Mean common bile duct diameter and range according to patient age.
\r\n\tThere will be a chapter on secondary causes of sexual dysfunction disorders related to diabetes, cardiovascular disease, and obesity. A chapter on remedial measures to enhance sexual activity and maintain human relationships will be discussed. As there is a growing number of cancer survivors a chapter on cancer-related sexual dysfunction will be welcomed for including it.
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The chapter begins with a background on the needs for such connectivity, why Architects need to be concerned with such technical matters, and the need for a multi-disciplinary approach to the issue. It then elaborates on some of the key concepts of connectivity that affect the architecture of spaces, extracting from a study done by the authors, to determine building interior components that affect connectivity, impacting propagation of radio waves. The results of the study point to certain interior features and their design, to increase efficiency of the system, and minimize propagation losses.
\nIn the discussion, conflicts, between best design scenarios focused on the connectivity issue, and satisfaction of other demands on internal spaces, are revealed. The field is still very new, as development in internet connection and propagation is progressing exponentially, with improvements taking place almost continuously. And if there is a gap in the transfer of knowledge, regarding what is required for good propagation, and what is being designed to house these systems, there is likely to be a clash of intentions, resulting in inefficient systems, and reduced user satisfaction. It is the intention of the authors, through this chapter to bring awareness to these inter-related issues, and to the need for collaboration, between the different professionals designing and implementing the spaces, on the one hand, and the systems, on the other.
\nIn a nutshell, the chapter addresses the issue of the Internet of Things (IoT), wireless connectivity and related issues, as affected by the architecture of built spaces. Based on a recent study completed at BUET on the subject, and on related research, the issues are looked at broadly, from an architectural point of view, and steps that need to be addressed immediately to resolve these, are touched on, with suggested guidelines.
\nThere has been a major shift in lifestyles caused by the Fourth Industrial Revolution (4IR). This revolution can be defined as a new chapter in human development, built on the previous three industrial revolutions that had shaped life since the mid-eighteenth century onwards: the first developing from water/steam power, the second from electric power, just before the beginning of the twentieth century, and the third building on developments in electronics and information technology, in the second half of the twentieth century [1].
\nThis fourth revolution, begun at the turn of this century, has been enabled by extraordinary technological advances, superseding the three preceding development phases, and here we see a fusion of technology, which blurs the lines between the physical, digital and biological spheres. This affects the way that the world is developing in three ways – the speed/pace (exponential) at which changes take place, the scope of the changes (due to unprecedented processing power, access to knowledge, artificial intelligence, blurring of boundaries, digital, nanotechnology, material science, etc), and the impact of the systems (on production, management and governance). And from the point of view of life, this fourth industrial revolution has completely changed the lifestyle of humans. Those who can take advantage of this revolution are the ones that will see progress, others will lag behind. And the scale of the gap will increase incrementally, given the tremendous force and interconnectivity of the phenomenon.
\nThe 4IR has ensured the passage of the internet of things and wireless technology into the forefront of life activities nowadays. The profusion of internet and information technology has led people to spend more and more time at their computers, smart devices and cell phones, spending their work time using these, and their leisure time enjoying them. Smart devices are used for functions ranging from communication, both officially and socially, to shopping, internationally and locally, to virtual meetings and social media, and has likewise extended to virtual education and training. This changed behavior has led the media to refer to today’s youth as the ‘indoor’ generation, and research finds that around 90 percent of people spend close to 22 hours indoors each day in the developed world [2], at the present time.
\nThroughout history, people have tried to adapt Indoor conditions to suit their needs, and based them on their available resources and know-how. But the needs, as well as available knowledge base, have now changed very rapidly, and it is becoming important to examine how suited today’s built spaces are, to accommodate these new needs, given the technology available to us. There are two major avenues of investigation here: whether the buildings allow proper conditions needed for such exchanges and activities, and whether the buildings can protect humans from any adverse effects of these exchanges.
\nMoreover, the technology behind the internet of things, is also in the process of shifting gears, from 3G to the present 4G, which is being upgraded to 5G soon. Up until now, this domain has been dominated only by RF (Radio Frequency) engineers, those who focus their expertise on the propagation of radio waves, and on their efficient and seamless transmission. RF Engineers work on improvement of the performance of wireless communication, by ensuring good RF signal strength at the receiver [3]. The need for Architects to be involved in these considerations is paramount at the moment, as it is they who are primarily responsible for designing and shaping the built environment, where all this propagation is to take place. They are the ones who will be ascertaining the arrival and receipt of any propagation, and thereby the success of such connectivity issues.
\nThe Internet of Things (IoT) is expanding exponentially, with improvements in connectivity and the related technology. It is now an important instrument, in the process used to communicate with society, and is thus increasing the participatory approach to a myriad of things. This phenomenon is driving much of human activity, and is one of the most compelling factors that are making humans into sedentary beings, focussed solely on indoor living. When considered within buildings themselves, this phenomenon is termed BIoT, or Building Internet of Things (BIoT).
\nAnother important innovation of recent times, is related to connectivity of equipment within ‘smart’ buildings, i.e. buildings having automated solutions for security, safety, energy management, comfort, entertainment, health, and so forth, all dependent on machine to machine (M2M) communication. This too is now becoming an integral part of BIoT and daily living, and occupants now depend on smart solutions within buildings, to ensure much that was previously under the domain of behavioral response, like adjusting window openings for thermal comfort, or controlling lighting level manually or using curtains and so on. In a smart building, service robots, and other devices for desired control, can be programmed to perform many of these activities, using 4G or 5G platforms, as indicated in Figure 1 [4].
\nAutomated devices using 4G or 5G platform in smart buildings [
Recent studies have revealed that certain building materials and their properties may be more suited to wireless signal penetration, while others are relatively opaque. Since Architects are the main decision-makers, regarding the final choice of such questions as above, while they have very little grounding in the technicalities involved, it is important to have them reflect on such questions, and seek answers through multi-disciplinary forums, thus also to deepen collaboration between the related professionals, in order to create more wireless connectivity in building interiors. From the user perspective, this is a vital need, as the user of today spends enormous amounts of time at these electronic, computing devices that require uninterrupted and quality connectivity. It is seen, therefore, that the performance of wireless communication is finding more direct bearing on the satisfaction level of users of the building, contributing thus to both their performance, as well as user comfort, above and over issues of comfort in terms of other environmental variables. It is becoming increasingly important now, to initiate studies on this aspect of comfort, as an added dimension of evaluating building performance, in a way that was in the past studied with reference to thermal and visual comfort issues.
\nIn addition to the above considerations, any building activity or development today must be sustainable, and the business-as-usual model comes with inherent risks to the planet and continued human existence. This requires us to look at the issue in several separate dimensions. As buildings are one of the highest consumers of electricity, and Architects are largely responsible for their design, it is imperative that they be conversant with all the pathways in which energy efficiency can be achieved in buildings. Good internet connectivity within buildings too, is directly affected by the design of buildings. It, therefore, becomes incumbent to look at whether the satisfaction of these two requirements, for connectivity, and for efficiency, cause contradictory physical manifestations in building design.
\nSustainability, considering the internet issue, can thus be approached, through an examination of connectivity needs, and any potential conflicts that they present, with other human and environment related issues. This involves studying the main linkages, synergies, and trade-offs with other issues, e.g. of health, comfort and productivity, bio-diversity, etc. As the issue of sustainability is intrinsically related to acceptance by user groups, it is also important to examine connectivity “solutions” available to the public and private sectors, their desirability, acceptance, affordability and other such factors, so that whatever solution is adopted for a building is inclusive, does not increase divides between different groups. This human factor is also one of the key indicators of sustainability.
\nA short discussion on the UN sustainable development goals (SDGs) set up in 2015, and the intrinsic interlink with the world-wide-web and internet connectivity is given below. If the spaces that serve such connectivity are not designed with seamless connectivity in view, there is no doubt that it will not be possible to achieve these goals. SDGs require that governments, private sector, civil society and citizens should partner together, aiming for a better planet for future generations [5]. And the road map to achieve this, banks largely on incorporating creativity, know-how, technology and financial resources available.
\nGoals 1 and 2 relate to deprived populations; no poverty and zero hunger. Much of poverty arises due to lack of opportunities, which is a direct result of not having proper access to available options of employment, business outlets, and so on. Clearly, these goals are interconnected, and cannot be tackled in isolation. Information exchange is vital, populations require to be connected through cell phones, etc. Goals 3 and 4, regarding health and education, are likewise related to connectivity. Proper monitoring, access, etc. are all dependent, on how easily information can be transferred from place to place, in order to stem problems at source. The internet is vital for present-day education, which can serve to be a tool, tackling the lack of libraries and information. Goal 8, decent work and economic growth, and Goal 9, industry, innovation and infrastructure, and again depend on increased connectivity, and the related issue of spaces and their design.
\nGoal 11 is directly about cities and thus architecture, and the way the built environment impacts our planet. The design of cities and urban areas affects the passage of internet connectivity, due to building positioning, spacing, material use and so forth, and thus decisions that impact these, are the direct concern of all the related professionals being discussed here.
\nGoal 12 relates to responsible consumption and production, and is also heavily dependent on internet availability. Connectivity within groups is vital to any business activity, therefore, the spaces where people produce, i.e. industries, and their design are vital in meeting this goal. Consumption is part and parcel of everyday living, and sustainable practices call for reduction, reuse and recycling, i.e. circular economies. Again connectivity is vital, to ensure that the system works properly and promptly, to avoid clogs and blockages within the flow.
\nGoal 13, is to control climate change. This is all pervasive, requiring attention to the design of built spaces, which is largely responsible for the carbon footprint and the consumption of resources on our planet. Buildings designed to conserve energy and use natural resources are important, just as are automated systems within buildings, which can monitor variables, and largely offset much waste of energy, and maintain the efficiency of systems. Such systems again cannot function without internet connectivity.
\nGoals 16 and 17 relate to people’s issues and their participation. Connectivity and platforms for voicing opinions are imperative to achieve these, making the internet and spaces of use directly related to their success.
\nThe above points have been raised, to underline the importance of treating the issue of connectivity as a key part of architecture considerations, and to the attainment of many of the SDGs. The need for the professionals to collaborate in the design of buildings, and spaces in between, is clear from these parallel associations.
\nArchitects, through their training, look at challenges existing in a given situation, and on means to address them through holistic solutions. Till recently, environmental forces were largely natural, but since the age of the information technology, the profusion of high frequency propagation has introduced a new dimension to ensure proper functioning, and with it are related health issues. The problem has been under the sole jurisdiction of Radio Frequency (RF) Engineers, who specialize in devices and transmission using and operating on radio waves, i.e. wireless devices like mobiles, which are largely becoming the centre of existence of modern lifestyles. But research shows that the efficiency of RF transmissions and reception, seems to be intrinsically associated with the design of spaces. It is therefore becoming imperative that Architects work hand-in-hand with RF Engineers, to create environments that are conducive to proper utilization of available RF regimes, to ease unnecessary losses, which can result in poor connectivity and energy inefficiency. This section summarizes a study done at BUET [6] and its follow up, to investigate the issue of internet connectivity and its connection to architecture.
\nThe first point highlighted in the study is that building occupants are now demanding increasingly higher data rate, as new applications are emerging. Examples of these are: Augmented Reality (AR), Virtual Reality (VR), Mixed Reality (MR), and Extended Reality (XR). The global mobile data traffic is expected to increase from 19.01 exabytes per month in 2018 to 77.5 exabytes per month by 2022, at an annual growth rate of 46 percent [7].
\nThe wireless connectivity in the building can be supported by many different technologies, as shown below.
Long Range High/Moderate Power: 3G/4G/5G cellular system.
For IoT devices, Narrowband-IoT (NB-IoT) or Extended Coverage GSM (EC-GSM) can be used.
In-Building Solutions (IBS): femtocells, picocells and Distributed Antenna System (DAS)
\n
\n
Bluetooth and BLE (Bluetooth Low Energy): Originally, standardized as IEEE 802.15.1 for operation in ISM radio bands.
ZigBee: Standardized as IEEE 802.15.4 for operation in ISM radio bands.
Thread: An IPv6-based, low-power mesh networking technology for IoT products.
Z-Wave: A low-power mesh networking technology, primarily used for home automation.
Long
Sigfox: A global cellular based network operator that supports IoT products at low-power.
LoRa: A cellular based technology that supports IoT products at low-power.
Waviot: A wireless technology that uses low-power and primarily, supports electricity meters and water meters.
Ingenu: A provider of wireless networks that supports IoT products at low-power.
Weightless: A set of open wireless technology standards that supports IoT products at low-power.
The chosen option for any particular building, will be affected by the geometry of the space, and its material quality. Therefore, contributions from architects can ease the job, towards ensuring proper wireless coverage and connectivity. Architects and RF engineers can complement each other, to address the growing challenge better. Green architecture considerations, apart from the physical features of the built spaces, can incorporate suggestions for various other measures, for example, solar panels, thermal mass building construction, green materials, including wood, stone, or earth, recycled waste materials, and so forth.
\nArchitectural intervention can improve wireless signal coverage, by ensuring maximum signal power, minimizing interference to its path. Such intervention is significant, since the building will undoubtedly last much more than a few decades, and should thus be ready for the rapid changes that are predicted in the wireless support arena. However, there has not been enough engagement of architects in this area so far, and mostly, analytical discussions have been made in this regard [8], restricted within RF engineering circles, often beyond the knowledge of Architects.
\n4G has changed the life of people, but 5G is set to change society in its entirety. While the key focus of the developers for generations up to 4G, has been to improve data rate support, 5G has an additional focus, which is to support numerous use cases, with diverse technological requirements. These use cases are categorized with three basic types of requirements as shown below [9], all of which are seeing increasing applicability in new urban paradigms:
\n
\n
\n
The categorization of various use cases towards the three classes for 5G is illustrated in Figure 2 [9].
\nCategorization of various use cases towards the three classes for 5G [
Another complication in wireless connectivity, arises from the rapid changes taking place in the related technology. Due to the exponential growth of internet use, the lower frequencies of propagation are getting saturated. Service providers have incrementally shifted from 2G to 3G to 4G in the space of fewer than 2 decades, and are now geared to shift to 5G coverage. So cellular operation, functioning at frequencies below 6 GHz, were suitable for systems designed for propagations up to 4G. However, the need for 5G cellular systems is to encompass much higher frequencies – starting from 500 MHz to 100 GHz. The BUET study [6], identified the following issues as the reason for wireless service in the buildings becoming increasingly challenging:
the growth in individual data rate demand,
the growth in the number of wireless devices, especially, BIoT devices,
the use of BIoT devices at deeper locations in buildings, and
the use of higher frequencies.
Ensuring proper radio coverage gets much more challenging, as the frequency increases, which is displayed in the three categories of use cases fit into the spectrum of 5G (Figure 3). Evidently, IoT based applications, typically, require low data rate and extended coverage, and thus, they suit lower frequencies. On the other hand, HD videos, VR, and other high data rate applications, require wide bandwidth and thus, high frequencies are used to facilitate eMBB. Similarly, URLLC applications fit in what ranges up to moderately high frequencies.
\nDistribution of the categories of use cases within the Spectrum for 5G [
Building design, clearly plays an important role in wireless connectivity. Undoubtedly, existing buildings will have their own difficulties in addressing the connectivity issues, but proper attention to the related problems is of paramount importance, for making new buildings suitable to this need, at the earliest design stages. This will ensure proper connectivity, as well as, user satisfaction, while addressing any adverse effects that this very propagation may have, on human well-being and health.
\nThis section looks at internet connectivity, as it is affected by the design of interior spaces. Previous studies, have pointed out the role of penetration losses of various building materials, a quality that largely affects internet connectivity. Good connectivity can cause more homogenous data rate within buildings, thus operating at lower transmit power, conserving their batteries and affecting energy efficiency. An architect’s consideration of wireless coverage at the design stage, can help improve coverage significantly. It is an established fact that signal coverage significantly depends on the nature of the space, and its bounding surfaces [3]. However, there is very little work done on establishing these qualities of building materials used in everyday construction.
\nAddressing this gap, penetration loss levels of some common building materials were determined, as part of the BUET study. The research also related the measured data with other existing information. Based on those measurements, taking into account the scope of architectural design, some guidelines were proposed for architectural intervention, to address the growing challenge of supporting wireless services in buildings. As an outcome of this research, a MATLAB program was developed, using radio propagation theories, which an architect can use during the design phase, to predetermine the impact of the proposed use of different penetration losses of building materials at various frequencies.
\nStudies show that there is a sharp penetration loss at higher frequencies, in typical commercial buildings [10], which use infra-red reflective glass facades, in order to achieve energy efficiency. This will likely have grave consequences on internet connectivity, when the transmission source is outdoors. Propagation losses in interiors, either due to partitions, or space layout, are also considerable at these higher frequencies, and are dependent on the materials used in the layering of the spaces. Such consequences are likely to affect the ‘smart’ indicators within building interiors, which largely depend on M2M.
\nSurprisingly, the higher the operating frequency, the faster is the deterioration of radio frequencies, and so the distance, between the transmitting source and receiver in building interiors, needs to be controlled. Another important factor is the path that the wave has to travel between these two points. The higher the frequency, the less its ability to bend around obstacles, therefore requiring more direct visibility/paths between the points. This puts additional restrictions on the design of spaces, than previously encountered. Thus, clearly, both the building structure, and interior partitions can severely obstruct signal strength and internet connectivity, which will result in high propagation losses. This in turn will affect the battery life of the devices, which in itself is challenging under present options, as in many instances they are irreplaceable. Corrective measures like setting up an IBS (in-building solution) is often not feasible for small buildings or residences.
\nIt is important for Architects, as well as interior designers, to be involved in the design and setting up of the wireless connection system, as space layout and the materials chosen, are all decisions taken by the Architect, and an understanding of these issues needs to be one of the considerations, that determine the ultimate design of the interior.
\nThis section summarizes the main guidelines suggested as a result of the BUET study [6]. The first of the guidelines concerned the choice of materials for internal partitions. Concrete and infrared reflective (IRR) glass exhibit high penetration losses. Loss due to concrete, takes place on account of it being a very heavy and dense material. Loss from IRR glass, which is not a heavy material, happens due to the reflection of a major part of the signal. On the other hand, plain glass and particle board exhibit low penetration losses, as they are light materials. Also, the higher the number of layers of a material used in a partition, and hence the thickness of the tested material, the higher was the measured penetration loss, with the loss increase being non-linear. In general, clear glass and particle board were found to be low penetration loss materials, while concrete and IRR glass was found to present high penetration losses at the frequencies they were tested for. For higher frequencies the loss would be likely to increase exponentially, pointing to the problems that would be encountered, in a shift from 4G to 5G transmission scenarios.
\nA stepped process of design was suggested for design to incorporate internet connectivity within buildings. Firstly, Selection of Options for Wireless Service, needs to be considered during building design, suitable for the particular wireless service option chosen. If the wireless signal from an outside cellular base station, seems sufficient for the wireless service in the building, then neither IBS nor Wi-Fi, Zigbee, WiGig, etc. are required. Then the architect should design, ensuring that the signal from outside can enter the building adequately, i.e. taking particular care of the building fenestration.
\nHowever, if an IBS is selected, the architect should design for better coverage from the IBS. If Wi-Fi, Zigbee, WiGig, etc. are selected, the installation locations of the sources may be pre-designed in the building, similar to designs produced for electric lights and plumbing. During the design phase, the architect may use indoor radio planning tools, and perform simulations, to check the potential wireless coverage, thereby making valuable adjustments in the architectural design of the building, to improve coverage and signal paths. A few indoor radio planning tools are currently available, like iBwave.
\nThe second step would be to focus on connectivity issues related to architectural design. For any wireless service option, open planning inside the building can help signals propagate better, and pervade throughout the whole building, as the wireless coverage will be dependent on uninterrupted paths within the building. The following points were highlighted to ensure smooth paths and transmission:
Open plan can be used, especially, allowing more LOS links for the propagation of radio wave. The open plan concept for buildings is already popular, with less walls to cut off the area, an open plan gives the appearance of more space, which is further compounded by the abundance of light. Since in the case of open plan, the design attempts to avoid the use of real partitions, it allows the best propagation of the radio signal.
Voids, corridors, room size, and so forth, can be incorporated to allow the geometry of space to enhance the openness.
Larger room sizes can be designed for the given design brief.
Long, unobstructed corridors will also allow smooth propagation
To improve the link between floors, vertical atriums or voids can be used
Both hard and soft partitions can be used with careful design. An appropriate setting of hard and soft partitions can help allow the desired signal, and block any interference signals. However, this requires proper knowledge and record, of the penetration loss for various building materials, and its variation with increasing frequencies.
The use of glass walls, within open plans can enhance desired signal power. Once the signal strengths are determined, low height walls or partitions can be used towards the desired signal, and high walls or partitions can be used towards any interference signal.
Similarly, thin walls or partitions can be used towards the desired signal and thick walls or partitions can be used towards any interference signal.
The position and orientation of hard or soft partitions can be carefully chosen, depending on the position of user devices, the desired signal source, and the interference signal source.
Multiple reflective walls, fringes or louvers may be used carefully to cause multipath signal bounce and get to the receiver.
The suggested guidelines have been presented for the consideration of an architect, but they also create awareness within other professionals, particularly RF Engineers, of the need to collaborate during the design phase, in order to bring relevant connectivity issues to the design board. The possible outcome of such collaboration and the architect’s contribution can be summarized as follows.
It can be much easier to improve the wireless coverage at the design phase, while the RF engineers will require less time, effort and cost in their installation process.
The wireless resources, which are scarce, can be used more efficiently, thus contributing to energy efficiency.
The user data rate can be much higher, improving user satisfaction, as well as productivity.
IoT devices at deeper locations in buildings can be operable.
IoT devices will require less transmit power in uplink and thus, save battery power and meet the requirement of a very long lifetime.
The undesired spillage of signal outside the building can be reduced.
The recent global pandemic of Covid-19 has also brought focused attention towards sick building syndromes, or SBS. This phenomenon has been a concern for the past five decades, ever since the widespread acceptance of fully air-conditioned buildings became the preferred typology of built spaces, particularly in the thermally challenged situations found in the tropics. The Covid pandemic resulted in the need to maintain social distancing, and in trying to increase the rate at which interior, potentially infected air, is replaced by purer and infection-free outdoor air. Both these requirements have necessitated a shift in the ways in which interiors are conceived.
\nAs the plan layout of spaces is a vital element in maintaining internet connectivity between the transmitting source and receivers, which may be fixed or moveable, these new considerations will also impact the quality of internet connectivity, and needs to be given due thought hand in hand, in order to ensure human health requirements. When more compartmentalization is the need, for isolating infections, and protecting the occupants, the positioning of partitions, their materials and design, all impact the efficiency of internet connectivity.
\nGreen and sustainable planners also advocate compactness in planning a new development, in order to reduce traffic loads, which can be a valuable energy saver. Compactness also allows increased pedestrian movement and biking between destinations, again an active energy efficient measure, which also promotes health benefits from exercise, an added sustainability feature. Again, this measure may contradict the need to create greater distancing between occupants, a requirement vital to control pandemic spreads. The density of neighborhoods is also likely to affect the internet connectivity issue, creating greater obstructions within smaller pathways, affecting the strength of the signals.
\nThe strongly synergistic connection, between the effects of each and every consideration on suitability, regarding physical distancing and/or compartmentalization, is a phenomenon that is encountered time and again, whenever any requirement is compared to others. For instance, the need for avoiding solar exposure may result in infra-red reflective glass facades, but this conflicts with the need to have uninterrupted internet receptivity within the interiors, as mentioned above.
\nMuch research is now required to address the conflicts between the different needs that a building is designed to serve, whether they be thermal comfort, visual comfort, privacy, security, health and air quality needs, and even inclusivity. It is now becoming vital for designers to address the various requirements, and make intelligent and considered choices regarding each, understanding what and the extent of compromises being made for different design decisions, and whether they are potentially harmful or not. The issue of the health hazards of RF transmissions is also of paramount concern at the moment and needs extensive research.
\nThe wireless connectivity, in a building, is an important aspect of today’s lifestyles, without which it is impossible to function and achieve sustainability. This is because it improves the life of building users greatly, while only consuming nominal energy, making it a key ingredient of green architecture. Thus, it is essentially providing great services, without destroying fossil fuels, and protecting the future world. And this is being demonstrated increasingly, given the work from home scenario found recently during the Covid pandemic. It is unclear how well the World could have handled the lock-down situation, had internet not reached its present development. This makes it of vital importance in the present World, to ensure the provision of seamless internet connectivity, for even the basics of life to function efficiently.
\nThe discussion has related the objectives of the UN SDGs to the issue of having internet access and connectivity, and their intrinsic link to the architecture of spaces. It is difficult in the present times to think of sustainability in the absence of seamless internet connectivity within building interiors. This combines the expertise of multi-disciplinary teams of Architects and RF Engineers.
\nFrom a recent research conducted at BUET relating these disciplines, the various options for wireless services have been listed, particularly since the services are increasing their data rate to 5G levels in the near future. Clearly building interiors need to be designed with focus on the issues of seamless propagation of RF waves. The different architectural measures that can be adopted to make this possible have been mentioned here. The geometry of spaces, their spatial flow and materials, their partitions, and openings, all contribute to the flow of internet connectivity. What remains still unaddressed is the matter of the health and safety issues related to 5G transmission scenarios, which it has been suggested deserves special attention in future research.
\nThis paper has brought out the importance of the different disciplines to collaborate in the design of the environment, in order to ensure seamless and safe transmission of internet connectivity. The collaboration needs to begin at the design phase, so that proper decisions are implemented with an understanding of the consequences holistically. Each of the professionals are experts in their own spheres, but they need to make each other aware of the needs which will best serve the built environment, and help improve user satisfaction, while reducing energy wastage. The participatory approach is the only acceptable way forward.
\nCholedochal cyst (CC) is an entity where there is a dilatation at any level of the bile duct, more common in the choledochus, hence its name. Although in almost all the literature, it is referred to as a “choledochal cyst,” the most appropriate way to refer to this pathology would be dilation of the bile duct, since it does not necessarily present as a cyst, and it is not necessary to appear in the choledochus either.
Therefore, to refer to a dilated duct, it is necessary to know the normal diameter of the common bile duct (choledochus). A study by Pina and colleagues reports an average of 5–6 mm in diameter of the common bile duct in adult patients; however the diameter varies according to age and measurement method (Table 1) [1, 2]. Another study where measurements were made on 173 children aged between 1 day and 13 years reported an average diameter of the common bile duct of 1.27 mm (± 3.3 mm) and < 1.2 mm in newborn and children up to 3 months [3]. Consequently, any measurement greater than reported can be considered abnormal.
Age (years) | Range (mm) |
---|---|
≤ 4 | 2–4 |
4–6 | 2–4 |
6–10 | 2–6 |
10–12 | 3–6 |
12–14 | 3–7 |
Adapted from Witcombe JB, Cremin BJ. The width of the common bile duct in childhood. Pediatr Radiol. 1978;7:147–149. |
Mean common bile duct diameter and range according to patient age.
Diverse classifications have been proposed to categorize the CC. Currently, Todani’s classification has been the most extensively accepted (Figure 1). It was described in 1977, based on evidence of the existence of various anatomical forms of biliary cystic dilatation that occur not only in the choledochus, but also in any part of the bile duct between the liver and the duodenum, previously the classifications for this entity include only choledochus dilations [4].
Types of choledochal cysts according to Todani’s classification. Type I (a = choledochal cyst in a narrow sense; b = segmental choledochal dilatation; c = diffuse or cylindrical dilatation.). Type II supraduodenal diverticulum. Type III (a = choledochocele; b = diverticular choledochocele). Type IV multiple dilatations [a = involving the intrahepatic biliary tract; b = sparing the intrahepatic biliary tract. Type V (or Caroli’s disease): Corresponds to multiple intrahepatic dilatations.
According to Todani’s classification, CCs are classified into five types:
Type I: Common type, represents 50–80% of CCs. It is characterized by cystic dilation of the common bile duct. It is further divided into three subgroups: a. choledochal cyst in a narrow sense; b. segmental choledochal dilatation; and c. diffuse or cylindrical dilatation.
Type II: Diverticulum type in the whole extrahepatic duct, represents 2%.
Type III: Choledochocele, represents 1.4%–4.5% of CCs. It is an intraduodenal cystic dilation of the distal common bile duct.
Type IV: Represents 15–35% of CCs. It is further divided into two subgroups. a. Multiple cysts at the intra- and extrahepatic ducts; b. multiple cysts at the extrahepatic duct only.
Type V: Intrahepatic bile duct cyst (single or multiple). Also known as Caroli’s disease, represents 20% of CCs [5].
Furthermore, there exists a special variant of CC named “forme fruste,” where the patients present with typical symptoms of CCs and are associated with abnormal pancreaticobiliary duct junction but little or no dilation of biliary ducts. It could be considered as an incomplete or atypical pathology [6].
There is an outstanding regional tendency, which affects predominantly Asian population with an incidence of 1 in 1000 live births, and two-thirds of the reported cases occur in Japan, compared with an incidence of 1 in 100,000–150,000 live births in the Western population [7, 8].
CCs type I and IV are more common and have a female-to-male ratio of 4:1 or 3:1. The cause for the Asian and female predominance remains under study, recent research studies settle that congenic bile duct dilatation has genetic basis, not only genetically heterogeneous but also non-monogenic, requiring mutations in more than one gene for the disease to develop. That is consistent with the low frequency and sporadic presentation of CC [9, 10, 11].
The etiology of a choledochal cyst remains unknown at present time, leading to the postulation of multiple theories. “Long common channel” theory by Babbit has been the most accepted explanation for the origin of the choledochal cyst. This theory states that the pancreaticobiliary junction is located outside the duodenal wall [12, 13].
In normal conditions, the common bile duct and the pancreatic duct enter into the duodenal muscle layer (sphincter of Oddi) and join in the submucosal layer just before opening into the duodenal lumen. This junction helps to regulate the output of digestive enzymes into the intestinal lumen but in a pancreaticobiliary maljunction (PBM), there is a dysfunction of the sphincter because the duct is external of the duodenal muscle layer, forming an extended common channel, 1–2 cm proximal to the sphincter of Oddi [14].
The maljunction of both ducts occurs during the fifth week of gestation. In normal embryological development, the pancreatic ventral bud fuses side by side with the dorsal bud, and in the sixth week, 180-degree rotation (clockwise) of ventral and choledochal, bud of the pancreas occurs around the duodenum to reach their finale positions [15]. PBM appears to be associated to the malrotation of the ventral bud, as the proximal portion of the hepatic diverticulum extends and the ventral primordium has been displaced away from the duodenum by elongation of the proximal part of the diverticulum.
Histological and immunohistochemical studies have demonstrated that the union of these two buds might occur in an oblique position, producing the formation of a long common channel [14, 16].
PBM was classified by Komi in 1992 into three types, based on the fusion pattern (Figure 2):
Pancreaticobiliary maljunction classification. Komi classification and Japanese study group on Pancreaticobiliary Maljunction (JSPBM).
Type I: The bile duct joins with the pancreatic duct forming a right angle. It is presented in 35.3% of the cases.
Type II: It seems that the pancreatic duct connects to the biliary duct in an acute angle. It was seen in 21.6% of the cases.
Type III in 43.1% of the cases. It is a complicated junction of both ducts [17].
In 2015, the Committee on Diagnostic Criteria of the Japanese Study Group on Pancreaticobiliary Maljunction (JSGPM) proposed a classification into four types [18]:
Type A (stenotic type): The narrow segment of the distal common bile duct joins the common channel and shows dilatation of the common bile duct.
Type B (non-stenotic type): The distal common bile duct without any narrow segment joins the common channel. Without dilatation of the common channel.
Type C (dilated type): The narrow segment of the distal common bile duct joins the common channel, and abrupt dilatation of the common channel is seen.
Type D (complex type): PBM associated with annular pancreas, pancreas divisum, or other complicated duct systems.
In addition to PBM and a higher pressure of the pancreatic duct, the developed long channel allows reflux of pancreatic juice into the common bile duct. However, it has been found that not all abnormal pancreaticobiliary junctions present dilatation of the bile duct, which could explain only a part of its pathophysiology.
Pancreatic proenzymes also play an important role in the origin of the choledochal cyst, inasmuch as they come into contact with the bile and activate before reaching the duodenum, they generate a state of inflammation, obstruction, increased pressure in the choledochus, and consequently, greater dilation [19]. Furthermore, trypsinogen, when activated into trypsin, modifies a protein called lithostatin in its insoluble form, aggregating and forming protein plugs. These plugs are compacted in the common channel or in the narrow distal part of the cyst, causing pancreatitis or increasing the pressure of the bile duct so much that it sometimes generates biliary perforation.
Pancreaticobiliary reflux and activation of proenzymes generate intermittent symptoms such as abdominal pain, vomiting, jaundice, and increased aminotransferases in children. This fact is confirmed by a retrospective study of 80 patients where biliary amylase measurements were performed, finding a relationship between the presence of biliary amylase and clinical manifestations, with the presence of jaundice as the most common symptom in those with amylase <200 U/L, and with the presence of abdominal pain in those with amylase >200 U/L [20].
It has been observed in adulthood that pancreaticobiliary reflux presents as dilatation of the bile duct and malignancy. This is secondary to the fact that biliary stasis, which was previously mixed with the refluxing pancreatic enzymes, creates damage to the biliary epithelium. Chronic inflammation activates the point mutation of KRAS, overexpresses COX2, and inactivates TP53, generating greater cell proliferation and consequently epithelial hyperplasia, which appears benign in childhood, but in adulthood presents as dysplasia and subsequent carcinogenesis. The site of malignant occurrence is generally within the cyst, but it can be anywhere within the biliary tree [21].
On the other hand, Babbitt’s theory is confronted by authors who state that PBM is present in only 50–80% of cases and that in choledochal cyst diagnosed prenatally, there wasn’t the presence of reflux, and suggest that neonatal pancreatic acini are not able to produce enough pancreatic enzymes [22]. For unknown reason, despite the presence of PBM, bile duct dilatation may not occur and frequently does not generate symptoms. Therefore, in these patients, PBM tends to be diagnosed at a later stage [23].
This previous theory applies to choledochal cyst types I and IV. Regarding type II (true CBD diverticulum) and type III (choledochocele), it is suspected that the cause is related to biliary duplications cysts for type II and biliary or duodenal duplications cysts for type III [24].
Type V CC and fibrocystic liver disease are related with both being a spectrum of the same congenital disease; ductal dysgenesis affects the biliary tree at multiple levels from the small intrahepatic bile ducts (congenital hepatic fibrosis) to the larger bile ducts (Caroli disease). The etiology type V CC is accepted to be a halt in the remodeling of the ductal plates, and it is associated with biliary atresia [25].
Alternatively, suboptimal number of ganglion cells has been demonstrated in the narrow portion in the distal common bile duct of patients with choledochal cyst when compared with controls. This might lead to the dilation of the proximal segment of the common bile duct, describing a pathogenesis similar to achalasia and Hirschsprung’s disease [26].
The bile duct cyst is scarcely detected in the prenatal stage, the cases reported in the literature range between 20 and 30sdg, being the earliest case described in the 16th week of gestation [27, 28]. The multi-slice high-resolution ultrasound visualizes several planes simultaneously, including sagittal, coronal, transverse, and oblique views being the main tool in the prenatal approach allowing an early diagnosis [27, 28, 29].
Among the suggestive findings is the presence of an anechoic cystic image in the right upper quadrant without central vascularity to the application of the Doppler and which is in relation to the contiguity with the gallbladder, in addition to allowing to evaluate the position of the cyst, the state of the proximal ducts, vascular anatomy, and the hepatic echotexture [27, 29].
The advantage of prenatal diagnosis is that it allows the multidisciplinary team adequate neonatal support and prompt surgical planning. During pregnancy, the behavior should be expectant with follow-up ultrasounds, prioritizing childbirth. After birth, the diagnosis can be confirmed with magnetic resonance cholangiopancreatography. There are no international publications so far about perinatal management [30, 31].
Differential diagnosis should include retroperitoneal cysts (hydronephrosis, polycystic kidney, cystic neuroblastoma, or adrenal hematoma) and intraperitoneal cysts (ovarian cysts, epiploic and mesenteric cysts, intestinal duplication, intestinal atresia, biliary atresia, pancreatic and hepatic cysts) [31, 32].
In a series of 13 patients with biliary disease and abnormal prenatal examinations, the correct diagnosis was made prenatally only in 15% of cases. The difficulty in differential diagnosis in the newborn lies between the bile duct cyst and cystic biliary atresia. Given the difficulty that exists of differential between these two entities by prenatal ultrasound, a child with presumed bile duct cyst should undergo an early examination to rule out biliary atresia. So far there are no unequivocal differential parameters that are accepted [30, 31, 32].
Clinical presentation patterns differ according to the age group at onset of symptoms and the type of cyst. The classic triad of abdominal pain, abdominal mass in the right upper quadrant, and jaundice, although predominant in children, is only reported in 5–10% [33, 34].
Abdominal pain is the most frequent symptom (61–94%) with a slight predominance in older children and adults, which has an intermittent course with a variable time interval from days to years [35, 36]. Abdominal mass and jaundice are usually a manifestation of newborns and infants. Cholangitis, pancreatitis, and liver function test abnormalities are common and are thought to be secondary to a PBM or choledocholithiasis [36, 37, 38].
The infantile presentation is characterized by obstructive cholestatic syndrome. Jaundice follows an intermittent pattern since the obstruction of the biliary tree is incomplete; unlike cystic biliary atresia, the main differential diagnosis in this age group.
The presentation of acute abdomen secondary to biliary peritonitis due to rupture of the cyst is rare, predominantly in infants (1–2%). Older children and adults with choledochal cyst present biliary or pancreatic symptoms, mainly associated with abdominal pain. The clinic in this age range is given by entities secondary to chronic biliary stasis, manifesting as complications: cholelithiasis (49%), cholangitis (32%), acute pancreatitis (10%), hepatolithiasis (7%), biliary carcinoma (3%), portal hypertension (2%), and chronic pancreatitis (2%) [39, 40, 41, 42, 43]. Fifteen percent of patients with CC may be asymptomatic [36].
On the one hand, some specialized centers in Asia reported direct comparison studies about the clinicopathological differences between children and adults with choledochal cyst. Pediatric patients were more likely to have abdominal mass (52.4% vs. 21.2%) and jaundice (33.3 vs. 0%) compared with adults. Children are more frequently associated with PBM (85.7% vs. 59.6%) and sudden severe stenosis of the terminal common bile duct (76.2% vs. 42.3%). Adults were more likely to have abdominal pain (98% vs. 76.2%), frequently stone disease, and they are more associated with neoplasms (21.2% vs. 21.0%). Malignancy rates are widely reported to be 14–18% [44, 45, 46].
On the other hand, a multi-institutional analysis from eight centers in North America and Europe reported clinical characteristics among children and adults, with mean age at diagnosis of 5 years and 45 years, respectively. Adults had more abdominal pain than children (71.8% vs. 40.7%), and children had more jaundice compared with adults (31.9% vs. 11.6%) [36].
Regarding the symptoms according to the type of cyst, jaundice is observed mainly in type I (56%) and IV cysts. Hepatomegaly, palpable mass and episodes of biliary pancreatitis are more prevalent in type I. Exclusively intrahepatic cysts (type V) present mainly with cholangitis and gallstones [47].
There is no specific marker for choledochal cyst in blood tests, what commonly occur are variations in serum concentrations of amylase, bilirubin, and hepatobiliary enzymes when the patient becomes symptomatic; however, in asymptomatic patients, it can occur or not some variation in blood tests.
Ultrasonography (US) is the initial study when pathology of the bile duct is suspected, the advantage of this study is that it is noninvasive, and in expert hands, it can give a very approximate diagnosis. The main finding in US is dilation of the biliary tract, although it is also useful for evaluating the position of the cyst, the proximal ducts, vascularity, whether there are stones in the bile duct and the characteristics of the liver parenchyma.
A technectium-99 HIDA scan may provide more information if a choledochal cyst is suspected by US, being helpful to distinguish a cyst for biliary atresia.
The abdominal computed tomography (CT) scan can show the bile duct along with intrahepatic and intrapancreatic ducts; it is especially useful to rule out tumors at this level with the disadvantage of exposing the patient to radiation and the difficulty to observe the common channel and the biliopancreatic junction clearly. Therefore, CT cholangiography is more sensitive to assess the biliary tree, it identifies the presence of stones and diagnose the choledochal cyst; with a sensitivity above 90%, but with the risk of generating hepatotoxicity or nephrotoxicity due to the contrast medium [48].
For these reasons, the most recommended study is magnetic resonance cholangiopancreatography (MRCP), which has a sensitivity of 90–100% for diagnosis, with the advantage of not being invasive and not exposing radiation (Figure 3). Some centers even have the possibility of generating 3D images for better visualization. This study allows evaluation of the anatomy of the intrahepatic and extrahepatic bile ducts, the pancreaticobiliary junction, as well as the measurement of the length of the common channel, which is generally >15 mm [49, 50, 51].
Coronal T2 MRCP shows a cystic dilation of the common bile duct (arrow) with preserved intrahepatic bile ducts. The gallbladder (asterisk) and the duodenum (arrowhead) are visualized as well.
Endoscopic retrograde cholangiopancreatography (ERCP) is also a diagnostic option; however, it is not the most common to perform due to its invasive method, although it is very useful, especially in those patients whose clinical and imaging studies are inconclusive. With this study, the path of the common channel, the common bile duct, and the position of the cyst can be assessed. However, ERCP relies on experienced personnel to perform the procedure, with a 10% rate of complications such as pancreatitis, infection, or bleeding. [52].
Intraoperative cholangiography (IOCG), like ERCP, is not indicated as a routine diagnostic method, it is only suggested in exceptional cases where previous studies have not been conclusive.
Medical treatment limits to the administration of antimicrobial therapy in case of cholangitis or supportive therapy in pancreatitis, trying to stabilize the patient prior to operative approach. If rupture of the cyst manifests, a drainage must be placed, pointing out the weirdness of these presentation [53].
Historically, drainage or cystenterostomy was the surgical management, but the high risk of malignant transformation and the recurrence of the symptoms demands aggressive surgical management as the overriding treatment [53, 54].
The prenatal diagnosis of congenital biliary dilatation (CBD) has helped to follow these patients after birth, establishing the ideal time to treat them, if the conditions of the patient allow it, the surgical procedure is recommended at the age of 6 months old. About half of the patients with prenatally diagnosis of CBD are asymptomatic; but if obstructive jaundice, cholangitis, pancreatitis, liver dysfunction, vomiting due to compression of the gastric outlet, or even rupture of the cyst development may be a mandatory earlier surgical exploration, even in the neonatal period [54].
Surgical treatment depends on the CC type. Type I, which is the most common, requires complete cyst excision followed by restoration of the biliary-enteric continuity.
A transverse or oblique incision is the traditional way to reach the hepatic hilum, but the laparoscopic approach (LA) has been increasingly adopted since 1995 when the first successful laparoscopic cyst excision with hepaticojejunostomy (HJ) was performed. A systematic review and update meta-analysis where 1767 patients were enrolled (853 laparoscopic group, 914 open group) reported that the operative time was longer in laparoscopic group, but also less intraoperative bleeding and less intraoperative blood transfusion as well as less time to initial feeding. Length of hospital stay was longer in open group. Short- and long-term postoperative complications were similar in both groups, but the total postoperative morbidity was lower in the laparoscopic group [55].
Minimal invasive robotic-assisted (RA) cyst excision and Roux-en-Y HJ were first reported by Woo in 2006 in a Type I cyst; since then, this practice has gained supporters. In a systematic review and meta-analysis, six studies with 484 patients (307 LA and 177 RA) were analyzed, the results and total complications showed no significant difference between the two groups. [56, 57]. Examination of the data regarding robotic CC excision is needed to determine the utility of this approach in children [53].
The CC transection should be at level of the common hepatic duct to assure a wide anastomosis, a complete excision of the distal portion into the duodenum just above of the pancreatic duct to avoid damage. It is not mandatory to perform IOCG, unless there are no images prior surgery through MRCP; although it is reported that in infants the biliopancreatic junction is very small and can easily go unnoticed during the CC excision. Therefore, if any doubts exist about the situation of the pancreaticobiliary junction, it is recommended to perform IOCG for reducing the risk of injury to the main pancreatic duct.
Some authors practice intraoperative antegrade cholangiography to evaluate also the common channel in all cases because endoscopic retrograde cholangiopancreatography is difficult to perform in early infancy due to the skill required and the potential for complications.
During the transection of the cyst, an adequate view of the hepatic ducts near the dilation is essential to discard stenosis or hypoplasia, which is related to bad prognosis. If protein plugs are present, wash them out by irrigating with saline solution or remove them with a blunt instrument or a pediatric cystoscope (Figure 4) [21, 58].
Intraoperative cystoscopy of the distal portion of the cyst with plug proteins. Level 1 likelihood of leaving residual cyst. Level 2 adequate to perform the transection. Level 3 likelihood of injuring the pancreatic duct.
The biliary reconstruction can be performed through either Roux-en-Y HJ or hepaticoduodenostomy (HD). A systematic review and meta-analysis reported 715 patients, of which 403 (56.3%) were performed a HJ and 312 (43.6%) a HD. Operative time, operative bleeding and length of stay favoring HD, similar rates of complications, including cholangitis. Some disadvantages of the HD are the bile reflux with an estimated incidence of ~5% and require more research and long-term studies [59]. The latest findings in patients followed up by Takada endoscopically demonstrate mild to moderate gastric erosion, but in his study, the development of metaplasia in the stomach [60] is unknown.
A wide Kocher maneuver and a further distal anastomosis in the duodenum have been described to decrease the bile reflux [61]. HD has the advantage to follow through with endoscopic revisions if a late complication is presented, like stenosis of the anastomosis or intrahepatic lithiasis. It is worth to mention that the HD is easier to perform laparoscopically in contrast to the technically challenging HJ. To prevent stenosis of the anastomosis, it is recommended to avoid excessive dissection when dissecting the anterior wall and completely excise ulcerative lesions from the inner wall of the cyst.
A prospective randomized controlled trial describes that a shorter loop Roux-en-Y HJ reconstruction for choledochal cyst is equally effective individualizing the length of the loop based on the distance between the hepatic hilum and the umbilicus, compared with the traditional 40 cm length loop; with no episodes of cholangitis in either group in the following 6 months [62].
Type II is a diverticulum of the bile duct, it is the most infrequent presentation of a CC. Surgical removal through laparoscopic approach with excellent results in the reports, but it is known that long-term follow-up and more clinical reports are needed [63].
Type III is a cystic dilatation of the distal common bile duct within the ampulla of Vater protruding into the duodenum, also called choledochocele. The treatment depends on the type of choledochocele, needing endoscopic transduodenal drainage of the lesion in pure choledochocele and with sphincterotomy and complete excision in diverticular choledochocele. Multiple endoscopic technics have been referred such as balloon dilation after incision of the cyst or stent placement, unroofing by partial snare excision of the cyst wall, or complete resection with a polypectomy snare [64, 65].
Type IVa or IVb CC involves dilatation of both intrahepatic and extrahepatic biliary trees. The standard procedure remains to be a complete excision of the dilated common bile duct and a hepaticoenterostomy. Depending on imaging studies, a hepatic segmentectomy or lobectomy might be needed in case of obstruction or to eradicate the segment with the most dilated intrahepatic cysts.
Major late complications such as pancreatic duct stones, intrahepatic calculi, stenosis might need other interventions such as pylorus-preserving pancreatoduodenectomy or duodenum-preserving pancreatic head resection. And sometimes a liver transplant is the only way to preserve a high quality of life [66].
Type V CC benefits from liver transplantation, a related living donor should be considered in time before the onset of life-threatening complications [66, 67].
The advancement of surgical treatment to include cyst excision has resulted in minimal morbidity and mortality and reduced the number of late complications, compared with past operative treatment of cystenterostomy. The most common short-term outcome in hepaticoenterostomy is anastomotic leakage and as a late complication continues to be anastomotic stricture (2.5–17%) and cholangitis (23–40%) [68, 69, 70, 71].
Perioperative morbidity is higher in adults than children (35.1% vs. 16.3%), requiring more surgical procedures following resection of the common bile duct cyst. However, adults were more likely to have wound, hepatobiliary, or gastrointestinal complications: seromas (3.1%), wound infections (9.7%), and perihepatic abscesses (7.7%). Instead, children had more anastomotic leaks (3%) and gastrointestinal tract perforations (3%) [36].
Early diagnosis and cyst excision result in low complication rates in most experienced centers. The technique of Roux-en-Y HJ is favored by most, although comparable results can be achieved by HD. Anyway, either procedure can be performed laparoscopically as well [68, 69]. In most reports comparing laparoscopic cyst excision with open cyst excision in children, operative time was found to be longer and overall costs higher when laparoscopy was used, but there was significantly less blood loss, and the duration of hospitalization was shorter. There were no significant differences in the incidence of bile leakage or wound infection rates. Although technically challenging and time-consuming, laparoscopic excision imparts less surgical stress on patients than open excision, and parents are generally more satisfied with the smaller scars.
Despite late complications being reduced with current surgical management, studies suggest that long-term follow-up is indicated due to the potential for problems such as anastomotic stricture, cholangitis, intrahepatic stone formation, and malignancy [69, 72]. Malignant degeneration occurs more often in type I and IV cysts and rarely in type II and III. This is particularly important in incompletely resected cystic hepatic ducts or recurrent cysts [46, 73].
Biliary cancer is reported in 5–10% of patients, increasing the incidence greater than 50% in patients over 50 years. The risk of malignancy is greatly reduced after cyst excision but is still elevated as compared with the general population, with an incidence ranging between 2.5 and 28% in adults. Nevertheless, it is reduced between 0.7 and 5.4% after complete surgical excision, with a 95.5% 5-year survival (adults 94.6%; children, 97.2%) [36, 74]. Therefore, lifelong follow-up with ultrasound, liver profile, and CA19–9 levels are recommended annually. Some authors perform biochemical follow with aspartate transaminase and alkaline phosphatase, every 4 months for 2 years; then every 6 months for 5 years [46].
A technectium-99 HIDA scan at 6 and 18 months after surgery can reveal mild episodes of cholangitis in asymptomatic patients or in those with occasional symptoms (less than two episodes per year), requiring only conservative therapy. If cholangitis is recurrent, a reoperation is advocated. In addition, technectium-99 HIDA scan can suggest the presence of anastomotic stricture with delayed flow greater than 60 minutes. However, percutaneous transhepatic cholangiography has still been considered to achieve definitive diagnosis [75].
Anastomotic stricture could occur as a consequence of small, tensive anastomosis, inflammation, or infection. Among the most used options are endoscopic retrograde cholangiopancreatography, percutaneous transhepatic biliary drainage, balloon dilation, and stenting with good results. Some authors pointed out that balloon dilation should be the first step as successful rate was 81%, whereas reoperation was considered as the final choice in all circumstances [69, 76].
Intrahepatic stone formation in the intraoperative setting has been evaluated and reported in the literature and seen in patients who showed no stone formation in the preoperative course. Stone formation has been reported to occur anywhere from 3 to 22 years postoperatively. However, if the duct is patent and there is no stenosis of the hepaticojejunostomy, stones are likely to pass spontaneously [77]. Intrahepatic stones usually present in cases of stenosis that initially cause bile stasis and lead to stone formation.
Todani and colleagues reported a 25-year review with the identification of biliary complications primarily associated with either anastomotic stricture or primary ductal stricture and recommended a wide hepatic hilum anastomosis to prevent biliary complications [78].
Choledochal cyst is a biliary anomaly that is often diagnosed at early age due to the imaging studies that are currently used. A careful and meticulous search can help establish early treatment, before serious sequelae arise.
Although the management of CC is established with acceptable results, a high rate of complications related to surgical procedures is still reported, so it is necessary to acquire an extensive knowledge of the different variants and provide greater technical skills that are acquired with practice to have better results and minimize the number of complications. In the same way, follow-up is necessary to detect the presence of malignancy in time and offer timely treatment.
The authors declare no conflict of interest.
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Although much of the research work has been done on modeling and predicting fouling, it is still a poorly understood phenomenon representing the complexity of its mechanism. The common fouling mitigation action after the onset of fouling is to optimize the operating condition, e.g., increase the bulk flow velocity or decrease surface temperature. However, many quantitative and semi-empirical models have been developed to predict the fouling rate for preventive actions and optimizing cleaning schedules.",book:{id:"11161",title:"Heat Transfer",coverURL:"https://cdn.intechopen.com/books/images_new/11161.jpg"},signatures:"Obaid ur Rehman, Nor Erniza Mohammad Rozali and Marappa Gounder Ramasamy"},{id:"83057",title:"Communication Technologies and Their Contribution to Sustainable Smart Cities",slug:"communication-technologies-and-their-contribution-to-sustainable-smart-cities",totalDownloads:1,totalDimensionsCites:0,doi:"10.5772/intechopen.106223",abstract:"Sustainable smart cities (SSC) are becoming a reality as many develop their unique model of smart cities based on vast communication infrastructure. New technologies led to innovative ecosystems where transportation, logistics, maintenance, etc., are automated and accessed remotely. Information and communication coordinate their overall activities. Sensors embedded in these devices sense the environment to provide the required input. Together with artificial intelligence, machine learning, and deep learning, it enables them to facilitate effective decision-making. This chapter discusses the role of integrating technologies in smart cities, focusing on the information and communication aspects, challenges, limitations, and mitigation strategies related to the infrastructure, implementations, and best practices for attaining SSC. We propose a four-layered model covering the main aspects of incorporating communication technology within sustainable smart cities. It covers the basic physical level, providing guidelines for designing a smart city that supports the requirements of a proper communications infrastructure. The level above is the network level where we describe current communication networks and technologies. The rest two upper layers represent the software with integrated and embedded communication components. In summary, we conclude that communication technology is the key enabler of most of the activities performed in smart cities.",book:{id:"11507",title:"New Generation of Sustainable Smart Cities",coverURL:"https://cdn.intechopen.com/books/images_new/11507.jpg"},signatures:"Menachem Domb"},{id:"83055",title:"Boron Clusters in Biomedical Applications: A Theoretical Viewpoint",slug:"boron-clusters-in-biomedical-applications-a-theoretical-viewpoint",totalDownloads:2,totalDimensionsCites:0,doi:"10.5772/intechopen.106215",abstract:"In this chapter, we presented an analysis of the recent advances in the applications of boron clusters in biomedical fields such as the development of biosensors and drug delivery systems on the basis of quantum chemical calculations. Biosensors play an essential role in many sectors, e.g., law enforcement agencies for sensing illicit drugs, medical communities for detecting overdosed medications from human and animal bodies, etc. The drug delivery systems have theoretically been proposed for many years and subsequently implemented by experiments to deliver the drug to the targeted sites by reducing the harmful side effects significantly. Boron clusters form a rich and colorful family of atomic clusters due to their unconventional structures and bonding phenomena. Boron clusters and their complexes have various biological activities such as the drug delivery, imaging for diagnosis, treatment of cancer, and probe of protein-biomolecular interactions. For all of these reactivities, the interaction mechanisms and the corresponding energetics between biomaterials and boron clusters are of essential importance as a basic step in the understanding, and thereby design of relevant materials. During the past few years, attempts have been made to probe the nature of these interactions using quantum chemical calculations mainly with density functional theory (DFT) methods. This chapter provides a summary of the theoretical viewpoint on this issue.",book:{id:"11762",title:"Characteristics and Applications of Boron",coverURL:"https://cdn.intechopen.com/books/images_new/11762.jpg"},signatures:"Ehsan Shakerzadeh, Elham Tahmasebi, Long Van Duong and Minh Tho Nguyen"}],onlineFirstChaptersTotal:815},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:90,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:107,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:33,numberOfPublishedChapters:330,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:14,numberOfPublishedChapters:145,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:9,numberOfPublishedChapters:140,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:123,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:112,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:22,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:11,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:"2753-6580",doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{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"}}}},{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"}}}}]},series:{item:{id:"11",title:"Biochemistry",doi:"10.5772/intechopen.72877",issn:"2632-0983",scope:"Biochemistry, the study of chemical transformations occurring within living organisms, impacts all areas of life sciences, from molecular crystallography and genetics to ecology, medicine, and population biology. Biochemistry examines macromolecules - proteins, nucleic acids, carbohydrates, and lipids – and their building blocks, structures, functions, and interactions. Much of biochemistry is devoted to enzymes, proteins that catalyze chemical reactions, enzyme structures, mechanisms of action and their roles within cells. Biochemistry also studies small signaling molecules, coenzymes, inhibitors, vitamins, and hormones, which play roles in life processes. Biochemical experimentation, besides coopting classical chemistry methods, e.g., chromatography, adopted new techniques, e.g., X-ray diffraction, electron microscopy, NMR, radioisotopes, and developed sophisticated microbial genetic tools, e.g., auxotroph mutants and their revertants, fermentation, etc. More recently, biochemistry embraced the ‘big data’ omics systems. Initial biochemical studies have been exclusively analytic: dissecting, purifying, and examining individual components of a biological system; in the apt words of Efraim Racker (1913 –1991), “Don’t waste clean thinking on dirty enzymes.” Today, however, biochemistry is becoming more agglomerative and comprehensive, setting out to integrate and describe entirely particular biological systems. The ‘big data’ metabolomics can define the complement of small molecules, e.g., in a soil or biofilm sample; proteomics can distinguish all the comprising proteins, e.g., serum; metagenomics can identify all the genes in a complex environment, e.g., the bovine rumen. This Biochemistry Series will address the current research on biomolecules and the emerging trends with great promise.",coverUrl:"https://cdn.intechopen.com/series/covers/11.jpg",latestPublicationDate:"August 2nd, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:33,editor:{id:"31610",title:"Dr.",name:"Miroslav",middleName:null,surname:"Blumenberg",slug:"miroslav-blumenberg",fullName:"Miroslav Blumenberg",profilePictureURL:"https://mts.intechopen.com/storage/users/31610/images/system/31610.jpg",biography:"Miroslav Blumenberg, Ph.D., was born in Subotica and received his BSc in Belgrade, Yugoslavia. He completed his Ph.D. at MIT in Organic Chemistry; he followed up his Ph.D. with two postdoctoral study periods at Stanford University. Since 1983, he has been a faculty member of the RO Perelman Department of Dermatology, NYU School of Medicine, where he is codirector of a training grant in cutaneous biology. Dr. Blumenberg’s research is focused on the epidermis, expression of keratin genes, transcription profiling, keratinocyte differentiation, inflammatory diseases and cancers, and most recently the effects of the microbiome on the skin. He has published more than 100 peer-reviewed research articles and graduated numerous Ph.D. and postdoctoral students.",institutionString:null,institution:{name:"New York University Langone Medical Center",institutionURL:null,country:{name:"United States of America"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:4,paginationItems:[{id:"14",title:"Cell and Molecular Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/14.jpg",isOpenForSubmission:!0,editor:{id:"165627",title:"Dr.",name:"Rosa María",middleName:null,surname:"Martínez-Espinosa",slug:"rosa-maria-martinez-espinosa",fullName:"Rosa María Martínez-Espinosa",profilePictureURL:"https://mts.intechopen.com/storage/users/165627/images/system/165627.jpeg",biography:"Dr. Rosa María Martínez-Espinosa has been a Spanish Full Professor since 2020 (Biochemistry and Molecular Biology) and is currently Vice-President of International Relations and Cooperation development and leader of the research group 'Applied Biochemistry” (University of Alicante, Spain). Other positions she has held at the university include Vice-Dean of Master Programs, Vice-Dean of the Degree in Biology and Vice-Dean for Mobility and Enterprise and Engagement at the Faculty of Science (University of Alicante). She received her Bachelor in Biology in 1998 (University of Alicante) and her PhD in 2003 (Biochemistry, University of Alicante). She undertook post-doctoral research at the University of East Anglia (Norwich, U.K. 2004-2005; 2007-2008).\nHer multidisciplinary research focuses on investigating archaea and their potential applications in biotechnology. She has an H-index of 21. She has authored one patent and has published more than 70 indexed papers and around 60 book chapters.\nShe has contributed to more than 150 national and international meetings during the last 15 years. Her research interests include archaea metabolism, enzymes purification and characterization, gene regulation, carotenoids and bioplastics production, antioxidant\ncompounds, waste water treatments, and brines bioremediation.\nRosa María’s other roles include editorial board member for several journals related\nto biochemistry, reviewer for more than 60 journals (biochemistry, molecular biology, biotechnology, chemistry and microbiology) and president of several organizing committees in international meetings related to the N-cycle or respiratory processes.",institutionString:null,institution:{name:"University of Alicante",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"15",title:"Chemical Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/15.jpg",isOpenForSubmission:!0,editor:{id:"441442",title:"Dr.",name:"Şükrü",middleName:null,surname:"Beydemir",slug:"sukru-beydemir",fullName:"Şükrü Beydemir",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003GsUoIQAV/Profile_Picture_1634557147521",biography:"Dr. Şükrü Beydemir obtained a BSc in Chemistry in 1995 from Yüzüncü Yıl University, MSc in Biochemistry in 1998, and PhD in Biochemistry in 2002 from Atatürk University, Turkey. He performed post-doctoral studies at Max-Planck Institute, Germany, and University of Florence, Italy in addition to making several scientific visits abroad. He currently works as a Full Professor of Biochemistry in the Faculty of Pharmacy, Anadolu University, Turkey. Dr. Beydemir has published over a hundred scientific papers spanning protein biochemistry, enzymology and medicinal chemistry, reviews, book chapters and presented several conferences to scientists worldwide. He has received numerous publication awards from various international scientific councils. He serves in the Editorial Board of several international journals. Dr. Beydemir is also Rector of Bilecik Şeyh Edebali University, Turkey.",institutionString:null,institution:{name:"Anadolu University",institutionURL:null,country:{name:"Turkey"}}},editorTwo:{id:"13652",title:"Prof.",name:"Deniz",middleName:null,surname:"Ekinci",slug:"deniz-ekinci",fullName:"Deniz Ekinci",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYLT1QAO/Profile_Picture_1634557223079",biography:"Dr. Deniz Ekinci obtained a BSc in Chemistry in 2004, MSc in Biochemistry in 2006, and PhD in Biochemistry in 2009 from Atatürk University, Turkey. He studied at Stetson University, USA, in 2007-2008 and at the Max Planck Institute of Molecular Cell Biology and Genetics, Germany, in 2009-2010. Dr. Ekinci currently works as a Full Professor of Biochemistry in the Faculty of Agriculture and is the Head of the Enzyme and Microbial Biotechnology Division, Ondokuz Mayıs University, Turkey. He is a member of the Turkish Biochemical Society, American Chemical Society, and German Genetics society. Dr. Ekinci published around ninety scientific papers, reviews and book chapters, and presented several conferences to scientists. He has received numerous publication awards from several scientific councils. Dr. Ekinci serves as the Editor in Chief of four international books and is involved in the Editorial Board of several international journals.",institutionString:null,institution:{name:"Ondokuz Mayıs University",institutionURL:null,country:{name:"Turkey"}}},editorThree:null},{id:"17",title:"Metabolism",coverUrl:"https://cdn.intechopen.com/series_topics/covers/17.jpg",isOpenForSubmission:!0,editor:{id:"138626",title:"Dr.",name:"Yannis",middleName:null,surname:"Karamanos",slug:"yannis-karamanos",fullName:"Yannis Karamanos",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002g6Jv2QAE/Profile_Picture_1629356660984",biography:"Yannis Karamanos, born in Greece in 1953, completed his pre-graduate studies at the Université Pierre et Marie Curie, Paris, then his Masters and Doctoral degree at the Université de Lille (1983). He was associate professor at the University of Limoges (1987) before becoming full professor of biochemistry at the Université d’Artois (1996). He worked on the structure-function relationships of glycoconjugates and his main project was the investigations on the biological roles of the de-N-glycosylation enzymes (Endo-N-acetyl-β-D-glucosaminidase and peptide-N4-(N-acetyl-β-glucosaminyl) asparagine amidase). From 2002 he contributes to the understanding of the Blood-brain barrier functioning using proteomics approaches. He has published more than 70 papers. His teaching areas are energy metabolism and regulation, integration and organ specialization and metabolic adaptation.",institutionString:null,institution:{name:"Artois University",institutionURL:null,country:{name:"France"}}},editorTwo:null,editorThree:null},{id:"18",title:"Proteomics",coverUrl:"https://cdn.intechopen.com/series_topics/covers/18.jpg",isOpenForSubmission:!0,editor:{id:"200689",title:"Prof.",name:"Paolo",middleName:null,surname:"Iadarola",slug:"paolo-iadarola",fullName:"Paolo Iadarola",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSCl8QAG/Profile_Picture_1623568118342",biography:"Paolo Iadarola graduated with a degree in Chemistry from the University of Pavia (Italy) in July 1972. He then worked as an Assistant Professor at the Faculty of Science of the same University until 1984. In 1985, Prof. Iadarola became Associate Professor at the Department of Biology and Biotechnologies of the University of Pavia and retired in October 2017. Since then, he has been working as an Adjunct Professor in the same Department at the University of Pavia. His research activity during the first years was primarily focused on the purification and structural characterization of enzymes from animal and plant sources. During this period, Prof. Iadarola familiarized himself with the conventional techniques used in column chromatography, spectrophotometry, manual Edman degradation, and electrophoresis). Since 1995, he has been working on: i) the determination in biological fluids (serum, urine, bronchoalveolar lavage, sputum) of proteolytic activities involved in the degradation processes of connective tissue matrix, and ii) on the identification of biological markers of lung diseases. In this context, he has developed and validated new methodologies (e.g., Capillary Electrophoresis coupled to Laser-Induced Fluorescence, CE-LIF) whose application enabled him to determine both the amounts of biochemical markers (Desmosines) in urine/serum of patients affected by Chronic Obstructive Pulmonary Disease (COPD) and the activity of proteolytic enzymes (Human Neutrophil Elastase, Cathepsin G, Pseudomonas aeruginosa elastase) in sputa of these patients. More recently, Prof. Iadarola was involved in developing techniques such as two-dimensional electrophoresis coupled to liquid chromatography/mass spectrometry (2DE-LC/MS) for the proteomic analysis of biological fluids aimed at the identification of potential biomarkers of different lung diseases. He is the author of about 150 publications (According to Scopus: H-Index: 23; Total citations: 1568- According to WOS: H-Index: 20; Total Citations: 1296) of peer-reviewed international journals. He is a Consultant Reviewer for several journals, including the Journal of Chromatography A, Journal of Chromatography B, Plos ONE, Proteomes, International Journal of Molecular Science, Biotech, Electrophoresis, and others. He is also Associate Editor of Biotech.",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorTwo:{id:"201414",title:"Dr.",name:"Simona",middleName:null,surname:"Viglio",slug:"simona-viglio",fullName:"Simona Viglio",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRKDHQA4/Profile_Picture_1630402531487",biography:"Simona Viglio is an Associate Professor of Biochemistry at the Department of Molecular Medicine at the University of Pavia. She has been working since 1995 on the determination of proteolytic enzymes involved in the degradation process of connective tissue matrix and on the identification of biological markers of lung diseases. She gained considerable experience in developing and validating new methodologies whose applications allowed her to determine both the amount of biomarkers (Desmosine and Isodesmosine) in the urine of patients affected by COPD, and the activity of proteolytic enzymes (HNE, Cathepsin G, Pseudomonas aeruginosa elastase) in the sputa of these patients. Simona Viglio was also involved in research dealing with the supplementation of amino acids in patients with brain injury and chronic heart failure. She is presently engaged in the development of 2-DE and LC-MS techniques for the study of proteomics in biological fluids. The aim of this research is the identification of potential biomarkers of lung diseases. She is an author of about 90 publications (According to Scopus: H-Index: 23; According to WOS: H-Index: 20) on peer-reviewed journals, a member of the “Società Italiana di Biochimica e Biologia Molecolare,“ and a Consultant Reviewer for International Journal of Molecular Science, Journal of Chromatography A, COPD, Plos ONE and Nutritional Neuroscience.",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorThree:null}]},overviewPageOFChapters:{paginationCount:42,paginationItems:[{id:"82914",title:"Glance on the Critical Role of IL-23 Receptor Gene Variations in Inflammation-Induced Carcinogenesis",doi:"10.5772/intechopen.105049",signatures:"Mohammed El-Gedamy",slug:"glance-on-the-critical-role-of-il-23-receptor-gene-variations-in-inflammation-induced-carcinogenesis",totalDownloads:12,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Chemokines Updates",coverURL:"https://cdn.intechopen.com/books/images_new/11672.jpg",subseries:{id:"18",title:"Proteomics"}}},{id:"82875",title:"Lipidomics as a Tool in the Diagnosis and Clinical Therapy",doi:"10.5772/intechopen.105857",signatures:"María Elizbeth Alvarez Sánchez, Erick Nolasco Ontiveros, Rodrigo Arreola, Adriana Montserrat Espinosa González, Ana María García Bores, Roberto Eduardo López Urrutia, Ignacio Peñalosa Castro, María del Socorro Sánchez Correa and Edgar Antonio Estrella Parra",slug:"lipidomics-as-a-tool-in-the-diagnosis-and-clinical-therapy",totalDownloads:7,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Fatty Acids - Recent Advances",coverURL:"https://cdn.intechopen.com/books/images_new/11669.jpg",subseries:{id:"17",title:"Metabolism"}}},{id:"82440",title:"Lipid Metabolism and Associated Molecular Signaling Events in Autoimmune Disease",doi:"10.5772/intechopen.105746",signatures:"Mohan Vanditha, Sonu Das and Mathew John",slug:"lipid-metabolism-and-associated-molecular-signaling-events-in-autoimmune-disease",totalDownloads:17,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Fatty Acids - Recent Advances",coverURL:"https://cdn.intechopen.com/books/images_new/11669.jpg",subseries:{id:"17",title:"Metabolism"}}},{id:"82483",title:"Oxidative Stress in Cardiovascular Diseases",doi:"10.5772/intechopen.105891",signatures:"Laura Mourino-Alvarez, Tamara Sastre-Oliva, Nerea Corbacho-Alonso and Maria G. Barderas",slug:"oxidative-stress-in-cardiovascular-diseases",totalDownloads:10,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Importance of Oxidative Stress and Antioxidant System in Health and Disease",coverURL:"https://cdn.intechopen.com/books/images_new/11671.jpg",subseries:{id:"15",title:"Chemical Biology"}}}]},overviewPagePublishedBooks:{paginationCount:33,paginationItems:[{type:"book",id:"7006",title:"Biochemistry and Health Benefits of Fatty Acids",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7006.jpg",slug:"biochemistry-and-health-benefits-of-fatty-acids",publishedDate:"December 19th 2018",editedByType:"Edited by",bookSignature:"Viduranga Waisundara",hash:"c93a00abd68b5eba67e5e719f67fd20b",volumeInSeries:1,fullTitle:"Biochemistry and Health Benefits of Fatty Acids",editors:[{id:"194281",title:"Dr.",name:"Viduranga Y.",middleName:null,surname:"Waisundara",slug:"viduranga-y.-waisundara",fullName:"Viduranga Y. Waisundara",profilePictureURL:"https://mts.intechopen.com/storage/users/194281/images/system/194281.jpg",biography:"Dr. Viduranga Waisundara obtained her Ph.D. in Food Science\nand Technology from the Department of Chemistry, National\nUniversity of Singapore, in 2010. She was a lecturer at Temasek Polytechnic, Singapore from July 2009 to March 2013.\nShe relocated to her motherland of Sri Lanka and spearheaded the Functional Food Product Development Project at the\nNational Institute of Fundamental Studies from April 2013 to\nOctober 2016. She was a senior lecturer on a temporary basis at the Department of\nFood Technology, Faculty of Technology, Rajarata University of Sri Lanka. She is\ncurrently Deputy Principal of the Australian College of Business and Technology –\nKandy Campus, Sri Lanka. She is also the Global Harmonization Initiative (GHI)",institutionString:"Australian College of Business & Technology",institution:{name:"Kobe College",institutionURL:null,country:{name:"Japan"}}}]},{type:"book",id:"6820",title:"Keratin",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/6820.jpg",slug:"keratin",publishedDate:"December 19th 2018",editedByType:"Edited by",bookSignature:"Miroslav Blumenberg",hash:"6def75cd4b6b5324a02b6dc0359896d0",volumeInSeries:2,fullTitle:"Keratin",editors:[{id:"31610",title:"Dr.",name:"Miroslav",middleName:null,surname:"Blumenberg",slug:"miroslav-blumenberg",fullName:"Miroslav Blumenberg",profilePictureURL:"https://mts.intechopen.com/storage/users/31610/images/system/31610.jpg",biography:"Miroslav Blumenberg, Ph.D., was born in Subotica and received his BSc in Belgrade, Yugoslavia. He completed his Ph.D. at MIT in Organic Chemistry; he followed up his Ph.D. with two postdoctoral study periods at Stanford University. Since 1983, he has been a faculty member of the RO Perelman Department of Dermatology, NYU School of Medicine, where he is codirector of a training grant in cutaneous biology. Dr. Blumenberg’s research is focused on the epidermis, expression of keratin genes, transcription profiling, keratinocyte differentiation, inflammatory diseases and cancers, and most recently the effects of the microbiome on the skin. He has published more than 100 peer-reviewed research articles and graduated numerous Ph.D. and postdoctoral students.",institutionString:null,institution:{name:"New York University Langone Medical Center",institutionURL:null,country:{name:"United States of America"}}}]},{type:"book",id:"7978",title:"Vitamin A",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7978.jpg",slug:"vitamin-a",publishedDate:"May 15th 2019",editedByType:"Edited by",bookSignature:"Leila Queiroz Zepka, Veridiana Vera de Rosso and Eduardo Jacob-Lopes",hash:"dad04a658ab9e3d851d23705980a688b",volumeInSeries:3,fullTitle:"Vitamin A",editors:[{id:"261969",title:"Dr.",name:"Leila",middleName:null,surname:"Queiroz Zepka",slug:"leila-queiroz-zepka",fullName:"Leila Queiroz Zepka",profilePictureURL:"https://mts.intechopen.com/storage/users/261969/images/system/261969.png",biography:"Prof. Dr. Leila Queiroz Zepka is currently an associate professor in the Department of Food Technology and Science, Federal University of Santa Maria, Brazil. She has more than fifteen years of teaching and research experience. She has published more than 550 scientific publications/communications, including 15 books, 50 book chapters, 100 original research papers, 380 research communications in national and international conferences, and 12 patents. She is a member of the editorial board of five journals and acts as a reviewer for several national and international journals. 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The preliminary objectives of the study are to understand and develop the evidence-based tools and interventions for the control and prevention of malaria in different sites of the INDIA. Alongside, with the help of next-generation genomics study, the team has studied the antimalarial drug resistance in India. Further, he has extended his research in the development of Humanized mice for the study of liver-stage malaria and identification of molecular marker(s) for the Artemisinin resistance. At present, his research focuses on understanding the role of B cells in the activation of CD8+ T cells in malaria. Received the CSIR-SRF (Senior Research Fellow) award-2018, FIMSA (Federation of Immunological Societies of Asia-Oceania) Travel Bursary award to attend the IUIS-IIS-FIMSA Immunology course-2019',institutionString:"Nirma University",institution:{name:"Nirma University",country:{name:"India"}}},{id:"334383",title:"Ph.D.",name:"Simone",middleName:"Ulrich",surname:"Ulrich Picoli",slug:"simone-ulrich-picoli",fullName:"Simone Ulrich Picoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334383/images/15919_n.jpg",biography:"Graduated in Pharmacy from Universidade Luterana do Brasil (1999), Master in Agricultural and Environmental Microbiology from Federal University of Rio Grande do Sul (2002), Specialization in Clinical Microbiology from Universidade de São Paulo, USP (2007) and PhD in Sciences in Gastroenterology and Hepatology (2012). She is currently an Adjunct Professor at Feevale University in Medicine and Biomedicine courses and a permanent professor of the Academic Master\\'s Degree in Virology. She has experience in the field of Microbiology, with an emphasis on Bacteriology, working mainly on the following topics: bacteriophages, bacterial resistance, clinical microbiology and food microbiology.",institutionString:null,institution:{name:"Universidade Feevale",country:{name:"Brazil"}}},{id:"229220",title:"Dr.",name:"Amjad",middleName:"Islam",surname:"Aqib",slug:"amjad-aqib",fullName:"Amjad Aqib",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229220/images/system/229220.png",biography:"Dr. Amjad Islam Aqib obtained a DVM and MSc (Hons) from University of Agriculture Faisalabad (UAF), Pakistan, and a PhD from the University of Veterinary and Animal Sciences Lahore, Pakistan. Dr. Aqib joined the Department of Clinical Medicine and Surgery at UAF for one year as an assistant professor where he developed a research laboratory designated for pathogenic bacteria. Since 2018, he has been Assistant Professor/Officer in-charge, Department of Medicine, Manager Research Operations and Development-ORIC, and President One Health Club at Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan. He has nearly 100 publications to his credit. His research interests include epidemiological patterns and molecular analysis of antimicrobial resistance and modulation and vaccine development against animal pathogens of public health concern.",institutionString:"Cholistan University of Veterinary and Animal Sciences",institution:{name:"University of Agriculture Faisalabad",country:{name:"Pakistan"}}},{id:"333753",title:"Dr.",name:"Rais",middleName:null,surname:"Ahmed",slug:"rais-ahmed",fullName:"Rais Ahmed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333753/images/20168_n.jpg",biography:null,institutionString:null,institution:{name:"University of Agriculture Faisalabad",country:{name:"Pakistan"}}},{id:"62900",title:"Prof.",name:"Fethi",middleName:null,surname:"Derbel",slug:"fethi-derbel",fullName:"Fethi Derbel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/62900/images/system/62900.jpeg",biography:"Professor Fethi Derbel was born in 1960 in Tunisia. He received his medical degree from the Sousse Faculty of Medicine at Sousse, University of Sousse, Tunisia. He completed his surgical residency in General Surgery at the University Hospital Farhat Hached of Sousse and was a member of the Unit of Liver Transplantation in the University of Rennes, France. He then worked in the Department of Surgery at the Sahloul University Hospital in Sousse. Professor Derbel is presently working at the Clinique les Oliviers, Sousse, Tunisia. His hospital activities are mostly concerned with laparoscopic, colorectal, pancreatic, hepatobiliary, and gastric surgery. He is also very interested in hernia surgery and performs ventral hernia repairs and inguinal hernia repairs. He has been a member of the GREPA and Tunisian Hernia Society (THS). During his residency, he managed patients suffering from diabetic foot, and he was very interested in this pathology. For this reason, he decided to coordinate a book project dealing with the diabetic foot. Professor Derbel has published many articles in journals and collaborates intensively with IntechOpen Access Publisher as an editor.",institutionString:"Clinique les Oliviers",institution:null},{id:"300144",title:"Dr.",name:"Meriem",middleName:null,surname:"Braiki",slug:"meriem-braiki",fullName:"Meriem Braiki",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/300144/images/system/300144.jpg",biography:"Dr. Meriem Braiki is a specialist in pediatric surgeon from Tunisia. She was born in 1985. She received her medical degree from the University of Medicine at Sousse, Tunisia. She achieved her surgical residency training periods in Pediatric Surgery departments at University Hospitals in Monastir, Tunis and France.\r\nShe is currently working at the Pediatric surgery department, Sidi Bouzid Hospital, Tunisia. Her hospital activities are mostly concerned with laparoscopic, parietal, urological and digestive surgery. She has published several articles in diffrent journals.",institutionString:"Sidi Bouzid Regional Hospital",institution:null},{id:"229481",title:"Dr.",name:"Erika M.",middleName:"Martins",surname:"de Carvalho",slug:"erika-m.-de-carvalho",fullName:"Erika M. de Carvalho",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229481/images/6397_n.jpg",biography:null,institutionString:null,institution:{name:"Oswaldo Cruz Foundation",country:{name:"Brazil"}}},{id:"186537",title:"Prof.",name:"Tonay",middleName:null,surname:"Inceboz",slug:"tonay-inceboz",fullName:"Tonay Inceboz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/186537/images/system/186537.jfif",biography:"I was graduated from Ege University of Medical Faculty (Turkey) in 1988 and completed his Med. PhD degree in Medical Parasitology at the same university. I became an Associate Professor in 2008 and Professor in 2014. I am currently working as a Professor at the Department of Medical Parasitology at Dokuz Eylul University, Izmir, Turkey.\n\nI have given many lectures, presentations in different academic meetings. I have more than 60 articles in peer-reviewed journals, 18 book chapters, 1 book editorship.\n\nMy research interests are Echinococcus granulosus, Echinococcus multilocularis (diagnosis, life cycle, in vitro and in vivo cultivation), and Trichomonas vaginalis (diagnosis, PCR, and in vitro cultivation).",institutionString:"Dokuz Eylül University",institution:{name:"Dokuz Eylül University",country:{name:"Turkey"}}},{id:"71812",title:"Prof.",name:"Hanem Fathy",middleName:"Fathy",surname:"Khater",slug:"hanem-fathy-khater",fullName:"Hanem Fathy Khater",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/71812/images/1167_n.jpg",biography:"Prof. Khater is a Professor of Parasitology at Benha University, Egypt. She studied for her doctoral degree, at the Department of Entomology, College of Agriculture, Food and Natural Resources, University of Missouri, Columbia, USA. She has completed her Ph.D. degrees in Parasitology in Egypt, from where she got the award for “the best scientific Ph.D. dissertation”. She worked at the School of Biological Sciences, Bristol, England, the UK in controlling insects of medical and veterinary importance as a grant from Newton Mosharafa, the British Council. Her research is focused on searching of pesticides against mosquitoes, house flies, lice, green bottle fly, camel nasal botfly, soft and hard ticks, mites, and the diamondback moth as well as control of several parasites using safe and natural materials to avoid drug resistances and environmental contamination.",institutionString:null,institution:{name:"Banha University",country:{name:"Egypt"}}},{id:"99780",title:"Prof.",name:"Omolade",middleName:"Olayinka",surname:"Okwa",slug:"omolade-okwa",fullName:"Omolade Okwa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/99780/images/system/99780.jpg",biography:"Omolade Olayinka Okwa is presently a Professor of Parasitology at Lagos State University, Nigeria. She has a PhD in Parasitology (1997), an MSc in Cellular Parasitology (1992), and a BSc (Hons) Zoology (1990) all from the University of Ibadan, Nigeria. She teaches parasitology at the undergraduate and postgraduate levels. She was a recipient of a Commonwealth fellowship supported by British Council tenable at the Centre for Entomology and Parasitology (CAEP), Keele University, United Kingdom between 2004 and 2005. She was awarded an Honorary Visiting Research Fellow at the same university from 2005 to 2007. \nShe has been an external examiner to the Department of Veterinary Microbiology and Parasitology, University of Ibadan, MSc programme between 2010 and 2012. She is a member of the Nigerian Society of Experimental Biology (NISEB), Parasitology and Public Health Society of Nigeria (PPSN), Science Association of Nigeria (SAN), Zoological Society of Nigeria (ZSN), and is Vice Chairperson of the Organisation of Women in Science (OWSG), LASU chapter. She served as Head of Department of Zoology and Environmental Biology, Lagos State University from 2007 to 2010 and 2014 to 2016. She is a reviewer for several local and international journals such as Unilag Journal of Science, Libyan Journal of Medicine, Journal of Medicine and Medical Sciences, and Annual Research and Review in Science. \nShe has authored 45 scientific research publications in local and international journals, 8 scientific reviews, 4 books, and 3 book chapters, which includes the books “Malaria Parasites” and “Malaria” which are IntechOpen access publications.",institutionString:"Lagos State University",institution:{name:"Lagos State University",country:{name:"Nigeria"}}},{id:"273100",title:"Dr.",name:"Vijay",middleName:null,surname:"Gayam",slug:"vijay-gayam",fullName:"Vijay Gayam",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/273100/images/system/273100.jpeg",biography:"Dr. Vijay Bhaskar Reddy Gayam is currently practicing as an internist at Interfaith Medical Center in Brooklyn, New York, USA. He is also a Clinical Assistant Professor at the SUNY Downstate University Hospital and Adjunct Professor of Medicine at the American University of Antigua. He is a holder of an M.B.B.S. degree bestowed to him by Osmania Medical College and received his M.D. at Interfaith Medical Center. His career goals thus far have heavily focused on direct patient care, medical education, and clinical research. He currently serves in two leadership capacities; Assistant Program Director of Medicine at Interfaith Medical Center and as a Councilor for the American\r\nFederation for Medical Research. As a true academician and researcher, he has more than 50 papers indexed in international peer-reviewed journals. He has also presented numerous papers in multiple national and international scientific conferences. His areas of research interest include general internal medicine, gastroenterology and hepatology. He serves as an editor, editorial board member and reviewer for multiple international journals. His research on Hepatitis C has been very successful and has led to multiple research awards, including the 'Equity in Prevention and Treatment Award” from the New York Department of Health Viral Hepatitis Symposium (2018) and the 'Presidential Poster Award” awarded to him by the American College of Gastroenterology (2018). He was also awarded 'Outstanding Clinician in General Medicine” by Venus International Foundation for his extensive research expertise and services, perform over and above the standard expected in the advancement of healthcare, patient safety and quality of care.",institutionString:"Interfaith Medical Center",institution:{name:"Interfaith Medical Center",country:{name:"United States of America"}}},{id:"93517",title:"Dr.",name:"Clement",middleName:"Adebajo",surname:"Meseko",slug:"clement-meseko",fullName:"Clement Meseko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/93517/images/system/93517.jpg",biography:"Dr. Clement Meseko obtained DVM and PhD degree in Veterinary Medicine and Virology respectively. He has worked for over 20 years in both private and public sectors including the academia, contributing to knowledge and control of infectious disease. Through the application of epidemiological skill, classical and molecular virological skills, he investigates viruses of economic and public health importance for the mitigation of the negative impact on people, animal and the environment in the context of Onehealth. \r\nDr. Meseko’s field experience on animal and zoonotic diseases and pathogen dynamics at the human-animal interface over the years shaped his carrier in research and scientific inquiries. He has been part of the investigation of Highly Pathogenic Avian Influenza incursions in sub Saharan Africa and monitors swine Influenza (Pandemic influenza Virus) agro-ecology and potential for interspecies transmission. He has authored and reviewed a number of journal articles and book chapters.",institutionString:"National Veterinary Research Institute",institution:{name:"National Veterinary Research Institute",country:{name:"Nigeria"}}},{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRET3QAO/Profile_Picture_2022-05-10T10:10:26.jpeg",biography:"Professor Dr. Shailendra K. Saxena is a vice dean and professor at King George's Medical University, Lucknow, India. His research interests involve understanding the molecular mechanisms of host defense during human viral infections and developing new predictive, preventive, and therapeutic strategies for them using Japanese encephalitis virus (JEV), HIV, and emerging viruses as a model via stem cell and cell culture technologies. His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. Dr. Saxena is a fellow of various international societies/academies including the Royal College of Pathologists, United Kingdom; Royal Society of Medicine, London; Royal Society of Biology, United Kingdom; Royal Society of Chemistry, London; and Academy of Translational Medicine Professionals, Austria. He was named a Global Leader in Science by The Scientist. He is also an international opinion leader/expert in vaccination for Japanese encephalitis by IPIC (UK).",institutionString:"King George's Medical University",institution:{name:"King George's Medical University",country:{name:"India"}}},{id:"94928",title:"Dr.",name:"Takuo",middleName:null,surname:"Mizukami",slug:"takuo-mizukami",fullName:"Takuo Mizukami",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94928/images/6402_n.jpg",biography:null,institutionString:null,institution:{name:"National Institute of Infectious Diseases",country:{name:"Japan"}}},{id:"233433",title:"Dr.",name:"Yulia",middleName:null,surname:"Desheva",slug:"yulia-desheva",fullName:"Yulia Desheva",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/233433/images/system/233433.png",biography:"Dr. Yulia Desheva is a leading researcher at the Institute of Experimental Medicine, St. Petersburg, Russia. She is a professor in the Stomatology Faculty, St. Petersburg State University. She has expertise in the development and evaluation of a wide range of live mucosal vaccines against influenza and bacterial complications. Her research interests include immunity against influenza and COVID-19 and the development of immunization schemes for high-risk individuals.",institutionString:'Federal State Budgetary Scientific Institution "Institute of Experimental Medicine"',institution:null},{id:"238958",title:"Mr.",name:"Atamjit",middleName:null,surname:"Singh",slug:"atamjit-singh",fullName:"Atamjit Singh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/238958/images/6575_n.jpg",biography:null,institutionString:null,institution:null},{id:"252058",title:"M.Sc.",name:"Juan",middleName:null,surname:"Sulca",slug:"juan-sulca",fullName:"Juan Sulca",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252058/images/12834_n.jpg",biography:null,institutionString:null,institution:null},{id:"191392",title:"Dr.",name:"Marimuthu",middleName:null,surname:"Govindarajan",slug:"marimuthu-govindarajan",fullName:"Marimuthu Govindarajan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/191392/images/5828_n.jpg",biography:"Dr. M. Govindarajan completed his BSc degree in Zoology at Government Arts College (Autonomous), Kumbakonam, and MSc, MPhil, and PhD degrees at Annamalai University, Annamalai Nagar, Tamil Nadu, India. He is serving as an assistant professor at the Department of Zoology, Annamalai University. His research interests include isolation, identification, and characterization of biologically active molecules from plants and microbes. He has identified more than 20 pure compounds with high mosquitocidal activity and also conducted high-quality research on photochemistry and nanosynthesis. He has published more than 150 studies in journals with impact factor and 2 books in Lambert Academic Publishing, Germany. He serves as an editorial board member in various national and international scientific journals.",institutionString:null,institution:null},{id:"274660",title:"Dr.",name:"Damodar",middleName:null,surname:"Paudel",slug:"damodar-paudel",fullName:"Damodar Paudel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/274660/images/8176_n.jpg",biography:"I am DrDamodar Paudel,currently working as consultant Physician in Nepal police Hospital.",institutionString:null,institution:null},{id:"241562",title:"Dr.",name:"Melvin",middleName:null,surname:"Sanicas",slug:"melvin-sanicas",fullName:"Melvin Sanicas",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/241562/images/6699_n.jpg",biography:null,institutionString:null,institution:null},{id:"117248",title:"Dr.",name:"Andrew",middleName:null,surname:"Macnab",slug:"andrew-macnab",fullName:"Andrew Macnab",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of British Columbia",country:{name:"Canada"}}},{id:"322007",title:"Dr.",name:"Maria Elizbeth",middleName:null,surname:"Alvarez-Sánchez",slug:"maria-elizbeth-alvarez-sanchez",fullName:"Maria Elizbeth Alvarez-Sánchez",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Universidad Autónoma de la Ciudad de México",country:{name:"Mexico"}}},{id:"337443",title:"Dr.",name:"Juan",middleName:null,surname:"A. Gonzalez-Sanchez",slug:"juan-a.-gonzalez-sanchez",fullName:"Juan A. Gonzalez-Sanchez",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Puerto Rico System",country:{name:"United States of America"}}},{id:"337446",title:"Dr.",name:"Maria",middleName:null,surname:"Zavala-Colon",slug:"maria-zavala-colon",fullName:"Maria Zavala-Colon",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Puerto Rico, Medical Sciences Campus",country:{name:"United States of America"}}}]}},subseries:{item:{id:"26",type:"subseries",title:"Machine Learning and Data Mining",keywords:"Intelligent Systems, Machine Learning, Data Science, Data Mining, Artificial Intelligence",scope:"The scope of machine learning and data mining is immense and is growing every day. It has become a massive part of our daily lives, making predictions based on experience, making this a fascinating area that solves problems that otherwise would not be possible or easy to solve. This topic aims to encompass algorithms that learn from experience (supervised and unsupervised), improve their performance over time and enable machines to make data-driven decisions. It is not limited to any particular applications, but contributions are encouraged from all disciplines.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/26.jpg",hasOnlineFirst:!0,hasPublishedBooks:!0,annualVolume:11422,editor:{id:"24555",title:"Dr.",name:"Marco Antonio",middleName:null,surname:"Aceves Fernandez",slug:"marco-antonio-aceves-fernandez",fullName:"Marco Antonio Aceves Fernandez",profilePictureURL:"https://mts.intechopen.com/storage/users/24555/images/system/24555.jpg",biography:"Dr. Marco Antonio Aceves Fernandez obtained his B.Sc. (Eng.) in Telematics from the Universidad de Colima, Mexico. He obtained both his M.Sc. and Ph.D. from the University of Liverpool, England, in the field of Intelligent Systems. He is a full professor at the Universidad Autonoma de Queretaro, Mexico, and a member of the National System of Researchers (SNI) since 2009. Dr. Aceves Fernandez has published more than 80 research papers as well as a number of book chapters and congress papers. He has contributed in more than 20 funded research projects, both academic and industrial, in the area of artificial intelligence, ranging from environmental, biomedical, automotive, aviation, consumer, and robotics to other applications. He is also a honorary president at the National Association of Embedded Systems (AMESE), a senior member of the IEEE, and a board member of many institutions. His research interests include intelligent and embedded systems.",institutionString:"Universidad Autonoma de Queretaro",institution:{name:"Autonomous University of Queretaro",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null,series:{id:"14",title:"Artificial Intelligence",doi:"10.5772/intechopen.79920",issn:"2633-1403"},editorialBoard:[{id:"43680",title:"Prof.",name:"Ciza",middleName:null,surname:"Thomas",slug:"ciza-thomas",fullName:"Ciza Thomas",profilePictureURL:"https://mts.intechopen.com/storage/users/43680/images/system/43680.jpeg",institutionString:null,institution:{name:"Government of Kerala",institutionURL:null,country:{name:"India"}}},{id:"16614",title:"Prof.",name:"Juan Ignacio",middleName:null,surname:"Guerrero Alonso",slug:"juan-ignacio-guerrero-alonso",fullName:"Juan Ignacio Guerrero Alonso",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002g6HB8QAM/Profile_Picture_1627901127555",institutionString:null,institution:{name:"University of Seville",institutionURL:null,country:{name:"Spain"}}},{id:"3095",title:"Prof.",name:"Kenji",middleName:null,surname:"Suzuki",slug:"kenji-suzuki",fullName:"Kenji Suzuki",profilePictureURL:"https://mts.intechopen.com/storage/users/3095/images/1592_n.jpg",institutionString:null,institution:{name:"University of Chicago",institutionURL:null,country:{name:"United States of America"}}},{id:"214067",title:"Dr.",name:"W. 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Possible contributions can address (but are not limited to) the following research topics: Bioinspired design and control of exoskeletons, orthoses, and prostheses; Experimental evaluation of the effect of assistive devices (e.g., influence on gait, balance, and neuromuscular system); Bioinspired technologies for rehabilitation, including clinical studies reporting evaluations; Application of neuromuscular and biomechanical models to the development of bioinspired technology.',annualVolume:11404,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/8.jpg",editor:{id:"144937",title:"Prof.",name:"Adriano",middleName:"De Oliveira",surname:"Andrade",fullName:"Adriano Andrade",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRC8QQAW/Profile_Picture_1625219101815",institutionString:null,institution:{name:"Federal University of Uberlândia",institutionURL:null,country:{name:"Brazil"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"49517",title:"Prof.",name:"Hitoshi",middleName:null,surname:"Tsunashima",fullName:"Hitoshi Tsunashima",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYTP4QAO/Profile_Picture_1625819726528",institutionString:null,institution:{name:"Nihon University",institutionURL:null,country:{name:"Japan"}}},{id:"425354",title:"Dr.",name:"Marcus",middleName:"Fraga",surname:"Vieira",fullName:"Marcus Vieira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003BJSgIQAX/Profile_Picture_1627904687309",institutionString:null,institution:{name:"Universidade Federal de Goiás",institutionURL:null,country:{name:"Brazil"}}},{id:"196746",title:"Dr.",name:"Ramana",middleName:null,surname:"Vinjamuri",fullName:"Ramana Vinjamuri",profilePictureURL:"https://mts.intechopen.com/storage/users/196746/images/system/196746.jpeg",institutionString:"University of Maryland, Baltimore County",institution:{name:"University of Maryland, Baltimore County",institutionURL:null,country:{name:"United States of America"}}}]},{id:"9",title:"Biotechnology - Biosensors, Biomaterials and Tissue Engineering",keywords:"Biotechnology, Biosensors, Biomaterials, Tissue Engineering",scope:"The Biotechnology - Biosensors, Biomaterials and Tissue Engineering topic within the Biomedical Engineering Series aims to rapidly publish contributions on all aspects of biotechnology, biosensors, biomaterial and tissue engineering. We encourage the submission of manuscripts that provide novel and mechanistic insights that report significant advances in the fields. Topics can include but are not limited to: Biotechnology such as biotechnological products and process engineering; Biotechnologically relevant enzymes and proteins; Bioenergy and biofuels; Applied genetics and molecular biotechnology; Genomics, transcriptomics, proteomics; Applied microbial and cell physiology; Environmental biotechnology; Methods and protocols. Moreover, topics in biosensor technology, like sensors that incorporate enzymes, antibodies, nucleic acids, whole cells, tissues and organelles, and other biological or biologically inspired components will be considered, and topics exploring transducers, including those based on electrochemical and optical piezoelectric, thermal, magnetic, and micromechanical elements. Chapters exploring biomaterial approaches such as polymer synthesis and characterization, drug and gene vector design, biocompatibility, immunology and toxicology, and self-assembly at the nanoscale, are welcome. Finally, the tissue engineering subcategory will support topics such as the fundamentals of stem cells and progenitor cells and their proliferation, differentiation, bioreactors for three-dimensional culture and studies of phenotypic changes, stem and progenitor cells, both short and long term, ex vivo and in vivo implantation both in preclinical models and also in clinical trials.",annualVolume:11405,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/9.jpg",editor:{id:"126286",title:"Dr.",name:"Luis",middleName:"Jesús",surname:"Villarreal-Gómez",fullName:"Luis Villarreal-Gómez",profilePictureURL:"https://mts.intechopen.com/storage/users/126286/images/system/126286.jpg",institutionString:null,institution:{name:"Autonomous University of Baja California",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"35539",title:"Dr.",name:"Cecilia",middleName:null,surname:"Cristea",fullName:"Cecilia Cristea",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYQ65QAG/Profile_Picture_1621007741527",institutionString:null,institution:{name:"Iuliu Hațieganu University of Medicine and Pharmacy",institutionURL:null,country:{name:"Romania"}}},{id:"40735",title:"Dr.",name:"Gil",middleName:"Alberto Batista",surname:"Gonçalves",fullName:"Gil Gonçalves",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYRLGQA4/Profile_Picture_1628492612759",institutionString:null,institution:{name:"University of Aveiro",institutionURL:null,country:{name:"Portugal"}}},{id:"211725",title:"Associate Prof.",name:"Johann F.",middleName:null,surname:"Osma",fullName:"Johann F. 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