Classification of fibro-benign lesions of the cranio-facial complex
\r\n\tgas sensors.
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D in Physics in 2012 from Indian Institute of Technology Guwahati, India. Presently, he is associated with the Faculty of Science, Sri Sri University, India as an Assistant Professor in Physics. Prior to joining the current\naffiliation, he was a postdoctoral fellow at different renowned institutions, Kobe University Japan, S. N. Bose National Centre for Basic Sciences, India and Cardiff University, United Kingdom. He was awarded prestigious JSPS postdoctoral fellowship based on his research contribution on semiconducting nanowires. He has published more than 32 research articles including 1 review article in high profile international journals and 3 book chapters to his credit. His research trust areas of interests are semiconductor nanostructures, optoelectronics, solid state lighting and light sensors, spectroscopy of nanomaterials, thin-film transistors (TFTs) etc.",institutionString:"Sri Sri University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"2",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"Sri Sri University",institutionURL:null,country:{name:"India"}}}],coeditorOne:{id:"442408",title:"Dr.",name:"Gorachand",middleName:null,surname:"Dutta",slug:"gorachand-dutta",fullName:"Gorachand Dutta",profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:"Dr. Gorachand Dutta, PhD is an Assistant Professor with the School of MedicalScience and Technology, Indian Institute of Technology Kharagpur. His research interests include the design and characterization of portable\r\nbiosensors, biodevices and sensor interfaces for miniaturized systems and biomedical applications for point-of-care testing. He received his Ph.D in Biosensor and Electrochemistry from Pusan National University, South Korea,\r\nwhere he developed different class of electrochemical sensors and studied the electrochemical properties of gold, platinum, and palladium based metal electrodes. He completed his Post-doctoral fellowships in the Department of\r\nMechanical Engineering, Michigan State University, USA and Department of Electronic and Electrical Engineering at University of Bath, UK. He has expertise on label-free multichannel electrochemical biosensors, electronically\r\naddressable biosensor arrays, aptamer- and DNA-based sensors and surface bio-functionalization.",institutionString:"Indian Institute of Technology Kharagpur",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"Indian Institute of Technology Kharagpur",institutionURL:null,country:{name:"India"}}},coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"11",title:"Engineering",slug:"engineering"}],chapters:null,productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"429341",firstName:"Paula",lastName:"Gavran",middleName:null,title:"Ms.",imageUrl:"//cdnintech.com/web/frontend/www/assets/author.svg",email:"paula@intechopen.com",biography:null}},relatedBooks:[{type:"book",id:"10198",title:"Response Surface Methodology in Engineering Science",subtitle:null,isOpenForSubmission:!1,hash:"1942bec30d40572f519327ca7a6d7aae",slug:"response-surface-methodology-in-engineering-science",bookSignature:"Palanikumar Kayaroganam",coverURL:"https://cdn.intechopen.com/books/images_new/10198.jpg",editedByType:"Edited by",editors:[{id:"321730",title:"Prof.",name:"Palanikumar",surname:"Kayaroganam",slug:"palanikumar-kayaroganam",fullName:"Palanikumar Kayaroganam"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1591",title:"Infrared Spectroscopy",subtitle:"Materials Science, Engineering and Technology",isOpenForSubmission:!1,hash:"99b4b7b71a8caeb693ed762b40b017f4",slug:"infrared-spectroscopy-materials-science-engineering-and-technology",bookSignature:"Theophile Theophanides",coverURL:"https://cdn.intechopen.com/books/images_new/1591.jpg",editedByType:"Edited by",editors:[{id:"37194",title:"Dr.",name:"Theophile",surname:"Theophanides",slug:"theophile-theophanides",fullName:"Theophile Theophanides"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3161",title:"Frontiers in Guided Wave Optics and Optoelectronics",subtitle:null,isOpenForSubmission:!1,hash:"deb44e9c99f82bbce1083abea743146c",slug:"frontiers-in-guided-wave-optics-and-optoelectronics",bookSignature:"Bishnu Pal",coverURL:"https://cdn.intechopen.com/books/images_new/3161.jpg",editedByType:"Edited by",editors:[{id:"4782",title:"Prof.",name:"Bishnu",surname:"Pal",slug:"bishnu-pal",fullName:"Bishnu Pal"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"371",title:"Abiotic Stress in Plants",subtitle:"Mechanisms and Adaptations",isOpenForSubmission:!1,hash:"588466f487e307619849d72389178a74",slug:"abiotic-stress-in-plants-mechanisms-and-adaptations",bookSignature:"Arun Shanker and B. 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[Table 1](Eversole, Su et al. 2008) In this reviews, subtypes vary with regard to behavior and propensity for recurrence after surgical excision. The definitive diagnosis can rarely be rendered on the basis of histopathological features alone and is usually dependent upon assessment of microscopic, clinical and imaging features together. This review will discuss the clinical, microscopic, radiological and therapeutic aspects of ossifying fibromas in this localization.
Neoplasms with a fibro-osseous histology are represented by the ossifying fibroma group of lesions. These are neoplasms in the true sense, exhibiting progressive proliferative capabilities with boney expansion and, importantly, well defined margins radiologically. According to their pattern of mineralization, four overlapping clinicopathological entities have been historically identified: juvenile psammomatous ossifying fibroma (JPOF), juvenile trabecular ossifying fibroma (JTOF), gigantiform cementoma (GC) and cemento-ossifying fibroma (COF) not otherwise specified (NOS), implying that the clinicopathologic features do not conform to the other types of ossifying fibromas. GC may show an autosomal dominant genetic or ‘‘familial’’ underpinning. Most ossifying fibromas are single focal lesions; however gigantiform cementoma is typically multifocal and may occur in all four jaw quadrants in a single patient. There are also reports of lesion multiplicity in the other forms of ossifying fibroma yet such occurrences are quite rare. Notwithstanding these entities, it must be emphasized the contrast of OF with the much more common fibrous dysplasia (FD), a developmental hamartomatous fibro-osseous lesion, from which the differential is difficult based solely on clinical or radiographic criteria (Brannon and Fowler 2001; El-Mofty 2002; Noudel, Chauvet et al. 2009).
Classification of fibro-benign lesions of the cranio-facial complex
According to WHO classification (2005) OF most commonly occurs in the 2nd to 4th decades and shows a predilection for females. The mean age of the histological subtypes varies. In patients with JPOF it is about 20 years compared to 35 years in cases of conventional ossifying fibroma. JTOF has a still lower mean age range (8.5-12 years).
The commonest fibrous-osseous lesions of the orbit and sinonasal tract are OF and FD. The diagnosis between these two entities may be challenging, because they share similar features. There are four main clinical subtypes of FD: monostotic (affects one bone, and accounts for 85% cases of FD), polyostotic (affects multiple bones), McCune–Albright syndrome in which multiple disseminated lesions of bone are accompanied by skin hyperpigmentation and endocrine disturbances; and osteofibrous dysplasia (Brannon and Fowler 2001; Smith, Newman et al. 2009).
The juvenile variants of ossifying fibromas share many similarities, but they have been distinguished on the basis of their histopathological features, site, and age of recurrence (Shields, Peyster et al. 1985; Noudel, Chauvet et al. 2009; Smith, Newman et al. 2009). Their location is also different: JPOF arises mainly around paranasal sinuses and orbits, whereas JTOF usually affects the maxilla. The last entity, COF, is an odontogenic neoplasm arising from the periodontal ligament and affects the tooth-bearing areas of the jaws, mandible, and the maxilla; the cementicles are the characteristic feature instead of the bone elements. JTOF also known as trabecular desmo-osteoblastoma affects mainly the jaws of children and adolescents. Only 20% of the patients are over 15 years of age. In a review of a number of case series the mean age range was found to be 8.5–12 years (Slootweg and Muller 1990; Slootweg, Panders et al. 1994; El-Mofty 2002). Origin in extragnathic locations is extremely rare. Clinically, it is often characterized by a progressive and sometimes rapid expansion of the affected area; pain is a rare symptom. Cystic degeneration and aneurysmal bone cyst formation has been reported in a few cases. Radiographically, JTOF is an expansive lesion and may be fairly well demarcated, with cortical thinning and perforation. Depending on the amount of calcified tissue produced, the lesion will show varying degrees of radiolucency or radiodensity. Ground-glass as well as a multilocular honeycomb appearance has been described.
Differing from JTOF, JPOF is a lesion that affects predominantly the extragnathic craniofacial bones, particularly centered on the periorbital, frontal, and ethmoid bones (El-Mofty 2002). First described by Gogl in 1949 and Margo in 1985, JPOF seems to stand out as a separate clinicopathologic entity different from the gnathic cemento-ossifying fibroma.(Gogl 1949; Margo, Ragsdale et al. 1985) Patients are young, although the average age of incidence has varied in different studies from 16 to 33 years with an age range of 3 months to 72 years (in general a few years older than those with JTOF). The greatest majority of the reported cases of JPOF originated in the paranasal sinuses, particularly frontal and ethmoid. About 10% have been reported in the calvarium. Around 7% may occur in the mandible. Orbital extension of sinonasal tumors may result in proptosis, and visual complaints including blindness, nasal obstruction, ptosis, papilledema, and disturbances in ocular mobility. Radiographic examination of JPOF shows a round, well-defined, sometimes corticated osteolytic lesion with a cystic appearance. Sclerotic changes are evident in the lesion which may show a ground-glass appearance (Su, Weathers et al. 1997). The lesions appear less dense than normal bone. Figure 1 and figure 2 show an example of a JPOF invading the left periorbit and ethmoid sinus.
Axial CT scan showing a fibrous-osseous lesion (JPOF) of the left orbit and ethmoid sinus.
Gadolinium-enhanced axial T1-weighted (a) and T2-weighted (b) magnetic resonance imaging (MRI) showing an expansive cystic lesion (JPOF) invading the left periorbit and ethmoid sinus.
Gigantiform cementoma is an extremely rare form of ossifying fibroma, usually multifocal with tumors that are often massive. Lesions arise during childhood and progressively expand to cause facial deformity during early adult years (Young, Markowitz et al. 1989; Rossbach, Letson et al. 2005).
Expansion of bone Unilateral, painless Alk phosphatase Mono/Polyostotic | Diffuse radiolucent/ ground glass | Trabecular ‘‘Chinese/Hebrew’’ | |
Ossifying fibroma Not otherwise specified | Expansile, painless Rarely multifocal Jaws | Circumscribed lucent or target lesion Root divergence | Trabecular Cementifying |
Ossifying fibroma Trabecular variant | Expansile, painles Root divergence Aggressive | Circumscribed lucent Floccular opacities | Trabecular Giant cell foci Fibroplasia |
Ossifying fibroma Psammomatoid | Expansile Facial bone Aggressive | Circumscribed Dense floccular opacities | Psammoma |
Massive, expansile Multiquadrant Often familial | Well delineated lucent with floccular opacities | Trabecular Cementifying |
Clinical, radiographic and microscopic parameters that distinguish among Ossifying Fibromas and Fibrous Dysplasia.
The etiology of OF is unknown but odontogenic, developmental and traumatic origins have been suggested, (Caylakli, Buyuklu et al. 2004; Noudel, Chauvet et al. 2009; Mohsenifar, Nouhi et al. 2011) and thought to be of periodontal ligament origin because of their capacity to produce cementum and osteoid material (Slootweg and Muller 1990).
It has been hypothesized that JPOF originates from overproduction of the myxofibrous cellular stroma normally involved in the growth of the septa in the paranasal sinuses as they enlarge and pneumatize. These stromal cells secrete hyaline material that ossifies and connective tissue mucin that initiates the cystic areas (Sarode, Sarode et al. 2011).
Ossifying fibroma NOS shows three histologic patterns or a mixture of these patterns:
Ossifying fibroma NOS (
Ossifying fibroma NOS showing areas of fibrous stroma with a storiform pattern. Courtesy of Manuel Jácome, MD, Department of Pathology of IPOFG-Porto.
Two distinct clinicopathologic entities are known:
Collagen is usually not observed, yet older lesions may show some collagenisation (Eversole, Leider et al. 1985; El-Mofty 2002; Eversole, Su et al. 2008).
Juvenile trabecular ossifying fibroma (
(2) Psammomatoid juvenile ossifying fibroma (JPOF)
On gross examination, the tumor is described as firm to hard in consistency and tan-white, grayish-white or grayish-brown in color and well demarcated from the surrounding bone, though not encapsulated. On sectioning, the cut surface is typically a tan-white, rubbery, homogeneous mass with a firm-to-gritty consistency and also displays large cystic areas (Sarode, Sarode et al. 2011).
On light microscopic examination, the tumor has multiple small acellular calcified structures, round and uniform and with concentric lamellar calcification, called ossicles/psammomatoid bodies; they are homogenously distributed in a relatively cellular stroma that may have whorled appearance, composed of uniform, stellate, and spindle shaped cells. In some cases the stroma is myxoid and may undergo cystic change with edema, hemorrage and clusters of multinucleated giant cells, where one can also find acellular mineralized deposits with bizarre shape (Noudel, Chauvet et al. 2009; Linhares, Pires et al. 2011; Sarode, Sarode et al. 2011). Occasionally, shrunken cells become embedded in the calcified matrix of the ossicles. The psammomatoid bodies are basophilic and bear superficial resemblance to dental cementum, but may have an osteoid rim. Mitotic activity is extremely rare in the stromal cells. At the periphery of the lesion, the ossicles may be very closely packed with little intervening stroma, or coalesce and form irregular thin bony trabeculae that may become thicker, with numerous reversal lines. A shell of normal bone is usually present and may show osteoclastic resorption endosteally associated with osteoblastic activity on the periosteal surface. Cystic degeneration and aneurismal bone cyst formation is commonly reported (El-Mofty 2002; Eversole, Su et al. 2008; Linhares, Pires et al. 2011).
This entity is often multifocal, with expansile masses of the maxilla and/or mandible; microscopic examination displays a benign hypercelular stroma with monomorfic appearing fibroblasts showing no mitosis, mature collagen fibers and scattered ovoid, often laminated, psammomatoid calcifications with variable size, many of them very large (Young, Markowitz et al. 1989; Abdelsayed, Eversole et al. 2001).
Ossifying fibroma (OF) is often confused with focal cementoosseous dysplasia (FCOD). Importantly, the later is an endosseous nonneoplastic process that occurs around the roots of mandibular teeth and fails to expand bone. Alternatively, OF is a potentially aggressive lesion that causes cortical expansion and often causes divergence of contiguous teeth. Both lesions may show similar histological features with trabecular bone and cementifying areas. Older lesions of FCOD may show dense corticated bone islands, a finding that is not present in OF.
While fibrous dysplasia (FD) and OF may share microscopic features, the clinicoradiologic differences are now widely accepted (Linhares, Pires et al. 2011).
In contrast to FD, JPOF shows osteoclasts and osteoblasts typically lining the trabeculae, which are composed of entrapped lamellar bone. The entities can be distinguished from one another on the basis of molecular detection of activating missense mutations of the GNAS1 gene in fibrous dysplasia of the jaws, while ossifying fibromas are found lacking (Hasselblatt, Jundt et al. 2005; Eversole, Su et al. 2008; Nasser 2009; Noudel, Chauvet et al. 2009).
JPOF might be easily mistaken for psamomatous meningioma, and in JPOF with a neurocranial location the likelihood of a misdiagnosis is increased. Even though there is frequent immunohistochemical negativity for epithelial membrane antigen (EMA) in JPOF, there are reported cases with EMA positivity; it is also positive for vimentin, smooth muscle actin and CD10, with lack of expression of CD34, S100 protein and cytokeratins. The diagnosis should be based on morphological, clinical and radiographic findings (Hasselblatt, Jundt et al. 2005; Noudel, Chauvet et al. 2009; Sarode, Sarode et al. 2011).
Cytogenetic analysis was done in only a few cases of ossifying fibroma. In one case of COF of the mandible, deletions were detected in 2q31-32 q35-36 (Dal Cin, Sciot, et al. 1993).A study of 3 cases of JPOF of the orbit demonstrated non random chromosome break points at Xq26 and 2q33 resulting in (X;2) translocations (Sawyer, Tryka,et al.1995). Regarding OF NOS there are reports that identify mutations in HRPT2 a gene that encodes parafibromin protein. Psammomatoid ossifying fibroma has been associated to chromosomal breakpoints t(X;2)(q26;q33) and interstitial insertion of bands 2q24.2q33 into Xq26.
Hyperparathyroidism associated ossifying fibroma has been associated with mutations in tumor suppressor gene HRPT2.
The rare gigantiform cementoma is related to an autosomal dominant inheritance in some cases whereas others are ‘‘familial’’. Among the few cases that have been reported, the gene appears to have a high level of penetrance with variable expressivity (Young, Markowitz et al. 1989; Finical, Kane et al. 1999; Abdelsayed, Eversole et al. 2001; Rossbach, Letson et al. 2005).
Complete excision of a OF lesion is the treatment of choice and it can be curative. Despite its benign features, they can be locally invasive, causing significant morbidity, and fatal consequences may be induced by intracranial extension (Baumann, Zimmermann et al. 2005; Cruz, Alencar et al. 2008; Bohn, Kalmar et al. 2011; Linhares, Pires et al. 2011). However, a surgical approach is dictated more by anatomic location and tumor size than by histologic subtype (Shields, Peyster et al. 1985; Hartstein, Grove et al. 1998; Smith, Newman et al. 2009).
Radiotherapy is generally contraindicated because of the risk of malignant transformation and the potentially harmful late effects in children (Nakagawa, Takasato et al. 1995; Noudel, Chauvet et al. 2009).
The clinical course of JTOF is characterized by infrequent recurrence following conservative excision. One or more recurrences were observed in 3 of 10 patients reported by Slootweg et al (Slootweg, Panders et al. 1994). Eventual complete cure could be achieved in those cases without resorting to radical surgical intervention. Malignant transformation has not been reported. Regarding JPOF, surgical excision is the treatment of choice, although recurrence even after definitive surgery is not unusual. Recurrence rates of 30% have been reported. In some cases, multiple recurrences over a long follow-up period are reported. No malignant change has been observed. Treatment for gigantiform cementoma is resection with immediate or staged reconstruction (Finical, Kane et al. 1999).
Overall recurrence rates after resection is reported to range from 30 to 56% and this is likely to be due to incomplete excision resulting from the infiltrative nature of the tumor borders more than to any intrinsic biological properties (Brannon and Fowler 2001; MacDonald-Jankowski 2004; Noudel, Chauvet et al. 2009).
Ossifying fibromas comprises entities with different morphological features that can be mistaken for other benign fibro-osseous lesions; this similarity and overlapping microscopic characteristics turns the multidisciplinary approach, comprehending clinical, radiological and pathological aspects, more reliable for a correct diagnosis.
They have locally aggressive behavior, with high recurrence rate, particularly in partial and incomplete excisions, with complete removal being the gold standard treatment. Prognosis is good, without metastases in the reported cases.
The authors thank Dr. Manuel Jácome of Department of Pathology of the IPOFG-Oporto for the courtesy of the images provided. The authors thank Dr. Hélder Rodrigues of Department of Pathology of CHUC for his assistance.
Indwelling pleural catheters (IPC) are now being considered worldwide for patients with recurrent pleural effusions [1]. It is commonly used for patients with malignant pleural effusions (MPE) and can be performed as outpatient based day care procedure. Talc pleurodesis and indwelling pleural catheters are the standard of care therapeutic options for the patients presenting with symptomatic malignant pleural effusions. In malignant pleural effusions, indwelling catheters are particularly useful in patients with trapped lung or failed pleurodesis. IPCs are effective, both in terms of symptom control and costs, and can dramatically improve the quality of life for patients who have traditionally needed lengthy hospital admissions.
Indwelling pleural catheter (IPC) is a multi-fenestrated flexible silicone elastomeric chest drain with a polyester cuff which envelops the medial portion of the tube. The proximal end of tube has a one-way access valve designed to be attached to vacuum drainage bottles. Its distal part is tunneled through the subcutaneous tissue before placing it in the pleural space (Figure 1). Most widely used IPCs are pleurx catheter and IPC by Rockett medical. Pleurx catheter was approved by FDA in 1997 for patients with symptomatic malignant pleural effusions to relieve Dyspnea [2].
Indwelling pleural catheter (IPC).
Before the advent of IPCs, conventional method for managing recurrent pleural effusions is to place a large bore chest drain with pleurodesis/multiple pleural aspirations. Some centers were able to offer more invasive procedures, such as parietal pleurectomy or pleuro-peritoneal shunting, but these inevitably carried a risk of morbidity and were limited to patients who were fit enough to undergo general anesthesia [3, 4].
A widely recognized precursor to indwelling pleural catheter was first described in 1994. Robinson et al. [5] treated 9 patients with recurrent MPE, who had previously failed pleurodesis, with a Tenckhoff catheter, which was tunneled into the pleural space under local anesthesia. Implantable Porta cath was also used in olden days for some patients for intrapleural immunotherapy used in mesothelioma [6].
Inability for the patient and care givers to handle or tolerate the drain.
Significant coagulopathy.
Parapneumonic effusion/empyema.
Local cellulitis in the insertion site.
Track metastasis over the proposed insertion site.
Individuals in immunocompromised state due to systemic diseases.
Most of this procedure can be performed as a day care procedure in outpatient settings. There is no need to admit the patient for IPC insertion unless clinically warranted. It is advisable to stop antiplatelet/antithrombotic medications before the procedure to minimize the risk of bleeding (Aspirin-withheld for 5 days, Clopidogrel—withheld for 7 days. IPC can be inserted in any position which is suitable for drainage. It is preferable to moniter his oxygen saturation and vitals during the procedure. Supplemental oxygen can be given to those patients who are dyspneic with hypoxemia. We often prefer to give supplemental oxygen to all our patients during the procedure.
It can be performed under conscious sedation with local anesthesia. The patient is typically placed in the lateral decubitus position, with the patient lying on the side contralateral to the effusion, although they can be inserted in other patient positions. Bedside ultrasound thorax is to be done which facilitates the site of entry and also helps to quantify the pleural effusion.
Under aseptic precaution, after local anesthetic (Lignocaine 1–2%) infiltration, two small incision are made, one at the pleural insertion point and another one 7–10 cm anterior to this, which will form the proximal end to the tunneled track. The IPC catheter is tunneled along this track with the pro-fibrotic cuff which promotes tissue growth and keeps the drain in-situ, situated approximately a third along the track.
The distal end of the catheter is then inserted into the pleural cavity, using the Seldinger technique. The incisions are then sutured closed, although the catheter itself is not sutured in place. A one-way valve on the external end is then attached to a drainage bag or vacuum bottle system.
Patients and care givers are advised to drain at least 3 times a week or in presence of symptoms i.e. dyspnoea. Normal drainage timing may lasts for 15–20 min which subsequently improves their symptoms and quality of life. Drainage bottles are commercially available which are connected to proprietary one-way access valve on the external portion of the drain. Training to the patients and their family members has to be done for proper dressing and drainage by connecting the bottles with aseptic precautions. This drainage bottle is primed with a vacuum (Figure 2) in order to draw out the pleural fluid usually to a maximum of 1000 ml.
Vacuum drainage bottles.
Complications which are directly related to IPC insertion are extremely rare [11].
It is common to see a small pneumothorax in the post procedure chest X ray as a result of air being drawn into the chest during insertion. Such appearances may also be produced by trapped lung if significant volumes of fluid have been removed or trapped lung itself is seen in 20–30% of patients with malignant pleural effusion.
Large significant pneumothorax should prompt consideration of Iatrogenic injury to underlying lung and may warrant an extended period of observation before discharge.
Subcutaneous emphysema is also been documented post procedure. This demonstrates another reason why careful consideration should be given to track length, as if it is made too long there is the possibility of a fenestration remaining in the extrapleural space.
Post procedure pain can be seen in significant number of patients which can be usually managed with analgesics. Severe pain and discomfort should prompt concerns over irritation or damage to intercostal nerves. Patient may experience pain and discomfort at the end of drainage which indicates complete drainage of the pleural space which is often seen in those with underlying trapped lung. Wound Dehiscence in IPC is rarely reported.
Initially there was a concern surrounding the risk of associated infections with indwelling pleural catheters. However, data from the observational and randomized studies have demonstrated a reassuring low incidence of associated infection with one large multicenteric multinational retrospective study of over a 1000 patients, demonstrating a 4.8% IPC-related pleural infection rate [12]. Common organisms implicated are
Usually the infectious complications are reported after 6 weeks after the insertion of IPC which indicates they are not secondary to the insertion but due to later spread of pathogens from the patient’s skin or lung parenchyma [13]. Proper care, IPC dressing and drainage techniques would help to minimize the risk. Reassuringly, the mortality rate from IPC-related infection is low (0.29%) and most of these patients can be managed with oral antibiotics [12]. There is no need to remove IPC as most patients responds very well to the therapy. If this approach is unsuccessful, then patient may require hospital admission for intravenous antibiotics and placing the catheter on continuous free-drainage to facilitate resolution of the infection. In case of loculated pleural effusions, Intrapleural thrombolytics like tissue plasminogen activator and DNAase can also be given via IPC [13].
In malignant pleural effusion insertion of IPC may lead to track metastasis usually occurs in malignant mesothelioma [14]. Reported cases in the literature are sparse, but the incidence of metastasis occurring appears to be just below 1% [15]. Diagnosis can be made clinically or using ultrasound-guided biopsy [16], followed by prophylactic radiotherapy to prevent track metastasis. There is nothing to suggest that radiotherapy damages the IPC [14] and treatment, based upon small case series, tends to be successful, obviating the need for drain removal [17].
IPC blockage is another concern one need to consider since patency of the tube is important for effective drainage. This can be managed by daily saline flushing and on rare occasions in presence of thick loculated collection, one may use intrapleural fibrinolytics. The loss of electrolytes, immune factors or proteins has occasionally been raised as a concern of the long-term use of IPCs [18].
Catheter fracture is rare and may occur when an IPC is removed. The polyester cuff promotes inflammation and fibrosis which leads to tight anchoring of the catheter makes it difficult to remove. The risk of catheter fracture is reported to be about 10% [19]. This is usually managed by surgical exploration or just leaving the catheter fragments inside the body. No complications have been reported from retained fragments of IPC.
Conventional approach to the patients with symptomatic MPE is therapeutic pleurocentesis and subsequent pleurodesis. Various pleurodesis agents can be used but the most commonly used agent is talc which can be guided by thoracoscopic talc poudrage or instillation via standard chest tube. Option of IPC insertion is given to the patients who had developed trapped lung. IPCs are the ideal way for palliative care as they can be sited easily and quickly, and can be drained as often as is required to alleviate symptoms, allowing for consistent improvement in the breathlessness which will afflict the vast majority of patients with a malignant effusion [20] and improvements seen even in those with trapped lung [21].
Davies et al. [22] compared the use of IPCs to standard talc slurry via chest drain in patients who had not previously undergone pleurodesis. The trial used self-reported dyspnoea scores as its main outcome measure, showing that 6 weeks after randomization there was no significant difference between the two treatment arms. Some of the secondary endpoints appeared more favorable in the IPC group, including the proportion of patients who achieved a clinically significant relief in their symptoms (86 vs. 74%); the median length of initial hospital stay (0 vs. 4 days), and the median number of days spent in hospital for drainage over the following 12 months (1 vs. 4.5 days). Eventhough the study is underpowered, similar findings were reported elsewhere. Intrapleural Fibrinolytics can also be guided with IPC in case of multiloculated/septated effusion.
It also holds the potential to allow direct anti-cancer therapy. Sterman et al. [23] showing that patients with MPE or mesothelioma can be safely given both single- and repeated-dose interferon-β gene therapy and another group reporting the administration of monthly rituximab via an IPC for a patient with non-Hodgkin’s lymphoma [24]. Jones et al. [25] and Rahman et al. [26] studied the use of Docataxel and Lipotechoic acid -T via IPC (Pleurx) respectively with favorable clinical response.
IPC can be combined with pleurodesis agents to achieve higher success rates and early pleurodesis in patients with high output effusion. Tremblay et al. [27] have demonstrated that low-level, repeated doses of intrapleural silver nitrate in a rabbit model can maintain the pleurodesis efficacy of a drug without raising the side effect profile. Dierdre B Fitzgerald et al. studied the use of talc via IPC with malignant pleural effusion and concluded that IPC combined with inpatient talc slurry pleurodesis, followed by daily home drainage provided good success rates [28].
Spontaneous pleurodesis is also possible in patients with IPC which is an added advantage. In a study by Yuvarajan et al. [29] Spontaneous pleurodesis was achieved in 55% of the patients with hepatic hydrothorax who were placed on IPC. Mean time for spontaneous pleurodesis is around 120.8 days. Collated data from various studies suggest an overall spontaneous pleurodesis rate of around 45% for patients with MPE [15], however, some studies have reported significantly higher [30, 31] or lower values [32]. Higher pleurodesis rates, often exceeding 70%, have been noted when more aggressive drainage regimens (daily or more frequent) have been used, or when patients undergo a talc pleurodesis at the same time as IPC insertion [31].
Usage of IPC significantly improves the dyspneoa, quality of life and their performance status which is crucial for initiating chemotherapy, as chemotherapy is usually deferred in patients with poor performance status. In spite of this, there is huge concern in the risk of infectious complications post chemotherapy in those patients with IPC. There was no difference in the pleural infection rates in a retrospective analysis of 170 patients who were receiving chemotherapy with IPC when compared to those patients who did not receive chemotherapy [33]. But the decision to place an IPC in those who is already on chemotherapy needs multidisciplinary discussion with oncologist, oncosurgeon, pulmonologist and infectious disease specialist.
The most common causes for nonmalignant pleural effusions are Parapneumonic effusions, effusions due to congestive heart failure (CHF), hepatic hydrothorax (HH) secondary to cirrhosis of the liver and effusions due to renal failure. IPC’s are being recently used even for benign effusions in case hepatic hydrothorax and in patients with CKD related pleural effusions. Yuvarajan et al. [29] did a retrospective analytical study on the use of IPC in hepatic hydrothorax. 30 patients with hepatic hydrothorax were placed with indwelling pleural catheters. Spontaneous pleurodesis was achieved in 18 patients (60%) and IPCs were removed in these patients. Most of the patients (70%) who achieved spontaneous pleurodesis with IPC received at atleast one TIPS (Transjugular Intrahepatic porto systemic shunt) procedure. Mean time in which pleurodesis achieved was 120.8 days (range, 15–290 days). Thus TIPS procedure increases the success rate of pleurodesis with indwelling pleural catheters in hepatic hydrothorax.
IPC placement may be a reasonable clinical option for patients with refractory HH, but it is associated with significant adverse events in this morbid population. Potechin et al. [34] did a cohort study on IPC usage in patients who presented with recurrent effusion in end stage renal disease and concluded that IPC insertion for pleural effusions associated with end-stage renal disease appears safe and effective.
Removal of IPC is often not required in most of the patients. However, spontaneous pleurodesis is one of the potential causes for considering its removal. Other indications include pleural sepsis, nonfunctional/defective IPC and Severe pain with local cellulitis which cannot be managed with conservative approach. Removing indwelling pleural catheter is not an easy task. Since the polyester cuff attached to the drain is designed to promote local fibrosis and the removal of a drain can become more difficult with long standing IPC. In addition, advanced malignancy promotes ingrowth of fibrotic strands into the fenestrations of IPC further making the extraction of catheter difficult. For removal, one need to do careful and meticulous dissection of the fibrous material around the cuff following appropriate incisions. In those circumstances of difficulty in removal of IPC, an alternative is to simply leave the drain and to remove only the proximal portion. Fysh et al. [35] described 2 cases of this being undertaken in a small series of complicated removals. In none of the cases in which tubing was left intrapleurally did the patient experience any infective or pain-related complications during follow-up.
So IPCs plays a major role in patients with recurrent pleural effusions especially malignant pleural effusions. It is particularly useful in palliative care of the patients with trapped lung and failed chemical pleurodesis. It can be performed safely as a day care procedure with consistently low rates of complications, reduced inpatient stay and the recognition that significant improvements in patients’ symptoms. They are relatively easy to insert, manage and remove, and provide the ability to empower patient’s in both the decisions regarding their treatment and the management of their disease itself.
Edited by Jan Oxholm Gordeladze, ISBN 978-953-51-3020-8, Print ISBN 978-953-51-3019-2, 336 pages,
\nPublisher: IntechOpen
\nChapters published March 22, 2017 under CC BY 3.0 license
\nDOI: 10.5772/61430
\nEdited Volume
This book serves as a comprehensive survey of the impact of vitamin K2 on cellular functions and organ systems, indicating that vitamin K2 plays an important role in the differentiation/preservation of various cell phenotypes and as a stimulator and/or mediator of interorgan cross talk. Vitamin K2 binds to the transcription factor SXR/PXR, thus acting like a hormone (very much in the same manner as vitamin A and vitamin D). Therefore, vitamin K2 affects a multitude of organ systems, and it is reckoned to be one positive factor in bringing about "longevity" to the human body, e.g., supporting the functions/health of different organ systems, as well as correcting the functioning or even "curing" ailments striking several organs in our body.
\\n\\nChapter 1 Introductory Chapter: Vitamin K2 by Jan Oxholm Gordeladze
\\n\\nChapter 2 Vitamin K, SXR, and GGCX by Kotaro Azuma and Satoshi Inoue
\\n\\nChapter 3 Vitamin K2 Rich Food Products by Muhammad Yasin, Masood Sadiq Butt and Aurang Zeb
\\n\\nChapter 4 Menaquinones, Bacteria, and Foods: Vitamin K2 in the Diet by Barbara Walther and Magali Chollet
\\n\\nChapter 5 The Impact of Vitamin K2 on Energy Metabolism by Mona Møller, Serena Tonstad, Tone Bathen and Jan Oxholm Gordeladze
\\n\\nChapter 6 Vitamin K2 and Bone Health by Niels Erik Frandsen and Jan Oxholm Gordeladze
\\n\\nChapter 7 Vitamin K2 and its Impact on Tooth Epigenetics by Jan Oxholm Gordeladze, Maria A. Landin, Gaute Floer Johnsen, Håvard Jostein Haugen and Harald Osmundsen
\\n\\nChapter 8 Anti-Inflammatory Actions of Vitamin K by Stephen J. Hodges, Andrew A. Pitsillides, Lars M. Ytrebø and Robin Soper
\\n\\nChapter 9 Vitamin K2: Implications for Cardiovascular Health in the Context of Plant-Based Diets, with Applications for Prostate Health by Michael S. Donaldson
\\n\\nChapter 11 Vitamin K2 Facilitating Inter-Organ Cross-Talk by Jan O. Gordeladze, Håvard J. Haugen, Gaute Floer Johnsen and Mona Møller
\\n\\nChapter 13 Medicinal Chemistry of Vitamin K Derivatives and Metabolites by Shinya Fujii and Hiroyuki Kagechika
\\n"}]'},components:[{type:"htmlEditorComponent",content:'This book serves as a comprehensive survey of the impact of vitamin K2 on cellular functions and organ systems, indicating that vitamin K2 plays an important role in the differentiation/preservation of various cell phenotypes and as a stimulator and/or mediator of interorgan cross talk. Vitamin K2 binds to the transcription factor SXR/PXR, thus acting like a hormone (very much in the same manner as vitamin A and vitamin D). Therefore, vitamin K2 affects a multitude of organ systems, and it is reckoned to be one positive factor in bringing about "longevity" to the human body, e.g., supporting the functions/health of different organ systems, as well as correcting the functioning or even "curing" ailments striking several organs in our body.
\n\nChapter 1 Introductory Chapter: Vitamin K2 by Jan Oxholm Gordeladze
\n\nChapter 2 Vitamin K, SXR, and GGCX by Kotaro Azuma and Satoshi Inoue
\n\nChapter 3 Vitamin K2 Rich Food Products by Muhammad Yasin, Masood Sadiq Butt and Aurang Zeb
\n\nChapter 4 Menaquinones, Bacteria, and Foods: Vitamin K2 in the Diet by Barbara Walther and Magali Chollet
\n\nChapter 5 The Impact of Vitamin K2 on Energy Metabolism by Mona Møller, Serena Tonstad, Tone Bathen and Jan Oxholm Gordeladze
\n\nChapter 6 Vitamin K2 and Bone Health by Niels Erik Frandsen and Jan Oxholm Gordeladze
\n\nChapter 7 Vitamin K2 and its Impact on Tooth Epigenetics by Jan Oxholm Gordeladze, Maria A. Landin, Gaute Floer Johnsen, Håvard Jostein Haugen and Harald Osmundsen
\n\nChapter 8 Anti-Inflammatory Actions of Vitamin K by Stephen J. Hodges, Andrew A. Pitsillides, Lars M. Ytrebø and Robin Soper
\n\nChapter 9 Vitamin K2: Implications for Cardiovascular Health in the Context of Plant-Based Diets, with Applications for Prostate Health by Michael S. Donaldson
\n\nChapter 11 Vitamin K2 Facilitating Inter-Organ Cross-Talk by Jan O. Gordeladze, Håvard J. Haugen, Gaute Floer Johnsen and Mona Møller
\n\nChapter 13 Medicinal Chemistry of Vitamin K Derivatives and Metabolites by Shinya Fujii and Hiroyuki Kagechika
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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. 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The quality practices or quality management systems adopted by industries will further evolve due to the changes of quality concepts as time goes by. This chapter discusses the change of quality concepts and the related revolution of quality management systems in the past century. The quality concepts were gradually changed from the achievement of quality standards, satisfaction of customer needs, and expectations to customer delight. Since merely satisfying customers is not enough to ensure customer loyalty, the enterprises gradually focus on customers’ emotional responses and their delight in order to pursue their loyalty. The emotion of “delight” is composed of “joy” and “surprise,” which can be achieved as the customers’ latent requirements are satisfied. Thus, the concept of “customer delight” and the means to provide the innovative quality so as to meet the unsatisfied customers’ latent needs are elaborated on. Finally, a framework of innovation creation is developed that is based on the mining of customer's latent requirements. This outline will manifest the essential elements of the related operation steps.",book:{id:"5486",slug:"quality-control-and-assurance-an-ancient-greek-term-re-mastered",title:"Quality Control and Assurance",fullTitle:"Quality Control and Assurance - An Ancient Greek Term Re-Mastered"},signatures:"Ching-Chow Yang",authors:[{id:"11862",title:"Prof.",name:"Ching-Chow",middleName:null,surname:"Yang",slug:"ching-chow-yang",fullName:"Ching-Chow Yang"}]},{id:"62915",title:"Advanced Methods of PID Controller Tuning for Specified Performance",slug:"advanced-methods-of-pid-controller-tuning-for-specified-performance",totalDownloads:3528,totalCrossrefCites:12,totalDimensionsCites:18,abstract:"This chapter provides a concise survey, classification and historical perspective of practice-oriented methods for designing proportional-integral-derivative (PID) controllers and autotuners showing the persistent demand for PID tuning algorithms that integrate performance requirements into the tuning algorithm. The proposed frequency-domain PID controller design method guarantees closed-loop performance in terms of commonly used time-domain specifications. One of its major benefits is universal applicability for both slow and fast-controlled plants with unknown mathematical model. Special charts called B-parabolas were developed as a practical design tool that enables consistent and systematic shaping of the closed-loop step response with regard to specified performance and dynamics of the uncertain controlled plant.",book:{id:"6323",slug:"pid-control-for-industrial-processes",title:"PID Control for Industrial Processes",fullTitle:"PID Control for Industrial Processes"},signatures:"Štefan Bucz and Alena Kozáková",authors:[{id:"21933",title:"Ms.",name:"Alena",middleName:null,surname:"Kozakova",slug:"alena-kozakova",fullName:"Alena Kozakova"},{id:"213658",title:"Dr.",name:"Štefan",middleName:null,surname:"Bucz",slug:"stefan-bucz",fullName:"Štefan Bucz"}]},{id:"75699",title:"Data Clustering for Fuzzyfier Value Derivation",slug:"data-clustering-for-fuzzyfier-value-derivation",totalDownloads:302,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"The fuzzifier value m is improving significant factor for achieving the accuracy of data. Therefore, in this chapter, various clustering method is introduced with the definition of important values for clustering. To adaptively calculate the appropriate purge value of the gap type −2 fuzzy c-means, two fuzzy values m1 and m2 are provided by extracting information from individual data points using a histogram scheme. Most of the clustering in this chapter automatically obtains determination of m1 and m2 values that depended on existent repeated experiments. Also, in order to increase efficiency on deriving valid fuzzifier value, we introduce the Interval type-2 possibilistic fuzzy C-means (IT2PFCM), as one of advanced fuzzy clustering method to classify a fixed pattern. In Efficient IT2PFCM method, proper fuzzifier values for each data is obtained from an algorithm including histogram analysis and Gaussian Curve Fitting method. Using the extracted information form fuzzifier values, two modified fuzzifier value m1 and m2 are determined. These updated fuzzifier values are used to calculated the new membership values. Determining these updated values improve not only the clustering accuracy rate of the measured sensor data, but also can be used without additional procedure such as data labeling. It is also efficient at monitoring numerous sensors, managing and verifying sensor data obtained in real time such as smart cities.",book:{id:"9976",slug:"fuzzy-systems-theory-and-applications",title:"Fuzzy Systems",fullTitle:"Fuzzy Systems - Theory and Applications"},signatures:"JaeHyuk Cho",authors:[{id:"329648",title:"Prof.",name:"JaeHyuk",middleName:null,surname:"Cho",slug:"jaehyuk-cho",fullName:"JaeHyuk Cho"}]},{id:"39778",title:"GPS and the One-Way Speed of Light",slug:"gps-and-the-one-way-speed-of-light",totalDownloads:3501,totalCrossrefCites:0,totalDimensionsCites:0,abstract:null,book:{id:"2387",slug:"new-approach-of-indoor-and-outdoor-localization-systems",title:"New Approach of Indoor and Outdoor Localization Systems",fullTitle:"New Approach of Indoor and Outdoor Localization Systems"},signatures:"Stephan J.G. 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The fact that each component of the function has different effects requires assigning different weight coefficients to these components. In this study, the Bees Algorithm (BA) is used to determine the weights. Using the multi-objective function in BA, it has been tried to determine the weights that reduce the current values together with the speed error. Three different PI controllers have been designed to compare the MPC method. The coefficients of one of these are tuned with BA. Good Gain Method and Tyreus-Luyben Method were used in the other two. As a result of experimental studies, it has been observed that MPC can control PMSM more smoothly and accurately than PI controllers, with weights optimized with BA. 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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"}}}},{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"}}}}]},series:{item:{id:"10",title:"Physiology",doi:"10.5772/intechopen.72796",issn:"2631-8261",scope:"Modern physiology requires a comprehensive understanding of the integration of tissues and organs throughout the mammalian body, including the cooperation between structure and function at the cellular and molecular levels governed by gene and protein expression. While a daunting task, learning is facilitated by identifying common and effective signaling pathways mediated by a variety of factors employed by nature to preserve and sustain homeostatic life. \r\nAs a leading example, the cellular interaction between intracellular concentration of Ca+2 increases, and changes in plasma membrane potential is integral for coordinating blood flow, governing the exocytosis of neurotransmitters, and modulating gene expression and cell effector secretory functions. Furthermore, in this manner, understanding the systemic interaction between the cardiovascular and nervous systems has become more important than ever as human populations' life prolongation, aging and mechanisms of cellular oxidative signaling are utilised for sustaining life. \r\nAltogether, physiological research enables our identification of distinct and precise points of transition from health to the development of multimorbidity throughout the inevitable aging disorders (e.g., diabetes, hypertension, chronic kidney disease, heart failure, peptic ulcer, inflammatory bowel disease, age-related macular degeneration, cancer). With consideration of all organ systems (e.g., brain, heart, lung, gut, skeletal and smooth muscle, liver, pancreas, kidney, eye) and the interactions thereof, this Physiology Series will address the goals of resolving (1) Aging physiology and chronic disease progression (2) Examination of key cellular pathways as they relate to calcium, oxidative stress, and electrical signaling, and (3) how changes in plasma membrane produced by lipid peroxidation products can affect aging physiology, covering new research in the area of cell, human, plant and animal physiology.",coverUrl:"https://cdn.intechopen.com/series/covers/10.jpg",latestPublicationDate:"July 20th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:14,editor:{id:"35854",title:"Prof.",name:"Tomasz",middleName:null,surname:"Brzozowski",slug:"tomasz-brzozowski",fullName:"Tomasz Brzozowski",profilePictureURL:"https://mts.intechopen.com/storage/users/35854/images/system/35854.jpg",biography:"Prof. Dr. Thomas Brzozowski works as a professor of Human Physiology and is currently Chairman at the Department of Physiology and is V-Dean of the Medical Faculty at Jagiellonian University Medical College, Cracow, Poland. 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From\r\n1964 to 1974, he worked as Assistant in Biochemistry at the School of MedicineUniversidad Nacional de La Plata, Argentina. From 1974 to 1976, he was a Fellowof the National Institutes of Health (NIH) at the University of Connecticut, Health Center, USA. From 1985 to 2004, he served as a Full Professor oBiochemistry at the Universidad Nacional de La Plata, Argentina. He is Member ofthe National Research Council (CONICET), Argentina, and Argentine Society foBiochemistry and Molecular Biology (SAIB). His laboratory has been interested for manyears in the lipid peroxidation of biological membranes from various tissues and different species. Professor Catalá has directed twelve doctoral theses, publishedover 100 papers in peer reviewed journals, several chapters in books andtwelve edited books. Angel Catalá received awards at the 40th InternationaConference Biochemistry of Lipids 1999: Dijon (France). W inner of the Bimbo PanAmerican Nutrition, Food Science and Technology Award 2006 and 2012, South AmericaHuman Nutrition, Professional Category. 2006 award in pharmacology, Bernardo\r\nHoussay, in recognition of his meritorious works of research. Angel Catalá belongto the Editorial Board of Journal of lipids, International Review of Biophysical ChemistryFrontiers in Membrane Physiology and Biophysics, World Journal oExperimental Medicine and Biochemistry Research International, W orld Journal oBiological Chemistry, Oxidative Medicine and Cellular Longevity, Diabetes and thePancreas, International Journal of Chronic Diseases & Therapy, International Journal oNutrition, Co-Editor of The Open Biology Journal.",institutionString:null,institution:{name:"National University of La Plata",institutionURL:null,country:{name:"Argentina"}}},editorTwo:null,editorThree:null},{id:"12",title:"Human Physiology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/12.jpg",isOpenForSubmission:!0,annualVolume:11408,editor:{id:"195829",title:"Prof.",name:"Kunihiro",middleName:null,surname:"Sakuma",slug:"kunihiro-sakuma",fullName:"Kunihiro Sakuma",profilePictureURL:"https://mts.intechopen.com/storage/users/195829/images/system/195829.jpg",biography:"Professor Kunihiro Sakuma, Ph.D., currently works in the Institute for Liberal Arts at the Tokyo Institute of Technology. He is a physiologist working in the field of skeletal muscle. He was awarded his sports science diploma in 1995 by the University of Tsukuba and began his scientific work at the Department of Physiology, Aichi Human Service Center, focusing on the molecular mechanism of congenital muscular dystrophy and normal muscle regeneration. His interest later turned to the molecular mechanism and attenuating strategy of sarcopenia (age-related muscle atrophy). 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Additionally, to understand how to maintain and improve physical function in older adults, to conduct studies about the mechanism of sarcopenia and determine when possible interventions are needed.",institutionString:null,institution:{name:"Ritsumeikan University",institutionURL:null,country:{name:"Japan"}}},editorThree:null},{id:"13",title:"Plant Physiology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/13.jpg",isOpenForSubmission:!0,annualVolume:11409,editor:{id:"332229",title:"Prof.",name:"Jen-Tsung",middleName:null,surname:"Chen",slug:"jen-tsung-chen",fullName:"Jen-Tsung Chen",profilePictureURL:"https://mts.intechopen.com/storage/users/332229/images/system/332229.png",biography:"Dr. Jen-Tsung Chen is currently a professor at the National University of Kaohsiung, Taiwan. He teaches cell biology, genomics, proteomics, medicinal plant biotechnology, and plant tissue culture. Dr. Chen\\'s research interests include bioactive compounds, chromatography techniques, in vitro culture, medicinal plants, phytochemicals, and plant biotechnology. He has published more than ninety scientific papers and serves as an editorial board member for Plant Methods, Biomolecules, and International Journal of Molecular Sciences.",institutionString:"National University of Kaohsiung",institution:{name:"National University of Kaohsiung",institutionURL:null,country:{name:"Taiwan"}}},editorTwo:null,editorThree:null}]},overviewPageOFChapters:{paginationCount:21,paginationItems:[{id:"83000",title:"Purine and Pyrimidine Pathways as Antimalarial Targets",doi:"10.5772/intechopen.106468",signatures:"Yacoba V.T. Minnow and Vern L. 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He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. Dr. Saxena is a fellow of various international societies/academies including the Royal College of Pathologists, United Kingdom; Royal Society of Medicine, London; Royal Society of Biology, United Kingdom; Royal Society of Chemistry, London; and Academy of Translational Medicine Professionals, Austria. He was named a Global Leader in Science by The Scientist. He is also an international opinion leader/expert in vaccination for Japanese encephalitis by IPIC (UK).",institutionString:"King George's Medical University",institution:{name:"King George's Medical University",institutionURL:null,country:{name:"India"}}}]},{type:"book",id:"7064",title:"Current Perspectives in Human Papillomavirus",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7064.jpg",slug:"current-perspectives-in-human-papillomavirus",publishedDate:"May 2nd 2019",editedByType:"Edited by",bookSignature:"Shailendra K. Saxena",hash:"d92a4085627bab25ddc7942fbf44cf05",volumeInSeries:2,fullTitle:"Current Perspectives in Human Papillomavirus",editors:[{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRET3QAO/Profile_Picture_2022-05-10T10:10:26.jpeg",biography:"Professor Dr. Shailendra K. Saxena is a vice dean and professor at King George's Medical University, Lucknow, India. His research interests involve understanding the molecular mechanisms of host defense during human viral infections and developing new predictive, preventive, and therapeutic strategies for them using Japanese encephalitis virus (JEV), HIV, and emerging viruses as a model via stem cell and cell culture technologies. His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. Dr. Saxena is a fellow of various international societies/academies including the Royal College of Pathologists, United Kingdom; Royal Society of Medicine, London; Royal Society of Biology, United Kingdom; Royal Society of Chemistry, London; and Academy of Translational Medicine Professionals, Austria. He was named a Global Leader in Science by The Scientist. He is also an international opinion leader/expert in vaccination for Japanese encephalitis by IPIC (UK).",institutionString:"King George's Medical University",institution:{name:"King George's Medical University",institutionURL:null,country:{name:"India"}}}]},{type:"book",id:"7123",title:"Current Topics in Neglected Tropical Diseases",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7123.jpg",slug:"current-topics-in-neglected-tropical-diseases",publishedDate:"December 4th 2019",editedByType:"Edited by",bookSignature:"Alfonso J. 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He is a vice-president of the Latin American Society for Travel Medicine (SLAMVI) and a Member of the Council of the International Society for Infectious Diseases (ISID). Since 2014, he has been recognized as a Senior Researcher, at the Ministry of Science of Colombia. He is a professor at the Faculty of Medicine of the Fundacion Universitaria Autonoma de las Americas, in Pereira, Risaralda, Colombia. He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. 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