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He is also a team leader in the Fujian Provincial Key Laboratory for Developmental Biology and Neurosciences, Key Laboratory of Optoelectronic Science and Technology for Medicine of Ministry of Education. He obtained his Ph.D. in 2008 and has a long teaching and research career. 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Such mental simulation process is called mental imagery and resembles perception, but without the immediate actual corresponding sensory input. Typically, mental imagery is often referred to as the experience of seeing with the mind\'s eye, hearing with the mind\'s ear. In other words, mental images could be generated from any sensorial system. Imagery experience is usually understood as evocation, copy, or reconstruction of actual perceptual experience from the long term memory systems, which is first recalled and then internally reproduced within working memory. At other times, participants may also anticipate possible or forthcoming events through imagery as a consequence of what they are expecting. A key feature of this simulation process is that it gives the ability to mentally rehearse motor acts without overt body movement, which is known as the motor imagery (MI) experience. Practically, MI is more often used when the whole human body or body segments are involved, hence requiring participants to imagine the body as the generator of acting forces and not only the effects of these forces on the external world. In this latter case, the information from the body is mainly used to build the mental image of the movement, e.g. tactile or any kind of proprioceptive data, from the muscles, the joints or the inner ear. In the wealth of motor learning literature, it is now well-established that MI is a valuable complement to physical practice to enhance cognitive and motor performance (Driskell et al., 1994; Guillot & Collet, 2008), as well as to promote motor recovery (Sharma, Pomeroy, & Baron, 2006; de Vries & Mulder, 2007; Di Rienzo et al., 2014a). Interestingly, different types of MI can be described and easily combined. While people commonly report using visual imagery (either through a first-person or third-person perspective), auditory imagery, and kinaesthetic imagery (Kosslyn et al., 1990), each perceptual modality can be accompanied by imagery. On the other hand, and with reference to perception, mental imagery combines several cues from different sensorial systems, thus making the imagery a global sensory-motor experience. Thus, investigating and assessing MI remains difficult due to its concealed nature.
Early on, MI has attracted attention from cognitive neuroscientists. In particular, understanding the neural correlates of goal-directed action, whether executed or imagined, has been an important purpose of cognitive brain research since the advent of neuroimaging techniques such as functional Magnetic Resonance Imaging (fMRI). Providing physiological recordings that correlate to the MI experience was therefore a major issue of the past two decades. In short, but not only, neuroimaging research demonstrated that MI engages motor systems, and that the cerebral plasticity due to actual practice also occurred during MI as well. These findings help to explain why MI can improve actual performance, and further contribute to motor memory consolidation. The present chapter was designed to provide an overview of the neural correlates of MI, with a threefold aim:
The most common aim of fMRI data analysis is to investigate the neural processes mediating higher cognitive functions, and detect correlations between brain activations and the task the participants have to perform during the scan. Since the early 1980s, fMRI has come to dominate the MI-related brain mapping research. During typical fMRI image acquisitions, participants are asked to alternatively perform a movement, either physically or mentally. These experimental conditions are also compared with a rest/control condition.
There are two main types of experimental design in fMRI: the block design and the event-related design. The block design paradigm consists of several epochs representing experimental conditions, during which stimuli are presented and actual execution or MI are required from participants, which are interleaved with time blocks of rest. Event-related designs rather associate brain processes with discrete events, with stimulus events being randomly presented one at a time, and being separated by an inter-stimulus interval of a pre-determined length. Habituation effects can be reduced, and stimuli are usually presented either tens of seconds apart or at a faster rate (e.g., every second). It should be noted that event-related designs are more sensitive to the details of the hemodynamic response model use. Figure 1 provides a schematic illustration of these two experimental designs when comparing the neural networks mediating MI and actual execution of the same movement.
Schematic representation of a block design (a) and an event-related design (b) fMRI paradigm. In the block design paradigm, sustained periods of 20–30 s are used for actual execution (AE), motor imagery (MI) or control (C) conditions during which several trials are performed successively (vertical arrows). Before each block of practice, brief periods of time (2-3s) are necessary to provide participants some instructions related to the forthcoming condition. Brief ‘rest’ periods can also be included. In the event-related design, each experimental condition is presented at random (orange and red vertical bars and vertical arrows).
There is not a universal procedure yet to acquire and process functional data and many researchers independently developed their methods and analyses, using different software. Practically, the most commonly technique used to map brain activity is based on the Blood Oxygenation Level Dependent (BOLD) effect, measuring regional differences in hemoglobin oxygenation. Therefore, a considerable amount of experimental studies investigated BOLD changes during MI. They primarily aimed at comparing the neuronal activations recorded during MI and actual practice of the same movement. For example, Grèzes and Decety (2001) provided evidence of a functional equivalence between intending, simulating, observing, and performing an action, as shown by the great deal of overlap among the corresponding neural substrates. Interestingly, brain activations recorded during MI do however not exactly match those of actual movement execution (Lotze & Halsband, 2006). Some differences also appear when comparing different types of MI or with regard to the individual features of the sample of participants. Put simply, fMRI allows the measurement of different neuronal activity in participants with high vs. low MI ability (Guillot et al., 2008), as well as differences in the patterns of cerebral activity related to the degree of expertise of the participants with the motor task (Lotze et al., 2003; Ross et al., 2003; Milton et al., 2007, 2008). Based on such evidence, fMRI offers a way to evidence the MI experience (Guillot et al., 2008). Finally, recent fMRI data suggested that different types of imagery elicit different patterns of neural activation (Solodkin et al., 2004; Jackson et al., 2006; Guillot et al., 2009; Lorey et al., 2009), while others nicely demonstrated, through positron emission tomography (PET), that the cerebral plasticity occurring after physical practice was reflected during MI (Lafleur et al., 2002; Jackson et al., 2003), hence reinforcing the principle of functional equivalence between MI and physical performance of the same task. Before we consider these issues and review the main related findings in the next section, an important methodological question remains to be addressed. Specifically, what are the additional benefits provided by fMRI to the study of MI compared to other neuroimaging and electrophysiological techniques, and, in turn, what are the limitations of fMRI recordings?
A first advantage of fMRI, compared to PET, is its non-invasive nature. There is no radiation exposure, and no need for injection of radioactive materials with fMRI. Another strength is its high spatial resolution allowing the measurement of brain activity from deep structures. Unlike electrophysiological techniques such as electroencephalography (EEG) or even magnetoencephalography (MEG) which are somewhat biased towards the cortical surface, fMRI records signal from all regions of the brain, including subcortical structures. This is of particular importance when pinpointing the neural correlates of MI as activation of cerebellum and basal ganglia is commonly reported. As every technique, however, fMRI has also some methodological disadvantages or weaknesses for the study of MI (e.g., Dietrich, 2008). A first limit is related to the causality between brain activation and the task the participants perform in the scanner. Although the baseline activity is subtracted from that recorded during the task and the result is averaged for all participants, the causality between activated structures and characteristics of the task is not straightforward. In other words, some brain structures could remain activated although this activity is not directly related to the task. Such argument for the causality however also holds for other brain imaging techniques. Second, the temporal resolution, of about several seconds must also be considered, as fMRI cannot track the rapid temporal dynamics of the functioning brain compared to high temporal resolution methods, e.g. EEG or MEG. Neuromodulatory effects of some cognitive functions such as attention and memory are also likely to affect the spatiotemporal resolution of the signal as they can affect large masses of cells, and potentially induce larger changes in the fMRI signal than the sensory signals themselves (Logothetis, 2008). Fourth, regarding data interpretation, advanced statistical methods are required to identify active voxels, while modifications of the brain activity might be due either to an excitatory or inhibitory influence. Finally, the position in the scanner and the limitation of body movements make it difficult to investigate complex motor skills. Indeed, the participant is lying in supine position in the scanner, and then performs both actual execution and mental representation of the same movement. However, in such situation, only simple movement of fingers, hands, feet, or tongue, or more complex movements of limited amplitude can actually be studied.
As reported by Logothetis (2008), and despite the shortcomings mentioned above, fMRI remains probably the best current available technique for providing insights into brain function and formulating interesting testable hypotheses. Logothetis also stated that some limitations of fMRI are directly due to inappropriate experimental protocols that ignore the circuitry and complex functional organization of the human brain. This is a critical aspect that must be considered before drawing general conclusions and when comparing results across experimental studies. In particular, a specific attention should be paid to the control condition from which MI-related brain activity is reported. In fMRI data analyses, images of activity from experimental and control conditions are subtracted to determine significant peaks of activation. Hence, a difference which does not reach the significant threshold does not necessarily reflect a lack of activity, but can also be due to similar brain activations during both experimental and control tasks. In other words, if the control task is not thoroughly determined, the remaining activity of some brain regions might bias the pattern of activity observed during the experimental condition, i.e. MI. Inspection of the MI literature reveals great differences across studies. Among others, participants were asked either to listen for auditory stimuli without engaging in MI (perceptual control condition), having rest, projecting into a restful state, fixating a static stimulus on a screen, or even imagining a ‘neutral’ static motor task. Obviously, such differences might significantly influence the pattern of activity recorded when contrasting the experimental and the control conditions. This is likely to render the functional brain map, hence hindering the conclusions that one can reach. Another example is the fact that MI can be performed either with open or closed eyes. Marx et al. (2003) suggested that eye closure is likely to improve imagination, but in some circumstances, MI paradigms might require participants to open their eyes to fixate a screen and/or wait for instructions. As some activation or deactivation of cortical regions could be undetected with eyes open, however, MI should ideally be performed with closed eyes as it was asked for the rest condition (Marx et al., 2004).
MI research provided convincing evidence that there is a functional equivalence between MI and motor performance (e.g., Jeannerod, 1994; Grèzes & Decety, 2001; Holmes & Collins, 2001; Szameitat et al., 2012; Burianova et al., 2013; Hétu et al., 2014). It is therefore not surprising that movement execution and MI reveal a high overlap of active brain regions, i.e. imagery draws on almost the same neural network that is used in actual perception and motor control (Murphy et al., 2008). Considerable evidence in support of the functional equivalence theory comes from fMRI studies which demonstrated that both cortical and subcortical brain areas are activated during MI. All studies showed that secondary motor areas are recruited during MI, but that the primary motor cortex might also be part of the network involved in imagined actions. Cerebellar and basal ganglia activations are also consistently reported during MI (Gerardin et al., 2000; Munzert et al., 2009). Finally, apart from motor-related areas, other regions such as parietal lobules are activated during mental simulation of actions (Gao et al., 2011). Taken together, these data support that MI and motor performance share the same neural substrate (Figure 2), but interestingly there are also some differences within the pattern of activity in these areas, as well as with regards to the characteristics of the participants or the content of the MI task.
Schematization of brain activity during MI and possible roles of motor-related regions.
Since the pioneering PET study by Roland et al. (1980), who did not find a significant activation of the contralateral primary motor cortex (cM1) during MI, the question of the contribution of cM1 during imagined actions has attracted considerable attention and remains controversial (for reviews, see Lotze & Halsband, 2006; Sharma et al., 2008; Munzert et al., 2009; Lotze & Zentgraf, 2010). For example, Binkofski et al. (2000), Gerardin et al. (2000), Kuhtz-Bushbeck et al. (2003) and Hanakawa et al. (2003, 2008) failed to find peaks of activation in cM1, while Dechent et al. (2004) reported fleeting involvement. In contrast, several studies reported significant activation in cM1 during MI (Leonardo et al., 1995; Sabbah et al., 1995; Porro et al. 1996, 2000; Roth et al., 1996; Lotze et al., 1999; Ehrsson et al. 2003; Nair et al., 2003; Solodkin et al. 2004; Guillot et al., 2008, 2009). In a seminal paper, Ehrsson et al. (2003) even showed that the content of MI was reflected in the pattern of motor cortical activation. Accordingly, they found that MI of hand, foot and tongue movements specifically activated the corresponding hand, foot and tongue sections of cM1. Transcranial magnetic studies also revealed cM1 activation during MI (for review, see Stinear et al., 2010). Finally, and as previously reviewed by Munzert et al. (2009), similar cM1 activation was found during MI of movements with the impaired limb to that during motor execution with the unimpaired limb in amputees (Ersland et al., 1996). The same result was found in healthy controls during motor execution of the same movement and in patients with spinal cord injury (Alkadhi et al., 2005; Cramer et al., 2005). The fact that these patients do not need to inhibit the movement might have influenced the nature of the MI process (Munzert et al., 2009). A recent MEG study however revealed similar patterns of activity in cM1 during MI and actual practice of the same movement in a patient with spinal cord injury, while a loss of power was observed in the matched healthy control participant (Di Rienzo et al., 2011, 2014b). These latter data support fMRI findings and further confirm both the contribution of cM1 during MI and the weakened inhibitory processes during MI in patients with spinal cord injury. Cerebral activations governing the inhibition of action during MI have not been yet fully explored. This would probably offer fruitful fMRI investigations in the future.
With regards to cM1 activation, Sharma et al. (2006) suggested that discrepancies in results may be due, at least partially, to methodological differences and difficulties in monitoring compliance with MI instructions. Definitely, the advent of fMRI techniques to investigate the contribution of cM1 during MI brought significant data into the debate. Furthermore, Sharma and colleagues argued that previous experimental studies did not specifically address whether the subdivisions of cM1 were differentially involved during MI. Furthermore, the primary motor cortex can be subdivided into an anterior component, thought to be executive in nature, while its posterior part would be involved in cognitive tasks or non-executive functions (Sanes & Donoghue, 2000). Accordingly, Sharma et al. (2008) reported that the cluster distribution in the anterior part of cM1 was significantly reduced during MI compared to the physical execution, while that of the posterior part was similar. Accordingly, they proposed that the role of cM1 and its subdivisions may be related to spatial encoding. Despite these results, determining how MI participates to the activation of cM1 remains difficult. Typically, cM1 activation during MI is usually smaller compared to that during overt motor execution, and is not systematically observed in all participants (Munzert et al., 2009). It was also demonstrated that cM1 was increasingly involved along with the complexity of movements (Kuhtz-Buschbeck et al., 2003). As well, activation of cM1 might be differentially influenced by MI instructions, MI ability and motor expertise (Lotze & Zentgraf, 2010).
Taken together, and despite some controversial data, fMRI studies support that cM1 is actually activated during MI but more weakly than during actual movement. Such activation is not essential for imagery and the neurons are not in the same location than those active during movement execution (Lotze & Halsband, 2006). Moreover, cM1 might not only have an execution function for the motor system (Lotze & Zentgraf, 2010), and it is particularly preparation for MI that may impact significantly cM1 activation (Johnson et al., 2002; Zang et al., 2003; Munzert et al., 2009).
Unlike the contribution of cM1, there is a general consensus regarding the activation of secondary motor areas of the cerebral cortex during MI. Accordingly, fMRI studies provided strong evidence that motor-related areas such as the ventral and dorsal parts of the premotor cortex (PMC), the supplementary motor area (SMA) and the pre-SMA, are active during MI of both simple and complex movements as well as subcortical areas such as the cerebellum and the putamen. Overall, it was shown that MI might activate a subset of the areas required for movement execution, albeit to a lesser extent (e.g., Macuga & Frey, 2011). Conversely, other activations could also be more robust in MI than during motor execution (e.g., Gerardin et al., 2000) thus leading to a partial overlapping of the networks mediating MI and actual execution of the same movement.
The activation of the SMA is now well-established during MI (Guillot et al., 2008; 2009; Hanakawa et al., 2003; Lotze et al., 1999; Munzert et al., 2009; Olsson et al., 2008; Solodkin et al., 2004). As neurons in the SMA are integrated in the functional loop controlling motor actions planning, it is therefore quite reasonable that similar preparatory aspects of the movement are engaged during MI. Kasess et al. (2008) further demonstrated that the SMA may inhibit activity of cM1 to prevent movement execution during MI. Interestingly, some authors also reported that the overlap of SMA activity during MI and motor execution is partial, and that the pre-SMA might rather play a specific role during imagined movements. Hence, the pattern of activity in this region could be higher during MI than during actual practice of the same task (Gerardin et al., 2000). Pre-SMA is known as being involved in acquiring new sequences, planning spatio-temporal actions, and updating motor plans for subsequent temporally ordered movements. As suggested by Malouin et al. (2003), the pre-SMA might thus be activated during MI to provide proper movement sequencing and timing. Taken together, MI would activate both the SMA and pre-SMA, not only for the preparation of the movement, but also for its suppressive influence on cM1 thus preventing movement execution.
Overlapping activity during MI and motor execution was also found in the premotor cortex (PMC-Guillot et al., 2008; Lotze & Halsband, 2006; Munzert et al., 2009), with potential more robust activity in the ventral part of the PMC during MI (Gerardin et al., 2000). The dorsal part of the PMC is involved in the preparation and control of movement, while the ventral part may play a crucial role in the planning of movements. Neurons with mirror properties which are active during action imitation and recognition were found in this region neighbouring Brodmann areas 44/45 (Rizzolatti et al., 1998). This may partially explain why more robust activity was reported in this area during MI than during motor execution.
Several studies also reported that MI and motor execution activate subcortical regions such as the basal ganglia and the cerebellum (e.g., Gerardin et al., 2000; Guillot et al., 2008; Lotze & Halsband, 2006; Munzert et al., 2009; Nair et al., 2003). These structures are known to strongly contribute to motor learning and motor preparation, and are closely connected to cortical motor-related areas. More specifically, the cerebellum contributes to predict movement outcomes as well as to correct the movement on the basis of sensori-motor feedback. Evidence that the cerebellum participates in the internal representation of movement, and therefore to MI, also comes from studies showing that cerebellar stroke disrupts MI (Battaglia et al., 2006; Gonzalez et al., 2005). In a seminal paper, Lotze et al. (1999) even postulated that the posterior cerebellum might play a crucial role in the inhibition of the motor command during MI (see also Lotze & Halsband, 2006). Likewise, basal ganglia play a substantial role in the storage of learned motor sequences, as well as in motor preparation (Alexander & Crutcher, 1990). While there is a general consensus regarding the activation of the basal ganglia during MI, few studies were devised to determine the specific role of this region. Li (2004) demonstrated that lesion of the putamen is likely to impair MI. More generally, however, studies on the effect of basal ganglia dysfunction on MI revealed inconsistent results (Heremans et al., 2011), with possible, but not systematic, MI impairment in patients with Parkinson’s disease. Taken together, and even if experimental studies still have to understand in greater details how the cerebellum and the basal ganglia specifically contribute to the MI process, there is no doubt about their activation during imagined movements. Interestingly, distinct contributions of the cortico-striatal and cortico-cerebellar anatomical systems have been proposed in the motor learning literature (Doyon & Ungerleider, 2002; Doyon & Benali, 2005). Although functional interactions between these anatomical systems are essential at the beginning of the learning process, there is ample evidence that the cerebellum plays a weaker role when the sequence is well learned and has reached asymptotic performance (for review, see Doyon & Benali, 2005), while basal ganglia remain active during the later stages of motor learning. By comparing the pattern of cerebral activations in 13 skilled and 15 unskilled imagers during both physical execution and MI sequence of finger movements, Guillot et al. (2008) showed that poor imagers not only need to recruit the cortico-striatal system, but also activate the cortico-cerebellar system as well. Findings also suggested that compared to poor imagers, good imagers would have a more efficient recruitment of movement engrams. Although this remains a working hypothesis awaiting experimental investigation, the authors concluded that the pattern of cerebral activation recorded during MI in poor imagers might improve and evolve close to that observed in good imagers after MI training. This might suggest that the expected changes in subcortical brain activations during MI would reflect those elicited by the process of actual motor learning (see also Lafleur et al., 2002; Jackson et al., 2003).
Activation of parietal areas including possibly the somatosensory cortex, but more certainly the inferior and superior parietal lobules and the precuneus, is frequently reported during MI (Binkofski et al., 2000; Gerardin et al., 2000; Guillot et al., 2009; Hanakawa et al., 2003; Lotze et al., 1999; Munzert et al., 2009; Nair et al., 2003). More importantly, the parietal cortex, and perhaps predominantly the left parietal cortex, could play a critical role in the formation of mental images. Experimental studies in patients with lesions located in the superior region of the parietal cortex showed that the temporal congruence between actual and MI times, known as being a reliable measure of MI quality (Guillot & Collet, 2005; Guillot et al., 2011; Malouin et al., 2008), was affected (Malouin et al., 2004; Sabate et al., 2007; Sirigu et al., 1996). Sirigu et al. (1996) postulated that the parietal cortex might set up an internal model of the forthcoming movement making the participants to predict the expected movement outcome. After parietal damage, coding for the spatial properties of the movement to be imagined and predicting the temporal feature of the movement might therefore be more difficult, hence reflecting the critical role of the posterior parietal cortex in the use of MI.
Interestingly, bilateral parietal lesions resulted in a complete unawareness of movement execution during imagery (Schwoebel et al., 2002). In fact, the patient exhibited hand movements during the MI of the same body segments, but explicitly denied that they occurred. These data strongly support that parietal areas are critically involved in the generation and guidance of imagined movements. More importantly, they further suggest that the patient failed to inhibit the motor consequences of MI, and therefore, that parietal areas may also play a critical role in the inhibitory processes of the motor command during MI. Finally, and in conjunction with previous fMRI data (Gerardin et al., 2000), these findings suggest a functional dissociation between cortical areas underlying MI and motor execution. The primary sensory area would be more activated during motor execution, due to sensory feedback processes, whereas MI might elicit greater activity both in the inferior and superior parietal cortices, especially in the left hemisphere.
A limited number of fMRI studies examined the influence of MI content on brain activations, and most specifically whether visual imagery and kinaesthetic imagery recruit different neural networks. In a first study looking at this issue, Binkofski et al. (2000) reported that the anterior part of the intraparietal sulcus was more active during kinaesthetic imagery of finger movements, while visual imagery yielded stronger activation in the posterior part. Bilateral activations were also reported during kinaesthetic imagery in the opercular portion of the ventral PMC. In a seminal paper, Solodkin et al. (2004) later investigated the neural networks mediating physical execution, visual imagery and kinaesthetic imagery of hand movements. Although these two types of imagery shared similar neural substrates, including the connection from the superior parietal lobule to the SMA, the main difference was found in the inputs from the superior parietal lobule and the SMA to cM1, which were opposite to those observed during motor execution. In the same line of research, Guillot et al. (2009) examined whether the same group of participants with high imagery abilities recruited similar or distinct brain activations during visual imagery and kinaesthetic imagery of complex hand movements. Visual imagery activated predominantly the visual pathways including the occipital regions and the precuneus, whereas the pattern of kinaesthetic imagery involved mainly motor-associated structures and the inferior parietal lobule (Figure 3). These data support the hypothesis that visual imagery of a motor sequence refers to the visual properties of visual perception, while kinaesthetic imagery includes in greater extent motor simulation processes related to the form and timing of actual movements (Michelon et al. 2006). Although visual and kinaesthetic imagery shared common brain structures, these data provide strong evidence that the patterns of neural activity mediating the ability to perform a specific MI type are partially different. Practically, it might suggest that participants are able to favor one sensory modality to form mental images, although MI is a multimodal and multidimensional construct.
Schematization of brain activations during visual and kinaesthetic imagery. During kinaesthetic imagery (blue), the pattern of activity involves motor-related regions mainly, including cM1, PMC, SMA, cerebellum and basal ganglia (hidden from the view), as well as in the inferior parietal cortex. In contrast, more activity is observed during visual imagery (red) in occipital regions and superior parietal lobule, including the precuneus.
Similar data have been reported in regards to the visual imagery perspectives, that is, by comparing first and third person imagery perspectives. The first study looking at this issue, was conducted by Ruby and Decety (2001) with PET scan. They investigated the neural networks mediating MI when the participants were asked either to mentally simulate an action or to imagine someone else (
More generally, these results provide clear evidence that both imagery types (e.g. visual vs. kinaesthetic imagery) and perspectives (first-person vs. third-person imagery) are partially mediated through separate neural systems, which may therefore contribute differently during the process of motor learning and neurological rehabilitation. This assumption is supported by a remarkable fMRI study demonstrating that MI engages systematically the organized sections of cM1 in a somatotopic manner, i.e., that the content of the mental images is reflected in the pattern of motor cortical activation (Ehrsson et al., 2003).
The fact that MI efficacy depends on the individual ability to form accurate mental images is now well-established. Although not systematic, this capacity to mentally simulate forthcoming actions may be influenced by the individual level of expertise in the corresponding motor task. While the concepts of motor expertise and MI ability measurements have been considered early on, researchers are able, for a short time, to assess the content of MI objectively using thorough procedures, in particular since the advent of functional brain mapping studies (Guillot et al., 2010). Taken overall, fMRI data strongly support the existence of distinct neural mechanisms of expertise in MI, as a function of the individual skill level. For instance, lower cortical activation was recorded in professional violinists as compared to amateurs (Lotze et al., 2003). Similar differences were observed in the neural networks mediating MI in novice and expert athletes (Milton et al., 2008). By comparing brain activations of six golfers of various handicaps during MI of a golf swing, Ross et al. (2003) found decreased activations of the SMA and cerebellum as a function of golf skill level, i.e. an inverse relationship between brain activity and skill level. Also, golf swing MI yielded few peaks of activation in the basal ganglia and cingulate gyri across all skill levels. Milton et al. (2007) finally reported that the posterior cingulate, the amygdala-forebrain complex, and the basal ganglia were activated in novices but not in elite golfers during motor planning of a golf swing movement, hence confirming that the neural networks controlling both motor planning and MI are influenced by the individual skill level. As a whole, changes in cerebral activations confirmed previous investigations showing that levels of expertise during the motor learning process are supported by different neural networks (Doyon & Benali, 2005).
Analogously, researchers investigated the neural networks mediating musical experience, training onset, and training stages. Langheim et al. (2002) first showed in participants who imagined playing a musical selection with their instrument that an associative network including the superior parietal lobule, the inferior frontal gyrus and the bilateral lateral cerebellum was activated during. This network would be particularly activated during the coordination of the complex spatial and timing components of musical performance. As mentioned above, Lotze et al. (2003) compared the patterns of brain activation during auditory imagery in experienced and novice musicians, with the professionals reporting frequent use of imagery with high vividness. Interestingly, experienced musicians recruited very few cerebral areas, while amateurs manifested a widely distributed activation map. In the professional group, however, more activation was observed in the SMA, the PMC, the superior parietal lobule and the cerebellum. Finally, Kleber et al. (2007) reported an increased activation in the fronto-parietal regions during imagined singing, suggesting increased involvement of working memory processes during imagery
To summarize, fMRI data provided strong evidence that partially separate neural networks are activated during MI of both motor and musical performance in regards to the individual differences in the level of expertise. These findings therefore strongly support the hypothesis of distinct neural mechanisms for expertise in imagery, independently of the imagery type, with the network integrating the superior parietal lobule being seen as mediating the imagery activity of highly experienced people.
Apart from the level of expertise itself, the rate at which the movement is performed and imagined is also likely to recruit distinct neural patterns. Accordingly, Sauvage et al. (2013) nicely demonstrated that although execution and imagination of slow and fast movements activate a common neural substrate, the rate of movement differentially yielded associative cortical, striatal and cerebellar areas. Their data suggest that slow movement and motor imagery of both slow and fast movements activated fronto-polar, orbitofrontal and dorsolateral prefrontal cortices, while fast movements recruited more intensively the premotor cortex and the cerebellum.
Going beyond the usual comparison of brain activation patterns that are associated with MI and motor execution of the same movement is the next step in this field of research. To do so, researchers may take advantage of the recent methodological fMRI developments. Both the use of real time fMRI and the recording of changes in functional and effective connectivity in the neural networks activated during MI are of particular interest. Also, reporting more systematically negative BOLD responses might contribute to expand our knowledge on neuronal inhibition during MI.
It is now possible to image human brain functioning in real time with fMRI (Esposito et al., 2003; Weiskopf et al., 2003; for an extensive review, see deCharms, 2008). This technique provides a reconstruction of the raw data obtained with the brain scan, while the scan is going on. There are several exciting research perspectives for considering the contribution of real time fMRI dedicated to MI study. This technique may first be useful during the MI learning process, especially when the pattern of activation during mental simulation is not the one expected. Indeed, real time images are expected to provide participants some objective information related to the vividness of MI, since they have been educated to gain some familiarity with the neuroanatomy before neurofeedback fMRI sessions. Receiving a feedback from brain activation in predetermined regions of interest seems possible. An average 2-5s time lapse usually remains necessary, due to the physiological delay of the haemodynamic response (a more simple feedback can also be used, e.g. a simple score using a Likert-type scale). A well-known study supporting the use of real time fMRI was published by Yoo and Jolesz (2002), who used visual feedback of brain activation to guide participants to adjust their motor task performance and to achieve the desired modulation of cortical activity. For example, during simple hand movements, participants spontaneously involved more muscle groups and increased tapping frequency along fMRI sessions. The biofeedback given to participants with regard to the activated neural network helped them to modulate their cortical activation. A significant illustration of the strength of this methodology in the field of MI was offered by deCharms et al. (2004) during imagery of a manual action task. In this study, participants received feedback about the activation level in the somatomotor cortex with a simple virtual reality interface. The results showed that they enhanced the fMRI level of activation driven by MI in the somatomotor cortex through the course of training. Moreover, the activation of this region after MI training was as robust as that recorded during actual practice. In a more recent study, Yoo et al. (2008) showed that real time fMRI might help individuals to learn how to increase region-specific cortical activity associated with a MI task. Practically, the level of increased activation in motor areas was consolidated after the 2-week self-practice period. Regarding the method for presentation of neurofeedback (intermittent presentation or continuous presentation) and the nature of the neurofeedback being presented to participants during a MI task (true or false neurofeedback regarding brain activations), Johnson et al. (2010) further reported that the intermittent presentation of feedback was more effective than the continuous presentation in promoting self-modulation of brain activity. Accordingly, regular interruptions in neurofeedback presentation allowed central processing and integration of the information conveyed in the feedback regarding brain activations. The authors also reported that false feedback resulted in irrelevant brain activations with regards to the regions of interest targeted by experimental instructions. Finally, Xie et al. (2011) supported the effectiveness of delivering neurofeedback during MI using real time fMRI, and further provided evidence that the SMA was controllable by participants. These data strongly support that real time fMRI is a valuable technique to investigate whether participants are able to use a cognitive strategy to control a target brain region in real time. In the field of neurorehabilitation, for example, a similar approach could be used to learn how controlling pain by learning to control the brain regions that mediate pain perception (deCharms et al., 2005). Indeed, there are multiple therapeutic applications of real time fMRI but it is too early to predict success or failure and new experimental results are awaited.
Real time fMRI might also particularly useful in developing brain-computer interfaces (deCharms, 2008). A brain-computer interface is a novel communication system that translates human thoughts or intentions into a control signal without using any muscle activity (for review, see Pfurtscheller & Neuper, 2010). To date, many brain-computer interface systems have used MI tasks to modulate sensorimotor EEG activity taken to operate and control an external device. Pfurtscheller & Neuper (2010) nicely demonstrated how brain-computer interface systems using MI can contribute to help patients with various motor impairments and paralysis. Despite the temporal limitations of fMRI, using fMRI data for brain-computer interface remains plausible as many cognitive processes change slowly, over seconds or minutes (deCharms, 2008). Practically, the method is appealing although future experimental studies are necessary to determine its feasibility and effectiveness, such as during motor recovery of patients with motor impairment. Real time fMRI might also be used to explore the state of consciousness and communicate with patients in a persistent vegetative state. Accordingly, Owen et al. (2006) detected awareness in such a patient following instructions to mentally imagine moving around a house and playing tennis. Brain activations were observed in the parahippocampal gyrus, the posterior parietal lobe and the lateral PMC during MI of walking, and in the SMA when imagining playing tennis. These data provide evidence that real time fMRI might be used along with MI to actually communicate with people and/or patient who are physically or conventionally unable to interact with their environment (deCharms, 2008).
Creating functional connectivity maps of distinct spatial distributions of temporally correlated brain regions is another methodological advanced tool offered by fMRI. Functional and effective connectivity can be used to examine interactions among brain regions. Practically, these techniques go beyond the usual activation maps obtained through peak-detection methods, by looking respectively at temporal correlation between the time course of activation of two regions, and the influence of one neuronal population over another (Doyon & Benali, 2005; Friston & Büchel, 2003; Friston et al., 1995). Multiple innovative data-driven methods have been proposed to investigate the changes observed in cerebral networks over time, or to study functional and effective connectivity. Some reliable examples are the structural equation modeling and the dynamic causal modeling. In the field of MI, few researchers examined the inter-relationships among brain areas selectively activated along different experimental conditions, that is, the effective connectivity between network components. Solodkin et al. (2004) explored the effective connectivity of the neural networks mediating motor execution, visual imagery, and kinaesthetic imagery of a finger to thumb opposition task. Their results provided evidence that the networks underlying these behaviors were almost different, despite the extensive overlap between motor execution and kinaesthetic imagery. In particular, inputs from SMA and lateral PMC to cM1, which were facilitated during motor execution, exhibited the opposite activity during kinaesthetic imagery, suggesting a physiological mechanism whereby the system prevents overt movements. A second study looking at the effective connectivity between SMA and cM1 suggested that the lack of activation in cM1 during MI might result from a suppressive influence of the SMA (Kasess et al., 2008). More recently, Gao et al. (2008) and Chen et al. (2009) reported that, in right-handed participants, more brain regions showed effective connections to the SMA during right-hand MI than during left-hand MI, but that the strength of the casual influence was stronger during left-hand MI. Furthermore, they found forward and backward effective connectivity between the SMA and the bilateral dorsal PMC, the contralateral primary and somatosensory cortex, and cM1. A last study by the same group of researchers confirmed these findings, and further showed that motor execution has some increased causal connections because of additional processes for the overt behavior stage (Gao et al., 2011). Taken together, these experimental studies highlight the advantages of studying functional and/or effective connectivity through fMRI to expand our understanding of the neural underpinnings of MI (see also Szameitat et al., 2012).
Reporting an elevation in the fMRI BOLD signal, namely positive BOLD, has become a common routine for mapping neural activity in the human brain. Aside from positive BOLD signal changes, several studies have also observed negative BOLD responses. The negative BOLD signal is a physiologic process correlated with a corresponding decrease in cerebral blood flow, oxygen consumption, and neuronal activity (for review, see Shmuel et al., 2002). Practically, negative BOLD signal reflects less neural processing for a given task as compared to a baseline condition. The negative BOLD response might be caused by a reduction in cerebral blood flow and is associated with decreases in the rate of oxygen consumption. Its neurobiological mechanisms are yet not well understood, and much of the debate has centered on whether its source is primarily vascular or neuronal. The neuronal origin might reflects a suppression of the local neuronal activity and/or a reduction in the afferent input, whereas the vascular origin refers to a reduction in cerebral blood flow to the less demanding regions due to the increase in flow to the demanding areas, without a necessary decrease in neuronal activity in the negative regions (Schmuel et al., 2002). Until recently, very few experimental studies were designed to analyze negative BOLD responses during either visual or MMI tasks. An interesting and innovative paper by Amedi et al. (2005) investigated the pattern of brain deactivation during visual imagery and compared it to the neural correlates of visual perception. While they found that visual imagery and visual perception share similar neural substrate, these two conditions yielded different brain-deactivation profiles as shown by negative BOLD responses. Of particular interest is that the authors reported a robust deactivation in early auditory areas as well as a selective deactivation in the somatosensory cortex during visual imagery, hence supporting that visual imagery is associated with deactivation of non-visual sensory processing. Based on these data, they stated that that pure visual imagery might be characterized by an isolated activation of visual cortical areas with concurrent deactivation of sensory inputs that may potentially disrupt the image created by the mind’s eye. They also considered that deactivation could be the consequence of filtering out irrelevant stimuli. The correlation between the level of deactivation and the vividness of visual imagery might support the hypothesis that participants with high imagery ability are able to shut down or disconnect the ‘‘irrelevant’’ cortices. To the best of our knowledge, unfortunately, there are no experimental studies specifically designed to look for similar results in MI paradigms
The data reviewed in this chapter strongly support that recording human brain functioning with fMRI during MI provides an objective measurement of the neural networks underlying MI processes. Although they are not totally overlapping, it is now well-established that the neural substrates mediating MI and actual execution of the same task are quite similar. Spurred by recent fMRI methodological advances, the next step of MI research will certainly contribute to understand in greater details the neural correlates of imagined movements, as well as the inhibition of the motor command. MI studies could therefore benefit from the use of real time fMRI, effective connectivity, and also negative BOLD. This latter technique might be of particular interest in investigating the inhibitory processes of the motor command during MI. Cerebral regions which are inhibited during mental operations or human behavior are certainly of the same scientific interest than those which are activated.
Our understanding of toxicity associated with exposure to radiation has increased since the discovery of X-rays in 1895. X-rays were used to treat a variety of malignant and non-malignant diseases. The effects of radioactive exposure on specific tissues can vary. Radioactive particles destroy or impair tissue by generating free radicals that damage important molecular structures, such as DNA. Radiation exposure can lead to catastrophic consequences, ranging from severe, acute injury to long-lasting effects that manifest years after the initial exposure. This chapter provides observations that demonstrate the importance of understanding guidelines to minimize radioactive exposure, and the expectations and treatment management following exposure [1, 2, 3].
Exposure to radioactive particles is divided into intentional or unintentional causes. Notable intentional causes include the atomic weapons activated on Hiroshima and Nagasaki in Japan during World War II. The immediate injuries and fatalities were from the heat and mechanical force generated by the trauma and physical destruction. However, it became apparent that there were longer lasting consequences. Survivors in the surrounding area were exposed to high levels of radiation and suffered from acute toxicity injuries and organ failure. Many of those who did not succumb to the effects of acute toxicity were known to suffer lifelong chronic conditions, such as developmental problems in newborns and increased cancer risk [4, 5, 6].
Unintentional causes are usually the result of radiation exposure without intent to injure. These unintentional causes are typically related to the effects of radioactive materials utilized for energy or medical treatment. The first radiograph was taken in 1895 and early pioneers in the field were unaware of the consequences of exposure. Initial procedures were often associated with unintentional exposure and were fraught with numerous complications such as skin blistering, hair loss and systemic toxicity that we now know were due to radiation toxicity. These signs and symptoms were similar to those present in exposed workers in the first nuclear development programs, many of whom would later develop injuries and cancers as a consequence of their profession [7, 8].
Despite these risks, nuclear power continues to be used for its benefits. Fortunately, we now know much more about how to avoid and minimize radioactive exposure. Rigorous standards enforcing safe practices with radioactive material and the formation of numerous regulatory agencies such as the Nuclear Regulatory Commission are a testament to how far we have come [9]. However, accidents involving radioactive material do occur. In this chapter, we describe a brief history of well-known incidents involving unintended radioactive exposure, as well as the clinical consequences and care of the patient following exposure.
One of the most significant nuclear accidents in history was Chernobyl. On that day, a series of missteps during a routine safety check resulted in a massive explosion that sent a plume of radioactive material into the air for an entire week. The range of this explosion extended well beyond the immediate vicinity, exposing other parts of Europe to radioactive gas in the process. In addition to exposing civilians to the radioactive material, first responders also received significant radiation levels and thermal injury, many of which were lethal. More recently, the nuclear reactor in Fukushima, Japan experienced a meltdown following the 2011 tsunami in Japan. While there were no immediate casualties, there was lasting environmental damage and the long-term health consequences are yet to be fully understood [8]. These examples demonstrate the importance of proper safety measures and providing an effective response to nuclear accidents.
Toxicity from radiation exposure can be divided into three types: acute, subacute and chronic/late. Acute radiation toxicity is defined as signs and symptoms ≤90 days following exposure. In a medical setting, treatment of acute exposure is quite common. During radiation therapy, radiation is targeted and delivered to tumors and management of side effects from the radiation exposure remains a mainstay of modern oncology.
The radioactive dose from these procedures is typically far less than the dose following unintended exposures outside of the clinical setting. The radiation treatment dose is usually fractionated, meaning the dose is given in intervals to reduce the short-term toxicity of the radioactive treatment. The clinical manifestations of acute toxicity following a radioactive accident may be much more severe than those typically encountered by most physicians and may warrant treatment in an emergency setting [4, 5].
Acute radiation toxicity involves many organ systems, including but not limited to the central nervous, gastrointestinal, and cardiovascular systems. Cells with self-renewal potential may be able to recover better from radiation damage compared to those without such protective mechanisms. Self-renewal processes are often accelerated as a response to injury where slowly proliferative tissues cannot. However, if the exposure is given in a single fraction of high enough dose, this ability for self-renewal potential will be overwhelmed. For example, a single total body dose >10 Gy will result in death within days from numerous possible causes. Damage to the central nervous system will result in cerebrovascular syndrome, with uncontrollable swelling in neuromuscular tissue. Despite best supportive care there are no medical interventions to prevent death at this level of exposure. Damage to the gastrointestinal system results in severe diarrhea and associated fluid loss. The mechanism involves depletion of most stem cells within the gastrointestinal crypts. Since these stem cells are required to replace the mucosal surface, these mucosal surfaces will disappear a few days after exposure and there will be no barrier to prevent fluid loss or bacterial entrance into the bloodstream. As a result, patients will typically present with fever, nausea, vomiting, fatigue, anorexia, and severe hypotension. Doses of 4–5 Gy are enough to cause death from depleted stem cells in the hematopoietic system without support. Those that survive the initial depletion typically succumb to infection a month later due to depleted lymphocytes and other immune elements. These manifestations can occur minutes after exposure, with severity being proportional to dose and a sharp decrease in lymphocytes within two days of exposure [1, 4, 5].
Should the patient be exposed to doses below 4 Gy, symptomatic and best supportive treatment is recommended. Nausea and vomiting are the typical initial symptoms and should be treated with hydration. If the exposure dose is unknown, noting the time of onset of vomiting is important as exposure dose is inversely proportional to time to emesis. It is not uncommon for patients at low exposure doses to feel fine for a few weeks before the gastrointestinal and hematopoietic symptoms drive a patient to seek medical care. Upon initiation of care, isolation and contact inhibition is vital since infection is a major contributor towards death in these patients as depletion of the hematopoietic system occurs. Blood transfusion and antibiotics can be delivered to alleviate these issues. A patient will often also present with skin injury burns at the site of radiation exposure as epidermal and dermal injury associated with stem cell depletion can mimic and appear similar to a thermal injury. These injuries should be treated promptly, as they are easy routes for infection to occur, which can be devastating to a patient with a compromised hematopoietic system. In patients with high exposure doses, end of life care is a possible consideration. At an exposure of 5 Gy, only about half of patients will survive after 30 days. An exposure of 10 Gy is considered lethal regardless of medical interventions [1, 5, 6]. Treating patients following radiation exposure is not only challenging in terms of clinical aspects, but emotionally as well.
Compounds that have been developed to reduce and even prevent the clinical manifestations following radiation exposure are called mitigators. These compounds work by altering the molecular response following radiation exposure. As such, a mitigator could inhibit lymphocyte recruitment at sites of radiation damage, increase proliferation of stem cells that would normally be inhibited by radiation exposure, or inhibit fibrosis. An example of a mitigator is Palifermin, a growth factor that stimulates cell growth in response to radiation exposure to reduce recovery time. Radioprotectors, on the other hand, are given before or immediately after radiation exposure to protect against the effects of radiation toxicity [10, 11]. Amifostone is one such radioprotector that has been approved by the FDA for reducing side effects from radiation therapy [12]. More mitigators and radioprotectors are expected to be approved as the need to protect against radiation toxicity increases. Although many compounds have been and are in development, no others to date are actively used in clinical practice and the role of both hematopoietic and mesenchymal transplant remains under investigation.
The subacute and/or late effects of radiation toxicity, by nature, are less visible and harder to identify for most emergency and primary care physicians. Often, these effects take many years to develop and are often mistaken as sequelae from another disease. However, they are nevertheless important to identify and address. A common misconception is that the degree to which a patient suffers from acute symptoms is proportional to severity of the long-term response. Unfortunately, patients who experience little to no acute sequela can experience serious long-term sequela, and vice versa. While both children and adults can experience the effects of late radiation toxicity, children are susceptible as they have a much longer period for these clinical manifestations to develop [13]. Unlike acute toxicity effects, anticipating long term effects is much more difficult. This technique relies heavily not only on a physician’s knowledge of potential long-term effects, but also their willingness to investigate a potential long-term effect.
A common theme in radiation injury is the ability of the tissue or organ to respond to cell death and self-regenerate. These aspects vary among organs and thus the clinical presentation and treatment is different depending on the organ involved. Injuries and treatment protocols for specific organs are as follows:
As previously discussed, damage to the hematopoietic system typically results from injury to progenitor cells, which can lead to hematopoietic crisis and infection. Fortunately, with the exception of whole-body exposure, the hematopoietic system is generally able to recover from radiation damage due to migration of stem cells from outside the site of exposure. Patients who are also receiving chemotherapy or taking medications that may result in immunosuppressed states should be carefully assessed. In the case of total body irradiation, an immediate decrease in circulating lymphocytes can be expected with subsequent defects in immune response. Symptomatic treatment, including blood infusions and antibiotics as needed, with isolation are crucial in these situations [13, 14]. Use of bone marrow transplants to replenish depleted progenitor cells has a theoretical survival benefit opportunity in total body irradiation patients, but to date has not been embraced as standard practice and often only applied to those most severely affected. The risk of graft-vs-host disease makes this approach controversial, especially in the setting of an emergency unrelated allogeneic transplant [6].
The skin is often the most direct site of radiation injury, as the epidermis covers all other organs and is susceptible to radiation damage. The dermal stem cells are the most susceptible component of the skin, as these are the actively dividing cells that replace other cells in the rest of the organ. Early symptoms of exposure typically involve erythema and swelling as vasodilation and the recruitment of inflammatory components localize to the area. These symptoms typically resolve within a month. Late term effects include decreased wound healing capacity with increased fibrosis and ulceration. Interestingly, the skin will appear to be more vascularized with more prominent vasculature. However, this is due to thinning of the epidermis, which causes veins to appear more prominent. Proper wound care is the standard treatment for these manifestations, with surgical debridement as needed. Particular concern must be paid for patients with medical conditions that are prone to fibrosis, such as those with dermatitis, lupus, and scleroderma. Skin infections, such as cellulitis, are particularly dangerous given the immunosuppressive effects of radiation therapy. Lastly, an interesting phenomenon occurs in some patients where previously irradiated skin can become erythemic and fibrotic several years later in response to certain medications like antibiotics and chemotherapy. The mechanism behind this phenomenon is unknown [15].
In the past, skin involvement from radiation therapy that could not be treated with topical ointments was relatively rare. However, with the increasing use of hypofractionation (radiation therapy with greater amounts of dose per treatment), these findings are becoming more common [16]. Thus, radiation damage to the skin is likely to become more prominent in the future as therapy becomes more compressed with higher doses delivered in a shorter period of time. Patients with a history of radiation therapy and significant skin sequalae should be carefully observed for more serious developments as injuries in treated tissues heal less well and contain less local immunity.
Like the skin, the gastrointestinal system is composed of mucosal cells with multiple layers underneath that are constantly replaced over time. Unfortunately, the rate at which some of these cells are replaced is higher than that of the skin, leading to more immediate and sometimes more severe clinical manifestations. Cells of the gastric and small bowel tend to have the highest rate of replacement, leading to very early nausea if these regions were exposed. Exposure to mucosal cells in the upper gastrointestinal system (mouth, esophagus, salivary glands) tend to present with clinical symptoms around two weeks after exposure due to a longer replacement rate. Damage to these cells tends to present with more localized pain and swelling. Exposure to the salivary glands can result not only with localized pain, but also xerostomia (dryness of mouth) and ageusia (loss of taste). Saliva can become more acidic which can further injure normal tissue and alter the environment of the oral cavity. Regardless of these manifestations, patients should be advised to maintain adequate nutrition and dental hygiene, as this practice helps mitigate the complications of an immunocompromised state. Symptomatic treatment of localized pain is also advised and considered standard of care as bone exposure can be a serious consequence of mucosal denudation [14]. Figure 1 represents modern head/neck radiation therapy treatment plan through the oral cavity demonstrating sparing of the parotid tissue with intensity modulation.
Parotid sparing. Image courtesy of the Department of Radiation Oncology, University of Massachusetts Medical School.
Farther along the digestive tract, the expected symptoms can be predicted based on the location of the tumor. Radiation exposure to the gastric mucosa during treatment of gastric tumors can result in near immediate nausea given the daily replacement the gastric mucosa. Treatment of esophageal tumors, which are now more commonly in the lower third of the esophagus, present with a timeline of symptoms similar to head and neck tumors (approximately two weeks after exposure). Tumors in this region typically cause dysphagia and anorexia. Treatment initially tends to relieve patient symptoms, but later patients may return thinking the tumor has returned when in reality these symptoms are due to swelling from the therapy. Like head and neck tumors, patients should be advised to continue maintaining adequate hydration and nutrition [13, 14].
Symptoms from radiation exposure in the small and large bowel are more complex and require more in-depth patient history and laboratory tests. The small bowel absorbs much of the nutrients from food. Damaging the microvilli of the mucosal surface, which are vital for nutrient absorption, can result in severe malabsorption regardless of a patient’s appetite. These findings can be confirmed by stool tests. Patients will often present to the emergency room with diarrhea, steatorrhea, bloating and general abdominal pain a few days after radiation exposure. The large bowel plays an important role in absorption of water, and exposure of large portions of this organ may compromise this function. Patients may complain of increased defecation frequency, which can lead to dehydration and electrolyte abnormalities that can be confirmed through electrolyte panels. To make matters more difficult, abdominal organs are prone to forming adhesions after surgical interventions, which disrupts blood flow to portions of the bowel that are exacerbated after concurrent radiation therapy. Anticipation of these issues through a careful patient history are vital to preventing severe complications from occurring [13, 14, 17].
Late effects of radiation also depend on location of the exposure. The mucosal cells of the oral cavity should theoretically recover like that of typical skin cells, but the combination of a tight space and harsh oral environment prone to infection and necrosis makes healing difficult. Thus, fibrosis and ulceration over a long period of time are possible. Acute effects of radiation typically damage mucosa of the gums and affect the pH of the saliva, facilitating microbial growth. These changes can lead to long-term problems with dental hygiene and patients should modify their dental habits accordingly through increased tooth brushing and fluoride mouthwash [13, 14]. Motility issues are also becoming more common, especially since patients who receive radiation therapy are now living longer. Dysphagia appears to be due to edema surrounding constrictor muscles, and physical therapy to encourage lymph drainage offers symptomatic treatment [18]. Gastric emptying issues due fibrosis at the gastric antrum and regions in the bowel where surgery was performed are also possible years after treatment. Atrophy of the pancreas many years after radiation exposure is also known to happen, although the clinical relevance of this is unknown [13, 14]. Symptoms can mimic malabsorption syndrome.
The main mechanism of radiation injury in the lungs is the generation of free oxygen and nitrogen radicals which damage the lung parenchyma with irregular repair of type I and II pneumocytes along the delicate reticulin network of pulmonary parenchyma. This oxidative damage causes disorganized repair and replacement of these cells associated with late fibrosis, impairs the ability for the lungs to oxygenate the blood. Pneumocyte damage also leads to recruitment of pro-inflammatory modulators that recruit immune cells to the region, leading to fibrosis and further depleting oxygenation capacity [19]. Furthermore, the radiation-driven production of nitric oxide has been suggested as a possible cause of damage to lung parenchyma outside of the field of radiation [20].
Complicating this situation is that many chemotherapeutic agents given with radiation therapy, such as bleomycin, also causes pulmonary fibrosis. The results of these sequelae are the development of pneumonitis up to two to six months after exposure. If asymptomatic, careful observation is standard of care. If symptomatic, the patient usually presents with occasional bouts of cough and dyspnea. Treatment with corticosteroids, supplementary oxygen, and prophylactic antibiotics are recommended in this situation. Once the pneumonitis resolves, fibrosis typically marks the site of radiation injury and can result in limited ventilation requiring long term use of supplemental oxygen. Given these findings, it is important to note that these patients tend to be at higher risk of developing chronic pulmonary disease compared to those who were unexposed [13, 21, 22, 23, 24]. Pulmonary rehabilitation is an important aspect to survivorship care and optimizing respiratory health is important to each patient as the rehabilitate from therapy. Figure 2 represents changes in lung parenchyma associated with immunotherapy and low dose radiation therapy with improvement seen after withdrawal of the immunotherapy.
(A) and (C) Therapy driven pneumonitis outlining the radiation therapy field while on immune check point inhibition. (B) and (D) Improvement after immunotherapy withdrawal. Courtesy of the Department of Radiation Oncology, University of Massachusetts Medical School.
Radiation injury to the liver, also known as radiation-induced liver disease (RILD), is unique in that it is often during the healing process that tissue function undergoes disorganized repair, including injury to the reticulum network, and limits the vascular relationship to the hepatocyte. While acute damage to hepatocytes affects liver function, as the cells divide during repair they tend to become disorganized, particularly if the structural reticulum of the liver is damaged. Increased distance between the hepatocytes and the blood supply leads to decreased liver function. This phenomenon explains why the state of the liver before exposure to radiation also plays an important role in this process. For example, a cirrhotic liver due to heavy alcoholic use or hepatitis will likely have pre-existing disorganized architecture, making this liver more susceptible to radiation damage. This includes veno-occlusive disease which also separates vascular anatomy from the hepatocyte. For these reasons, imaging studies such as magnetic resonance imaging before the delivery of radiation are obtained for evaluation of anatomy and function [25]. Disorganized repair can lead to migration of infusional therapies including radiolabeled therapy as the vascular anatomy can be disrupted and limit efficacy in spite of placement of therapy in close approximation to disease.
Patients with RILD typically experience symptoms that mimic cirrhosis, which include abdominal pain, elevated liver enzymes, jaundice, and ascites within four months of radiation exposure. Livers with pre-existing damage typically have earlier onset, with more severe symptoms. Treatment is symptomatic with keen observation of potential veno-occlusive and metabolic disease secondary to a congested liver with decreased function. Careful consideration must be given for medications that are metabolized in the liver, especially chemotherapeutic agents that are also hepatotoxic [25, 26].
All components of the kidney, including structures crucial for filtration, such as cells of the glomerulus, are susceptible to radiation damage. The signs of acute radiation damage are usually seen within 3–18 months, typically mimicking signs of renal failure. These signs include decreased glomerular filtration rate (GFR), increased serum β2-microglobulin, albuminuria, and other markers of poor renal function. Later signs of kidney radiation damage, which include hypertension and eventual renal failure, are often hard to distinguish from other pathological causes. For treatment of these sequelae, the use of hypertension medications such as angiotensin-converting-enzyme inhibitors (ACE) inhibitors are theoretically beneficial. Monitoring of renal function, both short and long term, also remains crucial in the standard of care for these patients [27, 28, 29]. In aging patients who are not candidates for surgery, radiation therapy with stereotactic techniques is being used more frequently to treat sub-total renal volumes for renal malignancies in an effort to spare as much renal function as possible.
The mechanism of radiation damage to the heart and blood vessels involves immediate cellular damage followed by fibrotic and disorganized repair, leading to reduced function in all cardiac segments including electrical conduction, myocardium, valves, and vascular anatomy. The time period is variable due to differences in size and functional architecture. However, what is clear is that unintended radiation exposure to the heart and blood vessels has a strong association with cardiovascular disease and complications [30, 31, 32, 33]. The lack of mitigation and therapeutic strategies in response to radiation of cardiovascular tissues explains why radiation oncologists spend such a large amount of effort to minimize cardiovascular exposure [34].
Generous radiation exposure to the heart can result in acute pericarditis. This diagnosis should always be in the differential in a patient with history of radiation exposure who presents with sharp, radiating chest pain that is relieved when sitting up. Anti-inflammatory medications like aspirin, colchicine and prednisone can offer symptomatic relief, with pericardiocentesis being an option in severe cases. Long term, patients who receive radiation exposure to the heart have a higher risk of heart disease and use of echocardiograms and nuclear stress tests in these patients is recommended if symptoms warrant use. Large blood vessels like the aortic, carotid, and femoral arteries can experience hyperplasia and atherosclerotic change from radiation doses. These changes can result in rupture and fistula formation, necessitating immediate treatment. This usually requires very high doses and prolonged exposure usually not seen in modern radiation therapy [30, 31, 32, 33]. With improvements in survival, patients can receive therapy with intentional overlap to previously treated volumes for second malignancies. These patients are vulnerable to vascular injury, including larger arteries and survivorship plans need to include periodic surveillance of vessels to optimize follow up care. Figure 3 demonstrates cardiac sparing for left-sided breast cancer treatment with breath-hold treatment techniques and optical tracking.
Cardiac sparing with deep inspiration breath-hold (DIBH), (left-free-breathing (FB); right-DIBH). Image courtesy of the Department of Radiation Oncology, University of Massachusetts Medical School.
Since most cells of the nervous system do not typically have a high turnover rate, it would seem reasonable to assume that the nervous system is more resistant to radiation damage than other organs. However, this assumption does not account for the immediate molecular effects of radiation. Regardless of the rate of cell division, all cells will receive damage to membranes, organelles, and other structures within the cell. Cells that do not divide very frequently will have to endure these injuries for long periods of time, leading to eventual clinical manifestations. Damage to nearby vasculature also limits growth and healing of these structures, leading to pronounced long term effects. There are clear reports of radiation damage to the central nervous system sometimes long after the initial radiation exposure [35, 36, 37, 38].
Patients who received radiosurgery or hypofractionation techniques are at risk of developing necrosis within six months of receiving therapy. Clinically, these developments can result in focal changes and change in behavior depending on the site of necrosis. Demyelinating syndromes, although rare, are also possible in the peripheral nerves and spinal cord. Often, neurotoxic symptoms are enhanced by chemotherapeutic agents, such as vinblastine, vincristine and cisplatin. Gathering a detailed physical exam, medical history and possible neurological referral may be required for definitive identification of these outcomes. Patients who received radiation therapy for pituitary adenomas or at sites near the optic structures are at risk for visual changes [36, 37]. This is because some structures, such as the lens and optic chasm, are sensitive to radiation exposure due to limited blood supply [15, 39, 40]. Patients treated for breast and head and neck cancers may rarely present with brachial plexopathy. Peripheral lymph nodes for these regions are often within the same field of treatment as the brachial plexus, resulting in unintended exposure to this region [41].
The effect of radiation therapy on the endocrine glands varies depending on the gland affected. The timeline for the development of clinical sequelae varies, with some cases even being reported many years after the radiation exposure. The pituitary gland is relatively radiation sensitive and results in panhypopituitary syndrome, requiring supplementation of depleted hormones. Secondary malignancies from un-intentional radiation exposure, while rare, have been reported [42]. Patients who received previous head and neck radiation therapy who now present with headache, vision loss and/or hormonal abnormalities should be carefully examined for the development of pituitary adenomas. The thyroid gland is also sensitive to radiation therapy, resulting in hypothyroid syndromes. Patients who receive radiation therapy to the head and neck often receive surgery that involves dissection of the thyroid gland, exasperating thyroid function loss. The thyroid also has a relatively higher incidence of developing secondary malignancies. This finding has been identified not only in patients receiving radiation therapy, but also victims of the Chernobyl incident [5]. The same care must be given to the parathyroid glands, given the proximity to the thyroid gland, which can present with signs and symptoms of hypoparathyroidism. Radiation exposure to the endocrine pancreas and adrenal glands are less characterized and are thought to be more radiation resistant. However, there are a few cases of injury to these organs associated with radiation exposure [42].
The reproductive organs are highly sensitive to radiation damage, with early exposure in pediatric patients leading to severe detriments like sterility and secondary malignancies (see Pediatrics). Since much of the reproductive system depends on hormonal homeostasis, radioactive effects on the endocrine system (see Endocrine) and the subsequent effect on hormone production, such as that on testosterone and estrogen, can drastically affect reproductive function and development depending on the effected hormone and gland. When investigating radiation injury to the reproductive system, it is always important to consider the location of exposure and any endocrine glands involved. Germ cells, such as spermatogonia, are particularly sensitive to radiation damage as they can experience inter-mitotic death. Even mild radiation exposure can lead to a heavy drop in sperm numbers. Mature sperm that receive radiation damage can harbor serious mutations or chromosomal abnormalities, leading to severe birth defects in progeny. Exposure to female reproductive organs can even lead to miscarriage and early menopause. As a result, it usually recommended for patients who receive gonadal exposure practice birth control methods for up to six months after the exposure. Because the ovaries rely on a regular, cyclical production of hormones from the follicles, radiation injury can lead to more pronounced effects on fertility. Mucosal atrophy and drying of female genitalia can cause great discomfort for the patient as well. Thus, fertility treatment and consultation should be considered for patients who received heavy or repeated radiation exposure to the gonads [13, 14, 42].
Pediatric patients are unique in that many organs and tissues are still developing. As a result, the cells involved are particularly sensitive to radiation damage as the fully developed adult organ can become abnormal or dysfunctional. Pediatric patients who receive radiation therapy are known to have a higher risk of developing growth abnormalities, chronic diseases, secondary malignancies and premature death compared to sibling controls [43]. Children who were treated with radiotherapy in the pelvis for tumors such as rhabdomyosarcoma or germ cell tumors are at high risk for gonadal abnormalities. Given the rapid growth in the musculoskeletal system during puberty, exposure to the spine at an early age can cause drastic changes to the respiratory and cardiovascular system. Radiation exposure to any cartilage or bone not only presents the risk of bone necrosis, but also may affect the fully developed form of such tissue, sometimes resulting in stunted extremity length and increased frequency of fractures. Children treated for Wilms tumors are at high risk of renal abnormalities later in their lifetime to the remaining kidney, therefore attention to detail for renal health as these patients become adults is an important aspect of a survivorship plan. Exposure to the bowel and hepatic structures are known to adversely affect the growth and development of intraabdominal organs. These effects can affect nutritional intake, indirectly causing developmental issues as the child matures [14, 43, 44]. As these patients mature into adulthood, detailed review of a patient’s radiation exposure history will play a pivotal role in survivorship plans.
As many of the side effects of radiation therapy are difficult to anticipate and manage, a great deal of effort has been put into reducing the amount of non-tumor tissue exposed to radiation. In the early days of radiation, this was difficult simply due to the lack of technology. Now, most radiation oncologists have access to various new tools, such as 4-dimensional conformal avoidance techniques to minimize off-target exposure [34]. Compact structures that were traditionally difficult to irradiate without significant off-target, such as the axilla and chest, can now be treated much more accurately with minimal exposure to non-tumor tissue [41]. Modern imaging techniques can be utilized to assess organ performance even before the administration of radiation to determine the risk of post-radiation symptoms. Indocyanine retention assays used in conjunction with MRI have determined the pre-exposure function of liver to assess if the patient is a good candidate for radiation therapy [25]. New guidelines are constantly being updated to ensure that the risks of radiation therapy are minimized. Novel pharmacological agents, such as the development of immunotherapy, are being implemented to supplement the efficiency of radiation therapy. As medicine becomes more collaborative and data is more available, physicians outside of radiation oncology will be able to better understand the radiation therapy treatment plans and define survivorship care plans accordingly.
The discovery of nuclear power and the utilization to benefit humanity has been one of the defining moments of the modern era. While this discovery certainly has benefits, there are also unintended and intended consequences which we must continue to mitigate. In the field of medicine, what is clear is that radiation remains a crucial tool to diagnose and treat diseases. Understanding and minimizing the risks of using this tool remains a priority for the safety and well-being of patients, especially given the broad impact it has on organs throughout the body and the long-term effects. It falls upon health care professionals to remain vigilant and well-informed to ensure that nuclear energy and radiation therapy remains a blessing and not a curse.
The authors declare no conflict of interest.
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',metaTitle:"Publication Agreement - Chapters",metaDescription:"IN TECH aims to guarantee that original material is published while at the same time giving significant freedom to our authors. For that matter, we uphold a flexible copyright policy meaning that there is no transfer of copyright to the publisher and authors retain exclusive copyright to their work.\n\nWhen submitting a manuscript the Corresponding Author is required to accept the terms and conditions set forth in our Publication Agreement as follows:",metaKeywords:null,canonicalURL:"/page/publication-agreement-chapters",contentRaw:'[{"type":"htmlEditorComponent","content":"The Corresponding Author (acting on behalf of all Authors) and INTECHOPEN LIMITED, incorporated and registered in England and Wales with company number 11086078 and a registered office at 5 Princes Gate Court, London, United Kingdom, SW7 2QJ conclude the following Agreement regarding the publication of a Book Chapter:
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The Corresponding Author (acting on behalf of all Authors) and INTECHOPEN LIMITED, incorporated and registered in England and Wales with company number 11086078 and a registered office at 5 Princes Gate Court, London, United Kingdom, SW7 2QJ conclude the following Agreement regarding the publication of a Book Chapter:
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\n\nLast updated: 2020-11-27
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Kessel",authors:[{id:"102383",title:"Dr.",name:"Marta",middleName:null,surname:"Suárez",slug:"marta-suarez",fullName:"Marta Suárez"},{id:"103822",title:"Dr.",name:"J.L",middleName:null,surname:"Menendez",slug:"j.l-menendez",fullName:"J.L Menendez"},{id:"103833",title:"Prof.",name:"Ramón",middleName:null,surname:"Torrecillas",slug:"ramon-torrecillas",fullName:"Ramón Torrecillas"},{id:"162633",title:"Dr.",name:"Adolfo",middleName:null,surname:"Fernández",slug:"adolfo-fernandez",fullName:"Adolfo Fernández"}]},{id:"23617",doi:"10.5772/24118",title:"Collagen- vs. Gelatine-Based Biomaterials and Their Biocompatibility: Review and Perspectives",slug:"collagen-vs-gelatine-based-biomaterials-and-their-biocompatibility-review-and-perspectives",totalDownloads:9373,totalCrossrefCites:60,totalDimensionsCites:196,abstract:null,book:{id:"1487",slug:"biomaterials-applications-for-nanomedicine",title:"Biomaterials",fullTitle:"Biomaterials Applications for Nanomedicine"},signatures:"Selestina Gorgieva and Vanja Kokol",authors:[{id:"55577",title:"Prof.",name:"Vanja",middleName:null,surname:"Kokol",slug:"vanja-kokol",fullName:"Vanja Kokol"},{id:"61285",title:"BSc",name:"Selestina",middleName:null,surname:"Gorgieva",slug:"selestina-gorgieva",fullName:"Selestina Gorgieva"}]},{id:"46243",doi:"10.5772/57255",title:"Corrosion Inhibitors – Principles, Mechanisms and Applications",slug:"corrosion-inhibitors-principles-mechanisms-and-applications",totalDownloads:13621,totalCrossrefCites:40,totalDimensionsCites:156,abstract:null,book:{id:"3817",slug:"developments-in-corrosion-protection",title:"Developments in Corrosion Protection",fullTitle:"Developments in Corrosion Protection"},signatures:"Camila G. Dariva and Alexandre F. Galio",authors:[{id:"169261",title:"Dr.",name:"Camila",middleName:"G.",surname:"Dariva",slug:"camila-dariva",fullName:"Camila Dariva"},{id:"170138",title:"Dr.",name:"Alexandre",middleName:"Ferreira",surname:"Galio",slug:"alexandre-galio",fullName:"Alexandre Galio"}]}],mostDownloadedChaptersLast30Days:[{id:"76780",title:"Basics of Clay Minerals and Their Characteristic Properties",slug:"basics-of-clay-minerals-and-their-characteristic-properties",totalDownloads:1553,totalCrossrefCites:8,totalDimensionsCites:11,abstract:"Clay minerals such as kaolinite, smectite, chlorite, micas are main components of raw materials of clay and formed in presence of water. A large number of clays used to form the different structure which completely depends on their mining source. They are known as hydrous phyllosilicate having silica, alumina and water with variable amount of inorganic ions like Mg2+, Na+, Ca2+ which are found either in interlayer space or on the planetary surface. Clay minerals are described by presence of two-dimensional sheets, tetrahedral (SiO4) and octahedral (Al2O3). There are different clay minerals which are categorized based on presence of tetrahedral and octahedral layer in their structure like kaolinite (1:1 of tetrahedral and octahedral layers), smectite group of clay minerals (2:1 of tetrahedral and octahedral layers) and chlorite (2:1:1 of tetrahedral, octahedral and octahedral layers). The particle size of clay minerals is <2microns which can be present in form of plastic in presence of water and solidified when dried. The small size and their distinctive crystal structure make clay minerals very special with their unique properties including high cation exchange capacity, swelling behavior, specific surface area, adsorption capacity, etc. which are described in this chapter. Due to all these unique properties, clay minerals are gaining interest in different fields.",book:{id:"10949",slug:"clay-and-clay-minerals",title:"Clay and Clay Minerals",fullTitle:"Clay and Clay Minerals"},signatures:"Neeraj Kumari and Chandra Mohan",authors:[{id:"258132",title:"Dr.",name:"Chandra",middleName:null,surname:"Mohan",slug:"chandra-mohan",fullName:"Chandra Mohan"},{id:"352399",title:"Dr.",name:"Neeraj",middleName:null,surname:"Kumari",slug:"neeraj-kumari",fullName:"Neeraj Kumari"}]},{id:"51535",title:"An Introduction to Hydrogels and Some Recent Applications",slug:"an-introduction-to-hydrogels-and-some-recent-applications",totalDownloads:11460,totalCrossrefCites:61,totalDimensionsCites:125,abstract:"Hydrogels have existed for more than half a century, and today they have many applications in various processes ranging from industrial to biological. There are numerous original papers, reviews, and monographs focused on the synthesis, properties, and applications of hydrogels. This chapter covers the fundamental aspects and several applications of hydrogels based on the old and the most recent publications in this field.",book:{id:"5251",slug:"emerging-concepts-in-analysis-and-applications-of-hydrogels",title:"Emerging Concepts in Analysis and Applications of Hydrogels",fullTitle:"Emerging Concepts in Analysis and Applications of Hydrogels"},signatures:"Morteza Bahram, Naimeh Mohseni and Mehdi Moghtader",authors:[{id:"179718",title:"Prof.",name:"Morteza",middleName:null,surname:"Bahram",slug:"morteza-bahram",fullName:"Morteza Bahram"},{id:"185713",title:"Dr.",name:"Naimeh",middleName:null,surname:"Mohseni",slug:"naimeh-mohseni",fullName:"Naimeh Mohseni"},{id:"185714",title:"Dr.",name:"Mehdi",middleName:null,surname:"Moghtader",slug:"mehdi-moghtader",fullName:"Mehdi Moghtader"}]},{id:"70661",title:"Bioremediation Techniques for Polluted Environment: Concept, Advantages, Limitations, and Prospects",slug:"bioremediation-techniques-for-polluted-environment-concept-advantages-limitations-and-prospects",totalDownloads:2409,totalCrossrefCites:6,totalDimensionsCites:18,abstract:"Environmental pollution has been rising in the past few decades due to increased anthropogenic activities. Bioremediation is an attractive and successful cleaning technique to remove toxic waste from polluted environment. Bioremediation is highly involved in degradation, eradication, immobilization, or detoxification diverse chemical wastes and physical hazardous materials from the surrounding through the all-inclusive and action of microorganisms. The main principle is degrading and converting pollutants to less toxic forms. Bioremediation can be carried out ex-situ and in-situ, depending on several factors, which include but not limited to cost, site characteristics, type, and concentration of pollutants. Hence, appropriate bioremediation technique is selected. Additionally, the major methodologies to develop bioremediation are biostimulation, bioaugmentation, bioventing, biopiles, and bioattenuation provided the environmental factors that decide the completion of bioremediation. Bioremediation is the most effective, economical, eco-friendly management tool to manage the polluted environment. All bioremediation techniques have its own advantage and disadvantage because it has its own specific applications.",book:{id:"9343",slug:"trace-metals-in-the-environment-new-approaches-and-recent-advances",title:"Trace Metals in the Environment",fullTitle:"Trace Metals in the Environment - New Approaches and Recent Advances"},signatures:"Indu Sharma",authors:[{id:"301262",title:"Associate Prof.",name:"Indu",middleName:null,surname:"Sharma",slug:"indu-sharma",fullName:"Indu Sharma"}]},{id:"18275",title:"Modeling and Identification of Parameters the Piezoelectric Transducers in Ultrasonic Systems",slug:"modeling-and-identification-of-parameters-the-piezoelectric-transducers-in-ultrasonic-systems",totalDownloads:9936,totalCrossrefCites:3,totalDimensionsCites:5,abstract:null,book:{id:"201",slug:"advances-in-ceramics-electric-and-magnetic-ceramics-bioceramics-ceramics-and-environment",title:"Advances in Ceramics",fullTitle:"Advances in Ceramics - Electric and Magnetic Ceramics, Bioceramics, Ceramics and Environment"},signatures:"Pawel Fabijanski and Ryszard Lagoda",authors:[{id:"13086",title:"Dr.",name:"Pawel",middleName:null,surname:"Fabijański",slug:"pawel-fabijanski",fullName:"Pawel Fabijański"}]},{id:"60680",title:"Environmental Contamination by Heavy Metals",slug:"environmental-contamination-by-heavy-metals",totalDownloads:15997,totalCrossrefCites:164,totalDimensionsCites:356,abstract:"The environment and its compartments have been severely polluted by heavy metals. This has compromised the ability of the environment to foster life and render its intrinsic values. Heavy metals are known to be naturally occurring compounds, but anthropogenic activities introduce them in large quantities in different environmental compartments. This leads to the environment’s ability to foster life being reduced as human, animal, and plant health become threatened. This occurs due to bioaccumulation in the food chains as a result of the nondegradable state of the heavy metals. Remediation of heavy metals requires special attention to protect soil quality, air quality, water quality, human health, animal health, and all spheres as a collection. Developed physical and chemical heavy metal remediation technologies are demanding costs which are not feasible, time-consuming, and release additional waste to the environment. This chapter summarises the problems related to heavy metal pollution and various remediation technologies. A case study in South Africa mines were also used.",book:{id:"6534",slug:"heavy-metals",title:"Heavy Metals",fullTitle:"Heavy Metals"},signatures:"Vhahangwele Masindi and Khathutshelo L. Muedi",authors:[{id:"225304",title:"Dr.",name:"Vhahangwele",middleName:null,surname:"Masindi",slug:"vhahangwele-masindi",fullName:"Vhahangwele Masindi"},{id:"241403",title:"M.Sc.",name:"Khathutshelo",middleName:"Lilith",surname:"Muedi",slug:"khathutshelo-muedi",fullName:"Khathutshelo Muedi"}]}],onlineFirstChaptersFilter:{topicId:"14",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"81825",title:"Quantification of Heavy Metal Levels in Sediments of the “Palizada” River in a Protected Natural Area of Southeastern Mexico",slug:"quantification-of-heavy-metal-levels-in-sediments-of-the-palizada-river-in-a-protected-natural-area-",totalDownloads:1,totalDimensionsCites:null,doi:"10.5772/intechopen.104657",abstract:"This chapter shows the results of the determination of the levels of Copper (Cu), Iron (Fe), Magnesium (Mg), Manganese (Mn), and Cadmium (Cd) in sediments of the “Palizada River”; evaluated by atomic absorption. The results show high levels of Fe, Mg, and Mn concerning previous studies and are directly related to agricultural and livestock activities in the area. The metal-metal correlation analysis show significant values, suggesting that the generation source is the same. Some of the pollutants produced by industrial or population centers; end up in natural water bodies; by different physical processes, such as precipitation, complex formation, and others. These contaminants can bioaccumulate in aquatic organisms and reach humans through the food chain. Certain heavy metals such as cadmium (Cd) produced by human activities have been found in the oceans and the tissues of different organisms; which constitutes a risk for consumption; Cd is classified as an element that predisposes to the presence of Cancer. Therefore, the study of sediments is fundamental for determining the degree of contamination of an ecosystem.",book:{id:"11120",title:"Environmental Impact and Remediation of Heavy Metals",coverURL:"https://cdn.intechopen.com/books/images_new/11120.jpg"},signatures:"Carlos Montalvo, Claudia A. Aguilar, Yunuen Canedo, Alejandro Ruiz, Brenda Zermeño, Ruby S. Gines and Rosa M. Cerón"},{id:"81461",title:"Fiber Inclusions-Based Epoxy Composites and Their Applications",slug:"fiber-inclusions-based-epoxy-composites-and-their-applications",totalDownloads:3,totalDimensionsCites:0,doi:"10.5772/intechopen.104118",abstract:"Because of their low cost, lightweight, easy production methods, and design flexibility, polymer-based composites are widely employed in a wide range of applications. Because of its high specific strength, superior mechanical characteristics, super adhesiveness, heat and solvent resistance, and so on, epoxy polymer or polyepoxide represent a significant majority of matrix composites. As a result, fiber fillers-reinforced epoxy resin composites have been investigated for a variety of applications, including high-tech in the ballistic, aircraft, automobile, construction, and sports sectors. In this chapter, the manufacturing procedures of fiber-reinforced epoxy composites have been described. Different categories of fiber are used as fillers in an epoxy matrix and their morphology is discussed as a function of the obtained properties.",book:{id:"11123",title:"Epoxy-Based Composites",coverURL:"https://cdn.intechopen.com/books/images_new/11123.jpg"},signatures:"Nassima Radouane and Abdelkrim Maaroufi"},{id:"81727",title:"Nanoparticle Based Collagen Biomaterials for Wound Healing",slug:"nanoparticle-based-collagen-biomaterials-for-wound-healing",totalDownloads:4,totalDimensionsCites:0,doi:"10.5772/intechopen.104851",abstract:"Wounds and infections are extremely common cases that are dealt with in the medical field. Their effective and timely treatment ensures the overall well-being of patients in general. Current treatments include the use of collagen scaffolds and other biomaterials for tissue regeneration. Although the use of collagenous biomaterials has been tested, the incorporation of nanoparticles into these collagenous biomaterials is a fairly new field, whose possibilities are yet to be explored and discovered. The current chapter explores the applications of the amalgamation of collagenous biomaterials with nanoparticles, which themselves are known to be effective in the treatment and prevention of infections.",book:{id:"10945",title:"Collagen Biomaterial",coverURL:"https://cdn.intechopen.com/books/images_new/10945.jpg"},signatures:"Kausalya Neelavara Makkithaya, Sharmila Nadumane, Guan-Yu Zhuo, Sanjiban Chakrabarty and Nirmal Mazumder"},{id:"81726",title:"Design and Fabrication of Microencapsulated Phase Change Materials for Energy/Thermal Energy Storage and Other Versatile Applications",slug:"design-and-fabrication-of-microencapsulated-phase-change-materials-for-energy-thermal-energy-storage",totalDownloads:3,totalDimensionsCites:0,doi:"10.5772/intechopen.102806",abstract:"Microencapsulated phase change materials have been considered as potential candidates to overcome the global energy shortage, as these materials can provide a viable method for storing thermal energy and offering consistent energy management by controllable heat release in desirable environments. Microencapsulation technology offers a method for overcoming the trouble associated with the handling of solid–liquid phase change materials (PCMs) via encapsulating PCMs with thin or tiny shells which are known as ‘microcapsules’. Microcapsule shells not only keep PCMs isolated from the surrounding materials but also provide a stable structure and sufficient surface for PCMs to enhance heat transfer. Thus microencapsulation technology received remarkable attention from fundamental studies to industrial growth in recent years. In order to provide a reliable source of information on recent progress and development in microencapsulated PCMs, this chapter emphases on methods and techniques for the encapsulation of PCMs with a diversity of shell materials from traditional organic polymers to novel inorganic materials to pursue high encapsulation efficiency, excellent thermal energy-storage performance and long-term operation durability. The chapter also highlights the design of bi- and multi-functional PCM-based microcapsules by fabricating various functional shells in a multilayered structure to meet the growing demand for versatile applications.",book:{id:"11077",title:"Microencapsulation - Recent Advances, New Perspectives and Applications of Smart Microcapsules",coverURL:"https://cdn.intechopen.com/books/images_new/11077.jpg"},signatures:"Tahira Mahmood, Rahmat Ali and Abdul Naeem"},{id:"81709",title:"New-Age Al-Cu-Mn-Zr (ACMZ) Alloy for High Temperature-High Strength Applications: A Review",slug:"new-age-al-cu-mn-zr-acmz-alloy-for-high-temperature-high-strength-applications-a-review",totalDownloads:8,totalDimensionsCites:0,doi:"10.5772/intechopen.104533",abstract:"One of the prime challenges with age hardened Al-Cu alloys is the strength degradation at high temperatures (above ∼250°C) due to the coarsening of strengthening θ′ precipitates and associated metastable θ′ → stable θ phase transformation. A recent discovery suggests that micro-alloying with Manganese (Mn) and Zirconium (Zr) can synergistically restrict θ′ precipitate coarsening, thereby rendering an excellent high temperature stability for Al-Cu-Mn-Zr (ACMZ) alloys. The θ′ precipitates are stabilized primarily from the reduction of interfacial energy by preferential solute segregation (Mn & Zr) at θ′ precipitate/α-Al matrix interfaces. The Al-Cu-Mn-Zr alloys thereby exhibit excellent high temperature hardness and tensile properties (yield and ultimate tensile strength) in addition to superior fatigue life and creep resistance. This newly developed Al-Cu-Mn-Zr alloys also showed excellent hot tearing resistance compared to the conventional cast Al-Cu alloys so much so that it meets the industrial standards as well. These alloys also have promising manufacturing possibility by additive route. Overall, Al-Cu-Mn-Zr alloys offer great potential for the automotive industry because of their unprecedented high temperature performance which should enable engineers to build light weight passenger vehicles leading to a safer and greener environment.",book:{id:"10847",title:"Aluminium Alloys - Design and Development of Innovative Alloys, Manufacturing Processes and Applications",coverURL:"https://cdn.intechopen.com/books/images_new/10847.jpg"},signatures:"Samarendra Roy and Shibayan Roy"},{id:"81716",title:"Groove Shape Optimization on Dry Gas Seals",slug:"groove-shape-optimization-on-dry-gas-seals",totalDownloads:7,totalDimensionsCites:0,doi:"10.5772/intechopen.103088",abstract:"In this paper, a topological optimum design for the shape of a groove in a dry gas seal is described. Dry gas seals are widely used in high speed and high pressure rotating machinery such as gas turbines, compressors, and so on because of their high reliability compared to other types of seals. However, recent requirements for reducing emission with further control of leakage are in order. With this background, we propose applying topological optimization to the groove shape in a dry gas seal to reduce its leakage while keeping its stiffness for safe operation. First, the method of topological optimum design as applied to the groove of a dry gas seal is explained via numerical analysis. Next, results of the topological optimization are shown via categorizing an optimum shape map. Finally, the mechanism of reducing the gas leakage with an optimized seal is discussed based on the prediction of the flow field using a CFD analysis.",book:{id:"10848",title:"Tribology of Machine Elements – Fundamentals and Applications",coverURL:"https://cdn.intechopen.com/books/images_new/10848.jpg"},signatures:"Masayuki Ochiai and Yuki Sato"}],onlineFirstChaptersTotal:87},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:8,numberOfPublishedChapters:87,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:98,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:27,numberOfPublishedChapters:286,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:9,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:139,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:129,numberOfOpenTopics:0,numberOfUpcomingTopics:2,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!1},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:106,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:9,numberOfPublishedChapters:101,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:11,numberOfOpenTopics:2,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:0,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!1},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:9,numberOfOpenTopics:4,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}},{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}}]},series:{item:{id:"6",title:"Infectious Diseases",doi:"10.5772/intechopen.71852",issn:"2631-6188",scope:"This series will provide a comprehensive overview of recent research trends in various Infectious Diseases (as per the most recent Baltimore classification). Topics will include general overviews of infections, immunopathology, diagnosis, treatment, epidemiology, etiology, and current clinical recommendations for managing infectious diseases. Ongoing issues, recent advances, and future diagnostic approaches and therapeutic strategies will also be discussed. This book series will focus on various aspects and properties of infectious diseases whose deep understanding is essential for safeguarding the human race from losing resources and economies due to pathogens.",coverUrl:"https://cdn.intechopen.com/series/covers/6.jpg",latestPublicationDate:"May 17th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:13,editor:{id:"131400",title:"Prof.",name:"Alfonso J.",middleName:null,surname:"Rodriguez-Morales",slug:"alfonso-j.-rodriguez-morales",fullName:"Alfonso J. Rodriguez-Morales",profilePictureURL:"https://mts.intechopen.com/storage/users/131400/images/system/131400.png",biography:"Dr. Rodriguez-Morales is an expert in tropical and emerging diseases, particularly zoonotic and vector-borne diseases (especially arboviral diseases). He is the president of the Travel Medicine Committee of the Pan-American Infectious Diseases Association (API), as well as the president of the Colombian Association of Infectious Diseases (ACIN). He is a member of the Committee on Tropical Medicine, Zoonoses, and Travel Medicine of ACIN. He is a vice-president of the Latin American Society for Travel Medicine (SLAMVI) and a Member of the Council of the International Society for Infectious Diseases (ISID). Since 2014, he has been recognized as a Senior Researcher, at the Ministry of Science of Colombia. He is a professor at the Faculty of Medicine of the Fundacion Universitaria Autonoma de las Americas, in Pereira, Risaralda, Colombia. He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. He is currently the Editor in Chief of the journal Travel Medicine and Infectious Diseases. His Scopus H index is 47 (Google Scholar H index, 68).",institutionString:"Institución Universitaria Visión de las Américas, Colombia",institution:null},editorTwo:null,editorThree:null},subseries:{paginationCount:6,paginationItems:[{id:"22",title:"Applied Intelligence",coverUrl:"https://cdn.intechopen.com/series_topics/covers/22.jpg",isOpenForSubmission:!0,editor:{id:"27170",title:"Prof.",name:"Carlos",middleName:"M.",surname:"Travieso-Gonzalez",slug:"carlos-travieso-gonzalez",fullName:"Carlos Travieso-Gonzalez",profilePictureURL:"https://mts.intechopen.com/storage/users/27170/images/system/27170.jpeg",biography:"Carlos M. Travieso-González received his MSc degree in Telecommunication Engineering at Polytechnic University of Catalonia (UPC), Spain in 1997, and his Ph.D. degree in 2002 at the University of Las Palmas de Gran Canaria (ULPGC-Spain). He is a full professor of signal processing and pattern recognition and is head of the Signals and Communications Department at ULPGC, teaching from 2001 on subjects on signal processing and learning theory. His research lines are biometrics, biomedical signals and images, data mining, classification system, signal and image processing, machine learning, and environmental intelligence. He has researched in 52 international and Spanish research projects, some of them as head researcher. He is co-author of 4 books, co-editor of 27 proceedings books, guest editor for 8 JCR-ISI international journals, and up to 24 book chapters. He has over 450 papers published in international journals and conferences (81 of them indexed on JCR – ISI - Web of Science). He has published seven patents in the Spanish Patent and Trademark Office. He has been a supervisor on 8 Ph.D. theses (11 more are under supervision), and 130 master theses. He is the founder of The IEEE IWOBI conference series and the president of its Steering Committee, as well as the founder of both the InnoEducaTIC and APPIS conference series. He is an evaluator of project proposals for the European Union (H2020), Medical Research Council (MRC, UK), Spanish Government (ANECA, Spain), Research National Agency (ANR, France), DAAD (Germany), Argentinian Government, and the Colombian Institutions. He has been a reviewer in different indexed international journals (<70) and conferences (<250) since 2001. He has been a member of the IASTED Technical Committee on Image Processing from 2007 and a member of the IASTED Technical Committee on Artificial Intelligence and Expert Systems from 2011. \n\nHe has held the general chair position for the following: ACM-APPIS (2020, 2021), IEEE-IWOBI (2019, 2020 and 2020), A PPIS (2018, 2019), IEEE-IWOBI (2014, 2015, 2017, 2018), InnoEducaTIC (2014, 2017), IEEE-INES (2013), NoLISP (2011), JRBP (2012), and IEEE-ICCST (2005)\n\nHe is an associate editor of the Computational Intelligence and Neuroscience Journal (Hindawi – Q2 JCR-ISI). He was vice dean from 2004 to 2010 in the Higher Technical School of Telecommunication Engineers at ULPGC and the vice dean of Graduate and Postgraduate Studies from March 2013 to November 2017. He won the “Catedra Telefonica” Awards in Modality of Knowledge Transfer, 2017, 2018, and 2019 editions, and awards in Modality of COVID Research in 2020.\n\nPublic References:\nResearcher ID http://www.researcherid.com/rid/N-5967-2014\nORCID https://orcid.org/0000-0002-4621-2768 \nScopus Author ID https://www.scopus.com/authid/detail.uri?authorId=6602376272\nScholar Google https://scholar.google.es/citations?user=G1ks9nIAAAAJ&hl=en \nResearchGate https://www.researchgate.net/profile/Carlos_Travieso",institutionString:null,institution:{name:"University of Las Palmas de Gran Canaria",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"23",title:"Computational Neuroscience",coverUrl:"https://cdn.intechopen.com/series_topics/covers/23.jpg",isOpenForSubmission:!0,editor:{id:"14004",title:"Dr.",name:"Magnus",middleName:null,surname:"Johnsson",slug:"magnus-johnsson",fullName:"Magnus Johnsson",profilePictureURL:"https://mts.intechopen.com/storage/users/14004/images/system/14004.png",biography:"Dr Magnus Johnsson is a cross-disciplinary scientist, lecturer, scientific editor and AI/machine learning consultant from Sweden. \n\nHe is currently at Malmö University in Sweden, but also held positions at Lund University in Sweden and at Moscow Engineering Physics Institute. \nHe holds editorial positions at several international scientific journals and has served as a scientific editor for books and special journal issues. \nHis research interests are wide and include, but are not limited to, autonomous systems, computer modeling, artificial neural networks, artificial intelligence, cognitive neuroscience, cognitive robotics, cognitive architectures, cognitive aids and the philosophy of mind. \n\nDr. Johnsson has experience from working in the industry and he has a keen interest in the application of neural networks and artificial intelligence to fields like industry, finance, and medicine. \n\nWeb page: www.magnusjohnsson.se",institutionString:null,institution:{name:"Malmö University",institutionURL:null,country:{name:"Sweden"}}},editorTwo:null,editorThree:null},{id:"24",title:"Computer Vision",coverUrl:"https://cdn.intechopen.com/series_topics/covers/24.jpg",isOpenForSubmission:!0,editor:{id:"294154",title:"Prof.",name:"George",middleName:null,surname:"Papakostas",slug:"george-papakostas",fullName:"George Papakostas",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002hYaGbQAK/Profile_Picture_1624519712088",biography:"George A. Papakostas has received a diploma in Electrical and Computer Engineering in 1999 and the M.Sc. and Ph.D. degrees in Electrical and Computer Engineering in 2002 and 2007, respectively, from the Democritus University of Thrace (DUTH), Greece. Dr. Papakostas serves as a Tenured Full Professor at the Department of Computer Science, International Hellenic University, Greece. Dr. Papakostas has 10 years of experience in large-scale systems design as a senior software engineer and technical manager, and 20 years of research experience in the field of Artificial Intelligence. Currently, he is the Head of the “Visual Computing” division of HUman-MAchines INteraction Laboratory (HUMAIN-Lab) and the Director of the MPhil program “Advanced Technologies in Informatics and Computers” hosted by the Department of Computer Science, International Hellenic University. He has (co)authored more than 150 publications in indexed journals, international conferences and book chapters, 1 book (in Greek), 3 edited books, and 5 journal special issues. His publications have more than 2100 citations with h-index 27 (GoogleScholar). His research interests include computer/machine vision, machine learning, pattern recognition, computational intelligence. \nDr. Papakostas served as a reviewer in numerous journals, as a program\ncommittee member in international conferences and he is a member of the IAENG, MIR Labs, EUCogIII, INSTICC and the Technical Chamber of Greece (TEE).",institutionString:null,institution:{name:"International Hellenic University",institutionURL:null,country:{name:"Greece"}}},editorTwo:null,editorThree:null},{id:"25",title:"Evolutionary Computation",coverUrl:"https://cdn.intechopen.com/series_topics/covers/25.jpg",isOpenForSubmission:!0,editor:{id:"136112",title:"Dr.",name:"Sebastian",middleName:null,surname:"Ventura Soto",slug:"sebastian-ventura-soto",fullName:"Sebastian Ventura Soto",profilePictureURL:"https://mts.intechopen.com/storage/users/136112/images/system/136112.png",biography:"Sebastian Ventura is a Spanish researcher, a full professor with the Department of Computer Science and Numerical Analysis, University of Córdoba. Dr Ventura also holds the positions of Affiliated Professor at Virginia Commonwealth University (Richmond, USA) and Distinguished Adjunct Professor at King Abdulaziz University (Jeddah, Saudi Arabia). Additionally, he is deputy director of the Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI) and heads the Knowledge Discovery and Intelligent Systems Research Laboratory. He has published more than ten books and over 300 articles in journals and scientific conferences. Currently, his work has received over 18,000 citations according to Google Scholar, including more than 2200 citations in 2020. In the last five years, he has published more than 60 papers in international journals indexed in the JCR (around 70% of them belonging to first quartile journals) and he has edited some Springer books “Supervised Descriptive Pattern Mining” (2018), “Multiple Instance Learning - Foundations and Algorithms” (2016), and “Pattern Mining with Evolutionary Algorithms” (2016). He has also been involved in more than 20 research projects supported by the Spanish and Andalusian governments and the European Union. He currently belongs to the editorial board of PeerJ Computer Science, Information Fusion and Engineering Applications of Artificial Intelligence journals, being also associate editor of Applied Computational Intelligence and Soft Computing and IEEE Transactions on Cybernetics. Finally, he is editor-in-chief of Progress in Artificial Intelligence. He is a Senior Member of the IEEE Computer, the IEEE Computational Intelligence, and the IEEE Systems, Man, and Cybernetics Societies, and the Association of Computing Machinery (ACM). Finally, his main research interests include data science, computational intelligence, and their applications.",institutionString:null,institution:{name:"University of Córdoba",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"26",title:"Machine Learning and Data Mining",coverUrl:"https://cdn.intechopen.com/series_topics/covers/26.jpg",isOpenForSubmission:!0,editor:{id:"24555",title:"Dr.",name:"Marco Antonio",middleName:null,surname:"Aceves Fernandez",slug:"marco-antonio-aceves-fernandez",fullName:"Marco Antonio Aceves Fernandez",profilePictureURL:"https://mts.intechopen.com/storage/users/24555/images/system/24555.jpg",biography:"Dr. Marco Antonio Aceves Fernandez obtained his B.Sc. (Eng.) in Telematics from the Universidad de Colima, Mexico. He obtained both his M.Sc. and Ph.D. from the University of Liverpool, England, in the field of Intelligent Systems. He is a full professor at the Universidad Autonoma de Queretaro, Mexico, and a member of the National System of Researchers (SNI) since 2009. Dr. Aceves Fernandez has published more than 80 research papers as well as a number of book chapters and congress papers. He has contributed in more than 20 funded research projects, both academic and industrial, in the area of artificial intelligence, ranging from environmental, biomedical, automotive, aviation, consumer, and robotics to other applications. He is also a honorary president at the National Association of Embedded Systems (AMESE), a senior member of the IEEE, and a board member of many institutions. 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He is currently a principal researcher in data analytics and optimisation at TECNALIA (Spain), a visiting fellow at the Basque Center for Applied Mathematics (BCAM) and a part-time lecturer at the University of the Basque Country (UPV/EHU). His research interests gravitate on the use of descriptive, prescriptive and predictive algorithms for data mining and optimization in a diverse range of application fields such as Energy, Transport, Telecommunications, Health and Industry, among others. In these fields he has published more than 240 articles, co-supervised 8 Ph.D. theses, edited 6 books, coauthored 7 patents and participated/led more than 40 research projects. 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He also obtained an MSc in Molecular and Genetic Medicine, and a Ph.D. in Clinical Immunology and Human Genetics from the University of Sheffield, UK. He also completed a short-term fellowship in Pediatric Clinical Immunology and Bone Marrow Transplantation at Newcastle General Hospital, England. Dr. Rezaei is a Full Professor of Immunology and Vice Dean of International Affairs and Research, at the School of Medicine, Tehran University of Medical Sciences, and the co-founder and head of the Research Center for Immunodeficiencies. He is also the founding president of the Universal Scientific Education and Research Network (USERN). Dr. Rezaei has directed more than 100 research projects and has designed and participated in several international collaborative projects. He is an editor, editorial assistant, or editorial board member of more than forty international journals. He has edited more than 50 international books, presented more than 500 lectures/posters in congresses/meetings, and published more than 1,100 scientific papers in international journals.",institutionString:"Tehran University of Medical Sciences",institution:{name:"Tehran University of Medical Sciences",country:{name:"Iran"}}},{id:"180733",title:"Dr.",name:"Jean",middleName:null,surname:"Engohang-Ndong",slug:"jean-engohang-ndong",fullName:"Jean Engohang-Ndong",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/180733/images/system/180733.png",biography:"Dr. Jean Engohang-Ndong was born and raised in Gabon. After obtaining his Associate Degree of Science at the University of Science and Technology of Masuku, Gabon, he continued his education in France where he obtained his BS, MS, and Ph.D. in Medical Microbiology. He worked as a post-doctoral fellow at the Public Health Research Institute (PHRI), Newark, NJ for four years before accepting a three-year faculty position at Brigham Young University-Hawaii. Dr. Engohang-Ndong is a tenured faculty member with the academic rank of Full Professor at Kent State University, Ohio, where he teaches a wide range of biological science courses and pursues his research in medical and environmental microbiology. Recently, he expanded his research interest to epidemiology and biostatistics of chronic diseases in Gabon.",institutionString:"Kent State University",institution:{name:"Kent State University",country:{name:"United States of America"}}},{id:"188773",title:"Prof.",name:"Emmanuel",middleName:null,surname:"Drouet",slug:"emmanuel-drouet",fullName:"Emmanuel Drouet",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/188773/images/system/188773.png",biography:"Emmanuel Drouet, PharmD, is a Professor of Virology at the Faculty of Pharmacy, the University Grenoble-Alpes, France. As a head scientist at the Institute of Structural Biology in Grenoble, Dr. Drouet’s research investigates persisting viruses in humans (RNA and DNA viruses) and the balance with our host immune system. He focuses on these viruses’ effects on humans (both their impact on pathology and their symbiotic relationships in humans). He has an excellent track record in the herpesvirus field, and his group is engaged in clinical research in the field of Epstein-Barr virus diseases. He is the editor of the online Encyclopedia of Environment and he coordinates the Universal Health Coverage education program for the BioHealth Computing Schools of the European Institute of Science.",institutionString:null,institution:{name:"Grenoble Alpes University",country:{name:"France"}}},{id:"131400",title:"Prof.",name:"Alfonso J.",middleName:null,surname:"Rodriguez-Morales",slug:"alfonso-j.-rodriguez-morales",fullName:"Alfonso J. Rodriguez-Morales",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/131400/images/system/131400.png",biography:"Dr. Rodriguez-Morales is an expert in tropical and emerging diseases, particularly zoonotic and vector-borne diseases (especially arboviral diseases). He is the president of the Travel Medicine Committee of the Pan-American Infectious Diseases Association (API), as well as the president of the Colombian Association of Infectious Diseases (ACIN). He is a member of the Committee on Tropical Medicine, Zoonoses, and Travel Medicine of ACIN. He is a vice-president of the Latin American Society for Travel Medicine (SLAMVI) and a Member of the Council of the International Society for Infectious Diseases (ISID). Since 2014, he has been recognized as a Senior Researcher, at the Ministry of Science of Colombia. He is a professor at the Faculty of Medicine of the Fundacion Universitaria Autonoma de las Americas, in Pereira, Risaralda, Colombia. He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. He is currently the Editor in Chief of the journal Travel Medicine and Infectious Diseases. His Scopus H index is 47 (Google Scholar H index, 68).",institutionString:"Institución Universitaria Visión de las Américas, Colombia",institution:null},{id:"332819",title:"Dr.",name:"Chukwudi Michael",middleName:"Michael",surname:"Egbuche",slug:"chukwudi-michael-egbuche",fullName:"Chukwudi Michael Egbuche",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/332819/images/14624_n.jpg",biography:"I an Dr. Chukwudi Michael Egbuche. I am a Senior Lecturer in the Department of Parasitology and Entomology, Nnamdi Azikiwe University, Awka.",institutionString:null,institution:{name:"Nnamdi Azikiwe University",country:{name:"Nigeria"}}},{id:"284232",title:"Mr.",name:"Nikunj",middleName:"U",surname:"Tandel",slug:"nikunj-tandel",fullName:"Nikunj Tandel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/284232/images/8275_n.jpg",biography:'Mr. Nikunj Tandel has completed his Master\'s degree in Biotechnology from VIT University, India in the year of 2012. He is having 8 years of research experience especially in the field of malaria epidemiology, immunology, and nanoparticle-based drug delivery system against the infectious diseases, autoimmune disorders and cancer. He has worked for the NIH funded-International Center of Excellence in Malaria Research project "Center for the study of complex malaria in India (CSCMi)" in collaboration with New York University. The preliminary objectives of the study are to understand and develop the evidence-based tools and interventions for the control and prevention of malaria in different sites of the INDIA. Alongside, with the help of next-generation genomics study, the team has studied the antimalarial drug resistance in India. Further, he has extended his research in the development of Humanized mice for the study of liver-stage malaria and identification of molecular marker(s) for the Artemisinin resistance. At present, his research focuses on understanding the role of B cells in the activation of CD8+ T cells in malaria. Received the CSIR-SRF (Senior Research Fellow) award-2018, FIMSA (Federation of Immunological Societies of Asia-Oceania) Travel Bursary award to attend the IUIS-IIS-FIMSA Immunology course-2019',institutionString:"Nirma University",institution:{name:"Nirma University",country:{name:"India"}}},{id:"334383",title:"Ph.D.",name:"Simone",middleName:"Ulrich",surname:"Ulrich Picoli",slug:"simone-ulrich-picoli",fullName:"Simone Ulrich Picoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334383/images/15919_n.jpg",biography:"Graduated in Pharmacy from Universidade Luterana do Brasil (1999), Master in Agricultural and Environmental Microbiology from Federal University of Rio Grande do Sul (2002), Specialization in Clinical Microbiology from Universidade de São Paulo, USP (2007) and PhD in Sciences in Gastroenterology and Hepatology (2012). She is currently an Adjunct Professor at Feevale University in Medicine and Biomedicine courses and a permanent professor of the Academic Master\\'s Degree in Virology. She has experience in the field of Microbiology, with an emphasis on Bacteriology, working mainly on the following topics: bacteriophages, bacterial resistance, clinical microbiology and food microbiology.",institutionString:null,institution:{name:"Universidade Feevale",country:{name:"Brazil"}}},{id:"229220",title:"Dr.",name:"Amjad",middleName:"Islam",surname:"Aqib",slug:"amjad-aqib",fullName:"Amjad Aqib",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229220/images/system/229220.png",biography:"Dr. Amjad Islam Aqib obtained a DVM and MSc (Hons) from University of Agriculture Faisalabad (UAF), Pakistan, and a PhD from the University of Veterinary and Animal Sciences Lahore, Pakistan. Dr. Aqib joined the Department of Clinical Medicine and Surgery at UAF for one year as an assistant professor where he developed a research laboratory designated for pathogenic bacteria. Since 2018, he has been Assistant Professor/Officer in-charge, Department of Medicine, Manager Research Operations and Development-ORIC, and President One Health Club at Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan. He has nearly 100 publications to his credit. His research interests include epidemiological patterns and molecular analysis of antimicrobial resistance and modulation and vaccine development against animal pathogens of public health concern.",institutionString:"Cholistan University of Veterinary and Animal Sciences",institution:null},{id:"62900",title:"Prof.",name:"Fethi",middleName:null,surname:"Derbel",slug:"fethi-derbel",fullName:"Fethi Derbel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/62900/images/system/62900.jpeg",biography:"Professor Fethi Derbel was born in 1960 in Tunisia. He received his medical degree from the Sousse Faculty of Medicine at Sousse, University of Sousse, Tunisia. He completed his surgical residency in General Surgery at the University Hospital Farhat Hached of Sousse and was a member of the Unit of Liver Transplantation in the University of Rennes, France. He then worked in the Department of Surgery at the Sahloul University Hospital in Sousse. Professor Derbel is presently working at the Clinique les Oliviers, Sousse, Tunisia. His hospital activities are mostly concerned with laparoscopic, colorectal, pancreatic, hepatobiliary, and gastric surgery. He is also very interested in hernia surgery and performs ventral hernia repairs and inguinal hernia repairs. He has been a member of the GREPA and Tunisian Hernia Society (THS). During his residency, he managed patients suffering from diabetic foot, and he was very interested in this pathology. For this reason, he decided to coordinate a book project dealing with the diabetic foot. 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She was a recipient of a Commonwealth fellowship supported by British Council tenable at the Centre for Entomology and Parasitology (CAEP), Keele University, United Kingdom between 2004 and 2005. She was awarded an Honorary Visiting Research Fellow at the same university from 2005 to 2007. \nShe has been an external examiner to the Department of Veterinary Microbiology and Parasitology, University of Ibadan, MSc programme between 2010 and 2012. She is a member of the Nigerian Society of Experimental Biology (NISEB), Parasitology and Public Health Society of Nigeria (PPSN), Science Association of Nigeria (SAN), Zoological Society of Nigeria (ZSN), and is Vice Chairperson of the Organisation of Women in Science (OWSG), LASU chapter. She served as Head of Department of Zoology and Environmental Biology, Lagos State University from 2007 to 2010 and 2014 to 2016. She is a reviewer for several local and international journals such as Unilag Journal of Science, Libyan Journal of Medicine, Journal of Medicine and Medical Sciences, and Annual Research and Review in Science. \nShe has authored 45 scientific research publications in local and international journals, 8 scientific reviews, 4 books, and 3 book chapters, which includes the books “Malaria Parasites” and “Malaria” which are IntechOpen access publications.",institutionString:"Lagos State University",institution:{name:"Lagos State University",country:{name:"Nigeria"}}},{id:"273100",title:"Dr.",name:"Vijay",middleName:null,surname:"Gayam",slug:"vijay-gayam",fullName:"Vijay Gayam",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/273100/images/system/273100.jpeg",biography:"Dr. Vijay Bhaskar Reddy Gayam is currently practicing as an internist at Interfaith Medical Center in Brooklyn, New York, USA. 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His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. Dr. Saxena is a fellow of various international societies/academies including the Royal College of Pathologists, United Kingdom; Royal Society of Medicine, London; Royal Society of Biology, United Kingdom; Royal Society of Chemistry, London; and Academy of Translational Medicine Professionals, Austria. He was named a Global Leader in Science by The Scientist. 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Fungal infectious illness prevalence and prognosis are determined by the exposure between fungi and host, host immunological state, fungal virulence, and early and accurate diagnosis and treatment. \r\nPatients with both congenital and acquired immunodeficiency are more likely to be infected with opportunistic mycosis. Fungal infectious disease outbreaks are common during the post- disaster rebuilding era, which is characterised by high population density, migration, and poor health and medical conditions.\r\nSystemic or local fungal infection is mainly associated with the fungi directly inhaled or inoculated in the environment during the disaster. The most common fungal infection pathways are human to human (anthropophilic), animal to human (zoophilic), and environment to human (soilophile). Diseases are common as a result of widespread exposure to pathogenic fungus dispersed into the environment. \r\nFungi that are both common and emerging are intertwined. In Southeast Asia, for example, Talaromyces marneffei is an important pathogenic thermally dimorphic fungus that causes systemic mycosis. Widespread fungal infections with complicated and variable clinical manifestations, such as Candida auris infection resistant to several antifungal medicines, Covid-19 associated with Trichoderma, and terbinafine resistant dermatophytosis in India, are among the most serious disorders. \r\nInappropriate local or systemic use of glucocorticoids, as well as their immunosuppressive effects, may lead to changes in fungal infection spectrum and clinical characteristics. Hematogenous candidiasis is a worrisome issue that affects people all over the world, particularly ICU patients. CARD9 deficiency and fungal infection have been major issues in recent years. Invasive aspergillosis is associated with a significant death rate. Special attention should be given to endemic fungal infections, identification of important clinical fungal infections advanced in yeasts, filamentous fungal infections, skin mycobiome and fungal genomes, and immunity to fungal infections.\r\nIn addition, endemic fungal diseases or uncommon fungal infections caused by Mucor irregularis, dermatophytosis, Malassezia, cryptococcosis, chromoblastomycosis, coccidiosis, blastomycosis, histoplasmosis, sporotrichosis, and other fungi, should be monitored. \r\nThis topic includes the research progress on the etiology and pathogenesis of fungal infections, new methods of isolation and identification, rapid detection, drug sensitivity testing, new antifungal drugs, schemes and case series reports. It will provide significant opportunities and support for scientists, clinical doctors, mycologists, antifungal drug researchers, public health practitioners, and epidemiologists from all over the world to share new research, ideas and solutions to promote the development and progress of medical mycology.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/4.jpg",keywords:"Emerging Fungal Pathogens, Invasive Infections, Epidemiology, Cell Membrane, Fungal Virulence, Diagnosis, Treatment"},{id:"5",title:"Parasitic Infectious Diseases",scope:"Parasitic diseases have evolved alongside their human hosts. In many cases, these diseases have adapted so well that they have developed efficient resilience methods in the human host and can live in the host for years. Others, particularly some blood parasites, can cause very acute diseases and are responsible for millions of deaths yearly. Many parasitic diseases are classified as neglected tropical diseases because they have received minimal funding over recent years and, in many cases, are under-reported despite the critical role they play in morbidity and mortality among human and animal hosts. The current topic, Parasitic Infectious Diseases, in the Infectious Diseases Series aims to publish studies on the systematics, epidemiology, molecular biology, genomics, pathogenesis, genetics, and clinical significance of parasitic diseases from blood borne to intestinal parasites as well as zoonotic parasites. We hope to cover all aspects of parasitic diseases to provide current and relevant research data on these very important diseases. In the current atmosphere of the Coronavirus pandemic, communities around the world, particularly those in different underdeveloped areas, are faced with the growing challenges of the high burden of parasitic diseases. At the same time, they are faced with the Covid-19 pandemic leading to what some authors have called potential syndemics that might worsen the outcome of such infections. Therefore, it is important to conduct studies that examine parasitic infections in the context of the coronavirus pandemic for the benefit of all communities to help foster more informed decisions for the betterment of human and animal health.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/5.jpg",keywords:"Blood Borne Parasites, Intestinal Parasites, Protozoa, Helminths, Arthropods, Water Born Parasites, Epidemiology, Molecular Biology, Systematics, Genomics, Proteomics, Ecology"},{id:"6",title:"Viral Infectious Diseases",scope:"The Viral Infectious Diseases Book Series aims to provide a comprehensive overview of recent research trends and discoveries in various viral infectious diseases emerging around the globe. The emergence of any viral disease is hard to anticipate, which often contributes to death. A viral disease can be defined as an infectious disease that has recently appeared within a population or exists in nature with the rapid expansion of incident or geographic range. This series will focus on various crucial factors related to emerging viral infectious diseases, including epidemiology, pathogenesis, host immune response, clinical manifestations, diagnosis, treatment, and clinical recommendations for managing viral infectious diseases, highlighting the recent issues with future directions for effective therapeutic strategies.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/6.jpg",keywords:"Novel Viruses, Virus Transmission, Virus Evolution, Molecular Virology, Control and Prevention, Virus-host Interaction"}],annualVolumeBook:{},thematicCollection:[],selectedSeries:null,selectedSubseries:null},seriesLanding:{item:{id:"7",title:"Biomedical Engineering",doi:"10.5772/intechopen.71985",issn:"2631-5343",scope:"Biomedical Engineering is one of the fastest-growing interdisciplinary branches of science and industry. The combination of electronics and computer science with biology and medicine has improved patient diagnosis, reduced rehabilitation time, and helped to facilitate a better quality of life. Nowadays, all medical imaging devices, medical instruments, or new laboratory techniques result from the cooperation of specialists in various fields. The series of Biomedical Engineering books covers such areas of knowledge as chemistry, physics, electronics, medicine, and biology. This series is intended for doctors, engineers, and scientists involved in biomedical engineering or those wanting to start working in this field.",coverUrl:"https://cdn.intechopen.com/series/covers/7.jpg",latestPublicationDate:"May 7th, 2022",hasOnlineFirst:!0,numberOfOpenTopics:3,numberOfPublishedChapters:96,numberOfPublishedBooks:12,editor:{id:"50150",title:"Prof.",name:"Robert",middleName:null,surname:"Koprowski",fullName:"Robert Koprowski",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYTYNQA4/Profile_Picture_1630478535317",biography:"Robert Koprowski, MD (1997), PhD (2003), Habilitation (2015), is an employee of the University of Silesia, Poland, Institute of Computer Science, Department of Biomedical Computer Systems. For 20 years, he has studied the analysis and processing of biomedical images, emphasizing the full automation of measurement for a large inter-individual variability of patients. Dr. Koprowski has authored more than a hundred research papers with dozens in impact factor (IF) journals and has authored or co-authored six books. Additionally, he is the author of several national and international patents in the field of biomedical devices and imaging. Since 2011, he has been a reviewer of grants and projects (including EU projects) in biomedical engineering.",institutionString:null,institution:{name:"University of Silesia",institutionURL:null,country:{name:"Poland"}}},subseries:[{id:"7",title:"Bioinformatics and Medical Informatics",keywords:"Biomedical Data, Drug Discovery, Clinical Diagnostics, Decoding Human Genome, AI in Personalized Medicine, Disease-prevention Strategies, Big Data Analysis in Medicine",scope:"Bioinformatics aims to help understand the functioning of the mechanisms of living organisms through the construction and use of quantitative tools. The applications of this research cover many related fields, such as biotechnology and medicine, where, for example, Bioinformatics contributes to faster drug design, DNA analysis in forensics, and DNA sequence analysis in the field of personalized medicine. Personalized medicine is a type of medical care in which treatment is customized individually for each patient. Personalized medicine enables more effective therapy, reduces the costs of therapy and clinical trials, and also minimizes the risk of side effects. Nevertheless, advances in personalized medicine would not have been possible without bioinformatics, which can analyze the human genome and other vast amounts of biomedical data, especially in genetics. The rapid growth of information technology enabled the development of new tools to decode human genomes, large-scale studies of genetic variations and medical informatics. The considerable development of technology, including the computing power of computers, is also conducive to the development of bioinformatics, including personalized medicine. In an era of rapidly growing data volumes and ever lower costs of generating, storing and computing data, personalized medicine holds great promises. Modern computational methods used as bioinformatics tools can integrate multi-scale, multi-modal and longitudinal patient data to create even more effective and safer therapy and disease prevention methods. Main aspects of the topic are: Applying bioinformatics in drug discovery and development; Bioinformatics in clinical diagnostics (genetic variants that act as markers for a condition or a disease); Blockchain and Artificial Intelligence/Machine Learning in personalized medicine; Customize disease-prevention strategies in personalized medicine; Big data analysis in personalized medicine; Translating stratification algorithms into clinical practice of personalized medicine.",annualVolume:11403,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/7.jpg",editor:{id:"351533",title:"Dr.",name:"Slawomir",middleName:null,surname:"Wilczynski",fullName:"Slawomir Wilczynski",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035U1loQAC/Profile_Picture_1630074514792",institutionString:null,institution:{name:"Medical University of Silesia",institutionURL:null,country:{name:"Poland"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"5886",title:"Dr.",name:"Alexandros",middleName:"T.",surname:"Tzallas",fullName:"Alexandros Tzallas",profilePictureURL:"https://mts.intechopen.com/storage/users/5886/images/system/5886.png",institutionString:"University of Ioannina, Greece & Imperial College London",institution:{name:"University of Ioannina",institutionURL:null,country:{name:"Greece"}}},{id:"257388",title:"Distinguished Prof.",name:"Lulu",middleName:null,surname:"Wang",fullName:"Lulu Wang",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRX6kQAG/Profile_Picture_1630329584194",institutionString:null,institution:{name:"Shenzhen Technology University",institutionURL:null,country:{name:"China"}}},{id:"225387",title:"Prof.",name:"Reda",middleName:"R.",surname:"Gharieb",fullName:"Reda Gharieb",profilePictureURL:"https://mts.intechopen.com/storage/users/225387/images/system/225387.jpg",institutionString:"Assiut University",institution:{name:"Assiut University",institutionURL:null,country:{name:"Egypt"}}}]},{id:"8",title:"Bioinspired Technology and Biomechanics",keywords:"Bioinspired Systems, Biomechanics, Assistive Technology, Rehabilitation",scope:'Bioinspired technologies take advantage of understanding the actual biological system to provide solutions to problems in several areas. Recently, bioinspired systems have been successfully employing biomechanics to develop and improve assistive technology and rehabilitation devices. The research topic "Bioinspired Technology and Biomechanics" welcomes studies reporting recent advances in bioinspired technologies that contribute to individuals\' health, inclusion, and rehabilitation. Possible contributions can address (but are not limited to) the following research topics: Bioinspired design and control of exoskeletons, orthoses, and prostheses; Experimental evaluation of the effect of assistive devices (e.g., influence on gait, balance, and neuromuscular system); Bioinspired technologies for rehabilitation, including clinical studies reporting evaluations; Application of neuromuscular and biomechanical models to the development of bioinspired technology.',annualVolume:11404,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/8.jpg",editor:{id:"144937",title:"Prof.",name:"Adriano",middleName:"De Oliveira",surname:"Andrade",fullName:"Adriano Andrade",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRC8QQAW/Profile_Picture_1625219101815",institutionString:null,institution:{name:"Federal University of Uberlândia",institutionURL:null,country:{name:"Brazil"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"49517",title:"Prof.",name:"Hitoshi",middleName:null,surname:"Tsunashima",fullName:"Hitoshi Tsunashima",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYTP4QAO/Profile_Picture_1625819726528",institutionString:null,institution:{name:"Nihon University",institutionURL:null,country:{name:"Japan"}}},{id:"425354",title:"Dr.",name:"Marcus",middleName:"Fraga",surname:"Vieira",fullName:"Marcus Vieira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003BJSgIQAX/Profile_Picture_1627904687309",institutionString:null,institution:{name:"Universidade Federal de Goiás",institutionURL:null,country:{name:"Brazil"}}},{id:"196746",title:"Dr.",name:"Ramana",middleName:null,surname:"Vinjamuri",fullName:"Ramana Vinjamuri",profilePictureURL:"https://mts.intechopen.com/storage/users/196746/images/system/196746.jpeg",institutionString:"University of Maryland, Baltimore County",institution:{name:"University of Maryland, Baltimore County",institutionURL:null,country:{name:"United States of America"}}}]},{id:"9",title:"Biotechnology - Biosensors, Biomaterials and Tissue Engineering",keywords:"Biotechnology, Biosensors, Biomaterials, Tissue Engineering",scope:"The Biotechnology - Biosensors, Biomaterials and Tissue Engineering topic within the Biomedical Engineering Series aims to rapidly publish contributions on all aspects of biotechnology, biosensors, biomaterial and tissue engineering. We encourage the submission of manuscripts that provide novel and mechanistic insights that report significant advances in the fields. Topics can include but are not limited to: Biotechnology such as biotechnological products and process engineering; Biotechnologically relevant enzymes and proteins; Bioenergy and biofuels; Applied genetics and molecular biotechnology; Genomics, transcriptomics, proteomics; Applied microbial and cell physiology; Environmental biotechnology; Methods and protocols. Moreover, topics in biosensor technology, like sensors that incorporate enzymes, antibodies, nucleic acids, whole cells, tissues and organelles, and other biological or biologically inspired components will be considered, and topics exploring transducers, including those based on electrochemical and optical piezoelectric, thermal, magnetic, and micromechanical elements. Chapters exploring biomaterial approaches such as polymer synthesis and characterization, drug and gene vector design, biocompatibility, immunology and toxicology, and self-assembly at the nanoscale, are welcome. Finally, the tissue engineering subcategory will support topics such as the fundamentals of stem cells and progenitor cells and their proliferation, differentiation, bioreactors for three-dimensional culture and studies of phenotypic changes, stem and progenitor cells, both short and long term, ex vivo and in vivo implantation both in preclinical models and also in clinical trials.",annualVolume:11405,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/9.jpg",editor:{id:"126286",title:"Dr.",name:"Luis",middleName:"Jesús",surname:"Villarreal-Gómez",fullName:"Luis Villarreal-Gómez",profilePictureURL:"https://mts.intechopen.com/storage/users/126286/images/system/126286.jpg",institutionString:null,institution:{name:"Autonomous University of Baja California",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"35539",title:"Dr.",name:"Cecilia",middleName:null,surname:"Cristea",fullName:"Cecilia Cristea",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYQ65QAG/Profile_Picture_1621007741527",institutionString:null,institution:{name:"Iuliu Hațieganu University of Medicine and Pharmacy",institutionURL:null,country:{name:"Romania"}}},{id:"40735",title:"Dr.",name:"Gil",middleName:"Alberto Batista",surname:"Gonçalves",fullName:"Gil Gonçalves",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYRLGQA4/Profile_Picture_1628492612759",institutionString:null,institution:{name:"University of Aveiro",institutionURL:null,country:{name:"Portugal"}}},{id:"211725",title:"Associate Prof.",name:"Johann F.",middleName:null,surname:"Osma",fullName:"Johann F. Osma",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSDv7QAG/Profile_Picture_1626602531691",institutionString:null,institution:{name:"Universidad de Los Andes",institutionURL:null,country:{name:"Colombia"}}},{id:"69697",title:"Dr.",name:"Mani T.",middleName:null,surname:"Valarmathi",fullName:"Mani T. Valarmathi",profilePictureURL:"https://mts.intechopen.com/storage/users/69697/images/system/69697.jpg",institutionString:"Religen Inc. | A Life Science Company, United States of America",institution:null},{id:"205081",title:"Dr.",name:"Marco",middleName:"Vinícius",surname:"Chaud",fullName:"Marco Chaud",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSDGeQAO/Profile_Picture_1622624307737",institutionString:null,institution:{name:"Universidade de Sorocaba",institutionURL:null,country:{name:"Brazil"}}}]}]}},libraryRecommendation:{success:null,errors:{},institutions:[]},route:{name:"profile.detail",path:"/profiles/194920",hash:"",query:{},params:{id:"194920"},fullPath:"/profiles/194920",meta:{},from:{name:null,path:"/",hash:"",query:{},params:{},fullPath:"/",meta:{}}}},function(){var e;(e=document.currentScript||document.scripts[document.scripts.length-1]).parentNode.removeChild(e)}()