for various international journals.",institutionString:"Kuwait University",institution:{name:"Kuwait University",country:{name:"Kuwait"}}},{id:"32650",title:"Prof.",name:"Lukas",middleName:"Willem",surname:"Snyman",slug:"lukas-snyman",fullName:"Lukas Snyman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/32650/images/4136_n.jpg",biography:"Lukas Willem Snyman received his basic education at primary and high schools in South Africa, Eastern Cape. He enrolled at today's Nelson Metropolitan University and graduated from this university with a BSc in Physics and Mathematics, B.Sc Honors in Physics, MSc in Semiconductor Physics, and a Ph.D. in Semiconductor Physics in 1987. After his studies, he chose an academic career and devoted his energy to the teaching of physics to first, second, and third-year students. After positions as a lecturer at the University of Port Elizabeth, he accepted a position as Associate Professor at the University of Pretoria, South Africa.\r\n\r\nIn 1992, he motivates the concept of 'television and computer-based education” as means to reach large student numbers with only the best of teaching expertise and publishes an article on the concept in the SA Journal of Higher Education of 1993 (and later in 2003). The University of Pretoria subsequently approved a series of test projects on the concept with outreach to Mamelodi and Eerste Rust in 1993. In 1994, the University established a 'Unit for Telematic Education ' as a support section for multiple faculties at the University of Pretoria. In subsequent years, the concept of 'telematic education” subsequently becomes well established in academic circles in South Africa, grew in popularity, and is adopted by many universities and colleges throughout South Africa as a medium of enhancing education and training, as a method to reaching out to far out communities, and as a means to enhance study from the home environment.\r\n\r\nProfessor Snyman in subsequent years pursued research in semiconductor physics, semiconductor devices, microelectronics, and optoelectronics.\r\n\r\nIn 2000 he joined the TUT as a full professor. Here served for a period as head of the Department of Electronic Engineering. Here he makes contributions to solar energy development, microwave and optoelectronic device development, silicon photonics, as well as contributions to new mobile telecommunication systems and network planning in SA.\r\n\r\nCurrently, he teaches electronics and telecommunications at the TUT to audiences ranging from first-year students to Ph.D. level.\r\n\r\nFor his research in the field of 'Silicon Photonics” since 1990, he has published (as author and co-author) about thirty internationally reviewed articles in scientific journals, contributed to more than forty international conferences, about 25 South African provisional patents (as inventor and co-inventor), 8 PCT international patent applications until now. Of these, two USA patents applications, two European Patents, two Korean patents, and ten SA patents have been granted. A further 4 USA patents, 5 European patents, 3 Korean patents, 3 Chinese patents, and 3 Japanese patents are currently under consideration.\r\n\r\nRecently he has also published an extensive scholarly chapter in an internet open access book on 'Integrating Microphotonic Systems and MOEMS into standard Silicon CMOS Integrated circuitry”.\r\n\r\nFurthermore, Professor Snyman recently steered a new initiative at the TUT by introducing a 'Laboratory for Innovative Electronic Systems ' at the Department of Electrical Engineering. The model of this laboratory or center is to primarily combine outputs as achieved by high-level research with lower-level system development and entrepreneurship in a technical university environment. Students are allocated to projects at different levels with PhDs and Master students allocated to the generation of new knowledge and new technologies, while students at the diploma and Baccalaureus level are allocated to electronic systems development with a direct and a near application for application in industry or the commercial and public sectors in South Africa.\r\n\r\nProfessor Snyman received the WIRSAM Award of 1983 and the WIRSAM Award in 1985 in South Africa for best research papers by a young scientist at two international conferences on electron microscopy in South Africa. He subsequently received the SA Microelectronics Award for the best dissertation emanating from studies executed at a South African university in the field of Physics and Microelectronics in South Africa in 1987. In October of 2011, Professor Snyman received the prestigious Institutional Award for 'Innovator of the Year” for 2010 at the Tshwane University of Technology, South Africa. This award was based on the number of patents recognized and granted by local and international institutions as well as for his contributions concerning innovation at the TUT.",institutionString:null,institution:{name:"University of South Africa",country:{name:"South Africa"}}},{id:"317279",title:"Mr.",name:"Ali",middleName:"Usama",surname:"Syed",slug:"ali-syed",fullName:"Ali Syed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/317279/images/16024_n.png",biography:"A creative, talented, and innovative young professional who is dedicated, well organized, and capable research fellow with two years of experience in graduate-level research, published in engineering journals and book, with related expertise in Bio-robotics, equally passionate about the aesthetics of the mechanical and electronic system, obtained expertise in the use of MS Office, MATLAB, SolidWorks, LabVIEW, Proteus, Fusion 360, having a grasp on python, C++ and assembly language, possess proven ability in acquiring research grants, previous appointments with social and educational societies with experience in administration, current affiliations with IEEE and Web of Science, a confident presenter at conferences and teacher in classrooms, able to explain complex information to audiences of all levels.",institutionString:null,institution:{name:"Air University",country:{name:"Pakistan"}}},{id:"75526",title:"Ph.D.",name:"Zihni Onur",middleName:null,surname:"Uygun",slug:"zihni-onur-uygun",fullName:"Zihni Onur Uygun",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/75526/images/12_n.jpg",biography:"My undergraduate education and my Master of Science educations at Ege University and at Çanakkale Onsekiz Mart University have given me a firm foundation in Biochemistry, Analytical Chemistry, Biosensors, Bioelectronics, Physical Chemistry and Medicine. After obtaining my degree as a MSc in analytical chemistry, I started working as a research assistant in Ege University Medical Faculty in 2014. In parallel, I enrolled to the MSc program at the Department of Medical Biochemistry at Ege University to gain deeper knowledge on medical and biochemical sciences as well as clinical chemistry in 2014. In my PhD I deeply researched on biosensors and bioelectronics and finished in 2020. Now I have eleven SCI-Expanded Index published papers, 6 international book chapters, referee assignments for different SCIE journals, one international patent pending, several international awards, projects and bursaries. In parallel to my research assistant position at Ege University Medical Faculty, Department of Medical Biochemistry, in April 2016, I also founded a Start-Up Company (Denosens Biotechnology LTD) by the support of The Scientific and Technological Research Council of Turkey. Currently, I am also working as a CEO in Denosens Biotechnology. The main purposes of the company, which carries out R&D as a research center, are to develop new generation biosensors and sensors for both point-of-care diagnostics; such as glucose, lactate, cholesterol and cancer biomarker detections. My specific experimental and instrumental skills are Biochemistry, Biosensor, Analytical Chemistry, Electrochemistry, Mobile phone based point-of-care diagnostic device, POCTs and Patient interface designs, HPLC, Tandem Mass Spectrometry, Spectrophotometry, ELISA.",institutionString:null,institution:{name:"Ege University",country:{name:"Turkey"}}},{id:"246502",title:"Dr.",name:"Jaya T.",middleName:"T",surname:"Varkey",slug:"jaya-t.-varkey",fullName:"Jaya T. Varkey",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/246502/images/11160_n.jpg",biography:"Jaya T. Varkey, PhD, graduated with a degree in Chemistry from Cochin University of Science and Technology, Kerala, India. She obtained a PhD in Chemistry from the School of Chemical Sciences, Mahatma Gandhi University, Kerala, India, and completed a post-doctoral fellowship at the University of Minnesota, USA. She is a research guide at Mahatma Gandhi University and Associate Professor in Chemistry, St. Teresa’s College, Kochi, Kerala, India.\nDr. Varkey received a National Young Scientist award from the Indian Science Congress (1995), a UGC Research award (2016–2018), an Indian National Science Academy (INSA) Visiting Scientist award (2018–2019), and a Best Innovative Faculty award from the All India Association for Christian Higher Education (AIACHE) (2019). She Hashas received the Sr. Mary Cecil prize for best research paper three times. She was also awarded a start-up to develop a tea bag water filter. \nDr. Varkey has published two international books and twenty-seven international journal publications. She is an editorial board member for five international journals.",institutionString:"St. Teresa’s College",institution:null},{id:"250668",title:"Dr.",name:"Ali",middleName:null,surname:"Nabipour Chakoli",slug:"ali-nabipour-chakoli",fullName:"Ali Nabipour Chakoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/250668/images/system/250668.jpg",biography:"Academic Qualification:\r\n•\tPhD in Materials Physics and Chemistry, From: Sep. 2006, to: Sep. 2010, School of Materials Science and Engineering, Harbin Institute of Technology, Thesis: Structure and Shape Memory Effect of Functionalized MWCNTs/poly (L-lactide-co-ε-caprolactone) Nanocomposites. Supervisor: Prof. Wei Cai,\r\n•\tM.Sc in Applied Physics, From: 1996, to: 1998, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Determination of Boron in Micro alloy Steels with solid state nuclear track detectors by neutron induced auto radiography, Supervisors: Dr. M. Hosseini Ashrafi and Dr. A. Hosseini.\r\n•\tB.Sc. in Applied Physics, From: 1991, to: 1996, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Design of shielding for Am-Be neutron sources for In Vivo neutron activation analysis, Supervisor: Dr. M. Hosseini Ashrafi.\r\n\r\nResearch Experiences:\r\n1.\tNanomaterials, Carbon Nanotubes, Graphene: Synthesis, Functionalization and Characterization,\r\n2.\tMWCNTs/Polymer Composites: Fabrication and Characterization, \r\n3.\tShape Memory Polymers, Biodegradable Polymers, ORC, Collagen,\r\n4.\tMaterials Analysis and Characterizations: TEM, SEM, XPS, FT-IR, Raman, DSC, DMA, TGA, XRD, GPC, Fluoroscopy, \r\n5.\tInteraction of Radiation with Mater, Nuclear Safety and Security, NDT(RT),\r\n6.\tRadiation Detectors, Calibration (SSDL),\r\n7.\tCompleted IAEA e-learning Courses:\r\nNuclear Security (15 Modules),\r\nNuclear Safety:\r\nTSA 2: Regulatory Protection in Occupational Exposure,\r\nTips & Tricks: Radiation Protection in Radiography,\r\nSafety and Quality in Radiotherapy,\r\nCourse on Sealed Radioactive Sources,\r\nCourse on Fundamentals of Environmental Remediation,\r\nCourse on Planning for Environmental Remediation,\r\nKnowledge Management Orientation Course,\r\nFood Irradiation - Technology, Applications and Good Practices,\r\nEmployment:\r\nFrom 2010 to now: Academic staff, Nuclear Science and Technology Research Institute, Kargar Shomali, Tehran, Iran, P.O. Box: 14395-836.\r\nFrom 1997 to 2006: Expert of Materials Analysis and Characterization. Research Center of Agriculture and Medicine. Rajaeeshahr, Karaj, Iran, P. O. Box: 31585-498.",institutionString:"Atomic Energy Organization of Iran",institution:{name:"Atomic Energy Organization of Iran",country:{name:"Iran"}}},{id:"248279",title:"Dr.",name:"Monika",middleName:"Elzbieta",surname:"Machoy",slug:"monika-machoy",fullName:"Monika Machoy",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/248279/images/system/248279.jpeg",biography:"Monika Elżbieta Machoy, MD, graduated with distinction from the Faculty of Medicine and Dentistry at the Pomeranian Medical University in 2009, defended her PhD thesis with summa cum laude in 2016 and is currently employed as a researcher at the Department of Orthodontics of the Pomeranian Medical University. She expanded her professional knowledge during a one-year scholarship program at the Ernst Moritz Arndt University in Greifswald, Germany and during a three-year internship at the Technical University in Dresden, Germany. She has been a speaker at numerous orthodontic conferences, among others, American Association of Orthodontics, European Orthodontic Symposium and numerous conferences of the Polish Orthodontic Society. She conducts research focusing on the effect of orthodontic treatment on dental and periodontal tissues and the causes of pain in orthodontic patients.",institutionString:"Pomeranian Medical University",institution:{name:"Pomeranian Medical University",country:{name:"Poland"}}},{id:"252743",title:"Prof.",name:"Aswini",middleName:"Kumar",surname:"Kar",slug:"aswini-kar",fullName:"Aswini Kar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252743/images/10381_n.jpg",biography:"uploaded in cv",institutionString:null,institution:{name:"KIIT University",country:{name:"India"}}},{id:"204256",title:"Dr.",name:"Anil",middleName:"Kumar",surname:"Kumar Sahu",slug:"anil-kumar-sahu",fullName:"Anil Kumar Sahu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204256/images/14201_n.jpg",biography:"I have nearly 11 years of research and teaching experience. I have done my master degree from University Institute of Pharmacy, Pt. Ravi Shankar Shukla University, Raipur, Chhattisgarh India. I have published 16 review and research articles in international and national journals and published 4 chapters in IntechOpen, the world’s leading publisher of Open access books. I have presented many papers at national and international conferences. I have received research award from Indian Drug Manufacturers Association in year 2015. My research interest extends from novel lymphatic drug delivery systems, oral delivery system for herbal bioactive to formulation optimization.",institutionString:null,institution:{name:"Chhattisgarh Swami Vivekanand Technical University",country:{name:"India"}}},{id:"253468",title:"Dr.",name:"Mariusz",middleName:null,surname:"Marzec",slug:"mariusz-marzec",fullName:"Mariusz Marzec",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/253468/images/system/253468.png",biography:"An assistant professor at Department of Biomedical Computer Systems, at Institute of Computer Science, Silesian University in Katowice. Scientific interests: computer analysis and processing of images, biomedical images, databases and programming languages. He is an author and co-author of scientific publications covering analysis and processing of biomedical images and development of database systems.",institutionString:"University of Silesia",institution:null},{id:"212432",title:"Prof.",name:"Hadi",middleName:null,surname:"Mohammadi",slug:"hadi-mohammadi",fullName:"Hadi Mohammadi",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/212432/images/system/212432.jpeg",biography:"Dr. Hadi Mohammadi is a biomedical engineer with hands-on experience in the design and development of many engineering structures and medical devices through various projects that he has been involved in over the past twenty years. Dr. Mohammadi received his BSc. and MSc. degrees in Mechanical Engineering from Sharif University of Technology, Tehran, Iran, and his PhD. degree in Biomedical Engineering (biomaterials) from the University of Western Ontario. He was a postdoctoral trainee for almost four years at University of Calgary and Harvard Medical School. He is an industry innovator having created the technology to produce lifelike synthetic platforms that can be used for the simulation of almost all cardiovascular reconstructive surgeries. He’s been heavily involved in the design and development of cardiovascular devices and technology for the past 10 years. He is currently an Assistant Professor with the University of British Colombia, Canada.",institutionString:"University of British Columbia",institution:{name:"University of British Columbia",country:{name:"Canada"}}},{id:"254463",title:"Prof.",name:"Haisheng",middleName:null,surname:"Yang",slug:"haisheng-yang",fullName:"Haisheng Yang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/254463/images/system/254463.jpeg",biography:"Haisheng Yang, Ph.D., Professor and Director of the Department of Biomedical Engineering, College of Life Science and Bioengineering, Beijing University of Technology. He received his Ph.D. degree in Mechanics/Biomechanics from Harbin Institute of Technology (jointly with University of California, Berkeley). Afterwards, he worked as a Postdoctoral Research Associate in the Purdue Musculoskeletal Biology and Mechanics Lab at the Department of Basic Medical Sciences, Purdue University, USA. He also conducted research in the Research Centre of Shriners Hospitals for Children-Canada at McGill University, Canada. Dr. Yang has over 10 years research experience in orthopaedic biomechanics and mechanobiology of bone adaptation and regeneration. He earned an award from Beijing Overseas Talents Aggregation program in 2017 and serves as Beijing Distinguished Professor.",institutionString:"Beijing University of Technology",institution:null},{id:"255757",title:"Dr.",name:"Igor",middleName:"Victorovich",surname:"Lakhno",slug:"igor-lakhno",fullName:"Igor Lakhno",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255757/images/system/255757.jpg",biography:"Lakhno Igor Victorovich was born in 1971 in Kharkiv (Ukraine). \nMD – 1994, Kharkiv National Medical Univesity.\nOb&Gyn; – 1997, master courses in Kharkiv Medical Academy of Postgraduate Education.\nPhD – 1999, Kharkiv National Medical Univesity.\nDSc – 2019, PL Shupik National Academy of Postgraduate Education \nLakhno Igor has been graduated from an international training courses on reproductive medicine and family planning held in Debrecen University (Hungary) in 1997. Since 1998 Lakhno Igor has worked as an associate professor of the department of obstetrics and gynecology of VN Karazin National University and an associate professor of the perinatology, obstetrics and gynecology department of Kharkiv Medical Academy of Postgraduate Education. Since June 2019 he’s a professor of the department of obstetrics and gynecology of VN Karazin National University and a professor of the perinatology, obstetrics and gynecology department of Kharkiv Medical Academy of Postgraduate Education . He’s an author of about 200 printed works and there are 17 of them in Scopus or Web of Science databases. Lakhno Igor is a rewiever of Journal of Obstetrics and Gynaecology (Taylor and Francis), Informatics in Medicine Unlocked (Elsevier), The Journal of Obstetrics and Gynecology Research (Wiley), Endocrine, Metabolic & Immune Disorders-Drug Targets (Bentham Open), The Open Biomedical Engineering Journal (Bentham Open), etc. He’s defended a dissertation for DSc degree \\'Pre-eclampsia: prediction, prevention and treatment”. Lakhno Igor has participated as a speaker in several international conferences and congresses (International Conference on Biological Oscillations April 10th-14th 2016, Lancaster, UK, The 9th conference of the European Study Group on Cardiovascular Oscillations). His main scientific interests: obstetrics, women’s health, fetal medicine, cardiovascular medicine.",institutionString:"V.N. Karazin Kharkiv National University",institution:{name:"Kharkiv Medical Academy of Postgraduate Education",country:{name:"Ukraine"}}},{id:"89721",title:"Dr.",name:"Mehmet",middleName:"Cuneyt",surname:"Ozmen",slug:"mehmet-ozmen",fullName:"Mehmet Ozmen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/89721/images/7289_n.jpg",biography:null,institutionString:null,institution:{name:"Gazi University",country:{name:"Turkey"}}},{id:"243698",title:"M.D.",name:"Xiaogang",middleName:null,surname:"Wang",slug:"xiaogang-wang",fullName:"Xiaogang Wang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/243698/images/system/243698.png",biography:"Dr. Xiaogang Wang, a faculty member of Shanxi Eye Hospital specializing in the treatment of cataract and retinal disease and a tutor for postgraduate students of Shanxi Medical University, worked in the COOL Lab as an international visiting scholar under the supervision of Dr. David Huang and Yali Jia from October 2012 through November 2013. Dr. Wang earned an MD from Shanxi Medical University and a Ph.D. from Shanghai Jiao Tong University. Dr. Wang was awarded two research project grants focused on multimodal optical coherence tomography imaging and deep learning in cataract and retinal disease, from the National Natural Science Foundation of China. He has published around 30 peer-reviewed journal papers and four book chapters and co-edited one book.",institutionString:"Shanxi Eye Hospital",institution:{name:"Shanxi Eye Hospital",country:{name:"China"}}},{id:"242893",title:"Ph.D. Student",name:"Joaquim",middleName:null,surname:"De Moura",slug:"joaquim-de-moura",fullName:"Joaquim De Moura",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/242893/images/7133_n.jpg",biography:"Joaquim de Moura received his degree in Computer Engineering in 2014 from the University of A Coruña (Spain). In 2016, he received his M.Sc degree in Computer Engineering from the same university. He is currently pursuing his Ph.D degree in Computer Science in a collaborative project between ophthalmology centers in Galicia and the University of A Coruña. His research interests include computer vision, machine learning algorithms and analysis and medical imaging processing of various kinds.",institutionString:null,institution:{name:"University of A Coruña",country:{name:"Spain"}}},{id:"267434",title:"Dr.",name:"Rohit",middleName:null,surname:"Raja",slug:"rohit-raja",fullName:"Rohit Raja",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRZkkQAG/Profile_Picture_2022-05-09T12:55:18.jpg",biography:null,institutionString:null,institution:null},{id:"294334",title:"B.Sc.",name:"Marc",middleName:null,surname:"Bruggeman",slug:"marc-bruggeman",fullName:"Marc Bruggeman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/294334/images/8242_n.jpg",biography:"Chemical engineer graduate, with a passion for material science and specific interest in polymers - their near infinite applications intrigue me. \n\nI plan to continue my scientific career in the field of polymeric biomaterials as I am fascinated by intelligent, bioactive and biomimetic materials for use in both consumer and medical applications.",institutionString:null,institution:null},{id:"244950",title:"Dr.",name:"Salvatore",middleName:null,surname:"Di Lauro",slug:"salvatore-di-lauro",fullName:"Salvatore Di Lauro",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0030O00002bSF1HQAW/ProfilePicture%202021-12-20%2014%3A54%3A14.482",biography:"Name:\n\tSALVATORE DI LAURO\nAddress:\n\tHospital Clínico Universitario Valladolid\nAvda Ramón y Cajal 3\n47005, Valladolid\nSpain\nPhone number: \nFax\nE-mail:\n\t+34 983420000 ext 292\n+34 983420084\nsadilauro@live.it\nDate and place of Birth:\nID Number\nMedical Licence \nLanguages\t09-05-1985. Villaricca (Italy)\n\nY1281863H\n474707061\nItalian (native language)\nSpanish (read, written, spoken)\nEnglish (read, written, spoken)\nPortuguese (read, spoken)\nFrench (read)\n\t\t\nCurrent position (title and company)\tDate (Year)\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. Private practise.\t2017-today\n\n2019-today\n\t\n\t\nEducation (High school, university and postgraduate training > 3 months)\tDate (Year)\nDegree in Medicine and Surgery. University of Neaples 'Federico II”\nResident in Opthalmology. Hospital Clinico Universitario Valladolid\nMaster in Vitreo-Retina. IOBA. University of Valladolid\nFellow of the European Board of Ophthalmology. Paris\nMaster in Research in Ophthalmology. University of Valladolid\t2003-2009\n2012-2016\n2016-2017\n2016\n2012-2013\n\t\nEmployments (company and positions)\tDate (Year)\nResident in Ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl.\nFellow in Vitreo-Retina. IOBA. University of Valladolid\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. \n\t2012-2016\n2016-2017\n2017-today\n\n2019-Today\n\n\n\t\nClinical Research Experience (tasks and role)\tDate (Year)\nAssociated investigator\n\n' FIS PI20/00740: DESARROLLO DE UNA CALCULADORA DE RIESGO DE\nAPARICION DE RETINOPATIA DIABETICA BASADA EN TECNICAS DE IMAGEN MULTIMODAL EN PACIENTES DIABETICOS TIPO 1. Grant by: Ministerio de Ciencia e Innovacion \n\n' (BIO/VA23/14) Estudio clínico multicéntrico y prospectivo para validar dos\nbiomarcadores ubicados en los genes p53 y MDM2 en la predicción de los resultados funcionales de la cirugía del desprendimiento de retina regmatógeno. Grant by: Gerencia Regional de Salud de la Junta de Castilla y León.\n' Estudio multicéntrico, aleatorizado, con enmascaramiento doble, en 2 grupos\nparalelos y de 52 semanas de duración para comparar la eficacia, seguridad e inmunogenicidad de SOK583A1 respecto a Eylea® en pacientes con degeneración macular neovascular asociada a la edad' (CSOK583A12301; N.EUDRA: 2019-004838-41; FASE III). Grant by Hexal AG\n\n' Estudio de fase III, aleatorizado, doble ciego, con grupos paralelos, multicéntrico para comparar la eficacia y la seguridad de QL1205 frente a Lucentis® en pacientes con degeneración macular neovascular asociada a la edad. (EUDRACT: 2018-004486-13). Grant by Qilu Pharmaceutical Co\n\n' Estudio NEUTON: Ensayo clinico en fase IV para evaluar la eficacia de aflibercept en pacientes Naive con Edema MacUlar secundario a Oclusion de Vena CenTral de la Retina (OVCR) en regimen de tratamientO iNdividualizado Treat and Extend (TAE)”, (2014-000975-21). Grant by Fundacion Retinaplus\n\n' Evaluación de la seguridad y bioactividad de anillos de tensión capsular en conejo. Proyecto Procusens. Grant by AJL, S.A.\n\n'Estudio epidemiológico, prospectivo, multicéntrico y abierto\\npara valorar la frecuencia de la conjuntivitis adenovírica diagnosticada mediante el test AdenoPlus®\\nTest en pacientes enfermos de conjuntivitis aguda”\\n. National, multicenter study. Grant by: NICOX.\n\nEuropean multicentric trial: 'Evaluation of clinical outcomes following the use of Systane Hydration in patients with dry eye”. Study Phase 4. Grant by: Alcon Labs'\n\nVLPs Injection and Activation in a Rabbit Model of Uveal Melanoma. Grant by Aura Bioscience\n\nUpdating and characterization of a rabbit model of uveal melanoma. Grant by Aura Bioscience\n\nEnsayo clínico en fase IV para evaluar las variantes genéticas de la vía del VEGF como biomarcadores de eficacia del tratamiento con aflibercept en pacientes con degeneración macular asociada a la edad (DMAE) neovascular. Estudio BIOIMAGE. IMO-AFLI-2013-01\n\nEstudio In-Eye:Ensayo clínico en fase IV, abierto, aleatorizado, de 2 brazos,\nmulticçentrico y de 12 meses de duración, para evaluar la eficacia y seguridad de un régimen de PRN flexible individualizado de 'esperar y extender' versus un régimen PRN según criterios de estabilización mediante evaluaciones mensuales de inyecciones intravítreas de ranibizumab 0,5 mg en pacientes naive con neovascularización coriodea secunaria a la degeneración macular relacionada con la edad. CP: CRFB002AES03T\n\nTREND: Estudio Fase IIIb multicéntrico, randomizado, de 12 meses de\nseguimiento con evaluador de la agudeza visual enmascarado, para evaluar la eficacia y la seguridad de ranibizumab 0.5mg en un régimen de tratar y extender comparado con un régimen mensual, en pacientes con degeneración macular neovascular asociada a la edad. CP: CRFB002A2411 Código Eudra CT:\n2013-002626-23\n\n\n\nPublications\t\n\n2021\n\n\n\n\n2015\n\n\n\n\n2021\n\n\n\n\n\n2021\n\n\n\n\n2015\n\n\n\n\n2015\n\n\n2014\n\n\n\n\n2015-16\n\n\n\n2015\n\n\n2014\n\n\n2014\n\n\n\n\n2014\n\n\n\n\n\n\n\n2014\n\nJose Carlos Pastor; Jimena Rojas; Salvador Pastor-Idoate; Salvatore Di Lauro; Lucia Gonzalez-Buendia; Santiago Delgado-Tirado. Proliferative vitreoretinopathy: A new concept of disease pathogenesis and practical\nconsequences. Progress in Retinal and Eye Research. 51, pp. 125 - 155. 03/2016. DOI: 10.1016/j.preteyeres.2015.07.005\n\n\nLabrador-Velandia S; Alonso-Alonso ML; Di Lauro S; García-Gutierrez MT; Srivastava GK; Pastor JC; Fernandez-Bueno I. Mesenchymal stem cells provide paracrine neuroprotective resources that delay degeneration of co-cultured organotypic neuroretinal cultures.Experimental Eye Research. 185, 17/05/2019. DOI: 10.1016/j.exer.2019.05.011\n\nSalvatore Di Lauro; Maria Teresa Garcia Gutierrez; Ivan Fernandez Bueno. Quantification of pigment epithelium-derived factor (PEDF) in an ex vivo coculture of retinal pigment epithelium cells and neuroretina.\nJournal of Allbiosolution. 2019. ISSN 2605-3535\n\nSonia Labrador Velandia; Salvatore Di Lauro; Alonso-Alonso ML; Tabera Bartolomé S; Srivastava GK; Pastor JC; Fernandez-Bueno I. Biocompatibility of intravitreal injection of human mesenchymal stem cells in immunocompetent rabbits. Graefe's archive for clinical and experimental ophthalmology. 256 - 1, pp. 125 - 134. 01/2018. DOI: 10.1007/s00417-017-3842-3\n\n\nSalvatore Di Lauro, David Rodriguez-Crespo, Manuel J Gayoso, Maria T Garcia-Gutierrez, J Carlos Pastor, Girish K Srivastava, Ivan Fernandez-Bueno. A novel coculture model of porcine central neuroretina explants and retinal pigment epithelium cells. Molecular Vision. 2016 - 22, pp. 243 - 253. 01/2016.\n\nSalvatore Di Lauro. Classifications for Proliferative Vitreoretinopathy ({PVR}): An Analysis of Their Use in Publications over the Last 15 Years. Journal of Ophthalmology. 2016, pp. 1 - 6. 01/2016. DOI: 10.1155/2016/7807596\n\nSalvatore Di Lauro; Rosa Maria Coco; Rosa Maria Sanabria; Enrique Rodriguez de la Rua; Jose Carlos Pastor. Loss of Visual Acuity after Successful Surgery for Macula-On Rhegmatogenous Retinal Detachment in a Prospective Multicentre Study. Journal of Ophthalmology. 2015:821864, 2015. DOI: 10.1155/2015/821864\n\nIvan Fernandez-Bueno; Salvatore Di Lauro; Ivan Alvarez; Jose Carlos Lopez; Maria Teresa Garcia-Gutierrez; Itziar Fernandez; Eva Larra; Jose Carlos Pastor. Safety and Biocompatibility of a New High-Density Polyethylene-Based\nSpherical Integrated Porous Orbital Implant: An Experimental Study in Rabbits. Journal of Ophthalmology. 2015:904096, 2015. DOI: 10.1155/2015/904096\n\nPastor JC; Pastor-Idoate S; Rodríguez-Hernandez I; Rojas J; Fernandez I; Gonzalez-Buendia L; Di Lauro S; Gonzalez-Sarmiento R. Genetics of PVR and RD. Ophthalmologica. 232 - Suppl 1, pp. 28 - 29. 2014\n\nRodriguez-Crespo D; Di Lauro S; Singh AK; Garcia-Gutierrez MT; Garrosa M; Pastor JC; Fernandez-Bueno I; Srivastava GK. Triple-layered mixed co-culture model of RPE cells with neuroretina for evaluating the neuroprotective effects of adipose-MSCs. Cell Tissue Res. 358 - 3, pp. 705 - 716. 2014.\nDOI: 10.1007/s00441-014-1987-5\n\nCarlo De Werra; Salvatore Condurro; Salvatore Tramontano; Mario Perone; Ivana Donzelli; Salvatore Di Lauro; Massimo Di Giuseppe; Rosa Di Micco; Annalisa Pascariello; Antonio Pastore; Giorgio Diamantis; Giuseppe Galloro. Hydatid disease of the liver: thirty years of surgical experience.Chirurgia italiana. 59 - 5, pp. 611 - 636.\n(Italia): 2007. ISSN 0009-4773\n\nChapters in books\n\t\n' Salvador Pastor Idoate; Salvatore Di Lauro; Jose Carlos Pastor Jimeno. PVR: Pathogenesis, Histopathology and Classification. Proliferative Vitreoretinopathy with Small Gauge Vitrectomy. Springer, 2018. ISBN 978-3-319-78445-8\nDOI: 10.1007/978-3-319-78446-5_2. \n\n' Salvatore Di Lauro; Maria Isabel Lopez Galvez. Quistes vítreos en una mujer joven. Problemas diagnósticos en patología retinocoroidea. Sociedad Española de Retina-Vitreo. 2018.\n\n' Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor Jimeno. iOCT in PVR management. OCT Applications in Opthalmology. pp. 1 - 8. INTECH, 2018. DOI: 10.5772/intechopen.78774.\n\n' Rosa Coco Martin; Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor. amponadores, manipuladores y tinciones en la cirugía del traumatismo ocular.Trauma Ocular. Ponencia de la SEO 2018..\n\n' LOPEZ GALVEZ; DI LAURO; CRESPO. OCT angiografia y complicaciones retinianas de la diabetes. PONENCIA SEO 2021, CAPITULO 20. (España): 2021.\n\n' Múltiples desprendimientos neurosensoriales bilaterales en paciente joven. Enfermedades Degenerativas De Retina Y Coroides. SERV 04/2016. \n' González-Buendía L; Di Lauro S; Pastor-Idoate S; Pastor Jimeno JC. Vitreorretinopatía proliferante (VRP) e inflamación: LA INFLAMACIÓN in «INMUNOMODULADORES Y ANTIINFLAMATORIOS: MÁS ALLÁ DE LOS CORTICOIDES. RELACION DE PONENCIAS DE LA SOCIEDAD ESPAÑOLA DE OFTALMOLOGIA. 10/2014.",institutionString:null,institution:null},{id:"265335",title:"Mr.",name:"Stefan",middleName:"Radnev",surname:"Stefanov",slug:"stefan-stefanov",fullName:"Stefan Stefanov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/265335/images/7562_n.jpg",biography:null,institutionString:null,institution:null},{id:"318905",title:"Prof.",name:"Elvis",middleName:"Kwason",surname:"Tiburu",slug:"elvis-tiburu",fullName:"Elvis Tiburu",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Ghana",country:{name:"Ghana"}}},{id:"336193",title:"Dr.",name:"Abdullah",middleName:null,surname:"Alamoudi",slug:"abdullah-alamoudi",fullName:"Abdullah Alamoudi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Majmaah University",country:{name:"Saudi Arabia"}}},{id:"318657",title:"MSc.",name:"Isabell",middleName:null,surname:"Steuding",slug:"isabell-steuding",fullName:"Isabell Steuding",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Harz University of Applied Sciences",country:{name:"Germany"}}},{id:"318656",title:"BSc.",name:"Peter",middleName:null,surname:"Kußmann",slug:"peter-kussmann",fullName:"Peter Kußmann",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Harz University of Applied Sciences",country:{name:"Germany"}}},{id:"338222",title:"Mrs.",name:"María José",middleName:null,surname:"Lucía Mudas",slug:"maria-jose-lucia-mudas",fullName:"María José Lucía Mudas",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Carlos III University of Madrid",country:{name:"Spain"}}},{id:"147824",title:"Mr.",name:"Pablo",middleName:null,surname:"Revuelta Sanz",slug:"pablo-revuelta-sanz",fullName:"Pablo Revuelta Sanz",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Carlos III University of Madrid",country:{name:"Spain"}}}]}},subseries:{item:{id:"11",type:"subseries",title:"Cell Physiology",keywords:"Neurodevelopment and Neurodevelopmental Disease, Free Radicals, Tumor Metastasis, Antioxidants, Essential Fatty Acids, Melatonin, Lipid Peroxidation Products and Aging Physiology",scope:"\r\n\tThe integration of tissues and organs throughout the mammalian body, as well as the expression, structure, and function of molecular and cellular components, is essential for modern physiology. The following concerns will be addressed in this Cell Physiology subject, which will consider all organ systems (e.g., brain, heart, lung, liver; gut, kidney, eye) and their interactions: (1) Neurodevelopment and Neurodevelopmental Disease (2) Free Radicals (3) Tumor Metastasis (4) Antioxidants (5) Essential Fatty Acids (6) Melatonin and (7) Lipid Peroxidation Products and Aging Physiology.
",coverUrl:"https://cdn.intechopen.com/series_topics/covers/11.jpg",hasOnlineFirst:!0,hasPublishedBooks:!0,annualVolume:11407,editor:{id:"133493",title:"Prof.",name:"Angel",middleName:null,surname:"Catala",slug:"angel-catala",fullName:"Angel Catala",profilePictureURL:"https://mts.intechopen.com/storage/users/133493/images/3091_n.jpg",biography:"Prof. Dr. Angel Catalá \r\nShort Biography Angel Catalá was born in Rodeo (San Juan, Argentina). 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. Angel Catalá received awards at the 40th InternationaConference Biochemistry of Lipids 1999: Dijon (France). W inner of the Bimbo PanAmerican Nutrition, Food Science and Technology Award 2006 and 2012, South AmericaHuman Nutrition, Professional Category. 2006 award in pharmacology, Bernardo\r\nHoussay, in recognition of his meritorious works of research. 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,series:{id:"10",title:"Physiology",doi:"10.5772/intechopen.72796",issn:"2631-8261"},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"}}}]},onlineFirstChapters:{paginationCount:19,paginationItems:[{id:"81067",title:"Encapsulation of Essential Oils and Their Use in Food Applications",doi:"10.5772/intechopen.103147",signatures:"Hamdy A. 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