Clinical classification of pancreatitis (OF: Organ failure).
\\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:"8282",leadTitle:null,fullTitle:"Polar Seismology - Advances and Impact",title:"Polar Seismology",subtitle:"Advances and Impact",reviewType:"peer-reviewed",abstract:"Seismology in polar regions (Arctic and Antarctic) allows us to study the static condition and high-latitude dynamics of the Earth. This book covers the recent developments in seismology in polar regions; observations and networks; international collaboration; heterogeneous structure and dynamics of the lithosphere; deep Earth's interiors observed from high latitudes; characteristics of seismicity and seismic wave propagation; and global tectonics in terms of Earth's history, including the interdisciplinary studies on the interaction between Earth's spheres. Since the International Polar Year (IPY) in 2007/2008 was the most exciting campaign launched within contemporary polar studies, this book observes recent seismological achievements by the IPY, specifically focusing on the seismic signals near the surface associated with cryosphere dynamics and evolution. Topics on cryoseismology, such as glacial earthquake activities, are viewed in terms of global warming. Moreover, observational experiments and long-term monitoring under the extreme conditions in the polar environment are also discussed.",isbn:"978-1-78923-569-2",printIsbn:"978-1-78923-568-5",pdfIsbn:"978-1-83881-839-5",doi:"10.5772/intechopen.78404",price:119,priceEur:129,priceUsd:155,slug:"polar-seismology-advances-and-impact",numberOfPages:116,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"69e0f0e64b988f29d30532c2618705b2",bookSignature:"Masaki Kanao",publishedDate:"October 10th 2018",coverURL:"https://cdn.intechopen.com/books/images_new/8282.jpg",numberOfDownloads:10243,numberOfWosCitations:0,numberOfCrossrefCitations:2,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:3,numberOfDimensionsCitationsByBook:0,hasAltmetrics:0,numberOfTotalCitations:5,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"May 8th 2018",dateEndSecondStepPublish:"May 29th 2018",dateEndThirdStepPublish:"July 28th 2018",dateEndFourthStepPublish:"October 16th 2018",dateEndFifthStepPublish:"December 15th 2018",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6,7",editedByType:"Authored by",kuFlag:!1,featuredMarkup:null,editors:[{id:"51959",title:"Dr.",name:"Masaki",middleName:null,surname:"Kanao",slug:"masaki-kanao",fullName:"Masaki Kanao",profilePictureURL:"https://mts.intechopen.com/storage/users/51959/images/system/51959.jpg",biography:"Dr. Masaki Kanao obtained his Ph.D. from Kyoto University. He is currently working at the National Institute of Polar Research in Tokyo. He is chiefly interested in the Earth\\'s structure and evolution from geoscience studies. Polar regions, both in Arctic and Antarctic, have been investigated by geophysical investigations particularly by passive and active seismic sources. He is also interested in the present Earth’s dynamics and tectonics of the continental lithosphere. The Antarctic continent, as a member of the past Gondwana super-continent, has been the main target to reveal lithospheric evolution history. Recently, inter-disciplinary studies in terms of glacial earthquakes, cryoseismic events in Greenland and Antarctica have been focusing on involving environmental changes associated with global warming. These investigations in polar regions have been contributing to the development of all kinds of global Earth sciences.",institutionString:"National Institute of Polar Research",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"17",totalChapterViews:"0",totalEditedBooks:"6",institution:{name:"National Institute of Polar Research",institutionURL:null,country:{name:"Japan"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"654",title:"Seismology",slug:"seismology"}],chapters:[{id:"61734",title:"Introduction: Progress of Seismology in Polar Region",doi:"10.5772/intechopen.78550",slug:"introduction-progress-of-seismology-in-polar-region",totalDownloads:1104,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Several kinds of seismological investigations have been conducted in the polar region, which include the areas of both the Arctic and the Antarctic regions, in various depth ranges from the surface layers to the deep interiors of the Earth. The polar region has an advantage in order to seek inside the physical condition of the Earth as a “window” viewed from high latitudes. In this chapter, historical issues and progress of seismic research and its observations in the polar region are demonstrated during the last half-century from the era of the International Geophysical Year (IGY 1957–1958).",signatures:"Masaki Kanao",downloadPdfUrl:"/chapter/pdf-download/61734",previewPdfUrl:"/chapter/pdf-preview/61734",authors:[{id:"51959",title:"Dr.",name:"Masaki",surname:"Kanao",slug:"masaki-kanao",fullName:"Masaki Kanao"}],corrections:null},{id:"61742",title:"An Overview of Seismological Projects during the International Polar Year",doi:"10.5772/intechopen.78551",slug:"an-overview-of-seismological-projects-during-the-international-polar-year",totalDownloads:902,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"During the International Polar Year (IPY 2007–2008), many seismological studies had been carried out in bipolar regions; particularly, advances and progresses in observation networks were established for the purpose of detecting precise data regarding geophysical studies. In this chapter, major seismological projects during the IPY, in both the Antarctic and the Arctic regions, are introduced with their fruitful scientific results and involved logistic operations.",signatures:"Masaki Kanao",downloadPdfUrl:"/chapter/pdf-download/61742",previewPdfUrl:"/chapter/pdf-preview/61742",authors:[{id:"51959",title:"Dr.",name:"Masaki",surname:"Kanao",slug:"masaki-kanao",fullName:"Masaki Kanao"}],corrections:null},{id:"61730",title:"Seismological Studies on the Deep Interiors of the Earth Viewed from the Polar Region",doi:"10.5772/intechopen.78552",slug:"seismological-studies-on-the-deep-interiors-of-the-earth-viewed-from-the-polar-region",totalDownloads:1012,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Seismological studies on the deep interiors of the Earth (depth range from the mantle to the inner core) viewed from the polar region have an advantage to promote global geosciences, such as for revealing the heterogeneous structural variations along the latitude from the poles to the equators. In this chapter, major seismological investigations, which had been held during the IPY, particularly newly identified founding of deep interiors of the Earth, will be introduced.",signatures:"Masaki Kanao",downloadPdfUrl:"/chapter/pdf-download/61730",previewPdfUrl:"/chapter/pdf-preview/61730",authors:[{id:"51959",title:"Dr.",name:"Masaki",surname:"Kanao",slug:"masaki-kanao",fullName:"Masaki Kanao"}],corrections:null},{id:"61763",title:"Structural Studies on the Earth’s Crust, Plates, and the Ice Sheet in the Polar Region",doi:"10.5772/intechopen.78553",slug:"structural-studies-on-the-earth-s-crust-plates-and-the-ice-sheet-in-the-polar-region",totalDownloads:941,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"During the International Polar Year (IPY 2007–2008), a number of seismological studies regarding the structure and dynamics of the Earth’s surface layers, the static inner structure of the crystalline crust and lithosphere involving Earth’s history, earthquake occurrence mechanism, inner deformation of the plates, crustal movement relating to deglaciation, seismic isotropy, and the other topics of the ice sheet overlying the solid earth were conducted. In this chapter, recent seismological results as for the structural study of the crust, plates, and ice sheet in bipolar regions are overviewed.",signatures:"Masaki Kanao",downloadPdfUrl:"/chapter/pdf-download/61763",previewPdfUrl:"/chapter/pdf-preview/61763",authors:[{id:"51959",title:"Dr.",name:"Masaki",surname:"Kanao",slug:"masaki-kanao",fullName:"Masaki Kanao"}],corrections:null},{id:"62218",title:"Studies on Seismicity in the Polar Region",doi:"10.5772/intechopen.78554",slug:"studies-on-seismicity-in-the-polar-region",totalDownloads:1029,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"During the International Polar Year (IPY 2007–2008), several seismological research studies have been conducted as a part of geophysical observations in bipolar regions. In this chapter, recent studies involving seismicity in bipolar regions are introduced on the basis of compiled data from the International Seismological Centre (ISC). The relationship between the present seismicity and the heterogeneous structure of the crust and upper mantle is discussed, together with a review of geoscientific achievements in terms of the tectonic history of the Earth.",signatures:"Masaki Kanao",downloadPdfUrl:"/chapter/pdf-download/62218",previewPdfUrl:"/chapter/pdf-preview/62218",authors:[{id:"51959",title:"Dr.",name:"Masaki",surname:"Kanao",slug:"masaki-kanao",fullName:"Masaki Kanao"}],corrections:null},{id:"61739",title:"A Decade of Advances in Cryoseismology",doi:"10.5772/intechopen.78555",slug:"a-decade-of-advances-in-cryoseismology",totalDownloads:1039,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Among the various kinds of seismological features observed in the polar region, the characteristics of the wavelets and involved seismicity related to cryosphere dynamics are introduced to mark a decade of advances in “cryoseismology.” Classifying the seismic waves originating from the cryosphere dynamics and understanding the generating mechanism as well as the temporal-spatial distributions in seismicity should be important in order to realize surface environmental variations associated with global warming in the polar region.",signatures:"Masaki Kanao",downloadPdfUrl:"/chapter/pdf-download/61739",previewPdfUrl:"/chapter/pdf-preview/61739",authors:[{id:"51959",title:"Dr.",name:"Masaki",surname:"Kanao",slug:"masaki-kanao",fullName:"Masaki Kanao"}],corrections:null},{id:"61769",title:"Seismic Detection in the Inland Plateau of East Antarctica",doi:"10.5772/intechopen.78556",slug:"seismic-detection-in-the-inland-plateau-of-east-antarctica",totalDownloads:1009,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Several international programs to deploy broadband seismic stations over the Antarctic continent were conducted during the International Polar Year (IPY 2007–2008). Antarctica’s Gamburtsev Province (AGAP)/Gamburtsev Mountains Seismic Experiment (GAMSEIS), which was a part of AGAP and the Polar Earth Observing Network (POLENET), contributed greatly to establish a geophysical network in Antarctica. AGAP/GAMSEIS was an internationally coordinated deployment of more than 30 seismographs over the crest of the Gamburtsev Mountains and the areas of Dome-A, -C, and -F. The project provided a detailed information on the crust and mantle structures and, key constraints on the origin of the Gamburtsev Mountains and more broadly on the structure and evolution of the East Antarctic craton and subglacial environment. With the data from GAMSEIS and POLENET, the local and regional seismic signals associated with ice movements, oceanic loadings, and local meteorological variations were recorded in addition to a number of teleseismic events around the globe. The characteristic seismic signals of local origin in the inland plateau of the ice sheet were demonstrated with a capability to investigate subglacial environment, particularly at the marginal areas of the East Antarctic continent.",signatures:"Masaki Kanao",downloadPdfUrl:"/chapter/pdf-download/61769",previewPdfUrl:"/chapter/pdf-preview/61769",authors:[{id:"51959",title:"Dr.",name:"Masaki",surname:"Kanao",slug:"masaki-kanao",fullName:"Masaki Kanao"}],corrections:null},{id:"61767",title:"A New Trend in Cryoseismology: A Proxy for Detecting the Polar Surface Environment",doi:"10.5772/intechopen.78557",slug:"a-new-trend-in-cryoseismology-a-proxy-for-detecting-the-polar-surface-environment",totalDownloads:1193,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:0,abstract:"“Cryoseismology” is a new branch of interdisciplinary science, which treats glacier-related seismic events and their dynamics associated with the variable phenomenon of the Earth’s surface. Cryoseismology is considered to be one of the proxies for detecting environmental variations, particularly in the polar region, which contains the majority volume of the cryosphere of the planet. Various kinds of cryoseismic signals recently reported are reviewed by classifying them into several categories on the basis of their occurrence locations and focal dynamics. Temporal-spatial variations in cryoseismic activities and their wave propagation characteristics could demonstrate a new image of cryodynamics, which have not yet been known well before but have a significant impact on the global environment and human activities.",signatures:"Masaki Kanao",downloadPdfUrl:"/chapter/pdf-download/61767",previewPdfUrl:"/chapter/pdf-preview/61767",authors:[{id:"51959",title:"Dr.",name:"Masaki",surname:"Kanao",slug:"masaki-kanao",fullName:"Masaki Kanao"}],corrections:null},{id:"61740",title:"Interactions among Multispheres of the Earth’s System and Polar Regions",doi:"10.5772/intechopen.78558",slug:"interactions-among-multispheres-of-the-earth-s-system-and-polar-regions",totalDownloads:1062,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Among the environmental variations in the surface layers of the Earth, global warming and those involving multisphere interactions in the polar region are reviewed with scientific research funding. By focusing on the wavelet phenomena with various generating sources within the Earth’s system, interdisciplinary research studies are conducted on the influences and responses to climate change in the polar region.",signatures:"Masaki Kanao",downloadPdfUrl:"/chapter/pdf-download/61740",previewPdfUrl:"/chapter/pdf-preview/61740",authors:[{id:"51959",title:"Dr.",name:"Masaki",surname:"Kanao",slug:"masaki-kanao",fullName:"Masaki Kanao"}],corrections:null},{id:"61741",title:"Summary: Global Seismology and the Polar Region",doi:"10.5772/intechopen.78559",slug:"summary-global-seismology-and-the-polar-region",totalDownloads:953,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"“Polar Seismology” has been developed since the International Geophysical Year (IGY 1957–1958) and contributed significantly to global seismology in particular through the big project of the International Polar Year (IPY 2007–2008). At present, in the first stage of the twenty-first century, “polar regions” play an important role to monitor and understand the drastic variations in the Earth’s system as well as to advance the inter-disciplinary studies of the interactions among multispheres within the system.",signatures:"Masaki Kanao",downloadPdfUrl:"/chapter/pdf-download/61741",previewPdfUrl:"/chapter/pdf-preview/61741",authors:[{id:"51959",title:"Dr.",name:"Masaki",surname:"Kanao",slug:"masaki-kanao",fullName:"Masaki Kanao"}],corrections:null}],productType:{id:"4",title:"Compact",chapterContentType:"chapter",authoredCaption:"Authored by"},subseries:null,tags:null},relatedBooks:[{type:"book",id:"892",title:"Seismic Waves",subtitle:"Research and Analysis",isOpenForSubmission:!1,hash:"77aca8357f09b77cf39eb669b711c862",slug:"seismic-waves-research-and-analysis",bookSignature:"Masaki Kanao",coverURL:"https://cdn.intechopen.com/books/images_new/892.jpg",editedByType:"Edited 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The incidence of AP is 20–35 cases per 100,000 inhabitants per year, with an overall mortality of 2–10%. In recent decades the incidence of AP has increased globally and is expected to increase even more. The most common cause is biliary lithiasis, which accounts for about 40–50%. The alcohol, predominantly in males, is the second most common cause, at over 30% and 10–25% the cause is unknown.
Most cases follow a mild, self-limiting course, but 10–20% of patients develop a severe form with systemic and local life-threatening complications of pancreatic and peripancreatic necrosis come about 20–40% of patient with severe AP and aggravate organ functions [2, 3, 4, 5, 6]. Infected necrotic tissue is defined as a gram positive of pancreatic or peripancreatic necrotic tissue obtained by means of fine-needle aspiration or from the first drainage procedure or operation, or the presence of gas in the fluid collection on contrast-enhanced computer tomography (CT). Suspected infected necrosis is defined as persistent sepsis or progressive clinical deterioration in the intensive care unit without documentation of infected necrosis. Failure of one or more organs occurs in 40% of these patients with pancreatic necrosis and on rare occasions it can also occur in cases without necrosis. Mortality amounts to 30% when infection of the pancreatic and/or peripancreatic necrosis is present [7].
The traditional approach to the treatment of necrotizing pancreatitis with secondary infection of necrotic tissue is open necrosectomy to remove the infected necrotic tissue. But this is associated with high rates of complications, death and pancreatic insufficiency. The studies show that death rates from open pancreatic necrosectomy are between 10–40% [8, 9, 10]. The management of AP has evolved greatly in recent years thanks to a better understanding of pathophysiology, the improvement of the therapeutic arsenal of intensive care units, nutritional support, conventional and interventional radiology techniques and surgical treatment. Recently, a randomized trial called “PANTER” very well designed study by the Dutch Pancreatitis Study Group, demonstrated the benefits of sequential treatment in cases of infected necrosis (“Step an approach”) compared to traditional open necrosectomy, showing less morbidity and lower costs [7]. The sequential treatment is an alternative to open necrosectomy, less invasive techniques, including percutaneous drainage, endoscopic (transgastric) drainage, and minimally invasive retroperitoneal necrosectomy. The importance of step up approach is that the first step is percutaneous or endoscopic drainage of the collection of infected fluid to mitigate sepsis and this step may postpone or even obviate surgical necrosectomy. If the drainage does not take to clinical recovery, the next step is minimally invasive retroperitoneal necrosectomy. With this approach, up to 35% of patients can be treated only with drainage, to avoid necrosectomy and to reduce the percentage of complications [7].
Before to describe the management of infected necrosis, we need to know the classification of acute pancreatitis [11, 12].
The severity of acute pancreatitis can be defined as mild, moderately severe, or severe according to the revised Atlanta classification (Table 1).
Mild acute pancreatitis: absence of organ failure or local and/or systemic complications.
Moderate acute pancreatitis: organ failure, and/or transient local or systemic complications that resolve within 48 hours maximum. Mortality in this group is less than 8%.
Severe acute pancreatitis: continued organic failure over 48 hours accompanied by local and/or systemic complications. Mortality in this group is 36–50%.
Potentially severe acute pancreatitis: organ failure or a warning sign at the beginning of its evolution (Table 2), and therefore requires closer monitoring, to anticipate the development of transitory, persistent organ failure or pancreatic infection. The need to detect and treat patients who are developing organ failure with invasive resuscitation measures as early as possible has been demonstrated with a strong degree of recommendation and a high level of evidence.
Mild acute pancreatitis | absence of OF or local and/or systemic complications |
Moderate acute pancreatitis | OF and/or transient local or systemic complications <48 hours |
Severe acute pancreatitis | OF and/or transient local or systemic complications >48 hours |
Potentially severe acute pancreatitis | OF or warning pancreatic sign (Table 2) |
Clinical classification of pancreatitis (OF: Organ failure).
Characteristics of patient | Analitics parameters | Radiological Features | Forecast scales |
---|---|---|---|
Age > 50 years | BUN >20 mg/dl | Pleural Effusion | APACHE II >2 |
BMI < 30 | Hematocrit >44% | Pancreatic collections or peritoneal free liquid. | Ranson-Glasgow >3 |
Deteriorate state of mind | Procalcitonin >0.5 ng/ml in the first 48 hours | ||
Comorbidity | Reactive C protein >150 mgl, or progressive elevation in 48 hours) | ||
Abdominal defense | Elevated Creatinine |
Warning pancreatic sign (BMI: Body mass index, BUN: Blood urea nitrogen).
There is another classification of AP severity that adds another step to the severity of these processes: Acute critical pancreatitis, in which persistent organ failure (OF) coexists with necrosis infection, described in 2012 by Petrov et al.
Classification according to radiological characteristics according to the Atlanta Classification:
Interstitial o edematous pancreatitis: the pancreas is enlargement due to inflammation or edema. The pancreatic parenchyma shows homogeneous enhancement, and the peripancreatic fat usually shows some inflammatory changes. Besides there may be some peripancreatic fluid. The clinical symptoms of interstitial o edematous pancreatitis usually resolve within the first week.
Necrotising pancreatitis: about 5–10% of patients develop necrosis of the pancreatic parenchyma, the peripancreatic tissue or both. Necrotising pancreatitis shows necrosis involving the pancreas and peripancreatic tissues and less commonly as necrosis of only the peripancreatic tissue or pancreatic parenchyma alone. The natural history of pancreatic and peripancreatic necrosis is variable, because it may remain solid or liquefy, remain sterile or become infected, persist or disappear over time. The presence of infection can be proved by extraluminal gas in the pancreatic and/or peripancreatic tissues or when percutaneous fine-needle aspiration is positive for bacteria and/or fungi on Gram.
Local complications of acute pancreatitis:
Acute peripancreatic liquid collection: presence of peripancreatic liquid in the context of edematous interstitial pancreatitis. It occurs in the first 4 weeks and is characterized by the appearance of homogeneous fluid adjacent to the pancreas and its fascial planes without the presence of a wall.
Pancreatic pseudocyst: well-defined collection with a wall formed without a solid component that occurs after 4 weeks of oedematous interstitial pancreatitis.
Acute necrotic collection: collection with a solid and liquid component that appears in the context of necrotizing pancreatitis and can affect the pancreas and surrounding tissues. It has no wall (Figure 1).
Encapsulated pancreatic necrosis (Walled-off necrosis): is an acute necrotic collection, mature, encapsulated with a well-defined inflammatory wall, and which appears 4 weeks after the onset of necrotic pancreatitis. It is heterogeneous and can affect peripancreatic tissues.
In the CT scan image we can see acute pancreatic collection without radiological signs of infection.
The most important consideration in treating local complications is to demonstrate the presence of infection.
Because the majority of patients with sterile pancreatic or peripancreatic necrosis can be treated conservatively, regardless of the size and extension of the collections.
Drainage in a sterile collection can produce iatrogenic infection, worsening the patient’s prognosis. Could only be an alternative in those patients with persistent symptoms such as abdominal pain, duodenal obstruction or jaundice [13, 14].
Necrosis infection usually occurs within 2–3 weeks of the onset of BP. Successive CT scans should be performed according to the evolution of the patient and not in a programmed way. Early onset is rare, and should be suspected if SIRS persists or recurs after 10 days-2 weeks [15]. Therefore, the suspicion of infection will be made according to the bad evolution of the patient: fever, increase of leukocytes, elevation of PCR and/or procalcitonin, sudden resurgence or worsening of FO. This clinical evolution can be given by sterile necrosis, and it is often a challenge to differentiate whether we are dealing with an infected necrosis or not. Given this scenario, CT has high sensitivity to detect signs of infection (gas in the collection only appears in 12–22% of infected cases (Figure 2). However the signs of infection are usually sufficient to diagnose a secondary infection of pancreatic or peripancreatic necrosis. In case of diagnostic uncertainty, a positive gram stain or culture of the necrotic collection, obtained by transabdominal fine needle aspiration, may be necessary. However, the disadvantage of fine needle aspiration in this scenario is the false negative rate of 25% [16].
CT scan image showing radiological signs of pancreatic necrosis due to the presence of gas in the acute necrotic collection.
We present the management of acute pancreatitis with signs of infected necrosis. For this we will describe each of the therapeutic options in the philosophy of step up approach (Algorithm 1).
The first step is the administration of broad- spectrum antibiotic therapy [16]. The germs most involved are
Recommended empirical therapy:
Meropenem: 1 gr. e.v. every 8 hours
Moxifloxacin: 400 mg e.v. every 24 hours
Once the final result of the cultivation is obtained, the anti-biotherapy will be adapted. A small proportion of patients can be managed with supportive care and antibiotics alone, without the need for additional invasive interventions [17].
Open surgery in the treatment of infected pancreatic necrosis has been replaced by the minimally invasive approach. The multi-centre randomized clinical trial PANTER [18] showed that step up approach treatment of necrotising pancreatitis reduces patient mortality, multiorgan failure, costs and late surgical complications. The step-up approach consists of percutaneous catheter drainage or endoscopic transluminal drainage, followed by minimally invasive necrosectomy only when clinically required, is the current standard treatment [19].
Secondary infection of pancreatic or peripancreatic necrosis can occur in the first 3 weeks after onset of disease, and long-term administration of antibiotics might lead to increased incidence of fungal infections and antibiotic resistance [15, 20]. The benefit of early drainage has been demonstrated, although its indication has to be established after confirmation of infection, otherwise we could be infecting a sterile collection. The ideal percutaneous drainage would be via the retroperitoneal route and on the left side, which would facilitate subsequent minimally invasive surgical access if necessary. Current evidence shows that 35% of patients treated with percutaneous drainage in this phase will not require additional surgical necrosectomy and that up to 50% in series where a progressive increase in the diameter of the drainage catheter is used [19]. Once the radiological drainage was carried out, the therapeutic sequence would be as follows:
if poor evolution persists after 48 hours and the patient’s conditions permit it, a new drainage with a larger diameter would be attempted.
if the poor clinical condition is maintained, despite the use of larger drains, surgical drainage should be carried out.
The current tendency is to be as non-invasive as possible. Several techniques have been described that will be developed in our service gradually, such as video assisted retroperitoneal access that presents significantly lower rates of abdominal complications than the most classic techniques. This technique uses radiological drainage as a guide to the collection, hence the importance of placing it on the left side as long as possible (Figure 3).
CT scan image showing left retroperitoneal collection with easy access for percutaneous drainage. And it will allow a retroperitoneal laparoscopic approach.
After 4 weeks, in addition to percutaneous radiological drainage in case of infection as mentioned above, endoscopic drainage could be evaluated. Generally, at this stage an inflammatory wall would already be formed consistent enough to withstand transgastic endoscopic drainage (walled-off necrosis).
The step-up approach can be done both surgically and endoscopically. The two different approaches have been compared with each other in two randomized trials. The first is the TENSION trial that concluded that the endoscopic step-up approach was not superior to the surgical step-up approach in reducing major complications or death but the rate of pancreatic fistulas and length of hospital stay were lower in the endoscopy group [21]. The second trial is MISER [22] randomizade controlled trial showed that an endoscopic transluminal approach for infected necrotizing pancreatitis, compared with minimally invasive surgery, significantly reduced major complications, lowered costs, and increased quality of life.
In short, the endoscopic staggered approach has become the approach of choice according to recent studies for the management of infected necrotizing pancreatitis [23, 24, 25, 26, 27]. However it could not be feasible in all patients. It depends on the anatomical location of the infected necrotic collections, availability of technique and experience of the center and trained personnel (Figure 4). The option of combined endoscopic transluminal and percutaneous catheter drainage, which is also known as dual-modality drainage, should not be overlooked in patients with large collections extending into the paracolic gutters or the pelvic region.
CT scan image showing infected acute necrotic collection of retrogastric location. We can see metallic stent drainage inside the collection.
Currently, the stents placed between gastric light and the infected collection are metallic (Figure 5). They were created in 2011 and replaced with plastic stents. These stents provide wider light that allows better drainage and facilitates transluminal necrosectomy. The best available evidence comes from a randomized trial that compared the efficacy of metal and plastic stents in the drainage of infected pancreatic necrosis. The study found no differences in the median number of procedures, readmissions, and length of hospital stay [28]. Although endoscopic treatment with metal stents was associated with higher procedure costs. In addition, adverse effects such as stent migration were observed. Therefore, the latest consensus guidelines recommend metal stents or double pigtail plastic stents for endoscopic transluminal drainage and removal after 4 weeks to minimize the risks of complications [28, 29].
Endoscopy image showing metallic stent that communicates the gastric camera and the acute necrotic collection.
Between 23–47% of patients will improve only with percutaneous or endoscopic drainage. But in those patients with persistent disease, surgery is the next step [18, 30, 31]. Objectives of surgical debridement are to control the source of infection and reduce the burden of necrosis, while minimizing the proinflammatory damage of the intervention itself on the weakened patient. The current trend is to be as non-invasive as possible. We will start with a videoassisted retroperitoneal approach and if it is not enough we will perform necrosectomy by open approach [32].
Several techniques have been described, such as video assisted retroperitoneal access that presents significantly lower rates of abdominal complications than the most classic techniques. This technique uses radiological drainage as a guide to the collection, hence the importance of placing it on the left side as long as possible. The tract formed by the anterior drainage is used to access the retroperitoneal space for intracavitary videoassisted necrosectomy (Figure 6). Traditional laparoscopic instruments are used under direct vision (Figures 7 and 8). We can leave well-positioned drains that allow washing. The process may be repeated if necessary to remove the infected pancreatic necrosis. It should be noted that the VARD approach is more effective in treating central to left parietocolic infected pancreatic necrosis. However, it will be more difficult to access the necrosis located to the right of the mesenteric vessels [32] (Figure 9).
CT scan image showing infected acute necrotic collection on the left flank. It allows a percutaneous drainage approach and subsequent laparoscopic retroperitoneal access.
Using left retroperitoneal percutaneous drainage as a guide, we can access it by minimally invasive approach. We observed laparoscopic trócar through which we introduced camera, vacuum cleaner and laparoscopic tweezers.
Image of CT scan that objective retroperitoneal necrotic collection with drainage inside placed by laparoscopic retroperitoneal access.
CT scan showing surgical drainage on the right flank by laparoscopic retroperitoneal access.
The concept is similar to endoscopic trasngastic drainage. It can be performed by open or laparoscopic approach. An anterior gastrostomy is required to access the posterior face of the stomach and then the infected cavity. It is especially useful in central collections that do not affect the flanks (Figure 10). It is advisable to leave a drain inside the cavity for washing. There are studies of small sample size that demonstrate the efficacy of the technique with low morbidity [33, 34, 35].
CT scan image showing collection near the gastric posterior wall that would allow a transgastic approach.
If these methods are unable to control the infectious condition, the patient’s deterioration, despite good drainage, including minimally invasive surgical drainage, would be indicated to the open surgical approach. The mortality of patients with infected necrosis is greater than 30%, as we have commented, the delay in surgery as much as possible will be more beneficial for the patient in terms of mortality and morbidity. Early debridement, and especially sterile necrosis, leads to a significant increase in mortality. Therefore, these techniques are reserved when everything else has not been enough [36, 37]. We have widely described open necrosectomy techniques. None of them has been shown to be clearly superior to the other due to the lack of randomized studies, but the ones that offer the best results are:
Open surgical necrosectomy with closed packing: described by A.L. Warshaw, with lower mortality rates than the other techniques (10%) and that would be indicated in limited necrosis.
Open surgical necrosectomy with closed postoperative lavage: in case of more extensive necrosis. The recommended wash would be 12–24 liters every 24 hours with potassium-free dialysis fluid.
Open surgical necrosectomy with open packing: it is the technique with the highest morbidity-mortality, but it would be indicated in cases with more extensive necrosis that exceed the colon.
Vacuum Assisted Closure therapy will be used as a temporary closure in cases where closure of the abdominal pare is impossible or in cases of abdominal compartment syndrome.
Current comparative studies, with the exception of randomized trials [18], should be interpreted with caution, given the severity of the often higher disease in patients undergoing open debridement. Open debridement is indicated in patients with a high necrosis load that is diffusely distributed throughout the abdomen and that do not respond to staggered handling [32].
RAMSON: Prognostic scale in acute pancreatitis (Table 3).
on admission | age > 55 yerars | age > 55 years |
white blood cell count>16.000 mm3 | blood glucose>10 mmol/l | |
blood glucose >200 mg % | LDH > 600 UI/l | |
LDH > 400 UI/l | AST > 100 UI/l | |
AST > 200 UI/l | serum urea>16 mmol/l | |
Arterial PaO2 < 60% | ||
serum Calcium<8 mg/dl | ||
serum albumin<3,2 mg/l | ||
white blood cell count>15.000 mm3 | ||
within 48 hours | hematocrit fall>10% | |
blood urea nitrogen rise >5 mg% | ||
Arterial PaO2 < 60 mmHg | ||
base deficit>4 mEq/l | ||
fluid sequestration >6 liters | ||
serum calcium<8 mg% |
Ramson and Glasgow prognostic scale.
GLASGOW: Prognostic scale in acute pancreatitis (Table 3).
Zero to do criteria met indicates mild pancreatitis; 3 or more criteria severe pancreatitis.
According to the number of criteria the rate of mortality is: 0–2 mortality >2%; 3–5 mortality 10–20%; 6–7 mortality 50–60%; > 7 mortality 70–90%.
Patients with diagnosis of acute necrotizing pancreatitis should be treated in centers with high experience by specialists in pancreatic surgery, endoscopists and radiologist experienced. It is essential the presence of a team of intensive doctors or anesthesiologists especially in the first weeks of evolution. Despite these measures the morbidity and mortality in these patients is still high, so we must try to reduce it with a correct management and applying the “step up approach”. The sequential treatment is an alternative to open necrosectomy, including percutaneous drainage, endoscopic (transgastric) drainage, and minimally invasive retroperitoneal necrosectomy. With this approach, up to 35% of patients can be treated only with drainage, to avoid necrosectomy and to reduce the percentage of complications.
Our thanks to the Biliopancreatic Surgery Unit that through effort and study have created a protocol for the management of severe pancreatitis. The team is made up of expert pancreatic surgeons, intensivist physicians, anesthesiologists, endoscopists with experience in echoendoscopy and radiologists specializing in the abdomen. Together we will continue to train for the good of our patients.
The authors declare no conflict of interest.
None
Algorithm 1. Management of acute pancreatitis with infected pancreatic necrosis. acute pancreatitis computer tomography organ failure body mass index blood urea nitrogen lactate dehydrogenase aaspartate ainotranferase blood pressure from oxygen video assited retroperitoneal debridement acute physiology and cronic health evaluation (Figure 11).
APACHE SCALE. Health care Financ rev. 1984 Nov; 1984(Suppl): 91–105.
Viroids are circular, highly structured, single-stranded RNA (ssRNA) phytopathogens. Although they do not code for any peptide, these enigmatic pathogens have evolved the capacity to replicate within cellular organella, the nucleus and chloroplast for
Citrus exocortis is a destructive disease infecting citrus species [9, 11]. The agent of this disease, citrus exocortis viroid [
Citrus exocortis could affect a various part of the tree including the rootstock (at bark and wood levels), scion, leaves, and fruits, thus causing different types of damages such as bark scaling and cracking, bumps, severe stunting, low fruit-bearing, the poor appearance of the canopy [21, 24, 25, 26, 27], and poor tree performance [28]. CEVd-infected trees in the orchard show typical symptoms. The most characteristic one is bark scaling on trifoliate orange rootstock, yellow stem blotch on trifoliate orange and its hybrids and Rangpur lime (
The major susceptible citrus rootstocks, which show exocortis bark scaling symptoms, are trifoliate orange and its hybrids, Palestine sweet lime (
The type and severity of symptoms induced by citrus exocortis disease depend not just on the selected rootstock as described above, but also on the amount of viroid present in the scion and the infection with other citrus viroids. High temperatures can also accelerate the development of symptoms [30]. The results of a long-term field trial carried out with clementine trees grafted on the trifoliate orange rootstock revealed that CEVd-induced effects might be both reduced or increased when CEVd-infected trees were exposed to mixed viroid infections. In other words, several interactions among viroids including CEVd have been revealed through comparative assays between symptoms developed on trees infected with CEVd alone or co-infected with other viroids. The most clear-cut interaction occurs between CEVd and Citrus viroid IV [
Numerous field trials have been conducted on different citrus species, varieties, and rootstocks under three different agroecosystems, to evaluate the effect of CEVd on vegetative growth and yield (Table 1). The first field trial has been conducted to assess the effect of CEVd infection on commune clementine trees grafted on Pomeroy trifoliate orange. CEVd-infected trees have been periodically monitored for a period of 12 years (from 1990 to 2002) for symptom expression, growth, and fruit yield. CEVd-infected trees showed a significant reduction of growth and yield, which became increasingly apparent over time with infection. Cumulative yield varied from 291,1 to 570,3 kg in 2001 for CEVd and the control, respectively. This equated to 50% cumulative yield lost. This yield attenuation was associated mainly with the loss of large fruit production. Indeed, it has been shown that CEVd reduced fruit production significantly for calibers 2 to 5. Cumulative weights were smaller than the control for caliber 0–1 and small calibers 6 and 7–8, with some significant difference [21]. The quality of fruits from CEVd-infected orange trees (Washington Navel) grafted on Carrizo citrange rootstock has been evaluated from 2004 to 2007. The results of this experiment showed that the quality of the fruit was not affected by CEVd infection [26].
Combination | Effect on | References | |||
---|---|---|---|---|---|
Scion | |||||
CEVd | |||||
Clementine | Orange Pomeroy trifoliate | NSE | [21] | ||
Oranger Washington Navel | Carrizo citrangec | NSE (Reduction of almost 17% and 27% for CEVd-129 and CEVd-117, respectively) | NSE (Low reduction of about 2% and 10% for CEVd-129 and CEVd-117, respectively) | [26] | |
Orange Maltaise demi sanguine | Soor orange ( | NSE | NSE | NSE (Reduction of almost 20%) | [46] |
Alemow | NSE | NSE | NSE | ||
Carrizo citrangec | NSE | NSE | NSE | ||
NSE | NSE (Reduction of almost 20%) | ||||
Cleopatra mandarin ( | NSE | NSE (Reduction of almost 25%) | NSE (Reduction of almost 20%) | ||
Swingle citrumelo (Citru)c | NSE | NSE | NSE | ||
Rangpur lime ( | NSE | NSE (Reduction of almost 28%) | NSE (Reduction of almost 20%) | ||
Trifoliate orangec | NSE | ||||
HSVd | |||||
Clementine | Orange Pomeroy trifoliatec | Little or no real impact | NSE | [21] | |
Orange Washington Navel | Carrizo citrangec | NSE (Reduction of almost 15% for CVd-IIc) | NSE (Reduction of almost 8% for CVd-IIb) | No effect | [26] |
Orange Maltaise demi sanguine | Soor orange ( | NSE | NSE | NSE (Reduction of almost 20%) | [46] |
Alemow | |||||
Carrizo citrangec | NSE | NSE | NSE | ||
NSE | NSE (Reduction of almost 20%) | ||||
Cleopatra mandarin ( | NSE | NSE | NSE (Reduction of almost 20%) | ||
Swingle citrumelo (Citru)c | NSE | NSE | |||
Rangpur lime ( | NSE | NSE | NSE (Reduction of almost 20%) | ||
Trifoliate orangec |
Results summary of the known field trials carried out in three citrus-growing countries of the Mediterranean area to evaluate the effect of CEVd and HSVd on vegetative growth and yield of different citrus scion and rootstock combinations.
Susceptible to citrus tristeza virus [
Susceptible to CTV stem-pitting and cachexia.
CTV tolerant.
A function of the used viroid isolates.
All citrus viroids are distributed primarily by the introduction and propagation of infected budwoods and subsequently by mechanical transmission, and CEVd is no exception [11]. Mechanical transmission of CEVd has been already reported. It took place on secateurs, tools, knives, and hedging equipment [9, 11, 27, 29] especially from lemon (
Cachexia is a destructive disease infecting citrus species [11]. The agent of this disease, hop stunt viroid [
Cachexia could affect a various part of the tree including the trunk, bark, twigs, branches, leaves, and fruits, thus causing different types of damages such as bark and trunk gumming with a rough and rugose appearance, bark-cracking, moderate and severe tree stunting, chlorosis, decline and death of severely affected trees, brown stipple spotting on the underside of the leaves, and the appearance of small pits on the wood [9, 21, 24]. Cachexia disease mainly affects some mandarins and their hybrids such as tangelos, and
As mentioned before, for CEVd, the type and severity of citrus cachexia symptoms depend also on the presence of other citrus viroids in the tree. The results of a long-term field trial carried out with clementine trees grafted on the trifoliate orange rootstock revealed that HSVd-induced effects might be both reduced or increased when HSVd-infected trees were exposed to mixed viroid infections. The most clear-cut interaction occurs between HSVd and CVd-IV. This interaction is manifested by a slight increase in fruit yield and reduction of scion circumferences [24].
The same field trials described before to evaluate the effect of CEVd on vegetative growth and yield (Table 1) were used for the same purpose for HSVd. Little or no effect in vegetative growth has been observed on commune clementine trees infected by HSVd as it has been determined by the measure of height and rootstock and scion circumferences [21]. Cumulative yield varied from 377,6 to 570,3 kg in 2001 for HSVd (CVd-IIc isolate) and the control, respectively. This equated to 34% cumulative yield lost [21]. The negative impact of HSVd infection on cumulative yield has been reported in another study carried out on Orange Maltaise demi sanguine grafted on Alemow (
As pointed out before, for CEVd, propagation of infected budwoods and mechanical inoculations with contaminating tools were reported as the principal causes for the omnipresence of multiple viroid species, including HSVd, among citrus orchards [34]. Mechanical transmission of HSVd has been already reported. Indeed, the results of a transmission assay carried out under greenhouse conditions revealed that all HSVd strains are mechanically transmitted from citron to healthy citron by a single slash with a knife blade [32]. As for CEVd, the potential involvement of gots in HSVd spread has been shown under controlled conditions [34]. Top working, a common practice in Mediterranean countries, seems to have largely contributed to HSVd spread in Mediterranean citrus orchards [9]. HSVd is not known to be seed-borne [47] in citrus or to have natural vectors [11, 48].
It is usually accepted that although the mechanisms through which viroids interact with their hosts are beginning to be dissected, the key triggering events and molecular mechanisms underlying viroid pathogenesis remain unclear [49, 50], and CEVd and HSVd are no exception. As demonstrated by various types of citrus pathogens [51, 52], further investigation of the molecular basis of viroid-host interactions is crucial to better understand the pathogenesis of viroids, and thus help to develop effective strategies to combat viroid diseases [50, 53]. Important changes occur in the chloroplast, cell wall, peroxidase, and symporter activities upon infection of Etrog citron with CEVd [54]. The CEVd-infected citron system has been subsequently used for studying the feedback regulation mechanism using transcriptomic analysis. The analysis of the woody host response to CEVd revealed the activation of basic defense and RNA-silencing mechanisms following CEVd infection. In other words, a large number of genes (about 1530) encoding key proteins involved in the RNA silencing pathway, and proteins related to basic defense responses are expressed following CEVd infection [53]. Furthermore, a recent study elucidates the role of phytohormone pathways, particularly those linked to ethylene, in disease development and ribosomal stress caused by CEVd infection by using tomato as an experimental host [55]. For HSVd, a small RNA-mediated gene silencing response has been highlighted upon the infection of lemon by HSVd. The large amounts of HSVd-small interfering RNA (siRNA) from both central and variant domains have been suggested to be involved in interference with host gene and symptom development [56].
Generally, biological assays based on indicator host plants expressing typical symptoms of infection and able to withstand higher levels of viroid replication played an essential role in both viroid detection and characterization [57]. CEVd and HSVd are viroid diseases present in citrus orchards around the world [11]. The biological diagnosis through indexing method is considered as an efficient tool to test the health status of a plant, regarding a disease by inoculation with the grafting of the budwood or any other infected tissue in indicator plants that allow viroid replication, symptoms expression [11, 58], and the enhancement of viroid concentration [59]. However, bioassays for CEVd and HSVd detection and identification may require a panel of indicator host plants [60]. Certain considerations need to be respected for the proper indexing of citrus viroids. These include the use of excellent plants, the work under warm temperatures, and the use of citron index plants grown one per container. As mentioned previously, citrus viroids are highly mechanically transmissible and tools must be disinfected to avoid their spread [9].
The citron test is a very sensitive and diagnostic index for determining the presence of CEVd [9]. However, indexing,
As to cachexia, Parson’s special mandarin budded on vigorous root-stock such as rough lemon or Volkamer lemon is reported as an excellent indicator for the disease [9, 65]. The biological indexing may take up to one year before symptoms are seen. The reaction of Parson’s Special mandarin may differ depending on HSVd isolates. In other words, some isolates are very mild reacting, whereas others are quite severe in their reaction to the indicator plant. Indeed, a mild strain reaction consists of just a slight browning at the bud union or cut back region of the Parson’s Special mandarin while a severe reaction consists of the appearance of gum in the wood that may extend via the entire plant [9]. Cuban Shaddock has been proved to be the best rootstock, compared to rough lemon or Volkamer lemon, for symptom expression on Clemeline 11–20 indicator plants for indexing cachexia. Furthermore, the application of 0,5% foliar urea sprays, alone or in combination with 20 ppm gibberellic acid showed to produce more intense expression of cachexia symptoms in the indicator Clemeline 11–20 than the unsprayed control [64].
Cross protection is a biological assay, in which the infection of a plant with a viroid strain ensures protection from infection with another strain of the same viroid. This bioassay can be used for indirect viroid biological indexing. It has been applied in the diagnosis of several viroids including CEVd and HSVd. Typically, the principle of this method is based on the infection of the plant with a mild strain of a viroid, followed by its inoculation with inoculum from a plant suspected to be infected with a severe strain of the same viroid. Positive indexing of the viroid is revealed by the non-expression of symptoms in the tested plants [60]. It has been shown in a cross-protection assay, performed with CEVd-129 as a “protecting” strain against the severe type strain of CEVd that a mild strain of CEVd could lead to apparent “protection” against challenge inoculation with the severe strain. However, it is important to highlight that variability has been shown in the induced protection effect. The latter varied from only a brief delay to almost total impairment of symptom expression. The level of protection depends on the length of the interval between the inoculations with the mild and severe strains [66].
Since viroids lack a protein capsid, serological techniques used routinely in plant viruses’ detection are not applicable [67]. Nucleic acid-based methods, including polyacrylamide gel electrophoresis (PAGE), hybridization (dot- and northern-blots and micro−/macroarrays), amplification (reverse transcription-polymerase chain reaction (RT-PCR) and reverse transcription loop-mediated isothermal amplification (RT-LAMP)) and sequencing (next-generation sequencing and Sanger sequencing), offer rapid cost-effective, and reliable diagnosis of viroids [60].
PAGE is considered as the first molecular technique used for the rapid (2–3 day period) identification of viroid infected plants. This technique continues to play a crucial role in the identification of new viroids since it is the only diagnostic method that is sequence-independent. PAGE analysis under denaturing conditions showed that many
Since the beginning of their use in the 1980s, dot blot hybridization and hybridization of tissue imprints began to replace PAGE for routine viroid detection. This is mainly because these methods allow the processing of a large number of samples [57]. A northern hybridization protocol, which relied on the analysis of preparations from bark tissues, was proved to be more sensitive than PAGE to detect CEVd and HSVd from field-grown plants of different citrus species and cultivars [70]. A citrus viroids-multiprobe composed of full-length clones of HSVd, CEVd, and two other citrus viroids has been constructed for the simultaneous detection of viroids associated with citrus trees. All the tested viroids were effectively detected with this multiprobe when tested by both northern hybridization and dot blot methods. It is important to highlight that this multiprobe does not allow the identification of the viroid type species resulting in a positive signal [71].
Due to the small size of viroids, numerous RT-PCR approaches can be applied for both their detection and subsequent characterization. In the case of CEVd and HSVd, numerous RT-PCR and real-time RT-PCR approaches have been developed and proved to allow the detection of CEVd and HSVd in both singleplex or multiplex assays [63, 72, 73, 74, 75, 76]. A list of some RT-PCR and related tests developed to detect CEVd and HSVd are presented in Table 2. Some of these tests allow also the discrimination between mild and severe CEVd strains and the identification of HSVd isolates associated with cachexia symptoms [77]. The multiplex one-step RT-PCR assay developed by Wang et al. [75] is considered a good tool streamlining the simultaneous detection of up to five citrus viroids, including CEVd and HSVd. This enables to reduce time and labor without affecting sensitivity and specificity. Indeed, serial dilution experiments showed that the singleplex RT-PCR sensitivity was similar to that of multiplex RT-PCR for all the tested viroids [75]. This type of assay could be used in high throughput screenings of viroids associated with citrus in field surveys, germplasm banks, nurseries, as well as in other viroid disease management programs [74]. Similarly, the multiplex RT-TaqMan PCR assay developed by Papayiannis [76] enables accurate discrimination between CEVd and HSVd with a diagnostic sensitivity and specificity of 100%. It is important to emphasize that in conventional RT-PCR tests, the overall sensitivity and specificity were lower and varied between 97 and 98% for HSVd, and 94 and 95% for CEVd. Therefore, this essay presented 1000-fold more analytical sensitivity [76]. The specificity of the tests described previously was confirmed by including healthy controls and/or plant tissue infected with other citrus graft transmissible virus and bacteria pathogens and non-targeted citrus viroids. Both singleplex and multiplex assays did not cross-react with any non-inoculated negative controls or other citrus pathogens [63, 74, 76]. To date, PCR-based approaches have been proven efficacy on viroid direct detection. However, false positives and negatives due to amplicon contamination and failure to generate cDNA of suitable size during reverse transcription, respectively, are not uncommon and therefore preclude the application of RT-PCR for large scale indexing [70].
Name of RT-PCR test | Sequence 5′-3′ | Tm (°C) | Genomic coordinates | Size of the expected product | References |
---|---|---|---|---|---|
Primer/Probe Name | |||||
RT-PCR | |||||
Singleplex | |||||
CEVd-R | GGGGATCCCTGAAGGACTT | 60 | 80-98a | 371 bp | [72, 85] |
CEVd-F | GGAAACCTGGAGGAAGTCG | 99-117a | |||
HSVd-F 27-mer VP-20 | CGCCCGGGGCAACTCTTCTCAGAATCC | 60 | 78–102 | 251 bp | [37, 73] |
HSVd-R 26-mer VP-19 | GCCCCGGGGCTCCTTTCTCAGGTAAG | 60–85 | |||
HSVd VP-98 | CTCCAGAGCACCGCGGCCCTC | DN | 120–140 | 140 bp | [37] |
HSVd VP-99 | CTGGGGAATTCTCGAGTTGCCGC | 1–23 | |||
Multiplex | |||||
CEVd-F194 | TTTCGCTGCTGGCTCCACA | 58 | 194–212 | 196 bp | [63] |
CEVd-R18 | ACCTCAAGAAAGATCCCGA | 371–18 | |||
HSVd-F1 | GGGGCAACTCTTCTCAGAATCC | 81–102 | 302 bp | ||
HSVd-R1 | GGGGCTCCTTTCTCAGGTAAGTC | 58–80 | |||
CEV-R | CCGGGGATCCCTGAAGGACTT | 58 | 78-98a | 371 bp | [75] |
CEV-F | GGAAACCTGGAGGAAGTCGAG | 99-119a | |||
HSVd-R | CCGGGGCTCCTTTCTCAGGTAAGT | 59-82b | 302 bp | ||
HSVd-F | GGCAACTCTTCTCAGAATCCAGC | 83-105b | |||
Real time-RT-PCR | |||||
Singleplex | |||||
CEVd −161 F | GTCCAGCGGAGAAACAGGAG | 60 | 181-200c | 105 bp | [74]* |
CEVd −258 R | AGAGAAGCTCCGGGCGA | 270-286c | |||
CEVd −187 P FAM | TCCTTCCTTTCGCTGCT | 212-228c | |||
HSVd-208 F | GAGACGCGACCGGTGG | 60 | 216-231d | 88 bp | |
HSVd-295 R | GCTCAAGAGAGGATCCGCG | 286-304d | |||
HSVd-226 P TET | TCACCTCTCGGTTCGTC | 234-250d | |||
Multiplex | |||||
CEVd-RTR_F | GTCGCCGCGGATCACT | 60 | 142–159 | 64 bp | [63] |
CEVd-RTR_R | CCAGCAGCGAAAGGAAGGA | 187–205 | |||
HSVd-RTR_F | GGAATTCTCGAGTTGCCGCA | 5–24 | 127 bp | ||
HSVd-RTR_R | CCGCGGCCCTCTCT | 118–131 | |||
CEVd-RTR_P | CCAGCGGAGAAACAG | 163–177 | — | ||
HSVd-RTR_P | CAACTCTTCTCAGAATCC | 85–102 | — | ||
CEVdF | GCGTCCAGCGGAGAAACA | 60 | 158–175e | 68 bp | [76] |
CEVdR | CAGCGACGATCGGATGTG | 226–208e | |||
CEVdTAQ | {FAM}-TCGTCTCCTTCCTTTCGCTGCTGG-{BHQ1} | 181–204e | |||
HSVdF | GCCTTCGAAACACCATCGA | 159–177f | 71 bp | ||
HSVdR | CACCGGTCGCGTCTCATC | 230–213f | |||
HSVdTAQ | {HEX}-CGTCCCTTCTTCTTTACCTTCTCCTGGCTC-{BHQ2} | 179–208f |
Primer sequences and their annealing temperature (Tm), primer/probe location, and expected size of PCR products for each primer pair when used to amplify CEVd and HSVd by RT-PCR and related tests (this is not a full or exclusive list).
The same primers have been also tested in multiplex Real time-RT-PCR test.
GenBank Accession no. NC-001464.
GenBank Accession no. NC-001351.
GenBank Accession no. CEVd-HQ284019.
GenBank Accession no. HSVd-KJ810553.
GenBank Accession no. U21126.
GenBank Accession no. GQ249348. R: antisense primer. F: sense primer.
Next-generation sequencing (NGS) technologies are currently becoming routinely applied in different fields of virus and viroids studies. These advanced technologies have therefore contributed to a revolution in both the detection and discovery of plant viruses and viroids [78, 79, 80, 81]. NGS has also provided an alternative method to identify viroids in the citrus cultivars. In other words, transcriptome sequencing has shown efficacy in citrus viroid diagnostics. Indeed, this method enabled the simultaneous identification of numerous viroids from various citrus samples, including CEVd and HSVd [82]. A deep sequencing approach, combined with bioinformatics analysis, is already being implemented for HSVd detection in
No naturally occurring durable resistance has been observed in most species, despite non-hosts for viroids exist. Therefore, the effective control methods for viroid diseases consist mainly of detection and eradication, and cultural controls [50].
Exocortis and cachexia are widespread diseases in the Mediterranean region. CEVd and HSVd have been reported in most Mediterranean countries and are among the most prevalent citrus viroids in the region [9]. The development of reliable diagnostic methods facilitated extensive surveys for CEVd and HSVd in different parts of the region. Both viroids were successively identified in many countries, including Morocco [89, 90, 91, 92], Cyprus [33], Spain [26], Egypt [43, 93], Italy [61, 94], Tunisia [46, 95], France [21], Syria [96], and Turkey [42].
In Morocco, exocortis and cachexia are among the major citrus viroid diseases [90, 91]. These diseases are prevalent in citrus orchards and can be found in all
Citrus viroids, including CEVd and HSVd, are distributed mainly by the introduction and propagation of infected budwoods, by top working, and by mechanical transmission [9, 11]. Both viroids are known for their ability to infect a large number of host plants [36]. CEVd and HSVd are destructive to certain citrus varieties and, can cause yield losses that may be as high as 34 to 76 percent depending on the combination viroid-rootstock-scion [21, 46]. The mechanisms through which CEVd and HSVd interact with their hosts and induce pathogenesis are beginning to be deciphered. In other words, the involvement of RNA-silencing and basic defense mechanisms following CEVd and HSVd infection has been highlighted [54, 56].
Once introduced and established in a country, both viroids can spread relatively rapidly because of their ability to be transmitted via mechanical means [9, 11]. Since CEVd and HSVd have a high resistance to heat, the chemical treatment appears to be the best method to disinfect CEVd- and HSVd-contaminated tools. For instance, a 0,25 to 0,5 and a 1 percent solution of sodium hypochlorite appears to be the best option to eliminate CEVd and HSVd, respectively, from contaminated hedging and budwood cutting tools [11, 98]. Like all citrus viroids, CEVd and HSVd seem to be successively eliminated from propagative material by shoot-tip grafting or by the deployment of nucellar budlines. Being extremely tolerant of heat, CEVd and HSVd have not been successfully eliminated from budwood by applying thermotherapy [9]. Certification programs must include measures to control viroid spread in nurseries [32]. The majority of rootstocks that are tolerant to the citrus tristeza virus [
Complicated interactions, including antagonism and synergy, occur between viroids coinfecting the same citrus host. These interactions may lead to different symptoms, canopy volumes, fruit yields, and commercial performance. Although no obvious physiological changes in citrus hosts have been described in mixed infections of CEVd and HSVd and both viroids do not induce severe symptoms in citrus [24, 99], their interaction was intriguing because they are commonly found simultaneously infecting different citrus cultivars and they have identical biological properties within the same host. The relationship between the two viroids has been investigated over 3 years (from 2011 to 2013). Results showed a positive correlation between CEVd and HSVd in specific tissues of two citrus cultivars (blood orange and Murcott mandarin). This result has been supported by three findings: titer enhancement, localization similarity, and lack of symptom aggravation under mixed-infection conditions. Compared to their concentrations under single-infection conditions, a significant increase in the CEVd and HSVd population has been observed under mixed-infection during 6 and only 1 season of the 12 monitored seasons, respectively. This result is somewhat surprising because no competition phenomenon for host resources occurs between the two viroids although they have the same biological functions and share identical cellular and subcellular spaces [27]. This issue merits consideration in future research.
Regarding the current situation of CEVd and HSVd in Morocco, this chapter provides a general overview of their spread in the Moroccan citrus-growing areas. Preventing the introduction and the establishment of exocortis and cachexia diseases in the Moroccan citrus orchards can be set up through the use of viroid-free (certified) planting material, disinfection of pruning tools, regular monitoring of citrus orchards to ensure early detection of both diseases, and by avoiding top working practice. This review pointers to new research avenues in exocortis and cachexia diseases in Morocco or elsewhere. These research fields could include for instance the characterization of CEVd and HSVd isolates, searching for secondary hosts, and developing sustainable control strategies. Investigating the prevalence of CEVd and HSVd infection in numerous natural host plants, and the characterization of the viroid sequence variants is valuable especially that a cross-transmission phenomenon between different hosts seems to be possible for HSVd [100].
Studying functional genomics through transcriptomic analysis and/or proteomic approaches in citrus-CEVd/HSVd interaction would be an interesting approach to shed more light on the full mechanisms underlying the complex and varied events associated with such interactome, and thus contribute to the development of novel diagnostic methods and plant protection strategies. This further advanced research will expand our understanding of CEVd and HSVd epidemiology and the mechanisms behind their spread across the world in general and Morocco in particular, and could potentially help in devising innovative management strategies of both viroids.
This research was financially supported by INRA Institute (CRRA de Oujda; Qualipole de Berkane) and the Phytopathology Unit of the Department of Plant Protection, Ecole Nationale d’Agriculture de Meknes.
The authors declare no conflict of interest.
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Work on the automatic detection of trenches and craters is presented here. Land cover can be extracted and is quite useful to help mine action. We present here a classification method based on Gabor filters. The relief of a region helps analysts to understand where mines could have been laid. Methods to be a digital terrain model from a digital surface model are explained. The special case of multi‐spectral classification is also addressed in this chapter. Discussion about data fusion is also given. Hyper‐spectral data are also addressed with a change detection method. Synthetic aperture radar data and its fusion with optical data have been studied. 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Different approaches developed at the Royal Military Academy in order to demonstrate the possibility of enhancing close‐range landmine detection and identification using ground‐penetrating radar under laboratory and outdoor conditions are summarized here. Data acquired using different affordable and practical GPR‐based systems are used to validate a number of promising developments in signal processing techniques for target detection and identification. 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Different approaches developed at the Royal Military Academy in order to demonstrate the possibility of enhancing close‐range landmine detection and identification using ground‐penetrating radar under laboratory and outdoor conditions are summarized here. Data acquired using different affordable and practical GPR‐based systems are used to validate a number of promising developments in signal processing techniques for target detection and identification. 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Three sensors used for the detection and identification of sea mines are studied here: sonar, gradiometer and infrared camera. These sensors can be applied to detect different types of sea mines. Some signal and image processing techniques developed to extract relevant information for the detection of underwater objects are presented in this chapter. These techniques are validated using data collected in the frame of different European and NATO projects.",book:{id:"4818",slug:"mine-action-the-research-experience-of-the-royal-military-academy-of-belgium",title:"Mine Action",fullTitle:"Mine Action - The Research Experience of the Royal Military Academy of Belgium"},signatures:"Olga Lucia Lopera Tellez, Alexander Borghgraef and Eric Mersch",authors:[{id:"176830",title:"Dr.",name:"Olga",middleName:"Lucia",surname:"Lopera Tellez",slug:"olga-lopera-tellez",fullName:"Olga Lopera Tellez"}]},{id:"53185",title:"Testing and Evaluating Results of Research in Mine Action",slug:"testing-and-evaluating-results-of-research-in-mine-action",totalDownloads:1122,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"This chapter summarizes the experience of the Royal Military Academy in testing and evaluating new tools for mine action. It first underscores the importance of testing and evaluating new methods in general and in mine action in particular. Some recommendations are given to help the design of test protocols: defining carefully the objectives of the test and what is to be measured, the importance of blind and double‐blind tests, choosing between realism and statistical relevance, the importance of how to display the results, etc. These recommendations are illustrated by real‐life examples, mainly from test and evaluation of detectors of mines in which RMA has been involved. A test protocol is detailed. It is the one that RMA designed and used to evaluate a detector that was proven to be useless and that led to the criminal conviction of its designer in the United Kingdom. Sources of available test protocols and test reports are also listed.",book:{id:"4818",slug:"mine-action-the-research-experience-of-the-royal-military-academy-of-belgium",title:"Mine Action",fullTitle:"Mine Action - The Research Experience of the Royal Military Academy of Belgium"},signatures:"Yann Yvinec",authors:[{id:"133433",title:"Dr.",name:"Yann",middleName:null,surname:"Yvinec",slug:"yann-yvinec",fullName:"Yann Yvinec"}]},{id:"53260",title:"Unmanned Ground and Aerial Robots Supporting Mine Action Activities",slug:"unmanned-ground-and-aerial-robots-supporting-mine-action-activities",totalDownloads:1264,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"During the Humanitarian‐demining actions, teleoperation of sensors or multi‐sensor heads can enhance-detection process by allowing more precise scanning, which is useful for the optimization of the signal processing algorithms. This chapter summarizes the technologies and experiences developed during 16 years through national and/or European‐funded projects, illustrated by some contributions of our own laboratory, located at the Royal Military Academy of Brussels, focusing on the detection of unexploded devices and the implementation of mobile robotics systems on minefields.",book:{id:"4818",slug:"mine-action-the-research-experience-of-the-royal-military-academy-of-belgium",title:"Mine Action",fullTitle:"Mine Action - The Research Experience of the Royal Military Academy of Belgium"},signatures:"Yvan Baudoin, Daniela Doroftei, Geert de Cubber, Jean‐Claude\nHabumuremyi, Haris Balta and Ioan Doroftei",authors:[{id:"176831",title:"Dr.",name:"Yvan",middleName:null,surname:"Baudoin",slug:"yvan-baudoin",fullName:"Yvan Baudoin"}]},{id:"52464",title:"InSAR Coherence and Intensity Changes Detection",slug:"insar-coherence-and-intensity-changes-detection",totalDownloads:1696,totalCrossrefCites:4,totalDimensionsCites:6,abstract:"This research aims at differentiating human-induced effects over the landscape from the natural ones by exploiting a combination of amplitude and phase changes in satellite radar images. At a first step, ERS and Envisat data stacks are processed using COS software developed by the company SARMAP. Various features related to amplitude and phase as well as to their changes are then extracted from images of the same sensor. Combinations of the features extracted from one image, from several images of one sensor as well as from different sensors are performed to derive robust indicators of potential human-related changes. Finally, possibilities of exploiting and integrating other types of information sources such as various reports, maps, historical or agricultural data, etc. in the combination process are analyzed to improve the obtained results. The outcomes are used to evaluate the potential of this method applied to Sentinel-1 images.",book:{id:"4818",slug:"mine-action-the-research-experience-of-the-royal-military-academy-of-belgium",title:"Mine Action",fullTitle:"Mine Action - The Research Experience of the Royal Military Academy of Belgium"},signatures:"Damien Closson and Nada Milisavljevic",authors:[{id:"13897",title:"Dr.",name:"Damien",middleName:null,surname:"Closson",slug:"damien-closson",fullName:"Damien Closson"}]}],onlineFirstChaptersFilter:{topicId:"1371",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:0,limit:8,total:null},allSeries:{pteSeriesList:[],lsSeriesList:[],hsSeriesList:[],sshSeriesList:[],testimonialsList:[]},series:{item:{id:"14",title:"Artificial Intelligence",doi:"10.5772/intechopen.79920",issn:"2633-1403",scope:"Artificial Intelligence (AI) is a rapidly developing multidisciplinary research area that aims to solve increasingly complex problems. In today's highly integrated world, AI promises to become a robust and powerful means for obtaining solutions to previously unsolvable problems. This Series is intended for researchers and students alike interested in this fascinating field and its many applications.",coverUrl:"https://cdn.intechopen.com/series/covers/14.jpg",latestPublicationDate:"May 18th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:9,editor:{id:"218714",title:"Prof.",name:"Andries",middleName:null,surname:"Engelbrecht",slug:"andries-engelbrecht",fullName:"Andries Engelbrecht",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRNR8QAO/Profile_Picture_1622640468300",biography:"Andries Engelbrecht received the Masters and PhD degrees in Computer Science from the University of Stellenbosch, South Africa, in 1994 and 1999 respectively. He is currently appointed as the Voigt Chair in Data Science in the Department of Industrial Engineering, with a joint appointment as Professor in the Computer Science Division, Stellenbosch University. Prior to his appointment at Stellenbosch University, he has been at the University of Pretoria, Department of Computer Science (1998-2018), where he was appointed as South Africa Research Chair in Artifical Intelligence (2007-2018), the head of the Department of Computer Science (2008-2017), and Director of the Institute for Big Data and Data Science (2017-2018). In addition to a number of research articles, he has written two books, Computational Intelligence: An Introduction and Fundamentals of Computational Swarm Intelligence.",institutionString:null,institution:{name:"Stellenbosch University",institutionURL:null,country:{name:"South Africa"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:6,paginationItems:[{id:"22",title:"Applied Intelligence",coverUrl:"https://cdn.intechopen.com/series_topics/covers/22.jpg",isOpenForSubmission:!0,editor:{id:"27170",title:"Prof.",name:"Carlos",middleName:"M.",surname:"Travieso-Gonzalez",slug:"carlos-travieso-gonzalez",fullName:"Carlos Travieso-Gonzalez",profilePictureURL:"https://mts.intechopen.com/storage/users/27170/images/system/27170.jpeg",biography:"Carlos M. Travieso-González received his MSc degree in Telecommunication Engineering at Polytechnic University of Catalonia (UPC), Spain in 1997, and his Ph.D. degree in 2002 at the University of Las Palmas de Gran Canaria (ULPGC-Spain). He is a full professor of signal processing and pattern recognition and is head of the Signals and Communications Department at ULPGC, teaching from 2001 on subjects on signal processing and learning theory. His research lines are biometrics, biomedical signals and images, data mining, classification system, signal and image processing, machine learning, and environmental intelligence. He has researched in 52 international and Spanish research projects, some of them as head researcher. He is co-author of 4 books, co-editor of 27 proceedings books, guest editor for 8 JCR-ISI international journals, and up to 24 book chapters. He has over 450 papers published in international journals and conferences (81 of them indexed on JCR – ISI - Web of Science). He has published seven patents in the Spanish Patent and Trademark Office. He has been a supervisor on 8 Ph.D. theses (11 more are under supervision), and 130 master theses. He is the founder of The IEEE IWOBI conference series and the president of its Steering Committee, as well as the founder of both the InnoEducaTIC and APPIS conference series. He is an evaluator of project proposals for the European Union (H2020), Medical Research Council (MRC, UK), Spanish Government (ANECA, Spain), Research National Agency (ANR, France), DAAD (Germany), Argentinian Government, and the Colombian Institutions. He has been a reviewer in different indexed international journals (<70) and conferences (<250) since 2001. He has been a member of the IASTED Technical Committee on Image Processing from 2007 and a member of the IASTED Technical Committee on Artificial Intelligence and Expert Systems from 2011. \n\nHe has held the general chair position for the following: ACM-APPIS (2020, 2021), IEEE-IWOBI (2019, 2020 and 2020), A PPIS (2018, 2019), IEEE-IWOBI (2014, 2015, 2017, 2018), InnoEducaTIC (2014, 2017), IEEE-INES (2013), NoLISP (2011), JRBP (2012), and IEEE-ICCST (2005)\n\nHe is an associate editor of the Computational Intelligence and Neuroscience Journal (Hindawi – Q2 JCR-ISI). He was vice dean from 2004 to 2010 in the Higher Technical School of Telecommunication Engineers at ULPGC and the vice dean of Graduate and Postgraduate Studies from March 2013 to November 2017. He won the “Catedra Telefonica” Awards in Modality of Knowledge Transfer, 2017, 2018, and 2019 editions, and awards in Modality of COVID Research in 2020.\n\nPublic References:\nResearcher ID http://www.researcherid.com/rid/N-5967-2014\nORCID https://orcid.org/0000-0002-4621-2768 \nScopus Author ID https://www.scopus.com/authid/detail.uri?authorId=6602376272\nScholar Google https://scholar.google.es/citations?user=G1ks9nIAAAAJ&hl=en \nResearchGate https://www.researchgate.net/profile/Carlos_Travieso",institutionString:null,institution:{name:"University of Las Palmas de Gran Canaria",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"23",title:"Computational Neuroscience",coverUrl:"https://cdn.intechopen.com/series_topics/covers/23.jpg",isOpenForSubmission:!0,editor:{id:"14004",title:"Dr.",name:"Magnus",middleName:null,surname:"Johnsson",slug:"magnus-johnsson",fullName:"Magnus Johnsson",profilePictureURL:"https://mts.intechopen.com/storage/users/14004/images/system/14004.png",biography:"Dr Magnus Johnsson is a cross-disciplinary scientist, lecturer, scientific editor and AI/machine learning consultant from Sweden. \n\nHe is currently at Malmö University in Sweden, but also held positions at Lund University in Sweden and at Moscow Engineering Physics Institute. \nHe holds editorial positions at several international scientific journals and has served as a scientific editor for books and special journal issues. \nHis research interests are wide and include, but are not limited to, autonomous systems, computer modeling, artificial neural networks, artificial intelligence, cognitive neuroscience, cognitive robotics, cognitive architectures, cognitive aids and the philosophy of mind. \n\nDr. Johnsson has experience from working in the industry and he has a keen interest in the application of neural networks and artificial intelligence to fields like industry, finance, and medicine. \n\nWeb page: www.magnusjohnsson.se",institutionString:null,institution:{name:"Malmö University",institutionURL:null,country:{name:"Sweden"}}},editorTwo:null,editorThree:null},{id:"24",title:"Computer Vision",coverUrl:"https://cdn.intechopen.com/series_topics/covers/24.jpg",isOpenForSubmission:!0,editor:{id:"294154",title:"Prof.",name:"George",middleName:null,surname:"Papakostas",slug:"george-papakostas",fullName:"George Papakostas",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002hYaGbQAK/Profile_Picture_1624519712088",biography:"George A. Papakostas has received a diploma in Electrical and Computer Engineering in 1999 and the M.Sc. and Ph.D. degrees in Electrical and Computer Engineering in 2002 and 2007, respectively, from the Democritus University of Thrace (DUTH), Greece. Dr. Papakostas serves as a Tenured Full Professor at the Department of Computer Science, International Hellenic University, Greece. Dr. Papakostas has 10 years of experience in large-scale systems design as a senior software engineer and technical manager, and 20 years of research experience in the field of Artificial Intelligence. Currently, he is the Head of the “Visual Computing” division of HUman-MAchines INteraction Laboratory (HUMAIN-Lab) and the Director of the MPhil program “Advanced Technologies in Informatics and Computers” hosted by the Department of Computer Science, International Hellenic University. He has (co)authored more than 150 publications in indexed journals, international conferences and book chapters, 1 book (in Greek), 3 edited books, and 5 journal special issues. His publications have more than 2100 citations with h-index 27 (GoogleScholar). His research interests include computer/machine vision, machine learning, pattern recognition, computational intelligence. \nDr. Papakostas served as a reviewer in numerous journals, as a program\ncommittee member in international conferences and he is a member of the IAENG, MIR Labs, EUCogIII, INSTICC and the Technical Chamber of Greece (TEE).",institutionString:null,institution:{name:"International Hellenic University",institutionURL:null,country:{name:"Greece"}}},editorTwo:null,editorThree:null},{id:"25",title:"Evolutionary Computation",coverUrl:"https://cdn.intechopen.com/series_topics/covers/25.jpg",isOpenForSubmission:!0,editor:{id:"136112",title:"Dr.",name:"Sebastian",middleName:null,surname:"Ventura Soto",slug:"sebastian-ventura-soto",fullName:"Sebastian Ventura Soto",profilePictureURL:"https://mts.intechopen.com/storage/users/136112/images/system/136112.png",biography:"Sebastian Ventura is a Spanish researcher, a full professor with the Department of Computer Science and Numerical Analysis, University of Córdoba. Dr Ventura also holds the positions of Affiliated Professor at Virginia Commonwealth University (Richmond, USA) and Distinguished Adjunct Professor at King Abdulaziz University (Jeddah, Saudi Arabia). Additionally, he is deputy director of the Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI) and heads the Knowledge Discovery and Intelligent Systems Research Laboratory. He has published more than ten books and over 300 articles in journals and scientific conferences. Currently, his work has received over 18,000 citations according to Google Scholar, including more than 2200 citations in 2020. In the last five years, he has published more than 60 papers in international journals indexed in the JCR (around 70% of them belonging to first quartile journals) and he has edited some Springer books “Supervised Descriptive Pattern Mining” (2018), “Multiple Instance Learning - Foundations and Algorithms” (2016), and “Pattern Mining with Evolutionary Algorithms” (2016). He has also been involved in more than 20 research projects supported by the Spanish and Andalusian governments and the European Union. He currently belongs to the editorial board of PeerJ Computer Science, Information Fusion and Engineering Applications of Artificial Intelligence journals, being also associate editor of Applied Computational Intelligence and Soft Computing and IEEE Transactions on Cybernetics. Finally, he is editor-in-chief of Progress in Artificial Intelligence. He is a Senior Member of the IEEE Computer, the IEEE Computational Intelligence, and the IEEE Systems, Man, and Cybernetics Societies, and the Association of Computing Machinery (ACM). Finally, his main research interests include data science, computational intelligence, and their applications.",institutionString:null,institution:{name:"University of Córdoba",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"26",title:"Machine Learning and Data Mining",coverUrl:"https://cdn.intechopen.com/series_topics/covers/26.jpg",isOpenForSubmission:!0,editor:{id:"24555",title:"Dr.",name:"Marco Antonio",middleName:null,surname:"Aceves Fernandez",slug:"marco-antonio-aceves-fernandez",fullName:"Marco Antonio Aceves Fernandez",profilePictureURL:"https://mts.intechopen.com/storage/users/24555/images/system/24555.jpg",biography:"Dr. Marco Antonio Aceves Fernandez obtained his B.Sc. (Eng.) in Telematics from the Universidad de Colima, Mexico. He obtained both his M.Sc. and Ph.D. from the University of Liverpool, England, in the field of Intelligent Systems. He is a full professor at the Universidad Autonoma de Queretaro, Mexico, and a member of the National System of Researchers (SNI) since 2009. Dr. Aceves Fernandez has published more than 80 research papers as well as a number of book chapters and congress papers. He has contributed in more than 20 funded research projects, both academic and industrial, in the area of artificial intelligence, ranging from environmental, biomedical, automotive, aviation, consumer, and robotics to other applications. He is also a honorary president at the National Association of Embedded Systems (AMESE), a senior member of the IEEE, and a board member of many institutions. His research interests include intelligent and embedded systems.",institutionString:"Universidad Autonoma de Queretaro",institution:{name:"Autonomous University of Queretaro",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null},{id:"27",title:"Multi-Agent Systems",coverUrl:"https://cdn.intechopen.com/series_topics/covers/27.jpg",isOpenForSubmission:!0,editor:{id:"148497",title:"Dr.",name:"Mehmet",middleName:"Emin",surname:"Aydin",slug:"mehmet-aydin",fullName:"Mehmet Aydin",profilePictureURL:"https://mts.intechopen.com/storage/users/148497/images/system/148497.jpg",biography:"Dr. Mehmet Emin Aydin is a Senior Lecturer with the Department of Computer Science and Creative Technology, the University of the West of England, Bristol, UK. His research interests include swarm intelligence, parallel and distributed metaheuristics, machine learning, intelligent agents and multi-agent systems, resource planning, scheduling and optimization, combinatorial optimization. Dr. Aydin is currently a Fellow of Higher Education Academy, UK, a member of EPSRC College, a senior member of IEEE and a senior member of ACM. In addition to being a member of advisory committees of many international conferences, he is an Editorial Board Member of various peer-reviewed international journals. He has served as guest editor for a number of special issues of peer-reviewed international journals.",institutionString:null,institution:{name:"University of the West of England",institutionURL:null,country:{name:"United Kingdom"}}},editorTwo:null,editorThree:null}]},overviewPageOFChapters:{paginationCount:17,paginationItems:[{id:"81791",title:"Self-Supervised Contrastive Representation Learning in Computer Vision",doi:"10.5772/intechopen.104785",signatures:"Yalin Bastanlar and Semih Orhan",slug:"self-supervised-contrastive-representation-learning-in-computer-vision",totalDownloads:3,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Pattern Recognition - New Insights",coverURL:"https://cdn.intechopen.com/books/images_new/11442.jpg",subseries:{id:"26",title:"Machine Learning and Data Mining"}}},{id:"79345",title:"Application of Jump Diffusion Models in Insurance Claim Estimation",doi:"10.5772/intechopen.99853",signatures:"Leonard Mushunje, Chiedza Elvina Mashiri, Edina Chandiwana and Maxwell Mashasha",slug:"application-of-jump-diffusion-models-in-insurance-claim-estimation-1",totalDownloads:2,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Data Clustering",coverURL:"https://cdn.intechopen.com/books/images_new/10820.jpg",subseries:{id:"26",title:"Machine Learning and Data Mining"}}},{id:"81557",title:"Object Tracking Using Adapted Optical Flow",doi:"10.5772/intechopen.102863",signatures:"Ronaldo Ferreira, Joaquim José de Castro Ferreira and António José Ribeiro Neves",slug:"object-tracking-using-adapted-optical-flow",totalDownloads:10,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Information Extraction and Object Tracking in Digital Video",coverURL:"https://cdn.intechopen.com/books/images_new/10652.jpg",subseries:{id:"24",title:"Computer Vision"}}},{id:"81558",title:"Thresholding Image Techniques for Plant Segmentation",doi:"10.5772/intechopen.104587",signatures:"Miguel Ángel Castillo-Martínez, Francisco Javier Gallegos-Funes, Blanca E. Carvajal-Gámez, Guillermo Urriolagoitia-Sosa and Alberto J. Rosales-Silva",slug:"thresholding-image-techniques-for-plant-segmentation",totalDownloads:13,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Information Extraction and Object Tracking in Digital Video",coverURL:"https://cdn.intechopen.com/books/images_new/10652.jpg",subseries:{id:"24",title:"Computer Vision"}}}]},overviewPagePublishedBooks:{paginationCount:9,paginationItems:[{type:"book",id:"7723",title:"Artificial Intelligence",subtitle:"Applications in Medicine and Biology",coverURL:"https://cdn.intechopen.com/books/images_new/7723.jpg",slug:"artificial-intelligence-applications-in-medicine-and-biology",publishedDate:"July 31st 2019",editedByType:"Edited by",bookSignature:"Marco Antonio Aceves-Fernandez",hash:"a3852659e727f95c98c740ed98146011",volumeInSeries:1,fullTitle:"Artificial Intelligence - Applications in Medicine and Biology",editors:[{id:"24555",title:"Dr.",name:"Marco Antonio",middleName:null,surname:"Aceves Fernandez",slug:"marco-antonio-aceves-fernandez",fullName:"Marco Antonio Aceves Fernandez",profilePictureURL:"https://mts.intechopen.com/storage/users/24555/images/system/24555.jpg",biography:"Dr. Marco Antonio Aceves Fernandez obtained his B.Sc. (Eng.) in Telematics from the Universidad de Colima, Mexico. He obtained both his M.Sc. and Ph.D. from the University of Liverpool, England, in the field of Intelligent Systems. He is a full professor at the Universidad Autonoma de Queretaro, Mexico, and a member of the National System of Researchers (SNI) since 2009. Dr. Aceves Fernandez has published more than 80 research papers as well as a number of book chapters and congress papers. He has contributed in more than 20 funded research projects, both academic and industrial, in the area of artificial intelligence, ranging from environmental, biomedical, automotive, aviation, consumer, and robotics to other applications. He is also a honorary president at the National Association of Embedded Systems (AMESE), a senior member of the IEEE, and a board member of many institutions. His research interests include intelligent and embedded systems.",institutionString:"Universidad Autonoma de Queretaro",institution:{name:"Autonomous University of Queretaro",institutionURL:null,country:{name:"Mexico"}}}]},{type:"book",id:"7726",title:"Swarm Intelligence",subtitle:"Recent Advances, New Perspectives and Applications",coverURL:"https://cdn.intechopen.com/books/images_new/7726.jpg",slug:"swarm-intelligence-recent-advances-new-perspectives-and-applications",publishedDate:"December 4th 2019",editedByType:"Edited by",bookSignature:"Javier Del Ser, Esther Villar and Eneko Osaba",hash:"e7ea7e74ce7a7a8e5359629e07c68d31",volumeInSeries:2,fullTitle:"Swarm Intelligence - Recent Advances, New Perspectives and Applications",editors:[{id:"49813",title:"Dr.",name:"Javier",middleName:null,surname:"Del Ser",slug:"javier-del-ser",fullName:"Javier Del Ser",profilePictureURL:"https://mts.intechopen.com/storage/users/49813/images/system/49813.png",biography:"Prof. Dr. Javier Del Ser received his first PhD in Telecommunication Engineering (Cum Laude) from the University of Navarra, Spain, in 2006, and a second PhD in Computational Intelligence (Summa Cum Laude) from the University of Alcala, Spain, in 2013. He is currently a principal researcher in data analytics and optimisation at TECNALIA (Spain), a visiting fellow at the Basque Center for Applied Mathematics (BCAM) and a part-time lecturer at the University of the Basque Country (UPV/EHU). His research interests gravitate on the use of descriptive, prescriptive and predictive algorithms for data mining and optimization in a diverse range of application fields such as Energy, Transport, Telecommunications, Health and Industry, among others. In these fields he has published more than 240 articles, co-supervised 8 Ph.D. theses, edited 6 books, coauthored 7 patents and participated/led more than 40 research projects. He is a Senior Member of the IEEE, and a recipient of the Biscay Talent prize for his academic career.",institutionString:"Tecnalia Research & Innovation",institution:null}]},{type:"book",id:"7656",title:"Fuzzy Logic",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7656.jpg",slug:"fuzzy-logic",publishedDate:"February 5th 2020",editedByType:"Edited by",bookSignature:"Constantin Volosencu",hash:"54f092d4ffe0abf5e4172a80025019bc",volumeInSeries:3,fullTitle:"Fuzzy Logic",editors:[{id:"1063",title:"Prof.",name:"Constantin",middleName:null,surname:"Volosencu",slug:"constantin-volosencu",fullName:"Constantin Volosencu",profilePictureURL:"https://mts.intechopen.com/storage/users/1063/images/system/1063.png",biography:"Prof. Dr. Constantin Voloşencu graduated as an engineer from\nPolitehnica University of Timișoara, Romania, where he also\nobtained a doctorate degree. He is currently a full professor in\nthe Department of Automation and Applied Informatics at the\nsame university. Dr. Voloşencu is the author of ten books, seven\nbook chapters, and more than 160 papers published in journals\nand conference proceedings. He has also edited twelve books and\nhas twenty-seven patents to his name. He is a manager of research grants, editor in\nchief and member of international journal editorial boards, a former plenary speaker, a member of scientific committees, and chair at international conferences. His\nresearch is in the fields of control systems, control of electric drives, fuzzy control\nsystems, neural network applications, fault detection and diagnosis, sensor network\napplications, monitoring of distributed parameter systems, and power ultrasound\napplications. 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