Power enhancement by movement of body.
\r\n\tThe aim of this book is to provide the reader with a comprehensive state-of-the-art in artificial neural networks, collecting many of the core concepts and cutting-edge application behind neural networks and deep learning.
",isbn:"978-1-83962-375-2",printIsbn:"978-1-83962-374-5",pdfIsbn:"978-1-83962-376-9",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!1,hash:"5cc6cd7972551be6cfc4d3c87bf8fb5c",bookSignature:"Dr. Pier Luigi Mazzeo and Dr. Paolo Spagnolo",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/10390.jpg",keywords:"Recurrent, Recursive Nets, Face Recognition, Crowd Analysis, Different Applications, Object Detection, Classification, Visual Tracking, Speech Recognition, Grams, Reinforcement Learning, 3-D Map",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"September 25th 2020",dateEndSecondStepPublish:"October 23rd 2020",dateEndThirdStepPublish:"December 22nd 2020",dateEndFourthStepPublish:"March 12th 2021",dateEndFifthStepPublish:"May 11th 2021",remainingDaysToSecondStep:"3 months",secondStepPassed:!0,currentStepOfPublishingProcess:4,editedByType:null,kuFlag:!1,biosketch:"Author and co-author of more than 80 works in national and international journals, conference proceedings, and book chapters, with Ph.D. in Computer Science Engineering.",coeditorOneBiosketch:"Dr. Spagnolo received the engineering degree in computer science from the University of Lecce, Italy. Since 2002 he has been with the Italian National Research Council. His work includes more than 80 publications on AI.",coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"17191",title:"Dr.",name:"Pier Luigi",middleName:null,surname:"Mazzeo",slug:"pier-luigi-mazzeo",fullName:"Pier Luigi Mazzeo",profilePictureURL:"https://mts.intechopen.com/storage/users/17191/images/system/17191.jpeg",biography:"Pier Luigi Mazzeo received the engineering degree in computer science from the University of Lecce, Lecce, Italy, in 2001. \nSince 2015 he has been with Institute of Applied Sciences and Intelligent Systems of the Italian National Research Council, Lecce, Italy. The most relevant topics, in which he is currently involved, include algorithms for video object tracking , face detection and recognition, facial expression recognition, deep neural network (CNN) and machine learning.\nHe has taken part in several national and international projects and he acts as a reviewer for several international journals and for some book publishers. He has been regularly invited to take part in the Scientific Committees of national and international conferences. \nDr. Mazzeo is author and co-author of more then 80 works in national and international journals, conference proceedings and book chapters.",institutionString:"Institute of Applied Sciences and Intelligent Systems (CNR)",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"1",institution:{name:"Institute of Applied Science and Intelligent Systems",institutionURL:null,country:{name:"Italy"}}}],coeditorOne:{id:"20192",title:"Dr.",name:"Paolo",middleName:null,surname:"Spagnolo",slug:"paolo-spagnolo",fullName:"Paolo Spagnolo",profilePictureURL:"https://mts.intechopen.com/storage/users/20192/images/system/20192.jpg",biography:"Paolo Spagnolo received the engineering degree in computer science from the University of Lecce, Lecce, Italy, in 2002.\nSince then he has been with the Italian National Research Council.\nHe has been working on several research topics regarding Artificial Intelligence and Computer Vision studying techniques and methodologies for multidimensional digital signal processing; linear and non-linear signal characterization; signal features extraction; supervised and unsupervised classification of signals; deep neural network (CNN).\nDr. Spagnolo is an author of over 80 papers on Artificial Intelligence. He also acts as a reviewer for several international journals.\nHe has also participated in a number of international projects in the area of image and video analysis and has been regularly invited to take part in the Scientific Committees of national and international conferences.",institutionString:"Institute of Applied Sciences and Intelligent Systems (CNR)",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"Institute of Applied Science and Intelligent Systems",institutionURL:null,country:{name:"Italy"}}},coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"9",title:"Computer and Information Science",slug:"computer-and-information-science"}],chapters:null,productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"297737",firstName:"Mateo",lastName:"Pulko",middleName:null,title:"Mr.",imageUrl:"https://mts.intechopen.com/storage/users/297737/images/8492_n.png",email:"mateo.p@intechopen.com",biography:"As an Author Service Manager my responsibilities include monitoring and facilitating all publishing activities for authors and editors. From chapter submission and review, to approval and revision, copyediting and design, until final publication, I work closely with authors and editors to ensure a simple and easy publishing process. I maintain constant and effective communication with authors, editors and reviewers, which allows for a level of personal support that enables contributors to fully commit and concentrate on the chapters they are writing, editing, or reviewing. I assist authors in the preparation of their full chapter submissions and track important deadlines and ensure they are met. I help to coordinate internal processes such as linguistic review, and monitor the technical aspects of the process. As an ASM I am also involved in the acquisition of editors. Whether that be identifying an exceptional author and proposing an editorship collaboration, or contacting researchers who would like the opportunity to work with IntechOpen, I establish and help manage author and editor acquisition and contact."}},relatedBooks:[{type:"book",id:"8725",title:"Visual Object Tracking with Deep Neural Networks",subtitle:null,isOpenForSubmission:!1,hash:"e0ba384ed4b4e61f042d5147c97ab168",slug:"visual-object-tracking-with-deep-neural-networks",bookSignature:"Pier Luigi Mazzeo, Srinivasan Ramakrishnan and Paolo Spagnolo",coverURL:"https://cdn.intechopen.com/books/images_new/8725.jpg",editedByType:"Edited by",editors:[{id:"17191",title:"Dr.",name:"Pier Luigi",surname:"Mazzeo",slug:"pier-luigi-mazzeo",fullName:"Pier Luigi Mazzeo"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1591",title:"Infrared Spectroscopy",subtitle:"Materials Science, Engineering and Technology",isOpenForSubmission:!1,hash:"99b4b7b71a8caeb693ed762b40b017f4",slug:"infrared-spectroscopy-materials-science-engineering-and-technology",bookSignature:"Theophile Theophanides",coverURL:"https://cdn.intechopen.com/books/images_new/1591.jpg",editedByType:"Edited by",editors:[{id:"37194",title:"Dr.",name:"Theophanides",surname:"Theophile",slug:"theophanides-theophile",fullName:"Theophanides Theophile"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3092",title:"Anopheles mosquitoes",subtitle:"New insights into malaria vectors",isOpenForSubmission:!1,hash:"c9e622485316d5e296288bf24d2b0d64",slug:"anopheles-mosquitoes-new-insights-into-malaria-vectors",bookSignature:"Sylvie Manguin",coverURL:"https://cdn.intechopen.com/books/images_new/3092.jpg",editedByType:"Edited by",editors:[{id:"50017",title:"Prof.",name:"Sylvie",surname:"Manguin",slug:"sylvie-manguin",fullName:"Sylvie Manguin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3161",title:"Frontiers in Guided Wave Optics and Optoelectronics",subtitle:null,isOpenForSubmission:!1,hash:"deb44e9c99f82bbce1083abea743146c",slug:"frontiers-in-guided-wave-optics-and-optoelectronics",bookSignature:"Bishnu Pal",coverURL:"https://cdn.intechopen.com/books/images_new/3161.jpg",editedByType:"Edited by",editors:[{id:"4782",title:"Prof.",name:"Bishnu",surname:"Pal",slug:"bishnu-pal",fullName:"Bishnu Pal"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"72",title:"Ionic Liquids",subtitle:"Theory, Properties, New Approaches",isOpenForSubmission:!1,hash:"d94ffa3cfa10505e3b1d676d46fcd3f5",slug:"ionic-liquids-theory-properties-new-approaches",bookSignature:"Alexander Kokorin",coverURL:"https://cdn.intechopen.com/books/images_new/72.jpg",editedByType:"Edited by",editors:[{id:"19816",title:"Prof.",name:"Alexander",surname:"Kokorin",slug:"alexander-kokorin",fullName:"Alexander Kokorin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1373",title:"Ionic Liquids",subtitle:"Applications and Perspectives",isOpenForSubmission:!1,hash:"5e9ae5ae9167cde4b344e499a792c41c",slug:"ionic-liquids-applications-and-perspectives",bookSignature:"Alexander Kokorin",coverURL:"https://cdn.intechopen.com/books/images_new/1373.jpg",editedByType:"Edited by",editors:[{id:"19816",title:"Prof.",name:"Alexander",surname:"Kokorin",slug:"alexander-kokorin",fullName:"Alexander Kokorin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"57",title:"Physics and Applications of Graphene",subtitle:"Experiments",isOpenForSubmission:!1,hash:"0e6622a71cf4f02f45bfdd5691e1189a",slug:"physics-and-applications-of-graphene-experiments",bookSignature:"Sergey Mikhailov",coverURL:"https://cdn.intechopen.com/books/images_new/57.jpg",editedByType:"Edited by",editors:[{id:"16042",title:"Dr.",name:"Sergey",surname:"Mikhailov",slug:"sergey-mikhailov",fullName:"Sergey Mikhailov"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"371",title:"Abiotic Stress in Plants",subtitle:"Mechanisms and Adaptations",isOpenForSubmission:!1,hash:"588466f487e307619849d72389178a74",slug:"abiotic-stress-in-plants-mechanisms-and-adaptations",bookSignature:"Arun Shanker and B. Venkateswarlu",coverURL:"https://cdn.intechopen.com/books/images_new/371.jpg",editedByType:"Edited by",editors:[{id:"58592",title:"Dr.",name:"Arun",surname:"Shanker",slug:"arun-shanker",fullName:"Arun Shanker"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"878",title:"Phytochemicals",subtitle:"A Global Perspective of Their Role in Nutrition and Health",isOpenForSubmission:!1,hash:"ec77671f63975ef2d16192897deb6835",slug:"phytochemicals-a-global-perspective-of-their-role-in-nutrition-and-health",bookSignature:"Venketeshwer Rao",coverURL:"https://cdn.intechopen.com/books/images_new/878.jpg",editedByType:"Edited by",editors:[{id:"82663",title:"Dr.",name:"Venketeshwer",surname:"Rao",slug:"venketeshwer-rao",fullName:"Venketeshwer Rao"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"4816",title:"Face Recognition",subtitle:null,isOpenForSubmission:!1,hash:"146063b5359146b7718ea86bad47c8eb",slug:"face_recognition",bookSignature:"Kresimir Delac and Mislav Grgic",coverURL:"https://cdn.intechopen.com/books/images_new/4816.jpg",editedByType:"Edited by",editors:[{id:"528",title:"Dr.",name:"Kresimir",surname:"Delac",slug:"kresimir-delac",fullName:"Kresimir Delac"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},chapter:{item:{type:"chapter",id:"61160",title:"Recent Progress in Nanostructured Zinc Oxide Grown on Fabric for Wearable Thermoelectric Power Generator with UV Shielding",doi:"10.5772/intechopen.76672",slug:"recent-progress-in-nanostructured-zinc-oxide-grown-on-fabric-for-wearable-thermoelectric-power-gener",body:'\nTurning textile fibers into progressively challenging and innovative product have seen manifold development in the last decade. The most promising characteristics of fibers drive the development of a wide range of fibrous products enabling digital components and electronics to be embedded in them known as smart clothing or smart textiles or smart fabrics. Adopting the new technology of smart fabrics is advantageous since they are relatively lightweight, comfortable, soft, and biodegradable. The move towards function-focus fibrous structures in pavement and embankment reinforcement may seem more appropriate, it implies technological applications such as stain resistance, antimicrobial, superhydrophobic/ super-hydrophilic, antistatic, sensors, power generators, electromagnetic/ultraviolet interference shielding, wrinkles resistant, and shrink-proof abilities.
\nAmong modern perspective, the wearable devices used to monitor a variety of health and environmental measures are becoming popular, and those devices requires capable of functioning autonomously for extended periods without replacing or recharge of batteries, but it is not practically impossible or ineffective. Since time immemorial, technology focuses to decrease the power consumption of devices so that the battery lasts for years. It has been done long ago, e.g., in watches. Low power consumption devices are developing gradually and that today offers provide opportunities for yesterday’s dreams [1, 2, 3, 4, 5, 6].
\nThe main drawbacks are to supply power stable and reliable to commercialize wearable devices, the efforts are being made to explore alternative energy sources for recharging of batteries is performed on a regular or occasional basis using the auxiliary power source of energy harvesting modules such as photovoltaic cells or thermoelectric devices, which are also known as renewable energies. The renewable energy sources, being clean energy sources, noiseless, have an extreme advantage over conventional energy resources from an environmental point of view. The photovoltaic cells are variable power supply, dependent on sunlight, which could lead to an energy shortage if too much of a region’s power comes from photovoltaic cells. Therefore, photovoltaic cells fail to provide long-term autonomy sufficient power for portable devices. Fortuitously, the thermoelectric devices have attracted much attention due to their ability of direct conversion of heat to electricity. The performance of thermoelectric devices is recycling wasted heat energy, lower production cost, scalability, long-lived power source, no side effects or harm, free from gas emission, easy to dispose and reliable source of energy [7, 8, 9] (Figure 1).
\nCommercial evolution of wearable thermoelectric devices.
The body heat from the human is one of the source to harvest energy, which produces electricity from tiny energies in the environment that is called thermoelectric (TE) power generator as shown in Figure 2. In this application, the power generator was designed in the form of textile, so-called wearable power generator (WPG). It is also made available in the form of curtain, tent, and umbrellas and therefore, it is useful not only for a daily life applications but for special applications such as natural disaster. TE materials have prominent aspects like reliability, environmental benignity, and easy incorporation into existing technologies. They can be used as long-life power sources and provide a long-lasting solution to the ever-growing demand for implantable medical devices. This increasing demands for lightweight, high flexible, stretchable, and washable presents critical challenges for the progress of WPG.
\nWearable power generation on human body.
In 1821, the Thematron’s technology developed watches at Centre Electronique Horloger (CEH) in Neuchatel, Switzerland. Basically, three different materials were used antimony, bismuth, and tellurium. The generators composed of two metal sheets: red one on the watch back side (in contact with the wrist’s skin) and a blue one at the top of the case (in contact with ambient air); it is based on “Seebeck effect” principle, which generates a voltage that supplies energy to the quartz caliber. They had very low conversion efficiency, and it could not hold the electrical load, thus the distribution was eventually stopped.
\nWith not much achievement, several efforts followed, when finally, in the year 1988, Seiko developed another thermic watch; which was connected to a lithium-ion battery with a 10 months’ power reserve. It has power saving mode, and it stopped when the watch was not being worn on hand to reduce energy consumption and save battery life.
\nIn 2010, Skinny Player was designed by Chinese engineers Chih-Wei Wang and Shou-His Fu; the player with a preloaded album onto it and to listen music you would simply stick the player onto your body; By sticking the player, it would gain power from its flexible battery charging device; it is eco-friendly and sustainable way; major issues with the player is when intended to exercise, the body is hot and usually sweats, however it was stuck on a sweating body for a long time.
\nA tremendous achievement in the same year by Orange Power Wellies; Boots that converts heat from your feet into electrical power to charge your mobile phone; the battery gets charged by 12 hours of walking but still its remarkable significant that the amount of energy can be harvested from the normal human activity; in order to decrease the charging period we should try more active duties like dancing or running; then the device contains pairs of p-type and n-type semiconductor materials forming a thermopile.
\nIn 2011, the first popular TE mobile developed by Nokia E-Cu designer Patrick Hilandom; the mobile would be able to heat-conductive charging system, being in your pocket and it creating a charger-free mobile phone future; the phone body is made up of copper on which are engraved heat sinks in the form of dried and cracked earth; basically, mobile phone chargers produce 51,000 tons of emission of energy in the environment, in addition to greenhouse gases.
\nIn 2013, Fujifilm has developed the flexible polymer TE conversion module; it can able to generate milliwatt to microwatt power; it would be possible to operate the medium and low-temperature waste heat that surrounds us all in our daily lives; the power is generated by affixing a film substrate coated with organic materials on to a heating source, and the possible power can be generated in the temperature difference ambient and human body temperature of even 1°C.
\nIn 2016, developed by Sam Shames in Embr Labs, Wristify is a heating and cooling bracelet that lets you make yourself comfortable by sending hot or cold pulses to a patch of skin on the wrist; it is more comfortable without changing your core temperature by focusing on the temperature at the skin, and sudden changing of the skin temperature can also notice immediately make you more comfortable.
\nThe performance of WPG is essential to develop high-efficient flexible TE materials. Theoretically, the efficiency of TE power generator rises monotonously with increasing dimensionless figure of merit, zT which is given by zT = (S2σ)/κ T, where S, σ, κ, and T denote the thermopower (Seebeck coefficient), electrical conductivity, thermal conductivity, and temperature respectively. Henceforth, with the aim of improving the efficiency, an increase in Seebeck coefficient and a decrease in thermal conductivity are required. Traditional materials for TE such as bismuth telluride have been studied and utilized commercially for the last half century, but recent advancements in materials selection are one of the principal function of active TE device as it determines the reliability of the fabrication regarding industrial and economic aspects [10].
\nAs a resolution of this purpose, the nanostructured materials are expected to enhance the Seebeck coefficient because of a carrier confinement effect and to lower the thermal conductivity because of an increase in the boundary scattering in phonon transport. The selection of the material has a significant role in the fabrication of high-performing TE materials. Owing to its flexible nature, conducting polymers (CPs) are favorable materials for the practical TE applications. Because of their high flexibility, environmental stability, and facile synthesis, they have the potential for use on human skin. However, most of the CPs such as polyaniline, polypyrrole, and poly(3,4-ethylenedioxythiophene) polystyrene sulfonate (PEDOT: PSS) are expensive and require complex treatments to achieve good electrical conductivity. Hence efforts have been made to find an alternative for fabricating flexible TE materials and composite materials have recently been attracting more and more attention since they possess many advantages including high thermopower, easy process-ability, and cost-effectiveness. Recently, many researcher’s efforts have been made to utilize oxide nanomaterials for WPG applications that may provide environmental stable, mechanical flexibility, and lightweight with low cost of manufacturing [11, 12, 13].
\nHuman skin as one of its charge-collectors, converts muscle movements into enough power for small electronics which requires optimization of a variety of conflicting properties. At the same time, it should enhance the performance of the material and increase the zT for which characteristics such as high electrical conductivity, lower the thermal conductivity and a high thermopower (Seebeck coefficient) are required. The three parameters are strongly interdependent each other to makes the enhancement of zT highly challenging. Sometimes the nanomaterials coated fiber bond is not the strongest, so it wears down and wears off through use and another challenge, which is related conductive fibers is erosion over time. Various techniques have been considered owing to maximum performance in TE materials; a few examples of manipulation are described in the following sections [14, 15, 16, 17].
\nHuman body releases the thermal energy of about 2.4 to 4.8 watts, but more can be achieved by placing at different parts of the body. The ideal positions are indicated in Figure 3. Similarly, the body heat trapping power may be enhanced by physical activity involved as shown in Table 1. Note, however, that energy harvested from the user may require considerable settings in position of the body. Most of the times it provides better expected results [18, 19, 20, 21, 22].
\nWPG recovery from body in different places.
Activity | \nSleeping | \nSitting | \nStanding | \nConversation | \nEating | \nDriving | \nHouse keeping | \nSwimming | \nRunning | \n
---|---|---|---|---|---|---|---|---|---|
Watts | \n81 | \n93 | \n116 | \n128 | \n128 | \n163 | \n175 | \n582 | \n1048 | \n
Kilo cal/hr | \n70 | \n80 | \n110 | \n110 | \n110 | \n140 | \n150 | \n500 | \n900 | \n
Power enhancement by movement of body.
On the other hand, we have focused on ZnO and rGO nanostructure composites as a high-efficiency WPG material because they are non-toxic to skin, inexpensive, available easily and possess attractive electronic properties, making them available for engineered clothing with low-cost fabrication. Up-to-date, several coating methods have been used to grow ZnO and rGO films for tuning its size and morphology, such as sol–gel method, solvothermal synthesis, chemical precipitation, microwave method, sonochemical route, chemical vapor deposition, vapor-phase method, sputtering, and electrochemical. Among these techniques, the solvothermal method is a promising method to synthesize nanostructures with high purity and isometric crystallization. As well as it improves a surface’s strength and durability. Furthermore, a variety of nanostructures such as nanorods, nanoneedles, nanotube, nanosheets, nanoflakes, nanodiscs, and nanoflowers can be obtained by solvothermal method. In precise, fabrics containing ZnO and rGO have shown great promise as N-type and P-type materials with improved transport and UV shielding properties [23, 24, 25, 26].
\nThe thermopower can be enhanced in the presence of chemical composition and crystallinity of thermoelectric materials at nano-inclusion via engineering of multicomponent nanomaterials (nanocomposites), it has proven which can reduce the lattice thermal conductivity by promoting the phonon scattering at gain boundaries and simultaneously it enhances the power factor due to electron filtering at grain boundaries [27, 28, 29, 30].
\nScouring is an important treatment stage of cotton fibers for reducing the amount of impurities such as oils, wax, gums, fatty materials, natural coloring. The absence of impurities produce the fabric more hydrophilic for achieving uniform nanomaterials coating as shown in Figure 4 before and after scouring process. The complete scouring process as shown below [31];
\nSEM image of cotton fabric (a) before and (b) after of scouring process.
The development of nanomaterials is closely linked to the following synthesis process.
\nSol gel approach began with inorganic ceramic materials at early mid 1800’s and especially fabrication of metal oxides. In a typical sol gel reaction process [32], the reactants involve conversion of monomers into a colloidal solution then it reacts as the precursor for an integrated network. The deposition of sol gel solution produces the coatings on the cotton fabric by dipping and followed by heat treatment to form an amorphous or crystalline coatings as shown in Figure 5 (a – d).
\nCoating method for cotton fibers (a–d) sol gel approach and (g–h) microwave approach.
Since in 2000, the Microwave-assisted approach is known to transform electromagnetic energy into heat for the ultra-fast synthesis of chemical reactions using microwave irradiation [33]. It has homogeneous, rapid with deep internal heating as resultant produce high yield and lower quantities of side products, purifications of yield are easier, reactions are more reproducible, and the reaction temperature is accurate but it not reproducible with conventional heating. The cotton fibers microwave assisted synthesis has established with producing nanostructures to influence both side distribution of fibers effectively as shown in Figure 5 (g–h).
\nIn this process, the desired component is precipitated under the aqueous region to synthesize high purity and crystallinity without significant defects. As the novel method performed at room temperature and suitable for quantifiable production because of its high yield, excellent repeatability, and low cost. Particularly, the metal hydroxides are precipitated from their precursor element because of low solubility, but the inclusion of alkaline solution can overcome it or raising the pH. For example, Figure 6 (a–d) shows the coated cotton fabric nanostructures is done by the co-precipitation approach with the addition of amine groups and metal precursors [34].
\nCotton fabric deposited with nanostructures via (a) co-precipitation method and (b) chemical bath method.
Since from 1933, it was known that for solution growth method, and it adopts the simplest form of the concentrated solution which induces a solid phase to exsolve substrate mounting for thin films. Those yields are stable, adherent, uniform coatings with good reproducibility by a simple process [35]. To grow a denser nanostructure without seed layers are also possible but the precursor species tend to be very dilute within the solution during the deposition process and tailoring of chemical bath deposition is not possible without a clear understanding or control of mechanism. We could observe the coated nanostructures on cotton fiber as shown in Figure 6 (e – h).
\nIt is the effect of sound wave propagating in forming acoustic cavitation in liquids, resulting high temperature and pressure in a microscopic region of the sonicated process. The most notable effects are consequences of primary and secondary radical reactions it increases chemical activity through the formation of new species [36, 37]. The effects in processes may modification of surface morphology and particle size at high velocity interparticle collisions as shown in Figure 7 (a–d).
\nDifferent techniques involved for coating on cotton fibers (a–d) sonochemical, (e–g) hydrothermal, and (i–l) solvothermal method.
In principle, hydrothermal technique refers to heterogeneous reactions in aqueous media above 100°C temperature and 1 bar pressure, these resulting powder needs no more high-temperature calcination and thus can avoid the nanoparticles from re-clustering (Oswald repining). The growth of nanomaterials is performed in an apparatus consisting of a steel vessel with Teflon container innermost that sustained the pressure. The morphology and size of the nanoparticles could be tuned easily by operating temperature, pressure and time duration. Using hydrothermal synthesis for depositing metal oxide on the cotton fabric [38, 39] was shown in Figure 7 (e–h).
\nThe phenomena of the solvothermal method are sol gel process followed by the hydrothermal approach, and they have involved two steps process for the crystallization process: crystal nucleation formation by sol gel process and subsequent growth rates by the hydrothermal approach. Particle size and morphology can by controlling by processing variables such as temperature, pH, precursor concentration and additives or surfactants. Thus, solvothermal synthesis allows for precise control over the size, shape distribution and crystallinity of metal oxide nanostructures on cotton fabric [40, 41, 42, 43] as shown in Figure 7 (i–l).
\nA current–voltage (IV) characteristics is a relationship, exemplary representation of graph between the electric current through a material and the corresponding potential difference obtained. In the precise IV measurement, current/ voltage response can be measured while applying voltage/ current to obtain current versus voltage and resistance characteristics and power dissipated or generated can be determined from the IV curve by the resistive element [44, 45, 46, 47, 48]. Figure 8 (a) shows the JASCO, CEP-25BX with which IV_ characteristics were monitored in this study.
\n(a) JASCO, CEP-25X, illustration of integral (b) and differential (c) technique for measuring thermopower (Seebeck coefficient), (d) schematic representation of system for measuring the thermopower and (e) UV shielding measurement system.
In general, the thermoelectromotive force determined by using probes that are directly connected to the samples, and the temperature difference is measured through thermocouples. Consequently, for a good measurement of thermopower (Seebeck coefficient), it is necessary to measure the thermoelectromotive force and temperature difference instantaneously at the same place, to make sure the probes in excellent thermal and electrical connection with the samples, and to have a high precision measurement device. There are two primary methods used to measure thermopower which is the integral and differential methods. The integral method typically used for analysis with large temperature difference, where one end of the sample is maintained at a constant temperature T1 while the temperature of other end is varied in the temperature range of interest (T2 = T1 +ΔT).
\nThe fitting technique is used to estimate the thermopower on complete measured data set of measured thermoelectromotive force V (T1. T2) as shown in Figure 8 (b). The integral method succeeds in minimizing the influence of voltage offset. Since the applied temperature difference is large which will produce a large thermoelectromotive force. However, it is hard to maintain the temperature at one end of the sample due to the flow of heat from the high temperature applied at the other end. Moreover, it is also difficult to obtain the proper fit for evaluating the thermopower from the measured data. In additionally, the differential method can operate from a small temperature difference is applied across the sample and it is maintained at the average temperature (T = (T1 + T2)/ΔT). Then the thermopower is evaluated from the linear fit of thermoelectromotive force and temperature difference for several sets of data as shown in Figure 8 (c). Hence, this evaluation of thermopower is valid for constant thermopower at average temperature. This technique is also effectively eliminating the offset voltages that arise from thermocouples in similarities and no equilibrium contact interfaces. In this study, the thermopower of samples is measured to be constant in the average temperature range, and a schematic representation of experimental setup shown in Figure 8 (d).
\nThere are two Cu plates were positioned side by side with a gap of ~1 mm. The sample for measuring placed across the gap, associate with both plates. A resistive heater was placed underneath the plate, and by controlling the heater current, a temperature difference could be produced in a plane parallel to the sample surface. A couple of probes and two K-type thermocouples were directly connected to the sample surface. The time evolution of the thermoelectromotive force was measured by a nanovoltmeter (Keithley 2182A) and simultaneously with the temperatures at the high- and low-temperature regions by a digital meter (Keithley 2700) equipped with a switching module (Keithley 7700) [49, 50, 51, 52].
\nThe human body have largest organ is skin, since in the beginning people desired to use sunscreen products to get beautiful and to prevent the skin burns from sun tan, without the risk towards change to burns. Now, it is necessary for all people to use sunscreen products because for the protection against ultraviolet (UV) radiation. The UV radiation is broadly divided into three distinct bands in order of decreasing wavelength and increasing energy. UVA (320–400 nm) has a longer wavelength; it penetrates skin through both the epidermis and dermis, UVB (290–320 nm) has an intermediate wavelength; these rays can be blocked by sunscreen, automobile glass, and windows but UVA is not filtered. UVC (200–290 nm) has a shorter wavelength; it is effectively filtered by the atmosphere (Ozone layer) and is therefore not a forethought to be a considerable factor. Those imbalances can result in formation of wrinkles, hair loss, rashes, life-threatening cancers, and disorders in immune regulation.
\nUV protection factor (UPF) applications due to increasing global awareness on green/eco textile products and their market demand. Research has been intensified in the area of development of sustainable UV protective textile using plant extracts and other natural polymeric materials or biocompatible. The Ultraviolet ray shielding measurement was analyzed by UV scattering and absorption spectroscopy by Lapsphere UV1000F as shown in Figure 8 (e). In the Australia/New Zealand standard AC/NZS 439:1996 method, Eq. (1) is used to determine,
\nwhere \n
Various growth techniques of ZnO have been developed for tuning its size and morphology, such as sol–gel method, solvothermal synthesis, chemical precipitation, microwave method, sonochemical route, chemical vapor deposition, and vapor-phase method [56, 57]. Among these techniques, the solvothermal method is a promising method to synthesize ZnO nanostructures with high purity and isometric ZnO crystallization. Furthermore, a variety of nanostructures such as nanorods, nanoneedles, nanotube, nanosheets, nanoflakes, nanodiscs, and nanoflowers [58, 59, 60, 61] can be obtained by solvothermal method. In applying the power generator to the textile, curtain, and so forth, the flexible TE material is required to have three principal functions of the superhydrophobic surface, ultraviolet (UV) shielding and high TE efficiency. Consequently, in this paper, we fabricated ZnO nanostructures on cotton fabric by the solvothermal method and characterized their UV shielding and thermoelectric properties. A facile solvothermal method was adapted to grow the mixed nanostructures like rods and sheets without any surfactant or amine additive. Due to the two-step process, the controlled growth and optimization of the ZnO mixed nanostructures, its functional properties were investigated [62].
\nIn Figure 9 shown the fabrication process of the ZnO nanostructures coating on cotton fabric by solvothermal method. To obtain the uniform and denser of ZnO coating on the cotton fabric surface, where the glass frame designed and manufactured for the small-scale screening of ZnO seed and growth conditions. The cotton fabric is treated by scouring process to eliminate the wax, fatty and other impurity materials. Pale white color of cotton fabric obtained after scouring process, surface of the fibers is smooth and it increased the surface area due to removal of unwanted materials. Two step process have been involved like seed creation and growth process, the end product apparently found that ZnO nanostructures with high density and high aspect ratios coatings obtained. The morphology images of Figure 10 (a1 & a2) show high density and uniformly aligned nanorods without any preferred orientation, which means ZnO nanorods grow preferably on c-axis direction towards the surface of each fibrous. Thus, the nanorods grew along the [002] direction. The nanosheets are shown Figure 10 (b1 & b2), which represents the overlapped layer by layer as seen in image. Moreover, thickness of nanosheets is around to be 4 nm. Figure 10 (c1 & c2) reveals the crumbled nanosheets with shrunken edges on nanorods.
\n(a) Growth technique (b) fabrication process of ZnO nanostructures coated on cotton fibers.
(a–c) morphology image of ZnO growth layer fibers and (d) UV shielding spectra.
These structural changes happening due to the concentration of zinc nitrate: hexamine as given in Table 2. When the growth solution of nanoparticles the OH− anions and Zn2+ cations were released, which leads to the immediate precipitation of Zn(OH)2 units. Successively ZnO nanostructures were made by the solvothermal of Zn(OH)2 units at extended reaction temperature and time. In self-assembling of nanoparticles takes place in the growth solution, hexamine act as a capping agent or stabilizer and building block. In the meantime the presence of ZnO seed layer can minimize the energy barrier and the lattice divergence at heterogeneous nucleation site of the growth layer. When amine group presence of high concentration, it encourages the growth oriented along the c-axis. Whereas if the amine group in equal concentration, c-axis oriented growth direction leads to longitudinal and lateral direction. In other case, subsequent growth formation which would coalescence of crumpled with shrinkage edges of nanosheets surrounded on nanorods. Ultraviolet (UV) ray protection values and description are shown in Figure 10 (d1). UV transmittance curve of the before and after coating of ZnO on cotton fabric is shown in Figure 10 (d2). The before coating of ZnO showed 6.66 which is poor protection against UV radiation, but coated nature which is greatly improved the blocking of UV radiation.
\nS. no | \nMaterials | \nNanostructures | \n|
---|---|---|---|
1 | \nZinc nitrate 1 molar | \nHexamine 2 molar | \nNanorods | \n
2 | \nZinc nitrate 1 molar | \nHexamine 1 molar | \nNanosheets | \n
3 | \nZinc nitrate 2 molar | \nHexamine 1 molar | \nNanosheets crumpled Nanorods | \n
Possible ZnO nanostructures.
Thermoelectric properties at room temperature are shown in Table 3, when oxygen vacancy occurs the Seebeck coefficient indicates n-type conduction. The Z1 resistivity and mobility are higher in nanorods compare with Z2 & Z3 nanostructures which is related to the poorer connection between grains. In Z2 as a thin film it reduce electrical resistivity and also the boundary scattering of charge carrier. However Z3, when the nanorods surrounded by nanosheets possess the intergranular electron transport is expected to be easier than nanorod, which explains the lower value of the electric resistivity qualitatively.
\nSample | \nConduction type | \nCarrier concentration n (1019 cm−3) | \nResistivity ρ (Ω-cm) | \nMobility μ (cm−2/V-s) | \nSeebeck coefficient S (μV/K) | \nPower factor PF (μW/m.K2) | \n
---|---|---|---|---|---|---|
Z1 | \nn | \n0.05 | \n0.15 | \n81.1 | \n45 | \n13 | \n
Z2 | \nn | \n2.1 | \n0.02 | \n13.7 | \n6 | \n1.4 | \n
Z3 | \nn | \n1.5 | \n0.04 | \n11.5 | \n28 | \n22 | \n
Thermoelectric properties at room temperature.
Material selection has a significant role in the fabrication of high TE performing materials. The conducting polymers are promising to its flexible nature and favorable for the TE applications. However, most of the conducting polymers are expensive and required complex synthesis procedure to achieve high electrical conductivity [63, 64, 65]. So the efforts have to be made for finding an alternative for fabricating flexible materials of TE applications and composites have recently been appealing more consideration such as thermopower, easy process ability, cost effective, and long life span [66, 67, 68]. Similar to the previous section here also two step solvothermal method for ZnO and their composite nanostructures on cotton fabric have been employed. The fabrication process of the ZnO nanocomposite coated cotton fabric represented in the Figure 11.
\nFabrication process of the nanocomposite coated cotton fabric.
As we discussed the amine group concentration in previous session, similarly higher concentration of hexamine longer nanorods are obtained as shown in Figure 12 (Z1) and when hexamine decreases the nanorods dramatically decreases as shown in Figure 12 (Z2). However, Sb composite ZnO influences the orientation of nanorods towards the surface of the fibers. Figure 12 (SZ1 & SZ2), high density Sb/ZnO composite formed on the fiber surface with intertwining into a cluster. Figure 12 (AZ1 & AZ2) exhibits the absents of nanorods and initiate the 3D network architectures growth of nanosheets assembled with lots of interspaces/ intermesh with each other’s [69, 70].
\nMorphology image of ZnO and its composite growth layer fibers.
The UV shielding effect of ZnO and its composite have shown in Figure 13 (a), bare fabric shown poor shielding response of 6.664 and coated of above 64 which means it is excellent for UV shielding performance. Figure 13 (b) shows the thermopower of coated cotton fabric. The ZnO coated fabric depict from −36.31 to −10.53 μV/K of longer to shorter nanorods as it higher concentration to low concentration of hexamine. Thus, the longer nanorods have possibility of connect with each other’s which contribute the electron transport easier than in the other case. The ZnO growth process disrupted, while the Sb composite introduced growth towards the surface of the fiber although the thermopower increases from −135.99 to −360.49 μV/K due to Sb incorporation into the Zn site. Similarly, when Ag composite led to favor the recombined with Zn material that may cause the positive effect on the charge separation efficiency of 471.9 to 13.2.2 μV/K. It plays an important role in charge transport and intergranular crystal structure.
\n(a) UV shielding effect and (b) Thermopower of before/after coating of cotton fabric.
In this chapter, we focused on wearable thermoelectric power generator since the performance of the device is recycling wasted heat energy, lower production cost, scalability, long-lived power source, no side effects or harm, free from gas emission, easy to dispose of and reliable source of energy. Herein, we have adopted the solvothermal method for the coating ZnO and its composite with various nanostructures such as nanorods, nanosheets, nanospheres, and nanowalls. The seed creation and growth condition, the concentration of precursors, growth time, have been systematically studied. The as-synthesized fabric sample of functional properties was analyzed by field emission scanning electron microscopy, transmission electron microscopy, UV shielding properties and thermoelectric properties. Besides, two different composite (Sb and Ag) were used to study the efficiency of thermopower.
\n“Oral cancer” is a term usually used to describe oral cavity and oropharyngeal malign tumors. Oropharyngeal cancers include the regions known as buccal mucosa, hard-soft palate, and floor of mouth—gums, tonsils, and base and oral tongue remain oropharynx regions [1]. Despite this, the typical use of the term “oropharyngeal cancer” is unsuitable for this current topic due to earlier determination of “oral cancer.” Although some reverse knowledge is in the literature, incidence of pharyngeal cancers is increasing, while oral cancer is declining in the USA according to the recent LeHew et al. report [1]. In addition, they connected this issue to human papillomavirus (HPV) and how it may cause many more pharyngeal cancers than oral cancers, while heavy alcohol consumption and tobacco use also cause more oral cancer. The same author emphasized ethnicity, gender, age, and other demographic factors that influence the occurrence of pharyngeal or oral cancers [1, 2, 3, 4]. The other paper published by Yadav [2] mentioned the increase of oral or mouth cancer in young individuals, especially female individuals, and that lifestyles affect the likelihood it occurs (such as smoking or chewing tobacco, chewing betel nuts). On the other hand, lip cancer occurrence is increasing because of ozone layer loss [2].
\nThe International Agency for Research on Cancer determined 25 years ago that types HPV 16–18 had a carcinogenic effect in humans which were responsible for the huge proportion (90%) of carcinoma of the cervix. HPV 16–18 had also been an etiologic factor related to various head, neck, and also oral carcinomas [5]. Fortunately, as relatively consolatory features of HPV-related cancers, Ang et al. [6] and Yadav [2] reported that these cancers are more sensitive to the current treatment options and have higher survival rates than other different etiologic factors, such as tobacco, causing carcinomas. Some of the other etiologic factors have mostly been seen in Southern Chinese ancestry: nasopharyngeal cancer, Epstein-Barr virus (EBV) exposure, and also consumption of salted fish [7].
\nWorldwide, oral cancer cases are meanly estimated at 500,000, with nearly 389,000 new cases per year and nearly 130,000 deaths [3, 4, 8]; 45,000 oral cancer cases in the USA face nearly 8500 deaths, and in the European Union, there are nearly 66,650 new cases faced each year [1, 3]. In further information found in the literature, Sri Lanka, India, Pakistan, Bangladesh, Hungary, and France show higher rates of new cases [3]. In addition to this information, South and Southeast Asian countries such as Pakistan, India, the Philippines, and Bangladesh are 80% of the newest cases due to increasing tobacco use and alcohol consumption and especially in Malaysian betel quid chewing [7, 8, 9].
\nThe most histological type of carcinoma is squamous cell carcinoma, seen in the oral and oropharyngeal region with 90% [3, 7, 10, 11, 12, 13, 14, 15, 16, 17, 18]. The histological variants of squamous cell carcinomas are revealed in the literature to be adenosquamous, verrucous squamous, basaloid squamous, and papillary squamous cell carcinomas. In addition, carcinoma in situ is the previous form of the invasive squamous cell carcinomas. The other type of carcinoma of oropharyngeal mucosa in basal cells is seen rarely, in the oral cavity under 5%. On the other hand, there are many types of epithelial malignancies, such as mucoepidermoid carcinoma with 54%, low-grade adenocarcinoma with 17%, and adenoid cystic carcinoma with 15% mostly in hard palate minor salivary glands (60%), lips (25%), and vestibular mucosa (15%). Moreover, tumors being aggressive in any part of the body, mucosal melanomas are rarely seen in the hard palate and gingiva. Bony tumors, such as very rare cases of ameloblastic carcinoma, can be seen in the oral region [3]. Lymphomas and all aspects of sarcomas and odontogenic tumors, as those have a different etiology, are managed with different methods [17].
\nIn this chapter, detection, diagnosis, multidisciplinary management, and post-management of patients with oral cancer and improvement of their quality of life will be used, instead of oral squamous cell cancer terms.
\nPrevention of oral cancer is an essential goal worldwide; if it is not possible to achieve this, then we should detect or diagnose oral cancer in early stages to completely manage it [1]. Prevention or early diagnosis of this entity requires public awareness action and practitioner education to be skillful in identification of oropharyngeal region pathology [4, 8].
\nSeverity or aggression of a disease, usually termed in the literature as “stage,” is essential to treating it in secure conditions without any recurrence. In addition, if it features severe aspects, it needs aggressive treatment modality such as surgical eradication and a reconstruction process. In body regions wherein cancer occurs, the classifications, severity, and level determination systems differ. The most popular system evaluating cancer type and severity is the TNM system according to two recent American Joint Committee on Cancer (AJCC) editions, the seventh and eighth [13, 19], used the world over due to its simplicity and friendly aspect [3]. The eighth edition has been in use since January, 2018. Additionally, the eighth edition differs from previous editions because it has taken HPV into account as an etiological factor [19].
\nIn the head and neck region, the classification of cancer has been standardized with TNM levels or a stage grouping system and a histological aspect, meaning the histological grading of a disease [5, 20]. Oral cancers are also included in this system [3].
\nThe patients diagnosed with oral cancer early should start treatment immediately, as soon as possible, to not worsen the prognosis. At advanced stages, oral cancer (especially in stages III and IV) has a very low survival rate at 9–50% [2, 4, 14]. According to some literature, 30% of patients’ efforts to seek out or find professional help for about 3 months without any intervention to malignancy but 1 month of delaying causes stage advancing and also dramatically reduces odds of survival [4, 21].
\nDiagnoses of oral cancer have been carried out to date by using clinical, radiological, and histopathological tools. In recent years, new technological tools and biomarkers have begun promising use as tools to diagnose oral cancer early. It can be caught in stages of cancer as early as stages I and II [10]. In addition, nanotechnology has started to see its use in diagnosing oral cancer [15]. Besides this, biomarkers were suggested to be used in detecting the malign transformation potential of premalignant lesions such as oral leukoplakia [22].
\nThe other issue: public awareness about premalignant lesions and formed oral cancer is very important to prevent or to cure them without any morbidity or threat to life [3, 4, 8, 22]. Public awareness about self-inspection of the mouth tissue and individuals recognizing the appearance of oral cancer is crucial [3, 4]. Fortunately, in the literature, there are many actions taken on this topic [2, 8] that should be continued by healthcare providers; also, world governments should support healthcare providers’ works and actions [1, 4, 8, 22] because the prognosis of oral cancer is continuing to worsen survival rates due to utilizing these pathologies at advanced stages [22].
\nOral cancer has still been challenging for public health and requires significant, demanding efforts [2, 3, 7, 23, 24]. The management of oral cancer is a complex issue that requires a multidisciplinary approach, including oral and maxillofacial surgeons, oral and maxillofacial radiologists, ENT specialists, medical and radiological oncologists, prosthodontists, dentists, general surgeons, primary care clinicians (such as family medicine), physical therapy and rehabilitation specialists, dietitians, speech therapists, supportive care experts, and also pathologists or, if possible, oral and maxillofacial pathologists [2, 24, 25].
\nAfter radical, surgical, and other treatment modalities such as radiotherapy and chemotherapy—especially in stages III and IV patients—improving a patient’s quality of life is very important [7, 14, 24, 26, 27]. Besides these, if patients have more advanced surgical (and other) treatment modality, the important thing is, of course, survival. Also, the second issue is improving quality of life. In this aspect, prosthodontics, speech therapy, dental implant-supported restoration with oral and maxillofacial surgeons, and other supportive specialties such as providers like physical therapists, mental health professionals, and dietitians and applications improve a patient’s quality of life [2, 24].
\nPreventive medicine acts as a unique control for oral cancers and also charges at all-time low costs to states across the world [2, 15]. In this way, many actions can be taken by health organizations, especially by the World Health Organization in the risky geographic regions of the world [28]. Prevention of oral cancer is mainly a management of those diseases, so public awareness should be the first priority for health workers (e.g., by using media to promote fast outcomes) [3, 14]. For awareness about encountering precancerous lesions [1, 22, 28], Jeihooni et al. [9] reported that 30.4% of patients had preventable oral cancer, while 50% did not, and the remaining 19.6% of patients were unclear as to whether or not oral cancer is preventable.
\nTo prevent oral cancers, the etiological factors should be known, and measures must be taken according to those causes. Etiological factors are tobacco use, especially in individuals older than 40 years of age, alcohol consumption, betel chewing, HPV infection or carriage, dietary intakes such as salted meat consumption, poor oral hygiene, genetic predisposition, Epstein-Barr virus (EBV) infection, long-term exposure to sunlight, and immune system disease such as organ transplant recipients and HIV-infected patients, especially as it causes lip cancer [1, 3, 4, 9, 13, 14, 29, 30].
\nHPV-related oral cancers, especially oropharyngeal cancers, differ from other cause-related cancers as HPV-related cancers have been seen in young, non- or former tobacco users, nonalcoholic patients, and also patients with small T tumors but with nodal involvement (fortunately, their prognosis is more satisfactory than non-related HPV tumors). In addition, HPV-related tumors are well-defined borderline, more exophytic with smaller sizes and lymph node metastasis with dominant cystic features [19]. To prevent HPV-related oral cancers, vaccination against HPV should be performed to decrease the incidence of oropharyngeal SCC [31], whereas Owosho et al. [31] reported that HPV-related oropharyngeal cancer reached its highest rate in the year 2006 and has since started to decline but not at a statistically significant rate. In the literature, vaccination programs have primarily focused on HPV infection related to cervical cancer [1]. Thus, Center for Disease Control and Prevention (CDC) is recommending that the vaccination program for HPV-related oropharyngeal cancers should be carried out for children at ages 11–12 in two doses by health providers [31].
\nOther efforts to prevent oral cancer should be done by controlling tobacco use or reduction programs [3, 6, 7, 11, 14, 29]. Alcohol consumption should be reduced or cut off as well [3, 7, 14]. If tobacco and alcohol are used together by the same individuals, that increases the oral cancer rate and may be a dramatically worse prognosis than HPV-related cancers [3, 5, 7, 11]. Unfortunately, alcohol is related to a very risky factor for cancer occurring even in non-smoking individuals [3, 5, 7].
\nOn the other hand, improving especially rich vegetable and fruit diet intake awareness programs, physical activity-increasing programs in daily life, regular sexual education for adolescents, and oral hygiene education activities may be helpful for reducing oral cancer rates in the future [1, 14, 32]. Awareness programs and activities should be conducted by healthcare providers or governments worldwide, especially in more risky regions such as Southeast Asia. For example, images of early oral cancer can be placed on cigarette packages [4].
\nIn the risky region, or those patients that have high risk, they should be encouraged to carry out self-inspection of their oral mucosa, and if they see any mouth abnormality, they are obligated to take professional advice or treatment [4]. In addition, oral hygiene education and encouragement to improve it in individuals are key factors in preventing or early detection of oral cancer [9]. Moreover, Rahmati-Najarkolaei et al. [32] reported that awareness activities with students about risky factors decreased fear of oral cancer and also changed their attitude about knowing whether they have oral cancer. Lack of public awareness about cancer-causing factors and predictors produces diagnosis of oral cancer at stages as late as III or IV [4]. Therefore, awareness may provide early diagnosing of lesions; it reduces the cost of treatment and also reduces treatment morbidity [16, 22].
\nTo date, many strategies have experimented with community awareness in the literature, such as mass media campaigns, which have gained some success from increased public awareness [1, 3, 8]. Unfortunately, these improvements are still not enough in terms of public awareness. Nowadays, Internet-based or online connections such as social media are very popular communication tools across the whole world. For example, the online-supported education or activities for tobacco cessation counseling revealed limited success in a randomized experiment [1, 8]. Internet-based education also applied for alcohol counseling with some success gained [1]. Billboards have also not been successful in delivering improved awareness to risky populations [1]. Prevention is the main management of oral cancers, and public awareness is a key part of prevention: where, when, and how it should be done and how it is possible is not important.
\nMany types of oral lesions have malignant transformation potential, aptly named premalignant or precancerous lesions. Premalignant lesions are described by using clinical, pathological, histochemical, and also many other screening techniques for which lesions such as leukoplakia, lichen planus with oral and cutaneous form, erythroplakia, stomatitis nicotina, and submucous fibrosis are named or classified [3, 10, 15, 18, 22, 33, 34, 35]. In addition, there is less malign transformation potential in lesions such as discoid lupus erythematosus and also a lesser likelihood of malignant transformation in hereditary entities such as epidermolysis bullosa and dyskeratosis congenita [34]. For the lip cancer, there are precancerous lesions like xeroderma pigmentosum, radiodermatitis, and chronic cheilitis [18]. However, histological investigation has only produced knowledge about malignant transformation potential—named dysplasia—and has been indicated or used as a prediction of malignant changes [34]. According to the WHO’s (2005) statement, carcinoma in situ has the highest degree of dysplasia and is also defined as a premalignant lesion [3, 10, 34]. Premalignant lesions are usually clinically screened for mouth mucosa such as white, red, or red-white mixed patches and are also called leukoplakia or erythroplakia [34, 35].
\nEarly detection of premalignant lesions and also cancer lesions is a crucial issue for the head and neck region, as the late diagnosing rate of 60% worldwide causes huge surgical and oncological interventions or low survival rate [14, 15, 36]. To date, there are many clinical, histopathological, radiological, and optical techniques to diagnose or capture precancerous and oral cancer lesions, such as vital tissue staining (toluidine blue stain), exfoliative cytology, OralCDx (OralCDx Laboratories, Suffern, NY) or Orcellex® (Rovers Medical Devices, BV, the Netherlands), brush cytology, and cell markers or biomarkers. There are also many new developments of novel real-time in vivo imaging and spectroscopy-based devices: high-resolution microendoscopy (HRME), autofluorescence imaging (AFI), targeted fluorescence imaging (TFI), and optical coherence tomography (OCT); also, there are other optical visualization methods such as ViziLite Plus with Orascoptic DK (Orascoptic, a Kerr Company, Middleton, Wis.), VELscope™ (Visually Enhanced Lesion Scope, LED Dental, White Rock, British Columbia, Canada), Microlux DL (AdDent, Danbury, Conn.), ViziLite (Zila Pharmaceuticals), TBlue (Zila Pharmaceuticals, Phoenix), Raman spectroscopy (RS), elastic scattering spectroscopy (ESS), narrowband imaging (NBI), diffuse reflectance spectroscopy (DRS), and confocal reflectance microscopy (CRM) in addition to normal biopsy of the tissue with histopathological investigation [12, 15, 16, 28, 34, 35, 36, 37, 38].
\nThese techniques are local detectors of lesions. Besides these, oral cancer may spread regionally and may also have distant metastasis. For instance, to make stage determining and treatment strategies for lesions, imaging systems as computed tomography (CT), magnetic resonance imaging (MRI), cone beam computerized tomography (CBCT), and positron emission tomography (PET) can be useful to scan the head and neck region for regional spread of oral cancer [15]. These techniques are divided into two categories, as either lesion detection or lesion assessment. Whether these tests have been tested across several works, however, remains questionable [37].
\nToluidine blue stain is a metachromatic thiazine material that binds to DNA in alcohol and water. Toluidine blue (TB) is a member of the thiazine group of metachromatic dyes, which binds to DNA and is partially soluble both in water and in alcohol. Theoretically, dysplastic and malignant cells have higher nucleic acid content; hence, it is stained with dyes that can be identified under the microscope due to nucleic acid and have been used since 1980 [34]. Toluidine blue stain, ViziLite, and VEL scope sensitivity and specificity in oral dysplasia patients are presented by Awan et al. [37] to be 84.1 and 77.3%, 15.3 and 27.8%, and 65.8 and 56.8%, respectively.
\nExfoliative cytology procures cells from a wide surface area of the affected tissue with fewer invasive effects on the tissue than biopsy. It also involves a lower contamination risk prior to DNA obtaining than surgical intervention [5]. Exfoliative cytology is obtained by scrapping the mucosa lesion using a blade as tongue blade. The obtained material is spread on a dry, clean glass lam and fixed with 100% ethanol. The lam is then sent to an experienced pathologist for examination under a light microscope for dysplastic evidences in the cells [35]. In addition, serum and saliva are the most commonly used as less invasive, easily accessible, cost-effective, and convenient samples for cancer detection [15]. The sensitivity and specificity of exfoliative cytology for oral cancer detection were revealed as 93.5 and 50.6%, respectively [15]. Although exfoliative cytology is less invasive, it is highly subjective and dependent upon the expertise of examiners. Moreover, exfoliative cytology related to the DNA aneuploidy and quantitative cytomorphometry has low specificity due to the collection of disassembled cells [15]. If the exfoliative cytology is used on heavy smoker and alcohol-using patients with negative malignancy findings, a biopsy procedure should be carried out as an additional supportive test [22].
\nOralCDx or Orcellex® brush cytology is a bit advanced for complementary forms of the exfoliative cytology, due to it including representative cells of all layers of epithelial tissue [34, 38]. Moreover, brush cytology has provided diagnostic accuracy because of computer assistance screening [34, 38]. Studies demonstrated that OralCDx or Orcellex® cytology has a potential value as an adjunct to oral diagnosing or screening in identifying premalignant pathologies at early stages that provides surgical or curative treatment that is most effective [39]. In the future, developing automatic, cytometric, or cytomorphometric techniques combined with genetic and related features may enhance screening strategies [34]. Affecting tissue with any pathology sample technique is still recommended if there is a strong suspicion of any lesion with malignancy regardless of the oral brush cytology result [34].
\nBiological, chemical, or reactional molecular agents named cell markers and biomarkers mean that signs of living organisms and the obviousness of their availability as tumor necrosis factor-alpha (TNF-α), epithelial growth factor (EGFR), vascular endothelial growth factor (VEGF), IL-8 and IL-8 mRNA, and interleukin 6 (IL-6) [10, 15]. Biomarker investigation of abnormalities of oral tissues as normal, tumorous, and inflammatory keratinocyte proteomes is likely to find new biomarker agents for oral cancer diagnosis, treatment, follow-up, and the development of personalized therapies for oral cancer and other tumorous regions [16].
\nThe most visible oral premalignant or precancerous lesion is oral leukoplakia (OL) that has been studied for its establishment of a biomarker that signals the malign transformation of OL [22]. For instance, OL has low prevalence in western countries, so the development of a new biomarker is challenging due to the low rate of malignant transformation, and it requires long follow-up periods to achieve a new biomarker [22]. Besides these, loss of heterozygosity (LOH) was described as the strongest and most valuable biomarker by Mao et al. at the end of the twentieth century. They reported that OL housing LOH at 3p14 or 9p21 was related to the 37% chance of developing invasive cancer compared with only 6% in lesions without these biomarkers [22]. Dysplasia is a very important sign of OL malign transformation; however, it does not mean that it will transform into a malign lesion, such as an oral squamous cell carcinoma lesion. Detecting or signaling oral leukoplakia malignant-transforming biomarkers is crucial in the future. Chemoprevention actions or works using retinoid evoked unique prospective gathering of biodata that led to the development of biomarkers [22]. Evidence-based studies showed that a visual examination of oral regions may be a cost-effective screening model, and finding adjunct auxiliaries and biomarkers is becoming more popular [28].
\nHence, if the environmental conditions could be changed, oral leukoplakia may be reversible even with advanced dysplasia, which does not change into any malign lesion such as OSCC [22]. However, the existence of dysplasia is often the important criterion that affects clinical treatment of oral leukoplakia [22].
\nMicroendoscopy (HRME) is a novel in vivo optical imaging and spectroscopy-based tool that has the content to provide an early diagnosis of cancer in real time. This tool is a cost-effective and noninvasive technique for point-of-care detection of premalignant and cancer in body regions including the oral cavity and hypopharynx. The HRME technique provides direct screening of malignant indicators such as nuclear crowding, pleomorphism, and elevated nuclear-to-cytoplasmic area ratio. This technique has almost identical possibility with cytology and invasive biopsy procedures. The HRME technique therefore has a promising development in the future [36, 40].
\nThe ViziLite system, as an oral optical lumenoscopy technique alone or in combination with other techniques mentioned above, has been used successfully in the last decade. The US Food and Drug Administration has received a combination of both ViziLite and TB systems (ViziLite Plus with TBlue System; Zila, Batesville, AR, USA), as an adjunct to visual screening of the oral cavity. This combined technique for detecting or diagnosing premalignant or cancerous lesions provides almost the same level of outcome that invasive method biopsy and histopathological investigation provide [15, 22, 34, 37].
\nVELscope™ (LED Dental, White Rock, British Columbia, Canada) is noninvasive and directly screens the changes of tissue autofluorescence characteristic screening tools in the oral cavity [12, 22]. It uses blue light between 400 and 460 nm wavelengths to influence the endogenous fluorophores. Because of its simplicity, it does not require any special training on the system and can be used in daily general subspecialty practice. Farah et al. [41] reported that VELscope™ screening did not provide a definitive diagnosis on the existence of epithelial dysplasia, so VELscope™ is not reliable for detecting epithelial dysplasia without clinical examination. In contrast to the Farah et al. [41] report, the other study carried out by Awan et al. [42] reported that VELscope™ is useful in confirming the existence of erythroplakia, oral leukoplakia, and other soft tissue diseases, but it cannot discriminate between low-risk and high-risk pathologies [34].
\nRaman spectroscopy (RS), a common optical diagnostic technique, works with vibrational spectroscopies that discriminate normal mucosa and malignant pathologies by reflecting variables within tissues and returning optical signals [15]. However, this optical tool’s original yet subjective finding outcomes depend on the practitioners’ evaluation experience [15]. Stone et al. [43] first applied the Raman spectroscopy in the head and neck region in 2000 to investigate the laryngeal mucosa by comparing with normal biopsy procedures in 15 patients. According to this study, RS produced a specificity of 90 and 92% sensitivity for detecting squamous cell carcinoma [43]. We may thus conclude that the RS technique is useful for daily practice.
\nEarly diagnosis, a crucial issue as mentioned above, is very easy, but across the world, oral cancer is being detected in late stage due to its subtlety in early stage [3]. The routine management of oral cancer is first surgical resection, with or without postoperative adjuncts and other therapies used as part of postoperative chemoradiation and radiation. This approach of combining multiple treatments has increased survival rates in the last decade.
\nSuccessful treatment of oral cancer patients is a complex issue that requires multidisciplinary approaches, including oral and maxillofacial surgeons, oral and maxillofacial radiologists, ENT specialists, medical and radiological oncologists, prosthodontists, dentists, general surgeons, primary care clinicians (such as family medicine), physical therapy and rehabilitation specialists, dietitians, speech therapists, supportive care experts, and also pathologists or, if possible, oral and maxillofacial pathologists [2, 3, 24, 25]. In addition, multidisciplinary approaches to oral cancer patients allow for the maximization of reliable oncologic control and also minimize morbidities such as patient function and form [3].
\nEarly diagnosis of oral cancer is vital for a patient’s survival rate and also for future quality of life. In addition, a dentist has an important role in initial diagnosing of any pathology in the oral region because of daily oral health practice [2, 14, 43]. So, any ignorance on behalf of dentists’ education and daily practice is a crucial phenomenon for detecting any lesions in early phase. If a dentist has detected any abnormality of oral tissue in an emergency situation, he or she should perform a biopsy procedure or immediately refer the patients to advanced specialties such as oral and maxillofacial surgeons, otolaryngologists, or advanced oncological-trained oral and maxillofacial surgeons, if it is possible [2, 14].
\nIn a majority of world regions, the oral and maxillofacial surgery specialty is based on dentistry education and is concerned with diagnosis, medical and surgical, and advanced treatment of disease, disorders, injuries, and malformation, including the functional and esthetic features of the oral and maxillofacial region’s soft and hard tissues and related neighboring structures [2]. Oral and maxillofacial surgeons take part in the biopsy, which checks whether it is a true- or false-positive diagnosis; advanced radiological imaging is required to investigate in this stage of pathology. In addition, they surgically treat precancerous lesions and also take part in the treatment of early-stage cancer.
\nA case with a 67-year-old male patient was referred to an experienced oral and maxillofacial surgeon and diagnosed with oral leukoplakia. The patient was treated with a diode laser using evaporation mode. According to the follow-up period, no recurrence has been revealed with the patient in healthy oral condition (Figures 1 and 2).
\n. Prelaser treatment of oral leukoplakia (Case 1 patient).
. Postoperative laser treatment view of oral leukoplakia (Case 1 patient).
If the OMF surgeon has not accrued enough experience for more extensive pathology, he or she should refer patients to trained or sufficiently experienced head and neck surgeons such as an oral and maxillofacial surgeon, ear nose throat surgeon, general surgeon, or a plastic surgeon; plastic surgeons and oral and maxillofacial surgeons have a duty to perform pre-prosthetic surgery, revision surgery, and also dental and oral and maxillofacial implants to rehabilitate the oral cavity for speech improvement, swallowing, mastication, and esthetic appearance. In addition, oral and maxillofacial surgeons promote maxillofacial prosthodontists for the construction of maxillofacial and oral prosthesis [2].
\nOral and maxillofacial oncology training was part of a related oral and maxillofacial surgery residency program for about 3–4 years, following the 5–6 years for a basic dentistry degree. In addition, these specially trained people take an additional 1 or 2 years’ oncological surgery training for cancer surgery and rehabilitation and reconstruction surgery such as regional vascular flap reconstruction, e.g., a pectoralis major flap with five to six costal grafts, a latissimus dorsi muscular flap with scapular graft, and other regional soft and hard tissue vascular flaps to reconstruct mandibular and maxillary resection defects are used. In addition, distant vascular-free flaps such as perineal musculocutaneous with fibula and an anterior radial forearm flap are used to reconstruct maxillary and mandibular oncologic resected defects by oral and maxillofacial oncologic program surgeons. On the other hand, the oncologic oral and maxillofacial surgeon training program includes core rotations on resection and reconstruction surgery, medical oncology, and radiation oncology. They also carry out duties like educating others in the dental profession on cancer screening and management. They take part in the oncological multidisciplinary team, including pathologists, radiologists, ENT specialists, and other professions [2].
\nThe transoral access is a common surgical approach to precancerous pathologies and superficial cancers of anterior portions of the mouth, tongue, and alveolus. In the posterior region of the mouth, an invasive approach is needed, especially if there is a limitation due to inadequate surgical view and trismus. Median lip-split paramedian mandibulotomy access is used for tumor management of the posterior mouth region. In addition, midfacial degloving and upper cheek access are typically useful for maxillary tumors [3].
\nNeck dissection is a very important part of oral cancer surgical management. Fortunately, 60% of cases with an early-stage tumor have clinically negative neck metastasis. Unfortunately, nearly 20–30% of entities have microscopically prominent neck nodal metastasis according to elective neck dissection (END). Nodal metastasis risk occurs for several reasons. One, cervical lymph node metastasis can reduce the survival rate by 50% when compared with similar primary tumors, excepting cervical or other regions. Tongue cancer on the mouth floor is more likely to advance into the neck lymph node; thus, these cases should require elective neck dissection, even if they are in an early stage.
\nThe maxillary gum and hard palate have relatively lower chances of neck metastasis occurring, and if this is determined to be the case, there is no need for END to be indicated [3].
\nIsolated node biopsy is an adjunct alternative to END for determining the stage of a cN0 neck in the T1–T2 stage of SCCOC [3, 44]. This method was first carried out in 2001 by Shoaib et al. [44], and it has been used by several other studies in Europe and the USA. However, this technique requires experienced practitioners to be able to carry out the procedure. It should therefore be done in select centers with experienced doctors [3].
\nIf patients are clinically or radiographically determined to have positive neck nodes, a comprehensive neck dissection should be done involving level I to V dissection. The requirement to sacrifice important structures like the sternocleidomastoid muscle, spinal accessory nerve, and internal jugular vein depends on the location of the nodal metastasis and its features [44]. A common type of wide neck dissection is the modified radical neck dissection, named MRND type 1. MRND, as a treatment choice, is a rarely selected option due to direct infiltration of the gross extranodal structures [3]. A patient with clinically negative neck node metastasis has metastasis risk mainly throughout levels I to III. Therefore, supraomohyoid neck dissection (SOHND) is usually enough for these diseases. However, patients with primary tongue squamous cell carcinoma require neck dissection level IV and may be obligated due to the likelihood of skip metastasis [3].
\nOral pathologists and oral medicine specialists also play key roles in oral cancer prevention, diagnosing, early management, and follow-up procedures. They perform the biopsy procedures in oral pathologies that identify lesions; hence, strategies are formed for the management process of the detected lesion [2].
\nMaxillofacial prosthodontists take part in key positions in management specifically to restore the function of jaws and maxillofacial tissue after tumor eradication. To improve the patients’ psychological condition, they replace the functional and cosmetic defects with prosthetic construction carried out by prosthodontics in the maxillofacial region [2].
\nCase 2 features a 78-year-old male patient who underwent total maxillectomy due to squamous cell carcinoma. With an oral and maxillofacial surgeon’s guidance, to improve the life quality of the patient, the maxillomandibular dentures were constructed by an experienced prosthodontist. The patient is chewing and eating smoothly, and he is still under the control period in uneventful condition (Figures 3, 4, 5).
\n. Prereconstruction dentures’ view of Case 2 patient’s oral structures after a maxillary cancer operation.
. Maxillomandibular dentures’ view of Case 2 patient.
. The appearance of prosthetic dentures placed in Case 2 patient.
The authors of this chapter thank IntechOpen for providing a unique opportunity to contribute to the book Oral Cancer.
\nThe authors of this manuscript declare that they have no conflict of interest.
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