Important ECG features that should be assessed when evaluating CIED function.
\\n\\n
Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\\n\\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\\n"}]',published:!0,mainMedia:{caption:"Highly Cited",originalUrl:"/media/original/117"}},components:[{type:"htmlEditorComponent",content:'IntechOpen is proud to announce that 191 of our authors have made the Clarivate™ Highly Cited Researchers List for 2020, ranking them among the top 1% most-cited.
\n\nThroughout the years, the list has named a total of 261 IntechOpen authors as Highly Cited. Of those researchers, 69 have been featured on the list multiple times.
\n\n\n\nReleased this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\n\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\n'}],latestNews:[{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"},{slug:"introducing-intechopen-book-series-a-new-publishing-format-for-oa-books-20210915",title:"Introducing IntechOpen Book Series - A New Publishing Format for OA Books"}]},book:{item:{type:"book",id:"20",leadTitle:null,fullTitle:"Virtual Reality",title:"Virtual Reality",subtitle:null,reviewType:"peer-reviewed",abstract:'Technological advancement in graphics and other human motion tracking hardware has promoted pushing "virtual reality" closer to "reality" and thus usage of virtual reality has been extended to various fields. The most typical fields for the application of virtual reality are medicine and engineering. The reviews in this book describe the latest virtual reality-related knowledge in these two fields such as: advanced human-computer interaction and virtual reality technologies, evaluation tools for cognition and behavior, medical and surgical treatment, neuroscience and neuro-rehabilitation, assistant tools for overcoming mental illnesses, educational and industrial uses. In addition, the considerations for virtual worlds in human society are discussed. This book will serve as a state-of-the-art resource for researchers who are interested in developing a beneficial technology for human society.',isbn:null,printIsbn:"978-953-307-518-1",pdfIsbn:"978-953-51-4532-5",doi:"10.5772/553",price:159,priceEur:175,priceUsd:205,slug:"virtual-reality",numberOfPages:688,isOpenForSubmission:!1,isInWos:1,isInBkci:!0,hash:null,bookSignature:"Jae-Jin Kim",publishedDate:"January 8th 2011",coverURL:"https://cdn.intechopen.com/books/images_new/20.jpg",numberOfDownloads:97093,numberOfWosCitations:133,numberOfCrossrefCitations:86,numberOfCrossrefCitationsByBook:9,numberOfDimensionsCitations:197,numberOfDimensionsCitationsByBook:10,hasAltmetrics:1,numberOfTotalCitations:416,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"April 7th 2010",dateEndSecondStepPublish:"May 5th 2010",dateEndThirdStepPublish:"September 9th 2010",dateEndFourthStepPublish:"October 9th 2010",dateEndFifthStepPublish:"December 8th 2010",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6,7,8",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"14702",title:"Prof.",name:"Jae-Jin",middleName:null,surname:"Kim",slug:"jae-jin-kim",fullName:"Jae-Jin Kim",profilePictureURL:"https://mts.intechopen.com/storage/users/14702/images/1652_n.jpg",biography:"Jae-Jin Kim received the M.D. (1987) and Ph.D. (2002) degrees in psychiatry from Seoul National University, Seoul, Korea. He currently works as a professor and a chair at the Department of Psychiatry, Yonsei University Gangnam Severance Hospital, and as s director at the Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea. His research interests are to develop the virtual reality programs for improving social functions in psychiatric patients such as schizophrenia and social phobia, and to investigate the pathophysiology of social deficits using the fMRI and PET. He has published a lot of papers about virtual reality and neuroimaging, and recently won the best researcher award, Yonsei University Gangnam Severance Hospital (Oct, 2010).",institutionString:null,position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"1",institution:null}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"573",title:"Virtual Computer System",slug:"virtual-computer-system"}],chapters:[{id:"12761",title:"Brain-Computer Interface Systems Used for Virtual Reality Control",doi:"10.5772/13467",slug:"brain-computer-interface-systems-used-for-virtual-reality-control",totalDownloads:3980,totalCrossrefCites:10,totalDimensionsCites:18,hasAltmetrics:0,abstract:null,signatures:"Gert Pfurtscheller, Robert Leeb, Josef Faller and Christa Neuper",downloadPdfUrl:"/chapter/pdf-download/12761",previewPdfUrl:"/chapter/pdf-preview/12761",authors:[{id:"14806",title:"Dr.",name:"Gert",surname:"Pfurtscheller",slug:"gert-pfurtscheller",fullName:"Gert Pfurtscheller"}],corrections:null},{id:"12762",title:"Hapto-Acoustic Interaction Metaphors in 3D Virtual Environments for Non-Visual Settings",doi:"10.5772/13116",slug:"hapto-acoustic-interaction-metaphors-in-3d-virtual-environments-for-non-visual-settings",totalDownloads:2424,totalCrossrefCites:1,totalDimensionsCites:2,hasAltmetrics:0,abstract:null,signatures:"Fabio De Felice, Floriana Renna, Giovanni Attolico and Arcangelo Distante",downloadPdfUrl:"/chapter/pdf-download/12762",previewPdfUrl:"/chapter/pdf-preview/12762",authors:[{id:"13846",title:"Dr.",name:"Floriana",surname:"Renna",slug:"floriana-renna",fullName:"Floriana Renna"},{id:"13901",title:"Dr.",name:"Giovanni",surname:"Attolico",slug:"giovanni-attolico",fullName:"Giovanni Attolico"},{id:"15132",title:"Dr.",name:"Fabio",surname:"De Felice",slug:"fabio-de-felice",fullName:"Fabio De Felice"},{id:"15133",title:"Dr.",name:"Arcangelo",surname:"Distante",slug:"arcangelo-distante",fullName:"Arcangelo Distante"}],corrections:null},{id:"13644",title:"Collaborative 3D Interaction in Virtual Environments: a Workflow-based Approach",doi:"10.5772/13013",slug:"collaborative-3d-interaction-in-virtual-environments-a-workflow-based-approach",totalDownloads:2654,totalCrossrefCites:1,totalDimensionsCites:2,hasAltmetrics:0,abstract:null,signatures:"Christophe Domingues, Frederic Davesne, Malik Mallem and Samir Otmane",downloadPdfUrl:"/chapter/pdf-download/13644",previewPdfUrl:"/chapter/pdf-preview/13644",authors:[{id:"13679",title:"Dr.",name:"Samir",surname:"Otmane",slug:"samir-otmane",fullName:"Samir Otmane"},{id:"15075",title:"Dr.",name:"Christophe",surname:"Domingues",slug:"christophe-domingues",fullName:"Christophe Domingues"},{id:"15076",title:"Dr.",name:"Frederic",surname:"Davesne",slug:"frederic-davesne",fullName:"Frederic Davesne"},{id:"15077",title:"Prof.",name:"Malik",surname:"Mallem",slug:"malik-mallem",fullName:"Malik Mallem"}],corrections:null},{id:"13645",title:"Virtual Reality to Simulate Visual Tasks for Robotic Systems",doi:"10.5772/12875",slug:"virtual-reality-to-simulate-visual-tasks-for-robotic-systems",totalDownloads:3105,totalCrossrefCites:4,totalDimensionsCites:6,hasAltmetrics:1,abstract:null,signatures:"Manuela Chessa, Fabio Solari and Silvio P. 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Detailed diagnostic data (pacing statistics, lead function, arrhythmia episode intracardiac electrograms etc.) are available using manufacturer-specific programmer devices or remote follow-up (Figure 1). However, patients may present with suspected cardiac or arrhythmia-related symptoms when these measures are not immediately available. Using conventional diagnostic methods basic device function can be evaluated and correlation with the clinical presentation may be assessed (McPherson, 2004). In certain cases, such as with transient events, these may be the only diagnostic clues available as current CIEDs do not have full Holter capability – only episodes of significance, as determined by the device, are stored.
\n\t\t\t\tDevice interrogation provides detailed information about intracardiac signals, their interpretation and device response. The tracing depicts an episode of ventricular tachycardia, where the implanted cardioverter-defibrillator attempted burst antitachycardia stimulation.
Basic evaluation of CIED function requires a 12-lead ECG and review of past medical records to identify device type and settings. If prior records are not available, a simple chest X-ray may provide important clues (pacemaker, ICD, or CRT; lead locations) (Jacob, 2011). In case intermittent or transient malfunction is detected and device interrogation does not provide clear answer, Holter monitoring or an event recorder may be required. If a programmer is available, diagnostic tests should be performed according to the guidelines (Wilkoff, 2008). Patient symptoms, if any, should be assessed, whether they can be signs of a possible device malfunction.
\n\t\t\tA 12-lead ECG may raise the suspicion of device malfunction. Careful evaluation of patient-related factors is required as these interact with device function (Table 1). Occasionally, very advanced forms of electrophysiological abnormalities may be identified as the devices generally do not prevent natural progression of underlying pathophysiology. In case an arrhythmia or device malfunction is suspected on a telemetry recording, a full 12-lead ECG is recommended to avoid misinterpretation (Figures 2-6). Artifacts may severely impact interpretation and tracings with good technical quality should be obtained (Figures 7-10). Atrial rhythm and characteristics of atrioventricular/ventriculoatrial conduction should also be assessed (Figures 11-17).
\n\t\t\t\n\t\t\t\t\t\t\t | \n\t\t\t\t\t\t\n\t\t\t\t\t\t\t | \n\t\t\t\t\t
Atrial rhythm | \n\t\t\t\t\t|
Bradycardia | \n\t\t\t\t\t\tShould be paced unless there is oversensing or no atrial lead present | \n\t\t\t\t\t
Premature beats | \n\t\t\t\t\t\tBlocked PACs should elicit different response than sinoatrial block if atrial sensing is present | \n\t\t\t\t\t
Atrial flutter | \n\t\t\t\t\t\tMay be tracked with high ventricular rate | \n\t\t\t\t\t
Atrial fibrillation | \n\t\t\t\t\t\tMay be undersensed, leading to ineffective atrial pacing | \n\t\t\t\t\t
Atrioventricular conduction | \n\t\t\t\t\t|
Variable AV conduction interval | \n\t\t\t\t\t\tMay lead to fusion and pseudofusion beats | \n\t\t\t\t\t
Complete heart block | \n\t\t\t\t\t\tMay be intermittent or unidirectional | \n\t\t\t\t\t
Retrograde conduction | \n\t\t\t\t\t\tMay lead to pacemaker-tachycardia or pacemaker syndrome | \n\t\t\t\t\t
Ventricles | \n\t\t\t\t\t|
Native QRS morphology | \n\t\t\t\t\t\tAssess biventricular capture during cardiac resynchronizationIf atrial pacing only, may be used to identify ischemia, etc. | \n\t\t\t\t\t
Premature beats | \n\t\t\t\t\t\tMay trigger safety or sense response pacing or activate rate smoothing algorithms | \n\t\t\t\t\t
Important ECG features that should be assessed when evaluating CIED function.
Certain conditions, such as acute heart failure may require adjustment of device settings, even without device malfunction – pacemaker algorithms do not provide optimal hemodynamics for all situations. Unfortunately, evidence-based approach is limited due to scarcity of data (Lahiri, 2011).
\n\t\t\tRhythm strip suggestive of high degree AV block (A). 12 lead ECG obtained at the same time actually shows that the low amplitude signals are QRS complexes and the higher amplitude ones are PVCs (B).
Artifacts masking AV block. High frequency artifacts mimic fast, irregular ventricular rate, resembling atrial fibrillation (A1). However, these artifacts are not present on the simultaneous tracing in a different lead (A2). Once the artifacts disappear, P waves are easily recognizable with high degree AV block (B1, B2).
Atrial flutter may mimic ventricular tachycardia in a rhythm strip (A), however, 12-lead ECG clearly identifies the flutter with dominantly 2:1 conduction (B).
Rhythm strip suggestive of atrial pacing with prolonged AV interval (A). 12 lead ECG shows no evidence of pacing, however, P pulmonale is present and the QRS is low amplitude in II (B).
The rhythm strip suggests atrial fibrillation with PVCs or escape beats (A). Simultaneous 12 lead ECG shows evidence of VVI pacing at 60/minute (B). Even when pacing spikes are not visible, wide QRS beats with constant coupling interval, and no R-R cycle longer than this interval should suggest ventricular demand pacing.
Low amplitude, high frequency artifact masking sinus or ectopic atrial bradycardia. The rhythm may be confused with atrial fibrillation and junctional rhythm, however, P waves can be identified in III and aVF.
High amplitude artifacts with low ECG voltage may be misinterpreted as atrial flutter of fibrillation. However, sinus tachycardia is easy to recognize in V1 and V2.
Artifacts suggestive of NSVT. However, the simultaneous V1 and V3, and the following V4-6 leads show that the underlying rhythm is sinus (A). Biventricular pacing is not affected by the artifact – this would be unlikely with any true ventricular arrhythmia (B).
High frequency artifacts causing false detection of pacing in automated ECG device. Although the pacemaker-spike gain and marker functions of the ECG systems may be very helpful to identify small pacing spikes, these systems may be overcalling artifacts. This patient does not have a pacemaker, the ECG improperly identifies some artifacts as pacing (black triangles on top (A). In some cases, the artifacts may be less obvious (B), or may closely resemble pacing spikes (C).
Rhythm strip suggestive of 2:1 AV block (A). However, the QRS complexes are „creeping in” on the preceding P waves – there is complete AV dissociation, more typical for complete heart block with junctional escape rhythm. A similarly difficult tracing (B), suggestive of first degree AV block. As the atrial rate accelerates, complete AV dissociation becomes apparent. (C) True 2:1 AV block – the PR interval following the conducted P waves is constant. Note that the P-P interval slightly irregular (short-long), which may represent ventriculophasic sinus arrhythmia or atrial bigeminy.
Blocked premature atrial beats (PACs) should be identified as they elicit a different response during atrial pacing (inhibition) than sinus arrest (pacing). In (A), V1 gives the clue for the arrhythmia mechanism – blocked PACs. In (B), there are no visible early P waves – this is 3:2 sinoatrial block.
Sinus tachycardia with 1st degree AV block resembling junctional tachycardia. P waves with constant PR interval can be seen in V1-2.
Junctional rhythm with 1:1 VA conduction. Retrograde P waves are visible in V1, which may be misinterpreted as T waves. Note, however, the prolonged QT in all other leads (A). Very long (640 ms) first degree AV block may be confused with junctional rhythm, however, P waves are seen in V1 (B).
Irregular atrial rhythm resembling atrial fibrillation. The actual rhythm is most likely sinus with PACs, The P waves are of low amplitude, however, they can be identified in III and aVL with 1:1 relationship to QRS and with constant AV delay.
Regular bradycardia with narrow QRS would suggest junctional rhythm, however, P waves are seen before each QRS in V1 – the driving focus is atrial. Advanced atrial conduction disease is not uncommon in pacemaker recipients, leading to low amplitude, fragmented P waves.
Atrial fibrillation with junctional escape. The regular rhythm may be misinterpreted as pure junctional rhythm, however, the ventricular rate changes when atrioventricular conduction improves and conducted activity overtakes junctional escape. Proper identification of atrial rhythm is important when evaluating pacemaker function – atrial fibrillation should suppress atrial pacing, while atrial pacing should take place with pure junctional rhythm, if an atrial lead is present.
Certain artifacts or interaction of pacemaker algorithms with underlying rhythm may lead to electrocardiographic findings, which may be difficult to distinguish from abnormal function (Balachander, 2011). P/QRS morphology, timing and response to pacing spikes should be addressed, when analyzing the ECG. With ubiquity of bipolar systems, spikes may be difficult to identify (Figure 18). In addition, myocardial depolarization has a vector, which may be isoelectric in certain leads, or may be delayed by intraatrial or intraventricular conduction delay, suggesting ineffective stimulation (Figure 19). Spike morphology may be affected be automatic signal gain function of the ECG system or issues with digital sampling (Figure 20). „Anticipated” spikes may be missing due to very small variations in heart rate, inhibiting demand pacing (Figure 21).
Variable signal morphology may be caused by fusion beats (when the resulting signal morphology is the sum of activation from the pacemaker and spontaneous/conducted activation) or pseudofusion beats (pacing occurs when the myocardium is already refractory from spontaneous/conducted activation, Figures 22-24). Identification of the pacing site is crucial to prove appropriate device function (Figures 25-28).
Occasionally, pacing mode may be difficult to identify based solely on the ECG (Figure 29). It may change due to algorithms trying to minimize right ventricular stimulation (Figures 30-32), rate smoothing function (Figure 33), or arrhythmia – mainly, atrial fibrillation (Israel, 2002).
\n\t\t\tRhythm strip suggestive of complete heart block and absence of pacing (A). Simultaneous 12 lead ECG shows appropriate ventricular stimulation – the vector of the myocardial activation is close to isoelectric in II.
P waves are not seen in I despite effective atrial pacing – the atrial depolarization vector may be isoelectric in certain leads, depending on the atrial pacing site and pathologic conditions. Note that there is a delay in each lead from the atrial spike to the P wave, suggestive of conduction delay (A). Intra-atrial conduction delay may present even in regions far from the pacing electrode – note instant capture in V1, however, significantly prolonged, fragmented P wave in the frontal leads (200 ms) (B).
Variable spike morphology (A). This is a normal finding as the spike morphology is affected by the digital sampling of the ECG system and whether it uses pacemaker signal identification/amplification. There is no clinically useful correlation between the spike height and pacing energy. Generally, unipolar pacing (B) leads to much higher amplitude signals than bipolar (A). Spike height may vary not just between different ECG leads, but even with each beat (C).
Sinus rhythm competing with AAI pacemaker – there is appropriate inhibition of atrial pacing when the P-P interval is shorter than the basic pacing cycle length.
Pseudofusion beats during ventricular stimulation – this is a normal phenomenon as detection of ventricular activation is delayed due to lead tip position (usually right ventricular apex – the ventricles may be partially depolarized, when signal is sensed in this region). Beats 2 and 6 show pseudofusion, ventricular pacing is delivered after the ventricles are depolarized and refractory to further stimuli. Beat 10 is sensed appropriately and pacing is inhibited, as the coupling interval is somewhat shorter - this makes ventricular undersensing very unlikely as the cause for pseudofusion (A). Fusion and pseudofusion beats are very common during atrial fibrillation due to the wide range of coupling intervals (B).
Fusion can be also encountered in the atria, although may be more difficult to identify due to lower signal amplitudes. Undersensing of PACs should be excluded and may require longer tracings or device interrogation.
Wide QRS beat encountered during regular atrial pacing with short PR interval. This is most likely a premature ventricular contraction (PVC), fusing with the atrial paced, spontaneously conducted beat.
Pacing spikes fall into the U waves in V2 and V3 and are not followed by apparent capture. However, in V1 atrial capture is clear.
Pseudo pseudofusion – a spike appears immediately before (3rd spike) or within a QRS (9th spike). However, these are atrial spikes and the tracing represents appropriate DDD pacemaker response to frequent premature ventricular and atrial beats. Origin of pacing spikes should be identified based on their timing and sequence to avoid misinterpretation as undersensing or ineffective capture.
Identification of pacing site is important to avoid misinterpretation. The 4th spike seems to be non-capturing and is followed by a wide QRS beat with an 80 ms delay. However, this is an atrial stimulus as it is apparent by reviewing the consecutive beats. The wide QRS beat is a PVC, which does not have any correlation with atrial pacing. The P waves are of low amplitude and difficult to identify, however, regular atrial pacing followed by regular ventricular activation with the same atrioventricular delay suggests consistent atrial capture.
High frequency pacing may occasionally be a sign of serious pacemaker malfunction (runaway pacemaker) or appropriate response to an arrhythmia (tracked sinus/atrial tachycardia). In dual chamber systems, proper identification of pacing spikes is necessary for troubleshooting. In this tracing, 150/minute pacing seems to be capturing 2:1. Note, however, that the pacing is regularly irregular (short-long) and the spike morphology is alternating in V1 – every other one is an atrial spike. The patient is in atrial fibrillation, which is undersensed and the DDD pacemaker is delivering dual chamber stimulation at 70/minute with an AV delay of 400 ms.
Pacing mode may be difficult to identify from surface ECG. (A) In III and aVF it may appear that the atrial activity is tracked to the ventricles. However, the ventricular rate is completely regular despite variable P-P intervals. AV dissociation is seen in V4 and V5. This device is a VVI pacemaker in a patient with complete heart block. (B) Isorhythmic dissociation between sinus rhythm and VVI pacing – close inspection of the PR intervals reveals that the atrial activity is not tracked
If pacing spikes are seen during tachycardia, most common causes are atrial tachyarrhythmia tracked by the pacemaker, or true PM mediated tachycardia (caused by retrograde conduction or atrial oversensing of ventricular events, leading to endless loop tachycardia). Rate response function may also cause transient increase in pacing rate. The differential is usually difficult based on surface ECG alone, unless initiation and termination can be clearly identified. Device interrogation is strongly recommended (Ip, 2011). Transient changes in rhythm may elucidate the mechanism of a suspected malfunction (Figure 34).
Both atrial and ventricular tachyarrhythmias may raise the concern of device malfunction. If no spikes are seen, the rhythm is likely not related to pacing and patient-related issues should be suspected (Figures 35-38). Underlying rhythm should be identified: atrial fibrillation/flutter may be difficult to recognize with asynchronous pacing, but still pose a thromboembolic risk (Figures 39-40).
\n\t\t\tResponse to a premature atrial beat with managed ventricular pacing algorithm (Medtronic, Inc). The DDD pacemaker is delivering atrioventricular stimulation, then an atrial-sensed ventricular pace following a premature atrial beat. Following this beat, an atrial stimulus is delivered with mode switch to ADI. As atrioventricular conduction is detected, the device continues with atrial stimulation and allows spontaneous conduction with prolonged AV delay.
Managed ventricular pacing may maintain very long AV interval, if the 1:1 atrial:ventricular ratio is maintained. In this case, atrial pacing spikes occur after the QRS, in the T waves. V1 shows atrial capture with an AV delay of 460 ms.
Heart rate may drop down to ≈50% of the basic rate for one cycle with managed ventricular pacing – in this case a late blocked PAC is followed by an atrial stimulus, followed by a ventricular stimulus with very short AV delay (wide QRS beat, the spikes are not visualized in these leads). V1 gives the clue that the rhythm is paced at 70/minute. The artifact in V4-6 is not related to pacing.
Rate smoothing with a DDD pacemaker (A). Following the premature beats, the atrial pacing rate is gradually decreased to the basic pacing rate. Irregular pacing caused by rate smoothing in a biventricular system (B). All premature beats are sensed (ventricular and atrial), and either a sense response pace or an tracked biventricular pace is delivered. The basic pacing rate is gradually decreased after these over a few cycles, the lowest pacing rate on this tracing is 65/minute.
Sudden changes in regular tachycardia may elucidate the mechanism. The premature beat unmasks a P wave, followed by a ventricular paced beat – this is a supraventricular tachycardia tracked by the dual chamber pacemaker.
Hidden premature atrial beat mimics pacemaker malfunction. The 5th atrial spike is delayed, suggestive of oversensing, however, the 4th T wave in the rhythm strip is different from the previous three, suggestive of a buried premature atrial beat, with AV block. The 5th atrial spike actually comes right on time as the pacing cycle was reset by the premature atrial beat. Additionally, a ventricular pace is delivered by the managed ventricular pacing algorithm.
Blocked PAC without tracking with a DDD pacemaker. This is normal function, as the blocked PAC (after the 6th QRS) comes very early and was sensed in the post-ventricular atrial refractory period. Instead, an atrial stimulus is delivered later to maintain the basic rate. As there is spontaneous AV conduction, ventricular pacing is inhibited. After 2 atrial paced beats, sinus rhythm takes over again.
Wide QRS tachycardia in pacemaker recipients. Sinus tachycardia with appropriate sensing and ventricular pacing (A). With bipolar pacing the spikes may not be visible in all leads and the rhythm may be misinterpreted as ventricular tachycardia – especially in telemetry tracings. When ventricular rate is higher than the upper tracking rate (if known) or the QRS morphology is not compatible with usual pacing sites, VT (B) or SVT with aberrancy should be suspected.
Non-sustained wide QRS tachycardia in a patient with a VVI pacemaker. Note appropriate demand pacing and the absence of spikes during the tachycardia – this is not pacing-related, but a true non-sustained ventricular tachycardia.
VVI pacing without retrograde conduction. An underlying, slow regular atrial rhythm is seen in V2 and V5. The spikes after the 3rd and 5th beats are artifacts.
ECG analysis should always include assessment of QRS and ST-T, even in patients with paced rhythms. Atrial pacing preserves normal ventricular activation, so it may be interpreted without interference from the device. Underlying conduction blocks may mimic paced beats (Figures 41-42). If artifacts limit interpretation, comparing multiple simultaneous ECG leads may be helpful (Figure 43).
In patients presenting with symptoms suspicious for pacemaker syndrome (hypotension, shortness of breath, dizziness, most commonly in an intermittent pattern), atrioventricular activation sequence and presence of ventriculoatrial conduction should be assessed. If these are compatible with PM syndrome, device settings should be adjusted (or the device should be upgraded), to restore AV synchrony and avoid atrial contraction during ventricular systole (Figures 44-45).
\n\t\t\tUnderlying rhythm is atrial tachycardia or slow atrial flutter with a cycle length around 320 ms. This is neither spontaneously conducted, nor tracked by the pacemaker to the ventricles, 80/minute ventricular stimulation is seen.
Atrial pacing preserves normal ventricular activation sequence, conventional ECG criteria may be used to identify ischemia, blocks, hypertrophy. RBBB (A), remote anterior MI (B).
Preexisting LBBB may be confused with dual chamber pacing. Close inspection of the QRS complexes reveals atrial pacing and typical LBBB (A). Acute inferior MI with atrial pacing – typical ST elevation with reciprocal changes (B).
Artifact suggestive of ventricular undersensing with a recently placed temporary right ventricular lead. There appears to be a pacemaker spike shortly after the first QRS with a captured beat, suspicious for undersensing. However, the morphology of this “paced” beat is not typical and note that in III there is a 120 ms delay between the “spike” and the QRS and no change in depolarization/repolarization compared to non-paced beats – this would be impossible with a ventricular paced beat. This phenomenon was caused by an artifact causing a high amplitude, positive deflection in I and II, imitating a LBBB pattern, and there was actually no pacing – the artifact was gained as a spike by the ECG. There are multiple artifacts in I, II and aVR, suggestive of noise coming from the right upper extremity ECG electrode.
Mode switch due to battery depletion (A). The patient with a DDD PM presented with sudden onset complaints typical for pacemaker syndrome. ECG shows 65/minute ventricular stimulation with 1:1 VA conduction (best seen in V1) – this pacemaker converted to VVI 65/min backup mode when battery condition reached end-of-service. (B) is a more typical presentation of VVI stimulation with 1:1 retrograde conduction – without significant atrial conductive system disease, retrograde P waves are easily recognized
Retrograde conduction may be intermittent even during VVI pacing at constant rate – in this case, it starts after the 2nd beat and ends 3 beats before the recording ends.
Most common pacemaker and lead related malfunctions, that should be promptly identified and corrected, include oversensing, undersensing and ineffective stimulation. These may be related to inappropriate settings that may be easily corrected with a programmer, however, pacemaker lead related issues (dislocation, fracture, insulation failure) may present similarly and require hardware revision. If true pacemaker dysfunction cannot be ruled out with certainty based on ECG, device interrogation should be performed – this is especially important, if the patient was exposed to factors with potential device interaction, such as MRI, therapeutic irradiation, trauma, or drugs with known effect on pacing threshold (Goldschlager, 2001).
Pure undersensing may be identified by a pacing spike that comes early compared to the anticipated timing, with appropriate capture, if the paced chamber is not refractory. Transient arrhythmias, such as premature ventricular beats, may lead to intermittent undersensing, as their intracardiac signal amplitude may be low (Figure 46). Atrial fibrillation is often undersensed and elicits different behavior in AAI and DDD systems (Figures 47-48).
Loss of capture is easily recognized, however, post-pacing artifacts should not be misinterpreted as capture (Figure 49). Complete lead fracture usually leads to exit block with no visible spikes, while lead dislocation or insulation failure may manifest in various ways (Figures 50-54).
\n\t\t\tVentricular undersensing in a patient with VVI pacemaker after AV node ablation for AF. The first PVC was detected and the pacing cycle was reset, however, the second PVC with a different morphology was not detected and inappropriate ventricular pacing occurred in the refractory period of the ventricles.
Undersensing of atrial fibrillation with an AAI pacemaker – there is asynchronous atrial pacing without capture. Pseudo pseudofusion beats are seen (2nd, 3rd). VVI pacing would give a similar picture in case of complete sensing failure and loss of capture.
Undersensing of atrial fibrillation with a DDD pacemaker. When the ventricular rate during AF falls below the basic pacing rate, the PM delivers an atrial stimulus, which is not capturing as the patient is in AF. If conduction does not occur after the preset AV delay, a ventricular stimulus is delivered. If conduction occurs after the atrial spike within the ventricular safety period, a ventricular safety pace is delivered, which is not capturing as the ventricles are refractory.
Pseudocapture during temporary external pacing. Transcutaneous pacing was initiated due to complete heart block (underlying rhythm is sinus tachycardia). An escape beat is seen (marked with a black triangle), then pacing is initiated and pacing energy is increased rapidly, causing progressively increasing post-pacing artifacts, which may be misinterpreted as capture (A). However, the slow escape rhythm is still visible between the spikes (best seen after the 6th spike). Later, dissociation between pacing and ventricular rhythm is even more evident despite marked post-pacing artifacts (B).
Atrial lead dislocation of a DDD pacemaker. The atrial activity is not sensed, which leads to asynchronous pacing without atrial capture, followed by ventricular pacing with capture. The 3rd beat is a sinus beat conducted with prolonged AV delay, which is sensed in the ventricular safety pacing interval, so a ventricular safety pace is delivered without capture – the ventricle is refractory at this time.
A) Undersensing and ineffective pacing with a unipolar pacemaker. Both single chamber atrial and ventricular pacemakers would present similarly in case of lead dislocation. (B) Complete failure of sensing and pacing in a dual chamber pacemaker. There is asynchronous dual chamber pacing, without capture in either chamber. Unipolar pacing causes notable post-spike artifacts, which should not be confused with cardiac electrical activity. (C) Intermittent loss of capture with a ventricular pacemaker. Sensing appears to be normal as each spontaneous QRS resets the pacing cycle. The last spontaneous beat comes very early after the pacing stimulus and is likely not detected due to sensing in the blanking period.
Lead dislocation in a recently implanted single chamber ICD. There is no ventricular sensing, so the pacing is at 40/min, asynchronous to the intrinsic rhythm. There is also lack of capture – attention should be paid when assessing capture as spikes 1-3 come very early when the ventricles may still be refractory. However, spike 5 should have lead to capture.
Intermittent loss of atrial capture during AAI stimulation. There is also intermittent undesensing - the atrial activation before the 3rd spike was not detected by the device. This scenario is suspicious for lead disclocation.
Loss of sensing with oversensing in a ventricular pacemaker. The first few beats may be misinterpreted as atrial pacing, however, the spike to QRS interval is not constant. Fusion and paced beats are seen when pacing occurs during an excitable period. Transient oversensing caused delayed pacing (3rd spike in V3). This scenario is suggestive of lead dislocation or failure.
Implantable cardioverter defibrillators have multiple therapeutic zones (bradycardia, „physiological”, ventricular tachycardia and fibrillation - VT, VF), that should be taken into account when interpreting ECG changes. While issues due to undersensing or ineffective capture usually manifest similarly to a pacemaker, oversensing may lead to inappropriate therapy due to false VT/VF detection.
As ICD therapies may cause severe patient distress or proarrhythmia, prompt device interrogation and expert consultation is required after such events, unless appropriate device behavior is evident (Figures 55-56). Even when appropriate therapies have been delivered, the patient has to be fully evaluated and appropriate measures should be taken to reduce the risk of arrhythmia recurrence (Mishkin, 2009). In cases when inappropriate therapy is suspected and the risk of recurrence is high (atrial fibrillation with rapid ventricular rate, oversensing), a magnet may be applied to temporarily inhibit tachyarrhythmia therapies, until the device may be interrogated and appropriately reprogrammed (Figure 57). Continuous monitoring is required in the meantime as the patient will not be protected from malignant tachyarrhythmias while in magnet effect.
\n\t\t\tAppropriate ICD function recorded on telemetry. Following ventricular paced rhythm, rapid polymorphic ventricular tachycardia develops, which is terminated by a single endocardial shock after appropriate detection.
Appropriate ICD function recorded on telemetry. Following ventricular paced rhythm, rapid polymorphic ventricular tachycardia develops, then burst antitachycardia stimulation is attempted, however, fails to terminate the arrhythmia, although changes it to monomorphic VT. The tachyarrhythmia is terminated by an endocardial shock.
Atrial fibrillation with rapid ventricular rate sensed as ventricular tachycardia – inappropriate burst antitachycardia pacing burst was delivered. The patient is at risk of further inappropriate therapies as the underlying rhythm did not change.
Consistent biventricular capture is required to maintain cardiac resynchronization. Paced QRS morphology may vary based on underlying conduction abnormalities, lead location, interventricular delay and the amount of myocardium captured by each lead, relative to each other. Typically, right axis deviation and atypical RBBB pattern is present. If interventricular delay is set greater than 0 ms, usually two pacing spikes can be seen prior to the QRS (Figure 58). In rare cases, conventional RV pacing may mimic biventricular paced QRS morphology (Figure 59). QRS morphology may change due to variable fusion with conducted beats either from variable AV delay or atrial fibrillation (Figures 60\n\t\t\t\t-61).
\n\t\t\tTypical atriobiventricular pacing. The paced QRS usually shows right axis deviation and an atypical RBBB pattern in V1. Two distinct pacing spikes, representing right and left ventricular stimulation with a delay around 20 ms, can be best seen in II and V3 on this tracing.
Although biventricular pacing may be recognized in most cases, underlying RBBB may mimic this QRS morphology during right ventricular pacing, especially, if fusion is present – this patient has a DDD pacemaker (A). His previous ECG showed atrial flutter with RBBB (B).
Sense response pacing is an algorithm that was designed to maintain the benefits of biventricular stimulation with premature beats or fast AV conduction – in case a ventricular event is sensed, a pacing stimulus is delivered simultaneously to decrease ventricular activation time. The resulting QRS morphology is affected by the origin of the premature beat and the amount of fusion (Figures 62-64).
Loss of left ventricular lead capture changes QRS morphology, so it becomes similar to RV pacing. A full 12-lead ECG should always be obtained during follow-up (Barold, 2011a and Barold, 2011b). Comparison with previous tracings is recommended as biventricular paced QRS morphology varies individually (Figure 65). Undersensing or oversensing may be more difficult to identify with resynchronization devices, than with conventional pacemakers, due to the algorithms designed to maintain biventricular pacing (Figure 66-67). In uncertain cases, device interrogation should be performed to prevent loss of resynchronization.
\n\t\t\tVariable fusion during biventricular pacing due changes in the atrial rate – the degree of ventricular fusion is different for atrial sensed and atrial paced beats, due to different atrioventricular delay, affecting how much of the ventricular myocardium can be activated through the native conduction system during biventricular pacing.
AF with biventricular pacing. When the ventricular rate increases, first it leads to more fusion, then to sense response pacing – appropriate response of the system.
Sense response pacing during biventricular stimulation – each ventricular sensed event (PVC, rapidly conducted AF) leads to simultaneous pacing, aiming to maintain optimal hemodynamics of biventricular pacing. Due to the various origin of these early beats, the result can be fusion of even pseudofusion. Despite irregular rate and variable QRS morphology, this tracing shows appropriate biventricular pacemaker function (A). This function may be easier to evaluate when the underlying rhythm is regular, such as in sinus rhythm (B). There is an appropriate sense response pace for each premature beat. Depending on the coupling interval of the premature beat and the atrial rate, this may lead to post-event atrial pacing, if the compensatory pause exceeds the basic pacing rate. Very early PVCs do not trigger sense response pacing if that would exceed a maximal tracking rate (C).
Atriobiventricular pacing with irregular ventricular rhythm due to frequent PVCs. Appropriate device behavior with sense response pacing during PVCs (best seen during the 1st PVC). There is notable interventricular delay between the right and left ventricular stimulation (60 ms).
Biventricular (sense response) pacing ceases above the upper biventricular tracking rate – this is appropriate pacemaker function, however, may lead to rapid deterioration if the tachycardia persists.
LBBB QRS morphology in a patient with a biventricular system should raise the suspicion of left ventricular non-capture. Other causes include suboptimal LV lead placement or too long RV-LV delay – these may diminish the amount of myocardium activated by the LV lead during biventricular pacing. In this case, biventricular pacing with 40 mm VV delay is apparent in V4.
Intermittent ventricular undersensing in a biventricular system. Most ventricular beats are biventricular paced at 75/minute or sense response paced (occurring faster that 75/min). However, there are few spikes coming late (instead of a sense response pace), at 75/minute – the ventricular activation was not detected by the device. The undersensing is intermittent, as the sense response paced beats present on this tracing require a sensed event.
Pacing below the basic rate in an atriobiventricular system is always abnormal – algorithms are designed to maintain the ventricular rate, track premature beats and provide sense response pacing. This patient with a biventricular defibrillator had a fracture of the right ventricular sensing/pacing/shock ICD lead, leading to intermittent ventricular oversensing and multiple inappropriate shocks.
Conventional 12-lead ECG is an important tool to evaluate CIED function. A systematic approach is required to identify appropriate device function and to decide whether further investigation is necessary. As advanced devices, such as implantable cardioverter-defibrillators and cardiac resynchronization systems become more abundant, even common malfunctions and pseudo-malfunctions may be more difficult to identify, due to the presence of special pacing algorithms. In uncertain cases, review of prior patient data, device interrogation and expert consultation is required.
\n\t\tForward problems are used to explain the propagation of photons within a tissue and to calculate the optical flux at the tissue boundary. The reconstruction of the tissue image is the inverse problem, from light measurements at the boundary phantom surface, tissue absorption, scattering factors, and optical flow [1]. The inverse problem is difficult to solve due to the issue of fairness. This indicates that the problem is not properly configured. Appropriate problem characteristics include the existence of a solution, the uniqueness of the solution, and the constant reliance on the data [2]. The third property determines the stability of the solution and is important for determining the inverse problem. The ill-posedness problem occurs when the problem solution does not depend on the data indefinitely. Small changes to the data can make a big difference in the solution in this case. Regularization method is used to solve this problem, which is a regularization method that introduces additional information in order to create well-posed data [3, 4]. Diffuse optical imaging [5, 6, 7, 8] is a technique that uses an MRI scan and X-rays generate spatially decomposed images and uses high-resolution complementary structural information to improve low-resolution functional images. A set of fiber optics has been connected the object’s boundary in experimental systems. The light source was a near-infrared (NIR) laser source that was diffused on the phantom, the scattered rays were measured with a photodetector [9]. Regularization method [10] is used to remove the ill-posedness, with the Levenberg–Marquardt method (LM) being one of the most commonly used methods. Following the regularization process, the Split Bregman reconstruction method [10, 11, 12] is used to reconstruct a soft tissue image. The sparsity regularization technique for image reconstruction in DOT is described by Bo Bi et al. [9]. Gehre et al. [13] investigates the possibility of sparsity constraints in the inverse problem of deriving distributed conductivity from critical potential measurements in electrical impedance tomography (EIT). Chamorro et al. [14] proposed an Algebraic reconstruction technique—Split Bregman (ART-SB) algorithm solved the L1-regularized problem. Wang et al. evaluated the Split Bregman iteration algorithm for the L1 norm regularization inverse problem in electrical impedance tomography. Figueiredo et al. [15] investigated the use of Split Bregman iterative algorithms for the L1-norm regularized inverse problem of electrical impedance constrained quadratic programming ill-tomography formulation.
In most cases, the measurement data in DOT reconstruction is derived from the numerical solution of the forward problem. Regularization techniques are used to eliminate the obtrusive inverse problem variables. The measurement technology of optical devices is so limited that their existence cannot be accurately determined from all angles. Instead, it gets the average contact angle data for the phantom. The purpose is to reconstruct the image from known scattering and absorption coefficients, which are assumed to be known. The reconstructed result is obtained by comparing the true value to the measured value. A variety of practical reconstruction algorithms have been developed in tomography to implement the process of reconstructing a 3D object from a projection [16]. These algorithms are mainly based on the mathematics of statistical knowledge of the data acquisition process and the geometry of the data imaging system [17].
The inverse problem is used to reconstruct an image in the following ways by estimating the scattering coefficient, absorption coefficient, and optical flux [18, 19]. The noise level is present in the actual measurement; both actual measurement data and actual data are shown here [9]. The following nonlinear equation is used to solve the inverse problem of DOT for
The inverse problem of DOT is inappropriate and uses regularization techniques to reconstruct the image [8], i.e. the Tikhonov functional feature that is minimized for the coefficient. R (
Over the set,
The standard reconstruction method is considered using Eqs. (3) and (4).
Traditional norm-squared penalties are believed to reduce the following functions,
In the inverse problem of DOT, the Levenberg–Marquardt regularization method [20] is used. The forward operator is linearized around the initial estimation for each;
where Eq. (7) denotes the Taylor remainder for the linearization around and the Frechet derivative is obtained by substituting the above equation and ignoring the higher-order remainder [13].
The Euler equation for discrete problems is
Solving this (9) yields the final Equation [16].
That is,
where
Sparsity reconstruction function can be minimized as
Such that d=
where
By dividing the minimization of (12) and d separately, the sub-problem can be minimized.
Consider
Consider
Consider
Minimize
The variational equation is given as
L1 is solved efficiently by the contraction operator; that is
Where the shrinkage operator is defined as
The rate of spilt Bregman is highly dependent on the rate of dissolution
Because the DOT image has poor spatial resolution due to severe ill-posedness, the regularization technique is used in conjunction with reconstruction algorithms to reconstruct the images.
for
for
i. Compute the Frechet derivative
end for.
i. Compute
ii. Update
iii. Check the stopping criterion.
end for.
Regularization parameters
While
For each
end while.
The split Bregman method entails locating the Fréchet derivative, which is nothing more than the first order derivative function. The algorithm is built with regularization parameters in mind.
The reconstructed image can be obtained using the Levenberg–Marquardt algorithm by providing optical flux, scattering coefficient, and absorption coefficient values, which are then compared to distinguish between normal soft tissue and cancer-affected tissue. The forward mesh has more nodes to extract all of the optical parameters of the tissue, whereas the inverse mesh has fewer nodes for reconstruction. As shown in Figure 1, the forward mesh has 1097 nodes and 2095 elements, and the reverse mesh has 286 nodes and 522 elements.
Mesh diagram of inverse problem.
Figure 2 depicts the reconstruction based on absorption and scattering coefficient measurements. The image is reconstructed using optical properties of human tissue such as absorption coefficient and scattering coefficient (and (r) = 2). The reconstructed image is based on the absorption and scattering coefficient values. It is possible to predict normal tissue and cancer-affected tissue by examining the reconstructed image with absorption and scattering coefficients. When the absorption and scattering coefficients are higher, the tumor is classified as malignant or benign soft tissue tumor.
Levenberg–Marquardt regularization and standard reconstruction.
The split Bregman algorithm with sparsity regularization efficiently solves the DOT image reconstruction problem. Figure 3 depicts a Spilt Bregman reconstruction from scattering coefficients. The scattering coefficient value distinguishes the variation of abnormal tissue to normal tissue. According to Figure 3, the abnormal tissue scattering coefficient ranges from 150 to 210, whereas the normal tissue scattering coefficient ranges from 0 to 20. When compared to other reconstruction algorithms, the Bregman algorithm produces more accurate results. The reconstructed image’s resolution is determined by calculating the signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), relative solution error norm (RE), and CPU time. SNR is calculated as follows:
Spilt Bregman regularization with sparsity reconstruction.
The CNR is a metric used to assess image quality. The mean and standard deviation values are used to calculate it. CNR is calculated as follows:
where are the image signal intensities and is the standard deviation of pure image noise. The Relative solution error norm is computed as follows:
Table 1 compares parameters used to evaluate the performance of reconstruction algorithms. The Split Bregman method has a higher SNR than the Gauss Newton algorithm and improves CNR more than the Gauss Newton method. To achieve better performance, the RE of a reconstructed image should be low. Because the Gauss Newton method has a high RE value, it is not an optimal solution for image reconstruction. Finally, when compared to the Gauss Newton method, the Split Bregman method requires less CPU time to execute. The graph of the performance analysis of the Split Bregman and Gauss Newton algorithms is shown in Figure 4.
Parameters | Split Bregman method | Gauss Newton |
---|---|---|
SNR | 9.2327 | 4.3402 |
CNR | 66.947 | 39.743 |
RE | 0.0508 | 0.2141 |
CPU time (s) | 72.231 | 75.197 |
Performance analysis of reconstruction algorithms.
Performance analysis of reconstruction algorithms.
The solution to diffuse light transport through tissues is provided by iterative non-linear reconstruction of diffuse optical tomography using a finite element forward model. The efficiency of the forward solver has a significant impact on reconstruction performance and reconstruction time, which is critical in making optical tomography a viable imaging modality in clinical diagnosis. Standard regularization (Levenburg-Marquadt) with a small anisotropy factor identifies the scattering coefficient better than sparsity regularization in the inverse model. Sparsity regularization (Split Bregman) localizes the inclusion position and has high anisotropy factor g while forward-peaking region. The absorption and scattering coefficient values of the reconstructed it is analyzed to determine the difference between normal soft tissue and cancerous tissue. Increasing the number of measurements by adding more photo detectors is one way to improve the quality of a reconstructed image. Finally, a regularization technique is used to remove the ill-posedness problem, and a Split Bregman reconstruction algorithm is used to achieve a high-resolution image.
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Medicine",slug:"cardiology-and-cardiovascular-medicine"},numberOfBooks:6,numberOfSeries:0,numberOfAuthorsAndEditors:154,numberOfWosCitations:62,numberOfCrossrefCitations:52,numberOfDimensionsCitations:104,videoUrl:null,fallbackUrl:null,description:null},booksByTopicFilter:{topicId:"984",sort:"-publishedDate",limit:12,offset:0},booksByTopicCollection:[{type:"book",id:"9060",title:"The Current Perspectives on Coronary Artery Bypass Grafting",subtitle:null,isOpenForSubmission:!1,hash:"cedc3547eae8f66f9440cc35216d7963",slug:"the-current-perspectives-on-coronary-artery-bypass-grafting",bookSignature:"Takashi Murashita",coverURL:"https://cdn.intechopen.com/books/images_new/9060.jpg",editedByType:"Edited by",editors:[{id:"192448",title:"Dr.",name:"Takashi",middleName:null,surname:"Murashita",slug:"takashi-murashita",fullName:"Takashi Murashita"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8819",title:"Cardiac Surgery Procedures",subtitle:null,isOpenForSubmission:!1,hash:"3d84cc6e6750d835e4b86578dfdbbdd9",slug:"cardiac-surgery-procedures",bookSignature:"Andrea Montalto, Antonio Loforte and Cristiano Amarelli",coverURL:"https://cdn.intechopen.com/books/images_new/8819.jpg",editedByType:"Edited by",editors:[{id:"222866",title:"Dr.",name:"Andrea",middleName:null,surname:"Montalto",slug:"andrea-montalto",fullName:"Andrea Montalto"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8218",title:"Aortic Stenosis",subtitle:"Current Perspectives",isOpenForSubmission:!1,hash:"d9a81a576f7026e76fa6d29c27b308a6",slug:"aortic-stenosis-current-perspectives",bookSignature:"Peter Magnusson",coverURL:"https://cdn.intechopen.com/books/images_new/8218.jpg",editedByType:"Edited 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Firstenberg",coverURL:"https://cdn.intechopen.com/books/images_new/6556.jpg",editedByType:"Edited by",editors:[{id:"64343",title:"Dr.",name:"Michael S.",middleName:null,surname:"Firstenberg",slug:"michael-s.-firstenberg",fullName:"Michael S. Firstenberg"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3542",title:"Artery Bypass",subtitle:null,isOpenForSubmission:!1,hash:"6b48ec67e1291ca98f3aded6a9af92ca",slug:"artery-bypass",bookSignature:"Wilbert S. Aronow",coverURL:"https://cdn.intechopen.com/books/images_new/3542.jpg",editedByType:"Edited by",editors:[{id:"164597",title:"Dr.",name:"Wilbert S.",middleName:null,surname:"Aronow",slug:"wilbert-s.-aronow",fullName:"Wilbert S. Aronow"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}],booksByTopicTotal:6,seriesByTopicCollection:[],seriesByTopicTotal:0,mostCitedChapters:[{id:"43500",doi:"10.5772/54723",title:"Pharmacology of Arterial Grafts for Coronary Artery Bypass Surgery",slug:"pharmacology-of-arterial-grafts-for-coronary-artery-bypass-surgery",totalDownloads:2976,totalCrossrefCites:9,totalDimensionsCites:19,abstract:null,book:{id:"3542",slug:"artery-bypass",title:"Artery Bypass",fullTitle:"Artery Bypass"},signatures:"Oguzhan Yildiz, Melik Seyrek and Husamettin Gul",authors:[{id:"164299",title:"Prof.",name:"Oguzhan",middleName:null,surname:"Yıldız",slug:"oguzhan-yildiz",fullName:"Oguzhan Yıldız"},{id:"164968",title:"Dr.",name:"Melik",middleName:null,surname:"Seyrek",slug:"melik-seyrek",fullName:"Melik Seyrek"},{id:"164969",title:"Dr.",name:"Husamettin",middleName:null,surname:"Gul",slug:"husamettin-gul",fullName:"Husamettin Gul"}]},{id:"43514",doi:"10.5772/54418",title:"The Role of The Angiosome Model in Treatment of Critical Limb Ischemia",slug:"the-role-of-the-angiosome-model-in-treatment-of-critical-limb-ischemia",totalDownloads:3760,totalCrossrefCites:5,totalDimensionsCites:11,abstract:null,book:{id:"3542",slug:"artery-bypass",title:"Artery Bypass",fullTitle:"Artery Bypass"},signatures:"Kim Houlind and Johnny Christensen",authors:[{id:"165363",title:"Associate Prof.",name:"Kim",middleName:null,surname:"Houlind",slug:"kim-houlind",fullName:"Kim Houlind"},{id:"167383",title:"Dr.",name:"Johnny",middleName:null,surname:"Christensen",slug:"johnny-christensen",fullName:"Johnny Christensen"}]},{id:"43476",doi:"10.5772/54509",title:"Impact of Ischemia on Cellular Metabolism",slug:"impact-of-ischemia-on-cellular-metabolism",totalDownloads:2729,totalCrossrefCites:5,totalDimensionsCites:9,abstract:null,book:{id:"3542",slug:"artery-bypass",title:"Artery Bypass",fullTitle:"Artery Bypass"},signatures:"Maximilien Gourdin and Philippe Dubois",authors:[{id:"164978",title:"Prof.",name:"Philippe",middleName:"E",surname:"Dubois",slug:"philippe-dubois",fullName:"Philippe Dubois"},{id:"164982",title:"Dr.",name:"Maximilien",middleName:null,surname:"Gourdin",slug:"maximilien-gourdin",fullName:"Maximilien Gourdin"}]},{id:"61397",doi:"10.5772/intechopen.76844",title:"The Ethics in Repeat Heart Valve Replacement Surgery",slug:"the-ethics-in-repeat-heart-valve-replacement-surgery",totalDownloads:1154,totalCrossrefCites:3,totalDimensionsCites:6,abstract:"The treatment of patients with intravenous drug use (IVDU) has evolved to include a wide range of medications, psychiatric rehabilitation, and surgical interventions, especially for life-threatening complications such as infective endocarditis (IE). These interventions remain at the discretion of physicians, particularly surgeons, whose treatment decisions are influenced by several medical factors, unfortunately not without bias. The stigma associated with substance use disorder is prevalent, which leads to significant biases, even in the healthcare system. This bias is heightened when IVDU patients require repeat valve replacement surgeries for IE due to continued drug use. Patients who receive a valve replacement and continue to use illicit drugs intravenously often return to their medical providers, months to a few years later, with a reinfection of their bioprosthetic valve; such patients require additional surgeries which are at the center of many ethical discussions due to high mortality rates, for many complex medical and social reasons, associated with continuous chemical dependency after surgical interventions. This chapter examines the ethics of repeat heart valve replacement surgery for patients who are struggling with addiction. Considerations of justice, the fiduciary therapeutic relationship, and guiding ethical principles justify medically beneficial repeat heart valve replacement surgeries for IVDU patient populations.",book:{id:"6556",slug:"advanced-concepts-in-endocarditis",title:"Advanced Concepts in Endocarditis",fullTitle:"Advanced Concepts in Endocarditis"},signatures:"Julie M. Aultman, Emanuela Peshel, Cyril Harfouche and Michael S.\nFirstenberg",authors:[{id:"64343",title:"Dr.",name:"Michael S.",middleName:null,surname:"Firstenberg",slug:"michael-s.-firstenberg",fullName:"Michael S. Firstenberg"},{id:"227150",title:"Ms.",name:"Emanuela",middleName:null,surname:"Peshel",slug:"emanuela-peshel",fullName:"Emanuela Peshel"},{id:"229719",title:"Dr.",name:"Julie",middleName:"M.",surname:"Aultman",slug:"julie-aultman",fullName:"Julie Aultman"},{id:"232060",title:"Mr.",name:"Cyril",middleName:null,surname:"Harfouche",slug:"cyril-harfouche",fullName:"Cyril Harfouche"}]},{id:"43498",doi:"10.5772/54928",title:"Treatment of Coronary Artery Bypass Graft Failure",slug:"treatment-of-coronary-artery-bypass-graft-failure",totalDownloads:4781,totalCrossrefCites:3,totalDimensionsCites:5,abstract:null,book:{id:"3542",slug:"artery-bypass",title:"Artery Bypass",fullTitle:"Artery Bypass"},signatures:"M.A. Beijk and R.E. Harskamp",authors:[{id:"164896",title:"Dr.",name:"Marcel",middleName:"A.",surname:"Beijk",slug:"marcel-beijk",fullName:"Marcel Beijk"},{id:"165094",title:"Dr.",name:"Ralf",middleName:null,surname:"Harskamp",slug:"ralf-harskamp",fullName:"Ralf Harskamp"}]}],mostDownloadedChaptersLast30Days:[{id:"80213",title:"Evolution of Heart Transplantation Surgical Techniques",slug:"evolution-of-heart-transplantation-surgical-techniques",totalDownloads:222,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Organ transplantation has kindled the human imagination since the beginning of time. Prehistorically, transplantation appeared as mythological stories: from creatures with body parts from different species, the heart transplant between two Chinese soldiers by Pien Ch’iao, to the leg transplant by physician Saints Cosmas and Damian. By 19th century, the transplantation concept become possible by extensive contributions from scientists and clinicians whose works had taken generations. Although Alexis Carrel is known as the founding father of experimental organ transplantation, many legendary names had contributed to the experimental works of heart transplantation, including Guthrie, Mann, and Demikhov. The major contribution to experimental heart transplantation before the clinical era were made by a team lead by Richard Lower and Norman Shumway at Stanford University in the early 1960s. They played the vital role in developing experimental and clinical heart transplantation as it is known today. Using Shumway biatrial technique Christiaan Barnard started a new era of clinical heart transplantation, by performing the first in man human-to-human heart transplantation in 1967. The techniques of heart transplant have evolved since the first heart transplant. This chapter will summarize the techniques that have been used in clinical heart transplantation.",book:{id:"11236",slug:null,title:"Heart Transplantation - New Insights in Therapeutic Strategies",fullTitle:"Heart Transplantation - New Insights in Therapeutic Strategies"},signatures:"Samuel Jacob, Anthony N. Pham and Si M. Pham",authors:null},{id:"70032",title:"Coronary Artery Bypass Grafting: Surgical Anastomosis: Tips and Tricks",slug:"coronary-artery-bypass-grafting-surgical-anastomosis-tips-and-tricks",totalDownloads:1310,totalCrossrefCites:0,totalDimensionsCites:1,abstract:"The definite feature of coronary artery disease is the focal narrowing in the vascular endothelium, and this leads to the decrease in the flow of blood to the myocardium. Atherosclerotic plaque is the main lesion. These patients can present with chest pain (angina or myocardial infarction) and need further workup noninvasively and invasively for the management. The main reasons for myocardial revascularization can be: (1) relief from symptoms of myocardial ischemia; (2) reduce the risks of future mortality; (3) to treat or prevent morbidities such as myocardial infarction, arrhythmias, or heart failure. Coronary artery bypass grafting (CABG) is the surgical technique of cardiac revascularization. In 1910, Dr. Alexis Carrel described a series of canine experiments in which he devised means to treat CAD by creating a “complementary circulation” for the diseased native coronary arteries. No clinical translation occurred at the time, but he was awarded the Nobel Prize in Medicine. Experimental refinements of coronary arterial revascularization, including the use of internal thoracic artery (ITA) grafts, were later reported by Murray and colleagues, Demikhov, and Goetz and colleagues in the 1950s and early 1960s. Dr. Rene Favaloro performed his first coronary bypass operation in May 1967 with an interposed saphenous vein graft (SVG) and shortly thereafter used aortocoronary bypasses sutured proximally to the ascending aorta. The stenosed segment is bypassed using an arterial or venous graft. Left internal thoracic artery is the most commonly used artery, and long saphenous vein is the most commonly used vein for the coronary artery grafting to reestablish the blood flow to the compromised myocardium. This can be performed with or without the help of cardiopulmonary bypass machine and also with or without arresting the heart. These techniques are called as on-pump beating or on-pump arrested and off-pump beating coronary artery bypass grafting surgery. Distal and proximal anastomoses are usually performed in an end-to-side manner, but in the case of doing sequential grafting, side-to-side anastomosis is also performed proximal to the end-to-side anastomosis. In this chapter we are going to discuss the coronary artery bypass grafting tips and tricks in details.",book:{id:"9060",slug:"the-current-perspectives-on-coronary-artery-bypass-grafting",title:"The Current Perspectives on Coronary Artery Bypass Grafting",fullTitle:"The Current Perspectives on Coronary Artery Bypass Grafting"},signatures:"Mohd. Shahbaaz Khan",authors:[{id:"278633",title:"Dr.",name:"Mohd. Shahbaaz",middleName:null,surname:"Khan",slug:"mohd.-shahbaaz-khan",fullName:"Mohd. Shahbaaz Khan"}]},{id:"65984",title:"Low Flow Low Gradient Severe Aortic Stenosis: Diagnosis and Treatment",slug:"low-flow-low-gradient-severe-aortic-stenosis-diagnosis-and-treatment",totalDownloads:2189,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Approximately 40% of patients with aortic stenosis (AS) show discordant Doppler-echocardiographic parameters with aortic valve area (AVA) <1 cm2 and/or index iAVA <0.6 cm2/m2 (consistent with severe AS) and the mean gradient (MG) <40 mmHg, consistent with mild/moderate AS. Accurate diagnosis of true severe low flow low gradient AS versus pseudo-severe aortic stenosis is important for prognosis and optimal timing for intervention. Doppler echocardiography using intravenous low dose dobutamine challenge is widely used for differentiating pseudo-severe from true severe aortic stenosis. However, relying on echocardiography alone may have limitations in accurate diagnosis. Reliable diagnosis using echocardiography is dependent on multiple factors like the angle of interrogation of the aortic jet, the assumption that the LVOT area is circular in cross section, optimal echo windows, the presence of underlying subclinical coronary artery disease prior to dobutamine challenge etc. In this chapter, we describe non-invasive and invasive strategies to assess the aortic valve using dobutamine stress. Direct measurement of gradients across the aortic valve while estimating the change in cardiac output and aortic valve area with increments of dobutamine infusion dose is complementary, safe and useful when conventional echocardiography techniques are inconclusive. Finally, the chapter describes effective strategies of treatment for low gradient severe aortic stenosis, including the role for diagnostic balloon valvuloplasty, in the era of transcatheter valve replacement (TAVR).",book:{id:"8218",slug:"aortic-stenosis-current-perspectives",title:"Aortic Stenosis",fullTitle:"Aortic Stenosis - Current Perspectives"},signatures:"Faeez Mohamad Ali, Vindhya Wilson and Rajesh Nair",authors:[{id:"280651",title:"Dr.",name:"Rajesh",middleName:null,surname:"Nair",slug:"rajesh-nair",fullName:"Rajesh Nair"},{id:"280829",title:"Dr.",name:"Faeez",middleName:null,surname:"Mohamad Ali",slug:"faeez-mohamad-ali",fullName:"Faeez Mohamad Ali"},{id:"290351",title:"Dr.",name:"Vindhya",middleName:null,surname:"Wilson",slug:"vindhya-wilson",fullName:"Vindhya Wilson"}]},{id:"59547",title:"Left Ventricular Assist Device Infections",slug:"left-ventricular-assist-device-infections",totalDownloads:1448,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Left ventricular assist device (LVAD) infections are important causes of morbidity and mortality in patients who receive these mechanical circulatory supports as a bridge to transplantation (BTT) or as destination therapy (DT) (for individuals who are not candidates for cardiac transplant). Infections are more common among persons who received pulsatile flow LVADs as opposed to newer continuous flow (CF) devices. Other risk factors for infection include obesity, renal failure, depression and immunosuppression. An LVAD infection increases the risk of infections in persons who undergo cardiac transplantation. Infections include percutaneous site, driveline, pump pocket and pump/cannula infections; sepsis, bacteremia, mediastinitis and endocarditis. Diagnosis is achieved by monitoring LVAD flow parameters and observing typical clinical and laboratory manifestations of infection. Imaging such as PET-CT or SPECT-CT imaging can be helpful to establish a diagnosis of pump pocket infection. Echocardiography may aid in detecting native valve endocarditis and thrombus associated with the LVAD. The most common pathogens include Staphylococcus, Corynebacterium, Enterococcus, Pseudomonas and Candida spp. Treatment requires targeted antimicrobials plus surgical debridement of infected tissue and device components. In cases of pump/cannula/LVAD endocarditis, especially if fungal pathogens or Mycobacterium chimaera are involved, LVAD removal/reimplantation vs. transplant is necessary, combined with extended antimicrobial therapy.",book:{id:"6556",slug:"advanced-concepts-in-endocarditis",title:"Advanced Concepts in Endocarditis",fullTitle:"Advanced Concepts in Endocarditis"},signatures:"Marion J. Skalweit",authors:[{id:"186717",title:"Associate Prof.",name:"Marion",middleName:null,surname:"Skalweit",slug:"marion-skalweit",fullName:"Marion Skalweit"}]},{id:"60658",title:"Humoral Rejection in Cardiac Transplantation: Management of Antibody-Mediated Rejection",slug:"humoral-rejection-in-cardiac-transplantation-management-of-antibody-mediated-rejection",totalDownloads:1072,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"After a successful heart transplantation, fundamental keys to achieve good results in the long term are to establish immunosuppressive therapy in the postoperative period in an appropriate manner and to ensure continuity of follow-ups. Despite the fact that these stages are maintained perfectly, patients may face one or more rejection episodes. T-cell-mediated acute cellular rejection of the cardiac allograft has well-established treatment algorithms, whereas antibody-mediated rejection (AMR) is challenging to diagnose, and its treatment varies between centers. Investigators reported that AMR is among the most important factors to improving long-term outcomes. Improved understanding of the roles of acute and chronic AMR has evolved in recent years following a major progress in the technical ability to detect and quantify recipient antihuman leukocyte antigen (HLA) antibody production. Recently, a study of the immunobiology of B cells and plasma cells that pertains to allograft rejection and tolerance has emerged. There are some questions regarding the classification of AMR, the diagnostic approaches, and the treatment strategies for managing. In this chapter, we are discuss the effector mechanisms that are used by antibodies to eliminate antigens and clinical experience about AMR and its treatment with a discussion about the latest articles.",book:{id:"6558",slug:"heart-transplantation",title:"Heart Transplantation",fullTitle:"Heart Transplantation"},signatures:"Umit Kervan, Dogan Emre Sert and Nesrin Turan",authors:[{id:"227772",title:"Prof.",name:"Umit",middleName:null,surname:"Kervan",slug:"umit-kervan",fullName:"Umit Kervan"},{id:"243592",title:"Dr.",name:"Dogan Emre",middleName:null,surname:"Sert",slug:"dogan-emre-sert",fullName:"Dogan Emre Sert"},{id:"243593",title:"Dr.",name:"Nesrin",middleName:null,surname:"Turan",slug:"nesrin-turan",fullName:"Nesrin Turan"}]}],onlineFirstChaptersFilter:{topicId:"984",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"81437",title:"Pediatric Heart Transplantation",slug:"pediatric-heart-transplantation",totalDownloads:13,totalDimensionsCites:0,doi:"10.5772/intechopen.104518",abstract:"Despite advances in medical management, patients submitted for heart transplantation procedures still are at risk to development of complications. This chapter will discuss some specific topics of pediatric heart transplantation, focusing on perioperative care: (i) recipient management, (ii) donor evaluation, (iii) immunosuppression, (iv) early postoperative management, (v) complications, and (vi) conclusions.",book:{id:"11236",title:"Heart Transplantation - New Insights in Therapeutic Strategies",coverURL:"https://cdn.intechopen.com/books/images_new/11236.jpg"},signatures:"Estela Azeka"},{id:"81451",title:"Donor Assessment and Management for Heart Transplantation",slug:"donor-assessment-and-management-for-heart-transplantation",totalDownloads:13,totalDimensionsCites:0,doi:"10.5772/intechopen.104504",abstract:"For many years, heart transplantation has been an established procedure for patients with end-stage heart failure using the so-called “Standard Criteria” for an optimal heart donor. However, annually listed patients for heart transplantation greatly increased worldwide, and the use of extended criteria donor hearts has been utilized as many as possible in many countries. In this chapter, firstly, pathophysiology of brain death is explained. Secondly, donor assessment and issues of extended criteria donors are introduced. Then, donor management to maximize the heart graft availability, and the Japanese donor assessment and evaluation system and its outcome are reviewed.",book:{id:"11236",title:"Heart Transplantation - New Insights in Therapeutic Strategies",coverURL:"https://cdn.intechopen.com/books/images_new/11236.jpg"},signatures:"Norihide Fukushima"},{id:"81057",title:"Induction Therapy in the Current Immunosuppressive Therapy",slug:"induction-therapy-in-the-current-immunosuppressive-therapy",totalDownloads:14,totalDimensionsCites:0,doi:"10.5772/intechopen.103746",abstract:"The current immunosuppressive therapy including calcineurin inhibitors, mycophenolate mofetil, and steroids, has substantially suppress rejections and improved clinical outcomes in heart transplant (HTx) recipients. Nevertheless, the management of drug-related nephrotoxicity, fatal acute cellular rejection (ACR), antibody-mediated rejection and infections remains challenging. Although previous some studies suggested that perioperative induction immunosuppressive therapy may be effective for the suppressing ACR and deterioration of renal function, increased incidence of infection and malignancy was concerned in recipients with induction immunosuppressive therapy. The international society of heart and lung transplantation (ISHLT) guidelines for the care of heart transplant recipients do not recommend routine use of induction immunosuppressive therapy, except for the patients with high risk of acute rejection or renal dysfunction, however, appropriate therapeutic regimen and indication of induction immunosuppressive therapy remains unclear in HTx recipients. We review current evidence of induction immunosuppressive therapy in HTx recipients, and discuss the appropriate therapeutic regimen and indication of induction therapy.",book:{id:"11236",title:"Heart Transplantation - New Insights in Therapeutic Strategies",coverURL:"https://cdn.intechopen.com/books/images_new/11236.jpg"},signatures:"Takuya Watanabe, Yasumasa Tsukamoto, Hiroki Mochizuki, Masaya Shimojima, Tasuku Hada, Satsuki Fukushima, Tomoyuki Fujita and Osamu Seguchi"},{id:"80305",title:"Hepatic and Endocrine Aspects of Heart Transplantation",slug:"hepatic-and-endocrine-aspects-of-heart-transplantation",totalDownloads:13,totalDimensionsCites:0,doi:"10.5772/intechopen.102418",abstract:"End-organ dysfunction is a progression that can often develop in patients with end-stage heart failure. Hepatic abnormalities in advanced systolic heart failure may affect several aspects of the liver function. Hepatic function is dependent on age, nutrition, previous hepatic diseases, and drugs. The hepatic dysfunction can have metabolic, synthetic, and vascular consequences, which strongly influence the short- and long-term results of the transplantation. In this chapter, the diagnostic and treatment modalities of the transplanted patient will be discussed. On the other hand, endocrine abnormalities, particularly thyroid dysfunction, are also frequently detected in patients on the waiting list. Endocrine supplementation during donor management after brain death is crucial. Inappropriate management of central diabetes insipidus, hyperglycemia, or adrenal insufficiency can lead to circulatory failure and graft dysfunction during procurement. Thyroid dysfunction in donors and recipients is conversely discussed.",book:{id:"11236",title:"Heart Transplantation - New Insights in Therapeutic Strategies",coverURL:"https://cdn.intechopen.com/books/images_new/11236.jpg"},signatures:"Andrea Székely, András Szabó and Balázs Szécsi"},{id:"79970",title:"The Role of Large Impella Devices in Temporary Mechanical Circulatory Support for Patients Undergoing Heart Transplantation",slug:"the-role-of-large-impella-devices-in-temporary-mechanical-circulatory-support-for-patients-undergoin",totalDownloads:14,totalDimensionsCites:0,doi:"10.5772/intechopen.101680",abstract:"Large microaxial pump systems (Impella 5.0, or Impella 5.5; i.e., Impella 5+) (Abiomed Inc., Danvers, MA, USA) have gained increasing levels of attendance as valuable tools of mechanical circulatory support (MCS). Patients undergoing heart transplantation (HTX) often need temporary MCS in the perioperative course, either as a preoperative bridge or occasionally in the early post-transplant period. Here we present our experience using Impella 5+ support for patients designated to undergo HTX, describe technical aspects of implantation and removal, and further analyze factors influencing the overall patient outcome. Significant factors are discussed in front of the background of contemporary international literature, and current scientific questions are highlighted.",book:{id:"11236",title:"Heart Transplantation - New Insights in Therapeutic Strategies",coverURL:"https://cdn.intechopen.com/books/images_new/11236.jpg"},signatures:"Yukiharu Sugimura, Sebastian Bauer, Moritz Benjamin Immohr, Arash Mehdiani, Hug Aubin, Ralf Westenfeld, Udo Boeken, Artur Lichtenberg and Payam Akhyari"},{id:"80721",title:"Gene Therapy for Cardiac Transplantation",slug:"gene-therapy-for-cardiac-transplantation",totalDownloads:66,totalDimensionsCites:0,doi:"10.5772/intechopen.102865",abstract:"Gene therapy is an advanced treatment approach that alters the genetic composition of cells to confer therapeutic protein or RNA expression to the target organ. It has been successfully introduced into clinical practice for the treatment of various diseases. Cardiac transplantation stands to benefit from applications of gene therapy to prevent the onset of post-transplantation complications, such as primary graft dysfunction, cardiac allograft vasculopathy, and rejection. Additionally, gene therapy can be used to minimize or potentially eliminate the need for immunosuppression post-transplantation. Several animal models and delivery strategies have been developed over the years with the goal of achieving robust gene expression in the heart. However, a method for doing this has yet to be successfully translated into clinical practice. The recent advances in ex vivo perfusion for organ preservation provide potential ways to overcome several barriers to achieving gene therapy for cardiac transplantation into clinical practice. Optimizing the selection of the gene-carrying vector for gene delivery and selection of the therapeutic gene to be conferred is also crucial for being able to implement gene therapy in cardiac transplantation. Here, we discuss the history and current state of research on gene therapy for cardiac transplantation.",book:{id:"11236",title:"Heart Transplantation - New Insights in Therapeutic Strategies",coverURL:"https://cdn.intechopen.com/books/images_new/11236.jpg"},signatures:"Michelle Mendiola Pla, Yuting Chiang, Jun-Neng Roan and Dawn E. 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He completed a one-year Post-Doctoral Fellowship awarded by the DFAIT (Foreign Affairs and International Trade Canada) at the Institute of Biomedical Engineering of the University of New Brunswick (Canada) in 2010. Currently, he is Professor in the Faculty of Electrical Engineering (UFU). He has authored and co-authored more than 200 peer-reviewed publications in Biomedical Engineering. He has been a researcher of The National Council for Scientific and Technological Development (CNPq-Brazil) since 2009. He has served as an ad-hoc consultant for CNPq, CAPES (Coordination for the Improvement of Higher Education Personnel), FINEP (Brazilian Innovation Agency), and other funding bodies on several occasions. He was the Secretary of the Brazilian Society of Biomedical Engineering (SBEB) from 2015 to 2016, President of SBEB (2017-2018) and Vice-President of SBEB (2019-2020). 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Radiotherapy and Nuclear Medicine Technology has always been my aspiration and my life. As years passed I accumulated a tremendous amount of skills and knowledge in Radiotherapy and Nuclear Medicine, Conventional Radiology, Radiation Protection, Bioinformatics Technology, PACS, Image processing, clinically and lecturing that will enable me to provide a valuable service to the community as a Researcher and Consultant in this field. My method of translating this into day to day in clinical practice is non-exhaustible and my habit of exchanging knowledge and expertise with others in those fields is the code and secret of success.",institutionString:null,institution:{name:"Majmaah University",country:{name:"Saudi Arabia"}}},{id:"313277",title:"Dr.",name:"Bartłomiej",middleName:null,surname:"Płaczek",slug:"bartlomiej-placzek",fullName:"Bartłomiej Płaczek",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/313277/images/system/313277.jpg",biography:"Bartłomiej Płaczek, MSc (2002), Ph.D. (2005), Habilitation (2016), is a professor at the University of Silesia, Institute of Computer Science, Poland, and an expert from the National Centre for Research and Development. His research interests include sensor networks, smart sensors, intelligent systems, and image processing with applications in healthcare and medicine. He is the author or co-author of more than seventy papers in peer-reviewed journals and conferences as well as the co-author of several books. He serves as a reviewer for many scientific journals, international conferences, and research foundations. Since 2010, Dr. Placzek has been a reviewer of grants and projects (including EU projects) in the field of information technologies.",institutionString:"University of Silesia",institution:{name:"University of Silesia",country:{name:"Poland"}}},{id:"35000",title:"Prof.",name:"Ulrich H.P",middleName:"H.P.",surname:"Fischer",slug:"ulrich-h.p-fischer",fullName:"Ulrich H.P Fischer",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/35000/images/3052_n.jpg",biography:"Academic and Professional Background\nUlrich H. P. has Diploma and PhD degrees in Physics from the Free University Berlin, Germany. He has been working on research positions in the Heinrich-Hertz-Institute in Germany. Several international research projects has been performed with European partners from France, Netherlands, Norway and the UK. He is currently Professor of Communications Systems at the Harz University of Applied Sciences, Germany.\n\nPublications and Publishing\nHe has edited one book, a special interest book about ‘Optoelectronic Packaging’ (VDE, Berlin, Germany), and has published over 100 papers and is owner of several international patents for WDM over POF key elements.\n\nKey Research and Consulting Interests\nUlrich’s research activity has always been related to Spectroscopy and Optical Communications Technology. Specific current interests include the validation of complex instruments, and the application of VR technology to the development and testing of measurement systems. He has been reviewer for several publications of the Optical Society of America\\'s including Photonics Technology Letters and Applied Optics.\n\nPersonal Interests\nThese include motor cycling in a very relaxed manner and performing martial arts.",institutionString:null,institution:{name:"Charité",country:{name:"Germany"}}},{id:"341622",title:"Ph.D.",name:"Eduardo",middleName:null,surname:"Rojas Alvarez",slug:"eduardo-rojas-alvarez",fullName:"Eduardo Rojas Alvarez",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/341622/images/15892_n.jpg",biography:null,institutionString:null,institution:{name:"University of Cuenca",country:{name:"Ecuador"}}},{id:"215610",title:"Prof.",name:"Muhammad",middleName:null,surname:"Sarfraz",slug:"muhammad-sarfraz",fullName:"Muhammad Sarfraz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/215610/images/system/215610.jpeg",biography:"Muhammad Sarfraz is a professor in the Department of Information Science, Kuwait University, Kuwait. His research interests include optimization, computer graphics, computer vision, image processing, machine learning, pattern recognition, soft computing, data science, and intelligent systems. Prof. Sarfraz has been a keynote/invited speaker at various platforms around the globe. He has advised/supervised more than 110 students for their MSc and Ph.D. theses. He has published more than 400 publications as books, journal articles, and conference papers. He has authored and/or edited around seventy books. Prof. Sarfraz is a member of various professional societies. He is a chair and member of international advisory committees and organizing committees of numerous international conferences. He is also an editor and editor in chief for various international journals.",institutionString:"Kuwait University",institution:{name:"Kuwait University",country:{name:"Kuwait"}}},{id:"32650",title:"Prof.",name:"Lukas",middleName:"Willem",surname:"Snyman",slug:"lukas-snyman",fullName:"Lukas Snyman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/32650/images/4136_n.jpg",biography:"Lukas Willem Snyman received his basic education at primary and high schools in South Africa, Eastern Cape. He enrolled at today's Nelson Metropolitan University and graduated from this university with a BSc in Physics and Mathematics, B.Sc Honors in Physics, MSc in Semiconductor Physics, and a Ph.D. in Semiconductor Physics in 1987. After his studies, he chose an academic career and devoted his energy to the teaching of physics to first, second, and third-year students. After positions as a lecturer at the University of Port Elizabeth, he accepted a position as Associate Professor at the University of Pretoria, South Africa.\r\n\r\nIn 1992, he motivates the concept of 'television and computer-based education” as means to reach large student numbers with only the best of teaching expertise and publishes an article on the concept in the SA Journal of Higher Education of 1993 (and later in 2003). The University of Pretoria subsequently approved a series of test projects on the concept with outreach to Mamelodi and Eerste Rust in 1993. In 1994, the University established a 'Unit for Telematic Education ' as a support section for multiple faculties at the University of Pretoria. In subsequent years, the concept of 'telematic education” subsequently becomes well established in academic circles in South Africa, grew in popularity, and is adopted by many universities and colleges throughout South Africa as a medium of enhancing education and training, as a method to reaching out to far out communities, and as a means to enhance study from the home environment.\r\n\r\nProfessor Snyman in subsequent years pursued research in semiconductor physics, semiconductor devices, microelectronics, and optoelectronics.\r\n\r\nIn 2000 he joined the TUT as a full professor. Here served for a period as head of the Department of Electronic Engineering. Here he makes contributions to solar energy development, microwave and optoelectronic device development, silicon photonics, as well as contributions to new mobile telecommunication systems and network planning in SA.\r\n\r\nCurrently, he teaches electronics and telecommunications at the TUT to audiences ranging from first-year students to Ph.D. level.\r\n\r\nFor his research in the field of 'Silicon Photonics” since 1990, he has published (as author and co-author) about thirty internationally reviewed articles in scientific journals, contributed to more than forty international conferences, about 25 South African provisional patents (as inventor and co-inventor), 8 PCT international patent applications until now. Of these, two USA patents applications, two European Patents, two Korean patents, and ten SA patents have been granted. A further 4 USA patents, 5 European patents, 3 Korean patents, 3 Chinese patents, and 3 Japanese patents are currently under consideration.\r\n\r\nRecently he has also published an extensive scholarly chapter in an internet open access book on 'Integrating Microphotonic Systems and MOEMS into standard Silicon CMOS Integrated circuitry”.\r\n\r\nFurthermore, Professor Snyman recently steered a new initiative at the TUT by introducing a 'Laboratory for Innovative Electronic Systems ' at the Department of Electrical Engineering. The model of this laboratory or center is to primarily combine outputs as achieved by high-level research with lower-level system development and entrepreneurship in a technical university environment. Students are allocated to projects at different levels with PhDs and Master students allocated to the generation of new knowledge and new technologies, while students at the diploma and Baccalaureus level are allocated to electronic systems development with a direct and a near application for application in industry or the commercial and public sectors in South Africa.\r\n\r\nProfessor Snyman received the WIRSAM Award of 1983 and the WIRSAM Award in 1985 in South Africa for best research papers by a young scientist at two international conferences on electron microscopy in South Africa. He subsequently received the SA Microelectronics Award for the best dissertation emanating from studies executed at a South African university in the field of Physics and Microelectronics in South Africa in 1987. In October of 2011, Professor Snyman received the prestigious Institutional Award for 'Innovator of the Year” for 2010 at the Tshwane University of Technology, South Africa. This award was based on the number of patents recognized and granted by local and international institutions as well as for his contributions concerning innovation at the TUT.",institutionString:null,institution:{name:"University of South Africa",country:{name:"South Africa"}}},{id:"317279",title:"Mr.",name:"Ali",middleName:"Usama",surname:"Syed",slug:"ali-syed",fullName:"Ali Syed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/317279/images/16024_n.png",biography:"A creative, talented, and innovative young professional who is dedicated, well organized, and capable research fellow with two years of experience in graduate-level research, published in engineering journals and book, with related expertise in Bio-robotics, equally passionate about the aesthetics of the mechanical and electronic system, obtained expertise in the use of MS Office, MATLAB, SolidWorks, LabVIEW, Proteus, Fusion 360, having a grasp on python, C++ and assembly language, possess proven ability in acquiring research grants, previous appointments with social and educational societies with experience in administration, current affiliations with IEEE and Web of Science, a confident presenter at conferences and teacher in classrooms, able to explain complex information to audiences of all levels.",institutionString:null,institution:{name:"Air University",country:{name:"Pakistan"}}},{id:"75526",title:"Ph.D.",name:"Zihni Onur",middleName:null,surname:"Uygun",slug:"zihni-onur-uygun",fullName:"Zihni Onur Uygun",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/75526/images/12_n.jpg",biography:"My undergraduate education and my Master of Science educations at Ege University and at Çanakkale Onsekiz Mart University have given me a firm foundation in Biochemistry, Analytical Chemistry, Biosensors, Bioelectronics, Physical Chemistry and Medicine. After obtaining my degree as a MSc in analytical chemistry, I started working as a research assistant in Ege University Medical Faculty in 2014. In parallel, I enrolled to the MSc program at the Department of Medical Biochemistry at Ege University to gain deeper knowledge on medical and biochemical sciences as well as clinical chemistry in 2014. In my PhD I deeply researched on biosensors and bioelectronics and finished in 2020. Now I have eleven SCI-Expanded Index published papers, 6 international book chapters, referee assignments for different SCIE journals, one international patent pending, several international awards, projects and bursaries. In parallel to my research assistant position at Ege University Medical Faculty, Department of Medical Biochemistry, in April 2016, I also founded a Start-Up Company (Denosens Biotechnology LTD) by the support of The Scientific and Technological Research Council of Turkey. Currently, I am also working as a CEO in Denosens Biotechnology. The main purposes of the company, which carries out R&D as a research center, are to develop new generation biosensors and sensors for both point-of-care diagnostics; such as glucose, lactate, cholesterol and cancer biomarker detections. My specific experimental and instrumental skills are Biochemistry, Biosensor, Analytical Chemistry, Electrochemistry, Mobile phone based point-of-care diagnostic device, POCTs and Patient interface designs, HPLC, Tandem Mass Spectrometry, Spectrophotometry, ELISA.",institutionString:null,institution:{name:"Ege University",country:{name:"Turkey"}}},{id:"246502",title:"Dr.",name:"Jaya T.",middleName:"T",surname:"Varkey",slug:"jaya-t.-varkey",fullName:"Jaya T. Varkey",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/246502/images/11160_n.jpg",biography:"Jaya T. Varkey, PhD, graduated with a degree in Chemistry from Cochin University of Science and Technology, Kerala, India. She obtained a PhD in Chemistry from the School of Chemical Sciences, Mahatma Gandhi University, Kerala, India, and completed a post-doctoral fellowship at the University of Minnesota, USA. She is a research guide at Mahatma Gandhi University and Associate Professor in Chemistry, St. Teresa’s College, Kochi, Kerala, India.\nDr. Varkey received a National Young Scientist award from the Indian Science Congress (1995), a UGC Research award (2016–2018), an Indian National Science Academy (INSA) Visiting Scientist award (2018–2019), and a Best Innovative Faculty award from the All India Association for Christian Higher Education (AIACHE) (2019). She Hashas received the Sr. Mary Cecil prize for best research paper three times. She was also awarded a start-up to develop a tea bag water filter. \nDr. Varkey has published two international books and twenty-seven international journal publications. She is an editorial board member for five international journals.",institutionString:"St. Teresa’s College",institution:null},{id:"250668",title:"Dr.",name:"Ali",middleName:null,surname:"Nabipour Chakoli",slug:"ali-nabipour-chakoli",fullName:"Ali Nabipour Chakoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/250668/images/system/250668.jpg",biography:"Academic Qualification:\r\n•\tPhD in Materials Physics and Chemistry, From: Sep. 2006, to: Sep. 2010, School of Materials Science and Engineering, Harbin Institute of Technology, Thesis: Structure and Shape Memory Effect of Functionalized MWCNTs/poly (L-lactide-co-ε-caprolactone) Nanocomposites. Supervisor: Prof. Wei Cai,\r\n•\tM.Sc in Applied Physics, From: 1996, to: 1998, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Determination of Boron in Micro alloy Steels with solid state nuclear track detectors by neutron induced auto radiography, Supervisors: Dr. M. Hosseini Ashrafi and Dr. A. Hosseini.\r\n•\tB.Sc. in Applied Physics, From: 1991, to: 1996, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Design of shielding for Am-Be neutron sources for In Vivo neutron activation analysis, Supervisor: Dr. M. Hosseini Ashrafi.\r\n\r\nResearch Experiences:\r\n1.\tNanomaterials, Carbon Nanotubes, Graphene: Synthesis, Functionalization and Characterization,\r\n2.\tMWCNTs/Polymer Composites: Fabrication and Characterization, \r\n3.\tShape Memory Polymers, Biodegradable Polymers, ORC, Collagen,\r\n4.\tMaterials Analysis and Characterizations: TEM, SEM, XPS, FT-IR, Raman, DSC, DMA, TGA, XRD, GPC, Fluoroscopy, \r\n5.\tInteraction of Radiation with Mater, Nuclear Safety and Security, NDT(RT),\r\n6.\tRadiation Detectors, Calibration (SSDL),\r\n7.\tCompleted IAEA e-learning Courses:\r\nNuclear Security (15 Modules),\r\nNuclear Safety:\r\nTSA 2: Regulatory Protection in Occupational Exposure,\r\nTips & Tricks: Radiation Protection in Radiography,\r\nSafety and Quality in Radiotherapy,\r\nCourse on Sealed Radioactive Sources,\r\nCourse on Fundamentals of Environmental Remediation,\r\nCourse on Planning for Environmental Remediation,\r\nKnowledge Management Orientation Course,\r\nFood Irradiation - Technology, Applications and Good Practices,\r\nEmployment:\r\nFrom 2010 to now: Academic staff, Nuclear Science and Technology Research Institute, Kargar Shomali, Tehran, Iran, P.O. Box: 14395-836.\r\nFrom 1997 to 2006: Expert of Materials Analysis and Characterization. Research Center of Agriculture and Medicine. Rajaeeshahr, Karaj, Iran, P. O. Box: 31585-498.",institutionString:"Atomic Energy Organization of Iran",institution:{name:"Atomic Energy Organization of Iran",country:{name:"Iran"}}},{id:"248279",title:"Dr.",name:"Monika",middleName:"Elzbieta",surname:"Machoy",slug:"monika-machoy",fullName:"Monika Machoy",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/248279/images/system/248279.jpeg",biography:"Monika Elżbieta Machoy, MD, graduated with distinction from the Faculty of Medicine and Dentistry at the Pomeranian Medical University in 2009, defended her PhD thesis with summa cum laude in 2016 and is currently employed as a researcher at the Department of Orthodontics of the Pomeranian Medical University. She expanded her professional knowledge during a one-year scholarship program at the Ernst Moritz Arndt University in Greifswald, Germany and during a three-year internship at the Technical University in Dresden, Germany. She has been a speaker at numerous orthodontic conferences, among others, American Association of Orthodontics, European Orthodontic Symposium and numerous conferences of the Polish Orthodontic Society. She conducts research focusing on the effect of orthodontic treatment on dental and periodontal tissues and the causes of pain in orthodontic patients.",institutionString:"Pomeranian Medical University",institution:{name:"Pomeranian Medical University",country:{name:"Poland"}}},{id:"252743",title:"Prof.",name:"Aswini",middleName:"Kumar",surname:"Kar",slug:"aswini-kar",fullName:"Aswini Kar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252743/images/10381_n.jpg",biography:"uploaded in cv",institutionString:null,institution:{name:"KIIT University",country:{name:"India"}}},{id:"204256",title:"Dr.",name:"Anil",middleName:"Kumar",surname:"Kumar Sahu",slug:"anil-kumar-sahu",fullName:"Anil Kumar Sahu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204256/images/14201_n.jpg",biography:"I have nearly 11 years of research and teaching experience. I have done my master degree from University Institute of Pharmacy, Pt. Ravi Shankar Shukla University, Raipur, Chhattisgarh India. I have published 16 review and research articles in international and national journals and published 4 chapters in IntechOpen, the world’s leading publisher of Open access books. I have presented many papers at national and international conferences. I have received research award from Indian Drug Manufacturers Association in year 2015. My research interest extends from novel lymphatic drug delivery systems, oral delivery system for herbal bioactive to formulation optimization.",institutionString:null,institution:{name:"Chhattisgarh Swami Vivekanand Technical University",country:{name:"India"}}},{id:"253468",title:"Dr.",name:"Mariusz",middleName:null,surname:"Marzec",slug:"mariusz-marzec",fullName:"Mariusz Marzec",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/253468/images/system/253468.png",biography:"An assistant professor at Department of Biomedical Computer Systems, at Institute of Computer Science, Silesian University in Katowice. Scientific interests: computer analysis and processing of images, biomedical images, databases and programming languages. He is an author and co-author of scientific publications covering analysis and processing of biomedical images and development of database systems.",institutionString:"University of Silesia",institution:null},{id:"212432",title:"Prof.",name:"Hadi",middleName:null,surname:"Mohammadi",slug:"hadi-mohammadi",fullName:"Hadi Mohammadi",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/212432/images/system/212432.jpeg",biography:"Dr. Hadi Mohammadi is a biomedical engineer with hands-on experience in the design and development of many engineering structures and medical devices through various projects that he has been involved in over the past twenty years. Dr. Mohammadi received his BSc. and MSc. degrees in Mechanical Engineering from Sharif University of Technology, Tehran, Iran, and his PhD. degree in Biomedical Engineering (biomaterials) from the University of Western Ontario. He was a postdoctoral trainee for almost four years at University of Calgary and Harvard Medical School. He is an industry innovator having created the technology to produce lifelike synthetic platforms that can be used for the simulation of almost all cardiovascular reconstructive surgeries. He’s been heavily involved in the design and development of cardiovascular devices and technology for the past 10 years. He is currently an Assistant Professor with the University of British Colombia, Canada.",institutionString:"University of British Columbia",institution:{name:"University of British Columbia",country:{name:"Canada"}}},{id:"254463",title:"Prof.",name:"Haisheng",middleName:null,surname:"Yang",slug:"haisheng-yang",fullName:"Haisheng Yang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/254463/images/system/254463.jpeg",biography:"Haisheng Yang, Ph.D., Professor and Director of the Department of Biomedical Engineering, College of Life Science and Bioengineering, Beijing University of Technology. He received his Ph.D. degree in Mechanics/Biomechanics from Harbin Institute of Technology (jointly with University of California, Berkeley). Afterwards, he worked as a Postdoctoral Research Associate in the Purdue Musculoskeletal Biology and Mechanics Lab at the Department of Basic Medical Sciences, Purdue University, USA. He also conducted research in the Research Centre of Shriners Hospitals for Children-Canada at McGill University, Canada. Dr. Yang has over 10 years research experience in orthopaedic biomechanics and mechanobiology of bone adaptation and regeneration. He earned an award from Beijing Overseas Talents Aggregation program in 2017 and serves as Beijing Distinguished Professor.",institutionString:"Beijing University of Technology",institution:null},{id:"255757",title:"Dr.",name:"Igor",middleName:"Victorovich",surname:"Lakhno",slug:"igor-lakhno",fullName:"Igor Lakhno",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255757/images/system/255757.jpg",biography:"Lakhno Igor Victorovich was born in 1971 in Kharkiv (Ukraine). \nMD – 1994, Kharkiv National Medical Univesity.\nOb&Gyn; – 1997, master courses in Kharkiv Medical Academy of Postgraduate Education.\nPhD – 1999, Kharkiv National Medical Univesity.\nDSc – 2019, PL Shupik National Academy of Postgraduate Education \nLakhno Igor has been graduated from an international training courses on reproductive medicine and family planning held in Debrecen University (Hungary) in 1997. Since 1998 Lakhno Igor has worked as an associate professor of the department of obstetrics and gynecology of VN Karazin National University and an associate professor of the perinatology, obstetrics and gynecology department of Kharkiv Medical Academy of Postgraduate Education. Since June 2019 he’s a professor of the department of obstetrics and gynecology of VN Karazin National University and a professor of the perinatology, obstetrics and gynecology department of Kharkiv Medical Academy of Postgraduate Education . He’s an author of about 200 printed works and there are 17 of them in Scopus or Web of Science databases. Lakhno Igor is a rewiever of Journal of Obstetrics and Gynaecology (Taylor and Francis), Informatics in Medicine Unlocked (Elsevier), The Journal of Obstetrics and Gynecology Research (Wiley), Endocrine, Metabolic & Immune Disorders-Drug Targets (Bentham Open), The Open Biomedical Engineering Journal (Bentham Open), etc. He’s defended a dissertation for DSc degree \\'Pre-eclampsia: prediction, prevention and treatment”. Lakhno Igor has participated as a speaker in several international conferences and congresses (International Conference on Biological Oscillations April 10th-14th 2016, Lancaster, UK, The 9th conference of the European Study Group on Cardiovascular Oscillations). His main scientific interests: obstetrics, women’s health, fetal medicine, cardiovascular medicine.",institutionString:"V.N. Karazin Kharkiv National University",institution:{name:"Kharkiv Medical Academy of Postgraduate Education",country:{name:"Ukraine"}}},{id:"89721",title:"Dr.",name:"Mehmet",middleName:"Cuneyt",surname:"Ozmen",slug:"mehmet-ozmen",fullName:"Mehmet Ozmen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/89721/images/7289_n.jpg",biography:null,institutionString:null,institution:{name:"Gazi University",country:{name:"Turkey"}}},{id:"243698",title:"M.D.",name:"Xiaogang",middleName:null,surname:"Wang",slug:"xiaogang-wang",fullName:"Xiaogang Wang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/243698/images/system/243698.png",biography:"Dr. Xiaogang Wang, a faculty member of Shanxi Eye Hospital specializing in the treatment of cataract and retinal disease and a tutor for postgraduate students of Shanxi Medical University, worked in the COOL Lab as an international visiting scholar under the supervision of Dr. David Huang and Yali Jia from October 2012 through November 2013. Dr. Wang earned an MD from Shanxi Medical University and a Ph.D. from Shanghai Jiao Tong University. Dr. Wang was awarded two research project grants focused on multimodal optical coherence tomography imaging and deep learning in cataract and retinal disease, from the National Natural Science Foundation of China. He has published around 30 peer-reviewed journal papers and four book chapters and co-edited one book.",institutionString:"Shanxi Eye Hospital",institution:{name:"Shanxi Eye Hospital",country:{name:"China"}}},{id:"242893",title:"Ph.D. Student",name:"Joaquim",middleName:null,surname:"De Moura",slug:"joaquim-de-moura",fullName:"Joaquim De Moura",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/242893/images/7133_n.jpg",biography:"Joaquim de Moura received his degree in Computer Engineering in 2014 from the University of A Coruña (Spain). In 2016, he received his M.Sc degree in Computer Engineering from the same university. He is currently pursuing his Ph.D degree in Computer Science in a collaborative project between ophthalmology centers in Galicia and the University of A Coruña. His research interests include computer vision, machine learning algorithms and analysis and medical imaging processing of various kinds.",institutionString:null,institution:{name:"University of A Coruña",country:{name:"Spain"}}},{id:"267434",title:"Dr.",name:"Rohit",middleName:null,surname:"Raja",slug:"rohit-raja",fullName:"Rohit Raja",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRZkkQAG/Profile_Picture_2022-05-09T12:55:18.jpg",biography:null,institutionString:null,institution:null},{id:"294334",title:"B.Sc.",name:"Marc",middleName:null,surname:"Bruggeman",slug:"marc-bruggeman",fullName:"Marc Bruggeman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/294334/images/8242_n.jpg",biography:"Chemical engineer graduate, with a passion for material science and specific interest in polymers - their near infinite applications intrigue me. \n\nI plan to continue my scientific career in the field of polymeric biomaterials as I am fascinated by intelligent, bioactive and biomimetic materials for use in both consumer and medical applications.",institutionString:null,institution:null},{id:"244950",title:"Dr.",name:"Salvatore",middleName:null,surname:"Di Lauro",slug:"salvatore-di-lauro",fullName:"Salvatore Di Lauro",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0030O00002bSF1HQAW/ProfilePicture%202021-12-20%2014%3A54%3A14.482",biography:"Name:\n\tSALVATORE DI LAURO\nAddress:\n\tHospital Clínico Universitario Valladolid\nAvda Ramón y Cajal 3\n47005, Valladolid\nSpain\nPhone number: \nFax\nE-mail:\n\t+34 983420000 ext 292\n+34 983420084\nsadilauro@live.it\nDate and place of Birth:\nID Number\nMedical Licence \nLanguages\t09-05-1985. Villaricca (Italy)\n\nY1281863H\n474707061\nItalian (native language)\nSpanish (read, written, spoken)\nEnglish (read, written, spoken)\nPortuguese (read, spoken)\nFrench (read)\n\t\t\nCurrent position (title and company)\tDate (Year)\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. Private practise.\t2017-today\n\n2019-today\n\t\n\t\nEducation (High school, university and postgraduate training > 3 months)\tDate (Year)\nDegree in Medicine and Surgery. University of Neaples 'Federico II”\nResident in Opthalmology. Hospital Clinico Universitario Valladolid\nMaster in Vitreo-Retina. IOBA. University of Valladolid\nFellow of the European Board of Ophthalmology. Paris\nMaster in Research in Ophthalmology. University of Valladolid\t2003-2009\n2012-2016\n2016-2017\n2016\n2012-2013\n\t\nEmployments (company and positions)\tDate (Year)\nResident in Ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl.\nFellow in Vitreo-Retina. IOBA. University of Valladolid\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. \n\t2012-2016\n2016-2017\n2017-today\n\n2019-Today\n\n\n\t\nClinical Research Experience (tasks and role)\tDate (Year)\nAssociated investigator\n\n' FIS PI20/00740: DESARROLLO DE UNA CALCULADORA DE RIESGO DE\nAPARICION DE RETINOPATIA DIABETICA BASADA EN TECNICAS DE IMAGEN MULTIMODAL EN PACIENTES DIABETICOS TIPO 1. Grant by: Ministerio de Ciencia e Innovacion \n\n' (BIO/VA23/14) Estudio clínico multicéntrico y prospectivo para validar dos\nbiomarcadores ubicados en los genes p53 y MDM2 en la predicción de los resultados funcionales de la cirugía del desprendimiento de retina regmatógeno. Grant by: Gerencia Regional de Salud de la Junta de Castilla y León.\n' Estudio multicéntrico, aleatorizado, con enmascaramiento doble, en 2 grupos\nparalelos y de 52 semanas de duración para comparar la eficacia, seguridad e inmunogenicidad de SOK583A1 respecto a Eylea® en pacientes con degeneración macular neovascular asociada a la edad' (CSOK583A12301; N.EUDRA: 2019-004838-41; FASE III). Grant by Hexal AG\n\n' Estudio de fase III, aleatorizado, doble ciego, con grupos paralelos, multicéntrico para comparar la eficacia y la seguridad de QL1205 frente a Lucentis® en pacientes con degeneración macular neovascular asociada a la edad. (EUDRACT: 2018-004486-13). Grant by Qilu Pharmaceutical Co\n\n' Estudio NEUTON: Ensayo clinico en fase IV para evaluar la eficacia de aflibercept en pacientes Naive con Edema MacUlar secundario a Oclusion de Vena CenTral de la Retina (OVCR) en regimen de tratamientO iNdividualizado Treat and Extend (TAE)”, (2014-000975-21). Grant by Fundacion Retinaplus\n\n' Evaluación de la seguridad y bioactividad de anillos de tensión capsular en conejo. Proyecto Procusens. Grant by AJL, S.A.\n\n'Estudio epidemiológico, prospectivo, multicéntrico y abierto\\npara valorar la frecuencia de la conjuntivitis adenovírica diagnosticada mediante el test AdenoPlus®\\nTest en pacientes enfermos de conjuntivitis aguda”\\n. National, multicenter study. Grant by: NICOX.\n\nEuropean multicentric trial: 'Evaluation of clinical outcomes following the use of Systane Hydration in patients with dry eye”. Study Phase 4. Grant by: Alcon Labs'\n\nVLPs Injection and Activation in a Rabbit Model of Uveal Melanoma. Grant by Aura Bioscience\n\nUpdating and characterization of a rabbit model of uveal melanoma. Grant by Aura Bioscience\n\nEnsayo clínico en fase IV para evaluar las variantes genéticas de la vía del VEGF como biomarcadores de eficacia del tratamiento con aflibercept en pacientes con degeneración macular asociada a la edad (DMAE) neovascular. Estudio BIOIMAGE. IMO-AFLI-2013-01\n\nEstudio In-Eye:Ensayo clínico en fase IV, abierto, aleatorizado, de 2 brazos,\nmulticçentrico y de 12 meses de duración, para evaluar la eficacia y seguridad de un régimen de PRN flexible individualizado de 'esperar y extender' versus un régimen PRN según criterios de estabilización mediante evaluaciones mensuales de inyecciones intravítreas de ranibizumab 0,5 mg en pacientes naive con neovascularización coriodea secunaria a la degeneración macular relacionada con la edad. CP: CRFB002AES03T\n\nTREND: Estudio Fase IIIb multicéntrico, randomizado, de 12 meses de\nseguimiento con evaluador de la agudeza visual enmascarado, para evaluar la eficacia y la seguridad de ranibizumab 0.5mg en un régimen de tratar y extender comparado con un régimen mensual, en pacientes con degeneración macular neovascular asociada a la edad. CP: CRFB002A2411 Código Eudra CT:\n2013-002626-23\n\n\n\nPublications\t\n\n2021\n\n\n\n\n2015\n\n\n\n\n2021\n\n\n\n\n\n2021\n\n\n\n\n2015\n\n\n\n\n2015\n\n\n2014\n\n\n\n\n2015-16\n\n\n\n2015\n\n\n2014\n\n\n2014\n\n\n\n\n2014\n\n\n\n\n\n\n\n2014\n\nJose Carlos Pastor; Jimena Rojas; Salvador Pastor-Idoate; Salvatore Di Lauro; Lucia Gonzalez-Buendia; Santiago Delgado-Tirado. Proliferative vitreoretinopathy: A new concept of disease pathogenesis and practical\nconsequences. Progress in Retinal and Eye Research. 51, pp. 125 - 155. 03/2016. DOI: 10.1016/j.preteyeres.2015.07.005\n\n\nLabrador-Velandia S; Alonso-Alonso ML; Di Lauro S; García-Gutierrez MT; Srivastava GK; Pastor JC; Fernandez-Bueno I. Mesenchymal stem cells provide paracrine neuroprotective resources that delay degeneration of co-cultured organotypic neuroretinal cultures.Experimental Eye Research. 185, 17/05/2019. DOI: 10.1016/j.exer.2019.05.011\n\nSalvatore Di Lauro; Maria Teresa Garcia Gutierrez; Ivan Fernandez Bueno. Quantification of pigment epithelium-derived factor (PEDF) in an ex vivo coculture of retinal pigment epithelium cells and neuroretina.\nJournal of Allbiosolution. 2019. ISSN 2605-3535\n\nSonia Labrador Velandia; Salvatore Di Lauro; Alonso-Alonso ML; Tabera Bartolomé S; Srivastava GK; Pastor JC; Fernandez-Bueno I. Biocompatibility of intravitreal injection of human mesenchymal stem cells in immunocompetent rabbits. Graefe's archive for clinical and experimental ophthalmology. 256 - 1, pp. 125 - 134. 01/2018. DOI: 10.1007/s00417-017-3842-3\n\n\nSalvatore Di Lauro, David Rodriguez-Crespo, Manuel J Gayoso, Maria T Garcia-Gutierrez, J Carlos Pastor, Girish K Srivastava, Ivan Fernandez-Bueno. A novel coculture model of porcine central neuroretina explants and retinal pigment epithelium cells. Molecular Vision. 2016 - 22, pp. 243 - 253. 01/2016.\n\nSalvatore Di Lauro. Classifications for Proliferative Vitreoretinopathy ({PVR}): An Analysis of Their Use in Publications over the Last 15 Years. Journal of Ophthalmology. 2016, pp. 1 - 6. 01/2016. DOI: 10.1155/2016/7807596\n\nSalvatore Di Lauro; Rosa Maria Coco; Rosa Maria Sanabria; Enrique Rodriguez de la Rua; Jose Carlos Pastor. Loss of Visual Acuity after Successful Surgery for Macula-On Rhegmatogenous Retinal Detachment in a Prospective Multicentre Study. Journal of Ophthalmology. 2015:821864, 2015. DOI: 10.1155/2015/821864\n\nIvan Fernandez-Bueno; Salvatore Di Lauro; Ivan Alvarez; Jose Carlos Lopez; Maria Teresa Garcia-Gutierrez; Itziar Fernandez; Eva Larra; Jose Carlos Pastor. Safety and Biocompatibility of a New High-Density Polyethylene-Based\nSpherical Integrated Porous Orbital Implant: An Experimental Study in Rabbits. Journal of Ophthalmology. 2015:904096, 2015. DOI: 10.1155/2015/904096\n\nPastor JC; Pastor-Idoate S; Rodríguez-Hernandez I; Rojas J; Fernandez I; Gonzalez-Buendia L; Di Lauro S; Gonzalez-Sarmiento R. Genetics of PVR and RD. Ophthalmologica. 232 - Suppl 1, pp. 28 - 29. 2014\n\nRodriguez-Crespo D; Di Lauro S; Singh AK; Garcia-Gutierrez MT; Garrosa M; Pastor JC; Fernandez-Bueno I; Srivastava GK. Triple-layered mixed co-culture model of RPE cells with neuroretina for evaluating the neuroprotective effects of adipose-MSCs. Cell Tissue Res. 358 - 3, pp. 705 - 716. 2014.\nDOI: 10.1007/s00441-014-1987-5\n\nCarlo De Werra; Salvatore Condurro; Salvatore Tramontano; Mario Perone; Ivana Donzelli; Salvatore Di Lauro; Massimo Di Giuseppe; Rosa Di Micco; Annalisa Pascariello; Antonio Pastore; Giorgio Diamantis; Giuseppe Galloro. Hydatid disease of the liver: thirty years of surgical experience.Chirurgia italiana. 59 - 5, pp. 611 - 636.\n(Italia): 2007. ISSN 0009-4773\n\nChapters in books\n\t\n' Salvador Pastor Idoate; Salvatore Di Lauro; Jose Carlos Pastor Jimeno. PVR: Pathogenesis, Histopathology and Classification. Proliferative Vitreoretinopathy with Small Gauge Vitrectomy. Springer, 2018. ISBN 978-3-319-78445-8\nDOI: 10.1007/978-3-319-78446-5_2. \n\n' Salvatore Di Lauro; Maria Isabel Lopez Galvez. Quistes vítreos en una mujer joven. Problemas diagnósticos en patología retinocoroidea. Sociedad Española de Retina-Vitreo. 2018.\n\n' Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor Jimeno. iOCT in PVR management. OCT Applications in Opthalmology. pp. 1 - 8. INTECH, 2018. DOI: 10.5772/intechopen.78774.\n\n' Rosa Coco Martin; Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor. amponadores, manipuladores y tinciones en la cirugía del traumatismo ocular.Trauma Ocular. Ponencia de la SEO 2018..\n\n' LOPEZ GALVEZ; DI LAURO; CRESPO. OCT angiografia y complicaciones retinianas de la diabetes. PONENCIA SEO 2021, CAPITULO 20. (España): 2021.\n\n' Múltiples desprendimientos neurosensoriales bilaterales en paciente joven. Enfermedades Degenerativas De Retina Y Coroides. SERV 04/2016. \n' González-Buendía L; Di Lauro S; Pastor-Idoate S; Pastor Jimeno JC. Vitreorretinopatía proliferante (VRP) e inflamación: LA INFLAMACIÓN in «INMUNOMODULADORES Y ANTIINFLAMATORIOS: MÁS ALLÁ DE LOS CORTICOIDES. 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This includes, but is not limited to: single-neuron modeling, sensory processing, motor control, memory, and synaptic plasticity, attention, identification, categorization, discrimination, learning, development, axonal patterning, guidance, neural architecture, behaviors, and dynamics of networks, cognition and the neuroscientific basis of consciousness. Particularly interesting are models of various types of more compound functions and abilities, various and more general fundamental principles (e.g., regarding architecture, organization, learning, development, etc.) found at various spatial and temporal levels.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/23.jpg",keywords:"Single-Neuron Modeling, Sensory Processing, Motor Control, Memory and Synaptic Pasticity, Attention, Identification, Categorization, Discrimination, Learning, Development, Axonal Patterning and Guidance, Neural Architecture, Behaviours and Dynamics of Networks, Cognition and the Neuroscientific Basis of Consciousness"},{id:"24",title:"Computer Vision",scope:"The scope of this topic is to disseminate the recent advances in the rapidly growing field of computer vision from both the theoretical and practical points of view. Novel computational algorithms for image analysis, scene understanding, biometrics, deep learning and their software or hardware implementations for natural and medical images, robotics, VR/AR, applications are some research directions relevant to this topic.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/24.jpg",keywords:"Image Analysis, Scene Understanding, Biometrics, Deep Learning, Software Implementation, Hardware Implementation, Natural Images, Medical Images, Robotics, VR/AR"},{id:"25",title:"Evolutionary Computation",scope:"Evolutionary computing is a paradigm that has grown dramatically in recent years. This group of bio-inspired metaheuristics solves multiple optimization problems by applying the metaphor of natural selection. It so far has solved problems such as resource allocation, routing, schedule planning, and engineering design. Moreover, in the field of machine learning, evolutionary computation has carved out a significant niche both in the generation of learning models and in the automatic design and optimization of hyperparameters in deep learning models. This collection aims to include quality volumes on various topics related to evolutionary algorithms and, alternatively, other metaheuristics of interest inspired by nature. For example, some of the issues of interest could be the following: Advances in evolutionary computation (Genetic algorithms, Genetic programming, Bio-inspired metaheuristics, Hybrid metaheuristics, Parallel ECs); Applications of evolutionary algorithms (Machine learning and Data Mining with EAs, Search-Based Software Engineering, Scheduling, and Planning Applications, Smart Transport Applications, Applications to Games, Image Analysis, Signal Processing and Pattern Recognition, Applications to Sustainability).",coverUrl:"https://cdn.intechopen.com/series_topics/covers/25.jpg",keywords:"Genetic Algorithms, Genetic Programming, Evolutionary Programming, Evolution Strategies, Hybrid Algorithms, Bioinspired Metaheuristics, Ant Colony Optimization, Evolutionary Learning, Hyperparameter Optimization"},{id:"26",title:"Machine Learning and Data Mining",scope:"The scope of machine learning and data mining is immense and is growing every day. It has become a massive part of our daily lives, making predictions based on experience, making this a fascinating area that solves problems that otherwise would not be possible or easy to solve. This topic aims to encompass algorithms that learn from experience (supervised and unsupervised), improve their performance over time and enable machines to make data-driven decisions. It is not limited to any particular applications, but contributions are encouraged from all disciplines.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/26.jpg",keywords:"Intelligent Systems, Machine Learning, Data Science, Data Mining, Artificial Intelligence"},{id:"27",title:"Multi-Agent Systems",scope:"Multi-agent systems are recognised as a state of the art field in Artificial Intelligence studies, which is popular due to the usefulness in facilitation capabilities to handle real-world problem-solving in a distributed fashion. The area covers many techniques that offer solutions to emerging problems in robotics and enterprise-level software systems. Collaborative intelligence is highly and effectively achieved with multi-agent systems. Areas of application include swarms of robots, flocks of UAVs, collaborative software management. Given the level of technological enhancements, the popularity of machine learning in use has opened a new chapter in multi-agent studies alongside the practical challenges and long-lasting collaboration issues in the field. It has increased the urgency and the need for further studies in this field. We welcome chapters presenting research on the many applications of multi-agent studies including, but not limited to, the following key areas: machine learning for multi-agent systems; modeling swarms robots and flocks of UAVs with multi-agent systems; decision science and multi-agent systems; software engineering for and with multi-agent systems; tools and technologies of multi-agent systems.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/27.jpg",keywords:"Collaborative Intelligence, Learning, Distributed Control System, Swarm Robotics, Decision Science, Software Engineering"}],annualVolumeBook:{},thematicCollection:[],selectedSeries:null,selectedSubseries:null},seriesLanding:{item:{id:"25",title:"Environmental Sciences",doi:"10.5772/intechopen.100362",issn:"2754-6713",scope:"\r\n\tScientists have long researched to understand the environment and man’s place in it. The search for this knowledge grows in importance as rapid increases in population and economic development intensify humans’ stresses on ecosystems. Fortunately, rapid increases in multiple scientific areas are advancing our understanding of environmental sciences. Breakthroughs in computing, molecular biology, ecology, and sustainability science are enhancing our ability to utilize environmental sciences to address real-world problems.
\r\n\tThe four topics of this book series - Pollution; Environmental Resilience and Management; Ecosystems and Biodiversity; and Water Science - will address important areas of advancement in the environmental sciences. They will represent an excellent initial grouping of published works on these critical topics.
\r\n\tPollution is caused by a wide variety of human activities and occurs in diverse forms, for example biological, chemical, et cetera. In recent years, significant efforts have been made to ensure that the environment is clean, that rigorous rules are implemented, and old laws are updated to reduce the risks towards humans and ecosystems. However, rapid industrialization and the need for more cultivable sources or habitable lands, for an increasing population, as well as fewer alternatives for waste disposal, make the pollution control tasks more challenging. Therefore, this topic will focus on assessing and managing environmental pollution. It will cover various subjects, including risk assessment due to the pollution of ecosystems, transport and fate of pollutants, restoration or remediation of polluted matrices, and efforts towards sustainable solutions to minimize environmental pollution.
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",annualVolume:11967,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/39.jpg",editor:{id:"137040",title:"Prof.",name:"Jose",middleName:null,surname:"Navarro-Pedreño",fullName:"Jose Navarro-Pedreño",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRAXrQAO/Profile_Picture_2022-03-09T15:50:19.jpg",institutionString:"Miguel Hernández University of Elche, Spain",institution:null},editorTwo:null,editorThree:null,editorialBoard:[{id:"177015",title:"Prof.",name:"Elke Jurandy",middleName:null,surname:"Bran Nogueira Cardoso",fullName:"Elke Jurandy Bran Nogueira Cardoso",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRGxzQAG/Profile_Picture_2022-03-25T08:32:33.jpg",institutionString:"Universidade de São Paulo, Brazil",institution:null},{id:"211260",title:"Dr.",name:"Sandra",middleName:null,surname:"Ricart",fullName:"Sandra Ricart",profilePictureURL:"https://mts.intechopen.com/storage/users/211260/images/system/211260.jpeg",institutionString:null,institution:{name:"University of Alicante",institutionURL:null,country:{name:"Spain"}}}]},{id:"40",title:"Ecosystems and Biodiversity",keywords:"Ecosystems, Biodiversity, Fauna, Taxonomy, Invasive species, Destruction of habitats, Overexploitation of natural resources, Pollution, Global warming, Conservation of natural spaces, Bioremediation",scope:"