Example data for linear least-squares approximation.
\r\n\tThe present book intends to provide to the reader a comprehensive overview of the state of art in empathy studies, embracing the different theoretical points of view and illustrating the advanced research such as the application of new technologies to promote perspective-taking. The critical aspects and the future directions of the study on empathy will also be presented.
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In 2017 Dr. Ventura won a competitive grant (Santiago Grisolia) at the University of Valencia at LABPSITEC group, where she was awarded her Ph.D. degree, supervised by Prof. Rosa Baños at the University of Valencia, and co-directed by Prof. Giuseppe Riva of the Catholic University of Milan.",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"227763",title:"Ph.D.",name:"Sara",middleName:null,surname:"Ventura",slug:"sara-ventura",fullName:"Sara Ventura",profilePictureURL:"https://mts.intechopen.com/storage/users/227763/images/system/227763.jpg",biography:"Sara Ventura gained a B.Sc in Psychology at the University of Padua (Italy) in 2013 and an M.Sc. in Ergonomic Psychology at the Catholic University of Milan (Italy) in 2015. In 2016, she carried out a postgraduate training at Universidad Nacional Autónoma de Mexico (Mexico) at the Ciberpsychology lab, working on a rehabilitation protocol for people with acquired brain injury through Virtual Reality. In 2020, Sara gained the Ph.D. in Clinical Psychology at University of Valencia (Spain) working with the LabPsitec group and focusing her research on the study of embodiment and empathy with the support of Virtual Reality. Actually, she is working both with Alma Mater Studiorum – University of Bologna (Italy), and the University of Valencia (Spain) on the fields of embodiment, stroke rehabilitation, empathy and patient care. Her research interests mainly focus on the adoption of new technologies, particularly Virtual/Augmented Reality and Artificial Intelligence for the psycho-social wellbeing with clinical and non-clinical populations, the study of human-computer interaction, and the user experience. 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Essential part of a mechatronics system is the measurement system that senses the variations in the physical parameters, such as temperature, pressure, displacement, and so on, and converts it to an electrical quantity, viz. electric voltage or current. The measurement system consists of mainly two parts: sensor and signal-conditioning circuit. A device that displays, records, or controls the measured variable utilizes the output of the measurement system.
In a measurement system, sensor detects the change in the physical parameters, but this measured variable is not usually in the form desired by the rest of the system. Signal-conditioning part may consist of sensor output amplification, analog-to-digital conversion (ADC), compensation, frequency-to-voltage conversion, and so on. The signal-conditioning interface is the part of the measurement system where the measured signal is converted to an analog or digital electrical signal that is required by the instrument.
The control of industrial processes and automated manufacturing systems requests accurate, moreover, linearized sensor measurements where numerous sensors have nonlinear characteristics. In mechatronic systems, accurate measurement of the dynamic variables plays a vital role for the actuators to function properly. An inaccurate measurement of the rotational position of a robot arm may result in a misplacement of an electronic part on a printed circuit board. The nonlinear voltage output of the temperature sensors embedded in the motor windings results in a lower temperature reading than the actual temperature, which may cause shutdown of the motor.
Emerging technologies in measurement systems have led to integrated signal-conditioning circuits within the sensors. Spreading the usage of microcontrollers or microprocessors in sensing technology has increasingly resulted in utilizing signal-processing functions embedded in the sensors, consequently accurate and linear signals are available at the outputs. For this reason, the appropriate selection of linearization technique is important while the processing time and memory usage of the processor must be limited for fast response and for maintaining the cost of the sensor reasonably priced. Linearization and calibration algorithm design with hardware and/or software is a broad research interest.
The vital part of a mechatronics system is the sensing of physical parameters—either discrete or continuous. In Electrical Transducer Nomenclature and Terminology standard, a sensor is defined as “a device which provides a usable output in response to a specified measurand” [1]. Our focus will be on nonlinear sensors.
In mechatronic systems, one of the most utilized sensors is the capacitive-type sensor. Capacitance changes nonlinearly with the displacement of a diaphragm in a pressure sensor, linear or rotational motion of an object from the reference, or the displacement of vibration sensors. Linearization and calibration of this sensor has been an extensive research area [2].
The other utilized sensor is the temperature sensor, which measures the process temperature, monitor the temperature of the rotor windings, or in temperature compensation of sensors whose performance is affected by temperature changes. Temperature is the most measured and controlled dynamic variable in manufacturing and machine control. There are various types of these sensors, which use resistance change of metals (resistance temperature detector (RTD)) and semiconductors (thermistors) and thermoelectric effect (thermocouples (T/Cs)) due to the change in temperature. Resistive temperature detectors and thermocouples are the most preferred ones due to high linearity of the RTDs and wide operating range of the T/Cs. Although highly nonlinear, thermistors are also used in temperature sensing due to their high sensitivity and low cost. Linearization of thermistors has found an extensive interest among researchers [3, 4].
Thermistor is a semiconductor-resistive temperature sensor made from metal oxides (negative temperature coefficient, NTC) and doped polycrystalline ceramic containing barium titanate and other compounds (positive temperature coefficient (PTC)). In NTC thermistors, the resistance decreases with the increase in temperature. NTC thermistors are widely used for a narrow range of −50 to 150°C.
The NTC thermistor resistance
where
RTDs are metal or metal alloy resistors that exhibit an increase in resistance with the increase in temperature. The operating temperature ranges from −200 to 850°C. They are characterized by a polynomial with respect to temperature as
where the curve-fitting coefficients are supplied for different types of RTDs.
Platinum RTDs are highly accurate (up to ±0.01% at 0°C), but they have relatively linear characteristic curve over large spans, but not exactly a straight line. The platinum RTD with a resistance value of 100 Ω at 0°C, called Pt100, has nearly linear characteristic curve as shown in Figure 1 compared to the nonlinear 100-Ω NTC thermistor.
RTD characteristic curve, data from DIN IEC 751 temperature/resistance table compared to NTC thermistor.
For platinum RTDs, according to IEC 751, the polynomial in Eq. (2) can be reduced to
in which
Thermocouple is a self-powered sensor where the ends of two different metals or metal alloys are weld bonded. The bead weld point is the hot junction, and the other point is the cold junction. A voltage in the order of millivolts is generated at this cold junction. This thermoelectric voltage is a function of the difference between the hot-junction and the cold-junction temperatures and also the composition of the metals as shown in Figure 2.
Thermoelectric voltage of a thermocouple.
NIST ITS-90 thermocouple database [7] presents this generated voltage for temperatures below 0°C as
and for temperatures above 0°C as
where the coefficients,
This generated voltage by T/C’s cold junction can be obtained by measuring the junction temperature with a thermistor, or an IC temperature sensor fixed on an isothermal block. The measured voltage corresponds to the cold-junction temperature and it is utilized in computing the hot-junction temperature. The voltage output of the cold-junction temperature can be fetched from the T/C reference tables according to IEC 584-1. The difference between this voltage and the measured voltage is the voltage generated by hot junction. Temperature value, which corresponds to the computed voltage, can also be fetched from the T/C temperature/mV output table. This process is the software compensation.
There are a variety of T/C types ranging from −270 to 2300°C. They are small in size, thus fast in response, and low in cost. Unfortunately, they have poor linearity and low sensitivity. The lead effect is so high that it must be compensated. Linearization, amplification of the low output, and compensation of the lead effect of temperature sensors can be carried out by analog circuit design [8, 9], by developed software embedded in a microcontroller [10, 11], or a circuit design where the sampled data stored in an SRAM is transferred to a computer for linearization process [12]. Anyway, temperature measurements with T/Cs are challenging, particularly when the temperature measurement is below 0°C.
We discuss the measurement system in mechatronics consisting of thermocouples as temperature sensors and the signal-conditioning circuits, providing detailed information on design process of an embedded measurement and linearization system. This system uses 32-bit microcontroller for T/C cold-junction compensation, analog-to-digital conversion, and T/C temperature sensor output linearization by software.
To overcome the poor linearity of T/Cs, linearization circuits are developed. Complicated analog electronic circuits are designed to cope with T/C’s nonlinear and low output voltage problem [13, 14]. These circuits amplify the low-voltage output to a desired level and linearize the output to obtain the intended accuracy in the operating range of the system [6]. Therefore, in linearization with hardware precise assignation of the circuit elements is considerably important to achieve the essential accuracy.
Software linearization techniques are also preferred among researchers. Wei et al. first amplified the T/C output, converted it to digital by on-chip analog-to-digital converter of the microcontroller, and then linearized the output using least-squares method [14]. Sarma and Boruah amplified type K T/C output, then converted to digital by 12-bit ADC, and finally linearized the output with an eight-bit microcontroller using a piecewise polynomial of ninth degree [15]. Engin used an eight-bit microcontroller, its on-chip programmable gain amplifier and 24-bit ADC to amplify and digitize the measured type T T/C output, and built-in temperature sensor for compensation, finally linearized the output by first- and second-degree polynomials, and piecewise linear interpolation methods [11]. Some researchers utilized a T/C amplifier for amplification and cold-junction compensation and linearized the output by look-up table (LUT) embedded in the microcontroller [11, 16, 17]. Wang et al. used B-spline method for linearizing the output of nonlinear sensors [18]. The sensor linearization process comprises complex mathematical computations that an eight-bit microcontroller cannot achieve. Therefore, many researchers had rather realized calibration algorithm on a computer through I/O interface cards. Danisman et al. initially amplified the T/C output with an instrumentation amplifier, then used an ADC for conversion to digital, and transmitted this digitized measurement to a computer where they applied artificial neural network (ANN) calibration algorithm by means of a virtual instrument [10]. Researchers who utilized low-cost microcontrollers for linearizing the sensor outputs limited the sensor’s input range to a part of the full scale.
In this section, we give a brief description of the linearization methods. Mathematical models and implementation by software will be the main scope.
A set of measured values from a sensor output needs to be fitted to a curve in order to obtain a mathematical representation of the sensor output. Linear least-squares regression is considerably the most used modeling method. This method utilizes linear algebra to determine the “best-fit” line for a data set by minimizing the sum of the squares of the vertical residuals of the data points to a modeling curve. The sum of the squares of the residuals is preferred because this warrants continuously differentiable residuals at every point contrary to the absolute error differentiation.
Our aim is to find the “best fit” particular to any finite linear combinations of the identified function instead of the best-fit line. Consequently, we can write a general equation including functions
is considered to be the best approximation to the data.
We have a set of
We must determine the coefficients
For linear approximation to the data, we can write that our model is
0 | 1 | 2 | 2.5 | 3 | 3.5 | 4 | 4.75 | 5 | |
2 | 1 | 0.5 | 1.125 | 1 | 1.125 | 0.75 | 0.5 | 0 |
Example data for linear least-squares approximation.
Linear least-squares regression plot for the given set of data.
Linear least-squares regression is the main instrument for process modeling since it is effective in finding a model that best fits, especially, a small set of data. Although there are sets of data that are better defined by nonlinear-coefficient functions, numerous practices in engineering can be described by linear models due to the fact that these processes are linear in nature or they can be approximated by a linear model within narrow ranges. In software-based sensor linearization, it provides minimum code size and consumes the lowest power.
On the other hand, for inherently nonlinear processes, it is more difficult to find a linear model to fit the set of measured data, particularly for wide range. Moreover, the computation time for linearization process run by a computer or a microcontroller will increase as the explanatory variables increase. The sensitivity to the outliers caused by improper measurements can also seriously deflect the “best-fit” line; therefore, model validation becomes critical to acquire accurate responses to the demands stimulating the construction of the model [19].
Curve fitting of a set of measured data from a sensor output can be accomplished by high-degree polynomial interpolants where we should abstain from equally spaced data points. This may result in a problem in producing accurate interpolant over a wide range. To overcome this difficulty is to partition the wide range into subintervals
Piecewise linear approximation is a technique of obtaining a function that fits a nonlinear objective function by adding binary or continuous variables and constraints to reformulate the original function [20]. The particular aim is to approximate a function of one variable in terms of sequential linear pieces. The successive data points connecting piecewise straight lines are called breakpoints.
Assume that a general nonlinear continuous function
Piecewise linearization of the data set in
The significance in reformulating a consider that we have the piecewise as a linear function is to use a distinct variable for each segment. Consider that we have the piecewise linear function
For each segment, the slope is
and the nonlinear function can be rewritten in terms of the slopes as
where
Unfortunately, there are piecewise linear functions that cannot be reformulated by linear programming as depicted above. Therefore, the nonlinear function (
You may find the piecewise linearization procedure in the nonlinear programming textbooks [21, 22], where a nonlinear function
The weight
This mixed integer programming ensures the validity of the approximation by the conditions in [22].
The accuracy of the linear approximation significantly relates to the number of breakpoints where a greater number of breakpoints result in more accurate approximation. Unavoidably, adding a number of breakpoints results in a considerable growth in the memory size for storing these values. When linearization of the sensor outputs by a microcontroller is accomplished, the number of breakpoints should be considered as well as the accuracy.
When polynomial, hyperbolically tangent or exponential functions are linearized, computations can be accomplished by look-up tables avoiding the Taylor-series expansion or other polynomial calculations with excessive floating point operations. The given values of the data are stored digitally in a memory. The data points in the LUT can then be approximated by piecewise linear approximation method.
Nonlinear outputs of the sensors have a variant degree of nonlinearity through the operating range. Consequently, in utilizing the linear approximation method to reach a precise accuracy, the data points in the LUT can be selected that are not equidistant. Whenever the sensor output is more “linear,” the distance between the data points can be increased, thus decreasing the memory need for LUT. In the fixed step table, the step size must be matched to the most “nonlinear” part of the function throughout the LUT.
Look-up table usage for linearization of the sensor outputs provides more accurate results particularly for small-scale-embedded systems having limited size of memory. Nevertheless, it is not recommended to make use of look-up tables for sensor outputs with high resolution, since it needs larger memory than a small-scale-embedded system has.
The linear interpolation method for sensor linearization process exhibits distortions that result in corners on the plot of the function at the breakpoints. To obtain an interpolating function that has continuity around the breakpoints, cubic splines are used. On the other hand, they are just piecewise continuous, inferring that the third derivative is not continuous. If the sensor linearization process is susceptible to the evenness of derivatives higher than the second, cubic spline method is not preferred.
Consider the general nonlinear continuous function
The cubic polynomial requires two conditions to match the values of the data set at each end of the intervals, which results in a piecewise continuous function on [
Providing smoother interpolation, the first and the second derivatives must be continuous
The remaining boundary conditions to complete the cubic spline polynomial are as follows:
For natural cubic spline:
For clamped cubic spline:
The data in Table 1 are now linearized by cubic spline interpolation method using a function added in Excel which is developed by SRS1 Software, LLC. Figure 5 indicates the cubic spline linearization of
Cubic spline linearization of the data set in
Sensor outputs are not as linear as we expect. Consequently, linearization by hardware or software has become one of the challenging parts in measurement systems.
There are a variety of temperature sensors in the market. Yet, numerous temperature sensors have nonlinear characteristics or temperature measuring ranges are quite narrow. While utilizing these sensors, outputs are compensated, and linearized using digital circuitry and software, resulting in “smart sensors.” These smart temperature sensors are thermocouples, thermistors, and resistive temperature detectors. The temperature sensors have low-voltage outputs, and nonlinear characteristic as mentioned in Section 2. Amplification and linearization of the voltage output of these temperature sensors is essential before utilizing them in industrial applications.
As the measurement range is the widest, and the linearity is poorer than most temperature sensors, thermocouples are in our scope of linearization practice. Due to their robustness to very high/very low temperatures, and oxidizing environments, they are preferred to other temperature sensors that melt with high temperature, or corrode with vapor. We present T/C compensation, and linearization with polynomial interpolation as a case study.
The development of a linearization block consists of several steps. We should first start with the nonlinear function
After obtaining the nonlinear function,
Sensor linearization procedure.
If the controller has an eight-bit processor with limited computing ability, then the best choice will be using a LUT stored in the memory. The function
When we choose to use LUT, there will be limited source data set; therefore, an interpolation method must be used to compute the measured value. In this case, the interpolated value,
where
Similar procedure will be applied for cubic spline interpolation by using the equations given in Section 3.4.
Considering the required size of the memory for LUT entries and accuracy of the measurement, we know that for
The most utilized thermocouples are types J, K, T, and E as given in Table 2. It can be interpreted from the table that the temperature ranges are the widest among other temperature sensors, but unfortunately the linearity is poor. We have selected type K T/C as its characteristic curve is considerably nonlinear, particularly in the negative temperature range as shown in Figure 7.
Characteristic curve of type K T/C (a) negative and (b) positive temperature range.
The suggested temperature measuring system consists of a type K T/C, a low-voltage micro-power amplifier, OPA333 with very low-offset voltage (max. 10 µV) and near-zero drift over time, 10 kΩ thermistor for cold-junction compensation of T/C, a cost-efficient 32-bit microcontroller, and a serial port driver (Figure 8). This system uses an analog hardware- and software-mixed linearization approach.
Temperature measuring system.
The low-voltage output of the type K T/C is in the range of −6.458 to 54.886 mV corresponding to −270 to 1372°C input range, so this output is amplified by an external amplifier. Then, the amplified voltage is applied to the built-in ADC input. A low-pass filter is used for noise suppression across the T/C ends.
We preferred Arduino Due based on a 32-bit ARM core microcontroller, which has 16-channel 12-bit ADCs; USB, Universal Synchronous/Asynchronous Receiver/Transmitter (USART), Serial Peripheral Interface (SPI), and I2C compatible Two-wire Interface (TWI) serial communication ports; 512 KB of flash and 100 KB of SRAM memory size are sufficient to run the linearization process by polynomial calculations, or to store the data for look-up table.
Type | Composition | Temperature range |
---|---|---|
J | Iron vs Cu-Ni alloy | −210 to 1200°C |
K | Ni-Cr alloy vs Ni-Al alloy | −270 to 1372°C |
T | Cu vs Cu-Ni alloy | −270 to 400°C |
E | Ni-Cr alloy vs Cu-Ni alloy | −270 to 1000°C |
Standard thermocouple types and their temperature ranges.
The embedded temperature measuring system is built and the amplified output of the T/C is connected to an analog channel of the microcontroller. The 12-bit built-in ADC of the controller board is used to obtain digital values corresponding to the mV output of the T/C.
Arduino Due board with ARM Cortex-M3 core can be programmed by its own integrated development environment (IDE) based on C/C++ programming language. The flowchart of the algorithm for the temperature measuring system is given in Figure 9.
Flowchart of the developed software for the temperature measuring system.
The sixth degree polynomial obtained by Excel tool and the ninth degree polynomial [7] are used to reconstruct the inverse function of the T/C’s characteristic function. For type K T/C, the following polynomial with the inverse coefficients given in Table 3 is used for calculating the temperature value corresponding to the measured voltage in millivolts:
Temperature range | −200 to 0°C | 0 to 500°C | 500 to 1372°C |
Voltage range | −5.891 to 0 | 0 to 20.644 | 20.644 to 54.886 |
0.00E+00 | 0.00E+00 | −1.32E+02 | |
2.52E+01 | 2.51E+01 | 4.83E+01 | |
−1.17E+00 | 7.86E−02 | −1.65E+00 | |
−1.08E+00 | −2.50E−01 | 5.46E−02 | |
−8.98E−01 | 8.32E−02 | −9.65E−04 | |
−3.73E−01 | −1.23E−02 | 8.80E−06 | |
−8.66E−02 | 9.80E−04 | −3.11E−08 | |
−1.05E−02 | −4.41E−05 | 0.00E+00 | |
−5.19E−04 | 1.06E−06 | 0.00E+00 | |
0.00E+00 | −1.05E−08 | 0.00E+00 | |
Error range | −0.02 to 0.04 | −0.05 to 0.04 | −0.05 to 0.06 |
Inverse coefficients for type K thermocouple.
The model for the type K T/C is implemented by polynomial calculations in Eqs. (4) and (5) in Simulink using NIST ITS-90 Thermocouple Database [8]. First, piecewise linear interpolation is used with LUT to linearize the temperature sensor output signal, and the interpolation values along with the measured temperature values are generated at the outputs. The model for type K T/C measuring system is shown in Figure 10.
Model for type K T/C measuring system.
The first block “Type K Thermocouple Model” calculates the polynomial model for negative and positive temperature ranges separately. The second block “ADC input and hardware model” consists of analog scaling of the measured voltage output of the TC, an anti-aliasing filter, and ADC quantizer with a sample and a hold block. The final block is for software specifications for converting ADC values to temperature where 1D LUT is used with linear and cubic spline interpolation algorithm for linearization.
The linearization algorithms are simulated for the most linear and most nonlinear parts of the thermocouple characteristic curve. Least-squares, linear, quadratic, and quartic spline polynomial interpolation methods are applied for linearization over the intervals −270 to 0°C and 0–300°C, and the simulation results are given in Figure 11.
Spline polynomial interpolation results for (a) −270 to 0°C and (b) 0–300°C.
The Simulink model shown in Figure 10 has given the simulation results as in Figure 12.
Linearization results for type K T/C by LUT with piecewise linear and cubic spline interpolation methods, respectively.
We have 212 breakpoints for the 12-bit ADC conversion for the most accurate result. Consequently, in the inverse function derivation part of the simulation block, the direct and interpolated temperature values traced each other closely with an error of −9.15E−05 to 8.61E−05°C in the 0–1370°C range, and −1.51E−05 to 1.51E−05°C in the −270 to 0°C range.
During the test procedure, the measurements are carried out by the type K T/C, and the temperature is increased by 10°C over the interval of −270 to 1372°C. The values are saved as text file that can be evaluated in Excel. The same measurements are made by an identical T/C using the Fluke-725 process calibrator.
The obtained results are interpreted in terms of errors. The errors obtained from the piecewise linearization process with LUT for 28 breakpoints are given in Figure 13, and the error resulted in the positive temperature range is approximately −0.18 to 0.28°C. Compared to the linear function calculation error results declared by NIST ITS-90, −0.05 to 0.04°C for 0–500°C range, and −0.05 to 0.06°C for 500–1372°C range, the error range appears considerably higher than the “near-to-ideal” values, but piecewise linear approximation of the source data in the memory of the microcontroller optimizes the computation time.
Error distribution for piecewise linear approximation method.
The ninth degree polynomial inverse function is also applied to the measured T/C voltage over −200 to 1310°C range for the ranges described in Table 3. The measured values are incremented by about 21 µV corresponding to 0.5°C. The results in Figure 14 revealed that for the negative portion of the temperature measurements, the sixth degree polynomial “best fits” the function, whereas the ninth degree polynomial tracks the temperature values better than the sixth degree polynomial for the positive temperature range. So, we propose a mixed linearization method for type K T/C for the negative and positive portions of the full range.
Linearization of T/C by polynomial for (a) negative and (b) positive temperature range.
In this chapter, we presented the measurement systems and linearization of sensors as well as the methods used in linearization. We presented the design and simulation process of a type K thermocouple as a case study. The linearization process was implemented with a 32-bit microcontroller. Type K thermocouple was connected to the Arduino Due controller board with an amplifier, and capacitors for the noise-suppression filter. Low-voltage output of the T/C, in the range of −6.458 to 54.886 mV, was amplified by an amplifier, and digitized by an internal 12-bit ADC. As the transmitters are low-power devices, a micro-power amplifier is utilized in the amplification of the output voltage of the T/C.
The cold-junction compensation of the thermocouple was realized by software using a thermistor fixed on an isothermal block. The actual type K thermocouple’s voltage output in the nonlinear range was linearized by piecewise linear and polynomial interpolation methods, which were used to compute the temperature values between each breakpoint. Fewer number of breakpoints resulted in larger errors.
LUTs are used in a large range of applications including sensor linearization. The crucial points to consider are the number of LUT entries for better accuracy and the size of the LUT in design. Fewer number of LUT entries may cause serious errors in the measurement system, whereas larger number of entries may consume the memory of the controller.
In the polynomial approach for linearization, we propose 32-bit microcontrollers for better accuracy at the expense of cost compared to the small-embedded systems with limited computing ability and memory size. The calculation time for high-order polynomial equations may be too long for low-cost small-embedded systems with limited computational ability, but for implementation of the exact inverse sensor characteristic, the 32-bit controller Arduino Due is a reasonable solution.
Compared to the previous mixed signal works of the authors [11, 16], this case study offers a 32-bit ARM controller with high-computational ability and memory to run high-order polynomial interpolation method for linearization as well as higher accuracy in LUT with piecewise linearization. The ninth degree of polynomial was utilized in T/C linearization in [15], but the range of linearization was limited to 0–200°C. We proposed a mixed polynomial linearization that best fits the negative and positive temperature ranges over the full range.
Experimental and clinical studies have demonstrated that atrial myocardial tissue surrounding the vein of Marshall (VOM) can support electrical focal activities [1] or stable reentries [2] priming atrial fibrillation or synchronized atrial arrhythmias. Moreover, the epicardial region along the path of VOM contains autonomic parasympathetic [3, 4] and sympathetic [5] innervation that have been implicated in triggering AF [6] unveiling important technical issues in the treatment of this arrhythmia and in the maintenance of sinus rhythm after ablation procedures. Thus, VOM is a promising therapeutic target because it fits perfectly with Coumel’s triangle components (trigger, substrate and autonomic tone). Since it is insulated by epicardial fat, physical ablation of the VOM bundle by radiofrequency has been highly challenging and potentially harmful. Chemical ablation by retrograde ethanol infusion in the Marshall vein (VOM-ETHO) has provided a new attractive approach for an efficient elimination of triggered activity originating from this region. As the atrial tissue surrounding the VOM connects the mitral annulus (coronary sinus) to the posterior left atrium (as well as the lateral ridge), this technique has proved to be highly effective in determining a complete mitral isthmus block both in terms of acute success and lesion durability [7].
Embryologically, the VOM is a remnant of the left superior vena cava, which, as it becomes atretic during fetal growth, may remain open in form of small vein diramation draining into the coronary sinus [5]. In 1850 Marshall first described this venous structure draining into the coronary sinus with trajectory directed toward the lateral and posterior wall of left atrium and directed up to the left pulmonary veins [8]. The VOM descends obliquely, posterior to the left atrial (appendage (LAA) on the epicardial aspect of the LA lateral ridge, running along the postero-lateral LA toward the CS. A comprehensive study of the atrial venous anatomy is provided by Valderrabano and colleagues based on analysis of a series of VOM-ETHO procedures performed on a large population of 218 patients scheduled for atrial fibrillation ablation interventions [9]. In this research, beyond the VOM, that was the most commonly cannulated vein, other atrial veins were variably opacified by dye infusion through collateral flow. A consistent pattern of atrial branches arising from coronary ostium were observed (as depicted in Figure 1): septal vein, a second inferior vein, the VOM, LAA veins, anterior roof veins. Other veins not connected to the CS were detected such as roof veins commonly connected with posterior veins and extracardiac collaterals.
Diagrammatic representation of atrial venous circulation from the posterior aspect of the left atrium. From: Valderrabano et al. [
VOM is typically localized at the ostial aspect of the valve of Vieussens. The incidence of VOM identification is about 75–92% according to data in the literature [9, 10]. Distance between CS ostium and VOM is 4.25 ± 2.57 cm, with substantial variability. VOM length before branching was 2.99 ± 1.82 cm. VOM is typically a true atrial vein, with branches and visible venules draining the neighboring atrial tissue. Variable branching was present in 78.2% of cases. According to relation to the left inferior pulmonary vein, VOM presents variable trajectory: smaller VOM which terminates before reaching the left inferior PV (17.6%), VOM visible up to the left inferior pulmonary vein (72.8%), VOM can reach the left superior pulmonary vein (9.6%). Communication between VOM and left pulmonary veins was demonstrated by contrast drainage in the left PVs during the VOM venogram, appearing to connect through the left pulmonary vein carina (it happens in 37.7% of cases).
The technique was pioneered by Valderrabano and coworkers in 2009 [11]. The protocol was studied in 17 dogs. VOM was visualized in 13. The electroanatomical map of left atrium repeated after ethanol infusion demonstrated a new crescent-shaped scar extending from mitral annulus in the posterior wall toward left pulmonary veins. To test the feasibility of VOM-ETHO in humans, 6 patients undergoing pulmonary veins antral isolation, had successful VOM cannulation and ethanol infusion with the confirmation of a new scar formation involving the infero-posterior left atrial wall extending toward the left pulmonary veins.
A right jugular approach [11, 12, 13, 14] and femoral vein approach [15] have been described for VOM cannulation and alcohol delivery. There are reports of success rate of 74% (23 out 31 patients) for VOM venogram using the right jugular approach and 89% (17 out 19 patients) using the femoral approach. Valderrabano et al. reported that 86% (188 of 218) of the VOM was accessible using a right jugular approach with a LIMA angiographic catheter [16].
The technique for VOM cannulation and ethanol infusion was subsequently well reported by the Bordeaux group [17] demonstrating a high success rate of VOM cannulation of 92.6% (50 of 54) with a femoral approach using the LIMA (left internal mammary artery) catheter (Figure 2).
A comprehensive schematic representation of the technical setting for ethanol infusion in the VOM. From Kitamura et al. [
from the right femoral vein, a steerable long sheat (Agilis NxT; Abbott) or long fixed curve sheath was inserted into the CS, guided by ablation catheter or steerable catheter. Once the long sheath was in place, a CS venogram was acquired (Figure 3, panel 1).
A selective venogram of the VOM was performed using a 5-Fr angiography catheter (left internal mammary artery [LIMA] via the long sheat). To acquire a clearer venogram of the VOM and avoid the overlapping CS, a right anterior oblique (RAO) view was preferred (Figure 3, panel 2). The LIMA catheter was inserted into the CS point both posteriorly and superiorly in the RAO view. In addition, the contrast indentation indicating the location of the valve of Vieussens was carefully explored to find the ostium of VOM. At each location, a small amount of the contrast was injected through the LIMA catheter to confirm engaging the VOM. When the VOM was not identified, a balloon occlusion venogram of CS was performed to explore the VOM.
After engaging VOM by LIMA catheter, an angioplasty wire 0.014 inch supported by an over-the-wire balloon catheter was advanced into the VOM. An appropriate size of balloon (1.5–2.5 mm diameter and 6–15 mm length) was used depending on the size of the VOM (Figure 3, panel 3–4)
The balloon was started to be inflated at low pressure (1–2 atm) until the operator feel some resistance on the inflator with a maximum of 6–8 atm in the VOM. After the balloon was inflated completely, the wire was removed.
A selective venogram of the VOM was obtained by injecting 1 mL of contrast medium through the wire port of the balloon (Figure 3, panel 5)
After confirming balloon occlusion and VOM distribution, 0.5–3 mL of ethanol (96% ethanol 10 mL) was slowly injected over 1 minute and selective venography of the VOM was repeated (Figure 3, panel 6–8). A total of 6 to 12 mL of ethanol was used as a maximum dose.
Step-by-step actions for VOM cannulation and ethanol delivery (right panels). Left panels: Pre and post-VOM-ETHO bipolar maps indicating typical location and shaping of scarring formation. From: Kitamura et al. [
Ethanol infusion in the VOM leads to generation of a new low-voltage area posterior and superior to the coronary sinus, encompassing variable extents of the posterior left atrial wall and the anterior aspect of the left inferior pulmonary vein. The area of the scarring depends on the size of the VOM. Valderrabano et al. reported that the area of scar (bipolar voltage amplitude <0.5 mV) was 10.2 + − 5.7 cm2 (range, 3.3 to 15.3 cm2) in the first human experience.17 On large population of over 700 patients, the Bordeaux group reported a scarring area of 10.2 + −5.3 cm2 [10, 17]. In this experience factors contributing to reduction of VOM-ETHO effectiveness in lesion formation were: VOM dissection (10.7%), iodine leakage (3.0%), and VOM morphology without visible branches (3.0%). Ethanol infusion in a wrong vein was associated with less mitral line block (72.7% versus 95.8%, P = 0.012).
VOM-ETHO is highly feasible with a success rate of 91% from latest data on a population of over 700 patients [10]. Factors associated to procedural failure were: nonidentification of VOM (6.2%), noncannulation (1.5%) or ethanol infusion in the wrong vein (1.7%). The Vieussens valve was a helpful landmark and was visible in 63.2% of cases. Remarkably, previous ablation inside the coronary sinus was strictly associated to VOM nonidentification. The success rate of VOM-ETHO procedures increases with the experience of operators.
Complications related to VOM-ETHO procedures are reported in Table 1.
Event | Rate (%) | Time | Comment | Management |
---|---|---|---|---|
VOM perforation | 2.8 | Acute | Infusion still feasible but with higher risk of delayed tamponade | Anti-inflammatory drugs and repeated echocardiography |
pericarditis | 1.8 | Delayed | Usually at day 2 | anti-inflammatory drugs |
Delayed tamponade | 0.8–6 | Delayed | serous nature of cardiac effusion in ⅔ of patients. Usually due to inflammatory reaction | pericardiocentesis |
Stroke | 0.6–1 | Delayed | stroke rate in the reported range | medical management |
Acute tamponade | 0.1–0.2 | Acute | related to cannulation manoeuvers and eventual per-procedural stem pops | Surgical drainage necessary |
Anaphylaxis | <0.2 | Acute | generally in case of hemodynamic collapse during infusion | adrenaline, corticosteroids |
High Degree AVB | <0.2 | Acute | must be favored by very proximal VOM ostium | monitoring AV conduction during ethanol infusion |
LAA Isolation | 0.2 | Acute | risk increased in case of large anterior scarring | Bachmann conduction assessment prior to VOM-ETHO in case of history of previous extensive ablations |
Acute and delayed pericardial effusion represented the most described complications. During the procedure, pericardial tamponade was generally due to inadvertent CS perforation during VOM cannulation maneuvers or steam pops occurred during ablation. After the procedure, subacute pericardial effusion requiring pericardiocentesis was related to inflammatory reaction after alcohol delivery. The higher rate of delayed cardiac effusion or tamponade observed in patients with VOM perforation advocates a causal relationship between the inflammatory reaction and the inadvertent drainage of ethanol in the pericardial space. LAA isolation occurring after VOM-ETHO procedures may be observed in patients with previous extensive ablation settings involving septal and anterior scarring.
Atrial tachycardias (ATs) are often seen in the context of atrial fibrillation ablation implicating macroreentrant or scar-related mechanisms [19, 20]. Radiofrequency catheter ablation is an effective therapy for patients with AF but perimitral ATs and localized reentry circuits commonly appear after pulmonary vein isolation or additional linear lesion in the left atrium [21]. Patients having connections between Marshall bundle and the myocardium of coronary sinus, left atrium or pulmonary veins, may develop the anatomical substrate to generate localized reentry circuits or macroreentrant ATs around the mitral isthmus, using the epicardial Marshall bundle [22]. Vlachos et al. [23], considering a population of 140 patients previously underwent a pulmonary vein isolation procedure, reported that the Marshall bundle is involved in a higher proportion of post-AF ablation ATs (30.2%), being 51.7% macroreentrant ATs and 48.3% localized reentry. Marshall bundle-dependent ATs can be terminated with RF ablation, either endocardial via Marshall-bundle-left atrium connection, or epicardially via Marshall bundle-CS connections, and with ethanol infusion inside the VOM being the Marshall bundle an electrically protected, isolated anatomical structure, difficult to target with RF ablation (Figures 4 and 5) [24].
The bipolar EGMs recorded in MB-LA connections and MB-CS connections have a characteristic electrophysiological pattern: high-frequency long-duration amplitude multicomponent (multiphasic) EGMs. From Vlachos et al. [
Example of Marshall Bundle-related perimitral circuit in a patient with previous pulmonary vein isolation and linear lesions in the left atrium (mitral line and roofline). Note that part of the circuit is lacking during endocardial mapping on the LAT Histogram (CARTO7 module). Circuit mapping is completed by annotating signals recorded on Vision-Wire (red arrow) in the VOM. Diastolic signal recorded on the mapping wire placed in the VOM appears fragmented and of long duration.
Endocardial ablation from within the left atrium may not successfully ablate the Marshall bundle, owing to the distance from endocardium to the critical site. As RF ablation induces a tissue heating by mostly resistive mechanism, the difficult to reach the epicardial Marshall bundle may explain the high failure rate of mitral isthmus block in published studies [25, 26]. For these reasons ethanol infusion inside the VOM may represent an adjunctive standalone strategy in patients with refractory Marshall bundle-related perimitral ATs or localized reentry circuits [14, 27, 28]. The additional use of VOM-ETHO strategy seems to improve ablation rates when compared with RF ablation alone [25, 26].
The VENUS-AF Trial (Vein of Marshall EthaNol in Untreated perSistent) completed in 2018 and published in 2020 [18], was a multicenter, randomized clinical trial comparing the rhythm-control effectiveness of 2 ablation strategies: catheter ablation alone or combined with vein of Marshall ethanol infusion in de novo ablation of AF in a 1:1.15 fashion (including 15% more patients in the VOM group predicting a 15% failure to complete the VOM procedure thus being able to compare VOM-completed patients with controls in a 1:1 ratio). Patients were recruited from 12 referral centers in the United States and were eligible if they were between 18 and 85 years of age and had symptomatic persistent AF (sustained AF lasting >7 days) refractory to at least 1 antiarrhythmic agent. Exclusion criteria included previous AF ablation attempts and left atrial diameter or volume exceeding 65 mm or 200 mL, respectively. The primary endpoint was freedom from AF or AT 30-second duration over 1-year follow-up, with 1-months continuous monitoring at 6 and 12 months, after a single procedure. A total of 343 patients were enrolled (185 randomized to VOM and 158 to PVI). VOM-ETHO was successfully completed in 155 of 185 patients. After a single procedure, 49.2% (91/185) in the VOM group resulted free from AT/AF compared to 38% (60/185) in the PVI group (p = 0.04). Considering patients with VOM-ETHO procedure successfully completed (as-treated analysis), the primary outcome was reached in 80/115 patients in the VOM group (51.6%, p = 0.02). Notably, AF burden, freedom from AF after multiple procedures and mitral line block achievement were significantly improved in VOM-treated patients. Kaplan–Meier plots showed significant reduction in AF or AT recurrence in the VOM group, in both the as-randomized analysis (hazard ratio 0.73; 95% CI 0.53–1.00; P 5 0.05) and the as-treated analysis (hazard ratio 0.67; 95% CI 0.47–0.93; P 5 0.02) (Figure 6). Interestingly, considering subjects with mitral line bidirectional block achievement, patients randomized to VOM-ETHO group (75 of 138) showed a better outcome respect to patients randomized to “ablation only” group (30 of 81) in terms of freedom from AT/AF in 1 year follow-up (54.3% vs. 37%, OR 0.49; 95% CI 0.28–0.87; P 5 0.01) [29].
Outcomes of the VENUS trial. A: time-to-recurrence of atrial fibrillation/atrial tachycardia “as randomized”. B: time to recurrence excluding patients “as-treated”, excluding patients in whom VOM-ETHO procedure was not completed. From: Valderrábano et al. [
Marshall-PLAN trial from the Bordeaux group adopted VOM-ETHO added to routine workflow in AF catheter ablation. Marshall-PLAN (Marshall bundle elimination, Pulmonary vein isolation, and Line completion for ANatomical ablation) trial [30] prospectively enrolled 75 consecutive patients with persistent AF for a de novo ablation procedure. All patients underwent VOM-ETHO and coronary sinus musculature ablation, PVI and anatomical isthmuses linear ablation (mitral, roof and cavotricuspid isthmus) (Figure 7). The primary endpoint was 12-months freedom from AF/atrial tachycardia. VOM-ETHO was completed in 69 patients (92%). The full lesion set was successfully completed in 68 patients (91%). At 12 months, 54 of 75 patients (72%) were free from AF/AT after a single procedure (without antiarrhythmic drugs) in the overall cohort. In the subset of patients with a complete lesion set (VOM-ETHO and anatomical lines), the single procedure success rate was 79%. After 1 or 2 procedures, 67 of 75 patients (89%) remained free from AF/AT without antiarrhythmic drugs (Figure 8).
Marshall-PLAN lesion set. Left: steps for ethanol infusion into vein of Marshall (VOM); A: contrast injection into the VOM with evidence of vein arborization (red arrows). B: (insertion of the angioplasty balloon inflated in the proximal portion of the VOM (yellow star: radiopaque marker of balloon). C: contrast injection in the VOM after alcoholization shows contrast staining. Middle: ablation set in the LA: targeting of CS musculature and “saddle” confirmed by fractionated local electrograms, pulmonary veins isolation and anatomical lines for roof and mitral isthmuses. Right: LA voltage map in sinus rhythm showing final lesion set. From: Derval et al. [
Freedom from atrial fibrillation (AF)/Atrial tachycardia (AT)-Kaplan–Meier event-free survival curves after a single ablation procedure, without antiarrhythmic drugs (A), and after 1 or 2 procedures, without antiarrhythmic drugs (B). From Derval et al. [
In the Marshall-PLAN trial anatomical structures considered critical to the fibrillatory process were targeted (PVs, CS and Marshall bundle network). VOM ethanol infusion was central to the Marshall-PLAN as it enhances the success of subsequent PVI and linear ablation. Patients experiencing AF/AT recurrences after the first procedure demonstrated gaps in the original lesion set. Interestingly, anatomical sites of gaps were clustered in the right posterior carina/roofline and mitral line. Reconnections was not related to conduction recovery through the VOM but rather due to reconnections at the CS/LA interface. These findings suggest that other epicardial structures could play important roles in achieving durable transmural lesions, such as the septopulmonary bundle (for right PVs and roof line), the CS (for the mitral line), and the CTI. It is important to note that patients with incomplete lesion set at the index procedures had arrhythmic recurrences. In the Marshall-PLAN trial two patients experienced a transient ischaemic attack with no neurologic sequelae and four patients had post-ablation pericarditis. Three patients experienced minor groin hematoma.
In terms of LA function, the analysis of A-wave velocities suggested significant improvements in LA function at 12 months in patients without arrhythmic recurrences after the index procedure.
PROMPT-AF (Prospective Randomized Comparison between upgraded “2C3L” vs. PVI approach for the catheter ablation of persistent atrial fibrillation) [31] aimed to compare VOM-ETHO added to PVI plus roofline, mitral line and CTI ablation to PVI alone with randomized design. Unlike the original project, the study published in 2021 [32] does not have a randomized design and enrolled 191 patients who underwent their first catheter ablation of persistent atrial fibrillation (PeAF). The 2C3L technique is a fixed ablation approach consisting of bilateral circumferential PVI and three linear ablation lesion sets across the mitral isthmus, left atrial roof, and cavo-tricuspid isthmus. Patients were selected consecutively and compared for VOM-ETHO plus 2C3L approach (group 1) and 2C3L approach “RF only” (group 2). The follow-up duration was 12 months. The primary endpoint was the rate of documented atrial arrhythmias lasting >30 seconds without any antiarrhythmic drugs, in 12 months after index ablation procedures considering a blanking period of 3 months. The final population consisted of 191 patients (66 in the group 1 and 125 in the group 2). Successful VOM-ETHO was performed in 53 patients in group 1 (VOM not cannulated in 12, VOM dissection in one). At the index procedure, 100% of patients showed successful PVI, bidirectional roofline block and CTI block while mitral isthmus block was achieved in 95.5% of patients in group 1 and 80.8% in group 2 (p 0.006). At 12-months follow-up, 58 (87.9%) patients were free from AF/AT in group 1 compared with 81 (64.8%) in group 2 (p < 0.001) (2 in group 1 and 3 in group 2 patients were on AAD during the 12-months follow-up). Considering patients who received successful VOM-ETHO (53), freedom from AF/AT was achieved in 47 (88.7%). At the survival analysis, group 1 showed higher survival freedom from AT recurrence after adjustment for age, LA diameter, long-standing persistent atrial fibrillation, hypertension, and heart failure (HR 0.27, 95% CI 0.12–0.59) (Figure 9). Two patient experienced mild complication in the “VOM-ETHO” group: one mild pericardial effusion with self-relief and one fluid overload during the procedure. Eight complications occurred in seven (5.6%) patients in “ablation only” group including four fluid overload, one mild pericardial effusion with self-relief, two arteriovenous fistulae, and one pleural effusion. No severe complications like death, stroke or atrial-esophageal fistula were observed.
K-M curve showing survival free from AT/AF recurrence with or without AAD in both groups. From Lai et al. [
Retrograde ethanol alcoholization of the vein of Marshall (VOM-ETHO) is a feasible, safe and effective strategy in treating atrial tachycardias depending on the mitral isthmus and improves long-term results if systematically added to conventional strategies in setting of persistent atrial fibrillation ablation. Results of randomized clinical trials adding VOM-ETHO to pulmonary vein ablation (VENUS AF) and PVI plus linear lesions (Marshall-PLAN) demonstrates beneficial impact of long-term sinus rhythm maintenance in patients with persistent atrial fibrillation.
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VR provides a 3D and dynamic view of structures and the ability of the user to interact with them. The recent technological advances in haptics, display systems, and motion detection allow the user to have a realistic and interactive experience, enabling VR to be ideal for training in hands-on procedures. Consequently, surgical and other interventional procedures are the main fields of application of VR. AR provides the ability of projecting virtual information and structures over physical objects, thus enhancing or altering the real environment. The integration of AR applications in the understanding of anatomical structures and physiological mechanisms seems to be beneficial. Studies have tried to demonstrate the validity and educational effect of many VR and AR applications, in many different areas, employed via various hardware platforms. Some of them even propose a curriculum that integrates these methods. This chapter provides a brief history of VR and AR in medicine, as well as the principles and standards of their function. Finally, the studies that show the effect of the implementation of these methods in different fields of medical training are summarized and presented.",book:{id:"6211",slug:"medical-and-surgical-education-past-present-and-future",title:"Medical and Surgical Education",fullTitle:"Medical and Surgical Education - Past, Present and Future"},signatures:"Panteleimon Pantelidis, Angeliki Chorti, Ioanna Papagiouvanni,\nGeorgios Paparoidamis, Christos Drosos, Thrasyvoulos\nPanagiotakopoulos, Georgios Lales and Michail Sideris",authors:[{id:"211650",title:"M.D.",name:"Panteleimon",middleName:null,surname:"Pantelidis",slug:"panteleimon-pantelidis",fullName:"Panteleimon Pantelidis"},{id:"211654",title:"Ms.",name:"Angeliki",middleName:null,surname:"Chorti",slug:"angeliki-chorti",fullName:"Angeliki Chorti"},{id:"220557",title:"Ms.",name:"Ioanna",middleName:null,surname:"Papagiouvanni",slug:"ioanna-papagiouvanni",fullName:"Ioanna Papagiouvanni"},{id:"220558",title:"Mr.",name:"Georgios",middleName:null,surname:"Paparoidamis",slug:"georgios-paparoidamis",fullName:"Georgios Paparoidamis"},{id:"220559",title:"Mr.",name:"Georgios",middleName:null,surname:"Lales",slug:"georgios-lales",fullName:"Georgios Lales"},{id:"220560",title:"Mr.",name:"Thrasyvoulos",middleName:null,surname:"Panagiotakopoulos",slug:"thrasyvoulos-panagiotakopoulos",fullName:"Thrasyvoulos Panagiotakopoulos"},{id:"220561",title:"Mr.",name:"Christos",middleName:null,surname:"Drosos",slug:"christos-drosos",fullName:"Christos Drosos"},{id:"220562",title:"Dr.",name:"Michail",middleName:null,surname:"Sideris",slug:"michail-sideris",fullName:"Michail Sideris"}]},{id:"50915",doi:"10.5772/63266",title:"Doped Bioactive Glass Materials in Bone Regeneration",slug:"doped-bioactive-glass-materials-in-bone-regeneration",totalDownloads:3499,totalCrossrefCites:13,totalDimensionsCites:34,abstract:"In the arena of orthopaedic surgery, autograft is considered to be the gold standard for correction of fracture repair or other bone pathologies. But, it has some limitations such as donor site morbidity and shortage of supply, which evolved the use of allograft that also has some disadvantages such as immunogenic response to the host, low osteogenicity as well as possibilities of disease transmission. Despite the benefits of autografts and allografts, the limitations of each have necessitated the pursuit of alternatives biomaterials that has the ability to initiate osteogenesis, and the graft should closely mimic the natural bone along with regeneration of fibroblasts. A variety of artificial materials such as demineralised bone matrix, coralline hydroxyapatite and calcium phosphate-based ceramics such as hydroxyapatite (HA), β-tricalcium phosphate (β-TCP) and bioactive glass have been used over the decades to fill bone defects almost without associated soft tissue development. Most of them were having only the properties of osteointegration and osteoconduction. Only bioactive glass possesses osteogenic property that stimulates proliferation and differentiation of osteoprogenitor cells and in some cases influencing the fibroblastic properties. But, this material has also some disadvantages such as short-term and low mechanical strength along with decreased fracture resistance; but, this was further minimised by ion doping that positively enhanced new bone formation. There are many metal ions such as magnesium (Mg), strontium (Sr), manganese (Mn), iron (Fe), zinc (Zn), silver (Ag) and some rare earths that have been doped successfully into bioactive glass to enhance their mechanical and biological properties. In some of the cases, mesoporous bioactive glass materials with or without such doping have also been employed (with homogeneous distribution of pores in the size ranging between 2 and 50 nm). These biomaterials can be served as scaffold for bone regeneration with adequate mechanical properties to restore bone defects and facilitate healing process by regeneration of soft tissues as well. This chapter encompasses the use of bioactive glass in bulk and mesoporous form with doped therapeutic ions, their role in bone tissue regeneration, use as delivery of growth factors as well as coating material for orthopaedic implants.",book:{id:"5164",slug:"advanced-techniques-in-bone-regeneration",title:"Advanced Techniques in Bone Regeneration",fullTitle:"Advanced Techniques in Bone Regeneration"},signatures:"Samit Kumar Nandi, Arnab Mahato, Biswanath Kundu and Prasenjit\nMukherjee",authors:[{id:"60514",title:"Dr.",name:"Samit",middleName:null,surname:"Nandi",slug:"samit-nandi",fullName:"Samit Nandi"}]},{id:"37120",doi:"10.5772/29607",title:"Trigeminocardiac Reflex in Neurosurgery - Current Knowledge and Prospects",slug:"the-trigeminocardiac-reflex-in-neurosurgery-current-knowledge-and-prospects",totalDownloads:3434,totalCrossrefCites:10,totalDimensionsCites:27,abstract:null,book:{id:"749",slug:"explicative-cases-of-controversial-issues-in-neurosurgery",title:"Explicative Cases of Controversial Issues in Neurosurgery",fullTitle:"Explicative Cases of Controversial Issues in Neurosurgery"},signatures:"Amr Abdulazim, Martin N. Stienen, Pooyan Sadr-Eshkevari, Nora Prochnow, Nora Sandu, Benham Bohluli and Bernhard Schaller",authors:[{id:"78171",title:"Prof.",name:"Bernhard",middleName:null,surname:"Schaller",slug:"bernhard-schaller",fullName:"Bernhard Schaller"},{id:"78525",title:"Mr.",name:"Amr",middleName:null,surname:"Abdulazim",slug:"amr-abdulazim",fullName:"Amr Abdulazim"},{id:"78530",title:"Dr",name:"Pooyan",middleName:null,surname:"Sadr-Eshkevari",slug:"pooyan-sadr-eshkevari",fullName:"Pooyan Sadr-Eshkevari"},{id:"126039",title:"Dr.",name:"Martin",middleName:"Nikolaus",surname:"Stienen",slug:"martin-stienen",fullName:"Martin Stienen"},{id:"126040",title:"Dr.",name:"Nora",middleName:null,surname:"Prochnow",slug:"nora-prochnow",fullName:"Nora Prochnow"},{id:"126041",title:"Dr.",name:"Benham",middleName:null,surname:"Bohluli",slug:"benham-bohluli",fullName:"Benham Bohluli"}]},{id:"26863",doi:"10.5772/26362",title:"The Bearing Surfaces in Total Hip Arthroplasty – Options, Material Characteristics and Selection",slug:"the-bearing-surfaces-in-total-hip-arthroplasty-options-material-characteristics-and-selection",totalDownloads:9526,totalCrossrefCites:10,totalDimensionsCites:21,abstract:null,book:{id:"938",slug:"recent-advances-in-arthroplasty",title:"Recent Advances in Arthroplasty",fullTitle:"Recent Advances in Arthroplasty"},signatures:"Hamid Reza Seyyed Hosseinzadeh, Alireza Eajazi and Ali Sina Shahi",authors:[{id:"66361",title:"Dr.",name:"Alireza",middleName:null,surname:"Eajazi",slug:"alireza-eajazi",fullName:"Alireza Eajazi"},{id:"74857",title:"Dr.",name:"Hamid Reza",middleName:null,surname:"Seyyed Hosseinzadeh",slug:"hamid-reza-seyyed-hosseinzadeh",fullName:"Hamid Reza Seyyed Hosseinzadeh"},{id:"173207",title:"Dr.",name:"Alisina",middleName:null,surname:"Shahi",slug:"alisina-shahi",fullName:"Alisina Shahi"}]}],mostDownloadedChaptersLast30Days:[{id:"65467",title:"Anesthesia Management for Large-Volume Liposuction",slug:"anesthesia-management-for-large-volume-liposuction",totalDownloads:6203,totalCrossrefCites:1,totalDimensionsCites:2,abstract:"The apparent easiness with which liposuction is performed favors that patients, young surgeons, and anesthesiologists without experience in this field ignore the many events that occur during this procedure. Liposuction is a procedure to improve the body contour and not a surgery to reduce weight, although recently people who have failed in their plans to lose weight look at liposuction as a means to contour their body figure. Tumescent liposuction of large volumes requires a meticulous selection of each patient; their preoperative evaluation and perioperative management are essential to obtain the expected results. The various techniques of general anesthesia are the most recommended and should be monitored in the usual way, as well as monitoring the total doses of infiltrated local anesthetics to avoid systemic toxicity. The management of intravenous fluids is controversial, but the current trend is the restricted use of hydrosaline solutions. The most feared complications are deep vein thrombosis, pulmonary thromboembolism, fat embolism, lung edema, hypothermia, infections and even death. The adherence to the management guidelines and prophylaxis of venous thrombosis/thromboembolism is mandatory.",book:{id:"6221",slug:"anesthesia-topics-for-plastic-and-reconstructive-surgery",title:"Anesthesia Topics for Plastic and Reconstructive Surgery",fullTitle:"Anesthesia Topics for Plastic and Reconstructive Surgery"},signatures:"Sergio Granados-Tinajero, Carlos Buenrostro-Vásquez, Cecilia\nCárdenas-Maytorena and Marcela Contreras-López",authors:[{id:"273532",title:"Dr.",name:"Sergio Octavio",middleName:null,surname:"Granados Tinajero",slug:"sergio-octavio-granados-tinajero",fullName:"Sergio Octavio Granados Tinajero"}]},{id:"42855",title:"Critical Care Issues After Major Hepatic Surgery",slug:"critical-care-issues-after-major-hepatic-surgery",totalDownloads:8935,totalCrossrefCites:2,totalDimensionsCites:2,abstract:null,book:{id:"3164",slug:"hepatic-surgery",title:"Hepatic Surgery",fullTitle:"Hepatic Surgery"},signatures:"Ashok Thorat and Wei-Chen Lee",authors:[{id:"52360",title:"Prof.",name:"Wei-Chen",middleName:null,surname:"Lee",slug:"wei-chen-lee",fullName:"Wei-Chen Lee"},{id:"157213",title:"Dr.",name:"Ashok",middleName:null,surname:"Thorat",slug:"ashok-thorat",fullName:"Ashok Thorat"}]},{id:"72175",title:"Fontan Operation: A Comprehensive Review",slug:"fontan-operation-a-comprehensive-review",totalDownloads:1299,totalCrossrefCites:3,totalDimensionsCites:2,abstract:"Since the first description of the Fontan operation in the early 1970s, a number of modifications have been introduced and currently staged, total cavopulmonary connection with fenestration has become the most commonly used multistage surgery in diverting the vena caval blood flow into the lungs. The existing ventricle, whether it is left or right, is utilized to supply systemic circuit. During Stage I, palliative surgery is performed, usually at presentation in the neonatal period/early infancy, on the basis of pathophysiology of the cardiac defect. During Stage II, a bidirectional Glenn procedure is undertaken in which the superior vena caval flow is diverted into the lungs at an approximate age of 6 months. During Stage IIIA, the blood flow from the inferior vena cava (IVC) is rerouted into the pulmonary arteries, typically by an extra-cardiac conduit along with a fenestration, generally around 2 years of age. During Stage IIIB, the fenestration is closed by transcatheter methodology 6–12 months after Stage IIIA. The evolution of Fontan concepts, the indications for Fontan surgery, and the results of old and current types of Fontan operation form the focus of this review.",book:{id:"9585",slug:"advances-in-complex-valvular-disease",title:"Advances in Complex Valvular Disease",fullTitle:"Advances in Complex Valvular Disease"},signatures:"P. Syamasundar Rao",authors:[{id:"68531",title:"Dr.",name:"P. Syamasundar",middleName:null,surname:"Rao",slug:"p.-syamasundar-rao",fullName:"P. Syamasundar Rao"}]},{id:"45712",title:"Serdev Sutures® in Middle Face",slug:"serdev-sutures-in-middle-face",totalDownloads:4952,totalCrossrefCites:0,totalDimensionsCites:0,abstract:null,book:{id:"2989",slug:"miniinvasive-face-and-body-lifts-closed-suture-lifts-or-barbed-thread-lifts",title:"Miniinvasive Face and Body Lifts",fullTitle:"Miniinvasive Face and Body Lifts - Closed Suture Lifts or Barbed Thread Lifts"},signatures:"Nikolay Serdev",authors:[{id:"32585",title:"Dr.",name:"Nikolay",middleName:null,surname:"Serdev",slug:"nikolay-serdev",fullName:"Nikolay Serdev"}]},{id:"55812",title:"Postural Restoration: A Tri-Planar Asymmetrical Framework for Understanding, Assessing, and Treating Scoliosis and Other Spinal Dysfunctions",slug:"postural-restoration-a-tri-planar-asymmetrical-framework-for-understanding-assessing-and-treating-sc",totalDownloads:7701,totalCrossrefCites:0,totalDimensionsCites:1,abstract:"Current medical practice does not recognize the influence of innate, physiological, human asymmetry on scoliosis and other postural disorders. Interventions meant to correct these conditions are commonly based on symmetrical models of appearance and do not take into account asymmetric organ weight distribution, asymmetries of respiratory mechanics, and dominant movement patterns that are reinforced in daily functional activities. A model of innate, human asymmetry derived from the theoretical framework of the Postural Restoration Institute® (PRI) explicitly describes the physiological, biomechanical, and respiratory components of human asymmetry. This model is important because it gives an accurate baseline for understanding predisposing factors for the development of postural disorders, which, without intervention, will likely progress to structural dysfunction. Clinical tests to evaluate tri-planar musculoskeletal relationships and function, developed by PRI, are based on this asymmetric model. These tests are valuable for assessing patient’s status in the context of human asymmetry and in guiding appropriate exercise prescription and progression. Balancing musculoskeletal asymmetry is the aim of PRI treatment. Restoration of relative balance decreases pain, restores improved alignment, and strengthens appropriate muscle function. It can also halt the progression of dysfunction and improve respiration, quality of life, and appearance. PRI’s extensive body of targeted exercise progressions are highly effective due to their basis in the tri-planar asymmetric human model.",book:{id:"5816",slug:"innovations-in-spinal-deformities-and-postural-disorders",title:"Innovations in Spinal Deformities and Postural Disorders",fullTitle:"Innovations in Spinal Deformities and Postural Disorders"},signatures:"Susan Henning, Lisa C. Mangino and Jean Massé",authors:[{id:"204825",title:"Dr.",name:"Susan",middleName:null,surname:"Henning",slug:"susan-henning",fullName:"Susan Henning"},{id:"206242",title:"Dr.",name:"Lisa C",middleName:null,surname:"Mangino",slug:"lisa-c-mangino",fullName:"Lisa C Mangino"},{id:"206245",title:"Dr.",name:"Jean",middleName:null,surname:"Massé",slug:"jean-masse",fullName:"Jean Massé"}]}],onlineFirstChaptersFilter:{topicId:"202",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"82020",title:"Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Novel Technique and Technology with Case Series",slug:"minimally-invasive-transforaminal-lumbar-interbody-fusion-a-novel-technique-and-technology-with-case",totalDownloads:6,totalDimensionsCites:0,doi:"10.5772/intechopen.105187",abstract:"Minimally invasive spine surgery (MIS) transforaminal lumbar interbody fusion (MI-TLIF) has been utilized to treat a variety of spinal disorders. Like other minimally invasive spine surgery techniques and technology, the MI-TLIF approach has the potential to limit the morbidity associated with larger exposures required for open surgery. The MI-TLIF approach has a number of advantages over many other minimally invasive spine surgery approaches including direct decompression of neural elements, collection of morselized autograph from the surgical site to achieve high fusion rates, restoration of spinal canal diameter, foraminal diameter, disk height, and reduction of spondylolisthesis. In this chapter, we discuss a novel technique for performing MI-TLIF developed by the senior author who is a leading minimally invasive spine surgeon. The technique and technology illustrated in this chapter were developed out of a recognition of a need to reduce the learning curve for performing MI-TLIF, as well as need for a cost-effective method that provides a high fusion rate, excellent clinical outcomes, and low complication rate. The indications, surgical planning, postoperative care, complications, and patient outcomes in a large series will be reviewed using this novel MI-TLIF technique.",book:{id:"10634",title:"Minimally Invasive Spine Surgery - Advances and Innovations",coverURL:"https://cdn.intechopen.com/books/images_new/10634.jpg"},signatures:"Mick Perez-Cruet, Ramiro Pérez de la Torre and Siddharth Ramanathan"},{id:"78335",title:"Safety and Efficiency of Cervical Disc Arthroplasty in Ambulatory Surgery Centers",slug:"safety-and-efficiency-of-cervical-disc-arthroplasty-in-ambulatory-surgery-centers",totalDownloads:5,totalDimensionsCites:0,doi:"10.5772/intechopen.99589",abstract:"Introduction Anterior cervical surgeries have been safely performed in ambulatory surgery centers since 1995 with the first cases being one level anterior cervical discectomies without fusion, then in 1996, one level anterior cervical discectomies with fusion (ACDF). When it is was certain that outpatient fusion was safe, the number of ACDF levels slowly and methodically were increased to the now standard outpatient maximum of four level ACDF. During this evolution, with the introduction of arthroplasty surgery, one level arthroplasties were considered appropriate for outpatient surgery and now two-level outpatient cervical arthroplasties are routine and some three level arthroplasties have been performed with no additional morbidity compared to one level procedures. The author first reported a series of 27 patients in 2010 who underwent cervical disc replacement at an ASC. (Wohns, R. Safety and cost-effectiveness of outpatient cervical disc arthroplasty. Surg. Neurol. Int. 1, 77, 2010). The average operative time was 40 minutes and the patients were observed over a period of three hours prior to discharge. None of the patients had major complications and there were no reports of worsening or persistent pain. The results of a Delphi study in 2018 compared the safety and efficiency of one-level and two-level arthroplasty procedures performed in an ASC and in a hospital setting. (Gornet et al. Safety and Efficiency of Cervical Disc Arthroplasty in Ambulatory Surgery Centers vs Hospital Settings. Int’l J of Spine Surgery. Vol. 12, No.5, 2018, pp. 557-564). The study analyzed outcomes of 145 ASC patients, 348 hospital outpatients and 65 hospital inpatients and the conclusion was that both one and two-level arthroplasties may be performed safely in an ASC. Surgeries in ASCs are of shorter duration and performed with less blood loss without increased AEs. At the present time, there does not appear to be any contra-indication to performing the vast majority of cervical arthroplasties in an ambulatory surgery center (ASC). Furthermore, the cost of an outpatient arthroplasty is commonly 30% to 50% of the cost of hospital-based procedures.",book:{id:"10634",title:"Minimally Invasive Spine Surgery - Advances and Innovations",coverURL:"https://cdn.intechopen.com/books/images_new/10634.jpg"},signatures:"Richard N.W. Wohns"},{id:"82255",title:"Minimally Invasive Laminectomy for Lumbar Stenosis with Case Series of Patients with Multi-level (3 or More Levels) Stenosis",slug:"minimally-invasive-laminectomy-for-lumbar-stenosis-with-case-series-of-patients-with-multi-level-3-o",totalDownloads:28,totalDimensionsCites:0,doi:"10.5772/intechopen.105186",abstract:"Lumbar stenosis is the most common pathology seen and treated by spine surgeons. It is often seen in the elderly population who frequently have multiple medical co-morbidities. Traditional approaches remove the spinous process and detach paraspinous muscles to achieve adequate canal decompression. This approach can damage the posterior tension band leading to permanent muscle damage, scar tissue formation, iatrogenic flatback syndrome, and increase risk of adjacent segment disease requiring reoperation. Performing lumbar laminectomy in a cost-effective manner is critical in effectively treating patients with lumbar stenosis. This chapter reviews a minimally invasive muscle-sparing approach to treating lumbar stenosis. The technique is performed through a tubular retractor. Direct decompression of the spinal stenosis is achieved while preserving the paraspinous muscle attachments and spinous process. This technique has multiple advantages and can potentially reduce load stress on adjacent levels and subsequent adjacent level pathology leading to further surgical intervention. In addition, the procedure shows how facet fusion is performed using the patient’s own locally harvested drilled morselized autograph to achieve bilateral facet fusion. By fusing the facets, we have shown that restenosis at the operative level is less likely to occur. This chapter will review a case series of multilevel lumbar stenosis including clinical outcomes.",book:{id:"10634",title:"Minimally Invasive Spine Surgery - Advances and Innovations",coverURL:"https://cdn.intechopen.com/books/images_new/10634.jpg"},signatures:"Mick Perez-Cruet, Ramiro Pérez de la Torre and Siddharth Ramanathan"},{id:"80705",title:"Cervical Arthroplasty",slug:"cervical-arthroplasty",totalDownloads:37,totalDimensionsCites:0,doi:"10.5772/intechopen.102964",abstract:"Technological advances have allowed spine surgery to follow the trend toward minimally invasive surgery in general. Specifically, we have seen a corresponding rise in the popularity of cervical arthroplasty. For the treatment of cervical disc disease, arthroplasty is a less invasive option than the gold standard of cervical discectomy and arthrodesis, which by nature is more disruptive to surrounding tissues. Arthroplasty preserves the facets, maintains motion, and reduces the rate of adjacent segment breakdown. These factors counteract the negative impacts of fusion while maintaining the benefits. Arthroplasty implants themselves have become more streamlined to implant as well with less native bone destruction, and biomechanics more compatible with the native disc. While initial implants were ball and socket devices with complex fixation and plane-specific movements, later devices incorporated such motions as translation and compression. Viscoelastic components and materials more closely resembling native tissues afford a more biocompatible implant profile. Until cell-based therapies can successfully reproduce native tissue, we will rely on artificial components that closely resemble and assimilate them.",book:{id:"10634",title:"Minimally Invasive Spine Surgery - Advances and Innovations",coverURL:"https://cdn.intechopen.com/books/images_new/10634.jpg"},signatures:"Jason M. Highsmith"},{id:"80605",title:"Minimally Invasive Treatment of Spinal Metastasis",slug:"minimally-invasive-treatment-of-spinal-metastasis",totalDownloads:42,totalDimensionsCites:0,doi:"10.5772/intechopen.102485",abstract:"Advancements in the treatment of systemic cancer have improved life expectancy in cancer patients and consequently the incidence of spinal metastasis. Traditionally, open spinal approaches combined with cEBRT (conventional external beam radiation therapy) allowed for local tumor control as well as stabilization and decompression of the spine and neural elements, but these larger operations can be fraught with one complications and delayed healing as well as additional morbidity. Recently, minimally invasive spine techniques are becoming increasingly popular in the treatment of spinal metastasis for many reasons, including smaller incisions with less perioperative complications and potential for expedited time to radiation therapy. These techniques include kyphoplasty with radiofrequency ablation, percutaneous stabilization, laminectomy, and epidural tumor resection through tubular retractors, as well as minimally invasive corpectomy. These techniques combined with highly conformal stereotactic radiosurgery have led to the advent of separation surgery, which allows for decompression of neural elements while creating space between neural elements and the tumor so adequate radiation may be delivered, improving local tumor control. The versatility of these minimally invasive techniques has significantly improved the modern management of metastatic disease of the spine by protecting and restoring the patient’s quality of life while allowing them to quickly resume radiation and systemic treatment.",book:{id:"10634",title:"Minimally Invasive Spine Surgery - Advances and Innovations",coverURL:"https://cdn.intechopen.com/books/images_new/10634.jpg"},signatures:"Eric R. Mong and Daniel K. Fahim"},{id:"76620",title:"Minimally Invasive Lateral Approach for Anterior Spinal Cord Decompression in Thoracic Myelopathy",slug:"minimally-invasive-lateral-approach-for-anterior-spinal-cord-decompression-in-thoracic-myelopathy",totalDownloads:146,totalDimensionsCites:0,doi:"10.5772/intechopen.97669",abstract:"Myelopathy can result from a thoracic disc herniation (TDH) compressing the anterior spinal cord. Disc calcification and difficulty in accessing the anterior spinal cord pose an operative challenge. A mini-open lateral approach to directly decompress the anterior spinal cord can be performed with or without concomitant interbody fusion depending on pre-existing or iatrogenic spinal instability. Experience using stand-alone expandable spacers to achieve interbody fusion in this setting is limited. Technical advantages, risks and limitations of this technique are discussed. We conducted a retrospective chart review of all patients with thoracic and upper lumbar myelopathy treated with a lateral mini-open lateral approach. Review of the literature identified 6 other case series using similar lateral minimally invasive approaches to treat thoracic or upper lumbar disc herniation showing efficient and safe thoracic disc decompression procedure for myelopathy. This technique can be combined with interbody arthrodesis when instability is suspected.",book:{id:"10634",title:"Minimally Invasive Spine Surgery - Advances and Innovations",coverURL:"https://cdn.intechopen.com/books/images_new/10634.jpg"},signatures:"Edna E. Gouveia, Mansour Mathkour, Erin McCormack, Jonathan Riffle, Olawale A. Sulaiman and Daniel J. 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The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}},{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}}]},series:{item:{id:"11",title:"Biochemistry",doi:"10.5772/intechopen.72877",issn:"2632-0983",scope:"Biochemistry, the study of chemical transformations occurring within living organisms, impacts all areas of life sciences, from molecular crystallography and genetics to ecology, medicine, and population biology. 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I am a Senior Lecturer in the Department of Parasitology and Entomology, Nnamdi Azikiwe University, Awka.",institutionString:null,institution:{name:"Nnamdi Azikiwe University",country:{name:"Nigeria"}}},{id:"284232",title:"Mr.",name:"Nikunj",middleName:"U",surname:"Tandel",slug:"nikunj-tandel",fullName:"Nikunj Tandel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/284232/images/8275_n.jpg",biography:'Mr. Nikunj Tandel has completed his Master\'s degree in Biotechnology from VIT University, India in the year of 2012. He is having 8 years of research experience especially in the field of malaria epidemiology, immunology, and nanoparticle-based drug delivery system against the infectious diseases, autoimmune disorders and cancer. He has worked for the NIH funded-International Center of Excellence in Malaria Research project "Center for the study of complex malaria in India (CSCMi)" in collaboration with New York University. The preliminary objectives of the study are to understand and develop the evidence-based tools and interventions for the control and prevention of malaria in different sites of the INDIA. Alongside, with the help of next-generation genomics study, the team has studied the antimalarial drug resistance in India. Further, he has extended his research in the development of Humanized mice for the study of liver-stage malaria and identification of molecular marker(s) for the Artemisinin resistance. At present, his research focuses on understanding the role of B cells in the activation of CD8+ T cells in malaria. Received the CSIR-SRF (Senior Research Fellow) award-2018, FIMSA (Federation of Immunological Societies of Asia-Oceania) Travel Bursary award to attend the IUIS-IIS-FIMSA Immunology course-2019',institutionString:"Nirma University",institution:{name:"Nirma University",country:{name:"India"}}},{id:"334383",title:"Ph.D.",name:"Simone",middleName:"Ulrich",surname:"Ulrich Picoli",slug:"simone-ulrich-picoli",fullName:"Simone Ulrich Picoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334383/images/15919_n.jpg",biography:"Graduated in Pharmacy from Universidade Luterana do Brasil (1999), Master in Agricultural and Environmental Microbiology from Federal University of Rio Grande do Sul (2002), Specialization in Clinical Microbiology from Universidade de São Paulo, USP (2007) and PhD in Sciences in Gastroenterology and Hepatology (2012). She is currently an Adjunct Professor at Feevale University in Medicine and Biomedicine courses and a permanent professor of the Academic Master\\'s Degree in Virology. She has experience in the field of Microbiology, with an emphasis on Bacteriology, working mainly on the following topics: bacteriophages, bacterial resistance, clinical microbiology and food microbiology.",institutionString:null,institution:{name:"Universidade Feevale",country:{name:"Brazil"}}},{id:"229220",title:"Dr.",name:"Amjad",middleName:"Islam",surname:"Aqib",slug:"amjad-aqib",fullName:"Amjad Aqib",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229220/images/system/229220.png",biography:"Dr. Amjad Islam Aqib obtained a DVM and MSc (Hons) from University of Agriculture Faisalabad (UAF), Pakistan, and a PhD from the University of Veterinary and Animal Sciences Lahore, Pakistan. Dr. Aqib joined the Department of Clinical Medicine and Surgery at UAF for one year as an assistant professor where he developed a research laboratory designated for pathogenic bacteria. Since 2018, he has been Assistant Professor/Officer in-charge, Department of Medicine, Manager Research Operations and Development-ORIC, and President One Health Club at Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan. He has nearly 100 publications to his credit. His research interests include epidemiological patterns and molecular analysis of antimicrobial resistance and modulation and vaccine development against animal pathogens of public health concern.",institutionString:"Cholistan University of Veterinary and Animal Sciences",institution:{name:"University of Agriculture Faisalabad",country:{name:"Pakistan"}}},{id:"333753",title:"Dr.",name:"Rais",middleName:null,surname:"Ahmed",slug:"rais-ahmed",fullName:"Rais Ahmed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333753/images/20168_n.jpg",biography:null,institutionString:null,institution:{name:"University of Agriculture Faisalabad",country:{name:"Pakistan"}}},{id:"62900",title:"Prof.",name:"Fethi",middleName:null,surname:"Derbel",slug:"fethi-derbel",fullName:"Fethi Derbel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/62900/images/system/62900.jpeg",biography:"Professor Fethi Derbel was born in 1960 in Tunisia. He received his medical degree from the Sousse Faculty of Medicine at Sousse, University of Sousse, Tunisia. He completed his surgical residency in General Surgery at the University Hospital Farhat Hached of Sousse and was a member of the Unit of Liver Transplantation in the University of Rennes, France. He then worked in the Department of Surgery at the Sahloul University Hospital in Sousse. Professor Derbel is presently working at the Clinique les Oliviers, Sousse, Tunisia. His hospital activities are mostly concerned with laparoscopic, colorectal, pancreatic, hepatobiliary, and gastric surgery. He is also very interested in hernia surgery and performs ventral hernia repairs and inguinal hernia repairs. He has been a member of the GREPA and Tunisian Hernia Society (THS). During his residency, he managed patients suffering from diabetic foot, and he was very interested in this pathology. For this reason, he decided to coordinate a book project dealing with the diabetic foot. Professor Derbel has published many articles in journals and collaborates intensively with IntechOpen Access Publisher as an editor.",institutionString:"Clinique les Oliviers",institution:null},{id:"300144",title:"Dr.",name:"Meriem",middleName:null,surname:"Braiki",slug:"meriem-braiki",fullName:"Meriem Braiki",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/300144/images/system/300144.jpg",biography:"Dr. Meriem Braiki is a specialist in pediatric surgeon from Tunisia. She was born in 1985. She received her medical degree from the University of Medicine at Sousse, Tunisia. She achieved her surgical residency training periods in Pediatric Surgery departments at University Hospitals in Monastir, Tunis and France.\r\nShe is currently working at the Pediatric surgery department, Sidi Bouzid Hospital, Tunisia. Her hospital activities are mostly concerned with laparoscopic, parietal, urological and digestive surgery. She has published several articles in diffrent journals.",institutionString:"Sidi Bouzid Regional Hospital",institution:null},{id:"229481",title:"Dr.",name:"Erika M.",middleName:"Martins",surname:"de Carvalho",slug:"erika-m.-de-carvalho",fullName:"Erika M. de Carvalho",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229481/images/6397_n.jpg",biography:null,institutionString:null,institution:{name:"Oswaldo Cruz Foundation",country:{name:"Brazil"}}},{id:"186537",title:"Prof.",name:"Tonay",middleName:null,surname:"Inceboz",slug:"tonay-inceboz",fullName:"Tonay Inceboz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/186537/images/system/186537.jfif",biography:"I was graduated from Ege University of Medical Faculty (Turkey) in 1988 and completed his Med. PhD degree in Medical Parasitology at the same university. I became an Associate Professor in 2008 and Professor in 2014. I am currently working as a Professor at the Department of Medical Parasitology at Dokuz Eylul University, Izmir, Turkey.\n\nI have given many lectures, presentations in different academic meetings. I have more than 60 articles in peer-reviewed journals, 18 book chapters, 1 book editorship.\n\nMy research interests are Echinococcus granulosus, Echinococcus multilocularis (diagnosis, life cycle, in vitro and in vivo cultivation), and Trichomonas vaginalis (diagnosis, PCR, and in vitro cultivation).",institutionString:"Dokuz Eylül University",institution:{name:"Dokuz Eylül University",country:{name:"Turkey"}}},{id:"71812",title:"Prof.",name:"Hanem Fathy",middleName:"Fathy",surname:"Khater",slug:"hanem-fathy-khater",fullName:"Hanem Fathy Khater",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/71812/images/1167_n.jpg",biography:"Prof. Khater is a Professor of Parasitology at Benha University, Egypt. She studied for her doctoral degree, at the Department of Entomology, College of Agriculture, Food and Natural Resources, University of Missouri, Columbia, USA. She has completed her Ph.D. degrees in Parasitology in Egypt, from where she got the award for “the best scientific Ph.D. dissertation”. She worked at the School of Biological Sciences, Bristol, England, the UK in controlling insects of medical and veterinary importance as a grant from Newton Mosharafa, the British Council. Her research is focused on searching of pesticides against mosquitoes, house flies, lice, green bottle fly, camel nasal botfly, soft and hard ticks, mites, and the diamondback moth as well as control of several parasites using safe and natural materials to avoid drug resistances and environmental contamination.",institutionString:null,institution:{name:"Banha University",country:{name:"Egypt"}}},{id:"99780",title:"Prof.",name:"Omolade",middleName:"Olayinka",surname:"Okwa",slug:"omolade-okwa",fullName:"Omolade Okwa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/99780/images/system/99780.jpg",biography:"Omolade Olayinka Okwa is presently a Professor of Parasitology at Lagos State University, Nigeria. She has a PhD in Parasitology (1997), an MSc in Cellular Parasitology (1992), and a BSc (Hons) Zoology (1990) all from the University of Ibadan, Nigeria. She teaches parasitology at the undergraduate and postgraduate levels. She was a recipient of a Commonwealth fellowship supported by British Council tenable at the Centre for Entomology and Parasitology (CAEP), Keele University, United Kingdom between 2004 and 2005. She was awarded an Honorary Visiting Research Fellow at the same university from 2005 to 2007. \nShe has been an external examiner to the Department of Veterinary Microbiology and Parasitology, University of Ibadan, MSc programme between 2010 and 2012. She is a member of the Nigerian Society of Experimental Biology (NISEB), Parasitology and Public Health Society of Nigeria (PPSN), Science Association of Nigeria (SAN), Zoological Society of Nigeria (ZSN), and is Vice Chairperson of the Organisation of Women in Science (OWSG), LASU chapter. She served as Head of Department of Zoology and Environmental Biology, Lagos State University from 2007 to 2010 and 2014 to 2016. She is a reviewer for several local and international journals such as Unilag Journal of Science, Libyan Journal of Medicine, Journal of Medicine and Medical Sciences, and Annual Research and Review in Science. \nShe has authored 45 scientific research publications in local and international journals, 8 scientific reviews, 4 books, and 3 book chapters, which includes the books “Malaria Parasites” and “Malaria” which are IntechOpen access publications.",institutionString:"Lagos State University",institution:{name:"Lagos State University",country:{name:"Nigeria"}}},{id:"273100",title:"Dr.",name:"Vijay",middleName:null,surname:"Gayam",slug:"vijay-gayam",fullName:"Vijay Gayam",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/273100/images/system/273100.jpeg",biography:"Dr. Vijay Bhaskar Reddy Gayam is currently practicing as an internist at Interfaith Medical Center in Brooklyn, New York, USA. He is also a Clinical Assistant Professor at the SUNY Downstate University Hospital and Adjunct Professor of Medicine at the American University of Antigua. He is a holder of an M.B.B.S. degree bestowed to him by Osmania Medical College and received his M.D. at Interfaith Medical Center. His career goals thus far have heavily focused on direct patient care, medical education, and clinical research. He currently serves in two leadership capacities; Assistant Program Director of Medicine at Interfaith Medical Center and as a Councilor for the American\r\nFederation for Medical Research. As a true academician and researcher, he has more than 50 papers indexed in international peer-reviewed journals. He has also presented numerous papers in multiple national and international scientific conferences. His areas of research interest include general internal medicine, gastroenterology and hepatology. He serves as an editor, editorial board member and reviewer for multiple international journals. His research on Hepatitis C has been very successful and has led to multiple research awards, including the 'Equity in Prevention and Treatment Award” from the New York Department of Health Viral Hepatitis Symposium (2018) and the 'Presidential Poster Award” awarded to him by the American College of Gastroenterology (2018). He was also awarded 'Outstanding Clinician in General Medicine” by Venus International Foundation for his extensive research expertise and services, perform over and above the standard expected in the advancement of healthcare, patient safety and quality of care.",institutionString:"Interfaith Medical Center",institution:{name:"Interfaith Medical Center",country:{name:"United States of America"}}},{id:"93517",title:"Dr.",name:"Clement",middleName:"Adebajo",surname:"Meseko",slug:"clement-meseko",fullName:"Clement Meseko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/93517/images/system/93517.jpg",biography:"Dr. Clement Meseko obtained DVM and PhD degree in Veterinary Medicine and Virology respectively. He has worked for over 20 years in both private and public sectors including the academia, contributing to knowledge and control of infectious disease. Through the application of epidemiological skill, classical and molecular virological skills, he investigates viruses of economic and public health importance for the mitigation of the negative impact on people, animal and the environment in the context of Onehealth. \r\nDr. Meseko’s field experience on animal and zoonotic diseases and pathogen dynamics at the human-animal interface over the years shaped his carrier in research and scientific inquiries. He has been part of the investigation of Highly Pathogenic Avian Influenza incursions in sub Saharan Africa and monitors swine Influenza (Pandemic influenza Virus) agro-ecology and potential for interspecies transmission. He has authored and reviewed a number of journal articles and book chapters.",institutionString:"National Veterinary Research Institute",institution:{name:"National Veterinary Research Institute",country:{name:"Nigeria"}}},{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRET3QAO/Profile_Picture_2022-05-10T10:10:26.jpeg",biography:"Professor Dr. Shailendra K. Saxena is a vice dean and professor at King George's Medical University, Lucknow, India. His research interests involve understanding the molecular mechanisms of host defense during human viral infections and developing new predictive, preventive, and therapeutic strategies for them using Japanese encephalitis virus (JEV), HIV, and emerging viruses as a model via stem cell and cell culture technologies. His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. Dr. Saxena is a fellow of various international societies/academies including the Royal College of Pathologists, United Kingdom; Royal Society of Medicine, London; Royal Society of Biology, United Kingdom; Royal Society of Chemistry, London; and Academy of Translational Medicine Professionals, Austria. He was named a Global Leader in Science by The Scientist. He is also an international opinion leader/expert in vaccination for Japanese encephalitis by IPIC (UK).",institutionString:"King George's Medical University",institution:{name:"King George's Medical University",country:{name:"India"}}},{id:"94928",title:"Dr.",name:"Takuo",middleName:null,surname:"Mizukami",slug:"takuo-mizukami",fullName:"Takuo Mizukami",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94928/images/6402_n.jpg",biography:null,institutionString:null,institution:{name:"National Institute of Infectious Diseases",country:{name:"Japan"}}},{id:"233433",title:"Dr.",name:"Yulia",middleName:null,surname:"Desheva",slug:"yulia-desheva",fullName:"Yulia Desheva",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/233433/images/system/233433.png",biography:"Dr. Yulia Desheva is a leading researcher at the Institute of Experimental Medicine, St. Petersburg, Russia. She is a professor in the Stomatology Faculty, St. Petersburg State University. She has expertise in the development and evaluation of a wide range of live mucosal vaccines against influenza and bacterial complications. Her research interests include immunity against influenza and COVID-19 and the development of immunization schemes for high-risk individuals.",institutionString:'Federal State Budgetary Scientific Institution "Institute of Experimental Medicine"',institution:null},{id:"238958",title:"Mr.",name:"Atamjit",middleName:null,surname:"Singh",slug:"atamjit-singh",fullName:"Atamjit Singh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/238958/images/6575_n.jpg",biography:null,institutionString:null,institution:null},{id:"252058",title:"M.Sc.",name:"Juan",middleName:null,surname:"Sulca",slug:"juan-sulca",fullName:"Juan Sulca",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252058/images/12834_n.jpg",biography:null,institutionString:null,institution:null},{id:"191392",title:"Dr.",name:"Marimuthu",middleName:null,surname:"Govindarajan",slug:"marimuthu-govindarajan",fullName:"Marimuthu Govindarajan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/191392/images/5828_n.jpg",biography:"Dr. M. Govindarajan completed his BSc degree in Zoology at Government Arts College (Autonomous), Kumbakonam, and MSc, MPhil, and PhD degrees at Annamalai University, Annamalai Nagar, Tamil Nadu, India. He is serving as an assistant professor at the Department of Zoology, Annamalai University. His research interests include isolation, identification, and characterization of biologically active molecules from plants and microbes. He has identified more than 20 pure compounds with high mosquitocidal activity and also conducted high-quality research on photochemistry and nanosynthesis. He has published more than 150 studies in journals with impact factor and 2 books in Lambert Academic Publishing, Germany. He serves as an editorial board member in various national and international scientific journals.",institutionString:null,institution:null},{id:"274660",title:"Dr.",name:"Damodar",middleName:null,surname:"Paudel",slug:"damodar-paudel",fullName:"Damodar Paudel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/274660/images/8176_n.jpg",biography:"I am DrDamodar Paudel,currently working as consultant Physician in Nepal police Hospital.",institutionString:null,institution:null},{id:"241562",title:"Dr.",name:"Melvin",middleName:null,surname:"Sanicas",slug:"melvin-sanicas",fullName:"Melvin Sanicas",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/241562/images/6699_n.jpg",biography:null,institutionString:null,institution:null},{id:"322007",title:"Dr.",name:"Maria Elizbeth",middleName:null,surname:"Alvarez-Sánchez",slug:"maria-elizbeth-alvarez-sanchez",fullName:"Maria Elizbeth Alvarez-Sánchez",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Universidad Autónoma de la Ciudad de México",country:{name:"Mexico"}}},{id:"337443",title:"Dr.",name:"Juan",middleName:null,surname:"A. Gonzalez-Sanchez",slug:"juan-a.-gonzalez-sanchez",fullName:"Juan A. Gonzalez-Sanchez",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Puerto Rico System",country:{name:"United States of America"}}},{id:"337446",title:"Dr.",name:"Maria",middleName:null,surname:"Zavala-Colon",slug:"maria-zavala-colon",fullName:"Maria Zavala-Colon",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Puerto Rico, Medical Sciences Campus",country:{name:"United States of America"}}},{id:"338856",title:"Mrs.",name:"Nur Alvira",middleName:null,surname:"Pascawati",slug:"nur-alvira-pascawati",fullName:"Nur Alvira Pascawati",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Universitas Respati Yogyakarta",country:{name:"Indonesia"}}}]}},subseries:{item:{id:"40",type:"subseries",title:"Ecosystems and Biodiversity",keywords:"Ecosystems, Biodiversity, Fauna, Taxonomy, Invasive Species, Destruction of Habitats, Overexploitation of Natural Resources, Pollution, Global Warming, Conservation of Natural Spaces, Bioremediation",scope:"