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Barely three months into the new year and we are happy to announce a monumental milestone reached - 150 million downloads.
\n\nThis achievement solidifies IntechOpen’s place as a pioneer in Open Access publishing and the home to some of the most relevant scientific research available through Open Access.
\n\nWe are so proud to have worked with so many bright minds throughout the years who have helped us spread knowledge through the power of Open Access and we look forward to continuing to support some of the greatest thinkers of our day.
\n\nThank you for making IntechOpen your place of learning, sharing, and discovery, and here’s to 150 million more!
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However, a clear vision and environmental culture are lacking because, even today, companies are motivated to act to improve the environment essentially by compliance with government regulations and the opportunity to achieve profit growth. This book presents practices, challenges, and opportunities for the digital and sustainable transformation of business as we know it.",isbn:"978-1-83969-630-5",printIsbn:"978-1-83969-629-9",pdfIsbn:"978-1-83969-631-2",doi:"10.5772/intechopen.94649",price:119,priceEur:129,priceUsd:155,slug:"product-life-cycle-opportunities-for-digital-and-sustainable-transformation",numberOfPages:114,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"52fbd37bc41094c7f82d1112e6ef3682",bookSignature:"Antonella Petrillo and Fabio De Felice",publishedDate:"December 1st 2021",coverURL:"https://cdn.intechopen.com/books/images_new/10680.jpg",numberOfDownloads:1219,numberOfWosCitations:0,numberOfCrossrefCitations:1,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:2,numberOfDimensionsCitationsByBook:0,hasAltmetrics:0,numberOfTotalCitations:3,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"March 3rd 2021",dateEndSecondStepPublish:"March 31st 2021",dateEndThirdStepPublish:"May 30th 2021",dateEndFourthStepPublish:"August 18th 2021",dateEndFifthStepPublish:"October 17th 2021",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"181603",title:"Dr.",name:"Antonella",middleName:null,surname:"Petrillo",slug:"antonella-petrillo",fullName:"Antonella Petrillo",profilePictureURL:"https://mts.intechopen.com/storage/users/181603/images/system/181603.jpg",biography:"Antonella Petrillo, Ph.D., is a professor in the Department of Engineering, University of Naples “Parthenope,” Italy. She received her Ph.D. in Mechanical Engineering from the University of Cassino and Southern Lazio, Italy. Her research interests include multi-criteria decision analysis, industrial plants, logistics, manufacturing, and safety. She serves as an associate editor for the International Journal of the Analytic Hierarchy Process and is an editorial board member for several other journals. 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His current research focuses on multi-criteria decision-making analysis (with emphasis on the analytic hierarchy process [AHP] and ANP) and industrial, project, and supply chain management. Currently, he is a member of the Scientific Advisory Committee of the International Symposium on the Analytic Hierarchy Process (ISAHP). He is the founder of AHP Academy, which promotes the diffusion of the culture and methodologies of decision making, with particular reference to those based on the analytic hierarchy process. He is a member of the editorial boards of several international organizations and journals and has authored/co-authored numerous articles in the areas of decision science and business management.",institutionString:"Parthenope University of Naples",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"6",totalChapterViews:"0",totalEditedBooks:"2",institution:{name:"Parthenope University of Naples",institutionURL:null,country:{name:"Italy"}}},coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"264",title:"Business Administration",slug:"social-sciences-business-administration"}],chapters:[{id:"79138",title:"Product Lifecycle: Social and Political Reflections from the Digital and Sustainable Perspectives",doi:"10.5772/intechopen.100938",slug:"product-lifecycle-social-and-political-reflections-from-the-digital-and-sustainable-perspectives",totalDownloads:174,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:1,abstract:"Digitalization and sustainability are the drivers of the global development of the future that have slowly conquered the agendas of governments and organizations on every continent. In this context, the pandemic has proved to be a powerful technological accelerator, helping to give a greater boost to these drivers, “guiding” leading the productive and economic sector throughout the world. Today the sustainability and digitalization represent the indispensable prerequisites to add economic, environmental, and social sovereignty. In fact, the scenario that the Coronavirus is leaving us foreshadows the need not to be satisfied with reaching targets for reducing greenhouse gas emissions, but to imagine “global” governance for the development of business models based on the new digital frontiers. Thus, what are the challenges for achieving the paradigms of sustainability and digitization in this new era? And what are the tools for a “digicircular” transformation? The aim of this chapter is to investigate these issues. To this end, it should be noted that, in this chapter, our aim is not to present an analysis of literature in the classical sense but rather political and social reflections.",signatures:"Fabio De Felice and Antonella Petrillo",downloadPdfUrl:"/chapter/pdf-download/79138",previewPdfUrl:"/chapter/pdf-preview/79138",authors:[{id:"181603",title:"Dr.",name:"Antonella",surname:"Petrillo",slug:"antonella-petrillo",fullName:"Antonella Petrillo"},{id:"161682",title:"Prof.",name:"Fabio",surname:"De Felice",slug:"fabio-de-felice",fullName:"Fabio De Felice"}],corrections:null},{id:"77682",title:"Precision Polishing Techniques for Metal Molding Dies and Glass Forming Technology “Slumping Method”",doi:"10.5772/intechopen.99208",slug:"precision-polishing-techniques-for-metal-molding-dies-and-glass-forming-technology-slumping-method-",totalDownloads:150,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Precision manufacturing techniques are required for the fabrication of small and large optical components in various fields. To prepare molding dies with highly precise geometric shapes and surface roughness that are used in certain molding processes, polishing techniques have been investigated for many materials. In this research, the polishing techniques used for a SUS310S stainless steel molding die for the glass forming technology “slumping method” were investigated. The surface roughness of the polished SUS310S molding die surface was below Rz = 120 nm (P–V), Ra = 20 nm after 35 h of polishing with 0.5% alumina polishing liquid under a pressure of 1.7 kPa. In addition, the centerless polishing machine was designed and manufactured to polish cylindrical molding die surfaces with same polishing conditions. As the result of using cylindrical molding dies that made by this centerless polishing machine, the surface roughness of the glass plate formed using the slumping method with the polished molding die was below Ra = 20 nm. These results indicate that the surface roughness of the molding die had a small effect on the glass plate surface formed using the slumping method.",signatures:"Akira Shinozaki and Junpei Kinoshita",downloadPdfUrl:"/chapter/pdf-download/77682",previewPdfUrl:"/chapter/pdf-preview/77682",authors:[{id:"418995",title:"Dr.",name:"Akira",surname:"Shinozaki",slug:"akira-shinozaki",fullName:"Akira Shinozaki"},{id:"424680",title:"Dr.",name:"Junpei",surname:"Kinoshita",slug:"junpei-kinoshita",fullName:"Junpei Kinoshita"}],corrections:null},{id:"77062",title:"Life Cycle Assessment of Ordinary Portland Cement (OPC) Using both Problem Oriented (Midpoint) Approach and Damage Oriented Approach (Endpoint)",doi:"10.5772/intechopen.98398",slug:"life-cycle-assessment-of-ordinary-portland-cement-opc-using-both-problem-oriented-midpoint-approach-",totalDownloads:247,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:0,abstract:"The concern for environmental related impacts of the cement industry is fast growing in recent times. The industry is challenged with high environmental impact which spans through the entire production process. Life cycle assessment (LCA) evaluates the environmental impact of product or process throughout the cycle of production. This can be done using either or both midpoint (process-oriented) and endpoint (damage-oriented) approaches of life cycle impact assessment (LCIA). This study assessed the environmental impact of 1 kg Ordinary Portland Cement (OPC) using both approaches of LCIA. This analysis was carried out using a data modeled after the rest of the world other than China, India, Europe, US and Switzerland. The dataset was taken from Ecoinvent database incorporated in the SimaPro 9.0.49 software. The result of the analysis showed that clinker production phase produced the highest impact and CO2 is the highest pollutant emitter at both endpoint and midpoint approaches. This is responsible for global warming known to affect both human health and the ecosystem. Also, toxicity in form of emission of high copper affects the ecosystem as well as humans. In addition, high fossil resources (crude oil) are consumed and pose the possibility for scarcity.",signatures:"Busola D. Olagunju and Oludolapo A. Olanrewaju",downloadPdfUrl:"/chapter/pdf-download/77062",previewPdfUrl:"/chapter/pdf-preview/77062",authors:[{id:"202964",title:"Dr.",name:"Oludolapo A.",surname:"Olanrewaju",slug:"oludolapo-a.-olanrewaju",fullName:"Oludolapo A. Olanrewaju"},{id:"352996",title:"Mrs.",name:"Busola D.",surname:"Olagunju",slug:"busola-d.-olagunju",fullName:"Busola D. Olagunju"}],corrections:null},{id:"77203",title:"Fostering Education for Circular Economy through Life Cycle Thinking",doi:"10.5772/intechopen.98606",slug:"fostering-education-for-circular-economy-through-life-cycle-thinking",totalDownloads:192,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Since 2002, the University of the Basque Country has supported several teaching experiences related to the so-called Life Cycle Thinking and Ecodesign in collaboration with local and regional public institutions and private companies. The implementation of a Master’s Degree entitled ‘Circular Economy: Business Application’ constitutes a milestone in the framework of these teaching experiences. From the very moment the European Green Deal was approved and, subsequently, before the state and regional strategies were launched, thanks to our prior experience, we have been able to offer the postgraduate course required by our administration and companies. The courses have been specifically designed to provide education for Circular Economy for new graduates as well as professionals with backgrounds as varied as product manufacturing engineering, environmental engineering, business administration or economics. It aims to become a European reference in its goal of promoting Circular Economy, life cycle thinking, ecodesign, industrial symbiosis and sustainable development and, at the same time, support the transition to circular economy in our region. As a result, in just two years the master’s degree has led to the creation within our university of a knowledge hub in Circular Economy, which hosts more than 20 research groups.",signatures:"Rikardo Minguez, Erlantz Lizundia, Maider Iturrondobeitia, Ortzi Akizu-Gardoki and Estibaliz Saez-de-Camara",downloadPdfUrl:"/chapter/pdf-download/77203",previewPdfUrl:"/chapter/pdf-preview/77203",authors:[{id:"225070",title:"Dr.",name:"Maider",surname:"Iturrondobeitia",slug:"maider-iturrondobeitia",fullName:"Maider Iturrondobeitia"},{id:"354233",title:"Dr.",name:"Rikardo",surname:"Minguez",slug:"rikardo-minguez",fullName:"Rikardo Minguez"},{id:"354295",title:"Dr.",name:"Estibaliz",surname:"Saez-de-Camara",slug:"estibaliz-saez-de-camara",fullName:"Estibaliz Saez-de-Camara"},{id:"354296",title:"Dr.",name:"Erlantz",surname:"Lizundia",slug:"erlantz-lizundia",fullName:"Erlantz Lizundia"},{id:"354297",title:"Dr.",name:"Ortzi",surname:"Akizu-Gardoki",slug:"ortzi-akizu-gardoki",fullName:"Ortzi Akizu-Gardoki"}],corrections:null},{id:"77423",title:"An Innovative Visualization Tool to Boost and Monitor Circular Economy: An Overview of Its Applications at Different Industrial Sectors",doi:"10.5772/intechopen.98761",slug:"an-innovative-visualization-tool-to-boost-and-monitor-circular-economy-an-overview-of-its-applicatio",totalDownloads:224,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"The quantification of the circular economy and sustainability is a relevant aspect at different levels of applications: (i) the companies need to evaluate and improve the environmental, economic, and social impacts of their products and processes; (ii) the financial bodies must have quantitative information about the potential and risks of different proposed initiatives to select the optimal opportunity; and (iii) the policy-makers must be guided for the coherent definition of strategies at regional, national and international scales, setting realistic targets and measuring their effectiveness. However, the lack of comprehensive and robust approaches to quantify circular economy makes it challenging to apply quantitative methods and indicators in different contexts and compare the results, with the risk of limiting the practical implementation of circular initiatives due to unknown and/or unclear potential and contribution. The ViVACE® tool (Visualization of Value to Assess Circular Economy), developed by the authors, is a promising and effective means to collect data in a systematized manner, helpful to assess sectorial and cross-sectorial indicators about sustainability. It has been applied to different industrial sectors (e.g., plastics, food processing, textile) for different purposes. These applications are described in detail to highlight the potential, versatility, and implications of the proposed tool in boosting the effective transition to a circular economy.",signatures:"Augusto Bianchini and Jessica Rossi",downloadPdfUrl:"/chapter/pdf-download/77423",previewPdfUrl:"/chapter/pdf-preview/77423",authors:[{id:"356387",title:"Associate Prof.",name:"Augusto",surname:"Bianchini",slug:"augusto-bianchini",fullName:"Augusto Bianchini"},{id:"356685",title:"Dr.",name:"Jessica",surname:"Rossi",slug:"jessica-rossi",fullName:"Jessica Rossi"}],corrections:null},{id:"77641",title:"Understanding the Stages of the Product Life Cycle",doi:"10.5772/intechopen.99036",slug:"understanding-the-stages-of-the-product-life-cycle",totalDownloads:234,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Originally formulated in the context of biological studies, the Life cycle (LC) concept was and now has become widely adopted as a framework for the interpretation and evaluation of phenomena that are subject to, and bound by the inevitability of change. The application of the LC concept to the development of industrial products is an important element in the administration of technological innovation. On this basis, therefore, it is referred to as the product life cycle (PLC). The concept of the PLC is used to support decision making in the management of product development. 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\r\n\tHyperspectral imaging is a spectroscopic imaging technique, which can generate either single or a time series of data cubes to yield insight into the spatial distribution of constitutive components in a spatial domain. Hence, the methodology can be used in multiple applications such as probing cellular processes in live cells, developing multiple biomedical imaging modalities, material characterizations, remote sensing, etc. Hyperspectral imaging can also take advantage of deep learning algorithms to retrieve valuable information from high-dimensional data in real-time. It is worth emphasizing that hyperspectral imaging is not limited to visible light. With other available excitation sources such as X-ray, electrons, etc. new hyperspectral imaging modalities can be extended to nanometer scales.
\r\n\r\n\tThis book intends to bring together diverse research areas of hyperspectral imaging. We hope to provide the reader with a comprehensive overview of the current state-of-the-art in this fascinating and important field and make this book project a useful platform to allow all those working in hyperspectral imaging to be benefited from the knowledge of widely different fields.
",isbn:"978-1-83969-094-5",printIsbn:"978-1-83969-093-8",pdfIsbn:"978-1-83969-113-3",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!0,isSalesforceBook:!1,isNomenclature:!1,hash:"b95808f12e716f6494aaedba4d67d98d",bookSignature:"Dr. Jung Y. Huang",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11950.jpg",keywords:"Spectroscopic Imaging, Snapshot Imager, Spectral Filter Arrays, Machine Learning, Deep Learning Network, Compressive Sensing, Super Resolution, Image Segmentation, Tera-Hertz Radiation, X-ray Photoemission Imaging, Molecular Imaging, Chemical Imaging",numberOfDownloads:8,numberOfWosCitations:0,numberOfCrossrefCitations:0,numberOfDimensionsCitations:0,numberOfTotalCitations:0,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"April 19th 2022",dateEndSecondStepPublish:"June 23rd 2022",dateEndThirdStepPublish:"August 22nd 2022",dateEndFourthStepPublish:"November 10th 2022",dateEndFifthStepPublish:"January 9th 2023",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"2 months",secondStepPassed:!0,areRegistrationsClosed:!1,currentStepOfPublishingProcess:3,editedByType:null,kuFlag:!1,biosketch:"An academic researcher specialized in developing optical probes for unraveling dynamic processes in live cells and nanostructured materials, with over 100 publications and a high h-index (34). Dr. Huang holds several patents in laser techniques, solar cells, and hyperspectral imaging, including ‘’Method of integrating light-trapping layer to thin-film solar cell’’ and ‘’Coherent multiple-stage optical rectification terahertz wave generator’’.",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"457620",title:"Dr.",name:"Jung",middleName:"Y.",surname:"Huang",slug:"jung-huang",fullName:"Jung Huang",profilePictureURL:"https://mts.intechopen.com/storage/users/457620/images/system/457620.jpg",biography:"Jung Y. Huang received his Ph.D. in 1988 from the Applied and Engineering Physics of Cornell University. He was a full professor and investigator in the Department of Photonics and T.K.B. Research Center for Photonics, Chiao Tung University, Taiwan. His research interests focus on the development of optical probes for unraveling cellular processes in live cells and characterizing functional properties of nanostructured materials. He had been an editorial board member of the Advances in Optoelectronics for twelve years, and a reviewer for about twenty scientific journals in optics, chemistry, and material sciences. He has co-authored more than a hundred publications in peer-reviewed scientific journals, five book chapters, and holds several patents in laser techniques, solar cells, and hyperspectral imaging.",institutionString:"National Chiao Tung University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"National Chiao Tung University",institutionURL:null,country:{name:"Taiwan"}}}],coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"11",title:"Engineering",slug:"engineering"}],chapters:[{id:"82450",title:"Hyperspectral and Multispectral Image Fusion Using Deep Convolutional Neural Network - ResNet Fusion",slug:"hyperspectral-and-multispectral-image-fusion-using-deep-convolutional-neural-network-resnet-fusion",totalDownloads:8,totalCrossrefCites:0,authors:[null]}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"444318",firstName:"Nika",lastName:"Karamatic",middleName:null,title:"Ms.",imageUrl:"https://mts.intechopen.com/storage/users/444318/images/20011_n.jpg",email:"nika@intechopen.com",biography:"As an Author Service Manager, my responsibilities include monitoring and facilitating all publishing activities for authors and editors. From chapter submission and review to approval and revision, copyediting and design, until final publication, I work closely with authors and editors to ensure a simple and easy publishing process. I maintain constant and effective communication with authors, editors and reviewers, which allows for a level of personal support that enables contributors to fully commit and concentrate on the chapters they are writing, editing, or reviewing. I assist authors in the preparation of their full chapter submissions and track important deadlines and ensure they are met. I help to coordinate internal processes such as linguistic review, and monitor the technical aspects of the process. As an ASM I am also involved in the acquisition of editors. Whether that be identifying an exceptional author and proposing an editorship collaboration, or contacting researchers who would like the opportunity to work with IntechOpen, I establish and help manage author and editor acquisition and contact."}},relatedBooks:[{type:"book",id:"10198",title:"Response Surface Methodology in Engineering Science",subtitle:null,isOpenForSubmission:!1,hash:"1942bec30d40572f519327ca7a6d7aae",slug:"response-surface-methodology-in-engineering-science",bookSignature:"Palanikumar Kayaroganam",coverURL:"https://cdn.intechopen.com/books/images_new/10198.jpg",editedByType:"Edited by",editors:[{id:"321730",title:"Prof.",name:"Palanikumar",surname:"Kayaroganam",slug:"palanikumar-kayaroganam",fullName:"Palanikumar Kayaroganam"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1591",title:"Infrared Spectroscopy",subtitle:"Materials Science, Engineering and Technology",isOpenForSubmission:!1,hash:"99b4b7b71a8caeb693ed762b40b017f4",slug:"infrared-spectroscopy-materials-science-engineering-and-technology",bookSignature:"Theophile Theophanides",coverURL:"https://cdn.intechopen.com/books/images_new/1591.jpg",editedByType:"Edited by",editors:[{id:"37194",title:"Dr.",name:"Theophile",surname:"Theophanides",slug:"theophile-theophanides",fullName:"Theophile Theophanides"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3161",title:"Frontiers in Guided Wave Optics and Optoelectronics",subtitle:null,isOpenForSubmission:!1,hash:"deb44e9c99f82bbce1083abea743146c",slug:"frontiers-in-guided-wave-optics-and-optoelectronics",bookSignature:"Bishnu Pal",coverURL:"https://cdn.intechopen.com/books/images_new/3161.jpg",editedByType:"Edited by",editors:[{id:"4782",title:"Prof.",name:"Bishnu",surname:"Pal",slug:"bishnu-pal",fullName:"Bishnu Pal"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"371",title:"Abiotic Stress in Plants",subtitle:"Mechanisms and Adaptations",isOpenForSubmission:!1,hash:"588466f487e307619849d72389178a74",slug:"abiotic-stress-in-plants-mechanisms-and-adaptations",bookSignature:"Arun Shanker and B. Venkateswarlu",coverURL:"https://cdn.intechopen.com/books/images_new/371.jpg",editedByType:"Edited by",editors:[{id:"58592",title:"Dr.",name:"Arun",surname:"Shanker",slug:"arun-shanker",fullName:"Arun Shanker"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3092",title:"Anopheles mosquitoes",subtitle:"New insights into malaria vectors",isOpenForSubmission:!1,hash:"c9e622485316d5e296288bf24d2b0d64",slug:"anopheles-mosquitoes-new-insights-into-malaria-vectors",bookSignature:"Sylvie Manguin",coverURL:"https://cdn.intechopen.com/books/images_new/3092.jpg",editedByType:"Edited by",editors:[{id:"50017",title:"Prof.",name:"Sylvie",surname:"Manguin",slug:"sylvie-manguin",fullName:"Sylvie Manguin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"72",title:"Ionic Liquids",subtitle:"Theory, Properties, New Approaches",isOpenForSubmission:!1,hash:"d94ffa3cfa10505e3b1d676d46fcd3f5",slug:"ionic-liquids-theory-properties-new-approaches",bookSignature:"Alexander Kokorin",coverURL:"https://cdn.intechopen.com/books/images_new/72.jpg",editedByType:"Edited by",editors:[{id:"19816",title:"Prof.",name:"Alexander",surname:"Kokorin",slug:"alexander-kokorin",fullName:"Alexander Kokorin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"2270",title:"Fourier Transform",subtitle:"Materials Analysis",isOpenForSubmission:!1,hash:"5e094b066da527193e878e160b4772af",slug:"fourier-transform-materials-analysis",bookSignature:"Salih Mohammed Salih",coverURL:"https://cdn.intechopen.com/books/images_new/2270.jpg",editedByType:"Edited by",editors:[{id:"111691",title:"Dr.Ing.",name:"Salih",surname:"Salih",slug:"salih-salih",fullName:"Salih Salih"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"117",title:"Artificial Neural Networks",subtitle:"Methodological Advances and Biomedical Applications",isOpenForSubmission:!1,hash:null,slug:"artificial-neural-networks-methodological-advances-and-biomedical-applications",bookSignature:"Kenji Suzuki",coverURL:"https://cdn.intechopen.com/books/images_new/117.jpg",editedByType:"Edited by",editors:[{id:"3095",title:"Prof.",name:"Kenji",surname:"Suzuki",slug:"kenji-suzuki",fullName:"Kenji Suzuki"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3828",title:"Application of Nanotechnology in Drug Delivery",subtitle:null,isOpenForSubmission:!1,hash:"51a27e7adbfafcfedb6e9683f209cba4",slug:"application-of-nanotechnology-in-drug-delivery",bookSignature:"Ali Demir Sezer",coverURL:"https://cdn.intechopen.com/books/images_new/3828.jpg",editedByType:"Edited by",editors:[{id:"62389",title:"PhD.",name:"Ali Demir",surname:"Sezer",slug:"ali-demir-sezer",fullName:"Ali Demir Sezer"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"872",title:"Organic Pollutants Ten Years After the Stockholm Convention",subtitle:"Environmental and Analytical Update",isOpenForSubmission:!1,hash:"f01dc7077e1d23f3d8f5454985cafa0a",slug:"organic-pollutants-ten-years-after-the-stockholm-convention-environmental-and-analytical-update",bookSignature:"Tomasz Puzyn and Aleksandra Mostrag-Szlichtyng",coverURL:"https://cdn.intechopen.com/books/images_new/872.jpg",editedByType:"Edited by",editors:[{id:"84887",title:"Dr.",name:"Tomasz",surname:"Puzyn",slug:"tomasz-puzyn",fullName:"Tomasz Puzyn"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},chapter:{item:{type:"chapter",id:"66143",title:"Neurologic Complications and Neuromonitoring on ECMO",doi:"10.5772/intechopen.85103",slug:"neurologic-complications-and-neuromonitoring-on-ecmo",body:'\nECMO is a cardiopulmonary bypass circuit to support patients in severe cardiac and/or respiratory failure. It is an advanced life support therapy for patients at high risk of dying from their respiratory or cardiac disease. Extracorporeal life support, while life-saving in many instances, can pose serious risks and is associated with several neurologic complications. In this chapter, we will review some of the more common neurologic adverse events seen in patients on extracorporeal membrane oxygenation (ECMO), as well as review some of the neuromonitoring modalities available for early recognition of neurologic morbidity. Based on a recent report from the Extracorporeal Life Support Organization (ELSO), the current survival to discharge after ECMO ranges from 28% for adult ECPR patients to 73% for neonatal respiratory ECMO [1]. As survival after ECMO improves with advances in technologies and patient care, there is ever increasing emphasis placed on reducing morbidity experience by survivors.
\nMajority of the literature on neurologic injuries come from analyses of the ELSO Registry and single center experiences. The ELSO registry currently collects limited information on presence of seizures (clinical or EEG confirmed), central nervous system (CNS) hemorrhages (intraventricular or parenchymal) as determined by ultrasound (US), Computed tomography (CT) or Magnetic Resonance Imaging (MRI); diffuse ischemia or CNS infarction; need for neurosurgical intervention, and brain death on ECMO [2]. In spite of advances in ECMO circuitry, anticoagulation, and clinical management, the rate of occurrence of neurologic injury has not changed in recent times [3].
\nECMO was first trialed on a neonate and the success with that patient gradually spread its popularity among the neonatal and eventually pediatric patient populations [4]. The H1N1 influenza pandemic in 2009 is primarily credited for the adoption of ECMO in many adult centers and its use in adults has grown exponentially since. While most of the early data came from neonates, more recent studies on neurologic injuries in adults are informing care of the ECMO patient. As ECMO is becoming more ubiquitously used, this chapter discusses neurologic complications noted across the age spectrum. However risk factors, types of complications and management often vary by patient population, from neonates to adults. Effort has been made to specify if certain descriptions are only applicable to a certain age group, and information may not be relevant for all ages.
\nQuantification of the burden of neurologic complications has been difficult due to voluntary and retrospective nature of reporting, variability and lack of consensus on neuromonitoring and heterogeneous populations.
\nAn ELSO registry analysis of neonates on ECMO from 2005 to 2010 showed that 20% had some neurologic complications [5]. Non hemorrhagic complications such as cerebral infarction, brain death and seizures were far less common than intracranial hemorrhage. A look at the subgroup of neonates with congenital heart disease failed to show an association between type of cardiac lesion and CNS injury [6]. The pediatric patient population is more heterogeneous than the neonatal group. A study by Hervey-Jumper et al. looked at children on ECMO from 1990 to 2009 and found that intracranial hemorrhage occurred in 7.4%, cerebral infarction in 5.7% and clinical seizures in 8.4% of all patients [7].
\nA systematic review of studies from 1990 to 2017 found that intracranial hemorrhage was the most common type of neurologic injury in adults, followed by acute ischemic stroke [8]. Incidence reported varies widely with a range of 2–21% for intracranial hemorrhage and 1–33% for acute ischemic stroke, with a median proportion of 5% of patients experiencing hemorrhages and another 5% with stroke. Seizures had the lowest incidence of about 2%. The study did find that neurologic injury was overall more commonly reported in VA ECMO than VV ECMO. The occurrence of neurologic injury significantly increases the in-hospital mortality with median mortality of 96% for hemorrhages, 84% for ischemic strokes 84, and 40% for seizures.
\nAn analysis of the ELSO registry of almost 5000 adult patients on VV ECMO found an overall incidence of neurologic complications in 7.1% of patients [3]. Injuries included hemorrhage in 42.5%, brain death in 23.5%, stroke in 19.9%, and seizures in 14.1%. This study also found that in-hospital mortality was much higher (75.8% versus 37.8%) for patients with neurological injuries. An analysis of the ELSO registry for adult patients on VA ECMO, by the same group, found similar findings in the venoarterial cohort [9]. A decade’s review of the Nationwide Inpatient Sample, that included over 23,000 patients, found that adult patients with acute ischemic stroke and intracranial hemorrhage on ECMO had higher rates of discharge to a long term facility and longer length of stay when compared to patients without neurologic injury [10].
\nA recent international randomized controlled trial, comparing ECMO to conventional mechanical ventilation for severe ARDS, showed a very low rate of ischemic stroke in the ECMO population [11]. Out of 124 patients randomized to receive ECMO, none had ischemic strokes compared to 5% of the patients initially randomized to conventional therapy, although there was the option of crossover to ECMO for refractory ARDS. It is unclear if this is due to a restrictive inclusion criteria of less than 7 days of mechanical ventilation combined with less severe hypoxemia and acidosis from early ECMO cannulation. However, the rates of hemorrhagic stroke were similar in the two groups.
\nCerebral autoregulation is the term used to describe the ability of cerebral arterioles to maintain steady cerebral blood flow across a wide range of cerebral blood pressure. This is achieved through dilation and constriction of cerebral blood vessels in response to fluctuations in mean arterial pressure. This is a complex process mediated through neurogenic regulation, involving sympathetic and cholinergic mechanisms, myogenic regulation involving smooth muscle tone, and metabolic regulation influenced by local concentration of metabolites [12]. Cerebral autoregulation can become disrupted focally or globally in pathological conditions leading to cerebral ischemia, hemorrhage or edema. These conditions associated with ECMO include vasospasm, severe acidosis, low cardiac output states, hypotension and hypertension, reperfusion injury and absence of pulsatile flow in VA ECMO. Hypercapnia is associated with cerebral vasodilation while hypocapnia causes cerebral vasoconstriction. A rapid decline in paCO2 after initiation of VV ECMO has been associated with central nervous system (CNS) injury [13].
\nA study by O’Brien using transcranial Doppler (TCD) showed that in patients that did not have neurologic injury, cerebral blood flow velocities on ECMO were much lower than predicted and returned closer to baseline after decannulation. However in patients that did have cerebral hemorrhage on ECMO, supranormal flows were noted in the days preceding the event [14]. A more recent multicenter study by the same author confirmed lower flow velocities on ECMO but did not show a difference in flow velocities in children with cerebral ischemia compared to those without. No patients in this study had cerebral hemorrhage [15].
\nCannulation of cervical vessels relies on a competent Circle of Willis to allow for cerebral perfusion of both hemispheres. Occlusion of vessels can cause ipsilateral venous stasis and this venous congestion can lead to venous hypertension and decreased cerebral perfusion. Changes in cerebral blood flow rate and volume can contribute to altered cerebral oxygenation as demonstrated by cerebral oximetry [12]. Impairments in cerebral autoregulation, based on wavelet transform coherence, are associated with findings on neuroimaging and neurologic outcomes [16].
\nThese can be divided into factors prior to initiation of ECMO and factors inherent to ECMO therapy [17]. There are also risk factors for neurological injury after ECMO such as ligation or anastomosis of cervical blood vessels. Because CNS injury is often multifactorial, and lesions are often detected retrospectively on imaging after ECMO, the exact timing of injury can be difficult to determine.
\nThe underlying physiologic conditions that necessitate ECMO cannulation, such as labile hemodynamics, severe hypoxemia and acidosis, refractory hypotension, etc., leave the patient vulnerable to neurologic insults. These can alter the mechanisms responsible for maintaining cerebral autoregulation and make the vasculature more susceptible to alterations in systemic blood pressure. Prematurity is associated with an increase in intraventricular and intracranial hemorrhage and can be a contraindication for ECMO cannulation. A prior history of neurologic injury puts one at further risk of adverse cerebrovascular events.
\nAnimal models have demonstrated the effects of carotid artery and jugular vein cannulation and ligation on cerebral blood flow [18, 19]. Adults with atherosclerosis may develop emboli during arterial cannulation. ECMO cannulae and circuits expose a patient to prothrombotic surfaces and the foreign materials often incite an inflammatory response. Platelets are consumed in the circuit components leading to thrombocytopenia, putting a patient at increased risk of bleeding. Maintaining patency of the circuits requires the use of anticoagulation, which needs to be closely monitored to avoid complications such as bleeding, or thrombosis and embolism. Reperfusion injury is another risk factor after adequate oxygenation and blood flow delivery have been ensured following a period of severe hypoxemia. VA ECMO cannulation for cardiogenic shock is also associated with non-pulsatile flow which is not physiologic. Neurologic exams are often limited for patients on ECMO, confounded by sedation and limited mobility, which can lead to delayed diagnosis and recognition. A precannulation lactate greater than 10 mmol/L was found to be associated with increased odds for ischemic strokes in adults [8]. A history of pre ECMO cardiac arrest, need for renal replacement therapy and elevated bilirubin levels were associated with increased odds of neurologic injury [3]. A study of neonates found that birth weight less than 3 kg, gestational age less than 34 weeks, a history of prior ECMO cannulation and severe acidosis were risk factors for neurologic injury [5].
\nVA ECMO carries with it the increased risk of embolization as blood is directly pumped into the arterial system, unlike in VV ECMO where the oxygenated blood is returned to the venous system where the lungs can filter thrombi. However, a study by Zahraa found that there was no difference in central nervous system complications between pediatric respiratory failure patients supported on VA versus VV ECMO [20]. Differential hypoxia, where the arterial oxygen tension is lower in the upper half of the body than in the lower half, is a phenomenon occasionally seen in patients supported on peripheral VA ECMO that causes cerebral ischemia [21]. For pediatric patients on VA ECMO, the incidence of stroke was much lower for transthoracic or central cannulation compared to peripheral cannulation [22]. VA ECMO is also unique in that poor cardiac function results in absence of pulsatile flow, with potential implications for cerebral autoregulation and vascular reactivity.
\nThe right carotid artery and internal jugular vein are commonly sacrificed during ECMO cannulation. Taylor et al. showed the feasibility of vascular repair with antegrade flow, without increasing the incidence of embolic phenomenon [23]. A larger, more recent study of neonates on VA ECMO, showed over 84% patency of repaired vessels. While 43% of all patients had a severe brain lesion after ECMO, there was no difference in early neurologic outcomes between the groups that underwent carotid repair versus carotid ligation [24].
\nECPR is the rapid deployment of VA ECMO for a patient in cardiac arrest, with ongoing CPR, prior to the return of spontaneous circulation. A systematic review of adult ECPR data showed that a shockable rhythm and duration of CPR were significantly associated with a favorable neurologic outcome [25]. A study of the ELSO registry looking at pediatric patients that received ECPR found an overall incidence of acute neurologic injury in 22% of patients [26]. The in-hospital mortality was high for these patients at 89%. An analysis of neonatal and pediatric ECPR events from a multicenter, national registry showed that while only 43.7% of patients survived to hospital discharge, the majority of survivors had favorable neurologic outcomes [27]. Another study comparing survivors of ECPR and those with return of circulation after conventional CPR found comparable neurologic outcomes between the two groups, with total duration of cardiac arrest being the only predictor of survival [28].
\nThere is a wide variety of neurological injuries that are noted after ECMO including embolic strokes, hypoxic-ischemic encephalopathy, cerebral infarction, intracranial and subarachnoid hemorrhages, seizures, cerebral edema and even brain death. Other complications, such as critical illness myopathy, neuropathies, delirium, hearing loss, vocal cord paralysis etc. are related to prolonged hospitalization and ICU stays, need for prolonged mechanical ventilation or tracheostomy, prolonged exposure to sedation, and limited mobility that often accompany ECMO runs. In this section of the chapter, we will look at some of the more common neurologic complications experienced by patients treated with ECMO.
\nIntracranial hemorrhage (ICH) is one of the most common adverse neurologic events on ECMO, carrying a high mortality rate. It can occur as intraparenchymal, intraventricular or subarachnoid hemorrhages. Gestational age at time of ECMO cannulation, severe acidosis needing correction, sepsis, need for epinephrine, therapeutic hypothermia and need for cardiopulmonary resuscitation (CPR) have been associated with intracranial hemorrhage in neonates [29, 30, 31]. A longer duration of ECMO, higher activated clotting times (ACTs), presence of bleeding at other sites, pre-admission antithrombotic therapy, and low platelet counts were associated with hemorrhage in adults [32, 33]. Rapid PaCO2 decrease/correction of hypercapnia and renal failure at ICU admission were associated with increased intracranial hemorrhage in one adult study [13]. In order to detect intracranial hemorrhage while on ECMO, cranial ultrasounds are used in neonates while CT imaging is used in children and adults. In one observational study, 42% of the cohort underwent withdrawal of life sustaining therapy, 18% did not require any intervention and 40% were treated. Treatments included hemostatic interventions, ICP management and surgical interventions with 14% of the cohort uneventfully decannulated [34]. Patients that have clinically significant bleeds, with progression of brain injury and little to no improvement on ECMO ultimately end up with withdrawal of life sustaining therapies due to poor prognosis and risk of progression of the bleed. Patients with very small or clinically insignificant hemorrhages can continue their ECMO courses with close neurological monitoring, decannulation at the earliest feasible time and possibly lowering of anticoagulation parameters while balancing thrombotic risks. Platelets and anti-fibrinolytics may need to be administered. Occasionally ECMO circuits can be trialed without any anticoagulation keeping a close eye on the circuit for clots and fibrin deposition. Life-threatening hemorrhage can be severe enough to warrant a craniotomy [7, 35]. Hematoma evacuation on ECMO is high risk and carries a high mortality although there are reports of patients who survived [34]. There is heterogeneity in practice with drugs used for anticoagulation (heparin versus bivalirudin), tests to assess for anticoagulation (TEG, ROTEM, activated clotting time, PT/PTT, heparin assays) and therapeutic targets for titration. Further research is needed to help develop guidelines and consensus on best practice to minimize and treat bleeding complications on ECMO.
\nIt occurs in about 5–6% of children and adults [8, 36], and is best identified on MR imaging. Due to multifactorial etiology for ischemic strokes such as hypotension, large vessel occlusion, thromboembolism, septic embolism, etc. it is difficult to characterize lesions anatomically or to prognosticate based on imaging. Timing of injury is also difficult to ascertain. There are conflicting reports on laterality of lesions [37] but seem to occur in the middle cerebral artery vascular territory. A single center pediatric study found that majority of strokes were bilateral, a few were unilateral right sided lesions and no patients had unilateral left sided strokes; majority of the lesions were in the anterior cerebral circulation distribution [22]. Ischemic lesions are associated with electrographic seizures and decreased survival [38]. Asymmetry in regional cerebral saturation or on continuous EEG monitoring might be suggestive of focal ischemia. Once detected, hemodynamics should be optimized through adequate pump flows on VA ECMO, vasoactives can be used if needed, and further neurologic injury should be minimized by avoiding hyperoxia and treating seizures.
\nAlthough less common than intracranial hemorrhage and stroke, seizures can be difficult to recognize if they are nonconvulsive or subclinical. A study of children and neonates undergoing ECMO revealed that 18% of patients had electrographic seizures, with 61% of those patients having electrographic status epilepticus and 83% having exclusively electrographic seizures [39]. Another recent study of neonatal and pediatric patients found electrographic seizures in 23% of their patients, especially within the first 24 hours of ECMO [40]. Patients with seizures had decreased survival to discharge (44% versus 74%). Older studies that reported lower incidence of seizures may have missed patients if only clinical seizures were reported, as the routine use of continuous EEG monitoring for patients is not yet a widespread practice, although recent recommendations advocate for its use in ECMO. Given that patients on ECMO are a high risk population, seizures should be treated with the help of neurologists.
\nSensorineural hearing loss has been reported in neonatal ECMO graduates with a frequency of 3–21% [41]. Diagnosis of congenital diaphragmatic hernia, duration of ECMO, and aminoglycoside antibiotic use were associated with hearing loss [42]. A follow-up study found that even children diagnosed with hearing loss after ECMO can go on to have normal language development [43].
\nProlonged immobilization, sedation and paralytics, hemodynamic instability, all contribute to neuromuscular weakness in ECMO patients. Studies have proved that active physiotherapy, with early mobilization, is feasible and safe in ECMO patients when performed with an experienced, multidisciplinary team [44, 45]. It may also shorten hospital duration and improve functional outcomes for patients [46].
\nA small study of pediatric cardiac ECMO patients diagnosed delirium in all their patients, in 21% of coma-free ECMO days [47]. Use of validated delirium screening tools can aid in early recognition and management of delirium. The move to liberate ICU patients should include patients on ECMO whenever feasible, with an emphasis on delirium prevention.
\nProgressive cerebral edema and large hemorrhages, whether from insults prior to cannulation or secondary to complications from ECMO, can ultimately lead to brain death in patients supported on ECMO. Diagnosis of brain death can be challenging on ECMO, but is important to determine as it is medically and ethically unreasonable to continue ECMO for a patient who has met criteria for brain death.
\nThe American Academy of Neurology issued guidelines on the determination of brain death in adults, most recently revised in 2010 [48]. Similarly the Society of Critical care Medicine, American Academy of pediatrics and the Child Neurology Society jointly published guidelines for the determination of brain death in children and infants in 2011 [49]. The following general criteria apply to all patients undergoing brain death testing, although the specifics may vary by institutional policies. Patients should be relatively normothermic, and electrolytes and glucose should be within acceptable ranges. Any medications that may interfere with respiratory drive and neurologic function must be discontinued, with drug levels obtained if needed. The patient must demonstrate absence of all motor function and lack of responsiveness to stimuli, except spinal reflexes. Cranial nerve testing should reveal absence of pupillary reflexes, corneal reflexes, oculovestibular and oculocephalic reflexes, absence of cough and gag reflexes and absent brain stem reflexes.
\nThe apnea test is an important component of brain death testing without which ancillary studies such as cerebral angiography, nuclear scanning for cerebral blood flow, electroencephalography, transcranial Doppler etc. are required to demonstrate absence of blood flow to the brain. The apnea test is performed to demonstrate absence of spontaneous respiratory drive in the presence of rising paCO2 levels in the blood. The patient is pre-oxygenated with 100% FiO2 and ventilated to achieve normocarbia, if possible. A baseline blood gas analysis is obtained. The patient is then disconnected from the ventilator and oxygenated via a T-piece or flow-inflating anesthesia bag. The patient is closely observed for signs of spontaneous respiration or chest rise. Serial blood gases are obtained at every few minute intervals. A rise in paCO2 > 60 mmHg and > 20 mmHg above baseline is conclusive of absence of respiratory drive. If the patient were to become hypoxic or hemodynamically unstable the apnea test should be discontinued and ancillary studies obtained.
\nWhile clinical criteria of absence of cortical function and brain stem reflexes can be assessed in the usual manner, apnea testing can be difficult on ECMO. A proposed method for apnea testing is oxygenating the patient by use of continuous positive airway pressure (CPAP) or T-piece or by placing the patient on a self-inflating anesthesia bag with a PEEP valve, while watching for spontaneous respirations. The oxygenator on the circuit can then be capped. Alternatively, the sweep gas is decreased to 0.5 –1 L/minute and oxygen increased to 100% FiO2 through the circuit, without any changes to extracorporeal blood flow [50, 51]. In-line gas monitoring on the ECMO circuit can be used to trend venous paCO2, but serial arterial blood gas analysis should be used to confirm the lack of ventilation secondary to central apnea. For patients on VA ECMO, hemodynamics should be maintained through circuit flows and use of vasoactive medications as needed. Patients found to be brain dead on ECMO can be considered as candidates for organ donation.
\nThere are currently no consensus guidelines for neuromonitoring on ECMO, with variations in practice at different institutions. Neuromonitoring may include assessment of brain structure or morphology via imaging, assessment of brain function via EEG or SSEPs, assessment of cerebral perfusion via cerebral oximetry or transcranial doppler, and assessment for neurological injury via biomarkers. Bembea and colleagues performed a systematic review of the literature; 39 observational and case-control studies met inclusion criteria, with most of the literature coming from neonatal studies [52]. There was very little data in pediatric and adult cohorts, and the study found limited data on the use and effectiveness of monitoring technologies. A recent review by Lin et al. discusses neuromonitoring in the neonatal ECMO patient [53].
\nNeuromonitoring of the ECMO patient should begin with daily neurologic assessments that are documented in the patients chart. These are limited by reliability when performed by multiple providers from different disciplines, however are useful for obtaining a daily baseline that can be suggestive of injury when a change is noted. This would also require daily sedation holidays for accurate assessments as well as using the least amount of sedation to keep the patient safe and comfortable. Use of neuromuscular blockade should be reserved for extremely ill patients and those whose movement limits ECMO flows. A change in neurologic exam is often the trigger for seeking additional information such as through neuroimaging.
\nCranial or head ultrasound (HUS) is a mode of imaging limited to neonates and infants with open fontanelles. Ultrasound uses high frequency sound waves transmitted via a probe that are reflected back based on the tissue’s composition as well as distance from the probe. Changes in tissue density from hemorrhage or ischemia will reflect back sound waves differently from surrounding tissue. Cranial ultrasounds are portable, easy to use, relatively inexpensive, and do not carry radiation risks. Most neonatal ECMO programs will obtain a HUS prior to ECMO cannulation as well as daily HUS for the 1st few days on ECMO. While it is best for detecting hemorrhages, ischemic changes are harder to interpret on HUS [54]. HUS can also give information on changes in ventricular size that would be seen in hydrocephalus. It is not as sensitive as other imaging techniques and a study showed that MRI was significantly more sensitive for detection of CNS lesions than HUS alone [55, 56]. The quality of images depends on the skill level of the ultrasound technician and interpretation of acquired images can be subjective and variable. HUS findings have not consistently correlated with neurodevelopmental outcomes and should not be used for predicting outcomes in neonatal ECMO survivors [37, 56].
\nComputed tomography (CT) is a diagnostic imaging modality that utilizes X-Rays directed at the patient that are picked up by a detector and sent to a computer to create thin 2D image slices, at different tissue depths. Multiple images can then be stacked to create a 3D picture. It is the most frequently used imaging modality for diagnosis of acute intracranial injury for patients on ECMO. A CT scan can be quickly obtained and has better sensitivity and specificity for detecting intracranial hemorrhage that might lead to clinical changes in management [53]. A disadvantage is exposure to radiation and its associated risks. Transporting a patient on ECMO to a CT scanner in the radiology department can be challenging in the absence of a portable scanner that can be brought to bedside. ELSO currently recommends a CT scan prior to hospital discharge for patients less than 4 years of age and if there is an abnormal neurologic exam for patients older than 4 years of age as part of post-ECMO follow up [57].
\nMagnetic Resonance Imaging (MRI) is a non-invasive technology that creates 3D anatomic images without exposing the patient to radiation. A strong magnetic field is used to force protons in the body into alignment. Then a brief radiofrequency pulse stimulates protons causing a change in alignment. The scanner can detect electromagnetic energy transmitted as the protons realign. It is reserved for patients after decannulation from ECMO, due to MRI incompatible materials in the cannulae and circuits. MRI is the most sensitive and specific imaging technique available. However it takes much longer time to obtain the study compared to a CT and is more expensive. While diffusion-restriction can be seen up to 10 days after acute ischemic injury, the optimal timing for obtaining an MRI after ECMO remains unclear [53].
\nWhile neuroimaging provides information on the structure of the brain, EEG provides real-time information on the electrical activity of the brain. Information is obtained via electrodes placed on the scalp, connected to a monitor, with very little burden to the patient that would include scalp abrasions. Continuous EEG (cEEG) monitoring requires technicians to set up the electrodes as well as neurologists to read the EEGs, which can be time consuming. Amplitude-integrated EEG (aEEG) compresses the raw EEG data from 1 to 2 leads, is easier to set up and interpret, but due to lower sensitivity, can be used as a screening tool or in resource limited settings [53]. Ischemic and hemorrhagic injuries can predispose a patient to seizures that require prompt treatment. Continuous EEG monitoring is important for early identification and treatment of subclinical seizures or electrical status epilepticus that may not be otherwise detected, although studies are needed to show its benefit in improving long term outcomes. EEG monitoring is especially useful in paralyzed patients in whom a neurological exam cannot be elicited. EEG can be used to detect early cerebral ischemia through loss of fast alpha and beta frequencies to slowing and even suppression of all electrical activity as might be seen in an infarct. In 2011, the American Clinical Neurophysiology Society deemed ECMO as a high risk clinical scenario in neonates that would warrant long term EEG monitoring due to cardiac or pulmonary risks for acute brain injury and clinical encephalopathy [58]. This recommendation is supported by ELSO in their guidelines for management of neonatal respiratory failure [59]. In their 2015 consensus statement on continuous EEG in critically ill adults and children, the American Clinical Neurophysiology Society recommended continuous EEG monitoring for patients treated with pharmacologic paralysis, including patients on ECMO [60].
\nThis is a non-invasive, portable test that is based on the Doppler effect. A Doppler probe is used to emit high frequency sound waves through the cranium that are reflected back by moving red blood cells in the blood vessels. The difference in frequencies of emitted and reflected waves is proportional to the cerebral blood flow. Studies have found that TCD velocities (TCDV) are much lower for pediatric patients on ECMO when compared to normative values for healthy and critically-ill children [15, 61]. While there was no significant association between global TCDV (systolic flow velocity, diastolic flow velocity, mean flow velocity) and neurologic injury, increased pulsatility index and regional increases in velocities or asymmetries might be predictive of neurologic injury.
\nNIRS monitoring is a non-invasive technology that uses near-infrared wavelength of light that penetrates brain tissue via a scalp electrode. It provides a continuous measurement of regional tissue oxygen saturation (rSO2), which is a marker of the balance between oxygen delivery and demand in the tissues. When the probe is placed on the forehead, it measures cerebral oximetry. An analysis of adult patients on VA ECMO showed that cerebral desaturation was common and mortality higher for patients with cerebral desaturation compared to those without [21]. A sudden decrease in cerebral saturation can be associated with an acute neurological event, prompting further investigation. It can also serve as an early predictor of inadequate oxygenation and cardiac output especially peri-cannulation [62]. It can influence management by prompting a need for increased flows in VA ECMO or alternate cannulation strategies if there is differential hypoxia. A very high rSO2 could also be suggestive of very poor oxygen extraction and poor neurologic outcomes.
\nSeveral plasma proteins have been evaluated as potential markers for brain injury [63]. These biomarkers include substances associated with glial injury (glial fibrillary acidic protein and s-100b), neuronal injury (neuron-specific enolase and brain-derived neurotrophic factor) and neuro-inflammation (intercellular adhesion molecue-5). Unfavorable neurologic outcomes have been associated with higher biomarker concentrations [64], with combinations of biomarkers providing higher sensitivities and specificities for detection of neurologic injury. These tests are more expensive and require laboratory equipment and processing availability. While not currently a routine component of neuromonitoring on ECMO in most institutions, there is potential for further research and applicability if these results can be obtained in real time to influence management.
\nSSEPs measure electrical signals in the somatosensory cortex after a peripheral stimulus, assessing the pathway of neuronal conduction from the peripheral nerve to the cortex. They are assessed as normal, abnormal (increased latency) or absent. ECMO cannulation is not thought to alter the ability to assess SSEPs from the hemispheres [65]. Small studies have shown an association between abnormal SSEPs and poor neurologic outcome after ECMO [66], but the predictive value of evoked potentials remains to be determined. In one study, absence of bilateral SSEPs was associated with progression to brain death for patients treated with ECPR [67].
\nIt is a simple bedside test used to detect elevated intracranial pressure. A cut-off of 5.2 mm is sensitive and specific for intracranial hypertension [68]. Its use in ECMO management is still in its infancy, although a study showed that higher ONSD was associated with poor neurological outcome after ECPR [69].
\nTherapeutic hypothermia has been shown to be neuroprotective for term neonates at risk of hypoxic ischemic encephalopathy secondary to perinatal asphyxia. However a randomized controlled study out of the United Kingdom did not show an improvement in outcomes for neonates on ECMO treated with mild hypothermia [70]. On the other hand, therapeutic hypothermia has been associated as a risk factor for intracranial hemorrhage and should be avoided [30]. In 2015, the American Heart Association recommended targeted temperature management of 32–36°C for comatose patients with return of spontaneous circulation after cardiac arrest [71]. This was also applied to patients who suffered in- hospital cardiac arrest leading to ECPR. A more recent large, multicenter, randomized control trial failed to show a benefit in survival with favorable neurological outcome for children with in-hospital cardiac arrest. There is no data to support routine therapeutic hypothermia for children undergoing ECPR although maintaining normothermia is still encouraged.
\nNeurologic complications contribute to significant morbidity and mortality for patients on ECMO, who constitute a high risk population. There are many modalities currently available for neuromonitoring, and as we gain more experience and information through more frequent use, we will be able to develop consensus guidelines and protocols to provide better care. A multimodal approach to active surveillance, early recognition and prompt management of neurologic injuries as they arise, may improve outcomes for patients on ECMO.
\nThe author has no “conflict of interest” to disclose.
Globally, diabetes is among the top ten causes of death in adults and was estimated to have caused the 4.2 million deaths resulting from diabetes and its complications in 2019. India is ranked second with almost 77 million cases in the list of countries that are most affected with diabetes while China leads the list with over 116.4 million diabetics. An estimated 15.8% (20.4 million) of live births are affected by hyperglycemia in pregnancy in 2019. This represents 9.3% of the world’s population in this age group. In the International Diabetes Federation (IDF) South-East Asia Region, 57% of adults aged 20–79 years with diabetes are undiagnosed. An estimated 1.1 million children and adolescents (aged under 20 years) have type 1 diabetes. The total number is projected to rise to 578 million (10.2%) by 2030 and to 700 million (10.9%) by 2045. Annual worldwide health spending on diabetes is estimated to be USD 760 billion. It is projected that expenditure will reach USD 825 billion by 2030 and USD 845 billion by 2045 [1].
Fifty percentage of patients with diabetes have some degree of neuropathy, resulting in at least one-foot ulcer throughout the lifetime in 15% of the cases. Neuropathic foot ulceration is a foremost cause of illness in patients with diabetes [2]. Diabetes patients have demonstrated that there are significantly increased skin temperatures and recognizable thermal radiation patterns, which differentiate them from healthy people. Thermometry of the diabetic foot is an impressive way to evaluate the risks associated with foot ulceration [3]. It has been revealed that monitoring foot skin temperature contributes to the clinical information before other medical signs of the wound can be recognized [4]. Differences in plantar thermal patterns in normal controls and non-ulcer diabetic patients were studied using thermometry [5]. Though, it has not been abundantly clarified to what extent the individual inconsistency of the plantar thermal patterns shows different trends between healthy and diabetes patients. Thermal imaging technology is capable to measure insignificant temperature irregularities to oversee some physiological circumstances [6]. Understanding of the temperature profile of foot is quite important to evolve thermal imaging system for detection of diabetic foot.
A healthy foot having healthy blood flow through healthy blood vessels whereas the decreased blood flow in the diabetic foot cause damage to organs like the leg and foot. The lack of blood flow caused by diabetes decreases the body’s ability to heal from injuries. The assessment of raised temperature distribution with infrared thermometry in the diabetic foot is employed to identify the varying metabolic activity. Skin examination with an IR thermometer is flexible to repetitive wound care practice and home health. Nevertheless, the IR thermometry method becomes difficult and insufficient when measuring the temperature at many points on the foot [7, 8]. The liquid crystal thermograph methodology provides the temperatures pattern of the foot area as a colored foot imprint on a plate encompassed by layers of compressed thermochromics liquid crystals. The imprint persists for few minutes and then gradually disappear away. A temperature profile cannot be obtained for non-contact areas like an arch [9, 10].
Employing high-resolution and very sensitive thermal imaging cameras, the heat radiation from the matter is acquired and processed into an image of the thermal map which can then be stored and analyzed on screen and computer. Increased temperature investigation can be attained even for non-contact foot areas. Thermal images of diabetic feet reveal that it is 2.2°C colder than the lower leg, and usually the toes are not observable to the camera as they have become so hypothermic. Diabetic foot can arise several years before repetitive blood glucose levels indicate diabetes, and as such, can provide the patient time to treat the illness before everlasting nerve impairment occurs to the foot [11, 12, 13].
Though thermal imaging system is a promising screening tool for diabetic foot, diagnosis is usually done manually by skilled professionals. Hence, analyses made from thermograms are greatly subjective in nature. In order to overcome issues such as lack of proficient personnel, an efficient machine learning framework needs to be developed. The developments made in thermography and pattern recognition techniques are used to develop a competent system for detection of diabetic foot in plantar thermograms. Such a system can be used for screening of diabetes mellitus patients in developing countries, specifically by primary health care specialists in rural areas where health care expert is lacking.
The main objective of this work is to perform statistical analysis in the thermal images to achieve reasonable and accurate inferences to make decisions accurately which aids in the prevention of numerous errors and biases. A Kernel Mixture Model (KMM) with four components approximates the plantar temperature distributions of the control group and DM group. Color texture features are extracted and analyzed to find the important features. A competent classification model to investigate the likelihood of diabetes in patients with maximum accuracy using the statistically significant temperature and color texture features is presented in Figure 1.
Statistical analysis-based system for detection of diabetic foot.
The camera specifications, dataset details, and image acquisition protocol used in this study are presented in the following sections.
Most of the work in plantar foot thermography has been done on thermograms acquired using an infrared thermal imaging camera. Thermal imaging cameras with a high resolution made suitable for medical applications can measure subtle temperature changes and hence are capable of improved detection of diabetic foot complications. A FLIR E60 thermal imaging camera is used for the present study to acquire plantar foot thermal images. It has a resolution of 320x240 pixels and covers a Field of View (FOV) of 25°x19°. The range of operation of the camera is in the region of the infrared spectrum from 7.5 μm to 13 μm wavelength. It can detect the temperature in the range of −20–650°C with thermal sensitivity of less than 0.05°C at 30°C and has an onboard digital camera with a resolution of 3.1 megapixels (MP). The onboard digital camera covers the same FOV as that of the thermal imaging camera and acquired images are of size 2048x1536 pixels. The temperature values are associated with a color palette (Rainbow Color Scheme palette) to represent and distinguish them graphically, where blue and green shades represent cooler regions. Warmer regions are represented by yellow, orange, and red colors in the increasing order of temperature respectively. Maximum temperature (intensity) is represented in white. It is ensured that the thermal imaging camera is calibrated against a black body reference as per the manufacturer’s recommendations [14].
In order to acquire accurate and convenient outcomes for clinical practice, the thermal images of the participants in the study were carried out in compliance with the protocols and guidelines set by the International Academy of Clinical Thermology Standards and Protocols [15, 16, 17] are listed below:
The examination was performed in a steady-state 20 ± 1°C environment.
The thermal images were acquired when the subject is sitting in a podiatric chair or comfortable and adequate position.
The thermal imaging system emissivity is set to 0.98
The thermal camera is calibrated prior to image acquisition by focusing lens on a black body
After socks have been removed, the foot regions are cleaned with a damp towel
All the subjects/patients are requested to remain in bare foot for 10–20 minutes before performing the actual measurements to eliminate the effect of external aspects on the temperature distributions of the foot
The camera should be placed at a distance of 1.1 m
During the investigation, the patient should be able to be placed relatively middle and sufficiently spaced from each wall
Any IR radiation source is available in the investigational room that should be shielded/covered
The schematic representation of the acquisition of plantar thermal image is depicted in Figure 2.
Schematic arrangement for acquisition of thermal image.
The control subjects and Diabetes Mellitus (DM) patients were considered in this study. A total of 35 control subjects and 35 DM patients were recruited from and Hycare for Wounds, Chennai. Both control and DM groups comprise male and female participants, aged between 30 and 65 years. The DM group thermal image collection has been granted by Hycare for Wounds – Institutional Review Board. The participants were informed about the study beforehand and written informed consent forms were obtained from the participants of the study. Sample color and thermal images of the control group and DM group are acquired by the highly sensitive FLIR E60 IR thermal imaging system and are shown in Figures 3 and 4 (a, b) respectively.
Control group samples images. (a) Color image of the foot. (b) Thermal image of the foot.
DM group samples images. (a) Color image of the foot. (b) Thermal image of the foot.
This study is carried out both on acquired and publicly available plantar thermogram database [17, 18, 19, 20, 21] for the early detection of diabetic foot. The plantar thermogram database was obtained in a controlled environment 20 ± 1°C using FLIR E60 and FLIR E6 IR thermal imaging system from 122 subjects diagnosed with diabetes (DM group) and 45 healthy subjects (control group). During the thermogram acquisition, the position of the camera is fixed by an adjustable vertical tripod to avoid any undesirable movement. The tripod is placed one meter away from the feet. The participants were asked to remove their shoes and socks and clean their feet with a damp towel. After that, the subjects were invited to maintain a supine position for 15 minutes (Figure 5).
(a) Database thermal image of the foot – Control group. (b) Database thermal image of the foot – DM group.
For each plantar thermogram, the left and right foot were extracted and was taken as a separate thermogram, obtaining a database of 334 individual thermograms. The subjects were recruited from the General Hospital of the North, the General Hospital of the South, the BIOCARE clinic, and the National Institute of Astrophysics, Optics and Electronics (INAOE) over 3 years (from 2012 to 2014). The sample thermal image from the control group and DM group of the database is depicted in Figure 4(a) and (b), respectively. The total number of images used in the study is tabulated in Table 1, where the left foot and right foot is denoted by LF and RF respectively.
Control Group | DM Group | |
---|---|---|
Acquired images | 70 (35 LF & 35 RF) | 70 (35 LF & 35 RF) |
Plantar thermogram database | 90 (45 LF & 45 RF) | 244 (122 LF & 122 RF) |
Total | 160 (80 LF & 80 RF) | 314 (157 LF & 157 RF) |
Number of images in the dataset.
Since the database images are having only the foot region, the segmentation is performed only for the acquired plantar thermal images. The left and right foot regions are segmented from each color image using the region growing algorithm [22]. The red, green, and blue planes are extracted from thermal images and multiplied with the corresponding segmented foot region to get the ROI as a thermal image. The foot position of the left and right foot regions is corrected. Figure 6(a) and (b) show the segmented plantar foot regions of the control group and DM group, respectively. The raw temperature profiles of the acquired thermal images are exported as a.csv file from FLIR Tools® thermal analysis and reporting software. The binary image of the segmented foot regions is multiplied with the raw temperature profile of the corresponding foot regions to obtain the temperature distribution for the foot regions.
(a) Segmented LF and RF regions of the control group. (b) Segmented left and right foot regions of the DM group.
The plantar foot region is divided into four regions covering the toe region, metatarsal heads, medial arch and heel region to quantitatively analyze the temperature distribution. Histogram plot of the temperature distributions is accomplished by computing the mean temperature for each row of the plantar raw temperature profile for both left and right foot. The temperature values which are greater than 0°C are alone used to compute the mean temperature while those temperature values that are equal to 0°C are related to background and hence eliminated in each row. The histogram plot of the temperature distributions was offset corrected and normalized. The balance of every single distribution is eliminated by deducting the smallest temperature value either at the start or termination of the distribution. Later it is normalized by selecting a precision of three decimal figures to differentiate deviations in temperature from one pixel to another pixel.
Once the final histogram is obtained, an approximation of density function is estimated using Kernel Density Estimation (KDE). A kernel distribution is a non-parametric representation of the probability density function (pdf) of a random variable. Let
Where
Smoothened temperature distribution - control group.
Smoothened temperature distribution - DM group.
The smoothening is repeated for all the four regions of each left and right foot of the control and DM group. The region-wise smoothened temperature distribution is superimposed on the whole foot smoothened output for the control and DM groups depicted in Figures 9 and 10, respectively. From the mean temperature distribution histogram plot it was observed that the control group have a larger mean temperature around 21–22°C with a smaller number of occurrences of temperatures distribution while the DM group have a larger mean temperature around 23–24°C with a larger number of occurrences of particular temperatures values. Similar kinds of deviations are observed in all the four ROIs of the left foot and right foot in the control and DM groups.
Region wise smoothened temperature distribution superimposed on the whole foot - control group.
Region wise smoothened temperature distribution superimposed on the whole foot output - DM group.
Since the KDE, which is a non-parametric distribution utilized to smoothen the temperature distribution, the central tendency among the control and DM groups was calculated by arranging the temperature distribution in ascending order to determine median and interquartile range for statistical analysis. Similarly, the median and interquartile range are also obtained for all the four ROIs with the corresponding smoothened temperature distribution for both control and DM groups. The computed median and interquartile range extracted from whole foot and region-wise for both groups are shown in Tables 2 and 3.
Group | Median (°C) | Interquartile Range (°C) | ||
---|---|---|---|---|
Left Foot | Right Foot | Left Foot | Right Foot | |
Control Group | 27 ± 1.80 | 26.98 ± 1.77 | 1.92 ± 0.60 | 1.94 ± 0.49 |
DM Group | 29.64 ± 2.85 | 29.84 ± 2.85 | 1.55 ± 0.66 | 1.59 ± 0.74 |
Median and interquartile range for whole foot.
Group | Region of Interest | Median (°C) | Interquartile Range (°C) | ||
---|---|---|---|---|---|
Left Foot | Right Foot | Left Foot | Right Foot | ||
Control Group | Toes | 25.3 ± 2.17 | 25.33 ± 2.32 | 1.68 ± 0.69 | 1.68 ± 0.64 |
Metatarsals | 26.9 ± 1.99 | 26.82 ± 1.93 | 1.00 ± 0.38 | 1.03 ± 0.35 | |
Arch | 28.23 ± 1.63 | 28.19 ± 1.61 | 1.79 ± 0.56 | 1.82 ± 0.55 | |
Heel | 26.69 ± 1.76 | 26.68 ± 1.75 | 1.19 ± 0.42 | 1.18 ± 0.41 | |
DM Group | Toes | 29.50 ± 3.66 | 29.72 ± 3.70 | 1.24 ± 0.79 | 1.32 ± 0.95 |
Metatarsals | 29.89 ± 3.15 | 30.12 ± 3.15 | 0.92 ± 0.52 | 0.89 ± 0.47 | |
Arch | 29.86 ± 2.55 | 30.06 ± 2.52 | 1.24 ± 0.58 | 1.19 ± 0.56 | |
Heel | 29.17 ± 2.73 | 29.45 ± 2.79 | 1.02 ± 0.42 | 1.08 ± 0.48 |
Region wise median and interquartile range.
Thus, between Tables 2 and 3 it was observed that the control group has a lower median temperature than the DM group. Since the mean temperature distribution is having a higher value in the lower quartile and upper quartile for the whole foot and region-wise, the interquartile range for the DM group is lesser than the control group.
The Chi-square goodness-of-fit [25] test was employed to assess the null hypothesis statistically for all the smoothened temperature distribution of left foot and right foot among control and DM group as shown in Table 4. This test is utilized to determine whether the variables are attained from the particular group temperature distribution or not and also to evaluate whether the sample data is representative of the full population of the temperature distribution. For both control and DM groups, the test returned an h value equivalent to one which specifies that chi-square goodness-of-fit rejects the null hypothesis at 5% significance level. Hence, these median and interquartile ranges are utilized to detect the diabetic foot in the classification process.
Group | Null Hypothesis (h) | Probability | ||
---|---|---|---|---|
Left Foot | Right Foot | Left Foot | Right Foot | |
Control Group | 1 | 1 | 0.00459 | 0.00290 |
DM Group | 1 | 1 | 0.00477 | 0.00448 |
Chi-square goodness-of-fit test results.
Color is one of the better notable and striking visual aspects that is employed in image retrieval and pattern recognition. Color moment (CM) is a computation technique utilized to discriminate images based on their color distribution in the image similar to the central tendency of the probability distribution. It is a potential technique for the description of color features [26, 27]. Once determined, these moments contribute a quantity for color resemblance among images. The red plane, green plane and blue plane images are extracted from each of the segmented thermal images for the control and DM groups. In this study, the mean (first moment), standard deviation (second moment), skewness (third moment), kurtosis (fourth moment), variance and entropy are extracted for all the four ROIs in each foot of all three color planes of images. The mean represents the average color value existing in the image. Variance is a measure of the color distribution of the image. Standard deviation is attained by executing a square root of the variance of the color distribution. Skewness is a measure of the degree of symmetry distribution of the color. The color textural features extracted from the green plane images of the left and right foot are highly correlated and shows very few dissimilarities within the values for all the four ROIs. Hence, the color texture features extracted from red and blue plane images alone are used for further processing. The skewness is having negative values for a few ROIs is the representation of the tail at the smaller end of the textural distribution is more pronounced than the tail at the larger end of the textural distribution.
Support Vector Machine (SVM) is a discriminative classifier algorithm, concerning the patterns represented by the subset
where
The KNN classifier is a non-parametric, non-linear, and simple method that is used to classify the features. In this algorithm, the classification of test data is executed by finding a majority vote of the known class, and the input data will attain the class that is most common among its k-nearest neighbors [30, 31]. It is obtained using a distance metric such as Euclidean distance between the training and test data set which is calculated by
where,
The test data is assigned to a class based on closest k-datasets for training based on resemblance measures, subsequently, the majority vote of the case neighbors is determined to categorize the case [32, 33].
The textural color features, median temperature and interquartile range forms the feature sets for detection of the diabetic foot using SVM and KNN classifier. The different grouping of feature sets which are extracted from the control and DM group was investigated in this study as follows:
In all the combination, 80% of features are used to train and the remaining 20% of features are used to test the performance of the classifier. In this study, the classification is carried out using the SVM classifier and K-Nearest Neighbors (KNN) classifier for automatic classification of the plantar thermal images into two classes. The performance evaluation metrics of SVM and KNN classifiers for the detection of diabetic foot are shown in Figure 11. It was realized that the SVM classifier has obtained a higher classification accuracy of 92.86%, a sensitivity of 96.55%, specificity of 84.62%, a precision of 93.33%, and an F1-score of 94.92% for Group 1 (RBT) features combination than other combinations of feature set.
Performance of SVM and KNN classifier in various combinations of feature set.
In this study, the statistical analysis of plantar temperature distribution based non-parametric way was done by using kernel density estimation. This approach showed the temperature distribution changes in different areas of the plantar region between the control and DM groups. The median and interquartile ranges are obtained from the statistical analysis. The extracted color features are grouped with the statistical measures of temperature distribution to automatically classify the data using SVM and KNN classifiers. Four different combinations of features sets were used to train and test the performance of the classifier. The SVM classier obtained better accuracy with Group 1 (RBT) feature sets.
Authors would like to register their profound gratitude to Dr.V.B.Narayanamurthy, Dr.K.Rajesh and Dr.R.Arvind, Directors of Hycare for Wouds, Chennai, India, for their help to get the ethical approval from Institutional Review Board (IRB) for acquisition of thermal images and Clinical inputs for the same. The authors are also thankful to the patients and healthy volunteers who actively participated in the data collection and the clinicians in the Hycare for Wounds, Chennai.
The authors declare no conflict of interest.
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This chapter is an updated overview of the signaling pathways going from external signals such as osmolarity and ionic concentration and their membrane reception to their transduction through the membrane and their final reception at the flagellar axoneme level. Additional factors such as energy management will be addressed as they constitute a limiting factor of the motility period of fish spermatozoa. Modern technologies used nowadays for quantitative description of fish sperm flagella in movement will be briefly described as they are more and more needed for prediction of the quality of sperm used for artificial propagation of many fish species used in aquaculture. The chapter will present some applications of these technologies and the information to which they allow access in some aquaculture species.",book:{id:"7912",slug:"biological-research-in-aquatic-science",title:"Biological Research in Aquatic Science",fullTitle:"Biological Research in Aquatic Science"},signatures:"Jacky Cosson",authors:[{id:"188281",title:"Dr.",name:"Jacky",middleName:null,surname:"Cosson",slug:"jacky-cosson",fullName:"Jacky Cosson"}]},{id:"20911",doi:"10.5772/19948",title:"The Significance of Suspended Sediment Transport Determination on the Amazonian Hydrological Scenario",slug:"the-significance-of-suspended-sediment-transport-determination-on-the-amazonian-hydrological-scenari",totalDownloads:4181,totalCrossrefCites:13,totalDimensionsCites:24,abstract:null,book:{id:"304",slug:"sediment-transport-in-aquatic-environments",title:"Sediment Transport in Aquatic Environments",fullTitle:"Sediment Transport in Aquatic Environments"},signatures:"Naziano Filizola, Jean-Loup Guyot, Hella Wittmann, Jean-Michel Martinez and Eurides de Oliveira",authors:[{id:"36890",title:"Dr.",name:"Naziano",middleName:null,surname:"Filizola",slug:"naziano-filizola",fullName:"Naziano Filizola"},{id:"60004",title:"Dr.",name:"Jean-Michel",middleName:null,surname:"Martinez",slug:"jean-michel-martinez",fullName:"Jean-Michel Martinez"},{id:"60005",title:"Dr.",name:"Jean-Loup",middleName:null,surname:"Guyot",slug:"jean-loup-guyot",fullName:"Jean-Loup Guyot"},{id:"102592",title:"Dr.",name:"Hella",middleName:null,surname:"Wittmann",slug:"hella-wittmann",fullName:"Hella Wittmann"},{id:"102593",title:"Mr.",name:"Eurides",middleName:null,surname:"De Oliveira",slug:"eurides-de-oliveira",fullName:"Eurides De Oliveira"}]},{id:"60698",doi:"10.5772/intechopen.74923",title:"Overview on Mediterranean Shark’s Fisheries: Impact on the Biodiversity",slug:"overview-on-mediterranean-shark-s-fisheries-impact-on-the-biodiversity",totalDownloads:1123,totalCrossrefCites:14,totalDimensionsCites:19,abstract:"Bibliographic analysis shows that the Mediterranean Sea is a hot spot for cartilaginous species biodiversity, including sharks, rays, and chimaeras; 49 sharks and 36 rays were recorded in this region. However, they are by far the most endangered group of marine fish in the Mediterranean Sea. The IUCN Red List shows clearly the vulnerability of elasmobranchs and the lack of data; 39 species (53% of 73 assessed species) are critically endangered, endangered, or vulnerable. The biological characteristics of elasmobranchs (low fecundity, late maturity, and slow growth) make them more vulnerable to fishing pressure than most teleost fish. Overfishing, the wide use of nonselective fishing practices, and habitat degradation are leading to dramatic declines of these species in the Mediterranean Sea. In general, elasmobranchs are not targeted but are caught incidentally. In many fisheries, they are, however, often landed and marketed. A decline in cartilaginous fish species landings has been observed while fishing effort has generally increased. Better understanding of the composition of incidental and targeted catches of sharks by commercial fisheries are fundamentally important for the conservation of these populations. Moreover, problems encountered by elasmobranchs in the area are highlighted, and conservation measures are suggested.",book:{id:"6266",slug:"marine-ecology-biotic-and-abiotic-interactions",title:"Marine Ecology",fullTitle:"Marine Ecology - Biotic and Abiotic Interactions"},signatures:"Mohamed Nejmeddine Bradai, Bechir Saidi and Samira Enajjar",authors:null}],mostDownloadedChaptersLast30Days:[{id:"60368",title:"Biological and Medicinal Importance of Sponge",slug:"biological-and-medicinal-importance-of-sponge",totalDownloads:2585,totalCrossrefCites:1,totalDimensionsCites:3,abstract:"Sponges are multicellular, heterotrophic parazoan organisms, characterized by the possession of unique feeding system among the animals. They are the most primitive types of animals in existence, featuring a cell-based organization where different cells have different tasks, but do not form tissues. Sponges (Porifera) are a predominantly marine phylum living from the intertidal to the abyssal (deepest ocean) zone. There are approximately 8500 described species of sponges worldwide with a prominent role in many reef coral communities. Several ecological studies reported have shown that secondary metabolites isolated from sponges often serve defensive purposes to protect them from threats such as predator attacks, biofouling, microbial infections, and overgrowth by other sessile organisms. In the recent years, interest in marine sponges has risen considerably due to presence of high number of interesting biologically active natural products. More than 5300 different natural products are known from sponges and their associated microorganisms, and every year hundreds of new substances are discovered. In addition to the unusual nucleosides, other classes of substances such as bioactive terpenes, sterols, fatty acids, alkaloids, cyclic peptides, peroxides, and amino acid derivatives (which are frequently halogenated) have been described from sponges or from their associated microorganisms. Many of these natural products from sponges have shown a wide range of pharmacological activities such as anticancer, antifungal, antiviral, anthelmintic, antiprotozoal, anti-inflammatory, immunosuppressive, neurosuppressive, and antifouling activities. This chapter covers extensive work published regarding new compounds isolated from marine sponges and biological activities associated with them.",book:{id:"6344",slug:"biological-resources-of-water",title:"Biological Resources of Water",fullTitle:"Biological Resources of Water"},signatures:"Musarat Amina and Nawal M. Al Musayeib",authors:[{id:"213049",title:"Dr.",name:"Musarat",middleName:null,surname:"Amina",slug:"musarat-amina",fullName:"Musarat Amina"},{id:"213050",title:"Dr.",name:"Nawal",middleName:null,surname:"M. Al Musayeib",slug:"nawal-m.-al-musayeib",fullName:"Nawal M. Al Musayeib"}]},{id:"59865",title:"Marine Fisheries in Nigeria: A Review",slug:"marine-fisheries-in-nigeria-a-review",totalDownloads:3937,totalCrossrefCites:9,totalDimensionsCites:11,abstract:"Fisheries production especially from marine is important for the socio-economic development of Nigerians and its contribution to the nation’s economic growth through the Gross Domestic Product (GDP). Nigeria is blessed with enough marine fisheries resources that could enhance increased fish production. Yet, fish supply from domestic production is far below the fish demand of her citizens. This chapter is therefore focused on marine fisheries in Nigeria. We adopted a desk review approach. This chapter is divided into different sections such as the Nigerian fisheries sector, marine fisheries resources in Nigeria, status of marine fisheries production in Nigeria, marine fisheries regulations, and constraints to optimal marine fisheries production in Nigeria. We concluded that the contribution of aquaculture to marine fisheries production has been low, compared to the marine capture fisheries production. Also, we noted that despite the availability of regulations, noncompliance by fisher folks has not helped to optimize marine fisheries production. We therefore recommended that the culture of marine fishes should be intensified. Marine waters should also be protected against destruction and pollution as a result of human activities. Available marine fisheries regulations should be enforced and violators of the regulations should be punished as stipulated in the regulations.",book:{id:"6266",slug:"marine-ecology-biotic-and-abiotic-interactions",title:"Marine Ecology",fullTitle:"Marine Ecology - Biotic and Abiotic Interactions"},signatures:"Olalekan Jacob Olaoye and Wahab Gbenga Ojebiyi",authors:null},{id:"57327",title:"Closed Aquaculture System: Zero Water Discharge for Shrimp and Prawn Farming in Indonesia",slug:"closed-aquaculture-system-zero-water-discharge-for-shrimp-and-prawn-farming-in-indonesia",totalDownloads:2527,totalCrossrefCites:2,totalDimensionsCites:4,abstract:"This chapter focuses on the development and application of zero water discharge (ZWD) system, which has become an alternative solution to conventional methods of aquaculture production. With this system, it is expected to answer many issues in aquaculture cultivation, such as environmental damage, disease outbreak, and land-use change, and to create a sustainable aquaculture cultivation system. ZWD system is an improved batch system with an emphasis on microbial manipulation in rearing tank. The principle of microbial selection is based on the role of each microbial component in nutrient cycle in the rearing tank. This chapter contains in detail how methods and stages are performed in order to conduct this system, including design of construction system, cultivation of microbial components, initial conditioning of this system, and microbial manipulation. The performance of the system was tested in crustacean culture such as white shrimp and giant freshwater prawns, and it showed that the system can increase the average survival rate of 10–20%. In addition, the technical and economic feasibility of this system was evaluated to illustrate the production efficiency upon the application of this system in the industry.",book:{id:"6344",slug:"biological-resources-of-water",title:"Biological Resources of Water",fullTitle:"Biological Resources of Water"},signatures:"Gede Suantika, Magdalena Lenny Situmorang, Pingkan Aditiawati,\nDea Indriani Astuti, Fahma Fiqhiyyah Nur Azizah and Harish\nMuhammad",authors:[{id:"216920",title:"Dr.",name:"Gede",middleName:null,surname:"Suantika",slug:"gede-suantika",fullName:"Gede Suantika"},{id:"220079",title:"Dr.",name:"Magdalena Lenny",middleName:null,surname:"Situmorang",slug:"magdalena-lenny-situmorang",fullName:"Magdalena Lenny Situmorang"},{id:"220081",title:"Dr.",name:"Pingkan",middleName:null,surname:"Aditiawati",slug:"pingkan-aditiawati",fullName:"Pingkan Aditiawati"},{id:"220082",title:"Dr.",name:"Dea Indriani",middleName:null,surname:"Astuti",slug:"dea-indriani-astuti",fullName:"Dea Indriani Astuti"},{id:"220083",title:"MSc.",name:"Fahma Fiqhiyyah Nur",middleName:null,surname:"Azizah",slug:"fahma-fiqhiyyah-nur-azizah",fullName:"Fahma Fiqhiyyah Nur Azizah"}]},{id:"59973",title:"Genetic Applications in the Conservation of Neotropical Freshwater Fish",slug:"genetic-applications-in-the-conservation-of-neotropical-freshwater-fish",totalDownloads:1716,totalCrossrefCites:3,totalDimensionsCites:9,abstract:"Neotropical fish correspond to approximately 30% of all fish species worldwide. The diversity of fish species found in Neotropical basins reflects variations in life-history strategies and exhibition of particular morphological, physiological and ecological attributes. These attributes are mainly related to different forms of feeding, life maintenance and reproduction. Today, fish populations are being threatened by anthropogenic actions that are having a visible impact on the natural state of continental aquatic ecosystems. The main causes are overfishing, non-native species introduction, reservoir-dam systems, mining, pollution and deforestation. The biology and population dynamics of the species are still unclear due to lack of research. Genetic tools can be useful resources for the conservation of Neotropical fish species in several ways. Molecular genetic markers are considered powerful tools to identify cryptic and hybrid fish and also allow the evaluation of the genetic variability and structure of populations of Neotropical ichthyofauna. Several analyses of molecular markers have been performed on Neotropical fish, including allozyme analysis, restriction fragment length polymorphisms in regions of DNA (RFLP), randomly amplified polymorphic DNA (AFLP), randomly amplified polymorphic DNA (RAPD), microsatellites, single nucleotide polymorphisms (SNPs) and mitochondrial DNA (mtDNA) markers. In order to analyse a high number of markers, next generation sequencing has allowed researchers to generate a large amount of genomic information that can be applied to the conservation of Neotropical fish.",book:{id:"6344",slug:"biological-resources-of-water",title:"Biological Resources of Water",fullTitle:"Biological Resources of Water"},signatures:"Vito Antonio Mastrochirico Filho, Milena V. Freitas, Raquel B.\nAriede, Lieschen V.G. Lira, Natália J. Mendes and Diogo T.\nHashimoto",authors:[{id:"215385",title:"Dr.",name:"Diogo",middleName:null,surname:"Hashimoto",slug:"diogo-hashimoto",fullName:"Diogo Hashimoto"},{id:"226741",title:"MSc.",name:"Vito",middleName:null,surname:"Matrochirico-Filho",slug:"vito-matrochirico-filho",fullName:"Vito Matrochirico-Filho"},{id:"226743",title:"MSc.",name:"Milena",middleName:null,surname:"Freitas",slug:"milena-freitas",fullName:"Milena Freitas"},{id:"226744",title:"MSc.",name:"Raquel",middleName:null,surname:"Ariede",slug:"raquel-ariede",fullName:"Raquel Ariede"},{id:"226745",title:"MSc.",name:"Natália",middleName:null,surname:"Mendes",slug:"natalia-mendes",fullName:"Natália Mendes"},{id:"226746",title:"MSc.",name:"Lieschen",middleName:null,surname:"Lira",slug:"lieschen-lira",fullName:"Lieschen Lira"}]},{id:"62582",title:"Mangrove Species Distribution and Composition, Adaptive Strategies and Ecosystem Services in the Niger River Delta, Nigeria",slug:"mangrove-species-distribution-and-composition-adaptive-strategies-and-ecosystem-services-in-the-nige",totalDownloads:2198,totalCrossrefCites:5,totalDimensionsCites:15,abstract:"Mangroves of the Niger River Delta grade into several plant communities from land to sea. This mangrove is a biodiversity hot spot, and one of the richest in ecosystem services in the world, but due to lack of data it is often not mentioned in many global mangrove studies. Inland areas are sandy and mostly inhabited by button wood mangroves (Conocarpus erectus) and grass species while seaward areas are mostly inhabited by red (Rhizophora racemosa), black (Laguncularia racemosa) and white (Avicennia germinans) mangroves species. Anthropogenic activities such as oil and gas exploration, deforestation, dredging, urbanization and invasive nypa palms had changed the soil type from swampy to sandy mud soil. Muddy soil supports nypa palms while sandy soil supports different grass species, core mangrove soil supports red mangroves (R. racemosa), which are the most dominant of all species, with importance value (Iv) of 52.02. The red mangroves are adapted to the swampy soils. They possess long root system (i.e. 10 m) that originates from the tree stem to the ground, to provide extra support. The red mangrove trees are economically most viable as the main source of fire wood for cooking, medicinal herbs and dyes for clothes.",book:{id:"6411",slug:"mangrove-ecosystem-ecology-and-function",title:"Mangrove Ecosystem Ecology and Function",fullTitle:"Mangrove Ecosystem Ecology and Function"},signatures:"Aroloye O. Numbere",authors:[{id:"215285",title:"Dr.",name:"Aroloye O.",middleName:null,surname:"Numbere",slug:"aroloye-o.-numbere",fullName:"Aroloye O. Numbere"}]}],onlineFirstChaptersFilter:{topicId:"105",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},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:139,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:122,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:21,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:10,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:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}}]},series:{item:{id:"24",title:"Sustainable Development",doi:"10.5772/intechopen.100361",issn:"2753-6580",scope:"