\\n\\n
Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\\n\\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\\n"}]',published:!0,mainMedia:{caption:"Highly Cited",originalUrl:"/media/original/117"}},components:[{type:"htmlEditorComponent",content:'IntechOpen is proud to announce that 191 of our authors have made the Clarivate™ Highly Cited Researchers List for 2020, ranking them among the top 1% most-cited.
\n\nThroughout the years, the list has named a total of 261 IntechOpen authors as Highly Cited. Of those researchers, 69 have been featured on the list multiple times.
\n\n\n\nReleased this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\n\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\n'}],latestNews:[{slug:"intechopen-supports-asapbio-s-new-initiative-publish-your-reviews-20220729",title:"IntechOpen Supports ASAPbio’s New Initiative Publish Your Reviews"},{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"}]},book:{item:{type:"book",id:"5411",leadTitle:null,fullTitle:"Fourier Transforms - High-tech Application and Current Trends",title:"Fourier Transforms",subtitle:"High-tech Application and Current Trends",reviewType:"peer-reviewed",abstract:"The main purpose of this book is to provide a modern review about recent advances in Fourier transforms as the most powerful analytical tool for high-tech application in electrical, electronic, and computer engineering, as well as Fourier transform spectral techniques with a wide range of biological, biomedical, biotechnological, pharmaceutical, and nanotechnological applications. The confluence of Fourier transform methods with high tech opens new opportunities for detection and handling of atoms and molecules using nanodevices, with potential for a large variety of scientific and technological applications.",isbn:"978-953-51-2894-6",printIsbn:"978-953-51-2893-9",pdfIsbn:"978-953-51-4114-3",doi:"10.5772/62751",price:119,priceEur:129,priceUsd:155,slug:"fourier-transforms-high-tech-application-and-current-trends",numberOfPages:262,isOpenForSubmission:!1,isInWos:1,isInBkci:!0,hash:"5c45d1a91daef66093a42a82448a70f0",bookSignature:"Goran S. Nikolic, Milorad D. Cakic and Dragan J. Cvetkovic",publishedDate:"February 8th 2017",coverURL:"https://cdn.intechopen.com/books/images_new/5411.jpg",numberOfDownloads:26612,numberOfWosCitations:34,numberOfCrossrefCitations:21,numberOfCrossrefCitationsByBook:5,numberOfDimensionsCitations:44,numberOfDimensionsCitationsByBook:5,hasAltmetrics:1,numberOfTotalCitations:99,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"March 30th 2016",dateEndSecondStepPublish:"April 20th 2016",dateEndThirdStepPublish:"July 25th 2016",dateEndFourthStepPublish:"October 23rd 2016",dateEndFifthStepPublish:"November 22nd 2016",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6,7,8",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"23261",title:"Prof.",name:"Goran",middleName:"S.",surname:"Nikolic",slug:"goran-nikolic",fullName:"Goran Nikolic",profilePictureURL:"https://mts.intechopen.com/storage/users/23261/images/system/23261.jpg",biography:"Dr. Goran Nikolić was born in Knez Selo (Niš, Serbia) on 1 November 1966. He received his B.Sc. degree in Chemistry (1990), M.Sc. degree in Organic Chemical Technology and Polymer Engineering (1996), and finally his PhD degree in Chemical Engineering (2002) from the University of Niš. Currently, he is a full professor at the same university, on Pharmaceutical-cosmetic engineering group of subjects at Faculty of Technology in Leskovac. His research activities are: quality control and stability of drugs, development of new pharmaceutical products (antianemic, antiseptic), pharmaceutical ingredients (synthesis and characterization), polynuclear and biocomplexes, surfactants. His competences are experience: in team work as a researcher, in project management, and managing of academic institution at different levels (vice dean, department chairman, head of chromatographic and spectrosopic laboratories, president of the quality assurance at the Faculty, and a member of the Committee for the improvement of the quality of the University). He is a member of the several national projects in the technological development area (granted by the Ministry of Science and Technological Development, Republic of Serbia), and member of numerous TEMPUS Joint European projects of sustainable technologies, environmental application and management courses (JPHES 2013, JPHES 2010, MCHEM 2010, IB-JEP 19020). He is a member of Serbian Chemical Society and Physicochemical Association of Serbia, and member of the Editorial Board of the journal Advanced Technologies. He has authored more than 300 scientific papers (in international and national scientific journals, on international conferences), numerous technological solutions for pharmaceutical industry, national monographies, international patents, university textbooks, invitation lecturers. He is the referee in numerous international and national journals, and editor of two international monographs on FTIR spectroscopy (InTech Open).",institutionString:"University of Niš",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"3",totalChapterViews:"0",totalEditedBooks:"4",institution:{name:"University of Nis",institutionURL:null,country:{name:"Serbia"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:{id:"195521",title:"Prof.",name:"Dragan",middleName:"J.",surname:"Cvetkovic",slug:"dragan-cvetkovic",fullName:"Dragan Cvetkovic",profilePictureURL:"https://mts.intechopen.com/storage/users/195521/images/5144_n.jpg",biography:"Prof. Dragan J. Cvetković was born on 26 June 1977 in Leskovac. He finished elementary and high school in Lebane, and then he completed his studies at the Faculty of Technology in Leskovac in the year 2002.He finished his PhD thesis in the year 2012 at the Faculty of Technology in Leskovac. Dragan Cvetković participated in the realization of numerous projects funded by the Ministry of Science, Republic of Serbia. He was engaged on the project “Folding and Stability of Phycobilisome Proteins” at the Institute of Biology and Technology of Saclay, France. He also participated in realization of the project entitled “Contribution of Chemical Quenching of Singlet Oxygen to Pro- and Antioxidant Activity of Carotenoids,” funded by the Polish Ministry of Science. He was elected as a teaching assistant in the year 2008on Physical Chemistry, Colloid Chemistry, and Instrumental Analysis, but in the year 2012, he was elected as an assistant professor on physicochemical group of subjects at the Faculty of Technology in Leskovac.",institutionString:null,position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"1",institution:{name:"University of Nis",institutionURL:null,country:{name:"Serbia"}}},coeditorTwo:{id:"195519",title:"Dr.",name:"Milorad",middleName:null,surname:"Cakic",slug:"milorad-cakic",fullName:"Milorad Cakic",profilePictureURL:"https://mts.intechopen.com/storage/users/195519/images/5143_n.jpg",biography:"Prof. Milorad D. Cakić was born on 26 May 1951 in Leskovac, Serbia. He finished\b his studies at the Faculty of Chemistry in Skopje (Macedonia) in 1975. He completed his master studies in the field of molecular spectroscopy in 1978. His PhD thesis was defended at the same university in 1984. He was elected in 1985 as assistant professor at the University of Niš, Faculty of Technology in Leskovac, where he works today as a full professor. His main scientific interest is structure-spectral correlation investigations by different spectroscopic and chromatographic methods. He had published a number of articles in the field of synthesis and characterization of compounds with proven or potential pharmaceutical activity. He was an editor of many scientific publications and reviewer in a number of journals. His competences are experience in project management and managing of academic institution at different levels (dean, vice dean, head of the department, head of the laboratory, member of the senate, and deputy president of the Expert Board for Natural Sciences and Mathematics). Prof. Cakić is a member of the Board for the Accreditation of Scientific-Research Organizations of the Republic of Serbia.",institutionString:null,position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"University of Nis",institutionURL:null,country:{name:"Serbia"}}},coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"974",title:"Signal Processing",slug:"applied-mathematics-signal-processing"}],chapters:[{id:"53143",title:"Inversion-Based Fourier Transform as a New Tool for Noise Rejection",doi:"10.5772/66338",slug:"inversion-based-fourier-transform-as-a-new-tool-for-noise-rejection",totalDownloads:2094,totalCrossrefCites:4,totalDimensionsCites:4,hasAltmetrics:0,abstract:"In this study, a new inversion method is presented for performing two-dimensional (2D) Fourier transform. The discretization of the continuous Fourier spectra is given by a series expansion with the scaled Hermite functions as square-integrable set of basis functions. The expansion coefficients are determined by solving an overdetermined inverse problem. In order to define a quick algorithm in calculating the Jacobian matrix of the problem, the special feature that the Hermite functions are eigenfunctions of the Fourier transformation is used. In the field of inverse problem theory, there are numerous procedures for noise rejection, so if the Fourier transformation is formulated as an inverse problem, these tools can be used to reduce the noise sensitivity. It was demonstrated in many case studies that the use of Cauchy-Steiner weights could increase the noise rejection capability of geophysical inversion methods. Following this idea, the two-dimensional Fourier transform is formulated as an iteratively reweighted least squares (IRLS) problem using Cauchy-Steiner weights. The new procedure is numerically tested using synthetic data.",signatures:"Mihály Dobróka, Hajnalka Szegedi and Péter Vass",downloadPdfUrl:"/chapter/pdf-download/53143",previewPdfUrl:"/chapter/pdf-preview/53143",authors:[{id:"189265",title:"Prof.",name:"Mihály",surname:"Dobróka",slug:"mihaly-dobroka",fullName:"Mihály Dobróka"},{id:"194562",title:"MSc.",name:"Hajnalka",surname:"Szegedi",slug:"hajnalka-szegedi",fullName:"Hajnalka Szegedi"},{id:"194563",title:"Dr.",name:"Péter",surname:"Vass",slug:"peter-vass",fullName:"Péter Vass"}],corrections:null},{id:"54042",title:"Single Bin Sliding Discrete Fourier Transform",doi:"10.5772/66337",slug:"single-bin-sliding-discrete-fourier-transform",totalDownloads:2259,totalCrossrefCites:3,totalDimensionsCites:3,hasAltmetrics:0,abstract:"The conventional method for spectrum analysis is the discrete Fourier transform (DFT), usually implemented using a fast Fourier transform (FFT) algorithm. However, certain applications require an online spectrum analysis only on a subset of M frequencies of an N-point DFT (M<N). In such cases, the use of single-bin sliding DFT (Sb-SDFT) is preferred over the direct application of FFT. The purpose of this chapter is to provide a concise overview of the Sb-SDFT algorithms, analyze their performance, and highlight advantages and limitations. Finally, a technique to mitigate the spectral leakage effect, which arises when using the Sb-SDFT in nonstationary conditions, is presented.",signatures:"Carlos Martin Orallo and Ignacio Carugati",downloadPdfUrl:"/chapter/pdf-download/54042",previewPdfUrl:"/chapter/pdf-preview/54042",authors:[{id:"187654",title:"Dr.",name:"Carlos",surname:"Orallo",slug:"carlos-orallo",fullName:"Carlos Orallo"},{id:"188926",title:"Dr.",name:"Ignacio",surname:"Carugati",slug:"ignacio-carugati",fullName:"Ignacio Carugati"}],corrections:null},{id:"53524",title:"Fourier Analysis for Harmonic Signals in Electrical Power Systems",doi:"10.5772/66733",slug:"fourier-analysis-for-harmonic-signals-in-electrical-power-systems",totalDownloads:4569,totalCrossrefCites:3,totalDimensionsCites:4,hasAltmetrics:0,abstract:"The harmonic content in electrical power systems is an increasingly worrying issue since the proliferation of nonlinear loads results in power quality problems as the harmonics is more apparent. In this paper, we analyze the behavior of the harmonics in the electrical power systems such as cables, transmission lines, capacitors, transformers, and rotating machines, the induction machine being the object of our study when it is excited to nonsinusoidal operating conditions in the stator winding. For this, a model is proposed for the harmonic analysis of the induction machine in steady‐state regimen applying the Fourier transform. The results of the proposed model are validated by experimental tests which gave good results for each case study concluding in a model proper for harmonic and nonharmonic analysis of the induction machine and for “harmonic” analysis in an electrical power system.",signatures:"Emmanuel Hernández Mayoral, Miguel Angel Hernández López,\nEdwin Román Hernández, Hugo Jorge Cortina Marrero, José\nRafael Dorrego Portela and Victor Ivan Moreno Oliva",downloadPdfUrl:"/chapter/pdf-download/53524",previewPdfUrl:"/chapter/pdf-preview/53524",authors:[{id:"187793",title:"Dr.",name:"Emmanuel",surname:"Hernández",slug:"emmanuel-hernandez",fullName:"Emmanuel Hernández"},{id:"202757",title:"Dr.",name:"Miguel Angel",surname:"Hernández López",slug:"miguel-angel-hernandez-lopez",fullName:"Miguel Angel Hernández López"},{id:"202758",title:"Dr.",name:"Hugo Jorge",surname:"Cortina Marrero",slug:"hugo-jorge-cortina-marrero",fullName:"Hugo Jorge Cortina Marrero"},{id:"202759",title:"Dr.",name:"Edwin Román",surname:"Hernández",slug:"edwin-roman-hernandez",fullName:"Edwin Román Hernández"},{id:"202760",title:"Dr.",name:"Victor Iván Moreno",surname:"Oliva",slug:"victor-ivan-moreno-oliva",fullName:"Victor Iván Moreno Oliva"},{id:"202761",title:"Dr.",name:"José Rafael Dorrego",surname:"Portela",slug:"jose-rafael-dorrego-portela",fullName:"José Rafael Dorrego Portela"}],corrections:null},{id:"53909",title:"High Resolution Single-Chip Radix II FFT Processor for High- Tech Application",doi:"10.5772/66745",slug:"high-resolution-single-chip-radix-ii-fft-processor-for-high-tech-application",totalDownloads:2478,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Electrical motors are vital components of many industrial processes and their operation failure leads losing in production line. Motor functionality and its behavior should be monitored to avoid production failure catastrophe. Hence, a high‐tech DSP processor is a significant method for electrical harmonic analysis that can be realized as embedded systems. This chapter introduces principal embedded design of novel high‐tech 1024‐point FFT processor architecture for high performance harmonic measurement techniques. In FFT processor algorithm pipelining and parallel implementation are incorporated in order to enhance the performance. The proposed FFT makes use of floating point to realize higher precision FFT. Since floating‐point architecture limits the maximum clock frequency and increases the power consumption, the chapter focuses on improving the speed, area, resolution and power consumption, as well as latency for the FFT. It illustrates very large‐scale integration (VLSI) implementation of the floating‐point parallel pipelined (FPP) 1024‐point Radix II FFT processor with applying novel architecture that makes use of only single butterfly incorporation of intelligent controller. The functionality of the conventional Radix II FFT was verified as embedded in FPGA prototyping. For area and power consumption, the proposed Radix II FPP‐FFT was optimized in ASIC under Silterra 0.18 µm and Mimos 0.35 µm technology libraries.",signatures:"Rozita Teymourzadeh",downloadPdfUrl:"/chapter/pdf-download/53909",previewPdfUrl:"/chapter/pdf-preview/53909",authors:[{id:"188300",title:"Associate Prof.",name:"Rozita",surname:"Teymourzadeh",slug:"rozita-teymourzadeh",fullName:"Rozita Teymourzadeh"}],corrections:null},{id:"53607",title:"Memristor Threshold Logic FFT Circuits",doi:"10.5772/66583",slug:"memristor-threshold-logic-fft-circuits",totalDownloads:1859,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"One of the possible approaches to achieve more than Moore's law with signal processing circuits is to inspire from functioning of human brain to mimic neural functions by exploring emerging technologies such as memristor circuits. While fast Fourier transform (FFT) implementations are largely based on CMOS gates, they are limited by the computation speed and availability limits on the number of Boolean variables it can handle at a given time. Biological neurons and networks on the other hand are generalized in nature and can handle both analogue and digital signals. Through this chapter, memristor‐based resistive threshold logic family of gates that inspire from brain‐like large variable logic functions is introduced. This logic consists of a memristors acting as weights to the inputs followed by threshold operations emulating neuronal synapse. Using this Boolean logic, a processing unit that can compute Fourier transform of a given set of inputs was developed. Various comparisons of the circuit are found to be advantageous in implementing neuromorphic circuits. The existing logic families were carried out and the proposed logic family was found too advantageous in many ways.",signatures:"Alex Pappachen James",downloadPdfUrl:"/chapter/pdf-download/53607",previewPdfUrl:"/chapter/pdf-preview/53607",authors:[{id:"6992",title:"Prof.",name:"Alex",surname:"James",slug:"alex-james",fullName:"Alex James"}],corrections:null},{id:"53640",title:"Application of Fourier Series Expansion to Electrical Power Conversion",doi:"10.5772/66581",slug:"application-of-fourier-series-expansion-to-electrical-power-conversion",totalDownloads:2735,totalCrossrefCites:2,totalDimensionsCites:2,hasAltmetrics:0,abstract:"Many power electronic applications demand generation of voltage of a rather good sinusoidal waveform. In particular, dc-to-ac voltage conversion could be done by multilevel inverters (MLI). A number of various inverter topologies have been suggested so far: diode-clamped (DC) MLI, capacitor-clamped (CC) MLI, cascaded H-bridge (CHB) MLI, and others. Fourier series expansions have been used to investigate and to form a basis of different topologies comparison, to discover their advantages and disadvantages, and to determine their control. In this chapter, we discuss modulation strategies of DCMLI and CHBMLI, solve their harmonics spectra analytically, and compare them using harmonic distortion indices.",signatures:"Irina Dolguntseva",downloadPdfUrl:"/chapter/pdf-download/53640",previewPdfUrl:"/chapter/pdf-preview/53640",authors:[{id:"188384",title:"Ph.D.",name:"Irina",surname:"Dolguntseva",slug:"irina-dolguntseva",fullName:"Irina Dolguntseva"}],corrections:null},{id:"52810",title:"Study of Green Nanoparticles and Biocomplexes Based on Exopolysaccharide by Modern Fourier Transform Spectroscopy",doi:"10.5772/65776",slug:"study-of-green-nanoparticles-and-biocomplexes-based-on-exopolysaccharide-by-modern-fourier-transform",totalDownloads:2046,totalCrossrefCites:2,totalDimensionsCites:6,hasAltmetrics:0,abstract:"The intention of this chapter is to contribute in clarification of nanoparticle synthesis and biocomplexes based on exopolysaccharide, green synthetic method development, their physico‐chemical characterization by modern spectroscopy, as well as testing of their antimicrobial activity. Silver nanoparticles of polysaccharide type have scientific interest, but practical importance too, because of their application in pharmaceutical and cosmetic product development due to proven antimicrobial and antioxidant activities. On the other hand, the biocomplexes based on exopolysaccharides are important in treatment of biometal deficiency in human and veterinary medicine, as well as in metal ion transporting in organism. Despite a number of studies of this kind of complexes, the investigations of effect of their structure to pharmaco‐biological activity are still interesting. It is important that question of interaction between reducing and stabilizing agents with metal ions is still opened. In this respect, the presented chapter offers further progress in the examination of silver nanoparticles and cobalt biocomplex synthesis with dextran oligosaccharides and its derivatives (such as dextran sulfate and carboxymethyl dextran). The complex structure, spectroscopic characterization, and the spectra‐structure correlation have been analyzed by different Fourier transform infrared (FTIR) spectroscopic techniques combined with energy‐dispersive X‐ray (EDX), X‐ray diffraction (XRD), scanning electron microscopy (SEM), and surface plasmon resonance UV‐Vis methods.",signatures:"Goran S. Nikolić, Milorad D. Cakić, Slobodan Glišić, Dragan J.\nCvetković, Žarko J. Mitić and Dragana Z. Marković",downloadPdfUrl:"/chapter/pdf-download/52810",previewPdfUrl:"/chapter/pdf-preview/52810",authors:[{id:"23261",title:"Prof.",name:"Goran",surname:"Nikolic",slug:"goran-nikolic",fullName:"Goran Nikolic"},{id:"195521",title:"Prof.",name:"Dragan",surname:"Cvetkovic",slug:"dragan-cvetkovic",fullName:"Dragan Cvetkovic"},{id:"195519",title:"Dr.",name:"Milorad",surname:"Cakic",slug:"milorad-cakic",fullName:"Milorad Cakic"},{id:"195520",title:"MSc.",name:"Slobodan",surname:"Glišić",slug:"slobodan-glisic",fullName:"Slobodan Glišić"},{id:"195522",title:"Dr.",name:"Žarko",surname:"Mitić",slug:"zarko-mitic",fullName:"Žarko Mitić"},{id:"195523",title:"MSc.",name:"Dragana",surname:"Marković-Nikolić",slug:"dragana-markovic-nikolic",fullName:"Dragana Marković-Nikolić"}],corrections:null},{id:"53409",title:"Fourier Transform Infrared and Two-Dimensional Correlation Spectroscopy for Substance Analysis",doi:"10.5772/66584",slug:"fourier-transform-infrared-and-two-dimensional-correlation-spectroscopy-for-substance-analysis",totalDownloads:1865,totalCrossrefCites:1,totalDimensionsCites:2,hasAltmetrics:0,abstract:"The development of Fourier transform infrared (FTIR) has had widened its scope of perspective application on different types of substances in terms of technique of material analysis and identification. The tri-step infrared analysis has shown its powerful application in the analysis and interpretation of spectra from pure compound, fraction, raw material, natural product and complex mixture.",signatures:"Yew-Keong Choong",downloadPdfUrl:"/chapter/pdf-download/53409",previewPdfUrl:"/chapter/pdf-preview/53409",authors:[{id:"171079",title:"Dr.",name:"Yew Keong",surname:"Choong",slug:"yew-keong-choong",fullName:"Yew Keong Choong"}],corrections:null},{id:"53419",title:"Fourier Transform Infrared Spectroscopy in the Study of Hydrated Biological Macromolecules",doi:"10.5772/66576",slug:"fourier-transform-infrared-spectroscopy-in-the-study-of-hydrated-biological-macromolecules",totalDownloads:2499,totalCrossrefCites:3,totalDimensionsCites:15,hasAltmetrics:0,abstract:"The interaction between biological macromolecules (proteins, nucleic acids, lipids and other biomolecules in the cell) and environmental water is an important determining factor in their conformational properties, stability and function. The hydration processes of biopolymers have been extensively studied in the past 20 years with reference to a considerable variety of models and concepts. In all recent works, a distinction is made between intracellular water that maintains the ordinary liquid state (bulk water) and water ordered in extended hydrogen‐bonded lattices at the surface and structured in the internal grooves of macromolecules (hydration water) in dependence on the chemical properties of the macromolecule surface. FTIR spectroscopy has been implemented in this field both for the sensitivity in the conformational analysis of biological macromolecules and the reliability in the investigation of the water network. A perturbation technique such as dehydration‐rehydration treatment modifies the macromolecule structure and water distribution. It was applied to two structurally different proteins: lysozyme, a globular (α + β) protein and collagen, a fibrous protein characterized by the triple helix structure. Submitted to the treatment both of them display irreversible conformational changes.",signatures:"Maria Grazia Bridelli",downloadPdfUrl:"/chapter/pdf-download/53419",previewPdfUrl:"/chapter/pdf-preview/53419",authors:[{id:"108760",title:"Dr.",name:"Maria Grazia",surname:"Bridelli",slug:"maria-grazia-bridelli",fullName:"Maria Grazia Bridelli"}],corrections:null},{id:"53388",title:"Fourier Transform Hyperspectral Imaging for Cultural Heritage",doi:"10.5772/66107",slug:"fourier-transform-hyperspectral-imaging-for-cultural-heritage",totalDownloads:1819,totalCrossrefCites:1,totalDimensionsCites:6,hasAltmetrics:0,abstract:"Hyperspectral imaging is a technique of analysis that associates to each pixel of the image the spectral content of the radiation coming from the scene. This content can be helpful to recognize the chemical nature of the materials within the scene or to calculate their colours under particular conditions. Different solutions of hyperspectral imager have been realized with different spatial resolution, spectral resolution and range in the electromagnetic spectrum. In particular, improving the spectral resolution allows discriminating smaller features in the spectrum and the unambiguous detection of the absorption bands characteristic of superficial materials. Hyperspectral imagers based on interferometers have the advantage of having a spectral resolution that can be varied according to the needs by changing the optical path delay of the interferometer. A spectrum for each pixel is obtained with an algorithm based on the Fourier transform of the calibrated interferogram. We present the results of the application of a hyperspectral imager based on Fabry‐Perot interferometers to the field of cultural heritage. On different artworks, the hyperspectral imager has been used for pigment recognition, for colour rendering elaborations of the image with different light sources or standard illuminants and for calculating the chromatic coordinates useful for specific purposes.",signatures:"Massimo Zucco, Marco Pisani and Tiziana Cavaleri",downloadPdfUrl:"/chapter/pdf-download/53388",previewPdfUrl:"/chapter/pdf-preview/53388",authors:[{id:"20909",title:"Dr.",name:"Marco Q.",surname:"Pisani",slug:"marco-q.-pisani",fullName:"Marco Q. Pisani"},{id:"20910",title:"Dr.",name:"Massimo E.",surname:"Zucco",slug:"massimo-e.-zucco",fullName:"Massimo E. Zucco"},{id:"194761",title:"Dr.",name:"Tiziana",surname:"Cavaleri",slug:"tiziana-cavaleri",fullName:"Tiziana Cavaleri"}],corrections:null},{id:"53366",title:"New Spectral Applications of the Fourier Transforms in Medicine, Biological and Biomedical Fields",doi:"10.5772/66577",slug:"new-spectral-applications-of-the-fourier-transforms-in-medicine-biological-and-biomedical-fields",totalDownloads:2392,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:1,abstract:"This chapter reviews some recent spectral applications of the Fourier transform techniques as they are applied in spectroscopy. An overview about Fourier transform spectroscopy (FTS) used like a powerful and sensitive tool in medical, biological, and biomedical analysis is provided. The advanced spectroscopic techniques of FTS, such as Fourier transform visible spectroscopy (FTVS), Fourier transform infrared-attenuated total reflectance (FTIR-ATR), Fourier transform infrared-photoacoustic spectroscopy (FTIR-PAS), Fourier transform infrared imaging spectroscopy (FTIR imaging), and their biomedical applications are described. 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We wish to have automatic devices/gadgets/instruments with no or minimal intervention from humans in their daily operation. Then only, these devices can qualify to call it is smart instruments. To fulfill this, one of the major requirements is to come up with highly sensitive, long-lasting, low-cost smart sensors. On the other hand, the healthcare industry demands low-cost, Lab-on-chip type biosensors for simple and rapid detection of various biomolecules or biogases. A sensor is an analytical device that detects the change in the environment and responds to some output in terms of a measurable analog resistance/voltage/current converted into a human-readable display or transmitted for further processing. In the last two decades, a significant amount of research has been devoted to the development of various types of gas sensors using different nanomaterials in the electronic and healthcare industry.
\r\n\r\n\tThis book aims to provide the reader (research scholars, scientists, and engineers working in the field of sensors) an overview of the recent advances made in the development of various gas sensors for the electronic and healthcare industries for the betterment of the human lifestyle. Also, this book will intend to address existing challenges and a few future directions of research for easy integration and cost-effective fast sensing of such
\r\n\tgas sensors.
Hydatid disease in people is mainly caused by infection with the larval stage of the dog tapeworm
Cystic hydatid disease usually affects the liver (50–70%) and less frequently the lung, the spleen, the kidney, the bones, and the brain [1-3]. Liver hydatidosis can cause dissemination or anaphylaxis after a cyst ruptures into the peritoneum or biliary tract. Infection of the cyst can facilitate the development of liver abscesses and mechanic local complications, such as mass effect on bile ducts and vessels that can induce cholestasis, portal hypertension, and Budd-Chiari syndrome [4].
Treatment of hydatid liver cyst has to be considered mandatory in symptomatic cysts and recommended in viable cysts because of the risk of severe complications [1]. The modern treatment of hydatid cyst of the liver varies from surgical intervention to percutaneous drainage or medical therapy. Surgery is still the treatment of choice and can be performed by the conventional or laparoscopic approach. However, laparoscopic approach leads to an important rate of recurrence of the disease. Percutaneous Aspiration-Injection-Reaspiration Drainage (PAIR) seems to be a better alternative to surgery in selected cases.
Echinococcus granulosus is spread almost all over t he world, especially in areas where sheep are raised, and is endemic in Asia, North Africa, South and Central America, North America, Canada and the Mediterranean region. In many countries, hydatid disease is more prevalent in rural areas where there is a closer contact between people and dogs and various domestic animals which act as intermediate vectors. Hydatid disease remains frequent and endemic in Tunisia [5]
The life cycle of
Once the eggs are ingested, they release larvae into the duodenum. The larvae migrate through the intestinal mucosa and gain access to mesenteric vessels which carry them to the liver. The liver is the site of up to 70% of echinococcal lesions. Larvae that escape hepatic filtering are carried to the lung, the site of an additional 15-30% of lesions. From the lungs, larvae may be disseminated to any part of the body.(figure 1). Larvae that escape the host\'s defenses and persist in a host organ develop into small cysts surrounded by a fibrous capsule. These cysts grow at a rate of 1-3 cm/year and may remain undetected for years.Thus; they can reach very large sizes before they become clinically evident. The cyst wall contains an outer chitinous layer and an inner germinal layer. The germinal layer may develop internal protrusions and eventually form daughter cysts within the original cyst.
The Life cycle of
A primary cyst in the liver is composed of three layers: (figure 2)
Adventitia (pericyst): consisting of compressed liver parenchyma and fibrous tissue induced by the expanding parasitic cyst.
Laminated membrane (ectocyst): is elastic white covering, easily separable from the adventitia. (Figure3-4)
Germinal epithelium (endocyst) – is a single layer of cells lining the inner aspects of the cyst and is the only living component, being responsible for the formation of the other layers as well as the hydatid fluid and brood capsules within the cyst. In some primary cysts, laminated membranes may eventually disintegrate and the brood capsules are freed and grow into daughter cysts. Sometimes the germinal Epithelium daughter cysts, which if left untreated may cause recurrence.
Hydatid cyst of the liver
Cystic structures with laminating fibrous wall and inner germinal layer
Tissue section of a hydatid cyst showing daughter cyst
Natural history of the hydatid cyst can be divided into two phases:
The first phase is that of growth during which rupture can occur when the pressure of the hydatid liquid becomes more important than resistance of the hydatic wall (pericyst). Finally, the complications such as acute allergic manifestations, infection, jaundice, vomique, are only the consequence of the rupture of the cystic wall.
The second phase is a phase of ageing and of progressive involution. It is the consequence of the overproduction of scolices and daughter cysts. During this phase, the hydatid cyst will be full of scolices and membranes which replace the hydatic liquid. Calcifications occur in the pericyst; the host is at the origin of the image of pericystic wall. Then the reaction of the host leads to a progressive calcification of the walls.The hydatid cyst is unique and localized in the right lobe of the liver in 65%. The most frequent extrahepatic locations are the lungs, the spleen and the peritoneum. Liver (55–70%) is the obvious first site after entry through the gut and passage in the portal circulation. Most cysts tend to be located in the right lobe. As the cysts enlarge local pressure causes a mass effect on surrounding tissue producing commensurate symptoms and signs. These may be generalized with upper abdominal pain and discomfort or more specific. Such as; obstructive jaundice. Biliary rupture may occur through a small fissure or bile duct fistula. A wide perforation allows the access of hydatid membranes to the main biliary ducts, which can cause symptoms simulating choledocholithiasis. Alternatively, it may produce a picture very similar to ascending cholangitis with fever, pain and jaundice.
Echinococcal cysts of the liver can cause complications in about 40% of cases. The most common complications in order of frequency are infection, rupture to the biliary tree; rupture to the peritoneal cavity; rupture to the pleural cavity.
However, rupture in the gastrointestinal tract; bladder and the vessels are very rare.
It is the most common complication and can be somewhat symptomatic.The evolution of an infected hydatid cyst is usually latent, subacute and is clinically translated by pains in the right hypochondrium, hepatomegaly, and fever [1-3].
Intrabiliary rupture of a hepatic hydatid cyst is a common complication and may occur in 2 forms: an occult rupture, in which only the cystic fluid drains to the biliary tree and is observed in 10-37% of the patients; and frank rupture, which has an overt passage of intracystic material to the biliary tract and is observed in 3-17% of the patients. Intrabiliary rupture mainly occurs in centrally localized cysts, and an intracystic water pressure up to 80 cm is also a predisposing factor for the rupture. Intrabiliary rupture occurs in the right hepatic duct (55-60% cases), left hepatic duct (25-30% cases), hepatic duct junction, common bile duct (CBD), or cystic duct (8-11%); perforation into the gallbladder may be observed in 5-6% of cases.
The incidence of rupture into the biliary tree ranges between 3 and 17% [4-6].
The rupture of the hydatid cyst in the biliary ducts and the migration of the hydatid material in the biliary tree lead to the apparition of other biliary complications like: cholangitis, sclerosis odditis, hydatid biliary lithiasis etc.
When ruptured into biliary tree, hydatid cysts commonly manifest with findings of biliary obstruction and cholangitis. Diagnosis of this complication can usually be made by using ultrasound and abdominal CT scan.
The presence of dilated common bile duct, jaundice, or both in addition to a cystic lesion of liver and bile ducts dilatation at CT-scan is strongly suggestive of a hydatid cyst with intrabiliary rupture. (Figure 5)
CT scan showing hepatic hydatid cyst with dilatation of left intra hepatic duct
Thoracic complications of hepatic hydatid cysts result from the proximity of hydatid cysts in the liver and the diaphragm and are seen in approximately 0.6% to 16% of cases.
Several factors, such as pressure gradient between thoracic and abdominal cavities, mechanical compression and ischemia of the diaphragm, sepsis in the hepatic cyst, or chemical erosion by bile, participate in promoting Intrathoracic evolution of hydatid cysts of the hepatic dome.[6-10]
Intrathoracic rupture of hepatic hydatid cyst is a rare but a severe condition causing a spectrum of lesions to the pleura, lung parenchyma, and bronchi. Cyst erosion is associated with pericystic inflammation. Adhesion formation determines whether the rupture is confined to lung parenchyma or the free pleural space, or both. Bronchobiliary fistula leads to hemoptysis and cyst expectoration.
The clinical presentation is predominately pulmonary, with abdominal symptoms being less frequent [11-12].Coughs, expectoration, and dyspnea are present in 30% of cases.
Diagnosis of thoracic complications is performed with Thoraco-abdominal CT-scan which shows the liver hydatid cyst, and the thoracic complication and sometimes could show the diaphragmatic fistula(figure 6-8). The treatment of this complication is usually made through abdominal approach associated to percutaneous drainage of the pleural collection. The indications for thoracotomy become rare.
Chest radiograph showing a right pleural effusion with atelectasis
Thoracic CT-scan showing an atelectasis of the lower lobe of right lung (a) and hydatid cyst of the hepatic dome (b)
Abdominal CT-scan showing a hepatic hydatid cyst of segment VII with communication with the right pleura
Rupture of the cyst in the peritoneal cavity is rare and generally followed by anaphylactic reactions.Afree intraperitoneal rupture has been reported between 1% and 8% in the literature [13-14].
Intraperitoneal cysts may rupture spontaneously, due to increased intracystic pressure, or as a consequence of trauma [8-9], leading to the spread of hydatid fluid in the intraperitoneal cavity.
Significant risk factors for hydatid cyst perforation include younger age, cyst diameter of >10 cm, and superficial cyst location.
Rupture into the peritoneum may present as acute abdominal pain. Antigenic fluid released into the peritoneal cavity and absorbed into the circulation may present with acute allergic manifestations. Abdominal pain, nausea, vomiting and urticaria are the most common symptoms. Allergic reactions may be seen in 25% of the cases.
In some cases, if the hydatid cyst contains bile due to associated rupture in the biliary tree, the patient will present peritonitis or even of hydatid choleperitonitis.
If the rupture is insidious, the release of brood capsules, scolices and even daughter cysts from a ruptured hydatid cyst into the peritoneal cavity leads to multiple cysts in the peritoneal cavity. This phenomenon is called secondary echinococcosis [15-16]. (Figure 9-13)
The diagnosis of this complication is mainly performed with the abdominal CT-scan that shows the hydatid cyst of the liver generally collapsed and peritoneal effusion or daughter cysts. In secondary echinococcosis, the CT –scan shows the hydatid cysts and many peritoneal cysts.
CT scan showing a rupture hydatid cyst of the liver in the peritoneum
CT-scan of the abdomen showing multiple hydatid cysts in the peritoneal cavity due to rupture of hepatic hydatid cyst (secondary echinococcosis)(A). Multiple peritoneal cysts(B)
An operative view in a 12 years old male showing a hydatid cyst of the liver with spontaneous rupture in peritoneum
Operative view showing a hydatid cyst of the peritoneum
Operative view showing a peritoneal echinococcosis
Some complications of the hydatid cyst of the liver are very rare.
About fistulization to the skin, It occurs most often by a cutaneous orifice leaving pus welling and sometimes hydatid membranes [17-18].
Portal hypertension (pre-hepatic, hepatic, post-hepatic) is a very rare complication of hydatid cyst of liver.The compression of the hepatic veins can be responsible for Budd-Chiari syndrome and portal hypertension [19-20]. (fig 14-15)
Vascular erosions are very rare complications of the hydatid cysts of the liver. The vessels could be either the hepatic vein or the veina cava. Some spontaneous ruptures into the veina cava have been described [19].
Acute abdominal pains with a sudden decrease in the volume of cyst and release of daughter vesicles during vomiting (hydatimesis) or in stool (hydatidentery) are highly suggestive of the opening of the cyst in the digestive tract.( fig 16-17)
Operative view showing a hydatid cyst of the liver with portal hypertension
CT scan showing a central hepatic cyst with vascular compression
CT-scan : hydatid cyst of the segment V showing a large fistula between the cyst and the right colon
Operative view showing the colonic fistula (A) and the suture of the fistula after cysto-colonic deconnexion(B)
After infection with Echinococcus granulosus, humans are usually asymptomatic for a long time.The growth of the cyst in the liver is variable, ranging from 1 mm to 5 mm in diameter per year. Most primary infections consist of a single cyst, but up to 20%-40% of infected people have multiple cysts. The symptoms depend not only on the size and number of cysts, but also on the mass effect within the organ and upon surrounding structures.[21]
Hydatid cyst of the liver is frequently silent and only diagnosed incidentally during abdominal investigation for other pathology. The clinical signs appear gradually with the increase volume of the cyst. The most common symptom, when it occurs, is right upper quadrant or epigastric pain and the most common findings on examination are an enlarged liver and a palpable mass. Pressure effects are initially vague. They may include non-specific pain, cough, low-grade fever, and the sensation of abdominal fullness. As the mass grows, the symptoms become more specific because the mass impinges on or obstructs specific organs.
Patients may also present with complications of the cyst such as biliary communication, intraperitoneal rupture (spontaneous or post-traumatic) and, rarely, intrathoracic or intrapericardial rupture.
Cyst rupture can be associated with anaphylaxis secondary to the highly antigenic content of the cyst fluid or may be silent and present with multiple intraperitoneal cysts.
With secondary infection, tender hepatomegaly, chills, and spiking temperatures occurs. Urticaria and erythema occur in cases of generalized anaphylactic reaction. With biliary rupture the classic triad of jaundice, biliary colic and urticaria occurs.
The diagnosis is most easily set by ultrasound or other imaging techniques such as CT-scan or MRI, combined with case history. Serology tests such as ELISA or immunoblotting can be used in addition, being 80-100% sensitive for liver cysts but only 50-56% for lungs and other organs [21]. False positive reactions may occur in persons with other tapeworm infections, cancer, or chronic immune disorders. Whether the patient has detectable antibodies depend on the physical location, integrity and viability of the cyst. Patients with senescent, calcified or dead cysts usually are sero-negative. Patients with alveolar echinococcosis have most of the time detectable antibodies.Fine needle biopsy should be avoided if dealing with E. granulosus since there is a great danger of leakage with subsequent allergic reactions and secondary recurrence.
A great part of the patients treated for hydatid disease get their diagnosis incidentally, seeking medical care for other reasons.
The time at when a previously silent cyst gives rise to pathology depends both on the size of the cyst, but also on its location, making presenting symptoms of cystic echinococcosis highly variable. Most presenting features are caused by the pressure that the enlarged cyst expels on its surroundings, but may also appear if there is a rupture of a cyst.
Symptoms leading to diagnosis mostly include abdominal pain, jaundice (caused by biliary duct obstruction) or a palpable mass in the hepatic area. Cysts in the liver may also cause cirrhosis.
If the cyst is damaged, there may be a leakage of fluid from inside. This fluid contains antigens that are highly toxic, causing allergic reactions like fever, asthma, urticaria, and eosinophilia and in some cases anaphylactic shock.
Considering that the early stages of infection are usually asymptomatic, the diagnosis of liver hydatid cyst may often be incidental, associated with an abdominal ultrasonography performed for other clinical reasons. In endemic areas, the presence of symptoms suggestive of hydatid liver cyst in a person with a history of exposure to sheep and dogs supports the suspicion of hydatidosis.
The definitive diagnosis of liver echinococcosis requires a combination of imaging, serologic, and immunologic studies.
Routine laboratory tests are rarely abnormal occasionally eosinophilia may be present in the presence of cyst leakage, or may be normal. Serum alkaline phosphatase levels are raised in one third of patients
Serological tests detect specific antibodies to the parasite and are the most commonly employed tools to diagnose past and recent infection with E. granulosus. Detection of IgG antibodies implies exposure to the parasite, while in active infection high titers of specific IgM and IgA antibodies are observed. Detection of circulating hydatid antigen in the serum is of use in monitoring after surgery and pharmacotherapy and in prognosis. ELISA is used most commonly, but alternate techniques are counter-immuno-electrophoresis and bacterial co-agglutination.
Elisa techniques have a high sensitivity above 90% and are useful in mass scale screening. The counter-immuno-electrophoresis has the highest specificity (100%) and high sensitivity (80 – 90%). CASONI TEST has been used most frequently in the past but is at present considered only of historical importance and has largely been abandoned because of low sensitivity.
Tests of humoral immunity are still widely used to confirm the diagnosis. The sensitivity and specificity of any humoraltest depends largely on the quality of the antigens utilised.
Antigens can be derived from the whole parasites or organelles, or soluble antigens from cyst fluid. Indirect immunofluorescence assay (IFA) is the most sensitive test (95%) in patients with hepatic CHD.
The sensitivity and specificity of enzyme-linked immunosorbentassay (ELISA) is highly dependent on the method of antigen preparation, and cross-reactions with other helminthic diseases occur if crude antigens are used. Purified fractions may yield high sensitivities (95%) and specificity (100%).[1,3,21]
Imaging modalities range from simple to complex and invasive. Ultrasonography (US) is the screening method of choice.
CT scan is an important preoperative diagnostic tool to determine vascular,biliary or extra hepatic extension, to recognize complications, such as rupture and infections, and therefore to assess respectability[22-28]
However, diagnostic tests such as CT and MRI are mandatory in liver hydatidosis because they allow thorough knowledge regarding lesion size, location, and relations to intrahepatic vascular and biliary structures, providing useful information for effective treatment and decrease in post-operative morbidity.
The right lobe is the most frequently involved portion of the liver. Imaging findings in hepatic hydatid disease depend on the stage of cyst growth (whether the cyst is unilocular, contains daughter vesicles, contains daughter cysts, is partially calcified, or is completely calcified.
Plain Radiographs
Plain radiographs of the abdomen and chest may reveal a thin rim of calcification delineating a cyst, or an elevated hemi diaphragm. Both signs are non-specific.
Calcification is seen at radiography in 20%–30% of hydatid cysts and usually manifests with a curvilinear or ringlike pattern representing calcification of the pericyst. During the natural evolution toward healing, dense calcification of all components of the cyst takes place. Although the death of the parasite is not necessarily indicated by calcification of the pericyst, it is implied by a complete calcification (Figure 18)\n\t\t\t\t\t
Plain radiograph of the abdomen showing a complete calcification of the cyst
Ultrasonography (US)
Ultrasonography is the screening method of choice. It is currently the primary diagnostic technique and has diagnostic accuracy of 90%. Findings usually seen are:
Solitary Cyst – anechoic univesicular cyst with well defined borders and enhancement of back wall echoes in a manner similar to simple or congenital cysts. Features are suggesting hydatid aetiology include dependent debris (hydatid sand) moving freely with change in position; presence of wall calcification or localized thickening in the wall corresponding to early daughter cysts.
Separation of membranes (ultrasonic water lily sign) due to collapse of germinal layer seen as an undulating linear collection of echoes.
Daughter cysts - probably the most characteristic sign with cysts within a cyst, producing a cartwheel or honeycomb cyst.
Multiple cysts with normal intervening parenchyma (differential diagnosis are necrotic secondaries, Polycystic liver disease, abscess, chronic hematoma and biliary cysts.
Complications may be evident such as echogenic cyst in infection or signs of biliary obstruction (dilated bile ducts with some images corresponding to hyperechoic vesicles or hydatid membranes within the biliary tract) usually implying a biliary communication.
Doppler ultrasonography is indicated to show the reports of hydatid cyst with vascular axes (portal vein, hepatic veins, and inferior vena cava).
However, in the types I and IV, we have to consider differential diagnosis.
Gharbi Classification on Ultrasonography features of Hydatid Cyst [23], (Figure19-20)
Type | Ultrasound Appearance |
I | Pure fluid Collection |
II | Fluid collection with a split wall ( |
III | Fluid collection with septa |
IV | Heterogeneous echo pattern ( |
V | Reflecting walls (Cyst with reflecting calcified thick wall) |
Intra-operative Ultrasonography is an important investigation during surgery for hydatid cyst of the liver.
Ultrasonography of Hydatid cyst of the liver type II ( Gharbi)
Ultrasonography of Hydatid cyst of the liver Type III ( Gharbi)
Different classifications of Ultrasonography have been described in the literature [24-25].
WHO introduced a standardized classification of Ultrasonography images of cystic echinococcosis, to obtain comparable resultsin patients worldwide and to link disease status with each morphological type of Hydatid cysts (Table 1).
Classification of hydatid cysts based on the ultrasound appearance.[in 24]
Computed Tomographic scan
Multi detector row computed tomography has the highest sensitivity of imaging of the cyst (100%). It is the best mode to detect the number, size, and location, of the cysts. It may provide clues to presence of complications such as infection, and intrabiliary ruptures. CT features include sharply marginated single or multiple rounded cysts of fluid density (3 – 30 Hounsfield units) with a thin dense rim. [26-28]
It is also helpful in identifying exogenous cysts, and the volume of the cyst can be estimated. CT is an important investigation when there is a diagnostic uncertainty on ultrasound (Type I and IV of Gharbi), when planning surgical intervention or when recurrent disease is diagnosed. In case of peritoneal hydatidosis, CT scan is indicated before surgery to assess the number and the exact localisations of the cysts.( Figure 21-24)
In case of ruptures in the thorax, the CT-scan allows a better study of the lung parenchyma and ensures a percutaneous drainage of the pleural collection.
Scan showing a peritoneal hydatidosis
CT- scan of the abdomen showing multiple intra peritoneal hydatid cysts
Scan showing typical type II cyst in right lobe of liver.
CT scan showing typical type III cyst in right lobe of liver.
Magnetic resonance Imaging (MRI scan)- MRI delineates the cyst capsule better than CT scan, as a low intensity on both T1 and T2 weighted images. However, CT scan is better in demonstratingmural calcifications, cysts less than 3 cm may not show any specific features and small peritoneal cysts may be missed. Magnetic resonance imaging (MRI) adds little to CT scanning. In the routine, this investigation is rarely required as a diagnostic tool for liver hydatidosis.[22,30, 32]
Endoscopic retrograde cholangiopancreatography (ERCP) remains an important tool in cases where a rupture into the biliary tree has occurred, allowing both the diagnosis of major biliary communication and clearance of the common bile duct (CBD) prior to surgery or intervention by the means of sphincterotomy [34]
Direct cholangiography: intra-operative cholangiography is performed through a cystic drain or a T-Tubein a suspected intrabiliary rupture and bile duct obstruction. This method is used to detect post-operative complications following surgery. (Figure 25)
Intra-operative cholangiography showing a daughter cyst in the CBD (a)- post - operative cholangiography (b)
Surgery remains the gold standard treatment for hydatid liver disease. The aim of surgical intervention is to inactivate the parasite, to evacuate the cyst along with resection of the germinal layer, to prevent peritoneal spillage of scolices and to obliterate the residual cavity. It can be performed successfully in up to 90% of patients if a cyst does not have a risky localisation. However, surgery may be impractical in patients with multiple cysts localised in several organs and if surgical facilities are inadequate. The introduction of chemotherapy and of the PAIR technique (puncture-aspiration-injection-respiration) offers an alternative treatment, especially in inoperable patients and for cases with a high surgical risk. Cysts with homogeneously calcified cyst walls need, probably, no surgery but only a ‘wait and observe’ approach.
The choice of an optimal treatment should be carefully assessed in each case.[33-34]
The principles of hydatid surgery are
Total removal of all infective components of the cysts;
the avoidance of spillage of cyst contents at time of surgery;
management of communication between cyst and adjacent structures;
management of the residual cavity;
Minimize risks of operation.
All the surgical procedures can be divided into two large groups, a conservative group and a radical one. The conservative technique communication between cyst and adjacent structures;
Conservative procedures are safe and technicallysimple, and are useful in the management of uncomplicatedhydatid cysts.Marsupialization was the most common used procedure because it is quick and safe. However, their main disadvantageis the high frequency of postoperative complications,the most common being bile leak from a cyst-biliary communication, bilomas and bile peritonitis (4%-28%).
Radical surgical procedures include cystectomy, pericystectomy, lobectomy and hepatectomy. Radical procedures have lower rate of complications and recurrences but many authors consider them inappropriate, claiming that intraoperative risks are too high for a benign disease. [35-39]
Cystectomy –. The procedure involves removal of hydatid cyst, comprising laminar layer, germinal layer and cyst contents (daughter cysts and brood capsules). The procedure is simple to perform and has low recurrence rates.( Figure 26-29)The management of the residual cavity is a challengingproblem especially in patients with gianthydatid Cysts.Various techniques have been described for the management of residual cavities, such as; external drainage,Capitonnage and omentoplasty
Pericystectomy – this procedure involves a non-anatomical resection of cyst and surrounding compressed liver tissue. This is technically a more difficult procedure than cystectomy and can be associated with considerable blood loss; it can also be hazardous in the case of large and complicated cysts when the cyst distorts vital anatomical structures such as; hepatic veins or biliary ducts. (Figure.30-31)
Hepatic resections – The arguments against hepatic resection as a primary modality of treatment are :firstly,outside of the dedicated liver units there is considerable morbidity and mortality from resection of what is essentially a benign condition.What is more, the distortion of the anatomy makes surgery harder.
Radical surgery: partial cystectomy [in 55]
Drainage of the residual cavity after partial cystectomy [in 55]
A34- year- old patient operated for hydatid cyst of segment VIII. Partial cystectomy and capitonnage
Hydatid cyst of liver with portal hypertension: partial cystectomy
Total pericystectomy for a hydatid cyst the lower surface of the right hepatic lobe.
Technique of the pericystectomy in [
The rapid development of laparoscopic techniques has encouraged surgeons to replicate principles of conventional hydatid surgery using a minimally invasive approach. Several reports have confirmed the feasibility of laparoscopic hepatic hydatid surgery [40-42]
A special instrument has been developed for the removal of the hydatid cyst with the laparoscope called the perforator-grinder-aspirator apparatus. Different instruments have been described to try to avoid leackage of daughter cysts and scolices.
Laparoscopic has some advantages compared to open surgery. In fact this approach to liver hydatid cyst offers a lower morbidity outcome and a shorter hospital stay and it is also associated with a faster surgery. In addition to that advantage, Laparoscopic procedure gives a better visual control of the cyst cavity under magnification which allows a better detection of biliary fistula. This approach is possible only in selected cases.
The Criteria to exclude laparoscopic treatment of hydatid cyst of liver are
Rupture of the cyst in biliary tract
Central localization of the cyst
Cysts dimension >15 cm
Number of cysts > 3
Thickened or calcified walls
opening of bile ducts that leak bile
Nevertheless, a disadvantage of laparoscopy is the lack of precautionary measures to prevent spillage under the high intraabdominal pressures caused by pneumoperitoneum, allergic reactions are more common in laparoscopic interventions due to peritoneal spillage, though the length of stay is generally shorter and morbidity rates are lower in comparison with open procedures.[40]
Laparoscopic experience has shown that spillage of scolices-rich cyst fluid or daughter cysts is common, and it is difficult to evacuate the cysts without spillage in the absence of the proven techniques available to open surgery [41-42 ].
Spillage may lead to peritoneal hydatidosis
Morbidity: Biliary leakage is the most frequent postoperative complication following surgery for hydatid cysts of liver. The rate varies between 6% and 28%. Although most of the external biliary fistulas close spontaneously, they may be persistent in 4%-27.5% of the cases.(figure 32)
Endoscopic sphincterotomy is performed after a 3-week waiting period in patients with low-flow fistulas or can be performed earlier in patients with high-flow fistulas [43-45]
Some other complications can occur in the post-operative period such as; infection of the residual cavity; which is mainly true for big hydatid cysts, in the hepatic dome and treated by partial cystectomy. This complication is more frequent when the pericyst is thick and calcified. This complication needs in some cases reoperation or percutaneous drainage under CT-scan guidance. For this reason, some authors recommend this type of cysts, a total pericystectomy.
Post-operative cholangiography showing a cysto-biliary fistula
Mortality: The surgical management of hydatid disease of liver carries a mortality rate of 0.9 to 3.6 %.
Recurrence rate varies with type of surgery; it is estimated up to 11.3 % within 5 years.
PAIR (puncture, aspiration, injection, and reaspiration) is a percutaneous treatment technique for hydatid disease. This technique was proposed in 1986 by the Tunisian team that first used it in a prospective study [48]. In this minimally invasive method, a needle is introduced into the cyst under ultrasound guidance.
Since that time, its use in the treatment of hydatid cysts has been somewhat controversial [46-50]. However, as this technique has become more common and its safety and efficacy have been reported in the literature [51-56, it has been increasingly accepted as a treatment option for hydatid disease. The World Health Organization currently supports PAIR as an effective alternative to surgery, although its use is limited.
The World Health Organization guidelines for indications and contraindications of PAIR are as follows:[54]
Indications for PAIR
Nonechoic lesion greater than or equal to 5 cm in diameter
Cysts with daughter cysts and/or with membrane detachment
Multiple cysts if accessible to puncture
Infected cysts
Patients who refuse surgery.
Patients who relapse after surgery.
Patients in whom surgery is contraindicated
Patients who fail to respond to chemotherapy alone
Children over 3 years.
Pregnant women
Contraindications for PAIR
Non cooperative patients
Inaccessible or risky location of the liver cyst
Cyst in spine, brain, and/or heart
Inactive or calcified lesion
Cyst communicating with the biliary tree
Patients should be followed clinically after PAIR treatment. Recurrence is increased in more complicated cysts, including those with multiple daughter cysts.
PAIR should only be performed in highly specialized centers with appropriately trained and experienced staff. In addition, an anaesthesiologist should be present for monitoring and treatment in case of anaphylactic shock. Surgeons should be notified immediately in case of complication.[46-57]
Punctures of hydatid cysts have been discouraged in the past due to the potential risk of Anaphylactic shock and peritoneal dissemination. However, in the recent years percutaneous drainage has been used successfully to treat the hepatic hydatid cysts. Khuroo et al [50] reported 88% disappearance of cysts with percutaneous drainage which was preceded by Albendazole therapy (10 mg/kg body weight) for 8 weeks. In his study, he showed that the efficacy of percutaneous drainage is similar to that of standard treatment with cystectomy, in terms of reducing the size of the cyst and causing its disappearance over a period of up to two years. The advantages of percutaneous drainage include a shorter hospital stay and a lower complication rate.
The ERCP is effective in diagnosing biliary tree involvement from the cyst.
The Endoscopic management is useful in presence of intrabiliary rupture, which requires exploration and drainage of the biliary tract and also after surgery in presence of residual hydatid material (membranes and daughter cyst) left in biliary tree. During the endoscopic exploration the biliary tree is cleared of any hydatid material with a balloon catheter or a dormia basket. The endoscopic sphincterotomy is also performed to facilitate drainage of the common bile duct. [44-45]
Medical treatment of hydatid liver cysts, primarily inducedin the 1970’s, is based on benzoimidazole carbamates,such as mebendazole and albendazole. It has beenproposed that these agents contribute to clinical improvementof the disease by diminishing the size of the cyst. The factors for successseem to be the ability of the drug to penetrate thecyst wall and the persistence of adequate levels of the activemetabolites. Albendazole seems to be more effectiveowing to better penetration and absorption.[58] Theseagents have actually been used in several studies as a conservativetreatment, leading to some decrease or stabilizationof the cyst size, especially in cases with small cysts.[58-59] However, their clinical efficacy still remainsdoubtful. They are used mainly for disseminatedsystemic disease, inoperable cases, and—combined withsurgery—to prevent postoperative recurrence.Side effects of Albendazole therapy are: mild abdominal pain, nausea, vomiting, pruritis, dizziness, alopecia, rash and headaches. Occasionally, leucopoenia, eosinophilia, icterus, and mild elevation in transaminase levels are seen.
The different schedules for the treatment are:
Inoperable cases - as primary treatment - 3 cycles
Pre-operatively – to reduce the risk of recurrence 6 weeks continuous treatment
Post-operatively to prevent recurrence in cases of intraoperative cyst spillage 3 cycles.
In a review by Dziri et al. [60], the authors sought to provide evidence-based answers to the following questions:
Should chemotherapy be used alone or in association with surgery?
What is the best surgical technique?
When are the percutaneous aspiration, injection, and reaspiration technique indicated?
The results showed that chemotherapy is not the ideal treatment for uncomplicated hydatid liver cyst when used alone, and the level of evidence was too low to help in choosing between radical or conservative treatment. Percutaneous drainage plus albendazole proved to be safe and effective in selected patients [38].
There are two different clinical settings associated with intrabiliary rupture: frank intrabiliary rupture and simple communication. In the former, the cyst content drains to biliary tract and causes cholestatic jaundice. In the latter simple communications are frequently overlooked and could cause post-operativebiliary fistulae [37-39]. If the cystobiliary opening was less than 5 mm, spontaneous drainage of the cystic content was uncommon and could be treated by suturing under the direct vision. If the CBD diameter was larger than 5 mm, cystic content migration into the biliary tract would occur in 65% of the casesVesicles, debris and purulent materials may be found in the biliary ducts. Surgery must be done early. Delay can cause suppurative cholangitis, septicemia and liver abscess formation. The orifice of bile leakage could be seen in 11.7-17.07% of the cases during the operation, while this was difficult in posteriorly localized cysts. In these cases, cholangiography could be done by a catheter pushed into the ductus cysticus or the cystobiliary fistula]. The injection of radioopac solution or methylene blue is helpful to diagnose intrabiliary rupture or to see the orifice
Once the Intraoperative cholangiography is performed, biliary communications with the cyst are identified and meticulously sutured. A supraduodenal choledochostomy is made and bile duct cleared by all membranes and debris with the help of choledocoscope. The choledochostomy is closed over a T-tube.
The treatment of the cysto-biliary communication is based on several techniques [5,6, 34, 38].
Direct suture: small cysto-biliary fistula could be sutured using a resorbable material. This technique could be performed when it is a small fistula
Repair using a T-Tube:This method allows to restore canal continuity and to drain the hepatic territory of upstream. The T-Tube is kept 4 at 6 weeks and is withdrawn only after cholangiography.
Other techniques:When a complete pericystectomy is not realizable under good conditions, 2 other techniques of treatment of cysto-biliary communication could be performed:
The transparieto-hepatic fistulization described by Perdromo
Transparieto-hepatic fistulization (perdromo)
The internal drainage technique described by Goinard (figure 34-35). This technique should be performed for central cyst with a large bilio-cystic fistula. In case of a big hydatid cyst, we should perform a partial pericystectomy to reduce the size of the residual cavity. The pericyst is then sutured and a T-tube is inserted in the common bile duct. This drain should be kept between 5 and 8 weeks, and its withdrawn should be performed after a cholangiography. This technique gives good results in case of central cyst with large cysto-biliary fistula in the right and/or left biliary canal. [6,38,39]
Internal drainage technique [in 34]
Post-operative cholangiography in a patient treated for hydatid cyst with large bilio-cystic fistula treated with partial cystectomy and internal drainage
Hydatid disease remains a continuous public health problemin endemic countries. The liver is the most common site for hydatid disease (75%of cases), followed by the lungs (15%), the spleen (5%),and other organs (5%).
Diagnosis of liver hydatid disease is made with Ultrasonography and computed tomography.Surgery combined with medical treatment by albendazole is effective in the eradication of hepatic hydatid disease and in the prevention of local recurrences.
Although surgery is the recommended treatment for liver hydatid disease, percutaneous treatment has been introduced as an alternative to surgery.PAIR is a valuable alternativeto surgery. It is safe and efficient in selected patients
We thank Professor Jemni Hela, Ibtissem Hasni and Kalthoum Graiess Tlili for their help in the selection and interpretation of the CT-scan and ultrasound and Dr Jaafar Mazhoud and Dr Mohamed Ben Mabrouk for their great help in collecting the operations view.
A special thank to Mr Bouraoui Chelly for his great help in the critical reading of the manuscript.
The method of operation for the vast majority of esthetic energy-based devices (EBD’s) is through the generation of heat causing physiologic modifications to the human tissue. RF energy is a method to deliver heat into the human body at a level and distribution required for the specific application. For sub-necrotic thermal applications, this heat can be a relatively low temperature for fibroblast stimulation and metabolism acceleration (hands free RF devices). Alternatively, the heat can be more aggressive, ablative coagulative and necrotic in nature (RF assisted lipolysis or Fractional micro-needling technology). It may occur that during the same treatment, RF energy effects will be both non-ablative on the skin and ablative-coagulative sub-dermally.
\nIn most instances with RF, microwave and light-based technologies, heat is the result of a common pathway for the desired thermal effects. This understanding has given rise to an entire generic category of esthetic and medical EBD’s
Selective thermal targeting of tissue by focusing energy at the desired spot internally or externally. Energy can be delivered to the selected volume in a minimally invasive manner by focusing energy to penetrate the tissue under the skin surface. An example of a minimally invasive treatment is electro-surgical devices which deliver thermal energy into the body via a tiny cannula or needle. Alternatively, electrocautery devices focus the energy on the tissue surface, ablating the tissue in proximity of the tip of the instrument to dissect the a soft tissue.
Non-selective bulk heating, used mostly for sub-necrotic heating to stimulate natural processes in the body leading to increased production of collagen, elastin and ground substances. The result may include tissue tightening, circumferential reduction and wrinkle reduction.
RF energy is an important part of the armamentarium for treatment options comprising tissue cutting and coagulation, minimally invasive selective tissue targeting and bulk heating. RF current is the accepted type of energy used in four out of five surgeries conducted in the world and most industry leaders in the aesthetic field employ RF energy in at least one of their applications.
\nElectromagnetic (EM) energy travels in waves and spans a very broad wavelength spectrum from DC voltage, to very short wavelengths in gamma radiation (Figure 1).
\nElectromagnetic Spectrum.
RF energy is small part of electromagnetic spectrum having frequencies in the range of Kilohertz to Gigahertz. The shorter wavelength and the higher frequency, the more energetic are quanta of EM radiation and the more destructive it can be for the tissue. RF energy, Microwaves, Infrared and Visible Light has relatively low frequencies and represent non-ionizing radiation which is not able to modify the DNA (genes) inside the cells. High frequency radiation as UV, X-ray and Gamma are ionizing radiation which in natural conditions is generated by plasma or by radiative isotopes.
\nA very small part of RF spectrum range is used in EBD, and its properties will be the primary focus of the current chapter.
\nRF energy has been used in medicine for over 100 years. Nikola Tesla, (1856–1943), Croatia-born electrical and mechanical engineer, is reputed as being the father of alternating high frequency current. But it was Dr. William Bovie (yes, of the “Bovie cautery fame”) that developed the first electrosurgical device during the period of 1914–1927 at Harvard University [1]. The first reported use of an electrosurgical generator in an operating room occurred on October 1st, 1926 in a surgery performed by Dr. Harvey Williams Cushing [2, 3]. Since Dr. Bovie introduced RF energy and the electrocautery, RF had been used for ablation [4] and coagulation [5] in surgery and medicine. Over the past 20 years, RF energy has evolved and come to dominate esthetic medicine (for good reasons, as will be explained in this chapter). RF was first being used in non-ablative form for skin collagen remodeling and other esthetic applications (Figure 2) [9, 10].
\nThe early pioneers of RF energy in medicine, [
The specificity of RF energy in medicine is that it acts as an electrical current flowing through the tissue but differently than radiation. RF energy is associated with electro-surgical devices and can be defined as high frequency alternating electrical current heating soft tissue without significant electrical nerve stimulation. It is critical to minimize nerve impact to avoid electric shock which may cause muscle spasm and cardiac arrest.
\nIt is important to remember that tissue has ion conductivity with the most prominent varieties being Na+, K+, and Cl– (sodium, potassium, and chlorine ions respectively). Nerves are affected as a result of ion penetration through the membrane of neuron. Under normal conditions the nerve is surrounded by electrically neutral liquid where ions with positive and negative charge compensate each other and bound by Coulomb force preventing free diffusion of the electrical charge. As an electrical field is applied the ion starts to move and the nerve stimulating effect depends on ion displacement (D) in alternating electrical field that can be presented as following:
\nwhere \n
It is obvious the displacement of the ions is higher when electrical field is stronger and it is applied for longer time (Figure 3).
\nIone displacement for a) low amplitude and high frequency of electric field; b) low amplitude and low frequency; c) high amplitude and low frequency.
In general, polarity of RF voltage is changed so fast that ions vibrate in the same place without significant movement. However, users of RF may occasionally observe small muscle tweaking when high RF parameters are used. Therefore, RF energy used in electrosurgery is limited by lowest frequency of 100 kHz, while the recently developed esthetic devices operate at frequencies above 300 kHz.
\nThe typical range of RF is 100 kHz to 5 MHz according to the FDA guidance [11]. This is intended to exclude other frequencies that may technically fall within the RF portion of the electromagnetic spectrum, but operate in a fundamentally different manner. However, there are few products with higher RF frequency of up to 40 MHz. If RF is higher than 5 MHz there is significant radiative component with reduced capability to predict the distribution in the patient’s body and can even potentially affect the treatment attendant.
\nThe ions oscillating in RF field interact with the surrounding tissue, losing its kinetic energy and generating the heat. The heat generated by electrical current in conductive media is described by Joule’s law:
\nThe heat generated in each point of tissue is proportional to tissue conductivity (\n
The Ohm’s low in vector form allows to calculate the density of RF current (
While continuity equation allows to analyze RF current distribution in the tissue
\nThe Eq. 4 states that electrical current coming into any volume of tissue is equal to the current going out of the same volume (Figure 4).
\nSchematic illustration of continuity law.
The other conclusion from the charge continuity equation is that all RF current emanating from one electrode into the tissue flows to the other electrode. The current density on the electrode surface depends on the size of the electrode.
\nPenetration depth of RF energy depends on the electrode geometry and divergence of the RF current inside the tissue. We will determine RF penetration depth as the depth where RF energy is decreased by exponential factor (
RF current distribution for typical geometries of electrodes.
The first case in Figure 5 illustrates small electrode distant from the return electrode. The RF current density and consequently electric field in vicinity of the electrode diverges spherically and current density drops as square of distance from electrodes. Taking into the account that heat is proportional to square of electric field. Therefore, heat created by RF energy can be represented as following:
\nWhere
\nFigure 5b shows two long electrodes having cylindrical surface contacting the tissue. The distance between the electrodes is larger than an electrode size. In this case the heat distribution near the electrode can be calculated using the following equation:
\nThe heating drops by exponential factor at the distance of
The case shown in Figure 5c represents two parallel electrodes having size comparable with the distance between them. Analysis of heat distribution required computer simulation but RF penetration depth can be estimated as half distance between the electrodes [10].
\nThe thermal measurements conducted for the three cases described above are shown in Figure 6.
\nThermal measurements of tissue temperature generated by RF current for typical geometries of electrodes.
Thermal experiments were conducted using porcine tissue and a RF generator with the frequency of 1 MHz and 50 W power. The thermal camera FLIR A320 was used for thermography of tissue during RF application.
\nHeat conductivity, real geometry of electrodes and non-uniformity of tissue effect the thermal imaging but measurements correlate well with theoretical consideration.
\nThe electrical properties of tissue play important role in understanding of RF-tissue interaction.
\nTissue conductivity is a strong function of tissue type. The fundamental article of Gabriel et al. [12] summarized data on electrical conductivity for different types of tissue. Figure 7 shows tissue conductivity of fat and skin in broad range of frequencies.
\nElectrical conductivity of skin and fat as a function of frequency of electrical current.
In the RF range, the tissue conductivity is a weak function of frequency. The tissue has resistive and capacitive properties. The capacitance of tissue in RF diapason is determined by recharging of cell membrane.
\nThe properties of different types of tissue are presented in Table 1.
\nTissue | \nConductivity, S m−1\n | \n
---|---|
Blood | \n0.7 | \n
Skin | \n0.25 | \n
Fat | \n0.03 | \n
Bone | \n0.02 | \n
Tissue conductivity at 1 MHz [12].
Our measurements in-vivo for tumesced adipose tissue show that fat’s conductivity is very similar to the one of skin and is in the range of 1 to 2 S m−1.
\nConductivity of tissue is a function of temperature and is changed in the range of sub-necrotic heating by 2%/oC [13]. Our measurements of tissue conductivity between two electrodes in-vivo showed smaller change for the temperature close to the normal body temperature and larger change when tissue temperature deviated more (Figure 8). The tissue was pre-heated to 43 °C during 15 min and then tissue impedance was measured for short RF pulses during two hours as skin cooled down.
\nImpedance of tissue measured between two electrodes applied to the skin surface.
As tissue is heated to higher temperatures resulting in tissue coagulation and dehydration, the tissue impedance is increased dramatically [10]. Schematic change of tissue impedance as function of temperature is shown in Figure 9.
\nSchematic impedance behavior as function of temperature.
As mentioned above regarding conductivity, heating of tissue reduces its impedance with a rate of about 2% per degree Centigrade [13]. This change is related to reduction of tissue viscosity which is reduced with temperature increase. Coagulation of the tissue causes a chemical change in tissue structure, subsequently changing the trend of impedance behavior. When heating up to 100 °C, the evaporation of liquids dehydrates the tissue, dramatically increasing tissue impedance. Additional heating of the tissue leads to its carbonization. Dependence of tissue conductivity on temperature is utilized by ELOS (Electro optical synergy) technology where tissue is preheated using optical energy creating a preferable path for RF current [14, 15]. This can provide treatment advantages for some applications.
\nThe RF energy can be delivered in continuous wave (CW) mode, burst mode and pulsed mode (Figure 10).
\nTypical RF waveforms.
For gradual treatment of large areas, the CW mode is most useful, allowing for the slow increase in temperature in large tissue volume. It is used for treatment of cellulite, subcutaneous fat and skin tightening. CW mode typically delivered in device intended for moving over the treatment area.
\nThe burst mode delivers RF energy with repetitive pulses of RF energy. It is used in applications where peak power is important while average power should be limited. Such an example would be blood coagulation. Also, it is used in hands free devices where energy is added by small portions maintaining the required temperature.
\nPulsed mode is optimal when small tissue volume should be affected without heat spreading to the surrounding tissue. Pulsed mode is used in micro-needling devices.
\nIn order to create tissue ablation, very high energy density is required. In electro-surgical cutting instruments, a very small electrode, or needle type electrode is used to concentrate electrical current to very small area, which increases the energy density to ablative levels. Coagulation instruments, which create energy and thermal profiles coagulating the cells and shrinking the collagen, usually have larger surface area electrodes than ablative devices. Typically, the surface area of such electrodes is a few square millimeters to generate heat in larger volume but at a lower level to create coagulation rather then ablation. Sub-necrotic heating is usually used for treatments related to stimulation of natural processes in the tissue, such as collagen remodeling, revascularization, speeding fat metabolism. In this case the spot size is about 1 square centimeter or larger. Schematical illustration of spot size effect is shown in Figure 11.
\nThe effect of electrode size, or spot size on the energy and power density.
Generally, the smaller the electrode, the higher the energy density and the effect tends to be ablative (e.g., cutting cautery tips), whereas larger sized electrodes, have a gentler tissue effect, either coagulation (hemostasis) or sub-necrotic tissue heating [16].
\nRF current always flows between two electrodes having opposite polarity. The FDA definition of monopolar devices relates to the size and position of electrodes in respect to patient during the treatment. According to FDA guidance [11], monopolar is an electrosurgical technique in which the current flows from a single active electrode at the surgical site, through the patient, to a relatively distant return electrode.
\nThe most common feature of a mono-polar device is a single electrode applied in the treatment area while the return electrode has a much larger contact surface and is placed outside of the treatment zone, usually in the form of a grounding pad. In this electrode geometry, the high RF current density is created near the active electrode and RF current diverges toward the large return electrode. The heat zone for this geometry can be estimated using analytic spherical model for continuity equation stating that electrical current flows continuously from one electrode to another.
\nTaking into account Ohm’s law in differential form (Eq. 3) and the definition of an electric field, Eq. 5 can be rewritten as:
\nWhere
Where
For the instance when the return electrode is much larger than the active electrode, the equation can be simplified as:
\nCorrespondently, heat power according to Joule’s law can be estimated as:
\nThis simple equation leads to a few interesting conclusions:
\nHeat generated by RF current near the active electrode does not depend on position of the return electrode when return electrode is much larger in size than the active electrode and located at a distance which is much larger than the active electrode size.
\nHeating decreases dramatically as distance increases from the active electrode. As was shown before, RF energy penetration depth is about one third of electrode radius (Figures 5 and 6). However, heating temperature on the electrode surface may reach hundreds of degrees centigrade and coagulation effect may be extended much larger than RF penetration depth. The other factor enlarging thermal zone is heat conductivity spreading heat around.
\nRF current behavior in the body for monopolar systems is visualized schematically in Figure 12.
\nSchematic RF current distribution between electrodes for monopolar system.
RF current is concentrated on the active RF electrode and rapidly diverges toward the return electrode.
\nMonopolar devices are most commonly used for tissue cutting. Schematically, the RF current flow through the patient for monopolar devices is shown in Figure 13.
\nElectrical current flowing through the patient and monopolar electrosurgical device.
The RF current is always flowing through a closed loop via the human body. As we showed above, the current density out of the vicinity of the return electrode is negligible. However, a malfunction where some low frequency current escapes out of a monopolar configuration holds high risk because the entire body is exposed to the electrical energy. Most commercially available devices have isolated output to avoid any unexpected RF current path to the surrounding metal equipment.
\nTreatment effects with monopolar devices depend on RF power and size of electrode. The classic use of monopolar technique is tissue cutting and ablation while occasionally it is used for soft tissue coagulation or sub-necrotic heating [9, 17, 18, 19].
\nThe main features of monopolar devices are:
Predictability of thermal effect near the active electrode
Ability to concentrate energy on a very small area
High non-uniformity of heat distribution which is strong at the surface of the active electrode and is reduced dramatically at a distance exceeding the size of electrode, thereby limiting penetration depth
According to FDA [11], bipolar is an electrosurgical device in which the current flows between two active electrodes placed in close proximity. In bipolar devices both electrodes create a similar thermal effect and are applied to the tissue treatment area (Figure 14). Bipolar devices create larger thermal zones and this circuit is used in electro-coagulators. The advantage of bipolar systems is the localization of all RF energy in the treatment zone (Figure 14).
\nElectrical current flowing through the patient and bipolar electrosurgical device.
Bipolar devices concentrate all RF energy between electrodes in the treatment area. This geometry is more suitable than a monopolar system to create uniform heating in larger volume of tissue. In order to understand heat distribution between electrodes the following three rules should be taken into the account:
Heating is always higher near the electrode’s surface and reduces with a distance because of current divergence. Divergence of RF current between electrodes reduces current density and correspondently generated heat.
For any geometry, RF current density is higher along the line of shortest distance between the electrodes and reduced with distance from the electrodes.
RF current is concentrated on part of the electrode having high curvature creating the hot spots.
A schematic distribution of electrical currents in uniform media in bipolar device is shown in Figure 15.
\nElectrical current distribution for bipolar system.
In bipolar devices, both electrodes create an equal thermal effect near each of the electrodes and the divergence of RF current is not as strong because of the small distance between the electrodes. For bipolar systems shown in Figure 15, most of the heat is concentrated between the electrodes.
\nPenetration depth of RF for bipolar devices is a function of electrode size and the distance between them. By increasing the distance between the electrodes, the electrical current can go deeper, but divergence is also increased. In case the distance between the electrodes is much larger than the electrode size, the heating profile will be similar to two monopolar electrodes. Schematically, bipolar current distribution and measured thermal effect are presented in Figures 5b and 6b, respectively.
\nThe most uniform distribution of RF current is obtained in planar geometry when tissue is placed between two large parallel electrodes. This can be realized when negative pressure forces the tissue to fill the cavity between the parallel electrodes. Measured RF energy distribution for the cavity filled with the tissue is shown in Figure 16.
\nThermal image of heat distribution created in the skin folded between two parallel electrodes.
High frequency current is able to penetrate through the dielectric material which behaves as capacitor. This effect is used to isolate metal electrode from patient. This method is called capacitive coupling. There are a number of devices in the medical esthetic market that use this technology for RF delivery [18, 19].
\nThe capacitance of planar dielectric layer is described by the following equation:
\nWhere \n
Impedance of the dielectric layer depends on frequency of current (f)
\nFor example, polyimide layer with area of 4cm2 and thickness of 100micron has capacitance of about 106 pF and impedance of this layer is 1.5 kOhm at 1 MHz and 375 Ohm at 4 MHz.
\nFor cylindrical geometry capacitance is represented by the following equation
\nWhere
The leakage of RF current through the dielectric coating should be taken into the account at design of electro-surgical instruments.
\nThe temperature dissipation is characterized by thermal relaxation time (TRT) of the targeted area. For localized treatment, in order to avoid significant heat transfer, the pulse duration should be less than the TRT.
\nThe TRT is a function of tissue thermal properties, heated volume shape and size. Soft tissue has thermal properties close to the water.
\nFor the planar object the TRT can be estimated as [20].
\nWhere
For a cylindrical object, such as a blood vessel or hair, a similar equation can be used with different geometrical factors.
\nwhere
Thermal relaxation time should be taken in to the account when thermal effect should be localized. It is critical in fractional RF technologies when thermal coagulation should by limited by small zones around the needle electrodes.
\nThe thermal effect of RF on tissue is not different from laser or any other heating method. Multiple studies [21, 22] discuss the temperature effect on tissue. Since treatment effect is not only a function of temperature, but also of the period of time (when this temperature is applied), it is known that in the millisecond range the coagulation temperature is 70-90 °C, while if temperature is applied for a few seconds, the temperature of 45 °C causes irreversible damage. Hyperthermia studied intensively for treatment of cancer confirms strong dependance of tissue vitality on time that temperature is maintained [23]. RF induced hyperthermia was measured for adipocytes in a clinical study [24]. The fat cell viability was 89% after RF heating for 1 min at 45 °C while after heating during 3 min the vitality dropped down to 40% (Table 2).
\nTemperature | \nTissue effect | \n
---|---|
37-44 °C | \nAcceleration of metabolism and other natural processes. | \n
45–50 °C | \nConformational changes, hyperthermia (cell death) | \n
50–80 °C | \nCoagulation of soft tissue | \n
50–80 °C | \nCollagen contraction | \n
90–100 °C | \nFormation of extracellular vacuoles, evaporation of liquids | \n
>100 °C | \nThermal ablation, carbonization | \n
Tissue thermal effect.
There is extensive data on the correlation between tissue temperature, pulse duration and treatment effect. Moritz and Henriques demonstrated that the skin thermal damage threshold is a function of temperature and time [25]. Later it was demonstrated that skin damage function can be described by Arrhenius equation where pre-exponential factor is a linear function of pulse duration [22].
\nPulse duration is one of the most critical parameters when utilizing RF energy in order to achieve a clinical response. It affects treatment results because timing influences the thermo-chemical process in tissue. The other effect of pulse duration is energy dissipation away from the treatment zone due to heat conductivity from the exposed area to the surrounding tissue.
\nIn other words, the degree of damage is a linear function of pulse duration and an exponential factor of tissue temperature. This means that tissue temperature is more influential on the degree of damage than the pulse duration.
\nIt is well known that sustained hyperthermia at 42 °C for tens of minutes causes death of most sensitive cells such as in the brain [26]. In laser medicine the pulse duration in the millisecond range causes tissue to burn at a temperature above 60-70 °C.
\nDehydration and carbonization of the ablated treated tissue may cause the accumulation of a non-conductive tissue layer on the electrode surface. This tissue is sometimes called eschar and if it accumulates on the surface of the treatment electrode, it may affect significantly the energy delivery to the electrode and hence the treatment zone or even damage the hand piece. Carbonization or Eschar reduces or totally blocks the working area of electrodes and affects treatment efficiency, reducing the electrical current flow to the tissue (Figure 17).
\nCutting Bovie electrocautery, with an eschar built upon the fine needle tip.
Usually, the surgeon must clean an electro-surgical instrument periodically during the treatment to remove any eschar from the treatment electrode. Alternatively, companies, like InMode created a technological solution avoiding this problem. In InMode devices, impedance monitoring measures the increase resistance to flow (increased impendence) caused by eschar on one of the electrodes and cuts off the RF energy and flow of RF current briefly, minimizing the risk of the eschar built up at all.
\nThe most important tissue modification induced by RF heating is a contraction of collagenous tissue. This effect is known for decades and is used intensively in orthopedy [27, 28] and ophthalmology [29].
\nSkin contraction was a primary focus for the first RF devices in esthetic medicine [9, 15, 17, 19]. Only in the last decade there is the understanding that the skin appearance is more affected by collagen in the reticular dermis and fibro septal network (FSN) binding skin with superficial fascia and muscles. A study published in 2011 [30] showed that skin has very dense collagenous tissue and shrinkage of collagen fibers is limited, while connective tissue in the subdermal space may contract above 30% during a few seconds of heating. The threshold temperature for collagen contraction was measured in the range of 60-70 °C.
\nIn the experiments in our facility, the contraction of FSN was quantified on ex-vivo post abdominoplasty human tissue. The area was marked proximal to the RFAL cannula tip and monitored during RF energy application. The resulting measurements are presented in Figure 18.
\nSubcutaneous fat before and after application of RF energy.
One can see that thermal exposure of subcutaneous tissue with RF energy during three seconds resulted in area contraction by 42%.
\nRFAL technology was developed by InMode Ltd. to improve treatment results during liposuction procedure. The thermal contraction of collagen in dermis and subdermal FSN allows treatment of patients with saggy skin and patients for whom previously excessive skin was a main concern [31].
\nThe uniqueness of RFAL technology is that it does not fall under any standard device definitions. It combines features of monopolar and bipolar technologies, minimally-invasive and non-invasive technologies, creating very specific energy profile treating simultaneously subcutaneous fat, connective tissue forming FSN and dermis. Each of these tissue components requires different thermal exposure. Adipose tissue should be destroyed, FSN should be remodeled without denaturation of collagen while skin should be exposed to sub-necrotic heat to modify it without superficial burn [31, 32, 33].
\nThe RFAL device geometry is shown in Figure 19. The RF current flows back and forth from the internal electrode (cannula tip), where the thermal effect is coagulative, to a larger, external electrode. The external electrode moves along the skin surface, in tandem with the internal electrode and creates a gentle, non-ablative bulk heating effect on the dermis. Ratio between size of internal and external electrode is selected to limit skin heating at sub-necrotic heating while temperature in the fat should reach 50-70 °C.
\nSchematic depiction of RFAL treatment geometry.
Moving the hand piece back and forth through the intended treatment area, uniform coagulation of adipose and vascular tissue is achieved. While the external electrode is always moved over the skin surface, the internal electrode should pass through the deep, intermediate and/or superficial fat layers to treat the adipose tissue up to the depth of 5 cm. The Lipo-coagulation, results in liquefaction of the adipose tissue, hemostasis and stimulated contraction of adjacent vertical, oblique and horizontal fibers of the FSN, that connects the overlying soft tissue to the underlying muscle.
\n\nFigure 20 shows thermal profile created by RFAL cannula inside porcine tissue.
\nThermal profile in the tissue created by RFAL device.
The temperature around the internal electrode is 70 °C. The volume exposed to high temperature around the cannula. The tissue between internal and external electrode is exposed to directional RF flowing between the electrodes.
\nComputer simulation shows similar thermal profile (Figure 21) to the measured thermography.
\nComputer simulation of temperature field created by RFAL device.
One of the advantages of RF energy is that it is can be delivered into the body though the very tiny sub-millimeter cannula. That allows to minimize incision and mechanical trauma at treatment of such delicate zones as face and neck [33]. Large size cannula results in higher non-uniformity and especially for subcutaneous fat.
\nAnother RF based technology enhancing liposuction results is micro needling RF. The fractional coagulation of subcutaneous tissue helps tight the skin and reduce skin sagginess after liposuction [34].
\nFractional skin treatment was introduced in esthetic medicine about two decades ago and has become one of the most popular modalities for the improvement of skin quality. This procedure is based on the coagulation of multiple small spots with a size of 100 microns to 0.5 millimeter. This allows the procedure to be very tolerable and with relatively short down-time. Focused laser beams or needle sized RF electrodes are used for ablation of micro-spots resulting in high efficiency and consistency of the treatment, with low risk of side effects and fast skin healing.
\nIn contrast to lasers where the thermal effect is limited by the ablation crater, the RF energy flows through the whole dermis, adding volumetric heating to fractional treatment. This volumetric bulk heating adds a skin tightening effect to the more superficial improvement generated by tissue ablation.
\nRF fractional technologies are differentiated by needle length and size. The flat electrodes provide a more superficial effect improving texture and fine lines [34, 35] while longer needles penetrate deeper, providing deeper dermis remodeling and causing substantial skin tightening [36].
\nThe needles can penetrate to the different depths allowing epidermal ablation and deep subdermal treatment. Recently the FDA cleared Morpheus8 device of InMode Ltd. for treatment up to depth of 7 mm.
\n\nFigure 22 shows Morpheus8 tip schematically with needles extended to the subdermal fat.
\nSchematic illustration of Morpheus8 tip with needles penetrating into the sub-dermal space.
Needles coated with polymer and releasing RF energy only at the needle end provide better protection of epidermis and provide lower down time.
\nA microscope image of a coated needle is shown in Figure 23. The gold plated needle has diameter of 0.3 mm and coated with polymer of 20 microns thickness.
\nCoated needle.
There are several different configurations of RF electrodes for micro-needling devices. The most common configuration is by applying RF energy between adjacent rows of needle electrodes. This method creates a coagulation zone in vicinity of the needle end.
\nThe alternative technology is used in the InMode Morpheus8 device where RF energy is applied between the needle and an external electrode applied to the skin surface. Each needle has a strong thermal effect near the needle end and gradient of bulk heating toward the external electrode, similar to RFAL technology. Each needle generates small bulk heating but superposition of the heat from multiple needles results in essential thermal effect. Morpheus8 device automatically treats tissue in multiple layers delivering RF energy sequentially during needle retraction. This burst mode creates three-dimensional matrix of coagulation zones and strong bulk heating. Schematically the burst mode treatment is shown in Figure 24.
\nSchematic illustration of burst mode treatment using Morpheus8 device.
Micro needling technology was developed for treatment of facial wrinkles but further development of the technology has extended its use to treat the body as well.
\nThe micro needling technology supplements both regular liposuction and energy-based minimally invasive technologies and addresses the first few millimeters of body coagulating adipose tissue and tightening FSN.
\nOne of the risks of any thermal treatment (laser, ultrasound, plasma or RF) is the possibility of a thermal skin injury. Thermal treatment in subcutaneous or subdermal layers may create full thickness skin burn. Therefore, monitoring of delivered energy, predictability of energy distribution and accurate measurement of tissue parameters during the treatment has crucial importance for the energy-based devices.
\nNon uniform treatment or over-heating the treatment area may result in the risk of unwanted thermal damage to the skin during the treatment. To avoid or minimize this risk of a skin burn, real time thermal measurements are necessary. There are two basic methods of skin temperature measurements:
Infrared (IR) thermometers measuring IR radiation of heated object.
Contact measurements using a thermocouple, thermistor or thermo-transistors.
Advantages of IR thermometers is the speed of measurements and that they do not need to be built into the device thus are independent of the treatment. The obvious weakness of this method is collecting IR radiation from relatively large area which depends on distance from the measured area. You are also relying on a third party that is not linked in time of space to the thermal treatment being performed. Most importantly, you are not measuring the internal thermal profile.
\nA typical IR thermometer measures area which depends on distance between skin and thermometer and it varies from 1cm2 to a few square inches at large distance from the patient. It allows you to monitor average skin temperature in treatment area but does not protect from appearance of small hot spots that lead to the full thickness skin burns.
\nThe thermistors or thermocouples are extremely miniature and can be embedded into the electro-surgical instrument. Limitation of such contact measurements is response time which depends on heat transfer from the tissue to the sensor. However, special design allows to reduce response time to sub-second range.
\nIdeally, the user should know the temperature inside the body where energy is utilized for the fat coagulation and FSN tightening, and temperature on the skin surface above the treatment zone to ensure skin safety.
\nIn addition, during the procedure sophisticated mechanisms monitor the tissue temperature together with its dynamic characteristics as the speed of temperature rise, allowing precautional measures before the critical temperature is reached.
\nTemperature monitoring for EBD is important not only for safety but also for treatment efficacy. Collagen contraction occurs in relatively narrow range of temperatures from 50 °C to 80 °C and overheating may result in denaturation of collagenous tissue and uncontrolled scar formation.
\nRFAL technology has maximum thermal safety measurements including:
Skin temperature monitoring;
Fat temperature monitoring;
Temperature surge protection catching fast temperature changes.
Most types of energy cannot be monitored directly but rather electrical supply to the energy source is monitored. RF energy has unique properties resulting from continuity Eq. (4) allowing to measure RF voltage and RF current flowing through the tissue and get in real time all information about energy deposition in the tissue. Measurement of electrical RF parameters is not difficult engineering project and it can be performed every micro-second that allows to control the RF energy delivery even for very short pulses.
\nMeasurements of RF current (
and Joule’s law
\nThe RF energy can be calculated as integral of RF power measurement over the time:
\nRFAL and Morpheus8 technologies of InMode Ltd. utilize all these measurements to control the treatment safety and efficacy.
\nMeasurements of tissue impedance should be considered separately because of importance of this parameter for different aspects of treatment. The most obvious use of the impedance measurements is indication of contact between electrodes and treated tissue. Contact measurements are important to avoid poor coupling of the RF device with patient and avoid arcing. Contact monitoring has become a common feature for most RF-based devices.
\nReferring to Figure 9 one can see that coagulation, dehydration of tissue and eschar formation result in impedance increase. Monitoring of tissue impedance can be used to limit heating process and avoid undesired treatment effect.
\nAnother use of impedance monitoring is to control the lower limit, which may indicate that the distance is too small between electrodes. In RFAL technology it is used to reduce the risk of the cannula coming too close to the skin surface.
\nAll above mentioned measurements of RF parameters worth nothing if its not used for enhanced treatment safety helping physician to optimize the procedure.
\nThe BodyTite device from InMode Ltd. uses RFAL technology, combines the maximal number of safety features, and should be used as the gold standard for safety features for RF devices.
\nPerforming liposuction, the physician should be concentrated on safe manipulation with the minimally invasive accessory. Safety features related to the thermal component of the treatment should be implemented in automatic or in a very intuitive way not disturbing physician attention.
\nThe skin impedance for each patient is different and may vary for the different treatment zones, amount of tumescent applied or treatment depth. RF energy is adjusted by the device automatically to provide the required optimal energy to the patient.
\nTissue impedance is monitored constantly by the BodyTite and the device automatically cuts RF energy if some of the limits are exceeded.
\nThe user may set desired temperature cut-off limits for skin and internal electrode. The device applies full power when the temperature is significantly below the threshold and starts to reduce power automatically as treatment approaches the required target temperature. This scheme allows to avoid thermal overshooting and maintains desired heat profile. RF energy delivery is accompanied by an audible signal which speeds up as the cut-off temperature is approached, similar to modern car approaching wall while parking. RF power is switched on and off automatically to maintain the desired temperature as the user scans the treatment area with the cannula.
\nIf the cannula accidentally comes too close to the dermis, the tissue volume between the electrodes is reduced and the applied RF power heats the tissue extremely fast. To address this issue, a temperature surge protection is implemented in BodyTite device. When the temperature sensor measures a temperature increase as too fast, the device automatically shuts RF energy and produces an audible sound to attract the physician’s attention.
\nRF based medical devices are a common tool for plastic surgeons, used during most surgical procedures. RFAL and RF fractional technologies have become important modalities for about 20% of plastic surgeons, for enhancing liposuction results or by its own for patients for whom reduction of adipose compound is not a main esthetic goal. Over the last 100 years extensive knowledge has been acquired about RF technology and RF-tissue interaction. The information in this chapter can help a potential buyer of new equipment make a rational choice, based on goals of treatment and physics of the RF device in question. Even more importantly, expanding the physician’s understanding of his or her devices already in use can maximize treatment outcomes and minimize unwanted side effects and complications.
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His studies in robotics lead him not only to a PhD degree but also inspired him to co-found and build the International Journal of Advanced Robotic Systems - world's first Open Access journal in the field of robotics.",institutionString:null,institution:{name:"TU Wien",country:{name:"Austria"}}},{id:"441",title:"Ph.D.",name:"Jaekyu",middleName:null,surname:"Park",slug:"jaekyu-park",fullName:"Jaekyu Park",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/441/images/1881_n.jpg",biography:null,institutionString:null,institution:{name:"LG Corporation (South Korea)",country:{name:"Korea, South"}}},{id:"465",title:"Dr.",name:"Christian",middleName:null,surname:"Martens",slug:"christian-martens",fullName:"Christian Martens",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Rheinmetall (Germany)",country:{name:"Germany"}}},{id:"479",title:"Dr.",name:"Valentina",middleName:null,surname:"Colla",slug:"valentina-colla",fullName:"Valentina Colla",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/479/images/358_n.jpg",biography:null,institutionString:null,institution:{name:"Sant'Anna School of Advanced Studies",country:{name:"Italy"}}},{id:"494",title:"PhD",name:"Loris",middleName:null,surname:"Nanni",slug:"loris-nanni",fullName:"Loris Nanni",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/494/images/system/494.jpg",biography:"Loris Nanni received his Master Degree cum laude on June-2002 from the University of Bologna, and the April 26th 2006 he received his Ph.D. in Computer Engineering at DEIS, University of Bologna. On September, 29th 2006 he has won a post PhD fellowship from the university of Bologna (from October 2006 to October 2008), at the competitive examination he was ranked first in the industrial engineering area. He extensively served as referee for several international journals. He is author/coauthor of more than 100 research papers. He has been involved in some projects supported by MURST and European Community. His research interests include pattern recognition, bioinformatics, and biometric systems (fingerprint classification and recognition, signature verification, face recognition).",institutionString:null,institution:null},{id:"496",title:"Dr.",name:"Carlos",middleName:null,surname:"Leon",slug:"carlos-leon",fullName:"Carlos Leon",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Seville",country:{name:"Spain"}}},{id:"512",title:"Dr.",name:"Dayang",middleName:null,surname:"Jawawi",slug:"dayang-jawawi",fullName:"Dayang Jawawi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Technology Malaysia",country:{name:"Malaysia"}}},{id:"528",title:"Dr.",name:"Kresimir",middleName:null,surname:"Delac",slug:"kresimir-delac",fullName:"Kresimir Delac",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/528/images/system/528.jpg",biography:"K. Delac received his B.Sc.E.E. degree in 2003 and is currentlypursuing a Ph.D. degree at the University of Zagreb, Faculty of Electrical Engineering andComputing. His current research interests are digital image analysis, pattern recognition andbiometrics.",institutionString:null,institution:{name:"University of Zagreb",country:{name:"Croatia"}}},{id:"557",title:"Dr.",name:"Andon",middleName:"Venelinov",surname:"Topalov",slug:"andon-topalov",fullName:"Andon Topalov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/557/images/1927_n.jpg",biography:"Dr. Andon V. Topalov received the MSc degree in Control Engineering from the Faculty of Information Systems, Technologies, and Automation at Moscow State University of Civil Engineering (MGGU) in 1979. He then received his PhD degree in Control Engineering from the Department of Automation and Remote Control at Moscow State Mining University (MGSU), Moscow, in 1984. From 1985 to 1986, he was a Research Fellow in the Research Institute for Electronic Equipment, ZZU AD, Plovdiv, Bulgaria. In 1986, he joined the Department of Control Systems, Technical University of Sofia at the Plovdiv campus, where he is presently a Full Professor. He has held long-term visiting Professor/Scholar positions at various institutions in South Korea, Turkey, Mexico, Greece, Belgium, UK, and Germany. And he has coauthored one book and authored or coauthored more than 80 research papers in conference proceedings and journals. His current research interests are in the fields of intelligent control and robotics.",institutionString:null,institution:{name:"Technical University of Sofia",country:{name:"Bulgaria"}}},{id:"585",title:"Prof.",name:"Munir",middleName:null,surname:"Merdan",slug:"munir-merdan",fullName:"Munir Merdan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/585/images/system/585.jpg",biography:"Munir Merdan received the M.Sc. degree in mechanical engineering from the Technical University of Sarajevo, Bosnia and Herzegovina, in 2001, and the Ph.D. degree in electrical engineering from the Vienna University of Technology, Vienna, Austria, in 2009.Since 2005, he has been at the Automation and Control Institute, Vienna University of Technology, where he is currently a Senior Researcher. 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Aalborg University has Two Satellite Campuses, one in Copenhagen (Aalborg University Copenhagen) and the other in Esbjerg (Aalborg University Esbjerg).\n· He is a member of prestigious IEEE (Institute of Electrical and Electronics Engineers), and IAENG (International Association of Engineers) organizations. \n· He is the chief Editor of the Journal of Software Engineering.\n· He is the member of the Editorial Board of International Journal of Computer Science and Software Technology (IJCSST) and International Journal of Computer Engineering and Information Technology. \n· He is also the Editor of Communication in Computer and Information Science CCIS-20 by Springer.\n· Reviewer For Many Conferences\nHe is the lead person in making collaboration agreements between Aalborg University and many universities of Pakistan, for which the MOU’s (Memorandum of Understanding) have been signed.\nProfessor Akbar is working in Academia since 1990, he started his career as a Lab demonstrator/TA at the University of Sussex. After finishing his P. hD degree in 1992, he served in the Industry as a Scientific Officer and continued his academic career as a visiting scholar for a number of educational institutions. In 1996 he joined National University of Science & Technology Pakistan (NUST) as an Associate Professor; NUST is one of the top few universities in Pakistan. In 1999 he joined an International Company Lineo Inc, Canada as Manager Compiler Group, where he headed the group for developing Compiler Tool Chain and Porting of Operating Systems for the BLACKfin processor. The processor development was a joint venture by Intel and Analog Devices. In 2002 Lineo Inc., was taken over by another company, so he joined Aalborg University Denmark as an Assistant Professor.\nProfessor Akbar has truly a multi-disciplined career and he continued his legacy and making progress in many areas of his interests both in teaching and research. 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