The angiographic ICA staging system modified by Mugikura et al.
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Barely three months into the new year and we are happy to announce a monumental milestone reached - 150 million downloads.
\n\nThis achievement solidifies IntechOpen’s place as a pioneer in Open Access publishing and the home to some of the most relevant scientific research available through Open Access.
\n\nWe are so proud to have worked with so many bright minds throughout the years who have helped us spread knowledge through the power of Open Access and we look forward to continuing to support some of the greatest thinkers of our day.
\n\nThank you for making IntechOpen your place of learning, sharing, and discovery, and here’s to 150 million more!
\n\n\n\n\n'}],latestNews:[{slug:"intechopen-supports-asapbio-s-new-initiative-publish-your-reviews-20220729",title:"IntechOpen Supports ASAPbio’s New Initiative Publish Your Reviews"},{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"}]},book:{item:{type:"book",id:"5687",leadTitle:null,fullTitle:"Pattern Recognition Techniques, Technology and Applications",title:"Pattern Recognition",subtitle:"Techniques, Technology and Applications",reviewType:"peer-reviewed",abstract:"A wealth of advanced pattern recognition algorithms are emerging from the interdiscipline between technologies of effective visual features and the human-brain cognition \r\nprocess. Effective visual features are made possible through the rapid developments in \r\nappropriate sensor equipments, novel filter designs, and viable information processing \r\narchitectures. While the understanding of human-brain cognition process broadens the way \r\nin which the computer can perform pattern recognition tasks. The present book is intended \r\nto collect representative researches around the globe focusing on low-level vision, filter \r\ndesign, features and image descriptors, data mining and analysis, and biologically inspired \r\nalgorithms. The 27 chapters coved in this book disclose recent advances and new ideas in \r\npromoting the techniques, technology and applications of pattern recognition.",isbn:null,printIsbn:"978-953-7619-24-4",pdfIsbn:"978-953-51-5793-9",doi:"10.5772/90",price:159,priceEur:175,priceUsd:205,slug:"pattern_recognition_techniques_technology_and_applications",numberOfPages:638,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"776a1270a14ebea65bf567dd6dfea1de",bookSignature:"Peng-Yeng Yin",publishedDate:"November 1st 2008",coverURL:"https://cdn.intechopen.com/books/images_new/5687.jpg",numberOfDownloads:117102,numberOfWosCitations:145,numberOfCrossrefCitations:149,numberOfCrossrefCitationsByBook:5,numberOfDimensionsCitations:284,numberOfDimensionsCitationsByBook:6,hasAltmetrics:1,numberOfTotalCitations:578,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"May 24th 2016",dateEndSecondStepPublish:null,dateEndThirdStepPublish:null,dateEndFourthStepPublish:null,dateEndFifthStepPublish:null,currentStepOfPublishingProcess:1,indexedIn:"1,2,3,4,5,6,7",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"5693",title:"Prof.",name:"Peng-Yeng",middleName:null,surname:"Yin",slug:"peng-yeng-yin",fullName:"Peng-Yeng Yin",profilePictureURL:"https://mts.intechopen.com/storage/users/5693/images/2062_n.png",biography:"Peng-Yeng Yin received his B.S., M.S. and Ph.D. degrees in Computer Science from National Chiao Tung University, Hsinchu, Taiwan. From 1993 to 1994, he was a visiting scholar at the Department of Electrical Engineering, University of Maryland, College Park, and the Department of Radiology, Georgetown University, Washington D.C. In 2000, he was a visiting Professor in the Visualization and Intelligent Systems Laboratory (VISLab) at the Department of Electrical Engineering, University of California, Riverside (UCR). From 2006 to 2007, he was a visiting Professor at Leeds School of Business, University of Colorado. From 2001 to 2003, he was a Professor at the Department of Computer Science and Information Engineering, Ming Chuan University, Taoyuan, Taiwan. Since 2003, he has been a Professor of the Department of Information Management, National Chi Nan University, Nantou, Taiwan, and is currently the Dean of Research and Development. Dr. Yin received the Overseas Research Fellowship from Ministry of Education in 1993, Overseas Research Fellowship from National Science Council in 2000. He is a member of the Phi Tau Phi Scholastic Honor Society and listed in Who’s Who in the World, Who’s Who in Science and Engineering, and Who’s Who in Asia. Dr. Yin has published more than 100 academic articles in reputable journals and conferences including IEEE Trans. on Pattern Analysis and Machine Intelligence, IEEE Trans. on Knowledge and Data Engineering, IEEE Trans. on Education, Pattern Recognition, Annals of Operations Research, IEEE International Conference on Computer Vision, etc. He is the Editor-in-Chief of the International Journal of Applied Metaheuristic Computing and is on the Editorial Board of International Journal of Advanced Robotic Systems, Journal of Education, Informatics and Cybernetics, Journal of Pattern Recognition Research, Artificial Intelligence Research, ISRN Signal Processing, The Open Artificial Intelligence Journal, The Open Signal Processing Journal and served as a program committee member in many international conferences. He has also edited two books in the pattern recognition area. 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\r\n\tMental health is an actual topic because of the high prevalence of mental health problems such as depression and anxiety. Mental health problems can affect all people regardless of their sociodemographic characteristics. It means that anyone is likely to have some form of mental health problem. The effects of mental health problems can be so devastating that they lead to suicide in many cases. For this reason, preventive measures to avoid mental health problems are important. Among the strategies used for the prevention and treatment of mental health problems, are the practice of physical activity, good levels of physical fitness, quality leisure time, socialization (especially in older adults), the use of counseling whenever there is a change in terms of mental health, religiosity and contemplation of the divine, psychological support and professional guidance stand out. With this book, we intend to present the different strategies that can be used to promote mental health.
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In ancient times, “medical” care mainly involved using plants as medicines. Throughout history, people all over the world have used herbs to maintain and improve health into the art of healing. A constant process of searching, testing, and verifying in all cultures across the globe resulted in the development of an empirical science. Many plants have an established place within scientific medicine and are used for a broad range of health conditions. A herb is a plant or its part used for its scent, flavor, or therapeutic properties. They are sold as tablets, capsules, powders, teas, extracts, and fresh or dried plants.
Herbal medicine as the oldest form of health care is the synthesis of therapeutic experiences of generations for over hundreds of years and has gained popularity again in today’s medical practice with over 85% of the world’s population using phytotherapeutic medicines according to WHO [1].
The increase in the use of herbal products is due to their cultural acceptability, availability, affordability, efficacy, and safety claims. Primitive humans distinguished useful herbs with beneficial effects from those that were inactive or toxic. The basis of modern medicinal drugs such as aspirin, morphine, digitoxin, and quinine is through scientific validation of herbal medicine. Review of different national pharmacopeia reveals that at least 120 distinct chemical products/moieties from herbal sources have been utilized as lifesaving drugs.
In 2010, the inventory of a British-American team of researchers revised the previously stated number of plants down from 900,000 plants to between 300,000 and 400,000 of which only 6% have been screened systematically for their biological activity and 15% have been investigated phytochemically and just under 10% have had any form of research carried out into the possible use as medicines. It is predictable that natural compounds and their derivatives comprise nearly 60% of all drugs in clinical use and medicinal plants contribute not less than 25% [2].
In medical systems based on herbalism, folklore, or shamanism, written documents do not exist, and the herbal formulations are often kept secret by the practitioners, making the information more difficult to access [3].
The practices and the philosophy of each herbal medicinal system are influenced by their region: Ayurveda, a health care system that has been founded by ancient Hindu healers and saints, has been still used in India for over 5000 years. Its materia medica provides a comprehensive description of over 1500 herbs and 10,000 formulations. The Indian government has recognized Ayurveda to be a complete health care system in comparison with western Medicine and has compiled and preserved traditional medicinal knowledge in the public domain with The Traditional Knowledge Digital Library (TKDL). Ayurgenomics aim to provide a base for human classification, diagnostics, and customized medicine with Ayurvedic concept of Prakriti from pharmacogenomics perspective, and AyuSoft has developed interactive software based on Ayurvedic classics as a decision support system. Herboprint uses three-dimensional HPLC to develop tools for activity-based standardization of botanicals.
A lot of medicinal plants, traditionally used for thousands of years, are present in a group of herbal preparations of the Indian traditional health care system named Rasayana proposed for their interesting antioxidant activities.
As metabolic diseases and age-related degenerative disorders are closely associated with oxidative processes in the body, the use of herbs and spices as a source of antioxidants to combat oxidation warrants further attention on validating the antioxidant capacity of herbs and spices after harvest, as well as testing their effects on markers of oxidation in parallel with clinical trials aiming to establish antioxidants as mediators of disease prevention. From a dietary perspective, the functionality of herbs and spices is exposed through consideration of their properties as foods. Through evidence-based frameworks for substantiating health claims related to foods, recommendations are warranted to support the consumption of foods rich in bioactive components, such as herbs and spices in the overall maintenance of health and protection from disease. In the book, a chapter is dedicated to the antioxidant properties of natural products [4, 5, 6].
In China, their own system known as the Traditional Chinese Medicine has been used throughout history. The oldest known herbal book in the world “The Devine Farmer’s Classic of Herbalism” was compiled in China about 2000 years ago, including numerous herbal pharmacopeias and various monographs on specific herbs and their composition information.
The first textbook fully devoted to the description of herbal drugs is the Shen-nung-pen-ts’ao ching (ShenNung’s Classic of Pharmaceutics) was written during the later Han period (25–220 AD). The literature of Chinese Materia Medica developed by continuous addition of new drugs as well as re-evaluation and addition of new indications for existing herbs during the centuries has been a valuable source for the acquisition of ethnopharmacological data and the development of new medicinal plants by studying the ancient textbooks.
The first compound derived from Chinese herbal remedies to enter the western market was ephedrine, an amphetamine-like stimulant from ma huang (
Kampo medicine, the Japanese herbal medicine dates back over 1500 years with approximately 148 formulations [7].
In 1873, the Ebers Papyrus, the most ancient Egyptian medicine treaty—dated 1600 BC, was found, proving the use of plants for therapeutic purposes.
During the Trojan War (1200 AC), the plant
After the fall of the Roman Empire, the tradition of herbal medicine moved to the monasteries. The writings of famous healers from earlier times were copied, and many monasteries established and maintained herb and medicinal plant gardens, which led to the acquisition of new medico-botanical knowledge.
In Germany, herbal medicine is identified as one of the elements of naturopathy, and approximately 600–700 plant-derived medicines are accessible and prescribed by approximately 70% of German physicians. In 2011, 20% of herbal drugs were sold as prescriptions and 80% over the counter in Germany. In the EU, annual revenues from herbal medicines surpassed US$ 6 billion in 2003.
The National Canadian Institutes disbursed approximately 89 million dollars for research in traditional therapies in 2004.
In 2005, the National Centre for Complementary and Alternative Medicine at the National Institutes of Health in the USA spent about 33 million US dollars on herbal medicine.
In recent decades, the pharmacological properties of numerous medicinal plants and opportunities in phytotherapy have been explored through research projects, reviews, and monographs. These studies confirm that medicinal plants offer new approaches to tackling diseases. Herbal medicine has become a popular form of health care; even though several differences exist between herbal and conventional pharmacological treatments, herbal medicine needs to be tested for efficacy using conventional trial methodology. The public is often misled to believe that all natural treatments are inherently safe, but herbal medicines do carry risks. The triad absorption/metabolism/efficacy of herbs and their extracts is still an unsolved problem in judging their health effects. Some side effects such as allergic reactions, mutations, intoxication, teratogenesis, carcinogenesis, and medication interactions may occur if the use of the phytotherapeutic or medicinal plant is unrestricted. The lack of a stricter control of these medicines enables contamination by heavy metals, conventional drugs, herbicides or pesticides [9].
Based on World Health Organization reports, resistance of bacteria to antibiotics is a major global health challenge now and in the future. Different strategies such as inhibition of multidrug resistance pumps and biofilm formation in bacteria and development of new antibiotics with novel mechanism of action have been proposed to tackle this problem. Flavonoids, a large class of natural compounds, have been extensively studied for their antibacterial activity, in more than 150 articles published since 2005 and especially chalcones showed up to sixfold stronger antibacterial activities than standard drugs in the market. Some synthetic derivatives of flavonoids also exhibited remarkable antibacterial activities with 20- to 80-fold more potent activity than the standard drug against multidrug-resistant Gram-negative and Gram-positive bacteria (including
In the concept of the “doctrine of signatures,” the healing effect of plants was deduced from their taste, shape, color, and other characteristics, for example, celandine (
The Nobel Prize in Physiology and Medicine 2015 was awarded for the discovery of two main natural products: (1) avermectin, a macrocyclic lactone isolated from the soil microorganism
The World Health Organization (WHO) defines herbal medicine as a practice, which includes herbs, herbal materials, herbal preparations, and finished herbal products, which contain as active ingredients parts of plants or other plant materials or combinations. These herbs are derived from plant parts such as leaves, stems, flowers, roots, and seeds.
Modern or scientific herbal medicine is also called phytomedicine or phytotherapy. Phytotherapy is a science-based medical practice with more traditional approaches, such as medical herbalism, which relies on an empirical appreciation of medicinal herbs linked to traditional knowledge.
Phytotherapy is defined as the study of the use of extracts of natural origin as medicines or health-promoting agents in an allopathic discipline, because they are directed against the causes and the symptoms of a disease. In Germany, phytotherapy is classified as a discipline of natural orthodox science-oriented medicine, with scientific requirements of the chemically defined substances in terms of quality, safety, and efficacy. Modern mass production of natural products as food supplements or herbal medicines may result in remedies that can differ greatly (dosage form, mode of administration, herbal medicinal ingredients, methods of preparation, and medical indications) from the traditions that form the basis for their safety and effectiveness, and an acceptable quality standard. The WHO has published monographs on the quality control, safety, and efficacy of selected medicinal plants and recommendations on their cultivation.
According to the World Health Organization, phytomedicine is defined as herbal preparations produced by subjecting plant materials to extraction, fractionation, purification, concentration, or other physical or biological processes. These preparations may be produced for immediate consumption or the basis for other herbal products. Such plant products may contain recipient or inert ingredients, in addition to the active ingredients.
Paraherbalism describes alternative and pseudoscientific practices of using unrefined plant or animal extracts as unproven medicines or health-promoting agents [12].
An herb may be any part of a plant including its leaves, stem, flowers, roots, and seeds. Herbal products may be raw or commercial preparations used to treat illnesses. Raw herbal products (leaves, seeds, or teas) are more used in less developed countries and commercial herbal preparations (tablets or pills) are more used in developed countries.
WHO published the requirements for clinical trials of herbal products, which contain the following definitions:
Herbal substance—material derived from the plant(s) by extraction, mechanical manipulation, or some other processes
Herbal product—the herbal material administered to clinical subjects
Herbal product synonyms—herbal remedy, herbal medicine, herbal drug, and botanical drug [13]
Herbal drugs, called phytochemicals, are the secondary metabolites of plants. Some are toxins, used to deter predation; some are pheromones, used to attract insects for pollination; others are phytoalexins, which protect against microbial infections; and yet others are allelochemicals, which inhibit rival plants competing for soil and light.
The first generations of plant medicine were simple botanical materials employed in more or less crude form. These medicines such as Cinchona, Opium, Belladonna, and Aloe were selected based on empirical evidence as gathered by traditional practitioners.
The second-generation phytopharmaceutical agents were pure molecules whose compounds differ from the synthetic therapeutic agent only in their origin, for example taxol from Taxus spp., quinine from Cinchona and reserpine from
In the development of third generation of plant medicine, the formulation is based on well-controlled double-blind clinical and toxicological studies with phytomedicine to improve the quality, efficacy, stability, and the safety of the preparations.
The following are characteristics of the phytomedicine:
The active principle is frequently unknown.
Standardization, stability, availability, and quality control are not easy.
Well-controlled double-blind clinical and toxicological studies to prove their efficacy and safety are rare.
They are cheaper than synthetic drugs.
The belief that phytomedicine is devoid of side effect since millions of people all over the world have been using phytomedicine for thousands of years.
The belief that phytomedicine is used for a wide range of treatment, especially of certain diseases where conventional medicine fails.
They are gentle, effective, and often specific in function to organs or systems of the body [14].
Although synthetic or chemical drugs can have greater or quicker effects than do equivalent phytomedicines, they present a higher degree of side effects and risks. For instance, psychopharmacological products with sedative and anxiolytic action are accompanied by undesirable side effects like uncoordinated motor skills and drowsiness, but phytomedicine acts on the body by regulating and balancing its vital processes rather than stopping or combatting certain symptoms. Its balancing effect prevents mental disorders and unbalanced mental condition.
The action of phytomedicines for the respiratory system is not limited to neutralizing the symptoms of any disease, but they also exert a true cleansing action for excessive mucus in the interior of the airway. They contain certain antibiotic substances that prevent bacteria growth in the mucus, for example
Phytomedicines are good dietary supplements, which are nutritive and replenish the body. For example, sunflower seed (
Phytomedicines are effective in curing human pathogens like
Recognition and application of phytomedicine depend on evidence-based clinical data. Phytomedicine can only enter in professional clinical application if safety, efficacy, and quality are proven in a comparable manner to conventional drugs. For this purpose, it is mandatory to conduct well-designed clinical trials. Awareness of Good Clinical Trial Practice and provision of knowledge worldwide is the existential foundation for proper scientific development [16].
“Medicinal plants” are neither phytomedicines nor phytotherapeutics. Once classified as a medicine, it is subject to the ethical standards defined by World Health Organization (WHO), and has to go through careful production processes from the time of collection and formulation until the time of packaging and distribution.
A plant may contain even thousands of chemical compounds acting in a synergistic way. Many conventional test methods are not always able to cope with the complexity of plant extracts to confirm the empirical and traditional use of a herb.
Many big pharmaceutical companies and scientists are returning to nature’s apothecary in the search of new medicines [17].
Rational drug discovery from plants started when the German apothecary assistant Friedrich Sertürner isolated the analgesic and sleep-inducing agent from opium, which he named morphium (morphine) after the god of dreams, Morpheus, in 1805. This was followed in succession by many other herbal remedies or phytopharmaceutical substances (referred to in international terminology as HMPs or Herbal Medicinal Products). Strychnine from the poison nut tree (Strychnos nux vomica) in 1819, caffeine from the coffee bean (
H.E. Merck in Darmstadt (Germany), the first apothecary extracting morphine and other alkaloids, was the first progenitor of pharmaceutical companies, which subsequently have produced natural products by chemical synthesis in order to facilitate production at higher quality and lower costs. Salicylic acid was the first natural compound produced by chemical synthesis in 1853.
The modern pharmaceutical industry laid its scientific and financial foundation after the discovery of penicillin (1928) from microbial sources. The therapeutic use of extracts and partly purified natural products has then been replaced by the use of pure compounds. For example, in the area of cancer, over the time frame from 1940s to the end of 2014, of the 175 small molecules approved 131, or 75%, are other than “S” (synthetic), with 85, or 49%, the actually being either natural or directly derived products.
Many big and medium-sized pharmaceutical companies have leaved their natural product research programs to academic universities and start-up companies [18].
Ethnobotany, as a research field of science, has been used for the documentation of indigenous knowledge on the use of plants for providing an inventory of useful plants from local floras. Plants that are used for traditional herbal medicine in different countries are an important part of the ethnobotanical studies, for the discovery of new drugs and new drug development. Over-harvesting, degradation of medical plants, and loss of traditional medical knowledge in local communities are common problems in the resource areas as well as issues of indigenous knowledge, intellectual property rights, and uncontrolled transboundary trade in medicinal plants [19].
Phytomedicine has become an important alternative treatment option for patients, as they seek to be treated in a holistic and natural way after an unsatisfactory response to conventional drugs.
Medical treatments cover the application of different components of plants (blossom, leaf, stem, and radix), aromatic essential oils, and herbal extracts as herbal teas, via massage as packs or wraps or in therapies using water, steam, or inhalation.
Although these subjects lost their importance in twentieth century because of the modern synthetic treatments, there is a renewed interest today in medicinal plants usage as natural products for the generation of semi-synthetic derivatives.
Currently, the paradigm of medicine has shifted from not only curing clinical diseases but also maintaining good health and enhancing quality of life with the integration of traditional medicine into the modern health care system [20].
In conventional medicine, drugs are generally used to combat the symptoms of an illness. This principle is called allopathy (directed against an ailment) as well as for phytotherapy.
In homeopathy (similar to the ailment), a substance in diluted (potentized) form, which produces certain phenomena in healthy people, has a healing effect for a patient suffering from the same phenomena.
Common features of homeopathy and phytotherapy are that they emphasize a holistic approach and the regulation of self-healing powers and they are based on empirical values.
In determining the outcome of any traditional treatment, both in experimental and clinical settings including
The World Health Organization (WHO) distinguishes terminologically between traditional medicine and complementary and alternative medicine (TM/CAM). The WHO refers the term traditional medicine to developing countries (in Africa, Latin America, Southeast Asia, and/or the Western Pacific), as indigenous medicine (Traditional Chinese Medicine, Hindu Ayurveda, Arab Unani, and various forms of indigenous medicine) deeply rooted in history. The WHO uses the term CAM when referring to developed countries.
According to the World Health Organization (WHO), TM is “the sum total of the knowledge, skills and practices based on the theories, beliefs and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health, as well as in the prevention, diagnosis, improvement, or treatment of physical and mental illnesses, which may rely exclusively on past experience or observation handed down from generation to generation, verbally or in writing.” It comprises therapeutic practices in existence for hundreds of years before the development of modern scientific medicine and is still in use today without much documented evidence of adverse effects [21].
TM therapies include medication therapies—use of herbal medicines, animal parts, and/or minerals—and nonmedication procedure-based therapies—without the use of medication, as in the case of acupuncture and related techniques, manual therapies, chiropractic, osteopathy, qigong, tai ji, yoga, naturopathy, thermal medicine, and other physical, mental, spiritual and mind-body therapies.
In countries where the dominant health care system is based on allopathic medicine, or where TM has not been incorporated into the national health care system, TM is termed as “complementary,” “alternative,” or “nonconventional” medicine.” The term “traditional medicine” denotes the indigenous health traditions of the world; “complementary and alternative medicines” refer to methods outside the biomedical mainstream, as a set of health care practices that are not part of a country’s own tradition and are not integrated into the dominant health care system, particularly in industrialized countries; and “conventional medicine” refers to “biomedicine” or modern medicine. Other terms that describe these health care practices, include “natural medicine,” “nonconventional medicine,” or “holistic medicine.” The terms complementary/alternative/nonconventional medicine are used interchangeably with traditional medicine in some countries [22].
WHO’s quality-of-life assessment of many traditional and complementary health systems includes spiritual dimensions of life and well-being, which is related to the sense of the meaning of the self or extending beyond the self. Expectancy based on belief and attitude causes a placebo, or “meaning response” effect on treatment outcomes in all therapeutic settings.
The traditional and complementary and alternative medicine (T/CAM) have claimed an increasing share of the public’s awareness and the agenda of medical researchers. About half the population of many industrialized countries use T/CAM, (United States, 42%; Australia, 48%, France, 49%; Canada, 70%) and the proportion is as high as 80% in many developing countries (China, 40%; Chile, 71%; Colombia, 40%; up to 80% in African countries). Accompanied by a growth in research and associated literature, with an increase in an evidence-based approach, T/CAM has long been practiced both within and outside the dominant health care system. Most research has focused on clinical and experimental medicine (safety, efficacy, and mechanism of action) and regulatory issues, to the general neglect of public health dimensions. Public health research must consider social, cultural, political, and economic contexts to maximize the contribution of T/CAM to health care systems globally. A public health agenda is needed in addition to the focus on experimental research. Public health professionals need to define the public health dimensions of traditional and complementary medicines.
Practices of traditional medicine vary greatly from country to country, and from region to region, as they are influenced by factors such as culture, history, personal attitudes, and philosophy. In many cases, their theory and application are quite different from those of conventional medicine. The theories and concepts of prevention, diagnosis, improvement, and treatment of illness in traditional medicine (both herbal medicines and traditional procedure-based therapies) historically rely on a holistic approach toward the sick individual, and disturbances are treated on the physical, emotional, mental, spiritual, and environmental levels simultaneously taken into account the cultural background. As a result, most systems of traditional medicine may use herbal medicines or traditional procedure-based therapies along with certain behavioral rules promoting healthy diets and habits. Holism is a key element of all systems of traditional medicine.
Traditional medicine has not only continued to be used for primary health care of the poor in developing countries, but has also been used in countries where conventional medicine is predominant in the national health care system. Despite its existence and continued use over many centuries, and its popularity and extensive use during the last decade, traditional medicine has not been officially recognized in most countries. Long historical use of many practices of traditional medicine, including experience passed on from generation to generation, has demonstrated the safety and efficacy of traditional medicine. However, scientific research and evaluation of the traditional medicine are needed to provide additional evidence of its safety and efficacy, considering knowledge and experience obtained through the long history of established practices.
With the tremendous expansion in the use of traditional medicine worldwide, safety and efficacy as well as quality control of herbal medicines and traditional procedure-based therapies have become important concerns for both health authorities and the public. Various practices of traditional medicine have been developed in different cultures in different regions without a parallel development of international standards and appropriate methods for evaluating traditional medicine. Governments and researchers, among others, are increasingly requesting WHO to provide standards, technical guidance, and information to ensure that traditional medicine is used properly and to determine how research and evaluation of traditional medicine should be carried out.
Consequently, education, training, and research in this area have not been accorded due to attention and support. The quantity and quality of the safety and efficacy data on traditional medicine are far from sufficient to meet the criteria needed to support its use worldwide. The reasons for the lack of research data are due not only to health care policies but also to a lack of adequate or accepted research methodology for evaluating traditional medicine. It should also be noted that there are published and unpublished data on research in traditional medicine in various countries, but further research in safety and efficacy should be promoted, and the quality of the research should be improved.
Since 1991, WHO has developed and issued a series of technical guidelines such as guidelines for the assessment of herbal medicines, research guidelines for evaluating the safety and efficacy of herbal medicines, and guidelines for clinical research on acupuncture. However, these guidelines are still not sufficient to cover the many challenging issues in the research and evaluation of traditional medicine. In 1997, with the support of the National Center of Complementary and Alternative Medicine, National Institutes of Health, Bethesda, MD, USA, a WHO informal discussion developed draft guidelines for methodology on research and evaluation of traditional medicine.
Traditional medicine (TM), variously known also as ethno-medicine, folk medicine, native healing, or complementary and alternative medicine (CAM), is the oldest form of health care system as an ancient and culture-bound method of healing that humans have used to cope and deal with various diseases that have threatened their existence and survival. Different societies have evolved different forms of indigenous healing methods e.g., Chinese, Indian, and African traditional medicines. Traditional healer, on the other hand, is “a person who is recognized by the community where he or she lives as someone competent to provide health care by using plant, animal, and mineral substances and other methods based on social, cultural, and religious practices” [23].
Prior to the introduction of the cosmopolitan medicine, traditional medicine (TM) used to be the dominant medical system available to millions of people in Africa in both rural and urban communities as the only source of medical care for a greater proportion of the population.
The traditional health care systems are still in use by the majority of the people not only in Africa but across the world. In indigenous African communities, the traditional healers treat patients holistically by reconnecting their social and emotional equilibrium based on community rules and relationships unlike medical doctors who only treat diseases in patients. The arrival of the Europeans marked a significant turning point in the history of this age-long tradition and culture. During several centuries of conquest and invasion, European systems of medicine were introduced by colonizers and preexisting African systems were stigmatized and marginalized. Indigenous knowledge systems denied the chance to systematize and develop and even banned in some extreme cases. They were believed to be primitive and wrongly challenged by foreign religions dating back during the colonial rule in Africa and subsequently by the conventional or orthodox medical practitioners. In postindependence period, after a century of colonialism and cultural imperialism, TM has been recognized and held back the development of African traditional health care as an important aspect of health care delivery system in Africa. Despite the “passionate ambivalence,” TM is still in use in modern day Africa after hundreds of years of its existence as a major African socio-cultural heritage without much reported cases of adverse effects.
The new health agenda in Africa focuses on the institutionalization of traditional medicine in parallel with orthodox medicine into the national health care scheme in order to move the health agenda forward since effective health cannot be achieved in Africa by orthodox medicine alone unless it has been complemented with traditional medicine.
As a whole, the annual market value of phytomedicine is close to $43 billion in all the world (more than some African annual budgets). Many African phytomedicines are well known in the international markets and Africa is one of the main world producers of the medicinal plants. For example, Cinchona yields quinine, an antiplasmodial drug for the treatment of malaria.
The WHO has helped most developing countries of the world by utilizing expert committees’ policy decisions, and resolutions in providing guidelines that will aid the countries to develop and utilize their indigenous medicines for their national health agenda. In Africa, the health agenda is targeted at the recognition and development of phytomedicines by indigenous medical and pharmaceutical research scientists. This has lead the African Heads of States to declare the first 10 years of the millennium (2001–2010) as the “Decade of Traditional Medicine in Africa” and to celebrate on 31st August every year to make sure that phytomedicine is recognized and appreciated in the health sector.
WHO has offered a memorandum to help African member states in institutionalizing African traditional medicine in their health system and challenging different African Research centers on traditional medicine to cure priority diseases in Africa, such as malaria, HIV/AIDS, sickle-cell anemia, diabetes, and hypertension.
WHO has provided guidelines for institutionalization of traditional medicine into the health scheme including the below steps:
Political recognition: the government and heads of states should develop research on traditional medicine for the treatment of priority diseases as they declared 2001–2010 as “Decade of African Traditional Medicine” at the African Summit of Heads of States.
Development of policy, legal and regulatory framework: governments should formulate national policies, legal frameworks, and registration according to the guidelines that WHO has provided for the assessment of herbal medicine to establish regional regulatory mechanisms regulating herbal medicine through national expert committees.
Promoting scientific research on traditional medicine and collaboration work: scientific research should be conducted on safety, efficacy, and quality of traditional medicine primarily used for the management of priority disease like malaria, HIV/AIDS, sickle-cell anemia, diabetes, and hypertension as proposed by WHO. Collaboration of traditional medicine practitioners with the scientific community can be achieved through staff exchange and training, sharing expensive equipment and joint publications by making partnership arrangements also with the private sector for the integration of traditional medicine.
Ensuring that intellectual property rights are protected: intellectual property rights of the indigenous knowledge about traditional medicine should be protected by particular legislation.
Disseminating appropriate information to the general public on the use of traditional medicine: appropriate information should be given to the general public to empower them with knowledge and skills for the proper use of traditional medicine through organization of seminars to raise awareness.
Providing a good economic environment: the government should ensure a good economic, political, and regulatory environment for local production by traditional herbal practitioners as well as develop industries that can produce standardized remedies to increase access and provide funding for their smooth operations.
There are many factors hindering the development of phytomedicine in Africa:
Development of drug from its natural source is more difficult than synthetic drug development; formulation of phytomedicine particularly in crude-drug form requires a specialized expert area of training and experience.
Lack of standardization and quality control of the herbal drugs used in clinical trials.
The risk of side effects due to:
toxicity,
over-dosage,
interaction with conventional drugs,
manufacturing problems such as misidentification of plants,
lack of standardization,
failure of good manufacturing practice,
contamination as a result of field microbial contamination,
poor packaging,
the bad environmental condition (temperature, light exposure),
substitution and adulteration of plants, and
incorrect preparation and dosage.
Imprecise diagnosis and dosage for phytomedicine.
The lack of communication and collaborative research among orthodox medical practitioners and scientists threaten to lose the ethnomedical knowledge concerning the plant and other aspects of the medicinal system.
Inadequate randomizations in most studies. Patients are not properly selected and the numbers of patients used in most trials are insufficient for the attachment of statistical significance.
Problem of serious attention, resource mobilization, commitment, and the required political will.
There is a wide variation in the duration of treatment using herbal medicine.
Domestication: it is difficult to convince members of the community to trust phytomedicine after a long use of orthodox medicine.
There is absence or inadequate record of what is available and many species are becoming extinct because they are not cultivated and protected from indiscriminate harvesting. Also, the traditional healers are of advancing age and dying.
Unfavorable legislation such as Witchcraft Act.
The quality and stability of phytomedicine is achieved by the use of fresh plants, regulated physical factors like temperature, light, water availability, and cultivation of plants in place of wild-harvested plants, because they show smaller variation in their constituents. The standardization of phytomedicine can also be achieved by the use of chromatography, infrared, and ultraviolet (UV) spectrometry.
The African pharmacognosists, pharmacologists, pharmacists, and physicians have to learn, acquire, document, and use traditional medicine to help curtail the extinction of plants and human resources. Collaborative work can be achieved through staff exchange and training and funding for capital building:
the government should help in funding researches on phytomedicine;
the private sector as well as nongovernmental agencies should help finance researches;
organization of seminars to raise awareness to the general public on the benefits of medicinal plants and remove the perception that scientists are out to harness their knowledge for money making;
abandoning outdated legislation (such as witchcraft Act); and
passing new legislation to protect indigenous traditional knowledge to integrate into the health scheme.
As medicinal plants are going global with increasing demand in the phytotherapeutic market, the following factors must be emphasized in Africa for the development of phytomedicine:
Emphasis on well-controlled and randomized clinical trials to prove the safety and efficacy of herbal medicine. With the growth of the botanical market, the quality, efficacy, and safety of phytomedicine used in clinical trials have to be improved to produce standardized drugs and to develop novel therapeutic methods with researches on traditional medicines.
An improvement in the processes of regulation and global harmonization of phytomedicine. The integration of African traditional medicine into the health system should bring harmony between traditional and modern systems of health care with minimum threat to each other.
Greater emphasis should be placed on collaboration work in order to bring traditional healers closer to scientists by engaging and training them in laboratory work, as well as get information on traditional prescriptions for specific diseases.
Emphasis has to be placed on domestication, production, biotechnological studies, and genetic improvement of medicinal plants. The domestication of plants will reduce the effects associated with wild-harvested plants, avoid misidentification and field contamination.
Increase the quality of raw materials and yield through genetic breeding and selection.
Production of phytomedicine with resistance to microorganism-induced diseases.
Detailed legislation on the ownership of intellectual property right has to be made.
Research has shown that a number of traditional medicines are effective therapeutic regimens in the management of a wide spectrum of diseases especially those which may not be effectively managed using Western medicines. Furthermore, inadequate accessibility to modern medicines and drugs to treat and manage diseases in middle- and low-income countries, especially in Africa, may have contributed to the widespread use of TM especially in poor households.
Besides accessibility to traditional healers, TM provides an avenue through which cultural heritages are preserved and respected. Indeed, TM practice is in line with the socio-cultural and environmental conditions of the people who use it in Africa.
Traditional medicine is becoming increasingly popular across the world. However, its growth potential has been understudied and poorly appreciated due to existing global political economy of health and any surrounding informal processes.
In developed countries, on the other hand, factors responsible for the widespread use of TM are beyond accessibility, affordability, and cultural compatibility. According to the World Health Organization anxiety about the adverse effects of chemical drugs, improved access to health information, changing values, and reduced tolerance of paternalism are some of the factors responsible for the growing demand for CAM in developed countries.
Traditional medicine in Africa is contrasted with biomedicine. Most traditional medical theories have a social and religious character and emphasize prevention and holistic features. Traditional medical practices are usually characterized by the healer’s personal involvement, by secrecy and a reward system. Biomedical theory and practice show an almost opposite picture: asocial and irreligious with professional detachment. Local communities do not expect that basic health care will improve when traditional healers become integrated into the service. They ask instead for improvement of basic health care itself: more services with better access, more dedication and respect from doctors and nurses, and more medicines and personnel. Fieldwork needs to be done at the community level to arrive at a better understanding and assessment of the community’s opinion concerning a possible role of traditional medicine in basic health care.
WHO has been working with African nations to integrate scientific and medical models of health to enhance the potentials of traditional medicine in the control of endemic diseases.
Intelligent application of traditional therapies have made useful contributions to alleviate sickness and suffering in Africa. Efforts should be made to protect plants from going extinct. The people and Orthodox practitioners need to be given appropriate information on phytomedicine. The integration or harmonization of phytomedicine should be developed in such a way to work hand-in-hand with orthodox medicine with minimum threat to each other [24, 25, 26].
In the book one, chapter is dedicated to the traditional medicine in Africa.
Biofield, a term coined during the US National Institutes of Health Conference in 1992, is defined as “a massless interacting field of energy and information that surrounds and permeates living systems.”
Biofield therapies are noninvasive therapies in which the practitioner manipulates individuals’ energy field in order to stimulate his/her healing responses.
The National Institutes of Health Center for Complementary and Alternative Medicine (NCCAM) has classified energy medicine therapies into two basic categories: bioelectromagnetic-based and biofield therapies. Bioelectromagnetic-based therapies involve the use or manipulation of electromagnetic fields (EMFs).
Biofield modalities, which sense and modulate surrounding “subtle energy fields” and interpenetrate the human body, have existed for thousands of years in a wide range of cultures. The vital energy concepts, which include the Indian term prana, the Chinese term ch’i, and the Japanese term qi, refer to subtle or nonphysical energies. Similar concepts in the West are reflected in the concepts of Holy spirit, or spirit, and can be dated back to the writings in the Old Testament.
A common thread is the development of specific techniques that use subtle energy to stimulate one’s own internal (intrapersonal) healing process, by movement-oriented practices such as yoga, tai-chi, or internal qigong, as part of the experience of meditation or prayer.
External (interpersonal) practices specifically use subtle energies for the process of healing another person, including local or proximal practices such as external Qigong, pranic healing, where a healer transmits or guides energy to a recipient who is physically present as well as distance practices where a healer sends energy to a recipient in a different physical location, such as intercessory prayer or distance healing.
A major distinction in biofield therapies involves whether the practitioner engages the patient’s biofield with (hands-on) or without physical contact (hands-off). Some modalities such as Reiki and Brennan healing contain techniques that are both hands-on and hands-off (but in close proximity), others such as Johrei and external qigong are practiced with hands at a slightly further distance from the body.
Biofield therapies are inexpensive compared with the costs of other types of therapy and effective to relieve daily life stress of patients by reduction in tension, anxiety, and pain with minimum side effects.
Biofield activities stimulate specific brain areas allowing for differentiation of certain moods. Humans distinguish between pleasant or unpleasant stimuli, based upon biofield information transmitted to the autonomic nervous system, immune system, and the endocrine system, so biofield therapy exert an influence throughout the entire human body.
The majority of practices intended to affect the body’s energy flow do not involve devices. Energy Medicine Practices that benefit energy flow and overall energy in the body include certain forms of exercise, mechanical manipulation, pressure, light, sound, scent, touch, position, the use of electrical current or magnetic pulses, or movement to stimulate the body’s own energy systems. Exercises of the energy medicine require a trained and authorized instructor to teach the technique (Pilates, Tai Chi) and rely either on manipulation (Alexander Technique, Cranial-sacral), on movement (Feldenkrais, FlexAware), on positions (yoga) or on scents (aroma therapy). Some practices that focus on particular areas of the body require touching (massage, reflexology, Reiki) and some others do not require touching (medical Qigong).
Although science has provided considerable information about how the body works, it cannot explain yet what differentiates living and nonliving matter and why the placebo effect is stronger than most drugs and the roles of attitude and intention, as well as the mechanisms by which they work, which may or may not be related to the placebo effect [27].
Biofield physiology is proposed as a descriptor for the electromagnetic, biophotonic, and other types of spatially distributed fields that living systems generate and respond as integral aspects of the self-regulation and organization of cell, tissue, and whole organism. Individual molecules can act as transmitting and receiving antennae in the mediation of efficient intermolecular communication via single photons.
As a means of information transfer, biophotons have the advantages of extremely high speed and the ability to penetrate through cell membranes that present barriers to the diffusion of molecular signals.
Electrical and magnetic fields, as well as biophotons in the full range from ultraviolet to infrared, are detected during normal physiological activity including the resonance signaling, and the modulation of cell function by specific electromagnetic frequencies.
Biologically generated biofields are a spatially distributed set of forces and physical properties that have the capacity to encode information and exert instructive influences on cells and tissues capable of perceiving and being modified by them [28].
Electric fields generated by the intracellular network of microtubules, centrosomes, and chromosomes play fundamental roles in regulating the dynamics of mitosis, meiosis, and a variety of other cellular activities [29].
Electric charge in motion, whether along a wire or a nerve axon, produces a magnetic field in the surrounding space, a type of biofield. Magnetic fields emanating from the body, although extremely weak relative to the geomagnetic field of the earth, are readily detected by superconducting quantum interference device (SQUID)–based magnetometers [30].
The strongest rhythmic electrical and magnetic fields in the body are produced by synchronous activity of arrays of the heart muscle cells and can be detected, as electrocardiogram (ECG) or magnetocardiogram (MCG). The heart’s magnetic field also carries information that can also be detected by other persons or animals and can be recorded up to several feet from the body surface.
An example of the informational potential (bioeffectiveness) of the heart biofields is cardiac-induced entrainment, or frequency locking, detected when the R-waves of one subject’s ECG become precisely synchronized with the onset of EEG alpha waves of another subject at a distance of up to 5 feet.
Heart fields may also encode psychoemotional information, as indicated by the 75% accuracy rate in detecting discrete emotional states from patterns of heart rate variability.
The electrical and magnetic fields generated by the composite activity of thousands of brain cells are detected as an electroencephalogram (EEG) or magnetoencephalogram (MEG). At a functional level, the electromagnetic activity of neural assemblies modulates neuron synchronization and circadian rhythmicity and the computational and cognitive processes of the brain. More specifically, weak sinusoidal electric fields enhance and entrain physiological neocortical network activity. Transmembrane currents in neurons also produce local electric fields that induce “ephaptic coupling” (nonsynaptic electrical coupling) between adjacent axons, which influences the synchronization and timing of action potential firing in neurons [31].
Another biofield phenomenon is the coherent, ultraweak photon emissions (UPE), detected from cell cultures and from the body surface. The fluctuations in UPE correlate with cerebral blood flow, cerebral energy metabolism, and EEG activity. Photonic stimulation at one end of a nerve increases UPE at the other end. Nonconventional means of UPE-mediated biosignaling include wave propagation within longitudinally oriented neuronal microtubules and passage through membrane-spanning regions of proteins that may serve as “light pipes” [32].
Numerous nonneural electrical fields have been detected and analyzed, including those arising from patterns of resting membrane potentials that guide development and regeneration, and from slowly varying transepithelial direct current fields that initiate cellular responses against tissue damage. In addition to the high-speed electrical signals conducted along nerve axons, a second communication network, based in ubiquitous epithelial cells, conducts information through varying direct currents, which spread across considerable distances and play key roles in recognizing damage and guiding cell migration necessary for wound healing especially in skin, heart, and cornea as well as in regulating the migration of neuronal path-finding.
Electrical fields—created by either mechanical stress (piezoelectricity) or streaming potentials—in bone, tendons, and fascia regulate the functioning of osteocytes and fibroblasts to adjust the density of supporting tissues in response to loads [33].
Unspecialized “loose” connective tissue, referred as fascia, forms a continuous head-to-toe network surrounding and permeating all tissues and organs. As an extracellular matrix, structured mainly by collagen fibers, fascia provides a supportive and regulatory framework for all organs of the body as it coordinates cellular perception and interpretation of mechanical forces. This extracellular system reaches into the interior of cells via transmembrane bridging molecules known as integrins, which allow information from the fascia to modify cell metabolism and genetic activity. Since collagen structures both conduct and modify photon pulses emitted from biological sources, signaling along collagen fibers serves as a surveillance system of endogenous biofield emission to complement the immune and nervous systems in monitoring tissue health.
Further speculation based on the water-protein relationship along collagen fibers invokes quantum coherence, a state that can occur when all water molecules in a particular domain or region are spinning synchronously, emitting spin or torsion waves. Such spin coherence and quantum coherence enable the collagen matrix to be ultrasensitive to electromagnetic fields in a manner that can be frequency selective due to a quantum phenomenon known as the Larmor Precession [34].
Global coherence is the multilevel integration of diverse biological activities across time and scale accounts for the most salient properties such as long-range order and coordination, rapid and efficient energy transfer, and extreme sensitivity to specific signals.
The receptor system for endogenous and exogenous biofields is a body-wide network that exhibits three types of potential receptor sites: molecular, charge flux, and endogenous field.
An important series of studies on cultured cells identified two examples of the first type of receptor sites—deoxyribonucleic acid (DNA) and the cell membrane—at which exogenous electromagnetic signals exert specific biological effects.
Charge flux sites, the second type of receptor as exemplified by the perturbation of transmembrane calcium fluxes, have been proposed as a generic mechanism by which weak electromagnetic fields affect biological systems.
Low-frequency electromagnetic fields also interact with DNA by accelerating the movement of electrons within the helical arrays of base pairs. While ion channels and ion pumps have major roles in establishing the resting potential of an individual cell, the gap junctions, which are the specialized electrical connections between adjacent cells, allow voltage and current-mediated signals to be propagated across groups of cells. In this manner, spatiotemporal patterns of resting potentials arise to provide bioelectrical guidance during tissue development, regeneration, and cancer suppression [35].
Deletion of the electromagnetic response elements (EMRE) eliminates the ability of the applied electromagnetic field to regulate the target genes, while other genes can be converted from electromagnetic nonresponders to responders by inserting the EMRE at upstream regions.
Sufficient evidence has accrued to consider biofield physiology as a scientific discipline, based on nonlocal, integrated, information-conveying phenomena as well as on emerging molecular details of localized biophysical interactions. Endogenously generated pulses of ultraweak photons, electromagnetic fields, and patterns of distributed membrane voltage are varied forms of physiological activity designated as biofields, each with established properties and proposed biological functions.
While bioelectromagnetics define the mechanisms of local interactions, biofield physiology is more about understanding the integrated, longer-range functions within the whole organism: the former more reductive and the latter more integrative [36].
While the nervous, endocrine, immune, and cardiovascular systems are in continuous intercommunication via electrical and molecular signals, endogenous biofields act as carriers of information between these systems. An example is heart-brain interaction, where several types of cardiac initiated signals appear to exert sequential effects on brain activity. Electromagnetic signals from the heart reach the brain in a relatively instantaneous manner, followed first by a range of neural signals arriving in millisecond timeframes and subsequently by pressure waves and hormonal signals arriving with delays of seconds [37].
Evidence of DNA response elements that respond to specific electromagnetic frequencies, analogous to DNA regions responsive to specific hormones, is an important finding.
Different types of signals mediating rapid/short-acting vs. slower/longer-lasting responses, neurally released adrenaline and hormonally released corticosteroids, respectively, coordinate the stress response. Physiological requirements for ultrarapid responses may be met by biofields. Raman and infrared spectroscopic techniques are now enabling rapid and sensitive chemical characterization of samples based strictly on the vibrational signatures of the molecules present in a sampling volume. When applied to biological systems, the techniques provide highly complex spectra that document changes taking place in the entire genome, proteome, and metabolome; real-time
Biomarkers, defined as physiological variables that have significant clinical relevance to the population being studied, may include measures of immune, endocrine, psychophysiological, autonomic nervous system (including skin conductance), and other neural functions (including electroencephalography, positron emission tomography). Biomarkers may indicate which physiological systems are affected by biofield therapy but do not necessarily shed light on the pathways by which these changes occur nor on the transduction events by which practitioner activity is converted to patient responses that initiate the cascade of physiological changes [38, 39, 40, 41, 42].
An increasing number of physicians and other health care providers have begun integrating biofield therapies into patient care, and a growing number of hospital-based programs offer these modalities to patients. The line between what is “alternative,” “complementary,” or “integrative” is often blurred when it comes to biofield therapies, their practice, and their use by patients.
In the book, one chapter will be about biofield interpretation.
Healing is a multidimensional process that is strengthened by reducing stress and accessing psychospiritual resources, congruent with their values, beliefs, and philosophical perspectives on life and well-being.
There is a need to re-evaluate all the traditional practices on a scientific base to complement and integrate into the conventional evidence-based medicine. In the last chapter, there is a trial to review and present the current situation and future trends in this integration.
Moyamoya disease [MMD] is a form of chronic cerebrovascular occlusion characterized by occlusion of terminal internal carotid artery [ICA] along with a network of collateral vessels at the base of the brain. The disease was first brought to light by Takeuchi and Shimizu, where they described a young man with bilateral occlusion of ICA which was found to be due to congenital hypoplasia rather than atherosclerotic lesion [1]. Similar cases have been described in Japanese literature. After that, the condition came to be known by various names and the term ‘spontaneous occlusion of the circle of Willis’ by Kudo gained popularity [2]. The disease was finally coined ‘
This cerebral angiopathy is broadly termed ‘moyamoya phenomenon’ comprising of two nosological entities. The cerebrovascular syndrome is called ‘Moyamoya syndrome’ [MMS] when it is associated with neurological and extra neurological diseases like Neurofibromatosis 1 [NF1], Down syndrome, thyroid disease, cranial irradiation, sickle cell anemia, among other pathological conditions [4]. The Guidelines of the Research Committee on the Pathology and Treatment of Spontaneous Occlusion of Circle of Willis defined isolated moyamoya angiopathy as being idiopathic and called it ‘Moyamoya disease’ [5].
MMD is more common in Asian ethnicities as compared to the Western population [6]. The increased prevalence in Japan, Korea and other East Asian countries raised genetic predisposition to this condition. Subsequently, Kamada
A literature search was conducted using PubMed. The keywords used were Moyamoya disease, Moyamoya syndrome, ‘puff of smoke’, Suzuki classification, angiography, revascularization procedures etc. Relevant articles were reviewed in detail. The search was filtered to include as many recent publications as possible. An effort was made to compile and highlight the key differences in the disease’s clinical profile from East to West.
For a very long time, Moyamoya disease was thought to be a disease of Asian lineage, but now it has been observed to be prevalent across the world in people with many ethnic backgrounds. MMD has been most extensively studied in Japan, where it is the most common pediatric cerebrovascular disease [8]. It shows a prominent East–West gradient, with a in East Asian countries ten times higher than the Western countries [9]. MMD is most frequently seen in Japan, with an incidence of 0.35–1.13/1,00,000/year and a prevalence of 3.16–10.5/1,00,000 [10]. In a study done in Hokkaido, Japan, 267 new cases were diagnosed between 2002–2006 [8]. The incidence and prevalence were also found to be high in other Asian countries like Korea, China and Taiwan [11]. The incidence in all these countries is found to be increasing over the years, most likely due to advancements in diagnostic modalities and a better understanding of the genetic factors linked to the disease [12]. Studies from outside Asia are very few. The incidence in Washington state and California was 0.086/1,00,000, but in them the incidence in Asian Americans was 4.6 times that of White [9]. In Europe, the incidence of MMD was 1/10th of that in Japan. North America’s incidence was as low as 0.09/1,00,000 individuals, although an increasing trend is now being noted [13].
A similar bimodal age distribution is seen across the world, with the first peak occurring at 5–14 years in the pediatric population and around 4th decade in adulthood [5]. In Japan, family history is present in 10–15% of cases, and the risk of the disease in a family member is about 30–40 times higher than the general population. A familial predisposition was less commonly seen in European countries. In most countries, the disease was more frequently seen in females, with male to female ratio ranging from 1:1.8 to 1:2.2 [10, 14]. These epidemiological parameters remained constant from East to West as evident in the literature review from across the world by Kim et al. [6].
The pathological features have been described based on autopsy findings of cases of MMD. The most common lesion is intracranial hemorrhage, which occurs in basal ganglia, thalamus, hypothalamus and brain stem. The intracranial hemorrhage may show intraventricular extension. Other findings are subarachnoid hemorrhage and small infarcts in the capsule- ganglionic area [14]. The main pathological findings according to the vessels involved are mentioned below.
Thus, the pathology of the disease can be viewed as ICA [Internal carotid artery] to ECA [External carotid artery] prism, where the contribution of ICA to cerebral blood supply gradually decreases, and the compensatory vascular network is formed which is predominantly fed by ECA.
The mechanisms leading to the above-mentioned pathology are not entirely known. It is not clear what leads to migration and proliferation of smooth muscle cells in the intima and leads to its thickening. Moreover, why this thickening happens only in the circle of Willis is unknown. Many features of the disease point towards a hereditary predisposition- high incidence in Japanese people, familial occurrence, association with other congenital disorders like sickle cell anemia, neurofibromatosis, Down syndrome, etc. A multifactorial mode of inheritance has been suggested. A possible linkage of the disease with markers located on chromosome 6, chromosome 17, chromosome 8q23 has been suggested [18, 19, 20]. Recently, a genetic locus in the Ring Finger Protein [RNF] 213 gene was also associated with MMD [7]. A higher carrier rate in Eastern Asia probably explains the higher prevalence of the disorder in Japan and other eastern Asian countries as compared to the Western world [21].
Moyamoya angiopathy has been identified with many genetic disorders like Neurofibromatosis 1, Noonan syndrome, Costello syndrome, Sickle cell disease, GUCY1A3 mutations, BRCC3/MTCP1 gene mutation, Down syndrome, Turner syndrome, etc. [19] Moyamoya disease associated with other familial or acquired conditions has also been termed as ‘quasi-MMD’. It was noted that unilateral presentation was more common than bilateral and hemorrhagic manifestations were less common in quasi- MMD [21].
Although genetic predisposition to the disease exists, the majority of cases are sporadic. Certain acquired factors have been suggested for disease progression. These include vasculitis [3], infections [20], cranial trauma [22], post-irradiation state [23] to name a few.
The pathological changes in cerebral arteries lead to cerebrovascular events in Moyamoya disease. Two peaks have been identified, at around ten years and 30–40 years. The peak occurs later in women than in men [24].
The symptoms can be classified in the following four main heads (Figure 1) [13].
Clinical symptoms of Moyamoya disease.
Transient ischemic attacks [TIA] and infarct may present as a variety of symptoms- motor paresis, sensory disturbance, speech disturbances, alteration of consciousness [25]. Whereas these symptoms present acutely, mental decline, dyskinesias tend to progress over the years. Dilated collateral vessels in basal ganglia have been implicated in the development of choreiform movements [26]. Bilateral disease is associated with cognitive deficits. Hemorrhagic type is more common in adults >40 years of age and most commonly present with impaired consciousness. Irrespective of the primary pathology [ischemic/hemorrhagic], the symptoms tend to be recurrent and usually a single pathology predominates in each individual. Headache is another common symptom generally seen in children <14 years old [27]. Dilated transdural collaterals stimulate dural nociceptors precipitating migraine-like headaches. Headache may also be a manifestation of chronic hypoxemia.
The symptoms are triggered by hyperventilation, such as blowing/crying due to decreased cerebral blood flow secondary to CO2 washout. Worsening is also seen with infection of the upper respiratory tract. Hypertension and aging often contribute to hemorrhage, which may occur at repetitive intervals. Massive bleeding may even lead to death. Epilepsy, as a manifestation of the disease, is usually seen in children less than ten years of age [28].
The clinical features also tend to vary from East to West. The ischemic manifestations are more predominant in the US [United States] than in other eastern countries. The rate of hemorrhagic disease in adults in Asian countries is higher [42%] than in those of Asian descent residing in the US [29]. The disorder’s overall spectrum remains constant worldwide, with ischemic manifestations as the main presenting feature in children and both ischemia and hemorrhage in adults.
Angiography is the gold standard for diagnosis and assessing disease progression. The hallmark findings of cerebral angiography are occlusion of intracranial internal carotid arteries (Figure 2) and abnormal smog-like arteriolar network [moyamoya vessels] at the base of the brain (Figure 3). The Circle of Willis and its main branches, leptomeningeal vessels and transdural anastomosis between ophthalmic artery, external carotid artery and vertebral artery are frequently seen. Involvement of posterior circulation is less commonly observed.
Neuroimaging of a 40 years old lady who presented with ICH. Non-contrast CT axial sections of brain (a, b, c) show intraventricular hemorrhage involving bilateral lateral ventricles (L > R), third and fourth ventricle. Angiographic images (d, e) show occlusion of the supraclinoid segment of the left internal carotid artery and attenuation on the right side with lenticulostriate collaterals showing a “puff of smoke” appearance (f).
Neuroimaging of a young boy of 6 years of age who presented with recurrent ischemic strokes. MRI brain axial sections show altered signal intensity areas hypointense on T1 (a) and hyperintense on T2 (b, c)) in bilateral frontoparietal cortex involving the MCA territory. Angiographic images show multiple tortuous collaterals involving both anterior (d) and posterior circulation (d, e, f) giving the typical
Suzuki et al. staged the disease progression into the following stages based on the angiographic findings [3, 22, 27].
Narrowing of the carotid forks
Initiation of moyamoya[dilated major cerebral artery and a slight network of collaterals]
Intensification of moyamoya with the disappearance of middle and anterior cerebral arteries
Minimization of moyamoya [disappearance of posterior cerebral artery and narrowing of individual moyamoya vessels]
Reduction of moyamoya [disappearance of main cerebral arteries, further minimization of moyamoya, increase in collaterals from external carotid arteries]
Disappearance of moyamoya [complete disappearance of moyamoya with blood flow derived only from the external carotid artery and vertebrobasilar system]
Apart from these changes, aneurysm formation can also be seen in angiography. A revised version of Suzuki staging system was given by Mugikura et al. (Table 1), where staging is done based on angiographic severity of stenosis of the middle cerebral artery and anterior cerebral artery [30].
ICA Stage | Angiographic findings |
---|---|
I | Mild to moderate stenosis around carotid bifurcation, absent/slightly developed moyamoya, ACA/MCA branches opacified in anterograde fashion |
II | Severe stenosis around carotid bifurcation, well developed moyamoya, several of ACA/MCA branches opacified in anterograde fashion |
III | Occlusion of proximal ACA/MCA, well developed moyamoya, only a few of ACA/MCA branches are faintly opacified in anterograde fashion through the mesh work of ICA moyamoya |
IV | Complete occlusion of proximal ACA and MCA, small amount of moyamoya, no opacification of either ACA/MCA branches in anterograde fashion |
The angiographic ICA staging system modified by Mugikura et al.
ACA- anterior cerebral artery, MCA- middle cerebral artery, ICA- internal cerebral artery.
Both the staging systems highlight that with the progression of the disease, the contribution of blood supply from ICA decreases and an intricate collateral network is formed which derives its blood flow from vessels outside the cerebral circulation.
CT scan shows hyperdensities in basal ganglia, thalamus, ventricular system and subarachnoid spaces in the hemorrhagic type of MMD. In the ischemic type of the disease, lacunar infarcts can be seen as the areas of hypodensities. When contrast-enhanced, tortuous and curvilinear vessels in basal ganglia can be visualized which represent the moyamoya vessels.
Magnetic Resonance Imaging and Angiography [MRI and MRA].
MRI and MRA provide visualization of the arterial tree without being invasive as conventional angiography. In addition to this, MRI also helps demonstrate small subcortical lesions that are difficult to identify on the CT scan. MRA helps to identify the stenotic distal end of the internal carotid artery, small moyamoya vessels and dural anastomosis between external carotid arteries and vessels of the posterior circulation.
The classification and scoring based on the MRA findings are given above in Tables 2 and 3. This MRA scoring system also finds its place in the 2012 Guidelines for the Diagnosis and Treatment of MMD in Japan [5].
Score for each artery | MRA finding |
---|---|
0 | Normal |
1 | Stenosis of C1 |
2 | Discontinuity of the C1 signal |
3 | Invisible |
0 | Normal |
1 | Stenosis of M1 |
2 | Discontinuity of the M1 signal |
3 | Invisible |
0 | Normal A2 and blood vessels distal to A2 |
1 | Signal decrease A2 and its distal blood vessels |
2 | Invisible |
0 | Normal P2 and blood vessels distal to P2 |
1 | Signal decrease P2 and its distal blood vessels |
2 | Invisible |
The classification and scoring based on the MRA findings- Score of each artery.
MRA total score | MRA stage |
---|---|
0–1 | 1 |
2–4 | 2 |
5–7 | 3 |
8–10 | 4 |
The classification and scoring based on the MRA findings – MRA total Score.
MRA: Magnetic Resonance Imaging.
In patients with moyamoya disease, the involvement of many extracranial arteries like external carotid arteries, aorta, pulmonary artery, celiac artery, and renal artery has been described. Characteristic signs like ‘ champagne bottleneck sign’ seen due to reduction in the diameter of proximal ICA and ‘diamond reversal sign’ due to smaller ICA diameter compared to external carotid artery have been demonstrated [31].
Though all the diagnostic modalities contribute to identifying and staging abnormal vasculature, angiography remains the mainstay of diagnosis. It is also helpful in documenting the postoperative resolution of moyamoya.
Electroencephalography [EEG].
The following EEG findings have been seen in moyamoya disease [32]:
Diffuse, bilateral, low voltage, slow spike and wave
‘Buildup’ phenomenon- a diffuse pattern of slow waves
‘Rebuildup’ phenomenon- diffuse slow waves during hyperventilation. This rebuild up phenomenon is seen due to decreased pCO2 on hyperventilation leading to cerebral ischemia and vasoconstriction.
The advancements in various diagnostic modalities lead to the formulation of diagnostic guidelines for Moyamoya disease shown in Table 4 [5].
A. Cerebral angiography should present at least the following findings: |
1. Stenosis/occlusion at the terminal portion of ICA and/or at the proximal portion of ACA and/or MCA |
2. Abnormal vascular network in the vicinity of stenotic/occluded vessels |
3. Bilateral findings |
B. Conventional angiogram not required when MRI/MRA demonstrate following findings:1. |
1. Stenosis/occlusion at the terminal portion of ICA and/or at the proximal portion of ACA and/or MCA on MRA |
2. Abnormal vascular network in the basal ganglia on MRA[>2 flow voids in basal ganglia in MRI]. |
3. Bilateral findings |
C. Absence of arteriosclerosis, autoimmune disease, meningitis, brain neoplasm, down syndrome, Recklinghausen’s disease, head trauma, irradiation to head, others. |
D. Pathological findings: |
1. Stenosis/occlusion due to intimal thickening at the terminal ICA, usually on both sides |
2. Arteries of Circle of Willis show varying degree of stenosis/occlusion of intima, attenuation of media and waving of internal elastic lamina |
3. Numerous small vascular channels around the Circle of Willis |
4. Reticular conglomerates of small vessels in pia matter. |
Definitive case: A/B + C[In children, a case that fulfills A1 and A2 or B1 and B2 on one side and remarkable stenosis of terminal ICA on opposite side is also included.] |
Probable case: A1 and A2 [or B1 and B2] and C [unilateral] |
Diagnostic guidelines for Moyamoya disease.
Moyamoya disease is a chronic progressive disease described earlier, leading to recurrent strokes due to internal carotid artery occlusion and ischemia due to narrow, low caliber collaterals. The illness’s mainstay is revascularization surgery to increase the intracranial blood flow using extracerebral blood vessels by direct bypass or pialsynangiosis. The decision for surgical intervention is based on the patient’s age, symptomatic/asymptomatic disease, ischemic/hemorrhagic manifestations, presence/absence of aneurysm and risk of recurrence.
The indication of surgery can be briefly summarized as follows in Figure 4 [33].
Overview of the management of Moyamoya disease.
Moyamoya disease is known to progress over the years. The disease progression rate was reported to be approximately 20% over six years in those managed conservatively [34]. The risk factors of disease progression and subsequent ischemic stroke were identified as follows:
Female gender
Graves’ disease
RNF213 variant
Family history positive [35]
Posterior circulation was also recognized as a decisive risk factor for ischemic stroke [36].
Moyamoya disease is a progressive disease, and symptomatic progression is seen in approximately two-thirds of patients [29]. In a large meta-analysis, where 1,156 people were studied, it was seen that 87% of those who underwent surgical revascularization showed partial or complete resolution of symptomatic cerebral ischemia [37].
A careful choice of treatment, that is, conservative vs. surgical should thus be made keeping in mind the above-mentioned risk factors.
The predominant manifestation of MMD is ischemic stroke. However, antiplatelet therapy is ineffective to prevent recurrent cerebral infarction in ischemic MMD. The ischemic insult in MMD patients is a consequence of hemodynamic instability. There is no evidence of endothelial dysfunction at the site of internal carotid artery bifurcation. Therefore, increased platelet adhesion is not seen in MMD. Hence, theoretically, antiplatelet drugs are ineffective for preventing ischemic stroke in MMD. Moreover, increased risk of hemorrhage remains with antiplatelets in patients with MMD [38]. The annual stroke rate in patients managed conservatively is between 3.2%–15% [35].
Surgical revascularization is done to increase the cerebral blood flow and restore reserve capacity. The increase in cerebral blood flow prevents recurrent cerebral infarction. The indications for surgical revascularization are:
Recurrent clinical symptoms due to cerebral ischemia
Pediatric MMD because pediatric MMD is more progressive than adult MMD. Early diagnosis and intervention are of paramount importance to prevent irreversible damage. In a recent study, Rosi et al. confirmed a high benefit/risk ratio, with better postoperative functional status and low rates for the need of surgical retreatment in the pediatric population undergoing surgical revascularization [39].
Role of revascularization surgery in asymptomatic MMD with stable hemodynamics is not well established but preferred by neurosurgeons given the disease being a progressive disorder. Risk–benefit ratio determines the feasibility of the surgical intervention in such patients.
Role of revascularization surgery in hemorrhagic stroke is controversial.
With increased understanding of MMD being familial in at least some of the world’s regions, it is being suggested that asymptomatic siblings and family members should be screened for moyamoya pathology. Whenever such a condition is detected, it should be managed surgically, keeping in mind the illness’s progressive nature.
Anastomosis is formed between the superficial temporal artery and cortical branches of middle cerebral arteries in this procedure. For posterior circulation, the occipital artery is used as a donor for nteroposterior cerebral arteries’ cortical branches. The transdural or transcalvarial collateral channels should be preserved during the surgery.
The advantage of this procedure is an immediate improvement in the cerebral blood flow after surgery. However, the successful restoration of cerebral blood flow is operator dependant as it is challenging to perform. Moreover, postoperative hyperperfusion syndrome may develop after surgery leading to neurological deterioration. Patency and amount of bypass flow may be assessed postoperatively by digital subtraction angiography or quantitative magnetic resonance angiography.
The annual stroke rate after direct revascularization was reportedly 0–1.6% [40].
The various surgical procedures are
Encephalomyosynangiosis[EMS] where deep temporal artery supplying the temporalis muscle is the vessel for neovascularization
Encephalo-duro-arteriosynangiosis[EDAS]: Here, superficial temporal artery[STA] is harvested with surrounding galea and periosteum; STA flap is placed with a galea cuff. The dura and galea are then sutured to cover the brain with arterial flap.
Encephalo-myo-arteriosynangiosis[EDAMS]
Encephalo-galeo-synangiosis[EGS]
Omental flap surgery
Multiple burr hole surgery
The last two surgeries are performed as primary or after failed revascularization by other techniques.
Indirect revascularization is relatively easier to perform than direct surgeries, and the incidence of hyperperfusion is also less. However, the improvement in cerebral revascularization takes longer than the direct surgeries where the effect is immediate.
After indirect revascularization, patients experienced 0–14.3% postoperative annual stroke rate [41].
Thus either of the indirect and direct revascularization procedures can be performed to rectify the underlying pathology, but the risk of recurrence is much less with the direct revascularization surgeries without any delay to the benefit.
The following complications have been noted in the peri/postoperative period in MMD:
The risk of postoperative stroke has been estimated to be 1.6%- 16% [42].
The risk of perioperative ischemic complications is more in patients with unstable hemodynamics and advanced Suzuki stage with a lower cerebral blood flow.
Hemorrhagic stroke develops in 0.7%–8% [42].
Hyperperfusion syndrome- due to the chronic changes in cerebral blood vessels, the auto-regulatory function is lost, and the vascular reserve is decreased. The excessive blood flow immediately after the surgery is sometimes not well tolerated, leading to cerebral hemorrhage. Another factor that may predispose to intracranial hemorrhage is increased vascular permeability secondary to chronic ischemia.
Epidural hematoma mainly in the pediatric population.
Skin problems due to scalp ischemia after revascularization.
Moyamoya disease is a chronic progressive vasculopathy seen in children and adults, characterized by occlusion/stenosis at the terminal portions of the internal carotid artery and abnormal collateral network formation at the base of the brain. It is predominantly seen in Asian countries. It may be idiopathic [moyamoya disease] or associated with other disorders when it is called moyamoya syndrome. Various angiographic and magnetic resonance angiographic findings have been described which form the basis of the diagnostic guidelines for MMD. It may present as an ischemic/hemorrhagic stroke. It is generally managed with direct/indirect revascularization surgical techniques that aim to restore the cerebral blood flow and prevent strokes that restore the cerebral blood flow and prevent strokes’ recurrence.
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\\n\\nPUBLISHING PROCESS STEPS
\\n\\nSee a complete overview of all publishing process steps and descriptions here.
\\n\\nCURRENT PROJECTS
\\n\\nTo view current Open Access book projects that are Open for Submissions visit us here.
\\n\\nNot sure if this is the right publishing option for you? Feel free to contact us at book.department@intechopen.com.
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\n\nOut of all of the publishing options available to researchers, why choose to contribute your research to an IntechOpen Edited Volume? The reasons are simple. IntechOpen has worked exceptionally hard over the past years to fine tune the Open Access book publishing process and we continue to work hard to deliver the best for all of our contributors. The quality of published content is of utmost importance to us, followed closely by speed, and of course, availability and accessibility. To view current Open Access book projects that are Open for Submissions visit us here.
\n\nQUALITY CONTENT
\n\nOver the years we have learned what is important. What makes a difference to the researchers that work with us, what they value. Something that is very high not only on their lists, but our own, is the quality of the published content.
\n\nOur books contain scientific content written by two Nobel Prize winners, two Breakthrough Prize winners and 73 authors who are in the top 1% Most Cited.
\n\nWith regular submission for coverage in the single most important database, the Book Citation Index in the Web of Science™ Core Collection (BKCI), and no rejected submissions to date, over 43% of all Open Access books indexed in the BKCI are IntechOpen published books.
\n\nIn addition to BKCI, IntechOpen covers a number of important discipline specific databases as well, such as Thomson Reuters’ BIOSIS Previews.
\n\nACCESS
\n\nThe need for up to date information available at the click of a mouse is one thing that sets IntechOpen apart. By developing our own technologies in order to streamline the publishing process, we are able to minimize the amount of time from initial submission of a manuscript to its final publication date, without compromising the rigor of the editorial and peer review process. This means that the research published stays relevant, and in this fast paced world, this is very important.
\n\nYOUR WORK, YOUR COPYRIGHT
\n\nThe utilization of CC licenses allow researchers to retain copyright to their work. Researchers are free to use, adapt and share all content they publish with us. You will never have to pay permission fees to reuse a part of an experiment that you worked so hard to complete and are free to build upon your own research and the research of others. The Edited Volume helps bring together research from all over the world and compiles that research into one book - accessible for all. The research presented in chapter one can inspire the author of chapter three to take his or her research to the next level. It is about sharing ideas, insights and knowledge.
\n\nCan collaboration be inspired by a publishing format? At IntechOpen, the answer is yes. The way the research is published, the way it is accessed, it’s all part of our mission to help academics make a greater impact by giving readers free access to all published work.
\n\nOur Open Access book collection includes:
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\n\nCURRENT PROJECTS
\n\nTo view current Open Access book projects that are Open for Submissions visit us here.
\n\nNot sure if this is the right publishing option for you? Feel free to contact us at book.department@intechopen.com.
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Recent Advances, New Perspectives and Applications",editors:[{id:"49813",title:"Dr.",name:"Javier",middleName:null,surname:"Del Ser",slug:"javier-del-ser",fullName:"Javier Del Ser",profilePictureURL:"https://mts.intechopen.com/storage/users/49813/images/system/49813.png",institutionString:"Tecnalia Research & Innovation",institution:{name:"Tecnalia",institutionURL:null,country:{name:"Spain"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{type:"book",id:"7723",title:"Artificial Intelligence",subtitle:"Applications in Medicine and Biology",coverURL:"https://cdn.intechopen.com/books/images_new/7723.jpg",slug:"artificial-intelligence-applications-in-medicine-and-biology",publishedDate:"July 31st 2019",editedByType:"Edited by",bookSignature:"Marco Antonio Aceves-Fernandez",hash:"a3852659e727f95c98c740ed98146011",volumeInSeries:1,fullTitle:"Artificial Intelligence - Applications in Medicine and Biology",editors:[{id:"24555",title:"Dr.",name:"Marco Antonio",middleName:null,surname:"Aceves Fernandez",slug:"marco-antonio-aceves-fernandez",fullName:"Marco Antonio Aceves Fernandez",profilePictureURL:"https://mts.intechopen.com/storage/users/24555/images/system/24555.jpg",institutionString:"Universidad Autonoma de Queretaro",institution:{name:"Autonomous University of Queretaro",institutionURL:null,country:{name:"Mexico"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null}]},subseriesFiltersForPublishedBooks:[{group:"subseries",caption:"Computational Neuroscience",value:23,count:1},{group:"subseries",caption:"Evolutionary Computation",value:25,count:1},{group:"subseries",caption:"Machine Learning and Data Mining",value:26,count:3},{group:"subseries",caption:"Applied Intelligence",value:22,count:4}],publicationYearFilters:[{group:"publicationYear",caption:"2022",value:2022,count:2},{group:"publicationYear",caption:"2021",value:2021,count:3},{group:"publicationYear",caption:"2020",value:2020,count:2},{group:"publicationYear",caption:"2019",value:2019,count:2}],authors:{paginationCount:148,paginationItems:[{id:"165328",title:"Dr.",name:"Vahid",middleName:null,surname:"Asadpour",slug:"vahid-asadpour",fullName:"Vahid Asadpour",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/165328/images/system/165328.jpg",biography:"Vahid Asadpour, MS, Ph.D., is currently with the Department of Research and Evaluation, Kaiser Permanente Southern California. He has both an MS and Ph.D. in Biomedical Engineering. He was previously a research scientist at the University of California Los Angeles (UCLA) and visiting professor and researcher at the University of North Dakota. He is currently working in artificial intelligence and its applications in medical signal processing. In addition, he is using digital signal processing in medical imaging and speech processing. Dr. Asadpour has developed brain-computer interfacing algorithms and has published books, book chapters, and several journal and conference papers in this field and other areas of intelligent signal processing. He has also designed medical devices, including a laser Doppler monitoring system.",institutionString:"Kaiser Permanente Southern California",institution:null},{id:"169608",title:"Prof.",name:"Marian",middleName:null,surname:"Găiceanu",slug:"marian-gaiceanu",fullName:"Marian Găiceanu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/169608/images/system/169608.png",biography:"Prof. Dr. Marian Gaiceanu graduated from the Naval and Electrical Engineering Faculty, Dunarea de Jos University of Galati, Romania, in 1997. He received a Ph.D. (Magna Cum Laude) in Electrical Engineering in 2002. Since 2017, Dr. Gaiceanu has been a Ph.D. supervisor for students in Electrical Engineering. He has been employed at Dunarea de Jos University of Galati since 1996, where he is currently a professor. Dr. Gaiceanu is a member of the National Council for Attesting Titles, Diplomas and Certificates, an expert of the Executive Agency for Higher Education, Research Funding, and a member of the Senate of the Dunarea de Jos University of Galati. He has been the head of the Integrated Energy Conversion Systems and Advanced Control of Complex Processes Research Center, Romania, since 2016. He has conducted several projects in power converter systems for electrical drives, power quality, PEM and SOFC fuel cell power converters for utilities, electric vehicles, and marine applications with the Department of Regulation and Control, SIEI S.pA. (2002–2004) and the Polytechnic University of Turin, Italy (2002–2004, 2006–2007). He is a member of the Institute of Electrical and Electronics Engineers (IEEE) and cofounder-member of the IEEE Power Electronics Romanian Chapter. He is a guest editor at Energies and an academic book editor for IntechOpen. He is also a member of the editorial boards of the Journal of Electrical Engineering, Electronics, Control and Computer Science and Sustainability. Dr. Gaiceanu has been General Chairman of the IEEE International Symposium on Electrical and Electronics Engineering in the last six editions.",institutionString:'"Dunarea de Jos" University of Galati',institution:{name:'"Dunarea de Jos" University of Galati',country:{name:"Romania"}}},{id:"4519",title:"Prof.",name:"Jaydip",middleName:null,surname:"Sen",slug:"jaydip-sen",fullName:"Jaydip Sen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/4519/images/system/4519.jpeg",biography:"Jaydip Sen is associated with Praxis Business School, Kolkata, India, as a professor in the Department of Data Science. His research areas include security and privacy issues in computing and communication, intrusion detection systems, machine learning, deep learning, and artificial intelligence in the financial domain. He has more than 200 publications in reputed international journals, refereed conference proceedings, and 20 book chapters in books published by internationally renowned publishing houses, such as Springer, CRC press, IGI Global, etc. Currently, he is serving on the editorial board of the prestigious journal Frontiers in Communications and Networks and in the technical program committees of a number of high-ranked international conferences organized by the IEEE, USA, and the ACM, USA. He has been listed among the top 2% of scientists in the world for the last three consecutive years, 2019 to 2021 as per studies conducted by the Stanford University, USA.",institutionString:"Praxis Business School",institution:null},{id:"320071",title:"Dr.",name:"Sidra",middleName:null,surname:"Mehtab",slug:"sidra-mehtab",fullName:"Sidra Mehtab",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00002v6KHoQAM/Profile_Picture_1584512086360",biography:"Sidra Mehtab has completed her BS with honors in Physics from Calcutta University, India in 2018. She has done MS in Data Science and Analytics from Maulana Abul Kalam Azad University of Technology (MAKAUT), Kolkata, India in 2020. Her research areas include Econometrics, Time Series Analysis, Machine Learning, Deep Learning, Artificial Intelligence, and Computer and Network Security with a particular focus on Cyber Security Analytics. Ms. Mehtab has published seven papers in international conferences and one of her papers has been accepted for publication in a reputable international journal. She has won the best paper awards in two prestigious international conferences – BAICONF 2019, and ICADCML 2021, organized in the Indian Institute of Management, Bangalore, India in December 2019, and SOA University, Bhubaneswar, India in January 2021. Besides, Ms. Mehtab has also published two book chapters in two books. Seven of her book chapters will be published in a volume shortly in 2021 by Cambridge Scholars’ Press, UK. Currently, she is working as the joint editor of two edited volumes on Time Series Analysis and Forecasting to be published in the first half of 2021 by an international house. Currently, she is working as a Data Scientist with an MNC in Delhi, India.",institutionString:"NSHM College of Management and Technology",institution:{name:"Association for Computing Machinery",country:{name:"United States of America"}}},{id:"226240",title:"Dr.",name:"Andri Irfan",middleName:null,surname:"Rifai",slug:"andri-irfan-rifai",fullName:"Andri Irfan Rifai",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/226240/images/7412_n.jpg",biography:"Andri IRFAN is a Senior Lecturer of Civil Engineering and Planning. He completed the PhD at the Universitas Indonesia & Universidade do Minho with Sandwich Program Scholarship from the Directorate General of Higher Education and LPDP scholarship. He has been teaching for more than 19 years and much active to applied his knowledge in the project construction in Indonesia. His research interest ranges from pavement management system to advanced data mining techniques for transportation engineering. He has published more than 50 papers in journals and 2 books.",institutionString:null,institution:{name:"Universitas Internasional Batam",country:{name:"Indonesia"}}},{id:"314576",title:"Dr.",name:"Ibai",middleName:null,surname:"Laña",slug:"ibai-lana",fullName:"Ibai Laña",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/314576/images/system/314576.jpg",biography:"Dr. Ibai Laña works at TECNALIA as a data analyst. He received his Ph.D. in Artificial Intelligence from the University of the Basque Country (UPV/EHU), Spain, in 2018. He is currently a senior researcher at TECNALIA. His research interests fall within the intersection of intelligent transportation systems, machine learning, traffic data analysis, and data science. He has dealt with urban traffic forecasting problems, applying machine learning models and evolutionary algorithms. He has experience in origin-destination matrix estimation or point of interest and trajectory detection. Working with large volumes of data has given him a good command of big data processing tools and NoSQL databases. He has also been a visiting scholar at the Knowledge Engineering and Discovery Research Institute, Auckland University of Technology.",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"314575",title:"Dr.",name:"Jesus",middleName:null,surname:"L. Lobo",slug:"jesus-l.-lobo",fullName:"Jesus L. Lobo",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/314575/images/system/314575.png",biography:"Dr. Jesús López is currently based in Bilbao (Spain) working at TECNALIA as Artificial Intelligence Research Scientist. In most cases, a project idea or a new research line needs to be investigated to see if it is good enough to take into production or to focus on it. That is exactly what he does, diving into Machine Learning algorithms and technologies to help TECNALIA to decide whether something is great in theory or will actually impact on the product or processes of its projects. So, he is expert at framing experiments, developing hypotheses, and proving whether they’re true or not, in order to investigate fundamental problems with a longer time horizon. He is also able to design and develop PoCs and system prototypes in simulation. He has participated in several national and internacional R&D projects.\n\nAs another relevant part of his everyday research work, he usually publishes his findings in reputed scientific refereed journals and international conferences, occasionally acting as reviewer and Programme Commitee member. Concretely, since 2018 he has published 9 JCR (8 Q1) journal papers, 9 conference papers (e.g. ECML PKDD 2021), and he has co-edited a book. He is also active in popular science writing data science stories for reputed blogs (KDNuggets, TowardsDataScience, Naukas). Besides, he has recently embarked on mentoring programmes as mentor, and has also worked as data science trainer.",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"103779",title:"Prof.",name:"Yalcin",middleName:null,surname:"Isler",slug:"yalcin-isler",fullName:"Yalcin Isler",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRyQ8QAK/Profile_Picture_1628834958734",biography:"Yalcin Isler (1971 - Burdur / Turkey) received the B.Sc. degree in the Department of Electrical and Electronics Engineering from Anadolu University, Eskisehir, Turkey, in 1993, the M.Sc. degree from the Department of Electronics and Communication Engineering, Suleyman Demirel University, Isparta, Turkey, in 1996, the Ph.D. degree from the Department of Electrical and Electronics Engineering, Dokuz Eylul University, Izmir, Turkey, in 2009, and the Competence of Associate Professorship from the Turkish Interuniversity Council in 2019.\n\nHe was Lecturer at Burdur Vocational School in Suleyman Demirel University (1993-2000, Burdur / Turkey), Software Engineer (2000-2002, Izmir / Turkey), Research Assistant in Bulent Ecevit University (2002-2003, Zonguldak / Turkey), Research Assistant in Dokuz Eylul University (2003-2010, Izmir / Turkey), Assistant Professor at the Department of Electrical and Electronics Engineering in Bulent Ecevit University (2010-2012, Zonguldak / Turkey), Assistant Professor at the Department of Biomedical Engineering in Izmir Katip Celebi University (2012-2019, Izmir / Turkey). He is an Associate Professor at the Department of Biomedical Engineering at Izmir Katip Celebi University, Izmir / Turkey, since 2019. In addition to academics, he has also founded Islerya Medical and Information Technologies Company, Izmir / Turkey, since 2017.\n\nHis main research interests cover biomedical signal processing, pattern recognition, medical device design, programming, and embedded systems. He has many scientific papers and participated in several projects in these study fields. He was an IEEE Student Member (2009-2011) and IEEE Member (2011-2014) and has been IEEE Senior Member since 2014.",institutionString:null,institution:{name:"Izmir Kâtip Çelebi University",country:{name:"Turkey"}}},{id:"339677",title:"Dr.",name:"Mrinmoy",middleName:null,surname:"Roy",slug:"mrinmoy-roy",fullName:"Mrinmoy Roy",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/339677/images/16768_n.jpg",biography:"An accomplished Sales & Marketing professional with 12 years of cross-functional experience in well-known organisations such as CIPLA, LUPIN, GLENMARK, ASTRAZENECA across different segment of Sales & Marketing, International Business, Institutional Business, Product Management, Strategic Marketing of HIV, Oncology, Derma, Respiratory, Anti-Diabetic, Nutraceutical & Stomatological Product Portfolio and Generic as well as Chronic Critical Care Portfolio. A First Class MBA in International Business & Strategic Marketing, B.Pharm, D.Pharm, Google Certified Digital Marketing Professional. Qualified PhD Candidate in Operations and Management with special focus on Artificial Intelligence and Machine Learning adoption, analysis and use in Healthcare, Hospital & Pharma Domain. Seasoned with diverse therapy area of Pharmaceutical Sales & Marketing ranging from generating revenue through generating prescriptions, launching new products, and making them big brands with continuous strategy execution at the Physician and Patients level. Moved from Sales to Marketing and Business Development for 3.5 years in South East Asian Market operating from Manila, Philippines. Came back to India and handled and developed Brands such as Gluconorm, Lupisulin, Supracal, Absolut Woman, Hemozink, Fabiflu (For COVID 19), and many more. In my previous assignment I used to develop and execute strategies on Sales & Marketing, Commercialization & Business Development for Institution and Corporate Hospital Business portfolio of Oncology Therapy Area for AstraZeneca Pharma India Ltd. Being a Research Scholar and Student of ‘Operations Research & Management: Artificial Intelligence’ I published several pioneer research papers and book chapters on the same in Internationally reputed journals and Books indexed in Scopus, Springer and Ei Compendex, Google Scholar etc. Currently, I am launching PGDM Pharmaceutical Management Program in IIHMR Bangalore and spearheading the course curriculum and structure of the same. I am interested in Collaboration for Healthcare Innovation, Pharma AI Innovation, Future trend in Marketing and Management with incubation on Healthcare, Healthcare IT startups, AI-ML Modelling and Healthcare Algorithm based training module development. I am also an affiliated member of the Institute of Management Consultant of India, looking forward to Healthcare, Healthcare IT and Innovation, Pharma and Hospital Management Consulting works.",institutionString:null,institution:{name:"Lovely Professional University",country:{name:"India"}}},{id:"310576",title:"Prof.",name:"Erick Giovani",middleName:null,surname:"Sperandio Nascimento",slug:"erick-giovani-sperandio-nascimento",fullName:"Erick Giovani Sperandio Nascimento",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0033Y00002pDKxDQAW/ProfilePicture%202022-06-20%2019%3A57%3A24.788",biography:"Prof. Erick Sperandio is the Lead Researcher and professor of Artificial Intelligence (AI) at SENAI CIMATEC, Bahia, Brazil, also working with Computational Modeling (CM) and HPC. He holds a PhD in Environmental Engineering in the area of Atmospheric Computational Modeling, a Master in Informatics in the field of Computational Intelligence and Graduated in Computer Science from UFES. He currently coordinates, leads and participates in R&D projects in the areas of AI, computational modeling and supercomputing applied to different areas such as Oil and Gas, Health, Advanced Manufacturing, Renewable Energies and Atmospheric Sciences, advising undergraduate, master's and doctoral students. He is the Lead Researcher at SENAI CIMATEC's Reference Center on Artificial Intelligence. In addition, he is a Certified Instructor and University Ambassador of the NVIDIA Deep Learning Institute (DLI) in the areas of Deep Learning, Computer Vision, Natural Language Processing and Recommender Systems, and Principal Investigator of the NVIDIA/CIMATEC AI Joint Lab, the first in Latin America within the NVIDIA AI Technology Center (NVAITC) worldwide program. He also works as a researcher at the Supercomputing Center for Industrial Innovation (CS2i) and at the SENAI Institute of Innovation for Automation (ISI Automação), both from SENAI CIMATEC. He is a member and vice-coordinator of the Basic Board of Scientific-Technological Advice and Evaluation, in the area of Innovation, of the Foundation for Research Support of the State of Bahia (FAPESB). He serves as Technology Transfer Coordinator and one of the Principal Investigators at the National Applied Research Center in Artificial Intelligence (CPA-IA) of SENAI CIMATEC, focusing on Industry, being one of the six CPA-IA in Brazil approved by MCTI / FAPESP / CGI.br. He also participates as one of the representatives of Brazil in the BRICS Innovation Collaboration Working Group on HPC, ICT and AI. He is the coordinator of the Work Group of the Axis 5 - Workforce and Training - of the Brazilian Strategy for Artificial Intelligence (EBIA), and member of the MCTI/EMBRAPII AI Innovation Network Training Committee. He is the coordinator, by SENAI CIMATEC, of the Artificial Intelligence Reference Network of the State of Bahia (REDE BAH.IA). He leads the working group of experts representing Brazil in the Global Partnership on Artificial Intelligence (GPAI), on the theme \"AI and the Pandemic Response\".",institutionString:"Manufacturing and Technology Integrated Campus – SENAI CIMATEC",institution:null},{id:"1063",title:"Prof.",name:"Constantin",middleName:null,surname:"Volosencu",slug:"constantin-volosencu",fullName:"Constantin Volosencu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/1063/images/system/1063.png",biography:"Prof. Dr. Constantin Voloşencu graduated as an engineer from\nPolitehnica University of Timișoara, Romania, where he also\nobtained a doctorate degree. He is currently a full professor in\nthe Department of Automation and Applied Informatics at the\nsame university. Dr. Voloşencu is the author of ten books, seven\nbook chapters, and more than 160 papers published in journals\nand conference proceedings. He has also edited twelve books and\nhas twenty-seven patents to his name. He is a manager of research grants, editor in\nchief and member of international journal editorial boards, a former plenary speaker, a member of scientific committees, and chair at international conferences. His\nresearch is in the fields of control systems, control of electric drives, fuzzy control\nsystems, neural network applications, fault detection and diagnosis, sensor network\napplications, monitoring of distributed parameter systems, and power ultrasound\napplications. He has developed automation equipment for machine tools, spooling\nmachines, high-power ultrasound processes, and more.",institutionString:'"Politechnica" University Timişoara',institution:null},{id:"221364",title:"Dr.",name:"Eneko",middleName:null,surname:"Osaba",slug:"eneko-osaba",fullName:"Eneko Osaba",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/221364/images/system/221364.jpg",biography:"Dr. Eneko Osaba works at TECNALIA as a senior researcher. He obtained his Ph.D. in Artificial Intelligence in 2015. He has participated in more than twenty-five local and European research projects, and in the publication of more than 130 papers. He has performed several stays at universities in the United Kingdom, Italy, and Malta. Dr. Osaba has served as a program committee member in more than forty international conferences and participated in organizing activities in more than ten international conferences. He is a member of the editorial board of the International Journal of Artificial Intelligence, Data in Brief, and Journal of Advanced Transportation. He is also a guest editor for the Journal of Computational Science, Neurocomputing, Swarm, and Evolutionary Computation and IEEE ITS Magazine.",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"275829",title:"Dr.",name:"Esther",middleName:null,surname:"Villar-Rodriguez",slug:"esther-villar-rodriguez",fullName:"Esther Villar-Rodriguez",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/275829/images/system/275829.jpg",biography:"Dr. Esther Villar obtained a Ph.D. in Information and Communication Technologies from the University of Alcalá, Spain, in 2015. She obtained a degree in Computer Science from the University of Deusto, Spain, in 2010, and an MSc in Computer Languages and Systems from the National University of Distance Education, Spain, in 2012. Her areas of interest and knowledge include natural language processing (NLP), detection of impersonation in social networks, semantic web, and machine learning. Dr. Esther Villar made several contributions at conferences and publishing in various journals in those fields. Currently, she is working within the OPTIMA (Optimization Modeling & Analytics) business of TECNALIA’s ICT Division as a data scientist in projects related to the prediction and optimization of management and industrial processes (resource planning, energy efficiency, etc).",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"49813",title:"Dr.",name:"Javier",middleName:null,surname:"Del Ser",slug:"javier-del-ser",fullName:"Javier Del Ser",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/49813/images/system/49813.png",biography:"Prof. Dr. Javier Del Ser received his first PhD in Telecommunication Engineering (Cum Laude) from the University of Navarra, Spain, in 2006, and a second PhD in Computational Intelligence (Summa Cum Laude) from the University of Alcala, Spain, in 2013. He is currently a principal researcher in data analytics and optimisation at TECNALIA (Spain), a visiting fellow at the Basque Center for Applied Mathematics (BCAM) and a part-time lecturer at the University of the Basque Country (UPV/EHU). His research interests gravitate on the use of descriptive, prescriptive and predictive algorithms for data mining and optimization in a diverse range of application fields such as Energy, Transport, Telecommunications, Health and Industry, among others. In these fields he has published more than 240 articles, co-supervised 8 Ph.D. theses, edited 6 books, coauthored 7 patents and participated/led more than 40 research projects. He is a Senior Member of the IEEE, and a recipient of the Biscay Talent prize for his academic career.",institutionString:"Tecnalia Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"278948",title:"Dr.",name:"Carlos Pedro",middleName:null,surname:"Gonçalves",slug:"carlos-pedro-goncalves",fullName:"Carlos Pedro Gonçalves",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRcmyQAC/Profile_Picture_1564224512145",biography:'Carlos Pedro Gonçalves (PhD) is an Associate Professor at Lusophone University of Humanities and Technologies and a researcher on Complexity Sciences, Quantum Technologies, Artificial Intelligence, Strategic Studies, Studies in Intelligence and Security, FinTech and Financial Risk Modeling. He is also a progammer with programming experience in:\n\nA) Quantum Computing using Qiskit Python module and IBM Quantum Experience Platform, with software developed on the simulation of Quantum Artificial Neural Networks and Quantum Cybersecurity;\n\nB) Artificial Intelligence and Machine learning programming in Python;\n\nC) Artificial Intelligence, Multiagent Systems Modeling and System Dynamics Modeling in Netlogo, with models developed in the areas of Chaos Theory, Econophysics, Artificial Intelligence, Classical and Quantum Complex Systems Science, with the Econophysics models having been cited worldwide and incorporated in PhD programs by different Universities.\n\nReceived an Arctic Code Vault Contributor status by GitHub, due to having developed open source software preserved in the \\"Arctic Code Vault\\" for future generations (https://archiveprogram.github.com/arctic-vault/), with the Strategy Analyzer A.I. module for decision making support (based on his PhD thesis, used in his Classes on Decision Making and in Strategic Intelligence Consulting Activities) and QNeural Python Quantum Neural Network simulator also preserved in the \\"Arctic Code Vault\\", for access to these software modules see: https://github.com/cpgoncalves. 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Currently working as an Assistant Professor in the Department of Mathematics, Institute of Applied Science, Mangalayatan University, Aligarh. She taught so many courses of Mathematics of UG and PG level. Her research Area of Expertise is Functional Analysis & Sequence Spaces. She has been working on Ideal Convergence of double sequence. She has published 17 research papers in National and International Journals including Cogent Mathematics, Filomat, Journal of Intelligent and Fuzzy Systems, Advances in Difference Equations, Journal of Mathematical Analysis, Journal of Mathematical & Computer Science etc. She has also reviewed few research papers for the and international journals. 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Dr. Koprowski has authored more than a hundred research papers with dozens in impact factor (IF) journals and has authored or co-authored six books. Additionally, he is the author of several national and international patents in the field of biomedical devices and imaging. Since 2011, he has been a reviewer of grants and projects (including EU projects) in biomedical engineering.",institutionString:null,institution:{name:"University of Silesia",institutionURL:null,country:{name:"Poland"}}},subseries:[{id:"7",title:"Bioinformatics and Medical Informatics",keywords:"Biomedical Data, Drug Discovery, Clinical Diagnostics, Decoding Human Genome, AI in Personalized Medicine, Disease-prevention Strategies, Big Data Analysis in Medicine",scope:"Bioinformatics aims to help understand the functioning of the mechanisms of living organisms through the construction and use of quantitative tools. The applications of this research cover many related fields, such as biotechnology and medicine, where, for example, Bioinformatics contributes to faster drug design, DNA analysis in forensics, and DNA sequence analysis in the field of personalized medicine. Personalized medicine is a type of medical care in which treatment is customized individually for each patient. Personalized medicine enables more effective therapy, reduces the costs of therapy and clinical trials, and also minimizes the risk of side effects. Nevertheless, advances in personalized medicine would not have been possible without bioinformatics, which can analyze the human genome and other vast amounts of biomedical data, especially in genetics. The rapid growth of information technology enabled the development of new tools to decode human genomes, large-scale studies of genetic variations and medical informatics. The considerable development of technology, including the computing power of computers, is also conducive to the development of bioinformatics, including personalized medicine. In an era of rapidly growing data volumes and ever lower costs of generating, storing and computing data, personalized medicine holds great promises. Modern computational methods used as bioinformatics tools can integrate multi-scale, multi-modal and longitudinal patient data to create even more effective and safer therapy and disease prevention methods. Main aspects of the topic are: Applying bioinformatics in drug discovery and development; Bioinformatics in clinical diagnostics (genetic variants that act as markers for a condition or a disease); Blockchain and Artificial Intelligence/Machine Learning in personalized medicine; Customize disease-prevention strategies in personalized medicine; Big data analysis in personalized medicine; Translating stratification algorithms into clinical practice of personalized medicine.",annualVolume:11403,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/7.jpg",editor:{id:"351533",title:"Dr.",name:"Slawomir",middleName:null,surname:"Wilczynski",fullName:"Slawomir Wilczynski",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035U1loQAC/Profile_Picture_1630074514792",institutionString:null,institution:{name:"Medical University of Silesia",institutionURL:null,country:{name:"Poland"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"5886",title:"Dr.",name:"Alexandros",middleName:"T.",surname:"Tzallas",fullName:"Alexandros Tzallas",profilePictureURL:"https://mts.intechopen.com/storage/users/5886/images/system/5886.png",institutionString:"University of Ioannina, Greece & Imperial College London",institution:{name:"University of Ioannina",institutionURL:null,country:{name:"Greece"}}},{id:"257388",title:"Distinguished Prof.",name:"Lulu",middleName:null,surname:"Wang",fullName:"Lulu Wang",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRX6kQAG/Profile_Picture_1630329584194",institutionString:"Shenzhen Technology University",institution:{name:"Shenzhen Technology University",institutionURL:null,country:{name:"China"}}},{id:"225387",title:"Prof.",name:"Reda R.",middleName:"R.",surname:"Gharieb",fullName:"Reda R. Gharieb",profilePictureURL:"https://mts.intechopen.com/storage/users/225387/images/system/225387.jpg",institutionString:"Assiut University",institution:{name:"Assiut University",institutionURL:null,country:{name:"Egypt"}}}]},{id:"8",title:"Bioinspired Technology and Biomechanics",keywords:"Bioinspired Systems, Biomechanics, Assistive Technology, Rehabilitation",scope:'Bioinspired technologies take advantage of understanding the actual biological system to provide solutions to problems in several areas. Recently, bioinspired systems have been successfully employing biomechanics to develop and improve assistive technology and rehabilitation devices. The research topic "Bioinspired Technology and Biomechanics" welcomes studies reporting recent advances in bioinspired technologies that contribute to individuals\' health, inclusion, and rehabilitation. Possible contributions can address (but are not limited to) the following research topics: Bioinspired design and control of exoskeletons, orthoses, and prostheses; Experimental evaluation of the effect of assistive devices (e.g., influence on gait, balance, and neuromuscular system); Bioinspired technologies for rehabilitation, including clinical studies reporting evaluations; Application of neuromuscular and biomechanical models to the development of bioinspired technology.',annualVolume:11404,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/8.jpg",editor:{id:"144937",title:"Prof.",name:"Adriano",middleName:"De Oliveira",surname:"Andrade",fullName:"Adriano Andrade",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRC8QQAW/Profile_Picture_1625219101815",institutionString:null,institution:{name:"Federal University of Uberlândia",institutionURL:null,country:{name:"Brazil"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"49517",title:"Prof.",name:"Hitoshi",middleName:null,surname:"Tsunashima",fullName:"Hitoshi Tsunashima",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYTP4QAO/Profile_Picture_1625819726528",institutionString:null,institution:{name:"Nihon University",institutionURL:null,country:{name:"Japan"}}},{id:"425354",title:"Dr.",name:"Marcus",middleName:"Fraga",surname:"Vieira",fullName:"Marcus Vieira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003BJSgIQAX/Profile_Picture_1627904687309",institutionString:null,institution:{name:"Universidade Federal de Goiás",institutionURL:null,country:{name:"Brazil"}}},{id:"196746",title:"Dr.",name:"Ramana",middleName:null,surname:"Vinjamuri",fullName:"Ramana Vinjamuri",profilePictureURL:"https://mts.intechopen.com/storage/users/196746/images/system/196746.jpeg",institutionString:"University of Maryland, Baltimore County",institution:{name:"University of Maryland, Baltimore County",institutionURL:null,country:{name:"United States of America"}}}]},{id:"9",title:"Biotechnology - Biosensors, Biomaterials and Tissue Engineering",keywords:"Biotechnology, Biosensors, Biomaterials, Tissue Engineering",scope:"The Biotechnology - Biosensors, Biomaterials and Tissue Engineering topic within the Biomedical Engineering Series aims to rapidly publish contributions on all aspects of biotechnology, biosensors, biomaterial and tissue engineering. We encourage the submission of manuscripts that provide novel and mechanistic insights that report significant advances in the fields. Topics can include but are not limited to: Biotechnology such as biotechnological products and process engineering; Biotechnologically relevant enzymes and proteins; Bioenergy and biofuels; Applied genetics and molecular biotechnology; Genomics, transcriptomics, proteomics; Applied microbial and cell physiology; Environmental biotechnology; Methods and protocols. Moreover, topics in biosensor technology, like sensors that incorporate enzymes, antibodies, nucleic acids, whole cells, tissues and organelles, and other biological or biologically inspired components will be considered, and topics exploring transducers, including those based on electrochemical and optical piezoelectric, thermal, magnetic, and micromechanical elements. Chapters exploring biomaterial approaches such as polymer synthesis and characterization, drug and gene vector design, biocompatibility, immunology and toxicology, and self-assembly at the nanoscale, are welcome. Finally, the tissue engineering subcategory will support topics such as the fundamentals of stem cells and progenitor cells and their proliferation, differentiation, bioreactors for three-dimensional culture and studies of phenotypic changes, stem and progenitor cells, both short and long term, ex vivo and in vivo implantation both in preclinical models and also in clinical trials.",annualVolume:11405,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/9.jpg",editor:{id:"126286",title:"Dr.",name:"Luis",middleName:"Jesús",surname:"Villarreal-Gómez",fullName:"Luis Villarreal-Gómez",profilePictureURL:"https://mts.intechopen.com/storage/users/126286/images/system/126286.jpg",institutionString:null,institution:{name:"Autonomous University of Baja California",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"35539",title:"Dr.",name:"Cecilia",middleName:null,surname:"Cristea",fullName:"Cecilia Cristea",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYQ65QAG/Profile_Picture_1621007741527",institutionString:null,institution:{name:"Iuliu Hațieganu University of Medicine and Pharmacy",institutionURL:null,country:{name:"Romania"}}},{id:"40735",title:"Dr.",name:"Gil",middleName:"Alberto Batista",surname:"Gonçalves",fullName:"Gil Gonçalves",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYRLGQA4/Profile_Picture_1628492612759",institutionString:null,institution:{name:"University of Aveiro",institutionURL:null,country:{name:"Portugal"}}},{id:"211725",title:"Associate Prof.",name:"Johann F.",middleName:null,surname:"Osma",fullName:"Johann F. 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