IntechOpen Book Series will also publish a program of research-driven Thematic Edited Volumes that focus on specific areas and allow for a more in-depth overview of a particular subject.
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IntechOpen Book Series will be launching regularly to offer our authors and editors exciting opportunities to publish their research Open Access. We will begin by relaunching some of our existing Book Series in this innovative book format, and will expand in 2022 into rapidly growing research fields that are driving and advancing society.
With the desire to make book publishing more relevant for the digital age and offer innovative Open Access publishing options, we are thrilled to announce the launch of our new publishing format: IntechOpen Book Series.
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Designed to cover fast-moving research fields in rapidly expanding areas, our Book Series feature a Topic structure allowing us to present the most relevant sub-disciplines. Book Series are headed by Series Editors, and a team of Topic Editors supported by international Editorial Board members. Topics are always open for submissions, with an Annual Volume published each calendar year.
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After a robust peer-review process, accepted works are published quickly, thanks to Online First, ensuring research is made available to the scientific community without delay.
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Our innovative Book Series format brings you:
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Topic Focused Publications - Each topic showcases high impact subject areas
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Renowned Editorial Expertise - Series Editors, Topic Editors, and a team of international Board Members that permanently support each Book Series
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Fast Publishing - quick turnaround which is unique for book publishing
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The benefit of ISSN and ISBN for increased citation and indexing possibilities
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IntechOpen Book Series will also publish a program of research-driven Thematic Edited Volumes that focus on specific areas and allow for a more in-depth overview of a particular subject.
\n\n
IntechOpen Book Series will be launching regularly to offer our authors and editors exciting opportunities to publish their research Open Access. We will begin by relaunching some of our existing Book Series in this innovative book format, and will expand in 2022 into rapidly growing research fields that are driving and advancing society.
We invite you to explore our IntechOpen Book Series, find the right publishing program for you and reach your desired audience in record time.
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Note: Edited in October 2021
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PID control effectiveness is usually caused by the nature of dynamical processes, conditioned that the majority of the industrial dynamical processes are well described by simple dynamic model of the first or second order. The efficacy of PID controllers vastly falls in case of complicated dynamics, nonlinearities, and varying parameters of the plant. This gives a pulse to further researches in the field of PID control. Consequently, the problems of advanced PID control system design methodologies, rules of adaptive PID control, self-tuning procedures, and particularly robustness and transient performance for nonlinear systems, still remain as the areas of the lively interests for many scientists and researchers at the present time. 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1. Introduction
EEG was first described as a promise to provide a “window into the brain” in 1929 by Hans Berger [1]. In spite of recent advances, the analytic potential of EEG has not been fully employed. On the other hand, brain function studies and neuroimaging methods have been deeply improved, severely discrediting EEG use. However, it is important to insist that EEG can give relevant information about topography of cerebral activity, even if it is difficult to have topographic information with a conventional EEG recording.
EEG recording is based on two-dimensional representation of potential differences between two electrodes in function of time and topographic information is based on integration of information across different channels [2].
Introduction of digital EEG techniques not only displays the EEG tracing but can provide additional measurement with quantitative EEG (QEEG), also called “EEG brain mapping”.
The use of EEG brain mapping is based on visualisation of coloured brain maps generated by digital analysis of cerebral electrical activity. These maps display many features that can be instantaneous of an averaged period of time. The cerebral maps include topographic displays of voltage, frequencies, power and statistical analysis with comparison with a normal reference population.
Still nowadays the clinical utility of QEEG techniques remains a controversial matter so that it could be considered as a useful tool, but also as a dangerous toy.
2. Short history of EEG spatial analysis
EEG is traditionally analysed in terms of temporal waveforms at different channels, looking at power of rhythms in terms of frequency, latency of peaks or presence of particular grapho-elements. This type of traditional EEG analysis provides important insights about brain functioning in health subjects and diseases that interfere with electric brain activity, even if it cannot be considered as an imaging method.
Numerical analysis of cerebral activity was started as early as the 1930s by Dietsch [3], followed by Grass and Gibbs [4] and Drohocki [5] who applied Fourier analysis to disassemble EEG signal. Successively, in 1943, Walter [6] described an automatic analogue frequency analyser and later in 1951 Walter and Shipton [7] developed an automated topographic display called “toposcope”.
With the development of microcomputers with colour graphic Duffy [8, 9] and many other researchers improved techniques for brain electrical activity mapping, EEG quantification and topographic analysis. Researchers as Lehmann directed their studies to the analysis of specific EEG spike–wave patterns, analysis of topography of a particular EEG feature at an instant time or the average of a recurring event [10].
3. General principles of EEG brain maps
EEG brain maps are produced using from 16 to 32 electrodes arranged in a grid pattern of human scalp, giving a spatial resolution of about 6 cm [11] (see Figure 1).
Figure 1.
Example of brain mapping in a traditional EEG showing absence of anomalies.
Brain maps are sensitive to the quality of data acquisition of the EEG in terms of montages, references, control settings or biological factors (such as medications, clinical problems or level of awareness), which must be considered in every cases before interpreting the data.
In fact, as Duffy himself has written “brain map without the EEG is blind” [12].
Cerebral maps are produced by a process of interpolation between the electrode sites. There are several methods of interpolation and still nowadays it is an object of controversy.
The use of EEG quantification, for example by spectral analysis, gives the possibility to reduce data and describe a long record by few numerical data. These data may be subjected to statistical analyses including visual EEG interpretation or clinical decision-making.
Recent development in the quantitative analysis of complex networks by using computer graphics has increased the availability of brain mapping, contributing to a renewed interest in quantitative investigations of EEG and it has been rapidly translated to studies of brain network organisation [13]. This is a welcome development, but the problem of mapping lies not so much in the method itself, particularly by uninformed users who can see cerebral maps as a neuroimaging technique.
But, instead, mapping systems must be operated by EEG certified neurologist expertise in the use of brain mapping [14].
4. Problems related to use of EEG mapping
One of the major problems of the brain maps is that similarity of brain mapping to classical neuroimaging techniques (CT, MRI or PET scans) is illusory. In classical neuroimaging techniques there is a direct and close correspondence between the image and the affected structure. On the contrary, in the case of topographic changes in electrical activity, there is a more complex relationship to function and cerebral pathology.
Cerebral maps could be easily misinterpreted. In fact, the selection of what to map is at the discretion of the user, there aren’t clear standards and interpretation is strongly subjective.
Maps do not distinguish between cerebral potentials and artefacts or between the feature of interest and a superimposed activity with different topography. Consequently, it is essential that users analyse with attention the trace recorded before plotting cerebral maps.
Another problem of quantitative EEG analysis is to determine the best method of deriving the signal to be analysed. Common reference derivation seems be the obvious choice. However asymmetrical activity involving ears reference is particularly open to misinterpretation so that asymmetries in alpha activity may be shown as reversed [15]. A paradox of EEG mapping is that when a focal activity occurs at or near the reference, the deflections produced are greatest on channels recording from the most distant electrodes [16]. This effect is particularly liable to misinterpretation in spectral maps: thus focal temporal delta activity may be misallocated to the contralateral central region [17].
5. General applications of EEG mapping
EEG topographic analysis could be useful in many neurological diseases as cerebrovascular diseases, degenerative encephalopathies, demyelinating diseases, head injuries, headache and study of different cognitive disorders (such as learning and attention disorders) or psychiatric pathologies.
In cerebrovascular disease EEG quantitative parameters are highly correlated with regional blood flow and regional cerebral metabolism. When used by neurologist expertise in EEG interpretation, EEG mapping could be used for detection of focal ischemia related to a cerebral impairment [18]. However, EEG anatomical localization is inferior to that found with conventional neuroradiological techniques as CT or MRI that remain the examinations of choice. Moreover, EEG quantitative changes are unable to differentiate a cerebral infarction from an haemorrhage, a tumour or another focal cerebral lesion [19]. Conventional EEG remains indicated in patients with cerebrovascular problems as possible seizures or coma. Intraoperative EEG quantitative analysis, as frequency analysis, could be used in patients who undergo carotid endarterectomy, during surgical procedure to identify or better measure changes in electrical brain activity [20].
In neurological degenerative pathologies as dementia, EEG quantitative analysis is useful in detecting focal or generalised slowing that strongly suggest an organic basis rather than a depressive condition [21]. EEG frequency analysis cannot distinguish between the types of dementias, but EEG waves patterns are highly suggestive of certain dementing disorders. The degree of EEG frequency analysis abnormality corresponds to the degree of dementia and disease progression so that it has been experimentally used to separate normal controls from patients with mild–moderate Alzheimer disease [22]. EEG spatial analysis conducted on patients with Alzheimer disease has showed decreased duration and increased number of microstates [23]. Quantitative EEG in expert hands could also be useful in evaluation of certain patients with dementia whose neuroimaging and routine EEG studies are not conclusive.
In patients with demyelinating disease as multiple sclerosis, studies of topographic analysis of multichannel recording of evoked potentials have been directly compared in sensitivity and specificity of values obtained from canonical analysis of individual evoked potentials waveforms [24].
Some studies, reports and retrospective observations have addressed EEG brain mapping techniques in patients with head injury [25]. In a small group of patients with post-concussion syndrome it has been reported an increase in 8 to 10 hz of alpha rhythm [26]. Other reports have confirmed alpha reduction in a much larger group of patients after head injury so that it has been proposed as a prognostic element [27]. In coma patients due to severe head injury, EEG monitoring, with or without frequency analysis, has been shown to predict outcome and able to detect non-convulsive seizures or other complications [28]. Even if EEG brain mapping techniques have reported interesting changes in some studies the results are not sufficient to support its use in diagnosis of patients with minor-moderate head trauma or post-concussive syndrome.
In a study of patients with headache Pechadre et al. [29] have demonstrated that migraineurs have specific findings upon EEG mapping during photo-stimulation, suggesting that neuronal excitability of visual cortex is altered in migraine patients [30].
EEG spatial analysis has been applied in the study of different cognitive disorders such as memory disorders, mechanism of memory formation and retrieval in human patients with amnesia [31] or language disorders such word production in stroke patients with aphasia [32]. EEG spatial analysis has also been applied to study the characteristics of brain function difficulties in children with Attention Deficits and Hyperactivity Disorders (ADHD) to evaluate time processing [33], to predict reading skills [34] or to evaluate treatment efficacy and predict changes in use of grammar in children with specific language disorders [35]. EEG specific patterns have been proposed in children with learning and attention disorders and researchers have proposed a relationship between EEG patterns and outcomes of therapy. EEG brain mapping have not been proven useful in establishing diagnosis or treatment for children with cognitive learning disabilities. Quantitative EEG is not recommended as an exam for diagnosing learning disabilities or attention disorders.
Finally, EEG spatial analysis, in the time as well as in the frequency domain, has been used to characterise different pathological states, particularly related to psychiatric pathologies. EEG analysis can identify slow wave or epileptiform abnormalities, which can occur in intoxication, delirium or other psychiatric disorders [36]. Frequency domain source localization has been used to identify brain regions with altered rhythms in patients with psychiatric disorders [37]. EEG microstate analysis has demonstrated that spatial characteristics of microstates are a sensitive measure of different mental states. For example, schizophrenic patients have a decreased duration and reduced number of some microstates [38] that could change and be normalised with medications [39]. Study of resting state in schizophrenic patients have showed that specific short microstates could be observed during auditory verbal hallucinations [40]. In depression microstates duration was also reduced or some microstates were repeated more frequently [41]. Anxiolytic or antipsychotic drugs as well as meditation or hypnosis can also alter the characteristics of cerebral microstates [42].
6. Applications of brain mapping in epilepsy
The most studied application of spatial EEG analysis is in the study of epilepsy in particular as a method to locate an epileptic focus (see Figure 2) and determine the type of epileptic syndrome [43].
Figure 2.
Example of patient in which traditional electroencephalograms shows a right temporo-parietal epileptiform grapho-elements. TC brain scan shows ipodensity area in right hemisphere, where a cerebral glioma was surgically removed. EEG brain mapping confirms topography of discharges in right hemisphere with prevalence of rhythms in theta band.
Digital spike and seizure detection can help to identify electric cerebral events that might be epileptic spikes even if are frequent false-positive detections. In long-term EEG monitoring records, candidate spikes or seizure events are automatically selected and saved but there is need of a professional visual review and confirmation, especially in recording lasting several days [44].
Automated seizure detection can also identify non-convulsive seizure occurring in intensive care unit patients at risk for such complication [45] or to monitory convulsive status epilepticus in patients requiring neuromuscular blockade [46].
Quantitative analysis of spikes characteristic (as spike dipole analysis) can suggest location of cortical generators, existence of multiple separate spike generators and direction of propagation of spikes especially if this information is combined with visual review of voltage mapping.
These techniques might be useful in non-invasive evaluation of epileptic patient candidate for epilepsy surgery, even if the information obtained with dipole analysis is not mathematically and anatomically precise.
A large number of studies have demonstrated that EEG mapping is a powerful tool to non-invasively localise an epileptic focus. The major advantage in the study of an epileptic focus localization compared to other neuro-functional conventional studies (such as fMRI or PET) is the high temporal resolution that allows for separating initiation from rapid propagation of epileptic activity.
The localization of epileptogenic foci with EEG mapping has been found in particular in mesial temporal lesions [47].
Sperli et al. [48], after EEG imaging analysis on 30 operated and seizure free children, reported correct localization of epileptic focus on a lobar level in 90% of cases. In another study, Michel et al. [49] showed 79% localization precision on a sublobar level. In a study conducted by Brodbeck et al. [50] were analysed 10 operated patients with normal MRI in which EEG spatial analysis showed in 8 of them correct localization within the resect margin. In a study conducted by Zumsteg et al. [51] in 2005, based on the analysis in 15 patients with mesial temporal lobe epilepsy the authors compared EEG imaging obtained by cortical electrodes with simultaneously recorded data from foramen ovale electrodes. They showed that 14 of the 19 patterns seen by foramen ovale electrodes could be correctly identified with source imaging, indicating that even mesial temporal sources can be recorded by scalp EEG as also previously demonstrated by Lantz et al. [52] in simultaneous cortical and intracranial EEG recording. Brodbeck et al. [53] were also able to localise correctly spike activity within the resected zone in 12 of 14 patients with large cerebral lesions.
Regional or focal EEG slowing has long been valued to help to lateralize an epileptic focus that might be overlooked by a routine visual evaluation [54].
Brain mapping techniques may highlight to characteristics not obvious to the observer, drawing attention to particular features of a transient event. Clinical examples of applications in epilepsy include the mid-frontal positivity of typical Rolandic spike in benign childhood epilepsy [55]. In Benign Rolandic Epilepsy in Childhood (BREC) quantitative spike voltage analysis has been demonstrated to be useful in determining field complexity and dipole model stability and differentiating “typical” from “atypical” forms, a distinction with prognostic and therapeutic significance [56].
Some quantitative EEG techniques are useful to differentiate primary generalised discharges from secondary bilateral synchrony by looking for interhemispheric small time differences during spike–wave activity and the characteristic distribution of maximal activity [57]. This analysis could be useful to choose the best antiepileptic drug as well as pre-surgical localization of epileptic focus. This potential application has not been clearly demonstrated to be used in general clinical use.
Data manipulations used to enhance isopotential maps and mapping of averages have been used to show subtle features and pattern of propagations [55].
In a retrospective study conducted on 152 operated patients Brodbeck et al. [58] showed that EEG source imaging has a sensitivity of 84% and a specificity of 88% if the EEG is recorded with a large number of electrodes, 128–256 channels and the individual MRI is used as head model. The obtained values resulted comparable to those of structural MRI, PET and ictal-interictal PET. Specificity and sensitivity of EEG mapping and source imaging decreased significantly with use of a low number of electrodes (<32) and a template of head model. On the bases of this study authors concluded that EEG source imaging analysis should be used as standard tool in pre-surgical evaluation of epileptic patients, especially in consideration of its low costs and high flexibility if compared to other imaging methods. However, caution must be exercised since erroneous localizations could occur even for experienced users for the simplified spherical head model commonly used [59].
On the bases of the promising studies above illustrated, Plummer et al. [60] realised a comprehensive review proposing EEG source imaging as a routine work-up of patients with localization-related epilepsy, but concluded that a prospective validation study conducted on larger patients is still required.
EEG imaging has also been demonstrated to be useful in epileptic focus localization in combination with functional MRI. A series of studies conducted to evaluate spike-related analysis have revealed that the temporal resolution of EEG source imaging helps to identify spike-related BOLD responses that correspond to start of epileptic discharge [61, 62, 63].
Grouiller et al. [64] conducted a study in which they used EEG topographic analysis to help to analyse fMRI data of epileptic patients that had no spike in the scanner or no-related BOLD responses. In this study they used the average spike-map of EEG recorded during a long-term monitoring and demonstrated that 78% of the otherwise inconclusive fMRI studies could nonetheless be interpreted.
7. Conclusions
EEG analysis in recent times has moved from the traditional analysis of grapho-elements to a comprehensive study of brain’s electric fields at the scalp.
Quantitative EEG provides more information than visual inspection of traditional EEG used for routine in neurology practice.
Quantitative EEG or other EEG brain mapping techniques cannot diagnose whether a patient has epilepsy but is useful to give additional information in epileptic patients for screening of spikes or possible epileptic spikes in long term EEG monitoring.
EEG spatial analysis is not only a synonymous of source localization but a new insight in brain functioning obtained just analysing the spatial changes of the scalp potential maps over time principally based on the quantitative analysis of EEG waveforms in terms of frequency and amplitude.
Given to the flexibility, non-invasively, easy use and cost-effectiveness EEG mapping is a powerful and interesting brain imaging device that can be easily combined with other traditional imaging techniques.
The potential use of this technique has limitations since quality of EEG mapping depends on the raw data inputs and lack of universally valid normative data due to inter-individual variability of EEG.
The problem of inter-individual variability is reduced with computer-assisted analysis of EEG even if more engineering and analysis tools are still needed to better develop this technique that can be actually used only by physicians highly skilled in clinical EEG and in conjunction with traditional EEG.
\n',keywords:"brain mapping, epilepsy, quantitative EEG, QEEG, brain maps, digital EEG, EEG spatial analysis, spike detection, spike analysis, seizure detection, epileptic focus, focus localization",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/74381.pdf",chapterXML:"https://mts.intechopen.com/source/xml/74381.xml",downloadPdfUrl:"/chapter/pdf-download/74381",previewPdfUrl:"/chapter/pdf-preview/74381",totalDownloads:344,totalViews:0,totalCrossrefCites:0,totalDimensionsCites:0,totalAltmetricsMentions:0,introChapter:null,impactScore:0,impactScorePercentile:31,impactScoreQuartile:2,hasAltmetrics:0,dateSubmitted:"August 14th 2020",dateReviewed:"November 24th 2020",datePrePublished:"December 10th 2020",datePublished:"April 28th 2021",dateFinished:"December 10th 2020",readingETA:"0",abstract:"EEG brain mapping is a neurophysiological technique based on computer-assisted analysis of conventional EEG. This technique, generally consisting in quantitative analysis of EEG (QEEG), includes topographic displays of frequency or voltage, statistical comparison to normal values and discriminant analysis. QEEG assessment still remains controversy about its clinical role. QEEG topographic analysis could be useful in many neurological diseases: in cerebrovascular disease EEG analysis is useful since EEG parameters are highly correlates with regional blood and metabolism; in degenerative disease (as dementia or encephalopathies) quantitative EEG frequency analysis could suggest an organic base of the disorder even if it is not able to distinguish between the types of dementia. QEEG techniques are also potentially useful in identifying anomalies in patients with cerebral trauma or in children with cognitive disorders. In the field of epilepsy EEG brain mapping could help clinics to detect spikes, locate an epileptic focus and suggest the type of epilepsy. In this chapter author describes principles of EEG brain mapping and its potential applications in particular in the epileptic field.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/74381",risUrl:"/chapter/ris/74381",book:{id:"9519",slug:"epilepsy-update-on-classification-etiologies-instrumental-diagnosis-and-treatment"},signatures:"Sandro Misciagna",authors:[{id:"103586",title:null,name:"Sandro",middleName:null,surname:"Misciagna",fullName:"Sandro Misciagna",slug:"sandro-misciagna",email:"sandromisciagna@yahoo.it",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/103586/images/system/103586.jpg",institution:{name:"Ospedale di Belcolle",institutionURL:null,country:{name:"Italy"}}}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Short history of EEG spatial analysis",level:"1"},{id:"sec_3",title:"3. General principles of EEG brain maps",level:"1"},{id:"sec_4",title:"4. Problems related to use of EEG mapping",level:"1"},{id:"sec_5",title:"5. General applications of EEG mapping",level:"1"},{id:"sec_6",title:"6. Applications of brain mapping in epilepsy",level:"1"},{id:"sec_7",title:"7. Conclusions",level:"1"}],chapterReferences:[{id:"B1",body:'Berger H. Uber das Elektrenkephalogramm des Menschen. Archiv für Psychiatrie und Nervenkrankheiten. 1929;87:527-570'},{id:"B2",body:'Acharya JN, Acharya VJ. Overview of EEG montages and principles of localization. Journal of Clinical Neurophysiology. 2019 Sep;36(5):325-329'},{id:"B3",body:'Dietsch G. Fourier-analyser von Elektencephalogrammen des Menschen. Arch ges Physiol. 1932;230:106-112'},{id:"B4",body:'Grass AM, Gibbs FA. Fourier bandform of the electroencephalogram. Journal of Neurophysiology. 1937;1:521-526'},{id:"B5",body:'Drohocki Z. L’electrospectrographie du cerveau. CR Soc Biol. 1938;129:889-893'},{id:"B6",body:'Walter WG. An automatic low frequency analyser. 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Equivalent dipole modelling-a new EEG method for localisation of epileptogenic foci. In: Pedley TA, Meldrum BS, editors. Current problems in epilepsy. Edinburgh: Churchill Livingstone; 1992. pp. 51-71'},{id:"B48",body:'Sperli F, Spinelli L, Seeck M, Kurian M, Michel CM, Lantz G. EEG source imaging in paediatric epilepsy surgery. A new perspective in presurgical workup. Epilepsia. 2006;47:981-990'},{id:"B49",body:'Michel CM, Lantz G, Spinelli L, De Peralta RG, Landis T, Seek M. 128-channel EEG source imaging in epilepsy. Clinical yield and localization precision. Journal of Clinical Neurophysiology. 2004;21:71-83'},{id:"B50",body:'Brodbeck V, Spinelli L, Lascano AM, Pollo C, Schaller K, Vargas MI, et al. Electrical source imaging for presurgical focus localization in epilepsy patients with normal MRI. Epilepsia. 2010;51:583-591'},{id:"B51",body:'Zumsteg D, Friedman A, Wennberg RA, Wieser HG. 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Comparisons of MEG, EEG, and ECoG source localization in neocortical partial epilepsy in humans. Electroencephalography and Clinical Neurophysiology. 1994;91:171-117'},{id:"B60",body:'Plummer C, Harvey AS, Cook M. EEG source localization in focal epilepsy: Where are we now? Epilepsia. 2008;49:201-218'},{id:"B61",body:'Groening K, Brodbeck V, Moeller F, Wolff S, van Baalen A, Michel CM, et al. Combination of EEG-fMRI and EEG source analysis improves interpretation of spike-associated activation networks in paediatric pharmacoresistent focal epilepsies. NeuroImage. 2009;46:827-833'},{id:"B62",body:'Siniatchkin M, Groening K, Moehring J, Moeller F, Boor R, Brodbeck V, et al. Lemieux l, Stephani U. neuronal networks in children with continuous spikes and waves during slow sleep. Brain. 2010;133:2798-2813'},{id:"B63",body:'Vulliemoz S, Lemieux L, Daunizeau J, Michel CM, Duncan JS. The combination of EEG source imaging and EEG-correlated functional MRI to map epileptic networks. 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1. Introduction
Bronchopleural fistula (BPF) is defined as a central fistulous connection of inspired air between trachea, major, lobar, or segmental bronchus into the pleural space [1, 2]. Or a BPF can occur peripherally when there are connections between the distal segmental bronchus or lung parenchyma and the pleural space [1, 2]. Although rare, managing a BPF is challenging and represents a high morbidity and mortality.
2. Etiology
After an anatomical lung resection, a BPF is rare but severe complications can occur and may be fatal. The BPF incidence after a pneumonectomy for lung cancer is between 4.5% and 20% and 0.5–1% after a lobectomy [1, 3, 4]. The mortality rate after a pneumonectomy is estimated to be 18–71% with a much lower rate for lobectomy [2, 4]. The pleural space is exposed to the endobronchial bacterial flora with the pleural effusion leaking into the major airway and into the peripheral alveolar space. The main cause of death is aspiration pneumonia, empyema, and subsequent respiratory distress [4, 5]. Treatment for BPF after surgery requires emergency treatment due to patient’s lung volume loss and short-term poor respiratory function with surgical damage to the respiratory muscles [5].
The less common causes of BPF include suppurative lung processes such as septic pulmonary emboli, infected pulmonary infarctions, or tuberculosis [6]. Neoplasms with tumor invasion into the pleural space may also lead to BPF. Iatrogenic etiologies due to complications with chest tube insertion, thoracentesis or lung biopsies may result in BPF [6].
When considering different surgical approaches and incidence of BPF, one study evaluated the Society of Thoracic Surgeons and General Thoracic Surgery Database (STS-GTD) to compare outcomes of video-assisted thoracoscopic surgery (VATS) and robotic-assisted lobectomy (RATS) for primary clinical stage I or II non-small cell lung cancer (NSCLC) at high volume centers from 2009 to 2013. This study identified 1,220 RATS and 12,378 VATS patients. The incidence of BPF between these two groups was not statistically significant (0.6% vs. 0.3%, p = 0.08) [7]. Another study that included 737 cases of VATS lobectomies and 748 cases of open lobectomies for the surgical treatment of resectable non-small cell lung cancer showed no statistical difference in incidence of BPF postoperatively [8].
3. Risk factors
Certain anatomic, technical, and patient factors lead to increased risk for BPF (Table 1). Generally, right-sided pneumonectomy is associated with high risk of BPF. Devascularization of the bronchial stump, diabetes, malnutrition, steroids, neoadjuvant chemoradiotherapy, stump closure, residual carcinomatous tissue, presence of empyema and postoperative mechanical ventilation all lead to increased risk of bronchial stump dehiscence [9, 10].
Anatomic Factors Right pneumonectomy Technical Factors Devascularization of bronchial stump Long bronchial stump Stump closure Residual carcinoma at bronchial margin Patient Factors Preoperative radiotherapy Presence of empyema Postoperative mechanical ventilation Diabetes Chronic Steroid Use Nutritional status
Table 1.
Risk factors for bronchopleural fistula after pulmonary resection.
3.1 Right sided surgery and right pneumonectomy
Generally, right-side pneumonectomy and right lower lobectomy are associated with high risk of BPF and are multifactorial. The right upper pulmonary artery is made up of the apical, anterior, and posterior ascending branches [11]. The apical and anterior branches are located in the front of the hilum and the posterior is located at the posterior segment of the horizontal fissure [11]. The right lower pulmonary artery is divided into the dorsal and basilar segment and is located at the corresponding position of the posterior ascending branch in the horizontal fissure [11]. This single bronchial artery supplies the entire right mainstem bronchus whereas the left mainstem bronchus has a vascular supply by two bronchial arteries [9]. During lymphadenectomy if the single artery of the right bronchus is damaged, the bronchial stump becomes ischemic [4].
After a right pneumonectomy, the risk for BPF increases due to the diversion of the entire cardiac output going through the smaller left lung and increased load on the right ventricle [12]. This compensation results in decreasing circulating blood volume, pulmonary hypertension, increased pulmonary pressures, increased pulmonary vascular resistance and right ventricular failure [12, 13]. Loss of the larger right lung may compromise pulmonary function resulting in respiratory failure predisposing the patient to the postpneumonectomy edema syndrome [12, 14, 15]. Larger perioperative fluid resuscitation causes overload of the pulmonary circulation and right ventricle and has been reported to be a poor outcome predictor [14, 15].
Anatomical differences in the right bronchus versus the left are significant factors in increased risk of BPF. The right main bronchus is more vertical and wider than the left increasing the accumulation of secretions in the bronchial stump [4]. The right mainstem bronchus is not naturally buttressed by mediastinal tissue coverage and therefore likely to be exposed to the thoracic pleural free space [9, 15]. The left main bronchial stump tends to be protected and covered by the aortic arch with its surrounding vascularized mediastinal tissue [9, 15]. The left bronchial stump retracts within that tissue under the aortic arch after dissection giving protection from the pleural free space.
3.2 Lymph node dissection
The surgical approach to mediastinal lymph node dissection at the time of pulmonary resection for NSCLC has been a subject of interest for several decades. Accurate pathologic lymph node examination offers the most accurate staging and survival benefit and provides the most significant prognostic factor [16]. Accurate nodal staging increases survival by improved risk categorization, increased detection of candidates for adjuvant therapy and possibly resection of oligometastatic disease [17]. Staging NSCLC may have lymph node metastases even after appearing localized by imaging which makes the extent of mediastinal lymph node removal controversial [18]. Patients with negative nodes by systematic lymph node dissection with early stage NSCLC did not have improved survival with complete mediastinal lymph node dissection [17, 18, 19]. Intraoperative lymph node sampling is removal of one or more lymph nodes decided by preoperative or intraoperative findings and is determined by the surgeon [19]. Systematic nodal dissection contains all mediastinal tissue containing lymph nodes and is removed systematically within anatomical landmarks. To meet minimal recommendations, for right-sided cancers, mediastinal lymphadenectomy should contain stations 2R, 4R, 7, 8, and 9. Left side stations 4 L, 5, 6, 7, 8 and 9 should be included [17, 18, 19]. Patients should have N1 and N2 node resection with a minimum of N2 stations sampled [17, 18, 19]. Some argue that systematic mediastinal lymph node sampling versus mediastinal lymph node dissection is adequate for staging and that complete dissection does not provide survival advantage as most patients with N2 disease die from systemic disease [18, 19].
Lymph node dissection removes tissue from adjacent organs and skeletonization of intrathoracic structures. It includes enblock removal of tissues with cancer cells that includes lymph nodes and fatty tissue within bronchus, trachea, superior vena cava, aorta, pulmonary vessels, and pericardium [17, 20].
Healing of the bronchial stump is delayed due to decreased post-operative blood supply after lymph node dissection. Superior and inferior mediastinal lymph node dissection for NSCLC is widely performed adjunct to pulmonary resection [21]. Vascular supply to the suture line is watershed from the descending thoracic aorta across the mediastinum and is decreased after mediastinal lymph node dissection [11]. Ischemic bronchitis after lymph node dissection due to decreased bronchial microvascularization negatively influences bronchial stump healing [11, 21]. Lymph node sampling rather than complete lymphadenectomy leading to devascularization of the bronchial stump can permit adequate blood flow to the bronchial stump [21]. Meticulous technique while dissecting around the bronchus is necessary. Preventing devascularization of the bronchus during lymph node dissection can decrease the incidence of fistulization [9, 21].
3.3 Stump closure
The Sweet principles on bronchial closure, emphasized in 1945 are still followed today. Trauma to the end of the bronchus should be minimized and the blood supply must be preserved all the way to the end cut of the bronchus [22]. The cut edges of the bronchus should be carefully approximated [22]. Tissue reinforcement of the bronchial closure should be provided. Clamps should not be used on the proximal bronchus [22]. The major change to Sweet’s original description has been leaving the posterior membranous wall longer when cutting the bronchus so it can be used as a flap to decrease tension on the closure [22].
Typically, when the bronchus is pulled to place a stapler, an abrupt onset of vagal-induced atrial fibrillation or bradycardia may occur, along with hypotension that leads to releasing the bronchus [23]. There is a natural tendency with the next attempt to reduce bronchial traction allowing for a longer stump. Using a Roticulator linear stapler is useful to suture and clip the main bronchus close to the carina [23]. To avoid pooling of secretions within the bronchial stump, the stump should be resected back to its origin and for a pneumonectomy divided as close to the level of the carina as possible [9, 24]. This is critical to avoid secretions pooling resulting in infection and stump breakdown.
When closing a very proximal right bronchial stump or thickened bronchial wall, attention must be directed to ensure there is no closure under tension [25]. Closure under tension can be implicated in right sided BPFs at the point of transection of the right mainstem bronchus as it is generally larger than the left [25]. By the Law of LaPlace, the tension on the curved cartilaginous membranes and the fluid within the crenelated surface is higher in the larger orifice of the right bronchial stump [18, 26, 27]. Elimination of the stump diverticulum may reduce surgical line tension [18, 26, 27]. The cartilaginous ring at the origin of the right mainstem bronchus tends to keep the bronchus open and closure should be parallel to the bifurcation spur of the resected bronchus [21, 28]. This decreases the intraluminal deformity of the remaining bronchi with the straightened angle of the longitudinal axes [21, 28].
3.3.1 Suture vs. staple closure
The surgical technique of bronchial closure remains controversial and has been studied extensively. The preferred technique of pulmonary hilum vessel ligation and bronchial stump closure has troubled thoracic surgeons for years. In 1909, regarding bronchial stump closure, Meyer advised his inversion technique [29]. In 1945, Sweet described the longitudinal, single interrupted silk suture closure [29, 30]. Dr. Mark Ravitch started using staplers in the United States in 1964 after having observed their early development in Russia [29]. In 1970, Kirksey reported 147 patients who underwent pulmonary resection with disposable and plastic American staplers called Thoraco-Abdominal (TA) [29]. Reluctance to use vascular staplers due to fear of fatal hemorrhage because of malfunction continued the debate concerning pulmonary hilum vessel manual ligation versus stapled division for many decades [29]. The cessation of the alarm resulted after Asamura et al., in 2002 published results of 842 vascular divisions using endoscopic staples with 0.1% incidence of stapling failure and Yano et al., in 2013 reported 3393 pulmonary vein and artery stapling uses with a failure rate of only 0.27% [29].
It is decided by the surgeon perioperatively to use either manual suturing or stapling methods [31]. None of these have proven superiority in reducing the incidence of BPF and around a 4% rate of BPF has been reported for mechanical stapling and suture technique [31, 32]. Ucvet et al., 2011 reported the weakest part of the line are the end points of the stapler and it may incompletely close the tissue [31]. The staple line that exceeded the length of the bronchus caused a detachment in this end site creating a microfistula. These microfistulas can lead to large BPF along with infections [31]. To provide stump safety, lateral suturing to the weak and risky stump end points was required [31].
Endoscopic staplers have 2 differences compared to conventional TA type staplers: proximal and distal ends can be closed, both division and stapling can be performed simultaneously in one firing motion [31, 33]. The advantages of using endostaplers during a pulmonary resection are: (1) Time required for closure can be reduced, compared to the TA stapler when closure of the distal end of the bronchus and division are required; (2) Both proximal and distal ends of the bronchi are simultaneously and tightly closed without purulent or contaminated discharge which minimizes contamination of the operative field; (3) By selecting the appropriate cartridges, endostaplers can be used safely in vascular division [31, 33].
Suture closure is considered when the bronchial wall is hardened due to calcification [10, 21, 33]. Suture closure is also used with position difficulty due to hilar adenopathy or when the tumor is close to the pulmonary hilum due to a more extensive proximal dissection or a technically difficult bronchial stump [10, 21, 33]. Manual suturing may have the advantage of allowing inspection and assessment of the bronchial mucosa quality. Tumor fragments may also be recovered after the main bronchus is clamped [34].
3.4 Tissue coverage of the bronchial stump
Generally, wound healing has three phases: (1) inflammatory phase (2) proliferation phase (3) remodeling phase [35]. The inflammatory phase is marked by the aggregation of platelets, infiltration with leukocytes and coagulation. This phase begins soon after injury and is followed by the proliferation phase. The proliferation phase is characterized by reepithelialization, fibroplasia, angiogenesis, and wound contraction. Persistent inflammation can last about 2 weeks and likely causes robust adhesion. The remodeling phase takes place over months when the epithelium produces collagen and matrix proteins responding to the injury [35]. The phase of wound healing needs to be considered when deciding which type of bronchial closure is used.
Several options are available for coverage of bronchial closure. To reduce the incidence of postpneumonectomy BPF with soft tissue buttressing after bronchial closure has been debated. Many suggest stump reinforcement in patients with increased risk factors for BPF [36]. Cerfolio et al., 2005 suggests the best way to treat postoperative complications is to prevent it [37]. Local soft tissue coverage may provide vascular ingrowth to promote stump healing and effectively contain a small bronchial stump dehiscence [38]. Algar et al. 2001, found that the absence of bronchial stump tissue coverage was an independent predictor of BPF in the final multivariable model (p = 0.039) [32].
3.4.1 Intercostal muscle flap
The intercostal muscle flap causes no functional disability, is easy to harvest, has adequate length to reach most sites, has adequate vascularity and is harvested through the same thoracotomy incision [39]. Sfyridis et al., discovered the group that received an intercostal muscle flap had a lower incidence of development of BPF (0% versus 8.8%; p < 0.02) [40]. This flap is harvested prior to chest retraction to not crush the flap and cause damage to the blood supply. The use of cautery to harvest this flap is necessary because it is lacking periosteum and over time will not calcify [9, 37, 40]. The intercostal muscle flap is harvesting by cutting approximately two-thirds of the posterior aspect of the latissimus dorsi and the entire serratus anterior muscle is spared [37]. The rib is not shingled or cut. For harvesting, rib instruments are not used. The intercostal muscle flap, usually overlying the sixth rib is harvested using cautery prior to chest retraction from the under surface of the fifth rib. Starting at the distal end of the muscle under the serratus anterior muscle, cautery is lowered from 40 to 70 and carefully the muscle is dissected with both hot and cold cautery. So the intercostal vein is not injured, the cautery tip is positioned so it is almost parallel with the surface of the fifth rib. The intercostal is posteriorly freed from the sixth rib, past the lumbar-dorsal fascia but not freed from the undersurface of the fifth rib past this structure due to risk of injury to the vein posterior of the fifth rib with any further dissection. The bronchial stump is then tested [37].
3.4.2 Pericardial fat pad
In a retrospective study, Taghavi et al., found 93 patients who underwent pneumonectomy for primary lung cancer, identified no BPF during follow up after using a pedicled pericardial flap for bronchial stump coverage [41]. A pericardial fat pad is harvested from the anterolateral pericardium, pedicled at its cranial part, avoiding inclusion or injury to the phrenic nerve [9, 42]. A wide based pedicle should be used to assure vascularity of the flap. Careful attention should be used to avoid twisting the pedicle. The flap is attached caplike over the bronchial stump with numerous single mattress stitches to avoid devascularization when tied down over the four corners of the bronchial stump. The defect in the pericardium is then reconstructed with mesh [9, 42].
3.4.3 Serratus anterior flap
Bronchopleural fistula is exceedingly rare when a pedicled muscle flap is used to buttress the lobar bronchus, even after preoperative radiation doses of 60Gy or higher are administered [43]. To provide sufficient protection after preoperative radiation, using omental or serratus as a prophylactic buttress for the highly irradiated right main stem bronchus after a right pneumonectomy is recommended [43].
If the patient is believed to be at extraordinary risk of stump complications, larger muscle or omental flaps are used. The serratus anterior flap and omental flap are also used to treat a postoperative bronchopleural fistula to close the fistula [43, 44].
The serratus anterior muscle, one of the workhorse flaps is easily harvested, reliable, often preserved during the initial pneumonectomy due to its utility in dealing with potential complications [44]. The vascular pedicle that runs on the lateral undersurface of the scapula is where the serratus anterior muscle is based [25]. This muscle is mobilized and placed between the ribs in the second or third interspace where it will reach the hilum without tension. The thoracodorsal vascular pedicle is protected throughout the dissection [44]. With tight interspaces, compromising the vascular supply of the flap, a segment of the third rib can be removed to allow the flap to enter the pleural space easily [25]. The serratus anterior flap is secured with interrupted absorbable sutures to the mediastinal areolar or peribronchial tissue [25] (Figure 1). This tissue helps with infection control and healing due to its blood supply emanating from regions beyond the inflamed field [25]. The flap is placed over the bronchial stump with uninterrupted suture to secure the closure [9, 25, 44].
Figure 1.
The serratus anterior muscle is harvested and mobilized into the chest between the ribs in the second or third interspace with rib segmentation. (Sugarbaker D, Bueno R, Burt B, et al, editors. Adult chest surgery. 3rd edition. New York: McGraw-Hill Education; 2020; with permission).
3.4.4 Omental flap
The omentum has superior blood supply and plasticity which allows for a very safe and easy bronchus closure even in the presence of fibrotic tissue or infection [45]. The omentum with a rich blood supply assures adequate antibiotic and oxygen delivery [46]. Delivering potent angiogenic factors, the omentum improves neovascularization of the bronchial suture lines in experimental models. Omental transposition does not impair muscle function or produce chest wall deformities seen with major muscle flaps [46].
The disadvantage of tradition omental flap transposition extends the surgical procedure into the abdomen, requiring laparotomic access. Usually the omentum is mobilized through the upper midline abdominal incision, transposed into the chest via a substernal or anterior transdiaphragmatic route [46]. This description applies a transdiaphragmatic harvesting technique of the greater omentum performed through the standard thoracotomy [46].
The five centimeter incision in the diaphragm is performed radially between its anterior insertion and central tendon through the standard thoracotomy [46, 47]. Oval forceps are used to slide through the diaphragm into the abdominal cavity. Once confirmation the omentum is free of adhesions, the greater omentum gently can be retracted through the diaphragm into the chest. The omental insertion of the transverse colon is identified and divided as extensively as possible. The most distal omental extremity is identified in the chest cavity by gentle traction and subsequently isolated carefully inspecting its vascular supply. After confirming the omental flap has no traction on the stomach or colon, the omentum is sutured to the bronchial stump in the usual fashion. The diaphragmatic incision is closed leaving a large enough opening to avoid strangulation of the omentum. The omental flap is sutured with interrupted sutures to the diaphragmatic opening to further relieve any tension. This technique is appropriate to reinforce the bronchial stump and can be large enough to fill the pleural space [46, 47].
3.5 Residual carcinoma at bronchial margin
Residual disease is characterized by residual carcinomatous tissue within the margin of resection either under visible inspection or under microscopy [48]. Residual disease at the bronchial stump may cause poor prognosis with the increased risk of lung cancer recurrence both distantly and locally [48]. It may also decrease the bronchial stump anastomosis which can lead to a fatal bronchopleural fistula or empyema [48, 49]. In all pulmonary resections, the estimated incidence of residual disease left at the bronchial stump is 4–5% [49]. Asamura et al. reported in 2359 patients that the most important risk factor for a BPF was resection type, followed by presence of residual microscopic tumor at the resection margin (p < 0.01) [28]. Survival is worse in patients with bronchial margin residual disease; 1 and 5 year survivals range between 20 and 50% and 0–20% respectively [48]. Mediastinal lymph node involvement is associated with the poor survival in 75–85% of patients with residual bronchial margin disease [48]. Radiotherapy or reoperation may be considered in these patients [48, 49].
3.6 Neoadjuvant chemoradiotherapy
Neoadjuvant chemoradiotherapy is a crucial strategy in multidisciplinary treatments to improve the survival rate and resectability for patients with lung cancer [50]. Especially for patients with advanced lung cancer, chemoradiotherapy can eliminate or reduce the micro-metastasis. Previously published randomized control trials have been integrated with recent systematic reviews and have concluded that neoadjuvant chemoradiotherapy can significantly benefit the survival outcomes in operable patients [50]. Relative to other pulmonary resections, pneumonectomy has been associated with increased morbidity and mortality. The mortality for a pneumonectomy after neoadjuvant therapy has reports with very low mortality (<5%) countered by other reports with alarmingly high mortality (>20%) [51]. For the patient with N2 disease who requires a pneumonectomy, the correct approach can be unclear with the postoperative and intraoperative complications remaining a debate [50, 51]. Bronchial mucosa ischemia is induced by radiotherapy but the mucosal blood flow can recover in eight to ten days after completion of therapy. Early effects of radiation can cause mucosal edema and inhibit capillary angiogenesis [52]. Late effects of radiation cause fibrotic small vessel disease through radiation vasculopathy [52]. Radiation pneumonitis, poor wound healing, and fibrosis can occur in previously irradiated bronchial tissue with a higher perioperative and postoperative complication leading to a bronchopleural fistula [53, 54]. Induction therapy may cause injury to the bronchial microvascularization predisposing to airway complications but published literature does not support the notion that all pneumonectomies after therapy are associated with postoperative mortalities [51, 55].
3.7 Empyema
Empyema is the presence of purulent fluid in the postpneumonectomy pleural space. Postpneumonectomy empyema occurs in 2–16% of patients and can be life threatening [55]. This postoperative complication is associated with BPF which can further increase morbidity and mortality [56]. Most BPFs associated with empyema is monomicribial with most pathogens being Streptococcus or Staphylococcus species and occur within 10 to 14 days of surgery [52, 57]. A late empyema can occur more than three months to 40 years after a pneumonectomy and is most often acquired via a hematogenous route [52, 57]. After a pneumonectomy, to avoid spillage of infected fluid into contralateral lung the patient should be kept upright at least 45 degrees [52]. An early empyema withing 10 to 14 days after surgery presents with expectoration of purulent sputum and fever [57]. Radiographic findings show a shift of the mediastinum away from the postpneumonectomy space, development of a new or sudden change in the existing air-fluid level, and failure of the mediastinum to shift normally in the immediate postoperative period [57]. Empyema diagnosis is confirmed by fluid sample in the postpneumonectomy space [57].
3.8 Mechanical ventilation
Mechanical ventilation in patients after a pneumonectomy, subjects the bronchial stump line to increased wall tension and continuous barotrauma [1]. Positive pressure ventilation can be challenging in these patients and the aim is to prevent further lung injury by keeping the airway pressure below the critical opening pressure of the fistula, optimizing pleural suction pressures and provide adequate alveolar ventilation of sufficient gas exchange [58, 59]. To decrease the flow across a BPF, reducing the proportion of minute ventilation provided by the ventilator, minimal levels of positive end expiratory pressure (PEEP), low tidal volumes and respiratory rate are helpful [1, 59]. Adverse effects in mechanically ventilated patients with BPF include loss of effective tidal volume, incomplete lung expansion, inability to remove carbon dioxide and prolonged ventilatory support [59]. The majority of reported studies report a significant relationship between the occurrence of BFP and mechanical ventilation after pneumonectomy [60].
3.9 Diabetes, chronic steroid use, nutritional status
Typically, surgeons consider diabetes mellitus in patients requiring surgical intervention an important contributor to some fatal adverse events [61]. Diabetic microangiopathy alters the vascular bed causing small vessel ischemia impairing proper wound healing [40]. This decreases the oxygen diffusion capacity and the bronchial stump circulation is particularly prone to poor wound healing [52, 61]. The largest retrospective analysis reported by Asamura et al. in 1992, showed statistical results from both univariate and multivariate analysis indicating significantly increased risk of postoperative BPF in patients with diabetes [28].
Preoperative use of corticosteroids is believed to contribute to several postoperative complications which include impaired bronchial healing [62]. In a study by Algar et al. 2001, patients with preoperative steroid therapy were associated with higher risk of BPF (p < 0.001) [32]. This same study found hypoalbuminemia to also be related to higher risk of BPF (p < 0.017) [32]. Hypoalbuminemia has a negative effect on the healing process, and in order to decrease the BPF risk, an albumin level above 3.5 mg/dl is the goal [63]. Patients requiring a pneumonectomy are usually very catabolic and nutritional assessment is essential in their management [1]. Metabolic alterations induced by the lung cancer tumor affects the nutrition in these patients [64]. These alterations lead to cachexia syndrome with higher levels of the proinflammatory cytokines interleukin-6 and tumor necrosis factor and lower levels of albumin [64]. Malnutrition increases the risk of 90-day mortality rate, postoperative infection and length of hospital stay after a pneumonectomy and a thorough preoperative evaluation is crucial [64].
4. Pathophysiology: clinical features and diagnosis
4.1 Early/acute bronchopleural fistula
An early BPF has a peak incidence within 8 to 12 days after surgery but can occur at any time in the postoperative period [59]. Surgical closure of the BPF is the cornerstone of management. If a BPF is seen within the first 4 days after surgery, it requires exploration as it is likely due to a mechanical failure of the bronchial stump [59]. Early BPFs are normally approached urgently through the previous thoracotomy incision. An acute BPF can be life-threatening due to asphyxiation from pulmonary flooding or tension pneumothorax due to a massive air leak [59, 65, 66] (Figure 2). Acute BPF should be suspected in patients who present with fever, dyspnea, subcutaneous emphysema, excessively productive cough of purulent fluid, hypotension, trachea or mediastinal shift, disappearance, or reduction of pleural effusion on the chest radiograph or persistent air leak [25, 59, 65]. Chest radiography monitors the efficacy of BPF therapy and plays an essential role in evaluating the possibility of a BPF after a lung resection [2]. These symptoms appearing should raise the index of suspicion and quick and accurate diagnosis must be made before there is an overwhelming amount of aspiration into the remaining lung [25].
Figure 2.
Axial lung window after right pneumonectomy with large pneumothorax with evidence suggesting communication of the bronchial stump and pleural space. Case courtesy of Radswiki, Radiopaedia.org, rID: 11262.
4.2 Late/chronic bronchopleural fistula
Late bronchopleural fistula present in the postoperative period more than 14 days [59]. The subacute and chronic forms present with more insidious symptoms and is characterized by fever, malaise, wasting, minimally productive cough, dullness to percussion on the affected side and reduced air entry with progressive clinical deterioration and varying levels of respiratory compromise [2, 59, 65]. A late BPF is often seen in debilitated or immunocompromised patients with many comorbidities [59]. In the chronic form that is associated with empyema, there is fibrosis of the mediastinum and pleural space preventing the mediastinal shift [59, 65].
Causes of late BPF include foreign body aspiration, refractory infection, chemotherapy and radiotherapy, and blunt chest trauma [67]. The time of interval is 2 months to 20 years between the surgery, therapy or injury and the onset of the late BPF [67].
In late BPF, due to the relatively stable mediastinal structures, conservative treatment is accepted by many investigators as the first step. Closure of the bronchial fistula with endoscopic treatment should be considered [67]. Proper antimicrobial coverage is mandatory along with proper nutrition with patients frequently requiring parenteral or enteral feeding [65]. Aggressive nutritional support and physical rehabilitation should be started early to optimize patients and enhance their recovery [65]. If surgery is indicated for a late BPF, the previous transthoracic approach may be unsafe due to fibrosis with associated inflammation with risk of bleeding and injury to vital structures [68, 69]. With a median sternotomy, approaching well vascularized, healthy, virgin tissues to reach the carina and bronchi may be preferrable and necessary. The advantages to the transsternal approach for BPF closure are avoidance of an inflamed operative field, scarring and adhesions in previous surgical fields and deformities of the thorax with thoracoplasty [68, 69]. The disadvantage of this approach is the infected empyema space is not managed at the time of closure. Previous cardiac surgery is not recommended for this type of approach [68, 69].
Once a BPF is suspected, a Computerized Tomography (CT) Scan with intravenous contrast to map the vasculature and better define the air-fluid levels and the peripheral rind enhancement is necessary [70]. This scan will identify the fistulous tract and will allow evaluation of the potential causes of BPF (i.e. recurrent tumor, staple line dehiscence, pneumonia, abscess, devascularized stump). It will also be simultaneously used to define the anatomic relationship of the adjacent mediastinal structures, vasculature, and diaphragm. A large fistulous tract can be clearly identified and a vigilant search must take place to look for subtle signs of a small BPF such as a change in the appearance of pre-existing pleural air-fluid levels and extraluminal air bubbles adjacent to the bronchial stump. Care must be taken to ensure while the patient is lying flat during the scan that they do not aspirate the pleural fluid through the BPF to the healthy lung [70].
All patients should undergo diagnostic bronchoscopy whether the BPF diagnosis is apparent radiographically or clinically [25]. A large fistula can be visualized but smaller 1 to 2 mm fistulas may be difficult to recognize [25]. Bronchoscopy provides information about the tissue at the level of the stump and condition of the remaining bronchial stump and can assist in deciding definitive repair [25].
5. Management of BPF
Management varies according to the individual patient, but the importance of addressing the risk of contralateral aspiration pneumonia and tension pneumothorax by drainage of the pleural space at time of diagnosis has to be emphasized [69]. The most important action when an acute BPF is suspected is protecting the contralateral lung from spillage of pleural fluid [2]. The primary principle is drainage of the pleural space by chest tube thoracostomy and care should be taken to place the chest tube above the previous thoracotomy incision as the diaphragm will be elevated with the normal thoracic remodeling that occurs after pneumonectomy [25, 59, 71, 72]. Pleural fluid should be sent for total protein, complete blood cell count, glucose, cytology, lactate dehydrogenase, triglycerides, gram stain and culture to evaluate for pleural infection [59]. Although integral for drainage, the chest tube can predispose the pleural space to infection and function as a foreign body [59]. Connecting the chest tube to a digital chest drainage system allows for more accurate and objective assessment of air flow and larger flow values and trend evaluation would provide more detailed information about the size and severity of the BPF [73]. For patients who are mechanically ventilated, the chest tube can be used for occlusion during the inspiratory phase or to add positive intrapleural pressure during the expiratory phase [59]. These interventions decrease BPF during inspiration and decrease air leak during expiration to maintain positive end-expiratory pressure (PEEP) [59].
5.1 Acute failure of the bronchial stump
Acute failure of the bronchial stump is usually due to bronchial stump dehiscence and expeditious surgical repair with this single-staged intervention is recommended once clinical stabilization is achieved [71, 74, 75]. Given the relative integrity of the tissue, early stage of the infectious process, minimal pleural contamination and no problematic residual space, early reoperation is warranted to reestablish an airtight stump [25, 71, 74, 75]. Exploration with surgical revision by posterolateral thoracotomy with selective intubation and lung isolation of the contralateral mainstem bronchus to prevent further spillage of the remaining lung is recommended [25, 71, 75]. The fistula, if not readily visible can be identified with the assistance of positive pressure ventilation while covering the bronchial stump with irrigation [25]. The pleural space should be completely debrided and irrigated to remove all necrotic tissue [25]. The bronchial stump is refashioned and carefully dissected to decrease trauma to the blood supply [25, 71]. Measured from the carina, all efforts are made to made for the final stump to be less than 1 cm in length [25] (Figure 3). The stump may be reclosed with a stapler if their remains sufficient length on initial exploration. In cases where there is too much inflammation to allow stapling, the bronchial stump is mobilized and reclosed with interrupted monofilament sutures [25, 71]. A balance between avoiding too much exposure that may damage blood supply and exposing enough bronchus to avoid tension on the closure much be achieved [25].
Figure 3.
A. The bronchial stump should be less than 1 cm. After inspection, if there is enough length on the stump, it can be closed with a stapling device. B. With too much inflammation, the stump may need to be sutured closed. (Sugarbaker D, Bueno R, Burt B, et al, editors. Adult chest surgery. 3rd edition. New York: McGraw-Hill Education; 2020; with permission).
5.2 Transposition of muscle flaps to treat BPF
Using a vascularized tissue to reinforce the suture line is the most important aspect of closure [25, 76]. Stump coverage was previously discussed as a preventive measure for BPF. The objective in treating a BPF with vascularized tissue is to obliterate the postpneumonectomy pleural space [25, 71, 75, 77]. Deciding which muscle flap to use depends on which muscle was preserved or damaged from the previous thoracotomy and the amount of space to be filled [71, 75, 77]. The most common muscles used in the pleural space to treat a BPF are serratus anterior, pectoralis major, pectoralis minor, latissimus dorsi, and intercostal muscles [25, 71, 75, 77, 78]. The latissimus dorsi is the most reliable and largest muscle but may not be sufficient to obliterate the postpneumonectomy cavity if it was already divided in the original thoracotomy [77, 78]. The greater omentum consists of a large fold of peritoneum with excellent blood supply and antibacterial effect, lymphoid tissue, and fat [76, 78]. Using large muscles as the latissimus dorsi, greater omentum and serratus anterior has the advantage to contribute bulk to fill some of the dead postpneumonectomy space sugar [76, 77, 78]. In a study by Mazzella et al. 2017, fourteen patients with early BPF were treated with surgical repair of the bronchial stump via thoracoscopy (2) or thoracotomy (12) with omentum and fibrin glue (2) parietal pleural (3), intercostal muscle (1) or pericardial patch (2) with no recurrence of BPF after surgery [79].
5.3 Clagett window and eloesser flap
Treating a BPF with empyema and sepsis may require an Eloesser flap for patients too debilitated or too ill for a decortication or prolonged procedure involving muscle flaps [25, 80, 81]. The difference between the Clagett open-window thoracostomy (OWT) procedure and Eloesser flap is that the Clagett procedure is larger than the Eloesser flap and the Clagett window is temporary to allow complete drainage of purulent drainage in the pleural space [80] (Figure 4). The Eloesser flap creates a permanent drainage window in the pleural space [80].
Figure 4.
(A) Clagett window and (B) Eloesser flap. (Sugarbaker D, Bueno R, Colson Y, et al, editors. Adult chest surgery. 2nd edition. New York: McGraw-Hill Education; 2015; with permission).
5.3.1 Clagett procedure
In 1963, Clagett and Geraci described a technique as a two-step procedure for the management of postpneumonectomy empyema [81, 82]. This procedure combined an open-window thoracostomy pleural drainage with repetitive irrigation of the infected cavity with obliteration of the space with antibiotic fluid without direct fistula closure [2, 25, 81, 82, 83, 84]. The procedure resulted in recurrences of fistulization and prolonged hospitalization and significant mortality. This technique is rarely used and has been modified with initial bronchial stump closure with muscle transposition described earlier [2, 25, 80, 81, 82, 83, 84].
Once the BPF is closed and buttressed with muscle transposition, diluted wet povidone-iodine (Betadine) dressings are placed in the thorax and changed every 48 hours in the operating room [81, 83, 84]. This is done for approximately 4 to 6 days until the muscle flap is adherent to the bronchial stump and adjacent mediastinum [81, 83, 84]. Then the pack is changed in the patient’s room 3 to 4 times a day. When health granulation is present in the pleural space, the entire cavity is filled with antibiotic solution selected to tailor culture and sensitivity results [25, 81, 83, 84]. In multiple layers to avoid leakage of fluid, the chest is then closed [25, 81, 83, 84].
The modified Clagett procedure involves daily intracavitary dressing changes, lasting for a long period of time and may not allow chest closure. Other ways to accelerate wound healing process were investigated [85]. Wound vacuum-assisted closure (VAC) therapy has recently been evaluated and used in patients with complex infected wounds without the OWT [86]. Bacterial proteinases are microorganisms and play a pathogenic role in an infected wound by consuming oxygen and nutrients that are required for tissue repair [87]. Reducing the bacterial proteinase load in a wound would allow the body to heal [87]. The VAC allows topical solutions to be cyclically flushed into the foam dressing before removal under negative pressure that irrigates, cleans, and removes infectious material from the pleural space [85, 87]. This is done without OWT, decreasing postoperative pain [88]. Recent studies show that as an adjunct to standard therapy, the VAC can decrease pain, hospital length of stay and morbidity in patients with complicated postoperative empyema [85, 88].
5.3.2 Eloesser flap
The Eloesser Flap OWT continues to evolve. A “H” or “U” shaped incision is made above the previous incision over the dependent portion of the space [25, 80]. A segmentary resection of one or two ribs are removed to obtain a window and limit the tendency of the opening to contract and close [25, 79, 80]. Necrotic tissue is debrided and edges of the flap are sutured directly to the parietal pleura with absorbable interrupted sutures to create an epithelized tract which encourages healing and maintains window patency [25, 79, 80]. The window should be not too far inferiorly which may interfere with the diaphragm and not too posterior that would be difficult for the patient to manage [25, 79, 80]. Using moistened gauze, dressing changes are performed until the cavity is decontaminated. Care is taken to prevent cardiac tamponade by excessive gauze inserted in the cavity [25, 79, 80]. The thoracostomy is closed with a thoracomyoplasty when clinical conditions suggest correct timing. In the chest cavity, healthy granulation tissue, improved clinical condition, closure of the bronchial stump and negative cultures of the chest cavity all suggest proper timing [25, 79, 80].
6. Endoscopic treatment of bronchopleural fistula
6.1 Biological glue
Many different biological glues for endoscopic BPF closure are available. Fibrin-based, albumin-glutaraldehyde tissue adhesive, and cyanoacrylate-based glues are the most common [2, 83]. Application technique is performed by a catheter inserted through the flexible bronchoscope and placed above the fistula [2, 83]. The glue is injected into the fistula and creates a plug after a few seconds that occludes the fistula with instantaneous cessation of air leak expected [2, 83]. Some prefer glue injection with a 21G needle due to less glue displacement and more effective closing of the BPF. This procedure may need to be repeated and endoscopic surveillance and close clinical monitoring is important for signs of failure [2, 83].
Cardillo et al. 2015, reported patients with BPF sized 1 cm or less with a viable bronchial stump were treated endoscopically [89]. The cure rate with endoscopic treatment was 92.3% in very small fistulas <2 mm with mechanical abrasion of the fistula. Cure rate was 71.4% in small fistulas >2 mm and < 3 mm with submucosal injection of 0.5 to 2 mL polidocanolhydroxypolyethoxydodecane at the fistula. This liquid surfactant causes endothelial cell lysis. It induces sclerosis and acts on the venous endothelium via interferences with cell membrane lipids. Cure rate with intermediate fistulas >3 mm and < 6 mm was 80%. Treatment was with n-butyl cyanoacrylate glue injected into the fistula. This mechanically occludes the fistula causing proliferation of the bronchial mucosa and a local inflammatory reaction. Morbidity and mortality rates were 5.8% [89].
6.2 Endobronchial valves
Endobronchial valves (EBV) have been available since 2003 and were originally developed for the reduction of lung volume in patients with emphysema [90, 91]. They were first described by Snell et al., 2005 for BPF [92]. Introduced through a flexible bronchoscope, EBV have a unidirectional valve to prevent airflow into the fistula and will result in atelectasis and collapse of the fistula [90, 91, 93]. This results in decreased or absent air leak. The process of recovery would lead to resolution of the shunt, fibrosis, and eventual extraction of the EBV [90, 91, 93]. Complete elimination of air flow through the BPF does not always occur and does not mean the EBV is unsuccessful. Decreased flows may bring the rate below critical rate flows and allow for fistula healing [91].
6.3 Amplatzer device closure
Many small fistulas (<3 mm) spontaneously heal or heal with glue placed endoscopically [94, 95]. Treatment for BPF endoscopically can bridge to control infection until a patient is able to able to undergo surgical repair [90, 92] (Figure 5). Amplatzer device is normally used for transcatheter closure of atrial septal defects. This device can contribute to intrabronchial granulation tissue and has good biocompatibility [94, 95]. The tissue growth reduces the risk of displacement. The waist of the Amplatzer device is placed inside the fistula and the two discs are placed at the distal and proximal ends of the fistula [94, 95]. Fruehter et al. 2011 treated nine patients with Amplazter device with BPF and the fistula was successfully closed [96]. After nine months, the results were maintained [96].
Figure 5.
Amplatzer Muscular VSD Occluder 8mm x 7mm placed to occlude the right mainstem bronchopleural fistula. Image courtesy of Dr. Tarek Dammad, Orlando, Florida.
7. Conclusion
Improvements in thoracic surgery have decreased the incidence of BPF but mortality remains high. Proactive approaches to risk management and mitigating potential causes for increased chance for BPF preoperatively and intraoperatively are essential to improved outcomes. Expeditious surgical repair for acute BPF, along with new therapies with wound vacuum-assisted closure (VAC) therapy and endoscopic options for small fistulas may all expedite closure of BPF and improve survival.
Conflict of interest
The author declares no conflict of interest.
Thanks
To my colleagues: Dr. Joseph Boyer, Dr. Nayer Khouzam, Dr. George Palmer and Dr. Marcello DaSilva at AdventHealth Orlando, Florida, U.S.A. and to Dr. Steve Talbert at the University of Central Florida. You all have taught me so much, for so many years, and I sincerely thank you.
\n',keywords:"bronchopleural fistula, pneumonectomy, empyema, lung cancer, thoracic surgery",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/78760.pdf",chapterXML:"https://mts.intechopen.com/source/xml/78760.xml",downloadPdfUrl:"/chapter/pdf-download/78760",previewPdfUrl:"/chapter/pdf-preview/78760",totalDownloads:232,totalViews:0,totalCrossrefCites:0,dateSubmitted:"June 6th 2021",dateReviewed:"August 31st 2021",datePrePublished:"September 25th 2021",datePublished:null,dateFinished:"September 25th 2021",readingETA:"0",abstract:"Bronchopleural fistula (BPF) after a pulmonary resection is rare with some of the most life-threatening consequences and a high mortality rate. Contamination of the pleural space resulting in empyema and spillage of the infected fluid into the remaining lung leading to respiratory distress remain the biggest concerns with BPF postoperatively. There are many patient characteristics and risk factors that can be evaluated to decrease the chance of a postoperative BPF. Presentation of BPF can be early or late with the late BPF more difficult to diagnosis and manage. 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Etiology",level:"1"},{id:"sec_3",title:"3. Risk factors",level:"1"},{id:"sec_3_2",title:"3.1 Right sided surgery and right pneumonectomy",level:"2"},{id:"sec_4_2",title:"3.2 Lymph node dissection",level:"2"},{id:"sec_5_2",title:"3.3 Stump closure",level:"2"},{id:"sec_5_3",title:"3.3.1 Suture vs. staple closure",level:"3"},{id:"sec_7_2",title:"3.4 Tissue coverage of the bronchial stump",level:"2"},{id:"sec_7_3",title:"3.4.1 Intercostal muscle flap",level:"3"},{id:"sec_8_3",title:"3.4.2 Pericardial fat pad",level:"3"},{id:"sec_9_3",title:"3.4.3 Serratus anterior flap",level:"3"},{id:"sec_10_3",title:"3.4.4 Omental flap",level:"3"},{id:"sec_12_2",title:"3.5 Residual carcinoma at bronchial margin",level:"2"},{id:"sec_13_2",title:"3.6 Neoadjuvant chemoradiotherapy",level:"2"},{id:"sec_14_2",title:"3.7 Empyema",level:"2"},{id:"sec_15_2",title:"3.8 Mechanical ventilation",level:"2"},{id:"sec_16_2",title:"3.9 Diabetes, chronic steroid use, nutritional status",level:"2"},{id:"sec_18",title:"4. Pathophysiology: clinical features and diagnosis",level:"1"},{id:"sec_18_2",title:"4.1 Early/acute bronchopleural fistula",level:"2"},{id:"sec_19_2",title:"4.2 Late/chronic bronchopleural fistula",level:"2"},{id:"sec_21",title:"5. Management of BPF",level:"1"},{id:"sec_21_2",title:"5.1 Acute failure of the bronchial stump",level:"2"},{id:"sec_22_2",title:"5.2 Transposition of muscle flaps to treat BPF",level:"2"},{id:"sec_23_2",title:"5.3 Clagett window and eloesser flap",level:"2"},{id:"sec_23_3",title:"5.3.1 Clagett procedure",level:"3"},{id:"sec_24_3",title:"5.3.2 Eloesser flap",level:"3"},{id:"sec_27",title:"6. Endoscopic treatment of bronchopleural fistula",level:"1"},{id:"sec_27_2",title:"6.1 Biological glue",level:"2"},{id:"sec_28_2",title:"6.2 Endobronchial valves",level:"2"},{id:"sec_29_2",title:"6.3 Amplatzer device closure",level:"2"},{id:"sec_31",title:"7. 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Ann Thorac Surg 2013;96:247-252.'},{id:"B56",body:'Deschamps C, Bernard A, Nichols F, Allen M, Miller D, Trastek V, et al. Empyema and bronchopleural fistula after pneumonectomy: Factors affecting incidence. Ann Thorac Surg 2001;72:243-248.'},{id:"B57",body:'Kopec S, Irwin R, Stoller J, Hollingsworth H: Sequelae and complications of pneumonectomy. Uptodate 2013, available from http://www.bsgdtphcm.vn/thamkhao/contents/UTD.htm?31/36/32329'},{id:"B58",body:'Matthews C, Goswami D, Ramchandani N, Huffard A, Reiger K, Young et al. The influence of airway closure technique for right pneumonectomy on wall tension during positive pressure ventilation: An experimental study. Semin Thoracic Surg 2020;32:1076-1084.'},{id:"B59",body:'Salik I, Vashisht R, Abramowicz A. Bronchopleural fistula. StatPearls [Internet] 2021. Available from https://www.ncbi.nlm.nih.gov/books/NBK534765/'},{id:"B60",body:'Toufektzian L, Patris V, Sepsas E, Konstantinou M. Does postoperative mechanical ventilation predispose to bronchopleural fistula formation in patients undergoing pneumonectomy? Interact Cardiovasc Thorac Surg 2015;21:379-382.'},{id:"B61",body:'Li S, Fan J, Zhou J, Ren Y, Shen C, Che G. Diabetes mellitus and risk of bronchopleural fistula after pulmonary resections: A meta-analysis. Ann Thorac Surg 2016;102:328-339.'},{id:"B62",body:'Kim H, Paik H, Kim S, Park M, Lee J. Preoperative corticosteroid use and early postoperative bronchial anastomotic complications after lung transplant. Korean J Thorac Cardiovasc Surg 2018; 51: 384-389.'},{id:"B63",body:'Suzuki M, Otsuji M, Saitoh Y, Iizasa T, Shibuya K, Sekine Y, et al. Bronchopleural fistula after lung cancer surgery. Multivariate analysis of risk factors. J Cardiovasc Surg 2002;42:263-267.'},{id:"B64",body:'Bagan P, Berna P, DeDominicis F, Pereira J, Mordant P, DeLaTour B, et al. Nutritional status and postoperative outcome after pneumonectomy for lung cancer. Ann Thorac Surg 2013;95:392-396.'},{id:"B65",body:'Lois M, Noppen M. Bronchopleural fistulas. An overview of the problem with special focus on endoscopic management. CHEST 2005; 128:3955-3965.'},{id:"B66",body:'Erwin F, Lakson G, Sarvasti D, Tahalele P. Spontaneous pneumothorax following bronchopleural fistula in geriatric patient: A case report and emergency management. J Widya Medika 2021; 3: 53-61.'},{id:"B67",body:'Zhang C, Pan Y, Zhang R, Wu W, Liu D, Zhang M. Late-onset bronchopleural fistula after lobectomy and adjuvant chemotherapy for lung cancer: A case report and review of the literature. Medicine 2019;98:1-5.'},{id:"B68",body:'Topcuogly M, Kayhan C, Ulus T. Transsternal Transpericardial approach for the repair of bronchopleural fistula with empyema. Ann Thorac Surg 2000;69:394-397.'},{id:"B69",body:'[69].Bal S, Ali K, Haridas B, Shrivastava G, Gupta S. Management of post pneumonectomy bronchopleural fistula: the transpericardial approach. J Vis Surg 2018;4:237-242.'},{id:"B70",body:'Gaur P, Dunne R, Colson Y, Gill R. Bronchopleural fistula and the role of contemporary imaging. J Thorac Cardiovasc Surg 2014;148:341-347.'},{id:"B71",body:'Teh E, West D. Bronchopleural fistula: prevention is still best. Shanghai Chest 2017;1:48.'},{id:"B72",body:'QV J, Chen G, Jiang G, Ding J, Gao W, Chen C. Risk factor comparison and clinical analysis of early and late bronchopleural fistula after non-small cell lung cancer surgery. Ann Thorac Surg 2009;88:1589-1593.'},{id:"B73",body:'Jacobsen K, Talbert S, Boyer J. The benefits of digital drainage system versus traditional drainage system after robotic-assisted pulmonary lobectomy. J Thorac Dis 2019; 11: 5328-5335.'},{id:"B74",body:'Cusmano G, Alifano M, Lococo F. Endoscopic and surgical treatment for bronchopleural fistula after major lung resection: an enduring challenge. J Thorac Dis 2019;11:S1351-S1356 .'},{id:"B75",body:'Bribriesco A, Patterson A. Management of postpneumonectomy bronchopleural fistula. From thoracoplasty to transsternal closure. Thorac Surg Clin 2018;28:323-335.'},{id:"B76",body:'Okada S, Shimomura M, Tsunezuka H, Ishihara S, Ishikawa N, Kameyama K, et al. One-stage closure of large bronchopleural fistula with pedicledlatissimus dorsi muscle flap after preemptive antibiotics: A case report. International J Surg Case Reports 2020;74:257-259.'},{id:"B77",body:'He Z, Shen L, Xu W, He X. Effective treatment of bronchopleural fistula with empyema by pedicled latissimus dorsi muscle flap transfer. Two case report. Medicine 2020; 99:41.'},{id:"B78",body:'Lu C, Feng Z, Ge D, Yuan Y, Zhang Y, Qi F, et al. Pedicle muscle flap transposition for chronic empyema with persistent bronchopleural fistula: Experience of a single clinical center in China. Surg Today 2016;46:1132-1137.'},{id:"B79",body:'Mazzella A, Pardolesi A, Maisonneuve P, Petrella F, Galetta D, Gasparri R, et al. Bronchopleural fistula after pneumonectomy: Risk factors and management, focusing on open-window thoracostomy. Semin Thorac Cardiovasc Surg 2018;30:104-113.'},{id:"B80",body:'Denlinger, C. Eloesser flap thoracostomy window. Oper Tech Thorac Cardiovasc Surg 2010;15:61-69.'},{id:"B81",body:'Pairolero P, Arnold P, Trastek V, Medland B, Kay P. Postpneumonectomy empyema. The role of intrathoracic muscle transposition. J Thorac Cardiovasc Surg 1990;99:958-968.'},{id:"B82",body:'Schneiter D, Cassina P, Korom S, Inci I, Al-Abdullatief M, Dutly A, et al. Accelerated treatment for early and late postpneumonectomy empyema. Ann Thorac Surg 2001;72:1668-1672.'},{id:"B83",body:'Azevedo I, Oliveira R, Ugalde P. Management of postpneumonectomy empyema and bronchopleural fistula. Shanghai Chest 2021;5:15.'},{id:"B84",body:'Zaheer S, Allen M, Cassivi S, Nichols F, Johnson C, Deschamps C, et al. Postpneumonectomy empyema: Results after the Clagett procedure. Ann Thorac Surg 2006;82:279-287.'},{id:"B85",body:'Saadi A, Perentes J, Gonzalez M, Tempia A, Wang Y, Demartines N, et al. Vacuum-assisted closure device: A useful tool in the management of severe intrathoracic infections. Ann Thorac Surg 2011;91:1582-1590.'},{id:"B86",body:'Haghshenasskashania A, Rahnavardia M, Yana T, McCaughan B. Intrathoracic application of a vacuum-assisted closure device in managing pleural space infection after lung resection: Is it an option? Interact Cardiovasc Thorac Surg 2011;13: 168-174.'},{id:"B87",body:'Gabriel A, Shores J, Bernstein B, DeLeon J, Kamepalli R, Wolvos T, et al. A clinical review of infected wound treatment with vacuum assisted closure® (V.A.C.®) therapy: Experience and case series. Int Wound J 2009; 6:1-25.'},{id:"B88",body:'Hoffman H, Neu R, Potzger T, Schemm R, Grosseri C, Szoke T, et al. Minimally invasive vacuum-assisted closure therapy with instillation (Mini-VAC-Instill) for pleural empyema. Surgical Innovation 2015;22: 235-239.'},{id:"B89",body:'Cardillo G, Carbone L, Carleo F, Galluccio G, DiMartino M, Giunti R, et al. The rationale for treatment of postresectional bronchopleural fistula: Analysis of 52 patients. Ann Thorac Surg 2015;100:251-257.'},{id:"B90",body:'Zo S, Song J, Kim B, Jeong B, Jeon K, Cho J, et al. Surgically intractable bronchopleural fistula treated with endobronchial valve insertion by isolating the tract with indigo carmine: A case report. Resp Med Case Reports 2020;29:100972.'},{id:"B91",body:'Gaspard D, Bartter T, Boujaoude Z, Raja H, Arya R, Meena N, et al. Endobronchial valves for bronchopleural fistula: Pitfalls and principles. Ther Adv Respir Dis 2017;11:3-8.'},{id:"B92",body:'Snell G, Holsworth L, Fowler S, Eriksson L, Reed A, Daniels F. et al. Occlusion of a broncho-cutaneous fistula with endobronchial oneway valves. Ann Thorac Surg 2005;80:1930-1932.'},{id:"B93",body:'Kalatoudis H, Nikhil M, Zeid F, Shweihat Y. Bronchopleural fistula resolution with endobronchial valve placement and liberation from mechanical ventilation in acute respiratory distress syndrome: A case study. Case Rep Crit Care 2017:3092457.'},{id:"B94",body:'Wu Y, He Z, Xu W, Chen G, Liu Z, Lu Z. The Amplatzer device and pedicle muscle flap transposition for the treatment of bronchopleural fistula with chronic empyema after lobectomy: Two case reports. World J Surg Onc 2021;19:1-7.'},{id:"B95",body:'Motus I, Bazhenov A, Basvrov R, Tsvirenko A. Endoscopic closure of a bronchopleural fistula after pneumonectomy with the Amplatzer occluder: A step forward? Interact Cardiovasc Thorac Surg 2020;30:249-254.'},{id:"B96",body:'Fruchter O, Kramer M, Dagan T, Raviv Y, Abdel-Rahman N, Saute M, et al. Endobronchial closure of bronchopleural fistulae using Amplatzer devices. Our experience and literature review. Chest 2011;139:682-687.'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Kristina Jacobsen",address:"kristina.jacobsen@adventhealth.com",affiliation:'
Division of Cardiothoracic Surgery, AdventHealth Hospital, Orlando, FL, USA
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The infection with a high-risk oncogenic Human Papillomavirus (HPV) subtypes, most commonly 16 and 18, is a necessary, although not sufficient, condition for development of invasive cervical cancer (ICC) and its precancerous precursor, cervical intra-epithelial neoplasia (CIN). It has been suggested that CIN disease severity and the diversity of vaginal microbiota are associated and this may determine viral persistence and disease behaviour. Our work focuses on the genetic variability associated to the modulation of genotoxicity induced by vaginal microbiota diversity. Relatively little is known about the mechanisms associated with clearance or persistence of HPV infection, therefore we hypothesized that may be under the influence of the genetic background.",signatures:"Andreia Matos, Alda Pereira da Silva, Rui Medeiros, Manuel Bicho\nand Maria Clara Bicho",authors:[{id:"159385",title:"Dr.",name:"Alda",surname:"Pereira Da Silva",fullName:"Alda Pereira Da Silva",slug:"alda-pereira-da-silva",email:"alda_pereira@hotmail.com"},{id:"159388",title:"Prof.",name:"Maria Clara",surname:"Bicho",fullName:"Maria Clara Bicho",slug:"maria-clara-bicho",email:"mclara.bicho@gmail.com"},{id:"165983",title:"Prof.",name:"Rui",surname:"Medeiros",fullName:"Rui Medeiros",slug:"rui-medeiros",email:"ruimmms@gmail.com"},{id:"196737",title:"M.Sc.",name:"Andreia",surname:"Matos",fullName:"Andreia Matos",slug:"andreia-matos",email:"andreiamatos@medicina.ulisboa.pt"},{id:"235447",title:"Prof.",name:"Manuel",surname:"Bicho",fullName:"Manuel Bicho",slug:"manuel-bicho",email:"manuelbicho@medicina.ulisboa.pt"}],book:{id:"6421",title:"Cervical Cancer",slug:"cervical-cancer-screening-treatment-and-prevention-universal-protocols-for-ultimate-control",productType:{id:"1",title:"Edited Volume"}}}],collaborators:[{id:"30473",title:"Prof.",name:"Sabina",surname:"Janciauskiene",slug:"sabina-janciauskiene",fullName:"Sabina Janciauskiene",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/30473/images/system/30473.jpg",biography:"Prof. Dr. Sabina Janciauskiene was born in 1960 in Sweden. Since 1992, overall objective of her research is to investigate the mechanisms controlling inflammation, with particular emphasis on the multiple roles played by serine protease inhibitors (serpins) like: alpha1-antitrypsin and alpha1-antichymotrypsin. Dr. Janciauskiene`s group was among the first to propose that serpin misfolding can also occur due to post-translational modifications of serpin molecule, such as oxidation, nitration, interaction with other molecules and cleavage. Dr. Janciauskiene is a member of the German Lung Research Center and European Respiratory Society. She is a receiver of several prices Teggers Stipendium, King`s Gustaf V & Queen`s Victoria Award and International ALTA B Laurell Award, for new insights in Alpha1-antitrypsin deficiency field, among others. Dr. Janciauskiene made substantial contributions through publications, book chapters, external oral/poster presentations, organizing conferences, contribution to the diagnostic test research and development, and active participation within the Leonardo Da Vinci educational program in Europe, and collaboration with Alpha1-Antitrypsin deficiency patient organizations in Sweden, Germany, and England",institutionString:null,institution:{name:"Hannover Medical School",institutionURL:null,country:{name:"Germany"}}},{id:"39188",title:"Dr.",name:"Csilla",surname:"Tothova",slug:"csilla-tothova",fullName:"Csilla Tothova",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"39585",title:"Prof.",name:"Gabriel",surname:"Kovac",slug:"gabriel-kovac",fullName:"Gabriel Kovac",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/39585/images/system/39585.jpg",biography:"Prof. Kováč was born on 8 November 1947 in Trnava in a workfolk family. Having finished the central agricultural technical school in Trnava (branch grower – breeder) in 1966 – 1972, he studied at the University of Veterinary Medicine in Košice.\nIn 1971, during academic study, he got married and brought up three children with his wife Maria – son Martin and daughters Gabriela and Adriana.With the diploma of a veterinary surgeon he succeeded to the department of Internal Diseases of Ruminants and Swine as a research assistant. In 1972 – 1973 he completed basic military service attendance at the military Veterinary Research Institute in Prague, where, inter alia, he broadened knowledge of scientific-research work, and published his first publications. After returning to the UVM in Košice, he continued with the activities he had started before the military service. Later, he worked as a pedagogic lecturer (1974). Since 1975, he started add-on post-graduate study and in 1978 he defended dissertation thesis („Serum concentrations of vitamin E in cattle and sheep in relation to age, season, pregnancy, breed, and application of its preparations'). In the framework of contemporary regulations in 1982 he was named associated professor and after 8 years of active pedagogic and science-research activities he defended his doctor dissertation thesis („Clinical picture and biochemical indices after application of VX substance in cattle, sheep, and swine'). After habilitation and inauguration hearings („Periods of low vitamin E concentrations in the blood serum of pigs, diagnosis and prevention) he was designated professor for internal diseases of animals and pharmacology by decree of the Slovak President in 1997. In 1989 – 1991, he was the head of the university department and vice-rector for scientific-research activities and foreign relations. In 1997 – 2002, he performed superintendence of the Department of Internal Diseases of Ruminants and Swine at UVM Košice. In the subsequent period 2003 – 2007, he was the chief of II. Clinical Department for Internal Diseases, and since September 2007 chief of the Department for Diseases of Ruminants at the UVM Košice. Already during study he was interested in the subject he later chose, as he worked as a demonstrator and scientific jumper on the Department of Histology and Embryology led by Prof. Hrudka and subsequently at the Department of Internal Diseases of Ruminants and Swine headed by Prof. Vrzgula. As a student, he was involved in the students' scientific and professional activities, in which he stayed as an assistant for 10 years as a scientific secretary. Later he completed several educational stays on the Veterinary faculty in Utrecht, Helsinki, and short-term educational and lecturing stays within European and worldwide scientific and professional events, particularly organized by buiatrics societies in Sophia, Budapest, Moscow, Olsztyn, Lublin, Havana, London, Aberdeen, Belfast, Cambridge, Lyon, Alford, Toulouse, Vienna, St. Paul, Bologna, Edinburgh, Sydney, Balatonfured, Punta del Este, Hannover, Lovran, Quebec, Hajduszoboszlo, Krakow, Nice, Radenci, Kodan, Lisboan, Bury, Gura Humurolui, Leipzig, Siofok, etc. Numerous foreign stays enriched his scientific-pedagogic profile and contributed to his appointment to prominent specialized and scientific commissions and scientific boards, not only at UVM in Košice, but also on Veterinary faculty VaFU Brno and Medical faculty UPJS Košice. Moreover, he was the chairman of the branch of veterinary medicine of the Slovak Academy of Agriculture Sciences, now he is its vice-president, he was the vice-president of Slovak Commission for Dispense of Scientific Ranks, member of presidency of Slovak Academy of Agriculture Sciences, Scientific College of Slovak Academy of Science for Agricultural, Forestry, and Veterinary Sciences, Slovak Association of Veterinary Surgeons and president of its Subsection of Diseases and Rearing of Cattle, contact person for World Buiatric Society and member of its board extension, co-founder and member of executive boards for organization of Middle-European Buiatrics Congresses, member of British VET Association for Cattle Diseases, member of the scientific board of advisers of the American Biographic Institute.\nProf. Kováč is a commissioner of VEGA (scientific grant agency) MS SR and SAV for Agricultural, Forestry, and Veterinary Sciences (for 5-times, last from r. 2005); vice president of Committee for Agriculture Sciences of Agency Supporting Research and Development; member of working parties of Accreditation Commission of SR related to veterinary sciences; member of Technical Board of SNAS (Slovak National Accreditation Service) for accreditation of certifications boards for risk management. Till now, he is a member of several editorial boards of scientific journals: „Biofarm', „Veterinarní medicína', „Folia Veterinaria', „Orbis Medicinae', etc. \nWithin his scientific and research activities he performed important functions as the president of the Common Special Committee for Defence of Dissertation Thesis (PhD.) in the field of study 'Internal Diseases of Animals', member of special committees for defence of dissertation thesis (PhD.) in the fields of study: 'Immunology', 'Nutrition and Dietetics', 'Toxicology', 'Pharmacology'. He is the chairman of Committee for Defence of Doctor Dissertation Thesis (DrSc.) at science branch 'Internal Diseases of Animals', member of special committees at science branches: 'Veterinary Morphology', 'Nutrition and Dietetics', 'Parasitology', 'Other Related Branches of Veterinary Sciences'.Prof. Kováč is engaged in advisory and expertise activities aimed at helping agricultural practice, he closely cooperates with various enterprises in proposing and verifying of new remedies and aids for agricultural and veterinary practice. \nHis present activities classified Prof. Kováč among head representatives of Slovak veterinary medicine, particularly in the field of internal diseases. This is proofed primarily by working out of aetiopathogenesis, diagnosis, therapy and prevention of the most important metabolic disorders in livestock and wild animals. Scientific and research activities of Prof. Kováč are presented at home, as well as abroad. Till now, he is a co-author of 22 Slovak scientific monographies, 11 foreign scientific monographies, author and co-author of three academic textbooks, 7 scripts, 91 scientific works in the Current Contents journals (88 foreign and three Slovak), 239 scientific and special papers in other journals (62 foreign and 177 Slovak), 141 scientific contributions in reviewed proceedings of foreign conferences, 371 scientific works in reviewed proceedings of Slovak conferences.\nProf. Kováč, as the principal investigator and co-investigator, participated in 23 defended final reports of state research tasks, 6 department research tasks, 2 international grant projects, and 6 grant projects within SR; 11 continuous research reports, 9 research and special works based on economic activities. He worked out 23 reviews of issued works, 42 opponent reviews of qualifying works, 3 special translations, 36 scientific-popular and informative contributions, he took part in the elaboration of subject words in four dictionaries and encyclopaedias, and other 96 published works (to prominent jubilee colleagues, information on important scientific and special events at home and abroad). At the present, he is the principal investigator of VEGA and APVV grant projects, and co-investigator of several other projects. Among the published works of Prof. Kováč, the most important is knowledge of periods of low vitamin E concentrations in the blood serum of cattle, sheep and swine in relation to stage of pregnancy, age, season, and response to various ways of administration of remedies based on vitamin E and selenium; clarifying of aetiopathogenesis, diagnosis, therapy, and prevention of nutritional muscular dystrophy in young cattle; hypovitaminoses of B-complex; interactions of natural antioxidants and poly-unsaturated fatty acids; the use of natural sorbents; knowledge of clinical picture and metabolic indices in livestock and wild animals in areas exposed to industrial and chemical contaminations. In close relation to educational stays abroad, Prof. Kováč paid also considerable attention to the clarification of aetiopathogenesis, diagnosis, therapy, and prevention of several organ entities, and methodical procedures. In the recent period, Prof. Kováč orientates his collective, particularly research activities of his PhD students, to use components of genomics, proteomics, nutrigenomics, metabolomics, for real selection of animals by health signs, which lags behind the selection of food animals based on production traits only. Prof. Kováč participated meaningly in under-graduate education within students' research and special works (21 students), diploma thesis (12 the students), young scientific-pedagogic workers for needs of UVM (5 PhD.), practice (2 PhD.), and foreign countries (2 PhD.); three associated professors, two regular professors; building up of former Department of Internal Diseases of Ruminants and Swine, later 2nd Clinical Department, and presently the Clinical Department for Ruminants at UVM Košice, as an up-to-date academic place of work within the University of veterinary medicine in Košice, as well as in European space (through acquirement of financial resources within developing projects).",institutionString:"University of Veterinary Medicine in Košice",institution:{name:"University of Veterinary Medicine in Košice",institutionURL:null,country:{name:"Slovakia"}}},{id:"47101",title:"Prof.",name:"Oskar",surname:"Nagy",slug:"oskar-nagy",fullName:"Oskar Nagy",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Veterinary Medicine in Košice",institutionURL:null,country:{name:"Slovakia"}}},{id:"47714",title:"Dr.",name:"Herbert",surname:"Seidel",slug:"herbert-seidel",fullName:"Herbert Seidel",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Veterinary Medicine in Košice",institutionURL:null,country:{name:"Slovakia"}}},{id:"157199",title:"Associate Prof.",name:"Paul",surname:"Witting",slug:"paul-witting",fullName:"Paul Witting",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Sydney",institutionURL:null,country:{name:"Australia"}}},{id:"158116",title:"Prof.",name:"Masaki",surname:"Otagiri",slug:"masaki-otagiri",fullName:"Masaki Otagiri",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Sojo University",institutionURL:null,country:{name:"Japan"}}},{id:"158238",title:"Dr.",name:"Kazuaki",surname:"Taguchi",slug:"kazuaki-taguchi",fullName:"Kazuaki Taguchi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Kumamoto University",institutionURL:null,country:{name:"Japan"}}},{id:"159716",title:"Dr.",name:"Simon",surname:"Davidson",slug:"simon-davidson",fullName:"Simon Davidson",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Harefield Hospital",institutionURL:null,country:{name:"United Kingdom"}}},{id:"165882",title:"Dr.",name:"Koji",surname:"Nishi",slug:"koji-nishi",fullName:"Koji Nishi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Keio University",institutionURL:null,country:{name:"Japan"}}}]},generic:{page:{slug:"open-access-funding-funders-list",title:"List of Funders by Country",intro:"
If your research is financed through any of the below-mentioned funders, please consult their Open Access policies or grant ‘terms and conditions’ to explore ways to cover your publication costs (also accessible by clicking on the link in their title).
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IMPORTANT: You must be a member or grantee of the listed funders in order to apply for their Open Access publication funds. Do not attempt to contact the funders if this is not the case.
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UK Research and Innovation (former Research Councils UK (RCUK) - including AHRC, BBSRC, ESRC, EPSRC, MRC, NERC, STFC.) Processing charges for books/book chapters can be covered through RCUK block grants which are allocated to most universities in the UK, which then handle the OA publication funding requests. It is at the discretion of the university whether it will approve the request.)
UK Research and Innovation (former Research Councils UK (RCUK) - including AHRC, BBSRC, ESRC, EPSRC, MRC, NERC, STFC.) Processing charges for books/book chapters can be covered through RCUK block grants which are allocated to most universities in the UK, which then handle the OA publication funding requests. It is at the discretion of the university whether it will approve the request.)
Wellcome Trust (Funding available only to Wellcome-funded researchers/grantees)
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His studies in robotics lead him not only to a PhD degree but also inspired him to co-found and build the International Journal of Advanced Robotic Systems - world's first Open Access journal in the field of robotics.",institutionString:null,institution:{name:"TU Wien",country:{name:"Austria"}}},{id:"441",title:"Ph.D.",name:"Jaekyu",middleName:null,surname:"Park",slug:"jaekyu-park",fullName:"Jaekyu Park",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/441/images/1881_n.jpg",biography:null,institutionString:null,institution:{name:"LG Corporation (South Korea)",country:{name:"Korea, South"}}},{id:"465",title:"Dr.",name:"Christian",middleName:null,surname:"Martens",slug:"christian-martens",fullName:"Christian Martens",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Rheinmetall (Germany)",country:{name:"Germany"}}},{id:"479",title:"Dr.",name:"Valentina",middleName:null,surname:"Colla",slug:"valentina-colla",fullName:"Valentina Colla",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/479/images/358_n.jpg",biography:null,institutionString:null,institution:{name:"Sant'Anna School of Advanced Studies",country:{name:"Italy"}}},{id:"494",title:"PhD",name:"Loris",middleName:null,surname:"Nanni",slug:"loris-nanni",fullName:"Loris Nanni",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/494/images/system/494.jpg",biography:"Loris Nanni received his Master Degree cum laude on June-2002 from the University of Bologna, and the April 26th 2006 he received his Ph.D. in Computer Engineering at DEIS, University of Bologna. On September, 29th 2006 he has won a post PhD fellowship from the university of Bologna (from October 2006 to October 2008), at the competitive examination he was ranked first in the industrial engineering area. He extensively served as referee for several international journals. He is author/coauthor of more than 100 research papers. He has been involved in some projects supported by MURST and European Community. His research interests include pattern recognition, bioinformatics, and biometric systems (fingerprint classification and recognition, signature verification, face recognition).",institutionString:null,institution:null},{id:"496",title:"Dr.",name:"Carlos",middleName:null,surname:"Leon",slug:"carlos-leon",fullName:"Carlos Leon",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Seville",country:{name:"Spain"}}},{id:"512",title:"Dr.",name:"Dayang",middleName:null,surname:"Jawawi",slug:"dayang-jawawi",fullName:"Dayang Jawawi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Technology Malaysia",country:{name:"Malaysia"}}},{id:"528",title:"Dr.",name:"Kresimir",middleName:null,surname:"Delac",slug:"kresimir-delac",fullName:"Kresimir Delac",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/528/images/system/528.jpg",biography:"K. Delac received his B.Sc.E.E. degree in 2003 and is currentlypursuing a Ph.D. degree at the University of Zagreb, Faculty of Electrical Engineering andComputing. His current research interests are digital image analysis, pattern recognition andbiometrics.",institutionString:null,institution:{name:"University of Zagreb",country:{name:"Croatia"}}},{id:"557",title:"Dr.",name:"Andon",middleName:"Venelinov",surname:"Topalov",slug:"andon-topalov",fullName:"Andon Topalov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/557/images/1927_n.jpg",biography:"Dr. Andon V. Topalov received the MSc degree in Control Engineering from the Faculty of Information Systems, Technologies, and Automation at Moscow State University of Civil Engineering (MGGU) in 1979. He then received his PhD degree in Control Engineering from the Department of Automation and Remote Control at Moscow State Mining University (MGSU), Moscow, in 1984. From 1985 to 1986, he was a Research Fellow in the Research Institute for Electronic Equipment, ZZU AD, Plovdiv, Bulgaria. In 1986, he joined the Department of Control Systems, Technical University of Sofia at the Plovdiv campus, where he is presently a Full Professor. He has held long-term visiting Professor/Scholar positions at various institutions in South Korea, Turkey, Mexico, Greece, Belgium, UK, and Germany. And he has coauthored one book and authored or coauthored more than 80 research papers in conference proceedings and journals. His current research interests are in the fields of intelligent control and robotics.",institutionString:null,institution:{name:"Technical University of Sofia",country:{name:"Bulgaria"}}},{id:"585",title:"Prof.",name:"Munir",middleName:null,surname:"Merdan",slug:"munir-merdan",fullName:"Munir Merdan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/585/images/system/585.jpg",biography:"Munir Merdan received the M.Sc. degree in mechanical engineering from the Technical University of Sarajevo, Bosnia and Herzegovina, in 2001, and the Ph.D. degree in electrical engineering from the Vienna University of Technology, Vienna, Austria, in 2009.Since 2005, he has been at the Automation and Control Institute, Vienna University of Technology, where he is currently a Senior Researcher. His research interests include the application of agent technology for achieving agile control in the manufacturing environment.",institutionString:null,institution:null},{id:"605",title:"Prof",name:"Dil",middleName:null,surname:"Hussain",slug:"dil-hussain",fullName:"Dil Hussain",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/605/images/system/605.jpg",biography:"Dr. Dil Muhammad Akbar Hussain is a professor of Electronics Engineering & Computer Science at the Department of Energy Technology, Aalborg University Denmark. Professor Akbar has a Master degree in Digital Electronics from Govt. College University, Lahore Pakistan and a P-hD degree in Control Engineering from the School of Engineering and Applied Sciences, University of Sussex United Kingdom. Aalborg University has Two Satellite Campuses, one in Copenhagen (Aalborg University Copenhagen) and the other in Esbjerg (Aalborg University Esbjerg).\n· He is a member of prestigious IEEE (Institute of Electrical and Electronics Engineers), and IAENG (International Association of Engineers) organizations. \n· He is the chief Editor of the Journal of Software Engineering.\n· He is the member of the Editorial Board of International Journal of Computer Science and Software Technology (IJCSST) and International Journal of Computer Engineering and Information Technology. \n· He is also the Editor of Communication in Computer and Information Science CCIS-20 by Springer.\n· Reviewer For Many Conferences\nHe is the lead person in making collaboration agreements between Aalborg University and many universities of Pakistan, for which the MOU’s (Memorandum of Understanding) have been signed.\nProfessor Akbar is working in Academia since 1990, he started his career as a Lab demonstrator/TA at the University of Sussex. After finishing his P. hD degree in 1992, he served in the Industry as a Scientific Officer and continued his academic career as a visiting scholar for a number of educational institutions. In 1996 he joined National University of Science & Technology Pakistan (NUST) as an Associate Professor; NUST is one of the top few universities in Pakistan. In 1999 he joined an International Company Lineo Inc, Canada as Manager Compiler Group, where he headed the group for developing Compiler Tool Chain and Porting of Operating Systems for the BLACKfin processor. The processor development was a joint venture by Intel and Analog Devices. In 2002 Lineo Inc., was taken over by another company, so he joined Aalborg University Denmark as an Assistant Professor.\nProfessor Akbar has truly a multi-disciplined career and he continued his legacy and making progress in many areas of his interests both in teaching and research. He has contributed in stochastic estimation of control area especially, in the Multiple Target Tracking and Interactive Multiple Model (IMM) research, Ball & Beam Control Problem, Robotics, Levitation Control. He has contributed in developing Algorithms for Fingerprint Matching, Computer Vision and Face Recognition. He has been supervising Pattern Recognition, Formal Languages and Distributed Processing projects for several years. He has reviewed many books on Management, Computer Science. Currently, he is an active and permanent reviewer for many international conferences and symposia and the program committee member for many international conferences.\nIn teaching he has taught the core computer science subjects like, Digital Design, Real Time Embedded System Programming, Operating Systems, Software Engineering, Data Structures, Databases, Compiler Construction. 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As a result, the optimal formula is obtained with 300 g of mycorrhizal and rhizobium strains + 500 g of black soil + 200 g of potato peel crust, which has an effective antagonistic capacity of 100% in pea cultivation, 90% in the barley, and 85% in the potato, besides that it achieves a biotisation in the cultivation of peas of 95%, in the barley 100% and in the potato 90%.",book:{id:"11177",title:"Biomass, Biorefineries and Bioeconomy",coverURL:"https://cdn.intechopen.com/books/images_new/11177.jpg"},signatures:"Henry Juan Javier Ninahuaman and Grimaldo Quispe Santivañez"},{id:"82542",title:"Effects of Veld Degradation on Biomass Production in the Arable Lands of South Africa",slug:"effects-of-veld-degradation-on-biomass-production-in-the-arable-lands-of-south-africa",totalDownloads:14,totalDimensionsCites:0,doi:"10.5772/intechopen.102605",abstract:"This paper reviews the impacts of veld degradation on species diversity, veld ecological condition. The major focus of this review is to assess the major critical factors that contributeto veld degradation. It is imperative to revitalize information on the effects of veld degradation in the South African pastoral farming systems. Current studies have indicated the limited research gaps that identify the adverse effects of veld degradation on species composition and biomass production. Grazing behavior in different grazing patterns has not been clear. Finally, this review will assist farmers, policymakers, and pastoralists to broaden their knowledge on policy development, and appropriate the veld management practices, coping measures of veld degradation, particularly those from resource-poor communities. Whereby, livestock production is the focus for food security and poverty alleviation. However, the use of legumes intercropped with temperate grass species can improve animal performance and herbage production during critical periods. The review further evaluates the veld management practices and their ability in providing adequate foliar cover with the use of the edible perennial grass plant that ensures long-term sustainable production with maximum economic returns during critical grazing seasons.",book:{id:"11177",title:"Biomass, Biorefineries and Bioeconomy",coverURL:"https://cdn.intechopen.com/books/images_new/11177.jpg"},signatures:"Nkosikhona Madolo and Francis B. Lewu"},{id:"82330",title:"Advances in Bioenergy Production Using Fast Pyrolysis and Hydrothermal Processing",slug:"advances-in-bioenergy-production-using-fast-pyrolysis-and-hydrothermal-processing",totalDownloads:7,totalDimensionsCites:0,doi:"10.5772/intechopen.105185",abstract:"This chapter provides an overview of current efforts and advances as well as environmental and economic aspects of fast pyrolysis and hydrothermal processing, which are potential technologies for bioenergy production, mainly bio-oil and syngas. Biomass is presently the primary bioenergy resource in the world. The chapter presents a brief discussion of sources and compositions of biomass. Biomass is converted to various products using thermochemical conversions. Pyrolysis is a thermochemical process that converts biomass into carbon-rich solid residue, condensable vapors, and non-condensable gases in the absence of oxygen. It is a promising technology for converting biomass into renewable biofuels with environmental and economic advantages. Pyrolysis processes are classified based on their operating conditions and desired products. Two thermochemical processes, fast pyrolysis and hydrothermal processing are reviewed. Fast pyrolysis produces a higher quantity and quality of bio-oil and syngas than slow and intermediate pyrolysis processes. Hydrothermal processing converts wet biomass into carbonaceous biofuel. The ability to produce higher-value bioenergy by these pyrolysis technologies depends on the feedstock and operating condition of the pyrolysis processes. This chapter will present the most promising features of fast pyrolysis and hydrothermal processing along with their optimal pyrolysis conditions in maximizing the production of biofuels.",book:{id:"11177",title:"Biomass, Biorefineries and Bioeconomy",coverURL:"https://cdn.intechopen.com/books/images_new/11177.jpg"},signatures:"Meegalla R. Chandraratne and Asfaw Gezae Daful"},{id:"81162",title:"Economic Assessment of Biomass Based Power Generation",slug:"economic-assessment-of-biomass-based-power-generation",totalDownloads:14,totalDimensionsCites:0,doi:"10.5772/intechopen.103692",abstract:"Biomass based power generation systems can play a significant role to alleviate energy crisis and reduce fossil fuel dependency in the countries that possess abundance of agricultural and forest biomass resources. Particularly the countries to go for biomass energy in a large scale must know power and energy potential for biomass based commercial production with proper economic assessment of the possibilities. In-depth knowledge is must to assess the profitability and sustainability of the projects. Profitability measures how the investment in the project can be secured to have an ensured surplus to be shared by the stake holders and sustainability ensures the long-term existence in the business with a positive trend of gaining market share day by day or simply to be in the business. This chapter will present the details of the economic assessment of biomass- based energy projects in terms of net present value (NPV), internal rate of return (IRR), discounted payback period (DPB), and cost of energy. The economic profitability measure is a must before advancing to a venture whether it is self-financed or loan financed. So, it is hoped that readers of the chapter should develop a proper evaluation capability and know how to analyze the biomass-based energy projects.",book:{id:"11177",title:"Biomass, Biorefineries and Bioeconomy",coverURL:"https://cdn.intechopen.com/books/images_new/11177.jpg"},signatures:"A.B.M. Abdul Malek"},{id:"80542",title:"Comparative Analysis of Biodiesel Production from Different Potential Feedstocks in the Philippines",slug:"comparative-analysis-of-biodiesel-production-from-different-potential-feedstocks-in-the-philippines",totalDownloads:31,totalDimensionsCites:0,doi:"10.5772/intechopen.102724",abstract:"In response to the worsening crisis on energy security and climate change, the Philippine Biofuels Law (Republic Act 9367) was enacted which mandates the blending of biodiesel to petroleum diesel sold in the country. Primarily, feedstock and pricing concerns led to stagnant growth of the Philippine biodiesel industry. Hence, viability of different potential biodiesel feedstocks such as coconut, oil palm, and soybean (first generation), jatropha and used cooking oil (second generation), and microalgae (third generation) was assessed through extensive research and developments. Among these sources, oil palm is regarded as the best complementary feedstock to coconut due to its high biodiesel productivity of 376 million liters per year. Oil palm biodiesel production in the Philippines was also found to have a low carbon footprint of 1.80 kg CO2e per liter and a GHG reduction potential of 42%, which corresponds to a GHG savings of about 1.05 million metric tons CO2e per year for a 5% blending mandate in 2025. Additionally, a low biodiesel selling price of about Php 33.26 per liter can be achieved from using this feedstock for biodiesel production. Hence, use of a low cost and readily available feedstock coupled with established processing technologies and pricing mechanisms will help boost the biodiesel industry in the Philippines.",book:{id:"11177",title:"Biomass, Biorefineries and Bioeconomy",coverURL:"https://cdn.intechopen.com/books/images_new/11177.jpg"},signatures:"Rona Joyce B. Landoy, Rex B. Demafelis, Bernadette T. Magadia and Anna Elaine D. Matanguihan"},{id:"80493",title:"Conventional and Unconventional Transformation of Cocoa Pod Husks into Value-Added Products",slug:"conventional-and-unconventional-transformation-of-cocoa-pod-husks-into-value-added-products",totalDownloads:42,totalDimensionsCites:0,doi:"10.5772/intechopen.102606",abstract:"The drive for a sustainable society and a circular economy has motivated researchers around the globe to turn to the transformation of renewable raw materials like biomass into value-added products that are akin or superior to their fossil counterparts. Among these biomass raw materials, cocoa pod husks (CPH) which is the non-edible portion of cocoa (ca. 70–75% weight of the while cocoa fruit) remains a promising bio-resource raw material for the production high-value added chemicals but yet largely underexploited. Currently, the most popular applications of CPH involves its use as low-value application products such as animal feed, raw material for soap making, and activated carbon. However, the rich source of lignocellulosic content, pectin, and phenolic compounds of CPH means it could be used as raw materials for the production industrially relevant platform chemicals with high potential in the agrochemicals, pharmaceutical, and food industries, if efficient transformations routes are developed by scientists. In this chapter, we will shed light on some of the works related to the transformation of CPH into various value-added products. An economic evaluation of the transformation of cocoa pod husk into relevant chemicals and products is also discussed.",book:{id:"11177",title:"Biomass, Biorefineries and Bioeconomy",coverURL:"https://cdn.intechopen.com/books/images_new/11177.jpg"},signatures:"Martina Francisca Baidoo, Nana Yaw Asiedu, Lawrence Darkwah, David Arhin-Dodoo, Jun Zhao, Francois Jerome and Prince Nana Amaniampong"}],onlineFirstChaptersTotal:17},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:90,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:107,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:33,numberOfPublishedChapters:330,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:18,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:14,numberOfPublishedChapters:145,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:9,numberOfPublishedChapters:139,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:122,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:112,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:21,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:10,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:"2753-6580",doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}}]},series:{item:{id:"14",title:"Artificial Intelligence",doi:"10.5772/intechopen.79920",issn:"2633-1403",scope:"Artificial Intelligence (AI) is a rapidly developing multidisciplinary research area that aims to solve increasingly complex problems. In today's highly integrated world, AI promises to become a robust and powerful means for obtaining solutions to previously unsolvable problems. This Series is intended for researchers and students alike interested in this fascinating field and its many applications.",coverUrl:"https://cdn.intechopen.com/series/covers/14.jpg",latestPublicationDate:"July 5th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:9,editor:{id:"218714",title:"Prof.",name:"Andries",middleName:null,surname:"Engelbrecht",slug:"andries-engelbrecht",fullName:"Andries Engelbrecht",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRNR8QAO/Profile_Picture_1622640468300",biography:"Andries Engelbrecht received the Masters and PhD degrees in Computer Science from the University of Stellenbosch, South Africa, in 1994 and 1999 respectively. He is currently appointed as the Voigt Chair in Data Science in the Department of Industrial Engineering, with a joint appointment as Professor in the Computer Science Division, Stellenbosch University. Prior to his appointment at Stellenbosch University, he has been at the University of Pretoria, Department of Computer Science (1998-2018), where he was appointed as South Africa Research Chair in Artifical Intelligence (2007-2018), the head of the Department of Computer Science (2008-2017), and Director of the Institute for Big Data and Data Science (2017-2018). In addition to a number of research articles, he has written two books, Computational Intelligence: An Introduction and Fundamentals of Computational Swarm Intelligence.",institutionString:null,institution:{name:"Stellenbosch University",institutionURL:null,country:{name:"South Africa"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:6,paginationItems:[{id:"22",title:"Applied Intelligence",coverUrl:"https://cdn.intechopen.com/series_topics/covers/22.jpg",isOpenForSubmission:!0,annualVolume:11418,editor:{id:"27170",title:"Prof.",name:"Carlos",middleName:"M.",surname:"Travieso-Gonzalez",slug:"carlos-travieso-gonzalez",fullName:"Carlos Travieso-Gonzalez",profilePictureURL:"https://mts.intechopen.com/storage/users/27170/images/system/27170.jpeg",biography:"Carlos M. Travieso-González received his MSc degree in Telecommunication Engineering at Polytechnic University of Catalonia (UPC), Spain in 1997, and his Ph.D. degree in 2002 at the University of Las Palmas de Gran Canaria (ULPGC-Spain). He is a full professor of signal processing and pattern recognition and is head of the Signals and Communications Department at ULPGC, teaching from 2001 on subjects on signal processing and learning theory. His research lines are biometrics, biomedical signals and images, data mining, classification system, signal and image processing, machine learning, and environmental intelligence. He has researched in 52 international and Spanish research projects, some of them as head researcher. He is co-author of 4 books, co-editor of 27 proceedings books, guest editor for 8 JCR-ISI international journals, and up to 24 book chapters. He has over 450 papers published in international journals and conferences (81 of them indexed on JCR – ISI - Web of Science). He has published seven patents in the Spanish Patent and Trademark Office. He has been a supervisor on 8 Ph.D. theses (11 more are under supervision), and 130 master theses. He is the founder of The IEEE IWOBI conference series and the president of its Steering Committee, as well as the founder of both the InnoEducaTIC and APPIS conference series. He is an evaluator of project proposals for the European Union (H2020), Medical Research Council (MRC, UK), Spanish Government (ANECA, Spain), Research National Agency (ANR, France), DAAD (Germany), Argentinian Government, and the Colombian Institutions. He has been a reviewer in different indexed international journals (<70) and conferences (<250) since 2001. He has been a member of the IASTED Technical Committee on Image Processing from 2007 and a member of the IASTED Technical Committee on Artificial Intelligence and Expert Systems from 2011. \n\nHe has held the general chair position for the following: ACM-APPIS (2020, 2021), IEEE-IWOBI (2019, 2020 and 2020), A PPIS (2018, 2019), IEEE-IWOBI (2014, 2015, 2017, 2018), InnoEducaTIC (2014, 2017), IEEE-INES (2013), NoLISP (2011), JRBP (2012), and IEEE-ICCST (2005)\n\nHe is an associate editor of the Computational Intelligence and Neuroscience Journal (Hindawi – Q2 JCR-ISI). He was vice dean from 2004 to 2010 in the Higher Technical School of Telecommunication Engineers at ULPGC and the vice dean of Graduate and Postgraduate Studies from March 2013 to November 2017. He won the “Catedra Telefonica” Awards in Modality of Knowledge Transfer, 2017, 2018, and 2019 editions, and awards in Modality of COVID Research in 2020.\n\nPublic References:\nResearcher ID http://www.researcherid.com/rid/N-5967-2014\nORCID https://orcid.org/0000-0002-4621-2768 \nScopus Author ID https://www.scopus.com/authid/detail.uri?authorId=6602376272\nScholar Google https://scholar.google.es/citations?user=G1ks9nIAAAAJ&hl=en \nResearchGate https://www.researchgate.net/profile/Carlos_Travieso",institutionString:null,institution:{name:"University of Las Palmas de Gran Canaria",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"23",title:"Computational Neuroscience",coverUrl:"https://cdn.intechopen.com/series_topics/covers/23.jpg",isOpenForSubmission:!0,annualVolume:11419,editor:{id:"14004",title:"Dr.",name:"Magnus",middleName:null,surname:"Johnsson",slug:"magnus-johnsson",fullName:"Magnus Johnsson",profilePictureURL:"https://mts.intechopen.com/storage/users/14004/images/system/14004.png",biography:"Dr Magnus Johnsson is a cross-disciplinary scientist, lecturer, scientific editor and AI/machine learning consultant from Sweden. \n\nHe is currently at Malmö University in Sweden, but also held positions at Lund University in Sweden and at Moscow Engineering Physics Institute. \nHe holds editorial positions at several international scientific journals and has served as a scientific editor for books and special journal issues. \nHis research interests are wide and include, but are not limited to, autonomous systems, computer modeling, artificial neural networks, artificial intelligence, cognitive neuroscience, cognitive robotics, cognitive architectures, cognitive aids and the philosophy of mind. \n\nDr. Johnsson has experience from working in the industry and he has a keen interest in the application of neural networks and artificial intelligence to fields like industry, finance, and medicine. \n\nWeb page: www.magnusjohnsson.se",institutionString:null,institution:{name:"Malmö University",institutionURL:null,country:{name:"Sweden"}}},editorTwo:null,editorThree:null},{id:"24",title:"Computer Vision",coverUrl:"https://cdn.intechopen.com/series_topics/covers/24.jpg",isOpenForSubmission:!0,annualVolume:11420,editor:{id:"294154",title:"Prof.",name:"George",middleName:null,surname:"Papakostas",slug:"george-papakostas",fullName:"George Papakostas",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002hYaGbQAK/Profile_Picture_1624519712088",biography:"George A. Papakostas has received a diploma in Electrical and Computer Engineering in 1999 and the M.Sc. and Ph.D. degrees in Electrical and Computer Engineering in 2002 and 2007, respectively, from the Democritus University of Thrace (DUTH), Greece. Dr. Papakostas serves as a Tenured Full Professor at the Department of Computer Science, International Hellenic University, Greece. Dr. Papakostas has 10 years of experience in large-scale systems design as a senior software engineer and technical manager, and 20 years of research experience in the field of Artificial Intelligence. Currently, he is the Head of the “Visual Computing” division of HUman-MAchines INteraction Laboratory (HUMAIN-Lab) and the Director of the MPhil program “Advanced Technologies in Informatics and Computers” hosted by the Department of Computer Science, International Hellenic University. He has (co)authored more than 150 publications in indexed journals, international conferences and book chapters, 1 book (in Greek), 3 edited books, and 5 journal special issues. His publications have more than 2100 citations with h-index 27 (GoogleScholar). His research interests include computer/machine vision, machine learning, pattern recognition, computational intelligence. \nDr. Papakostas served as a reviewer in numerous journals, as a program\ncommittee member in international conferences and he is a member of the IAENG, MIR Labs, EUCogIII, INSTICC and the Technical Chamber of Greece (TEE).",institutionString:null,institution:{name:"International Hellenic University",institutionURL:null,country:{name:"Greece"}}},editorTwo:null,editorThree:null},{id:"25",title:"Evolutionary Computation",coverUrl:"https://cdn.intechopen.com/series_topics/covers/25.jpg",isOpenForSubmission:!0,annualVolume:11421,editor:{id:"136112",title:"Dr.",name:"Sebastian",middleName:null,surname:"Ventura Soto",slug:"sebastian-ventura-soto",fullName:"Sebastian Ventura Soto",profilePictureURL:"https://mts.intechopen.com/storage/users/136112/images/system/136112.png",biography:"Sebastian Ventura is a Spanish researcher, a full professor with the Department of Computer Science and Numerical Analysis, University of Córdoba. Dr Ventura also holds the positions of Affiliated Professor at Virginia Commonwealth University (Richmond, USA) and Distinguished Adjunct Professor at King Abdulaziz University (Jeddah, Saudi Arabia). Additionally, he is deputy director of the Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI) and heads the Knowledge Discovery and Intelligent Systems Research Laboratory. He has published more than ten books and over 300 articles in journals and scientific conferences. Currently, his work has received over 18,000 citations according to Google Scholar, including more than 2200 citations in 2020. In the last five years, he has published more than 60 papers in international journals indexed in the JCR (around 70% of them belonging to first quartile journals) and he has edited some Springer books “Supervised Descriptive Pattern Mining” (2018), “Multiple Instance Learning - Foundations and Algorithms” (2016), and “Pattern Mining with Evolutionary Algorithms” (2016). He has also been involved in more than 20 research projects supported by the Spanish and Andalusian governments and the European Union. He currently belongs to the editorial board of PeerJ Computer Science, Information Fusion and Engineering Applications of Artificial Intelligence journals, being also associate editor of Applied Computational Intelligence and Soft Computing and IEEE Transactions on Cybernetics. Finally, he is editor-in-chief of Progress in Artificial Intelligence. He is a Senior Member of the IEEE Computer, the IEEE Computational Intelligence, and the IEEE Systems, Man, and Cybernetics Societies, and the Association of Computing Machinery (ACM). Finally, his main research interests include data science, computational intelligence, and their applications.",institutionString:null,institution:{name:"University of Córdoba",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"26",title:"Machine Learning and Data Mining",coverUrl:"https://cdn.intechopen.com/series_topics/covers/26.jpg",isOpenForSubmission:!0,annualVolume:11422,editor:{id:"24555",title:"Dr.",name:"Marco Antonio",middleName:null,surname:"Aceves Fernandez",slug:"marco-antonio-aceves-fernandez",fullName:"Marco Antonio Aceves Fernandez",profilePictureURL:"https://mts.intechopen.com/storage/users/24555/images/system/24555.jpg",biography:"Dr. Marco Antonio Aceves Fernandez obtained his B.Sc. (Eng.) in Telematics from the Universidad de Colima, Mexico. 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He has both an MS and Ph.D. in Biomedical Engineering. He was previously a research scientist at the University of California Los Angeles (UCLA) and visiting professor and researcher at the University of North Dakota. He is currently working in artificial intelligence and its applications in medical signal processing. In addition, he is using digital signal processing in medical imaging and speech processing. Dr. Asadpour has developed brain-computer interfacing algorithms and has published books, book chapters, and several journal and conference papers in this field and other areas of intelligent signal processing. He has also designed medical devices, including a laser Doppler monitoring system.",institutionString:"Kaiser Permanente Southern California",institution:null},{id:"169608",title:"Prof.",name:"Marian",middleName:null,surname:"Găiceanu",slug:"marian-gaiceanu",fullName:"Marian Găiceanu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/169608/images/system/169608.png",biography:"Prof. Dr. Marian Gaiceanu graduated from the Naval and Electrical Engineering Faculty, Dunarea de Jos University of Galati, Romania, in 1997. He received a Ph.D. (Magna Cum Laude) in Electrical Engineering in 2002. Since 2017, Dr. Gaiceanu has been a Ph.D. supervisor for students in Electrical Engineering. He has been employed at Dunarea de Jos University of Galati since 1996, where he is currently a professor. Dr. Gaiceanu is a member of the National Council for Attesting Titles, Diplomas and Certificates, an expert of the Executive Agency for Higher Education, Research Funding, and a member of the Senate of the Dunarea de Jos University of Galati. He has been the head of the Integrated Energy Conversion Systems and Advanced Control of Complex Processes Research Center, Romania, since 2016. He has conducted several projects in power converter systems for electrical drives, power quality, PEM and SOFC fuel cell power converters for utilities, electric vehicles, and marine applications with the Department of Regulation and Control, SIEI S.pA. (2002–2004) and the Polytechnic University of Turin, Italy (2002–2004, 2006–2007). He is a member of the Institute of Electrical and Electronics Engineers (IEEE) and cofounder-member of the IEEE Power Electronics Romanian Chapter. He is a guest editor at Energies and an academic book editor for IntechOpen. He is also a member of the editorial boards of the Journal of Electrical Engineering, Electronics, Control and Computer Science and Sustainability. Dr. Gaiceanu has been General Chairman of the IEEE International Symposium on Electrical and Electronics Engineering in the last six editions.",institutionString:'"Dunarea de Jos" University of Galati',institution:{name:'"Dunarea de Jos" University of Galati',country:{name:"Romania"}}},{id:"4519",title:"Prof.",name:"Jaydip",middleName:null,surname:"Sen",slug:"jaydip-sen",fullName:"Jaydip Sen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/4519/images/system/4519.jpeg",biography:"Jaydip Sen is associated with Praxis Business School, Kolkata, India, as a professor in the Department of Data Science. His research areas include security and privacy issues in computing and communication, intrusion detection systems, machine learning, deep learning, and artificial intelligence in the financial domain. He has more than 200 publications in reputed international journals, refereed conference proceedings, and 20 book chapters in books published by internationally renowned publishing houses, such as Springer, CRC press, IGI Global, etc. Currently, he is serving on the editorial board of the prestigious journal Frontiers in Communications and Networks and in the technical program committees of a number of high-ranked international conferences organized by the IEEE, USA, and the ACM, USA. He has been listed among the top 2% of scientists in the world for the last three consecutive years, 2019 to 2021 as per studies conducted by the Stanford University, USA.",institutionString:"Praxis Business School",institution:null},{id:"320071",title:"Dr.",name:"Sidra",middleName:null,surname:"Mehtab",slug:"sidra-mehtab",fullName:"Sidra Mehtab",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00002v6KHoQAM/Profile_Picture_1584512086360",biography:"Sidra Mehtab has completed her BS with honors in Physics from Calcutta University, India in 2018. She has done MS in Data Science and Analytics from Maulana Abul Kalam Azad University of Technology (MAKAUT), Kolkata, India in 2020. Her research areas include Econometrics, Time Series Analysis, Machine Learning, Deep Learning, Artificial Intelligence, and Computer and Network Security with a particular focus on Cyber Security Analytics. Ms. Mehtab has published seven papers in international conferences and one of her papers has been accepted for publication in a reputable international journal. She has won the best paper awards in two prestigious international conferences – BAICONF 2019, and ICADCML 2021, organized in the Indian Institute of Management, Bangalore, India in December 2019, and SOA University, Bhubaneswar, India in January 2021. Besides, Ms. Mehtab has also published two book chapters in two books. Seven of her book chapters will be published in a volume shortly in 2021 by Cambridge Scholars’ Press, UK. Currently, she is working as the joint editor of two edited volumes on Time Series Analysis and Forecasting to be published in the first half of 2021 by an international house. Currently, she is working as a Data Scientist with an MNC in Delhi, India.",institutionString:"NSHM College of Management and Technology",institution:{name:"Association for Computing Machinery",country:{name:"United States of America"}}},{id:"226240",title:"Dr.",name:"Andri Irfan",middleName:null,surname:"Rifai",slug:"andri-irfan-rifai",fullName:"Andri Irfan Rifai",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/226240/images/7412_n.jpg",biography:"Andri IRFAN is a Senior Lecturer of Civil Engineering and Planning. He completed the PhD at the Universitas Indonesia & Universidade do Minho with Sandwich Program Scholarship from the Directorate General of Higher Education and LPDP scholarship. He has been teaching for more than 19 years and much active to applied his knowledge in the project construction in Indonesia. His research interest ranges from pavement management system to advanced data mining techniques for transportation engineering. He has published more than 50 papers in journals and 2 books.",institutionString:null,institution:{name:"Universitas Internasional Batam",country:{name:"Indonesia"}}},{id:"314576",title:"Dr.",name:"Ibai",middleName:null,surname:"Laña",slug:"ibai-lana",fullName:"Ibai Laña",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/314576/images/system/314576.jpg",biography:"Dr. Ibai Laña works at TECNALIA as a data analyst. He received his Ph.D. in Artificial Intelligence from the University of the Basque Country (UPV/EHU), Spain, in 2018. He is currently a senior researcher at TECNALIA. His research interests fall within the intersection of intelligent transportation systems, machine learning, traffic data analysis, and data science. He has dealt with urban traffic forecasting problems, applying machine learning models and evolutionary algorithms. He has experience in origin-destination matrix estimation or point of interest and trajectory detection. Working with large volumes of data has given him a good command of big data processing tools and NoSQL databases. He has also been a visiting scholar at the Knowledge Engineering and Discovery Research Institute, Auckland University of Technology.",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"314575",title:"Dr.",name:"Jesus",middleName:null,surname:"L. Lobo",slug:"jesus-l.-lobo",fullName:"Jesus L. Lobo",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/314575/images/system/314575.png",biography:"Dr. Jesús López is currently based in Bilbao (Spain) working at TECNALIA as Artificial Intelligence Research Scientist. In most cases, a project idea or a new research line needs to be investigated to see if it is good enough to take into production or to focus on it. That is exactly what he does, diving into Machine Learning algorithms and technologies to help TECNALIA to decide whether something is great in theory or will actually impact on the product or processes of its projects. So, he is expert at framing experiments, developing hypotheses, and proving whether they’re true or not, in order to investigate fundamental problems with a longer time horizon. He is also able to design and develop PoCs and system prototypes in simulation. He has participated in several national and internacional R&D projects.\n\nAs another relevant part of his everyday research work, he usually publishes his findings in reputed scientific refereed journals and international conferences, occasionally acting as reviewer and Programme Commitee member. Concretely, since 2018 he has published 9 JCR (8 Q1) journal papers, 9 conference papers (e.g. ECML PKDD 2021), and he has co-edited a book. He is also active in popular science writing data science stories for reputed blogs (KDNuggets, TowardsDataScience, Naukas). Besides, he has recently embarked on mentoring programmes as mentor, and has also worked as data science trainer.",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"103779",title:"Prof.",name:"Yalcin",middleName:null,surname:"Isler",slug:"yalcin-isler",fullName:"Yalcin Isler",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRyQ8QAK/Profile_Picture_1628834958734",biography:"Yalcin Isler (1971 - Burdur / Turkey) received the B.Sc. degree in the Department of Electrical and Electronics Engineering from Anadolu University, Eskisehir, Turkey, in 1993, the M.Sc. degree from the Department of Electronics and Communication Engineering, Suleyman Demirel University, Isparta, Turkey, in 1996, the Ph.D. degree from the Department of Electrical and Electronics Engineering, Dokuz Eylul University, Izmir, Turkey, in 2009, and the Competence of Associate Professorship from the Turkish Interuniversity Council in 2019.\n\nHe was Lecturer at Burdur Vocational School in Suleyman Demirel University (1993-2000, Burdur / Turkey), Software Engineer (2000-2002, Izmir / Turkey), Research Assistant in Bulent Ecevit University (2002-2003, Zonguldak / Turkey), Research Assistant in Dokuz Eylul University (2003-2010, Izmir / Turkey), Assistant Professor at the Department of Electrical and Electronics Engineering in Bulent Ecevit University (2010-2012, Zonguldak / Turkey), Assistant Professor at the Department of Biomedical Engineering in Izmir Katip Celebi University (2012-2019, Izmir / Turkey). He is an Associate Professor at the Department of Biomedical Engineering at Izmir Katip Celebi University, Izmir / Turkey, since 2019. In addition to academics, he has also founded Islerya Medical and Information Technologies Company, Izmir / Turkey, since 2017.\n\nHis main research interests cover biomedical signal processing, pattern recognition, medical device design, programming, and embedded systems. He has many scientific papers and participated in several projects in these study fields. He was an IEEE Student Member (2009-2011) and IEEE Member (2011-2014) and has been IEEE Senior Member since 2014.",institutionString:null,institution:{name:"Izmir Kâtip Çelebi University",country:{name:"Turkey"}}},{id:"339677",title:"Dr.",name:"Mrinmoy",middleName:null,surname:"Roy",slug:"mrinmoy-roy",fullName:"Mrinmoy Roy",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/339677/images/16768_n.jpg",biography:"An accomplished Sales & Marketing professional with 12 years of cross-functional experience in well-known organisations such as CIPLA, LUPIN, GLENMARK, ASTRAZENECA across different segment of Sales & Marketing, International Business, Institutional Business, Product Management, Strategic Marketing of HIV, Oncology, Derma, Respiratory, Anti-Diabetic, Nutraceutical & Stomatological Product Portfolio and Generic as well as Chronic Critical Care Portfolio. A First Class MBA in International Business & Strategic Marketing, B.Pharm, D.Pharm, Google Certified Digital Marketing Professional. Qualified PhD Candidate in Operations and Management with special focus on Artificial Intelligence and Machine Learning adoption, analysis and use in Healthcare, Hospital & Pharma Domain. Seasoned with diverse therapy area of Pharmaceutical Sales & Marketing ranging from generating revenue through generating prescriptions, launching new products, and making them big brands with continuous strategy execution at the Physician and Patients level. Moved from Sales to Marketing and Business Development for 3.5 years in South East Asian Market operating from Manila, Philippines. Came back to India and handled and developed Brands such as Gluconorm, Lupisulin, Supracal, Absolut Woman, Hemozink, Fabiflu (For COVID 19), and many more. In my previous assignment I used to develop and execute strategies on Sales & Marketing, Commercialization & Business Development for Institution and Corporate Hospital Business portfolio of Oncology Therapy Area for AstraZeneca Pharma India Ltd. Being a Research Scholar and Student of ‘Operations Research & Management: Artificial Intelligence’ I published several pioneer research papers and book chapters on the same in Internationally reputed journals and Books indexed in Scopus, Springer and Ei Compendex, Google Scholar etc. Currently, I am launching PGDM Pharmaceutical Management Program in IIHMR Bangalore and spearheading the course curriculum and structure of the same. I am interested in Collaboration for Healthcare Innovation, Pharma AI Innovation, Future trend in Marketing and Management with incubation on Healthcare, Healthcare IT startups, AI-ML Modelling and Healthcare Algorithm based training module development. I am also an affiliated member of the Institute of Management Consultant of India, looking forward to Healthcare, Healthcare IT and Innovation, Pharma and Hospital Management Consulting works.",institutionString:null,institution:{name:"Lovely Professional University",country:{name:"India"}}},{id:"310576",title:"Prof.",name:"Erick Giovani",middleName:null,surname:"Sperandio Nascimento",slug:"erick-giovani-sperandio-nascimento",fullName:"Erick Giovani Sperandio Nascimento",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0033Y00002pDKxDQAW/ProfilePicture%202022-06-20%2019%3A57%3A24.788",biography:"Prof. Erick Sperandio is the Lead Researcher and professor of Artificial Intelligence (AI) at SENAI CIMATEC, Bahia, Brazil, also working with Computational Modeling (CM) and HPC. He holds a PhD in Environmental Engineering in the area of Atmospheric Computational Modeling, a Master in Informatics in the field of Computational Intelligence and Graduated in Computer Science from UFES. He currently coordinates, leads and participates in R&D projects in the areas of AI, computational modeling and supercomputing applied to different areas such as Oil and Gas, Health, Advanced Manufacturing, Renewable Energies and Atmospheric Sciences, advising undergraduate, master's and doctoral students. He is the Lead Researcher at SENAI CIMATEC's Reference Center on Artificial Intelligence. In addition, he is a Certified Instructor and University Ambassador of the NVIDIA Deep Learning Institute (DLI) in the areas of Deep Learning, Computer Vision, Natural Language Processing and Recommender Systems, and Principal Investigator of the NVIDIA/CIMATEC AI Joint Lab, the first in Latin America within the NVIDIA AI Technology Center (NVAITC) worldwide program. He also works as a researcher at the Supercomputing Center for Industrial Innovation (CS2i) and at the SENAI Institute of Innovation for Automation (ISI Automação), both from SENAI CIMATEC. He is a member and vice-coordinator of the Basic Board of Scientific-Technological Advice and Evaluation, in the area of Innovation, of the Foundation for Research Support of the State of Bahia (FAPESB). He serves as Technology Transfer Coordinator and one of the Principal Investigators at the National Applied Research Center in Artificial Intelligence (CPA-IA) of SENAI CIMATEC, focusing on Industry, being one of the six CPA-IA in Brazil approved by MCTI / FAPESP / CGI.br. He also participates as one of the representatives of Brazil in the BRICS Innovation Collaboration Working Group on HPC, ICT and AI. He is the coordinator of the Work Group of the Axis 5 - Workforce and Training - of the Brazilian Strategy for Artificial Intelligence (EBIA), and member of the MCTI/EMBRAPII AI Innovation Network Training Committee. He is the coordinator, by SENAI CIMATEC, of the Artificial Intelligence Reference Network of the State of Bahia (REDE BAH.IA). He leads the working group of experts representing Brazil in the Global Partnership on Artificial Intelligence (GPAI), on the theme \"AI and the Pandemic Response\".",institutionString:"Manufacturing and Technology Integrated Campus – SENAI CIMATEC",institution:null},{id:"1063",title:"Prof.",name:"Constantin",middleName:null,surname:"Volosencu",slug:"constantin-volosencu",fullName:"Constantin Volosencu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/1063/images/system/1063.png",biography:"Prof. Dr. Constantin Voloşencu graduated as an engineer from\nPolitehnica University of Timișoara, Romania, where he also\nobtained a doctorate degree. He is currently a full professor in\nthe Department of Automation and Applied Informatics at the\nsame university. Dr. Voloşencu is the author of ten books, seven\nbook chapters, and more than 160 papers published in journals\nand conference proceedings. He has also edited twelve books and\nhas twenty-seven patents to his name. He is a manager of research grants, editor in\nchief and member of international journal editorial boards, a former plenary speaker, a member of scientific committees, and chair at international conferences. His\nresearch is in the fields of control systems, control of electric drives, fuzzy control\nsystems, neural network applications, fault detection and diagnosis, sensor network\napplications, monitoring of distributed parameter systems, and power ultrasound\napplications. He has developed automation equipment for machine tools, spooling\nmachines, high-power ultrasound processes, and more.",institutionString:'"Politechnica" University Timişoara',institution:null},{id:"221364",title:"Dr.",name:"Eneko",middleName:null,surname:"Osaba",slug:"eneko-osaba",fullName:"Eneko Osaba",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/221364/images/system/221364.jpg",biography:"Dr. Eneko Osaba works at TECNALIA as a senior researcher. He obtained his Ph.D. in Artificial Intelligence in 2015. He has participated in more than twenty-five local and European research projects, and in the publication of more than 130 papers. He has performed several stays at universities in the United Kingdom, Italy, and Malta. Dr. Osaba has served as a program committee member in more than forty international conferences and participated in organizing activities in more than ten international conferences. He is a member of the editorial board of the International Journal of Artificial Intelligence, Data in Brief, and Journal of Advanced Transportation. He is also a guest editor for the Journal of Computational Science, Neurocomputing, Swarm, and Evolutionary Computation and IEEE ITS Magazine.",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"275829",title:"Dr.",name:"Esther",middleName:null,surname:"Villar-Rodriguez",slug:"esther-villar-rodriguez",fullName:"Esther Villar-Rodriguez",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/275829/images/system/275829.jpg",biography:"Dr. Esther Villar obtained a Ph.D. in Information and Communication Technologies from the University of Alcalá, Spain, in 2015. She obtained a degree in Computer Science from the University of Deusto, Spain, in 2010, and an MSc in Computer Languages and Systems from the National University of Distance Education, Spain, in 2012. Her areas of interest and knowledge include natural language processing (NLP), detection of impersonation in social networks, semantic web, and machine learning. Dr. Esther Villar made several contributions at conferences and publishing in various journals in those fields. Currently, she is working within the OPTIMA (Optimization Modeling & Analytics) business of TECNALIA’s ICT Division as a data scientist in projects related to the prediction and optimization of management and industrial processes (resource planning, energy efficiency, etc).",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"49813",title:"Dr.",name:"Javier",middleName:null,surname:"Del Ser",slug:"javier-del-ser",fullName:"Javier Del Ser",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/49813/images/system/49813.png",biography:"Prof. Dr. Javier Del Ser received his first PhD in Telecommunication Engineering (Cum Laude) from the University of Navarra, Spain, in 2006, and a second PhD in Computational Intelligence (Summa Cum Laude) from the University of Alcala, Spain, in 2013. He is currently a principal researcher in data analytics and optimisation at TECNALIA (Spain), a visiting fellow at the Basque Center for Applied Mathematics (BCAM) and a part-time lecturer at the University of the Basque Country (UPV/EHU). His research interests gravitate on the use of descriptive, prescriptive and predictive algorithms for data mining and optimization in a diverse range of application fields such as Energy, Transport, Telecommunications, Health and Industry, among others. In these fields he has published more than 240 articles, co-supervised 8 Ph.D. theses, edited 6 books, coauthored 7 patents and participated/led more than 40 research projects. He is a Senior Member of the IEEE, and a recipient of the Biscay Talent prize for his academic career.",institutionString:"Tecnalia Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"278948",title:"Dr.",name:"Carlos Pedro",middleName:null,surname:"Gonçalves",slug:"carlos-pedro-goncalves",fullName:"Carlos Pedro Gonçalves",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRcmyQAC/Profile_Picture_1564224512145",biography:'Carlos Pedro Gonçalves (PhD) is an Associate Professor at Lusophone University of Humanities and Technologies and a researcher on Complexity Sciences, Quantum Technologies, Artificial Intelligence, Strategic Studies, Studies in Intelligence and Security, FinTech and Financial Risk Modeling. He is also a progammer with programming experience in:\n\nA) Quantum Computing using Qiskit Python module and IBM Quantum Experience Platform, with software developed on the simulation of Quantum Artificial Neural Networks and Quantum Cybersecurity;\n\nB) Artificial Intelligence and Machine learning programming in Python;\n\nC) Artificial Intelligence, Multiagent Systems Modeling and System Dynamics Modeling in Netlogo, with models developed in the areas of Chaos Theory, Econophysics, Artificial Intelligence, Classical and Quantum Complex Systems Science, with the Econophysics models having been cited worldwide and incorporated in PhD programs by different Universities.\n\nReceived an Arctic Code Vault Contributor status by GitHub, due to having developed open source software preserved in the \\"Arctic Code Vault\\" for future generations (https://archiveprogram.github.com/arctic-vault/), with the Strategy Analyzer A.I. module for decision making support (based on his PhD thesis, used in his Classes on Decision Making and in Strategic Intelligence Consulting Activities) and QNeural Python Quantum Neural Network simulator also preserved in the \\"Arctic Code Vault\\", for access to these software modules see: https://github.com/cpgoncalves. He is also a peer reviewer with outsanding review status from Elsevier journals, including Physica A, Neurocomputing and Engineering Applications of Artificial Intelligence. Science CV available at: https://www.cienciavitae.pt//pt/8E1C-A8B3-78C5 and ORCID: https://orcid.org/0000-0002-0298-3974',institutionString:"University of Lisbon",institution:{name:"Universidade Lusófona",country:{name:"Portugal"}}},{id:"241400",title:"Prof.",name:"Mohammed",middleName:null,surname:"Bsiss",slug:"mohammed-bsiss",fullName:"Mohammed Bsiss",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/241400/images/8062_n.jpg",biography:null,institutionString:null,institution:null},{id:"276128",title:"Dr.",name:"Hira",middleName:null,surname:"Fatima",slug:"hira-fatima",fullName:"Hira Fatima",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/276128/images/14420_n.jpg",biography:"Dr. Hira Fatima\nAssistant Professor\nDepartment of Mathematics\nInstitute of Applied Science\nMangalayatan University, Aligarh\nMobile: no : 8532041179\nhirafatima2014@gmal.com\n\nDr. Hira Fatima has received his Ph.D. degree in pure Mathematics from Aligarh Muslim University, Aligarh India. Currently working as an Assistant Professor in the Department of Mathematics, Institute of Applied Science, Mangalayatan University, Aligarh. She taught so many courses of Mathematics of UG and PG level. Her research Area of Expertise is Functional Analysis & Sequence Spaces. She has been working on Ideal Convergence of double sequence. She has published 17 research papers in National and International Journals including Cogent Mathematics, Filomat, Journal of Intelligent and Fuzzy Systems, Advances in Difference Equations, Journal of Mathematical Analysis, Journal of Mathematical & Computer Science etc. She has also reviewed few research papers for the and international journals. 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Main aspects of the topic are: Applying bioinformatics in drug discovery and development; Bioinformatics in clinical diagnostics (genetic variants that act as markers for a condition or a disease); Blockchain and Artificial Intelligence/Machine Learning in personalized medicine; Customize disease-prevention strategies in personalized medicine; Big data analysis in personalized medicine; Translating stratification algorithms into clinical practice of personalized medicine.",annualVolume:11403,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/7.jpg",editor:{id:"351533",title:"Dr.",name:"Slawomir",middleName:null,surname:"Wilczynski",fullName:"Slawomir Wilczynski",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035U1loQAC/Profile_Picture_1630074514792",institutionString:null,institution:{name:"Medical University of Silesia",institutionURL:null,country:{name:"Poland"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"5886",title:"Dr.",name:"Alexandros",middleName:"T.",surname:"Tzallas",fullName:"Alexandros Tzallas",profilePictureURL:"https://mts.intechopen.com/storage/users/5886/images/system/5886.png",institutionString:"University of Ioannina, Greece & Imperial College London",institution:{name:"University of Ioannina",institutionURL:null,country:{name:"Greece"}}},{id:"257388",title:"Distinguished Prof.",name:"Lulu",middleName:null,surname:"Wang",fullName:"Lulu Wang",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRX6kQAG/Profile_Picture_1630329584194",institutionString:"Shenzhen Technology University",institution:{name:"Shenzhen Technology University",institutionURL:null,country:{name:"China"}}},{id:"225387",title:"Prof.",name:"Reda R.",middleName:"R.",surname:"Gharieb",fullName:"Reda R. 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Possible contributions can address (but are not limited to) the following research topics: Bioinspired design and control of exoskeletons, orthoses, and prostheses; Experimental evaluation of the effect of assistive devices (e.g., influence on gait, balance, and neuromuscular system); Bioinspired technologies for rehabilitation, including clinical studies reporting evaluations; Application of neuromuscular and biomechanical models to the development of bioinspired technology.',annualVolume:11404,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/8.jpg",editor:{id:"144937",title:"Prof.",name:"Adriano",middleName:"De Oliveira",surname:"Andrade",fullName:"Adriano Andrade",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRC8QQAW/Profile_Picture_1625219101815",institutionString:null,institution:{name:"Federal University of Uberlândia",institutionURL:null,country:{name:"Brazil"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"49517",title:"Prof.",name:"Hitoshi",middleName:null,surname:"Tsunashima",fullName:"Hitoshi Tsunashima",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYTP4QAO/Profile_Picture_1625819726528",institutionString:null,institution:{name:"Nihon University",institutionURL:null,country:{name:"Japan"}}},{id:"425354",title:"Dr.",name:"Marcus",middleName:"Fraga",surname:"Vieira",fullName:"Marcus Vieira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003BJSgIQAX/Profile_Picture_1627904687309",institutionString:null,institution:{name:"Universidade Federal de Goiás",institutionURL:null,country:{name:"Brazil"}}},{id:"196746",title:"Dr.",name:"Ramana",middleName:null,surname:"Vinjamuri",fullName:"Ramana Vinjamuri",profilePictureURL:"https://mts.intechopen.com/storage/users/196746/images/system/196746.jpeg",institutionString:"University of Maryland, Baltimore County",institution:{name:"University of Maryland, Baltimore County",institutionURL:null,country:{name:"United States of America"}}}]},{id:"9",title:"Biotechnology - Biosensors, Biomaterials and Tissue Engineering",keywords:"Biotechnology, Biosensors, Biomaterials, Tissue Engineering",scope:"The Biotechnology - Biosensors, Biomaterials and Tissue Engineering topic within the Biomedical Engineering Series aims to rapidly publish contributions on all aspects of biotechnology, biosensors, biomaterial and tissue engineering. We encourage the submission of manuscripts that provide novel and mechanistic insights that report significant advances in the fields. Topics can include but are not limited to: Biotechnology such as biotechnological products and process engineering; Biotechnologically relevant enzymes and proteins; Bioenergy and biofuels; Applied genetics and molecular biotechnology; Genomics, transcriptomics, proteomics; Applied microbial and cell physiology; Environmental biotechnology; Methods and protocols. Moreover, topics in biosensor technology, like sensors that incorporate enzymes, antibodies, nucleic acids, whole cells, tissues and organelles, and other biological or biologically inspired components will be considered, and topics exploring transducers, including those based on electrochemical and optical piezoelectric, thermal, magnetic, and micromechanical elements. Chapters exploring biomaterial approaches such as polymer synthesis and characterization, drug and gene vector design, biocompatibility, immunology and toxicology, and self-assembly at the nanoscale, are welcome. Finally, the tissue engineering subcategory will support topics such as the fundamentals of stem cells and progenitor cells and their proliferation, differentiation, bioreactors for three-dimensional culture and studies of phenotypic changes, stem and progenitor cells, both short and long term, ex vivo and in vivo implantation both in preclinical models and also in clinical trials.",annualVolume:11405,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/9.jpg",editor:{id:"126286",title:"Dr.",name:"Luis",middleName:"Jesús",surname:"Villarreal-Gómez",fullName:"Luis Villarreal-Gómez",profilePictureURL:"https://mts.intechopen.com/storage/users/126286/images/system/126286.jpg",institutionString:null,institution:{name:"Autonomous University of Baja California",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"35539",title:"Dr.",name:"Cecilia",middleName:null,surname:"Cristea",fullName:"Cecilia Cristea",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYQ65QAG/Profile_Picture_1621007741527",institutionString:null,institution:{name:"Iuliu Hațieganu University of Medicine and Pharmacy",institutionURL:null,country:{name:"Romania"}}},{id:"40735",title:"Dr.",name:"Gil",middleName:"Alberto Batista",surname:"Gonçalves",fullName:"Gil Gonçalves",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYRLGQA4/Profile_Picture_1628492612759",institutionString:null,institution:{name:"University of Aveiro",institutionURL:null,country:{name:"Portugal"}}},{id:"211725",title:"Associate Prof.",name:"Johann F.",middleName:null,surname:"Osma",fullName:"Johann F. 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