Summary of the aerodynamic characteristics of the wings of eight bats.
\\n\\n
Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\\n\\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\\n"}]',published:!0,mainMedia:{caption:"Highly Cited",originalUrl:"/media/original/117"}},components:[{type:"htmlEditorComponent",content:'IntechOpen is proud to announce that 191 of our authors have made the Clarivate™ Highly Cited Researchers List for 2020, ranking them among the top 1% most-cited.
\n\nThroughout the years, the list has named a total of 261 IntechOpen authors as Highly Cited. Of those researchers, 69 have been featured on the list multiple times.
\n\n\n\nReleased this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\n\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
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He has published research in Research Policy, Applied Economics, Review of Economic Philosophy, Strategic Change, International Journal of Logistics, Sustainability, Journal of Environmental Management, Journal of Global Information Management, Journal of Cleaner Production, M@N@GEMENT, and more. He is a member of CEDIMES Institut (France), Academy of International Business (AIB), Strategic Management Society (SMS), Academy of Management (AOM), Administrative Science Association of Canada (ASAC), and Canadian council of small business and entrepreneurship (CCSBE). He is currently the director of the Research Group on Contemporary Asia (GERAC) at Laval University. He is also co-managing editor of Transnational Corporations Review and a guest editor for Electronic Commerce Research and Journal of Internet Technology.",institutionString:"Université Laval",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"2",totalChapterViews:"0",totalEditedBooks:"3",institution:{name:"Université Laval",institutionURL:null,country:{name:"Canada"}}}],coeditorOne:{id:"474140",title:"Dr.",name:"Tareque",middleName:null,surname:"Aziz",slug:"tareque-aziz",fullName:"Tareque Aziz",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003SaNGSQA3/Profile_Picture_2022-05-13T10:39:36.png",biography:'Dr. Mohammed Tareque Aziz is the country’s leading service sector management consultant. Currently, Dr. Aziz is the Dean and professor of relationship marketing and retailing at Green Business School (GBS) of Green University Bangladesh (GUB). He is a member of the editorial board of the Journal for Service Quality Improvement (JSQE). Officially the patent applicant and copyright owner of Bangladesh\'s "Service Quality Index (SQI)" certification. BRAC University and the University Grants Commission have named him a "Certified Academic Quality Expert." In addition, he is an honorary Senior Fellow at India\'s Centre for Advanced Studies in Policy Research (CASPR). He is on the International Fellowship Journal of Interdisciplinary Research\'s Editorial Advisory Board.',institutionString:"Green University of Bangladesh",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"Green University of Bangladesh",institutionURL:null,country:{name:"Bangladesh"}}},coeditorTwo:{id:"154427",title:"Dr.",name:"Sreenivasan",middleName:null,surname:"Jayashree",slug:"sreenivasan-jayashree",fullName:"Sreenivasan Jayashree",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bS8DPQA0/Profile_Picture_2022-05-13T10:37:31.jpg",biography:"Dr. S. Jayashree is an associate professor at the Faculty of Management (FOM), Multimedia University, Persiaran Multimedia, 63100, Cyberjaya, Selangor, Malaysia. She is pioneering research in Technology and cross-cultural area. Her research has been published in leading peer-reviewed journals and books. She has also presented her findings at many international conferences.",institutionString:"Multimedia University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"Multimedia University",institutionURL:null,country:{name:"Malaysia"}}},coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"23",title:"Social Sciences",slug:"social-sciences"}],chapters:null,productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"184402",firstName:"Romina",lastName:"Rovan",middleName:null,title:"Ms.",imageUrl:"https://mts.intechopen.com/storage/users/184402/images/4747_n.jpg",email:"romina.r@intechopen.com",biography:"As an Author Service Manager my responsibilities include monitoring and facilitating all publishing activities for authors and editors. 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The acquisition of powered flight required a series of morphological and physiological changes in the basic mammal body plan. The structure of the limbs is the most obvious specialization, however, adaptations for powered flight encompass most organ systems, in particular the cardiovascular and respiratory apparatus. Flight performance is strongly determined by wing morphology, which in turn is associated with the biomechanics and energetics of flight, as well as ecological aspects such as foraging behavior and habitat selection.
In this chapter we focus on respiratory, cardiac and wing morphology characteristics of some bat species present in Chile, correlating the results with ecological and behavioral information. The small community of Chilean bat species shows a pattern similar to that found in other bat communities. With respect to wing morphology we found that
Also the respiratory and cardiovascular systems of bats are modifications or refinements that allow them to survive this extreme way of life. Bats have lung volumes about 72% greater than non-flying mammals of the same size. Pulmonary ventilation can rapidly increase 10 to 17 times as flight begins. These respiratory adaptations, along with structural changes of lungs, lead to higher oxygen consumption than other mammals of similar size, reaching up to 22 mlO2/gh at low temperatures and during hovering. We found that the bronchial morphology of
The order Chiroptera (“winged hands”) is practically defined by saying that it is constituted by flying mammals. These animals require deep structural changes associated with their lifestyle, but based on a mammalian model. Flight influences its main characteristic: wings formed by a membrane called a patagyum. The arms are the dominant limbs while legs are reduced, contributing to the reduction in body mass which is necessary for flight. These structural changes are also associated with the colonization of the crepuscular and nocturnal air space which required the specialization of the visual system in megachiropterans and the development of echolocation in michrochiropterans, where excepting macro chiropterans the vision contributes little, but where the emission and reception of ultrasound, or echolocation, allows the recognition of the surrounding environment; the ear is the main organ sense of the group.
Body size is associated with flight behavior, diet selection, reproductive behavior, physiology and practically all aspects of the biology of bats. (Swartz et al., 2003). Bat body sizes vary from 2 g and 16 cm wingspan in the mammal with the lowest body mass known
The superior limit of body size is not imposed by flight, because among birds there are species which weigh up to 14 Kg, such as Koris`s bustard, and the extinct pterosaurs reached giant sizes. It is possible that in bats the superior limit to body mass is imposed by a combination of behavioral, ecological and physiological factors. Insectivorous bats would have aerodynamic and sensorial restrictions. Barclay & Brigham (1991) proposed that associated with an increase in the body mass there is a decrease in the maneuverability that prey detection at long distances requires. However, this would condition the use of low frequencies during echolocation, with a decrease in spatial resolution. Thus, the abundance of large prey could be a limiting factor of body size in these bats, which is corroborated in part by the positive correlation between prey size and body size of bats (Aldridge & Rautenbach 1987; O\'Neil & Taylor, 1989). However, this does not apply to large fruit bats that do not use echolocation. In the latter restrictions derived from muscle physiology may operate; kinematics of flight or wing loading and mechanical stress imposed on the bones by flight (Marden, 1994). While the force per unit mass generated by a muscle is approximately constant, the mass-specific power to fly scales positively with mass, resulting in less lift generation per unit of muscle power (Marden, 1994). Similarly, the mechanical power required for flight grows faster (α Mb 1.185) than the oxygen consumption of bats (Maina et al., 1991; Maina 2000) helping to establish an upper limit of about 1.5 Kg for bats (Carpenter 1986, Maina 2000).
Limbs of bats are completely conditioned by flight. While the forelimbs are large and strong, the legs are small, contributing to a reduced mass allowing flying. However, these latter have adaptations such as the joint mechanism of the claws, which pivot on the distal phalanges. While an elastic ligament extends the dorsal claw, the long plantar tendon inserts on the ventral side of the base of the claw, flexing it. Thus, when bats hang inverted during rest, the body weight flexes the claw and allows it to catch on a branch or a cliff (Neuweiler, 2000). In most mammals the diameter of the femur scales with body mass raised to the 1/3 power (geometric similarity), but in bats femur diameter is smaller than that of other mammals of similar size. An exception to this generalization is the vampire bat
The body and forelimbs are significantly modified for flight. The thin patagium is richly vascularized with muscles that allow tension and bending, thus contributing dynamically to flight. Occipitopollicalis muscles, Dorsoplagiopatagialis, Humeropatagialis, Coracocutaneus, Uropatagialis and Plagiopatagial Tensor contribute to this dynamic tension, while the adductor of the fifth digit causes the arched profile necessary for flight. While bird wing movement is controlled mainly by two muscles and the point of rotation of the wing is slightly medial or dorsal to the level of shoulder joint, in the bats this point is shifted ventrally to the sterno –clavicular articulation, allowing the scapula to participate in wing movements. In the movement of bat wings at least 17 muscles are involved (Neuweiler, 2000). The main lift muscles are the Trapezium, rhomboids, Acromiodeltoideus and Spinodeltoideus, while the lowering of the wings is controlled mainly by Pectoralis, Serratus, Clavodeltoid and Subscapularis. Extension and flexion of the wing are governed by a special muscle arrangement that automates these movements. Both the triceps (extensor, dorsal) and the biceps (flexor, ventral) are inserted from the scapula to the forearm, bypassing the humeral insertion. Also the extensor carpi radialis and flexor carpi ulnaris bypass the radius. Thus the contraction of the triceps causes the extension of the radio-carpal extensor and the whole wing in an almost automatic form (Neuweiler, 2000).
Wing morphology is highly variable, associated with the biomechanics and energetics of flight (Rayner 1979, 1982), and with ecological and behavioral factors such as flight pattern, foraging behavior and habitat selection (Norberg & Rayner 1987, Norberg 1994; Canals et al. 2001, Iriarte-Díaz et al. 2002, Canals et al., 2005).
There are four important parameters related to the aerodynamics of flight: 1) wing loading:
which represents the weight per unit area (N/m2) to be supported by the wings; 2) wingspan (B), corresponding to the length of the wings from tip to tip, 3) the aspect ratio:
which is a dimensionless measure of the relative length to width of the wings, so high AR values correspond to long, thin wings and vice versa, and finally 4) wing acuity ratio (i.e., tip length ratio: TL = length of third finger / arm length) (Neuweiler, 2000).
In its most simple terms, a bat must move the air with its wings in such a way as to produce aerodynamic force. The component of the aerodynamic force that propels the bat forward is thrust and the component that keeps the bat from falling is lift. These forces are opposed by drag (an aerodynamic force) and gravity, respectively. In contrast to planes that continuously produce thrust and lift (by their engines and the constant flow over the wings), bats generate aerodynamic force in a cyclic manner due to the flapping of the wings. Thus, flight in bats is dependent of an appropriate modulation of wing kinematics in order to generate enough aerodynamic force.
Unlike terrestrial locomotion, where limbs push against a solid substrate, aerial fliers use their wings to push against fluids, which distort and swirl to form a complex wake (Dickinson et al., 2000). Although it is the wing motion that is directly responsible for the generation of lift and thrust, we can estimate the aerodynamic forces by looking at the fluid motion left behind a flying animal. Newton’s third law requires that the forces exerted by the air upon the wings must be equal and opposite to the forces exerted by the wings upon the air. The wake left behind the wing thus contains a complete ‘footprint’ of its force generation. An everyday example of this are the vapor trails left by airplane wings, the tip vortices, that arise directly from the aerodynamic forces produced as the plane moves through the atmosphere. Bats also leave an aerodynamic wake and this wake can be measured by looking at the movement of the air left behind.
An aerodynamic wake can be efficiently analyzed in terms of its
Effect of the oscillation of the wings on the position of the center of mass (COM) and accelerations of the body. When external forces, such as aerodynamic and gravitational forces, are absent, the position of the COM will remain constant but the body moves in opposition to the flapping wings to conserve momentum. Closed and open symbols correspond to the pelvis and chest markers, respectively. During upstroke (A), the upward and backward acceleration of the wings will produce an inertial force (black arrow) that will move the body forward and downward with respect to the downstroke. This force will produce a forward-oriented component, or inertial thrust, during upstroke (grey arrow). During downstroke (B), the downward and forward acceleration of the wings will produce an inertial force (black arrow) that will move the body backward and upward while keeping the position of the COM constant. The horizontal component of this inertial force will produce negative inertial thrust during downstroke (grey arrow).
Aerodynamic theory predicts that the wing loading, the wing span and aspect ratio are significant parameters in determining performance in flight. For example, during flight the organism should generate sustained lift (L) to support body weight and thrust (T) to overcome drag (D). Thus, the power required to fly is:
where v is the relative velocity of air over the wings. The cost of transport (C), which corresponds to the work done to move a unit of weight for a unit of distance is inversely proportional to the speed:
with P = power, m the body mass and g gravity acceleration). Furthermore, the speed is proportional to WL\n\t\t\t\t1 / 2, so that both high wing loading and high flight speeds are associated with low transportation costs (Norberg 1987).
The energy per unit time (power) required to fly can be decomposed into that needed to move the wings (inertial power: Pin) and the power required to produce the aerodynamic force (R). The latter can be decomposed into the power required to overcome the resistance of the body (parasite power: PPAR), the profile of the wings (Power Profile: PPRO) and the power to generate lift and thrust (induced power: PI). Thus the total aerodynamic power is the sum these:
Plotting the power according to flight speed a typical "U" curve is obtained, whose minimum determines the speed at which it produces the minimum energy expenditure (VMP). It is also possible to calculate the speed which determines the minimum cost of transport (VMR), which is determined by the intersection between the curve and the tangent to it passing through the point (v = 0) (Norberg, 1987).
All these components of energy expenditure of flight are correlated with B and WL, for example Pparα v3 α (WL)3/2, Ppro α S(B/τ)3 during hovering, where τ is the wing beat period, PI α (Mg)3/2/B during hovering and PIα (Mg)2/(B2v) during forward flight, and Pin α B2 (Norberg, 1987). In addition, the minimum resistance (Dmin) and the minimum power required to fly (Pmin) are inversely correlated with the aspect ratio:
and
where Cr is the combined parasite and profile friction coefficient. Thus high values of AR are critical in reducing both parameters; AR is considered to be a measure of aerodynamic efficiency (Norberg, 1994). Another important aspect is the high wing acuity (i.e., TL) that allows adequate air movement dynamics around the wings without turbulence. By contrast, rounded wings can generate turbulent flow by increasing the resistance to movement and therefore PPRO.
Norberg and Rayner (1987) attempted to establish a relationship between lifestyle and major aerodynamic parameters of wing morphology, being able to classify four groups of bats: i) bats of open space and faster flight have long and narrow wings, with high wing loadings up 20N/m2 and aspect ratios as high as 14.3 in some Molossidae (Fenton 1992, Norberg & Rayner 1987), ii) slow-flying bats of forested areas with short and broad wings, with low wing loading, about 5 to 6 N/m2, and low aspect ratios, about 5 (Canals et al. 2001, Iriarte-Díaz et al. 2002), iii) fast flying bats with stationary or short flights, which have high wing loading but low aspect ratios, and finally iv) slow-flying bats in open spaces, which have high aspect ratios but low wing loading (Figure 2).
Species that forage in and around foliage tend to have short, rounded wings with low values of AR and TL, which produces low wing loading. They have a relatively slow flight, between 2.5 and 6 m / s, and are very maneuverable (Neuweiler, 2000). Many of them can use hovering to locate and capture prey over the foliage or to feed on pollen or nectar. Species that forage on leaves are slender, with long, thin wings (high AR) and high wing loading. Their flight speed is high, between 9 and 15 m / s. These bats have less maneuverability. However, their agility, defined as the ability to accelerate and stop quickly, is increased, as is an ability related to wing loading (Norberg & Rayner, 1987). An example of such bats is the Molossidae, for example
Principal components for morphological characteristics in several bat species. The first component was explained for body mass, but second and third components are related with wing loading (WL) and the aspect ratio (AR) respectively. This analysis allow recognize different eco-morphological groups of bats. Modified from Wainwright & Reilly 1994.
Frugivorous bats usually fly long distances for foraging, occasionally flying over 27 km. This requires sustained flight and highly developed flight muscles that result in high wing loading, however, their wings are broad and rounded (Neuweiler 2000). The same is true in the vampire bat
In a series of studies, Canals et al (2001), Iriarte et al (2002) and Canals et al (2005) examined some aspects of the wing morphology of 8 species of bats present in Chile, correlating the results with available ecological information. They estimated aspect ratio, wingspan, wing surface, and wing loading of the molossids
Species | ||||||
6.76 ± 0.18 | 23.69 ± 0.39 | 98.29 ± 3.47 | 6.8 ± 0.23 | 5.76 ± 0.16 | 3.89 ± 0.49 | |
12.5 | 29.2 | - | - | - | 23.1 | |
9.37 ± 0.29 | 29.67 ± 0.58 | 129.67 ± 4.20 | 7.08 ± 0.19 | 6.78 ± 0.06 | 21.17 ± 3.52 | |
7.87 ± 1.12 | 25.37 ± 2.49 | 93.73 ± 8.87 | 8.20 ± 0.46 | 6.87 ± 0.70 | 12.68 ± 9.30 | |
19.55 ± 6.58 | 30.20 ± 1.41 | 165.45 ± 52.07 | 15.42 ± 5.75 | 5.72 ± 1.29 | 26.78 ± 5.06 | |
11.95 ± 0.62 | 28.65 ± 0.63 | 100.14 ± 4.61 | 11.56 ± 0.66 | 8.12 ± 0.16 | 11.15 ± 2.61 | |
3.10 ± 1.13 | 17.25 ± 0.35 | 32.4 ± 2.26 | 9.28 ± 2.77 | 9.20 ± 0.27 | 5.85 ± 5.98 | |
33.48 | 33.5 | 167.23 | 19.61 | 6.71 | 68.3 | |
4.3 | 19.7 | 58.8 | 7.17 | 6.6 | 9.3 | |
12.23 ± 2.71 | 27.33 ± 0.68 | 93.50 ± 8.18 | 12.74 ± 2.07 | 8.01 ± 0.44 | 21.24 ± 14.01 |
Summary of the aerodynamic characteristics of the wings of eight bats.
* From Iriarte-Díaz & Canals 2002 and Canals et al., 2005.Mb = body mass, B = wing span, S = wing surface, WL = wing loading, AR = aspect ratio and Ih = second moment of humeral area in median section. Asterisks indicate juvenile individuals. In one adult
The free-tailed bat
The small community of Chilean bats showed a similar pattern to that found by Norberg and Rayner for many species, but at a small scale. Principal components analysis showed two axes, the first correlated positively with wing loading and negatively with wingspan and the second positively correlated with the aspect ratio. In these species 4 functional groups can be recognized, one for each quadrant in the graph:
The molossids
Most of vespertilionids in the zone of high maneuverability and low speed which correspond to bats which inhabit wooded areas;
The differences in flight performance observed in bats can be associated with higher energy expenditure efficiency as well as very high levels of maneuverability. For example, among animals of comparable body size, hovering flight of nectar-feeding bats is 40 and 60% less costly metabolically that that of hawkmoths and hummingbirds, respectively (Winter, 1998; Winter and von Helversen, 1998; Voigt and Winter, 1999), suggesting that bats have more efficient mechanisms of lift generation than member of other groups. Although the kinematics of hovering of bats differ from those of insects and hummingbirds, we lack experimental measurements that can explain such differences in efficiency. In a recent study using PIV methods, it was shown that bats can increase lift generation during slow flights by 40% by using attached leading-edge vortices around the wings (Muijres et al., 2008), similar to those used by insects (Fry et al., 2005) and hummingbirds (Warrick et al., 2005) during hovering flight. Why hovering flight in bats is energetically cheaper than that of insects and hummingbirds of similar size is still unclear.
The ability to quickly alter flight direction and speed is essential for bats to successfully navigate complex three-dimensional environments, to capture prey, and to avoid predators. Despite the importance of this task, maneuvering abilities and its mechanisms have been barely investigated. A flying organism has six degrees-of-freedom of movement: translation in three dimensions in space and rotation around three orthogonal axes centered on the center of mass, termed yaw, pitch, and roll.
In its most basic form, a turning maneuver requires the reorientation of the body in such a way that the net aerodynamic force is tilted laterally effectively producing a centripetal force that will drive the bat through the turn. The most common method in the literature is the bank turn. In this kind of turn, the body rolls into a bank, which orients the lift vector towards the direction of the turn, producing a centripetal force. When the turn is complete, the body rolls back into the unbanked position such that centripetal force is no longer produced. Airplanes use this mechanism, it has been observed in insects and birds, and it has been assumed that bats use it as well. If a flying organism performs a banked turn, then for any given lift coefficient and bank angle, the turning radius depends directly of the wing loading or body weight per unit wing area; there is some evidence consistent with this relationship from bats in both field and obstacle course settings (Aldridge, 1986; Aldridge and Rautenbach, 1987; Stockwell, 2001).
However, growing evidence suggest that differences in turning techniques (e.g., gliding versus flapping turns, Aldridge, 1987b) and changes in wing posture throughout the turn (Lentink et al., 2007) can substantially alter the turning performance. The only study to investigate the mechanisms of turning in bats suggest a more complex mechanism. Detailed analysis of the wing motion and body orientation during 90-degree turns in the pteropodid
One aspect of flight performance that remains virtually unstudied is the importance of inertial forces generated by the flapping motion of relatively massive wings. The wings of bats comprise a significant portion of total body mass, ranging from 11 to 20% in a few measured species (Thollesson and Norberg, 1991; Watts et al., 2001) and consequently, inertial forces produced by accelerating these masses are expected to be high and the potential effect of these forces on flight performance is still not well understood. In a recent study, the effect of wing’s inertial forces was studied on
The first law of thermodynamics states that energy is neither created nor destroyed, only transformed. Living organisms as physical systems obey this principle, acquiring, converting, assigning, storing and dissipating energy. The transformation of energy plays a crucial role in the evolution, ecology and physiology of organisms. Thus the internal and external boundaries of the use and transformation of energy affect their fitness and may affect species richness, reproductive effort, activity patterns, habitat use and life history (McNab 2002, Cruz-Neto et al 2003; 2006).
Field metabolic rate (FMR) integrates all the energy costs of free-living organisms, including the costs of thermoregulation, locomotion etc. This has been quantified in the Australian bat
The thermal conductance of a microchiropteran of 10 g is about 6 times that of a mega-chiropteran of 500 g (Geiser 2006). Thus the maintenance of homeothermy is especially relevant in small bats with large membranous wings and large lungs. Bats have a respiratory area 6 times greater and a conductance between 1.5 and 4 times greater than non-flying mammals (Neuweiler, 2000), although the minimum conductance at rest appears to be similar (see Speakman & Thomas 2003). Despite this, bats can remain active and euthermic within wide temperature ranges.
To maintain their temperature bats may use different behavioral and physiological strategies. Behaviorally they can avoid overheating by wing movements that favor convection or licking the surface of their skin to increase evaporation, since they do not have sweat glands. Small bats find microenvironments with high thermal stability in caves or shelters, and can travel to other shelters to avoid overheating at times of high temperatures. Thus, the solitary bat
The first physiological response to cold is to increase muscle tone generating heat, followed by shivering, which actually consists of rhythmic but asynchronous fibrillary muscle contractions. However, heat generation consumes so much energy that with limited resources it is not convenient for long periods.
When ambient temperatures fall below the lower limit of thermoneutrality, bats have the "option" to maintain their body temperature at a high energy cost, or to enter into torpor, maintaining a temperature similar to that of the environment with a significant decrease in energy expenditure. Entering into torpor seems to depend upon the interaction among resource availability, reproductive status and body size. McNab (1983) proposed a boundary line of endothermy, allometrically related to body size with an exponent -0.67, which intersects the Kleiber line for mass-specific metabolism at 37 g. Thus, individuals under this line and weighing less than 37 g may use torpor as a physiological response to save energy. During torpor, animals enter into a rhythmic pattern of breathing and apnea; the periods are longer as the temperature drops.. These periods allow the accumulation of CO2 that triggers breathing and prevents evaporation in the lungs. The mechanism that triggers the awakening is still unknown. Many bats have facultative stupor, maintaining significant fluctuations of oxygen consumption and body temperature (heterothermy), saving a great amount of energy. Some examples of this behavior are found in
Another long-term mechanism for energy saving is hibernation, in which metabolism falls to extremely low levels; heart rate can also decrease from more than 400 beats to a few beats per minute and the peripheral circulation and urine output may fall to almost nil. The respiratory quotient drops to 0.6-0.7, indicating that metabolism of lipids and blood glucose values may reach about 25 mg / dl. In contrast to torpor in which the values of Q10 (ratio of metabolic change with 10° C of temperature change) are around 2, during hibernation they are temperature-dependent, increasing from 2 to 4 with an increase of temperature, which suggests an active metabolic depression. For example at 20° C the metabolism of a bat in torpor is twice that of a hibernating bat.
This metabolic depression could be due to metabolic acidosis, low thyroid hormone or mediated by fatty acids (Neuweiler, 2000). The mechanisms that trigger hibernation have not been established, although it has been postulated that hibernation is regulated autonomously. Temperature, energy depletion and loss of water have been postulated as triggers that regulate arousal.
The perpetuation of animals over time requires an average positive energy balance, which is particularly difficult for small mammals such as the insectivorous bat
The torpor in
The answer seems to come from the energy balance
where M is metabolism and E the energy balance.
A) Relation between ambient temperature and metabolism (MR, mlO2/gh) and B) Relation between ambient temperature and body (Tb, °C) in
Data on the chemical composition of various flying insects indicates that their assimilated energy is approximately 5.3 Kcal / g; thus an individual of 5.8 g which ingested 11% of its weight in insects every day assimilates 5.8 x0, 11x5, 32 = 3.39 kcal / day. Therefore this individual may have two situations:
Euthermy: The temperature the shelters of
Torpor: If instead it spends 20 hours in torpor with a metabolism of 1.2 cal / gh, 1 hour of euthermic rest (30 min before and after feeding) and the same three hours of activity, it would expend 5.8 x1, 2x20 = 0.14 Kcal in torpor, the same 1.88 Kcal during activity and 1x36x5, 8 = 0.21 Kcal at euthermic rest, giving a balance 3.39 = 0.21 + 1.88 + 0.14 + E. Now the energy budget is positive: E = +1.16 kcal / day.
Endothermic animals depend on aerobic metabolism for most of their vital functions. The energy from food is allocated to different functions such as maintenance of homeostasis (i.e. temperature), reproduction, exchange mechanisms, maintenance of tone and locomotion. As most bats are small and therefore have a large surface area per unit volume, they have trouble maintaining their body temperature high and constant as consequence of the significant energy loss through the skin. Moreover, flight requires high energy expenditure, especially since many bats are exposed to cold nights and fly at high altitudes with low oxygen partial pressures (Harrison & Roberts 2000). In this sense bats may be considered as mammals adapted to extreme environments where oxygen management is crucial. Both the respiratory and cardiovascular systems undergo changes or refinements that allow them to optimize the acquisition and delivery of oxygen to tissues, and thus survive this extreme way of life.
Breathing in mammals consists basically of two connected events: ventilator convection and alveolar diffusion. The first is the displacement of a volume of air through the airway and the second in the effective exchange of oxygen and CO2 at the alveolar level.
Alveolar ventilation (
Thus increments in ventilation are possible only through effective tidal volume or respiratory rate increments. However, increasing alveolar ventilation may be costly in energetic terms as the movement of larger volumes of air results in greater breathing work. Moreover, the work of breathing (Tr) not only depends on the volume but also on the pressure necessary to mobilize this volume:
This in turn is a direct function of the resistance to air movement which is influenced by a) a geometric factor:
(Poiseuille Law), where l is the length of the airway, η the air viscosity and r the radius of the bronchi, which basically indicates that the resistance to flow is inversely proportional to the fourth power of the radius, and b) a dynamic factor:
where v is the velocity of air flow, which indicates higher resistance at higher flow rates (or breathing rates). Thus the total resistance to airflow through the airway as a function of breath rate follows a U-shaped curve, determining for each species, according to the geometric characteristics of the airway, an optimal respiratory rate with minimal resistance. Murray (1926) and later Weibel and Gomez (1962) and Wilson (1967) established that respiratory geometry could be adapted to a minimum overall work of breathing and minimum entropy dissipation during mechanical ventilation, following approximately the Murray law "For minimum breathing work, ventilation (Q: minute volume) should be proportional to the third power of the radius (r):
However, mammals have considerable deviations from this pattern, especially due to the presence of asymmetries in diameter in the bronchial bifurcations and non-uniform length of segmental and subsegmental bronchi (Horstfield, 1990, Canals et al., 2002).
Bats have a much greater lung volume than non-flying mammals and they remove about 60% of the total lung capacity with each breath during flight (Neuweiler, 2000). Lung volume is about 72% greater than in non-flying mammals of similar weight (Canals et al, 2005a) (Table 2). At rest, pulmonary ventilation is similar to that of non-flying mammals. However, this can rapidly increase 10 to 17 times when flight begins (Thomas, 1987). This is due to increases of 3 to 5 times in breath rates and 2 to 4 times in tidal volume. The respiratory rate is synchronized to the wing beat frequency, reaching a value of 400 min-1. These respiratory adaptations function together with structural changes of lung yield in oxygen consumption reaching to 2.5 to 3 times higher than mammals of equal size (Thomas, 1987) and high maximum oxygen consumption, which can reach 22 to mlO2/gh at low temperatures (Canals et al., 2005b) and during hovering (Winter et al., 1998, Voigt & Winter, 1999; Voigt, 2004).
The morphology of the airways also appears to play a role in saving energy during flight. Canals et al. (2005) studied the airway of
Species | Mb (g) | LV (cc) | RLV=LV/Mb (cc/g) |
11.95 ± 1.36 | 0.654 ± 0.091 | 0.055 ± 0.011 | |
3.1 ± 1.13 | 0.162 ± 0.024 | 0.054 ± 0.021 | |
6.95 ± 0.54 | 0.406 ± 0.071 | 0.058 ± 0.009 | |
9.80 ± 0.666 | 0.602 ± 0.094 | 0.061 ± 0.005 | |
12.5 | 0.696 | 0.056 | |
6.8 ± 2.05 | 0.455 | 0.064 ± 0.004 | |
16.06 ± 7.62 | 1.025 ± 0.389 | 0.066 ± 0.010 | |
97.8 ± 2.56 | 4.95 ± 0.255 | 0.051 ± 0.007 | |
456.0 ± 20.87 | 15.37 ± 1.93 | 0.034 ± 0.011 | |
667.0 | 22.20 | 0.033 | |
928.0 | 39.24 | 0.042 |
Lung volume (LV) and relative lung volume (RLV) in several species of bats (from Canals et al 2005a and Maina et al., 1991*)
Optimization of the proximal airway of
The diffusion of oxygen through the alveolar-capillary barrier depends directly on the gradient of partial pressure of oxygen between the alveoli and the capillary (ΔPO2) and the respiratory surface (A), and inversely on the thickness of the alveolar-capillary membrane (τh) This can be expressed as:
where the alveolar surface is expressed as the product of lung volume (Vp) and the surface density per unit of lung volume (dSa), κ is Krogh\'s constant and VO2 is the oxygen consumption (Weibel et al., 1981). Thus, high oxygen consumption may be achieved through increases in alveolar surface density or lung volume, or by reducing the thickness of the alveolar-capillary barrier. The factor:
is known as conductance or oxygen diffusing capacity (DO2). As mentioned above, bats have a lung volume 1.72 to 1.75 times that of non-flying mammals, however, alveolar surface density is similar to that of non-flying mammals (Maina, 2000). As a result, the total respiratory area of bats is larger than in non-flying mammals. In addition, these animals have a very thin alveolar-capillary barrier (Maina et al., 1991; Maina, 2000a) that may reach a value of 0.1204 microns in
Respiratory adaptations are insufficient to ensure adequate oxygen delivery to tissues, so these must be accompanied by changes in the cardiovascular system. Here the blood flow generated by the heartbeat, the resistance to flow, and transport of oxygen in the blood are all relevant.
Blood flow (Q) can be expressed as the product of volume ejected in each beat (VE) and heart rate (fc) or as the ratio between the gradient of pressure to generate the flow (ΔP) and peripheral resistance (R):
Peripheral resistance follows a Poiseuille relationship and cardiac work, similar to respiratory work, depends on expulsive volume and pressure:
Thus high flow is obtained by increasing the expulsive volume or heart rate and by decreasing peripheral resistance.
26.3 ± 2.00 | 0.303 ± 0.037 | 589.37 ± 45.26 | 0.846 ± 0.28 | 2.565x10-6 | |
25.48 ± 1.93 | 0.345 ± 0.057 | 791.8 ± 229.68 | 0.972 ± 0.12 | 3.589x10-6 | |
75.0 ± 4.96 | 0.223 ± 0.033 | 1140.5 ± 92.0 | 1.91 ± 0.17 | 4.92 x10-6 | |
11.25 ± 0.50 | 0.230 ± 0.086 | 690.28 ± 156.96 | 0.585 ± 0.09 | 6.398x10-6 | |
6 ± 0.10 | 0.219 ± 0.015 | 2020.3 ± 71.0 | 0.360 ± 0.01 | 20.4x10-6 | |
142 ± 1.55 | 0.171 ± 0.026 | 3102.9 ± 175 | 3.77 ± 0.06 | 9.28x10-6 | |
39.9± 1.4 | 0.302 ±0.118 | 2328.9 ±426.4 | 1.04± 0.04 | 4.19x10-6 | |
78.4± 2.4 | 0.186± 0.008 | 2580.4± 190.3 | 2.11 ±0.07 | 7.04 x10-6 | |
398 ± 11.7 | 0.469 ± 0.019 | 1811.3 ± 27 | 11.32 ± 0.43 | 2.07x10-6 |
Pulmonary parameters of some Chilean species rodents, bats and birds. Mb = body mass; τh6 = harmonic mean of alveolo-capillary barrier thickness; Dsa = density of respiratory surface; VLp = volume of lung parenchyma and DtO2/Mb = mass-specific oxygen diffusion capacity of the alveolo-capillary barrier (data from Canals et al., 2005b; Figueroa et al., 2006; Alfaro et al., 2010).
Bats have the largest hearts of mammals relative to body mass, usually representing about 1% of body weight (Neuweiler, 2000), but reaching 2% (Jurgens et al., 1981, Canals et al., 2005a) (Table 4). They have great development of the right ventricle associated with better lung perfusion and high density of capillaries per unit volume. They also have the highest level of energy reserves in the form of ATP that has been measured in the heart of any animal (Neuweiler, 2000). Despite increased cardiac output, the volume expelled is similar to other mammals, somewhat greater than 1.5 ml / kg, indicating that the increase in heart size is mainly at the expense of muscle hypertrophy. The heart rate is extremely variable and may range from a few beats per minute during hibernation to over 1000 beats per minute during flight (Wolf & Bogdanowics, 1987, Neuweiler, 2000).
Mh obs Mh exp | ||||
11.25 ± 1.13 | 0.145 ±0.033 | 1.29 ± 0.23 | 0.943 ± 0.176 | |
3.1 ± 1.13 | 0.057 ± 0.018 | 1.88 ± 0.10 | 1.041 ± 0.022 | |
6.88 ± 0.47 | 0.096 ± 0.0145 | 1.40 ± 0.20 | 0.921 ± 0.137 | |
9.65 ± 0.61 | 0.166 ± 0.0350 | 1.71 ± 0.03 | 1.213 ± 0.237 | |
12.5 | 0.272 | 2.18 | 1.627 ± 0 | |
7.87 ± 1.10 | 0.120 ± 0.02 | 1.55 ± 0.27 | 1.046 ± 0.169 | |
12.76 ± 2.74 | 0.173 ± 0.042 | 1.40 ± 0.04 | 1.042 ± 0.279 | |
4.85 ± 0.18 | – | 1.26 ± 0.24 | – | |
20.6 ± 0.9 | – | 0.98 ± 0.08 | – | |
38.2 ± 1.4 | – | 0.97 ± 0.01 | – | |
45.2 ± 1.34 | – | 0.94 ± 0.09 | – | |
146.0 ± 7.5 | – | 0.84 ±0.08 | – |
Heart size of several bat species. Mb = body mass; Mh = heart mass; RHM = relative heart mass; Mhobs/Mhexp = ratio of observed to that expected by allometry. (Data from Canals et al., 2005a; Jurgens et al., 1981*)
The vessels of bats follow a mammalian pattern, with some arterial and venous modifications. Unlike other mammals, the venous return of the forelimbs occurs through two vena cava; inferior vena cava have a muscular zone that allow regulation of venous return, lower during rest and high during flight. The arteries of the wing branch into arterioles with a muscle base which can regulate the flow to the wings and maintain the arteriovenous differential pressure. There are also arteriovenous shunts and venous vessels with pulsating zones (venous hearts) that can regulate the return of blood from the wings. The volume of blood is similar to other mammals as well as the affinity of hemoglobin. However, bats have the highest levels of hematocrit measured in mammals and may reach values above 70% in
By comparing the structural and functional adaptations in birds and bats it can be established that they reach very similar aerobic capacities. However, strategies to achieve these high performances during flight are different. Birds have a large set of structural changes in their respiratory system, such as air bags, parabronchi systems, respiratory capillaries, cross-current flows, etc. In contrast, bats have a cardio-respiratory system fully modified to accomplish an extreme way of life. This mammalian structural base is highly refined, operating near maximum values (Maina, 1998) (Table 5). Thus, Maina (1998) comparing a set of 7 parameters including birds, bats and non-flying mammals, found that bats have higher "degrees" of optimization in 5 of them: resting respiratory rate, hematocrit, hemoglobin concentration, resting heart rate and blood count.
Increase of lung volumen | Increase of heart size |
Thin alveolo-capillary membrane | Development of right half of the heart |
Small alveoles | Regulation of venous return |
High oxygen diffusing capacity | High hematocrit |
High respiratory frequency | Small GR |
Proximal airway adjusted to lower energy loss | Greater concentration of hemoglobin |
Greater oxygen transport capacity |
Strategy of respiratory and cardiovascular optimization in bats.
We thanks FONDECYT grants 100673, 1040649, 1080038 and 1110058.
Chiropractic Biophysics® (CBP®) technique is a full-spine and posture correcting method that incorporates engineering and mathematical principles into a unique approach in the treatment of spine disorders [1, 2, 3, 4, 5]. CBP technique is best described as a ‘structural’ rehabilitation approach as opposed to ‘functional’ rehabilitation that typically encompasses physiotherapeutic modalities, stretching and exercises to regain function. The goal in structural rehabilitation is to restore the spine alignment and posture to as near normal as possible.
CBP operates on three main premises: 1. There is a normal/ideal static spinal configuration; 2. Abnormal alterations of the spine/posture result in abnormal function disrupting homeostatic balance; 3. Altered static spine/postural alignment results in abnormal dynamics [1]. The contemporary spine literature supports all three of these premises (See Section 4). CBP technique has published research on many facets of the technique including defining what normal/ideal spine alignment is, how to measure spine alignment parameters with reliable and repeatable methods, how to correct/re-align spinal displacements, and evidence proving correcting spine and postural displacements correlates with improvements in pain, disability and quality of life (QOL) measures (These studies are detailed later).
Herein, an overview is given of the scientific approach to treating spine disorders (i.e. subluxation) by the unique approach of CBP technique. A review will be given of the historical beginnings of CBP, rotations and translations of posture, the Harrison normal spinal model, radiographic analysis, posture and spinal coupling, the CBP protocol, clinical evidence of efficacy as well as the safety of the use of X-rays (The term ‘X-rays’ imply the use of plain radiographs throughout this chapter).
Donald D. Harrison, who had a Master’s degree in Mechanical Engineering and a Doctorate degree in Applied Mathematics developed a devote urgency to bring contemporary science to chiropractic. In the late 1970s, Harrison was the main instructor for the chiropractic technique named ‘Pettibon.’ Dissatisfied with the failure to produce spinal correction, he often incorporated his own methods in certain cases to better attain spine and posture improvements. It was in the treatment of one particular case (circa 1980) where he discovered that the body must be treated using the principles of mathematics; the term ‘mirror image®’ adjusting he later coined to describe these new approaches [1].
A 1974 paper by Panjabi et al. describes a Cartesian coordinate system for use in the description and study of joint biomechanics (Figure 1) [6]. Harrison was the first to apply this system of analysis to upright human posture (Figures 2 and 3). Harrison began discovering the rotations and translations of human posture in 1980. During the early 1980s, the analysis system evolved to incorporate a full spine analysis of the head, rib cage and pelvis in three-dimensions. The technique methods continued to evolve with intellectual contributions from early practitioners of CBP including among others, Drs. DeGeorge, Gambale, Pope and Deed Harrison (founder’s son).
A vertebra described in terms of rotations about and translations along the
If the head, thoracic cage, and pelvis are considered rigid bodies, then the possible rotations in three-dimensions are illustrated. Flexion and extension are rotations on the
If the head, thoracic cage, and pelvis are considered rigid bodies, then the possible translations in three-dimensions are illustrated. Lateral translations occur along the
One of the unique methods within CBP is the use of ‘extension traction’ to restore the normal cervical or lumbar lordosis (Figures 4 and 5). The first cervical extension traction was with use of an inclined bench that utilized a camlock and pulley system to hyperextend the neck by pulling on the forehead [7]. This is the traction used in the first CBP non-randomized controlled clinical trial (nRCT) that showed that no traction either by no treatment or only cervical manipulation but no traction resulted in no improved alignment, while the traction group (also receiving cervical spinal manipulation) achieved improved lordosis [7].
Cervical extension traction (courtesy CBP seminars).
Lumbar extension traction (courtesy CBP seminars).
Further development in cervical traction involved the addition of a posterior-to-anterior (PA) pull through the mid cervical spine with simultaneous extension and distraction of the head while sitting in a chair, so-called ‘Pope’s 2-way’ traction (Figure 4) [8]. A slight modification of this traction involves the use of a chin-forehead strap to add weight directly to the patients head as an extension-compression 2-way traction (Figure 4) [9]. More recently, a cervical extension orthotic (Denneroll) has been shown to be effective at increasing cervical lordosis (Figure 4).
In the mid 1990s, Deed Harrison helped to develop precision vectors for lumbar extension traction (Figure 5), where the first nRCT showing lumbar curve restoration was published in the
CBP technique is one of the most scientifically based posture and spine correcting techniques. There are many randomized controlled trials (RCTs), nRCTs, and well over 100 case reports/series documenting the improvement of diverse spine deformity patterns with concomitant reduction of pain, disability and increased QOL measures [11].
The main strength of CBP technique is its fundamental underpinnings in engineering and mathematics [1]. It is a general theorem that any object can be decomposed as a rotation, a translation and a deformation [12]. Acknowledging that deformation of living tissues occurs, as in compressing of discs, ligaments, muscles etc., we divert attention to rotations and translations of posture. The main masses of the body, namely the head, thorax and pelvis can be described in relation to the body mass below within a Cartesian coordinate system (Figures 2 and 3). That is, the head is described in relation to the thorax, the thorax in relation to the pelvis, and the pelvis in relation to the feet [1, 13].
Any rotations or translations of the body masses as seen in neutral posture via external observation or internally by X-ray is acknowledged as abnormal. Therefore, no offset of the masses equates to the normal postural alignment (i.e. un-subluxated position). It is important to note that in the assessment of a patient, it is the presence of a rotation or translation in the neutral standing position that is abnormal. When Harrison first applied this method of analysis, the treatment became apparent with the postural diagnosis. That is, for any rotation or translation apparent in neutral standing posture, the opposite position would need to be the treatment as applied during exercises, spinal traction or spinal adjustments, as this is the mathematical solution, “the exact reversing of the patient’s abnormal posture.” [1] In fact, because the soft tissues require a significant magnitude of stress and strains to attempt to correct the spinal position via mirror image methods, Harrison suggested that postural reflections (i.e. ‘mirror image’ adjustments) need to be applied in “twice the negative of the translation distances and rotation angles.” [1].
It should be noted when Harrison finally developed the full spine analysis of rotations and translations of posture in the mid 1980s, he discovered that virtually 50% of all human movements had never been studied (except forward head posture). Thus, the Harrison research group performed several studies to evaluate the normal range of motion for several translation postures including lateral head and thoracic postures as well as anterior and posterior thoracic translation postures (Discussed in Section 6). [2, 3] Clinically, the spinal coupling patterns as discovered to be associated with these common postural positions are of utmost importance in the treatment of these spinal disorders.
Importance of the study of these never previously studied translation postures can be highlighted in the distinction between true scoliosis and ‘pseudo-scoliosis’ (Figure 6) [14] Pseudo-scoliosis is a lateral thoracic translation posture that characteristically features little to no vertebral rotation (simple to correct) [15, 16], whereas, true scoliosis characteristically features significant vertebral rotation (and is typically much more difficult to treat). X-ray screening of the spine is the only way to differentiate true scoliosis from pseudo-scoliosis.
Posture image and antero-posterior lumbar radiographs depicting a left lateral thoracic translation (side shift). Both patients in the radiographs have a 20 mm left lateral shift of T10 off midline. Left patient has a pure left lateral thoracic translation posture, aka ‘pseudo-scoliosis.’ Right patient has a true left lumbar scoliosis (vertebral rotation). Green line is vertical; red line highlights patient alignment (courtesy CBP seminars).
As mentioned, the absence of rotations and translations of the body masses in standing posture is normal. However, the shape of the spine position, particularly in the sagittal plane has traditionally been debated.
In the mid 1990s to the mid 2000s, the Harrison research team performed a series of spine modeling studies of the sagittal spinal curves (Figure 7) [17, 18, 19, 20, 21, 22, 23, 24]. To this day, this seminal work serves as the treatment outcome goal (i.e. gold standard) for providing structural rehabilitation by CBP methods (Figure 8). In a series of systematic studies, elliptical shape modeling of the path of the posterior longitudinal ligament was performed as it could be easily compared to the posterior vertebral body margins on X-rays, the same anatomical region used for measuring the sagittal spinal curves (i.e. Harrison posterior tangents (Figure 9) [25, 26, 27, 28]).
The Harrison normal sagittal spine model as the path of the posterior longitudinal ligament. The cervical, thoracic and lumbar curves are all portions of an elliptical curve having a unique minor-to-major axis ratio. The cervical curve is circular meaning the minor and major axes are equal (courtesy CBP seminars).
Three patients demonstrating dramatically different spine alignment patterns. Left: excessive lumbar hyperlordosis, L4 anterolisthesis, and excessive anterior sagittal balance in a mid-aged female with disabling low back pain; middle: excessive thoracolumbar kyphosis and early degenerative changes in a mid-aged male; right: excessive thoracic hyperkyphosis in a young male with Scheuermann’s disease. Red line is contiguous with posterior vertebral body margins; green line represents Harrison normal spinal model (courtesy PAO).
Harrison posterior tangent method involves lines drawn contiguous with the posterior vertebral body margins. Intersegmental as well as regional sagittal curves are easily quantified having a standard error of measurement within about 2° (courtesy CBP seminars).
Computer iterations of spine shape modeling were applied to determine the best-fit geometric spinal shapes by fitting ellipses of varying minor-to-major axis ratios to the digitized data points from the posterior vertebral body corners from X-ray samples for each of the three regions of the spine (cervical [17, 18, 19], thoracic [20, 21], and lumbar spine [22, 23, 24]). As shown in Figure 7, the Harrison normal spinal model features a circular cervical lordosis, an elliptical thoracic curve featuring greater curvature cephalad with a straightened thoraco-lumbar junction and an elliptical lumbar lordosis showing a greater distal lumbar curvature. The spine is assumed to be vertical in the front view.
Although some have attempted to criticize the Harrison normal spinal model, it is important to acknowledge that it has been validated in several ways. Simple analysis of alignment data on samples of normal, asymptomatic populations have been done [17, 18, 19, 20, 21, 22, 23, 24]. Comparison studies between normal samples to symptomatic samples have been performed [17, 29]. Comparisons between normal samples to theoretical ideal models have been done [17, 18, 20, 23]. Statistical differentiation of asymptomatic subjects from symptomatic pain group patients based on alignment data has been performed [19, 24].
In subsequent biomechanical modeling studies, the Harrison group used a validated postural loading model to verify that sagittal spinal balance and the sagittal curves of the spine are critical biomechanical parameters for maintaining postural load balance in healthy subjects [30]. Keller et al. [30] stated “because the pattern of [intervertebral disc] IVD postural stresses mirrored the sagittal curvatures and sagittal displacement of the spine, a failure of the IVD’s hydrostatic mechanism under these sustained loads could occur”. In a similar biomechanical modeling study, Harrison et al. determined that anterior sagittal thoracic posture (anterior thorax translation relative to the pelvis) resulted in significant increases in disc loads and stresses for all vertebral levels below T9 and that the extensor muscle loads required to maintain static equilibrium in upright anterior posture increased almost five times that of normal [31]. In another study Keller et al. [32] determined that “postural forces are responsible for initiation of osteoporotic spinal deformity in elderly subjects”.
The Harrison group also used an elliptical shell model to evaluate the loads and bending moments on the cervical vertebrae in varying cervical spine deformity alignments [33, 34]. They found that in normal lordosis the anterior and posterior vertebral body stresses are nearly uniform and minimal, whereas, in cervical deformity configurations having kyphosis (S-shape kyphosis high or low, total kyphosis), the vertebral body stresses are ‘very large’ and opposite in direction compared to normal lordosis [33]. They concluded “This analysis provides the basis for the formation of osteophytes (Wolff’s Law) on the anterior margins of vertebrae in kyphotic regions of the sagittal cervical curve. This indicates that any kyphosis is an undesirable configuration in the cervical spine” [33]. Anterior head translation and a ‘military’ neck also displayed significantly increased vertebral body stresses that are reverse in direction from C5-T1 and are also proven to be “undesirable configurations in the cervical spine” [34].
All radiographs should be taken in the ‘neutral’ standing position with the feet positioned with the heels at hips width apart. This is to avoid any induced postural deviations due to foot position. Also, to ensure a reproducible neutral (i.e. natural) body position, the subject should close their eyes and nod the head back and forth a couple times to where the subject should stop in their preferred position and then open their eyes while maintaining this adopted stance. Any postural misalignments seen in the subject should not be corrected. The lower body mass on the particular view being taken should be centered to the bucky. All X-rays should be taken without footwear.
It should be mentioned that the measurement of different sagittal spinal contours including regional curves or absolute rotation angles (ARAs) (i.e. cervical/lumbar lordosis; thoracic kyphosis) and intersegmental relative rotation angles (RRAs) between adjacent vertebrae can be easily quantified by use of the Harrison posterior tangent (HPT) lines (Figure 9) [25, 26, 27, 28]. The HPT method is preferred for three main reasons, 1. The posterior margins of the vertebral bodies are less affected by osteoarthritic changes as compared to the anterior margins which makes anatomical measurements more reliable and valid; 2. The posterior tangents are contiguous with the slope of the spinal curves and represent the first derivative in an engineering analysis and therefore, their intersection accurately depicts the sagittal configuration; 3. The HPT method has a small standard error of measurement (SEM) of approximately 2° versus higher SEMs with the Cobb (4.5–10°) [25, 26, 27]. This is why the HPT method is superior to other methods of sagittal spine mensuration including the popular Cobb method.
Generally, the global curves are measured as C2-C7, T1-T12, and L1-L5, however since the inflection of the cervical lordosis to thoracic kyphosis occurs at T1, some clinicians prefer to measure the cervical curve from C1-T1, and the thoracic curve from T2-T11 or T3-T10. Anterior sagittal translation distances are simply measured by the horizontal displacement offset between comparison vertebrae such as C2-S1, C2-C7 or T1, T1-T12, etc.
The anterior-to-posterior (AP) or PA X-rays are taken using the same postural positioning. The modified Risser-Ferguson method is employed to measure coronal plane alignment (Figure 10) [28]. On the AP/PA cervicothoracic view an upper angle is created as the angle between the best fit line of the upper cervical segments and intersection with the bite line, and a lower angle is formed between the best fit lines of the upper to lower spine segments [28]. The Rz angle is the angle formed by a vertical axis line (VAL) drawn from T4 and the lower cervicothoracic best fit line. Normal upper angle, lower angle and Rz cervicothoracic angles are 90°, 0° and 0°, respectively. The AP/PA thoracic view may show an angle. The lumbo-pelvic view has an upper angle, the angle between the best fit line of the upper versus lower lumbar segments, and a lower angle, the angle between the best fit line between the lower segments and the horizontal pelvic line [28]. The upper angle and lower angle should be 0° and 90°, respectively. Any regional or full-spine coronal balance offset (i.e. imbalance) can be easily quantified as the horizontal distance between the uppermost segment to the lowermost segment (e.g. C2-T2, T1-T12, T12-S1, C2-S1).
AP radiographic line drawing by modified Risser-Ferguson method.
Postural rotations and translations as described by Harrison (Figures 2 and 3) are understood as ‘main motions’ and the corresponding spinal displacements to accommodate the postural positions are termed ‘coupled motions’ [2, 3, 35, 36, 37, 38]. In CBP, a considerable clinical significance is placed on the correlation between the patient’s three-dimensional postural presentation (posture displacement in terms of rotations and translations) and the two-dimensional X-ray coupled motion (spinal rotations and translations) [2, 3, 38].
Of prime importance is the appreciation that unless there is buckling, anomalies or ligament damage, standing neutral postural rotation and translation displacements of the head or thorax
A classic demonstration of the ‘matching’ versus ‘mismatching’ of rotations and translations of posture and spine coupling patterns can be illustrated with forward head posture, aka, anterior head translation (AHT) (Figure 11). The natural and expected spine coupling with a forward translated head posture involves lower cervical spine flexion and upper cervical spine extension. As seen in Figure 11, many spine different vertebral coupling patterns are possible including hyperlordosis, hypolordosis, or kyphosis and accordingly, each cervical configuration requires its own unique application of CBP methods for its ideal correction.
Forward head translation as shown in posture and in three unique lateral cervical radiographs. All three X-ray images have about 25 mm of forward head translation. Left: hyperlordosis; middle: hypolordosis; right: kyphosis. Green line is normal alignment; red line highlights patient alignment.
These cervical spine patterns have been termed harmonics and their presence can only be determined by radiography [2, 39]. Importantly, in CBP treatment approaches, each cervical spine coupling pattern (harmonic) requires its own unique treatment protocol. This is why many manual therapy approaches (e.g. Mackenzie head retractions) are inadequate at correcting posture and spine alignment as these are prescribed universally (i.e. ‘blackbox treatment’) resulting in many patients receiving treatment protocols that are contraindicated. A patient with a hyperlordotic cervical spine should never be prescribed neck extension exercises as this would dynamically hyperextend the cervical joints. A patient with a complete cervical kyphosis should never be prescribed head retraction exercises as this often ‘buckles’ the spine into further kyphosis.
Also, as mentioned and illustrated in Figure 6, ‘pseudo-scoliosis’ or pure lateral translations of the thorax (or head) must be distinguished from true scoliosis by examination of the spinal coupling patterns [14]. If there is minimal or no vertebral rotation then this represents a typical case requiring CBP mirror image postural correction [3]. If there is vertebral rotation then it is considered true scoliosis and a completely different application of CBP methods (i.e. non-commutative properties of finite rotation angles [40, 41]). Case examples of the special application of CBP methods in the treatment of scoliosis is described later.
The CBP patient management protocol [2, 3, 4] involves all typical initial patient examination procedures including the consultation, examination as well as pain, disability and quality of life questionnaires (Figure 12). In addition, CBP treatment consideration requires, without exception, a full-spine posture assessment as well as full-spine AP and lateral standing radiographs. Posture needs to be either qualitatively, but ideally quantitatively assessed as rotations and translations of the head, thorax and pelvis in three-dimensions (Figures 2 and 3). The X-rays need to be digitized and quantified, ideally with the Harrison posterior tangent method for the sagittal images and with the modified Risser-Ferguson on the AP images.
CBP protocol treatment algorithm.
As seen in Figure 12, if appropriate, a new patient should be treated for their acute pain that is distinct and separate from CBP methods. It is recommended that the acute ‘pain care’ treatment include spinal manipulation, stretching (e.g. proprioceptive neuromuscular facilitation (PNF), Yoga, etc.), heat/ice, soft tissue myofascial therapy (e.g. transverse friction, Nimmo-receptor tonus technique, etc.). Once the patient experiences some initial pain relief (e.g. 6–12 treatments) they can be re-assessed and graduated to CBP structural rehabilitation. The decision to first treat a new patient with ‘acute’ pain care is a clinical decision that is mainly for patients that have either never seen a chiropractor previously or they have not been previously treated for their acute condition. For patients who have received recent previous treatment without relief, CBP rehabilitation care is recommended from the start of treatment [2, 3, 4].
CBP structural rehabilitation is suggested as either three times per week for 12-weeks (36 treatments) or four times per week for 9-weeks (36 treatments), however, the controlled trial data support treatment blocks of 30–40 treatment sessions [7, 8, 9, 10, 15, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55]. An initial patient who has acute or chronic pains and who has not been treated recently or at all for their current spine issue should be treated for an initial 6–12 sessions to provide pain relief. After signs of relief have occurred, a progress exam should be performed and the patient should be transitioned or ‘graduated’ to CBP corrective care.
CBP treatment occurs in ‘blocks of care.’ Numerous CBP controlled clinical trials (RCTs [43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55] and nRCTs [7, 8, 9, 10, 15, 42]) provide evidence for spine altering changes to occur in the range of 30–40 treatment sessions; thus, it is the practitioners’ choice to set their protocol within this range (i.e. treatment blocks). The end of each ‘block’ of CBP care requires a progress exam which includes all of the typical assessment procedures as well as a posture and X-ray assessment. Exam results may either dictate the need for further CBP treatment or the recommendation for ‘supportive’ or maintenance care. An initial block of CBP structural rehabilitation will include any acute care provided in the first 2–4 weeks. It is always recommended that ongoing ‘progress exams’ be performed regularly, at either 4-week or 12 treatment intervals, or as frequently as recommended by each practitioner’s regional regulatory board requirements.
CBP does not specifically support ‘long-term’ care plans. However, based on the data, an adult typically needs 6-months of corrective care (e.g. 72 treatments over 6-months at 3x/week) which is an evidence-based recommendation. Although, any given patient may require a shorted (i.e. 3-month) or longer treatment program based on their initial presenting postural parameters—approximate treatment extrapolations can be made by studying Tables 1–3. There is also support for supportive/maintenance care at a frequency of approximately 2×/month [8, 9, 10].
Study | Journal | Traction method | Traction time | Number of treatments | Change (*) | Change/txt (*) | Theoretical treatment extrapolation | ||
---|---|---|---|---|---|---|---|---|---|
Hypolordotic -20° | No curve 0° | Kyphotic +20° | |||||||
RCTs | |||||||||
Moustafa | Sci Reports | Denneroll | 20m | 30 | 13.9 | 0.46 | 32 | 76 | 119 |
Moustafa | Heliyon | Denneroll | 15–20m | 30 | 13.4 | 0.45 | 34 | 78 | 123 |
Moustafa | J Athl Train | Denneroll | 20m | 30 | 14.7 | 0.49 | 31 | 71 | 112 |
Moustafa | APMR | Denneroll | 20m | 30 | 13.1 | 0.44 | 34 | 80 | 126 |
Moustafa | EJPRM | Denneroll | 20m | 30 | 13.7 | 0.46 | 33 | 77 | 120 |
Moustafa | BFPTCU | Denneroll | 20m | 36 | 12.8 | 0.36 | 42 | 98 | 155 |
nRCTs | |||||||||
Harrison | JMPT | Pope 2-way | 20m | 38 | 17.9 | 0.47 | 32 | 74 | 117 |
Harrison | APMR | 2way | 20m | 35 | 14.2 | 0.41 | 37 | 86 | 136 |
Harrison | JMPT | Ext-comp | 10m | 60 | 13.2 | 022 | 68 | 159 | 250 |
Summary of cervical lordosis improvement by number of treatments, magnitude correction/treatment and the extrapolation to typical sagittal cervical curve subluxation types and the theoretical treatment number required for their correction to -35° C2-7 ARA.
*Note: Correction is estimated to achieve -35 of cervical lordosis.
Study | Journal | Traction method | Traction time | Number of treatments | Change (*) | Change/ txt (*) | Theoretical treatment extrapolation | ||
---|---|---|---|---|---|---|---|---|---|
Hypolordotic -30° | Hypolordotic -15° | No curve 0° | |||||||
RCTs | |||||||||
Moustafa | JBMR/JMPT | LET | 20m | 30 | 6.2 | 0.21 | 48 | 121 | 194 |
Moustafa | Clin Rehab | LET | 20m | 30 | 8.7 | 0.29 | 34 | 86 | 138 |
nRCTs | |||||||||
Harrison | APMR | LET | 20m | 36 | 11.3 | 0.31 | 32 | 80 | 127 |
Summary of lumbar lordosis improvement by number of treatments, magnitude correction/treatment and the extrapolation to typical sagittal lumbar curve subluxation types and the theoretical treatment number required for their correction to -40° L1-5 ARA.
*Note: Correction is estimated to achieve -40 of lumbar lordosis.
Study | Journal | Traction method | Traction time | Number of treatments | Change (mm) | Change/txt (mm) | Theoretical treatment extrapolation | ||
---|---|---|---|---|---|---|---|---|---|
Mild offset ±10mm | Moderate offset ±20mm | Severe offset ±30mm | |||||||
nRCTs | |||||||||
Head trans Harrison | JRRD | Lat trans | 20 m | 37 | 6.9 | 0.19 | 54 | 107 | 161 |
Thorax trans Harrison | Eur Sp J | Lat trans | 20 m | 36 | 7.7 | 0.21 | 47 | 94 | 140 |
Summary of AP head and thorax lateral translation reduction by number of treatments, magnitude correction/treatment and the extrapolation to larger coronal plane offset subluxations and the theoretical treatment number required for their correction.
Note: Correction is estimated to achieve 0mm of offset.
As mentioned, CBP technique has an abundance of clinical evidence supporting its effectiveness in correcting spine deformity and posture [7, 8, 9, 10, 15, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55]. Recently, systematic reviews have summarized the clinical evidence as reported in the published controlled trials on these methods [56, 57]. We summarize the evidence here in four parts: cervical lordosis, lumbar lordosis, lateral translation (pseudo-scoliosis) postures of the head and thorax, and finally, evolving evidence from case reports/series on other important spine deformities including lumbar spondylolisthesis, cervical spondylolisthesis, thoracic hyperkyphosis, thoraco-lumbar junctional kyphosis, thoracic hypokyphosis (straight back syndrome), anterior sagittal balance, lumbar kyphosis (flat back syndrome), lumbar hyperlordosis, post-surgical cervical spine fusion and scoliosis.
A recent systematic review found that of the RCTs and nRCTs on CBP extension traction methods, a 12–18° improvement in cervical lordosis can be achieved in 10–15 weeks after 30–36 treatment sessions [57]. Most RCTs have used the cervical Denneroll [43, 44, 45, 46, 47, 49, 50], and the three nRCTs all used different CET methods (Table 1) [7, 8, 9].
Table 1 shows the improvement in degrees per treatment as well as theoretical numbers of treatments for various presenting cervical spine subluxations. On average, there appears to be just less than a half degree improvement per treatment session; obviously, there are patients that will have both more correction and less correction than this. Using this estimation as an initial guideline, evidence-based treatment numbers can be predicted. For example, a patient presenting with a cervical kyphosis of 20° would require over 100 treatments to restore the neck to a curve of 35°.
Figures 13 and 14 show the long-term outcomes in patients receiving cervical extension traction versus comparative groups not receiving the traction. The patients restoring lordosis via CBP traction methods show improved cervical alignment which is maintained at a years’ follow-up (Figure 13) whereas, comparative groups receiving various physiotherapeutic treatments less the extension traction do not experience cervical improvement (Figure 13) and also show that any initial pain relief regresses back towards baseline levels after the cessation of treatment (Figure 14). Patient’s with improved lordosis retain their initial pain relief a year later (Figure 14). This is alarming as it shows patients receiving various physiotherapeutic treatments who do not improve their cervical lordosis (in hypolordotic patients) will have a future regression of symptoms post-treatment and may be misled by ‘apparent treatment efficacy’ [5, 57].
Data from five RCTs demonstrates patients achieving cervical lordosis improvement (via extension traction) as well as conventional treatments have lordosis improvements that are sustained for 1 year after stopping treatment versus the cervical curve of comparative groups (controls not achieving lordosis improvement) remain unaffected by conventional treatments (weighted averages from five RCTs [
Data from five RCTs demonstrates patients achieving cervical lordosis improvement (via extension traction) as well as conventional treatments have pain reductions that are sustained for 1 year after stopping treatment versus comparative groups (controls not achieving lordosis improvement) who show a regression (increase) of pain intensity towards baseline after stopping treatment (weighted averages from five RCTs [
A recent systematic review found “Limited but good quality evidence substantiates that the use of extension traction methods in rehabilitation programs definitively increases lumbar hypolordosis” [56]. The authors further stated: “Preliminarily, these studies indicate these methods provide longer-term relief to patients with low back disorders versus conventional rehabilitation approaches tested” [56]. On average, a 7–11° increase in lordosis can be achieved over 10–12 weeks after 30–36 treatment sessions (Table 2).
It must be mentioned that lumbar extension traction is necessary to increase the lumbar lordosis. Importantly, using the data from published trials [10, 53, 54, 55], one can extrapolate approximate treatment duration (Table 2). As seen, a mild hypolordotic lumbar spine of 30° (L1-L5 ARA) may only require 32–48 treatments, whereas, a flat lumbar curve would require 127–194 treatments to achieve a normal 40° lordosis.
The same trend as observed in patients receiving cervical lordosis correction versus comparative groups not receiving lordosis improvement is seen in the trials on the lumbar spine [5, 56]. Lordosis increase in patients receiving lumbar extension traction is achieved and maintained at 6-months follow-up (Figure 15); these patients also retain their initial pain relief whereas, comparative patient groups not receiving lordosis improvement (Figure 15) lose their initial pain relief by 6-months after cessation of treatment (Figure 16). Again, this is alarming and shows how active low back treatment, although offering transient pain relief, will likely regress after treatment if not receiving concurrent lordosis correction in those suffering from hypolordotic-related LBP [5, 56].
Data from two RCTs demonstrates patients achieving lumbar lordosis improvement (via extension traction) as well as conventional treatments have lordosis improvements that are sustained for 6-months after stopping treatment versus the lumbar curve of comparative groups (controls not achieving lordosis improvement) remain unaffected by conventional treatments (weighted averages from two RCTs [
Data from two RCTs demonstrates patients achieving lumbar lordosis improvement (via extension traction) as well as conventional treatments have pain reductions that are sustained for 6-months after stopping treatment versus comparative groups (controls not achieving lordosis improvement) who show a regression (increase) of pain intensity towards baseline after stopping treatment (weighted averages from two RCTs [
Coronal plane lateral translations of the head and thorax also referred to as ‘pseudo-scoliosis’ each has an nRCT published [15, 42] and many case reports demonstrating its reduction [16, 58, 59, 60, 61, 62, 63]. As discussed earlier, the differentiation from true scoliosis is that the involved vertebrae have minimal to no rotation, whereas, true scoliosis has substantial vertebral rotation (Figure 6). Also, the spinal coupling pattern of a laterally translated body mass (head or thorax) will demonstrate the lower involved spinal region to laterally flex towards the side of the translation and the upper involved spinal region to laterally flex back towards the vertical [35, 36].
Based on the data, a laterally translated body mass can be reduced about 7–8 mm after about 35 treatments. On average, correction of a laterally translated head or thorax can be corrected at about 0.2 mm per treatment, or about 1 mm per five treatments. Extrapolations of treatment numbers to patient subluxation presentation are shown in Table 3. From the data in each of the nRCTs, an approximate 50% reduction of the initial laterally translated head and thorax postures occurred; therefore, an average patient having an approximate 15 mm translation posture (head or rib cage) requires 6-months of corrective care (approximately 72 treatments). It must also be mentioned that many case reports have demonstrated larger lateral translation postural corrections/reductions with CBP methods in similar time frames [16, 58, 59, 60, 61, 62, 63], thus, these serve as approximate treatment extrapolations.
It is known that the science for manual therapies is lacking [64]. Therefore, lesser forms of evidence must be considered when evaluating various treatment approaches used to treat various spinal conditions by manual therapists [65, 66]; this includes treatment utilizing CBP methods. We now highlight more recent case studies and series showing structural spinal correction for a variety of relatively common disorders.
Fedorchuk et al. [67] reported on an 11 mm reduction (13.3–2.4 mm) of an L4 anterolisthesis in a 69-year old suffering from LBP and leg cramping. Pain relief was achieved after 60 treatments over 45 weeks. This was the first documented report of a reduction of a Grade 2 lumbar spondylolisthesis by CBP methods, as well as any other non-surgical method.
Oakley and Harrison reported on the reduction of multiple retrolistheses from L1-L4 ranging from 4.5 to 5.9 mm in a 32-year old male with LBP [68]. These were all reduced to within normal (<4.5 mm) after approximately 36 treatments over 14-weeks. A 13-month follow-up indicated the patient remained well and reported no back pain and the corrections had remained stable.
Fedorchuk et al. [69] reported on the reduction of L1 (−6.6 to −1.7 mm) and L2 (−6.1 to −2.0 mm) retrolistheses and an L5 anterolisthesis (+6.8 to −2.5 mm) in a 63-year old female bodybuilder with severe LBP and osteoarthritis. Thirty treatments were given over 10-weeks which resulted in normalizing all spondylolistheses as well as a dramatic reduction in pain and an ability to leg press 60 more pounds in the gym.
Fedorchuk et al. reported the complete reduction of an L3 retrolisthesis and L4 anterolisthesis after 50 treatments over a 7-month period [70]. The patient was 57-years old with severe LBP and sciatica. The L3 retrolisthesis reduced from −5.3 to −1.7 and the L4 anterolisthesis reduced from +5.4 to +1.0 mm. After treatment the patient was able to return to playing hockey and experienced full resolution of the back pain which had forced him to retire from sport. A 1-year follow-up showed the patient had remained well and maintained the corrections.
Recently, Fedorchuk et al. present a case series of eight female patients with concomitant cervical hypolordosis, forward head translation and spondylolistheses [71]. All were in motor vehicle collisions, each having at least one, and at most four simultaneous cervical vertebral spondylolistheses ranging in magnitude from >2 mm up to 4.5 mm. All cases experienced a reduction in translational offset of the spondylolistheses, and increase in cervical lordosis and a decrease in forward head translation as well as an increase in spinal canal diameter at the location of the spondylolisthesis after 30 treatment sessions that included cervical extension traction over a duration of 12-weeks. On average, the spondylolistheses reduced by 2.6 mm and there was an average drop in neck disability by 30%.
In another case, Fedorchuk et al. presented a single case of a 52-year old with chronic neck pain [72]. The patient had a C4 anterolisthesis of 2.4 mm which was reduced to 0.7 mm as well as an increase in cervical lordosis and reduction in forward head translation after 30 treatments over 12-weeks. The patient reported a resolution of their neck pain and stiffness.
Thoracic hyperkyphosis is a relatively common subluxation pattern in the aging. Although there is one RCT on CBP methods showing reduction of the deformity, it is yet to be formally published [52]. A systematic review of CBP methods used to reduce thoracic hyperkyphosis was published [73] and summarized the outcomes of several case reports and series [74, 75, 76, 77, 78, 79]. In Table 2 of the Oakley and Harrison review an average 12° reduction in thoracic kyphosis occurred after 32 treatments over 14.5 weeks from a total of 17 patients [52]. The improved posture correlated with reduced pain, disability and improved QOL [52]. Figures 17 and 18 show various CBP mirror image spinal exercises and traction, respectively.
CBP recommended mirror image exercises for patients with thoracic hyper-kyphosis.
CBP mirror image traction for patients with thoracic hyper-kyphosis.
Thoracolumbar kyphosis is the forward angled spine at the junction of the thoracic and lumbar spine and is associated with chronic LBP (CLBP). Gubbels et al. presented a case of the minimization of pain in a 16-year old female after a 22° reduction of thoracolumbar kyphosis, a 48 mm reduction of posterior sagittal balance, an 11° increase in lumbar lordosis and a 10° increase in sacral inclination [80]. Twenty-four in office treatments were given over an 8-week period with daily home traction resulting in a minimization of back pains.
Thoracic spine hypolordosis is termed straight back syndrome (SBS) and is associated with back pains and exertional dyspnea. Fortner et al. [81] reported on an 18-year old male suffering from back pains and exertional dyspnea. Twenty-four treatments over a 9-week period resulted in a 15° increase in thoracic kyphosis, a decrease in pain and improved exertional dyspnea symptoms. A 4-month follow-up showed the patient remained well.
Betz et al. [82] reported the improvement in a 19-year old male who suffered from exertional dyspnea and back pain. Over 12-weeks a 14° increase in thoracic curve was achieved resulting in relief of exertional dyspnea and pain, as well as increases in both the antero-posterior thoracic diameter and the ratio of antero-posterior to transthoracic diameter, both measures critical to the wellbeing of patients with SBS. A 2.75-year follow-up showed the patient remained well.
Fedorchuk et al. [83] reported on a 13° increased thoracic curve in a 26-year old male with back pains and type 1 diabetes. Treatment over 7-weeks included 36 sessions. Back pains reduced and importantly, there was also improvement in blood glucose immediately following the onset of each visit. An improvement in blood glucose averages, percentage of time of blood glucose in a healthy target range, and glycosylated hemoglobin occurred and the patient was able to reduce their basal insulin need by approximately half after the 7-weeks of care.
Mitchel et al. [84] reported a 10° increase in thoracic curve over 16-weeks in a 33-year old male suffering from exertional dyspnea and back pains. The measured lung capacity improved by 2L, the back pain diminished and the exertional dyspnea resolved. A 7-month follow-up indicated the patient remained well.
Anterior sagittal balance (ASB) is the forward displacement of the upper body over the pelvis. Haas et al. reported on the dramatic 110 mm reduction in ASB in an 87-year old female with CLBP and sciatica [85]. Treatment consisted of 24 in office sessions over an 8-week period. The patient achieved a dramatic reduction of symptoms, improvements in flexibility and orthopedic testing.
Anderson et al. [86] reported on a 91 mm reduction in ASB in a 59-year old male patient suffering from a variety of symptoms associated with Parkinson’s disease. Initial treatment involved 38 treatments over 5 months. The patient experienced significant improvements in multiple postural parameters, gait, balance, hand tremors, low back and knee pains and SF-36 values. A 21-month follow-up showed the patient remained essentially well and most of the initial postural improvements were maintained.
Flat back syndrome (FBS) is the anterior translation of the upper body and gross loss (or kyphosis) of the lumbar spine and is associated with high pain and disability. In a case series, Harrison and Oakley describe the significant restoration of lumbar lordosis in two patients suffering from debilitating CLBP from flat back syndrome [87]. One patient had a 50° lordosis improvement in 100 treatments over 20 weeks, the other had a 26° lordosis improvement in 70 treatments over 16.5 weeks. In the discussion section of the report, it was calculated that the treatment costs of the patients receiving CBP treatment versus the projected costs for the surgical procedures recommended to the two patients equated to only 1–8%; the authors stated “at first 70 or 100 treatments may be criticized as ‘over-treatment,’ however, considering the overall cost-effectiveness and positive patient outcomes, it certainly is not” [87].
Although lumbar hypolordosis is the most common lumbar misalignment in those presenting with chronic LBP [10], lumbar hyperlordosis is also seen clinically. CBP methods can be directed at decreasing lumbar lordosis and its typically associated anteriorly rotated pelvis. In a recent case, Oakley et al. [88] presented a case demonstrating the relief of CLBP and hip pains after an 8° reduction in lumbar hyperlordosis, a 5° reduction in pelvic tilt and an accompanying 17 mm reduction of forward sagittal balance. This occurred over a period of 13 months and 73 total treatments.
Post-surgical cervical spine intervertebral fusion is not a common finding in clinical practice however, it is occasionally encountered. Many of these patients continue to suffer years after the intervention. Harrison et al. [89] presented a case showing improvement in sagittal postural parameters which corresponded with improved clinical outcome in a 52-year old male. Over a 6-month period, a 6° increase in cervical lordosis was achieved as well as a 13 mm reduction in anterior head translation (AHT). These improvements were maintained at a 2.5-year follow-up.
Fedorchuk et al. [90] also presented a successful outcome in a 43-year old with a C5-6 intersegmental fusion. After 36 treatments over 3-months, there was a 13° increase in cervical lordosis, a 9 mm decrease in AHT and a 5 mm reduction in lateral head translation.
Although too large of a topic to address in this chapter, CBP technique has a unique approach in the treatment of scoliosis [3]. CBP methods incorporates the ‘non-commutative property of finite rotation angles under addition’ to ascertain the order of postural movements to be prescribed in the mirror image treatment of this disorder. Harrison and Oakley described reductions in curve magnitude in five lumbar or thoracolumbar scoliosis patients ranging from 5° to 24° after 18–84 treatments [40]. All patients were female and ranged in age from 19 to 45 years.
Haggard et al. reported a 19° reduction in a thoracolumbar curve in a 15-year old female patient after 24 office treatments over 15-weeks. The patient also performed 45 at home spine blocking sessions as prescribed by the attending chiropractor [41]. The patients LBP and headaches were dramatically improved, and the curve was reduced to 8°.
Use of X-ray for spine analysis is essential for treating spine deformities, including with CBP technique methods. Historically, there has been concerns of carcinogenicity associated with X-ray use. Recently, however, new evidence has come to light showing that anti-X-ray sentiment stemming from the supposed carcinogenicity is based on flawed science [91, 92, 93]. The bottom line is the linear no-threshold (LNT) model used to support radiation risk analysis is not scientific as it is not consistent with current radiobiological data [94, 95, 96, 97, 98].
X-rays and CT scans deliver low-dose radiation doses (<200 mGy), and because of this they cannot cause cancer. This is because low-dose (versus high-dose) radiation exposures stimulate the adaptive repair systems of the body to repair any damage done [99, 100, 101]. Although this topic is important, it is a much larger issue than the scope of this chapter but many recent reviews have found that X-rays (and CT scans) are not harmful [103]. In fact, after a substantial and critical review of higher quality studies on radiation exposure, Schultz et al. concluded: “The evidence suggests that exposure to multiple CT scans and other sources of low-dose radiation with a cumulative dose up to 100 mSv (approximately 10 scans), and possibly as high as 200 mSv (approximately 20 scans), does not increase cancer risk.” Thus, there should be no hesitation or misunderstanding surrounding X-ray risks. Doctors and patients need to become updated on X-ray safety and not succumb to the traditional carcinogenicity misinformation.
CBP technique is a well-studied approach to the structural improvement of spinal disorders. Many spinal disorders with associated pain and functional syndromes have either well characterized or evolving evidence for their treatment by the mirror image approach that underpins CBP methods. The correlation of the spine alignment and postural rotations and translations of posture are of critical importance and unique in the CBP approach.
We acknowledge the pioneering work of Dr. Donald D. Harrison.
D.E.H. teaches spine rehabilitation methods and sells products related to the treatment of spine deformities; P.A.O. is a paid consultant to CBP.
AHT | anterior head translation |
ASB | anterior sagittal balance |
AP | anterior-to-posterior |
ARA | absolute rotation angle |
CBP | Chiropractic BioPhysics® |
CLBP | chronic low back pain |
HPT | Harrison posterior tangent |
IVD | intervertebral disc |
LBP | low back pain |
LNT | linear no-threshold |
nRCT | non-randomized controlled trial |
QOL | quality of life |
PA | posterior-to-anterior |
PNF | proprioceptive neuromuscular facilitation |
RCT | randomized controlled trial |
RRA | relative rotation angle |
SEM | standard error of measurement |
SBS | straight back syndrome |
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Cárdenas-Aguayo, M. del C. Silva-Lucero, M. Cortes-Ortiz,\nB. Jiménez-Ramos, L. Gómez-Virgilio, G. Ramírez-Rodríguez, E. Vera-\nArroyo, R. Fiorentino-Pérez, U. García, J. 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MRI is commonly used once treating brain, prostate cancers, ankle and foot. The Magnetic Resonance Imaging (MRI) images are usually liable to suffer from noises such as Gaussian noise, salt and pepper noise and speckle noise. So getting of brain image with accuracy is very extremely task. An accurate brain image is very necessary for further diagnosis process. During this chapter, a median filter algorithm will be modified. Gaussian noise and Salt and pepper noise will be added to MRI image. A proposed Median filter (MF), Adaptive Median filter (AMF) and Adaptive Wiener filter (AWF) will be implemented. The filters will be used to remove the additive noises present in the MRI images. The noise density will be added gradually to MRI image to compare performance of the filters evaluation. The performance of these filters will be compared exploitation the applied mathematics parameter Peak Signal-to-Noise Ratio (PSNR).",book:{id:"6144",slug:"high-resolution-neuroimaging-basic-physical-principles-and-clinical-applications",title:"High-Resolution Neuroimaging",fullTitle:"High-Resolution Neuroimaging - Basic Physical Principles and Clinical Applications"},signatures:"Hanafy M. Ali",authors:[{id:"213318",title:"Dr.",name:"Hanafy",middleName:"M.",surname:"Ali",slug:"hanafy-ali",fullName:"Hanafy Ali"}]},{id:"41589",doi:"10.5772/50323",title:"The Role of the Amygdala in Anxiety Disorders",slug:"the-role-of-the-amygdala-in-anxiety-disorders",totalDownloads:9671,totalCrossrefCites:4,totalDimensionsCites:28,abstract:null,book:{id:"2599",slug:"the-amygdala-a-discrete-multitasking-manager",title:"The Amygdala",fullTitle:"The Amygdala - A Discrete Multitasking Manager"},signatures:"Gina L. Forster, Andrew M. Novick, Jamie L. Scholl and Michael J. 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Particularly in the case of motor imagery BCIs, users may need several training sessions before they learn how to generate desired brain activity and reach an acceptable performance. A typical training protocol for such BCIs includes execution of a motor imagery task by the user, followed by presentation of an extending bar or a moving object on a computer screen. In this chapter, we discuss the importance of a visual feedback that resembles human actions, the effect of human factors such as confidence and motivation, and the role of embodiment in the learning process of a motor imagery task. Our results from a series of experiments in which users BCI-operated a humanlike android robot confirm that realistic visual feedback can induce a sense of embodiment, which promotes a significant learning of the motor imagery task in a short amount of time. We review the impact of humanlike visual feedback in optimized modulation of brain activity by the BCI users.",book:{id:"6610",slug:"evolving-bci-therapy-engaging-brain-state-dynamics",title:"Evolving BCI Therapy",fullTitle:"Evolving BCI Therapy - Engaging Brain State Dynamics"},signatures:"Maryam Alimardani, Shuichi Nishio and Hiroshi Ishiguro",authors:[{id:"11981",title:"Prof.",name:"Hiroshi",middleName:null,surname:"Ishiguro",slug:"hiroshi-ishiguro",fullName:"Hiroshi Ishiguro"},{id:"231131",title:"Dr.",name:"Maryam",middleName:null,surname:"Alimardani",slug:"maryam-alimardani",fullName:"Maryam Alimardani"},{id:"231134",title:"Dr.",name:"Shuichi",middleName:null,surname:"Nishio",slug:"shuichi-nishio",fullName:"Shuichi Nishio"}]}],mostDownloadedChaptersLast30Days:[{id:"29764",title:"Underlying Causes of Paresthesia",slug:"underlying-causes-of-paresthesia",totalDownloads:192666,totalCrossrefCites:3,totalDimensionsCites:7,abstract:null,book:{id:"1069",slug:"paresthesia",title:"Paresthesia",fullTitle:"Paresthesia"},signatures:"Mahdi Sharif-Alhoseini, Vafa Rahimi-Movaghar and Alexander R. 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Precise anatomical description along with a correct characterization of the component structures is essential for understanding its functions.",book:{id:"6331",slug:"hypothalamus-in-health-and-diseases",title:"Hypothalamus in Health and Diseases",fullTitle:"Hypothalamus in Health and Diseases"},signatures:"Miana Gabriela Pop, Carmen Crivii and Iulian Opincariu",authors:null},{id:"57103",title:"GABA and Glutamate: Their Transmitter Role in the CNS and Pancreatic Islets",slug:"gaba-and-glutamate-their-transmitter-role-in-the-cns-and-pancreatic-islets",totalDownloads:3478,totalCrossrefCites:3,totalDimensionsCites:9,abstract:"Glutamate and gamma-aminobutyric acid (GABA) are the major neurotransmitters in the mammalian brain. Inhibitory GABA and excitatory glutamate work together to control many processes, including the brain’s overall level of excitation. The contributions of GABA and glutamate in extra-neuronal signaling are by far less widely recognized. In this chapter, we first discuss the role of both neurotransmitters during development, emphasizing the importance of the shift from excitatory to inhibitory GABAergic neurotransmission. The second part summarizes the biosynthesis and role of GABA and glutamate in neurotransmission in the mature brain, and major neurological disorders associated with glutamate and GABA receptors and GABA release mechanisms. The final part focuses on extra-neuronal glutamatergic and GABAergic signaling in pancreatic islets of Langerhans, and possible associations with type 1 diabetes mellitus.",book:{id:"6237",slug:"gaba-and-glutamate-new-developments-in-neurotransmission-research",title:"GABA And Glutamate",fullTitle:"GABA And Glutamate - New Developments In Neurotransmission Research"},signatures:"Christiane S. Hampe, Hiroshi Mitoma and Mario Manto",authors:[{id:"210220",title:"Prof.",name:"Christiane",middleName:null,surname:"Hampe",slug:"christiane-hampe",fullName:"Christiane Hampe"},{id:"210485",title:"Prof.",name:"Mario",middleName:null,surname:"Manto",slug:"mario-manto",fullName:"Mario Manto"},{id:"210486",title:"Prof.",name:"Hiroshi",middleName:null,surname:"Mitoma",slug:"hiroshi-mitoma",fullName:"Hiroshi Mitoma"}]},{id:"35802",title:"Cross-Cultural/Linguistic Differences in the Prevalence of Developmental Dyslexia and the Hypothesis of Granularity and Transparency",slug:"cross-cultural-linguistic-differences-in-the-prevalence-of-developmental-dyslexia-and-the-hypothesis",totalDownloads:3601,totalCrossrefCites:2,totalDimensionsCites:7,abstract:null,book:{id:"673",slug:"dyslexia-a-comprehensive-and-international-approach",title:"Dyslexia",fullTitle:"Dyslexia - A Comprehensive and International Approach"},signatures:"Taeko N. Wydell",authors:[{id:"87489",title:"Prof.",name:"Taeko",middleName:"N.",surname:"Wydell",slug:"taeko-wydell",fullName:"Taeko Wydell"}]},{id:"58597",title:"Testosterone and Erectile Function: A Review of Evidence from Basic Research",slug:"testosterone-and-erectile-function-a-review-of-evidence-from-basic-research",totalDownloads:1331,totalCrossrefCites:2,totalDimensionsCites:2,abstract:"Androgens are essential for male physical activity and normal erectile function. Hence, age-related testosterone deficiency, known as late-onset hypogonadism (LOH), is considered a risk factor for erectile dysfunction (ED). This chapter summarizes relevant basic research reports examining the effects of testosterone on erectile function. Testosterone affects several organs and is especially active on the erectile tissue. The mechanism of testosterone deficiency effects on erectile function and the results of testosterone replacement therapy (TRT) have been well studied. Testosterone affects nitric oxide (NO) production and phosphodiesterase type 5 (PDE-5) expression in the corpus cavernosum through molecular pathways, preserves smooth muscle contractility by regulating both contraction and relaxation, and maintains the structure of the corpus cavernosum. Interestingly, testosterone deficiency has relationship to neurological diseases, which leads to ED. Testosterone replacement therapy is widely used to treat patients with testosterone deficiency; however, this treatment might also induce some problems. Basic research suggests that PDE-5 inhibitors, L-citrulline, and/or resveratrol therapy might be effective therapeutic options for testosterone deficiency-induced ED. Future research should confirm these findings through more specific experiments using molecular tools and may shed more light on endocrine-related ED and its possible treatments.",book:{id:"5994",slug:"sex-hormones-in-neurodegenerative-processes-and-diseases",title:"Sex Hormones in Neurodegenerative Processes and Diseases",fullTitle:"Sex Hormones in Neurodegenerative Processes and Diseases"},signatures:"Tomoya Kataoka and Kazunori Kimura",authors:[{id:"219042",title:"Ph.D.",name:"Tomoya",middleName:null,surname:"Kataoka",slug:"tomoya-kataoka",fullName:"Tomoya Kataoka"},{id:"229066",title:"Prof.",name:"Kazunori",middleName:null,surname:"Kimura",slug:"kazunori-kimura",fullName:"Kazunori Kimura"}]}],onlineFirstChaptersFilter:{topicId:"18",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"81646",title:"Cortical Plasticity under Ketamine: From Synapse to Map",slug:"cortical-plasticity-under-ketamine-from-synapse-to-map",totalDownloads:14,totalDimensionsCites:0,doi:"10.5772/intechopen.104787",abstract:"Sensory systems need to process signals in a highly dynamic way to efficiently respond to variations in the animal’s environment. For instance, several studies showed that the visual system is subject to neuroplasticity since the neurons’ firing changes according to stimulus properties. This dynamic information processing might be supported by a network reorganization. Since antidepressants influence neurotransmission, they can be used to explore synaptic plasticity sustaining cortical map reorganization. To this goal, we investigated in the primary visual cortex (V1 of mouse and cat), the impact of ketamine on neuroplasticity through changes in neuronal orientation selectivity and the functional connectivity between V1 cells, using cross correlation analyses. We found that ketamine affects cortical orientation selectivity and alters the functional connectivity within an assembly. These data clearly highlight the role of the antidepressant drugs in inducing or modeling short-term plasticity in V1 which suggests that cortical processing is optimized and adapted to the properties of the stimulus.",book:{id:"11374",title:"Sensory Nervous System - Computational Neuroimaging Investigations of Topographical Organization in Human Sensory Cortex",coverURL:"https://cdn.intechopen.com/books/images_new/11374.jpg"},signatures:"Ouelhazi Afef, Rudy Lussiez and Molotchnikoff Stephane"},{id:"81582",title:"The Role of Cognitive Reserve in Executive Functioning and Its Relationship to Cognitive Decline and Dementia",slug:"the-role-of-cognitive-reserve-in-executive-functioning-and-its-relationship-to-cognitive-decline-and",totalDownloads:22,totalDimensionsCites:0,doi:"10.5772/intechopen.104646",abstract:"In this chapter, we explore how cognitive reserve is implicated in coping with the negative consequences of brain pathology and age-related cognitive decline. Individual differences in cognitive performance are based on different brain mechanisms (neural reserve and neural compensation), and reflect, among others, the effect of education, occupational attainment, leisure activities, and social involvement. These cognitive reserve proxies have been extensively associated with efficient executive functioning. We discuss and focus particularly on the compensation mechanisms related to the frontal lobe and its protective role, in maintaining cognitive performance in old age or even mitigating the clinical expression of dementia.",book:{id:"11742",title:"Neurophysiology",coverURL:"https://cdn.intechopen.com/books/images_new/11742.jpg"},signatures:"Gabriela Álvares-Pereira, Carolina Maruta and Maria Vânia Silva-Nunes"},{id:"81488",title:"Aggression and Sexual Behavior: Overlapping or Distinct Roles of 5-HT1A and 5-HT1B Receptors",slug:"aggression-and-sexual-behavior-overlapping-or-distinct-roles-of-5-ht1a-and-5-ht1b-receptors",totalDownloads:19,totalDimensionsCites:0,doi:"10.5772/intechopen.104872",abstract:"Distinct brain mechanisms for male aggressive and sexual behavior are present in mammalian species, including man. However, recent evidence suggests a strong connection and even overlap in the central nervous system (CNS) circuitry involved in aggressive and sexual behavior. The serotonergic system in the CNS is strongly involved in male aggressive and sexual behavior. In particular, 5-HT1A and 5-HT1B receptors seem to play a critical role in the modulation of these behaviors. The present chapter focuses on the effects of 5-HT1A- and 5-HT1B-receptor ligands in male rodent aggression and sexual behavior. Results indicate that 5-HT1B-heteroreceptors play a critical role in the modulation of male offensive behavior, although a definite role of 5-HT1A-auto- or heteroreceptors cannot be ruled out. 5-HT1A receptors are clearly involved in male sexual behavior, although it has to be yet unraveled whether 5-HT1A-auto- or heteroreceptors are important. Although several key nodes in the complex circuitry of aggression and sexual behavior are known, in particular in the medial hypothalamus, a clear link or connection to these critical structures and the serotonergic key receptors is yet to be determined. This information is urgently needed to detect and develop new selective anti-aggressive (serenic) and pro-sexual drugs for human applications.",book:{id:"10195",title:"Serotonin and the CNS - New Developments in Pharmacology and Therapeutics",coverURL:"https://cdn.intechopen.com/books/images_new/10195.jpg"},signatures:"Berend Olivier and Jocelien D.A. Olivier"},{id:"81093",title:"Prehospital and Emergency Room Airway Management in Traumatic Brain Injury",slug:"prehospital-and-emergency-room-airway-management-in-traumatic-brain-injury",totalDownloads:49,totalDimensionsCites:0,doi:"10.5772/intechopen.104173",abstract:"Airway management in trauma is critical and may impact patient outcomes. Particularly in traumatic brain injury (TBI), depressed level of consciousness may be associated with compromised protective airway reflexes or apnea, which can increase the risk of aspiration or result in hypoxemia and worsen the secondary brain damage. Therefore, patients with TBI and Glasgow Coma Scale (GCS) ≤ 8 have been traditionally managed by prehospital or emergency room (ER) endotracheal intubation. However, recent evidence challenged this practice and even suggested that routine intubation may be harmful. This chapter will address the indications and optimal method of securing the airway, prehospital and in the ER, in patients with traumatic brain injury.",book:{id:"11367",title:"Traumatic Brain Injury",coverURL:"https://cdn.intechopen.com/books/images_new/11367.jpg"},signatures:"Dominik A. Jakob, Jean-Cyrille Pitteloud and Demetrios Demetriades"},{id:"81011",title:"Amino Acids as Neurotransmitters. The Balance between Excitation and Inhibition as a Background for Future Clinical Applications",slug:"amino-acids-as-neurotransmitters-the-balance-between-excitation-and-inhibition-as-a-background-for-f",totalDownloads:19,totalDimensionsCites:0,doi:"10.5772/intechopen.103760",abstract:"For more than 30 years, amino acids have been well-known (and essential) participants in neurotransmission. They act as both neuromediators and metabolites in nervous tissue. Glycine and glutamic acid (glutamate) are prominent examples. These amino acids are agonists of inhibitory and excitatory membrane receptors, respectively. Moreover, they play essential roles in metabolic pathways and energy transformation in neurons and astrocytes. Despite their obvious effects on the brain, their potential role in therapeutic methods remains uncertain in clinical practice. In the current chapter, a comparison of the crosstalk between these two systems, which are responsible for excitation and inhibition in neurons, is presented. The interactions are discussed at the metabolic, receptor, and transport levels. Reaction-diffusion and a convectional flow into the interstitial fluid create a balanced distribution of glycine and glutamate. Indeed, the neurons’ final physiological state is a result of a balance between the excitatory and inhibitory influences. However, changes to the glycine and/or glutamate pools under pathological conditions can alter the state of nervous tissue. Thus, new therapies for various diseases may be developed on the basis of amino acid medication.",book:{id:"10890",title:"Recent Advances in Neurochemistry",coverURL:"https://cdn.intechopen.com/books/images_new/10890.jpg"},signatures:"Yaroslav R. Nartsissov"},{id:"80821",title:"Neuroimmunology and Neurological Manifestations of COVID-19",slug:"neuroimmunology-and-neurological-manifestations-of-covid-19",totalDownloads:41,totalDimensionsCites:0,doi:"10.5772/intechopen.103026",abstract:"Infection with SARS-CoV-2 is causing coronavirus disease in 2019 (COVID-19). Besides respiratory symptoms due to an attack on the broncho-alveolar system, COVID-19, among others, can be accompanied by neurological symptoms because of the affection of the nervous system. These can be caused by intrusion by SARS-CoV-2 of the central nervous system (CNS) and peripheral nervous system (PNS) and direct infection of local cells. In addition, neurological deterioration mediated by molecular mimicry to virus antigens or bystander activation in the context of immunological anti-virus defense can lead to tissue damage in the CNS and PNS. In addition, cytokine storm caused by SARS-CoV-2 infection in COVID-19 can lead to nervous system related symptoms. Endotheliitis of CNS vessels can lead to vessel occlusion and stroke. COVID-19 can also result in cerebral hemorrhage and sinus thrombosis possibly related to changes in clotting behavior. Vaccination is most important to prevent COVID-19 in the nervous system. There are symptomatic or/and curative therapeutic approaches to combat COVID-19 related nervous system damage that are partly still under study.",book:{id:"10890",title:"Recent Advances in Neurochemistry",coverURL:"https://cdn.intechopen.com/books/images_new/10890.jpg"},signatures:"Robert Weissert"}],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:87,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:98,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:27,numberOfPublishedChapters:288,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:9,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:139,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:129,numberOfOpenTopics:0,numberOfUpcomingTopics:2,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!1},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:107,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:10,numberOfPublishedChapters:103,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:12,numberOfOpenTopics:2,numberOfUpcomingTopics:1,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:0,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!1},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:11,numberOfOpenTopics:4,numberOfUpcomingTopics:1,issn:null,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:"6",title:"Infectious Diseases",doi:"10.5772/intechopen.71852",issn:"2631-6188",scope:"This series will provide a comprehensive overview of recent research trends in various Infectious Diseases (as per the most recent Baltimore classification). Topics will include general overviews of infections, immunopathology, diagnosis, treatment, epidemiology, etiology, and current clinical recommendations for managing infectious diseases. Ongoing issues, recent advances, and future diagnostic approaches and therapeutic strategies will also be discussed. This book series will focus on various aspects and properties of infectious diseases whose deep understanding is essential for safeguarding the human race from losing resources and economies due to pathogens.",coverUrl:"https://cdn.intechopen.com/series/covers/6.jpg",latestPublicationDate:"May 19th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:13,editor:{id:"131400",title:"Prof.",name:"Alfonso J.",middleName:null,surname:"Rodriguez-Morales",slug:"alfonso-j.-rodriguez-morales",fullName:"Alfonso J. Rodriguez-Morales",profilePictureURL:"https://mts.intechopen.com/storage/users/131400/images/system/131400.png",biography:"Dr. Rodriguez-Morales is an expert in tropical and emerging diseases, particularly zoonotic and vector-borne diseases (especially arboviral diseases). He is the president of the Travel Medicine Committee of the Pan-American Infectious Diseases Association (API), as well as the president of the Colombian Association of Infectious Diseases (ACIN). He is a member of the Committee on Tropical Medicine, Zoonoses, and Travel Medicine of ACIN. 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. He is currently the Editor in Chief of the journal Travel Medicine and Infectious Diseases. His Scopus H index is 47 (Google Scholar H index, 68).",institutionString:"Institución Universitaria Visión de las Américas, Colombia",institution:null},editorTwo:null,editorThree:null},subseries:{paginationCount:5,paginationItems:[{id:"19",title:"Animal Science",coverUrl:"https://cdn.intechopen.com/series_topics/covers/19.jpg",editor:{id:"259298",title:"Dr.",name:"Edward",middleName:null,surname:"Narayan",slug:"edward-narayan",fullName:"Edward Narayan",profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",biography:"Dr. Edward Narayan graduated with Ph.D. degree in Biology from the University of the South Pacific and pioneered non-invasive reproductive and stress endocrinology tools for amphibians - the novel development and validation of non-invasive enzyme immunoassays for the evaluation of reproductive hormonal cycle and stress hormone responses to environmental stressors. \nDr. Narayan leads the Stress Lab (Comparative Physiology and Endocrinology) at the University of Queensland. A dynamic career research platform which is based on the thematic areas of comparative vertebrate physiology, stress endocrinology, reproductive endocrinology, animal health and welfare, and conservation biology. \nEdward has supervised 40 research students and published over 60 peer reviewed research.",institutionString:null,institution:{name:"University of Queensland",institutionURL:null,country:{name:"Australia"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"258334",title:"Dr.",name:"Carlos Eduardo",middleName:null,surname:"Fonseca-Alves",slug:"carlos-eduardo-fonseca-alves",fullName:"Carlos Eduardo Fonseca-Alves",profilePictureURL:"https://mts.intechopen.com/storage/users/258334/images/system/258334.jpg",institutionString:null,institution:{name:"Universidade Paulista",institutionURL:null,country:{name:"Brazil"}}},{id:"191123",title:"Dr.",name:"Juan José",middleName:null,surname:"Valdez-Alarcón",slug:"juan-jose-valdez-alarcon",fullName:"Juan José Valdez-Alarcón",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSBfcQAG/Profile_Picture_1631354558068",institutionString:"Universidad Michoacana de San Nicolás de Hidalgo",institution:{name:"Universidad Michoacana de San Nicolás de Hidalgo",institutionURL:null,country:{name:"Mexico"}}},{id:"161556",title:"Dr.",name:"Maria Dos Anjos",middleName:null,surname:"Pires",slug:"maria-dos-anjos-pires",fullName:"Maria Dos Anjos Pires",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bS8q2QAC/Profile_Picture_1633432838418",institutionString:null,institution:{name:"University of Trás-os-Montes and Alto Douro",institutionURL:null,country:{name:"Portugal"}}},{id:"209839",title:"Dr.",name:"Marina",middleName:null,surname:"Spinu",slug:"marina-spinu",fullName:"Marina Spinu",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRLXpQAO/Profile_Picture_1630044895475",institutionString:null,institution:{name:"University of Agricultural Sciences and Veterinary Medicine of Cluj-Napoca",institutionURL:null,country:{name:"Romania"}}},{id:"92185",title:"Dr.",name:"Sara",middleName:null,surname:"Savic",slug:"sara-savic",fullName:"Sara Savic",profilePictureURL:"https://mts.intechopen.com/storage/users/92185/images/system/92185.jfif",institutionString:'Scientific Veterinary Institute "Novi Sad"',institution:{name:'Scientific Veterinary Institute "Novi Sad"',institutionURL:null,country:{name:"Serbia"}}}]},{id:"20",title:"Animal Nutrition",coverUrl:"https://cdn.intechopen.com/series_topics/covers/20.jpg",editor:{id:"175967",title:"Dr.",name:"Manuel",middleName:null,surname:"Gonzalez Ronquillo",slug:"manuel-gonzalez-ronquillo",fullName:"Manuel Gonzalez Ronquillo",profilePictureURL:"https://mts.intechopen.com/storage/users/175967/images/system/175967.png",biography:"Dr. Manuel González Ronquillo obtained his doctorate degree from the University of Zaragoza, Spain, in 2001. He is a research professor at the Faculty of Veterinary Medicine and Animal Husbandry, Autonomous University of the State of Mexico. He is also a level-2 researcher. He received a Fulbright-Garcia Robles fellowship for a postdoctoral stay at the US Dairy Forage Research Center, Madison, Wisconsin, USA in 2008–2009. He received grants from Alianza del Pacifico for a stay at the University of Magallanes, Chile, in 2014, and from Consejo Nacional de Ciencia y Tecnología (CONACyT) to work in the Food and Agriculture Organization’s Animal Production and Health Division (AGA), Rome, Italy, in 2014–2015. He has collaborated with researchers from different countries and published ninety-eight journal articles. He teaches various degree courses in zootechnics, sheep production, and agricultural sciences and natural resources.\n\nDr. Ronquillo’s research focuses on the evaluation of sustainable animal diets (StAnD), using native resources of the region, decreasing carbon footprint, and applying meta-analysis and mathematical models for a better understanding of animal production.",institutionString:null,institution:{name:"Universidad Autónoma del Estado de México",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"175762",title:"Dr.",name:"Alfredo J.",middleName:null,surname:"Escribano",slug:"alfredo-j.-escribano",fullName:"Alfredo J. 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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. 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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:"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:"Polytechnic University of Timişoara",institution:{name:"Polytechnic University of Timişoara",country:{name:"Romania"}}},{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:null},{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. She is a member of Indian Mathematical Society.",institutionString:null,institution:null},{id:"414880",title:"Dr.",name:"Maryam",middleName:null,surname:"Vatankhah",slug:"maryam-vatankhah",fullName:"Maryam Vatankhah",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Borough of Manhattan Community College",country:{name:"United States of America"}}},{id:"414879",title:"Prof.",name:"Mohammad-Reza",middleName:null,surname:"Akbarzadeh-Totonchi",slug:"mohammad-reza-akbarzadeh-totonchi",fullName:"Mohammad-Reza Akbarzadeh-Totonchi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Ferdowsi University of Mashhad",country:{name:"Iran"}}},{id:"414878",title:"Prof.",name:"Reza",middleName:null,surname:"Fazel-Rezai",slug:"reza-fazel-rezai",fullName:"Reza Fazel-Rezai",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"American Public University System",country:{name:"United States of America"}}},{id:"302698",title:"Dr.",name:"Yao",middleName:null,surname:"Shan",slug:"yao-shan",fullName:"Yao Shan",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Dalian University of Technology",country:{name:"China"}}},{id:"125911",title:"Prof.",name:"Jia-Ching",middleName:null,surname:"Wang",slug:"jia-ching-wang",fullName:"Jia-Ching Wang",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"National Central University",country:{name:"Taiwan"}}},{id:"357085",title:"Mr.",name:"P. Mohan",middleName:null,surname:"Anand",slug:"p.-mohan-anand",fullName:"P. Mohan Anand",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Indian Institute of Technology Kanpur",country:{name:"India"}}},{id:"356696",title:"Ph.D. Student",name:"P.V.",middleName:null,surname:"Sai Charan",slug:"p.v.-sai-charan",fullName:"P.V. Sai Charan",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Indian Institute of Technology Kanpur",country:{name:"India"}}},{id:"357086",title:"Prof.",name:"Sandeep K.",middleName:null,surname:"Shukla",slug:"sandeep-k.-shukla",fullName:"Sandeep K. Shukla",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Indian Institute of Technology Kanpur",country:{name:"India"}}},{id:"356823",title:"MSc.",name:"Seonghee",middleName:null,surname:"Min",slug:"seonghee-min",fullName:"Seonghee Min",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Daegu University",country:{name:"Korea, South"}}},{id:"353307",title:"Prof.",name:"Yoosoo",middleName:null,surname:"Oh",slug:"yoosoo-oh",fullName:"Yoosoo Oh",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:"Yoosoo Oh received his Bachelor's degree in the Department of Electronics and Engineering from Kyungpook National University in 2002. He obtained his Master’s degree in the Department of Information and Communications from Gwangju Institute of Science and Technology (GIST) in 2003. In 2010, he received his Ph.D. degree in the School of Information and Mechatronics from GIST. In the meantime, he was an executed team leader at Culture Technology Institute, GIST, 2010-2012. In 2011, he worked at Lancaster University, the UK as a visiting scholar. In September 2012, he joined Daegu University, where he is currently an associate professor in the School of ICT Conver, Daegu University. Also, he served as the Board of Directors of KSIIS since 2019, and HCI Korea since 2016. From 2017~2019, he worked as a center director of the Mixed Reality Convergence Research Center at Daegu University. From 2015-2017, He worked as a director in the Enterprise Supporting Office of LINC Project Group, Daegu University. His research interests include Activity Fusion & Reasoning, Machine Learning, Context-aware Middleware, Human-Computer Interaction, etc.",institutionString:null,institution:{name:"Daegu Gyeongbuk Institute of Science and Technology",country:{name:"Korea, South"}}},{id:"262719",title:"Dr.",name:"Esma",middleName:null,surname:"Ergüner Özkoç",slug:"esma-erguner-ozkoc",fullName:"Esma Ergüner Özkoç",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Başkent University",country:{name:"Turkey"}}},{id:"346530",title:"Dr.",name:"Ibrahim",middleName:null,surname:"Kaya",slug:"ibrahim-kaya",fullName:"Ibrahim Kaya",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Izmir Kâtip Çelebi University",country:{name:"Turkey"}}},{id:"419199",title:"Dr.",name:"Qun",middleName:null,surname:"Yang",slug:"qun-yang",fullName:"Qun Yang",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Auckland",country:{name:"New Zealand"}}},{id:"351158",title:"Prof.",name:"David W.",middleName:null,surname:"Anderson",slug:"david-w.-anderson",fullName:"David W. Anderson",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Calgary",country:{name:"Canada"}}}]}},subseries:{item:{id:"14",type:"subseries",title:"Cell and Molecular Biology",keywords:"Omics (Transcriptomics; Proteomics; Metabolomics), Molecular Biology, Cell Biology, Signal Transduction and Regulation, Cell Growth and Differentiation, Apoptosis, Necroptosis, Ferroptosis, Autophagy, Cell Cycle, Macromolecules and Complexes, Gene Expression",scope:"The Cell and Molecular Biology topic within the IntechOpen Biochemistry Series aims to rapidly publish contributions on all aspects of cell and molecular biology, including aspects related to biochemical and genetic research (not only in humans but all living beings). We encourage the submission of manuscripts that provide novel and mechanistic insights that report significant advances in the fields. Topics include, but are not limited to: Advanced techniques of cellular and molecular biology (Molecular methodologies, imaging techniques, and bioinformatics); Biological activities at the molecular level; Biological processes of cell functions, cell division, senescence, maintenance, and cell death; Biomolecules interactions; Cancer; Cell biology; Chemical biology; Computational biology; Cytochemistry; Developmental biology; Disease mechanisms and therapeutics; DNA, and RNA metabolism; Gene functions, genetics, and genomics; Genetics; Immunology; Medical microbiology; Molecular biology; Molecular genetics; Molecular processes of cell and organelle dynamics; Neuroscience; Protein biosynthesis, degradation, and functions; Regulation of molecular interactions in a cell; Signalling networks and system biology; Structural biology; Virology and microbiology.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/14.jpg",hasOnlineFirst:!0,hasPublishedBooks:!0,annualVolume:11410,editor:{id:"165627",title:"Dr.",name:"Rosa María",middleName:null,surname:"Martínez-Espinosa",slug:"rosa-maria-martinez-espinosa",fullName:"Rosa María Martínez-Espinosa",profilePictureURL:"https://mts.intechopen.com/storage/users/165627/images/system/165627.jpeg",biography:"Dr. Rosa María Martínez-Espinosa has been a Spanish Full Professor since 2020 (Biochemistry and Molecular Biology) and is currently Vice-President of International Relations and Cooperation development and leader of the research group 'Applied Biochemistry” (University of Alicante, Spain). 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Her research interests include archaea metabolism, enzymes purification and characterization, gene regulation, carotenoids and bioplastics production, antioxidant\ncompounds, waste water treatments, and brines bioremediation.\nRosa María’s other roles include editorial board member for several journals related\nto biochemistry, reviewer for more than 60 journals (biochemistry, molecular biology, biotechnology, chemistry and microbiology) and president of several organizing committees in international meetings related to the N-cycle or respiratory processes.",institutionString:null,institution:{name:"University of Alicante",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null,series:{id:"11",title:"Biochemistry",doi:"10.5772/intechopen.72877",issn:"2632-0983"},editorialBoard:[{id:"79367",title:"Dr.",name:"Ana Isabel",middleName:null,surname:"Flores",slug:"ana-isabel-flores",fullName:"Ana Isabel Flores",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRpIOQA0/Profile_Picture_1632418099564",institutionString:null,institution:{name:"Hospital Universitario 12 De Octubre",institutionURL:null,country:{name:"Spain"}}},{id:"328234",title:"Ph.D.",name:"Christian",middleName:null,surname:"Palavecino",slug:"christian-palavecino",fullName:"Christian Palavecino",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000030DhEhQAK/Profile_Picture_1628835318625",institutionString:null,institution:{name:"Central University of Chile",institutionURL:null,country:{name:"Chile"}}},{id:"186585",title:"Dr.",name:"Francisco Javier",middleName:null,surname:"Martin-Romero",slug:"francisco-javier-martin-romero",fullName:"Francisco Javier Martin-Romero",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSB3HQAW/Profile_Picture_1631258137641",institutionString:null,institution:{name:"University of Extremadura",institutionURL:null,country:{name:"Spain"}}}]},onlineFirstChapters:{paginationCount:17,paginationItems:[{id:"81647",title:"Diabetes and Epigenetics",doi:"10.5772/intechopen.104653",signatures:"Rasha A. 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