Comparison of STN and GPi stimulation
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",isbn:"978-1-83969-070-9",printIsbn:"978-1-83969-069-3",pdfIsbn:"978-1-83969-071-6",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!0,isSalesforceBook:!1,isNomenclature:!1,hash:"6504dee75dbbfd7792308293a8f1a27f",bookSignature:"Prof. Moulay Tahar Lamchich",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11520.jpg",keywords:"Optimal Method, Intelligent Technique, Torque Control, Speed Control, Electrical Machine, Hybrid Vehicle, Renewable Energy System, Embedded System, Electrical Vehicle, Electrical Generator, Machine's Noise, Special Machine",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"April 19th 2022",dateEndSecondStepPublish:"June 24th 2022",dateEndThirdStepPublish:"August 23rd 2022",dateEndFourthStepPublish:"November 11th 2022",dateEndFifthStepPublish:"January 10th 2023",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"2 months",secondStepPassed:!0,areRegistrationsClosed:!1,currentStepOfPublishingProcess:3,editedByType:null,kuFlag:!1,biosketch:"Dr. Moulay Tahar Lamchich is a pioneering researcher in the management, supervision, and control of multi-source energy conversion systems and electrical machines. He completed his thesis in electromechanics in September 1991 and received his Ph.D. in July 2001. Dr. Lamchich is currently a Professor at the Faculty of Sciences Semlalia at Marrakech (Morocco). He has published over fifty technical papers in reviews and international conferences. His main activity is based on short-circuit mechanical effects.",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"21932",title:"Prof.",name:"Moulay Tahar",middleName:null,surname:"Lamchich",slug:"moulay-tahar-lamchich",fullName:"Moulay Tahar Lamchich",profilePictureURL:"https://mts.intechopen.com/storage/users/21932/images/system/21932.png",biography:"Moulay Tahar Lamchich is a Professor at the Faculty of Sciences Semlalia, Cadi Ayyad University at Marrakech (Morocco). He completed his thesis in electromechanics in September 1991 and received his Ph.D. in July 2001. His main activity is based on short-circuit mechanical effects in substation structures, control of different types of machine drives, static converters, active power filters. For more than tweenty years, his research interests have included renewable energies, particularly the control and supervision of hybrid and multiple source systems for decentralized energy production, and intelligent management of energy. He has published more than fifty technical papers in reviews and international conferences. With IntechOpen, he has published two chapters and was editor of the books 'Torque Control” and 'Harmonic Analysis”. 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However, some of the motor symptoms, and most of the non-motor symptoms, may not be improved by STN-DBS; in fact, they may deteriorate after surgery. Even after the successful introduction of STN-DBS as a treatment for PD, controversy still exists over a variety of issues: patient selection criteria, the anatomical target such as STN or globus pallidus (GPi), targeting methods (MRI alone, CT scan with image fusion, or ventriculography), microelectrode recordings (yes/no), and anesthetic procedures (awake with sedative or under general anesthesia). In this chapter we will discuss these controversial issues by integrating our experience with a review of the literature.
A successful DBS surgery may involve several surgical procedures, but patient selection is always a key issue to address because it contributes to whether there is a good surgical outcome. In 1992, a common evaluation protocol for PD was suggested by the the Core Assessment Program for Intracerebral Transplantations(CAPIT) committee, which allowed for comparisons between different study groups. For example, they defined “off-medication” and “on-medication” status. The core assessment methodologies of this protocol include the following: Unified Parkinson’s Disease Rating Scale (UPDRS), Hoehn and Yahr Staging, Dyskinesia Rating Scale, Self-reporting diary, and timed test for bradykinesia [1]. In 1996, the Network for European CNS Transplantation and Restoration (NECTAR), developed a new Core Assessment Program for Surgical Interventional Therapies in PD (CAPSIT-PD) and gave advice to add evaluations for cognitive function and quality of life [2]. Since then, thousands of papers have been published in the fields of PD and DBS, and clinicians and researchers have paid attention to the issue of patient selection in order to ensure a good outcome [3-9].
In 2009, Australia offered a referral guideline for neurologists to establish methods for enrolling ideal PD candidates for DBS. In 2010, consensus was reached for DBS in PD. With respect to patient selection, these experts stated that, “...Best results have been reported in patients with advanced PD and (1) levodopa response, (2) younger age, (3) no or few axial non–LD-responsive motor symptoms, (4) no or very mild cognitive impairment, and (5) absence of or well controlled psychiatric disease” [10]. The ideal candidate has all of the above components; however, even with these guidelines, pitfalls and controversy still exist.
It is important to differentiate PD from atypical parkinsonism to ensure a good long-term outcome of STN-DBS, but it can be hard to discriminate between them because they share clinical features such as bradykinesia, rigidity and tremor. It is especially difficult when the disease is in its early stage and l-dopa responsiveness is moderate. Poor prognostic factors for STN-DBS can be the following: a poor response to l-dopa, the additional presence of pyramidal or cerebellar signs (e.g., ataxia), an early presentation of posture instability and autonomic failure (e.g., hypotension), within 5 years of onset, a non-tremor dominant presentation, and persistent unilateral disease [11-12]. The UK Brain Bank Diagnostic Criteria for PD is recommended for assessing all surgical candidates, although it should be noted that the early symptoms of PD, such as hyposmia, REM sleep behavioral disorders, constipation and depression may precede the obvious motor symptoms and are not included on the list [13]. The use of Hoehn and Yahr (H&Y) staging and the Unified Parkinson’s Disease Rating Scale (UPDRS) is a basic requirement for evaluating patients before starting any PD intervention. In 2007, the revising process for the UPDRS was started by a task force of the Movement Disorder Society (MDS), which is aimed at incorporating more detail on non-motor symptoms, but it has not yet been published [14-17].
Age is a confounding factor and has a negative correlation with STN-DBS outcome. A trend for greater long-term STN-DBS improvements on the UPDRS part II and part III measures in younger patients has been shown; however, it is also effective in elderly patients, though the benefits may persist for only a short period of time [18]. Most studies also have shown a negative correlation with motor outcome, non-motor outcome (e.g., apathy and depression) and quality of life upon long-term follow-up [18-22]. While the cut-off age proposed by most studies is 70 years old, the benefits and risks of surgery should be weighed to meet the expectations of the patient and the care giver.
Advanced PD patients with obvious medication side effects of motor fluctuation and/or dyskinesia would be good candidates for DBS. However, an H&Y Stage 1 patient with tremor dominant symptoms who is within 5 years of onset can also be a good candidate for DBS and show a substantial benefit, as can a bed-ridden Stage 5 patient. Because there have been no proven neuroprotective effects of DBS, the recommendation for an earlier intervention is based on quality of life, which will improve substantially in domains related to movement disorders and general health [23]. Though some authors postulate that disease severity may be correlated with STN-DBS outcome, a study of ours found that the outcome was not correlated with H&Y staging or disease duration [18].
LD responsiveness, as measured by the UPDRS part III, may predict the motor outcome of STN-DBS in a PD patient with disabling motor fluctuations and dyskinesia. In fact, this is true for all cardinal symptoms (except LD refractory tremor) that can be well controlled by STN-DBS. Pre-operative LD responsiveness may only lead to consistent UPDRS part III improvement from STN-DBS at 3 months, and its predictive value may not be valid for long-term follow-up due to co-morbid non-motor symptoms. The pre-operative LD responsiveness of tremor and axial symptoms are stable predictors for the long-term effect of DBS [18].
Non-motor symptoms in PD patients are a significant source of disability and impairment in the performance of activities of daily living. The non-motor symptoms of PD include dementia, sleep disorders, and dysautonomia along with neuropsychiatric and sensory complaints. Most centers exclude PD patients with dementia and neuropsychiatric symptoms from STN-DBS. As for sleep disorders and sensory complaints, some reports have shown improvement after treatment when these symptoms are present. More generally, normal pre-operative cognitive functioning is positively correlated with post-operative improvement in UPDRS part III at a long-term follow-up [18]. STN-DBS may still lead to a decline in cognitive and executive function even with strict inclusion criteria [24]; however, it has been suggested that sub-optimal contact stimulation (caused by the small volume of STN) is more strongly correlated with post-operative psychiatric events. Although there are still debates about post-operative psychiatric events, the possibility of increased depression and suicide risk prompts us to evaluate the patient’s psychological function in detail prior to the operation.
STN-DBS is the current gold-standard surgical treatment in PD, but a high occurrence of adverse effects and neuropsychological problems following STN-DBS stimulation cause some centers to study alternative surgical targets, such as the GPi. The issues to consider when choosing a target for DBS include the following: a different set of patient selection criteria, the amount of levodopa being used, the extent of levodopa-related dyskinesia, battery life and surgeon preference.
In randomized trials, DBS has been demonstrated to be superior to the best known-medical treatment for advanced PD. Under most circumstances, STN is the chosen target rather than GPi. Although several reports have shown that the efficacy of pallidal stimulation decreases over the long-term follow up [25], others have demonstrated a persistent benefit from pallidal stimulation for up to 3 years [26]. In 2005, the first randomized trial was published by Anderson and colleagues, and their patients showed a similar improvement in motor function from subthalamic and pallidal stimulation [27]. Still, deciding which target is best is a topic still subject to debate, and several points of view need to be considered.
PD is characterized by disabling motor symptoms. Previous reports seem to have concluded that STN-DBS improves more than GPi-DBS in UPDRS part III (motor) [26-28]. However, a recent large randomized trial showed a similar improvement from either STN or GPi stimulation [29]. It should be noted that the follow-up duration in this study was only 24 months and GPi might show less of a benefit after a longer period of time [25, 30].
Non-motor symptoms of PD have received more attention in recent years and seem to play a pivotal role in the change in quality of life caused by the amelioration of motor disabilities through medical or surgical treatment [31]. An increased percentage of post-stimulation behavioral and cognitive complications is still a major concern for STN-DBS [27, 32-33] as it is not conclusively known whether DBS causes a change in these non-motor symptoms. Although a recent randomized trial comparing PD patients undergoing STN stimulation to those who only received the best medication-based treatment showed no significant differences [34], a second study comparing STN stimulation with GPi did show that depression was worse in those who received STN-DBS [29]. This finding reminds us that non-motor symptoms should be considered during target selection for patients who plan to receive electrode implantation.
One of the main reasons that pallidal stimulation has not become popular may be that it limits the amount one can decrease medication dosages. Most studies have shown that patients who undergo STN stimulation require a lower dose of dopaminergic medication than those who undergo GPi stimulation [28-29]. This effect is probably due to different mechanisms of action underlying the STN and GPi response to electrical current. It has been suggested that STN stimulation reverses the sensitization phenomenon that underpins levodopa induced dyskinesia (LID) [35]. In fact, STN stimulation per se cannot ameliorate LID without decreasing dopaminergic medication [36]. Contrary to this, GPi stimulation may itself decrease the severity of LID [37]. The interaction between STN and GPi activity has been suggested to play a major role in the pathogenesis of dyskinesia, and the amelioration of stimulation-related dyskinesia through proximal contact (i.e., stimulating pallido-subthalamic fibers) shown in previous reports and our own young onset PD (YOPD) patients suggests a more beneficial effect of GPi than STN in ameliorating treatment-related dyskinesia. Overall, most comparative studies showed that the daily dosage of levodopa can be reduced only in an STN-DBS group [26].
The stimulation amplitude within the implantable pulse generator (IPG) is one significant determinant of battery life. In a multicenter study, Rodriguez-Oroz and colleagues found a similar amplitude for patients undergoing STN and GPi stimulation for 3 to 4 years [26]. However, most studies (including one large randomized trial) have shown that STN stimulation requires significantly less electrical power around 0.7~0.8 V and a pulse width of 20 μsec [38]. These parameters allow patients to receive STN stimulation for a longer period of time between pulse-generator replacements as compared to GPi stimulation. Most cost-effectiveness studies also have confirmed this benefit of STN stimulation over solely medication-based treatment for advanced PD. For countries where DBS devices are not reimbursed by health insurance, such as Taiwan, the replacement of the IPG will be a large burden for most patients. Larger amplitudes and pulse widths for GPi stimulation may lead to more frequent battery replacement and more device-related complications [30]. Improving future IPG technology may alleviate this economic consideration.
Adverse effects of stimulation in general include cognitive decline, verbal fluency deterioration, gait disorders and mood instability (in the form of compulsiveness or depression). Most studies show that the adverse effects of stimulation are more common in STN-DBS [27, 29]. In the COMPARE trial, which was a prospective randomized trial, it was shown that under optimal conditions there was no significant difference in the incidence of mood or cognitive alteration following DBS implantation. However, a sub-scale analysis of the Visual Analogue Mood Scale showed that there was more “anger” after STN-DBS. Another randomized trial also has suggested that depression may be worse after subthalamic stimulation but improved after pallidal stimulation.
The volume of the STN (~158 mm3) is much smaller than the GPi (~478 mm3) nucleus. Moreover, the sub-territory within the STN nucleus and surrounding fibers involve motor, associative and limbic circuitry that are more compact and close together. Therefore, a sub-optimal electrode placement or electrical-current perturbation is more often going to be associated with STN stimulation, which may lead to mood changes and verbal fluency dysfunction.
Although a randomized control trial has shown a comparable benefit for GPi stimulation compared to STN stimulation, longer follow-up studies are needed to decide which target is preferable for each patient. We have made a comparison of the targets in Table 1. Clinical trials are ongoing for alternative targets in the pedunculopontine nucleus, radiation prelemniscalis, and caudal zona incerta, and stimulation on these targets may improve symptoms that are currently unresponsive to treatment with either levodopa or STN stimulation.
STN stimulation | GPi stimulation | |
Motor improvement | 50~60%, coherent [29, 34] | 27~50%, variable in long-term [29, 72] |
Mood effect | higher, esp. suboptimal contact | seems unchanged |
LEDD reduction | greater reduction (31.5%) | less reduction (17.8%) |
Battery life | lower amplitude | higher amplitude |
General adverse effect | 56% | 51% |
Comparison of STN and GPi stimulation
There are a number of targeting methods used in DBS. Which method is used depends on the facilities of the institution and the familiarity of the surgeon with a given procedure. Most practicing centers use magnetic resonance imaging (MRI) as the only tool for targeting, but others use image fusion techniques to co-register MRI and computed tomography (CT) images, or intra-operative ventriculography, which is the traditional targeting method, for determining targeting accuracy. Below we compare these methods on acquisition time, procedure complexity, and ultimate accuracy.
The size of the STN is extremely small and it has an ovoid shape and oblique orientation [39]. The accuracy of DBS targeting may be one of the most important factor in surgical outcome because the position of the electrode determines the area across which the electrical current diffuses. Given that there are very few evidence-based studies that have directly compared the safety and effectiveness of the various imaging techniques, the best targeting method remains under debate. The methods include MRI, CT, ventriculography and various combinations thereof.
Stereotactic targeting with ventriculography is the traditional method for stereotactic functional neurosurgery that has been in use for decades. While it is still used by some teams, there are concerns over its invasiveness and serious complications, such as CSF leakage and intracranial hemorrhage, which are major obstacles for most functional neurosurgeons [40]. The method involves injecting a contrast medium into the right frontal horn and acquiring representative images to determine the location of the anterior commissure and posterior commissure, which then can be used to calculate various target coordinates [41]. Compared with targeting methods that may have higher accuracy (e.g., ventriculography), targeting with MRI can be affected by the anterior displacement of the anterior commissure (AC), which elongates anterior commissure - posterior commissure (AC-PC) length [40]. A magnetic field can cause this nonlinear distortion, especially in the anterior-posterior and medial-lateral axis.
Most centers only use MRI for targeting while others use image fusion techniques to co-register MRI and CT scans. MRI-directed targeting for STN-DBS has proven to be a simple yet accurate method in most DBS practicing centers; it has been a standard procedure in our hospital since 2002 [42]. The advantages of MRI includes better demarcation of deep nuclei (e.g., the red and subthalamic nucleus) as references for targeting, better visualization of critical structures that can prevent inadvertent injury (e.g., lateral ventricles and vasculatures within sulci) and a clear delineation of simulating trajectory for electrode.
There are three current strategies to localize the coordinates of targets on stereotactic MRI. In direct targeting, the STN is located on MRI without any references, which is inherently prone to errors. The vague configuration of the STN makes determining the STN boundaries on a T2-weighted MR image rely on the subjective visual impression of the neurosurgeon. An indirect method of targeting uses the AC and PC as reference points, thereby avoiding bias when differentiating the border between the STN and substantia nigra, which has been shown to be more accurate than direct targeting. Targeting based on the red nucleus (RN) has not only the same accuracy as indirect targeting but also less variance, which indicates greater precision across subjects (Fig. 1) [43]. Although MRI-based targeting is becoming more popular, the potential distortion of the STN that a nonlinear magnetic field can induce is still a major concern. To counter this, some groups still use ventriculography which reliably identifies the AC-PC for indirect targeting methods using intraventricular landmarks.
Although the AC-PC and the target itself (e.g., the STN) are poorly visualized on CT, MRI fused to stereotactic CT are believed to combine the advantages of both modalities, thereby increasing the spatial validity of the image and ensuring a more accurate localization, which continues to improve as fusion technology improves [44]. In our experience, stereotactic CT fused to MRI during DBS surgery can allow for a longer microelectrode recording length of STN and fewer recording tracts (Fig. 2). This indirectly demonstrates that stereotactic CT may have a better pre-operative targeting ability leading to the stimulation of optimal anatomical sites. It should be noted that it may be difficult for advanced PD patients to
Direct targeting using MR images is depicted. The target coordinates for the tip of the permanent implantable electrode are at the intersection of the perpendicular lines. The horizontal line is located along the anterior border of the red nucleus. The longitudinal lines are at 2-mm intervals from the lateral border of the red nucleus. Axial section taken at the level of the superior colliculus, just below the lowest border of the STN (4.5 mm below the mid–commissural point). 1= red nucleus; 2=substantia nigra reticulata; 3=crus cerebri.
undergo MRI with a stereotactic frame, especially in an un-medicated state where obvious tremors or severe stoop posture will be present. There is a risk for these patients when sedated in the MRI suite in an attempt to quell the severe tremor because the scanning time for MRI may take more than 20 minutes. For this reason, some centers use a specific protocol for direct visualization of the STN in stereotactic MRI, which saves time [45]. At our institution, a stereotactic CT scan takes about 3 minutes, which is far below the average MRI acquisition time of 20-25 minutes for most protocols.
With advances in imaging technology, we may be able to define the border of the STN directly using MRI in the future and eliminate the inherent error of nonlinear MRI distortion.
A) Stereotactic axial computed tomography (CT) images for fiducial registration. (B) Nonfused axial magnetic resonance image (MRI) T1 images and stereotactic CT images. (C) Co-registered Schaltenbran-Wahren atlas for red nucleus and subthalamic nucleus (STN) target planning simulation. (D) Fused axial MRI T2 and CT images, spyglass with visualization of red nucleus (thin arrow) and STN (thick arrow).
Precise results in DBS surgery are traditionally achieved by MRI targeting followed by electrophysiological confirmation with microelectrode recording (MER) [46]. MRI scans are not always of sufficient quality to identify the target structure and are always susceptible to image distortion. MER can localize the target with more precision when MRI targeting is not precise enough. MER is used in DBS surgery to identify the target’s structural border, the subdivisions of the targeted structure and the outlines of its three-dimensional shape. MRI and MER are complementary in DBS surgery [47]; however, there are disadvantages of MER in DBS surgery, including the following: 1) it is time consuming, 2) it may increase the risk of a hemorrhage complication and 3) it is not always useful, for example when the target is located in white matter or has a large and distinct boundary that can be easily visualized with MRI. Here we will focus on whether MER is necessary in STN-DBS surgery for treating PD.
Direct MRI targeting without MER is possible in STN-DBS surgery with the recent advances in high-resolution MRI (field strength of 3-Tesla or more) and advanced image processing techniques. However, there is a paucity of publications that report on the use of stereotactic MRI for direct visualization in STN-DBS surgery without MER [48]. Recently, a large series of STN-DBS without MER has been published by Foltynie et al. [49]. We compared their results with those of Krack et al [50], who performed STN-DBS with MER which recruited from a single center. Table 2 compares the demographic data of the studies’ patients, effect of DBS and complications of surgery. The baseline data of the patients are comparable except that Krack’s sample size is less than Foltynie’s. However, we should note that Krack’s report is designed for long term follow-up (5 years later) and they recruited the first 49 STN-DBS patients from their center. The effect of STN-DBS at a one-year follow-up was similar in the two studies. The DBS effect is better in Krack’s study but not significantly so. In terms of surgery-related adverse events, Krack showed greater transient confusion and intracerebral hemorrhage in their patients. Foltynie showed less transient confusion and no hemorrhage events.
The risk of intracerebral hemorrhage inevitably increases with a greater number of micro- or DBS electrode penetration events [51-52]. Post-operative transient confusion in DBS surgery is common. The incidence of transient confusion in STN-DBS surgery is 15.6% [53]. This phenomenon is often attributed to a mild pneumocephalus that occurs during surgery. It is not a precisely understood phenomenon, but it occurs more frequently in older and cognitively disabled patients. The risk for and volume of pneumocephalus positively correlates with the amount of time the skull is open during surgery. MER may therefore increase the risk of pneumocephalus because it is time consuming.
Based on the above comparison, the same therapeutic effect for patients can be achieved in STN-DBS with and without MER, but MER has more surgery-related adverse events. Others have reported that the use of MER improves the outcome of STN-DBS [42]. With the advancement of MRI technology and imaging processing, MRI-guided STN-DBS without MER may be an alternative surgical method for advanced PD patients. The reports of MRI-guided STN-DBS are sparse; therefore, we cannot conclude that this surgical method is better than STN-DBS with MER. Overall, the necessity of MER in STN-DBS surgery remains controversial.
With MER (Krack et al) | Without MER (Foltynie et al) | |||||
Demographic data | Mean | ± | SD | Mean | ± | SD |
Sex (no. of patients) | 24 men | / | 25 women | 49 men | / | 30 women |
Age at surgery | 55.0 | ± | 7.5 (34-68) | 57.3 | ± | 7.7 (34.5-70.2) |
Duration of disease | 14.6 | ± | 5.0 | 13.4 | ± | 7.0 |
L-dopa equivalent dose | 1409.0 | ± | 605.0 | 1620.0 | ± | 641.0 |
Effect of STN DBS | ||||||
UPDRS III motor scores Baseline off-medication | 55.7 | ± | 11.9 | 51.5 | ± | 14.9 |
UPDRS III motor scores One year after operation on-stimulation, off-medication | 19.0 | ± | 11.1 | 23.8 | ± | 11.2 |
UPDRS III motor scores One year after operation on-stimulation, on-medication | 11.4 | ± | 8.9 | 14.5 | ± | 8.3 |
Adverse events related to procedure | ||||||
Intracerebral hemorrhage | 2 | 0 | ||||
Transient confusion | 12 | 7 | ||||
Seizures | 2 | 2 |
Comparison between DBS with and without MER
Traditionally, DBS is an awake surgical procedure in order to allow electrophysiological mapping and stimulation testing to assess motor responses and potential side effects. However, PD patients with obvious “off-medication” symptoms of anxiety, painful dystonia, and respiratory distress may not be good candidates for the lengthy tolerating the surgical procedures while awake [54-57]. In this section, we will report our own experience with general anesthesia during DBS surgery with MER and compare it with data from awake procedures (see Table 3).
Operation procedures: | Awake DBS | General Anesthetic DBS |
Patient’s condition | communicative and cooperative; Can tolerate severe off-symptoms | Anxious; Cannot tolerate severe off-symptoms, such as: pain, dystonia and/or respiratory difficulties |
Anesthetic agents | None | Desflurane (Patient intubated under regular induction and muscle relaxant, keep Mac around 0.8~1.0) [54] |
Sedative agents | propofol / remifentanil (intermittent use, e.g. during trephination) | None |
MER signals | Yes | Yes |
Passive movement-related MER signals | Yes | Yes |
Test stimulation | Yes | No |
Motor outcome | Good | Good |
Surgical complication | Comparable | Comparable |
Stimulation side effect | Lower | May be higher |
Risk period | During surgery | Induction and extubation |
Patient monitoring by anesthesiologist | Yes | Yes |
Comparison between awake DBS and general anesthetic DBS procedures
Most DBS centers prefer that their PD patients receive electrode implantation procedures in an awake state in order to retrieve sound electrophysiological signals from MER and to perform test stimulation. Time is crucial for a patient to tolerate the procedure while awake. Patel et al tried an MRI direct-targeting method with macro-stimulation alone. They conclude that without MER the procedure is more efficient and safe but still has a good outcome [58-59]. In the awake state, macro-stimulation is beneficial because it excludes the side effect from electrode stimulation [59]. Sedative agents are inevitable during awake procedures, especially during trephination. Propofol is popular during DBS procedures as a brief general anesthetic agent, but it may require full-time surveillance of the patient’s airway and vital signs by an anesthesiologist. The function of the patient’s airway can be a severe problem in an advanced PD patient’s “off” state.
MER has been shown to perform properly and without affecting the surgical outcome only when remifentanil was completely stopped and the dose of propofol was carefully monitored [52, 58, 60-61]. Duque et al reported a case with these same anesthetic agents using Bispectral Analysis of the Electroencephalogram (BIS) to monitor cortical activity in order to titrate the hypnotics, which may interfere with MER procedures. While this technique may be useful, it is not convenient [62].
A detailed MER mapping within the STN may lead to an optimal placement of DBS electrodes, but the drawbacks are the length of the procedure and that the patient must be kept awake during the procedure. Some patients with severe “off-medication” PD symptoms, such as major anxiety, poorly tolerated off-medication dystonia, or respiratory difficulties may refuse DBS or may be poor candidates for DBS in an awake state [55, 57]. STN-DBS during a state of general anesthesia may be another choice for those patients with advanced PD for whom symptoms are difficult to control with medication only.
In patients with advanced PD who undergo STN-DBS while awake, test stimulation after the permanent electrode is implanted is helpful to confirm the electrode position. The test stimulation verifies the maximal clinical effects intraoperatively as well as the side effects of low voltage in the case that the electrode position was sub-optimal. Test stimulation in patients receiving a general anesthetic is controversial. Hertel et al. performed test stimulation to verify possible capsular effects when using low-voltage electrode stimulation, and the voltage causing the capsular effects may be incorrectly estimated if the excitability of the capsule has been decreased by general anesthesia. In our study, we did not perform test stimulation, but no patient suffered post-operative capsular effects because our selection criteria for the trajectory of electrode implantation chose the most appropriate track [54].
The knowledge of STN topography is crucial in general anesthesia DBS surgery; therefore, MER must be used as it is the only intra-operative tool to identify the STN, map its boundaries, and map its sensorimotor component through the detection of movement-related neuronal firing [61, 63-65].
Most anesthesiologists are treating intubated patients under general anesthesia and in awake procedures like DBS, it can be challenging to ensure neuronal firing on the one hand and monitor patient safety the other. Avoiding medications that may interfere with MER can negatively affect patient safety, especially when the patient is agitated by a prolonged DBS procedure. However, it also is difficult to maintain a secure airway if the patient is too deeply unconscious [66-67]. In hypertensive patients, the alpha-2 agonist dexmedetomidine has been suggested as an effective sedative agent that may provide the patient comfort and good blood-pressure control and yet still allow satisfactory MER mapping by the neurophysiologist [67]. Complications may still occur during awake DBS procedures. Deoganokar reported a case of venous air embolism in an elderly PD patient with a myocardial infarction [68]. Glossop and Dobbs also report two cases of coronary artery vasospasm during electrode implantation. Though these patients recovered, the authors suggest full monitoring by an anesthesiologist throughout the surgical procedures [69].
Desflurane (2,2,2-trifluoro-1-fluoroethyl-difluoromethyl ether) is a highly fluorinated methylethyl ether used for maintenance of a general anesthetic. It has the most rapid onset and offset of all of the volatile anesthetic drugs used for general anesthesia because of its low solubility in blood. It also is popular in neurosurgery because it can allow early extubation and facilitate early neurological evaluation [70-71]. MER also can be performed well at an anesthetic level of 0.8±0.2 minimum alveolar concentration (MAC) [54].
The subthalamic nucleus plays an important role in the functional control of motor activity in the indirect dopaminergic pathway of the basal ganglia. Twenty years after the first introduction of DBS to treat PD, it remains as an important alternative treatment to l-dopa, especially in the patient with motor fluctuation and obvious l-dopa related complication. Centers performing DBS may have different protocol according to their experiences and facilities. Controversial points exist inevitably, however, through proper patient selections, cooperation between multidisciplinary teams, and refine surgical techniques we can ensure a good outcome for DBS candidate.
This work was supported by Master Cheng Yen, President of the Tzu-Chi Foundation, and Tzu-Chi General Hospital grant TCSP 0104.
This contribution introduces the Medical Humanities approach to the health sector. Medical Humanities constitute an approach to care using the “human sciences” as a tool to improve skills and abilities and to limit the stress of care professionals and operators.
A useful discipline in this context is related to cultural heritage, as all artistic objects can be “places” of observation and “mirror” of one’s knowledge and skills, becoming tools for learning and well-being. In particular, we will refer to experiences in the medical education sector that uses visual art.
Going deeper into the topic, we can realize, for example, how art and medicine have been integrated for centuries. It is enough to go far back in time to find examples transmitted by artistic objects to understand, as a whole, the importance of the solid relationship between medicine and the visual arts.
Art can therefore lead us, through its observation, to understand the anatomy represented or the reality of the cure, in fact, over the centuries, it has become a witness to illness, death, and healing activities. In the care sector, there are many references to art as therapy and many studies that show psycho-physiological evidence of the positive effects that artistic practice and its use can have on the person for the promotion of well-being and health.
For some years, the humanities and in particular, arts have also been used for the development of skills in learning environments. One of these sectors is that of basic and permanent training in the area of care (medicine, health professions) and more generally in the area of health in which Human Sciences have been introduced for the application of innovative models for the development of useful skills. This approach is referred to as Medical Humanities.
We will therefore try to describe the opportunity that the visual arts and pedagogical methodologies can offer to the field of medical education for the development of skills and abilities to improve the work of health professionals, increase resilience, and promote their well-being.
As a result of reading history, we can be aware of how much art and medicine have remained integrated for centuries. It is enough to go far back in time to find examples transmitted by artistic objects to understand, as a whole, the importance of the solid relationship between medicine and visual arts starting from when in ancient Greece, which can be considered the cradle of our modern culture, the anatomists asked the artists for help to understand the human body. In fact, at that time, dissection was practiced on the bodies of animals, while it was forbidden to explore human anatomy for social and religious reasons.
Respect for the body of the deceased on the one hand and the consideration of the corpse as a source of impurity on the other had meant that the conditions were not created for carrying out this type of investigation. Even after 1241, the year of the edict of Frederick II which authorized, and indeed stimulated, the use of dissection of corpses, the anatomical investigation was accompanied throughout its path by the activity of artists who have put their skills at the service of scientific studies and of the representation of the human body, which needed scientific investigation to be able to fully express itself.
The practice of observation and the in-depth study of shapes allowed them to reproduce the muscles in a way that exactly correspond to anatomical science and often in the sculptures we can look at muscle groups portrayed in the act of participating in the movement of the body as a whole.
Art can therefore lead us, through its observation, to understand the anatomy represented or the reality of the cure; in fact, over the centuries, it has become a witness to illness, death, and healing activities. Through art it is possible to have evidence of missing pathologies and diseases useful for study, as the Italian doctor, G. Franceschini already wrote about it in 1906, who suggested that “Even the saddest and most painful sides of human life… have been… subject of study by artists, and how even the most pitiful and repulsive sciences of medicine have snatched from the creative brush of the passionate craftsman, pulsating works of life, truth, sentiment. And since beauty is the splendor of truth, it can be said that even the crudest truths of human pathology, clothed in the splendors of art from a skillful hand of craftsman, contributed to the creation of beauty, with sublime works of painting and sculpture” [1].
Art is also a representation of reality and can present itself as a “mirror” for the viewer who can understand emotions and knowledge of activities and meanings related to their personal experiences. Art, as experience, has often guided the pedagogical studies to be used as a tool to develop innovative educational methods [2].
The cognitive reaction to the processes of creation and use of the artistic image can determine knowledge. Starting from this concept, we can understand, first of all, why the observation of art can stimulate us to consider more than one interpretation and therefore more than one possible solution to a single question. Important in this area is the research of R. Arnheim. It explains the connection between visual perception and thought. “Identifying what we see is an act of knowledge,” Arnheim tells us according to the psychology of perception [3]. When we look at something, mechanisms of understanding are rapidly implemented to recognize and grasp the sense of what is placed before our eyes. Furthermore, thanks to visual stimuli, thoughts and skills to solve problems are automatically set in motion. The careful observation of a work of art activates, in an almost instinctive way, multiple reasoning capable to achieve logical and analytical solutions, thanks to the multiple intelligences useful for cognitive development, including, mostly, the visual-spatial one [4].
In the care sector, there are many references to art as therapy and many studies that show psycho-physiological evidence of the positive effects that artistic practice and its use can have on the person for the promotion of well-being and health.
The role of visual arts and their usefulness, both for therapy and for the promotion of well-being and for the development of clinical skills, is highlighted by the report of the European section of the World Health Organization [5]. Furthermore, exposure to arts or exercising artistic activities can be “therapeutic,” lowering cortisol levels and therefore limiting stress [6, 7].
For some years, the humanities, specially the arts, have also been used for the development of skills in learning environments. One of these sectors is that of basic and continuing medical education in the area of care (medicine, health professions) and more generally of the health sector in which for several years the Human Sciences have been introduced. These disciplines have been applied in innovative learning models for the development of skills useful to the care profession for building a Medical Humanities approach. Recent studies have shown how activities related to the arts can help; for example, medical students have benefitted from such activities to develop a certain type of skills and, moreover, to limit the risk of stress and burnout during the years of clinical practice [8].
It should be noted that already in 1948, the Constitution of the World Health Organization gave an alternative definition of health to that considered by the biomedical model: “A state of complete physical, social and mental well-being, and not only the ‘absence of disease or infirmity…” [9], and subsequently describing health promotion in the Ottawa charter: “Health is considered not so much an abstract condition as a means aimed at an objective which, in operational terms, can be considered a resource that allows people to lead a productive life on an individual, social and economic level. Health is a resource for daily life and not the purpose of existence. It is a positive concept that enhances social and personal resources, as well as physical abilities” [10].
This holistic vision of health led to the research and definition of a new bio-psycho-social approach applied to the medical and health area with the assumption that every health condition or disease is the consequence of the interaction between biological, psychological, and social. In addition, the basic methodological triad for the clinical trial is defined consisting of observation (external vision), introspection (internal vision), and dialog (interview) and these ultimately render the patient’s data as scientific [11].
We can therefore talk to extend the concept of health about “global well-being.”
This approach places the patient at the center of the treatment process and solicits the doctor or health professional to review his preparation in order to face the knowledge of the disease in a holistic context trying to improve “The medical gaze”, the so-called clinical eye considered the “semiological ability to use the senses to produce the diagnosis of a disease.” The skills and abilities useful in this context are therefore linked to soft skills, teamwork, understanding the other through empathy and self-care of the health worker to limit the stress that this type of activity can feed. Among the activities useful for the development of skills we also find pedagogical methods that use the arts and in particular the visual arts. Regarding the adoption of these methods in medical and health education, a lot of scientific literature can be found indicating growing evidence that traits associated with empathy, for example, can be cultivated and taught through guided observation of works of visual art [12]. In addition, visual arts help in the development of clinical skills, including the observation, analysis, and communication of visual information. Representational art allows students to focus on identifying recognizable shapes and contextual information, while abstract art encourages the development of pattern recognition skills and greater tolerance of ambiguity with the freedom to follow one’s imagination and emotion. Also in Italy, the introduction of pedagogical methods that use visual art as a tool for improving certain skills and abilities in the field of Medical Education is being experimented with positive results [13].
An important element in this context is training for all those who work to improve the relations between professional care and patients. Important skills are those related to collaborative work, communication, and empathy. Being empathetic, patient-centered, compassionate, humble, and respectful is essential for healthcare professionals to deliver holistic care. Another important activity to practice is to facilitate useful strategies for limiting stress and burnout in operators with a decrease in empathy and observation and analysis skills starting from basic training to continuing education. Furthermore, an important skill is that related to critical thinking to keep an open mind, self-awareness and respect and appreciation of different points of view that make each situation and patient experience unique [14].
The art works represent the moods, the relational dynamics, and the emotions that can be learned and recognized through exercise. Some collaborative activities related to the observation of a work of art can also help to change the approach with the other and therefore with the patient and his family.
One of the methods that use artistic images and which has been applied for years in the United States and experimented in Italy for basic and continuing training in the medical and health area is Visual Thinking Strategies (VTS). VTS originated in 1988 from the integration of the research of the cognitive psychologist Abigail Housen and Philip Yenawine educator at the Museum of Modern Art in New York [15, 16].
This structured method for involving museum visitors becomes an important tool for learning in school and an important activity in the medical and health education sector [17]. The practice of VTS takes place in small groups, in front of a work of art, considered equal for basic knowledge and culture. An experienced facilitator will use only three questions to lead the discussion. It is important to listen to the opinions of others, as everyone will be able to enrich their point of view, creating a collective consciousness.
The questions are as follows: What is going on in this picture? What do you see that makes you say that? What else can you find?
It is therefore important that the observations and opinions of the participants are always substantiated by visual elements. This apparently simple step activates cognitive mechanisms for recognizing reality on the basis of one’s previous experiences.
The experience of observing the image with the VTS method stimulates the awareness of how perception works: at the beginning, we have an overview, we identify details that, based on our knowledge and experience, lead us to an elaboration of the information perceived by assigning a certain meaning, the subsequent observation and listening to other possible interpretations, based on new details or the same decoded in a different way, lead us to a further elaboration and assignment of meaning, thus activating a problem-solving process. This experience also suggests that we need to take time in front of an image to understand its meaning. This exercise makes us reflect on the multiple interpretations that the same image can suggest; in fact, if we are based on previous knowledge and experiences, the same image can be understood and therefore described differently by each participant, thus learning to accept the ambiguity of the perception related to our knowledge and that of others. This exercise helps us to develop divergent thinking at the basis of creativity. Group discussion also allows to improve communication and listening skills.
In summary, we can list a series of objectives and purposes that have emerged in the various studies conducted on VTS related to the medical and health profession:
Improve observation and clinical reasoning skills, or better understand the clinical scenario (patient and social context).
Improve communication skills, fundamental skills in the work of the doctor and nurse and more generally of the health professional, both in the relationship with the patient and family members, and with colleagues.
Encourage critical thinking and problem solving, which in clinical practice translate into a guide to choose the best solution for the patient.
Promote empathy, which is fundamental in the relationship of care with the patient.
Express oneself freely; this is especially important for students, as it improves the quality of learning.
Improve the tolerance of ambiguity, that is, get used to the diversity of the individual and the individuality of responses to treatment.
Improve interpersonal skills and therefore group work.
An interesting analogy that we can focus on is that between the modality of discussion in small groups that the VTS stimulates in front of a work of art and the visits or meetings organized with the care team during which doctors present, discuss, and plan for patient health with students’ request for hypothesis with experts acting as mentors and facilitators to guide discussion and formulate a care plan [18].
These activities with art can be very useful for improving the skills such as observation, problem solving, and critical thinking. In this context, the clinical observation, which includes the identification of data, the recognition of patterns in the collected data, and the interpretation and re-reading of the same, is the basis of the complex decision-making process of the doctor, through which he collects data, achieves the conclusions and chooses the most suitable therapy.
The skills of problem solving and critical thinking are also considered key and fundamental skills in the care sector, and art can help in their development. This arrangement is linked to the essence of the artistic artifact: the work of art can be defined as a “text” open to multiple levels of reading and the information it offers can be correlated with each other even if with a different meaning, as they can be represented as conceptual nodes of a hypertext that is configured while the perception continues to be applied with the identification of new details and therefore with the elaboration of new contents starting from the attributed meanings. In relation to the development of Critical Thinking, we find an interesting example that represents a useful collaboration between the cultural sector and medicine. Ohio State University College of Medicine (OSUCOM), in partnership with the Columbus Museum of Art (CMA), during the 2010–2011 academic year conducted an innovative experience for medical students who applied the analysis of works of art using observation supported by a column on critical thinking combined with a group discussion called “Art of Analysis.” The critical thinking column is called “ODIP”, an acronym for “observe, describe, interpret, and demonstrate.” The goals of the Art of Analysis (AoA) are to encourage critical thinking skills, generate empathy, create a foundation for cooperative outcomes, increase students’ tolerance for ambiguity, and improve the observation skills of junior doctors. This activity includes a form that suggests activating an observation, a description, an interpretation and a test, stimulating the students to learn to collect information objectively, to identify different possible interpretations to choose the best one based on evidence and therefore to implement a problem solving and critical thinking process [19]. Another fundamental skill for doctors and care staff is empathy. The term empathy derives from the Greek word “εμπαθεία” (> en and patheo, that is “inside” and “feel” = “feel inside”, “put yourself in the other’s shoes”); it indicated the emotional relationship of participation that bound the author-cantor to his audience. The term “empathy” has been equated with the German “Einfühlung”, coined by the philosopher Robert Vischer at the end of the nineteenth century and only later it was translated into the English term “empathy.” Vischer also defined for the first time the specific meaning of esthetic sympathy, or the feeling, not otherwise definable, that one feels in front of a work of art.
Vischer conceived this term as the ability to feel inside and to allow, that is, to perceive the external nature, as internal, belonging to our own body. It therefore represents the ability to project feelings from us to others and to the things we perceive [20].
In the human sciences, empathy designates an attitude toward others characterized by a commitment to understanding the other, excluding any personal affective attitude (sympathy, antipathy) and any moral judgment. Fundamental in this context was the discovery of mirror neurons by the research group of Prof. G. Rizzolatti. It is a particular class of cells that are activated both when a person performs an action and when he sees him doing, thus allowing us to understand what others are doing or feeling. It is therefore a fundamental mechanism not only for learning through imitation, but also to make the observer participates in the emotions of others or rather recognize the state of the other [21]. It is now clear that we cannot ignore taking care of the whole person to treat his illness and therefore empathy is considered essential for a good doctor-patient relationship. Also, for this type of ability, the work of art can be a valid tool for understanding the complexity of human nature. In particular, courses based on the observation of art have been shown to help students be more aware of emotions, their role in medicine, and to express empathy.
An interesting example concerns the program of the course for medical students of the Weill Cornell Medical College in collaboration with the Frick Collection art museum of New York published in 2001. The program included the examination of the portraits of the museum by students with the help of experts of art and by doctors according to indications that they had to replicate with photographs of the faces of patients. This activity is useful not only to improve observation skills but also to learn to understand the different states mood and the different emotions of the faces developing a greater emotional awareness [22].
A capacity whose concept was defined not so long ago is the Tolerance of Ambiguity.
Intolerance to ambiguity, or aversion to ambiguity, was first identified more than 50 years ago. It has been described as a personality trait in which “new, complex or insoluble” situations are perceived as “sources of threat.” Given that the field of medicine and healthcare can be characterized by novelty, complexity, and sometimes insolubility, it is extremely important to understand how clinicians, and others, react to such circumstances. In general, individuals with high tolerance for ambiguity are attracted or fascinated by the unknown. Conversely, those with low tolerance tend to deny, avoid, or minimize ambiguity and experience significant stress on account of it. In medical practice, low tolerance of ambiguity is associated with the biomedical model rather than a bio-psycho-social vision of care [23].
The increase in the intolerance of ambiguity can be associated with stress [24]. Yet studies indicate that medical students or healthcare staff may feel uncomfortable with ambiguity. The use of Medical Humanities and in particular art can help improve this ability.
Another important practice that uses art is icono-diagnosis, which can help in learning a correct diagnosis process. The concept of icono-diagnosis was introduced in 1983 by A. Pontius, a psychiatrist at Harvard University, committed to demonstrate the ancient presence of Crouzon syndrome in the Cook archipelago, examining the features of the statues found in these islands [25]. In recent years, several doctors such as V. Franco, pathologist of the University of Palermo [26] or F.J. Barbado bring their students to the Prado Museum for a “medical examination” to the artworks exposed [27]. The enormous talent of the great masters of painting allows only by looking at a portrait to imagine the thoughts of this person and his state of mind. With our didactic activity, however, we can go further, and by observing carefully, know more intimate details such as; a disease that may have plagued the person, their past history and their wishes. For example, always with careful observation, a spot on the skin, a knot in the neck or a strange formation in the fingers can show signs of specific pathologies. These can be traced back to the models that have been immortalized and confirm our theoires with other historical sources. Thus, through this practice, it is possible to “train” the clinical eye. It allows also to rewrite the history of the people portrayed or of the artists. An Italian study published in the Journal of the Royal Society of Medicine analyzed three portraits of Michelangelo, arguing that the joints of the artist’s left hand were almost certainly affected by arthrosis, a disease that would have affected Michelangelo at the end of the seventh decade of his life. In the details of the portraits, we can see the nodules precisely, the typical deformities of arthrosis, the diagnosis of which offers a plausible explanation for Michelangelo’s loss of dexterity in old age and also underlines his victory over the disease. The continuous and intense work would have helped the artist to maintain the use of his hands as long as possible [28]. There are several studies that are represented in the scientific literature and that give us an idea of how to use a multidisciplinary team for research on particular pathologies and offer students suggestions for the development of clinical skills [29, 30, 31].
This brief description can give an idea of how art and medicine have a lot in common and how one can support the other. As you will see, art can promote the development of skills useful to doctors and medicine can help in understanding the history of the characters and communities represented but also be able to rewrite the history of art by suggesting other visions.
The experimentation of art as a tool in medical education is being carried out in many different countries. In Italy, at the Sapienza University of Rome, a special course that applies art practice was introduced in the curriculum of medicine and nursing. From the 2014–2015 academic year, a Sapienza research group began experimenting this type of activities and currently the Laboratory of Art and Medical Humanities has been developed to coordinate art courses for the training of physicians and nursing and healthcare operators and continues in the context of study and research in this sector. The results were very interesting; even the activities organized in distance learning in the pandemic period were effective [32]. These courses are acquiring a curricular character with positive qualitative and quantitative results in line with those presented by the international literature of the sector.
These experiences also led to the validation of a useful grid to measure the improvement of some of the skills previously mentioned after participating in the proposed discussion and art production activities [33]. Other experiences in other countries reported the positive results obtained by adopting this useful evaluation system [34].
Other experiences in the field of continuing education, always in the health sector, have found a positive welcome by the attendants. In the United States, the use of works of art has become an approach used in the care sector by many universities to involve medical students, residents, doctors, and nurses in an innovative learning process. Medical schools are expanding their educational programs by collaborating with local art museums [35]. In Italy too, an experimentation linked to the activities applied in the United States is underway.
The last notation that is considered important to report is the one that is linked to these experiences carried out at a distance in period of COVID pandemic with extremely positive results in the various areas in which they have been applied—university environment, groups connected to palliative care, patients in psychotherapy, in distance teaching.
These experiences have helped to raise awareness of how much arts, and in this case visual art, can be a valuable tool for developing to upgrade useful skills and abilities in the care sector and improve the state of well-being of professionals in the medicine and healthcare field.
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The problem of mercury toxicity was only widely explored in the second half of the 20th century, following cases of fatal poisonings as a result of the consumption of contaminated fish and grains preserved with mercury compounds. According to HELCOM reports, Hg emission in the Baltic region at the beginning of the 21st century was lower than during the 1980s. In addition to mercury transformation, climate warming, particularly in the autumn-winter season, is another factor contributing to the changes in mercury circulation, especially in the area of land-sea contact. The increase in rainfall, particularly in the summer, is of particular importance for the marine environment. This is related to an increased inflow of Hg with wet precipitation, but the warm season is also favourable for intensive growth of sea organisms and, consequently, a faster accumulation of chemical substances, including toxic ones. As a result, the concentration of mercury in organism biomass increases.",book:{id:"5096",slug:"applied-studies-of-coastal-and-marine-environments",title:"Applied Studies of Coastal and Marine Environments",fullTitle:"Applied Studies of Coastal and Marine Environments"},signatures:"Magdalena Bełdowska",authors:[{id:"176840",title:"Dr.",name:"Magdalena",middleName:null,surname:"Bełdowska",slug:"magdalena-beldowska",fullName:"Magdalena Bełdowska"}]},{id:"49999",doi:"10.5772/62205",title:"Fabrication and Properties of Zinc Composite Coatings for Mitigation of Corrosion in Coastal and Marine Zone",slug:"fabrication-and-properties-of-zinc-composite-coatings-for-mitigation-of-corrosion-in-coastal-and-mar",totalDownloads:1742,totalCrossrefCites:3,totalDimensionsCites:5,abstract:"Deterioration of metals and alloys during service due to corrosion and wear phenomena shortens materials’ life span and structural integrity particularly in aggressive environments such as coastal and marine. This degradation also limits the use of these materials in most industrial applications. Therefore, the improvement of the quality of these materials in order to combat these challenges in industry remains critical. Surface modification techniques are employed to enhance materials’ properties to enable better performance and to extend their applications in demanding environments. Electrodeposition has been a useful method developed to improve the corrosion and mechanical properties of materials. In the present contribution, ample knowledge about electrodeposition of Zn composite/nanocomposite coatings and their characteristics are reviewed to address coastal and marine degradation of metals and alloys.",book:{id:"5096",slug:"applied-studies-of-coastal-and-marine-environments",title:"Applied Studies of Coastal and Marine Environments",fullTitle:"Applied Studies of Coastal and Marine Environments"},signatures:"Patricia A.I. Popoola, Nicholus Malatji and Ojo Sunday Fayomi",authors:[{id:"169258",title:"Dr.",name:"Patricia",middleName:null,surname:"Popoola",slug:"patricia-popoola",fullName:"Patricia Popoola"},{id:"174331",title:"Dr.",name:"Ojo Sunday",middleName:null,surname:"Fayomi",slug:"ojo-sunday-fayomi",fullName:"Ojo Sunday Fayomi"},{id:"176997",title:"Mr.",name:"Nicholus",middleName:null,surname:"Malatji",slug:"nicholus-malatji",fullName:"Nicholus Malatji"}]}],mostDownloadedChaptersLast30Days:[{id:"49582",title:"Geological Evolution of Coastal and Marine Environments off the Campania Continental Shelf Through Marine Geological Mapping - The Example of the Cilento Promontory",slug:"geological-evolution-of-coastal-and-marine-environments-off-the-campania-continental-shelf-through-m",totalDownloads:1448,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"The geological evolution of coastal and marine environments offshore the Cilento Promontory through marine geological mapping is discussed here. The marine geological map n. 502 “Agropoli,” located offshore the Cilento Promontory (southern Italy), is described and put in regional geologic setting. The study area covers water depths ranging between 30 and 200 m isobaths. The geologic map has been constructed in the frame of a research program financed by the National Geological Survey of Italy (CARG Project), finalized to the construction of an up-to-date cartography of the Campania region. Geological and geophysical data on the continental shelf and slope offshore the southern Campania region have been acquired in an area bounded northward by the Gulf of Salerno and southward by the Gulf of Policastro. A high-resolution multibeam bathymetry has permitted the construction of a digital elevation model (DEM). Sidescan sonar profiles have also been collected and interpreted, and their merging with bathymetric data has allowed for the realization of the base for the marine geologic cartography. The calibration of geophysical data has been attempted through sea-bottom samples. The morpho-structures and the seismic sequences overlying the outcrops of acoustic basement reported in the cartographic representation have been studied in detail using single-channel seismics. The interpretation of seismic profiles has been a support for the reconstruction of the stratigraphic and structural setting of the Quaternary continental shelf successions and the outcrops of rocky acoustic basement in correspondence to the Licosa Cape morpho-structural high. These areas result from the seaward prolongation of the stratigraphic and structural units, widely cropping out in the surrounding emerged sector of the Cilento Promontory. The cartographic approach is based on the recognition of laterally coeval depositional systems, interpreted in the frame of system tracts of the Late Quaternary depositional sequence.",book:{id:"5096",slug:"applied-studies-of-coastal-and-marine-environments",title:"Applied Studies of Coastal and Marine Environments",fullTitle:"Applied Studies of Coastal and Marine Environments"},signatures:"Gemma Aiello and Ennio Marsella",authors:[{id:"100661",title:"Dr.",name:"Gemma",middleName:null,surname:"Aiello",slug:"gemma-aiello",fullName:"Gemma Aiello"}]},{id:"49642",title:"Engineering Tools for the Estimation of Dredging-Induced Sediment Resuspension and Coastal Environmental Management",slug:"engineering-tools-for-the-estimation-of-dredging-induced-sediment-resuspension-and-coastal-environme",totalDownloads:2337,totalCrossrefCites:1,totalDimensionsCites:6,abstract:"In recent years, increasing attention has been paid to environmental impacts that may result from resuspension, sedimentation and increase in concentration of chemicals during dredging activities. Dredging dislodges and resuspends bottom sediments that are not captured by dredge-head movements. Resuspended sediments are advected far from the dredging site as a dredging plume and the increase in the suspended solid concentration (SSC) can strongly differ, in time and space, depending on site and operational conditions. Well-established international guidelines often include numerical modelling applications to support environmental studies related to dredging activities. Despite the attention that has been focused on this issue, there is a lack of verified predictive techniques of plume dynamics at progressive distances from the different dredging sources, as a function of the employed dredging techniques and work programs, i.e., spatial and temporal variation of resuspension source. This chapter illustrates predictive techniques to estimate the SSC arising from dredges with different mechanisms of sediment release and to assess the spatial and temporal variability of the resulting plume in estuarine and coastal areas. Predictive tools are aimed to support technical choices during planning and operational phases and to better plan the location and frequency of environmental monitoring activities during dredging execution.",book:{id:"5096",slug:"applied-studies-of-coastal-and-marine-environments",title:"Applied Studies of Coastal and Marine Environments",fullTitle:"Applied Studies of Coastal and Marine Environments"},signatures:"Iolanda Lisi, Marcello Di Risio, Paolo De Girolamo and Massimo\nGabellini",authors:[{id:"15209",title:"Prof.",name:"Marcello",middleName:null,surname:"Di Risio",slug:"marcello-di-risio",fullName:"Marcello Di Risio"},{id:"116232",title:"Dr.",name:"Massimo",middleName:null,surname:"Gabellini",slug:"massimo-gabellini",fullName:"Massimo Gabellini"},{id:"176998",title:"Ph.D.",name:"Iolanda",middleName:null,surname:"Lisi",slug:"iolanda-lisi",fullName:"Iolanda Lisi"},{id:"177000",title:"Prof.",name:"Paolo",middleName:null,surname:"De Girolamo",slug:"paolo-de-girolamo",fullName:"Paolo De Girolamo"}]},{id:"50060",title:"Depositional Environment of Phosphorites of the Sonrai Basin, Lalitpur District, Uttar Pradesh, India",slug:"depositional-environment-of-phosphorites-of-the-sonrai-basin-lalitpur-district-uttar-pradesh-india",totalDownloads:1823,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"Phosphates are regarded as one of the most important fertilizer minerals used by man. In Sonrai basin of Lalitpur the phosphorites are found to occur as lenticular and detached bodies throughout the Formation of the Bijawar Group. Individual bodies range from a few meters to about 4 km in length, and width varies from thin bands to about 125 meter with P2O5 concentration ranging from 10 to 20%. The Paleoproterozoic Bijawar Group are overlain by the Archaean Bundelkhand Basement Complex and underlain by Vindhyan Supergroup. The occurrence of phosphorites is confined to the Sonrai Formation which consists of massive to brecciated phosphorite within the lower reddish shales, with at least three bands identified. Megascopic study reveals that the brecciated phosphorite is reddish brown in color and fine to medium grained with angular fragments of chert and quartz embedded in a groundmass of iron oxides and secondary silica intercalated with minor veins of chert and iron oxides. The phosphorite horizon in the Lalitpur area is associated with pink to white brecciated massive quartzite, shale, dolomite and limestone of the basal unit. The concentration trends of certain major oxides indicate that the phosphorites are more enriched in CaO, P2O5 and SiO2 than Al2O3, Fe2O3, TiO2, Na2O and K2O. The concentration trends of trace elements reveal that the phosphorites are moderately enriched in Co, Zn, Zr, Pb, U than in Sc, Ba, V, Cr, Ni, , Rb, Sr, Y and Th. The dispersion patter, correlation coefficient and mutual relationship of significant major oxides represented by plotted diagrams, indicate that SiO2, CaO, MgO are antipathetically related with P2O5. The relationship suggests a gradual replacement among these oxides during diagenesis. High values of P2O5 and CaO in the phosphorites indicate more concentration of apatite constituent. The difference in geochemical behavior of CaO and MgO may be due to ionic substitution of Ca+2 by MgO+2 in the apatite crystal lattice during alkaline environment of the basin. The strong negative relationship between P2O5 with Fe2O3 in phosphorites may be due to leaching and/mild weathering of iron from the ores and reprecipitation along with P2O5 in the pore spaces, cavities/voids, veins, etc in highly oxidizing marine environment of the basin. The minimum evidence of organic matter, absence of sulphide minerals and lower concentration of V, Ni, and Cu suggest that the phosphorites were deposited in an oxidizing environment with slightly anaerobic to highly aerobic facies.",book:{id:"5096",slug:"applied-studies-of-coastal-and-marine-environments",title:"Applied Studies of Coastal and Marine Environments",fullTitle:"Applied Studies of Coastal and Marine Environments"},signatures:"Shamim A. Dar and K. F. Khan",authors:[{id:"176685",title:"Dr.",name:"Shamim",middleName:"A",surname:"Dar",slug:"shamim-dar",fullName:"Shamim Dar"},{id:"181312",title:"Dr.",name:"K.F",middleName:null,surname:"Khan",slug:"k.f-khan",fullName:"K.F Khan"},{id:"181314",title:"Dr.",name:"Saif A",middleName:null,surname:"Khan",slug:"saif-a-khan",fullName:"Saif A Khan"}]},{id:"49930",title:"Monitoring the Coastal Environment Using Remote Sensing and GIS Techniques",slug:"monitoring-the-coastal-environment-using-remote-sensing-and-gis-techniques",totalDownloads:2707,totalCrossrefCites:7,totalDimensionsCites:10,abstract:"The coastal zone has been of importance for economic development and ecological restoration due to their rich natural resources and vulnerable ecosystems. Remote sensing techniques have proven to be powerful tools for the monitoring of the Earth’s surface and atmosphere on a global, regional, and even local scale, by providing important coverage, mapping and classification of land cover features such as vegetation, soil, water and forests. This chapter introduced the methods for monitoring the coastal environment using remote sensing and GIS techniques. Case studies of port expansion monitoring in typical coastal regions, together with the coastal environment changes analysis were also presented.",book:{id:"5096",slug:"applied-studies-of-coastal-and-marine-environments",title:"Applied Studies of Coastal and Marine Environments",fullTitle:"Applied Studies of Coastal and Marine Environments"},signatures:"Dong Jiang, Mengmeng Hao and Jingying Fu",authors:[{id:"25222",title:"Dr.",name:"Dong",middleName:null,surname:"Jiang",slug:"dong-jiang",fullName:"Dong Jiang"},{id:"176843",title:"Dr.",name:"Jingying",middleName:null,surname:"Fu",slug:"jingying-fu",fullName:"Jingying Fu"},{id:"176844",title:"MSc.",name:"Mengmeng",middleName:null,surname:"Hao",slug:"mengmeng-hao",fullName:"Mengmeng Hao"}]},{id:"49825",title:"Management of Marine Protected Zones – Case Study of Bahrain, Arabian Gulf",slug:"management-of-marine-protected-zones-case-study-of-bahrain-arabian-gulf",totalDownloads:2928,totalCrossrefCites:2,totalDimensionsCites:6,abstract:"Coastal and marine environments in Bahrain are characterized by a variety of habitats, including seagrass beds, coral reefs, and mangroves that support some of the most endangered species such as dugongs and turtles. Marine Protected Areas (MPAs) are considered the most advocated approach for marine conservation. Several MPAs have been established in Bahrain. This study explores the ecological and legal contexts of MPAs in Bahrain and evaluates the effectiveness of these MPAs in achieving their conservation goals. Although MPAs are contributing to the protection of critical coastal and marine habitats and their associated flora and fauna, there is yet further need to strengthen efforts on conserving coastal and marine environments in Bahrain. Effectiveness of MPAs in Bahrain could be enhanced by developing management plans, implementing the necessary regulatory measures, and investing in long-term monitoring and research programs. Findings of this study could contribute to wider regional and international experience of the effectiveness of MPAs in protecting important coastal and marine environments.",book:{id:"5096",slug:"applied-studies-of-coastal-and-marine-environments",title:"Applied Studies of Coastal and Marine Environments",fullTitle:"Applied Studies of Coastal and Marine Environments"},signatures:"Humood A. Naser",authors:[{id:"50322",title:"Dr.",name:"Humood",middleName:null,surname:"Naser",slug:"humood-naser",fullName:"Humood Naser"}]}],onlineFirstChaptersFilter:{topicId:"789",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:90,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:107,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:33,numberOfPublishedChapters:330,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:14,numberOfPublishedChapters:145,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:9,numberOfPublishedChapters:140,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:123,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:112,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:22,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:11,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:"2753-6580",doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}}]},series:{item:{id:"14",title:"Artificial Intelligence",doi:"10.5772/intechopen.79920",issn:"2633-1403",scope:"Artificial Intelligence (AI) is a rapidly developing multidisciplinary research area that aims to solve increasingly complex problems. In today's highly integrated world, AI promises to become a robust and powerful means for obtaining solutions to previously unsolvable problems. This Series is intended for researchers and students alike interested in this fascinating field and its many applications.",coverUrl:"https://cdn.intechopen.com/series/covers/14.jpg",latestPublicationDate:"July 5th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:9,editor:{id:"218714",title:"Prof.",name:"Andries",middleName:null,surname:"Engelbrecht",slug:"andries-engelbrecht",fullName:"Andries Engelbrecht",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRNR8QAO/Profile_Picture_1622640468300",biography:"Andries Engelbrecht received the Masters and PhD degrees in Computer Science from the University of Stellenbosch, South Africa, in 1994 and 1999 respectively. He is currently appointed as the Voigt Chair in Data Science in the Department of Industrial Engineering, with a joint appointment as Professor in the Computer Science Division, Stellenbosch University. Prior to his appointment at Stellenbosch University, he has been at the University of Pretoria, Department of Computer Science (1998-2018), where he was appointed as South Africa Research Chair in Artifical Intelligence (2007-2018), the head of the Department of Computer Science (2008-2017), and Director of the Institute for Big Data and Data Science (2017-2018). In addition to a number of research articles, he has written two books, Computational Intelligence: An Introduction and Fundamentals of Computational Swarm Intelligence.",institutionString:null,institution:{name:"Stellenbosch University",institutionURL:null,country:{name:"South Africa"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:6,paginationItems:[{id:"22",title:"Applied Intelligence",coverUrl:"https://cdn.intechopen.com/series_topics/covers/22.jpg",isOpenForSubmission:!0,editor:{id:"27170",title:"Prof.",name:"Carlos",middleName:"M.",surname:"Travieso-Gonzalez",slug:"carlos-travieso-gonzalez",fullName:"Carlos Travieso-Gonzalez",profilePictureURL:"https://mts.intechopen.com/storage/users/27170/images/system/27170.jpeg",biography:"Carlos M. Travieso-González received his MSc degree in Telecommunication Engineering at Polytechnic University of Catalonia (UPC), Spain in 1997, and his Ph.D. degree in 2002 at the University of Las Palmas de Gran Canaria (ULPGC-Spain). He is a full professor of signal processing and pattern recognition and is head of the Signals and Communications Department at ULPGC, teaching from 2001 on subjects on signal processing and learning theory. His research lines are biometrics, biomedical signals and images, data mining, classification system, signal and image processing, machine learning, and environmental intelligence. He has researched in 52 international and Spanish research projects, some of them as head researcher. He is co-author of 4 books, co-editor of 27 proceedings books, guest editor for 8 JCR-ISI international journals, and up to 24 book chapters. He has over 450 papers published in international journals and conferences (81 of them indexed on JCR – ISI - Web of Science). He has published seven patents in the Spanish Patent and Trademark Office. He has been a supervisor on 8 Ph.D. theses (11 more are under supervision), and 130 master theses. He is the founder of The IEEE IWOBI conference series and the president of its Steering Committee, as well as the founder of both the InnoEducaTIC and APPIS conference series. He is an evaluator of project proposals for the European Union (H2020), Medical Research Council (MRC, UK), Spanish Government (ANECA, Spain), Research National Agency (ANR, France), DAAD (Germany), Argentinian Government, and the Colombian Institutions. He has been a reviewer in different indexed international journals (<70) and conferences (<250) since 2001. He has been a member of the IASTED Technical Committee on Image Processing from 2007 and a member of the IASTED Technical Committee on Artificial Intelligence and Expert Systems from 2011. \n\nHe has held the general chair position for the following: ACM-APPIS (2020, 2021), IEEE-IWOBI (2019, 2020 and 2020), A PPIS (2018, 2019), IEEE-IWOBI (2014, 2015, 2017, 2018), InnoEducaTIC (2014, 2017), IEEE-INES (2013), NoLISP (2011), JRBP (2012), and IEEE-ICCST (2005)\n\nHe is an associate editor of the Computational Intelligence and Neuroscience Journal (Hindawi – Q2 JCR-ISI). He was vice dean from 2004 to 2010 in the Higher Technical School of Telecommunication Engineers at ULPGC and the vice dean of Graduate and Postgraduate Studies from March 2013 to November 2017. He won the “Catedra Telefonica” Awards in Modality of Knowledge Transfer, 2017, 2018, and 2019 editions, and awards in Modality of COVID Research in 2020.\n\nPublic References:\nResearcher ID http://www.researcherid.com/rid/N-5967-2014\nORCID https://orcid.org/0000-0002-4621-2768 \nScopus Author ID https://www.scopus.com/authid/detail.uri?authorId=6602376272\nScholar Google https://scholar.google.es/citations?user=G1ks9nIAAAAJ&hl=en \nResearchGate https://www.researchgate.net/profile/Carlos_Travieso",institutionString:null,institution:{name:"University of Las Palmas de Gran Canaria",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"23",title:"Computational Neuroscience",coverUrl:"https://cdn.intechopen.com/series_topics/covers/23.jpg",isOpenForSubmission:!0,editor:{id:"14004",title:"Dr.",name:"Magnus",middleName:null,surname:"Johnsson",slug:"magnus-johnsson",fullName:"Magnus Johnsson",profilePictureURL:"https://mts.intechopen.com/storage/users/14004/images/system/14004.png",biography:"Dr Magnus Johnsson is a cross-disciplinary scientist, lecturer, scientific editor and AI/machine learning consultant from Sweden. \n\nHe is currently at Malmö University in Sweden, but also held positions at Lund University in Sweden and at Moscow Engineering Physics Institute. \nHe holds editorial positions at several international scientific journals and has served as a scientific editor for books and special journal issues. \nHis research interests are wide and include, but are not limited to, autonomous systems, computer modeling, artificial neural networks, artificial intelligence, cognitive neuroscience, cognitive robotics, cognitive architectures, cognitive aids and the philosophy of mind. \n\nDr. Johnsson has experience from working in the industry and he has a keen interest in the application of neural networks and artificial intelligence to fields like industry, finance, and medicine. \n\nWeb page: www.magnusjohnsson.se",institutionString:null,institution:{name:"Malmö University",institutionURL:null,country:{name:"Sweden"}}},editorTwo:null,editorThree:null},{id:"24",title:"Computer Vision",coverUrl:"https://cdn.intechopen.com/series_topics/covers/24.jpg",isOpenForSubmission:!0,editor:{id:"294154",title:"Prof.",name:"George",middleName:null,surname:"Papakostas",slug:"george-papakostas",fullName:"George Papakostas",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002hYaGbQAK/Profile_Picture_1624519712088",biography:"George A. Papakostas has received a diploma in Electrical and Computer Engineering in 1999 and the M.Sc. and Ph.D. degrees in Electrical and Computer Engineering in 2002 and 2007, respectively, from the Democritus University of Thrace (DUTH), Greece. Dr. Papakostas serves as a Tenured Full Professor at the Department of Computer Science, International Hellenic University, Greece. Dr. Papakostas has 10 years of experience in large-scale systems design as a senior software engineer and technical manager, and 20 years of research experience in the field of Artificial Intelligence. Currently, he is the Head of the “Visual Computing” division of HUman-MAchines INteraction Laboratory (HUMAIN-Lab) and the Director of the MPhil program “Advanced Technologies in Informatics and Computers” hosted by the Department of Computer Science, International Hellenic University. He has (co)authored more than 150 publications in indexed journals, international conferences and book chapters, 1 book (in Greek), 3 edited books, and 5 journal special issues. His publications have more than 2100 citations with h-index 27 (GoogleScholar). His research interests include computer/machine vision, machine learning, pattern recognition, computational intelligence. \nDr. Papakostas served as a reviewer in numerous journals, as a program\ncommittee member in international conferences and he is a member of the IAENG, MIR Labs, EUCogIII, INSTICC and the Technical Chamber of Greece (TEE).",institutionString:null,institution:{name:"International Hellenic University",institutionURL:null,country:{name:"Greece"}}},editorTwo:null,editorThree:null},{id:"25",title:"Evolutionary Computation",coverUrl:"https://cdn.intechopen.com/series_topics/covers/25.jpg",isOpenForSubmission:!0,editor:{id:"136112",title:"Dr.",name:"Sebastian",middleName:null,surname:"Ventura Soto",slug:"sebastian-ventura-soto",fullName:"Sebastian Ventura Soto",profilePictureURL:"https://mts.intechopen.com/storage/users/136112/images/system/136112.png",biography:"Sebastian Ventura is a Spanish researcher, a full professor with the Department of Computer Science and Numerical Analysis, University of Córdoba. Dr Ventura also holds the positions of Affiliated Professor at Virginia Commonwealth University (Richmond, USA) and Distinguished Adjunct Professor at King Abdulaziz University (Jeddah, Saudi Arabia). Additionally, he is deputy director of the Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI) and heads the Knowledge Discovery and Intelligent Systems Research Laboratory. He has published more than ten books and over 300 articles in journals and scientific conferences. Currently, his work has received over 18,000 citations according to Google Scholar, including more than 2200 citations in 2020. In the last five years, he has published more than 60 papers in international journals indexed in the JCR (around 70% of them belonging to first quartile journals) and he has edited some Springer books “Supervised Descriptive Pattern Mining” (2018), “Multiple Instance Learning - Foundations and Algorithms” (2016), and “Pattern Mining with Evolutionary Algorithms” (2016). He has also been involved in more than 20 research projects supported by the Spanish and Andalusian governments and the European Union. He currently belongs to the editorial board of PeerJ Computer Science, Information Fusion and Engineering Applications of Artificial Intelligence journals, being also associate editor of Applied Computational Intelligence and Soft Computing and IEEE Transactions on Cybernetics. Finally, he is editor-in-chief of Progress in Artificial Intelligence. He is a Senior Member of the IEEE Computer, the IEEE Computational Intelligence, and the IEEE Systems, Man, and Cybernetics Societies, and the Association of Computing Machinery (ACM). Finally, his main research interests include data science, computational intelligence, and their applications.",institutionString:null,institution:{name:"University of Córdoba",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"26",title:"Machine Learning and Data Mining",coverUrl:"https://cdn.intechopen.com/series_topics/covers/26.jpg",isOpenForSubmission:!0,editor:{id:"24555",title:"Dr.",name:"Marco Antonio",middleName:null,surname:"Aceves Fernandez",slug:"marco-antonio-aceves-fernandez",fullName:"Marco Antonio Aceves Fernandez",profilePictureURL:"https://mts.intechopen.com/storage/users/24555/images/system/24555.jpg",biography:"Dr. Marco Antonio Aceves Fernandez obtained his B.Sc. (Eng.) in Telematics from the Universidad de Colima, Mexico. He obtained both his M.Sc. and Ph.D. from the University of Liverpool, England, in the field of Intelligent Systems. He is a full professor at the Universidad Autonoma de Queretaro, Mexico, and a member of the National System of Researchers (SNI) since 2009. Dr. Aceves Fernandez has published more than 80 research papers as well as a number of book chapters and congress papers. He has contributed in more than 20 funded research projects, both academic and industrial, in the area of artificial intelligence, ranging from environmental, biomedical, automotive, aviation, consumer, and robotics to other applications. He is also a honorary president at the National Association of Embedded Systems (AMESE), a senior member of the IEEE, and a board member of many institutions. 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Dr. Aydin is currently a Fellow of Higher Education Academy, UK, a member of EPSRC College, a senior member of IEEE and a senior member of ACM. In addition to being a member of advisory committees of many international conferences, he is an Editorial Board Member of various peer-reviewed international journals. He has served as guest editor for a number of special issues of peer-reviewed international journals.",institutionString:null,institution:{name:"University of the West of England",institutionURL:null,country:{name:"United Kingdom"}}},editorTwo:null,editorThree:null}]},overviewPageOFChapters:{paginationCount:20,paginationItems:[{id:"82526",title:"Deep Multiagent Reinforcement Learning Methods Addressing the Scalability Challenge",doi:"10.5772/intechopen.105627",signatures:"Theocharis Kravaris and George A. 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After completing his residency in anaesthesiology at AHEPA University Hospital, he worked as a consultant anaesthesiologist in the District General Hospital of Veria, Greece. Later, he completed his fellowship in intensive care at “G. Papageorgiou” General Hospital, Thessaloniki, Greece. Since 2017 he has been working as a consultant at AHEPA University Hospital. He also teaches medical students at the School of Medicine, Aristotle University of Thessaloniki, and students in the Postgraduate Nursing Specialties Program, University General Hospital AHEPA, and the Committee for the European Education in Anesthesiology (CEEA) teaching programs.",institutionString:"AHEPA University Hospital",institution:{name:"AHEPA University Hospital",country:{name:"Greece"}}},{id:"181267",title:"Dr.",name:"Jie",middleName:null,surname:"Tang",slug:"jie-tang",fullName:"Jie Tang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/181267/images/system/181267.png",biography:"Jie Tang, MD, MPH, is an academic nephrologist and associate professor of Medicine at Albert Medical School, Brown University, USA. His research interest is in glomerular disorders and bone mineral metabolism. Dr. Tang has served on journal editorial boards and published many articles in peer-reviewed journals. He is also a well-regarded clinician-educator, mentoring medical students, residents, and nephrology fellows. He gives lectures every year on national and international stages and has authored book chapters on various topics. He is a fellow of the American Society of Nephrology and an active member of the International Society of Nephrology. Dr. Tang is currently serving on the medical advisory boards for the National Kidney Foundation and End-Stage Renal Disease Network.",institutionString:"Brown University",institution:{name:"Brown University",country:{name:"United States of America"}}},{id:"200252",title:"Dr.",name:"Theodoros",middleName:null,surname:"Aslanidis",slug:"theodoros-aslanidis",fullName:"Theodoros Aslanidis",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/200252/images/system/200252.png",biography:"Dr. Theodoros K. Aslanidis received an MD from Plovdiv Medical University, Bulgaria, and a Ph.D. from Aristotle University of Thessaloniki, Greece. After serving as a medical doctor in the Hellenic Army Force and as a rural physician at Outhealth Centre, Iraklia and Serres’ General Hospital, Greece, he completed anesthesiology specialty training at Hippokratio General Hospital of Thessaloniki. He also completed Critical Care subspecialty training at AHEPA University Hospital, and the Prehospital Emergency Medicine postgraduate program, Hellenic National Centre for Emergency Care. He served as an EMS physician and emergency communication center medic before moving to his current post as consultant-researcher at the Intensive Care Unit, St. Paul General Hospital of Thessaloniki, Greece. He also serves as a senior lecturer in the Research Faculty, College of Offshore and Remote Medicine, Pretty Bay, Malta.",institutionString:"Saint Paul General Hospital of Thessaloniki",institution:null},{id:"313921",title:"Dr.",name:"Hassan M.",middleName:null,surname:"Heshmati",slug:"hassan-m.-heshmati",fullName:"Hassan M. Heshmati",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/313921/images/system/313921.jpg",biography:"Dr. Hassan Massoud Heshmati is an endocrinologist with 46 years of experience in clinical research in academia (university-affiliated hospitals, Paris, France; Mayo Foundation, Rochester, MN, USA) and pharmaceutical companies (Sanofi, Malvern, PA, USA; Essentialis, Carlsbad, CA, USA; Gelesis, Boston, MA, USA). His research activity focuses on pituitary tumors, hyperthyroidism, thyroid cancers, osteoporosis, diabetes, and obesity. He has extensive knowledge in the development of anti-obesity products. Dr. Heshmati is the author of 299 abstracts, chapters, and articles related to endocrinology and metabolism. He is currently a consultant at Endocrinology Metabolism Consulting, LLC, Anthem, AZ, USA.",institutionString:"Endocrinology Metabolism Consulting, LLC",institution:null},{id:"418340",title:"Dr.",name:"Jyotirmoi",middleName:null,surname:"Aich",slug:"jyotirmoi-aich",fullName:"Jyotirmoi Aich",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000038Ugi5QAC/Profile_Picture_2022-04-15T07:48:28.png",biography:"Biotechnologist with 15 years of research including 6 years of teaching experience. Demonstrated record of scientific achievements through consistent publication record (H index = 13, with 874 citations) in high impact journals such as Nature Communications, Oncotarget, Annals of Oncology, PNAS, and AJRCCM, etc. Strong research professional with a post-doctorate from ACTREC where I gained experimental oncology experience in clinical settings and a doctorate from IGIB where I gained expertise in asthma pathophysiology. A well-trained biotechnologist with diverse experience on the bench across different research themes ranging from asthma to cancer and other infectious diseases. An individual with a strong commitment and innovative mindset. Have the ability to work on diverse projects such as regenerative and molecular medicine with an overall mindset of improving healthcare.",institutionString:"DY Patil Deemed to Be University",institution:null},{id:"319365",title:"Assistant Prof.",name:"Manash K.",middleName:null,surname:"Paul",slug:"manash-k.-paul",fullName:"Manash K. Paul",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/319365/images/system/319365.png",biography:"Manash K. Paul is a Principal Investigator and Scientist at the University of California Los Angeles. He has contributed significantly to the fields of stem cell biology, regenerative medicine, and lung cancer. His research focuses on various signaling processes involved in maintaining stem cell homeostasis during the injury-repair process, deciphering lung stem cell niche, pulmonary disease modeling, immuno-oncology, and drug discovery. He is currently investigating the role of extracellular vesicles in premalignant lung cell migration and detecting the metastatic phenotype of lung cancer via machine-learning-based analyses of exosomal signatures. Dr. Paul has published in more than fifty peer-reviewed international journals and is highly cited. He is the recipient of many awards, including the UCLA Vice Chancellor’s award, a senior member of the Institute of Electrical and Electronics Engineers (IEEE), and an editorial board member for several international journals.",institutionString:"University of California Los Angeles",institution:{name:"University of California Los Angeles",country:{name:"United States of America"}}},{id:"349288",title:"Prof.",name:"Soumya",middleName:null,surname:"Basu",slug:"soumya-basu",fullName:"Soumya Basu",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035QxIDQA0/Profile_Picture_2022-04-15T07:47:01.jpg",biography:"Soumya Basu, Ph.D., is currently working as an Associate Professor at Dr. D. Y. Patil Biotechnology and Bioinformatics Institute, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India. With 16+ years of trans-disciplinary research experience in Drug Design, development, and pre-clinical validation; 20+ research article publications in journals of repute, 9+ years of teaching experience, trained with cross-disciplinary education, Dr. Basu is a life-long learner and always thrives for new challenges.\r\nHer research area is the design and synthesis of small molecule partial agonists of PPAR-γ in lung cancer. She is also using artificial intelligence and deep learning methods to understand the exosomal miRNA’s role in cancer metastasis. Dr. Basu is the recipient of many awards including the Early Career Research Award from the Department of Science and Technology, Govt. of India. She is a reviewer of many journals like Molecular Biology Reports, Frontiers in Oncology, RSC Advances, PLOS ONE, Journal of Biomolecular Structure & Dynamics, Journal of Molecular Graphics and Modelling, etc. She has edited and authored/co-authored 21 journal papers, 3 book chapters, and 15 abstracts. She is a Board of Studies member at her university. She is a life member of 'The Cytometry Society”-in India and 'All India Cell Biology Society”- in India.",institutionString:"Dr. D.Y. Patil Vidyapeeth, Pune",institution:{name:"Dr. D.Y. Patil Vidyapeeth, Pune",country:{name:"India"}}},{id:"76477",title:"Prof.",name:"Mirza",middleName:null,surname:"Hasanuzzaman",slug:"mirza-hasanuzzaman",fullName:"Mirza Hasanuzzaman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/76477/images/system/76477.png",biography:"Dr. Mirza Hasanuzzaman is a Professor of Agronomy at Sher-e-Bangla Agricultural University, Bangladesh. He received his Ph.D. in Plant Stress Physiology and Antioxidant Metabolism from Ehime University, Japan, with a scholarship from the Japanese Government (MEXT). Later, he completed his postdoctoral research at the Center of Molecular Biosciences, University of the Ryukyus, Japan, as a recipient of the Japan Society for the Promotion of Science (JSPS) postdoctoral fellowship. He was also the recipient of the Australian Government Endeavour Research Fellowship for postdoctoral research as an adjunct senior researcher at the University of Tasmania, Australia. Dr. Hasanuzzaman’s current work is focused on the physiological and molecular mechanisms of environmental stress tolerance. Dr. Hasanuzzaman has published more than 150 articles in peer-reviewed journals. He has edited ten books and written more than forty book chapters on important aspects of plant physiology, plant stress tolerance, and crop production. According to Scopus, Dr. Hasanuzzaman’s publications have received more than 10,500 citations with an h-index of 53. He has been named a Highly Cited Researcher by Clarivate. He is an editor and reviewer for more than fifty peer-reviewed international journals and was a recipient of the “Publons Peer Review Award” in 2017, 2018, and 2019. He has been honored by different authorities for his outstanding performance in various fields like research and education, and he has received the World Academy of Science Young Scientist Award (2014) and the University Grants Commission (UGC) Award 2018. He is a fellow of the Bangladesh Academy of Sciences (BAS) and the Royal Society of Biology.",institutionString:"Sher-e-Bangla Agricultural University",institution:{name:"Sher-e-Bangla Agricultural University",country:{name:"Bangladesh"}}},{id:"213308",title:"Associate Prof.",name:"Manuel Víctor",middleName:null,surname:"López-González",slug:"manuel-victor-lopez-gonzalez",fullName:"Manuel Víctor López-González",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/213308/images/10301_n.jpg",biography:null,institutionString:null,institution:{name:"University of Malaga",country:{name:"Spain"}}},{id:"169212",title:"Prof.",name:"Pavol",middleName:null,surname:"Svorc",slug:"pavol-svorc",fullName:"Pavol Svorc",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/169212/images/system/169212.jpg",biography:"Dr. Pavol Švorc is an Associate Professor, Doctor of the Natural Sciences, Philosophe Doctor. In 1982 he became a Doctor of the Natural Sciences from General Biology, Natural Faculty, Šafarik’s University in Košice. In 1995 he received a PhD. – Physiology and Patophysiology, Natural Faculty Šafarik’s University in Košice. In 2005 he became an Associate Professor from Normal and Patological Physiology, Medical Faculty, Šafarik’s University in Košice. From 1982 to 1983 Dr.Švorc worked as an independent specialist in the local museum in Poprad, Slovakia. In 1983 he started working as a lecturer at the Department of Physiology, Šafarik’s University in Kosice, Slovakia. From\r\n2011 until 2014 he was a Head of the Institute of Physiology and Pathophysiology, Medical Faculty, University of Ostrava, Czech Republic. His research interest includes:\r\nChronobiology of cardiovascular system, respiratory system and autonomic nervous system.",institutionString:"Pavol Josef Safarik University",institution:{name:"University of Pavol Jozef Šafárik",country:{name:"Slovakia"}}},{id:"187859",title:"Prof.",name:"Kusal",middleName:"K.",surname:"Das",slug:"kusal-das",fullName:"Kusal Das",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSBDeQAO/Profile_Picture_1623411145568",biography:"Kusal K. Das is a Distinguished Chair Professor of Physiology, Shri B. M. Patil Medical College and Director, Centre for Advanced Medical Research (CAMR), BLDE (Deemed to be University), Vijayapur, Karnataka, India. Dr. Das did his M.S. and Ph.D. in Human Physiology from the University of Calcutta, Kolkata. His area of research is focused on understanding of molecular mechanisms of heavy metal activated low oxygen sensing pathways in vascular pathophysiology. He has invented a new method of estimation of serum vitamin E. His expertise in critical experimental protocols on vascular functions in experimental animals was well documented by his quality of publications. He was a Visiting Professor of Medicine at University of Leeds, United Kingdom (2014-2016) and Tulane University, New Orleans, USA (2017). For his immense contribution in medical research Ministry of Science and Technology, Government of India conferred him 'G.P. Chatterjee Memorial Research Prize-2019” and he is also the recipient of 'Dr.Raja Ramanna State Scientist Award 2015” by Government of Karnataka. He is a Fellow of the Royal Society of Biology (FRSB), London and Honorary Fellow of Karnataka Science and Technology Academy, Department of Science and Technology, Government of Karnataka.",institutionString:"BLDE (Deemed to be University), India",institution:null},{id:"243660",title:"Dr.",name:"Mallanagouda Shivanagouda",middleName:null,surname:"Biradar",slug:"mallanagouda-shivanagouda-biradar",fullName:"Mallanagouda Shivanagouda Biradar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/243660/images/system/243660.jpeg",biography:"M. S. Biradar is Vice Chancellor and Professor of Medicine of\nBLDE (Deemed to be University), Vijayapura, Karnataka, India.\nHe obtained his MD with a gold medal in General Medicine and\nhas devoted himself to medical teaching, research, and administrations. He has also immensely contributed to medical research\non vascular medicine, which is reflected by his numerous publications including books and book chapters. Professor Biradar was\nalso Visiting Professor at Tulane University School of Medicine, New Orleans, USA.",institutionString:"BLDE (Deemed to be University)",institution:{name:"BLDE University",country:{name:"India"}}},{id:"289796",title:"Dr.",name:"Swastika",middleName:null,surname:"Das",slug:"swastika-das",fullName:"Swastika Das",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/289796/images/system/289796.jpeg",biography:"Swastika N. Das is Professor of Chemistry at the V. P. Dr. P. G.\nHalakatti College of Engineering and Technology, BLDE (Deemed\nto be University), Vijayapura, Karnataka, India. She obtained an\nMSc, MPhil, and PhD in Chemistry from Sambalpur University,\nOdisha, India. Her areas of research interest are medicinal chemistry, chemical kinetics, and free radical chemistry. She is a member\nof the investigators who invented a new modified method of estimation of serum vitamin E. She has authored numerous publications including book\nchapters and is a mentor of doctoral curriculum at her university.",institutionString:"BLDEA’s V.P.Dr.P.G.Halakatti College of Engineering & Technology",institution:{name:"BLDE University",country:{name:"India"}}},{id:"248459",title:"Dr.",name:"Akikazu",middleName:null,surname:"Takada",slug:"akikazu-takada",fullName:"Akikazu Takada",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/248459/images/system/248459.png",biography:"Akikazu Takada was born in Japan, 1935. After graduation from\nKeio University School of Medicine and finishing his post-graduate studies, he worked at Roswell Park Memorial Institute NY,\nUSA. He then took a professorship at Hamamatsu University\nSchool of Medicine. In thrombosis studies, he found the SK\npotentiator that enhances plasminogen activation by streptokinase. He is very much interested in simultaneous measurements\nof fatty acids, amino acids, and tryptophan degradation products. By using fatty\nacid analyses, he indicated that plasma levels of trans-fatty acids of old men were\nfar higher in the US than Japanese men. . He also showed that eicosapentaenoic acid\n(EPA) and docosahexaenoic acid (DHA) levels are higher, and arachidonic acid\nlevels are lower in Japanese than US people. By using simultaneous LC/MS analyses\nof plasma levels of tryptophan metabolites, he recently found that plasma levels of\nserotonin, kynurenine, or 5-HIAA were higher in patients of mono- and bipolar\ndepression, which are significantly different from observations reported before. In\nview of recent reports that plasma tryptophan metabolites are mainly produced by\nmicrobiota. He is now working on the relationships between microbiota and depression or autism.",institutionString:"Hamamatsu University School of Medicine",institution:{name:"Hamamatsu University School of Medicine",country:{name:"Japan"}}},{id:"137240",title:"Prof.",name:"Mohammed",middleName:null,surname:"Khalid",slug:"mohammed-khalid",fullName:"Mohammed Khalid",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/137240/images/system/137240.png",biography:"Mohammed Khalid received his B.S. in Chemistry in July 2000, and his Ph.D. in Physical Chemistry in 2007 from the University of Khartoum, Sudan. In 2009 he joined the Dr. Ron Clarke research group at the School of Chemistry, Faculty of Science, University of Sydney, Australia as a postdoctoral fellow where he worked on the Interaction of ATP with the phosphoenzyme of the Na+, K+-ATPase, and Dual mechanisms of allosteric acceleration of the Na+, K+-ATPase by ATP. He then worked as Assistant Professor at the Department of Chemistry, University of Khartoum, and in 2014 was promoted to Associate Professor ranking. In 2011 he joined the staff of the Chemistry Department at Taif University, Saudi Arabia, where he is currently active as an Assistant Professor. His research interests include:\r\n(1) P-type ATPase Enzyme Kinetics and Mechanisms; (2) Kinetics and Mechanism of Redox Reactions; (3) Autocatalytic reactions; (4) Computational enzyme kinetics; (5) Allosteric acceleration of P-type ATPases by ATP; (6) Exploring of allosteric sites of ATPases and interaction of ATP with ATPases located in the cell membranes.",institutionString:"Taif University",institution:{name:"Taif University",country:{name:"Saudi Arabia"}}},{id:"63810",title:"Prof.",name:"Jorge",middleName:null,surname:"Morales-Montor",slug:"jorge-morales-montor",fullName:"Jorge Morales-Montor",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/63810/images/system/63810.png",biography:"Dr. Jorge Morales-Montor was recognized with the Lola and Igo Flisser PUIS Award for best graduate thesis at the national level in the field of parasitology. He received a fellowship from the Fogarty Foundation to perform postdoctoral research stay at the University of Georgia. He has 153 journal articles to his credit. He has also edited several books and published more than fifty-five book chapters. He is a member of the Mexican Academy of Sciences, Latin American Academy of Sciences, and the National Academy of Medicine. He has received more than thirty-five awards and has supervised numerous bachelor’s, master’s, and Ph.D. students. Dr. Morales-Montor is the past president of the Mexican Society of Parasitology.",institutionString:"National Autonomous University of Mexico",institution:{name:"National Autonomous University of Mexico",country:{name:"Mexico"}}},{id:"217215",title:"Dr.",name:"Palash",middleName:null,surname:"Mandal",slug:"palash-mandal",fullName:"Palash Mandal",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/217215/images/system/217215.jpeg",biography:null,institutionString:"Charusat University",institution:null},{id:"49739",title:"Dr.",name:"Leszek",middleName:null,surname:"Szablewski",slug:"leszek-szablewski",fullName:"Leszek Szablewski",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/49739/images/system/49739.jpg",biography:"Leszek Szablewski is a professor of medical sciences. He received his M.S. in the Faculty of Biology from the University of Warsaw and his PhD degree from the Institute of Experimental Biology Polish Academy of Sciences. He habilitated in the Medical University of Warsaw, and he obtained his degree of Professor from the President of Poland. Professor Szablewski is the Head of Chair and Department of General Biology and Parasitology, Medical University of Warsaw. Professor Szablewski has published over 80 peer-reviewed papers in journals such as Journal of Alzheimer’s Disease, Biochim. Biophys. Acta Reviews of Cancer, Biol. Chem., J. Biomed. Sci., and Diabetes/Metabol. Res. Rev, Endocrine. He is the author of two books and four book chapters. He has edited four books, written 15 scripts for students, is the ad hoc reviewer of over 30 peer-reviewed journals, and editorial member of peer-reviewed journals. Prof. Szablewski’s research focuses on cell physiology, genetics, and pathophysiology. He works on the damage caused by lack of glucose homeostasis and changes in the expression and/or function of glucose transporters due to various diseases. He has given lectures, seminars, and exercises for students at the Medical University.",institutionString:"Medical University of Warsaw",institution:{name:"Medical University of Warsaw",country:{name:"Poland"}}},{id:"173123",title:"Dr.",name:"Maitham",middleName:null,surname:"Khajah",slug:"maitham-khajah",fullName:"Maitham Khajah",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/173123/images/system/173123.jpeg",biography:"Dr. Maitham A. Khajah received his degree in Pharmacy from Faculty of Pharmacy, Kuwait University, in 2003 and obtained his PhD degree in December 2009 from the University of Calgary, Canada (Gastrointestinal Science and Immunology). Since January 2010 he has been assistant professor in Kuwait University, Faculty of Pharmacy, Department of Pharmacology and Therapeutics. His research interest are molecular targets for the treatment of inflammatory bowel disease (IBD) and the mechanisms responsible for immune cell chemotaxis. He cosupervised many students for the MSc Molecular Biology Program, College of Graduate Studies, Kuwait University. Ever since joining Kuwait University in 2010, he got various grants as PI and Co-I. He was awarded the Best Young Researcher Award by Kuwait University, Research Sector, for the Year 2013–2014. He was a member in the organizing committee for three conferences organized by Kuwait University, Faculty of Pharmacy, as cochair and a member in the scientific committee (the 3rd, 4th, and 5th Kuwait International Pharmacy Conference).",institutionString:"Kuwait University",institution:{name:"Kuwait University",country:{name:"Kuwait"}}},{id:"195136",title:"Dr.",name:"Aya",middleName:null,surname:"Adel",slug:"aya-adel",fullName:"Aya Adel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/195136/images/system/195136.jpg",biography:"Dr. Adel works as an Assistant Lecturer in the unit of Phoniatrics, Department of Otolaryngology, Ain Shams University in Cairo, Egypt. Dr. Adel is especially interested in joint attention and its impairment in autism spectrum disorder",institutionString:"Ain Shams University",institution:{name:"Ain Shams University",country:{name:"Egypt"}}},{id:"94911",title:"Dr.",name:"Boulenouar",middleName:null,surname:"Mesraoua",slug:"boulenouar-mesraoua",fullName:"Boulenouar Mesraoua",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94911/images/system/94911.png",biography:"Dr Boulenouar Mesraoua is the Associate Professor of Clinical Neurology at Weill Cornell Medical College-Qatar and a Consultant Neurologist at Hamad Medical Corporation at the Neuroscience Department; He graduated as a Medical Doctor from the University of Oran, Algeria; he then moved to Belgium, the City of Liege, for a Residency in Internal Medicine and Neurology at Liege University; after getting the Belgian Board of Neurology (with high marks), he went to the National Hospital for Nervous Diseases, Queen Square, London, United Kingdom for a fellowship in Clinical Neurophysiology, under Pr Willison ; Dr Mesraoua had also further training in Epilepsy and Continuous EEG Monitoring for two years (from 2001-2003) in the Neurophysiology department of Zurich University, Switzerland, under late Pr Hans Gregor Wieser ,an internationally known epileptologist expert. \n\nDr B. Mesraoua is the Director of the Neurology Fellowship Program at the Neurology Section and an active member of the newly created Comprehensive Epilepsy Program at Hamad General Hospital, Doha, Qatar; he is also Assistant Director of the Residency Program at the Qatar Medical School. \nDr B. Mesraoua's main interests are Epilepsy, Multiple Sclerosis, and Clinical Neurology; He is the Chairman and the Organizer of the well known Qatar Epilepsy Symposium, he is running yearly for the past 14 years and which is considered a landmark in the Gulf region; He has also started last year , together with other epileptologists from Qatar, the region and elsewhere, a yearly International Epilepsy School Course, which was attended by many neurologists from the Area.\n\nInternationally, Dr Mesraoua is an active and elected member of the Commission on Eastern Mediterranean Region (EMR ) , a regional branch of the International League Against Epilepsy (ILAE), where he represents the Middle East and North Africa(MENA ) and where he holds the position of chief of the Epilepsy Epidemiology Section; Dr Mesraoua is a member of the American Academy of Neurology, the Europeen Academy of Neurology and the American Epilepsy Society.\n\nDr Mesraoua's main objectives are to encourage frequent gathering of the epileptologists/neurologists from the MENA region and the rest of the world, promote Epilepsy Teaching in the MENA Region, and encourage multicenter studies involving neurologists and epileptologists in the MENA region, particularly epilepsy epidemiological studies. \n\nDr. Mesraoua is the recipient of two research Grants, as the Lead Principal Investigator (750.000 USD and 250.000 USD) from the Qatar National Research Fund (QNRF) and the Hamad Hospital Internal Research Grant (IRGC), on the following topics : “Continuous EEG Monitoring in the ICU “ and on “Alpha-lactoalbumin , proof of concept in the treatment of epilepsy” .Dr Mesraoua is a reviewer for the journal \"seizures\" (Europeen Epilepsy Journal ) as well as dove journals ; Dr Mesraoua is the author and co-author of many peer reviewed publications and four book chapters in the field of Epilepsy and Clinical Neurology",institutionString:"Weill Cornell Medical College in Qatar",institution:{name:"Weill Cornell Medical College in Qatar",country:{name:"Qatar"}}},{id:"282429",title:"Prof.",name:"Covanis",middleName:null,surname:"Athanasios",slug:"covanis-athanasios",fullName:"Covanis Athanasios",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/282429/images/system/282429.jpg",biography:null,institutionString:"Neurology-Neurophysiology Department of the Children Hospital Agia Sophia",institution:null},{id:"190980",title:"Prof.",name:"Marwa",middleName:null,surname:"Mahmoud Saleh",slug:"marwa-mahmoud-saleh",fullName:"Marwa Mahmoud Saleh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/190980/images/system/190980.jpg",biography:"Professor Marwa Mahmoud Saleh is a doctor of medicine and currently works in the unit of Phoniatrics, Department of Otolaryngology, Ain Shams University in Cairo, Egypt. She got her doctoral degree in 1991 and her doctoral thesis was accomplished in the University of Iowa, United States. Her publications covered a multitude of topics as videokymography, cochlear implants, stuttering, and dysphagia. She has lectured Egyptian phonology for many years. Her recent research interest is joint attention in autism.",institutionString:"Ain Shams University",institution:{name:"Ain Shams University",country:{name:"Egypt"}}},{id:"259190",title:"Dr.",name:"Syed Ali Raza",middleName:null,surname:"Naqvi",slug:"syed-ali-raza-naqvi",fullName:"Syed Ali Raza Naqvi",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259190/images/system/259190.png",biography:"Dr. Naqvi is a radioanalytical chemist and is working as an associate professor of analytical chemistry in the Department of Chemistry, Government College University, Faisalabad, Pakistan. Advance separation techniques, nuclear analytical techniques and radiopharmaceutical analysis are the main courses that he is teaching to graduate and post-graduate students. In the research area, he is focusing on the development of organic- and biomolecule-based radiopharmaceuticals for diagnosis and therapy of infectious and cancerous diseases. Under the supervision of Dr. Naqvi, three students have completed their Ph.D. degrees and 41 students have completed their MS degrees. He has completed three research projects and is currently working on 2 projects entitled “Radiolabeling of fluoroquinolone derivatives for the diagnosis of deep-seated bacterial infections” and “Radiolabeled minigastrin peptides for diagnosis and therapy of NETs”. He has published about 100 research articles in international reputed journals and 7 book chapters. Pakistan Institute of Nuclear Science & Technology (PINSTECH) Islamabad, Punjab Institute of Nuclear Medicine (PINM), Faisalabad and Institute of Nuclear Medicine and Radiology (INOR) Abbottabad are the main collaborating institutes.",institutionString:"Government College University",institution:{name:"Government College University, Faisalabad",country:{name:"Pakistan"}}},{id:"58390",title:"Dr.",name:"Gyula",middleName:null,surname:"Mozsik",slug:"gyula-mozsik",fullName:"Gyula Mozsik",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/58390/images/system/58390.png",biography:"Gyula Mózsik MD, Ph.D., ScD (med), is an emeritus professor of Medicine at the First Department of Medicine, Univesity of Pécs, Hungary. He was head of this department from 1993 to 2003. His specializations are medicine, gastroenterology, clinical pharmacology, clinical nutrition, and dietetics. His research fields are biochemical pharmacological examinations in the human gastrointestinal (GI) mucosa, mechanisms of retinoids, drugs, capsaicin-sensitive afferent nerves, and innovative pharmacological, pharmaceutical, and nutritional (dietary) research in humans. He has published about 360 peer-reviewed papers, 197 book chapters, 692 abstracts, 19 monographs, and has edited 37 books. He has given about 1120 regular and review lectures. He has organized thirty-eight national and international congresses and symposia. He is the founder of the International Conference on Ulcer Research (ICUR); International Union of Pharmacology, Gastrointestinal Section (IUPHAR-GI); Brain-Gut Society symposiums, and gastrointestinal cytoprotective symposiums. He received the Andre Robert Award from IUPHAR-GI in 2014. Fifteen of his students have been appointed as full professors in Egypt, Cuba, and Hungary.",institutionString:"University of Pécs",institution:{name:"University of Pecs",country:{name:"Hungary"}}},{id:"277367",title:"M.Sc.",name:"Daniel",middleName:"Martin",surname:"Márquez López",slug:"daniel-marquez-lopez",fullName:"Daniel Márquez López",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/277367/images/7909_n.jpg",biography:"Msc Daniel Martin Márquez López has a bachelor degree in Industrial Chemical Engineering, a Master of science degree in the same área and he is a PhD candidate for the Instituto Politécnico Nacional. His Works are realted to the Green chemistry field, biolubricants, biodiesel, transesterification reactions for biodiesel production and the manipulation of oils for therapeutic purposes.",institutionString:null,institution:{name:"Instituto Politécnico Nacional",country:{name:"Mexico"}}},{id:"196544",title:"Prof.",name:"Angel",middleName:null,surname:"Catala",slug:"angel-catala",fullName:"Angel Catala",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/196544/images/system/196544.jpg",biography:"Angel Catalá studied chemistry at Universidad Nacional de La Plata, Argentina, where he received a Ph.D. in Chemistry (Biological Branch) in 1965. From 1964 to 1974, he worked as an Assistant in Biochemistry at the School of Medicine at the same university. From 1974 to 1976, he was a fellow of the National Institutes of Health (NIH) at the University of Connecticut, Health Center, USA. From 1985 to 2004, he served as a Full Professor of Biochemistry at the Universidad Nacional de La Plata. He is a member of the National Research Council (CONICET), Argentina, and the Argentine Society for Biochemistry and Molecular Biology (SAIB). His laboratory has been interested for many years in the lipid peroxidation of biological membranes from various tissues and different species. Dr. Catalá has directed twelve doctoral theses, published more than 100 papers in peer-reviewed journals, several chapters in books, and edited twelve books. He received awards at the 40th International Conference Biochemistry of Lipids 1999 in Dijon, France. He is the winner of the Bimbo Pan-American Nutrition, Food Science and Technology Award 2006 and 2012, South America, Human Nutrition, Professional Category. In 2006, he won the Bernardo Houssay award in pharmacology, in recognition of his meritorious works of research. Dr. Catalá belongs to the editorial board of several journals including Journal of Lipids; International Review of Biophysical Chemistry; Frontiers in Membrane Physiology and Biophysics; World Journal of Experimental Medicine and Biochemistry Research International; World Journal of Biological Chemistry, Diabetes, and the Pancreas; International Journal of Chronic Diseases & Therapy; and International Journal of Nutrition. He is the co-editor of The Open Biology Journal and associate editor for Oxidative Medicine and Cellular Longevity.",institutionString:"Universidad Nacional de La Plata",institution:{name:"National University of La Plata",country:{name:"Argentina"}}},{id:"186585",title:"Dr.",name:"Francisco Javier",middleName:null,surname:"Martin-Romero",slug:"francisco-javier-martin-romero",fullName:"Francisco Javier Martin-Romero",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSB3HQAW/Profile_Picture_1631258137641",biography:"Francisco Javier Martín-Romero (Javier) is a Professor of Biochemistry and Molecular Biology at the University of Extremadura, Spain. He is also a group leader at the Biomarkers Institute of Molecular Pathology. Javier received his Ph.D. in 1998 in Biochemistry and Biophysics. At the National Cancer Institute (National Institute of Health, Bethesda, MD) he worked as a research associate on the molecular biology of selenium and its role in health and disease. After postdoctoral collaborations with Carlos Gutierrez-Merino (University of Extremadura, Spain) and Dario Alessi (University of Dundee, UK), he established his own laboratory in 2008. The interest of Javier's lab is the study of cell signaling with a special focus on Ca2+ signaling, and how Ca2+ transport modulates the cytoskeleton, migration, differentiation, cell death, etc. He is especially interested in the study of Ca2+ channels, and the role of STIM1 in the initiation of pathological events.",institutionString:null,institution:{name:"University of Extremadura",country:{name:"Spain"}}},{id:"198499",title:"Dr.",name:"Daniel",middleName:null,surname:"Glossman-Mitnik",slug:"daniel-glossman-mitnik",fullName:"Daniel Glossman-Mitnik",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/198499/images/system/198499.jpeg",biography:"Dr. Daniel Glossman-Mitnik is currently a Titular Researcher at the Centro de Investigación en Materiales Avanzados (CIMAV), Chihuahua, Mexico, as well as a National Researcher of Level III at the Consejo Nacional de Ciencia y Tecnología, México. His research interest focuses on computational chemistry and molecular modeling of diverse systems of pharmacological, food, and alternative energy interests by resorting to DFT and Conceptual DFT. He has authored a coauthored more than 270 peer-reviewed papers, 32 book chapters, and 4 edited books. He has delivered speeches at many international and domestic conferences. He serves as a reviewer for more than eighty international journals, books, and research proposals as well as an editor for special issues of renowned scientific journals.",institutionString:null,institution:null},{id:"318757",title:"Associate Prof.",name:"Irina Alexandrovna",middleName:null,surname:"Savvina",slug:"irina-alexandrovna-savvina",fullName:"Irina Alexandrovna Savvina",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/318757/images/18742_n.jpg",biography:null,institutionString:null,institution:null}]}},subseries:{item:{id:"28",type:"subseries",title:"Animal Reproductive Biology and Technology",keywords:"Animal Reproduction, Artificial Insemination, Embryos, Cryopreservation, Conservation, Breeding, Epigenetics",scope:"The advances of knowledge on animal reproductive biology and technologies revolutionized livestock production. Artificial insemination, for example, was the first technology applied on a large scale, initially in dairy cattle and afterward applied to other species. Nowadays, embryo production and transfer are used commercially along with other technologies to modulate epigenetic regulation. Gene editing is also emerging as an innovative tool. This topic will discuss the potential use of these techniques, novel strategies, and lines of research in progress in the fields mentioned above.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/28.jpg",hasOnlineFirst:!1,hasPublishedBooks:!0,annualVolume:11417,editor:{id:"177225",title:"Prof.",name:"Rosa Maria Lino Neto",middleName:null,surname:"Pereira",slug:"rosa-maria-lino-neto-pereira",fullName:"Rosa Maria Lino Neto Pereira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bS9wkQAC/Profile_Picture_1624519982291",biography:"Rosa Maria Lino Neto Pereira (DVM, MsC, PhD and) is currently a researcher at the Genetic Resources and Biotechnology Unit of the National Institute of Agrarian and Veterinarian Research (INIAV, Portugal). She is the head of the Reproduction and Embryology Laboratories and was lecturer of Reproduction and Reproductive Biotechnologies at Veterinary Medicine Faculty. She has over 25 years of experience working in reproductive biology and biotechnology areas with a special emphasis on embryo and gamete cryopreservation, for research and animal genetic resources conservation, leading research projects with several peer-reviewed papers. Rosa Pereira is member of the ERFP-FAO Ex situ Working Group and of the Management Commission of the Portuguese Animal Germplasm Bank.",institutionString:"The National Institute for Agricultural and Veterinary Research. 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