Human PRL prohormone amino acid sequence (position 1–227) and mature PRL (position 29–227). The signal peptide is position 1-28 in the bold letters.
\r\n\tThe WHO classification in 2007; was based on the histogenesis and cell origin of the tumor. In the latest classification made in 2016; to better characterize the tumor and obtain better data on its prognosis; The combination of molecular and genetic biomarkers and histopathological features of the tumor was used. Despite all current treatment approaches, the median survival time is around 12 months in most GBM patients. Compared with the situation of some types of successfully treated cancers; the survival time of GBM patients is not at an acceptable level today. In the treatment of CNS tumors; surgery, chemotherapy, and radiation treatments (x-rays, gamma rays, electron and proton beams) are used. The therapeutic potential of chemotherapy; New strategies are needed to increase drug concentration at the diseased site, as this largely depends on the ability of the chemotherapeutic agent to achieve effective concentrations at tumor localization. Based on our better understanding of the genetic and molecular characteristics of CNS tumors; Targeted therapies, including vaccines, and treatment protocols such as immunotherapy are promising developments.
\r\n\r\n\tThis book supposes to be written by many authors who have an internationally honored place in their field to share their ideas about the treatment of CNS tumors. Surgery, Radiotherapy, Chemotherapy and Antiangiogenic Therapy Protocols, Immunotherapy, Molecular Therapy, Specific target-agents therapy with Nanoparticles and Gene Therapy for CNS tumors among the book chapters.
\r\n\tIn these sections; there are many practical pieces of information that can help the students who graduated from the Medicine Faculty and specialist doctors who are interested in Neurosurgery.
For centuries, the inguinal hernias have played an important role in the surgical literature and continue to preserve this feature today. With many procedures, inguinal hernia interventions continue to be the most common general surgery operations worldwide and approximately 2 million people are operated for inguinal hernia every year. There are many techniques described on the surgical treatment of inguinal hernias. There is no other example of disease preoccupied in the surgical literature. Existence of the postoperative complications suggests that we have not found the ideal treatment option yet because a wide variety of techniques have been described and most of the surgeons engaged in this procedure have completed learning curves a long time ago. In 1984, about hernia, Sir Astley Paston Cooper says: “No disease from the human body, belonging to the surgeon, demands in its treatment, a better mixture of precise, anatomical knowledge along with surgical skill, compared to hernia in most of its variations”. In this chapter, the details and results of two laparoscopic techniques, which have become common in inguinal hernia treatment today, are evaluated in detail.
\nThe incidence of inguinal hernia varies according to age and sex. There is a bi-modal distribution in males and it increases in the first year of life and in older ages. The rate of 15% in the second decade increases with age and reaches 47% in the seventh decade. In females, this rate is 3% for life. There is a significant difference between the male/female ratio and is reported as 1:15. Although the majority of the inguinal hernia patients do not face great problems in resuscitating their lives, the incidence of general incidence and emergency case incidence (incarceration-strangulation) increases with age [1].
\nInguinal hernias are classified as direct or indirect inguinal hernia according to their mechanism and anatomical characteristics. Indirect inguinal hernias are the most common subtype and the risk of strangulation is much higher compared to direct hernias. In the case of strangulation, it is also necessary to mention that the femoral hernias head to this issue. Femoral hernias, which are found in 70% of women and generally settled in the principle of “should be fixed when they are detected”, due to the risk of strangulation, have not been included in this section [2].
\nWhen the side is concerned, it is a fact that all inguinal hernias are seen more on the right side. One of the theories developed to explain this is that there is anatomically protective effect of the sigmoid colon present on the left side and delayed atrophy of the processus vaginalis due to the slower descent of the scrotum on the right side during embryological development.
\nThe word “hernia” came from the Latin word “rupture” and was described as a disease in the first fifteenth century in papyrus. The idea of repairing surgery came out between fifteenth and seventeenth centuries although the inguinal region anatomy has been described in detail by Hesselbach, Cooper, Camper, Scarpa and Gimbernat during eighteenth and nineteenth centuries. In the twentieth century, “tension-free repairs” started to be proposed and in the last 25 years, parallel to technological developments, videoscopic repairs became widespread. As a result of this development, surgical procedures have now become the standard procedure for “strengthening the abdominal wall in the transverse fascia plan” and are accepted all over the world [3].
\nThe idea of laparoscopic repair was first alleged by Ger in 1982 by the collapse of the internal loop. In 1990, Schultz used transperitoneal plugs and developed the intraperitoneal onlay mesh (IPOM) technique, which was performed in the same year by patching the Fitzgibbons peritoneum. Transabdominal preperitoneal (TAPP) patch application was first performed by Leroy in 1990. Then in 1991 Dulucq and in 1992 McKernan introduced total extraperitoneal (TEP) intervention [4].
\nIn the inguinal region, four different types of hernia—indirect, direct, femoral and obturator—can develop. One of the most important advantages of the posterior approach is the ability to reveal the entirety of hernia types. There are median, medial and lateral ligaments in the anterior wall of the abdomen after fetal period, followed by urachus obliteration, umbilical artery obliteration and inferior epigastric vessels, respectively. In addition, there are iliopubic tractus, pectineal ligament (Cooper) and lacunar ligament in pubic region, pubic tubercule, spina iliaca anterior superior (SIAS) and superior pubic ramus bones [5].
\nThere are two potential gaps in the preperitoneum. The “Bogros gap” is located between the transverse fascia and the peritoneum. Preperitoneal fatty tissue and porous connective tissue fill this area. The medial part of the preperitoneal cavity on the bladder is known as the “Retzius cavity”. The posterior view angle allows examination of the myofektineal orifice, which is a relatively weak part of the abdominal wall and is divided by the inguinal ligament [6].
\nThe external iliac vessels are anastomosed with the inferior epigastric vessels and the superior epigastric vessels. They supply the abdominal wall and penetrate the rectus abdominus through the cranial route within the vagina musculature rectus. Posteriorly inspected anulus inguinalis profundus will reveal the deep location of inferior epigastric vessels. In addition, the aberrant obturator arteries formed by the anastomosis of the pubic ramus of the epigastric artery with the obturator artery, known as “Corona Mortis”, constitute the basis of the death triangle. The medial side of this triangle is vas deferens, the lateral side is the spermatic cord and the posterior border is the peritoneal margin.
\nThe inferolateral border of the iliopubic tract, the superomedial border of the gonadal vessels and the lateral border of the peritoneal catheter is defined as the area of the pain triangle and the intermediate cutaneous branches of the lateral femoral cutaneous nerve, the femoral branch of the genitofemoral nerve and the anterior branch of the femoral nerve contain posterior anatomical approach.
\nWe performed laparoscopic inguinal hernia surgery in 163 patients between January 2017 and 2018 in our clinic. Laparoscopic hernia repair was recommended to patients who are suitable for general anesthesia, had no previous abdominal surgery or incarceration or strangulated hernia or without acute mechanical intestinal obstruction. In terms of learning curve, TAPP was performed on first 50 cases and TEP on the following cases. A total of 155 (95%) patients were male and 8 (5%) were female. A total of 51 patients received TAPP (31.2%) and 112 patients (68.7%) received TEP. Eight patients who underwent TAPP (15.6%) were operated for recurrence. Thirteen patients (25.4%) underwent bilateral repair while three (5.8%) patients underwent the same session umbilical hernia repair. The groups were evaluated in terms of operation time, pain scores, recurrence rates, duration of hospitalization and return to daily activity and complication rates. TAPP average operation time is 58 min while in bilateral cases this duration is 72 min. The duration of operation of recurrent cases was 59 min average and there was no significant difference between these patients and the primary cases. A total of 112 patients were treated with TEP technique. Nineteen patients (16.9%) were operated for recurrent hernia, and 14 patients (12.5%) underwent bilateral repair. In three patients (2.6%), the same session umbilical hernia repair was also performed. Average duration of TEP is 47 min while in bilateral cases this duration is observed as elongated, 56 min. The duration of operation in recurrent cases was 56 min and there was no significant difference between these patients and the primary cases. The hospital stay was measured as 1.2 days for TAPP and 1.1 days for TEP, and no significant difference was found between the groups. It was also found that the pain scores between the two groups were similar as 3.2 and 2.9 for TAPP and TEP, respectively. The time to return to the daily activity for TAPP was 5.6 days and for TEP was 5.3 days and no significant difference was found between the two groups. As a complication, seroma in four patients (2.4%), recurrent hernia in two patients (1.2%) and chronic persistent pain in six patients (3.6%) occurred. Patients with recurrence were reoperated. Five patients with chronic persistent pain were treated with medical therapy within 6 months, and one patient with osteitis pubis was detected and curettage was performed by orthopedics clinic. In our study, no significant difference in recurrence, return duration to work, pain score, duration of hospitalization and postoperative complication were detected between the groups.
\nThe use of laparoscopic methods for inguinal hernia surgery is advanced minimal invasive surgery with less tissue trauma, less postoperative pain, lower postoperative infection risk and faster postoperative recovery. It is possible to combine positive effects such as faster return to work and better cosmetic results. As with all surgical techniques, minimally invasive techniques also have advantages. Compared to open surgery, some disadvantages of inguinal hernia surgery are the initial operation time and the long learning curve. Also, the cost is relatively high. In addition, unlike open surgery, the lack of sense of depth in the image, that is, the operation with the 2D image requires the surgeon to dominate the inguinal region anatomy at a high level. Instead of cost problem, by time, the integration of the learning curve and the increase in the experience reduce most of the problems.
\nThere are two main techniques when laparoscopic inguinal hernia repair is concerned. These are defined as transabdominal preperitoneal approach (TAPP) and total extraperitoneal approach (TEP). According to the International Endohernia Group’s 2011 Guidelines, revised in 2015, TAPP and TEP have become the preferred repair techniques for the Lichtenstein technique, especially after hernia recurs by open pre-repair [7].
\nIt is stated that TAPP is the first method to be learned because it is applicable in all inguinal region hernia types. As an advantage of the intraabdominal approach, the posterior wall anatomy can be better dominated, so proper and adequate parietalization can be made more comfortable. Compared to TEP, the cost is lower and the learning curve is shorter. TAPP is a highly successful method for both incarcerated and scrotal hernias. Due to intraabdominal vision, providing a wide field of view study is one of its greatest advantages and is a method that can be used in laparoscopically repaired recurrent hernias.
\nThe opposite side of the surgical field and both legs are in closed position. In bilateral hernia repair, both arms are in closed position. The videomonitor laparoscopy tower is placed on the patient’s foot, on the side to be operated. The operator can be placed on the opposite side of the area to be operated and the camera assistant can be placed on the same side or opposite side of the surgeon depending on the experience and habits of the team. We prefer the camera assistant to sit on the same side of the surgeon (Figure 1).
\nOperating room: The surgeon and camera assistant placed on the opposite side of the surgical area.
\n
Standard laparoscopic equipment consisting of camera, monitor, light and bag
10 mm diameter and 30° angle camera
One 10 mm and two 5 mm in diameter totally 3 trocars
Veress needle
Endoinstruments (Atraumatic pens, dissector, scissors, hook, acutenaculum, aspirator)
5 mm diameter vessel sealing device
15 × 15 cm polypropylene or polyester special shaped patch
Fixing material for mesh detection and peritoneal closure (mechanical stapler, tissue adhesive or non-absorbable suture material) (Figure 2).
Surgical instruments for TAPP procedure.
A single dose of 1 g second-generation cephalosporin as prophylactic antibiotic is injected half an hour before the onset of operation. The patient should urinate before operation and preoperative fluid resuscitation should be kept to a minimum. Before the operation, the patient is scrubbed and covered in the supine position for sterility. Under general anesthesia, by Hasson technique or with Veress needle which is placed in the infraumbilical region, produces caphno pneumoperitoneum. General intraabdominal exploration is completed with a 10 mm trocar inserted in the infraumbilical region. The operating table position is kept (30° Trendelenburg and 15°–20°opposite to the operating area). Two operating ports (5 mms) are placed on the umbilical level transverse line, with the lateral sides of both rectus muscles localized and placed under direct vision. The trocars on the operative side are placed on infraumbilical transverse line, while the opposite trocar is placed 4–5 cm caudal side on this line (Figure 3). In bilateral hernias, it is suggested that both trocars to be placed on the transverse line at the same level.
\nTrocar placement for TAPP procedure.
As the trocar placements are complete, the inguinal area is examined with care. The hernia type is detected and the content—if present—of the hernia is carefully reduced to origin with atraumatic clamp. If there are elements such as intestine or omentum in the hernia sac, the vitability of intestine or omentum is checked after reducement.
\nThe preparation of the peritoneal flap starts on approximately 5 cm above the hernia canal at the level of the anterior superior crista iliaca on the upper outer side of the annulus inguinalis. The incision is advanced to the medial side of the transverse plane through the upper 5 cm of the inguinal canal’s inner ring and terminated at approximately 2 cm to median ligament.
\nThe peritoneal incision can be done with endoscissors or hooks. Rest of the peritoneal flap on the inguinal canal inner ring can be easily disrupted with the help of intraabdominal CO2 pressure, stretched with endograsper. Peritoneal dissection, below the inguinal canal inner ring, is a little more difficult. The lower peritoneal flap is liberated until lateral visualization of the iliopubic tract, and medial visualization of the Cooper ligament. The hernia sac is carefully dissected from the spermatic cord and elements that are attached through the lower peritoneal membrane (Figure 4). The peritoneal upper and lower flaps are dissected in each direction to provide large parietalization and vision of myopectineal orifice. Thus, enough space is available to lay a mesh on probable direct, indirect and femoral herniation defect sources. If bilateral hernias are present, the peritoneal incision can be extended from one side of the crista iliaca to the other side of the crista iliaca, but in the literature it is suggested that a single incision should be made and a peritoneal bridge could be released in the midline.
\nAnatomic details of left inguinal region after peritoneal flap preparation.
Special shaped polypropylene or polyester patches prepared in size appropriate to the anatomical characteristics of the hernia of the patient are used. The patch is rolled from the outside to the inside and from top to bottom in the form of a roll with limb or without limb (Figure 5). It is placed into the abdomen through a 10 mm trocar. With the help of two endograspers, placed in the working ports, the roll is unfolded in the opposite direction and is laid to cover the existing hernia defect and potential hernia sources. Also, it must be ensured that the patch is placed with a proper tension. When a limb patch is applied the lower limb is passed under the spermatic cord and it is wrapped in a tie and is joined laterally with the upper limb again. The location and number of staples is very important for the immobilization of the mesh patch. The basic rule—with different suggestions about this—is that the staples must be placed on the ileo-pubic tract. We prefer to fix it with two absorbable staples totally, one medially to the Cooper ligament and one to the back of the transverse fascia (Figure 6). Tissue adhesives or absorbable suture materials may also be used for detection.
\nMesh preparation.
After mesh fixation in TAPP procedure.
After the integration of fixation, the upper and lower leaves of the peritoneum are covered on the patch and the opposite edges are closed with either continuous stitches or with clips. Closing the peritoneum with stitches is more convenient but requires more time and experience. The hernia sac, which is usually left in the lower peritoneal sheet and reduced into the peritoneum, can be left if it is small, also the larger sacs can be partially resected before closing the peritoneal leaves. According to experience and preference, a drain can be placed behind the peritoneal flap. After the peritoneum is closed, 5 mm ports are removed under direct vision and the operation is terminated.
\nOral intake can be started a few hours after surgery and the patient is mobilized the same evening. The following day the patient can be discharged by removal of the drain. There is no need to regulate postoperative medical treatment other than oral analgesics.
\nDespite discussions about the use of laparoscopy in the repair of primary unilateral groin hernias, the superiority of TEP in bilateral or recurrent hernias is accepted. The major advantages of this method are that it is extraperitoneal and there is no break in peritoneum. The dominance of the anatomy of the posterior wall is not as good as TAPP, but sufficient parietalization is possible with TEP. Nowadays it becomes the first choice especially for athletes both men and women.
\nThe opposite side of the surgical field and both legs are in closed position. In bilateral hernia repair, both arms are in closed position. The videomonitor laparoscopy tower is placed on the patient’s foot, on the side to be operated. The operator can be placed on the opposite side of the area to be operated and the camera assistant can be placed on the same side or opposite side of the surgeon depending on the experience and habits of the team. We prefer the camera assistant to sit on the same side of the surgeon.
\nStandard laparoscopic equipment consisting of a camera, a monitor, a light and an insuflator
10 mm diameter balloon trocar
Laparoscope with a diameter of 10 mm and a 30° angle
A 10 mm, two 5 mm diameter, totally 3 trocars
Atraumatic clamps, endodissectors, endoscissors, endohooks, endoclapms, endoaspirators
5 mm diameter vessel sealing device
15 × 15 cm polypropylene or polyester special shaped patch
Fixation material (mechanical staple or tissue adhesive)
A single dose of 1 g second-generation cephalosporin as prophylactic antibiotic is injected half an hour before the onset of operation. The patient should urinate before operation and pre-operatory fluid resuscitation should be kept to a minimum. With general anesthesia, the operation starts in supine position. In method of TEP, the patient should be wider painted than the TAPP technique, from the nipple to the perineum. Infraumbilical, slightly lateralized incision is made on the hernia side and then the rectus sheath is opened by transverse incision. Rectus fibers are removed with Farabeuf retractor and blunt dissection is performed to reach the Bogros area. A tunnel is made between umbilicus to pubis. In front of this tunnel, there is a parietal peritoneum from the back of the rectus muscle and from the end of this fascia to the transverse course of the linea semilunaris. After blunt dissection and cannula is completely inserted from the preperitoneal tunnel to the pubis, it is removed from the trocar cannula and replaced with a telescope, and the cannula is inflated with a balloon attached to the mandrel. Air is discharged 20–25 times with puar after waiting for 30 s and this process is repeated three times. With some balloons, it is possible to view inside with scope as it inflates. It can also be monitored whether the definite surgical area is viewed during this observation. Upper view of rectus fibrils and lower view of parietal peritoneum indicates the right position. A 10 mm trocar is placed in the infraumbilical incision to prevent gas leakage and the telescope is placed. The preperitoneal space is inflated with 10–12 mmHg CO2. Two 5 mm ports are placed at a distance of 5 cm from the midline in direct view (Figure 7).
\nTrocar placement for TEP procedure.
After the 30° camera is inserted, the inferior epigastric artery and vein are observed along the bottom of the rectus muscle. The parietal peritoneum is dissected in the medial and lateral directions to remain underneath. The Cooper ligament is visible in the inferomedial area and it is removed. The lateral aspect of the rectus is up to the border of the crista iliaca and the fascia transversalis is opened with blunt and sharp dissections posteriorly. The potential hernia areas are examined and the hernia type is determined (Figure 8). In the indirect inguinal hernia, the hernia sac is found adhered to the spermatic cord. The hernia sac should be dissected from the pubic tuberculum to the level of the external iliac vein. Large scrotal or indirect hernia may be released by Zig technique if it is confirmed that the hernia sac does not contain omentum or intestinal contents. The anatomic regions described as Femoral and Hasselbach triangles should be examined in terms of direct and femoral hernia that may be accompanied. The ililopubic tract must be detected not to injure the femoral and lateral femoral cutaneous nerves of the underlying genitofemoral nerve. The lateral dissection does not need to be as wide as the TAPP technique. The hernia sac should be gently released and reduced from the spermatic cord and cremaster fibers. If the peritoneum is wounded during the dissection procedure, the defect can be closed with a clip. If gas insufflation flows through the gap to the peritoneal defect, the enlarged abdomen will restrict the area of dissection. In order to prevent this, intraperitoneal air could be taken out from the upper left quadrant of the midclavicular line through the abdominal cavity (Palmer’s point) with Veress needle. The valve is left open, the evacuation of the gas is provided and the operation can be continued.
\nPotential hernia areas for TEP procedure.
Special shaped 15 × 15 cm polypropylene or polyester patch can be used according to the anatomy of the patient. The patch can be prepared with limb or without limb. It is rolled up from the top and laid to the extraperitoneal space by the 10 mm camera trocars. With the help of two endograspers placed in the working ports, the patch is unfolded in the opposite direction and is laid to cover the existing hernia defect and potential hernia areas. It should be ensured that the area where the patch is applied covers it with a proper tension. When a limb patch is applied, the lower limb is passed under the spermatic cord and it is wrapped in a tie and is laterally joined to the lower limb (Figure 9). The lower edge of the patch is placed so that it remains at least 2 cm above the released hernia sheath. The locations and numbers are very important if the absorbable staple is preferred for the detection of the mesh. The basic rule, with different suggestions about this, is that the mesh must be placed on the ileo-pubic tract. We prefer to fix it with a total of two absorptive staples, one medially to the Cooper ligament and one to the back of the transverse fascia laterally. On the lateral edge of the spermatic cord there are anatomical areas defined as the triangle of pain mentioned above and the death triangle at the medial border. Staples must be avoided in these areas. Tissue adhesives have also been used today as fixing material. The use of drains varies according to experience and habits. We routinely use aspirative drain after TEP.
\nAfter mesh fixation.
Oral intake can be started a few hours after surgery and the patient is mobilized the same evening. The following day the patient can be discharged by removal of the drain. There is no need to regulate postoperative medical treatment other than oral analgesics.
\nIn this chapter, details take place as noted; details in current practice are given while applying the laparoscopic hernia repair. The points to be considered are evaluated for both techniques. In addition, the difficulties faced by the surgeon are itemized.
\n\n
As all laparoscopic operations, the first point to note in laparoscopic hernia surgery is trocar entry sites. Correct positioning of the appropriate points will prevent intestinal injuries that may occur at the time of first entry and bleeding which may be caused by the injury of the abdominal wall, especially the epigastric vessels.
A complete exploration should be done in terms of hernia type, size, presence of accompanying incarceration and other pathologies in intraabdominal exploration.
Taking enough width for dissection during the preparation of the peritoneal flap will ensure that the exploration area is convenient. Working on a sufficient width of dissection will facilitate the spread of the patch, the adequate closure of the hernia defect and the operator’s work during the detection of the patch.
A very careful dissection should be performed in order to avoid damage to the spermatic cord structures, especially in the presence of indirect hernia, when the hernia incision is dissected, as interference with the anatomical planes may result in attempts made for recurrent hernia.
Should be very careful not to hold Vas Deferens by endo-devices so as to not disturb.
The dissection should be performed at an adequate width of the myopectinale opening, but should be avoided from the extreme dissection in front of the psoas site in the lateral direction. There is an anatomic area defined as triangular pain in this region and it should be especially noted that the cutaneous femoral lateralis and femoral branches of genitofemoral nerves are not damaged. Postoperative chronic pain syndromes can be encountered in the event of a possible nerve injury.
Death triangle is defined as the anastomotic area between the external iliac vein and the obturator vein and should be avoided from the extreme dissection. Because, in the event of a possible vascular injury in this region, catastrophic consequences may be encountered.
The staples used for patch detection due to the same reasons should never be used under the iliopubic tract.
Should be sure to place the staples on the medial side, especially on the Cooper ligament, so that postoperative osteitis pubis is avoided.
It is generally advised to use the least amount of other materials that can be used for stapling or patch fixation.
Wide laying of the mesh will reduce the recurrence rate by covering the three hernia areas.
Reducing the intraabdominal CO2 pressure during the peritoneal flap closure and correcting the patient’s position will facilitate closure because it will reduce tension. The effective closing of the flap is important to prevent postoperative intestinal adhesions.
\n
The infraumbilical incision should be made from slightly left or right lateral. What should be noted here is to be on the rectus front sheath. If the linea alba is opened by mistake, the gas will flow to the intraabdominal region and strengthen the technique at the start.
It is important to notice the bright white color of the rectus posterior sheath, and it is important that the balloon is inflated by advancing the balloon trocar in this space. The balloon dissection between the fibers of the rectus will cause bleeding between the muscle fibers, disturbing the dissection plans and preventing the vision.
If gas flows into the abdomen during possible peritoneal injuries in the TEP technique, as mentioned in the techniques section, the gas must be evacuated with the Veress needle, which will be entered from the Palmer point.
Large peritoneal defects may cause postoperative patchy contact with the intestines and lead to postoperative intestinal adhesion development. For this reason, large peritoneal defects should be closed with endoclips.
In this section, complications related to laparoscopic inguinal hernia surgery, literature information about management of these complications and suggestions based on our own experience are included.
\nThe most common complications are serous fluid deposits (seroma) and bleeding(hematoma) which may develop during operation. Patients should be informed in the preoperative period about these complications. Postoperative seromas usually resorb spontaneously within 2 weeks and do not require treatment. Therapeutic drainage needs arise in the presence of seroma persistent for longer than 6–8 weeks or in the presence of seroma causing clinical symptoms. The use of peroperative aspirative drains in risky patients of who may be predicted seroma and hematoma development may prevent the development of these complications. Scrotal elevation is recommended in the postoperative period. If abdominal wall ecchymosis occur, mechanical compression, cold application and medical treatment can be tried. Subcutaneous emphysema is often untreated and spontaneous. In rare occasional hydrocele cases, it will be more appropriate to consult with a urologist.
\nThe treatment of chronic pain syndromes after laparoscopic hernia surgery is often long and difficult. Chronic postoperative pain has been reported in up to 63% of all groin repairs and significantly affects clinical outcomes. The pain following laparoscopic surgery is usually neuropathic pain. The cause is usually the damage or trapping of the lateral femoral cutaneous or femoral branch of the genitofemoral nerve. Clinically it occurs as acute burning and/or crushing pain in a particular dermatome. Mareljia parestetika is the name of a pain clinic that develops after a lateral femoral cutaneous nerve injury and persistent paresthesia lateral of the femoral area. It is recommended to apply corticosteroids or anesthetic injections which can be applied at rest, cold application, NSAIDs, physical therapy, locally. Osteitis pubis is; the name of the pain clinic that occurs due to public inflammation and arises especially on the middle of the groin or on the pubis, especially with femoral adduction. Diagnosis can be made by excluding recurrent hernia diagnosis radiographically and performing bone imaging. The treatment approach is the same as neuropathic pain. Often, 6 months are required to respond to treatment. However, if the cure is not available, the orthopedic consultation may be needed to consider possible bone resection or curettage options.
\nIschemic orchitis should be considered in the complaints of hardened, enlarged and painful testicles that appear about 10 days after the repair of the inguinal hernia. It is often self-limiting. It is usually the result of a possible damage to the pampiniform plexus, not the testicular artery. Ultrasound can distinguish necrosis or ischemia. If testicular necrosis is detected, urgent orchiectomy may be necessary. Treatment includes IV hydration and NSAIDs. If testicular artery is damaged, it can be caused testicular atrophy after long periods of operation. Vas deferens may not be manipulated during surgery and maximum effort to avoid disturbing their nutrition may help to avoid these complications.
\nPostoperative pain, swelling and the presence of a mass in the inguinal region should be considered. Diagnosis can be made by radiological examinations. Technical factors that play a role in the development of recurrence include inappropriate patch size, inadequate patch, stress or inaccurate detection, lack of experience, tissue ischemia and infections. Factors related to the patient include malnutrition, obesity, wound healing disorders and uncontrolled diabetes mellitus. Surgical intervention should be considered in the treatment.
\nOther complications include urinary retention, which can be prevented by the patient’s urination before surgery or by peroperative urinary catheterization. Paralytic ileus, visceral injuries, vascular injuries, intestinal obstruction, hypercapnia, pneumothorax and gas embolism are also uncommon complications.
\nThe results of laparoscopic and open inguinal hernia surgeries are now being compared very much. Postoperative pain complications, recurrence rates, patient satisfaction, cost analysis are frequently discussed. Papachariston and colleagues in their postoperative evaluation of pain study [8], even though it was reported to require more analgesic in the first 6 h in the TAPP group, pain was reported in 2–11% of the open surgery group and reported as 1–4.2% in the laparoscopic group. In the same study, persistent pain lasting from seventh day to 1 year in the open surgical group was associated with postoperative fibrosis, while point pain in the laparoscopic group was associated with scar tissue rupture. In a meta-analysis evaluating persistent pain [9], patch repair has been shown to reduce persistent pain as opposed to pain relief, and it has also been found that chronic pain is less in the laparoscopic method.
\nIn a study in which approximately 10,000 patient outcomes were assessed in the United States and patients were followed for 3 years [10], the recurrence rate of the laparoscopic method was found to be 0.4%, and it was emphasized that the most important difference between open and laparoscopic operations was the achievement of sufficient experimentation, the number of operations performed. According to this recommendation, a randomized controlled trial conducted by the Veterans Affairs Cooperative Study and reporting of 2-year follow-ups [11], recurrence rates were reported as 10% for laparoscopic repair and 5% for open repair, but after 250 laparoscopic cases techniques, results were improved. In a more recent study, Lal et al. [12] has shown that surgeons have reduced recurrence rates from 9 to 2.9% after 100 operations. In different studies, it has been reported that the laparoscopic techniques are spreading and the time to assess the competence of the surgeons is between 50 and 100 cases. A meta-analysis by Köckerling et al. [13] evaluating the relationship between patch fixation and recurrence, cases that patch fixation was performed and in cases not performed, there was no difference in the duration of operation, patch-related complications, recurrence and duration of hospital stay.
\nIn a randomized controlled meta-analysis in which Wei and colleagues evaluated the outcomes of 1000 patients published in 2015, there was no difference between the two surgeries, pain score, operation time, return to daily activity, hospitalization time, complication and cost between the two surgeries. In conclusion, TEP was found to be more complicated than TAPP and advised to start laparoscopic surgery with TAPP to inexperienced surgeons [14]. In a study published by Köckerling et al. [15] there was no difference between two surgeries in terms of intraoperative complications and reoperation rates. However, after TAPP surgery, complication rates were found to be higher due to possible large complications, more scrotal hernia, elderly patient selection.
\nIn a study conducted by Payne et al. [16] to measure postoperative quality of life, it has been shown that patients’ compliance with straight leg exercises is better after laparoscopic surgery. Designed in the same way and studied by Lawrence et al. [17], this difference was more evident in bilateral hernia repair.
\nThe problem of cost is still an important problem, with the fact that it has been removed from the big picture compared to the past. In the study conducted by Stylopoulos et al. [18] in 2003 and the results of 1.5 million patients evaluated, laparoscopic operations have been claimed to reduce costs compared to long-term open surgery when salary, health insurance costs, reduced job quality, delayed work shifts and the salary of the worker looking after the patient are taken into consideration. Farinas et al. [19] showed that 60% reduction in indirect costs could be achieved despite the 40% increase in the direct costs of using non-disposable devices and shortening of the operation time.
\nWhen TEP and TAPP were compared, there was no difference between the two techniques in terms of hospitalization time, recovery time and short term recurrence rates. The duration of the TEP technique is shorter than that of the TAPP technique [20]. However, according to the International Endohernia Association, it has been suggested that surgeons should apply the TEP technique after learning the TAPP technique and acquiring a certain experience in the learning curve [21].
\nIn our study, we have found that there is only a minimal difference between TAPP and TEP techniques, in terms of operative time. There was no difference in both techniques when recurrence, return to work, pain score, duration of hospitalization and complications were evaluated. Particularly, we observed that bilateral and recurrent hernia had high patient satisfaction. Also we observed that TAPP surgery in the early stages of surgery, shortened the learning curve.
\nIn conclusion, laparoscopic inguinal hernia surgery takes place in daily practice as an increasingly widespread up-to-date treatment method in which training and experience gained over time and patient satisfaction of clinical outcomes are very good.
\nThe authors declare that they have no conflict of interest.
Prolactin (PRL) is a multifunctional hormone which is synthesized and secreted by pituitary [1]. Human PRL gene is located on chromosome 6 [2]. The secretory mode of PRL is autocrine and paracrine [3], and the secretion of PRL is pulsating and circadian rhythm [4]. The concentration of PRL in human serum has a certain reference range, and when its concentration is too high or too low, it will have a certain impact on the body. Dopamine can inhibit the secretion of PRL, and there are cases where dopamine is used to treat hyperprolactinemia [1]. PRL’s biological functions include production, growth, development, immunoregulation, and metabolism [5, 6]. PRL can exert its biological functions only when it binds to its receptor and activates some signaling pathways [7]. According to the concept of proteoforms, a protein is defined as a set of proteoforms, due to different splicing, post-translational modifications (PTMs), and even unknown factors. Each proteoform has its own specific isoelectric point (p
Recently 2DGE and MS have been recognized as high throughput and useful tool to study proteoforms [13, 14, 15]. 2DGE is able to separate each proteoform in the first dimension—isoelectric focusing (IEF) based on proteoform charge difference, and in the second dimension—sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) based on proteoform relative mass difference [16]. Therefore, 2DGE achieves proteoform separation based on the difference in p
Pituitary adenomas are the common disease occurred in pituitary organ to severely impact on the human endocrine system. PRL is an important pituitary hormone. It has important scientific merit in clarification of PRL proteoform pattern changed in different subtypes of pituitary adenomas compared to control pituitaries. This book chapter focuses on the PRL proteoforms in human pituitary and investigates the PRL proteoform pattern alterations in pituitary adenomas relative to controls, with 2DGE and MS. These findings provide the scientific data to in-depth study the PRL functions and to discover PRL proteoform biomarker for PRL-related adenomas.
\nEight human post-mortem control pituitary tissues, five PRL-positive prolactinoma tissues, three non-hormone expressed nonfunctional pituitary adenoma (NF-NFPA) tissues, three luteinizing hormone (LH)-positive NFPA tissues, three follicle-stimulating hormone (FSH)-positive NFPA tissues, and three LH/FSH-both positive NFPA tissues were used to extract proteins, with the previously described procedure [21, 22]. The extracted protein of each tissue sample was used for 2DGE and MS analysis.
\nA amount (70 μg) of proteins was diluted into 350 μL of protein sample buffer (7 mol/L urea, 2 mol/L thiourea, 40 g/L CHAPS, 100 mmol/L dithiothreitol (DTT), 5 mol/L immobilized pH gradient (IPG) buffer pH 3–10 NL, and a trace of bromophenol blue, followed by rehydration (18 h, 20°C) of precast IPG strips pH 3–10 NL (180 x 3 × 0.5 mm) in 18-cm IPG strip holder on an IPGphor instrument, and IEF (25°C) with parameters (Gradient 250 V and 1 h for 125 Vh, gradient at 1000 V and 1 h for 500 Vh, gradient at 8000 V and 1 h for 4000 Vh, step-and-hold at 8000 and 4 h for 32,000 Vh, step-and-hold at 500 V and 0.5 h for 250 Vh to achieve a total of 36,875 Vh). After IEF, the proteins on IPG strip were reduced (15 min) with DTT, and alkylated with iodoacetamide, followed by separation with 12% SDS-PAGE (250 × 215 × 1.0 mm) in an Ettan DALT II system (GE Healthcare, up to 12 gels at a time) with a constant voltage (250 V, 360 min). All 2DGE-arrayed proteins were stained with silver-staining [23], and then digitized and analyzed with Discovery Series PDQuest 2D Gel Analysis software [24, 25]. Each sample was performed for 3–5 times.
\nThe proteins in the 2D gel were partially transferred to a polyvinylidene fluoride (PVDF) membrane (0.8 mA/cm2 for 80 min) using Amersham Pharmacia Biotech Nova Blot semi-dry transfer instrument, followed by blocking (1 h, room temperature) with bovine serum albumin (BSA), incubation (1 h, room temperature) with rabbit anti-hPRL antibodies, incubation (1 h, room temperature) with goat anti-rabbit alkaline phosphatase conjugated IgG, and visualization with 5-bromo-4-chloro-3-indolyl phosphate. The detailed procedure was described previously [9].
\nThe proteins in each Western blot-positive spot was performed in-gel digestion with trypsin, purification of tryptic peptides with ZipTipC18, followed by analysis with three types of MS instruments, including MALDI-TOF MS [24], LC-ESI-Q-IT MS [24], and MALDI-TOF-TOF MS [9]. The detailed procedure was described previously [9, 24]. The obtained peptide mass fingerprint (PMF) and tandem mass spectrometry (MS/MS) data were used to search Swiss-Prot human database for protein determination and PTM analysis.
\nThe phosphorylation sites, O-glycosylation sites, and N-glycosylation sites in the PRL amino acid sequence were predicted with NetPhos 3.1 Server (http://www.cbs.dtu.dk/services/NetPhos) [26, 27], NetOGlyc 4.0 Server (http://www.cbs.dtu.dk/services/NetOGlyc) [28], and NetNGlyc 1.0 Server (http://www.cbs.dtu.dk/services/NetNGlyc) [29]. The PRL proteoform pattern changes were tested with the Chi-square test among different subtypes of pituitary adenomas (p < 0.05).
\nIn human pituitary, the PRL prohormone is synthesized in the ribosome, with 227 amino acids (position 1–227; 25.9 kDa), containing a signal peptide (position 1–28) (Table 1), which was assigned with Swiss-Prot accession No. P01236. However, the mature human PRL only contains 199 amino acids (position 29–227; 22.9 kDa), which removed the signal peptide (position 1–28), and secreted into the circulation system to bind to its target organ for exerting PRL function.
\n1 | \n2 | \n3 | \n4 | \n5 | \n
---|---|---|---|---|
\n | \n\n | \n\n | \nICPGGAARCQ | \nVTLRDLFDRA | \n
6 | \n7 | \n8 | \n9 | \n10 | \n
VVLSHYIHNL | \nSSEMFSEFDK | \nRYTHGRGFIT | \nKAINSCHTSS | \nLATPEDKEQA | \n
11 | \n12 | \n13 | \n14 | \n15 | \n
QQMNQKDFLS | \nLIVSILRSWN | \nEPLYHLVTEV | \nRGMQEAPEAI | \nLSKAVEIEEQ | \n
16 | \n17 | \n18 | \n19 | \n20 | \n
TKRLLEGMEL | \nIVSQVHPETK | \nENEIYPVWSG | \nLPSLQMADEE | \nSRLSAYYNLL | \n
21 | \n22 | \n\n | \n | \n |
HCLRRDSHKI | \nDNYLKLLKCR | \nIIHNNNC | \n\n | \n |
Human PRL prohormone amino acid sequence (position 1–227) and mature PRL (position 29–227). The signal peptide is position 1-28 in the bold letters.
Reproduced from Qian et al. [9], with copyright permission from Frontiers in open access article, copyright 2018.
The PRL proteoform pattern was found in human pituitaries. Qian et al. [9] found six PRL proteoforms with 2DGE in human pituitaries and then verified four of six PRL proteoforms with 2DGE-based Western blot in human pituitaries (Figures 1 and 2). The p
PRL proteoform pattern in human pituitaries with a 2DGE gel image. Reproduced from Qian et al. [
Verification of PRL proteoforms with 2DGE-based Western blot in human pituitaries. (A) Western blot image. (B) Silver-stained image. Reproduced from Qian et al. [
PMF analysis of hPRL that was contained in spot v6. Reproduced from Qian et al. [
MS/MS analysis of the tryptic peptide 118SWNEPLYHLVTEVR131 that was derived from PRL in spot v6. Reproduced from Qian et al. [
Calc. [M + H]+\n | \nPosition | \nCharacteristic tryptic peptide sequence | \nObserved [M + H]+\n | \n
---|---|---|---|
505.2803 | \n1–4 | \nMNIK | \n− | \n
1060.5608 | \n1–9 | \nMNIKGSPWK | \n+ | \n
3930.1893 | \n1–38 | \nMNIKGSPWKGSLLLLLVSNLLLCQSVAPLPICPGGAAR | \n− | \n
574.2983 | \n5–9 | \nGSPWK | \n− | \n
3443.9268 | \n5–38 | \nGSPWKGSLLLLLVSNLLLCQ SVAPLPICPGGAAR | \n− | \n
2888.6463 | \n10–38 | \nGSLLLLLVSNLLLCQSVAPL PICPGGAAR | \n− | \n
3589.0154 | \n10–44 | \nGSLLLLLVSNLLLCQSVAPL PICPGGAARCQVTLR | \n− | \n
954.5189 | \n29–38 | \nLPICPGGAAR | \n− | \n
1654.8879 | \n29–44 | \nLPICPGGAARCQVTLR | \n− | \n
2301.1954 | \n29–49 | \nLPICPGGAARCQVTLRDLFD R | \n− | \n
Characteristic tryptic peptides to determine signal peptide (position1–28) within human PRL proteoforms in human pituitary.
+, this peptide ion was observed with mass spectrometry in each MS spectrum. −, this peptide was not observed with mass spectrometry. Reproduced from Qian et al. [9], with copyright permission from Frontiers in open access article, copyright 2018.
The PRL proteoform pattern changed in different subtypes of pituitary adenomas compared to control pituitaries (Table 3). The ratio of each subtype of pituitary adenoma relative to control pituitaries was decreased or unchanged. The proportional ratio of six PRL proteoforms among five subtypes of pituitary adenomas was changed (Table 4 and Figure 5). In FSH+/LH+ and PRL+ pituitary adenomas, the proportion of PRL proteoform v1 is the largest. In FSH+ pituitary adenoma, the proportion of PRL proteoform v5 is the largest. The PRL proteoform changes suggest their scientific merit for clinical application.
\nPRL proteoform no. | \nSwiss-Prot no. | \n\n | \n\n | \nRatio (NF−: Con) | \nRatio (FSH+/LH+: Con) | \nRatio (FSH+: Con) | \nRatio (LH+: Con) | \nRatio (PRL: Con) | \n
---|---|---|---|---|---|---|---|---|
V1 | \nP01236 | \n6.1 | \n26.0 | \n−8.3 | \n−99.9 | \n−46.2 | \n−12.6 | \n−3.4 | \n
V2a\n | \nP01236 | \n6.3 | \n26.4 | \n−4.9 | \n−3.8 | \n1 | \n−4.1 | \n1 | \n
V3 | \nP01236 | \n6.3 | \n27.9 | \n1 | \n−12.3 | \n−14.6 | \n−26.2 | \n1 | \n
V4 | \nP01236 | \n6.5 | \n26.1 | \n−100 | \n−19.0 | \n−17.6 | \n−20.1 | \n1 | \n
V5 | \nP01236 | \n6.8 | \n25.9 | \n−100 | \n−19.7 | \n−100 | \n−36.7 | \n1 | \n
V6 | \nP01236 | \n6.7 | \n25.9 | \n−100 | \n−32.6 | \n−11.3 | \n−33.6 | \n1 | \n
Prolactin proteoform pattern changed in different subtypes of pituitary adenomas compared to control pituitaries.
Characterized with LC-ESI MS/MS.
Characterized with LC-ESI-MS/MS and MALDI-TOF PMF.
Modified from Qian et al. [9], with copyright permission from Frontiers in open access article, copyright 2018.
All other proteins were characterized with MALDI-TOF PMF. Con, control; −, decreased relative to controls; −100, lost relative to controls; 1, no change relative to controls;
PRL proteoform | \nNF− (%) | \nFSH+/LH+ (%) | \nFSH+ (%) | \nLH+ (%) | \nPRL+ (%) | \n
---|---|---|---|---|---|
V1 | \n2.64 | \n53.34 | \n24.24 | \n9.45 | \n40.48 | \n
V2 | \n1.56 | \n2.03 | \n0.52 | \n3.08 | \n11.90 | \n
V3 | \n0.31 | \n6.57 | \n7.66 | \n19.65 | \n11.91 | \n
V4t | \n31.83 | \n10.14 | \n9.18 | \n15.08 | \n11.90 | \n
V5 | \n31.83 | \n10.52 | \n52.47 | \n27.53 | \n11.91 | \n
V6 | \n31.83 | \n17.40 | \n5.93 | \n25.21 | \n11.90 | \n
Total | \n100.00 | \n100.00 | \n100.00 | \n100.00 | \n100.00 | \n
Proportional ratio changes of PRL proteoforms among five subtypes of pituitary adenomas.
Chi-square test = 360.606, p = 0.000 (p < 0.01) among five subtypes of pituitary adenomas.
Reproduced from Qian et al. [9], with copyright permission from Frontiers in open access article, copyright 2018.
Proportional ratio changes of PRL proteoforms among five subtypes of pituitary adenomas. Reproduced from Qian et al. [
PRL is a hormone which is secreted by pituitary gland. PRL has a variety of biological functions. Only when it reaches a specific target organ and binds to its receptor can it play its biological function (Figure 6). PRL can bind to short PRL receptor or long PRL receptor and then plays its biological functions. The long or short PRL receptors definitely bind to different PRL proteoforms. PRL proteoforms are definitely derived from a PRL gene undergoing splicing, transcription, translation, PTMs, translocation/re-distribution, and interaction with other molecules, etc. Therefore, phosphorylation sites in hPRL (position 1–227) were predicted with NetPhos 3.1 Server with a score more than 0.5. It obtained 22 statistically significantly phosphorylation sites in hPRL (position 1–227). N-glycosylation sites in hPRL (position 1–227) were predicted with NetNGlyc 1.0 Server with score more than 0.5. It obtained 10 statistically significant N-glycosylation sites in hPRL (position 1–227). O-glycosylation sites in hPRL (position 1–227) were predicted with NetOGlyc 4.0 Server with score more than 0.5. It obtained six statistically significant O-glycosylation sites in hPRL (position 1–227). These data suggest that PTMs such as phosphorylation and glycosylation might be the important reason to cause the PRL proteoforms.
\nPRL proteoform-driven signaling pathway via the short or long PRL receptors. Reproduced from Qian et al. [
Prolactin synthesized in the ribosome in the pituitary secretes into blood circulation to reach its target organ and exert its biological roles, which is closely associated with multiple physiological and pathological processes, including pituitary adenomas. This study found six PRL proteoforms with different with differential isoelectric point (p
Six PRL proteoforms were identified in human pituitary tissue with 2DGE and MS analyses, and four of six PRL proteoforms were validated with 2DGE-based Western blot, MS, and MS/MS analyses. There were significant differences in PRL proteoform pattern among five different subtypes of pituitary adenomas (LH+, NF−, FSH+, FSH+/LH+, and PRL+) (P < 0.05). Moreover, MS analysis revealed that six PRL proteoforms are PRL prohormone. PRL proteoforms might be derived from PTMs such as phosphorylation, deamidation, and glycosylation. Further, different PRL proteoforms might bind to different PRL receptors to produce different physiological functions. These findings provide scientific basis for in-depth understanding of pituitary adenomas, and help develop biomarkers for treatment of pituitary adenoma patients. The serum PRL proteoform pattern has important clinical application value for prediction, diagnosis, and prognostic assessment of pituitary adenomas.
\nThe authors acknowledge the financial supports from the Hunan Provincial Hundred Talent Plan (to X.Z.), National Natural Science Foundation of China (Grant No. 81572278 and 81272798 to X.Z.), China “863” Plan Project (Grant No. 2014AA020610-1 to X.Z.), the Hunan Provincial Natural Science Foundation of China (Grant No. 14JJ7008 to X.Z.), and the Xiangya Hospital Funds for Talent Introduction (to X.Z.).
\nThe authors declare that they have no financial and personal relationships with other people or organizations.
X.Z. conceived the concept, designed the manuscript, wrote and critically revised the manuscript, coordinated, and was responsible for the correspondence work and financial support. Q.S. participated in the literature analysis, data analysis, prepared figures, and wrote partial manuscript.
\nDTT | dithiothreitol |
FSH | follicle-stimulating hormone |
GO | gene ontology |
IEF | isoelectric focusing |
IPG | immobilized pH gradient |
LH | luteinizing hormone |
\nMr\n\n | molecular weight |
MS | mass spectrometry |
pI\n | isoelectric point |
PRL | prolactin |
PTM | post-translational modifications |
PVDF | polyvinylidene fluoride |
SDS-PAGE | sodium dodecyl sulfate polyacrylamide gel electrophoresis |
2DGE | two-dimensional gel electrophoresis |
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His studies in robotics lead him not only to a PhD degree but also inspired him to co-found and build the International Journal of Advanced Robotic Systems - world's first Open Access journal in the field of robotics.",institutionString:null,institution:{name:"TU Wien",country:{name:"Austria"}}},{id:"441",title:"Ph.D.",name:"Jaekyu",middleName:null,surname:"Park",slug:"jaekyu-park",fullName:"Jaekyu Park",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/441/images/1881_n.jpg",biography:null,institutionString:null,institution:{name:"LG Corporation (South Korea)",country:{name:"Korea, South"}}},{id:"465",title:"Dr.",name:"Christian",middleName:null,surname:"Martens",slug:"christian-martens",fullName:"Christian Martens",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Rheinmetall (Germany)",country:{name:"Germany"}}},{id:"479",title:"Dr.",name:"Valentina",middleName:null,surname:"Colla",slug:"valentina-colla",fullName:"Valentina Colla",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/479/images/358_n.jpg",biography:null,institutionString:null,institution:{name:"Sant'Anna School of Advanced Studies",country:{name:"Italy"}}},{id:"494",title:"PhD",name:"Loris",middleName:null,surname:"Nanni",slug:"loris-nanni",fullName:"Loris Nanni",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/494/images/system/494.jpg",biography:"Loris Nanni received his Master Degree cum laude on June-2002 from the University of Bologna, and the April 26th 2006 he received his Ph.D. in Computer Engineering at DEIS, University of Bologna. 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His research interests include pattern recognition, bioinformatics, and biometric systems (fingerprint classification and recognition, signature verification, face recognition).",institutionString:null,institution:null},{id:"496",title:"Dr.",name:"Carlos",middleName:null,surname:"Leon",slug:"carlos-leon",fullName:"Carlos Leon",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Seville",country:{name:"Spain"}}},{id:"512",title:"Dr.",name:"Dayang",middleName:null,surname:"Jawawi",slug:"dayang-jawawi",fullName:"Dayang Jawawi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Technology Malaysia",country:{name:"Malaysia"}}},{id:"528",title:"Dr.",name:"Kresimir",middleName:null,surname:"Delac",slug:"kresimir-delac",fullName:"Kresimir Delac",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/528/images/system/528.jpg",biography:"K. Delac received his B.Sc.E.E. degree in 2003 and is currentlypursuing a Ph.D. degree at the University of Zagreb, Faculty of Electrical Engineering andComputing. His current research interests are digital image analysis, pattern recognition andbiometrics.",institutionString:null,institution:{name:"University of Zagreb",country:{name:"Croatia"}}},{id:"557",title:"Dr.",name:"Andon",middleName:"Venelinov",surname:"Topalov",slug:"andon-topalov",fullName:"Andon Topalov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/557/images/1927_n.jpg",biography:"Dr. Andon V. Topalov received the MSc degree in Control Engineering from the Faculty of Information Systems, Technologies, and Automation at Moscow State University of Civil Engineering (MGGU) in 1979. He then received his PhD degree in Control Engineering from the Department of Automation and Remote Control at Moscow State Mining University (MGSU), Moscow, in 1984. 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His research interests include the application of agent technology for achieving agile control in the manufacturing environment.",institutionString:null,institution:null},{id:"605",title:"Prof",name:"Dil",middleName:null,surname:"Hussain",slug:"dil-hussain",fullName:"Dil Hussain",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/605/images/system/605.jpg",biography:"Dr. Dil Muhammad Akbar Hussain is a professor of Electronics Engineering & Computer Science at the Department of Energy Technology, Aalborg University Denmark. Professor Akbar has a Master degree in Digital Electronics from Govt. College University, Lahore Pakistan and a P-hD degree in Control Engineering from the School of Engineering and Applied Sciences, University of Sussex United Kingdom. Aalborg University has Two Satellite Campuses, one in Copenhagen (Aalborg University Copenhagen) and the other in Esbjerg (Aalborg University Esbjerg).\n· He is a member of prestigious IEEE (Institute of Electrical and Electronics Engineers), and IAENG (International Association of Engineers) organizations. \n· He is the chief Editor of the Journal of Software Engineering.\n· He is the member of the Editorial Board of International Journal of Computer Science and Software Technology (IJCSST) and International Journal of Computer Engineering and Information Technology. \n· He is also the Editor of Communication in Computer and Information Science CCIS-20 by Springer.\n· Reviewer For Many Conferences\nHe is the lead person in making collaboration agreements between Aalborg University and many universities of Pakistan, for which the MOU’s (Memorandum of Understanding) have been signed.\nProfessor Akbar is working in Academia since 1990, he started his career as a Lab demonstrator/TA at the University of Sussex. After finishing his P. hD degree in 1992, he served in the Industry as a Scientific Officer and continued his academic career as a visiting scholar for a number of educational institutions. In 1996 he joined National University of Science & Technology Pakistan (NUST) as an Associate Professor; NUST is one of the top few universities in Pakistan. In 1999 he joined an International Company Lineo Inc, Canada as Manager Compiler Group, where he headed the group for developing Compiler Tool Chain and Porting of Operating Systems for the BLACKfin processor. The processor development was a joint venture by Intel and Analog Devices. In 2002 Lineo Inc., was taken over by another company, so he joined Aalborg University Denmark as an Assistant Professor.\nProfessor Akbar has truly a multi-disciplined career and he continued his legacy and making progress in many areas of his interests both in teaching and research. He has contributed in stochastic estimation of control area especially, in the Multiple Target Tracking and Interactive Multiple Model (IMM) research, Ball & Beam Control Problem, Robotics, Levitation Control. He has contributed in developing Algorithms for Fingerprint Matching, Computer Vision and Face Recognition. He has been supervising Pattern Recognition, Formal Languages and Distributed Processing projects for several years. He has reviewed many books on Management, Computer Science. Currently, he is an active and permanent reviewer for many international conferences and symposia and the program committee member for many international conferences.\nIn teaching he has taught the core computer science subjects like, Digital Design, Real Time Embedded System Programming, Operating Systems, Software Engineering, Data Structures, Databases, Compiler Construction. In the Engineering side, Digital Signal Processing, Computer Architecture, Electronics Devices, Digital Filtering and Engineering Management.\nApart from his Academic Interest and activities he loves sport especially, Cricket, Football, Snooker and Squash. He plays cricket for Esbjerg city in the second division team as an opener wicket keeper batsman. 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