\r\n\tThis book aims to explore the issues around the rheology of polymers, with an emphasis on biopolymers as well as the modification of polymers using reactive extrusion.
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1. Introduction
In Slovakia, since 1930 occurrence and mortality rates for cancer are increasing. According to the National oncological register of SR, occurrence has an increasing trend since 1968–1970, when about 12,000 new cases were annually registered in 2003, the number reached 22,000 and according to other data, last year it was 24,000 cases more, one‐tenth thereof made up by adolescents [1].
There are specific issues of occurrence, progression and treatment of oncologic disease in adolescents and also issues regarding their re‐integration in common adolescent life. Just in this age group, an important role is played by social problems and related issues of social care [2]. Also this period of life is characterized by emotional instability, frequent and striking changes of moods, impulsiveness in acting and instability which make the situation worse. Moreover, it involves increased fatigue, alteration of being apathetic and short phases of increased activity [3]. This study is mainly about the theoretical insight into the problems of oncological diseases in adolescence with some results of research in this field of study.
2. Theoretical background
The issue of the purpose in life is granted more and more importance in the last decades. The cause being that a human finds himself all alone in post‐modern times. Not knowing animal instincts that could direct him what he must do and also give up traditions that would determine his obligations [4].
Křivohlavý [5] claims that in creating the purpose in life, it is a process when people evaluate and revaluate the importance of one or several life events. They try to find the sense of it. If people get to stressing situations bringing about great suffering, there is an increased need to find the sense in something that is going on.
Halama [6] states that the purpose in life is not a simple phenomenon. It depends on several aspects, above all ideals and objectives. Those ideals and objectives, experiencing the feeling of having the reason to live, teach mutual interactions. The purpose in life is perceived as a personal system of objectives, ideals and values that enables a person to experience, to realize and to control his life as valuable, purposeful and satisfying.
Seriously ill patients can have some doubts about the purpose in life or they do not lose the hope that such reason exists at all. Just logo therapy provides help in looking for the purpose, it assists the patient to find the reason to live, helps the patient and awakens the desire for satisfaction. It determines that the person is essentially full of will to live.
At present, the issue of such purpose has transferred from searching for “the true values” to the analysis of the role, experience and conditions, under which the purpose in life can develop. Halama [6] presents studies which deal with the relation between the purpose in life and mental wellbeing of a person, the impact of purpose in life to cope with stress and the relation between senselessness and addictions. Debats [5] talks about three theoretical approaches to purposefulness of life. The principal representatives advocating the approach to purposefulness of life are considered Frank, Maslow and Yalom. Everyone of them viewed the issue from a different prospective.
The outlook of the American psychologist Maslow [7] regarding the purpose in life is affected by his definition of superior and inferior needs. He considers the purpose as an inner property which is demonstrated as a power of motivation, when the inferior needs are satisfied. The purpose can be experienced by a self‐actualized person who uses creativity to develop his own potential. However, the actual representative of psychotherapy Yalom [8] claims that finally life has no purpose at all. He says that the person must create such purpose and actively be involved in it to cope with such senselessness.
Křivohlavý [5] pursues an opinion that a verbal phrase “purpose in life” belongs to the human subjective—personal and initial experiences. The feeling of a purpose in life depicts a deep motivation, which is significant for any human activity, that is, it is a superior need, which involves the rest of all needs.
Waren [9] adds that to know the purpose of our life is very important because we came in this world with a certain intention. If we have purpose and objective in our life, the life will have a certain direction, because it will help us to concentrate our efforts and energy to important issues. He also says that the purpose will provide motivation for our life, because nothing can give a person more enthusiasm than his own objective. The final declaration is that the purpose in life will prepare us for eternity. The purpose in life of different people is so different, that many specialists tried to classify it and give it some measurable form [2].
A significant person who dealt with the purpose in life was Frankl [7] who states that “To be a human means to be devoted to something, to be concentrated and set for something or someone, by which he asserts himself, develops, is himself and reaches some purpose which should be achieved.”
Drapela [10] presents Frank’s opinion that searching for purpose in life is the principal responsibility of a human, because any situation in life makes sense, however, it just cannot be introduced in the situation. He also describes that an individual can find such purpose in three ways: (a) By performing an act, where every activity involves a hidden purpose; (b) by experiencing a value, it means experiencing any real human experience that enriches an individual. According to Frank it is love, which is (c) fulfillment of a human purpose by the form of suffering.
Bačová [11] describes, that Frankl considers searching for purpose in life to be the principal motivation and driving force of a human life. One of the alternatives of existential psychology is logo therapy and existential analysis. Frankl survived a concentration camp and his theory is also based on that, which stands on the term Wille zum Sinn, which can be translated as “the will for a purpose”. Frankl depicts it as an inborn desire sleeping in a human [7].
Bačová [11] defines such desire as the deepest desire of a human, where it is necessary to respond to day‐to‐day challenges and questions in life. Frankl [7] adds that if such desire for the purpose is not fulfilled, existential frustration develops that leads to doubts in a human about the purpose of his existence and depression and neurosis of all kinds develop.
Another significant author who faced the issue of the purpose in life and was the founder of individual psychology was Adler. He worked as a general practitioner and later he orientated at psychiatry. An important aspect of his theory of the purpose in life is the origin and the roots of the purpose which he can see in early childhood. A child creates verbal and notional conclusions from the point of his feelings and strong experiences. According to it the child creates general form of his behavior, such as roles in life, purposes in life and general life style, and then the model of an adult personality develops. The human psychic is created by setting a certain goal or an ideal at the age of 15, overcoming the actual state and shortcomings. According to that goal an individual imagines successful future. Without the particular goals the activities of an individual would not find purpose [12, 13].
Analytic psychologist Jung in his concept of the purpose in life includes a personal view of the world. In his opinion a human by being born wakes up in the world, which he does not understand, tries to explain it and discovers it to understand the purpose in life. Explaining the purpose in life is dangerous, because such efforts spring out of the deepest mental misery, as the need to discover the unity of life and purpose. Life itself asks a human the question of his existence which is just being hard to understand. Just that is according to Jung the elementary super‐personal life role of every human being [6, 7].
The author who is ranked to the stream of the social psycho‐analysis or to the existentialism‐orientated authors is Fromm. In relation to the purpose in life those characteristics are important for a human, which separate him from animals, for example, self‐confidence, imagination or brain. A human creates an imagination of the world which is internally compact and structured. This imagination has orientation framework and it is ranked among the basic existential needs. An individual sets a goal which he should be set for and go for it. The term “subject of worship” is used by Fromm as a certain elementary value, at which a human can concentrate his vital energy. That value is elementary for other values in life and lifts a human above his existence, doubts and uncertainties and gives purpose to his life [6].
Nákonečný [14] defines the opinion on regarding purpose in life, where growing individualization of a human means growth of his loneliness, and consequently growth of his own purpose in life. Plháková [15] adds that according to Fromm, a human can become an active creator in life, for example, a woman delivers a child and a man production or culture. Humans can also create true love by living for each other. Love is divided as fraternal, maternal and erotic. This is characterized by Fromm as the basis of human existence.
One of the most influential humanist psychologists is Maslow, who is known by his concept of personal growth and hierarchic concept of the needs. Such hierarchy of needs was set according to necessity and order, how human needs demonstrate. Elementary needs are physical needs, after their satisfaction there comes the need of safety, followed by the need to belonging somewhere and to be loved. Another level involves the need for self‐esteem, knowledge, followed by the need for beauty, harmony and self‐assertion. Superior needs are satisfied after satisfying the inferior need [15, 16]. Maslow [7] considered purpose in life “an internal property of a human which emerges like a vigorous motivational power, when inferior needs are satisfied.”
Křivohlavý [5] adds that everyone can choose his purpose in life either according to his own motivation, free will or natural character. However, if it is not fulfilled, a human falls into depression and disease.
According to Yalom [8] life has no final purpose or a goal. He points out four existential dynamics, that is, death, liberty, isolation and senselessness, which he deals with in the issue of purpose in life. Purpose in life is just creative response of a human to the total senselessness of the world. If a human wants to cope with this senselessness, he must with all of his heart dedicate to resolve and experience the purpose in life and actively engage in it. Yalom also pursues two opinions, how a human should find his own purpose in life. The first way is being searching for cosmic purpose, where a human responds to the questions such as “Has life a purpose in general, if yes, is my life involved in it?” This way of searching for a purpose in life mostly occurs in religious or spiritual ideologies. Another way is searching for a secular purpose, which is more defined by searching for goals and values. We know altruism (life in favor of the others, to be useful for the others), devotion (obligation to the others), creativity (creating something new), hedonism (effort for joy, comfort and happiness) and self‐actualization (considering own options). According to Yalom, these values are not about contents, but intensity of engagement, which is a human tool to fulfill his purpose in life.
3. Adolescent age in the context of specifics of an oncological disease
Adolescent age is a temporary phase between childhood and adulthood. It involves one decade of life from 10 to 20 years. This period involves a complete personality transfer in all aspects: somatic, mental and social. Many changes are primarily biologically conditioned, however, always significantly affected by mental and social factors which involve their interaction. Initial sexual maturation involves physical changes (as a result of a complicated process of alternating stimulation and suppression of internal secretion glands, whose hormonal activity starts physical changes and controls them), their being new and intensive impacts mental experience.
Adolescent age is definitely a psycho‐social phenomenon. The principal problem of an adolescent is his “social uncertainty”. He does not feel as a child, however, yet not as an adult. An adolescent asks himself questions: Who am I? (real self‐reflection), What do I want myself to be? (ideal self‐reflection) and How other people see me? (assumed reflection by the others). The answers in this age is lability of feelings of self‐value, an adolescent oscillates between extremely euphoric expectations and depressive under‐estimation. This uncertainty produces conflicts incurring in puberty and adolescent age mostly between children and their parents. Adolescents separate themselves from their parents or other former authorities and get involved in a group of people of the same age, where they are perceived as “adults”. A culture of youngsters develops, which is often presented as a culture of rebellion against ruling culture of adults.
However, adolescent age brings also positive development. There is self‐reflection (an adolescent is capable to cope with his environment and take critical standpoints to it, he discovers himself as an independently thinking and acting individual, etc.) and to the social separation of adolescents, that is, separation from the family; however, even though an adolescent is emancipated from the family, still some bonds to the family last [17]. Adolescent is also a period when changes in life events occur in a different sight, which has in many aspects existential character, resulting from the character of adolescent problems. Discovering own limits as a normal part in life involves also thinking of death. Research in this area is important, directly related to the issue of oncological disease. Rationality of modern and post‐modern human pushes out the ultimate reality of death from mind and it reflects it less. Death is tabooed at present and is extinct as death reflected, and its individual and personal concern is hidden behind anonymous dying in hospitals. Also adolescents realize death and many think about it. Coming across their own mortality is a strong experience. Adolescents thinking about death are more mature than adolescents, for whom this issue was absent or it was supressed [18].
For a child, an oncological disease presents a major change in his previous way of life. After discovering diagnosis he undergoes many examinations, sometimes painful ones, therapy and hospitalization. He must get used to impersonal hospital environment, exposed to unknown situations, adapt to the new regimen, be people and engage in new daily activities, all of that in isolation from the family and friends [19].
It applies also to an adolescent that disease does not affect only individual organs and their functions, but the overall human personality as well. On the top of physical stress, for an adolescent such disease presents a changed life situation which he must cope with. Certainly, an adolescent realizes his disease and his close social environment shares this experience; he reflects to the changed social situation and tries to cope with it. Uncertainty of the parents and other close people, their moods, standpoints, unusual conduct and sudden behaviors changes, all of that can affect the patient severely [20].
Adolescent age is a period of human development, his preparation for adulthood. It depends on the closes surroundings. An adolescent is trying to achieve his own place in the society, that is, the social status and his role in it. However, he needs for that satisfaction of his necessities and requirements in the real extent, time and space and his rights to be respected. From this aspect, we perceive adolescent age as a social phenomenon. And it is true that of all the cases of occurrence of cancer in European population adolescent and infant patient make up only about 1%. It seems that it is unnecessary to deal with this issue if this disease is relatively rare in infants and adolescents. However, cancer is the second most frequents cause of death in infant age. In the period of the last 30 years, we can observe permanent mild increase of its incidence. At present annually 14 of 100,000 children in the age under 15 years fall ill. Annual incidence of cancer in the Slovak republic is 13.0–13.6 per 100, 000 children under 15 years of age. That means that annually in this age group, 170–180 new cases of cancer occur. Other 70–80 involve the group of 15–18 years of age. Under conditions of SR, cancer is on the second place of death causes of children (after accidents) which corresponds to the world statistics. Oncological diseases in children present a serious medical, ethic and social problems [21]. Although the percentage of children and adolescents which get cancer, does not seem so alarming at the first sight in comparison with the percentage of adult population, it is necessary to pay attention to it. Above all because a human society perceives a child as a human youngster which must be long time cared for, it needs a lot of love and understanding and protection and its development must be directed the way to make it able to get involved in the society and which ensures its further growth.
Cancer in children is serious but curable and at present the percentage of curable cases is high. In 1960s, 97% of children with cancer died. Ever since there is growth of cured children rare. At present 75% of infant patients are cured at specialized department [22].
In treatment of cancer patients an unfavorable role has been played for centuries by lasting and still live “myth of cancer”. These are false imaginations of disease accompanied by great suffering and inevitable death. Moreover, a part of this negativist attitude is supported by the natural and deeply rooted imagination that children and adolescents should not be fatally endangered; they should not be dying, but living. Such imagination is suddenly ruined, because the disease often comes like a flash of lightning, without previous warning; it affects a kid that had always been healthy before. To “wipe it out” is as much important as to recognize it early and to cure it. Only this way it will be possible to prove objectively and definitely that cancer in children and adolescent is a serious disease, but it makes no difference from other, also serious diseases, which are not surrounded by such a myth. There is a lot of work left still for the specialists in this area [23].
Life quality of children is significantly different from that one of the adults, because disease itself as well as the treatment damages normal psycho‐motoric development of the child. An important role is played by his growth and development, immunologic and hormonal immaturity. The disease reduces his life quality by intellectual, emotional and physical impairment. Physical and functional deficiency leads to emotional unbalance of the child, to the feeling of depending on others, to the feelings of inferiority. As he cannot come with the environment, this often involves problems to be a part of desired children’s life. All of that can lead to the feeling of fear, loneliness and isolation. Anger with all the surroundings appears with the feeling of crying. Every child must be approached individually [24].
Successful treatment of an adolescent with cancer (with long‐term life prospective in future) assumes management of the three areas, which are mutually conditioned (a) biological treatment (a cured child will die as an adult in unlimited time period and for other reason), which is a condition for (b) mental treatment (personal coping with cancer, its treatment and eventual complications and consequences, also unlimited capability to cope with different life situations). This conditions (c) social treatment (equal involvement in society).
Cancer brings an extraordinary interference in the life of a child and an adolescent, their families and all the surroundings. Disease affects not only the patient himself, but all the members of his family. Every family has its own way of common functioning, which is seriously affected by a serious and long‐term disease and it is necessary to create a new, temporary model. To keep the family functioning in this period, it is important not only to divide obligations and roles flexibly but to include the common rituals and activities (meals, play, tales before sleep) which should involve the patient as well. The patient must have a space in the family to be involved in the family in spite of his limitations caused by disease. The patient himself should control how much family activities he can stand and when he needs some rest. It is a painful feeling to be a burden.
It is important for his family to understand and know the natural needs of an adolescent considering his age and find a way to satisfy him maximally in spite of the limitations. Communication quality with an adolescent diagnosed with cancer (besides others also the one concerning providing or concealing information regarding his disease) can significantly affect experiencing of such a period by the young person. A young person can feel that something serious is going on with him anyway. He can observe it also from conduct of his environment, atmosphere in the family and non‐verbal speech of others. If such conduct is in accordance with the verbal information the patient receives, this will make him feel confused and scared.
Sometimes disease cannot be stopped. If an adolescent’s life cannot be saved, we do not decide on death which is coming. However, we can decide on life which is left. In spite of the painful fact that we cannot save the young person, we can do a lot for him to avoid insupportable suffering, to be able to feel joy and life to the fullest. In such case, we concentrate on treatment of the problems caused by the disease with the objective to improve life quality as much as possible. We do not treat the cause of disease, because it is not possible. We treat the problems caused by the disease to avoid his suffering. We cannot change duration of life but its quality. Adolescents, who feel their life is coming to an end, always feel that they walk to the unknown and their way cannot be changed. Uncertainty, fear from departure, loneliness, suffering of the close people cause sadness. They often detach themselves, do not wish to go out and to meet friends and lie or sit alone in the room for hours. Sometimes they reject food and pills. To accept for a human that his life is coming to an end, he must be sometime left alone to cope with the anxiety and internal pain. We should respect his wish, but should stay close to be ready to help when he needed.
To consider it, we must try to sup up the adolescent period in the context of cancer, having regard to the fact that there are significant individual differences between adolescents.
Under standard conditions an adolescent is gradually involved in the society of adults as an equal partner. He has an intensive feeling of adulthood and wants this adulthood to be recognized also by the others. However, adult people often are unable or do not want to respect the efforts of an adolescent to be independent. They often impose their superiority, care and wisdom against him. An adolescent longs for independence and freedom. To become a mature, independent and responsible person, he needs to be free from dependence of the family and parents’ authority. Life in the family therefore becomes stressful and uninteresting. He looks for an appropriate position in his life, thinks about future, forms his life goals and thinks about purpose in life. In the moment when a serious oncological disease appears in his life, this process of achieving independence is interrupted. Building his own independence is reverted by the disease to the position of maximal dependence. Attitude to adolescent must be very sensitive, because that period typically involves tendencies to isolation, negativism, feeling inferior and pessimism, supported by severe disease and aggressive treatment, which is long term, cyclic, unpleasant and sometimes even painful. An adolescent becomes dependent of his environment, above all of the parents and relatives. New authorities anger his life in the form of physicians, nurses and specialists. Again he must subordinate to the requirements of adults, severe regiment and discipline.
This period is characterized by emotional liability, frequent mood changes, impulsive action and instability which worsen the situation. Moreover, it involves increased fatigue, alternating and being apathetic and short phases of increased activities. This state can be accompanied by neurovegetative disorders such as sleeping disorders, impaired sleep, appetite disorders, etc. The fact of disease with eventual permanent limitation for future is processed by adolescents with more difficulties than younger children or adults. Endangered life, reality of death is understood as shocking, unjust, destructive and traumatizing fact. They react with anger, confusion, disgust, destructive conduct (externalizing) or escaping from reality and depression (internalization). Sometimes different escapades occur as substance abuse or other auto‐destructive conduct as suicidal risks. These are important facts which may affect significantly treatment and rehabilitation process.
Even under normal circumstances the adolescent age is the period when a youngster must cope with a lot of life problems. He should, for example, select and prepare himself for future profession. At the end of this period he may start a career. Disease and following treatment will often cause interruption of studies which may affect the whole process of gradual professionalization of a youngster and totally ruin his imaginations of his own future.
Own body becomes for the adolescent a subject of continual attention and physical maturity increases his self‐confidence. An adolescent is often dissatisfied with his body; he would like to look different—which is the source of negative evaluation. An adolescent cares for his appearance, carefully selects clothes, hair style, etc. Self‐reflection concerns also interest in his personality. A youngster creates an imagination what he should look like.
He develops self‐confidence. Sock adolescents are especially worried what will they look like, if they stay alive and become adult. However, they are afraid how they will be accepted by the people of their age if they are different. Their self‐confidence suffers their self. Adolescents create their spiritual orientation; spirituality plays an important role for a human. Such questions are most frequently asked in adolescent period looking for one’s individuality and orientation, mainly in the situation when all of a sudden an adolescent comes across a disease facing his own mortality.
Adolescents qualitatively change their interests (regarding intensity, level, depth and diversity). Quantity of interests is reduced, but selected interests are improved and extended and become permanent. According to the researches, most interest adolescents show for sports, trips to the nature, tourism and camping in the nature. Sports are good recreation, ventilation of fight and aggression, occasion to stay in a good team. Adolescents with cancer are, however, endangered by their physical and functional deficiency. Their interest must be adjusted to the new situation. Instead of activities of sport character they may develop their cultural and artistic interests, as music, fine arts, drama, (film and theatre) and literature, although in passive form. A youngster often shows interest in social occasions involving dancing, which provide a good opportunity to meet and know other people of the same age. Disease and impaired immunity system, related different physical changes (as hair loss and emaciation) make it possible to a cancer patient to visit a cinema, theatre and library, to go to a concert or disco.
This period involves a strong interest in discussion, to which an adolescent dedicates enough time. It is necessary as it resolves the issue of purpose in life and helps the adolescents to gain experience through conversation. The experts should use this fact and via conversations let out negative feelings (as fear, anger, anxiety, etc.) of an adolescent/a patient.
They should not hide behind a mask of “a hero”, which patients often do. An adolescent is able to oppress and heroically stand the pain, physical or mental. However, this does not mean, that inside he has coped with it. Work of assisting professionals can be made difficult by ambivalent attitude of adolescents to authorities. Besides a strong interest of an adolescent in conversations, one fact makes it difficult that they are demanding partners for communication. They expect partnership attitude, respecting their space, privacy and intimacy; however, on the other hand they need much support and understanding. During treatment they should have a chance to participate actively in it, make decisions and also be responsible for its course.
Social relations issues are also significant—time of first love and of their own discovered sexuality. They break ties of social contacts based on personal ties in the family, but he just cannot remain cut off. He find it with the people of the same age and they spend lots of time together. It is an important source of social experience. He takes over their ways of conduct, appearance. He needs to be accepted and recognized by the people of the same age. In case of rejection by a group of the people of the same age, he would get into a complicated life situation. He cares for good relations with people of the same sex and partners of another sex. Friendship of adolescents is more stable, deeper, more confidential and more sincere. Friendship provides support to a young person in time when he takes his life in his own hands and feels alone and hapless. Pair relations of the people of different sexes are a true need. Awakening sexuality can take over their minds and bodies; sexual issue becomes crucial. Media, conduct of adults and other facts in actual society present sex as an important part of life. Age at the end of adolescent age is suitable (although not optimal) to get married. Theoretically adolescents can take a role of a parent. Emotional unbalance of a patient leads to a feeling of dependence from others, an inferiority feeling. They often cannot cope with their environment and to get involved in desired healthy life of the people of the same age. All of that can lead to a feeling of fear, loneliness and isolation, separation from the surroundings, depressive moods, communication breakdown, eventually aggressive and rejecting conduct.
An important fact which is also reflected in the life of an adolescent with cancer even in case of successful treatment are eventual later effects of anti‐cancer treatment. As a result of increasing number of cured children and adolescents these later consequences of anti‐cancer treatment come forward to the attention and also related quality of survival. For example, it involves damage of lungs, disorders of growth and development, damaged bones, thyroid, breasts, liver, muscles, senses, immunity system, skin, fertility disorders and also psycho‐social problems. At present the members of multidisciplinary team caring for an infant or adolescent patient must concentrate not only on the treatment of the patient but also how to minimize treatment consequences.
Life brings many changes, some are small and expected (e.g. changes of life periods, including adolescent age) and those can take place without even noticing them, not being a burden. However, others are more demanding; we can see them as a burden and look for the ways to cope with them. These ways are called coping strategies. Although adolescent period is considered expecting change; in spite of that it is a sort of burden. As described above, it involves looking for social and personal identity. Disturbing the process of looking for own identity with cancer is very serious. An adolescent getting affected in the phase of looking for an identity, being confronted with a serious life problem, has huge impacts on his whole identity.
4. Results of study
The objective of research performed in January 2014–2015 was to find out which statistically important differences exist in perception of the purpose in life and its components between healthy and sick adolescents studying at grammar schools and apprentice schools according to individual social‐demographic aspects. The research was realized in quantitative study by means of a standardized questionnaire PIL [25, 26]. After the evaluation of results by means of t‐tests for two independent selections in determining the level of significance p ≤ 0.05 statistically important results were proven, of which we choose the most significant ones. From the aspect of school type in the component of affirmation of living sick students of grammar schools achieved significantly higher score in comparison with healthy students of apprentice schools (015). Similarly in the components of perception of objectives healthy grammar students achieved significantly higher score in comparison to sick grammar school students (012). Regarding gender, in the component self‐accepting, healthy adolescents reached significantly higher score in comparison to healthy female adolescents (024). Also in the component of perceiving future, healthy male adolescents achieved significantly higher score than healthy adolescents (039).
In qualitative research, we have found from no standardized interviews that adolescents deal with issues related to the topics of purpose in life even more frequently than healthy ones of the same age. They look for the answers of the kind: “Why do I live?”, “What have I achieved?”, “What else I am to achieve in my life?”, etc. They are trying in maximum extent to fulfill the rest of their life that they are left with. Here we can see the positive aspect of the suffering brought by the disease. In spite of the well‐known fact that just adolescent age is the period of the first experiences with addictive substances, the respondents have negative attitude to their use; they do not wish to make easier the solution of difficult situation in life by substance abuse and appreciate the rest of their life they are left with. They do not think about suicide and they appreciate life they are left with. They feel responsible to their families and environment and religious adolescents. Moreover, they do not want to act against laws of God, prefer to pray, ask God for help, redeeming and salvation.
5. Application of results
Assisting workers should provide help in searching for the purpose in life and awaken desire for its fulfillment, use disease for personal development and maturing, to create the correct attitude to the disease and eventually suffering that accompanies the client. Accepting disease is related to experiencing high meaningfulness of life.
In social practice and consulting, it is possible to utilize in favor of sick male and female adolescents above all the results of research targeted above all to reasons to live and experiencing depression related to difficult treatment of oncologic diseases.
The higher the overall score in perception of their meaningfulness of life is, the lower is the overall score in the scale of experienced depression [27].
In social work and consulting in favor of adolescents, we recommend to apply purpose‐orientated attitude in building resilience according to P.T.P. Wonga [28, 29], above all module PURE and module ABCDE.
In the interest of resilience of youth, we emphasize above all the need for integrated attitude.
6. Conclusion
The potential contribution of this chapter arises from the findings about the facts of diagnosis of oncological disease in adolescence in the Slovak adolescents. These adolescents try to find some purpose in this difficult life situation.
These findings provide the basis for the possible future studies in this field and for the all people which work with adolescents in the situation of oncological diseases (teachers, medical staff, parent, family members, etc.). The attention is given to help to find some solution in the field of study and in the real life situation.
\n',keywords:"Adolescents, oncological diseases, purpose of life, life, treatment",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/56604.pdf",chapterXML:"https://mts.intechopen.com/source/xml/56604.xml",downloadPdfUrl:"/chapter/pdf-download/56604",previewPdfUrl:"/chapter/pdf-preview/56604",totalDownloads:535,totalViews:143,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,dateSubmitted:"October 9th 2016",dateReviewed:"February 20th 2017",datePrePublished:null,datePublished:"September 6th 2017",dateFinished:null,readingETA:"0",abstract:"Under common circumstances, adolescent age is the period of a young person having to cope with many life problems (resolving issues if personal maturity which increases, respect decreases self‐confidence, changing quality of interests, etc.) We can claim that adolescent age itself involves existential character. If this process involves a serious disease, the situation is really demanding. The aim of the chapter is to describe the process of seeking their own identity in the situation of coping with occurrence of an oncologic disease.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/56604",risUrl:"/chapter/ris/56604",book:{slug:"well-being-and-quality-of-life-medical-perspective"},signatures:"Eva Žiaková, Karolina Barinková and Katarína Šiňanská",authors:[{id:"197632",title:"Ph.D.",name:"Karolína",middleName:null,surname:"Barinková",fullName:"Karolína Barinková",slug:"karolina-barinkova",email:"karolina.barinkova@gmail.com",position:null,institution:{name:"University of Pavol Jozef Šafárik",institutionURL:null,country:{name:"Slovakia"}}},{id:"197633",title:"Prof.",name:"Eva",middleName:null,surname:"Žiaková",fullName:"Eva Žiaková",slug:"eva-ziakova",email:"eva.ziakova@gmail.com",position:null,institution:null}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Theoretical background",level:"1"},{id:"sec_3",title:"3. Adolescent age in the context of specifics of an oncological disease",level:"1"},{id:"sec_4",title:"4. Results of study",level:"1"},{id:"sec_5",title:"5. Application of results",level:"1"},{id:"sec_6",title:"6. Conclusion",level:"1"}],chapterReferences:[{id:"B1",body:'Valovičová, E. 2008. Onkologická výchova pre stredné školy. 2. vyd. Bratislava: Liga proti rakovine. ISBN 978‐80‐89201‐38‐9. Podkapitola Výskyt rakoviny v Slovenskej republike, s. 22‐23; Kapitola Liečba rakoviny, s. 36‐37.'},{id:"B2",body:'Žiaková, E. 2013. Cesta sociálneho pracovníka k zmyslu jeho práce. In Sociálna práca: cesta k zmyslu života. Košice: Katedra Sociálnej práce Filozofickej fakulty UPJŠ.'},{id:"B3",body:'Vašutová, M. a kol. 2010. Základy biodromální psychologie. Ostrava: Filozofická fakulta Ostravskej univerzity v Ostravě. ISBN 978‐7368‐934‐6.'},{id:"B4",body:'Frankl, V. E. 2006. Vule ke smyslu. Vybrané přednášky o logoterapii. Brno: Cesta. ISBN 80‐7295‐084‐3.'},{id:"B5",body:'Křivohlavý, J. 2006. Psychologie smysluplnosti existence : otázky na vrcholu života. 1. vyd. Praha: Grada. ISBN 80‐247‐1370‐5.'},{id:"B6",body:'Halama, P. 2007. Zmysel života z pohladu psychológie. Bratislava: SAP‐Slovak Academic Press. ISBN 978‐80‐8095‐023‐1.'},{id:"B7",body:'Tavel, P. 2004. Smysl života podla Viktora Emanuela Frankla. Bratislava: Iris.'},{id:"B8",body:'Yalom, I. D. 1980. Existential psychotherapy. New York: Basic Books.'},{id:"B9",body:'Waren, R. 2005. Život s jasným cielom. 1. vyd. Bratislava: Porta Libri.'},{id:"B10",body:'Drapela, V. J. 2008. Přehled teórií osobnosti. 5. vyd. Praha: Portál.'},{id:"B11",body:'Bačová, M. 2006. Logoterapia a existenciálna analýzy v liečbe závislosti. In Empatia, 2006, roč. 13, č. 2, s. 21-28.'},{id:"B12",body:'Adler, A. 1999. Porozumění životu: úvod do individuální psychologie. 1. vyd. Praha: Aurora.'},{id:"B13",body:'Výrost, J., Ruisel, I. 2000. Kapitoly z psychológie osobnosti. Bratislava: Veda.'},{id:"B14",body:'Nákonečný, M. 2009. Psychologie osobnosti. 2. roz. a preprac. vyd. Praha: Academia.'},{id:"B15",body:'Plháková, A. 2007. Učebnice obecné psychologie. Praha: Academia.'},{id:"B16",body:'Říčan, P. 2007. Psychologie osobnosti : obor v pohybu. 5. vyd. Praha: Grada.'},{id:"B17",body:'Kern, H. a kol. 2000. Přehled psychologie. Praha: Portál. 287 s. ISBN 80‐7367‐121‐2.'},{id:"B18",body:'Hvozdík, Stanislav. 2001. Psychologické pohlady na edukáciu a postmodernizmus. Prešov: Grafotlač. 343 s. ISBN 80‐8068‐072‐8.'},{id:"B19",body:'Andrášiová, Mária. 2009. Ked do života vstúpi rakovina. Bratislava: Landy, s.r.o., 2009. 249 s. ISBN 978 80‐970127‐0‐0.'},{id:"B20",body:'Dunovský, Jiří. 1999. Sociální pediatrie. Praha : Grada, 1999. 279 s. ISBN 80‐7169‐254‐4.'},{id:"B21",body:'Kubíková, Eliška. 2001. Etické problémy sociálnej starostlivosti u detí s onkologickými ochoreniami. In Medicínska etika a bioetika. ISSN 1335‐0560, roč. 8, č. 3‐4, s. 9-10.'},{id:"B22",body:'Koutecký, Josef, Cháňová, Markéta. 2003. Děti s nádorovým oněmocněním I. Rady rodičum. Praha: Triton. 224 s. ISBN 80‐7254‐332‐6.'},{id:"B23",body:'Koutecký, Josef. 2002. Detská onkológia pre prax. Praha: Triton, 2002. 179 s. ISBN 80‐7254‐288‐5.'},{id:"B24",body:'Škanderová, Jana. 1996. Starostlivost o dieta s onkologickým ochorením. In Revue profesionálnej sestry. ISSN 1335‐1753, 1996, roč. 3, č. 5, s. 6-7.'},{id:"B25",body:'Crumbaugh, J., L. Maholick. 1964. Purpose in Life Scale: Psychometric Properties for Social Drinkers and Drinkers in Alcohol Treatment.'},{id:"B26",body:'Crumbaugh, J., L. Maholick. 1964. An experimental study of existentialism: The psychometric approach to Frankl’s concept of noogenic neurosis. Journal of Clinical Psychology, 20, 200‐207.'},{id:"B27",body:'Šiňanská, K., E. Žiaková. 2013. Stratégie zvládania a zmysel života onkologicky chorých adolescentov. Možnosti využitia logoterapie vo vztahu pomáhajúci profesionál – pacient. In: Aké princípy vládnu zdravotníctvu? : právne, etické, ekonomické a psychosociálne aspekty zdravotnej starostlivosti : zborník z medzinárodnej vedeckej konferencie: Košice, 11. máj 2013. Košice: Medius. ISBN 9788081550072. s. 303-323.'},{id:"B28",body:'Šiňanská, K., E. Žiaková. 2014. E‐learning as a Significant Part of Education Increasing the Possibilities of Coping with Oncological Disease in Adolescents. In: Procedia ‐ Social and Behavioral Sciences [elektronický zdroj]. ISSN 1877‐0428. Vol. 132 (2014), s. 715-721.'},{id:"B29",body:'Šiňanská, K., E. Žiaková. 2012. Edukácia ako jedna z možností zvládania onkologického ochorenia u adolescentov z aspektu sociálnej práce. In: Aktuálne výskumné otázky pomáhajúcich profesií ‐ nové výzvy pre prax: zborník príspevkov z konferencie mladých vedeckých pracovníkov s medzinárodnou účastou 30. apríla 2010 v Prešove. Prešov: Filozofická fakulta Prešovskej univerzity v Prešove, 2012. ISBN 9788055505800. s. 182-187.'}],footnotes:[],contributors:[{corresp:null,contributorFullName:"Eva Žiaková",address:null,affiliation:'
Social Work Department, Faculty of Arts, P. J. Safarik University, Košice, Slovak Republic
Social Work Department, Faculty of Arts, P. J. Safarik University, Košice, Slovak Republic
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1. Introduction
\n
Stereotaxy was coined by Victor Horsley and Robert Clarke in 1908 to describe a method of locating points within the brain by using the Cartesian coordinate system that measures distance from a fixed reference point derived from external cranial landmarks [1]. This was followed by the development of image guidance in 1986, which integrated stereotaxy with computed tomography [2]. The development happened in the backdrop of transition from frame-based to frameless stereotaxy based on enhancements in spatial fidelity of imaging data, computational power, and 3-D digitizers [3]. However, spinal surgery applications of the image guidance systems arising from these refinements carry limitations. These include dependence on a direct line of sight between the optical tracking system and navigated instruments for ensuring screw insertion accuracy and a learning curve for using the navigation system. The learning curve comes from the fact that the surgeon now has to redirect his or her eyes from the patient to the navigation screen in order to follow the planned trajectory for screw placement. This can result in surgical errors since attention is taken away from the patient at the point of screw insertion. An attempt to address this shortcoming has led to the development of robotic systems that utilize similar image guidance platforms while physically guiding the surgeon to the preplanned trajectory for screw placement [4, 5].
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The field of spinal surgery is characterized by a unique set of defining features such as the need for high order of surgical precision as several critical structures are located in close proximity of the vertebral column. Injury to these structures, which include blood vessels and nerves, can lead to a wide spectrum of consequences ranging from pain to paralysis. The close association of critical structures is compounded by the narrow operating corridors for doing surgeries involving the spinal column. This set of challenging circumstances strengthens the case for robots as surgical assistants due to the lack of fatigability while undertaking tasks repeatedly and without showing a reduction in performance. Since the introduction of da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA), cleared for use by the Food and Drug Administration (FDA) in 2000, the field of robotic surgery has continued to mature and gain more widespread acceptance. However, the field of neurosurgery has seen growing interest only in recent times for the use of surgical robotic systems to assist the surgeon in operative procedures.
\n
With surgical robots becoming more visible in a number of surgical disciplines, the various systems in use can be broadly classified into three main categories depending on the interaction of the surgeon with the robot [3]. The first category is supervisory-controlled systems where the actions carried out by the robot are preprogrammed by the surgeon who then monitors the robot performing the specified steps autonomously. The second type is the telesurgical systems where the surgical manipulator follows the movements of an input device directly manipulated by the surgeon in a master-slave manner. The third type is the shared-control models where the motions are concurrently controlled by both the surgeon and the robot via shared control of the surgical instruments. Despite the shared control, the surgeon remains in charge of the decision-making related to the procedure with the robot providing steady-hand manipulation of the instruments [3]. All the surgical robots approved by the FDA for spinal procedures fall under the third category of shared-control systems.
\n
To this point, robotics have largely been utilized in placement of pedicle screws and shown comparable and/or superior accuracy of screw placement compared to conventional, freehand technique of screw placement [6, 7, 8]. Despite the initial encouraging findings, the adoption of surgical robots has been relatively slow among the spine surgical community with robots not yet considered as part of the routine standard operative procedure for spinal indications. A major concern for the tepid response to robots is the significant capital investments required for the surgical robot and the associated navigation equipment. The use of navigation systems irrespective of surgical robots is still not commonplace across the surgical suites, which places training requirements on top of the added cost. Further compounding the situation is the perception that adding steps to the operation workflow would lead to increased operation time and decreased efficiency. Given the limited scientific literature on operative and clinical outcomes, there is skepticism toward robots by the surgical community. In the present article, we attempt to explore the evolution of robotic-assisted spinal surgery to where the field stands now and conclude with future applications.
\n
\n
2. Commercial surgical robotic systems in current use
\n
The last two decades have seen the introduction of several robotic systems in spinal surgery but the Food and Drug Administration approval has been granted to three of these systems (Figure 1). These include SpineAssist® (Medtronic Inc., Dublin, Ireland), ROSA® (Medtech S.A., Montpellier, France), and ExcelsiusGPS® (Globus Medical Inc., Audubon, PA). SpineAssist®, which received both FDA clearance and European CE Mark of approval in 2004, was the first robotic assistance system to be used in the spinal surgery. Subsequent iterations of SpineAssist®, Renaissance®, and Mazor X™ were released to address some of the limitations of SpineAssist® and received both FDA and CE approval in 2011 and 2017, respectively. The most recent follow-up of SpineAssist® is Mazor X™ Stealth Edition, which received FDA clearance in 2018. The second system approved for commercial use, ROSA®, obtained CE Mark of approval in 2014 FDA clearance in 2016, while the most recent surgical robot system, ExcelsiusGPS®, received both FDA and CE approvals in 2017.
\n
Figure 1.
Systems for robotic-assisted spine surgery: Mazor Renaissance® (A), Mazor X™ (B), ROSA® (C), and ExcelsiusGPS® (D).
\n
2.1 SpineAssist®
\n
SpineAssist® was the first commercially available system for robotic-assisted spinal surgery. It comprises a cylindrical device mounted to a patient-specific anatomical landmark, which relies on pre- and/or intraoperative CT imaging to allow trajectory planning for screw insertion. Subsequent iterations of SpineAssist® include Renaissance® followed by Mazor X™ (list price ~US$1.2 M) with the latter consisting of an independent robotic arm where the attachment to the patient is done using a single pin in place of a robot-mounted platform as is the case with the former. Medtronic Stealth System is used concurrently to provide navigation. Recently, Mazor X™ Stealth Edition has been released, which also obviates the need for K-wires and a separate navigation system. Like the previous versions, it requires the robotic arm to be mounted to the bedframe.
\n
\n
2.2 ROSA®
\n
The second system approved by the FDA is the ROSA®, which works similar to the SpineAssist® in using pre- or intraoperative CT imaging to plan screw trajectory but provides the additional convenience of built-in navigation for determination of screw depth.
\n
\n
2.3 ExcelsiusGPS®
\n
ExcelsiusGPS®, the third and most recently approved commercial robotic system (list price ~US$1.2 M), has a built-in navigation system similar to ROSA® but does not require attachment to the patient or the operating table. In addition, it removes the need for a K-wire by providing an end effector for the passage of instruments and detecting “skiving” of instruments. There is also a secondary passive reflective marker to monitor the accuracy of robotic navigation system.
\n
Table 1 highlights salient features of each of the surgical robotic systems.
\n
Robotic system
Navigation
Direct implant placement
K-wire required
Imaging
Portability
Intra-op
Pre-op
Fluoroscopy
Renaissance
Separate
No
Yes
✓
Patient mounted
Mazor X
Separate
No
Yes
✓
✓
Bed mounted
Mazor X Stealth Edition
Integrated
Yes
No
✓
✓
Bed mounted
ROSA
Integrated
No
Yes
✓
Free standing
ExcelsiusGPS
Integrated
Yes
No
✓
✓
✓
Free standing
Table 1.
Comparison of commercially available spine robotic systems.
\n
In the subsequent section, the experience with the use of these systems is described followed by an appraisal of the limitations of the present systems and avenues for future research. Due to relative longevity of SpineAssist® availability for commercial application, a significant portion of the published literature is based on the experience of using SpineAssist® and its subsequent iterations, Renaissance® and Mazor X™.
\n
\n
\n
3. Applications of robotics in spinal surgery
\n
3.1 Pedicle screw instrumentation
\n
Despite being the most commonly performed procedure related to the thoracolumbar spine, a steep learning curve is associated with transpedicular fixation. Subsequently, the primary application of surgical robots in spinal surgery has been transpedicular fixation. The use of robotic surgical assistants in transpedicular fixation arose from the wide variability of findings about accuracy of screw placements reported for various versions of conventional, fluoroscopic-dependent techniques. The results on the accuracy of pedicle screw instrumentation using surgical robotic assistants have been largely superior to the manual screw insertion using fluoroscopy. The commonly accepted method of determining insertion accuracy involves the use of postoperative CT scans, which despite providing radiographic confirmation of screw placement is limited in divulging the clinical implications of the radiographic findings. This limits the inferences that can be drawn to some extent, but given the popularity of this method of comparison, the various robotic systems are discussed with respect to screw insertion accuracy.
\n
A detailed evaluation of the scientific literature highlights that a significant share of studies document results from SpineAssist® and its iterations, namely, Renaissance® and Mazor X™. The first account on the use of robotics was provided by Sukovich et al. in a 2006 retrospective analysis, which used SpineAssist® in 14 patients for the placement of 98 pedicle screws through a combination of open and minimally invasive techniques. The authors showed that 96% of the screws were within 1–2 mm of the planned trajectory with no cases of pedicle breach [9]. In another study, Pechlivanis et al. looked at the screw insertion accuracy of SpineAssist® during minimally invasive posterior lumbar interbody fusion (PLIF). The accuracy was determined on postoperative CT scans using the Gertzbein and Robbins system (GRS) for evaluating the accuracy of pedicle screw insertion [10, 11]. The GRS grades the screws into four categories based on the location of the screw within the pedicle: Grade A, screw is completely within the pedicle; Grade B, screw breach is <2 mm; Grade C, screw breach is >2 and <4 mm; Grade D, screw breach is >4 and <6 mm; and Grade E, screw breach is >6 mm. Grades A and B are considered acceptable for screw accuracy. Of the 122 screws inserted, with the exception of one screw that was Grade D, the remaining screws were either GRS Grade A (108) or GRS Grade B [13]. Devito et al. performed a multicenter, retrospective review comprising of 3271 pedicle screws placed with SpineAssist® and showed 98% of the screw insertions to be acceptable when assessed by intraoperative fluoroscopy. Further, accuracy measurements done on postoperative CT scans in a subset of these screws (646) showed over 98% of the screws fell within the safe zone (GRS Grades A and B) [12]. In a study involving 112 patients and 494 screws using SpineAssist®, van Dijk and colleagues found a 97.9% rate of clinically acceptable screw insertion [13]. Hu et al. evaluated 960 pedicle screws placed with Renaissance® and found that 949 screws (98.9%) were placed accurately [14]. A separate study by the same group showed successful screw placement in nine patients with spinal column tumors [15]. In a review of 50 patients with adolescent idiopathic scoliosis (AIS) that underwent robotic MIS posterior spinal fusion, Macke et al. evaluated a total of 662 pedicle screws inserted using Renaissance®. The authors observed a 92.7% acceptable placement rate. Lower rates of screw malpositioning were noted with robotic MIS than prior published data, and improved accuracy of screw insertion was observed when using preoperative CT obtained in the prone position [16].
\n
A number of studies have compared accuracy between conventional freehand and robotic-assisted procedures. In a retrospective analysis, Kantelhardt et al. used SpineAssist® and performed pedicle screw placement accuracy comparisons between three groups, namely, conventional freehand versus open robotic-assisted versus percutaneous robotic-assisted, and showed comparable accuracy rates for the combined robotic-assisted groups (94.5%) and the freehand group (91.4%) for screw insertion [17]. Schatlo and colleagues used SpineAssist® and demonstrated similar rates of clinically acceptable screw placement between open fluoroscopy-guided and robotic-assisted placement (open and percutaneous) groups [18]. In a separate analysis by the same group, the impact of experience of surgeon on screw insertion accuracy was evaluated for 1265 pedicle screws. The authors showed 1217 (96.2%) screw placements were of an acceptable grade with screw misplacement peaking between the first 10 and 20 surgeries and declining as more surgeries were performed by the surgeon [19]. The same group followed this up with an analysis involving 169 patients that underwent posterior instrumentation for spinal instability and showed a higher proportion of non-misplaced screws in the robot (93.4%) than the freehand fluoroscopy-guided cohort (88.9%), which was statistically significant [20]. Schizas et al. evaluated robot-assisted (open or percutaneous) versus fluoroscopy cohort and showed comparable accuracy rates with 95.3% for the robotics group and 92.2% for the freehand group [21]. The accuracy of screw insertion was assessed using the Rampersaud scale, which describes the relative position of the screw to the pedicle and comprises the following four grades: Grade A, completely in; Grade B, <2 mm breach; Grade C, 2–4 mm breach; and Grade D, >4 mm breach [22]. Solomiichuk and colleagues performed a retrospective matched cohort study in 70 patients diagnosed with metastatic spine disease and showed grade A or B screw placement in 162 of 192 (84.4%) in the robotic-assisted group and in 179 of 214 (83.6%) in the conventional group with no differences in screw accuracy between the groups. Further, no differences were found between the cohorts for accuracy, duration of surgery, radiation exposure, or surgical site infection with the exception of intensity of radiation [23]. Keric et al. evaluated 90 patients treated for spondylodiscitis with posterior spinal fusion via either conventional, open freehand, or percutaneous robot-assisted spinal instrumentation using Renaissance®. Their findings revealed robotic cohort was associated with higher accuracy and lower likelihood for revision procedures for improper screw placement. Further, the robotic-assisted MIS cohort had lower intraoperative fluoroscopy and shorter postoperative stay [24]. In a separate review of 1857 implanted screws, Keric and colleagues showed increased rates of screw deviation in clinical diagnosis such as tumor, infection, and osteoporotic fractures [25]. In another review of 206 patients with spondylodiscitis that underwent posterior spinal fusion, Alaid et al. observed a lower rate of revision for wound breakdown in the robotic MIS group using SpineAssist® than the open, freehand group [26].
\n
The comparison of screw accuracy between freehand and robotic-guided screw insertion has also been analyzed through a number of randomized controlled trials. Kim et al. compared the accuracy and safety of screw insertion between robotic-assisted minimally invasive PLIF using Renaissance® (37 patients) and conventional, freehand technique for PLIF (41 patients). For intrapedicular accuracy, no significant differences were observed between the groups. Of the 74 screws in the robotic cohort, none breached the proximal facet joint, while 13 of the 82 screws in the freehand group violated the proximal facet joint (P < 0.001). Further, the average distance of the screws from the left and right facets was significantly smaller in the freehand group [27]. Roser et al. used SpineAssist® to compare screw accuracy between fluoroscopic-guided freehand, navigation-guided, and robotic-assisted screw instrumentation. The authors found no significant differences for screw accuracy between the different techniques, but the conclusion was not backed by statistical analysis due to small study size [28]. Ringel et al. compared an equal number of patients randomly assigned to either percutaneous screw placement using SpineAssist® or conventional, open freehand technique. The results of their RCT differ from the large majority of studies in that a lower rate (85%) of clinically acceptable screw placement was reported for robotic-guided technique than the freehand technique (93%) for screw insertion [29]. Hyun and colleagues performed a prospective study comparing fluoroscopy-guided approach with MIS screw insertion using Renaissance® in lumbar fusions. The authors observed all screws in the robotic group were placed accurately, while in the freehand group, the accuracy rate was 98.6% [30]. In a prospective analysis, Park and colleagues compared 37 patients with MIS screw insertion using Renaissance® and 41 patients that underwent freehand technique for pedicle screw insertion during posterior interbody fusion surgery. They showed both groups had similar improvement in clinical outcomes at 2-year follow-up [31].
\n
Aside from studies on SpineAssist® and its iterations, only a small number of publications have explored other surgical systems. Lonjon et al. compared screw placement using the ROSA® with freehand technique of screw insertion. The authors found a 97.2% accuracy rate in the robotic group and a 92% accuracy rate in the freehand group [32]. In a study by Huntsman et al., MIS screw placement using ExcelsiusGPS® showed 99% of screw placed successfully based on the surgeon’s interpretation of intraoperative plain film radiographs, with no cases of screw malposition requiring revision surgery [33].
\n
\n
3.2 Other applications
\n
Bederman et al. evaluated the utility of SpineAssist® or Renaissance® robotic system in the placement of S2-alar-iliac screws and found all screws are placed accurately with no breach of the anterior sacrum [34]. Hu et al. performed a retrospective analysis of 18 patients who underwent S2AI fixation with assistance from Renaissance® robotic system and found accurate screw trajectory on postoperative CT scans without any violations of iliac cortex or breaches of the anterior sacrum [35]. In another study comprising of four adult spinal deformity patients who underwent minimally invasive robotic-guided insertion of S2-alar-iliac (S2AI) screws using Renaissance® robotic system, Hyun et al. observed all the screw trajectories were positioned accurately based on postoperative X-rays and CT scans [36]. Laratta and colleagues evaluated S2AI screw insertion in 23 consecutive patients who underwent spinopelvic fixation with Renaissance® robotic system and noted two violations of iliac cortex but no neurologic, vascular, or visceral complications among the 46 S2AI screws that were inserted [37]. In a retrospective matched cohort analysis, Shillingford et al. compared robotic-assisted using Renaissance® robotic system (23 patients, 46 screws) and conventional, freehand (28 patients, 59 screws) S2AI screw placement in 68 consecutive patients with spinal deformity. The authors observed no differences between the groups for screw insertion accuracy or intraoperative complications [38].
\n
\n
\n
4. Illustrative case examples
\n
4.1 Case 1: MIS robotic-assisted thoracolumbar instrumentation for adult trauma
\n
A 44-year-old healthy man presented to the hospital following a 12-ft fall from the roof of a house while repairing it. He complained of severe back pain with right-sided leg numbness. Physical examination demonstrated severe pain and numbness in the lower limbs. On CT, a burst fracture at L1 was observed with MRI showing injury to the posterior ligamentous complex (PLC) (Figure 2). The decision-making for the clinical management for the patient was evaluated using the thoracolumbar injury classification and severity score (TLICS), a classification system for thoracolumbar injuries that predicts the need for surgery [39]. It comprises three independent predictors, which are morphology, integrity of PLC, and neurological status. The patient presentation was given a TLICS score of 7, and consequently the patient underwent robotic-assisted MIS T11-L3 fixation and fusion (Figure 3). The patient had complete recovery.
\n
Figure 2.
Case 1: Preoperative CT (A and B) and MRI (C) showing L1 burst fracture with injury to the posterior ligamentous complex (red circles).
\n
Figure 3.
Case 1: Intraoperative X-rays showing MIS T11–L3 transpedicular fixation (A and B).
\n
\n
4.2 Case 2: open robotic-assisted thoracolumbar fusion for pediatric trauma
\n
A 13-year-old boy presented to the hospital after landing on his upper back while attempting to jump out of a swinging hammock. He reported thoracolumbar pain, which was located in the hip region but had no radicular pain into the lower abdomen or legs. MRI revealed T11/T12 anterolisthesis, T12 wedge fracture with T11–T12 facet dislocation, and posterior ligamentous injury with small dorsal epidural hematoma (Figure 4). CT thoracic spine showed fracture and subluxation at T11–T12 with bilateral perched T11 facets, right pedicle fracture of T12 extending into the superior end plate of the vertebral body with wedging of T12 along with anterior and inferior displacement of the anterior ring apophysis, and spinous process fractures of T11 and to a lesser extent T10 (Figure 5). Based on the clinical presentation and imaging findings, a decision to operate was made. The patient underwent robotic-assisted T10-L1 fixation and fusion, T11/T12 open reduction and internal fixation at T11–T12, and T11 laminotomy for epidural hematoma evacuation (Figure 6). The patient had complete recovery and subsequently underwent removal of the hardware at 1 year.
\n
Figure 4.
Case 2: Preoperative MRI showing T11–T12 anterolisthesis, T12 wedge fracture with T11–T12 facet dislocation, and posterior ligamentous injury with small dorsal epidural hematoma (red circle).
\n
Figure 5.
Case 2: Preoperative CT thoracic spine (A–D) showing bilateral T11–T12 facet dislocation, bilateral perched facets, and T10 spinous process fracture (red circles).
\n
Figure 6.
Case 2: Postoperative X-ray showing T10–L1 transpedicular fixation and restoration of spinal alignment.
\n
\n
4.3 Case 3: MIS robotic-assisted TLIF for degenerative spine
\n
A 58-year-old female presented to the hospital with back and leg pain. The leg pain was on the left side and radiating to the left foot. The patient mentioned the back pain was worse than the left lower extremity (LLE) pain with duration of pain progressing over the last 2 years. Additionally, she complained of LLE weakness and numbness as well as cramping in bilateral calf muscles. Imaging showed 11 mm L4/5 anterolisthesis on standing XR (Figure 7) and severe spinal stenosis at L4/5 on MRI (Figure 8). Her medication history included hydrocodone, meloxicam, and tizanidine. Due to the long duration of the pain, the patient had tried a number of conservative treatments such as chiropractic, transcutaneous electrical nerve stimulation (TENS), and heat/ice packs but mentioned that none of these treatments had worked for her. Based on the clinical presentation and imaging findings, a decision to surgical operation was made, and the patient underwent an MIS robotic-assisted transforaminal lumbar interbody fusion (TLIF, Figure 9). The patient was discharged within a day and had resolution of back and leg symptoms on follow-up.
\n
Figure 7.
Case 3: Preoperative standing X-ray showing 11 mm L4/5 anterolisthesis.
\n
Figure 8.
Case 3: Preoperative MRI in axial (A and B) and sagittal (C) planes showing severe spinal canal, lateral recess, and foraminal stenoses at L4–5.
\n
Figure 9.
Case 3: Postoperative standing X-ray showing L4–5 transforaminal lumbar interbody fusion with spondylolisthesis reduction and disc height restoration.
\n
\n
4.4 Case 4: hybrid MIS robotic-assisted cervicothoracic fusion for adult trauma
\n
A 30-year-old female presented to the hospital after being involved in a rollover motor vehicle accident. Physical examination demonstrated severe neck pain and tingling in the left arm. On imaging, she had left C5–C6 facet fracture dislocation and bilateral C5–C6 facet distraction (Figure 10). The patient underwent C4-T1 fixation and fusion with percutaneous MIS robotic-assisted T1 pedicle screws (Figure 11). Her midline incision could be minimized to approximately 3 inches. She had complete recovery and was discharged to the rehabilitation unit.
\n
Figure 10.
Case 4: Preoperative CT showing C5–C6 facet fracture dislocation and bilateral C5–C6 facet distraction (red and gray circles).
\n
Figure 11.
Case 4: Intraoperative CT showing percutaneous robotic-assisted T1 pedicle screws.
\n
\n
\n
5. Discussion and future directions
\n
Radiation exposure is an important consideration when comparing the utility of robotics in spinal surgery to conventional, fluoroscopic techniques. With expanding indications for the use of MIS in more complex spinal cases, the concern about radiation is a major factor in technology adoption going forward. Recognizing the impact of this issue on increased adoption of robotics, a number of studies have looked at the radiation exposure in patients operated with the assistance from surgical robotics vis-à-vis patients treated with conventional, fluoroscopic techniques. Based on the limited literature on this topic, it appears the incorporation of robots in the operating workflow is associated with reduction in both the time and the levels of radiation exposure [40]. In a prospective randomized controlled trial, Hyun et al. observed shorter radiation times and output in the robotic group, which was statistically significant [30]. Kim and colleagues noted a significant reduction in fluoroscopy duration in later cases when compared to the early cases [41]. In a study comparing different guiding methods for pedicle screw insertion, Fan et al. showed that robotic-assisted technique was associated with shorter fluoroscopic time than conventional, freehand technique or O-arm-based navigation but longer time than patient-specific navigational template technique [42]. Another study looking at different screw insertion guiding techniques showed the lowest dose of radiation in the standard navigation group, which was followed by the robotic group and then the conventional, freehand group [28]. Kantelhardt et al. found that robotic-assisted screw insertion had statistically significant lower radiation exposure than conventional, freehand technique. However, the authors found no difference between percutaneous and open robotic-assisted pedicle screw insertion [17]. Similarly, Keric and colleagues noted lower fluoroscopy time in the robotic-assisted screw insertion cohort [24]. In contrast, Ringel et al. and Schizas et al. found no differences in radiation exposure between the robotic and the freehand groups [21, 29]. Based on published data, it appears that robotic-assisted procedures lead to reduction in radiation exposure with the greatest value addition of robots being in percutaneous screw insertion. The use of robots in this case has the potential to reduce the radiation exposure, which tends to increase dramatically for conventional screw insertion techniques. The end result of incorporating robotics could obviate the need for lead apron by the operating room staff.
\n
When compared with navigation, the use of robotics allows for preplanning of screws. This saves operative time and allows the operating room staff to prepare implants ahead of time. By preparing for any anatomical variations that the surgeon might encounter (such as in deformity, trauma, and previously arthrodesed spines), the robot can be deployed for spinal procedures that involve more complex anatomical relationships. Over time, enhancements to graphical user interface have simplified the screw trajectory planning. By allowing the superimposition of intraoperative scans over preoperative imaging, the robots help the surgeon to take into consideration patient movement to more accurately plan the procedure while also providing the surgeon with the ability to select optimal screw dimensions. By taking into account patient immobilization, a robotic surgical assistant can lead to a diminished operating time while reducing pedicle and vertebral body violations. Further, the visualization provided by the robotic software platform can aid in rod contouring/placement through optimized screw cadence and skin incision optimization for MIS procedures in obese patients.
\n
The experience with the use of surgical robots in spine surgery has been positive so far with a large majority of studies documenting outcomes observed with robots that are equal or superior to the findings observed with conventional, openhand technique. This is on account of the reduction of human manual error as the robot provides a stable, rigid channel for guiding surgical instruments by the surgeon. The same advantage holds true when compared to navigation-assisted screw placement, which is more prone to deviations due to lack of a stable conduit for maneuvering instruments. Further, the ability to lock trajectories allows for repeatability during surgical procedures by limiting the influence of physiological hand tremor, which allows for efficiency gains over time. This element of repeatability has the added benefit of providing the surgeon the ability to better plan skin incisions. Despite the possible advantages of robots, the capabilities of the present robotic systems are fairly limited, which only favors their role in a narrow, specific set of indications as evident from most of the present literature being on the use of robots for primarily pedicle screw fixation. However, it is crucial to acknowledge the results by Ringel et al. that noted lower screw insertion accuracy with the use of surgical robotic system. A number of possible reasons could have led to these findings including lateral skidding of the cannula at the entrance point caused by the steep slope of the lateral aspect of the facet joint or using a platform fixed to a cranial spinal process with a K-wire and attached to the operating table by a bed mount, which meant the robot was only attached to the patient via a single K-wire [43].
\n
With robotics continuing to become more visible in the spinal surgery, a discussion of future areas of developments is warranted. A major thrust for moving the field of robotics forward would involve arriving at reproducible definitions of screw trajectory that mitigate the interruptions to the surgical workflow caused by the present manual method of trajectory planning. Knez and colleagues employed nonparametric models of vertebral bodies and pedicles registered to the patient CT while also accounting for spinal curvature to calculate automatic trajectories that showed close agreement with manually defined plans [44, 45]. In a study based on an atlas-based method that incorporated patterns of biomechanically optimal constructs and a surgeon’s own planning preferences, Vijayan et al. highlighted a method that is generalizable to other surgical planning applications [46]. The abovementioned methods are not only built on the premise of introducing consistency to screw trajectories but also hold potential for the estimation of screw diameter(s) and length(s) to be used in a given operation.
\n
Perhaps the greatest challenge impeding the growth of robotic systems stems from the inability of present systems to utilize visual cues from the surroundings to identify objects both accurately and automatically. Therefore, the functionality of a robot is completely modeled by the humans, and accordingly robots are only able to perform tasks for which they are preconfigured. The present state of affairs shows the path forward, which in all likelihood will see robotics integrating with artificial intelligence (AI) to confer robots with increased accuracy in visual identification and autonomous decision-making capacity. This would entail competing with visual systems seen in humans where two-dimensional inputs from the environment are collected by the human eye and converted into three-dimensional interpreted by the brain. Further, the surgical environment is a dynamic one and responding in such a way an environment would need sequential processing of external stimuli in real time. This is necessary for the robots to transition from mere translators of preprogrammed structured scenarios to dynamic adaptors in the external world. The enhancements to spatial and temporal visual information processing capabilities bring to attention the central role of neural networks in bringing these capabilities online. Modeled on the parallel processing structure of the human brain, an artificial neural network is composed of interconnected processing elements. Neural network learning is driven by the training algorithm autonomously and continually adjusting the connection weights based on exposure to input/output data. By being exposed to the surgeon’s screw planning preferences, the robot would over time be able to automatically plan the screws for the surgeon. Further, machine learning could be utilized to pool data from several surgeons and make use of their combined expertise to suggest optimized screw trajectories over the cloud, irrespective of the geographical location of the surgeon.
\n
As technological adoption increases among the younger generations of surgeons, virtual reality (VR) platforms for skills acquisition and operative planning among other function would grow in demand. While a virtual depiction of the operating environment is imperative from an educational point of view, the superimposition of virtual objects over real-world environment via hybrid systems known as augmented reality (AR) is needed for enhanced manipulation. An example of such a scenario would perhaps include head-mounted visor that projects screw trajectory in front of the surgeon on a virtual display with the surgeon not located in the immediate vicinity of the patient. This would demand capabilities for seamless, real-time transmission and integration of stereoscopic images defining the operative field and imaging data defining the patient anatomy. The rise of AR could also be instrumental in ushering remote collaboration between surgeons located at distant geographic locations. This would need improvements in information transmission capabilities to allow for real-time collaboration, an area where fifth generation (5G) network technology might be of assistance. However, these developments speak to a more distant future, and in the more immediate time frame, robotics in spinal surgery might come to resemble the da Vinci Surgical System, a slave master system, where the surgeon sits at a console and controls the robot.
\n
Of note, the enhanced capabilities would need to be designed in a manner that makes the robot a hand dexterity enhancer for the surgeon while still being in full control by the surgeon. As robotic technology becomes more sophisticated, the move toward autonomous robots will raise concerns about the transfer of control from the surgeon to the robot and the growing dependence of the surgeon on the in-built systems of the robot. Further, the possibility for real-time collaboration among physicians for screw planning recommendation as well doing the actual screw placement will raise concerns about patient consent, medical liability, and data confidentiality, among others. These are relevant ethical challenges of our time that demand more research into crucial areas of robotic design related to both software and hardware as well as the medicolegal requirements protecting the patient such as the Health Insurance Portability and Accountability Act (HIPAA).
\n
\n
6. Conclusions
\n
The current state of robotics in spinal surgery is comprised of a limited range of clinical indications related to screw placement. With emerging data showing acceptable rates for screw insertion and radiation exposure, the field of robotics is expected to benefit from further technological developments.
\n
\n',keywords:"robotics, spine surgery, pedicle screws, radiation, shared-control system, CT scans, fluoroscopy",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/68630.pdf",chapterXML:"https://mts.intechopen.com/source/xml/68630.xml",downloadPdfUrl:"/chapter/pdf-download/68630",previewPdfUrl:"/chapter/pdf-preview/68630",totalDownloads:427,totalViews:0,totalCrossrefCites:1,dateSubmitted:"April 26th 2019",dateReviewed:"July 20th 2019",datePrePublished:"August 19th 2019",datePublished:null,dateFinished:null,readingETA:"0",abstract:"Robotic-assisted spinal surgery is in its infancy. It aims to improve the accuracy of screw placement, lower the risk of surgical complications, and reduce radiation exposure to the patient and the surgical team. The present chapter attempts to provide an overview of the evolution of robotic-assisted spinal surgery and highlights different commercially available spine robotic systems in present use. The review concludes with future applications of robotics in spinal surgery.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/68630",risUrl:"/chapter/ris/68630",signatures:"Mayank Kaushal, Shekar Kurpad and Hoon Choi",book:{id:"8339",title:"Neurosurgical Procedures",subtitle:"Innovative Approaches",fullTitle:"Neurosurgical Procedures - Innovative Approaches",slug:"neurosurgical-procedures-innovative-approaches",publishedDate:"April 22nd 2020",bookSignature:"Alba Scerrati and Pasquale De Bonis",coverURL:"https://cdn.intechopen.com/books/images_new/8339.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",editors:[{id:"182614",title:"Dr.",name:"Alba",middleName:null,surname:"Scerrati",slug:"alba-scerrati",fullName:"Alba Scerrati"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:null,sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Commercial surgical robotic systems in current use",level:"1"},{id:"sec_2_2",title:"2.1 SpineAssist®",level:"2"},{id:"sec_3_2",title:"2.2 ROSA®",level:"2"},{id:"sec_4_2",title:"2.3 ExcelsiusGPS®",level:"2"},{id:"sec_6",title:"3. Applications of robotics in spinal surgery",level:"1"},{id:"sec_6_2",title:"3.1 Pedicle screw instrumentation",level:"2"},{id:"sec_7_2",title:"3.2 Other applications",level:"2"},{id:"sec_9",title:"4. Illustrative case examples",level:"1"},{id:"sec_9_2",title:"4.1 Case 1: MIS robotic-assisted thoracolumbar instrumentation for adult trauma",level:"2"},{id:"sec_10_2",title:"4.2 Case 2: open robotic-assisted thoracolumbar fusion for pediatric trauma",level:"2"},{id:"sec_11_2",title:"4.3 Case 3: MIS robotic-assisted TLIF for degenerative spine",level:"2"},{id:"sec_12_2",title:"4.4 Case 4: hybrid MIS robotic-assisted cervicothoracic fusion for adult trauma",level:"2"},{id:"sec_14",title:"5. Discussion and future directions",level:"1"},{id:"sec_15",title:"6. Conclusions",level:"1"}],chapterReferences:[{id:"B1",body:'Schurr PH, Merrington WR. The Horsley-Clarke stereotaxic apparatus. The British Journal of Surgery. 1978;65(1):33-36'},{id:"B2",body:'Roberts DW, Strohbehn JW, Hatch JF, Murray W, Kettenberger H. A frameless stereotaxic integration of computerized tomographic imaging and the operating microscope. Journal of Neurosurgery. 1986;65(4):545-549'},{id:"B3",body:'Nathoo N, Cavusoglu MC, Vogelbaum MA, Barnett GH, et al. Neurosurgery. 2005;56(3):421-433. Discussion 33'},{id:"B4",body:'Overley SC, Cho SK, Mehta AI, Arnold PM. Navigation and robotics in spinal surgery: Where are we now? Neurosurgery. 2017;80(3S):S86-S99'},{id:"B5",body:'Theodore N, Arnold PM, Mehta AI. Introduction: The rise of the robots in spinal surgery. Neurosurgical Focus. 2018;45(VideoSuppl1):Intro'},{id:"B6",body:'Gao S, Lv Z, Fang H. Robot-assisted and conventional freehand pedicle screw placement: A systematic review and meta-analysis of randomized controlled trials. European Spine Journal. 2018;27(4):921-930'},{id:"B7",body:'Ghasem A, Sharma A, Greif DN, Alam M, Maaieh MA. The arrival of robotics in spine surgery: A review of the literature. Spine. 2018;43(23):1670-1677'},{id:"B8",body:'Fan Y, Du JP, Liu JJ, Zhang JN, Qiao HH, Liu SC, et al. Accuracy of pedicle screw placement comparing robot-assisted technology and the free-hand with fluoroscopy-guided method in spine surgery: An updated meta-analysis. Medicine. 2018;97(22):e10970'},{id:"B9",body:'Sukovich W, Brink-Danan S, Hardenbrook M. Miniature robotic guidance for pedicle screw placement in posterior spinal fusion: Early clinical experience with the SpineAssist. International Journal of Medical Robotics and Computer Assisted Surgery. 2006;2(2):114-122'},{id:"B10",body:'Pechlivanis I, Kiriyanthan G, Engelhardt M, Scholz M, Lucke S, arders A, et al. Percutaneous placement of pedicle screws in the lumbar spine using a bone mounted miniature robotic system: First experiences and accuracy of screw placement. Spine. 2009;34(4):392-398'},{id:"B11",body:'Gertzbein SD, Robbins SE. Accuracy of pedicular screw placement in vivo. Spine. 1990;15(1):11-14'},{id:"B12",body:'Devito DP, Kaplan L, Dietl R, Pfeiffer M, Horne D, Silberstein B, et al. Clinical acceptance and accuracy assessment of spinal implants guided with SpineAssist surgical robot: Retrospective study. Spine. 2010;35(24):2109-2115'},{id:"B13",body:'van Dijk JD, van den Ende RP, Stramigioli S, Kochling M, Hoss N. Clinical pedicle screw accuracy and deviation from planning in robot-guided spine surgery: Robot-guided pedicle screw accuracy. Spine. 2015;40(17):E986-E991'},{id:"B14",body:'Hu X, Ohnmeiss DD, Lieberman IH. Robotic-assisted pedicle screw placement: Lessons learned from the first 102 patients. European Spine Journal. 2013;22(3):661-666'},{id:"B15",body:'Hu X, Scharschmidt TJ, Ohnmeiss DD, Lieberman IH. Robotic assisted surgeries for the treatment of spine tumors. International Journal of Spine Surgery. 2015;9:1'},{id:"B16",body:'Macke JJ, Woo R, Varich L. Accuracy of robot-assisted pedicle screw placement for adolescent idiopathic scoliosis in the pediatric population. Journal of Robotic Surgery. 2016;10(2):145-150'},{id:"B17",body:'Kantelhardt SR, Martinez R, Baerwinkel S, Burger R, Giese A, Rohde V. Perioperative course and accuracy of screw positioning in conventional, open robotic-guided and percutaneous robotic-guided, pedicle screw placement. European Spine Journal. 2011;20(6):860-868'},{id:"B18",body:'Schatlo B, Molliqaj G, Cuvinciuc V, Kotowski M, Schaller K, Tessitore E. Safety and accuracy of robot-assisted versus fluoroscopy-guided pedicle screw insertion for degenerative diseases of the lumbar spine: A matched cohort comparison. Journal of Neurosurgery. Spine. 2014;20(6):636-643'},{id:"B19",body:'Schatlo B, Martinez R, Alaid A, von Eckardstein K, Akhavan-Sigari R, Hahn A, et al. Acta Neurochirurgica. 2015;157(10):1819-1823. Discussion 23'},{id:"B20",body:'Molliqaj G, Schatlo B, Alaid A, Solomiichuk V, Rohde V, Schaller K, et al. Accuracy of robot-guided versus freehand fluoroscopy-assisted pedicle screw insertion in thoracolumbar spinal surgery. Neurosurgical Focus. 2017;42(5):E14'},{id:"B21",body:'Schizas C, Thein E, Kwiatkowski B, Kulik G. Pedicle screw insertion: Robotic assistance versus conventional C-arm fluoroscopy. Acta Orthopaedica Belgica. 2012;78(2):240-245'},{id:"B22",body:'Rampersaud YR, Pik JH, Salonen D, Farooq S. Clinical accuracy of fluoroscopic computer-assisted pedicle screw fixation: A CT analysis. Spine. 2005;30(7):E183-E190'},{id:"B23",body:'Solomiichuk V, Fleischhammer J, Molliqaj G, Warda J, Alaid A, von Eckardstein K, et al. Robotic versus fluoroscopy-guided pedicle screw insertion for metastatic spinal disease: A matched-cohort comparison. Neurosurgical Focus. 2017;42(5):E13'},{id:"B24",body:'Keric N, Eum DJ, Afghanyar F, Rachwal-Czyzewicz I, Renovanz M, Conrad J, et al. Evaluation of surgical strategy of conventional vs. percutaneous robot-assisted spinal trans-pedicular instrumentation in spondylodiscitis. Journal of Robotic Surgery. 2017;11(1):17-25'},{id:"B25",body:'Keric N, Doenitz C, Haj A, Rachwal-Czyzewicz I, Renovanz M, Wesp DMA, et al. Evaluation of robot-guided minimally invasive implantation of 2067 pedicle screws. Neurosurgical Focus. 2017;42(5):E11'},{id:"B26",body:'Alaid A, von Eckardstein K, Smoll NR, Solomiichuk V, Rohde V, Martinez R, et al. Robot guidance for percutaneous minimally invasive placement of pedicle screws for pyogenic spondylodiscitis is associated with lower rates of wound breakdown compared to conventional fluoroscopy-guided instrumentation. Neurosurgical Review. 2018;41(2):489-496'},{id:"B27",body:'Kim HJ, Jung WI, Chang BS, Lee CK, Kang KT, Yeom JS. A prospective, randomized, controlled trial of robot-assisted vs freehand pedicle screw fixation in spine surgery. International Journal of Medical Robotics and Computer Assisted Surgery. 2017;13(e1779)'},{id:"B28",body:'Roser F, Tatagiba M, Maier G. Spinal robotics: Current applications and future perspectives. Neurosurgery. 2013;72(Suppl 1):12-18'},{id:"B29",body:'Ringel F, Stuer C, Reinke A, Preuss A, Behr M, Auer F, et al. Accuracy of robot-assisted placement of lumbar and sacral pedicle screws: A prospective randomized comparison to conventional freehand screw implantation. Spine. 2012;37(8):E496-E501'},{id:"B30",body:'Hyun SJ, Kim KJ, Jahng TA, Kim HJ. Minimally invasive robotic versus open fluoroscopic-guided spinal instrumented fusions: A randomized controlled trial. Spine. 2017;42(6):353-358'},{id:"B31",body:'Park SM, Kim HJ, Lee SY, Chang BS, Lee CK, Yeom JS. Radiographic and clinical outcomes of robot-assisted posterior pedicle screw fixation: Two-year results from a randomized controlled trial. Yonsei Medical Journal. 2018;59(3):438-444'},{id:"B32",body:'Lonjon N, Chan-Seng E, Costalat V, Bonnafoux B, Vassal M, Boetto J. Robot-assisted spine surgery: Feasibility study through a prospective case-matched analysis. European Spine Journal. 2016;25(3):947-955'},{id:"B33",body:'Huntsman KT, Ahrendtsen LA, Riggleman JR, Ledonio CG. Robotic-assisted navigated minimally invasive pedicle screw placement in the first 100 cases at a single institution. Journal of Robotic Surgery. 2019'},{id:"B34",body:'Bederman SS, Hahn P, Colin V, Kiester PD, Bhatia NN. Robotic guidance for S2-alar-iliac screws in spinal deformity correction. Clinical Spine Surgery. 2017;30(1):E49-E53'},{id:"B35",body:'Hu X, Lieberman IH. Robotic-guided sacro-pelvic fixation using S2 alar-iliac screws: Feasibility and accuracy. European Spine Journal. 2017;26(3):720-725'},{id:"B36",body:'Hyun SJ, Kim KJ, Jahng TA. S2 alar iliac screw placement under robotic guidance for adult spinal deformity patients: Technical note. European Spine Journal. 2017;26(8):2198-2203'},{id:"B37",body:'Laratta JL, Shillingford JN, Lombardi JM, Alrabaa RG, Benkli B, Fischer C, et al. Accuracy of S2 alar-iliac screw placement under robotic guidance. Spine Deformity. 2018;6(2):130-136'},{id:"B38",body:'Shillingford JN, Laratta JL, Park PJ, Lombardi JM, Tuchman A, Saifi C, et al. Human versus robot: A propensity-matched analysis of the accuracy of free hand versus robotic guidance for placement of S2 alar-iliac (S2AI) screws. Spine. 2018;43(21):E1297-EE304'},{id:"B39",body:'Vaccaro AR, Zeiller SC, Hulbert RJ, Anderson PA, Harris M, Hedlund R, et al. The thoracolumbar injury severity score: A proposed treatment algorithm. Journal of Spinal Disorders & Techniques. 2005;18(3):209-215'},{id:"B40",body:'Stull JD, Mangan JJ, Vaccaro AR, Schroeder GD. Robotic guidance in minimally invasive spine surgery: A review of recent literature and commentary on a developing technology. Current Reviews in Musculoskeletal Medicine. 2019;12(2):245-251'},{id:"B41",body:'Kim HJ, Lee SH, Chang BS, Lee CK, Lim TO, Hoo LP, et al. Monitoring the quality of robot-assisted pedicle screw fixation in the lumbar spine by using a cumulative summation test. Spine. 2015;40(2):87-94'},{id:"B42",body:'Fan Y, Du J, Zhang J, Liu S, Xue X, Huang Y, et al. Comparison of accuracy of pedicle screw insertion among 4 guided technologies in spine surgery. Medical Science Monitor. 2017;23:5960-5968'},{id:"B43",body:'Marcus HJ, Cundy TP, Nandi D, Yang GZ, Darzi A. Robot-assisted and fluoroscopy-guided pedicle screw placement: A systematic review. European Spine Journal. 2014;23(2):291-297'},{id:"B44",body:'Knez D, Likar B, Pernus F, Vrtovec T. Computer-assisted screw size and insertion trajectory planning for pedicle screw placement surgery. IEEE Transactions on Medical Imaging. 2016;35(6):1420-1430'},{id:"B45",body:'Knez D, Nahle IS, Vrtovec T, Parent S, Kadoury S, editors. Computer-assisted pedicle screw placement planning: Towards clinical practice. In: 2018 IEEE 15th International Symposium on Biomedical Imaging (ISBI 2018); 4-7 April 2018'},{id:"B46",body:'Vijayan R, De Silva T, Han R, Zhang X, Uneri A, Doerr S, et al. Automatic pedicle screw planning using atlas-based registration of anatomy and reference trajectories. Physics in Medicine and Biology. 2019'}],footnotes:[],contributors:[{corresp:null,contributorFullName:"Mayank Kaushal",address:null,affiliation:'
Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, USA
Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, USA
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His current research interests are in vivo/in silico cardiac electrophysiology and optimization of device-based arrhythmia therapy. His collaborations include projects such as research on atrioventricular conduction in atrial fibrillation and pacemaker-based non-pharmacological rate control, avoidance of phrenic nerve stimulation during cardiac resynchronization therapy, use of remote monitoring to predict adverse events in patients with implanted defibrillators, and an international effort to investigate factors affecting utilization of cardiac resynchronization therapy in Europe. Currently he is a cardiovascular diseases fellow at the Hospital of St. Raphael (New Haven, CT, USA). 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Voino-Yasenetsky Krasnoyarsk State Medical University. She is also the Head of the Russian-Italian laboratory of Medical Genetics MAGI and the Chairman of the executive committee “Young Cardiologists” of the Russian Society of Cardiology.",institutionString:null,institution:{name:"Krasnoyarsk State Medical University",institutionURL:null,country:{name:"Russia"}}},{id:"71165",title:"Dr.",name:"Vladimir",surname:"Shulman",slug:"vladimir-shulman",fullName:"Vladimir Shulman",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Krasnoyarsk State Medical University",institutionURL:null,country:{name:"Russia"}}},{id:"71993",title:"Dr.",name:"Hanan",surname:"Azzam",slug:"hanan-azzam",fullName:"Hanan Azzam",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"106099",title:"Dr.",name:"Pavel",surname:"Shesternya",slug:"pavel-shesternya",fullName:"Pavel Shesternya",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Kursk State Medical University",institutionURL:null,country:{name:"Russia"}}}]},generic:{page:{slug:"partnerships",title:"Partnerships",intro:"
IntechOpen has always supported new and evolving ideas in scholarly publishing. We understand the community we serve, but to provide an even better service for our IntechOpen Authors and Academic Editors, we have partnered with leading companies and associations in the scientific field and beyond.
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ALPSP
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The Association of Learned and Professional Society Publishers (ALPSP) is the largest association of scholarly and professional publishers in the world. Its mission is to connect, inform, develop and represent the international scholarly and professional publishing community. IntechOpen has been a member of ALPSP since 2016 and has consequently stayed informed about industry trends through connecting with peers and developing jointly.
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OASPA
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The Open Access Scholarly Publishers Association (OASPA) was established in 2008 to represent the interests of Open Access (OA) publishers globally in all scientific, technical and scholarly disciplines. Its mission is carried out through exchange of information, the setting of standards, advancing models, advocacy, education, and the promotion of innovation.
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STM
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The International Association of Scientific, Technical and Medical Publishers (STM) is the leading global trade association for academic and professional publishers. As a member, IntechOpen has not only made a commitment to STM's Ethical Principles.
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COPE
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The Committee on Publication Ethics (COPE) provides advice to editors and publishers on all aspects of publication ethics and, in particular, how to handle cases of misconduct in research and publication. IntechOpen has been a member of COPE since 2013 and adheres to the COPE Code of Conduct and Best Practice Guidelines, ensuring that we maintain the highest ethical standards.
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Creative Commons
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Creative Commons (CC) is a nonprofit organization that enables the sharing and use of creativity and knowledge through free legal tools. IntechOpen uses the CC BY 3.0 license for chapters, meaning Authors retain copyright and their work can be reused and adapted as long as the source is properly cited and Authors are acknowledged.
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Crossref
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Crossref is the official Digital Object Identifier (DOI) Registration Agency for scholarly and professional publications with a goal of making scholarly communications more effective. IntechOpen deposits metadata and registers DOIs for all content using the Crossref System. IntechOpen also deposits its references and uses the Crossref Cited-by service that enables researchers to track citation statistics.
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Altmetric and Dimensions from Digital Science
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Digital Science is a technology company serving the needs of scientific and research communities at key points along the full cycle of research. They support innovative businesses and technologies that make all parts of the research process more open, efficient and effective. IntechOpen integrates tools such as Altmetric to enable our researchers to track and measure the activity around their academic research and Dimensions, to ease access to the most relevant information and better understand and analyze the global research landscape.
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CLOCKSS
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CLOCKSS preserves scholarly publications in original formats, ensuring that they always remain available and openly accessible to everyone.
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Counter
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COUNTER provides the Code of Practice that enables publishers and vendors to report usage of their electronic resources in a consistent way. This enables libraries to compare data received from different publishers and vendors.
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DORA
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DORA is a worldwide initiative covering all scholarly disciplines which recognizes the need to improve the ways in which the outputs of scholarly research are evaluated and seeks to develop and promote best practice. To date it has been signed by over 1500 organizations and around 14,700 individuals.
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iThenticate
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iThenticate is the leading provider of professional plagiarism detection and prevention technology and is used worldwide by scholarly publishers and research institutions to ensure the originality of written work before publication. IntechOpen uses the iThenticate plagiarism software to ensure content originality and the research integrity of our published work.
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Enago
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IntechOpen collaborates with Enago, through its sister brand, Ulatus, one of the world’s leading providers of book translation services. Their services are designed to convey the essence of your work to readers from across the globe in the language they understand.
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IntechOpen Authors that wish to use this service will receive a 20% discount on all translation services. To find out more information or obtain a quote, please visit https://www.enago.com/intech
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SPi Global
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SPi Global is the market leader in technology-driven solutions for the extraction, enrichment and transformation of content assets. IntechOpen publishing services are designed to meet the unique needs of Authors. As part of our commitment to that objective, we have an ongoing partnership agreement for production solutions.
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Amazon
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Amazon is the world’s largest online retailer and cloud services provider. IntechOpen books have been available on Amazon since 2017, guaranteeing more visibility for our Authors and Academic Editors.
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DHL
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IntechOpen has partnered with DHL since 2011 to ensure the fastest delivery of Print on Demand books.
The Association of Learned and Professional Society Publishers (ALPSP) is the largest association of scholarly and professional publishers in the world. Its mission is to connect, inform, develop and represent the international scholarly and professional publishing community. IntechOpen has been a member of ALPSP since 2016 and has consequently stayed informed about industry trends through connecting with peers and developing jointly.
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\n\n
OASPA
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\n\t
The Open Access Scholarly Publishers Association (OASPA) was established in 2008 to represent the interests of Open Access (OA) publishers globally in all scientific, technical and scholarly disciplines. Its mission is carried out through exchange of information, the setting of standards, advancing models, advocacy, education, and the promotion of innovation.
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\n\n
STM
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\n\t
The International Association of Scientific, Technical and Medical Publishers (STM) is the leading global trade association for academic and professional publishers. As a member, IntechOpen has not only made a commitment to STM's Ethical Principles.
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\n\n
COPE
\n\n
\n\t
The Committee on Publication Ethics (COPE) provides advice to editors and publishers on all aspects of publication ethics and, in particular, how to handle cases of misconduct in research and publication. IntechOpen has been a member of COPE since 2013 and adheres to the COPE Code of Conduct and Best Practice Guidelines, ensuring that we maintain the highest ethical standards.
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Creative Commons
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\n\t
Creative Commons (CC) is a nonprofit organization that enables the sharing and use of creativity and knowledge through free legal tools. IntechOpen uses the CC BY 3.0 license for chapters, meaning Authors retain copyright and their work can be reused and adapted as long as the source is properly cited and Authors are acknowledged.
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\n\n
Crossref
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\n\t
Crossref is the official Digital Object Identifier (DOI) Registration Agency for scholarly and professional publications with a goal of making scholarly communications more effective. IntechOpen deposits metadata and registers DOIs for all content using the Crossref System. IntechOpen also deposits its references and uses the Crossref Cited-by service that enables researchers to track citation statistics.
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\n\n
Altmetric and Dimensions from Digital Science
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\n\t
Digital Science is a technology company serving the needs of scientific and research communities at key points along the full cycle of research. They support innovative businesses and technologies that make all parts of the research process more open, efficient and effective. IntechOpen integrates tools such as Altmetric to enable our researchers to track and measure the activity around their academic research and Dimensions, to ease access to the most relevant information and better understand and analyze the global research landscape.
\n
\n\n
CLOCKSS
\n\n
\n\t
CLOCKSS preserves scholarly publications in original formats, ensuring that they always remain available and openly accessible to everyone.
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\n\n
Counter
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\n\t
COUNTER provides the Code of Practice that enables publishers and vendors to report usage of their electronic resources in a consistent way. This enables libraries to compare data received from different publishers and vendors.
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DORA
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DORA is a worldwide initiative covering all scholarly disciplines which recognizes the need to improve the ways in which the outputs of scholarly research are evaluated and seeks to develop and promote best practice. To date it has been signed by over 1500 organizations and around 14,700 individuals.
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iThenticate
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iThenticate is the leading provider of professional plagiarism detection and prevention technology and is used worldwide by scholarly publishers and research institutions to ensure the originality of written work before publication. IntechOpen uses the iThenticate plagiarism software to ensure content originality and the research integrity of our published work.
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Enago
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\n\t
IntechOpen collaborates with Enago, through its sister brand, Ulatus, one of the world’s leading providers of book translation services. Their services are designed to convey the essence of your work to readers from across the globe in the language they understand.
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IntechOpen Authors that wish to use this service will receive a 20% discount on all translation services. To find out more information or obtain a quote, please visit https://www.enago.com/intech
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SPi Global
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SPi Global is the market leader in technology-driven solutions for the extraction, enrichment and transformation of content assets. IntechOpen publishing services are designed to meet the unique needs of Authors. As part of our commitment to that objective, we have an ongoing partnership agreement for production solutions.
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Amazon
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Amazon is the world’s largest online retailer and cloud services provider. IntechOpen books have been available on Amazon since 2017, guaranteeing more visibility for our Authors and Academic Editors.
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DHL
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\n\t
IntechOpen has partnered with DHL since 2011 to ensure the fastest delivery of Print on Demand books.
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I am also a member of the team in charge for the supervision of Ph.D. students in the fields of development of silicon based planar waveguide sensor devices, study of inelastic electron tunnelling in planar tunnelling nanostructures for sensing applications and development of organotellurium(IV) compounds for semiconductor applications. I am a specialist in data analysis techniques and nanosurface structure. 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After obtaining a Master's degree in Mechanical Engineering, he continued his PhD studies in Robotics at the Vienna University of Technology. Here he worked as a robotic researcher with the university's Intelligent Manufacturing Systems Group as well as a guest researcher at various European universities, including the Swiss Federal Institute of Technology Lausanne (EPFL). During this time he published more than 20 scientific papers, gave presentations, served as a reviewer for major robotic journals and conferences and most importantly he co-founded and built the International Journal of Advanced Robotic Systems- world's first Open Access journal in the field of robotics. Starting this journal was a pivotal point in his career, since it was a pathway to founding IntechOpen - Open Access publisher focused on addressing academic researchers needs. Alex is a personification of IntechOpen key values being trusted, open and entrepreneurial. Today his focus is on defining the growth and development strategy for the company.",institutionString:null,institution:{name:"TU Wien",country:{name:"Austria"}}},{id:"19816",title:"Prof.",name:"Alexander",middleName:null,surname:"Kokorin",slug:"alexander-kokorin",fullName:"Alexander Kokorin",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/19816/images/1607_n.jpg",biography:"Alexander I. Kokorin: born: 1947, Moscow; DSc., PhD; Principal Research Fellow (Research Professor) of Department of Kinetics and Catalysis, N. Semenov Institute of Chemical Physics, Russian Academy of Sciences, Moscow.\r\nArea of research interests: physical chemistry of complex-organized molecular and nanosized systems, including polymer-metal complexes; the surface of doped oxide semiconductors. He is an expert in structural, absorptive, catalytic and photocatalytic properties, in structural organization and dynamic features of ionic liquids, in magnetic interactions between paramagnetic centers. The author or co-author of 3 books, over 200 articles and reviews in scientific journals and books. He is an actual member of the International EPR/ESR Society, European Society on Quantum Solar Energy Conversion, Moscow House of Scientists, of the Board of Moscow Physical Society.",institutionString:null,institution:{name:"Semenov Institute of Chemical Physics",country:{name:"Russia"}}},{id:"62389",title:"PhD.",name:"Ali Demir",middleName:null,surname:"Sezer",slug:"ali-demir-sezer",fullName:"Ali Demir Sezer",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/62389/images/3413_n.jpg",biography:"Dr. Ali Demir Sezer has a Ph.D. from Pharmaceutical Biotechnology at the Faculty of Pharmacy, University of Marmara (Turkey). He is the member of many Pharmaceutical Associations and acts as a reviewer of scientific journals and European projects under different research areas such as: drug delivery systems, nanotechnology and pharmaceutical biotechnology. Dr. Sezer is the author of many scientific publications in peer-reviewed journals and poster communications. Focus of his research activity is drug delivery, physico-chemical characterization and biological evaluation of biopolymers micro and nanoparticles as modified drug delivery system, and colloidal drug carriers (liposomes, nanoparticles etc.).",institutionString:null,institution:{name:"Marmara University",country:{name:"Turkey"}}},{id:"61051",title:"Prof.",name:"Andrea",middleName:null,surname:"Natale",slug:"andrea-natale",fullName:"Andrea Natale",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"100762",title:"Prof.",name:"Andrea",middleName:null,surname:"Natale",slug:"andrea-natale",fullName:"Andrea Natale",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"St David's Medical Center",country:{name:"United States of America"}}},{id:"107416",title:"Dr.",name:"Andrea",middleName:null,surname:"Natale",slug:"andrea-natale",fullName:"Andrea Natale",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Texas Cardiac Arrhythmia",country:{name:"United States of America"}}},{id:"64434",title:"Dr.",name:"Angkoon",middleName:null,surname:"Phinyomark",slug:"angkoon-phinyomark",fullName:"Angkoon Phinyomark",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/64434/images/2619_n.jpg",biography:"My name is Angkoon Phinyomark. I received a B.Eng. degree in Computer Engineering with First Class Honors in 2008 from Prince of Songkla University, Songkhla, Thailand, where I received a Ph.D. degree in Electrical Engineering. My research interests are primarily in the area of biomedical signal processing and classification notably EMG (electromyography signal), EOG (electrooculography signal), and EEG (electroencephalography signal), image analysis notably breast cancer analysis and optical coherence tomography, and rehabilitation engineering. I became a student member of IEEE in 2008. During October 2011-March 2012, I had worked at School of Computer Science and Electronic Engineering, University of Essex, Colchester, Essex, United Kingdom. In addition, during a B.Eng. I had been a visiting research student at Faculty of Computer Science, University of Murcia, Murcia, Spain for three months.\n\nI have published over 40 papers during 5 years in refereed journals, books, and conference proceedings in the areas of electro-physiological signals processing and classification, notably EMG and EOG signals, fractal analysis, wavelet analysis, texture analysis, feature extraction and machine learning algorithms, and assistive and rehabilitative devices. I have several computer programming language certificates, i.e. Sun Certified Programmer for the Java 2 Platform 1.4 (SCJP), Microsoft Certified Professional Developer, Web Developer (MCPD), Microsoft Certified Technology Specialist, .NET Framework 2.0 Web (MCTS). 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